Cardiovascular risk assessment and association with novel biomarkers in patients with Type 2 diabetes mellitus.

Aim: To investigate the association between cardiovascular risk and biomarkers in patients with Type 2 diabetes (T2DM). Methods: Cross-sectional study, with evaluation of traditional and new biomarkers (serum FGF-23, Syndecan-1 [Sdc-1] and vascular cell adhesion molecule-1 [VCAM-1] and urinary VEGF and kidney injury molecule-1 [KIM-1]) and risk scores (Framingham-FRS and UK Prospective Diabetes Study [UKPDS]). Results: 128 diabetics were included, with predominance of high risk by FRS and low risk by UKPDS. There was an independent association of VCAM-1 and VEGF with higher risk by FRS-lipids and UKPDS. Conclusion: There was an independent association of VCAM-1 and VEGF with higher cardiovascular risk, showing a subclinical endothelial dysfunction in T2DM. The inclusion of novel biomarkers to risk scores may increase accuracy when assessing cardiovascular risk of diabetic individuals.

Primary Myiasis in Surgical Wound of Mandible Symphisis Fracture.

A 42 year old patient was referred to the Department of Oral and Maxillofacial Surgery of the Federal University of Uberlândia, for treatment of mandibular fractures (condyles and symphysis), a victim of a run over. The symphysis was surgically approached, using as surgical access the pre-existing laceration in the submental region. Five days after discharge, the patient returned with dehiscence of the wound and physical examination showed infestation by larvae in the symphysis. Mechanical removal and debridement were performed under local anesthesia, where plate exposure was noted. The patient underwent oral ivermectin therapy, intravenous antibiotic therapy and a thorough debridement was performed under general anesthesia due to the invasion of deep spaces in the supra-hyoid region. After 2 weeks, it presented with purulent drainage at the site. The miniplates were replaced by a 2.4 mm reconstruction plate and antibiotic therapy was maintained. Due to the social risk, the patient remained hospitalized for 45 days, when he was discharged with outpatient return, but did not attend the returns.

Clinical correlation between N-terminal pro-B-type natriuretic peptide and angiographic coronary atherosclerosis.

OBJECTIVES: This study aimed to investigate the clinical correlation between angiographic coronary atherosclerosis and N-terminal pro-B-type natriuretic peptide along with other known correlated factors. METHODS: In total, 153 patients with a diagnostic hypothesis of stable angina, unstable angina or acute myocardial infarction were classified as group A (patients with angiographically normal coronary arteries) or group B (patients with angiographic coronary atherosclerosis). The two groups were analyzed with respect to the following factors: gender, age, body mass index, abdominal circumference, smoking, diabetes mellitus, arterial hypertension, early family history of atherosclerosis, statin use, the presence of metabolic syndrome, clinical presentation and biochemical factors, including cholesterol, creatinine and fibrinogen plasma concentrations, monocyte counts and N-terminal pro-B-type natriuretic peptide. RESULTS: Univariate analyses comparing the two groups revealed that group B patients more frequently had diabetes, used statins and had systolic dysfunction, N-terminal pro-B-type natriuretic peptide levels ≥ 250 pg/mL, fibrinogen levels >500 mg/dL and ≥ 501 monocytes/mm3 compared with group A patients (p<0.05). Nevertheless, multivariate logistic regression analysis demonstrated that the independent predictors of angiographic coronary atherosclerosis were an N-terminal pro-B-type natriuretic peptide level ≥ 250 pg/mL, diabetes mellitus and increased monocyte numbers and fibrinogen plasma concentration, regardless of the creatinine level or the presence of systolic dysfunction. CONCLUSIONS: An N-terminal pro-B-type natriuretic peptide plasma concentration of ≥ 250 pg/mL is an independent predictor of angiographic coronary atherosclerosis.

Clinical correlation between N-terminal pro-b-type natriuretic peptide and angiographic coronary atherosclerosis

OBJECTIVES: This study aimed to investigate the clinical correlation between angiographic coronary atherosclerosis and N-terminal pro-B-type natriuretic peptide along with other known correlated factors. METHODS: In total, 153 patients with a diagnostic hypothesis of stable angina, unstable angina or acute myocardial infarction were classified as group A (patients with angiographically normal coronary arteries) or group B (patients with angiographic coronary atherosclerosis). The two groups were analyzed with respect to the following factors: gender, age, body mass index, abdominal circumference, smoking, diabetes mellitus, arterial hypertension, early family history of atherosclerosis, statin use, the presence of metabolic syndrome, clinical presentation and biochemical factors, including cholesterol, creatinine and fibrinogen plasma concentrations, monocyte counts and N-terminal pro-B-type natriuretic peptide. RESULTS: Univariate analyses comparing the two groups revealed that group B patients more frequently had diabetes, used statins and had systolic dysfunction, N-terminal pro-B-type natriuretic peptide levels ≥250 pg/mL, fibrinogen levels >500 mg/dL and ≥501 monocytes/mm3 compared with group A patients (p<0.05). Nevertheless, multivariate logistic regression analysis demonstrated that the independent predictors of angiographic coronary atherosclerosis were an N-terminal pro-B-type natriuretic peptide level ≥250 pg/mL, diabetes mellitus and increased monocyte numbers and fibrinogen plasma concentration, regardless of the creatinine level or the presence of systolic dysfunction. CONCLUSIONS: An N-terminal pro-B-type natriuretic peptide plasma concentration of ≥250 pg/mL is an independent predictor of angiographic coronary atherosclerosis. .

Tumor cardiaco en un paciente de mediana edad con enfermedad coronaria - una rara asociación / Cardiac tumor in a middle aged patient with coronary disease - a rare association

Se describe una rara asociación de tumor cardíaco y enfermedad coronaria. Un varón de 42 años de edad fue admitido con queja de disnea. El electrocardiograma mostró ritmo sinusal, bloqueo de rama derecha y repolarización anormal de la pared ventricular anterior. El ecocardiograma mostró una estructura con ecogenicidad aumentada dentro de la aurícula izquierda, compatible con tumor cardíaco. El paciente fue enviado a cirugía; se estabilizó y fue dado de alta en el cuarto día post-operatorio sin complicaciones y sin síntomas.

We describe a rare association between cardiac tumor and coronary disease. A 42 years old male was admitted with complaints of dyspnea. The physical examination was unremarkable. The electrocardiogram showed sinus rhythm, with right bundle block and ventricular anterior wall repolarization abnormality. The echocardiogram showed a structure with increased echogenicity inside the left atrium, compatible with cardiac tumor. A surgery was then indicated to remove the tumor. The patient became stable and was discharged in the fourth post-operative day with no symptom and no complication.

Cardiovascular disease in patients with end-stage renal disease on hemodialysis in a developing country.

Cardiovascular disease is the main cause of death among patients with end-stage renal disease (ESRD). The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on hemodialysis (HD) in Brazil. Their mean age was 47 ± 39 years. The main risk factors for cardiovascular diseases were arterial hypertension (89.4%), dyslipidemia (78.3%), low high-density lipoprotein levels (84.2%) and low physical activity (64.1%). Family history of coronary insufficiency and high low-density lipoprotein levels were significantly associated with coronary artery disease (P = 0.005 and P = 0.029, respectively). Sedentary life style, diabetes mellitus, secondary hyperparathyroidism and hyperglycemia also showed a significant association with the underlying vascular disease (P = 0.017, P = 0.039, P = 0.037 and P = 0.030, respectively). Hypercalcemia, hypertension and black race were factors significantly associated with left ventricular systolic dysfunction (P = 0.01, P = 0.0013 and P = 0.024, respectively). Our study shows that the most prevalent cardiovascular diseases in patients with ESRD were left ventricular hypertrophy, atherosclerotic disease, valvular disease and coronary artery disease. Hypertension and dyslipidemia were the common risk factors associated with cardiovascular diseases. The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on HD in a single center in Brazil.

Restrição ao uso de tabaco e a prevenção do câncer bucal / Restriction of tobacco use and the prevention of oral cancer

A Organização Mundial da Saúde relata que a epidemia mundial de tabagismo é uma das maiores ameaças à saúde pública dos tempos modernos. O objetivo deste estudo foi relacionar a adoção de medidas restritivas ao uso do tabaco e suas implicações na prevenção ao câncer bucal, por meio de revisão crítica. As evidencias científicas apontam que o uso de tabaco é considerado como causa primária de muitos problemas e doenças bucais, dentre às quais se destacam o câncer bucal, doença periodontal, perdas dentárias e defeitos congênitos. No Brasil e no mundo os principais documentos que regulam a disposição, uso e estratégias de combate aotabaco são relacionados à legislação vigente, documentos internacionais e aos estudos epidemiológicos. Conclui-se que a prevenção ao câncer bucal está relacionada à conscientização das populações quanto aos malefícios causados por hábitos deletérios, como o uso de tabaco, à adoção de práticas saudáveis, bem como se evidencia a necessidade de desenvolvimento de ações abrangentes para o controle do câncer, nos diferentes níveis de atuação e a adoção de medidas mais amplas de restrição ao uso de tabaco pelos diversossetores da sociedade.

The World Health Organization reports that the worldwide epidemic of smoking is the major threat to the public health of modern times. The objective of this study was to relate the adoption of restrictive measures to tobacco use and its implications in the prevention of oral cancer, through critical review. The scientific evidence suggests that the use of tobacco is considered as the primary cause of many problems and oraldiseases, among which are the oral cancer, periodontal disease, tooth loss and congenital defects. In Brazil and the world the main documents regulating the provision, use and strategies to combat tobacco use are related to legislation, international documents and the epidemiological studies. It is concluded that prevention of oral cancer is related to awareness of people about the harm caused by deleterious habits such as use of tobacco, the adoption of healthy practices, and as well as highlighting the need for development ofcomprehensive actions to control the cancer, the different levels of performance and the adoption of furthermeasures to restrict the use of tobacco by the different sectors of society.

Prevalance of anemia and its association with cardio-renal syndrome.

BACKGROUND: Anemia is common in cardio-renal syndrome and may contribute to increase mortality. OBJECTIVE: To examine the prevalence of anemia and its relationship with cardio-renal syndrome, and to evaluate the risk factors for death. METHODS: Retrospective study with all patients admitted with congestive heart failure (CHF). The parameters as age, gender, hemoglobin (Hb), estimated glomerular filtration rate (eGFR), New York Heart Association (NYHA) functional class, ejection fraction (EF%), hospital stay, hypertension, diabetes, smoking and CHF etiology were analyzed. Anemia was defined as Hb<12 g/dL, systolic dysfunction EF<55% and renal failure was stratified according to K-DOQI classification. Statistical analysis was done by the programs EpiInfo and SPSS for windows. RESULTS: A total of 174 patients were studied. The average age was 63+/-16 years, 65.5% were males, and 18 of them (11%) were non-survivors. Anemia was observed in 45% of patients, and 82% presented some degree of renal failure. The majority of patients (87%) were classified as NYHA functional class III or IV. The average ejection fraction was 43.9+/-16.6%, and there was no difference between survivors and non-survivors (p>0.05). Mortality was not significantly higher among patients with anemia (12.4%) when comparing to those without anemia (8.3%, p=0.31). There was a progressive decrease in the level of hemoglobin as renal function decreased (p<0.05). Increased serum creatinine was a significant risk factor for death (OR=1.59, 95% CI=1.074-2.363, p=0.021), and increased EF% was a protection factor against development of death (OR=0.904, 95% CI=0.845-0.973, p=0.007). CONCLUSIONS: The prevalence of anemia is high among patients with cardio-renal syndrome but was not associated with increased mortality. Increased serum creatinine and low EF% were variables associated with death.