Реферат
Abstract Dyslipidemia is an abnormal lipid profile associated with many common diseases, including coronary heart disease and atherosclerosis. Cholesteryl ester transfer protein (CETP) is a hydrophobic plasma glycoprotein that is responsible for the transfer of cholesteryl ester from high-density lipoprotein athero-protective particles to pro-atherogenic very low-density lipoprotein and low-density lipoprotein particles. The requirement for new CETP inhibitors, which block this process has driven our current work. Here, the synthesis as well as the ligand-based and structure-based design of seven oxoacetamido-benzamides 9a-g with CETP inhibitory activity is described. An in vitro study demonstrated that most of these compounds have appreciable CETP inhibitory activity. Compound 9g showed the highest inhibitory activity against CETP with an IC50 of 0.96 µM. Glide docking data for compounds 9a-g and torcetrapib provide evidence that they are accommodated in the CETP active site where hydrophobic interactions drive ligand/CETP complex formation. Furthermore, compounds 9a-g match the features of known CETP active inhibitors, providing a rationale for their high docking scores against the CETP binding domain. Therefore, these oxoacetamido-benzamides show potential for use as novel CETP inhibitors
Тема - темы
Benzamides/adverse effects , Dyslipidemias/complications , Cholesterol Ester Transfer Proteins/antagonists & inhibitors , In Vitro Techniques/methods , Cholesterol Esters , Coronary Disease/pathology , Inhibitory Concentration 50 , Lipoproteins, HDL/classification , Lipoproteins, LDL/classificationРеферат
Introducción: las enfermedades renales constituyen una causa frecuente de consulta médica, de ingreso hospitalario y de mortalidad. Objetivo: analizar algunas variables demográficas, clínicas y anatomopatológicas en fallecidos por estas enfermedades durante 40 años en un servicio de Nefrología. Métodos: estudio retrospectivo y observacional de variables demográficas, clínicas y anatomopatológicas en 272 fallecidos del servicio de nefrología del hospital Dr. Luis Díaz Soto, a los que se les practicó autopsia, ocurridas de 1974 al 2013. Resultados: predominaron los pacientes masculinos, de piel blanca y con edades de 35 a 64 años. La edad promedio se ha ido incrementando. Los principales diagnósticos clínicos de causa directa de muerte fueron bronconeumonía, infarto agudo de miocardio y shock. Como causa básica se plantearon la insuficiencia renal crónica, la hipertensión arterial y la diabetes mellitus. En los estudios anatomopatológicos fueron señaladas como más frecuentes causas directas de la muerte la bronconeumonía, el edema pulmonar, el shock y el infarto agudo de miocardio; mientras que en los principales diagnósticos de causa básica de muerte fueron registrados el riñón terminal, la cardiopatía hipertensiva, la diabetes mellitus y la aterosclerosis. Conclusiones: los indicadores de mortalidad, necropsia y correspondencia clínico patológica fueron adecuados. Se apreció un incremento, progresivo en el tiempo, de la edad de los pacientes fallecidos estudiados. La bronconeumonía y las cardiopatías fueron las principales causas de muerte. Los signos de aterosclerosis estuvieron presentes en la mayoría de los estudios realizados(AU)
Introduction: Renal diseases are a frequent cause of medical consultation, hospitalization and mortality. Objective: Analyze some demographic, clinical and anatomical and pathological variables in the deaths of renal diseases during 40 years in a Nephrology service. Methods: A retrospective and observational study was conducted of demographic, clinical and anatomical and pathological variables in 272 deaths of the nephrology service at Dr. Luis Díaz Soto hospital, who were autopsied, from 1974 to 2013. Results: There were predominantly male patients, white skin and aged 35 to 64 years. The average age has been increasing. The main clinical diagnoses of direct cause of death were bronchopneumonia, acute myocardial infarction and shock. As a basic cause, chronic renal failure, arterial hypertension and diabetes mellitus were considered. In anatomical and pathological studies, bronchopneumonia, pulmonary edema, shock and acute myocardial infarction were identified as more frequent causes of death; while in the main diagnoses of the basic cause of death, the terminal kidney, hypertensive heart disease, diabetes mellitus, and atherosclerosis were documented. Conclusions: Mortality, necropsy, and clinical pathological correspondence indicators were adequate. There was a progressive increase in the age of the deceased patients studied. Bronchopneumonia and heart disease were the main causes of death. Signs of atherosclerosis were present in most of the studies(AU)
Тема - темы
Humans , Male , Adult , Middle Aged , Autopsy/methods , Bronchopneumonia/mortality , Renal Insufficiency, Chronic/mortality , Retrospective Studies , Coronary Disease/pathology , Observational StudyТема - темы
Male , Female , Humans , Adult , Aged , Hypertension/diagnosis , Hypertension/therapy , Coronary Disease/pathology , Kidney Diseases/pathology , Monitoring, Ambulatory/methodsРеферат
BACKGROUND: Disturbance of the equilibrium between reactive oxygen species (ROS) and anti-oxidants (AOX) has been implicated in various diseases, including atherosclerosis, the most common pathologic process underlying coronary heart disease (CHD). Thus, the defense systems against ROS are critical protecting blood vessel walls against oxidative damage. In this study, we investigate whether Ala16Val MnSOD and Pro198Leu GPx polymorphisms are associated with CHD susceptibility and/or severity. METHODS: Both polymorphisms were genotyped in a sample of 203 controls and 164 patients. CHD risk and severity, antioxidant status (enzymatic and/or non enzymatic) and biochemical parameters were assessed and analysed by genotype. RESULTS: A significant association of MnSOD variant to CHD risk was revealed in males. Males harboring the Val/Val genotype were approximately at twofold increased risk of CHD compared to controls (Ala carriers vs Val/Val, adjusted OR 1.89; 95 % CI 1.18-3.42, p = 0.03). Significant decreases in SOD activity and total antioxidant status (TAS) were observed in Val carriers and by CHD status. Whereas, no association of GPx variant genotype (Leu/Leu) and activity to cardiopathy events was discerned. CHD severity, as demonstrated by the number of vessel stenosis, was associated with significantly higher frequency of Val allele and LDL levels in CHD subjects. CONCLUSIONS: Our results showed a lack of association of Pro198Leu GPx polymorphism to CHD risk and severity. However, they suggest that Ala16Val MnSOD polymorphism and decreased antioxidant defences are likely contributed to CHD risk in Tunisian men. Furthermore, the Val encoding MnSOD allele and decreased SOD activity were significantly correlated with CHD stenosis progression
Тема - темы
Humans , Male , Female , Adult , Middle Aged , Aged , Polymorphism, Genetic , Superoxide Dismutase/genetics , Coronary Disease/genetics , Glutathione Peroxidase/genetics , Time Factors , Tunisia , Severity of Illness Index , Case-Control Studies , Polymerase Chain Reaction , Risk Factors , Analysis of Variance , Risk Assessment , Oxidative Stress , Coronary Disease/pathology , GenotypeРеферат
Antecedentes: las enfermedades cardiovasculares constituyen la primera causa de morbimortalidad a nivel mundial y nacional; sobresale la enfermedad coronaria. Esto ha contribuido para que el tratamiento quirúrgico de revascularización miocárdica sea considerado como un procedimiento de rutina. Éste es uno de los avances más importantes de la medicina durante el siglo XX. En Bogotá, los registros estadísticos muestran que más del 50% del total de cirugías cardiovasculares corresponde a ella. Objetivo: realizar la caracterización de pacientes que se encuentran en posoperatorio temprano de revascularización miocárdica, quienes presentan cambios fisiológicos en su esfera biológica, secundarios al procedimiento, a nivel neurológico, cardiovascular, respiratorio, gastrointestinal, de eliminación y de la piel. Metodología: se realizó un estudio descriptivo, de seguimiento prospectivo. Se observaron y revisaron las historias clínicas de 151 pacientes en posoperatorio de 48 a 96 horas. La revisión de la historia clínica se realizó por el investigador. Se consignó la información en una hoja de registro de información y se procesó mediante métodos de análisis exploratorio multidimensional: análisis factorial de correspondencias múltiples combinado con el Método Cluster de Clasificación. Resultados: estuvieron relacionados con clases de pacientes de acuerdo con los eventos clínicos presentes en cada uno de los sistemas estudiados donde se evidencia que presentan alteración de los sistemas neurológico, cardiovascular, respiratorio y de la piel. Conclusión: la caracterización de los pacientes en posoperatorio de una revascularización miocárdica permite que el cuidado de enfermería sea enfocado hacia la solución de problemas de los sistemas antes mencionados.
Background: cardiovascular diseases are the leading cause of morbidity and mortality at global and national level; stands out coronary disease. This has contributed to make the surgical treatment of coronary artery bypass grafting being considered a routine procedure. This is one of the most important advances in medicine during the twentieth century. In Bogota, statistical records show that more than 50% of all cardiovascular surgeries corresponds to it. Objective: to characterize patients who are in early postoperative myocardial revascularization, who present physiological changes secondary to procedure, in the biological area at neurological, cardiovascular, respiratory, and gastrointestinal level, elimination system and skin. Methodology: a descriptive study was performed and followed prospectively. The medical records of 151 patients in postoperative 48 to 96 hours were seen and reviewed. The review of the medical history was performed by the researcher. The information was collected on a recording sheet and then recorded and processed by methods of multidimensional exploratory analysis: Multiple correspondence analysis combined with Cluster Classification Method. Results: they were related to the kind of patient according to clinical events present in each of the studied systems where there is evidence of alteration of the neurological, cardiovascular and respiratory systems, and skin. Conclusion: the characterization of patients in postoperative of myocardial revascularization allows nursing care to be focused on solving problems of the aforementioned systems.
Тема - темы
Humans , Myocardial Revascularization/education , Myocardial Revascularization/adverse effects , Myocardial Revascularization/nursing , Myocardial Revascularization/statistics & numerical data , Myocardial Revascularization/methods , Myocardial Revascularization/mortality , Myocardial Revascularization/rehabilitation , Coronary Disease/surgery , Coronary Disease/complications , Coronary Disease/nursing , Coronary Disease/epidemiology , Coronary Disease/etiology , Coronary Disease/physiopathology , Coronary Disease/history , Coronary Disease/mortality , Coronary Disease/pathology , Coronary Disease/rehabilitationРеферат
Introducción: A pesar de que la obesidad es un evento adverso frecuente en el tratamiento con antipsicóticos atípico, no ha sido suficientemente elucidado el grado de su contribución independiente al riesgo de enfermedad coronaria en estos pacientes. Objetivo: Determinar si la obesidad inducida por antipsicóticos de segunda generación o atípicos es un factor de riesgo independiente para el aumento de incidencia de enfermedad arterial coronaria y eventos cardíacos. Método: Se utilizó un modelo similar al usado en el estudio de Framingham basado en estimar los siguientes parámetros: edad, género, presión arterial, consumo de cigarrillo y niveles de lipoproteínas de colesterol de alta densidad, con el objetivo de determinar el riesgo prospectivo de padecer enfermedad arterial coronaria en aquellos pacientes tratados con antipsicóticos atípicos que cursaban un cuadro de obesidad (N=33; edad media 38.1, 54 % hombres) comparados con aquellos con peso normal (N=33; edad media 39.9 años, 47.0 % hombres). Se excluyeron aquellos pacientes con síndrome metabólico, medicados con drogas antihipertensivas, hipoglucemiantes o estatinas. Resultados: El riesgo de enfermedad arterial coronaria fue mayor para la muestra de pacientes obesos comparado con la muestra de pacientes con peso normal (5.3±2.7 vs. 2.1±0.62, RR=2.17 IC 95%=1.94-2.39; p=0.017), incluyendo un aumento de 12 unidades de IMC (p<0.0001) y 16 cm de circunferencia de cintura mayor (p<0.0001) en la población con obesidad inducida por antipsicóticos atípicos. El riesgo fue mayor para hombres (5.9±2.9 vs. 2.8±0.4, RR=2.98, IC 95%=1.97-3.16; p=0.0034) comparados con las mujeres (3.1±1.2 vs. 1.2±0.5; RR=1.78, IC 95 %=1.58-1.94; p=0.011). Limitaciones: la validez predictiva para el riesgo de enfermedad coronaria en pacientes psiquiátricos basada en el sistema de clasificación de Framingham requiere una confirmación prospectiva...
Obesity is an adverse effect frequently observed during second generation antipsychotics treatment. In spite of that, its independent contribution to coronary artery disease in patients treated with this class of drugs remains unsolved. Objective: assess whether antipsychotics induced obesity is an independent risk factor contributing to an increase in cardiac events and coronary artery disease. Methods: a similar model to that used in Framingham Study was used based on an estimate of following parameters: age, gender, blood pressure, cigarette use, high density cholesterol lipoproteins levels with the goal of estimate prospective risk of suffering coronary artery disease between those patients treated with second generation antipsychotics which also had obesity (N=33; average age 38.1 years, 54% men) compared with those on normal weight (N=33; average age 39.9 years, 47.0% men). Excluded were those patients with metablic Syndrome treated with antihypertensive drugs, hypoglycemic drugs and statins. Results: risk of coronary artery diseases was higher for obese patients compared with normal wight ones (5.3 ±2.7 vs. 2.1±0.62, RR=2.17 IC 95%=1.94 - 2.39; p=0.017), including an increase of 12 units in BMI (p<0.0001) and 16 cm in abdominal waist (p<0.0001) in antipsychotic drugs induced obesity sample...
Тема - темы
Humans , Male , Antidepressive Agents, Second-Generation/adverse effects , Antidepressive Agents, Second-Generation/therapeutic use , Coronary Disease/pathology , Obesity , Risk Factors , Metabolic Syndrome/pathologyРеферат
El objetivo del trabajo fue determinar si el tratamiento periodontal intensivo(TPI), es seguro de realizar en pacientes de alto riesgo (AR) cardiovascular. Para ello se estudiaron 20 pacientes con enfermedad Periodontal severa que participaron del estudio FEEP1 (Función Endotelial y Enfermedad Periodontal), que presentaran AR. El TPI consistió en el raspaje y alisado de todas las piezas afectadas por enfermedad Periodontal, en una sola sesión.Todos los pacientes fueron controlados cardiológicamente24hs. previas y posteriores al TPI, asícomo a los 15 días. Se monitoreó la frecuencia cardíaca, tensión arterial y oximetría de pulso. Resultados:Durante el tratamiento odontológico y/o con posterioridad al mismo, ninguno de los pacientes desarrolló sintomatologíacompatible con isquemia miocárdica nicomplicaciones cardiovasculares. Conclusiones: El tratamiento Periodontal intensivo, resultó ser seguro en elgrupo de pacientes cardiovascularmente estables con cardiopatía isquémica de alto riesgo estudiados.
Тема - темы
Humans , Male , Female , Dental Scaling , Coronary Disease/complications , Coronary Disease/pathology , Periodontal Diseases/etiology , Periodontal Diseases/therapy , Argentina , Cardiovascular Diseases/complications , Risk Factors , Root Planing , Treatment OutcomeРеферат
La evidencia sugiere que los factores de riesgo cardiovascular no convencionales podrían ser considerados para la construcción de diagnósticos de enfermería con la finalidad de prevenir un infarto súbito en el subgrupo de individuos que presentan factores tradicionales en límites normales. Objetivos: a) señalar la importancia de conformar algunos elementos clínico-observacionales y de laboratorio en la valoración de enfermería para integrar los factores de riesgo tradicionales y no convencionales para enfermedad arterial coronaria en los diagnósticos de enfermería; b) explicar y entender las bases moleculares causales de dichos factores de riesgo no convencionales en la génesis del proceso de formación de la placa aterosclerótica. La redacción del diagnóstico propuesto para los casos presentados se realizó con base al formato PES (Problema, etiología, signos y síntomas), auxiliado por el Modelo del Déficit de Autocuidado de Orem y la propuesta de Alfaro sugiriendo la nomenclatura de la NANDA. Discusión: La redacción de diagnósticos de riesgo cardiovascular requiere más allá de una valoración clínico-observacional; la enfermería necesita conocer los avances en el escrutinio de los factores de riesgo coronario desde la intimidad de la biología molecular y valerse de los recursos de laboratorio para fundamentar el diagnóstico y sus intervenciones.
Evidence suggests non conventional cardiovascular risk factors could be considered in nursing diagnostics construction aiming to prevent a sudden infarction within a group of individuals that show traditional factors at normal limits. Objectives: a) point out the importance of assembling some clinical observational and laboratory elements in the nursing evaluation in order to integrate traditional and non conventional risk factors for a coronary arterial disease; b) explain and understand the molecular bases causing such non conventional risk factors in the process of the arteriosclerosis plaque formation. The proposed diagnostics wording for the submitted cases was done based on the PES format assisted by the Orems Self-Care Deficit Model and the Alfaros proposal suggesting a NANDA nomenclature. Discussion: Cardiovascular risk diagnostics wording requires more than a clinical- observational evaluation; nursing needs to know the advances on the coronary risk factors scrutiny from the intimacy of molecular biology and make use of laboratory resources to lay foundation for diagnostics and its interventions.
Тема - темы
Humans , Coronary Disease/diagnosis , Coronary Disease/nursing , Coronary Disease/pathology , Risk Factors , Nursing Diagnosis/methods , Nursing DiagnosisТема - темы
Aged , Female , Humans , Cerebral Arterial Diseases/pathology , Coronary Disease/pathology , Embolism, Air/pathology , Fatal OutcomeРеферат
Este livro aborda tópicos importantes nas áreas de stress, saúde ocupacional e qualidade de vida, reunindo um grupo multidisciplinar de especialistas que fornecem análises aprofundadas sobre o tema. Pelo fato de o stress no trabalho Ter se formado em uma preocupação mundial, este livro assume uma perspectiva verdadeiramente internacional sobre o stress ocupacional e o bem-estar dos colaboradores. A obra apresenta temas do que é atualmente uma literatura em expansão que visa atender as causas, os efeitos e a prevenção do stress no local de trabalho. Começa com três capítulos sobre as diferentes fontes de stress ocupacional, abordando de fatores organizacionais a atributos dos próprios trabalhadores. Os cinco capítulos seguintes atualizam a compreensão sobre os efeitos adversos que o stress pode ter sobre os indivíduos, suas famílias e as organizações. O último grupo de capítulos do livro tem um tom mais positivo, avaliando os benefícios de ambientes de trabalho saudáveis e formas de superar a prevenir o stress no trabalho. Em suma, os capítulo destacam o conhecimento básico e os novos avanços no campo em rápida expansão de pesquisa na área do trabalho e stress. Com a leitura desta obra, os leitores vão obter informações que sirvam para alertar para as causas e os custos do stress ocupacional. O texto fornece incentivos e idéias para que as organizações no Brasil e em outros países comecem a pensar e a buscar formas de criar um ambiente menos estressante, garantindo, assim, a sua produtividade e a qualidade dos seus produtos sem prejuízos à saúde e ao bem-estar da sua força de trabalho.
Тема - темы
Humans , Coronary Disease/pathology , Burnout, Professional/pathology , Burnout, Professional/prevention & control , Burnout, Professional/psychology , Burnout, Professional/complications , Workplace/psychology , Occupational Health , Professional-Family Relations , Risk Factors , Work Hours , Working ConditionsРеферат
Se trata de paciente de sexo masculino, de 47 años de edad, quien ingresa a la emergencia del Hospital Dr Héctor Nouel Joubert del IVSS de Ciudad Bolívar por presentar disartria de aparición brusca, disfagia, hemiparesia derecha e hipo intermitente. Al examen físico se encontraron cifras tensionales elevadas (160/80mmHg), voz ronca, lengua lateralizada a la derecha, ptosis velopalatina derecha discreta, hemihipoestesia facial derecha con hemihipoestesia térmica izquierda, hemiparesia derecha, reflejo nauseoso ausente en el lado derecho, todo por afectación de los pares craneales: V, VII, IX, X y XII. Se realizó resonancia magnética contrastada con énfasis en fosa posterior, revelando imagen de 6 mm en bulbo raquídeo, correspondiente a oclusión aterotrombótica de la arteria cerebelosa posterior izquierda, lo cual explica la clínica del paciente. Debe resaltarse el inicio brusco de la sintomatología del paciente y que, a diferencia de otros casos presentados, éste no comenzó con vértigo, náuseas y vómitos, así como tampoco la presencia del Síndrome de Horner ipsilateral, descrito en algunos casos de Síndrome de Wallenberg
A 47-years old male patient admitted to the emergency service of the Dr. Héctor Nouel Joubert Venezuelan Institute of Social Security Hospital of Ciudad Bolivar presented with sudden-onset dysarthria, dysphagia, right-sided hemiparesis, and intermittent hiccups. A physical evaluation revealed high blood pressure (160/80mmHg), hoarseness, tongue deviation to the right, discrete ptosis of the soft palate, right facial hemihypoesthesia with left thermal hemihypoesthesia, right-sided hemiparesis and absent gag reflex on the right side all due to impairment of cranial nerves V, VII, IX, X, and XII. A contrast-enhanced MRI with focus on the posterior fossa revealed a 6mm image in the medulla oblongata, corresponding to an atheroembolic occlusion of the left posterior cerebellar artery, which explains the patients bodily disorder. It is worth noting that the symptoms appeared suddenly and, unlike in other cases, they did not include vertigo, nausea, pr vomits, nor the ipsilateral Horners Syndrome described in some cases of Wallenbergs Syndrome
Тема - темы
Humans , Male , Middle Aged , Atherosclerosis , Lateral Medullary Syndrome , Lateral Medullary Syndrome/diagnosis , Taste Buds , /complications , /pathology , Coronary Disease/pathology , Hypertension/pathologyРеферат
Los trastornos de conducción representan un marcador de mál pronóstico en pacientes con cardiopatía. El objetivo fundamental fue evaluar la sincronía ventricular en pacientes con bloqueo de rama derecha del haz de His (BRDHH) y bloqueo de rama izquierda del haz de His (BRIHH). Estudio prospectivo, observacional, transversal, no experimental. Se evaluaron 45 pacientes: 25 con BRDHH y 20 con BRIHH e igual número de controles, que consultaron a la Emergencia de Adultos del Hospital "Dr. Alfredo Van Grieken", entre marzo y septiembre de 2008. Con ecocardiógrafo HP SONOS 5500 se determinó retardo intraventricular (RIV) según método de Pitzalis. Se observó RIV significativamente mayor en pacientes con BRIHH (x: 194,25 ± 73,33) que en BRDHH (x: 81,8 ± 39,23) y que en los controles (x: 21,96 ± 14,18), (P<0,01). La fracción de eyección (FE) fue menor en BRIHH (X: 35,05 ± 15,26) que en BRDHH (x: 57,28 ± 13,56) y que en controles (x: 63,49 ± 13,36), (P<=0,01). Se encontró correlación negativa significativa entre el RIV de BRIHH y la FE (r: 5,32, p: 0,05), la correlación entre la anchura del QRS y el RIV no fue significativa en BRDHH (r: 0,144), p: NS) ni en BRIHH (r: 0,160, p: NS). Se determinó asincronía intraventricular en 12% de los pacientes con BRDHH y en el 85% con BRIHH, 40% de este grupo falleció antes de culminar el estudio. La asincronía intraventricular en pacientes con BRIHH representa un riesgo de mortalidad cardiovascular elevado, lo cual nos obliga a implementar medidas profilácticas en la aparición de complicaciones y seleccionar a los pacientes para resincronización cardíaca.
Conduction disorders represent a marker of poor pronosis in patients with heart disease. The primary objective was to evaluate the ventricular synchrony in patients with right block (RBBB) and left bundle branch block (LBBB). Prospective, observational, cross-sectional, non experimental study. A total of 45 patients were evaluated: 25 with RBBB and 20 with LBBB and an equal number ofcontrols, that consulted the Adult Emergency Hospital "Dr. Alfredo Van Grieken", between march and septiember of 2008. Echocardiographic HP SONOS 5500 was used to determine intraventricular delay (IVD) by the Pitzalis method. IVD was significantly higher in patients with LBBB (x: 194.25 ± 73.33) thain in RBBB (x: 81.8 ± 39.23) and that in the controls (x: 21.96 ± 14.18), (P<0.01). The ejection fraction (EF) was lower in LBBB (x: 35.05 ± 15.26) than in RBBB (x: 57.28 ± 13.56) as well as control (x: 63.49 ±13.36). (P<0.01). Significant negative correlation was found between the IVD of LBBB and EF (r= 5.32, P: 0.05), the correlation betwen the width of the QRS and the IVD was not significant in RBBB (r: 0144, p: NS) nor in LBBB (r: 0160, p: NS). Intraventricular asynchrony was found in 12% of patients with RBBB. Death occurred in 40% of this group before completion of the study. Intraventricular asynchrony in patients with LBBB represents an elevated risk of cardiovascular mortality, which prophylactic measures to avoid complications and to select patients for cardiac resynchronization.
Тема - темы
Humans , Male , Female , Adolescent , Adult , Middle Aged , Blood Pressure , Bundle-Branch Block/physiopathology , Coronary Disease/pathology , Bundle of His/pathology , Cardiomyopathy, Dilated/pathology , Aortic Valve Stenosis/pathology , VenezuelaРеферат
Fundamento: Descrevemos as bases teóricas e o formato do "Estudo PAINT - Intervenção percutânea com stents com eluição de paclitaxel ou sirolimus em polímero biodegradável comparados com stents sem recobrimento no tratamento de lesões coronárias de novo". Objetivo: Avaliar duas novas formulações de stents com eluição de paclitaxel ou sirolimus em comparação com um stent de estrutura metálica idêntica, porém sem recobrimento polimérico ou eluição de droga. Métodos: O PAINT é um estudo randomizado, multicêntrico, de 3 braços, conduzido em centros terciários brasileiros, que incluiu 275 pacientes alocados para tratamento com os stents InfinniumR (paclitaxel), the SupralimusR (sirolimus) ou Milennium MatrixR (sem recobrimento) na proporção 2:2:1 ratio. Os pacientes apresentavam lesões coronarianas de novo em vasos nativos com um diâmetro entre 2,5 e 3,5 mm, passíveis de tratamento com um único stent com comprimento de 29 mm ou menos. O objetivo primário era comparar a perda tardia aos nove meses de ambos stents com paclitaxel- ou sirolimus versus a perda luminal dos stents convencionais de controle. Objetivos secundários importantes incluíam a comparação angiográfica entre os dois tipos de stents farmacológicos, bem como a análise da ocorrência de eventos clínicos adversos. Resultados e conclusões: O estudo PAINT apresenta um formato peculiar e único que permitiu a avaliação da segurança e eficácia de duas novas formulações de stents farmacológicos, com carreador polimérico biodegradável, e liberação de paclitaxel ou sirolimus, os quais foram comparados contra um stent metálico convencional (objetivo primário). Uma vez que os stents farmacológicos diferiram entre sí somente pela droga, mas eram idênticos nas suas outras características, os estudo também permitiu a comparação do efeito anti-restenótico entre sirolimus e paclitaxel (objetivo secundário).
Background: We describe the rationale and design for the "PercutAneous Intervention with biodegradable-polymer based paclitaxel-eluting or sirolimus-eluting versus bare stents for de novo coronary lesions - PAINT trial". Objectives: To evaluate two novel formulations of paclitaxel-eluting stent and the sirolimus-eluting stent against a stent with the same metallic structure but without polymer coating or drug elution. Methods: The PAINT is a multicenter 3-arm randomized trial, conducted in Brazilian tertiary institutions, which included 275 patients allocated for the InfinniumR paclitaxel-eluting stent, the SupralimusR sirolimus-eluting stent or the Milennium MatrixR bare metal stent in a 2:2:1 ratio. Patients had de novo coronary lesions in native vessels with a diameter between 2.5 and 3.5 mm, amenable for treatment with a single stent of 29 mm or less in length. The primary objetive was to compare the in-stent late loss at 9 months of both paclitaxel- and sirolimus-eluting versus the late loss of control bare metal stents. Important secondary objectives included the comparison in outcomes between sirolimus and paclitaxel stents, as well as the analysis of the incidence of major adverse cardiac events. Results amd conclusions: The PAINT trial had a unique design that allowed for the evaluation of the safety and efficacy profiles of two novel drug-eluting stent formulations, with a biodegradable-polymer carrier and releasing paclitaxel or sirolimus, which were compared against a bare metal stent (primary objective). As the drug-eluting stents differed by the drug, but were identical otherwise, the trial also allowed the comparison of the anti-restenosis effects of sirolimus versus paclitaxel (secondary objective).
Fundamento: Describimos las bases teóricas y el formato del "Estudio PAINT - Intervención percutánea con stents recubiertos de paclitaxel o sirolimus en polímero biodegradable comparados con stents no recubiertos en el tratamiento de lesiones coronarias de novo". Objetivo: Evaluar dos nuevas formulaciones de stents con liberación de paclitaxel o sirolimus en comparación con un stent de estructura metálica idéntica, pero sin recubierto polimérico o liberación de droga. Métodos: El PAINT es un estudio randomizado, multicéntrico, de 3 brazos, llevado a cabo en centros terciaros brasileños, que incluyó a 275 pacientes destinados a tratamiento con los stents InfinniumR (paclitaxel), the SupralimusR (sirolimus) o Milennium MatrixR (no recubierto) en la proporción 2:2:1. Los pacientes presentaban lesiones coronarias de novo en vasos nativos con un diámetro entre 2,5 y 3,5 mm, pasibles de tratamiento con un único stent de hasta 29 mm de longitud. El objetivo primario era comparar la pérdida luminal tardía a los nueve meses de ambos stents con paclitaxel- o sirolimus versus la pérdida luminal de los stents convencionales de control. Los objetivos secundarios importantes incluían la comparación angiográfica entre los dos tipos de stents farmacológicos, así como el análisis de la ocurrencia de eventos clínicos adversos. Resultados y conclusiones: El estudio PAINT presenta un formato peculiar y único que permitió la evaluación de la seguridad y eficacia de dos nuevas formulaciones de stents farmacológicos, con transportador polimérico biodegradable, y liberación de paclitaxel o sirolimus, los que fueron comparados con un stent metálico convencional (objetivo primario). Dado que los stents farmacológicos diferían entre sí solamente por la droga, pero eran idénticos en sus otras características, el estudio también permitió la comparación del efecto antireestenótico entre sirolimus y paclitaxel (objetivo secundario).
Тема - темы
Adolescent , Humans , Young Adult , Angioplasty, Balloon, Coronary/instrumentation , Coronary Disease/therapy , Drug-Eluting Stents , Paclitaxel/administration & dosage , Polymers/chemistry , Sirolimus/administration & dosage , Absorbable Implants , Angioplasty, Balloon, Coronary/methods , Brazil/epidemiology , Cardiovascular Agents/administration & dosage , Coronary Disease/pathology , Coronary Restenosis/prevention & control , Coronary Thrombosis/epidemiology , Coronary Thrombosis/etiology , Drug-Eluting Stents/adverse effects , Epidemiologic Methods , Prosthesis Design , Treatment Outcome , Young AdultРеферат
INTRODUÇÃO: Pouco se conhece sobre a comparação entre métodos de avaliação da placa aterosclerótica coronária, como a tomografia computadorizada com múltiplos detectores (TCMD) e o ultrassom intravascular com técnica de histologia virtual (HV). MÉTODO: Foram analisados prospectivamente os vasos coronários principais de 21 pacientes à TCMD e à HV. Cada vaso analisado foi dividido em subsegmentos de 4 mm (unidades básicas para a análise). Os subsegmentos foram pareados conforme sua localização axial. Os limites da luz e do vaso foram traçados à HV e à TCMD com o auxílio de programas específicos. A contribuição porcentual de cada componente da placa à HV e a razão necrose:cálcio foram quantificadas. A placa à TCMD foi avaliada por sua densidade radiológica em unidades Hounsfield (UH). RESULTADOS: Foram analisados 641 subsegmentos, obtidos de 70 vasos. A contribuição porcentual dos componentes à HV foi: fibroso = 64%; fibrolipídico = 20%; núcleo necrótico = 11%; cálcio denso = 5%; e razão necrose:cálcio = 5,1. A atenuação da placa à TCMD variou de 44 UH a 440 UH. Para a análise, as placas foram divididas em três grupos de tamanhos semelhantes, conforme a densidade da placa à TCMD (1º tercil: 44-128 UH, 2º tercil: 129-178 UH, e 3º tercil: 178-440 UH). Houve correlação inversa entre a razão necrose/cálcio à HV e densidade da placa à TCMD (1º tercil: 4,1, 2º tercil: 2,9, e 3º tercil: 2,3; P < 0,01) e relação direta entre o porcentual de cálcio denso à HV e a densidade da placa à TCMD (1º tercil: 1,5%, 2º tercil: 2,5%, e 3º tercil: 3,8%; P < 0,01). CONCLUSÃO: A densidade da placa aterosclerótica avaliada pela TCMD em tomógrafo de 64 colunas de detectores associa-se significativamente com a composição da placa à HV.
BACKGROUND: Little is known about the comparative results of coronary plaque assessment by multidetector computed tomography (MDCT) against the novel intravascular ultrasound virtual histology (IVUS-VH). METHOD: Threevessel IVUS-VH and MDCT were prospectively obtained from 21 patients. Each vessel was divided into 4-mm subsegments, which were used as the basic unit for analysis. The 4-mm subsegments were matched by their axial location. Lumen and outer vessel boundaries for IVUS-VH and for MDCT were traced by specific automatic softwares. The percent contribution of each IVUS-VH plaque tissue type and the ratio of necrotic tissue to calcium were quantified. The MDCT plaque was evaluated through its average density in Hounsfield units (HU). RESULTS: A total of 641 matched subsegments were computed from 70 vessels. Overall, the average IVUS-VH tissue composition was: fibrous = 64%; fibrofatty = 20%; necrotic tissue = 11%; dense calcium = 5%; and calcium/necrosis ratio = 5.1. MDCT average plaque attenuation ranged from 44 to 440 HU and was divided into three groups of similar size (1st tertile: 44-128 HU; 2nd tertile: 129-178 HU; 3rd tertile: 178-440 HU). There was an inverse correlation between IVUS-VH necrotic/ dense calcium ratio and MDCT plaque density (1st tertile: 4.1, 2nd tertile: 2.9, 3rd tertile: 2.3; P < 0.01) and a direct relationship between percent IVUS-VH dense calcium and MDCT plaque density (1st tertile: 1.5%, 2nd tertile: 2.5%, 3rd tertile: 3.8%; P < 0.01). CONCLUSION: Atherosclerotic plaque density evaluated by 64-MDCT significantly associates with plaque composition assessed by IVUS-VH.
Тема - темы
Humans , Male , Middle Aged , Ultrasonography , Coronary Disease/pathology , Tomography, Spiral Computed/methods , Tomography, Spiral ComputedРеферат
Determinar la incidencia de trombosis intrastent en pacientes sometidos a intervencionismo coronario del Centro Cardiovascular Regional ASCARDIO, comparar incidencia de trombosis intrastent entre stent bare y stent medicado, determinar la inicidencia de trombosis en pacientes diábeticos. Estudio retrospectivo, descriptivo. Se revisaron 500 casos de intervencionismo coronario de los cuales se obtuvo información completa de 244 pacientes. Se tomó en cuenta la nueva clasificación de trombosis intrastent de la Academic Research Consortium. La incidencia de trombosis intrastent fue de 5,74% (14 pacientes) y la de trombosis definitiva de 2,87% (7 pacientes), no hubo diferencia significativa entre stent medicados; la incidencia de trombosis en diábeticos fue de 10% vs el 4,4% en los no diábeticos (P=0,104). En los pacientes con trombosis definitiva recibían significativamente más terapia dual antiplaquetaria que los probables o posibles (P=0,02). La longitud de los stents medicados trombosados fue significativamente mayor (23,22 ± 4,73 mm) que en los stents convencionales (15,89 ± 5,2 mm) (P=0,01) y el diámetro fue menor (2,82 ± 0,22mm) que en los convencionales (3,07 ± 0,18 mm)(P=0,05). También se encontro una mayor incidencia de trombosis en los stent medicados colocados en la coronaria derecha (P=0,02). La incidencia de trombosis definitivas en nuestro centro es mayor a la reportada; las trombosis intrastent tempranas y tardías no tienen diferencia significativa entre stents convencionales y los medicados. La longitud de los stents convencionales y los medicados trombosados fue significativamente mayor y de menor diámetro, comparado con los stent bare; la trombosis intrastent en diabéticos no mostro diferencia en relación al tipo de stent.
To determine the incidence of stent thrombosis on patients undergoing coronary interventions at the Centro Cardiovascular Regional Ascardio; and to compare the incidence of stent thrombosis between BMS and DES; and to determine the incidence of thrombosis on diabetic patients. This was a retrospective descriptive study. From 500 cases of coronary interventions, data was obtained on 244. The new classification of stent thrombosis by American Researche Consortium was applied. The incidence of thrombosis was 5.74% (14 patients) and for definite thrombosis was 2.87% (7 patients). there was no significant diferences between BMS and DES (P=1). The incidence of thrombosis on diabetic patients was 10% as compared to 4.4% on nondiabetic patients (P=0,104). We shown that patients with definite thrombosis received significantly more dual antiplatelet therapy than likely or possible thrombosis cases (P=0,02). The length of thrombosed DES was significantly higher (23.22 ± 4.73mm) tha BMS (15.89 ± 5.2mm, P=0.01)and the diameter was significantly lower (2.82 ± 0.22mm) than BMS (3.07 ± 0.18 mm, P=0.05). We also found a higher incidence of thrombosis for DES implanted on the right coronary artery (P=0.02). The incidence of definite thrombosis in our center was mildly higher than the reported incidence; early and late stent thrombosis showed no significant difference between BMS and DES; however the length of DES was significantly higher and less diameter tha BMS; dibetes was no significamtly higher on thrombosed stents.
Тема - темы
Humans , Male , Female , Adult , Middle Aged , Coronary Disease/surgery , Coronary Disease/pathology , Thrombosis/therapy , Thrombosis/urine , Angioplasty/methods , Drug-Eluting StentsРеферат
La ateroesclerosis y las patologías asociadas han emergido como la primera causa de morbimortalidad en el mundo occidental y son, por lo tanto, un gran problema de salud pública. Se ha sugerido que los radicales libres y las especies reactivas del oxígeno están involucradas en la fisiopatología de estas enfermedades. Se sabe que la actividad física tiene un gran papel como medida de salud pública al, entre otras cosas, disminuir en la población general el riesgo de eventos cardiovasculares relacionados con ateroesclerosis. Se conoce también que la actividad física aumenta en varios tejidos la producción de radicales libres y especies reactivas de oxígeno. En el presente texto se revisa la relación entre ateroesclerosis, estrés oxidativo y actividad física discutiendo la aparente paradoja según la cual la actividad física regular reduce la ateroesclerosis y el riesgo cardiovascular al mismo tiempo que se da un fenómeno aparentemente dañino como es el aumento del estrés oxidativo. Se presenta una hipótesis que incluye la evidencia experimental y clínica para explicar dicha paradoja.
Тема - темы
Atherosclerosis , Motor Activity/physiology , Coronary Disease/pathology , Oxidative StressРеферат
Recientemente se ha demostrado la importancia de las alteraciones en los valores séricos lipídicos como factor de riesgo de mortalidad por enfermedad cardiovascular en población aparentemente sana, asimismo de una relación significativa entre la hiperlipidemia y la extensión de la aterosclerosis. Con el objetivo de conocer la prevalencia de hipertrigliceridemia en adultos jóvenes se realizó un estudio en 122 pacientes con edades comprendidas entre los 20 y 24 años de edad que asistieron al Ambulatorio Militar La Rosaleda durante los años 2003-2005. El valor máximo encontrado fue de 858 mg/dL correspondiente al sexo masculino, y el valor menor fue de 25 mg/dL también del sexo masculino. El promedio de los niveles séricos para el sexo femenino fue de 114 mg/dL y para el sexo masculino fue de 134 mg/dL. La prevalencia general fue del 24,6 por ciento. El 13,94 por ciento corresponde al sexo femenino y el 10,66 por ciento corresponde al sexo masculino
It has been recently proven that changes in lipid serum levels are a significant risk factor for cardiovascular disease-related mortality in apparently healthy population, and show a close relation between hyperlipidemia and atherosclerosis extension. In order to know the prevalence of hyper-tryglyceridemia among young adults, 122 patients aged 20 to 24 and visiting the La Rosaleda Military Ambulatory Hospital between 2003 and 2005 were studied. Among male patients, the highest level found was 858 mg/dL, and the lowest 25 mg/dL. The average serum level for female patients was 114 mg/dL,and 134 mg/dL for male patients. Overall prevalence was 24.6%. The 13.94% among females and 10.66% among males
Тема - темы
Humans , Male , Adult , Female , Coronary Disease/mortality , Coronary Disease/pathology , Hypercholesterolemia/etiology , Hyperlipidemias/pathology , Chronic Disease , Coronary Artery Disease/etiologyРеферат
Apoptosis is a biological process of death or cellular suicide present in all the cells of the metazoans. It maintains the balance between the regeneration of pluripotential cells -or stem cells- and the elimination of cells that have already served their function, of cells that have reproduced in excess, or have been genetically damaged beyond repair. Apoptosis activation in cardiomyocytes is a common problem in a large variety of cardiomyopathies; it has been suggested that it is an important contributor ventricular hypertrophy and to the increase of the infarct size in patients with cardiac failure and cardiovascular disease. Clinical diagnosis of apoptosis is a reality in the medical science, its application in different aspects of cardiology includes from coronary cardiopathy to rhythm alterations. In this sense, the use of the non-invasive imaging, can be very useful for the in vivo detection of this type of cellular death in patients with myocardial necrosis, acute myocardial infarct, acute rejection of cardiac transplantation, myocarditis, intracardial malignant tumours, as well as in cardiotoxicity cases and other cardiomyopathies. Particularly, binding of Tc99m-labeled Annexin V, produces gammagraphic images that allow the identification of apoptotic cells in vivo in SPECT and SestaMiBi systems. In summary, the use of these techniques will be invaluable in the near future for anti-apoptosis therapy and intervention in the routine of the daily Cardiology practice.