RESUMO
The pathogenesis of COVID-19 warrants unravelling. Genetic polymorphism analysis may help answer the variability in disease outcome. To determine the role of KIR and HLA polymorphisms in susceptibility, progression, and severity of SARS-CoV-2 infection, 458 patients and 667 controls enrolled in this retrospective observational study from April to December 2020. Mild/moderate and severe/death study groups were established. HLA-A, -B, -C, and KIR genotyping were performed using the Lifecodes® HLA-SSO and KIR-SSO kits on the Luminex® 200™ xMAP fluoroanalyser. A probability score using multivariate binary logistic regression analysis was calculated to estimate the likelihood of severe COVID-19. ROC analysis was used to calculate the best cut-off point for predicting a worse clinical outcome with high sensitivity and specificity. A p ≤ 0.05 was considered statistically significant. KIR AA genotype protected positively against severity/death from COVID-19. Furthermore, KIR3DL1, KIR2DL3 and KIR2DS4 genes protected patients from severe forms of COVID-19. KIR Bx genotype, as well as KIR2DL2, KIR2DS2, KIR2DS3 and KIR3DS1 were identified as biomarkers of severe COVID-19. Our logistic regression model, which included clinical and KIR/HLA variables, categorised our cohort of patients as high/low risk for severe COVID-19 disease with high sensitivity and specificity (Se = 94.29%, 95% CI [80.84-99.30]; Sp = 84.55%, 95% CI [79.26-88.94]; OR = 47.58, 95%CI [11.73-193.12], p < 0.0001). These results illustrate an association between KIR/HLA ligand polymorphism and different COVID-19 outcomes and remarks the possibility of use them as a surrogate biomarkers to detect severe patients in possible future infectious outbreaks.
Assuntos
COVID-19 , Receptores KIR , SARS-CoV-2 , Humanos , COVID-19/genética , COVID-19/imunologia , COVID-19/virologia , Receptores KIR/genética , Masculino , Feminino , Pessoa de Meia-Idade , SARS-CoV-2/imunologia , Projetos Piloto , Estudos Retrospectivos , Polimorfismo Genético , Idoso , Genótipo , Predisposição Genética para Doença , Adulto , Índice de Gravidade de Doença , Antígenos HLA/genéticaRESUMO
Paravalvular leak (PVL) is a serious complication after surgical valve replacement or after transcatheter aortic valve replacement. Approximately 1-5% of PVLs can lead to serious clinical consequences, including congestive heart failure and/or haemolytic anaemia. For years, surgical re-intervention has been considered the treatment of choice for symptomatic patients with PVLs. However, surgical re-intervention is associated with a high risk of morbidity and mortality. Transcatheter PVL (TPVL) closure is a less invasive alternative to surgical re-intervention. The safety and feasibility of TPVL closure has been confirmed in several registries and a meta-analysis.In this review, we discuss the clinical implications and diagnosis of PVLs, technical considerations for TPVL, execution of the procedure and assessment of the results.
Assuntos
Procedimentos Endovasculares , Embolia Pulmonar/terapia , Adulto , Idoso de 80 Anos ou mais , Terapia Combinada , Contraindicações de Medicamentos , Dobutamina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Parada Cardíaca Extra-Hospitalar/terapia , Embolia Pulmonar/tratamento farmacológico , Choque Cardiogênico/terapia , Terapia TrombolíticaRESUMO
BACKGROUND: Risk stratification of patients with unstable angina or non-ST-segment elevation myocardial infarction (UA/NSTEMI) is problematic given the heterogeneous presentation of the condition. This study was undertaken to compare, in UA/NSTEMI patients, the prognostic value of two clinical risk scores (RS) (i.e. Thrombolysis in Myocardial Infarction (TIMI) and physician's risk assessment (PRA)) and to assess whether serum biomarkers can increase the prognostic accuracy of these RS. METHODS: We prospectively assessed 610 consecutive UA/NSTEMI patients, 217 (36%) UA and 393 (64%) NSTEMI. In all patients RS, high sensitivity C-reactive protein, CD40 ligand, IL6, IL10, IL18, E-selectin, P-selectin, white blood cell count, neopterin, myeloperoxidase, fibrinogen and NT proBNP were assessed at study entry. The primary study endpoint was death and non-fatal MI at 30 and 360 days of follow-up. RESULTS: At 1 year, 54 patients (8.9%) had reached the primary study endpoint (26 suffered a cardiac death (4.3%) and 34 (5.6%) a non-fatal MI). For both RS, the study endpoint occurred more commonly in patients at a "higher risk" compared to those classified as being at a "lower risk". Moreover, TIMI and PRA RS had similar discriminatory accuracy. TIMI RS, however, was a better predictor of events than PRA at both 30- and 360-day follow-up. The inflammatory biomarkers assessed in the study did not improve significantly the predictive value of RS. CONCLUSIONS: Our study suggests both that TIMI RS is a better marker of risk than PRA RS and inflammatory biomarkers do not increase the predictive value of these clinical risk scores.
Assuntos
Angina Instável/diagnóstico , Angina Instável/mortalidade , Morte Súbita Cardíaca/epidemiologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Idoso , Biomarcadores/sangue , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To determine the differences in the inflammatory status between diabetic and non-diabetic patients and to evaluate the usefulness of C reactive protein, fibrinogen, and leucocyte count as predictors of death in diabetic patients with unstable coronary disease. DESIGN: Nested case-control comparisons of the inflammatory status between diabetic and non-diabetic patients. Prospective cohort analysis of C reactive protein concentration, fibrinogen concentration, and leucocyte count as predictors of cardiovascular death in diabetic patients. SETTING: Coronary care unit in Spain. PARTICIPANTS: 83 diabetic patients with non-ST elevation acute coronary syndrome and 83 sex and aged matched patients selected from 361 non-diabetic patients with non-ST elevation acute coronary syndrome. MAIN OUTCOME MEASURES: Plasma concentrations of C reactive protein and fibrinogen, and leucocyte count. Investigators contacted patients to assess clinical events. RESULTS: Concentrations of C reactive protein and fibrinogen, and leucocyte count on admission were higher in diabetic than in non-diabetic patients (7 mg/l v 5 mg/l, p = 0.020; 3.34 g/l v 2.90 g/l, p = 0.013; and 8.8 x 10(9)/l v 7.8 x 10(9)/l, p = 0.040). Among diabetic patients, these values were also higher in those who died during the 22 month follow up (13 mg/l v 6 mg/l, p = 0.001; 3.95 g/l v 3.05 g/l, p < 0.001; and 11.4 x 10(9)/l v 8.4 x 10(9)/l, p = 0.005). After adjustment for confounding factors, diabetic patients in the highest tertile of C reactive protein had a hazard ratio for cardiovascular death of 4.51 (95% confidence interval (CI) 1.62 to 12.55). Similar hazard ratios were for fibrinogen 3.74 (95% CI 1.32 to 10.62) and for leucocyte count 3.64 (95% CI 1.37 to 9.68). CONCLUSIONS: Inflammation appears more evident in diabetic than in non-diabetic patients with acute coronary syndrome. C reactive protein concentration, fibrinogen concentration, and leucocyte count constitute independent predictors of cardiovascular death in diabetics with unstable coronary disease.
Assuntos
Angina Instável/mortalidade , Proteína C-Reativa/análise , Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/mortalidade , Fibrinogênio/análise , Infarto do Miocárdio/mortalidade , Idoso , Angina Instável/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Angiopatias Diabéticas/sangue , Feminino , Humanos , Contagem de Leucócitos , Masculino , Análise Multivariada , Infarto do Miocárdio/sangue , Prognóstico , Espanha/epidemiologia , Análise de SobrevidaAssuntos
Insuficiência Cardíaca/etiologia , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/etiologia , Falha de Prótese , Idoso , Cateterismo Cardíaco/métodos , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Reoperação , Resultado do TratamentoRESUMO
There is controversy as to whether the double-balloon or the Inoue technique of percutaneous mitral balloon valvuloplasty (PMBV) provides superior immediate and long-term results. This study was undertaken to analyze the effect of the learning curve of the Inoue technique of PMBV in the immediate and long-term outcome of PMBV. The learning curve of Inoue PMBV was analyzed in 233 Inoue PMBVs divided into 2 groups: "early experience" (n = 100) and "late experience" (n = 133). The results of the overall Inoue technique were compared with those of 659 PMBVs performed with the double-balloon technique. Baseline clinical and morphologic characteristics between early and late experience Inoue groups were similar. Post-PMBV mitral valve area (1.89 +/- 0.56 vs 1.69 +/- 0.57 cm(2); p = 0.008) and success rate (60% vs 75.9%; p = 0.009) were significantly higher in the late experience Inoue group. Furthermore, there was a trend for less incidence of severe post-PMBV mitral regurgitation > or = 3+ in the late experience group (6.8% vs 12%; p = 0.16). Although the post-PMBV mitral valve area was larger with the double-balloon technique (1.94 +/- 0.72 vs 1.81 +/- 0.58 cm(2); p = 0.01), the success rate (71.3% vs 69.1%; p = NS), incidence of > or = 3+ mitral regurgitation (9% vs 9%), in-hospital complications, and long-term and event-free survival were similar with both techniques. In conclusion, there is a significant learning curve of the Inoue technique of PMBV. Both the Inoue and the double-balloon techniques are equally effective techniques of PMBV because they resulted in similar immediate success, in-hospital adverse events, and long-term and event-free survival.
Assuntos
Cateterismo/métodos , Competência Clínica , Estenose da Valva Mitral/mortalidade , Estenose da Valva Mitral/terapia , Boston , Estudos de Coortes , Intervalo Livre de Doença , Ecocardiografia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
Endocarditis related to pacemaker lead is a rare complication of permanent transvenous pacing, of which the diagnosis is carried out with the presence of verrucae in echocardiography and positive blood cultures, its treatment being mixed -medical and surgical- because the isolated medical treatment is rarely successful and the lead should be extracted. We present the case of recurrent endocarditis of several years of evolution, in the which it was not possible to extract of the electrode due to the special characteristics of the patiente (epicardial lead perforating into right atrial).
Assuntos
Endocardite Bacteriana , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Estafilocócicas/etiologia , Staphylococcus epidermidis , Idoso , Eletrodos , Humanos , Masculino , Pericárdio , RecidivaRESUMO
The beneficial short and long-term results of coronary stenting have resulted in a dramatic increase in stent utilization, accounting for greater than 80% of coronary interventions [1--9]. However, the long-term beneficial effect of coronary stenting is limited by the occurrence of a 14 to 61% restenosis rate [10--13]. The optimal percutaneous revascularization strategy for the treatment of in-stent restenosis remains undetermined. Although balloon angioplasty has been performed with high initial procedural success, the long-term results are disappointing due to significant recurrence [14--18]. In this article we describe the feasibility, safety, immediate and long-term outcome of directional coronary atherectomy (DCA) as a treatment modality in a cohort of patients undergoing percutaneous intervention for the treatment of in-stent restenosis at the Massachusetts General Hospital.
Assuntos
Aterectomia Coronária , Doença da Artéria Coronariana/terapia , Stents , Idoso , Doença da Artéria Coronariana/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Resultado do TratamentoRESUMO
Kidney failure is the common end of hypertension and renal diseases. Several authors have suggested that vasodilatory prostaglandins participate in the hemodynamic mechanism responsible for the development of kidney failure. However, the mechanism by which prostaglandins are increased in renal disease is not clear. Recently, 2 isoforms of the enzyme responsible for prostaglandin synthesis, cyclooxygenase, have been described as cyclooxygenase-1 (COX-1), a constitutive isoform, and cyclooxygenase-2 (COX-2), an inducible isoform. In the present study, we investigated whether COX-2-dependent prostaglandins participate in the evolution of renal functional changes after renal ablation. We inhibited prostaglandin synthesis by COX-1 and COX-2 with indomethacin (3 mg/kg) and prostaglandin synthesis by COX-2 with NS-398 (3 mg/kg) and tested the effect of these inhibitors on the renal functional changes elicited by renal ablation. Renal ablation produced an increase in urinary volume, protein, and prostaglandin E(2), whereas urinary sodium and potassium were not affected and urinary osmolarity decreased; treatment with indomethacin or NS-398 partially prevented the renal functional changes elicited by renal ablation. Immunoblots for COX showed an increase in the expression of COX-2 protein 2 days after renal ablation. Furthermore, COX-2 mRNA expression was increased 1 day after renal ablation. These data suggest that COX-2-dependent prostaglandins participate in the renal mechanisms associated with the development of renal functional changes after renal ablation.
Assuntos
Inibidores de Ciclo-Oxigenase/farmacologia , Dinoprostona/fisiologia , Indometacina/farmacologia , Isoenzimas/fisiologia , Nitrobenzenos/farmacologia , Prostaglandina-Endoperóxido Sintases/fisiologia , Insuficiência Renal/metabolismo , Sulfonamidas/farmacologia , Animais , Ciclo-Oxigenase 1 , Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase/uso terapêutico , Indometacina/uso terapêutico , Testes de Função Renal , Masculino , Proteínas de Membrana , Nitrobenzenos/uso terapêutico , Ratos , Ratos Wistar , Insuficiência Renal/fisiopatologia , Insuficiência Renal/prevenção & controle , Sulfonamidas/uso terapêuticoRESUMO
The metal atom in the title complex, [CoCl2(C8H8N2)2], has a slightly distorted tetrahedral coordination involving two Cl- ions and two N atoms from the aromatic groups. The dihedral angle between the planes of the two 1-methylbenzimidazole ligands is 117.7 (7) degrees.
Assuntos
Concentração de Íons de Hidrogênio , Compostos Organometálicos/química , Cobalto/química , Cristalografia por Raios X , Estrutura MolecularRESUMO
OBJECTIVE: To compare the clinical and epidemiological characteristics of cholera patients and patients with diarrhea of different etiology (controls), treated at Mexican Institute of Social Security medical units in northeast Mexico City, from 1995 to 1998. MATERIAL AND METHODS: Cross-sectional analytical study design. Data were collected using the official form "Immediate Notification of Cholera Cases" that each medical unit reports to the Coordination of Community Health. Statistical analysis consisted of comparisons of means and proportions between both groups. RESULTS: In 4,952 notifications, there were 588 cholera cases and 4,364 controls. The age range of cases was 39 to 51 years and 54% were females. During 1995 and 1997 (years with higher proportion of cases) patients with cholera had a greater frequency of watery evacuations than controls (97% vs. 73%), "rice water" appearance (31% vs. 13%), vomiting (72% vs. 63%), muscular spasms (49% vs. 26%), dehydration (83% vs. 71%), hypovolemic shock (10% vs. 1%) and death (0.85% vs. 0.25%). These differences were statistically significant. CONCLUSIONS: Cholera presents a biannual cyclic behavior; greater frequencies are associated with greater severity and complications. It is necessary to increase epidemiologic surveillance and medical efforts for opportune diagnosis and treatment.
Assuntos
Cólera/epidemiologia , População Urbana/estatística & dados numéricos , Adulto , Distribuição por Idade , Estudos Transversais , Diarreia/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Morbidade/tendências , Distribuição por SexoRESUMO
Atrial standstill is a very rare form of bradyarrhythmia and consists of a transitory or permanent loss of the electrical and mechanical activity of the atria. We report a series of 8 patients, all of them with rheumatic valve disease (5 of them with a prosthetic valve) with symptomatic bradyarrhythmia secondary to atrial standstill, requiring an implantable pacemaker.
Assuntos
Bradicardia/diagnóstico , Valva Mitral , Cardiopatia Reumática/diagnóstico , Idoso , Bradicardia/etiologia , Bradicardia/terapia , Feminino , Átrios do Coração , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/terapia , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , Cardiopatia Reumática/complicações , Cardiopatia Reumática/terapiaRESUMO
Extracorporeal shock wave lithotripsy (ESWL) has proven to be effective for the treatment of renal calculi. However, its use for ureteral stones as monotherapy is controversial. In this study, 142 patients underwent in situ ESWL for ureteral stones. Stone fragmentation was achieved in 87.4% of the patients. Stone clearance rate at 3 months was 95.8%, 94.7%, and 94.2% for stones located in upper, middle, and lower ureter, respectively. Efficiency quotient calculated for the overall stone clearance at 15 days, 1 month, and 3 months was 74.6, 71.8, and 71.7, respectively. Treatment was performed in 82.5% of patients as an outpatient procedure. Our data show that in situ monotherapy is an effective and noninvasive method for treating ureteral stones.
Assuntos
Litotripsia/instrumentação , Cálculos Ureterais/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Avaliação como Assunto , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
We reviewed our experience with ESWL in the treatment of 401 patients with ureteral stones in order to evaluate if a higher disintegration and clearance rates could be achieved without prior manipulation of ureteral calculi, i.e., ESWL used as "in situ" monotherapy. The global stone free rate were 83%, 85% and 91% at 15 days, 1 month and 3 months after ESWL. We also analyzed the results according to the efficiency quotient (EQ).
Assuntos
Litotripsia , Cálculos Ureterais/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Azatioprina/uso terapêutico , Ciclosporina/uso terapêutico , Transplante de Rim/fisiologia , Prednisona/uso terapêutico , Adulto , Análise de Variância , Cadáver , Quimioterapia Combinada , Feminino , Teste de Histocompatibilidade , Humanos , Terapia de Imunossupressão/métodos , Transplante de Rim/imunologia , Masculino , Análise Multivariada , Resultado do TratamentoRESUMO
Report on the evolution of a series of 64 patients with T2-4 N0-3 M0 infiltrant transitional carcinoma of the bladder, treated with TUR and radical cystectomy (28/62) or intra-operative radiotherapy (IOR) 15 Gy and external radiotherapy 40 Gy prior to cystectomy (34/62). The last group including 24 patients which received neo-adjuvant chemotherapy. Seventy percent (15 p0N-, 5 p0N+, 1 p1N-, 3 p1N+) patients treated with radiotherapy, with and without chemotherapy, had local response. Considering just the group which received IOR, external radiotherapy and co-adjuvant chemotherapy (24/34), the local response accounts for 79% (10 p0N-, 5 p0N+, 1 p1N-, 3 p1N+). Current survival of the group receiving concomitant multiple therapy is 92 +/- 5%, 75 +/- 9% and 57 +/- 11% at 1, 3 and 5 years; for equal intervals current survival of the group undergoing cystectomy is 57 +/- 9%, 46 +/- 9% and 40 +/- 10% (p = 0.02). The univariate analysis has confirmed that stage decrease is significantly more frequent in the group receiving radiotherapy with and without chemotherapy (p less than 0.001). Such a decrease significantly biased survival (p = 0.001). In the multivariate analysis, the variables with greater prognostic power were pre-surgical renal function (p less than 0.001), use of radiotherapy (p less than 0.001) and surgical complications (p less than 0.001). Preliminary results show a very high local response to multiple therapy which has been translated so far in increased survival.