Characteristics of the clinical treatment of Brazilian and French older adults with diabetes.

OBJECTIVE: The study aimed to compare the drug therapy profile between French older adults with diabetes of the GERODIAB cohort and Brazilian older adults with diabetes assessed in a cross-sectional study conducted in Brazil. METHOD: This quantitative cross-sectional study was conducted with a sample of 246 Brazilian people aged 65 and over receiving care through the Unified Health System in the city of Fortaleza, Northeastern Brazil, who were compared to a sample of 987 French people aged 70 and over receiving care the Rouen University Center in France. RESULTS: The French participants treated for type 2 diabetes (T2D) with insulin alone, insulin + oral hypoglycemic agent (OHA) or OHA/GLP-1 analogue were older and presented higher mean values for body mass index, waist circumference and duration of diabetes in years. The French reported more episodes of hypoglycemia in all treatment modalities. These episodes occurred more frequently in the older adults treated with insulin alone and less frequently in those treated with OHA or GLP-1 analogues. The percentage of Brazilian and French older adults who monitored capillary blood glucose differed significantly in all treatment modalities. CONCLUSION: The significant differences relating to the drug therapy modalities used by Brazilian and French older adults with diabetes point to the importance of understanding the therapeutic objective of drug therapy with older adults with diabetes. Adapting the therapy to the patient's clinical conditions can prevent the worsening of comorbidities that influence the loss of autonomy and frailty.

Multicenter study of perioperative evaluation for noncardiac surgeries in Brazil (EMAPO).

INTRODUCTION: The accuracy of perioperative evaluation methods available is better than chance, but their performance is not ideal. OBJECTIVES: To compare a new evaluation method (EMAPO) to the American College of Physicians method for determining the risk of cardiovascular complications in noncardiac surgeries and to look for new influencing variables. METHODS: Evaluations through EMAPO and the American College of Physicians method were employed for 700 patients. Cardiac events and deaths were recorded, the risk variables related to the occurrence of complications were verified, and the models were compared by analyzing the areas under the receiver operating characteristic curves. RESULTS: Mortality rate was 3.4%, and the incidence of cardiovascular complications was 5.3%. Renal failure (P = 0.01), major surgery (P = 0.004), and emergency surgery (P = 0.003) were independently related to the occurrence of cardiovascular complications. The two methods produced similar results. CONCLUSION: EMAPO is as good as the American College of Physicians method in determining the risk of cardiovascular complications in noncardiac surgeries. New variables related to surgical risk were identified.

Matrix metalloproteinase-2 -735C/T polymorphism is associated with resistant hypertension in a specialized outpatient clinic in Brazil.

BACKGROUND: Matrix metalloproteinases (MMPs) are enzymes involved in cardiovascular (CV) remodeling and hypertension-mediated target organ damage (TOD). Genetic polymorphisms in matrix metalloproteinase 2 (MMP-2) gene [-1575G/A (rs243866); -1306C/T (rs243865); and -735C/T (rs2285053)] are associated with several CV conditions, however the relationship between MMP-2 polymorphisms and resistant hypertension (RH) is unknown. We evaluated whether these genetic single nucleotide polymorphisms (SNPs) in MMP-2 gene are associated with 1) MMP-2 and tissue inhibitor of metalloproteinase-2 (TIMP-2) levels in RH and mild to moderate hypertensive (HT) subjects, 2) left ventricular hypertrophy (LVH) and arterial stiffness and 3) the presence of RH. METHODS: One hundred and nineteen RH and 136 HT subjects were included in this cross-sectional study. Genotypes were determined by real-time PCR using TaqMan probes. Haplotypes were estimated using Bayesian method. RESULTS: The levels of MMP-2 and TIMP-2 were similar among genotypes and haplotypes for the three studied polymorphisms in HT and RH groups. RH showed higher frequency for GCC haplotype and lower frequency of GCT and ATC haplotypes (-1575G/A, -1306C/T and -735C/T, respectively) compared to HT (0.77 vs. 0.64; 0.09 vs. 0.17; 0.13 vs. 0.19, p=0.003 respectively). GCC haplotype was associated to RH apart from potential confounders (odds ratio (OR)=2.09; 95% confidence interval (CI)=1.20-3.64; p=0.01). In addition, CC genotype (OR=2.93; 95% CI=1.22-7.01; p=0.02) and C allele (OR=2.81; 95% CI=1.26-6.31; p=0.01) for -735C/T polymorphism were independently associated with RH. GCT haplotype was associated with reduced probability of having RH (OR=0.35; 95% CI=0.16-0.79; p=0.01). Finally, no relationship was found between studied MMP-2 SNPs and left ventricular hypertrophy and arterial stiffness in both groups. CONCLUSION: GCC haplotype carriers showed higher probability to have RH (odds ratio>1), while the GCT haplotype carriers showed lower probability to have RH, suggesting that the GCT haplotype may represent a protective genetic factor for the development of RH. These finds suggest that GCC and GCT haplotypes, and C allele and CC genotype of the -735C/T MMP-2 gene polymorphism may have a role in RH.

Increased Circulating Tissue Inhibitor of Metalloproteinase-2 Is Associated With Resistant Hypertension.

Resistant hypertension (RH) is associated with organ damage and cardiovascular risk. Evidence suggests the involvement of matrix metalloproteinase 2 (MMP-2) and tissue inhibitor of metalloproteinase 2 (TIMP-2) in hypertension and in cardiovascular remodeling. The aim of this study was to assess the levels of MMP-2 and TIMP-2 in RH and its relation with organ damage, including arterial stiffness and cardiac hypertrophy. MMP-2 and TIMP-2 levels were compared among 19 patients with normotension (NT), 116 with nonresistant hypertension (HTN) and 116 patients with resistant HTN (RH). MMP-2 levels showed no differences among NT, HTN, and RH groups, while TIMP-2 levels were higher in RH compared with HTN and NT groups (90.0 [76.1-107.3] vs 70.1 [57.7-88.3] vs 54.7 [40.9-58.1] ng/mL, P<.01), respectively. MMP-2/TIMP-2 ratio was reduced in the RH group compared with the HTN and NT groups (2.7 [1.9-3.4] vs 3.3 [2.6-4.2] vs 4.9 [4.5-5.3], P<.01), respectively. No associations were found between MMP-2 levels, TIMP-2, and MMP-2/TIMP-2 ratio with cardiac hypertrophy and arterial stiffness in the RH and HTN groups. Finally, in a regression analysis, reduced MMP-2/TIMP-2 ratio and increased TIMP-2 levels were independently associated with RH. The present findings provide evidence that TIMP-2 is associated with RH and might be a possible biomarker for screening RH patients.

Recommendations of the Brazilian Society of Cardiac Arrhythmias for holter monitoring services.

BACKGROUND: There are innumerous indicators to assure the quality of a service. However, medical competence and the proper performance of a procedure determine its final quality. The Brazilian Society of Cardiac Arrhythmias recommends minimum parameters necessary to guarantee the excellence of ambulatory electrocardiographic monitoring services. OBJECTIVE: To recommend minimum medical competences and the information required to issue a Holter monitoring report. METHODS: This study was grounded in the concept of evidence-based medicine and, when evidence was not available, the opinion of a writing committee was used to formulate the recommendation. That committee consisted of professionals with experience on the difficulties of the method and management in providing services in that area. RESULTS: The professional responsible for the Holter monitoring analysis should know cardiovascular pathologies and have consistent formation on electrocardiography, including cardiac arrhythmias and their differential diagnoses. The report should be written in a clear and objective way. The minimum parameters that comprise a Holter report should include statistics of the exam, as well as quantification and analysis of the rhythm disorders observed during monitoring. CONCLUSION: Ambulatory electrocardiographic monitoring should be performed by professionals knowledgeable about electrocardiographic analysis, whose report should comprise the minimum parameters mentioned in this document.

Mechanical, biological and clinical aspects of zirconia implants.

The objective of this narrative overview is to discuss several in vitro and in vivo studies regarding the performance of one-piece zirconia implants in combination with the description of two clinical scenarios where zirconia implant prototypes were utilized with emphasis on the possible scientific and clinical concerns that may affect the functional, biological and esthetic long-term outcomes.

Recomendações da sociedade brasileira de arritmias cardíacas para serviços de holter / Recommendations of the Brazilian society of cardiac arrhythmias for holter monitoring services

FUNDAMENTOS: Inúmeros indicadores são utilizados para assegurar a qualidade de um serviço; entretanto, a competência médica e o adequado fluxo de realização de um procedimento são determinantes da qualidade final. Nesse contexto, a Sociedade Brasileira de Arritmias Cardíacas pretende recomendar parâmetros mínimos necessários para garantir a excelência dos serviços de monitorização eletrocardiográfica ambulatorial. OBJETIVOS: Recomendar competências médicas mínimas e as informações necessárias para emissão do laudo de Holter. MÉTODOS: O documento foi fundamentado no conceito de medicina baseada em evidência, e nas circunstâncias em que a evidência não estava disponível a opinião de uma comissão de redação foi utilizada para a formulação da recomendação. Essa comissão foi formada por profissionais que apresentam vivência nas dificuldades do método e gestão na prestação de serviços nessa área. RESULTADOS: O profissional responsável pela análise de Holter deve conhecer as patologias cardiovasculares e ter formação consistente em eletrocardiografia, incluindo arritmias cardíacas e seus diagnósticos diferenciais. O laudo deve ser redigido de forma clara e objetiva. Os parâmetros mínimos que devem constar no laudo incluem as estatísticas do exame, assim como quantificação e análise dos distúrbios do ritmo observados durante a monitorização. CONCLUSÃO: A monitorização eletrocardiográfica ambulatorial deve ser realizada por profissionais com vivência em análise eletrocardiográfica e o laudo deve conter os parâmetros mínimos mencionados nesse documento.

BACKGROUND: There are innumerous indicators to assure the quality of a service. However, medical competence and the proper performance of a procedure determine its final quality. The Brazilian Society of Cardiac Arrhythmias recommends minimum parameters necessary to guarantee the excellence of ambulatory electrocardiographic monitoring services. OBJECTIVE: To recommend minimum medical competences and the information required to issue a Holter monitoring report. METHODS: This study was grounded in the concept of evidence-based medicine and, when evidence was not available, the opinion of a writing committee was used to formulate the recommendation. That committee consisted of professionals with experience on the difficulties of the method and management in providing services in that area. RESULTS: The professional responsible for the Holter monitoring analysis should know cardiovascular pathologies and have consistent formation on electrocardiography, including cardiac arrhythmias and their differential diagnoses. The report should be written in a clear and objective way. The minimum parameters that comprise a Holter report should include statistics of the exam, as well as quantification and analysis of the rhythm disorders observed during monitoring. CONCLUSION: Ambulatory electrocardiographic monitoring should be performed by professionals knowledgeable about electrocardiographic analysis, whose report should comprise the minimum parameters mentioned in this document.

Análise do risco de acidente vascular encefálico em pacientes portadores de fibrilação atrial / Analysis of the stroke risk in patients with atrial fibrillation

JUSTIFICATIVA E OBJETIVOS: A fibrilação atrial (FA) é arritmia cardíaca frequente que está relacionada ao prejuízo hemodinâmico e eventos tromboembólicos, com consequente elevação de custos e morbimortalidade cardiovascular. A grande importância clínica da FA repousa no fato de que esta arritmia é a maior causa direta conhecida de acidente vascular encefálico isquêmico (AVEi). O objetivo deste estudo foi verificar se os fatores de risco associados ao AVE em pacientes com FA, estabelecidos na população norte-americana, podem ser aplicados em população de consultório.MÉTODO: Foram estudados os prontuários de 143 pacientes na faixa etária acima de 45 anos, com diagnóstico de FA atendidos em consultório de Cardiologia. Os parâmetros analisados foram: identificação do paciente; história da FA; presença de fatores de risco referidos na diretriz de FA do American College of Cardiology/American Heart Association (ACC/AHA), para AVE em pacientes com FA.RESULTADOS: A presença de doença aterosclerótica nas carótidas e tromboembolismo prévio mostrou significância estatística; os demais fatores não foram significativos. CONCLUSÃO: Dentre os 10 fatores de risco estabelecidos para a população norte-americana, somente dois foram significativos nessa população de consultório: doença aterosclerótica nas carótidas e evento tromboembólico prévio. Discutiram-se as possíveis causas que levaram os outros fatores a não apresentarem significância estatística.(AU)

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) is common cardiac arrhythmia related to hemodynamic disturbance and thromboembolic events, with a consequent increase in costs and cardiovascular morbimortality. The great importance of clinical FA rests on the fact that this arrhythmia is the largest known direct cause of ischemic stroke. This study aimed to determine whether the risk factors associated with stroke in patients with AF established in the North American population, can be applied to a population of office in our country.METHOD: We studied the records of 143 patients in the age group over 45 years, diagnosed with FA treated in a cardiology clinic. The parameters were examined: identification data of the patient; data on the history of the FA; presence of risk factors listed in the guideline of the FA American College of Cardiology/American Heart Association (ACC/AHA) for stroke in patients with AF.RESULTS: The presence of carotid atherosclerosis and previous thromboembolism demonstrated statistical significance; whereas other factors where not significant.CONCLUSION: Among the ten risk factors established for the North American population, only two where significant in this population of office: carotid artery atherosclerosis and previous thromboembolism. The authors discuss possible causes that led to the other factors not present statistical significance.(AU)