Trends of Infective Endocarditis at Two Teaching Hospitals: A 12-Year Retrospective Cohort Study in Rio de Janeiro, Brazil.

BACKGROUND: Despite advances in diagnosis and treatment, the incidence and mortality of infective endocarditis (IE) have increased in recent decades. Studies on the risk factors for mortality in endocarditis in Latin America are scarce. METHODS: This retrospective cohort study included 240 patients diagnosed with IE according to the modified Duke criteria who were admitted to two university hospitals in Rio de Janeiro, Brazil from January 2009 to June 2021. Poisson regression analysis was performed for trend tests. The multivariate Cox proportional hazards model was used to estimate the hazard ratio (HR) of predictors of in-hospital mortality. FINDINGS: The median age was 55 years (IQR: 39-66 years), 57% were male, and 41% had a Charlson comorbidity index (CCI) score > 3. Healthcare-associated infective endocarditis (54%), left-sided native valve IE (77.5%), and staphylococcal IE (26%) predominated. Overall, in-hospital mortality was 45.8%, and mortality was significantly higher in the following patients: aged ≥ 60 years (53%), CCI score ≥ 3 (60%), healthcare-associated infective endocarditis (HAIE) (53%), left-sided IE (51%), and enterococcal IE (67%). Poisson regression analysis showed no trend in in-hospital mortality per year. The adjusted multivariate model determined that age ≥ 60 years was an independent risk factor for in-hospital mortality (HR = 1.9; 95% CI 1.2-3.1; p = 0.008). INTERPRETATION: In this 12-year retrospective cohort, there was no evidence of an improvement in survival in patients with IE. Since older age is a risk factor for mortality, consensus is needed for the management of IE in this group of patients.

Inflammatory and cytotoxic mediators in COVID-19 patients and in ChAdOx1 nCoV-19 (AZD1222) vaccine recipients.

Immunological and cytotoxic mediators are induced in natural infection and are essential for the effectiveness of vaccination. Vaccination is useful to prevent the spread of SARS-CoV-2 and limit the morbidity/mortality of COVID-19. ChAdOx1 nCoV-19 is one of the most widespread vaccines in the world. We compared the detection of anti-S1 SARS-CoV2 IgG and the profile of inflammatory and cytotoxic responses of patients who developed different clinical outcomes of COVID-19 with individuals previously exposed or not to the virus received the first and booster doses of ChAdOx1 nCoV-19. Plasma from 35 patients with COVID-19 and 11 vaccinated were evaluated by multiplex assay. Here, no vaccinated subjects had serious adverse effects. Those vaccinated with a booster dose had higher anti-S1 IgG than mild/moderate and recovered patients. Critically ill and deceased patients had IgG levels like those immunized. By univariate analysis, IL-2, IL-17, and perforin do not differentiate between patients and vaccinated individuals. Granzyme A increased at dose 1, while patients had their levels reduced. High levels of granulysin, sFas, and IL-6 were detected in the deaths, but after vaccination, all were declined. The multivariate analysis supports the role of IL-6 and granulysin as associated and non-confounding variables related to the worst clinical outcome of COVID-19, but not sFas. Our data confirm the ability of the ChAdOx1 vaccine to produce specific antibody levels up to booster time. Furthermore, our data suggest that the vaccine can regulate both the hyper-production and the kinetics of the production of inflammatory and cytotoxic mediators involved in the cytokine storm, such as granulysin and IL-6.

The Role of Growth Factors in the Pathogenesis of Dengue: A Scoping Review.

Growth factors (GFs) have a role in tissue repair and in the modulation of the expression of inflammatory cells in damage caused by pathogens. This study aims to systematize the evidence on the role of GFs in the pathogenesis of dengue. This scoping review considered all published peer-reviewed studies in the MEDLINE and Embase databases. Ultimately, 58 studies that analyzed GFs in dengue patients, published between 1998 and 2021, were included. DENV-2 infection and secondary infection were more frequent in the patients studied. ELISA and multiplex immunoassay (Luminex) were the most used measurement techniques. Increased levels of vascular endothelial growth factor, granulocyte-macrophage colony-stimulating factor, granulocyte colony-stimulating factor, transforming growth factor beta, and hepatocyte growth factor as well as reduced levels of platelet-derived growth factor and epidermal growth factor were observed in severe dengue in most studies. Vascular endothelial growth factor and hepatocyte growth factor were identified as biomarkers of severity. In addition, there is evidence that the dengue virus can use the growth factor pathway to facilitate its entry into the cell and promote its viral replication. The use of tyrosine kinase inhibitors is an alternative treatment for dengue that is being studied.

Subsets of Cytokines and Chemokines from DENV-4-Infected Patients Could Regulate the Endothelial Integrity of Cultured Microvascular Endothelial Cells.

Introduction: It is a consensus that inflammatory mediators produced by immune cells contribute to changes in endothelial permeability in dengue. We propose to relate inflammatory mediators seen in dengue patients with the in vitro alteration of endothelial cells (ECs) cultured with serum from these patients. Methods: Patients with mild (DF) to moderate and severe dengue (DFWS/Sev) were selected. ELISA quantified inflammatory mediators. Expression of adhesion molecules and CD147 were evaluated in the ECs cultured with the patient's serum by flow cytometry. We assessed endothelial permeability by measuring transendothelial electrical resistance in cocultures of ECs with patient serum. Results: Dengue infection led to an increase in inflammatory mediators-the IL-10 distinguished DF from DFWS/Sev. There were no changes in CD31, CD54, and CD106 but decreased CD147 expression in ECs. DFWS/Sev sera induced a greater difference in endothelial permeability than DF sera. Correlation statistical test indicated that low IL-10 and IFN-γ and high CCL5 maintain the integrity of ECs in DF patients. In contrast, increased TNF, IFN-γ, CXCL8, and CCL2 maintain EC integrity in DFWS/Sev patients. Conclusions: Our preliminary data suggest that a subset of inflammatory mediators may be related to the maintenance or loss of endothelial integrity, reflecting the clinical prognosis.

Increased Indoleamine 2,3-Dioxygenase 1 (IDO-1) Activity and Inflammatory Responses during Chikungunya Virus Infection.

Chikungunya virus (CHIKV) infection causes intense cytokine/chemokine inflammatory responses and debilitating joint pain. Indoleamine2,3-dioxygenase 1 (IDO-1) is an enzyme that initiates the tryptophan degradation that is important in initial host innate immune defense against infectious pathogens. Besides that, IDO-1 activation acts as a regulatory mechanism to prevent overactive host immune responses. In this study, we evaluated IDO-1 activity and cytokine/chemokine patterns in CHIKV patients. Higher IDO-1 (Kyn/Trp ratio) activation was observed during the early acute phase of CHIKV infection and declined in the chronic phase. Importantly, increased concentrations of Tumor Necrosis Factor-α (TNF-α), Interleukin-6 (IL-6), Interferon γ (IFN-γ), C-C motif chemokine ligand 2/Monocyte Chemoattractant Protein-1 (CCL2/MCP-1) and C-X-C motif chemokine ligand 10/Interferon Protein-10 (CXCL10/IP-10) were found in the acute phase of infection, while C-C motif chemokine ligand 4/Macrophage Inflammatory Protein 1 ß (CCL4/MIP-1ß) was found at increased concentrations in the chronic phase. Likewise, CHIKV patients with arthritis had significantly higher concentrations of CCL4/MIP-1ß compared to patients without arthritis. Taken together, these data demonstrated increased IDO-1 activity, possibly exerting both antiviral effects and regulating exacerbated inflammatory responses. CCL4/MIP-1ß may have an important role in the persistent inflammation and arthritic symptoms following chikungunya infection.

Comparative Analysis of Circulating Levels of SARS-CoV-2 Antibodies and Inflammatory Mediators in Healthcare Workers and COVID-19 Patients.

Advances in knowledge of the pathophysiology of COVID-19 have been acquired; however, the host factors that could explain the mild and severe forms of the disease are not fully understood. Thus, we proposed to evaluate anti-SARS-CoV-2 antibodies and the inflammatory response of different groups of individuals, including healthcare workers (HCW), sick and dead COVID-19 patients and also recovered patients to contribute to this knowledge gap. Our objective is to relate the clinical evolution of these individuals with the level of detection and functionality of specific antibodies and with the production of inflammatory mediators. As main findings, IgA and IgG anti-SARS-CoV-2 were detected in asymptomatic HCW. IFN-γ and TNF-α levels were higher in symptomatic HCWs than patients with COVID-19 and those who died. Patients who died had higher levels of IL-6, IL-10, and CCL2/MCP-1. We found an imbalance between antiviral and pro-inflammatory mediators in the groups, in which IFN-γ and TNF-α seem to be more associated with protection and IL-6 and CCL2/MCP-1 with pathology. Our work is pioneering the Brazilian population and corroborates data from people from other countries.

Was It Chikungunya? Laboratorial and Clinical Investigations of Cases Occurred during a Triple Arboviruses' Outbreak in Rio de Janeiro, Brazil.

The co-circulation of chikungunya virus (CHIKV), dengue virus (DENV) and Zika virus (ZIKV) in Rio de Janeiro (RJ), Brazil, caused a challenging triple epidemic, as they share similar clinical signs and symptoms and geographical distribution. Here, we aimed to investigate the clinical and laboratorial aspects of chikungunya suspected cases assisted in RJ during the 2018 outbreak, focusing on the differential diagnosis with dengue and zika. All suspected cases were submitted to molecular and/or serological differential diagnostic approaches to arboviruses. A total of 242 cases suspected of arbovirus infection were investigated and 73.6% (178/242) were molecular and/or serologically confirmed as chikungunya. In RT-qPCR confirmed cases, cycle threshold (Ct) values ranged from 15.46 to 35.13, with acute cases presenting lower values. Chikungunya cases were mainly in females (64%) and the most frequently affected age group was adults between 46 to 59 years old (27%). Polyarthralgia affected 89% of patients, especially in hands and feet. No dengue virus (DENV) and Zika virus (ZIKV) infections were confirmed by molecular diagnosis, but 9.5% (23/242) had serological evidence of DENV exposure by the detection of specific anti-DENV IgM or NS1, and 42.7% (76/178) of chikungunya positive cases also presented recent DENV exposure reflected by a positive anti-DENV IgM or NS1 result. A significantly higher frequency of arthritis (p = 0.023) and limb edema (p < 0.001) was found on patients with CHIKV monoinfection compared to dengue patients and patients exposed to both viruses. Lastly, phylogenetic analysis showed that the chikungunya cases were caused by the ECSA genotype. Despite the triple arboviruses' epidemic in the state of RJ, most patients with fever and arthralgia investigated here were diagnosed as chikungunya cases, and the incidence of CHIKV/DENV co-detection was higher than that reported in other studies.

Different Profiles of Cytokines, Chemokines and Coagulation Mediators Associated with Severity in Brazilian Patients Infected with Dengue Virus.

The incidence of dengue in Latin America has increased dramatically during the last decade. Understanding the pathogenic mechanisms in dengue is crucial for the identification of biomarkers for the triage of patients. We aimed to characterize the profile of cytokines (IFN-γ, TNF-α, IL-1ß, IL-6, IL-18 and IL-10), chemokines (CXCL8/IL-8, CCL2/MCP-1 and CXCL10/IP-10) and coagulation mediators (Fibrinogen, D-dimer, Tissue factor-TF, Tissue factor pathway inhibitor-TFPI and Thrombomodulin) during the dengue-4 epidemic in Brazil. Laboratory-confirmed dengue cases had higher levels of TNF-α (p < 0.001), IL-6 (p = 0.005), IL-10 (p < 0.001), IL-18 (p = 0.001), CXCL8/IL-8 (p < 0.001), CCL2/MCP-1 (p < 0.001), CXCL10/IP-10 (p = 0.001), fibrinogen (p = 0.037), D-dimer (p = 0.01) and TFPI (p = 0.042) and lower levels of TF (p = 0.042) compared to healthy controls. A principal component analysis (PCA) distinguished between two profiles of mediators of inflammation and coagulation: protective (TNF-α, IL-1ß and CXCL8/IL-8) and pathological (IL-6, TF and TFPI). Lastly, multivariate logistic regression analysis identified high aspartate aminotransferase-to-platelet ratio index (APRI) as independent risk factors associated with severity (adjusted OR: 1.33; 95% CI 1.03-1.71; p = 0.027), the area under the receiver operating characteristics curve (AUC) was 0.775 (95% CI 0.681-0.869) and an optimal cutoff value was 1.4 (sensitivity: 76%; specificity: 79%), so it could be a useful marker for the triage of patients attending primary care centers.

Risk factors associated with mortality in patients hospitalized for coronavirus disease 2019 in Rio de Janeiro, Brazil.

INTRODUCTION: Understanding the mortality-associated risk factors of coronavirus disease 2019 will impact clinical decisions. METHODS: This retrospective longitudinal study included patients hospitalized for coronavirus disease in Rio de Janeiro, Brazil. The Kaplan-Meier method and multivariate Cox regression analysis were used. RESULTS: Sequential Organ Failure Assessment score of ≥2 (hazard ratio 4.614; 95% confidence interval =2.210-9.634; p<0.001) and neutrophil/lymphocyte ratio of >5 (hazard ratio=2.616; 95% confidence interval=1.303-5.252; p=0.007) were independently associated with mortality. CONCLUSIONS: Sequential Organ Failure Assessment score and neutrophil/lymphocyte ratio on admission can identify coronavirus disease patients at increased risk of death and guide subsequent clinical decisions.

Risk factors associated with mortality in patients hospitalized for coronavirus disease 2019 in Rio de Janeiro, Brazil

Abstract INTRODUCTION: Understanding the mortality-associated risk factors of coronavirus disease 2019 will impact clinical decisions. METHODS: This retrospective longitudinal study included patients hospitalized for coronavirus disease in Rio de Janeiro, Brazil. The Kaplan-Meier method and multivariate Cox regression analysis were used. RESULTS: Sequential Organ Failure Assessment score of ≥2 (hazard ratio 4.614; 95% confidence interval =2.210-9.634; p<0.001) and neutrophil/lymphocyte ratio of >5 (hazard ratio=2.616; 95% confidence interval=1.303-5.252; p=0.007) were independently associated with mortality. CONCLUSIONS: Sequential Organ Failure Assessment score and neutrophil/lymphocyte ratio on admission can identify coronavirus disease patients at increased risk of death and guide subsequent clinical decisions.

Association of rs1285933 single nucleotide polymorphism in CLEC5A gene with dengue severity and its functional effects.

Outbreaks of the Zika, dengue, and chikungunya viruses, especially in the Americas, pose a global threat due to their rapid spread and difficulty controlling the vector. Extreme phenotypes are often observed, from asymptomatic to severe clinical manifestations, which are well-studied in dengue. Host variations are also important contributors to disease outcomes, and many case-control studies have associated single nucleotide polymorphisms (SNPs) with severe dengue. Here, we found that the TC genotype and T-carriers for SNP rs1285933 in the C-type lectin superfamily member 5 (CLEC5A) gene was associated with severe dengue in a Northern Brazilian population (OR=2.75 and p-value=0.01, OR=2.11 and p-value=0.04, respectively). We also tested the functional effect of the CLEC5A protein and found that it is upregulated on the surface of human monocytes after in vitro dengue infection. CLEC5A was correlated with viral load inside the monocytes (Spearman r=0.55, p=0.008) and TNF production in culture supernatants (Spearman r=0.72, p=0.03). Analysis of mRNA in blood samples from DENV4-infected patients exhibiting mild symptoms showed that CLEC5A mRNA expression is correlated with TNF (r=0.67, p=0.0001) and other immune mediators. Monocytes from rs1285933 TT/TC individuals showed lower CLEC5A expression compared to CC genotypes. However, in these cells, CLEC5A was not correlated with TNF production. In summary, we confirmed that CLEC5A is genetically associated with dengue severity outcome, playing a central role during the immune response triggered by a dengue viral infection, and rs1285933 is a relevant SNP that is able to regulate signaling pathways after interactions between the dengue virus and CLEC5A receptors.

Analysis of Clinical and Laboratory Alterations Related to Dengue Case Severity: Comparison between Serotypes 2 and 4 in Brazil.

The increase in severe dengue (SD) cases has caused great impact on public health and has concerned authorities of countries where the disease is endemic and epidemics reach high proportions. The recognition of progression signs of this severe disease during the initial febrile phase can be difficult, since the symptoms are often indistinguishable from other febrile diseases. The aim of this study was to evaluate the clinical manifestations and laboratory findings in patients from two dengue outbreaks and their association with the disease. The study was conducted in patients (n = 153) with signs and symptoms consistent with dengue occurred during two distinct epidemics, 2010 and 2013, in the city of Campos dos Goytacazes, Rio de Janeiro, Brazil. According to the 2009 World Health Organization criteria, patients were classified as dengue without warning signs ([DwoWS] 60.6%, 57/94), dengue with warning signs ([DwWS] 30.9%, 29/94), and SD (4.25%, 4/94). Patients with DwWS/SD presented lower platelet and leukocyte counts and higher transaminase levels when compared with the DwoWS ones. Interestingly, patients from the epidemic of 2010 caused by dengue virus 2 (DENV-2) had lower platelet counts than patients of the 2013 epidemic caused by DENV-4. Furthermore, plasma leakage, gastrointestinal bleeding, and pleural effusion, hallmarks for a more severe disease, were also more frequently observed in those cases. Although previous studies may have extensively reported the wide range of the clinical aspects of dengue, the characterization of DENV-4 is desirable considering the burden of the disease during epidemics, especially for the health units and hospitals performing patient's management.

Increased circulating procoagulant and anticoagulant factors as TF and TFPI according to severity or infecting serotypes in human dengue infection.

Tissue Factor (TF) is the initiator of coagulation and Tissue Factor Inhibitor (TFPI) is the physiological inhibitor of the TF/FVIIa complex. Circulating levels of TF and TFPI were quantified in dengue patients and the relationships with disease severity and infecting serotype analysed. A significant decrease in TF and TPFI plasma levels was observed in mild DF patients compared with severe dengue. Furthermore, both factors were associated with haemorrhagic manifestations. Finally, TF levels were significantly increased in DENV-1/2 infected patients as compared with DENV-4. These findings suggest that activation of TF-pathway is an important component of DENV -related coagulation disorders.

Dengue epidemics in two distinct periods reveal distinct epidemiological, laboratorial and clinical aspects in a same scenario: analysis of the 2010 and 2013 epidemics in Mato Grosso do Sul, Brazil.

BACKGROUND: Dengue is a major problem in Brazil. Epidemiological and clinical aspects were characterized in patients from two epidemics which occurred in Mato Grosso do Sul, Brazil. METHODS: Dengue cases were classified according to the 2009 WHO criteria, tested by serological and molecular biology tests and analysed for nonstructural protein 1 (NS1) antigenemia. RESULTS: Dengue was confirmed in 78.7% (48/61) and 75.6% (118/156) of the cases studied in 2010 and 2013, respectively. DENV-1 and DENV-2 were the serotypes involved in the 2010 epidemic and DENV-4 in the 2013 one. Most of the cases were classified as dengue without warning; however, severe dengue was observed in 18.7% (9/48) of the cases in 2010 and less observed in DENV-4 cases. NS1 levels were higher in patients with dengue with warning signs and severe dengue in 2010. Circulating aspartate aminotransferase (AST) and alanine transferase (ALT) were altered in all groups, independently of the infecting serotype or epidemic. Patients with DENV-1 and DENV-2 presented significant lower monocyte counts when compared to patients with DENV-4. An inverse correlation was found between platelet count, leucocytes, monocytes and NS1 levels. CONCLUSIONS: Epidemics caused by the prevalence of distinct DENV serotypes had different impacts and clinical characteristics in a same scenario and, despite the occurrence of secondary infections, the DENV-4 emergence was not associated with severe cases.

Association between hypertension and quality of life in pregnancy.

PURPOSE: To assess the association between hypertension in pregnancy and women's quality of life (QoL) and the variation in the quality of life over gestational trimesters. METHOD: A questionnaire was applied to 194 hypertensive pregnant women and 195 pregnant women without complications. The questionnaire was composed of two parts: socioeconomic profile and specifically QoL, using the instrument Ferrans & Powers Quality of Life Index. All women included underwent a physical examination. RESULTS: Blood pressure was found to be approximately 20 mmHg higher in hypertensive pregnant women compared to pregnant women without complications. All QoL domains of hypertensive pregnant women had lower scores than those of pregnant women without complications, with health/functioning rated the lowest, averaging 17.63. The least affected domain was family, having the best average score (26.0). The QoL had no significant variations in relation to gestational trimesters. CONCLUSIONS: Pregnancy causes intense changes, both physical and psychological, in women's lives and hypertension was found to be a factor of high interference in pregnant woman's QoL, causing lower scores in all QoL domains of hypertensive pregnant women, compared with pregnant woman without complications.

Determining respiratory system resistance and reactance by impulse oscillometry in obese individuals.

OBJECTIVE: To evaluate peripheral respiratory system resistance and reactance (Rrs and Xrs, respectively) in obese individuals. METHODS: We recruited 99 individuals, dividing them into four groups by body mass index (BMI): < 30.0 kg/m2 (control, n = 31); 30.0-39.9 kg/m2 (obesity, n = 13); 40.0-49.9 kg/m2 (severe obesity, n = 28); and ≥ 50.0 kg/m2 (morbid obesity, n = 13). Using impulse oscillometry, we measured total Rrs, central Rrs, and Xrs. Peripheral Rrs was calculated as the difference between total Rrs and central Rrs. All subjects also underwent spirometry. RESULTS: Of the 99 individuals recruited, 14 were excluded because they failed to perform forced expiratory maneuvers correctly during spirometry. The individuals in the severe obesity and morbid obesity groups showed higher peripheral Rrs and lower Xrs in comparison with those in the two other groups. CONCLUSIONS: Having a BMI ≥ 40 kg/m2 was associated with a significant increase in peripheral Rrs and with a decrease in Xrs.

Determining respiratory system resistance and reactance by impulse oscillometry in obese individuals / Resistência e reatância do sistema respiratório por oscilometria de impulso em indivíduos obesos

Objective: To evaluate peripheral respiratory system resistance and reactance (Rrs and Xrs, respectively) in obese individuals.Methods: We recruited 99 individuals, dividing them into four groups by body mass index (BMI): < 30.0 kg/m2 (control, n = 31); 30.0-39.9 kg/m2 (obesity, n = 13); 40.0-49.9 kg/m2 (severe obesity, n = 28); and ≥ 50.0 kg/m2 (morbid obesity, n = 13). Using impulse oscillometry, we measured total Rrs, central Rrs, and Xrs. Peripheral Rrs was calculated as the difference between total Rrs and central Rrs. All subjects also underwent spirometry.Results: Of the 99 individuals recruited, 14 were excluded because they failed to perform forced expiratory maneuvers correctly during spirometry. The individuals in the severe obesity and morbid obesity groups showed higher peripheral Rrs and lower Xrs in comparison with those in the two other groups.Conclusions: Having a BMI ≥ 40 kg/m2 was associated with a significant increase in peripheral Rrs and with a decrease in Xrs.

Objetivo: Avaliar a resistência do sistema respiratório (Rsr) periférica e a reatância (Xsr) em indivíduos obesos.Métodos: Recrutamos 99 indivíduos, divididos em quatro grupos pelo índice de massa corpórea (IMC): < 30,0 kg/m2; (controle, n = 31); 30,0-39,9 kg/m2 (obesidade, n = 13); 40,0-49,9 kg/m2 (obesidade grave, n = 28); e ≥ 50,0 kg/m2 (obesidade mórbida, n = 13). Utilizando oscilometria de impulso, foram mensuradas Rsr total, Rsr central, Xsr. A Rsr periférica foi calculada como a diferença entre Rsr total e Rsr central. Todos os indivíduos também foram submetidos a espirometria.Resultados: Entre os 99 indivíduos recrutados, 14 foram excluídos por incapacidade de executar corretamente as manobras expiratórias forçadas na espirometria. Os indivíduos dos grupos obesidade grave e obesidade mórbida apresentaram aumento da Rsr periférica e redução da Xsr quando comparados aos dos outros grupos.Conclusões: Ter IMC ≥ 40 kg/m2 associou-se com aumento significativo da Rsr periférica e redução da Xsr.

Association Between Ankle-Brachial Index and Coronary Lesions Assessed by Coronary Angiography.

BACKGROUND: The ankle-brachial index (ABI) is a simple, non-invasive, and inexpensive method used in the diagnosis of peripheral arterial disease (PAD) and can identify individuals at risk for cardiovascular disease in other arteries of the body, especially the coronary and carotid arteries. The primary objective of this study was to assess whether patients with an ABI < 0.9 have more severe coronary artery disease detected on coronary angiography compared to patients with a normal ABI. METHODS: This is a prospective, analytical, cross-sectional study that was performed from July 1, 2013 to June 31, 2014 that recruited 163 patients (101 men (62%) and 62 women (38%)) according to the inclusion and exclusion criteria. All patients underwent coronary angiography, and then ABI measurements were performed. Pearson's Chi-square and Student's t-tests were used to compare variables between groups. The Poisson regression model was used to evaluate whether ABI was an independent predictor of stenoses > 50%. RESULTS: The prevalence of ABI < 0.9 was 9.8%. Patients with an ABI < 0.9 had a higher prevalence of stenoses ≥ 50% in the left anterior descendant (LAD) (68.7% vs. 36%, P = 0.02) and left main (8.7% vs. 0.6%, P < 0.001) than those with a normal ABI. On multivariate Poisson regression, an ABI < 0.9 was an independent predictor of stenosis ≥ 50% in the LAD (odds ratio (OR): 2.05 (1.39 - 3.04), P < 0.001). CONCLUSIONS: Patients with an ABI < 0.9 had a higher prevalence of stenoses ≥ 50% in the LAD and left main than those with a normal ABI. An abnormal ABI was an independent predictor of lesions ≥ 50% in LAD.

Estudo dos mediadores inflamatórios e de coagulação na epidemia 2013 pelo DENV-4 / Evaluation of inflammatory and coagulation mediators in 2013 dengue virus type 4 outbreak

A dengue se tornou a arbovirose mais difundida no mundo, atingindo mais de 100 países. O sorotipo DENV-4 foi reintroduzido no Brasil em 2010, se espalhou para as diferentes regiões brasileiras sendo responsável por uma das maiores epidemias de dengue relatadas no país em 2013. O objetivo deste estudo foi avaliar o perfilclínico-laboratorial, citocinas/quimiocinas inflamatórias e mediadores da coagulação em pacientes infectados pelo DENV durante esta epidemia. Para isto, foram avaliados 265 casos confirmados de dengue atendidos nos centros de saúde dos estados do RJ e MS no ano de 2013. Os pacientes foram classificados de acordo com a nova classificação da OMS, 2009 nos grupos: 158 (70,2 por cento) dengue sem sinais de alarme (DSSA), 65 (28,9 por cento) dengue com sinais de alarme (DCSA) e 2 (0,9 por cento)dengue grave. Os sinais de alarme mais frequentes foram dor abdominal persistente(61,5 por cento) e sangramento de mucosas (32,3 por cento). O DENV-4 foi o sorotipo de maior incidência e 85,2 por cento dos pacientes apresentaram infecção secundária. Pacientes DCSA/DG apresentaram baixa contagem de leucócitos totais, de plaquetas e altos níveis séricos de AST/TGO e ALT/TGP quando comparados aos pacientes DSSA e aqueles ODF (outras doenças febris). A quantificação dos mediadores inflamatórios por ensaios imunoenzimáticos indicou: (i) níveis aumentados de citocinas (TNF-alfa, IL-6 e IL-10) e quimiocinas (IL-8/CXCL8, IP-10/CXCL10 e MCP-1/CCL2) nos pacientes DSSA e DCSA/DG quando comparados com o grupo controle; (ii) níveis aumentados de IL-10 e IL-6 nos pacientes DCSA/DG enquanto que IL-8/CXCL8 foimaior nos pacientes DSSA...

Dengue has become the most widespread arbovirus in the world, reaching more than100 countries. The DENV-4 serotype was reintroduced in Brazil in 2010, and spreadto the different Brazilian regions being responsible for one of the largest epidemics ofdengue reported in the country in 2013. The objective of this study was to evaluatethe clinical and laboratory profile, and inflammatory cytokines/chemokines andcoagulation mediators in patients infected with DENV during this epidemic. For this,were evaluated 265 confirmed cases of dengue attended at health centers in thestates of RJ and MS in the year 2013. Patients were classified according to the newWHO classification, 2009 in groups: 158 (70.2 percent) dengue without warning signs(DwoWS), 65 (28.9 percent) dengue with warning signs (DwWS) and 2 (0.9 percent) severedengue (SD). The most frequent warning signals were persistent abdominal pain(61.5 percent) and mucosal bleeding (32.3 percent). The DENV-4 was the most prevalentserotype and 85,2 percent of dengue patients showed secondary infection. DwWS/SDpatients showed lower white blood cell and platelet counts, and higher AST and ALTserum levels compared to DwoWS and other febrile illnesses patients. Quantificationof inflammatory mediators by immunoassays indicated: (i) increased levels ofcytokines (TNF-alpha, IL-6 and IL-10) and chemokines (IL-8/CXCL8, IP-10/CXCL10 andMCP-1/CCL2) in DwoWS and DwWS patients compared with healthy individuals; (ii)increased levels of IL-10 and IL-6 in DwWS/SD patients while IL-8/CXCL8 wasincreased in DSSA patients; In respect to coagulation parameters: (iii) DwoWS andDwWS/SD patients showed lower levels of sTF and higher of TFPI compared withthe control group; (iv) Lower levels of fibrinogen were found in DwWS/SD patientsand higher levels of thrombomodulin in patients between 4-7 days of illness...

Relação entre índice tornozelo-braquial e doença aterosclerótica carotídea / Association between ankle-brachial index and carotid atherosclerotic disease

FUNDAMENTO: A associação do índice tornozelo-braquial (ITB) com a medida do complexo médio intimal das artérias carótidas (MCMI) não está amplamente estudada. OBJETIVO: Objetivamos avaliar se pacientes com ITB < 0,9 apresentam maior prevalência de placa aterosclerótica carotídea do que aqueles com ITB > 0,9. MÉTODOS: No período de janeiro a dezembro de 2011, recrutamos 118 pacientes (48 homens e 70 mulheres) que tiveram seus ITB e MCMI mensurados. Os pacientes foram divididos em grupo 1 (ITB < 0,9) e grupo 2 (ITB > 0,9). Utilizamos os testes de Mann-Whitney, qui-quadrado e Fischer para comparações entre os grupos. Para avaliar correlação entre ITB e MCMI empregamos a correlação de Pearson. RESULTADOS: A prevalência de ITB < 0,9 foi 29,7%, enquanto a da MCMI > 1,5 mm de 34,7%. Não houve diferença de características clínicas entre os grupos 1 e 2: idade média (64 ± 9 vs. 62 ± 7,2 anos, p = 0,1), homens (40% vs. 41%, p = 0,9), hipertensão (74% vs. 59%, p = 0,1), diabetes melito (54% vs. 35%, p = 0,051), dislipidemia 26% vs. 24%, p = 0,8), tabagismo (57% vs. 65%, p = 0,4). A prevalência de placa carotídea foi maior no grupo 1 (48,6% vs. 28,9%, p = 0,04). A correlação de Pearson entre o ITB e a MCMI foi de - 0,235, com valor de p = 0,01. CONCLUSÕES: Pacientes com ITB < 0,9 apresentaram maior prevalência de aterosclerose carotídea. Houve correlação negativa entre o ITB e a MCMI.

BACKGROUND: The association between the ankle brachial index (ABI) and the measurement of intimal medial thickness (IMT) has not been fully studied. OBJECTIVE: We aimed to evaluate whether the prevalence of carotid atherosclerosis was higher in patients with ABI < 0.9 than in those with ABI > 0.9. METHODS: From January 2011 to December 2011, 118 patients (48 men and 70 women) were enrolled. ABI and IMT Measurements were performed in all patients. Patients were divided in Group 1 (ABI < 0.9) and Group 2 (ABI > 0.9) according to ABI values. Mann-Whitney, Chi-square and Fischer tests were used for comparison among the groups. Pearson's correlation was used to assess correlation between ABI and IMT. RESULTS: The prevalence of ABI < 0.9 was 29.7%, whereas carotid atherosclerosis > 1.5 mm was 34.7 %. Clinical characteristics were similar between groups 1 and 2: mean age (64 ± 9 vs. 62 ± 7.2 years, p = 0.1), male gender (40% vs. 41%, p = 0.9), hypertension (74% vs. 59%, p = 0.1), diabetes mellitus (54% vs. 35%, p = 0.051), dyslipidemia (26% vs. 24%, p = 0.8), smoking (57% vs. 65%, p = 0.4). The prevalence of carotid atherosclerosis was higher in group 1 (48.6% vs. 28.9%, p = 0.04). Pearson's correlation between ABI and IMT was -0.235, with a p value = 0.01. CONCLUSION: Patients with ABI < 0.9 showed a higher prevalence of carotid atherosclerosis. There was a negative correlation between ABI and IMT.