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INTRODUCTION: New approaches to the study of the binge-watching phenomenon require new technology, leading to the development of a non-intrusive and low-cost analytical research software that facilitates a holistic understanding of binge-watching in an uncontrolled environment remotely (e.g., the home). BWDAT was developed to allow the collection of three types of data: users' physiological data gathered from a smartwatch, users' interactions from video-on-demand interfaces, and self-reported data. This tool offers the possibility to generate automatic data analysis reports, facilitating researchers' data analysis tasks. METHODS: Two trial studies and a long-term study were used to evaluate the design and the technical implementation of the BWDAT tool. The metrics used were the BWDAT smartwatch's App data coverage of the viewing sessions, and the data's reliability of the viewer's interactions with the Netflix interface, collected by the BWDAT Chrome Extension. RESULTS: High percentages of data coverage and content coverage were verified in the sessions collecting the smartwatch's data. The reporting system developed proved to be useful in the collection and synchronization of physiological and users' interaction data with Netflix interface, both generated in uncontrolled environments. Furthermore, the BWDAT tool facilitated the analysis of a large amount of nuanced data. CONCLUSION: The results obtained confirm the reliability, accuracy, and usability of BWDAT. This tool has the potential to help researchers shed new light on the field of media and audience studies, and in particular on binge-watching.
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BACKGROUND: Iron-deficiency anemia is the most common type of nutritional disorder. New strategies for the treatment of anemia are very important for its reduction. The aim of this study was to assess the efficacy and feasibility of cyclical iron supplementation as a strategy to reduce the prevalence of anemia among preschoolers. METHODS: A randomized controlled trial was performed in the entire population of under five-year-old children who attended government daycare centers in a small town in the State of Sao Paulo, Brazil. The children were randomly allocated into two intervention groups: the Weekly and Cyclical Groups. During a ten-month period, the Weekly Group (n = 51) received weekly doses of 30 mg elemental iron (40 doses) and the Cyclical Group (n = 48) received two cycles of 20 daily doses of 30 mg elemental iron separated by a four-month period (40 doses). RESULTS: Overall, at the end of ten months, the prevalence of anemia of the children on both supplementation regimens showed a significant decrease from 20.20% to 5.05% (p-value < 0.0005). There was no significant difference in the anemia between the two groups (p-value = 0.35). The mean hemoglobin concentration increased by 0.27 g/dL (p-value < 0.016) and 0.47 g/dL (p-value < 0.0005) in the Weekly and Cyclical Groups, respectively; again there was no significant difference between groups (p-value = 0.17). However, the cyclical regimen was easier to manage. CONCLUSIONS: Both supplementation regimens significantly reduced the prevalence of anemia however administration of the Cyclical Group was easier to carry out and control. CLINICAL TRIAL REGISTRATION NUMBER: NCT00992823.
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Anemia Ferropénica/dietoterapia , Suplementos Dietéticos , Esquema de Medicación , Hierro/administración & dosificación , Anemia Ferropénica/prevención & control , Brasil , Preescolar , Femenino , Ferritinas/sangre , Humanos , Lactante , Deficiencias de Hierro , Masculino , Resultado del TratamientoRESUMEN
FUNDAMENTO: A Hipertensão Arterial Sistêmica (HAS) é importante causa de Insuficiência Cardíaca sistólica Crônica (ICC) em países em desenvolvimento. Seria necessário conhecerem-se os fatores de predição de mortalidade para pacientes com essa condição clínica para melhor tratamento científico. OBJETIVO: Determinar os fatores de risco de mortalidade geral em pacientes com ICC secundária à HAS na era moderna do tratamento da ICC por disfunção sistólica do ventrículo esquerdo. MÉTODOS: Todos os pacientes rotineira e prospectivamente tratados na Clínica de Cardiomiopatia em nossa instituição de janeiro de 2000 a abril de 2008 com o diagnóstico de ICC secundária à HAS foram selecionados para o estudo. O modelo de riscos proporcionais de Cox foi utilizado para o estabelecimento de fatores de predição independentes de mortalidade geral. RESULTADOS: Cento e trinta pacientes foram estudados; 74 (57 por cento) eram homens. Trinta e um (24 por cento) pacientes faleceram; cinco (4 por cento) submeteram-se a transplante cardíaco; e 94 (72 por cento) estavam vivos ao final do estudo. A probabilidade de sobrevivência aos 12, 24, 36, 48 e 60 meses foi de 96 por cento, 93 por cento, 84 por cento, 79 por cento e 76 por cento, respectivamente. Idade (Razão de Riscos = 1,05, Intervalo de Confiança 95 por cento de 1,01 a 1,08, p = 0,01), dimensão diastólica do ventrículo esquerdo (Razão de Riscos = 1,08; Intervalo de Confiança 95 por cento de 1,02 a 1,09; p = 0,003) e terapia com betabloqueador (Razão de Riscos = 0,41; Intervalo de Confiança 95 por cento de 0,19 a 0,86; p = 0,02) foram os fatores de predição independentes de mortalidade geral. CONCLUSÃO: Idade, dimensão diastólica do ventrículo esquerdo e não uso de betabloqueador são fatores de predição independentes de mortalidade geral em pacientes com ICC sistólica secundária à HAS na população estudada.
BACKGROUND: Systemic arterial hypertension (SAH) is an important cause of chronic systolic heart failure (CHF) in underdeveloped countries. It would be desirable to know predictors of mortality for patients with this condition in order to provide proper scientific treatment. OBJECTIVE: To determine risk factors for all-cause mortality in patients with CHF secondary to SAH in the current era of heart failure therapy for left ventricular systolic dysfunction. METHODS: All patients routinely and prospectively followed at the Cardiomyopathy Clinic of our Institution from January, 2000 to April, 2008 with the diagnosis of CHF secondary to SAH were screened for the study. Cox proportional hazards model was used to establish independent predictors of all-cause mortality. RESULTS: One hundred thirty patients were included; 74 (57 percent) were male. Thirty one (24 percent) patients died, 5 (4 percent) underwent heart transplantation, and 94 (72 percent) were alive at study end. Survival probability at 12, 24, 36, 48, and 60 months was 96 percent, 93 percent, 84 percent, 79 percent, and 76 percent, respectively. Age (Hazard Ratio=1,05, 95 percent Confidence Interval 95 percent 1,01 to 1,08, p value=0,01), left ventricular diastolic dimension (Hazard Ratio=1,08; 95 percent Confidence Interval 1,02 to 1,09; p value=0,003), and B-Blocker therapy (Hazard Ratio=0,41; 95 percent Confidence Interval 0,19 to 0,86; p value=0,02) were found to be independent predictors of mortality. CONCLUSION: Age, left ventricular diastolic dimension and underuse of Beta-Blocker therapy were independent predictors of mortality for patients with CHF secondary to SAH in the population studied.
BUNDAMENTO: La Hipertensión Arterial Sistémica (HAS) es importante causa de Insuficiencia Cardíaca sistólica Crónica (ICC) en países en desarrollo. Sería necesario conocer los factores de predicción de mortalidad para pacientes con esa condición clínica para mejor tratamiento científico. OBJETIVO: Determinar los factores de riesgo de mortalidad general en pacientes con ICC secundaria a la HAS en la era moderna del tratamiento de la ICC por disfunción sistólica del ventrículo izquierdo MÉTODOS: Todos los pacientes rutinaria y prospectivamente tratados en la Clínica de Cardiomiopatía en nuestra institución de enero de 2000 a abril de 2008 con diagnóstico de ICC secundaria a la HAS fueron seleccionados para el estudio. El modelo de riesgos proporcionales de Cox fue utilizado para el establecimiento de factores de predicción independientes de mortalidad general. RESULTADOS: Ciento treinta pacientes fueron estudiados; 74 (57 por ciento) eran hombres. Treinta y un (24 por ciento) pacientes fallecieron; cinco (4 por ciento) se sometieron a transplante cardíaco; y 94 (72 por ciento) estaban vivos al final del estudio. La probabilidad de supervivencia a los 12, 24, 36, 48 y 60 meses fue de 96 por ciento, 93 por ciento, 84 por ciento, 79 por ciento y 76 por ciento, respectivamente. Edad (Razón de Riesgos = 1,05, Intervalo de Confianza 95 por ciento de 1,01 a 1,08, p = 0,01), dimensión diastólica del ventrículo izquierdo (Razón de Riesgos = 1,08; Intervalo de Confianza 95 por ciento de 1,02 a 1,09; p = 0,003) y terapia con betabloqueante (Razón de Riesgos = 0,41; Intervalo de Confianza 95 por ciento de 0,19 a 0,86; p = 0,02) fueron los factores de predicción independientes de mortalidad general. CONCLUSIÓN: Edad, dimensión diastólica del ventrículo izquierdo y no uso de betabloqueante son factores de predicción independientes de mortalidad general en pacientes con ICC sistólica secundaria a la HAS en la población estudiada.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Insuficiencia Cardíaca Sistólica/mortalidad , Hipertensión/complicaciones , Factores de Edad , Causas de Muerte , Enfermedad Crónica , Métodos Epidemiológicos , Insuficiencia Cardíaca Sistólica/etiología , Insuficiencia Cardíaca Sistólica/patología , Ventrículos Cardíacos/patología , PronósticoRESUMEN
BACKGROUND: Systemic arterial hypertension (SAH) is an important cause of chronic systolic heart failure (CHF) in underdeveloped countries. It would be desirable to know predictors of mortality for patients with this condition in order to provide proper scientific treatment. OBJECTIVE: To determine risk factors for all-cause mortality in patients with CHF secondary to SAH in the current era of heart failure therapy for left ventricular systolic dysfunction. METHODS: All patients routinely and prospectively followed at the Cardiomyopathy Clinic of our Institution from January, 2000 to April, 2008 with the diagnosis of CHF secondary to SAH were screened for the study. Cox proportional hazards model was used to establish independent predictors of all-cause mortality. RESULTS: One hundred thirty patients were included; 74 (57%) were male. Thirty one (24%) patients died, 5 (4%) underwent heart transplantation, and 94 (72%) were alive at study end. Survival probability at 12, 24, 36, 48, and 60 months was 96%, 93%, 84%, 79%, and 76%, respectively. Age (Hazard Ratio=1,05, 95% Confidence Interval 95% 1,01 to 1,08, p value=0,01), left ventricular diastolic dimension (Hazard Ratio=1,08; 95% Confidence Interval 1,02 to 1,09; p value=0,003), and B-Blocker therapy (Hazard Ratio=0,41; 95% Confidence Interval 0,19 to 0,86; p value=0,02) were found to be independent predictors of mortality. CONCLUSION: Age, left ventricular diastolic dimension and underuse of Beta-Blocker therapy were independent predictors of mortality for patients with CHF secondary to SAH in the population studied.
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Insuficiencia Cardíaca Sistólica/mortalidad , Hipertensión/complicaciones , Factores de Edad , Causas de Muerte , Enfermedad Crónica , Métodos Epidemiológicos , Femenino , Insuficiencia Cardíaca Sistólica/etiología , Insuficiencia Cardíaca Sistólica/patología , Ventrículos Cardíacos/patología , Humanos , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
BACKGROUND: Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. However, these patients frequently die as a consequence of primary or secondary multiple organ failure (MOF), often as a result of sepsis. We investigated the early perioperative risk factors for in-hospital death due to MOF in surgical patients. METHODS: This was a prospective, multicenter, observational cohort study performed in 21 Brazilian intensive care units (ICUs). Adult patients undergoing noncardiac surgery who were admitted to the ICU within 24 hours after operation were evaluated. MOF was characterized by the presence of at least 2 organ failures. To determine the relative risk (RR) of in-hospital death due to MOF, we performed a logistic regression multivariate analysis. RESULTS: A total of 587 patients were included (mean age, 62.4 ± 17 years). ICU and hospital mortality rates were 15% and 20.6%, respectively. The main cause of death was MOF (53%). Peritonitis (RR 4.17, 95% confidence interval [CI] 1.38-12.6), diabetes (RR 3.63, 95% CI 1.17-11.2), unplanned surgery (RR 3.62, 95% CI 1.18-11.0), age (RR 1.04, 95% CI 1 0.01-1.08), and elevated serum lactate concentrations (RR 1.52, 95% CI 1.14-2.02), a high central venous pressure (RR 1.12, 95% CI 1.04-1.22), a fast heart rate (RR 3.63, 95% CI 1.17-11.2) and pH (RR 0.04, 95% CI 0.0005-0.38) on the day of admission were independent predictors of death due to MOF. CONCLUSIONS: MOF is the main cause of death after surgery in high-risk patients. Awareness of the risk factors for death due to MOF may be important in risk stratification and can suggest routes for therapy.
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Causas de Muerte/tendencias , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/mortalidad , Complicaciones Posoperatorias/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: A few studies have shown a beneficial effect of B-Blocker therapy on cardiac function and functional status in patients with chronic heart failure secondary to Chagas' cardiomyopathy. METHODS: The medical charts of patients routinely followed from January, 2000 to January, 2007 were reviewed to collect clinical, standard laboratory tests, 12-lead electrocardiogram, chest X-Ray, and Doppler echochardiogram variables. A Cox proportional hazards model was used to establish independent predictors of all-cause mortality for patients with Chagas' cardiomyopathy with chronic heart failure. RESULTS: A total of 231 consecutive patients were enrolled in the study. Median follow up was 19 (7, 46) months. Twenty (9%) patients underwent heart transplantation and 120 (52%) died during the investigation. Left ventricular systolic dimension (hazard ratio=1.04; 95% confidence interval=1.02 to 1.06; p<0.005) and need of inotropic support (hazard ratio=1.80; 95% confidence interval 1.2 to 2.60; p=0,03), were positively associated, whereas B-Blocker therapy (HR=0.34; 95% confidence interval 0.23 to 0.51; p<0.0005) was negatively associated with mortality. Mortality was significantly lower in patients taking in comparison to those not taking B-Blockers. Patients taking a mean daily dose of carvedilol>or=to 9.375mg had a marked decrease in mortality in comparison to those not on carvedilol therapy. CONCLUSION: B-Blockers are effective, not detrimental, and may improve survival in Chagas' disease patients with chronic heart failure. A randomized trial is necessary to confirm these findings.
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Antagonistas Adrenérgicos beta/uso terapéutico , Cardiomiopatía Chagásica/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Cardiomiopatía Chagásica/complicaciones , Cardiomiopatía Chagásica/diagnóstico , Ecocardiografía Doppler , Electrocardiografía , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
We describe the epidemiology of malaria in a frontier agricultural settlement in Brazilian Amazonia. We analysed the incidence of slide-confirmed symptomatic infections diagnosed between 2001 and 2006 in a cohort of 531 individuals (2281.53 person-years of follow-up) and parasite prevalence data derived from four cross-sectional surveys. Overall, the incidence rates of Plasmodium vivax and P. falciparum were 20.6/100 and 6.8/100 person-years at risk, respectively, with a marked decline in the incidence of both species (81.4 and 56.8%, respectively) observed between 2001 and 2006. PCR revealed 5.4-fold more infections than conventional microscopy in population-wide cross-sectional surveys carried out between 2004 and 2006 (average prevalence, 11.3 vs. 2.0%). Only 27.2% of PCR-positive (but 73.3% of slide-positive) individuals had symptoms when enrolled, indicating that asymptomatic carriage of low-grade parasitaemias is a common phenomenon in frontier settlements. A circular cluster comprising 22.3% of the households, all situated in the area of most recent occupation, comprised 69.1% of all malaria infections diagnosed during the follow-up, with malaria incidence decreasing exponentially with distance from the cluster centre. By targeting one-quarter of the households, with selective indoor spraying or other house-protection measures, malaria incidence could be reduced by more than two-thirds in this community.
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Malaria Falciparum/epidemiología , Malaria Vivax/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Métodos Epidemiológicos , Femenino , Humanos , Lactante , Recién Nacido , Malaria Falciparum/prevención & control , Malaria Vivax/prevención & control , Masculino , Persona de Mediana Edad , Plasmodium falciparum/aislamiento & purificación , Plasmodium vivax/aislamiento & purificación , Reacción en Cadena de la Polimerasa , Salud Rural , Adulto JovenRESUMEN
BACKGROUND: The role of Chagas' etiology of chronic heart failure in predicting patient outcomes while awaiting heart transplantation is unknown. Accordingly, in this study we compare outcomes in Chagas' disease with non-Chagas'-disease-related advanced heart failure among patients on the waiting list for heart transplantation. METHODS: We reviewed the clinical outcomes of 103 consecutive patients with chronic heart failure listed for heart transplantation from August 2000 to January 2008 at a single institution. Forty-six (44%) patients were diagnosed with Chagas' disease on the basis of positive serology. A Cox proportional hazards model was used to establish independent predictors of mortality, whereas competing risk analysis was used to estimate time-related prevalence of death and heart transplantation in Chagas' disease and non-Chagas' disease patients. RESULTS: In the multivariate model, inotropic support (p < 0.0005; hazard ratio = 5.96; 95% confidence interval [CI] 2.41 to 14.71) and Chagas' disease etiology of heart failure (p = 0.02; hazard ratio = 2.27; 95% CI 1.14 to 4.52) were retained as independent predictors of mortality. Prevalence of death at 100 days after listing was 30% in Chagas' disease and 16% in non-Chagas' disease patients (p = 0.02), despite no difference in the competing rates of transplantation (30% in Chagas' and 37% in non-Chagas' patients, p = 0.5). CONCLUSIONS: Chagas' disease etiology serves as an independent predictor of mortality in patients listed for heart transplantation, with a worse outcome when compared with non-Chagas' disease patients.
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Enfermedad de Chagas/complicaciones , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/mortalidad , Trasplante de Corazón , Listas de Espera , Adulto , Enfermedad Crónica , Femenino , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Modelos de Riesgos Proporcionales , Estudios RetrospectivosRESUMEN
BACKGROUND: The main adverse effect of polymyxin B is nephrotoxicity. There are few data on polymyxin-associated renal injury. OBJECTIVE: To assess the prevalence of and risk factors for acute kidney injury (AKI) in patients treated with polymyxin B. METHODS: The studied population included 114 patients who received at least 3 consecutive days of intravenous polymyxin B and had baseline serum creatinine (SCr) and at least one further SCr measurement during treatment. AKI was defined as an SCr increase to 1.8 mg/dL or greater in patients with baseline SCr less than 1.5 mg/dL, or an increase greater than or equal to 50% in baseline SCr when it was already greater than or equal to 1.5 mg/dL, or need for dialysis. RESULTS: AKI developed in 22% of the patients. They were older, had a higher baseline SCr, had a higher frequency of baseline SCr greater than or equal to 1.5 mg/dL, used other nephrotoxic drugs and furosemide more often, and required vasoactive drugs and mechanical ventilation more frequently. Progression to renal failure was significantly more probable when the bacteria were isolated in the abdomen, catheter, or blood. AKI patients had a higher mortality rate (92% vs 53%; p < 0.001). Logistic regression identified abnormal baseline SCr (odds ratio [OR] 3.51); need for vasoactive drugs (OR 3.03); and abdomen, blood, or catheter as the infection site (OR 3.82) as independent risk factors for AKI. CONCLUSIONS: Patients who developed AKI had a strikingly elevated mortality rate. Polymyxin B should be used with extreme caution in patients who have an abnormal baseline SCr; use vasoactive drugs; or have abdomen, blood, or catheter as the infection site.
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Antibacterianos/efectos adversos , Enfermedades Renales/inducido químicamente , Polimixina B/efectos adversos , Enfermedad Aguda , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/fisiopatología , Creatinina/sangre , Progresión de la Enfermedad , Femenino , Humanos , Infusiones Intravenosas , Enfermedades Renales/etiología , Enfermedades Renales/mortalidad , Modelos Logísticos , Masculino , Persona de Mediana Edad , Polimixina B/uso terapéutico , Prevalencia , Respiración Artificial/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Vasoconstrictores/efectos adversos , Vasoconstrictores/uso terapéutico , Adulto JovenRESUMEN
OBJECTIVES: Hypertension is a highly prevalent disease worldwide, constituting one of the main risk factors for cardiovascular morbidity and mortality. The aims of this study were to evaluate the level of awareness and control of hypertension comparing sex, socioeconomic and educational level, BMI and drug therapy in over 40-year-old patients. The cost-effectiveness of the main pharmacologic classes of antihypertensives, as monotherapy and combination therapy, was also assessed. METHODS: In this randomized and cross-sectional populational study, a sample of 738 hypertensive adults with ages at least 40 years were evaluated. Of these, 345 (46.7%) were men and 393 (53.3%) were women. RESULTS: A total of 72.9% of the hypertensives knew about their disease. Women in the 40-49 and 50-59 age groups and obese individuals had a higher rate of awareness of their hypertensive status. The rates of awareness were similar in different social classes and educational levels, however, blood pressure control varied. beta-Blockers were the most effective drugs to control blood pressure with no differences being observed between monotherapy and combinations. Diuretics were the most cost-effective. CONCLUSION: Approximately half of the participants received monotherapy. The best percentage of control with monotherapy was obtained with beta-blockers but the diuretics treatment was the most cost-effective. The levels of awareness and control were high compared with developed countries, most evident in the higher social classes and higher education levels.
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Antihipertensivos/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Hipertensión/psicología , Adulto , Anciano , Antihipertensivos/economía , Concienciación , Brasil , Análisis Costo-Beneficio , Estudios Transversales , Femenino , Humanos , Hipertensión/prevención & control , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Población UrbanaRESUMEN
This study sought to determine independent predictors of all-cause mortality for patients with Chagas' disease heart failure listed for heart transplantation. Need of inotropic support (p=0.01; hazard ratio=14.68, 95% Confidence Interval 1.86 to 115.82) and the Transpulmonary Gradient (p=0.02; HR=1.15, 95% Confidence Interval 1.03 to 1.30) were established independent predictors of all-cause mortality.
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Cardiomiopatía Chagásica/mortalidad , Cardiomiopatía Chagásica/cirugía , Trasplante de Corazón/estadística & datos numéricos , Listas de Espera , Adulto , Brasil/epidemiología , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Modelos de Riesgos ProporcionalesAsunto(s)
Cardiomiopatía Chagásica/mortalidad , Muerte Súbita Cardíaca/epidemiología , Desfibriladores Implantables/estadística & datos numéricos , Medición de Riesgo/métodos , Taquicardia Ventricular/mortalidad , Taquicardia Ventricular/prevención & control , Brasil/epidemiología , Enfermedad Crónica , Comorbilidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Análisis de Supervivencia , Tasa de SupervivenciaRESUMEN
BACKGROUND AND AIMS: We sought to identify predictors of all-cause mortality for Chagas' disease patients with chronic systolic heart failure because they are virtually lacking in the current era of heart failure therapy. METHODS AND RESULTS: This study focus on 127 patients with the diagnosis of chronic systolic heart failure secondary to Chagas' cardiomyopathy. Mean follow up was 25+/-19 months. Sixty-three (50%) patients died during the study period. Cox regression analysis showed lack of B-blocking agent use (p=0.002, hazard ratio=0.30, 95% Confidence Interval 0.14 to 0.64), serum sodium levels (p=0.01, hazard ratio=0.93, 95% Confidence Interval 0.87 to 0.98), left ventricular ejection fraction (p=0.02, hazard ratio=0.96, 95% Confidence Interval 0.93 to 0.99), digoxin treatment (p=0.04, hazard ratio=8.47, 95% Confidence Interval 1.13 to 62.52) and New York Heart Association Class IV on admission (p=0.034, hazard ratio=1.92, 95% Confidence Interval 1.02 to 3.51) independent predictors of all-cause mortality. CONCLUSION: Lack of B-blocking agent use, serum sodium levels, left ventricular ejection fraction, digoxin treatment and New York Heart Association Class IV are independent predictors of all-cause mortality for patients with chronic heart failure secondary to Chagas' cardiomyopathy in the current era of heart failure therapy.
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Cardiomiopatía Chagásica/mortalidad , Insuficiencia Cardíaca Sistólica/mortalidad , Insuficiencia Cardíaca Sistólica/parasitología , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Cardiotónicos/uso terapéutico , Causas de Muerte , Cardiomiopatía Chagásica/fisiopatología , Enfermedad Crónica , Digoxina/uso terapéutico , Femenino , Insuficiencia Cardíaca Sistólica/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Curva ROC , Análisis de Regresión , Factores de Riesgo , Sodio/sangre , Volumen Sistólico , Análisis de SupervivenciaRESUMEN
We sought to determine clinical characteristics as well as outcome of angina-free patients with chronic ischemic heart failure. In comparison with ischemic chest pain patients, angina-free patients have higher heart rate and systolic blood pressure on admission, lower number of diseased coronary artery vessels at coronary arteriogram and higher survival probability. Thus, angina-free patients with ischemic heart failure have a distinctive clinical picture and a better outcome than ischemic chest pain patients with chronic heart failure.
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Isquemia Miocárdica/fisiopatología , Angina de Pecho/fisiopatología , Dolor en el Pecho/fisiopatología , Distribución de Chi-Cuadrado , Enfermedad Crónica , Frecuencia Cardíaca/fisiología , Humanos , Pronóstico , Estadísticas no Paramétricas , Tasa de Supervivencia , SístoleRESUMEN
We studied the clinical course of 44 cardiac transplant recipients at our institution according to socioeconomic status (socioeconomic class level, educational level, household family income, dwelling, presence of caregiver, and national health insurance) before the procedure. Patients in the low socioeconomic status had a prognosis similar to that seen in patients in the median socioeconomic status. Thus, low socioeconomic status has no unfavorable impact on outcome of cardiac transplant recipients in Brazil.
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Cardiomiopatía Chagásica/cirugía , Trasplante de Corazón , Renta , Clase Social , Adulto , Brasil , Estudios de Casos y Controles , Escolaridad , Femenino , Humanos , Seguro de Salud , Masculino , Pronóstico , Estudios Prospectivos , Factores Socioeconómicos , Resultado del TratamientoRESUMEN
BACKGROUND: Implantable Cardioverter Defibrillators (ICD) have sporadically been used in the treatment of either Sustained Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF) in Chagas' disease patients. This study aimed at determining predictors of all-cause mortality for Chagas' disease patients receiving ICD therapy. METHODS AND RESULTS: Ninety consecutive patients were entered the study. Mean left ventricular ejection fraction was 47 +/- 13%. Twenty-five (28%) patients had no left ventricular systolic dysfunction. After device implantation, all patients were given amiodarone (mean daily dose = 331, 1 +/- 153,3 mg), whereas a B-Blocking agent was given to 37 (40%) out of 90 patients. RESULTS: A total of 4,274 arrhythmias were observed on stored electrogram in 64 (71%) out of 90 patients during the study period; SVT was observed in 45 out of 64 (70%) patients, and VF in 19 (30%) out of 64 patients. Twenty-six (29%) out of 90 patients had no arrhythmia. Fifty-eight (64%) out of 90 patients received appropriate shock, whereas Antitachycardia Pacing was delivered to 58 (64%) out of 90 patients. There were 31 (34%) deaths during the study period. Five patients were lost to follow up. Sudden cardiac death affected 2 (7%) out of 26 patients, whereas pump failure death was detected in the remaining 24 (93%) patients. Number of shocks per patient per 30 days was the only independent predictor of mortality. CONCLUSION: Number of shocks per patient per 30 days predicts outcome in Chagas' disease patients treated with ICD.
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Cardiomiopatía Chagásica/mortalidad , Muerte Súbita Cardíaca/epidemiología , Desfibriladores Implantables/estadística & datos numéricos , Medición de Riesgo/métodos , Taquicardia Ventricular/mortalidad , Taquicardia Ventricular/prevención & control , Brasil/epidemiología , Enfermedad Crónica , Comorbilidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Análisis de Supervivencia , Tasa de SupervivenciaRESUMEN
Objetivo: Avaliar se a causa do óbito, tempo de conservação da córnea, idade do doador influenciaram a contagem de células endoteliais (CCE) em córneas viáveis para ceratoplastia penetrante com finalidade óptica. Métodos: Avaliação da CCE em 105, córneas com microscópio especular de Banco de Olhos em um hospital escola de janeiro de 2003 a janeiro 2004. A análise de regressão linear comparou a CCE em relação ao tempo de preservação da córnea após o óbito e a idade do doador. A análise de variância foi utilizada para avaliar a CCE com as diferentes causas do óbito. Resultados: A análise de regressão linear da CCE em função da idade do doador foi significante nos olhos direitos (p=0,002) e esquerdos (p=0,007). Conclusão: Entre os fatores analisados a idade do doador foi o único fator que se mostrou significativo para CCE.
Purpose: To evaluate whether the cause of death, cornea preservation time, and the age of the donor had an influence at the viable endothelial cell counting (ECC) for penetrating keratoplasty (PK) with optical purpose.Methods: The corneas were evaluated using an Eye Bank specular microscopy in a teaching hospital from January 2003 to January 2004. Linear regression analysis compared the ECC regarding the cornea preservation time after the donors death and age. Analysis of variance was used to evaluate the ECC compared with the different causes of death. Results: The linear regression analysis of the ECC in relation to the donors age was significant in the right eyes (p=0.002) as well as in the left eyes (p=0.007). Conclusions: Among the analyzed factors, the donors age was the only one that was significant to ECC.
Asunto(s)
Humanos , Causas de Muerte , Células Endoteliales/trasplante , Recuento de Células/métodos , Preservación de Órganos/métodosAsunto(s)
Cardiomiopatía Chagásica/cirugía , Trasplante de Corazón/inmunología , Inmunosupresores/uso terapéutico , Ácido Micofenólico/análogos & derivados , Animales , Cardiomiopatía Chagásica/etiología , Enfermedad de Chagas/complicaciones , Rechazo de Injerto/inmunología , Rechazo de Injerto/prevención & control , Corazón/parasitología , Humanos , Inmunosupresores/efectos adversos , Ácido Micofenólico/efectos adversos , Ácido Micofenólico/uso terapéutico , Trypanosoma cruzi/patogenicidadRESUMEN
Hypermethylation in the promoter region has been associated with a loss of gene function that may give a selective advantage to neoplastic cells. In this study, the methylation pattern of genes CDKN2A (alias p14, p14(ARF), p16, p16(INK4a)), DAPK1, CDH1, and ADAM23 was analyzed in 43 samples of head and neck tumors using methylation-specific polymerase chain reaction. In the oropharynx, there was a statistically significant association between hypermethylation of the DAPK1 gene and the occurrence of lymph node metastases, and in the larynx there was statistically significant evidence of an association between hypermethylation of the ADAM23 gene and advanced stages of the tumors. Thus, a correlation was observed between hypermethylation of the promoter region of genes DAPK1 and ADAM23 and the progression of head and neck cancer.
Asunto(s)
Proteínas ADAM/genética , Proteínas Reguladoras de la Apoptosis/genética , Cadherinas/genética , Proteínas Quinasas Dependientes de Calcio-Calmodulina/genética , Inhibidor p16 de la Quinasa Dependiente de Ciclina/genética , Metilación de ADN , Neoplasias de Cabeza y Cuello/genética , Anciano , Anciano de 80 o más Años , Antígenos CD , Línea Celular Tumoral , ADN de Neoplasias/genética , ADN de Neoplasias/metabolismo , Proteínas Quinasas Asociadas a Muerte Celular , Femenino , Células HCT116 , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa/métodos , Regiones Promotoras GenéticasRESUMEN
No previous study has examined the association of clinical variables and QTc interval dispersion in patients with Chagas-Hypertensive cardiomyopathy. Sixty-four patients with Chagas-Hypertensive cardiomyopathy were entered for the study. Seventy-one chronic Chagas' disease heart failure patients and 68 patients with Hypertensive cardiomyopathy heart failure were used in the comparison of QTc interval dispersion. The QTc interval dispersion was defined as the difference between maximum and minimum QTc. Median QTc interval dispersion was 75 (55) ms in patients with Chagas' cardiomyopathy, (56) 73 ms in patients with Hypertensive cardiomyopathy, and (87.3) 98 ms in patients with Chagas-Hypertensive cardiomyopathy (p>0.05). In patients with Chagas-Hypertensive cardiomyopathy, median QTc interval was (134) 100 ms in survivors and (87) 96 ms in nonsurvivors (p>0.05). Thus, QTc interval dispersion values in patients with Chagas-Hypertensive cardiomyopathy are not associated with mortality and similar to those found in patients with Chagas' cardiomyopathy and in patients with Hypertensive cardiomyopathy.