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1.
Chemosphere ; 352: 141444, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38346513

RESUMO

This study assessed the occurrence of five antibiotics, three hormones, caffeine, and long and short-chain perfluoroalkyl and polyfluoroalkyl substances (PFASs) in surface water and feedstuff samples obtained from aquaculture cages in Três Marias reservoir in Brazil. This is the first work to evaluate the presence of PFAS in surface water used for aquaculture in Brazil. Solid-phase extraction and low temperature partitioning extraction followed by liquid chromatography coupled to mass spectrometry (LC-MS) were performed to process and analyze surface water samples and feedstuff, respectively. The ecotoxicological risk quotient was calculated for target compounds detected in water. Ciprofloxacin and caffeine were detected in all surface water samples. Pharmaceutical drugs ranged from 0.7 ng L-1 (trimethoprim) to 389.2 ng L -1 (ß-estradiol). Estrone (10.24 ng g-1) and ß-estradiol (66.20 ng g-1) were also found in feedstuff. Four PFASs (PFOA, PFDoA, PFTeDA, and PFBS) were detected (9.40-15.2 µg L-1) at levels higher than reported in studies conducted worldwide. Ecotoxicological risk assessment indicated high risks for caffeine and PFOA, PFDoA, and PFTeDA with RQ values from 10 to 103. These findings reveal risks to biodiversity, ecosystem integrity and human health considering possible intake of these contaminants by fish consumption due to potential bioaccumulation of these substances. Hence, it is critical to conduct more studies in this direction in Brazil and other low and middle-low-income countries.


Assuntos
Ácidos Alcanossulfônicos , Ciclídeos , Fluorocarbonos , Poluentes Químicos da Água , Humanos , Animais , Água/análise , Brasil , Monitoramento Ambiental , Antibacterianos/análise , Ácidos Alcanossulfônicos/análise , Cafeína/análise , Ecossistema , Estradiol/análise , Poluentes Químicos da Água/análise , Fluorocarbonos/análise
2.
Int J Mol Sci ; 25(4)2024 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-38397041

RESUMO

Cisplatin is an antineoplastic agent used to treat various tumors. In mammals, it can cause nephrotoxicity, tissue damage, and inflammation. The release of inflammatory mediators leads to the recruitment and infiltration of immune cells, particularly neutrophils, at the site of inflammation. Cisplatin is often used as an inducer of acute kidney injury (AKI) in experimental models, including zebrafish (Danio rerio), due to its accumulation in kidney cells. Current protocols in larval zebrafish focus on studying its effect as an AKI inducer but ignore other systematic outcomes. In this study, cisplatin was added directly to the embryonic medium to assess its toxicity and impact on systemic inflammation using locomotor activity analysis, qPCR, microscopy, and flow cytometry. Our data showed that larvae exposed to cisplatin at 7 days post-fertilization (dpf) displayed dose-dependent mortality and morphological changes, leading to a decrease in locomotion speed at 9 dpf. The expression of pro-inflammatory cytokines such as interleukin (il)-12, il6, and il8 increased after 48 h of cisplatin exposure. Furthermore, while a decrease in the number of neutrophils was observed in the glomerular region of the pronephros, there was an increase in neutrophils throughout the entire animal after 48 h of cisplatin exposure. We demonstrate that cisplatin can have systemic effects in zebrafish larvae, including morphological and locomotory defects, increased inflammatory cytokines, and migration of neutrophils from the hematopoietic niche to other parts of the body. Therefore, this protocol can be used to induce systemic inflammation in zebrafish larvae for studying new therapies or mechanisms of action involving neutrophils.


Assuntos
Injúria Renal Aguda , Cisplatino , Animais , Cisplatino/toxicidade , Cisplatino/metabolismo , Peixe-Zebra , Neutrófilos/metabolismo , Larva , Injúria Renal Aguda/metabolismo , Inflamação/induzido quimicamente , Inflamação/metabolismo , Citocinas/metabolismo , Mamíferos
3.
Sci Rep ; 13(1): 22685, 2023 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-38114708

RESUMO

Focal segmental glomerulosclerosis (FSGS) is the leading cause of nephrotic syndrome, which is characterized by podocyte injury. Given that the pathophysiology of nondiabetic glomerulosclerosis is poorly understood and targeted therapies to prevent glomerular disease are lacking, we decided to investigate the tight junction protein claudin-1 and the histone deacetylase sirtuin-1 (SIRT1), which are known to be involved in podocyte injury. For this purpose, we first examined SIRT1, claudin-1 and podocin expression in kidney biopsies from patients diagnosed with nondiabetic FSGS and found that upregulation of glomerular claudin-1 accompanies a significant reduction in glomerular SIRT1 and podocin levels. From this, we investigated whether a small molecule activator of SIRT1, SRT1720, could delay the onset of FSGS in an animal model of adriamycin (ADR)-induced nephropathy; 14 days of treatment with SRT1720 attenuated glomerulosclerosis progression and albuminuria, prevented transcription factor Wilms tumor 1 (WT1) downregulation and increased glomerular claudin-1 in the ADR + SRT1720 group. Thus, we evaluated the effect of ADR and/or SRT1720 in cultured mouse podocytes. The results showed that ADR [1 µM] triggered an increase in claudin-1 expression after 30 min, and this effect was attenuated by pretreatment of podocytes with SRT1720 [5 µM]. ADR [1 µM] also led to changes in the localization of SIRT1 and claudin-1 in these cells, which could be associated with podocyte injury. Although the use of specific agonists such as SRT1720 presents some benefits in glomerular function, their underlying mechanisms still need to be further explored for therapeutic use. Taken together, our data indicate that SIRT1 and claudin-1 are relevant for the pathophysiology of nondiabetic FSGS.


Assuntos
Glomerulosclerose Segmentar e Focal , Nefropatias , Podócitos , Humanos , Camundongos , Animais , Glomerulosclerose Segmentar e Focal/patologia , Claudina-1/genética , Claudina-1/metabolismo , Sirtuína 1/genética , Sirtuína 1/metabolismo , Glomérulos Renais/patologia , Podócitos/metabolismo , Nefropatias/patologia , Doxorrubicina/farmacologia
4.
Front Immunol ; 14: 1183465, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37292196

RESUMO

Introduction: The tumor microenvironment (TME) of glioblastoma (GB) is characterized by an increased infiltration of immunosuppressive cells that attenuate the antitumor immune response. The participation of neutrophils in tumor progression is still controversial and a dual role in the TME has been proposed. In this study, we show that neutrophils are reprogrammed by the tumor to ultimately promote GB progression. Methods: Using in vitro and in vivo assays, we demonstrate the existence of bidirectional GB and neutrophil communication, directly promoting an immunosuppressive TME. Results and discussion: Neutrophils have shown to play an important role in tumor malignancy especially in advanced 3D tumor model and Balb/c nude mice experiments, implying a time- and neutrophil concentration-dependent modulation. Studying the tumor energetic metabolism indicated a mitochondria mismatch shaping the TME secretome. The given data suggests a cytokine milieu in patients with GB that favors the recruitment of neutrophils, sustaining an anti-inflammatory profile which is associated with poor prognosis. Besides, glioma-neutrophil crosstalk has sustained a tumor prolonged activation via NETs formation, indicating the role of NFκB signaling in tumor progression. Moreover, clinical samples have indicated that neutrophil-lymphocyte ratio (NLR), IL-1ß, and IL-10 are associated with poor outcomes in patients with GB. Conclusion: These results are relevant for understanding how tumor progression occurs and how immune cells can help in this process.


Assuntos
Glioblastoma , Neutrófilos , Animais , Camundongos , Camundongos Nus , Transdução de Sinais , Imunidade , Microambiente Tumoral
5.
Rev. bras. epidemiol ; 26: e230021, 2023. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1423224

RESUMO

RESUMO Objetivo: To describe the initial baseline results of a population-based study, as well as a protocol in order to evaluate the performance of different machine learning algorithms with the objective of predicting the demand for urgent and emergency services in a representative sample of adults from the urban area of Pelotas, Southern Brazil. Methods: The study is entitled "Emergency department use and Artificial Intelligence in PELOTAS (RS) (EAI PELOTAS)" (https://wp.ufpel.edu.br/eaipelotas/). Between September and December 2021, a baseline was carried out with participants. A follow-up was planned to be conducted after 12 months in order to assess the use of urgent and emergency services in the last year. Afterwards, machine learning algorithms will be tested to predict the use of urgent and emergency services over one year. Results: In total, 5,722 participants answered the survey, mostly females (66.8%), with an average age of 50.3 years. The mean number of household people was 2.6. Most of the sample has white skin color and incomplete elementary school or less. Around 30% of the sample has obesity, 14% diabetes, and 39% hypertension. Conclusion: The present paper presented a protocol describing the steps that were and will be taken to produce a model capable of predicting the demand for urgent and emergency services in one year among residents of Pelotas, in Rio Grande do Sul state.


RESUMO Objetivo: Descrever os resultados iniciais da linha de base de um estudo de base populacional, bem como um protocolo para avaliar o desempenho de diferentes algoritmos de aprendizado de máquina, com o objetivo de predizer a demanda de serviços de urgência e emergência em uma amostra representativa de adultos da zona urbana de Pelotas, no Sul do Brasil. Métodos: O estudo intitula-se "Emergency department use and Artificial Intelligence in PELOTAS (RS) (EAI PELOTAS)" (https://wp.ufpel.edu.br/eaipelotas/). Entre setembro e dezembro de 2021, foi realizada uma linha de base com os participantes. Está previsto um acompanhamento após 12 meses para avaliar a utilização de serviços de urgência e emergência no último ano. Em seguida, serão testados algoritmos de machine learning para predizer a utilização de serviços de urgência e emergência no período de um ano. Resultados: No total, 5.722 participantes responderam à pesquisa, a maioria do sexo feminino (66,8%), com idade média de 50,3 anos. O número médio de pessoas no domicílio foi de 2,6. A maioria da amostra tem cor da pele branca e ensino fundamental incompleto ou menos. Cerca de 30% da amostra estava com obesidade, 14% com diabetes e 39% eram hipertensos. Conclusão: O presente trabalho apresentou um protocolo descrevendo as etapas que foram e serão tomadas para a produção de um modelo capaz de prever a demanda por serviços de urgência e emergência em um ano entre moradores de Pelotas, no estado do Rio Grande do Sul.

7.
Peptides ; 155: 170834, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35753504

RESUMO

Intestinal epithelial cells constantly crosstalk with the gut microbiota and immune cells of the gut lamina propria. Enteroendocrine cells, secrete hormones, such as incretin hormones, which participate in host physiological events, such as stimulating insulin secretion, satiety, and glucose homeostasis. Interestingly, evidence suggests that the incretin pathway may influence immune cell activation. Consequently, drugs targeting the incretin hormone signaling pathway may ameliorate inflammatory diseases such as inflammatory bowel diseases, cancer, and autoimmune diseases. In this review, we discuss how these hormones may modulate two subsets of CD4 + T cells, the regulatory T cells (Treg)/Th17 axis important for gut homeostasis: thus, preventing the development and progression of inflammatory diseases. We also summarize the main experimental and clinical findings using drugs targeting the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide (GLP-1) signaling pathways and their great impact on conditions in which the Treg/Th17 axis is disturbed such as inflammatory diseases and cancer. Understanding the role of incretin stimulation in immune cell activation and function, might contribute to new therapeutic designs for the treatment of inflammatory diseases, autoimmunity, and tumors.


Assuntos
Diabetes Mellitus Tipo 2 , Incretinas , Diabetes Mellitus Tipo 2/tratamento farmacológico , Polipeptídeo Inibidor Gástrico/metabolismo , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Glucose/metabolismo , Humanos , Incretinas/uso terapêutico , Insulina/metabolismo , Linfócitos T Reguladores/metabolismo
8.
Fish Shellfish Immunol Rep ; 2: 100007, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36420484

RESUMO

The host immune system tends to reject xenogenic-implanted cells making tumor development in adult host animal models difficult. Immune system suppression is used for successful xenotransplantation of human cancer cells in many animal models. The studies of cancer development processes in vivo offer opportunities to understand cancer biology and discover new therapeutic strategies. In this context, zebrafish is a model that has been widely applied in the study of human diseases, such as cancer. However, the long-term immunosuppression of these adult zebrafish is still under study as a xenograft animal model for human cancer. This work aimed to evaluate the effects of 21 days of (long-term) exposure of dexamethasone in zebrafish-transplanted with MGSO-3 cells, human breast tumor cell line. Our results show that the animals, while kept on dexamethasone treatment, remained with a 50% reduction in the number of peripheral lymphocytes. In vitro data demonstrated that up to 7 days of dexamethasone treatment did not alter the morphology, proliferation, or viability of MGSO-3 cells. The animals that received a prolonged dexamethasone treatment allowed the engraftment of tumor cells in 100% of the zebrafish tested. These animals also showed tumor progression over 21 days. The experimental group that received only previous exposure to dexamethasone had their tumors regressed after 14 days. In conclusion, the prolonged use of dexamethasone in zebrafish showed a potential strategy for in vivo monitoring of xenograft tumor growth for development studies, as well as in anticancer drug discovery.

9.
Psicol. soc. (Online) ; 33: e225927, 2021. tab, graf
Artigo em Português | LILACS, INDEXPSI | ID: biblio-1250537

RESUMO

Resumo Este artigo é um recorte da pesquisa que analisou as percepções de meninas de 6 a 14 anos sobre os aspectos que facilitam e/ou impedem o desenvolvimento de suas habilidades e a garantia de seus direitos a partir do ambiente familiar, escolar, comunitário e social. O estudo teve abordagem plurimetodológica e abrangeu as cinco regiões do Brasil. Em particular, destaca-se a percepção de meninas a partir do exame das respostas a duas questões. Observou-se que as meninas argumentam os aspectos negativos de gênero a partir de quatro grandes fatores: (a) violência sexual, (b) comportamentos e estética, (c) relação com o corpo e sexualidade e (d) responsabilidades e restrição da liberdade. Em todos eles, os discursos das meninas confirmam o quanto as relações de poder são determinantes nas concepções, representações e práticas de gênero ainda hegemônicas na sociedade.


Resumen Este artículo es un recorte de la investigación que analizó las percepciones de niñas de 6 a 14 años sobre los aspectos que facilitan y/o impiden el desarrollo de sus habilidades y la garantía de sus derechos, desde el ambiente familiar, escolar, comunitario y social. El estudio tuvo un enfoque plurimetodológico y abarcó las cinco regiones de Brasil. En particular, se destaca la percepción de las niñas a partir del examen de las respuestas a dos cuestiones. Se observó que las niñas argumentan los aspectos negativos de género a partir de cuatro grandes factores: (i) violencia sexual, (ii) comportamientos y estética, (iii) relación con el cuerpo y sexualidad y (iv) responsabilidades y restricción de la libertad. En todos ellos, los discursos de las niñas confirman cuánto las relaciones de poder son determinantes en las concepciones, representaciones y prácticas de género aún hegemónicas en la sociedad.


Abstract This article is a clipping of a research that analyzed the perceptions of girls aged 6-14 on the aspects that facilitate and/or prevent the development of their abilities, and the guarantee of their rights, from their family, school, community and social environment. The study had a multi-methodological approach and covered Brazil's five regions. In particular, the girls' perception stands out based on the examination of their answers to two questions. It was observed that the girls argue negative aspects of gender from four big factors: (a) sexual violence, (b) behavior and aesthetics, (c) relations with the body and sexuality, and (d) responsibilities and freedom restriction. In all of them, the girls' discourses confirm how power relations are determinant in the conceptions, representations and practices of gender that are still hegemonic in society.


Assuntos
Humanos , Criança , Adolescente , Mulheres , Criança , Adolescente , Feminismo , Violência de Gênero , Percepção , Comportamento , Brasil , Poder Psicológico , Sexualidade , Estética , Liberdade
10.
Enferm. foco (Brasília) ; 11(5): 130-135, dez. 2020. ilus
Artigo em Português | LILACS, BDENF | ID: biblio-1177528

RESUMO

Objetivo: construir aplicativo para educação em saúde de pessoas com Diabetes Mellitus sobre prevenção de complicações agudas da doença. Métodos: Estudo metodológico aplicado, exploratório, fase de produção tecnológica. Produção do aplicativo ocorreu em duas etapas: revisão de literatura; construção do aplicativo. Resultados: Revisão: identificou-se 13 estudos. Na produção do aplicativo "Descomplica, Dona Bete", optou-se pela construção em mídia, texto e áudio, com tela inicial de boas-vindas e tela secundária que direciona aos tópicos sobre prevenção das complicações agudas Hipoglicemia, Hiperglicemia, Cetoacidose Diabética e Estado Hiperglicêmico Hiperosmolar. Conclusão: o processo de construção do aplicativo baseado em evidências da literatura foi o primeiro passo para suprir parte de uma lacuna, considerando o déficit de conhecimento de pessoas diabéticas acerca das complicações agudas da doença. Portanto, constitui um suporte interativo para ações de educação em saúde com potencialidade para incentivar pessoas com diabetes a aprimorar o autocuidado preventivo. (AU)


Objective: To build an application for health education of people with Diabetes Mellitus on prevention of acute complications of the disease. Methods: Applied, exploratory methodological study, technological production phase. Application production took place in two stages: literature review; building the application. Results: 13 studies were identified. In the production of the application "Descomplica, Dona Bete", we opted for the construction in media, text and audio, with a welcome initial screen and a secondary screen that directs to topics on prevention of acute complications Hypoglycemia, Hyperglycemia, Diabetic Ketoacidosis and Status Hyperglycemic Hyperosmolar. Conclusion: The process of building the application based on evidence from the literature was the first step to fill part of a gap, considering the lack of knowledge of diabetic people about the acute complications of the disease. Therefore, it constitutes an interactive support for health education actions with the potential to encourage people with diabetes to improve preventive self-care. (AU)


Objetivo: Desarrollar una aplicación para la educación sanitaria de las personas con diabetes mellitus sobre la prevención de complicaciones agudas de la enfermedad. Métodos: Estudio metodológico exploratorio aplicado, fase de producción tecnológica. La producción de la aplicación se produjo en dos etapas: revisión de la literatura; construyendo la aplicación. Resultados: Revisión: se identificaron 13 estudios. En la producción de la aplicación "Descomplica, Dona Bete", elija construir en medios, texto y audio, con una pantalla de inicio de bienvenida y una pantalla secundaria que lo dirija a respuestas sobre complicaciones de complicaciones agudas Hipoglucemia, hiperglucemia, cetoacidosis diabética y estado hiperglucémico Hiperosmolar. Conclusión: El proceso de construcción de la aplicación basada en la literatura fue el primer paso para llenar un vacío, considerando la falta de conocimiento de las personas diabéticas sobre las complicaciones agudas de la enfermedad. Por lo tanto, ofrecer apoyo interactivo para acciones de educación en salud con el potencial de alentar a las personas con diabetes a mejorar o prevenir el autocuidado. (AU)


Assuntos
Enfermagem , Cetoacidose Diabética , Tecnologia Educacional , Hiperglicemia , Hipoglicemia
11.
Cogit. Enferm. (Online) ; 25: e70889, 2020. tab
Artigo em Português | LILACS-Express | LILACS, BDENF | ID: biblio-1142802

RESUMO

RESUMO Objetivo: evidenciar e discutir os cuidados de enfermagem no que concerne à termorregulação de recém-nascidos prematuros. Método: revisão integrativa com busca por artigos primários completos, publicados de 2014 a 2019, em português, inglês ou espanhol na Biblioteca Virtual de Saúde, PubMed e Cochrane Library. Utilizou-se os descritores: Termorregulação; Recém-Nascido; Enfermagem; "Enfermeiras e Enfermeiros"; "Body Temperature Regulation"; e "Infant, Newborn". Resultados: foram incluídos nove artigos para síntese, com estudos realizados em diferentes países. Emergiram categorias sobre cuidados na termorregulação de recém-nascidos prematuros e sobre protocolos para a termorregulação neonatal na prática clínica. Considerações finais: os cuidados de enfermagem na termorregulação incluem o uso de cama aquecida, aquecedor radiante, métodos de isolamento corporal e ajuste da temperatura ambiente. Este estudo contribui fornecendo base para pesquisas sobre a situação clínica de recém-nascidos e possíveis associações entre a assistência de enfermagem que poderiam comprometer a termorregulação neonatal.


RESUMEN: Objetivo: evidenciar y debatir los cuidados de enfermería en lo referente a la termorregulación de recién nacidos prematuros. Método: revisión integradora con búsqueda por artículos primarios completos, publicados entre 2014 y 2019, en portugués, inglés o español en la Biblioteca Virtual de Salud, PubMed y la Cochrane Library. Se utilizaron los siguientes descriptores: Termorregulação; Recém-Nascido; Enfermagem; "Enfermeiras e Enfermeiros"; "Body Temperature Regulation"; e "Infant, Newborn". Resultados: se incluyeron nueve artículos para la síntesis, con estudios realizados en diferentes países. Surgieron categorías sobre cuidados en la termorregulación de recién nacidos prematuros y sobre protocolos para la termorregulación neonatal en la práctica clínica. Consideraciones finales: los cuidados de enfermería en la termorregulación incluyen el uso de una cama con calefacción, calefactor radiante, métodos de aislamiento corporal y ajuste de la temperatura ambiente. Este estudio contribuye con el aporte de una base para realizar investigaciones sobre la situación clínica de los recién nacidos y sus posibles asociaciones en la asistencia de enfermería que podrían poner en riesgo la termorregulación neonatal.


ABSTRACT Objective: to evidence and discuss nursing care regarding thermo-regulation for pre-term newborns. Method: An integrative review with search by complete primary articles, published from 2014 to 2019 in Portuguese, English or Spanish in the Virtual Health Library, PubMed, and the Cochrane Library. The following descriptors were used: Termorregulação; Recém-Nascido; Enfermagem; "Enfermeiras e Enfermeiros"; "Body Temperature Regulation"; and "Infant, Newborn". Results: nine articles were included for synthesis, with studies conducted in different countries. Categories emerged about care in the thermo-regulation of pre-term newborns and on protocols for neonatal thermo-regulation in the clinical practice. Final considerations: nursing care in thermo-regulation includes the use of a heated bed, radiant heater, body insulation methods, and adjustment of room temperature. This study contributes by providing a basis for research on the clinical situation of newborns and possible associations in nursing care that could compromise neonatal thermo-regulation.

12.
Rev. urug. cardiol ; 35(2): 68-87, 2020. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1127265

RESUMO

Resumen: Antecedentes: la endocarditis infecciosa es una enfermedad con elevada morbimortalidad, la cual se encuentra en torno al 25%. Aproximadamente el 50% de los casos requiere tratamiento quirúrgico. En nuestro medio se desconocen las características clínicas y evolutivas de pacientes operados por endocarditis infecciosa activa. Objetivos: primario, determinar mortalidad operatoria (MO) y sobrevida a largo plazo; secundario, definir predictores de embolias, complicaciones locales (CL), MO y endocarditis protésica (EP) en la evolución. Métodos: trabajo retrospectivo y analítico. Se identificaron pacientes que recibieron cirugía cardíaca por endocarditis activa entre enero de 2006 y diciembre de 2017. Mediante regresión logística multivariada se identificaron predictores para los objetivos enunciados. Resultados: se incluyeron 101 pacientes. El microorganismo más frecuentemente encontrado fue Staphylococcus aureus (SA) (15,8%). La topografía fue protésica en 20,8%, aórtica en 46,5%, mitral en 23,8% y mitro-aórtica en 13,9%. La MO fue 11,3% y 29,5% (p=0,025), según ausencia o presencia de CL, único predictor independiente de mortalidad (OR=3,38). El 47,5% presentó CL, siendo la más frecuente el absceso (25,7%). Fueron predictores independientes: EP (OR=5,8), endocarditis valvular aórtica (OR=2,9) y sexo masculino (OR=3,5). La incidencia de EP precoz fue 3% y tardía 4%. El 30% de los pacientes adquirió la EI como consecuencia de un procedimiento médico invasivo en los 6 meses previos. De los siete pacientes con EP en la evolución, seis tenían CL (p<0,05). El 31,7% presentaba embolias, resultando predictores independientes: Staphylococcus aureus (OR=4,6), vegetación en el velo mitral posterior (OR=3,2) y antecedente de hipertensión arterial (OR=3,32). La sobrevida a cinco y diez años fue de 88,20%±0,04 y 81,50%±0,05 respectivamente. Conclusiones: la MO de la endocarditis activa en nuestro medio es similar a la reportada internacionalmente. La presencia de CL se asocia a EP en la evolución y resultó ser un predictor independiente de sobrevida a largo plazo, y de MO. La sobrevida a largo plazo es similar a la reportada internacionalmente. Se observó una alta incidencia de agentes intrahospitalarios y procedimientos invasivos como causas probables.


Summary: Introduction: infective endocarditis is a high morbidity and mortality disease, which is about 25%. About fifty percent of patients require heart surgery. In our environment, clinical and evolutionary characteristics of patients operated with active endocarditis are unknown. Objective: primary, determine operative mortality and long-term survival; secondary, define predictors of embolisms, local complications, operative mortality and prosthetic endocarditis in evolution. Methods: retrospective, analytical study. Patients who received cardiac surgery for active endocarditis between January 2006 and December 2017 were identified. Through multivariate logistic regression, predictors were identified for the stated objectives. Results: one hundred and one patients were included. The most frequently found microorganism was Staphylococcus aureus (15.8%). The topography was prosthetic in 20.8%, aortic 46.5%, mitral 23.8% and mitro-aortic 13.9%. The operative mortality was 11.3% and 29.5% (p = 0.025) according to the absence or presence of local complications , the only independent predictor of mortality (OR = 3.32). Local complications were present in 47.5%, the most frequent were abscess (25.7%), independent predictors were: prosthetic endocarditis (OR=5.8), aortic endocarditis (OR=2.9) and male sex (OR=3.5). The incidence of early prosthetic endocarditis was 3% and late 4%. Thirty percent of patients acquired infective endocarditis as a result of an invasive medical procedure in the previous 6 months. Of the seven patients with prosthetic endocarditis in evolution, six had local complications (p <0.05). Embolic events were present in 31.7% of patients, were independent predictors: Staphylococcus aureus (OR=4.6), presence of vegetation in the posterior mitral leaflet (OR=3.2) and history of hypertension (OR=3.32). Survival at 5 and 10 years was 88.20% ± 0.04 and 81.50% ± 0.05 respectively. Conclusions: operative mortality of active endocarditis in our environment is high and similar to that reported internationally. The presence of local complications is associated with prosthetic endocarditis in evolution and proved to be an independent predictor of long-term survival, and operative mortality. Long-term survival is similar to that reported internationally. A high incidence of in-hospital agents was observed and invasive procedures as probable causes.


Resumo: Antecedentes: a endocardite infecciosa é uma doença com alta morbimortalidade. Requerem tratamento cirúrgico o 50%. Em nosso meio, as características clínicas e evolutivas dos pacientes operados com endocardite ativa são desconhecidas. Objetivos: primário, determinar a mortalidade operatória e a sobrevida a longo prazo; secundário: Definir preditores de embolias, complicações locais, mortalidade operatória e endocardite protética na evolução. Métodos: trabalho retrospectivo, analítico. Foram identificados no banco de dados pacientes submetidos à cirurgia de endocardite ativa entre janeiro de 2006 e dezembro de 2017. Através de regressão logística multivariada, os preditores foram identificados para os objetivos estabelecidos. Resultados: cento e um pacientes foram incluídos. Staphylococcus aureus foi o microrganismo mais frequente (15,8%). A topografia foi protética em 20,8%, aórtica 46,5%, mitral 23,8% e mitroaórtica 13,9%. A mortalidade operatória foi de 11,3% e 29,5% (p = 0,025), de acordo com a ausência ou presença de complicações locais, o único preditor independente de mortalidade (OR). Um 47,5% apresentaram complicações locais, sendo o mais frequente o abscesso (25,7%). Os preditores independentes foram: endocardite protética (OR = 5,8), endocardite valvar aórtica (OR=2,9)) e sexo masculino (OR = 3,5). A incidência de endocardite protética precoce foi de 3% e tardia de 4%. Trinta por cento dos pacientes adquiriram endocardite infecciosa como resultado de um procedimento médico invasivo nos 6 meses anteriores. Dos pacientes com endocardite protética na evolução, 85,7% apresentava complicações locais (p <0,05). O 31,7% apresentava embolia, resultando em preditores independentes: Staphylococcus aureus (OR = 4,6), vegetação no véu mitral posterior (OR = 3,2) e história de hipertensão arterial (OR = 3,32). A sobrevida em 5 e 10 anos foi de 88,20% ± 0,04 e 81,50% ± 0,05, respectivamente. Conclusões: a mortalidade operatória da endocardite ativa em nosso ambiente é alto e semelhante ao relatado internacionalmente. A presença de complicações locais está associada à endocardite protética na evolução e provou ser um preditor independente de sobrevida a longo prazo e mortalidade operatória. A sobrevivência a longo prazo é semelhante à relatada internacionalmente. Foi observada alta incidência de agentes hospitalares e procedimentos invasivos como causas prováveis.

13.
Rev. urug. cardiol ; 34(3): 26-48, dic. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1058902

RESUMO

resumen está disponible en el texto completo


Summary: Introduction: the amino-terminal pro brain-type natriuretic peptide (NT-proBNP) is a diagnostic and prognostic biomarker in heart failure. Its use as a prognosis predictor of postoperative evolution in cardiac surgery has not been established. Objective: to determine if the value of preoperative NT in cardiac surgery is associated with postoperative evolution parameters. Primary objective: to evaluate its association with the length of stay in intensive care unit. Secondary objectives: to evaluate its association with the time of mechanical ventilation and inotropic agents requirements. To determine the evolution of NT-proBNP concentration after cardiopulmonary bypass. Methods: multicentric retrospective study, endorsed by the Research Committee of the National Institute of Cardiac Surgery and the Ethic Research Committee of the Clinic Hospital. It included patients who underwent cardiac surgery between March and August 2018. NT-proBNP was measured during anesthesia induction and after cardiopulmonary bypass. A possible association of preoperative NT-proBNP with risk factors and type of procedure performed was studied. By analysing the ROC curve, the area under curve (AUC) was calculated and then, the best cut-off value of NT-proBNP to predict prolonged intensive care unit stay was determined. Intensive care unit stays, mechanical ventilation and inotropic requirements were defined as prolonged when they exceeded 2 days, 6 and 24 hours respectively. Through the use of multivaried logistics, the predicting value of NT-proBNP was determined for each one of the aforementioned variables. A value of alfa 0.05 was considered significant. Results: a total of 155 patients were included in the study. Age, creatininemia, and left ventricular ejection fraction were 65.8±11.4 years, 1.15±1.10 mg/dl and 52.8±11.9% respectively. Female prevalence was 30.3%, arterial hypertension 77.4%, diabetes mellitus 25.2% and dyslipidemia 50.3%. In 42.6% isolated myocardial revascularization was performed, in 12.9% myocardial revascularization plus one or more valve procedures, and in 44.5% isolated valve procedures. In all cases there was a significant reduction between preoperative (443 pg/ml, interquartile range 143-1.193) and postoperative NT-proBNP (362 pg/ml, interquartile range 138-939) (p<0.001). Age, creatininemia, left ventricular ejection fraction, functional classification IV of the New York Heart Association and dyslipidemia turned out to be predictors of preoperative NT-proBNP. Preoperative NT-proBNP was higher in patients with prolonged intensive care unit stay, mechanical ventilation and inotropic requirements. However, it turned out to be an independent predictor only for prolonged intensive care unit stay. (OR=1.62; IC95%:1.11-2.35. p=0.012). The best cut-off value for prolonged intensive care unit stay was 409 pg/ml (AUC=0.68). Conclusion: preoperative determination of NT-proBNP is an efficient tool to predict postoperative evolution. Cardiopulmonary bypass is associated to a significant drop in that marker.


Resumo: Introdução: a porção terminal amino do peptído natriurético tipo B é um biomarcador diagnóstico e prognóstico na insuficiência cardíaca. Seu uso como preditor prognóstico no pós-operatório de cirurgia cardíaca não está estabelecido. Objetivo: determinar se o valor de NT-proBNP no período pré-operatório de cirurgia cardíaca está associado a parâmetros de evolução pós-operatória. Objetivo primário: avaliar sua associação com tempo prolongado de internação em unidade de terapia intensiva. Objetivos secundários: associação com tempo de ventilação mecânica e necessidade inotrópica. Determinar a evolução da concentração de NT-proBNP após circulação extracorpórea. Método: estudo multicêntrico retrospectivo endossado pelo Comitê de Pesquisa do Instituto Nacional de Cirurgia Cardíaco e pelo Comitê de Ética da Pesquisa do Hospital da Clínica. Foram incluídos pacientes operados de março a agosto de 2018. O NT-proBNP foi dosado durante a indução anestésica e após a circulação extracorpórea. O NT-proBNP foi comparado de acordo com os fatores de risco e procedimentos realizados. A área da curva (AUC) foi determinada pela análise da curva ROC e o melhor ponto de corte NT-proBNP foi estabelecido na previsão do tempo prolongado de internação em unidade de terapia intensiva. O tempo de internação em unidade de terapia intensiva, tempo de ventilação mecânica e necessidade inotrópica prolongada foram definidos como maiores que 2 dias, 6 e 24 horas, respectivamente. Um alfa de 0,05 foi considerado significativo. Resultados: 155 pacientes foram incluídos. Idade, creatininemia e fração de ejeção do ventrículo esquerdo foram 65,8± 11,4 anos, 1,15 ± 1,10 mg/dl e 52,8 ± 11,9 %, respectivamente. A prevalência do sexo feminino foi 30,3%, hipertensão arterial 77,4%, diabetes mellitus 25,2% e dislipidemia 50,3%. Em 42,6%, foi realizada revascularização do miocárdio isolada, em 12,9% revascularização do miocárdio associada a um ou mais procedimentos valvares, e em 44,5% procedimentos puros da válvula. Em todos os casos, houve uma diminuição significativa entre o pré-operatório (443 pg/ml, rango interquartílico 143-1.193) e o pós-operatório de NT-proBNP (362 pg/ml, rango interquartilico 138-939) (p <0,001). Idade, cretininemia, fração de ejeção do ventrículo esquerdo, classe funcional IV da New York Heart Association e dislipidemia foram preditores de NT-proBNP pré-operatório. NT-proBNP pré-operatório foi elevado em pacientes com tempo prolongado de internação em unidade de terapia intensiva, tempo de ventilação mecânica e necessidade inotrópica prolongada, mas apenas acabou por ser preditor independente em internação prolongada em unidade de terapia intensiva (OR=1,62; IC95%:1,11-2,35. p=0,012). O melhor valor de corte para internação prolongada foi de 409 pg/ml (AUC = 0,68). Conclusão: a determinação pré-operatória de NT-proBNP é útil como ferramenta na previsão da evolução pós-operatória. A circulação extracorpórea está associada a uma diminuição significativa desse marcador.

14.
Pesqui. vet. bras ; 39(11): 879-888, Nov. 2019. tab, graf, ilus
Artigo em Inglês | VETINDEX, LILACS | ID: biblio-1056911

RESUMO

Brazil has one of the largest commercial cattle herds in the world, which naturally coexist with an enormous number of parasitic species. Southern cattle tick, Rhipicephalus (Boophilus) microplus, is among these species, interfering with animal productivity and causing losses to the beef and dairy cattle sector. The use of chemical acaricides in the control of this mite has resulted in the emergence of resistant populations. In this sense, alternative control measures using plants as sources of botanical acaricides have shown to be effective. Eugenia pyriformis Cambess is a Brazilian plant with antioxidant and antimicrobial activity; however, there are no reports on its acaricidal activity in the literature. The present study aimed to evaluate the acaricidal and larvicidal potential of E. pyriformis leaf essential oil (EO) on southern cattle tick at different stages of the reproductive cycle. E. pyriformis leaves were collected and dried, and had their EO extracted by hydrodistillation (3h) using a modified Clevenger apparatus. Chemical analysis was performed by gas chromatography coupled with mass spectrometry (GC/MS), and 32 compounds belonging to the sesquiterpene class were identified: hydrocarbons (17.98%) and oxygenated forms (81.96%), with spathulenol (43.65%) and caryophyllene oxide (12.17%) as the most common. The EO was evaluated by the Adult Immersion Test at the concentrations (500.00 to 3.12mg/mL) in which the following parameters were measured: mortality of females (%), hatchability of eggs (%), and product efficiency (%). Larvae were assessed by the Larval Packet Test at concentrations ranging from 25.00 to 0.00004mg/mL. Lethal concentrations (LC) required for killing 50 and 99.9% of adult females and larvae were determined using Probit analysis. LC50 and LC99.9 of EO were 0.06 and 24.60mg/mL and 1,208.80 and 2,538mg/mL for larvae and adult females, respectively. Action of the EO in the free-living cycle of R. (B.) microplus larvae was another parameter assessed. To this end, the larvae were deposited in pots containing Brachiaria decumbens and, after migration to the leaf apex, a solution containing LC99.9 (24.60mg/mL) of the EO was sprayed. After 24h, 72.25% of the larvae had died, indicating stability of the EO when subjected to uncontrolled temperature and humidity conditions. The mechanism of action through which the EO killed the larvae and adult females was investigated by the Bioautographic Method, which showed inhibition of 3.15mg/mL of the EO on the acetylcholinesterase (AChE) enzyme. The results found in the present experiment indicate that E. pyriformis essential oil is an alternative in the control of southern cattle tick in the larval (parasitic) and free-living cycle (non-parasitic) stages under field conditions.(AU)


O Brasil dispõe de um dos maiores rebanhos bovinos comerciais do mundo, sendo natural que junto a esse rebanho, coexista uma enorme quantidade de espécies parasitárias; dentre estes o carrapato Rhipicephalus (Boophilus) microplus que interfere na produtividade animal, causando prejuízos à pecuária de corte e leite. A utilização de acaricidas químicos no controle deste ácaro tem causado o surgimento de populações resistentes e neste sentido, controles alternativos utilizando plantas como fontes de acaricidas botânicos têm se mostrado eficazes. Eugenia pyriformis Cambess é uma planta brasileira com atividades antioxidante e antimicrobiana, entretanto não há relatos da atividade acaricida. O objetivo do presente estudo consistiu na avaliação do potencial acaricida e larvicida do óleo essencial das folhas de E. pyriformis sobre o carrapato bovino nos diferentes estágios do ciclo reprodutivo. As folhas foram coletadas, secas e o OE extraído por hidrodestilação (3 horas) em aparelho Clevenger modificado. A análise química foi realizada por cromatografia gasosa acoplada à espectrometria de massas (CG/EM) sendo identificados 32 compostos, pertencentes à classe sesquiterpenos: hidrocarbonetos (17.98%) e oxigenados (81.96%); tendo como majoritários o spathulenol (43,65%) e caryophylene oxide (12,17%). O OE foi avaliado pelo teste de imersão de adultos nas concentrações (500,00 a 3,12mg/mL) onde foram mensurados os parâmetros: mortalidade das fêmeas (%), eclodibilidade dos ovos (%) e eficiência do produto (%). As larvas foram avaliadas pelo teste de imersão larval (Larval Packet Test) nas concentrações que variaram de 25,00 a 0,00004mg/mL. Foram determinadas as concentrações letais (CLs) necessárias para matar 50 e 99,9% das fêmeas adultas e das larvas utilizando a análise de Probitos. As CL50 e CL99,9 do OE foram (0,06 e 24,60mg/mL) para as larvas e (1.208,80 e 2.538mg/mL) para as fêmeas adultas, respectivamente. Outro parâmetro avaliado em nossa pesquisa foi mensurar a ação do OE no ciclo de vida livre das larvas de R.(B.) microplus; onde as larvas foram depositadas em vasos com Brachiaria decumbens e após migração destas para o ápice das folhas, foi aspergido solução contendo a CL99,9 (24,60mg/mL) do OE. Após 24 horas, 72,25% das larvas morreram indicando que houve estabilidade do OE quando submetido a condições de temperatura e umidade não controladas. O mecanismo de ação pelo qual o OE matou as larvas e fêmeas adultas foi investigado pelo método bioautográfico, indicando uma inibição de 3,15mg/mL do óleo essencial sobre a enzima acetilcolinesterase (AChE). Os resultados encontrados no presente experimento indicaram que o óleo essencial de E. pyriformis é uma alternativa no controle do carrapato bovino no estágio larval (parasitário) e no ciclo de vida livre (estágio não parasitário) em condições de campo.(AU)


Assuntos
Animais , Bovinos , Rhipicephalus , Larvicidas , Acaricidas , Eugenia , Anti-Infecciosos Locais/uso terapêutico
15.
Biosci. j. (Online) ; 35(5): 1575-1587, sept./oct. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1049056

RESUMO

Several technologies have been developed to controlAedes aegypti, mainly studies on isolated plant molecules. The Schinus terebinthifolius (Raddi) (Anacardiaceae), popularly known as pink pepper is a plant widely used in reforestation of degraded areas and its fruits are used as condiments. The objective of this work was to investigate the potential of essential oils (EOs) and fractions (FRs) obtained from fresh fruits and leaves of S. terebinthifolius. The EOs were obtained by hydrodistillation (2 hours), fractionated on a chromatographic column using as the stationary phase silica gel 60 (0.063-0.2mm), mobile phases: n-hexane, dichloromethane, ethyl acetate and methanol and chemically evaluated by gas chromatography coupled to mass spectrometer (GC/MS). EOs and FRs were tested against larvae of the third stage and pupae of Ae. aegypti by Immersion Test at concentrations ranging from 500.00 to 0.003 mg mL-1 (v/v). The hexane FRs obtained from fruits and leaves were the ones that showed the greatest activity on the larvae (LC99.9= 0.60 mg mL-1 and LC99.9 0.64 mg mL-1, respectively) and pupae (LC99,9 = 2.51 mg mL-1 and 2.61 mg mL-1, respectively). These results were confirmed by the anticholinesterase activity where the hexane (fruit and leaf) FRs presented the highest inhibitory potential on the acetylcholinesterase enzyme (0.156 mg mL-1 and 0.312 mg mL-1, respectively), suggesting the likely mechanism of action. The larvicidal potential can be explained by the presence of the major compounds bicyclogermacrene and germacrene D in the hexane FRs, indicating in this way that they may replace or even act in synergisms with conventional chemical larvicides. In this way the present study opens the field for new researches, aiming the development of products with the compounds bicyclogermacrene and germacrene D, as an alternative in the control of this culicide.


Diversas tecnologias têm sido desenvolvidas para o controle do Aedes aegypti, destacando pesquisas com moléculas isoladas de plantas. A Schinus terebinthifolius (Raddi) (Anacardiaceae), conhecida popularmente como pimenta rosa é uma planta muito utilizada no reflorestamento de áreas degradadas e seus frutos são utilizados como condimentos. O objetivo deste trabalho foi investigar o potencial dos óleosessenciais (OEs) e frações (FRs) obtidos dos frutos e folhas frescos de S. terebinthifolius. Os OEs foram obtidos por hidrodestilação (2 horas), fracionados em coluna cromatográfica utilizando como fase estacionária sílica gel 60 (0,063-0,2mm), fases móveis: n-hexano, diclorometano, acetato de etila e metanol e avaliados quimicamente por cromatografia gasosa acoplada à espectrometria de massas (CG/EM). Os OEs e FRs foram testados frente a larvas do terceiro estádio e pupas do Ae. aegypti pelo Teste de Imersão em concentrações que variaram de 500,00 à 0,003 mg/mL (v/v). As FRs hexano obtidas dos frutos e folhas, foram as que apresentaram maior atividade sobre as larvas (CL99,9= 0,60 mg mL-1 e CL99,9 0,64 mg mL-1, respectivamente) e pupas (CL99,9= 2,51mg mL-1 e 2,61 mg mL-1, respectivamente). Estes resultados foram confirmados pela atividade anticolinesterase onde as FRs hexano (fruto e folha), foram as que apresentaram maior potencial inibitório sobre a enzima acetilcolinesterase (0,156 mg mL-1 e 0,312 mg mL-1, respectivamente), sugerindo desta forma o provável mecanismo de ação. O potencial larvicida encontrado pode ser explicado pela presença dos compostos majoritários biciclogermacreno e germacreno D nas FRs hexano, indicando desta forma, queestes possam vir a substituir, ou até mesmo agir em sinergismos com os larvicidas químicos convencionais. Desta forma o presente estudo abre campo para novas pesquisas, visando o desenvolvimento de produtos com os compostos bicyclogermacrene e germacrene D, como alternativa no controle deste culicídeo.


Assuntos
Óleos Voláteis , Aedes , Anacardiaceae
16.
Biosci. j. (Online) ; 35(4): 1198-1212, july/aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1048859

RESUMO

In this study the potential bioinseticide of the essential oil (OE) extracted from the rhizomes of the species Curcuma zedoaria (Zingiberaceae) was evaluated. The rhizomes were collected during dormancy (winter) and budding (summer). The EO was obtained by hydrodistillation (2h) and identified by GC/MS. In addition, a multivariate exploratory analysis was done to determine the analysis of the major compounds (PCA). The EO yield in dormancy was 0.61± 0.07 (%) and in budding 0.55 ± 0.08 (%). The bioassays on Aedes aegypti larvae and pupae were done by immersion test at different EO concentrations which ranged from 500.00 to 0.003 mg mL-1 (v/v). The results on the larvae and pupae indicated LC99.9 of (0.01 and 1.38 mg mL-1) for EO in dormancy, and (0.08 and 2.63 mg mL-1) for EO during budding, respectively. The action mechanism of EOs in both periods was determined by autobiographic method evaluating the inhibitory potential on the acetylcholinesterase enzyme, indicating greater inhibition of the EO enzyme during dormancy (0.039 mg mL-1) when compared to the EO during budding (0.156 mg mL-1). The projection representation of the EO chemical classes in both evaluated periods indicated that oxygenated sesquiterpenes are the major compound class (46.99% in dormancy) and (43.59% in budding). The projection of major chemical compounds of EOs presented three compounds with greater mass flow distancing: epicurzerenone (18.20% and 12.10%); 1.8 cineole (15.76% and 12.10%) and ß-elemene (4.43 and 0.01%) that are found in greater amounts in the dormancy EO when compared to budding, respectively. These results corroborate with the greater potential on Ae. aegypti larvae and pupae found for the dormancy EO. The results are promising because they show in which vegetative cycle phase C. zedoaria EO presents greater bioinsecticidepotential.


Neste trabalho foi avaliado o potencial bioinseticida do óleo essencial (OE) extraído dos rizomas da espécie Curcuma zedoaria (Zingiberaceae), coletados no período de dormência (inverno) e brotação das gemas (verão). O OE foi obtido por hidrodestilação (2h) e identificado por CG/EM foi observado rendimento 0,61 ± 0,07 (%) no óleo da dormência, quando comparado no período de brotação 0,55 ± 0,08 (%). Os bioensaios sobre as larvas e pupas de Aedes aegypti foram realizados pelo teste de imersão em diferentes concentrações dos OEs, que variaram de 500,00 a 0,003 mg mL-1 (v/v). Os resultados sobre as larvas e pupas indicaram uma CL99,9 de (0,01 e 1,38 mg mL-1) para o OE da dormência, e (0,08 e 2,63 mg mL-1) para o OE do período de brotação, respectivamente. Indicando maior atividade do OE da dormência. O mecanismo de ação dos OEs nos dois períodos foi determinado pelo método autobiográfico avaliando o potencial inibitório sobre a enzima acetilcolinesterase. Os resultados indicaram maior inibição da enzima do OE no período de dormência (0,039 mg mL-1), quando comparado ao OE de brotação (0,156 mg mL-1). A análise química destacou três compostos: epicurzerenone (18,20% e 12,10%) e 1,8 cineol (15,76% e 14,05%) e ß- elemeno (4,43 e 0,01%) em maior quantidade no período de dormência quando comparado ao período de brotação, respectivamente. Esta diferença pode explicar a maior ação inseticida do OE de dormência sobre as larvas e pupas do Ae. aegypti. Os resultados são promissores, pois estabelece em qual período do ciclo vegetativo o OE da C. zedoaria apresenta maior potencial bioinseticida.


Assuntos
Óleos Voláteis , Aedes , Curcuma , Inseticidas , Bioensaio
17.
Rev. bras. cir. cardiovasc ; 34(2): 173-178, Mar.-Apr. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-990582

RESUMO

Abstract Introduction: Previous cardiac surgery (PCS) is a risk factor for operative mortality in pa-tients undergoing reoperative aortic valve replacement (AVR) and may be influenced by the volume of patients in each center. The aim of this study was to evaluate the results of AVR in patients with previous cardiac surgery in a low volume cardiac center (400 cases per year). Methods: Between January 2006 and December 2016, 854 patients underwent isolated AVR surgery at our institution. Of these, 70 had PCS. Propensity match (PM) was per-formed to balance basal covariates. Operative mortality and survival were the primary outcomes. Results: The PCS and first-time surgery (FTS) groups had significant differences in base-line characteristics (PCS group were older, higher incidence of hypertension, endocarditis, NYHA III/IV, lower LVEF, higher creatinine and higher EuroSCORE). In the unmatched population, patients with PCS had higher operative mortality (17.1% vs. 4.6%, P=0.001). In the PM groups, this difference was not significant (12.5% and 3.6%, P=0.08). The only independent predictors for operative mortality found in the PCS group were age and fe-male gender. Age and diabetes were identified as the only independent predictors of sur-vival. Conclusion: PCS was not a predictor for operative mortality nor long-term survival in pa-tients undergoing isolated aortic valve replacement.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Reoperação/mortalidade , Implante de Prótese de Valva Cardíaca/mortalidade , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Prognóstico , Fatores de Tempo , Fatores Sexuais , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Fatores Etários , Resultado do Tratamento , Mortalidade Hospitalar , Medição de Risco/métodos , Estimativa de Kaplan-Meier
18.
Braz J Cardiovasc Surg ; 34(2): 173-178, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30916127

RESUMO

INTRODUCTION: Previous cardiac surgery (PCS) is a risk factor for operative mortality in pa-tients undergoing reoperative aortic valve replacement (AVR) and may be influenced by the volume of patients in each center. The aim of this study was to evaluate the results of AVR in patients with previous cardiac surgery in a low volume cardiac center (400 cases per year). METHODS: Between January 2006 and December 2016, 854 patients underwent isolated AVR surgery at our institution. Of these, 70 had PCS. Propensity match (PM) was per-formed to balance basal covariates. Operative mortality and survival were the primary outcomes. RESULTS: The PCS and first-time surgery (FTS) groups had significant differences in base-line characteristics (PCS group were older, higher incidence of hypertension, endocarditis, NYHA III/IV, lower LVEF, higher creatinine and higher EuroSCORE). In the unmatched population, patients with PCS had higher operative mortality (17.1% vs. 4.6%, P=0.001). In the PM groups, this difference was not significant (12.5% and 3.6%, P=0.08). The only independent predictors for operative mortality found in the PCS group were age and fe-male gender. Age and diabetes were identified as the only independent predictors of sur-vival. CONCLUSION: PCS was not a predictor for operative mortality nor long-term survival in pa-tients undergoing isolated aortic valve replacement.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Reoperação/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
19.
Rev. urug. cardiol ; 33(2): 1-19, ago. 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-962333

RESUMO

Resumen: Introducción: tanto el uso de bioprótesis como de prótesis mecánicas en la sustitución valvular aórtica (SVA) tiene sus ventajas y desventajas en determinados grupos de pacientes. Datos internacionales no terminan de definir el beneficio a largo plazo de una u otra opción. Objetivo: estudiar el valor predictivo de sobrevida según el tipo de prótesis empleada en los pacientes sometidos a SVA. Métodos: se incluyeron pacientes operados de SVA aislada o asociada a cirugía de revascularización (CRM) desde enero de 2006 hasta diciembre de 2016. Se extrajeron las variables demográficas, operatorias y de seguimiento. Para disminuir la heterogeneidad entre ambos grupos se realizó un pareamiento por puntaje de propensión (PP). La sobrevida se evaluó de forma global y según estrato etario (< y ³ 60 años). Definimos el valor predictivo de sobrevida de cada tipo de prótesis mediante regresión de Cox. Resultados: se incluyeron 1.516 pacientes. Se implantó prótesis biológica a 1.230 pacientes (81,1%) y mecánica a 286 pacientes (18,9%). Se logró parear 145 pacientes en cada grupo. No se encontraron diferencias en la mortalidad operatoria ni en las complicaciones posoperatorias evaluadas (incidencia de accidente cerebrovascular [ACV], implante de marcapaso definitivo, requerimiento de diálisis, sangrado y complicaciones asociadas a la anticoagulación) tanto en la población global como luego del pareamiento. El uso de bioprótesis no fue predictor de sobrevida alejada en la población pareada por PP (HR=0,86, IC 95%: 0,51-1,4). En ninguno de los dos estratos etarios el tipo de prótesis fue predictor de sobrevida. Conclusión: en nuestro medio, en los pacientes sometidos a SVA la sobrevida a largo plazo es similar con ambos tipos de prótesis.


Summary: Introduction: the use of bioprosthesis and mechanical prosthesis has its advantages and disadvantages that vary according to each patient. International data do not agree on the long-term benefit in survival of either prosthesis. Objective: evaluate survival and predictive role of type of prosthesis in patients who underwent aortic valve replacement (AVR). Methods: we included patients who underwent AVR from January 2006 to December 2016. Demographic, operative and follow-up variables were extracted from the institution database. In order to decrease patient heterogeneity, propensity match (PM) was performed. Survival was analyzed globally and according to age strata (< and ³ 60 years old). Predictive role of prosthesis type was evaluated with Cox regression. Results: 1.516 patients were included. Bioprosthesis was used in 1.230 (81,1%) and mechanical in 286 (18,9%) patients; 145 PM patients were evaluated in each group. No differences were found in operative mortality and postoperative complications (stroke, pacemaker, dialysis, bleeding and anticoagulation complications) either in the global population or the PM. Use of bioprosthesis was not an independent predictor for survival in the PM (HR=0.86,95%CI:0.51-1.14). In neither of the age strata was type of prosthesis a predictor of survival. Conclusion: locally, patients who undergo AVR have similar survival regardless of the type of prosthesis.

20.
Braz J Cardiovasc Surg ; 33(1): 47-53, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29617501

RESUMO

OBJECTIVE: In contrast to unstable angina, optimal therapy in patients with stable angina is debated. Our aim was to evaluate the outcomes of patients with stable angina scheduled for isolated coronary artery bypass grafts and the effect of preoperative use of beta-blockers. Overall and cardiovascular survivals were our primary outcome. Operative mortality and postoperative complications along with subgroup analysis of diabetic patients were our secondary outcomes. METHODS: Retrospective evaluation of patients with stable angina scheduled for isolated coronary artery bypass grafts was included. Pre- and postoperative variables were extracted from the institution database. Survival was obtained from the National Registry. RESULTS: We included 282 patients with stable angina, with a mean age of 65.6±9.5 years. 26.6% were female and 38.7% had diabetes. Three-vessel disease was present in 76.6% of patients. Previous beta-blocker treatment was evident in 69.9% of patients. 10-year overall survival in the whole population was 60.5% (95% confidence interval [CI]: 50.3-70.7%). Operative mortality during the study period was 3.5%. Patients with preoperative use of beta-blocker therapy had better overall survival (9.0 years, 95%CI: 8.6-9.5) than those without treatment (7.9 years, 95%CI: 7.1-8.8 years; P=0.048). Predictors for overall survival were: hypertension, diabetes, and age. Predictors for cardiovascular survival in diabetic patients were: beta-blocker use, gender, and age. CONCLUSION: Coronary artery bypass grafts surgery in patients with stable angina carries low operative mortality, postoperative complications, and excellent long-term cardiovascular survival. The preoperative use of beta-blockers in diabetic patients is associated with better cardiovascular survival after coronary artery bypass grafts.


Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Angina Estável/cirurgia , Ponte de Artéria Coronária/métodos , Cuidados Pré-Operatórios/métodos , Idoso , Angina Estável/complicações , Angina Estável/mortalidade , Ponte de Artéria Coronária/mortalidade , Diabetes Mellitus , Feminino , Humanos , Hipertensão , Masculino , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
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