An Information Model on Pain Management: Cultural Validation and Refinement.

This study aimed to validate and refine an information model on pain management in a Brazilian hospital, considering the institutional culture, using an expert consensus approach. The first stage took place through a computerized questionnaire and Content Validity Index calculation. Pain management attributes were considered validated with 75% consensus among 19 experts. The second stage validated and refined the information model by three experts via an online meeting. Results showed that out of 11 evaluated attributes, five were validated. In the second stage, the inclusion of new attributes was suggested to address institutional culture. The final information model resulted from 23 sets of revised attributes: 12 validated, seven suggested and four not validated. The resulting Brazilian model has the potential to support the implementation of interventions and propose improvements to the institution's electronic system, which can be reused in other institutions.

Incidência e fatores associados a microrganismos multirresistentes entre adultos internados por COVID-19: coorte retrospectiva / Incidence and factors associated with multi-resistant microorganisms among adults hospitalized for COVID-19: retrospective cohort / Incidencia y factores asociados a microorganismos multiresistentes en adultos hospitalizados por COVID-19: cohorte retrospectivo

Objetivo: identificar a incidência e os fatores de risco para o Microrganismo Multirresistente (MDR) e comparar os cuidados de Enfermagem entre os pacientes com e sem MDR. Método: coorte retrospectivo de adultos com a COVID-19. Os dados foram fornecidos a partir de uma base de dados e coletados por meio do formulário do Google Forms. As variáveis demográficas e clínicas foram comparadas por meio de análise univariada. Os fatores associados à ocorrência de MDR foram verificados por Regressão de Cox. O estudo foi aprovado pelo Comitê de Ética e Pesquisa da instituição (CAAE: 57234822.5.0000.5327).Resultados: a média de idade dos 371 pacientes foi de 57,06 ± 14,3 anos, 51,2% eram homens. A incidência de MDR foi de 10,5%. Os fatores de risco para MDR foram a internação em Unidade de Terapia Intensiva (HR:14,0; IC95%: 1,8-18,6) e o uso de ventilação mecânica (HR:2,4; IC95%: 1,5-39,9). Apesar de 93,3% dos pacientes terem cuidados de Enfermagem prescritos, houve uma menor prescrição de medidas de precaução entre os pacientes com MDR.Conclusão:a incidência de MDR entre os pacientes com a COVID-19 ocorreu em cerca de um décimo dos pacientes e foi associada a uma maior gravidade clínica durante a hospitalização. Suscita-se uma maior adesão à prescrição dos cuidados de Enfermagem como modo de prevenir a ocorrência de MDR nessa amostra de pacientes. (AU)

Objective:To identify the incidence and risk factors for multidrug-resistant microorganism (MDR) and compare nursing care between patients with and without MDR. Method:Retrospective cohort of adults with COVID-19. Data were provided from a database and collected through GoogleForms. Demographic and clinical variables were compared using univariate analysis. Factors associated with the occurrence of MDR were verified by Cox regression. The study was approved by the Ethics and Research Committee of the institution (CAEE: 57234822.5.0000.5327). Results:The mean age of the 371 patients was 57.06 ± 14.3 years, 51.2% were men. The incidence of MDR was 10.5%. Risk factors for MDR were admission to the intensive care unit (HR:14.0;95%CI: 1.8-18.6) and use of mechanical ventilation (HR:2.4;95%CI: 1.5-39.9). Although 93.3% of patients had prescribed nursing care, there was less prescription of precautionary measures among patients with MDR. Conclusion:The incidence of MDR among patients with COVID-19 occurred in about one-tenth of patients and was associated with greater clinical severity during hospitalization. Greater adherence to the prescription of nursing care is suggested as a way to prevent the occurrence of MDR in this sample of patients. (AU)

Objetivo:identificar la incidencia y los factores de riesgo para el Microorganismo Multirresistente (MDR), y comparar los cuidados de enfermería entre pacientes con y sin MDR. Método:cohorte retrospectivo de adultos con COVID-19. Los datos se proporcionaron desde una base de datos y se recopilaron a través del formulario de Google Forms. Las variables demográficas y clínicas se compararon mediante análisis univariado. Los factores asociados con la ocurrencia de MDR fueron verificados por regresión de Cox. El estudio fue aprobado por el Comité de Ética e Investigación de la institución (CAEE: 57234822.5.0000.5327).Resultados: la edad media de los 371 pacientes fue de 57,06 ± 14,3 años,el 51,2% eran hombres. La incidencia de MDR fue del 10,5%. Los factores de riesgo para MDR fueron la admisión a la Unidad de Cuidados Intensivos (HR:14,0;95% IC: 1,8-18,6) y el uso de ventilación mecánica (HR:2,4;95% IC: 1,5-39,9). Aunque el 93,3% de los pacientes tenían prescritos cuidados de enfermería, hubo menos prescripción de medidas cautelares entre los pacientes con MDR. Conclusión:la incidencia de MDR entre pacientes con COVID-19 ocurrió en aproximadamente una décima parte de los pacientes y se asoció con una mayor gravedad clínica durante la hospitalización. Se sugiere una mayor adherencia a la prescripción de los cuidados de enfermería como forma de prevenir la ocurrencia de MDR en esta muestra de pacientes. (AU)

Validation of Two Pain Assessment Tools Using a Standardized Nociceptive Stimulation in Critically Ill Adults.

CONTEXT: The Behavioral Pain Scale (BPS) or the Critical-Care Pain Observation Tool (CPOT) are recommended in practice guidelines for pain assessment in critically ill adults unable to self-report. However, their use in another language requires cultural adaptation and validation testing. OBJECTIVES: Cross-cultural adaptation of the CPOT and BPS English versions into Brazilian Portuguese, and their validation by comparing behavioral scores during rest, standardized nociceptive stimulation by pressure algometry (SNSPA), and turning were completed. In addition, we explored clinical variables that could predict the CPOT and BPS scores. METHODS: A prospective cohort study was conducted with 168 medical-surgical critically ill adults unable to self-report in the intensive care unit. Two nurses were trained to use the CPOT and BPS Brazilian Portuguese versions at the following assessments: 1) baseline at rest, 2) after SNSPA with a pressure of 14 kgf/cm2, 3) during turning, and 4) 15 minutes after turning. RESULTS: Inter-rater reliability of nurses' CPOT and BPS scores was supported by high weighted kappa >0.7. Discriminative validation was supported with higher CPOT and BPS scores during SNSPA or turning in comparison to baseline (P < 0.001). The Glasgow Coma Scale score was the only variable that predicted CPOT and BPS scores with explained variance of 44.5% and 55.2%, respectively. CONCLUSION: The use of the Brazilian CPOT and BPS versions showed good reliability and validity in critically ill adults unable to self-report. A standardized procedure, the SNSPA, was used for the first time in the validation process of these tools and helped us improve the validation process.

Decompressive craniotomy for the treatment of malignant infarction of the middle cerebral artery: mortality and outcome.

OBJECTIVE: To assess, by Rankin scale, the functional disability of patients who had a malignant middle cerebral artery (MCA) ischemic stroke, who underwent decompressive craniotomy (DC) within the first 30 days. METHODS: A cross-sectional study in a University hospital. Between June 2007 and December 2014, we retrospectively analyzed the records of all patients submitted to DC due to a malignant MCA infarction. The mortality rate was defined during the hospitalization period. The modified outcome Rankin score (mRS) was measured 30 days after the procedure, for stratification of the quality of life. RESULTS: The DC mortality rate was 30% (95% CI 14.5 to 51.9) for the 20 patients reported. The mRS 30 days postoperatively was ≥ 4 [3.3 to 6] for all patients thereafter. CONCLUSION: DC is to be considered a real alternative for the treatment of patients with a malignant ischemic MCA infarction.

Decompressive craniotomy for the treatment of malignant infarction of the middle cerebral artery: mortality and outcome / Craniotomia descompressiva para tratamento do infarto maligno da artéria cerebral media: mortalidade e desfecho

ABSTRACT Objective To assess, by Rankin scale, the functional disability of patients who had a malignant middle cerebral artery (MCA) ischemic stroke, who underwent decompressive craniotomy (DC) within the first 30 days. Methods A cross-sectional study in a University hospital. Between June 2007 and December 2014, we retrospectively analyzed the records of all patients submitted to DC due to a malignant MCA infarction. The mortality rate was defined during the hospitalization period. The modified outcome Rankin score (mRS) was measured 30 days after the procedure, for stratification of the quality of life. Results The DC mortality rate was 30% (95% CI 14.5 to 51.9) for the 20 patients reported. The mRS 30 days postoperatively was ≥ 4 [3.3 to 6] for all patients thereafter. Conclusion DC is to be considered a real alternative for the treatment of patients with a malignant ischemic MCA infarction.

RESUMO Objetivo Avaliar a capacidade funcional de pacientes com acidente vascular cerebral isquêmico no território da artéria cerebral média (ACM) submetidos à craniotomia descompressiva (CD) no período de 30 dias pela escala de Rankin. Métodos Estudo transversal em um hospital universitário. Entre junho de 2007 e dezembro de 2014, analisados retrospectivamente os registros de todos os pacientes submetidos a CD devido a enfarte maligno na ACM. A taxa de mortalidade foi definida durante o período de internação. O resultado da estratificação da qualidade de vida foi através da escala Rankin modificado (mRS) mensurado em 30 dias após o procedimento. Resultados A taxa de mortalidade CD foi de 30% (IC 95% 14,5-51,9) para os 20 pacientes relatados. A mRS 30 dias de pós-operatório foi => 4 [3,3-6] para todos os pacientes. Conclusão CD deve ser considerada uma alternativa real para o tratamento de pacientes com enfarte isquêmico no território da ACM.

Conhecimento do enfermeiro sobre insuficiência cardíaca em hospital geral / Conocimiento del enfermero sobre insuficiencia cardiaca en hospital general / Nurses' knowledge on heart failure in general hospital

Objetivos: verificar entre os enfermeiros de dois hospitais gerais o conhecimento da síndrome de Insuficiência Cardíaca (IC) e os fatores que interferem nas orientações prestadas aos pacientes. Métodos: o conhecimento foi avaliado pelo Questionário de conhecimento para enfermeiros sobre IC (Q-CENIC), composto por 14 questões. Também foram realizados questionamentos relacionados à orientação, limitações para orientação, e auto avaliação sobre conhecimentos da IC. Resultados: foram avaliados 51 enfermeiros, destes 82,4% atingiram o percentual de 70% de acertos. Sintomas de IC avançada e uso de sildenafil foram questões que tiveram percentuais menores de acertos. Mais de 70% (n=40) dos enfermeiros orienta os pacientes sobre IC e autocuidado. O fator que mais interfere Objetivos: verificar entre os enfermeiros de dois hospitais gerais o conhecimento da síndrome de Insuficiência Cardíaca (IC) e os fatores que interferem nas orientações prestadas aos pacientes. Métodos: o conhecimento foi avaliado pelo Questionário de conhecimento para enfermeiros sobre IC (Q-CENIC), composto por 14 questões. Também foram realizados questionamentos relacionados à orientação, limitações para orientação, e auto avaliação sobre conhecimentos da IC. Resultados: foram avaliados 51 enfermeiros, destes 82,4% atingiram o percentual de 70% de acertos. Sintomas de IC avançada e uso de sildenafil foram questões que tiveram percentuais menores de acertos. Mais de 70% (n=40) dos enfermeiros orienta os pacientes sobre IC e autocuidado. O fator que mais interfere nas orientações é a falta de tempo. Conclusão: os resultados indicam que os enfermeiros orientam e apresentaram conhecimento satisfatório sobre o manejo da síndrome de IC. A falta de tempo foi a principal dificuldade para otimização desse processo. falta de tempo foi a principal dificuldade para otimização desse processo.

Objective: to evaluate the knowledge of nurses from two general hospitals on heart failure (HF) syndrome and the factors that interfere with the guidance they provide to patients. Methods: knowledge was assessed by the 14-item Nurses’ Knowledge of Heart Failure (NKHF) questionnaire. Participants were also asked about guidance, guidance limitations, and self-assessment of knowledge on HF. Results: fifty-one nurses were evaluated, 82.4% of which achieved a percentage of 70% of correct answers. Symptoms of advanced HF and use of sildenafil were the items that had the lowest percentages of correct answers. More than 70% (n=40) of nurses provided patients with guidance on HF and self-care. The factor that most interfered with guidance was lack of time. Conclusion: results indicate that nurses advise patients and have satisfactory knowledge on the management of HF syndrome. Lack of time was the main difficulty for optimizing this process.

Objetivos: verificar el conocimiento sobre insuficiencia cardiaca (IC) entre enfermeros de dos hospitales generales y los factores que interfieren en las orientaciones a los pacientes. Métodos: se evaluó el conocimiento mediante el Cuestionario de Conocimiento sobre IC para enfermeros (Q-CENIC), compuesto de 14 preguntas. También se cuestionó sobre la orientación, limitaciones a la orientación, y autoevaluación de conocimientos sobre IC. Resultados: se evaluaron 51 enfermeros, el 82,4% de los cuales llegaron al 70% de aciertos. Síntomas de IC avanzada y uso de sildenafil fueron los tópicos con los menores porcentajes de acierto. Más del 70% (n=40) de los enfermeros orienta a los pacientes sobre IC y autocuidado. El factor que más interfiere en las orientaciones es falta de tiempo. Conclusión: los resultados indican que los enfermeros orientan y presentan conocimiento satisfactorio sobre el manejo de la IC. La falta de tiempo fue la principal dificultad para la optimización del proceso.

[Risk factors for falls in hospitalized adult patients: an integrative review]. / Fatores de risco para quedas em pacientes adultos hospitalizados: revisão integrativa.

OBJECTIVE: Identifying risk factors for the occurrence of falls in hospitalized adult patients. METHOD: Integrative review carried out in the databases of LILACS, SciELO, MEDLINE and Web of Science, including articles published between 1989 and 2012. RESULTS: Seventy-one articles were included in the final sample. Risk factors for falls presented in this review were related to patients (intrinsic), the hospital setting and the working process of health professionals, especially in nursing (extrinsic). CONCLUSION: The systematic screening of risk factors for falls was identified as a contributing factor to the reduction of this injury, helping the non-occurrence of this event that, despite being preventable, can have serious consequences including death.

Risk factors for falls in hospitalized adult patients: an integrative review / Fatores de risco para quedas em pacientes adultos hospitalizados: revisão integrativa / Factores de riesgo de caídas en pacientes adultos hospitalizados: revisión integradora de la literatura

Objective: Identifying risk factors for the occurrence of falls in hospitalized adult patients. Method: Integrative review carried out in the databases of LILACS, SciELO, MEDLINE and Web of Science, including articles published between 1989 and 2012. Results: Seventy-one articles were included in the final sample. Risk factors for falls presented in this review were related to patients (intrinsic), the hospital setting and the working process of health professionals, especially in nursing (extrinsic). Conclusion: The systematic screening of risk factors for falls was identified as a contributing factor to the reduction of this injury, helping the non-occurrence of this event that, despite being preventable, can have serious consequences including death.
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Objetivo: Identificar los factores de riesgo para la ocurrencia de caídas en pacientes adultos hospitalizados. Método: Revisión integradora de la literatura de artículos publicados entre los años 1989 al 2012 en las bases de datos LILACS, SciElO, MEDLINE y Web of Science. Resultados: La muestra final estuvo compuesta por setenta y un artículos. Entre los factores de riesgo de caídas indicados en esta revisión están los relacionados con el paciente (intrínsecos), con el ambiente hospitalario y con el proceso de trabajo de los profesionales de la salud, especialmente enfermería (extrínsecos). Conclusión: La detección sistemática de factores de riesgo asociados a caídas fue identificada como un factor que contribuye a la reducción de este daño, favoreciendo de esta manera su no ocurrencia, la que a pesar de ser prevenible puede acarrear consecuencias graves, incluyendo la muerte.
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Objetivo: Identificar os fatores de risco para a ocorrência de quedas em pacientes adultos hospitalizados. Método: Revisão integrativa realizada nas bases de dados LILACS, SciELO, MEDLINE e Web of Science, abrangendo artigos publicados entre 1989 e 2012. Resultados: Setenta e um artigos compuseram a amostra final do estudo. Os fatores de risco para quedas apresentados nesta revisão foram relacionados ao paciente (intrínsecos), ao ambiente hospitalar e ao processo de trabalho dos profissionais da saúde, em especial à enfermagem (extrínsecos). Conclusão: A triagem sistemática de fatores de risco para queda foi identificada como fator contribuinte para a redução desse agravo, auxiliando a não ocorrência deste evento que, apesar de ser prevenível, pode determinar consequências graves incluindo o óbito.

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[Cross-cultural adaptation and validation of a questionnaire on what nurses know of heart failure]. / Adaptação transcultural e validação de um questionário de conhecimento sobre insuficiência cardíaca para enfermeiros.

This study aims to perform the cross-cultural adaptation and to verify the content validity and stability of Nurses' Knowledge of Heart Failure Education Principles to evaluate what Brazilian nurses know of heart failure. The process of cross-cultural adaptation involved translation, synthesis, back-translation, committee's proofreading and pre-test. The following psychometric properties were assessed content validity (face), reliability through internal consistency (Cronbach's Alpha) and stability (Kappa coefficient). After the cross-cultural adaptation, the instrument was applied to 54 nurses (27 from a cardiology hospital and 27 from a general hospital). The Cronbach's Alpha was 0.7. The questions 4, 5, and 11 presented a Kappa coefficient less than or equal to 0.4, and further questions presented a Kappa coefficient superior or equal to 0.7. This questionnaire was validated and proved to be adequate to assess the knowledge of this group of professionals.

Adaptação transcultural e validação de um questionário de conhecimento sobre insuficiência cardíaca para enfermeiros / Adaptación transcultural y validad de un cuestionario de conocimiento sobre insuficiencia cardiaca para enfermeros / Cross-cultural adaptation and validation of a questionnaire on what nurses know of heart failure

Estudo com objetivo de realizar a adaptação transcultural, assim como verificar a validade de conteúdo e a estabilidade do Nurses' Knowledge of Heart Failure Education Principles para avaliar o conhecimento de enfermeiros brasileiros sobre insuficiência cardíaca. O processo de adaptação transcultural constituiu-se da tradução, síntese, retrotradução, revisão por um comitê e pré-teste. Foram avaliadas as propriedades psicométricas: validade de conteúdo (face), fidedignidade por meio da consistência interna (Alfa de Cronbach) e estabilidade (Coeficiente Kappa). Após adaptação transcultural, o instrumento foi aplicado a 54 enfermeiros (27 de um hospital especializado em cardiologia e 27 de hospital geral). O Alfa de Cronbach foi de 0,7. As questões de números 4, 5 e 11 apresentaram coeficiente Kappa inferior ou igual a 0,4, e as demais questões apresentaram Kappa superior ou igual a 0,7. Este questionário foi validado e mostrou-se adequado para avaliar o conhecimento desse grupo de profissionais.

Estudio que propone realizar la adaptación transcultural y comprobar la autoridad del contenido y la estabilidad del Nurses Knowledge of Heart Failure Education Principles para evaluar el conocimiento de enfermeros brasileños sobre insuficiencia cardíaca. El proceso de adaptación transcultural se constituye de traducción, síntesis, retrotraducción, revisión por un comité y pre test. Fueron evaluadas las propiedades psicométricas: validad de contenido (fase), confiabilidad a través de consistencia interna (Alfa de Cronbach) y estabilidad (Coeficiente Kappa). Tras la adaptación transcultural, el instrumento fue aplicado a 54 enfermeros, (27 de hospital especializado en cardiología y 27 de hospital general). Alfa de Cronbach fue de 0,7. Las cuestiones número 4,5 y 11 presentaron coeficiente Kappa inferior o igual a 0,4 – las demás cuestiones presentaron Kappa superior o igual a 0,7. Este cuestionario es válido y se mostró adecuado para evaluar el conocimiento de ese grupo de profesionales..

This study aims to perform the cross-cultural adaptation and to verify the content validity and stability of Nurses' Knowledge of Heart Failure Education Principles to evaluate what Brazilian nurses know of heart failure. The process of cross-cultural adaptation involved translation, synthesis, back-translation, committee's proofreading and pre-test. The following psychometric properties were assessed: content validity (face), reliability through internal consistency (Cronbach's Alpha) and stability (Kappa coefficient). After the cross-cultural adaptation, the instrument was applied to 54 nurses (27 from a cardiology hospital and 27 from a general hospital). The Cronbach's Alpha was 0.7. The questions 4, 5, and 11 presented a Kappa coefficient less than or equal to 0.4, and further questions presented a Kappa coefficient superior or equal to 0.7. This questionnaire was validated and proved to be adequate to assess the knowledge of this group of professionals.

Sleep apnea is a stronger predictor for coronary heart disease than traditional risk factors.

BACKGROUND: Sleep apnea (SA) may be linked to coronary artery disease (CAD). Both conditions have similar risk factors, confounding the analyses. Investigation of the lipid profile is routine in the adult population, even without symptoms or suspected cardiac ailment. SA, however, remains underdiagnosed even in the presence of unambiguous clinical manifestations. PURPOSE: The aim of this study was to verify the association between SA and CAD, adjusting for usual CAD risk factors. METHODS: Patients who underwent diagnostic or therapeutic coronariography and portable type III polysomnography were studied. The severity of SA was determined by the apnea-hypopnea index (AHI). We measured classic CAD risk factors: fasting glucose; total, HDL, and LDL cholesterols; triglycerides; uric acid, and high-sensitivity C-reactive protein. We excluded patients older than 65 years, with body mass index higher than 40 kg/m(2), with diabetes, and with history of smoking in the last year. RESULTS: Of 55 included patients, 28 had AHI > 14, showing an odds ratio of 8.7 for CAD. Patients without (n = 29) and with CAD (n = 26), showed AHI of, respectively, 11 ± 11 and 23 ± 14 per hour (P = 0.001). In a binary logistic regression to predict CAD, controlling for all the above risk factors, the only variables entered in the stepwise model were AHI (either as continuous or categorical variable) and uric acid. CONCLUSION: In a sample without smokers, morbidly obese, or diabetic patients, AHI is the main predictor of CAD. SA should integrate the set of risk factors routinely assessed in clinical investigation for coronary disease risk stratification.

High risk for sleep apnea in the Berlin questionnaire and coronary artery disease.

INTRODUCTION: Obstructive sleep apnea (OSA) affects up to 30% of the adult population and is a risk factor for coronary artery disease (CAD). The diagnostic process, involving polysomnography, may be complex. Berlin questionnaire (BQ) is a validated and economical screening tool. PURPOSE: The aim of this study was to assess the performance of the BQ for the diagnosis of OSA in individuals with angina complaints. METHODS: Patients undergoing diagnostic cineangiography, portable type III polysomnography to determine the apnea-hypopnea index (AHI), and who answered the BQ were included. We excluded patients older than 65 years that were smokers, diabetics, and morbidly obese. High risk for OSA was based on positive responses in two of three symptom criteria of the BQ. CAD was defined by the presence of >50% lesion in coronary arteries. RESULTS: In 57 included cases, high risk in the BQ indicates significant odds ratio [95% confidence interval] for the presence of CAD (4.5[1.03-19.25], P = 0.045), adjusted for usual confounders: gender, age, and body mass index. The sensitivity and the specificity of BQ for CAD were 70% and 48%, respectively; the positive and negative predictive values are 56% and 64%. CONCLUSIONS: In conclusion, simple questionnaire-based diagnostic tools can be included in the screening procedures of patients with angina to detect the need for further OSA evaluation. In conclusion, the BQ is an effective instrument for this purpose.

Inflammatory and oxidative stress markers after intravenous insulin in percutaneous coronary intervention with stent in type 2 diabetes mellitus: a randomized controlled trial.

CONTEXT/OBJECTIVE: The objective of the study was to evaluate the effects of normalizing glycemia through iv insulin per 24 h on markers of oxidative stress and inflammation in patients with diabetes submitted to percutaneous coronary intervention (PCI) with stent. PATIENTS/METHODS: This was a prospective, open-label, randomized controlled trial, comparing continuous iv insulin per 24 h targeting glycemia less than 110 mg/dl iv insulin treatment (IIT; n = 35) to standard treatment (ST; n = 35, regular insulin if glycemia was greater than 200 mg/dl). Blood samples for glycemia, glycated hemoglobin, lipids, inflammatory markers [C-reactive protein (CRP), soluble CD40 ligand, IL-6, and endothelin 1 (ET-1)] and oxidative stress (total antioxidant status, carbonyl) were collected immediately after and 24 h after PCI. RESULTS: Seventy patients were included. Mean age was 60.5 ± 10 yr, 60% were men, glycated hemoglobin was 8.1 ± 1.8 (IIT) vs. 7.6 ± 1.6% (ST) (P = 0.39). The intensive insulin group had lower glycemia (P = 0.006) and higher insulinemia (P < 0.001). Insulin did not change CRP [4.5 (2.1-11.7) vs. 6.8 (2.4-10.3), P = 0.35], soluble CD40 ligand [402 (191-843) vs. 610 (230-1200), P = 0.68], IL-6 [6.21 (3.1.-10.4) vs. 10.37 (5.9-15.3), P = 0.09], and ET-1 [1.02 (0.7-1.8) vs. 1.10 (0.7-1.9), P = 0.657]. CRP, IL-6, and ET-1 increased after PCI in both groups (P < 0.05). No change was observed on protein oxidation (carbonyl, P = 0.70; total antioxidant status, P = 0.33). There was a positive correlation between CRP and glycemia (r = 0.29, P = 0.002). CONCLUSIONS: Continuous iv insulin for 24 h increased insulin levels and prevented hyperglycemia. Insulin infusion did not prevent the rise in inflammatory and oxidative stress markers, and no differences were observed between IIT and ST after PCI with a stent.

Carbonyl groups: Bridging the gap between sleep disordered breathing and coronary artery disease.

Sleep disordered breathing (SDB) is related to coronary artery disease (CAD), but the mechanisms are uncertain. SDB is characterized by periods of intermittent hypoxia and free radical formation. This study tested the hypothesis that carbonylation can be the link between SDB and CAD. It included 14 cases with CAD and 33 controls with <50% coronary narrowing. CAD cases have higher erythrocyte carbonyl levels than controls (p = 0.012). Positive correlation was observed between apnea-hypopnea index (AHI) and erythrocyte carbonyl concentration (rho = 0.310; p = 0.027). To predict CAD, including as regressors: AHI, erythrocyte carbonyl, gender, age and body mass index, the significant variables in the Poisson multiple regression model were AHI and erythrocytes carbonyl. An increase of 1 pmol/gHb in erythrocyte carbonyl levels increases by 1.8% the risk of CAD and one unit of AHI increases by 3.8% the risk of CAD. The present findings represent the first evidence in humans that SDB may cause CAD through protein carbonylation.