Benefits of using a support bra in women undergoing coronary artery bypass graft surgery: A randomized trial.

BACKGROUND: Approximately 30 % of cardiac surgeries are conducted on women by median sternotomy, which often causes discomfort such as pain, affects quality of life, and delayed recovery compared with men. Breast size is related to operative wound complications, such as incisional pain, sternum dehiscence, and infection, which may affect hospital costs due to prolonged hospital stays. OBJECTIVE: To evaluate breast size and operative wound complications and the effect of breast support on the incidence of pain, infection, and quality of life in women after coronary artery bypass grafting. METHOD: Women were randomly assigned to one of three groups: group A (surgical breast support), group B (ordinary breast support), and group C (no-support). Observations were taken daily between the second and seventh postoperative days and at 30, 60, and 180 days. Pain was assessed using the Short-Form 36 Health Survey (SF36) for quality of life and a verbal numerical scale. The authors used the nonparametric Kruskal-Wallis and Friedman tests to examine variance. The authors used the Pearson correlation coefficient or the Spearman correlation for correlations between variables. A multivariate study was conducted to evaluate the occurrence of infection, and the logistic regression model with "stepwise" variable selection was used. A linear regression model with the "stepwise" variable selection was also used for hospitalization. The authors used SPSS 17.0 software for Windows, with a significance level of p < 0.05. RESULTS: There was no difference in pain evaluation between the groups in 190 women (p > 0.05). When comparing quality of life, there was a statistically significant difference in the functional capacity domain at 30 and 60 days, with group A having the best functional capacity (p < 0.05). The larger the breast size, the longer the hospital stay (p < 0.001) and the higher the probability of infection (p = 0.032). Patients with a history of stroke had a 3.8 higher incidence of infection (p = 0.040). CONCLUSION: The use of surgical support did not affect acute pain or sternal infection rate in the 6-month follow-up. However, it was effective in the functional capacity domain 30 days after surgery and maintained at 60 days.

Shock-Wave Therapy Improves Myocardial Blood Flow Reserve in Patients with Refractory Angina: Evaluation by Real-Time Myocardial Perfusion Echocardiography.

BACKGROUND: Cardiac shock-wave therapy (CSWT) has been demonstrated as an option for the treatment of patients with refractory angina (RA), promoting immediate vasodilatory effects and, in the long-term, neoangiogenic effects that would be responsible for reducing the myocardial ischemic load. The aim of this study was to determine the effects of CSWT on myocardial blood flow reserve (MBFR) assessed by quantitative real-time myocardial perfusion echocardiography in patients with RA. METHODS: Fifteen patients (mean age 61.5 ± 12.8 years) with RA who underwent CSWT during nine sessions, over 3 months of treatment, were prospectively studied. A total of 32 myocardial segments with ischemia were treated, while another 31 did not receive therapy because of technical limitations. Myocardial perfusion was evaluated at rest and after dipyridamole stress (0.84 mg/kg) before and 6 months after CSWT, using quantitative real-time myocardial perfusion echocardiography. Clinical effects were evaluated using Canadian Cardiovascular Society grading of angina and the Seattle Angina Questionnaire. RESULTS: The ischemic segments treated with CSWT had increased MBFR (from 1.33 ± 0.22 to 1.74 ± 0.29, P < .001), a benefit that was not observed in untreated ischemic segments (1.51 ± 0.29 vs 1.54 ± 0.28, P = .47). Patients demonstrated increased global MBFR (from 1.78 ± 0.54 to 1.89 ± 0.49, P = .017). Semiquantitative single-photon emission computed tomographic analysis of the treated ischemic segments revealed a score reduction from 2.10 ± 0.87 to 1.68 ± 1.19 (P = .024). There was improvement in Canadian Cardiovascular Society score (from 3.20 ± 0.56 to 1.93 ± 0.70, P < .05) and in Seattle Angina Questionnaire score (from 42.3 ± 12.99 to 71.2 ± 14.29, P < .05). No major cardiovascular events were recorded during follow-up. CONCLUSIONS: CSWT improved MBFR in ischemic segments, as demonstrated by quantitative real-time myocardial perfusion echocardiography. These results suggest that CSWT has the potential to increase myocardial blood flow, with an impact on symptoms and quality of life in patients with RA.

Regional body composition and muscle strength are related to bone mineral content in elderly / Composição corporal regional e força muscular se relacionam com o conteúdo mineral ósseo em idosos / Composición regional y fuerza muscular si relacionan con él contenido mineral óseo de mayores

ABSTRACT Introduction: The increase, or maintenance, of lean body mass and muscle strength are major determinants of functional independence in the elderly, since they are associated with bone remodeling, and therefore with a reduced risk of falls and fractures. However, the regional relationship between lean body mass/strength and bone mineral content (BMC) has not sufficient theoretical support. Objective: To analyze whether regional body composition and muscle strength are factors potentially related to BMC. Methods: Ten older men (63.3±6.4 years, 169.4±6.8 cm and 79.3±10.5 kg) underwent body composition assessments using dual energy X-ray absorptiometry (DXA) to obtain regional and whole-body lean mass and BMC measures. The subjects also underwent the one-repetition maximum (1RM) test involving flat bench press, 45° leg press, arm curl and knee extension. Regional/whole-body composition and 1RM values were correlated to BMC using Pearson's coefficient (r). The level of significance for the correlations was p ≤0.05, the confidence interval was 95% (Z1-a/2=1.96), and the sample power was 80% (1-b). Results: The flat bench press 1RM was related to BMC in the left (r=0.764) and right (r=0.748) arms, while the 45° leg press 1RM was associated with BMC in the left (r=0.677) and right (r=0.714) legs and trunk (r=0.810), with sample power of 77.7%, 66.8%, 12.7%, 40.4% and 97.0%, respectively. Whole-body BMC was related to abdominal skinfold (r=0.819), lean mass of left arm (r=0.834), left (r=0.845) and right (r=0.868) legs, and whole-body lean mass (r=0.787), with sample power of 98.4%, 99.6%, 99.9%, 100.0% and 90.1%, respectively. Conclusion: The results supported regional lean body mass as a parameter related to BMC, with potential similar to that consistently reported for whole-body lean mass. Results also suggested that muscle strength plays an important role in improving or maintaining regional and whole-body BMC. Level of Evidence II; Development of diagnostic criteria in consecutive patients (with "gold" benchmark standard applied).

RESUMO Introdução: O aumento ou a manutenção, da massa magra e da força muscular são importantes fatores que determinam a independência funcional em idosos, uma vez que se associam ao remodelamento ósseo e, assim, à redução dos riscos de quedas e fraturas. Todavia, a relação regional da massa magra e da força muscular com o conteúdo mineral ósseo (BMC) não apresenta suficiente apoio teórico. Objetivo: Analisar se a composição regional e a força muscular são fatores possivelmente relacionados à BMC. Métodos: Dez homens idosos (63,3 ± 6,4 anos; 169,4 ± 6,8 cm e 79,3 ± 10,5 kg) submeteram-se às avaliações de composição por meio de absorciometria por feixe duplo de raio-X (DEXA) para obter a massa magra e BMC regionais e corporais. Os participantes também foram submetidos ao teste de uma repetição máxima (1RM) com supino horizontal, leg press 45°, rosca direta e extensão de joelho. Os valores de composição regional e corporal e de 1RM foram relacionados ao BMC pelo coeficiente de Pearson (r). O nível de significância para as correlações foi p ≤ 0,05, o intervalo de confiança foi 95% (Z1-α/2=1,96) e o poder da amostra foi 80% (1-b). Resultados: A 1RM no supino horizontal relacionou-se ao BMC do braço esquerdo (r = 0,764) e direito (r = 0,748), assim como 1RM no leg press 45° associou-se ao BMC da perna esquerda (r = 0,677), direita (r = 0,714) e do tronco (r = 0,810), com poder de amostra de 77,7%, 66,8%, 12,7%, 40,4% e 97,0%, respectivamente. O BMC corporal relacionou-se a prega cutânea abdominal (r = 0,819), massa magra do braço esquerdo (r = 0,834), perna esquerda (r = 0,845) e direita (r = 0,868) e massa magra corporal (r = 0,787), com poder de amostra de 98,4%, 99,6%, 99,9%, 100,0% e 90,1%, respectivamente. Conclusão: Os resultados confirmaram a massa magra regional como parâmetro relacionado ao BMC, com potencial similar ao da massa magra corporal e também sugerem que a força muscular tem papel importante no aumento ou manutenção do BMC regional e corporal. Nível de Evidência II; Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com aplicação do padrão de referência).

RESUMEN Introducción: El aumento o mantenimiento de la masa delgada y fuerza son determinantes de independencia funcional de adultos mayores, debido a asociaciones con la modulación ósea y, de la misma forma, con la reducción de riesgos de fracturas y caídas. Sin embargo, las relaciones regionales de masa delgada y fuerza con el contenido mineral óseo (CMO) no tienen suficiente apoyo teórico. Objetivo: Analizar si la composición regional y la fuerza están potencialmente relacionadas con CMO. Métodos: Diez adultos mayores (63,3±6,4 años, 169,4±6,8cm y 79,3±10,5kg) se sometieron a las evaluaciones de composición corporal por absorciometría de doble rayos-X (DXA) que proveyó la masa delgada para y CMO regional y corporal, así como el test de repetición máxima (1RM) en supino horizontal, leg press 45°, flexión de brazo y extensión rodilla. Los valores de la composición regional, corporal y de 1RM se relacionaron con CMO por el coeficiente de Pearson (r). El nivel de significancia fue p≤0,05 para las correlaciones, y el índice de seguridad de 95% (Z1-α/2=1,96) y potencia de muestra de 80% (1-β) para evaluar el poder de la muestra. Resultados: El 1RM en supino horizontal se relacionó con CMO del brazo izquierdo (r=0,764) y derecho (r=0,748), así como el 1RM en leg press 45° se relacionó al CMO de la pierna izquierda (r=0,677), derecha (r=0,714), y tronco (r=0,810), con poder de muestra, respectivamente, de 77,7%, 66,8%, 12,7%, 40,4% y 97,0%. El parámetro CMO corporal se relacionó con el pliegue cutáneo abdominal (r=0,819), masa delgada del brazo izquierdo (r=0,834), pierna izquierda (r=0,845), derecha (r=0,868) y masa delgada corporal (r = 0,787), con poder de muestra, respectivamente, de 98,4%, 99,6%, 99,9%, 100,0% y 90,1%. Conclusión: Los resultados confirman haber relación entre masa delgada regional e CMO, con potencial similar a la masa delgada corporal, sugiriendo también que la fuerza muscular ejerce un papel promisor en el aumento, o manutención, del CMO regional y corporal. Nivel de Evidencia II; Desarrollo de criterios diagnósticos en pacientes consecutivos (con estándar de referencia "oro" aplicado).

ASSOCIATION BETWEEN ALCOHOL CONSUMPTION AND BREAST CANCER DEVELOPMENT: A CASE-CONTROL STUDY / Associação entre ingesta alcoólica e desenvolvimento de câncer de mama: um estudo de caso-controle

Objectives: To identify the association of alcohol consumption with the development of breast cancer in a patient population of Salvador, Bahia. Methods: Case-control study, conducted between December 2013 and May 2015, with 69 patients with breast ductal carcinoma and 71 controls. Sample calculation was made with 140 patients, with 5% presumed difference between groups and 10% acceptable difference. The χ2 test was used to evaluate the correlation between categorical variables, and Student's t-test was applied to compare continuous variables. Results: From all cases, medium alcohol intake was 3.66±8.60 g/day; among controls, the average was 3.71±7.40 g/day (p=0.890). When analyzing the association between alcohol intake and breast cancer, odds ratio was 0.99 (95% confidence interval 0.524­1.890), p=0.988. For alcohol consumption greater than 10 g/day and breast cancer, odds ratio was 1.579 (95%CI 0.624­3.995), p=0.332. Conclusions: Although published data suggest an association between alcohol consumption and breast cancer, in this study there was no statistical significance between the variables assessed and the onset of this pathology.

Objetivo: Identificar a associação do consumo alcoólico com o desenvolvimento de câncer de mama em uma população de pacientes de Salvador, Bahia. Métodos: Estudo de caso-controle realizado entre dezembro de 2013 e maio de 2015 com 69 pacientes com diagnóstico de carcinoma ductal da mama e 71 controles. Foi realizado cálculo amostral com 140 pacientes, esperando-se uma diferença presumida de 5% entre os grupos e com diferença aceitável de 10%. Realizou-se teste do χ2 para avaliação de correlação entre as variáveis categóricas e teste t de Student entre as variáveis contínuas. Resultados: Entre os casos, a ingesta alcoólica média foi de 3,66±8,60 g/dia; já entre os controles a média foi de 3,71±7,40 g/dia (p=0,890). Ao analisar-se a associação entre ingesta alcoólica e câncer de mama, obtivemos odds ratio de 0,99 (intervalo de confiança de 95% ­ IC95% 0,524­1,890), p=0,988. Em relação ao consumo de álcool maior do que 10 g/dia e câncer de mama, a odds ratio foi de 1,579 (IC95% 0,624­3,995), p=0,332. Conclusão: Apesar de dados publicados e hipóteses sugerirem associação entre ingesta alcoólica e câncer de mama, neste estudo não houve significância estatística entre as variáveis analisadas e a presença da patologia.

Terapia hormonal e câncer de mama / Hormonal therapy and breast cancer

Objetivo: Realizar uma revisão sistemática da literatura e uma análise crítica sobre o uso da terapia hormonal associada ao risco de câncer de mama. Métodos: Revisão sistemática de literatura, por meio das bases de dados PubMed e Periódicos Capes, entre o período de 1995 e 2016, utilizando as palavras-chave "breast cancer", "breast cancer risk", "hormone replacement therapy", "bioidentical hormone replacement therapy" e "natural hormone replacement therapy". Resultados: Os sete artigos escolhidos mostraram forte relação da incidência do câncer de mama com fatores hormonais, mas existem divergências entre os estudos. O WHI EP trial, o LIBERATE trial e o HABITS trial demonstraram aumento da incidência e recidiva do câncer de mama com uso hormonal, enquanto o WHI E alone trial, o Stockholm trial, o DOPS study e o LIFT study obtiveram resultados opostos. Conclusão: Atualmente, a terapia hormonal sintética é controversa em quem não tem história de câncer de mama, mas contraindicada nas sobreviventes e naquelas com fortes fatores de risco para desenvolvimento do câncer. Os riscos do uso de hormônios bioidênticos permanecem incertos. Nas mulheres sem fatores de risco associados, a terapia hormonal é sugerida por, no máximo, cinco anos.

Objective: This study aimed at performing a systematic literature review and a critical analysis of the use of hormone replacement therapy associated with the risk of breast cancer. Methods: Systematic review of literature by means of databases PubMed and Periodicos Capes, in the period between 1995 and 2016, using the keywords "breast cancer", "breast cancer risk", "hormone replacement therapy", "bioidentical hormone replacement therapy", and "natural hormone replacement therapy". Results: The seven chosen articles demonstrated strong relationship between the incidence of breast cancer and hormonal factor; however, discrepancies among the studies were found. The WHI EP trial, LIBERATE trial and the HABITS trial demonstrated increased incidence and recurrence of breast cancer with hormone use, whereas the WHI E alone trial, the Stockholm trial, the DOPS study and the LIFT study obtained opposite results Conclusion: Currently, synthetic hormone therapy is controversial for those who have no breast cancer history, but contraindicated in survivors and those with strong risk factors for breast cancer development. The risks of using bioidentical hormones remain uncertain. In women with no risk factors, hormone therapy is suggested by a maximum of five years.

Avaliação da aplicabilidade do modelo de Gail como preditor de risco de câncerde mama em mulheres baianas / Evaluation of the applicability of Gail model as a predictor of breast cancer risk in women from Bahia

Objetivo: Avaliar a acurácia do modelo de Gail em mulheres baianas. Métodos: Estudo de casocontrole, com 64 casos e 64 controles. Este estudo foi conduzido em duas clínicas de Salvador, Bahia, que atendem pacientes conveniados aos planos de saúde: o Núcleo de Oncologia da Bahia e o Núcleo da Mama. Foram calculados dois valores do índice de Gail para cada paciente, com etnia referida e com etnia desconhecida. Os valores encontrados foram comparados entre os grupos caso e controle, comanálise de significância pelo teste t de Student. Também foi calculado qual o percentual de pacientes do grupo caso que apresentavam alto (?1,67%) e baixo risco (<1,67%). Resultados: As  médias dos valores do índice de Gail do grupo controle foram superiores às médias dos valores nos casos,independente de qual risco foi avaliado (em cinco anos ou ?life-time?) e da etnia utilizada (autoreferida ou desconhecida). Quando utilizada a etnia auto-referida, apenas 26,7% das pacientes com câncer de mama teriam sido identificadas como alto risco pelo modelo, e, quando utilizada a etniadesconhecida, apenas 34,7%. Conclusão: Na presente amostra com mulheres baianas, o modelo de Gail não foi um bom preditor para o desenvolvimento de câncer de mama.

Purpose: To evaluate the accuracy of Gail model applied to women from Bahia. Methods: It is a casecontrol study, with 64 cases and 64 controls. This study was lead in two clinics in Salvador, Bahia, Brazil, that attend patients with health insurance: Núcleo de Oncologia da Bahia and Núcleo da Mama. Two values of Gail model were calculated for each patient, one using self-reported ethnicity and other using ethnicity as unknown. The values were compared between case and control groups, using significance analysis by Student t test. It was also calculated which percentage of patients in case group were at high-risk (?1.67%) or low risk (<1.67). Results: The mean values of the Gail model was higher in the control group than the mean values in the case group, regardless of which risk was assessed (in five years or life-time) and of ethnicity was used (self-reported or unknown). When used the self-reported ethnicity for calculation, only 26.7% of women with breast cancer would have been identified as high-risk by the Gail model, and when used unknown ethnicity, only 34.7% of these would have been identified. Conclusion: In the present sample, the Gail model was nota good predictor for the development of breast cancer in womens from Bahia.

Perfil epidemiológico dos subtipos moleculares de carcinoma ductal da mama em população de pacientes em Salvador, Bahia / Epidemiological profile of molecular subtypes of breast ductal carcinoma in patients population in Salvador, Bahia

Objetivo: Avaliar o perfil dos subtipos moleculares do câncer de mama em uma população de pacientes de duas clínicas privadas de Salvador, Bahia: o Núcleo da Mama e o Núcleo de Oncologia da Bahia. Metodologia: Estudo de corte transversal que incluiu pacientes do sexo feminino com diagnóstico aná- tomo-patológico de carcinoma invasivo sem tipo especial (ductal invasor). Foram excluídas as pacientes com história de câncer prévio, exceto câncer de pele não melanoma; com dados clínicos anteriores ao tratamento sistêmico indisponíveis e sem laudo de imuno-histoquímica. Foi realizada classificação do câncer de mama com base no subtipo molecular em quatro padrões principais: luminal A, luminal B, HER2+ e triplo-negativo. Frequências e proporções foram estabelecidas para cada um dos subtipos moleculares. Outros dados clínicos e laboratoriais também foram colhidos para estabelecer o perfil da população estudada. Resultados: Foram recrutadas 59 pacientes entre dezembro de 2012 e maio de 2014, com idade média de 56,9 anos. O subtipo molecular mais comum na amostra foi o luminal B, com 35 casos (59,3%), seguido do luminal A, (11 casos; 18,6%), triplo-negativo (6 casos, 10,2%) e HER2+ (7 casos; 11,9%). Conclusões: Corroborando outros estudos realizados em população brasileira, o subtipo luminal B é o mais comum encontrado nesta amostra de pacientes de Salvador, Bahia. O achado ajuda a confirmar o padrão atípico do país em relação ao descrito na literatura internacional, com importantes implicações terapêuticas e prognósticas.

Objective: The aim of this study is to evaluate breast cancer molecular subtype distribution in a female population of two private centers in Salvador, Bahia, Brazil: Núcleo da Mama e o Núcleo de Oncologia da Bahia. Methodology: This is a cross-sectional study involving female patients with pathological diagnosis of invasive ductal carcinoma not otherwise specified (NOS). Patients with history of previous cancer except non-melanoma skin câncer; clinical data prior to systemic treatment unavailable and those without immunohistochemical report were excluded from the study. Breast cancer classification was based on four main molecular subtype patterns: luminal A, luminal B, HER2 + and triple negative. Frequencies and proportions were established for each of the molecular subtypes. Other clinical and laboratory data were also collected to determine baseline characteristics of the population studied. Results: We recruited 59 patients between December 2012 and May 2014 with an average age of 56.9 years. The most common molecular subtype of the sample was luminal B subtype, with 35 cases (59.3%), followed by luminal A (11 cases; 18.6%), triple negative (6 cases, 10.2%) and HER2+ (7 cases; 11.9%). Conclusions: Similar to other studies with Brazilian population samples, luminal B subtype is the most common in this sample of patients in Salvador, Bahia. The finding helps confirm the atypical pattern of the country in relation to that described in international literature, with important therapeutic and prognostic implications.

Associação entre índice de massa corpórea e câncer de mama em pacientes de Salvador, Bahia / Association between body mass index and breast cancer in patients from Salvador, Bahia

Objetivo: Identificar a associação entre o índice de massa corpórea (IMC) e a ocorrência de câncer de mama em uma população de pacientes de duas clínicas de Salvador (BA). Métodos: Estudo caso-controle no qual foram recrutadas 190 pacientes entre 2012 e 2014, sendo 68 diagnosticadas com carcinoma ductal da mama e 122 controles. Foi realizado cálculo amostralcom n=140 pacientes por meio do programa Winpepi. Dados de peso e altura foram coletados para cálculo do IMC de cada paciente. Com base nos critérios da Organização Mundial de Saúde (OMS), foram classificadas como desnutridas pacientes com IMC <18,5, normais aquelas com IMC ?18,5 e <25,0 kg/m², sobrepeso com ?25 e <30 kg/m², e obesas com ?30 kg/m².Proporções de cada categoria de IMC foram determinadas para casos e controles. Análise estatística incluiu realização de teste do ?2 para avaliação de correlação entre as variáveis categóricas. Resultados: A idade média foi de 56,7±13 anos entre os casos e de 53,1±11,9 anos entre os controles. IMC médio foi de 27,5±4,6 kg/m² entre os casos e de 26,1±4,9 kg/m² entre os controles. A proporção de pacientes normais, sobrepeso e obesas foi de 33,8, 38,2 e 27,9% entre os casos e de 43,4, 43,4 e 13,1% entre os controles, respectivamente. Houve significativamente mais obesas entre os casos do que entre os controles (OR=2,57; IC95% 1,22?5,42; p=0,011),com mulheres na menacme e pós-menopausadas. Conclusão: Os resultados demonstram correlação entre a presença de câncer de mama e o IMC elevado na amostra estudada, o que está condizente com os resultados de outros estudos.

Objective: Identify the association between body mass index (BMI) and breast cancer in a population of patients from two clinics in Salvador (BA). Methods: A case-control study in which 190 patients were recruited between 2012 and 2014, 68 diagnosed with ductal breast carcinoma and 122 controls. Sample calculation was performed with n=140 patients, through Winpepi program. Weight and height data were collected to calculate the body mass index of each patient. Based on the World Health Organization (WHO) criteria were classified as malnourished patients with BMI <18.5, those with normal BMI ?18.5 and <25.0 kg/m², overweight ?25 and <30 kg/m² and obese ?30 kg/m². BMI proportions of each category were determined for cases and controls. Statistical analysis included performing chi-square test to evaluate the correlation between categorical variables. Results: Mean age was 56.7±13 years between cases and 53.1±11.9 years among controls. Mean BMI was 27.5±4.6 kg/m² among cases and 26.1±4.9 kg/m² among controls. The proportion of normal patients, overweight and obese was 33.8, 38.2 and 27.9% in the cases and 43.4, 43.4 and 13.1% among controls, respectively. There were significantly more obese among cases than among controls (OR=2.57, 95%CI 1.22?5.42; p=0.011), with women in premenopausal and post-menopausal. Conclusion: The resultsshow a correlation between the presence of breast cancer and high BMI in this sample, consistent with the results of other studies.

Favorable effects of ezetimibe alone or in association with simvastatin on the removal from plasma of chylomicrons in coronary heart disease subjects.

OBJECTIVE: Reductions on the clearance from plasma of chylomicrons are associated with atherosclerosis. Statins improve the removal from plasma of chylomicrons in a dose dependent manner. There is controversy whether ezetimibe modifies the plasma clearance of chylomicrons. Effects of ezetimibe alone or in combination with simvastatin were compared with low and high dose of the latter, upon the kinetics of a chylomicron-like emulsion in coronary heart disease (CHD) patients. METHODS: 25 CHD patients were randomized for treatment with ezetimibe 10 mg (group 1) or simvastatin 20 mg (group 2) with progression to ezetimibe + simvastatin 10/20 mg or simvastatin 80 mg, respectively. Kinetic studies were performed at baseline and after each treatment period of 6 weeks. The fractional catabolic rates (FCR) of the emulsion labeled with (14)C-CE and (3)H-TG, that represent respectively chylomicron remnant and triglyceride removal, were calculated. Comparisons were made by ANOVA. RESULTS: The (14)CE-FCR in group 1 were 0.005 ± 0.004, 0.011 ± 0.008 and 0.018 ± 0.005 min(-1) and in group 2 were 0.004 ± 0.003, 0.011 ± 0.008 and 0.019 ± 0.007 min(-1) respectively at baseline, after 6 and 12 weeks (p < 0.05 vs. baseline, and 6 vs. 12 weeks). The (3)H-TG-FCR in group 1 were 0.017 ± 0.011, 0.024 ± 0.011 and 0.042 ± 0.013 min(-1) and in group 2 were 0.016 ± 0.009, 0.022 ± 0.009 and 0.037 ± 0.012 min(-1) at baseline, after 6 and 12 weeks (p < 0.05 vs. baseline, and 6 vs. 12 weeks). There were no differences between groups in time. CONCLUSION: Both treatments increased similarly the removal from plasma of chylomicron and remnants in CHD patients.

Long-term prospective study of the influence of estrone levels on events in postmenopausal women with or at high risk for coronary artery disease.

BACKGROUND: The link between endogenous estrogen, coronary artery disease (CAD), and death in postmenopausal women is uncertain. We analyzed the association between death and blood levels of estrone in postmenopausal women with known coronary artery disease (CAD) or with a high-risk factor score for CAD. METHODS: 251 postmenopausal women age 50-90 years not on estrogen therapy. Fasting blood for estrone and heart disease risk factors were collected at baseline. Women were grouped according to their estrone levels (<15 and ≥15 pg/mL). Fatal events were recorded after 5.8 ± 1.4 years of followup. RESULTS: The Kaplan-Meier survival curve showed a significant trend (P = 0.039) of greater all-cause mortality in women with low estrone levels (<15 pg/mL). Cox multivariate regression analysis model adjusted for body mass index, diabetes, dyslipidemia, family history, and estrone showed estrone (OR = 0.45; P = 0.038) as the only independent variable for all-cause mortality. Multivariate regression model adjusted for age, body mass index, hypertension, diabetes, dyslipidemia, family history, and estrone showed that only age (OR = 1.06; P = 0.017) was an independent predictor of all-cause mortality. CONCLUSIONS: Postmenopausal women with known CAD or with a high-risk factor score for CAD and low estrone levels (<15 pg/mL) had increased all-cause mortality.

New prognostic score for stable coronary disease evaluation.

BACKGROUND: The need to improve the exercise testing accuracy, pushed the development of scores, whose applicability was already broadly recognized. OBJECTIVE: Prognostic evaluation of stable coronary disease through a new simplified score. METHODS: A new score was applied in 372 multivessel coronary patients with preserved ventricular function, 71.8% male, age: 59.5 (± 9.07) years old, randomized to medical treatment, surgery (CABG) or angioplasty (PTCA), with 5 years of follow-up. Cardiovascular death was considered the primary endpoint. Non-fatal myocardial infarction, death and re-intervention were considered for a combined secondary endpoint. The score was based on an equation previously validated, resulting from a sum of one point for: male gender, infarction history, angina, diabetes, insulin use and one point for each decade of life after 40 years old. Positive exercise testing summed one additional point. RESULTS: Thirty six deaths was observed (10 in group PTCA, 15 in CABG and 11 in the clinical group), p = 0.61. We observed 93 combined events: 37 in PTCA group, 23 in CABG and 33 in the clinical group (p = 0.058). 247 patients presented clinical score ≥ 5 points and 216 ≥ 6 points. The cutoff point ≥ 5 or ≥ 6 points identified higher risk, p = 0.015 and p = 0.012, respectively. The survival curve showed a different death incidence after the randomization when score reached 06 points or more (p = 0.07), and a distinct incidence of combined events between the patients with score < 6 and ≥ 6 points (p = 0.02). CONCLUSION: The new score was consistent for multiarterial stable coronary disease risk stratification.

Frequência etiológica da hipertensão pulmonar em ambulatório de referência na Bahia / Etiological frequency of pulmonary hypertension in a reference outpatient clinic in Bahia, Brazil / Frecuencia etiológica de la hipertensión pulmonar en un ambulatorio de referencia en Bahia

Fundamento: A hipertensão pulmonar (HP) resulta de diversas etiologias com possíveis influências geográficas, porém poucos trabalhos descrevem a frequência etiológica da HP, especialmente em nosso meio. Não está claro se existe associação entre etiologia e nível de pressão pulmonar ou intensidade da sintomatologia. Objetivo: 1) descrever a prevalência etiológica da HP na Bahia; 2) avaliar se a etiologia é fator determinante no nível de pressão pulmonar; 3) avaliar se a etiologia é fator determinante na classe funcional; 4) identificar os demais preditores do nível de pressão pulmonar e da classe funcional. Métodos: Estudo observacional, de corte transversal, em portadores de HP atendidos no Ambulatório Magalhães Neto, entre junho de 2005 e dezembro de 2007. A HP foi definida como pressão sistólica da artéria pulmonar (PSAP) > 40 mmHg pelo ecocardiograma. Pacientes com doença pulmonar obstrutiva crônica ou doença ventricular esquerda não foram incluídos. Resultados: Foram estudados 48 pacientes com PSAP de 86 ± 24 mmHg. Quanto à etiologia, 42 por cento dos pacientes foram classificados como idiopáticos, seguidos de 25 por cento de esquistossomose, 19 por cento de cardiopatia congênita e 10 por cento de embolia pulmonar crônica. O maior tempo de doença prediz pressões mais elevadas em cardiopatas. Indivíduos com esquistossomose tiveram melhor desempenho funcional quando comparados aos demais (456 ± 58 vs. 299 ± 138 metros, p = 0,005). Etiologia esquistossomótica e idades menores apresentam melhor classe funcional. Conclusão: 1) Prevalece a classificação idiopática, sendo a esquistossomose a causa específica mais frequente em nosso meio; 2) pacientes com etiologia esquistossomótica e de idades menores apresentam melhor classe funcional; 3) cardiopatia congênita resulta em maior nível de pressão na artéria pulmonar, provavelmente devido ao maior tempo de doença.

Background: Pulmonary hypertension (PH) results from several etiologies, with possible geographic influences; however, few studies have described the etiological frequency of PH, especially in our country. It is not clear whether there is an association between etiology and pulmonary pressure level or symptom intensity. Objectives: 1) to describe the etiological prevalence of PH in the state of Bahia, Brazil; 2) to evaluate whether the etiology is a determinant factor for the pulmonary pressure level; 3) to evaluate whether the etiology is a determinant factor for functional class; 4) to identify the other predictors of pulmonary pressure level and functional class. Methods: The present was an observational, cross-sectional study that analyzed individuals with PH treated at the Magalhaes Neto Outpatient Clinic, between June 2005 and December 2007. PH was defined as pulmonary artery systolic pressure (PASP) > 40 mmHg measure at the echocardiogram. Patients with chronic obstructive pulmonary disease or ventricular disease were excluded from the study. RESULTS: A total of 48 patients with PASP = 86 ± 24 mmHg were studied. Regarding the etiology, 42 percent of the patients were classified as idiopathic, followed by 25 percent as schistosomatic, 19 percent as congenital cardiopathy and 10 percent of chronic pulmonary embolism. A longer time of disease predicted higher pressures in patients with cardiopathy. Individuals with schistosomiasis had the best functional performance when compared to the others (456 ± 58 vs. 299 ± 138 meters, p=0.005). The schistosomatic etiology and younger age presented better functional class. Conclusions: 1) the idiopathic classification is the most prevalent, with schistosomiasis being the most frequent specific cause in our country; 2) patients with schistosomatic etiology and of younger age present better functional class. 3) the congenital cardiopathy results in a higher pressure level in the pulmonary artery, ...

Fundamento: La hipertensión pulmonar (HP) es la resultante de diversas etiologías con posibles influencias geográficas, pero pocos trabajos describen la frecuencia etiológica de la HP, especialmente en nuestro medio. No está claro si existe asociación entre etiología y nivel de presión pulmonar o intensidad de la sintomatología. Objetivo: (1) Describir la prevalencia etiológica de la HP en Bahía; (2) evaluar si la etiología es factor determinante en el nivel de presión pulmonar; (3) evaluar si la etiología es factor determinante en la clase funcional; (4) identificar los demás predictores del nivel de presión pulmonar y de la clase funcional. Métodos: Estudio observacional, de corte transversal, en portadores de HP atendidos en el Ambulatorio Magalhães Neto, entre junio de 2005 y diciembre de 2007. La HP fue definida como presión sistólica de la arteria pulmonar (PSAP) > 40 mmHg por ecocardiograma. No se incluyó a los pacientes con enfermedad pulmonar obstructiva crónica o deterioro del ventrículo izquierdo. Resultados: Se estudiaron a 48 pacientes con PSAP de 86±24 mmHg. En cuanto a la etiología, el 42 por ciento de los pacientes fue clasificado como idiopático, seguido del 25 por ciento por esquistosomiasis, el 19 por ciento por cardiopatía congénita y el 10 por ciento por embolia pulmonar crónica. El mayor tiempo de enfermedad predice presiones más elevadas en cardiópatas. Los individuos con esquistosomiasis tuvieron mejor desempeño funcional cuando se los comparó con los demás (456±58 vs. 299±138 metros, P = 0,005). Pacientes con etiología esquistosomiásica y edades más jóvenes cursan con mejor capacidad funcional. Conclusión: (1) Prevalece la clasificación idiopática, y la esquistosomiasis constituye la causa específica más frecuente en nuestro medio; (2) pacientes con etiología esquistosomiásica y de edades menores presentan mejor clase funcional; (3) la cardiopatía congénita resulta en mayor nivel de presión en la arteria pulmonar, ...

Etiological frequency of pulmonary hypertension in a reference outpatient clinic in Bahia, Brazil.

BACKGROUND: Pulmonary hypertension (PH) results from several etiologies, with possible geographic influences; however, few studies have described the etiological frequency of PH, especially in our country. It is not clear whether there is an association between etiology and pulmonary pressure level or symptom intensity. OBJECTIVES: 1) to describe the etiological prevalence of PH in the state of Bahia, Brazil; 2) to evaluate whether the etiology is a determinant factor for the pulmonary pressure level; 3) to evaluate whether the etiology is a determinant factor for functional class; 4) to identify the other predictors of pulmonary pressure level and functional class. METHODS: The present was an observational, cross-sectional study that analyzed individuals with PH treated at the Magalhaes Neto Outpatient Clinic, between June 2005 and December 2007. PH was defined as pulmonary artery systolic pressure (PASP) > 40 mmHg measure at the echocardiogram. Patients with chronic obstructive pulmonary disease or ventricular disease were excluded from the study. RESULTS: A total of 48 patients with PASP = 86 +/- 24 mmHg were studied. Regarding the etiology, 42% of the patients were classified as idiopathic, followed by 25% as schistosomatic, 19% as congenital cardiopathy and 10% of chronic pulmonary embolism. A longer time of disease predicted higher pressures in patients with cardiopathy. Individuals with schistosomiasis had the best functional performance when compared to the others (456 +/- 58 vs. 299 +/- 138 meters, p=0.005). The schistosomatic etiology and younger age presented better functional class. CONCLUSIONS: 1) the idiopathic classification is the most prevalent, with schistosomiasis being the most frequent specific cause in our country; 2) patients with schistosomatic etiology and of younger age present better functional class. 3) the congenital cardiopathy results in a higher pressure level in the pulmonary artery, probably due to the longer duration of the disease.

A Importância do Auto-Enfrentamento na Autoconsciencioterapia / The Importance of Self-Confrontation in Self-Conscientiotherapy / La Importancia del Autoenfrentamiento en la Autoconciencioterapia

Este artigo visa analisar a terceira etapa da Autoconsciencioterapia –o auto-enfrentamento – com o objetivo de detalhar suas especificidades e favorecera sua aplicação. Embasa-se nas vivências do autor na aplicação daautoconsciencioterapia, assim como nas experiências pessoais na condição deconsciencioterapeuta. Desenvolve-se a partir do estudo de 4 assuntos: o autoenfrentamentopropriamente dito; a autoprescrição consciencioterapêutica;a técnica paraterapêutica; a revisão da autoprescrição. Conclui-se ser a autoconsciencioterapiaum recurso otimizador da auto-evolução, sendo o auto--enfrentamento das próprias parapatologias condição fundamental para a obtenção de autocuras(AU)

The article aims at analyzing the third stage of self-conscientiotherapy –the self-confrontation – with the objective of specifying the subject and favoringits application. The study is based on the author’s experiences as a conscientiotherapistas well as on his own employment of self-conscientiotherapy. The articleunfolds itself starting from 4 themes: the self-confrontation strictly speaking;the conscientiotherapeutic self-prescription; the paratherapeutic technique andthe revision of self-prescription. The author concludes pointing out that selfconscientiotherapyis an optimizing tool for self-evolution while self-confrontationof one’s own parapathologies is fundamental for self-cure(AU)

Este artículo visa analizar la tercera etapa de la Autoconciencioterapia –el autoenfrentamiento – con el objetivo de detallar sus especificidadesy favorecer su aplicación. Se embasa en las vivencias del autor en la aplicaciónde la autoconciencioterapia, así como en las experiencias personales en la condiciónde conciencioterapeuta. Se desenvuelve a partir del estudio de 4 asuntos: elautoenfrentamiento propiamente dicho; la autoprescripción conciencioterapéutica;la técnica paraterapéutica; la revisión de la autoprescripción. Se concluyeque la autoconciencioterapia es un recurso optimizador de la autoevolución,siendo el autoenfrentamiento de las propias parapatologías condiciónfundamental para la obtención de autocuras(AU)

Sistematização da parassemiologia

Este artigo tem por objetivo propor uma sistematização e análise geral da especialidade Parassemiologia. Destaca-se a importância da Cosmanálise, Conscienciometria e, principalmente, das parapercepções para se realizar uma investigação parassemiológica(AU)

Renal effects of N-acetylcysteine in patients at risk for contrast nephropathy: decrease in oxidant stress-mediated renal tubular injury.

BACKGROUND: N-Acetylcysteine has been shown to protect against contrast nephropathy, although the mechanisms underlying such an effect are unclear. Surprisingly, studies have shown that post-radiocontrast renal function actually improves in chronic renal failure patients receiving N-acetylcysteine. However, there have been no studies investigating the cause of this improvement. METHODS: In a double-blind, placebo-controlled study, 24 patients (aged 65+/-2 years) suffering from stable mild-to-moderate renal insufficiency and undergoing elective coronary angiography were randomized to receive either placebo or N-acetylcysteine. All received similar hydration. Renal function parameters were assessed 48 h before and 48 h after radiocontrast administration. Urinary 15-isoprostane F2(t), a specific marker of oxidative stress, was measured immediately before and after the procedure. Expression of urinary alpha-glutathione S-transferase protein, a specific proximal tubular injury marker, was assessed after the procedure. RESULTS: Comparing creatinine clearance values before and after angiography, a significant increase was seen in N-acetylcysteine patients (44.7+/-4.2 vs 57.2+/-6.3 ml/min/1.73 m(2); P = 0.02), whereas placebo patients presented no change (46.6+/-5.0 vs 46.9+/-4.3 ml/min/1.73 m(2); P = 0.90). After radiocontrast, urinary 15-isoprostane F2(t) levels in placebo patients increased significantly over baseline values (2.9+/-0.7 vs 10.3+/-2.1 ng/mg creatinine; P = 0.007), whereas urinary 15-isoprostane F2(t) levels in N-acetylcysteine patients remained basically unchanged (3.5+/-0.5 vs 4.1+/-0.9 ng/mg creatinine; P = 0.63). Furthermore, N-acetylcysteine treatment led to lower levels of alpha-glutathione S-transferase than did placebo treatment (0.8+/-0.2 vs 2.4+/-0.7 micro g/g; P = 0.046). CONCLUSIONS: In chronic renal failure patients, the improvement in renal function induced by post-radiocontrast administration of N-acetylcysteine is strongly associated with suppression of oxidant stress-mediated proximal tubular injury.