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1.
ACS Appl Energy Mater ; 7(7): 2779-2790, 2024 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-38606034

RESUMO

An increasing number of studies focus on organic flow batteries (OFBs) as possible substitutes for the vanadium flow battery (VFB), featuring anthraquinone derivatives, such as anthraquinone-2,7-disulfonic acid (2,7-AQDS). VFBs have been postulated as a promising energy storage technology. However, the fluctuating cost of vanadium minerals and risky supply chains have hampered their implementation, while OFBs could be prepared from renewable raw materials. A critical component of flow batteries is the electrode material, which can determine the power density and energy efficiency. Yet, and in contrast to VFBs, studies on electrodes tailored for OFBs are scarce. Hence, in this work, we propose the modification of commercial carbon felts with reduced graphene oxide (rGO) and poly(ethylene glycol) for the 2,7-AQDS redox couple and to preliminarily assess its effects on the efficiency of a 2,7-AQDS/ferrocyanide flow battery. Results are compared to those of a VFB to evaluate if the benefits of the modification are transferable to OFBs. The modification of carbon felts with surface oxygen groups introduced by the presence of rGO enhanced both its hydrophilicity and surface area, favoring the catalytic activity toward VFB and OFB reactions. The results are promising, given the improved behavior of the modified electrodes. Parallels are established between the electrodes of both FB technologies.

3.
Artigo em Inglês | MEDLINE | ID: mdl-38662292

RESUMO

In this study, the effect of the cell density of monolithic catalysts was investigated and further mathematically modeled on cordierite supports used in CO2 methanation. Commercial cordierite monoliths with 200, 400, and 500 cpsi cell densities were coated by immersion into an ethanolic suspension of Ni/CeO2 active phase. SEM-EDS analysis confirmed that, owing to the low porosity of cordierite (surface area < 1 m2 g-1), the Ni/CeO2 diffusion into the walls was limited, especially in the case of low and intermediate cell density monoliths; thus, active phase was predominantly loaded onto the channels' external surface. Nevertheless, despite the larger exposed surface area in the monolith with high cell density, which would allow for better distribution and accessibility of Ni/CeO2, its higher macro-pore volume resulted in some introduction of the active phase into the walls. As a result, the catalytic evaluation showed that it was more influenced by increments in volumetric flow rates. The low cell density monolith displayed diffusional control at flow rates below 500 mL min-1. In contrast, intermediate and high cell density monoliths presented this behavior up to 300 mL min-1. These findings suggest that the interaction reactants-catalyst is considerably more affected by a forced non-uniform flow when increasing the injection rate. This condition reduced the transport of reactants and products within the catalyst channels and, in turn, increased the minimum temperature required for the reaction. Moreover, a slight diminution of selectivity to CH4 was observed and ascribed to the possible formation of hot spots that activate the reverse water-gas shift reaction. Finally, a mathematical model based on fundamental momentum and mass transfer equations coupled with the kinetics of CO2 methanation was successfully derived and solved to analyze the fluid dynamics of the monolithic support. The results showed a radial profile with maximum fluid velocity located at the center of the channel. A reactive zone close to the inlet was obtained, and maximum methane production (4.5 mol m-3) throughout the monolith was attained at 350 °C. Then, linear streamlines of the chemical species were developed along the channel.

4.
JAMA Netw Open ; 7(3): e240809, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38446482

RESUMO

Importance: The MOSCA-FRAIL randomized clinical trial compared invasive and conservative treatment strategies in patients with frailty with non-ST-segment elevation myocardial infarction (NSTEMI). It showed no differences in the number of days alive and out of the hospital at 1 year. Objective: To assess the outcomes of the MOSCA-FRAIL trial during extended follow-up. Design, Setting, and Participants: The MOSCA-FRAIL randomized clinical trial was conducted at 13 hospitals in Spain between July 7, 2017, and January 9, 2021, and included 167 adults (aged ≥70 years) with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. In this preplanned secondary analysis, follow-up was extended to January 31, 2023. Data analysis was performed from April 5 to 29, 2023, using the intention-to-treat principle. Interventions: Patients were randomized to a routine invasive (coronary angiography and revascularization if feasible [n = 84]) or a conservative (medical treatment with coronary angiography only if recurrent ischemia [n = 83]) strategy. Main outcomes and measures: The primary end point was the difference in restricted mean survival time (RMST). Secondary end points included readmissions for any cause, considering recurrent readmissions. Results: Among the 167 patients included in the analysis, the mean (SD) age was 86 (5) years; 79 (47.3%) were men and 88 (52.7%) were women. A total of 93 deaths and 367 readmissions accrued. The RMST for all-cause death over the entire follow-up was 3.13 (95% CI, 2.72-3.60) years in the invasive and 3.06 (95% CI, 2.84-3.32) years in the conservative treatment groups. The RMST analysis showed inconclusive differences in survival time (invasive minus conservative difference, 28 [95% CI, -188 to 230] days). Patients under invasive treatment tended to have shorter survival in the first year (-28 [95% CI, -63 to 7] days), which improved after the first year (192 [95% CI, 90-230] days). Kaplan-Meier mortality curves intersected, displaying higher mortality to 1 year in the invasive group that shifted to a late benefit (landmark analysis hazard ratio, 0.58 [95% CI, 0.33-0.99]; P = .045). Early harm was more evident in the subgroup with a Clinical Frailty Scale score greater than 4. No differences were found for the secondary end points. Conclusions and Relevance: In this extended follow-up of a randomized clinical trial of patients with frailty and NSTEMI, an invasive treatment strategy did not improve outcomes at a median follow-up of 1113 (IQR, 443-1441) days. However, a differential distribution of deaths was observed, with early harm followed by later benefit. The phenomenon of depletion of susceptible patients may be responsible for this behavior. Trial registration: ClinicalTrials.gov Identifier: NCT03208153.


Assuntos
Fragilidade , Infarto do Miocárdio sem Supradesnível do Segmento ST , Infarto do Miocárdio com Supradesnível do Segmento ST , Feminino , Humanos , Masculino , Tratamento Conservador , Angiografia Coronária , Análise de Dados , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
5.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-38460882

RESUMO

INTRODUCTION AND OBJECTIVES: Stroke and bleeding risks in atrial fibrillation (AF) are often assessed at baseline to predict outcomes years later. We investigated whether dynamic changes in CHA2DS2-VASc and HAS-BLED scores over time modify risk prediction. METHODS: We included patients with AF who were stable while taking vitamin K antagonists. During a 6-year follow-up, all ischemic strokes/transient ischemic attacks (TIAs) and major bleeding events were recorded. CHA2DS2-VASc and HAS-BLED were recalculated every 2-years and tested for clinical outcomes at 2-year periods. RESULTS: We included 1361 patients (mean CHA2DS2-VASc and HAS-BLED 4.0±1.7 and 2.9±1.2). During the follow-up, 156 (11.5%) patients had an ischemic stroke/TIA and 269 (19.8%) had a major bleeding event. Compared with the baseline CHA2DS2-VASc, the CHA2DS2-VASc recalculated at 2 years had higher predictive ability for ischemic stroke/TIA during the period from 2 to 4 years. Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) showed improvements in sensitivity and better reclassification. The CHA2DS2-VASc recalculated at 4 years had better predictive performance than the baseline CHA2DS2-VASc during the period from 4 to 6 years, with an improvement in IDI and an enhancement of the reclassification. The recalculated HAS-BLED at 2-years had higher predictive ability than the baseline score for major bleeding during the period from 2 to 4 years, with significant improvements in sensitivity and reclassification. A slight enhancement in sensitivity was observed with the HAS-BLED score recalculated at 4 years compared with the baseline score. CONCLUSIONS: In AF patients, stroke and bleeding risks are dynamic and change over time. The CHA2DS2-VASc and HAS-BLED scores should be regularly reassessed, particularly for accurate stroke risk prediction.

6.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-38428580

RESUMO

Atrial fibrillation (AF) causes progressive structural and electrical changes in the atria that can be summarized within the general concept of atrial remodeling. In parallel, other clinical characteristics and comorbidities may also affect atrial tissue properties and make the atria susceptible to AF initiation and its long-term persistence. Overall, pathological atrial changes lead to atrial cardiomyopathy with important implications for rhythm control. Although there is general agreement on the role of the atrial substrate for successful rhythm control in AF, the current classification oversimplifies clinical management. The classification uses temporal criteria and does not establish a well-defined strategy to characterize the individual-specific degree of atrial cardiomyopathy. Better characterization of atrial cardiomyopathy may improve the decision-making process on the most appropriate therapeutic option. We review current scientific evidence and propose a practical characterization of the atrial substrate based on 3 evaluation steps starting with a clinical evaluation (step 1), then assess outpatient complementary data (step 2), and finally include information from advanced diagnostic tools (step 3). The information from each of the steps or a combination thereof can be used to classify AF patients in 4 stages of atrial cardiomyopathy, which we also use to estimate the success on effective rhythm control.

7.
Environ Res ; 246: 118162, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38218517

RESUMO

This study investigated the application of adsorption with activated carbons (ACs) and photodegradation to reduce the concentration of triclosan (TCS) in aqueous solutions. Concerning adsorption, ACs (Darco, Norit, and F400) were characterised and batch experiments were performed to elucidate the effect of pH on equilibrium. The results showed that at pH = 7, the maximum adsorption capacity of TCS onto the ACs was 18.5 mg g-1 for Darco, 16.0 mg g-1 for Norit, and 15.5 mg g-1 for F400. The diffusional kinetic model allowed an adequate interpretation of the experimental data. The effective diffusivity varied and increased with the amount of TCS adsorbed, from 1.06 to 1.68 × 10-8 cm2 s-1. In the case of photodegradation, it was possible to ensure that the triclosan molecule was sensitive to UV light of 254 nm because the removal was over 80 % using UV light. The removal of TCS increased in the presence of sulfate radicals. It was possible to identify 2,4-dichlorophenol as one of the photolytic degradation products of triclosan, which does not represent an environmental hazard at low concentrations of triclosan in water. These results confirm that the use of AC Darco, Norit, and F400 and that photodegradation processes with UV light and persulfate radicals are effective in removing TCS from water, reaching concentration levels that do not constitute a risk to human health or environmental hazard. Both methods effectively eliminate pollutants with relatively easy techniques to implement.


Assuntos
Triclosan , Poluentes Químicos da Água , Humanos , Triclosan/química , Carvão Vegetal/química , Adsorção , Fotólise , Água , Poluentes Químicos da Água/análise
8.
Gels ; 10(1)2024 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-38247776

RESUMO

The electro-Fenton process is based on the generation of hydroxyl radicals (OH•) from hydroxide peroxide (H2O2) generated in situ by an oxygen reduction reaction (ORR). Catalysts based on carbon gels have aroused the interest of researchers as ORR catalysts due to their textural, chemical and even electrical properties. In this work, we synthesized metal-free electrocatalysts based on carbon gels doped with graphene oxide, which were conformed to a working electrode. The catalysts were prepared from organic-gel-based inks using painted (brush) and screen-printed methods free of binders. These new methods of electrode preparation were compared with the conventional pasted method on graphite supports using a binder. All these materials were tested for the electro-Fenton degradation of amoxicillin using a homemade magnetite coated with carbon (Fe3O4/C) as a Fenton catalyst. All catalysts showed very good behavior, but the one prepared by ink painting (brush) was the best one. The degradation of amoxicillin was close to 90% under optimal conditions ([Fe3O4/C] = 100 mg L-1, -0.55 V) with the catalyst prepared using the painted method with a brush, which had 14.59 mA cm-2 as JK and a H2O2 electrogeneration close to 100% at the optimal voltage. These results show that carbon-gel-based electrocatalysts are not only very good at this type of application but can be adhered to graphite free of binders, thus enhancing all their catalytic properties.

9.
Environ Res ; 241: 117671, 2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-37984789

RESUMO

Six Functionalized Activated Carbon Cloths (FACCs) were designed to obtain fundamental information for training a Bayesian Regularized Artificial Neural Network (BRANN) capable of predicting adsorption capacity of the FACCs to synthesize tailor-made materials with potential application as dialysis membranes. Characterization studies showed that FACCs have a high surface area (1354-2073 m2 g-1) associated with increased microporosity (W0, average: 0.57 cm3 g-1). Materials are carbonaceous, with a carbon content between 69 and 92%. Chemical treatments modify the pHpzc of materials between 4.1 and 7.8 due to incorporating functional groups on the surface (C=O, -COOH, -OH, -NH, -NH2). Uremic toxins tests showed a high elimination rate of p-cresol (73 mg g-1) and creatinine (90 mg g-1) which is not affected by the matrix (aqueous solution and simulated serum). However, in the case of uric acid, adsorption capacity decreased from 143 mg g-1 to 71 mg g-1, respectively. When comparing the kinetic constants of the adsorption studies in simulated serum versus the studies in aqueous solution, it can be seen that this does not undergo significant changes (0.02 min-1), evidencing the versatility of the material to work in different matrices. The previous studies, in combination with characterization of the materials, allowed to establish the adsorption mechanism. Thus, it permitted to train the BRANN to obtain mathematical models capable to predict the kinetic adsorption of the toxins studied. It is concluded that the predominant adsorption mechanism is due to π-π interactions between the adsorbate unsaturations with the material's pseudo-graphitic planes. Results show that FACCs are promising materials for hemodialysis membranes. Finally, taking into consideration the adsorption capacities and rates, as well as the semiquantitative analysis of the environmental impact associated with the preparation of the adsorbents, the best adsorbent (CC, Eco-Scale = 91.5) was selected. The studies presented show that the material is eco-friendly and highly efficient in the elimination of uremic toxins.


Assuntos
Toxinas Urêmicas , Poluentes Químicos da Água , Adsorção , Inteligência Artificial , Teorema de Bayes , Carvão Vegetal , Diálise Renal/métodos , Cinética , Água
10.
Transl Res ; 264: 1-14, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-37690706

RESUMO

Cardiovascular calcification is a significant public health issue whose pathophysiology is not fully understood. NOR-1 regulates critical processes in cardiovascular remodeling, but its contribution to ectopic calcification is unknown. NOR-1 was overexpressed in human calcific aortic valves and calcified atherosclerotic lesions colocalizing with RUNX2, a factor essential for osteochondrogenic differentiation and calcification. NOR-1 and osteogenic markers were upregulated in calcifying human valvular interstitial cells (VICs) and human vascular smooth muscle cells (VSMCs). Gain- and loss-of-function approaches demonstrated that NOR-1 negatively modulates the expression of osteogenic genes relevant for the osteogenic transdifferentiation (RUNX2, IL-6, BMP2, and ALPL) and calcification of VICs. VSMCs from transgenic mice overexpressing NOR-1 in these cells (TgNOR-1VSMC) expressed lower basal levels of osteogenic genes (IL-6, BMP2, ALPL, OPN) than cells from WT littermates, and their upregulation by a high-phosphate osteogenic medium (OM) was completely prevented by NOR-1 transgenesis. Consistently, this was associated with a dramatic reduction in the calcification of both transgenic VSMCs and aortic rings from TgNOR-1VSMC mice exposed to OM. Atherosclerosis and calcification were induce in mice by the administration of AAV-PCSK9D374Y and a high-fat/high-cholesterol diet. Challenged-TgNOR-1VSMC mice exhibited decreased vascular expression of osteogenic markers, and both less atherosclerotic burden (assessed in whole aorta and lesion size in aortic arch and brachiocephalic artery) and less vascular calcification (assessed either by near-infrared fluorescence imaging or histological analysis) than WT mice. Our data indicate that NOR-1 negatively modulates the expression of genes critically involved in the osteogenic differentiation of VICs and VSMCs, thereby restraining ectopic cardiovascular calcification.


Assuntos
Estenose da Valva Aórtica , Calcificação Vascular , Animais , Humanos , Camundongos , Valva Aórtica/metabolismo , Valva Aórtica/patologia , Células Cultivadas , Subunidade alfa 1 de Fator de Ligação ao Core/metabolismo , Interleucina-6/genética , Músculo Liso Vascular/fisiologia , Osteogênese/genética , Pró-Proteína Convertase 9/genética , Regulação para Cima , Calcificação Vascular/genética , Calcificação Vascular/metabolismo , Calcificação Vascular/patologia
11.
Zookeys ; 1183: 73-80, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37953750

RESUMO

Epitomaptaaumakuasp. nov. occurs at a depth of 2.5 m in Kualoa, O`ahu, Hawai`i, living in coarse sand. It is distinctive in having 12 pinnate tentacles, each tentacle with three pairs of digits and 6-8 sensory cups. The body wall bears papillae or oval bumps, and the length of body reaches a maximum length of 18.4 mm after relaxation.

12.
Expert Rev Cardiovasc Ther ; 21(12): 923-936, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37905915

RESUMO

INTRODUCTION: Oral anticoagulation (OAC) significantly mitigates thromboembolism risks in atrial fibrillation (AF) and venous thromboembolism (VTE) patients yet concern about major bleeding events persist. In fact, clinically relevant hemorrhages can be life-threatening. Bleeding risk is dynamic and influenced by factors such as age, new comorbidities, and drug therapies, and should not be assessed solely based on static baseline factors. AREAS COVERED: We comprehensively review the bleeding risk associated with OAC therapy. Emphasizing the importance of assessing both thromboembolic and bleeding risks, we present clinical tools for estimating stroke and systemic embolism (SSE) and bleeding risk in AF and VTE patients. We also address overlapping risk factors and the dynamic nature of bleeding risk. EXPERT OPINION: The OAC management is undergoing constant transformation, motivated by the primary objective of mitigating thromboembolism and bleeding hazards, thereby amplifying patient safety throughout the course of treatment. The future of OAC embraces personalized approaches and innovative therapies, driven by advanced pathophysiological insights and technological progress. This holds promise for improving patient outcomes and revolutionizing anticoagulation practices.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/efeitos adversos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Comorbidade , Fatores de Risco , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Administração Oral
14.
Sci Rep ; 13(1): 15355, 2023 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-37717045

RESUMO

Corn nixtamalization generates a waste byproduct that requires diverse environmental preservation measures depending on the country. Such measures could include catalytic and advanced oxidation processes. This study aims to exploit the hemicellulose within the nejayote (32.5%) to create added value chemicals such as furfural using photocatalytic hydrolysis. In the present work, titania (TiO2) nanoparticles (NPs) were greenly synthesized using Ricinus Communis (RC), Moringa Oleifera (MO) or Bougainvillea Spectabilis (BS) plant extracts. Obtained nanoparticles were characterized using XRD, SEM, EDS, BET, XPS and UV-vis techniques. Furthermore, the photocatalytic performance of the obtained samples was evaluated in the furfural production from nejayote. Furfural yield reached 44% in 30 min using the BS synthesized material, which is 1.6 × the yield obtained by the material synthesized with MO extract (26.4% at 45 min) and 6 × the yield obtained by the material obtained with RC (7.2% at 90 min). Such results have not been reported before in the literature and could be the groundwork for novel waste treatments in the tortilla-making industry.

16.
Gels ; 9(8)2023 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-37623120

RESUMO

The Electro-Fenton (EF) process has emerged as a promising technology for pollutant removal. However, the EF process requires the use of two catalysts: one acting as an electrocatalyst for the reduction of oxygen to H2O2 and another Fenton-type catalyst for the generation of ·OH radicals from H2O2. Thus, the search for materials with bifunctionality for both processes is required for a practical and real application of the EF process. Thus, in this work, bifunctional electrocatalysts were obtained via doping carbon microspheres with Eco-graphene, a form of graphene produced using eco-friendly methods. The incorporation of Eco-graphene offers numerous advantages to the catalysts, including enhanced conductivity, leading to more efficient electron transfer during the Electro-Fenton process. Additionally, the synthesis induced structural defects that serve as active sites, promoting the direct production of hydroxyl radicals via a 3-electron pathway. Furthermore, the spherical morphology of carbon xerogels enhances the accessibility of the reagents to the active sites. This combination of factors results in the effective degradation of Tetracycline (TTC) using metal-free catalysts in the Electro-Fenton process, achieving up to an impressive 83% degradation without requiring any other external or additional catalyst.

17.
Med Clin (Barc) ; 161(8): 344-350, 2023 10 27.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-37517924

RESUMO

Peripheral artery disease (PAD) is a condition related to atherosclerosis affecting >200 million people worldwide, and it increases cardiovascular morbidity (mainly from myocardial infarction and stroke) and mortality. Indeed, PAD patients are classified as patients at very high cardiovascular risk. The most common manifestation of PAD is intermittent claudication, which is associated with reduced mobility and leg pain. Nevertheless, asymptomatic PAD is the most frequent form of PAD worldwide; therefore, it remains underdiagnosed and undertreated. The major risk factors for PAD are smoking, diabetes mellitus, hyperlipidemia, hypertension, overweight/obesity, age, male sex, and black race. Hence, the first and most relevant approach in PAD treatment is lifestyle management, with measures such as smoking cessation, healthy diet, weight loss, and regular physical exercise. This should also be supported by an optimal pharmacological approach including lipid-lowering drugs, antihypertensive drugs, antidiabetic agents, and antithrombotics.


Assuntos
Aterosclerose , Doença Arterial Periférica , Humanos , Masculino , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/etiologia , Doença Arterial Periférica/terapia , Claudicação Intermitente/tratamento farmacológico , Claudicação Intermitente/etiologia , Anti-Hipertensivos/uso terapêutico , Aterosclerose/complicações , Fatores de Risco
18.
Psicothema ; 35(3): 259-270, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37493149

RESUMO

BACKGROUND: Problems of behaviour, communication, and social interaction associated with Autism Spectrum Disorders can overwhelm parents. Disturbances in parents' psychological well-being (anxiety, depression) affect adherence to treatment, making it less effective. There is a need to investigate how to increase psychological wellbeing in parents of children with autism. METHOD: An 8-week brief training programme using the Mindfulness Parenting (MP) intervention was applied to fourteen parents (6 couples and two mothers). Participants were assigned to one of two groups, both groups received the same treatment but at two different time points. Measures of anxiety (SCAARED), parental stress (PSI-4), autism severity level (AIM) and mindfulness awareness (FFMQ), were assessed. RESULTS: Analysis indicates that MP training increased mindfulness awareness, increasing non-judgment and reactivity, and consequently, reduced anxiety (parental, general, social), improving parent-child interaction. This improvement did not influence parents' perception of the severity of the disorder. CONCLUSIONS: The small number of participants precludes generalisation of the results. More clinical trials are needed to demonstrate the usefulness of including these programmes in early intervention services, as well as profiles of parents who may potentially benefit from it.


Assuntos
Transtorno do Espectro Autista , Atenção Plena , Feminino , Humanos , Transtorno do Espectro Autista/terapia , Poder Familiar/psicologia , Pais/psicologia , Estresse Psicológico/terapia , Masculino
19.
Am J Cardiol ; 203: 122-127, 2023 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-37487406

RESUMO

Renal impairment confers worse prognosis in patients with atrial fibrillation (AF) but there is scarce evidence about the influence of direct-acting oral anticoagulants in routine clinical practice. Herein, we compared clinical outcomes between patients with AF with and without renal impairment on rivaroxaban and investigated predictors for clinical outcomes in patients with AF with renal impairment. This was a multicenter study including patients with AF on rivaroxaban for at least 6 months. During 2.5 years follow-up, ischemic strokes (IS)/transient ischemic attacks (TIA)/systemic embolisms (SE)/myocardial infarctions (MI), major bleeding, and major adverse cardiovascular events (MACE) were recorded. Creatinine clearance (CrCl) was estimated using the Cockroft-Gault equation, renal impairment was defined as a CrCl <60 ml/min, and 1,433 patients (34.8% with CrCl <60 ml/min) were included. Patients with CrCl <60 ml/min showed higher event rates for major bleeding (1.87%/year vs 0.62%/year; p = 0.003) and MACE (1.97%/year vs 0.62%/year; p = 0.002) but similar event rates for IS/TIA/SE/MI (0.66%/year vs 0.67%/year; p = 0.955). In patients with renal impairment, CHA2DS2-VASc was associated with higher risk of IS/TIA/SE/MI; HAS-BLED and any dependency level were associated with higher risk of major bleeding; and male gender and heart failure were associated with higher risk of MACE. Antiplatelets were independently associated with increased risk of IS/TIA/SE/MI and MACE. In conclusion, in patients with AF on rivaroxaban, the incidence of IS/TIA/SE/MI did not increase in those with renal impairment, suggesting that rivaroxaban may be an effective option in this subgroup. In patients with AF, male gender, heart failure, dependency, antiplatelets, CHA2DS2-VASc, and HAS-BLED were associated with increased risk of adverse outcomes.


Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Ataque Isquêmico Transitório , Infarto do Miocárdio , Insuficiência Renal , Acidente Vascular Cerebral , Humanos , Masculino , Rivaroxabana , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Ataque Isquêmico Transitório/epidemiologia , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Hemorragia/complicações , Insuficiência Renal/complicações , Insuficiência Renal/epidemiologia , Infarto do Miocárdio/epidemiologia , Insuficiência Cardíaca/complicações , Anticoagulantes/uso terapêutico , Fatores de Risco
20.
Front Endocrinol (Lausanne) ; 14: 1167087, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37260447

RESUMO

Background: Diabetes mellitus (DM) is one of the most frequent comorbidities in patients suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a higher rate of severe course of coronavirus disease (COVID-19). However, data about post-COVID-19 syndrome (PCS) in patients with DM are limited. Methods: This multicenter, propensity score-matched study compared long-term follow-up data about cardiovascular, neuropsychiatric, respiratory, gastrointestinal, and other symptoms in 8,719 patients with DM to those without DM. The 1:1 propensity score matching (PSM) according to age and sex resulted in 1,548 matched pairs. Results: Diabetics and nondiabetics had a mean age of 72.6 ± 12.7 years old. At follow-up, cardiovascular symptoms such as dyspnea and increased resting heart rate occurred less in patients with DM (13.2% vs. 16.4%; p = 0.01) than those without DM (2.8% vs. 5.6%; p = 0.05), respectively. The incidence of newly diagnosed arterial hypertension was slightly lower in DM patients as compared to non-DM patients (0.5% vs. 1.6%; p = 0.18). Abnormal spirometry was observed more in patients with DM than those without DM (18.8% vs. 13; p = 0.24). Paranoia was diagnosed more frequently in patients with DM than in non-DM patients at follow-up time (4% vs. 1.2%; p = 0.009). The incidence of newly diagnosed renal insufficiency was higher in patients suffering from DM as compared to patients without DM (4.8% vs. 2.6%; p = 0.09). The rate of readmission was comparable in patients with and without DM (19.7% vs. 18.3%; p = 0.61). The reinfection rate with COVID-19 was comparable in both groups (2.9% in diabetics vs. 2.3% in nondiabetics; p = 0.55). Long-term mortality was higher in DM patients than in non-DM patients (33.9% vs. 29.1%; p = 0.005). Conclusions: The mortality rate was higher in patients with DM type II as compared to those without DM. Readmission and reinfection rates with COVID-19 were comparable in both groups. The incidence of cardiovascular symptoms was higher in patients without DM.


Assuntos
COVID-19 , Diabetes Mellitus , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Síndrome Pós-COVID-19 Aguda , Reinfecção , SARS-CoV-2 , COVID-19/complicações , COVID-19/epidemiologia , Sistema de Registros , Diabetes Mellitus/epidemiologia
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