Discontinuing vs continuing ACEIs and ARBs in hospitalized patients with COVID-19 according to disease severity: Insights from the BRACE CORONA trial.

BACKGROUND: We explored the effect of discontinuing versus continuing angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) on clinical outcomes in patients with COVID-19 according to baseline disease severity. METHODS: We randomized 659 patients with a confirmed diagnosis of COVID-19 and classified them as having mild or moderate COVID-19 disease severity at hospital presentation using blood oxygen saturation and lung imaging. The primary outcome was the mean ratio of number of days alive and out of the hospital at 30 days according to disease severity. RESULTS: At presentation, 376 patients (57.1%) had mild and 283 (42.9%) had moderate COVID-19. In patients with mild disease, there was no significant difference in the number of days alive and out of the hospital between ACEI/ARB discontinuation (mean 23.5 [SD 6.3] days) and continuation (mean 23.8 [SD 6.5] days), with a mean ratio of 0.98 (95% CI 0.92-1.04). However, in patients with moderate disease, there were fewer days alive and out of the hospital with ACEI/ARB discontinuation (mean 19.6 [SD 9.5] days) than continuation (mean 21.6 [SD 7.6] days), with a mean ratio of 0.90 (95% CI 0.81-1.00; P-interaction = .01). The impact of discontinuing versus continuing ACEIs/ARBs on days alive and out of hospital through 30 days differed according to baseline COVID-19 disease severity. CONCLUSIONS: Unlike patients with mild disease, patients with moderate disease who continued ACEIs/ARBs had more days alive and out of hospital through 30 days than those who discontinued ACEIs/ARBs. This suggests that ACEIs/ARBs should be continued for patients with moderate COVID-19 disease severity. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT04364893).

Seguimento pós-operatório em longo prazo de pacientes submetidos à cirurgia valvar / Long term follow up of patients undergoing valvular cardiac surgery

Fundamentos: A valva nativa pode ser substituída por uma prótese mecânica ou biológica e a escolha do tipo de substituto valvar é passível de discussão, pois implica morbimortalidade dos pacientes operados. Objetivo: Comparar a evolução dos pacientes que receberam próteses biológicas e mecânicas. Métodos: Estudo retrospectivo realizado em prontuários de pacientes submetidos à primeira cirurgia de troca de valva (mitral e/ou aórtica), no período de 1995 a 2000, em hospital terciário da rede pública. Foram selecionados 303 pacientes: 173 constituíram o grupo com prótese mecânica. As variáveis analisadas foram sexo, idade na época da cirurgia, comorbidades, tipo de cirurgia realizada, fração de ejeção ventricular no pré-operatório e no pós-operatório, ritmo cardíaco antes e pós-procedimento e desfechos: óbito, reoperação, acidente vascular encefálico (AVE), e endocardite infecciosa. Resultados: O tempo médio de seguimento foi 10 anos. A mortalidade tardia foi 3,46% (bioprótese) e 5,38% (mecânica), p=0,568. A reoperação foi maior no grupo bioprótese (43,4%) vs. grupo prótese mecânica (4,6%) - OR=15,83 (IC 95% 6,61-7,85; p>0,001). A prevalência de AVE foi semelhante (11% - bioprótese vs.9,5% - prótese mecânica, p=0,561), assim como a prevalência de endocardite (11,6% - bioprótese vs. 6,2% - prótese mecânica, p=0,115). Conclusões: A mortalidade, a prevalência de AVE e a endocardite foram estatisticamente semelhantes entre os grupos (prótese biológica e prótese mecânica) e o número de reoperações foi significativamente maior no grupo com bioprótese, tanto em posição mitral como em posição aórtica.

Background: The native valve may be replaced by a mechanical or biological prosthesis, with this choice often open to discussion, as it raises morbidity and mortality issues for operated patients. Objective: To compare the progress of patients receiving biological and mechanical prostheses. Methods: Retrospective study of the medical records of patients undergoing first valve replacements (aortic and/or mitral), from 1995 to 2000 at a tertiary hospital in the National Health network. Of the 303 records selected, 173 constituted the biological group and 130 the mechanical prosthesis group. The variables analyzed included gender, age when operated, comorbidities, type of surgery, ventricular ejection fraction and cardiac rhythm before and after surgery, and outcones: death, reoperation, stroke and infective endocarditis. Results: The median follow-up time was 10 years, with delayed mortality at 3.46% (bio-prothesis) and 5.38% (mechanical), p=0.568. There were more reoperations in the bio-prosthesis group (43,3%) than in the mechanical group (4.6%), with and OR of 15.83 (CI 95% 6.61 - 7.85; p<0.001). The stroke rate was similar (11% for bio-prosthesis vs 8.5% mechanical) p=0.561, with endocarditis at 11.6% for bio-prosthesis vs 6.2% mechanical (p=0.115). Conclusions: The mortality, stroke and endocarditis rates were statistically similar between the groups, but with significantly more reoperations in the mitral and aortic bio-prosthesis groups.

Síndrome coronariana aguda no idoso: diagnóstico e tratamento / Acute coronary syndrome in the elderly: diagnosis and treatment

As doenças cardiovasculares representam um importante problema de saúde pública em todo o mundo, visto que constituem uma das principais causas de morbidade e mortalidade, além de apresentarem altos custos em assistência médica. A incidência dessas doenças na população aumenta dramaticamente com o envelhecimento...

Recurrent pulmonary hyalinizing granuloma.

We report the case of a 61-year-old male patient who underwent surgical excision of a lung mass for anatomopathological study. The patient had previously presented with fever, dry cough, and chest pain, together with lung masses detected by chest X-ray, and had undergone thoracotomy for diagnostic investigation on two occasions (1976 and 1981), although a conclusive diagnosis had not been made. A CT scan of the chest revealed large masses with areas of calcification in both lung fields. The anatomopathological study was consistent with pulmonary hyalinizing granuloma. In the postoperative period, the patient experienced several episodes of bronchospasm, which was reversible with the use of symptomatic medication. At this writing, the patient was receiving maintenance therapy with prednisone (40 mg/day) and had shown clinical improvement.

Granuloma hialinizante de pulmão recidivante / Recurrent pulmonary hyalinizing granuloma

Relatamos o caso de um paciente de 61 anos, masculino, internado com objetivo de exérese de massa pulmonar para estudo anatomopatológico. O paciente apresentara anteriormente um quadro de febre, tosse seca e dor torácica, associado à presença de massas pulmonares detectadas por radiografia de tórax, tendo sido submetido em duas ocasiões (1976 e 1981) a toracotomia para a investigação diagnóstica, sem diagnóstico anatomopatológico conclusivo. A TC de tórax revelou volumosas massas com áreas de calcificação em ambos os campos pulmonares. O material do estudo anatomopatológico foi compatível com granuloma hialinizante de pulmão. No pós-operatório, o paciente apresentou vários episódios de broncoespasmo que foram revertidos com medicação sintomática. Foi mantido com prednisona na dose de 40 mg/dia com boa evolução clínica até o envio deste relato.

We report the case of a 61-year-old male patient who underwent surgical excision of a lung mass for anatomopathological study. The patient had previously presented with fever, dry cough, and chest pain, together with lung masses detected by chest X-ray, and had undergone thoracotomy for diagnostic investigation on two occasions (1976 and 1981), although a conclusive diagnosis had not been made. A CT scan of the chest revealed large masses with areas of calcification in both lung fields. The anatomopathological study was consistent with pulmonary hyalinizing granuloma. In the postoperative period, the patient experienced several episodes of bronchospasm, which was reversible with the use of symptomatic medication. At this writing, the patient was receiving maintenance therapy with prednisone (40 mg/day) and had shown clinical improvement.

Study of acute hepatotoxicity of Equisetum arvense L. in rats.

PURPOSE: To evaluate the acute hepatotoxicity of Equisentum arvense L. in rats. METHODS: Fifty Wistar rats were used, these being divided in four groups, one being the control (receiving only water) and the other groups receiving graded doses of Equisentum arvense L. (30, 50, and 100mg/kg respectively) for 14 days. Blood samples were obtained to determine TGO, TGP, FA, DHL and GT-gamma activities. After that, hepatic tissue samples were collected for the anatomopathologic analysis. RESULTS: The anatomopathologic exam of the hepatic tissue showed organ with preserved lobular structure. In the same way, there was no significant change in the seric activities of the hepatic enzymes when compared to control group. CONCLUSION: The oral treatment with graded doses of Equisentum arvense L. was not able to produce hepatic changes. Further studies are necessary to evaluate the chronic hepatotoxicity of Equisentum arvense L. in rats.

Study of acute hepatotoxicity of Equisetum arvense L. in rats / Estudo da hepatotoxicidade aguda da Equisetum arvense L. em ratos

PURPOSE: To evaluate the acute hepatotoxicity of Equisentum arvense L. in rats. METHODS: Fifty Wistar rats were used, these being divided in four groups, one being the control (receiving only water) and the other groups receiving graded doses of Equisentum arvense L. (30, 50, and 100mg/kg respectively) for 14 days. Blood samples were obtained to determine TGO, TGP, FA, DHL and GT-gamma activities. After that, hepatic tissue samples were collected for the anatomopathologic analysis. RESULTS: The anatomopathologic exam of the hepatic tissue showed organ with preserved lobular structure. In the same way, there was no significant change in the seric activities of the hepatic enzymes when compared to control group. CONCLUSION: The oral treatment with graded doses of Equisentum arvense L. was not able to produce hepatic changes. Further studies are necessary to evaluate the chronic hepatotoxicity of Equisentum arvense L. in rats.

OBJETIVO: Investigar a hepatotoxicidade aguda da Equisetum arvense L. em ratos. MÉTODOS: foram utilizados 50 ratos Wistar, os quais foram divididos em quatro grupos, sendo um controle (recebendo apenas água) e os outros grupos recebendo doses crescentes de cavalinha (30, 50 e 100mg/Kg, respectivamente) por 14 dias. Foram coletadas amostras de sangue para determinação da atividade sérica de TGO, TGP, FA, DHL e gama-GT. Em seguida, foram obtidas amostras de tecido hepático para análise anatomopatológica. RESULTADOS: O exame anatomopatológico de tecido hepático demonstrou órgão com estrutura lobular preservada. Da mesma forma, não houve alteração significativa na atividade sérica das enzimas hepáticas, quando comparado ao grupo controle. CONCLUSÃO: O tratamento com doses crescentes de Equisetum arvense L., não induziu hepatotoxicidade aguda em ratos. Novos estudos são necessários para avaliar a hepatoxicidade crônica de Equisetum arvense L. em ratos.

Bioequivalence study of four different trademarks of enalapril maleate in spontaneously hypertensive rats.

INTRODUCTION: High blood pressure is a systemic disease which has major clinical and psycho-social repercussions, involves a high morbidity-mortality rate and generates high costs for the health system. Its treatment involves the use of antihypertensive drugs, which are commercialized as trademark, generic or similar drugs. PURPOSE: To verify the antihypertensive effect produced by a similar dose of different trademarks of enalapril maleate in spontaneously hypertensive rats (SHR). METHODS: Fifteen mg/kg of enalapril maleate were administered by gavage in 50 SHR rats and their blood pressure was verified through tail plethysmography every three days in a period of 16 days. RESULTS: The group treated with reference drug has shown a significant reduction on blood pressure levels when compared to the control group. Thus, treatments with enalapril maleate of generic, similar-A and similar-B brands have also shown significant reduction on animals' blood pressure. CONCLUSION: The use of generic drug and similars (A and B) drugs in the same doses and for the same period of time has not shown significant difference regarding the reference drug, which suggests that the brands tested are bioequivalent.

Bioequivalence study of four different trademarks of enalapril maleate in spontaneously hypertensive rats

INTRODUCTION: High blood pressure is a systemic disease which has major clinical and psycho-social repercussions, involves a high morbidity-mortality rate and generates high costs for the health system. Its treatment involves the use of antihypertensive drugs, which are commercialized as trademark, generic or similar drugs. PURPOSE: To verify the antihypertensive effect produced by a similar dose of different trademarks of enalapril maleate in spontaneously hypertensive rats (SHR). METHODS: Fifteen mg/kg of enalapril maleate were administered by gavage in 50 SHR rats and their blood pressure was verified through tail plethysmography every three days in a period of 16 days. RESULTS: The group treated with reference drug has shown a significant reduction on blood pressure levels when compared to the control group. Thus, treatments with enalapril maleate of generic, similar-A and similar-B brands have also shown significant reduction on animals' blood pressure. CONCLUSION: The use of generic drug and similars (A and B) drugs in the same doses and for the same period of time has not shown significant difference regarding the reference drug, which suggests that the brands tested are bioequivalent.

INTRODUÇÃO: A hipertensão arterial é uma doença sistêmica que traz grandes repercussões clínicas e psico-sociais, cursa com uma elevada morbi-mortalidade e gera elevados gastos para o sistema de saúde. Seu tratamento envolve a utilização de fármacos anti-hipertensivos, os quais são comercializados como remédios de marca, genéricos ou similares. PURPOSE: Verificar o efeito anti-hipertensivo produzido por dose igualitária de diferentes marcas de maleato de enalapril, em ratos naturalmente hipertensos. MÉTODOS: Foram administrados, por meio de gavagem, 15 mg/kg de maleato de enalapril em 50 ratos naturalmente hipertensos e verificada a pressão arterial, através de pletismografia de cauda, a cada três dias, em um período de 16 dias. RESULTADOS: O grupo testado com o fármaco de referência mostrou uma redução significativa dos níveis pressóricos quando comparado ao grupo controle. Da mesma forma, o tratamento com Maleato de Enalapril da marca genérica e das marcas similar-A e similar-B também produziu redução significativa da pressão arterial dos animais. CONCLUSÃO: A utilização do medicamento genérico e os similares A e B nas doses utilizadas e no tempo de experimentação adotado, não indicou diferença significativa em relação ao fármaco de referência, sugerindo que as marcas testadas são bioequivalentes.