Nonalcoholic Fatty Liver Disease and Coronary Artery Disease: Big Brothers in Patients with Acute Coronary Syndrome.

BACKGROUND: The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing. This study aimed to evaluate the prevalence of NAFLD, as diagnosed by ultrasound, in patients with acute coronary syndrome (ACS) and to assess whether NAFLD is associated with the severity of coronary obstruction as diagnosed by coronary angiography. METHODS: We performed a prospective single-center study in patients hospitalized due to acute coronary syndrome who underwent diagnostic coronary angiography. Consecutive patients who presented to the emergency room were diagnosed with acute coronary syndrome and were included. All patients underwent ultrasonography of the upper abdomen to determine the presence or absence of NAFLD; NAFLD severity was graded from 0 to 3 based on a previously validated scale. All patients underwent diagnostic coronary angiography in the same hospital, with the same team of interventional cardiologists, who were blinded to the patients' clinical and ultrasonographic data. CAD was then angiographically graded from none to severe based on well-established angiographic criteria. RESULTS: This study included 139 patients, of whom 83 (59.7%) were male, with a mean age of 59.7 years. Of the included patients, 107 (77%) patients had CAD, 63 (45%) with serious injury. Regarding the presence of NAFLD, 76 (55.2%) had NAFLD including 18 (23.6%) with grade III disease. In severe CAD, 47 (60.5%) are associated with NAFLD, and 15 (83.3%) of the patients had severe CAD and NAFLD grade III. CONCLUSIONS: NAFLD is common in patients with ACS. The intensity of NAFLD detected by ultrasonography is strongly associated with the severity of coronary artery obstruction on angiography.

Impact of Glycemic Variability and Hypoglycemia on the Mortality and Length of Hospital Stay among Elderly Patients in Brazil.

BACKGROUND: Glycemic variability (GV) is an alternative diabetes-related parameter that has been associated with mortality and longer hospitalization periods. There is no ideal method for calculating GV. In this study, we used standard deviation and coefficient of variation due to their suitability for this sample and ease of use in daily clinical practice. OBJECTIVE: This study aimed to investigate the association between GV, hypoglycemia, and the 90-day mortality and length of hospital stay (LOS) among non-critically ill hospitalized elderly patients. METHODS: The medical records of 2,237 elderly patients admitted to the Zilda Arns Elderly Hospital over a 2.5-year period were reviewed. Hypoglycemia was defined as a glucose level <70 mg/dL (hypoglycemia alert value) and represented by the proportion of days in which the patient presented with this condition relative to the LOS. The Charlson comorbidity index was used to evaluate prognosis. Data were analyzed using multiple linear and logistic multivariate regression analyses. RESULTS: Adjusted analysis of 687 patients (305 men [44.4%] and 382 women [55.6%], mean age of 77.86±9.25 years) revealed that GV was associated with a longer LOS (p=0.048). Mortality was associated with hypoglycemia (p=0.005) and mean patient-day blood glucose level (p=0.036). Variables such as age (p<0.001), Charlson score (p<0.001), enteral diet (p<0.001), and corticosteroid use (p=0.007) were also independently associated with 90-day mortality. CONCLUSION: Increased GV during hospitalization is independently associated with a longer LOS and hypoglycemia in non-critically ill elderly patients, while the mean patient-day blood glucose is associated with increased mortality.

Neck Circumference and its Correlation to Other Anthropometric Parameters and Finnish Diabetes Risk Score (FINDRISC).

BACKGROUND: The Neck Circumference (NC) is an anthropometric measure to evaluate obesity. The FINDRISC predicts the risk of developing type 2 diabetes mellitus. Our aims were to identify the mean value of NC in individuals with higher (≥15 points) and lower FINDRISC and to establish cutoff values that indicate individuals with higher FINDRISC. METHODS: It is a population-based, cross-sectional study representative of the city of Curitiba, Brazil. We studied individuals (>18 years), without diabetes mellitus, between August 2013 and August 2014. We evaluated anthropometric parameters, glycaemia, socioeconomic situation, chronic conditions, and their risk factors. In a sex-specific analysis, data are presented as mean and standard deviation. We performed Pearson's and Spearman's correlation between NC and the waist circumference, body mass index and FINDRISC. Receiver Operating Characteristic curves were estimated for NC and higher FINDRISC. Logistic regression models were built to analyze the association between higher FINDRISC and 1-SD increase in NC. RESULTS: We studied 950 individuals (621 women) with a mean age of 47.4 ± 17.6 years and body mass index of 26.2 ± 5.6 kg/m2. The mean NCs were 34.1 ± 3.1 cm in women and 38.2 ± 3.5 cm in men. Mean NC was lower in women (33.7 ± 2.9 cm vs. 35.8 ± 3.2 cm) and men (37.7 ± 3.4 cm vs. 41 ± 3.6 cm) with lower FINDRISC (p <0.001). All the correlations with NC were significant (p ≤ 0.001). The area under the curve for NC and the higher FINDRISC was 0.702 (95% CI 0.653 - 0.752) for women and 0.762 for men (95% CI 0.679 - 0.845), determining the best cutoff value of 34.5 cm for women and 39.5 cm for men to discriminate individuals with higher FINDRISC. Fully adjusted odds ratios for higher FINDRISC per 1-SD increase in NC in women and men were, respectively 1.89 (95% CI 1.53 - 2.33) and 2.86 (95% CI 1.91 - 4.29). CONCLUSION: NC is positively correlated to the body mass index, waist circumference, glycaemia, and FINDRISC scores in a population-based sample of adults. We identified the mean values of NC in higher and lower FINDRISC and established cutoff values for NC and higher FINDRISC.

Sclerochorioretinal abnormalities in hypercholesterolemic rabbits treated with rosiglitazone.

BACKGROUND AND OBJECTIVE: To evaluate early retinal, choroidal, and scleral abnormalities induced by a hypercholesterolemic diet and the prevention of these abnormalities after oral administration of rosiglitazone in rabbits. MATERIALS AND METHODS: Fifty-four New Zealand rabbits were divided into four study groups: control group, normal diet; group 1, hypercholesterolemic diet; group 2, hypercholesterolemic diet associated with daily administration of 3 mg of rosiglitazone from day 14 after beginning the diet; and group 3, hypercholesterolemic diet associated with daily administration of 3 mg of rosiglitazone since the beginning of the experiment. Sclera and choroid underwent histologic and histomorphometric analyses. Retina underwent immunohistochemical analysis with anti-calretinin and anti-glial fibrillary acidic protein (GFAP) antibodies. RESULTS: No abnormalities were observed in the control group. Group 1 had significant increases in scleral and choroidal thicknesses compared with the control group (P < .01) and group 3 (P < .05). Group 1 presented significant increases in immunoreactivity (P < .001) to the anti-calretinin antibody compared with the other groups. Groups 2 and 3 had significant (P < .002) increases in calretinin immunoreactivity compared with the control group. GFAP was negative in all groups. CONCLUSION: The hypercholesterolemic diet induced early retinal, choroidal, and scleral abnormalities. Rosiglitazone preserved the structural anatomy.

Evaluation of early abnormalities of the sensory retina in a hypercholesterolemia experimental model: an immunohistochemical study / Avaliação das anormalidades precoces da retina sensorial em modelo experimental de hipercolesterolemia: estudo imunohistoquímico

PURPOSE: The aim of this study is to demonstrate the early changes of the sensory retina induced by hypercholesterolemia in an experimental model. METHODS: New Zealand rabbits were divided into two groups: CG (Control Group) was fed a normal diet for 6 weeks. G1 was initially fed a 1 percent cholesterol diet for two weeks and from the 14th day on a 0.5 percent cholesterol diet until the 42nd day. The eyes underwent an immunohistochemical analysis with monoclonal antibodies anti-calretinin and anti-glial fibrillary acidic protein (GFAP). RESULTS: G1 cells and cell elements presented significant immunoreactivity to anti-calretinin. No immunoreactivity to anti-glial fibrillary acidic protein was observed in both groups. CONCLUSION: This study has shown that a hypercholesterolemic diet may induce early changes in the sensory retina in rabbits. The anti-calretinin monoclonal antibody was able to reveal calcium accumulation inside the nerve cells.

OBJETIVO: O objetivo deste estudo é demonstrar experimentalmente as alterações precoces da retina sensorial induzidas pela hipercolesterolemia. MÉTODOS: Coelhos New Zealand foram organizados em dois grupos: GC (grupo controle), composto por 6 coelhos (6 olhos), recebeu dieta normal por 6 semanas; G1, composto por 12 coelhos (12 olhos), tratado previamente com ração colesterol a 1 por cento (Sigma-Aldrich) por 2 semanas e a partir do 14º dia com ração colesterol a 0,5 por cento (Sigma-Aldrich). Os olhos foram submetidos à análise imunohistoquímica com os anticorpos monoclonais anticalretinina e anti-glial fibrillary acidic protein (GFAP). RESULTADOS: G1 apresentou maior número de células e elementos celulares imunoreativos a anticalretinina que o GC, com relevância estatística. GFAP foi negativo em ambos os grupos. CONCLUSÃO: Este estudo demonstrou que a dieta hipercolesterolêmica pode induzir alterações precoces na retina sensorial em coelhos. O anticorpo monoclonal anticalretinina foi capaz de revelar o acúmulo de cálcio dentro das células neuronais retiniana.

[Evaluation of choroid and sclera early alterations in hypercholesterolemic rabbits: histologic and histomorphometric study]. / Avaliação das alterações precoces na coróide e esclera ocorridas em coelhos hipercolesterolêmicos: estudo histológico e histomorfométrico.

PURPOSE: To demonstrate experimentally, by means of histological and histomorphometric examinations, the sclera and choroid degenerative alterations, which take place at an early stage due to a hypercholesterolemic diet. METHODS: New Zealand rabbits were divided into two groups: CG (control group) of 6 rabbits (6 eyes) received a regular diet for 6 weeks; G1, of 12 rabbits (12 eyes), was first fed a 1% cholesterol diet (Sigma-Aldrich) for 2 weeks and then from the 14th day on a 0.5% cholesterol diet (Sigma-Aldrich). The eyes underwent a histological analysis, stained with hematoxiline-eosine, and a morphometric examination. The histomorphometric analysis was performed in the posterior region, adjacent to the optic disk, and in the peripheral region. RESULTS: The CG presented a mean sclera and choroid thickness of 228.61 +/- 31.71 micrometers in the peripheral region, while the thickness in the posterior region was approximately 246.07 +/- 25.66 micrometers. In G1, these values were 303.56 +/- 44.21 micrometers in the peripheral region and 295.59 +/- 62.59 in the posterior region. There was a statistically significant difference in the sclera and choroid thickness between the groups in the peripheral region (p<0.001); however, this difference did not occur in the posterior region (p=0.250). The large number of histiocytes and collagen fibers accounted for the increase of G1 wall thickness in relation to CG. CONCLUSION: This study demonstrated that the hypercholesterolemic diet in rabbits induces a fast increase in the choroid and sclera thickness, mainly due to the increase in the number of histiocytes and collagen fibers.

Avaliação das alterações precoces na coróide e esclera ocorridas em coelhos hipercolesterolêmicos: estudo histológico e histomorfométrico / Evaluation of choroid and sclera early alterations in hypercholesterolemic rabbits: histologic and histomorphometric study

OBJETIVO: Demonstrar experimentalmente, através de exames histológicos e histomorfométricos, as alterações degenerativas da esclera e coróide desencadeadas precocemente pela dieta hipercolesterolêmica. MÉTODOS: Coelhos New Zealand foram organizados em dois grupos: GC (grupo controle), composto por 6 coelhos (6 olhos), recebeu dieta normal por 6 semanas; G1, composto por 12 coelhos (12 olhos), tratado previamente com ração colesterol a 1 por cento (Sigma-Aldrich) por 2 semanas e a partir do 14º dia com ração colesterol a 0,5 por cento (Sigma-Aldrich). Os olhos foram submetidos à análise histológica, avaliados com corante de hematoxilina-eosina e ao exame morfométrico. A análise histomorfométrica foi realizada no setor posterior, adjacente ao disco óptico, e na periferia. RESULTADOS: O GC apresentou espessura média da esclera e coróide na periferia de 228,61 ± 31,71 micrômetros, enquanto na região posterior de aproximadamente 246,07 ± 25,66 micrômetros. No G1, observou-se espessura média da esclera e coróide na periferia de aproximadamente 303,56 ± 44,21 micrômetros, enquanto na região posterior de aproximadamente 295,59 ± 62,59. Houve diferença estatisticamente significativa da espessura da esclera e coróide entre os grupos na região periférica (p<0,001), não ocorrendo o mesmo no setor posterior (p=0,250). O aumento da espessura da parede de G1 em relação ao GC deve-se principalmente à quantidade elevada de histiócitos e fibras colágenas. CONCLUSÃO: Este estudo demonstrou que a dieta hipercolesterolêmica em coelhos induz rapidamente aumento da espessura da coróide e esclera, principalmente à custa de histiócitos e fibras colágenas.

PURPOSE: To demonstrate experimentally, by means of histological and histomorphometric examinations, the sclera and choroid degenerative alterations, which take place at an early stage due to a hypercholesterolemic diet. METHODS: New Zealand rabbits were divided into two groups: CG (control group) of 6 rabbits (6 eyes) received a regular diet for 6 weeks; G1, of 12 rabbits (12 eyes), was first fed a 1 percent cholesterol diet (Sigma-Aldrich) for 2 weeks and then from the 14th day on a 0.5 percent cholesterol diet (Sigma-Aldrich). The eyes underwent a histological analysis, stained with hematoxiline-eosine, and a morphometric examination. The histomorphometric analysis was performed in the posterior region, adjacent to the optic disk, and in the peripheral region. RESULTS: The CG presented a mean sclera and choroid thickness of 228.61 ± 31.71 micrometers in the peripheral region, while the thickness in the posterior region was approximately 246.07 ± 25.66 micrometers. In G1, these values were 303.56 ± 44.21 micrometers in the peripheral region and 295.59 ± 62.59 in the posterior region. There was a statistically significant difference in the sclera and choroid thickness between the groups in the peripheral region (p<0.001); however, this difference did not occur in the posterior region (p=0.250). The large number of histiocytes and collagen fibers accounted for the increase of G1 wall thickness in relation to CG. CONCLUSION: This study demonstrated that the hypercholesterolemic diet in rabbits induces a fast increase in the choroid and sclera thickness, mainly due to the increase in the number of histiocytes and collagen fibers.

Evaluation of early abnormalities of the sensory retina in a hypercholesterolemia experimental model: an immunohistochemical study.

PURPOSE: The aim of this study is to demonstrate the early changes of the sensory retina induced by hypercholesterolemia in an experimental model. METHODS: New Zealand rabbits were divided into two groups: CG (Control Group) was fed a normal diet for 6 weeks. G1 was initially fed a 1% cholesterol diet for two weeks and from the 14th day on a 0.5% cholesterol diet until the 42nd day. The eyes underwent an immunohistochemical analysis with monoclonal antibodies anti-calretinin and anti-glial fibrillary acidic protein (GFAP). RESULTS: G1 cells and cell elements presented significant immunoreactivity to anti-calretinin. No immunoreactivity to anti-glial fibrillary acidic protein was observed in both groups. CONCLUSION: This study has shown that a hypercholesterolemic diet may induce early changes in the sensory retina in rabbits. The anti-calretinin monoclonal antibody was able to reveal calcium accumulation inside the nerve cells.

Fibroelastoma de valva mitral como causa de acidente vascular isquêmico transitório / Fibroelastoma of the mitral valve as a cause of transient ischemic stroke

A 44-year-old woman had a transient ischemic stroke, fibroelastoma of the mitral valve being the source of the embolus. The patient evolved with neutropenia induced by ticlopidine after 10 days of treatment. We report the major clinical features, therapeutical options, and medicamentous toxicity resulting from the use of antiplatelet drugs