Cardiovascular disease in patients with ankylosing spondylitis from the rheumatology outpatient clinic of the UFMS-affiliated Hospital / Doença cardiovascular em pacientes com espondilite anquilosante do ambulatório de reumatologia do Hospital afiliado à UFMS

Background: Cardiovascular diseases are a major cause of morbidity and mortality today. Despite its wide distribution, it presents particularly prevalent in certain groups of individuals, particularly when exposed to a higher degree of inflammation, giving increased cardiovascular risk. Rheumatic diseases expose their holders to this increased cardiovascular risk condition; however only recently have been associated with spondyloarthritis, particularly ankylosing spondylitis (AS). For being a classically autoimmune disease related to HLA histocompatibility system, AS may present phenotypic variations in different ethnic groups with possible diverse cardiovascular consequences. Objectives: To estimate the prevalence of cardiovascular disease (CVD) and the cardiovascular risk profile, correlating the time since diagnosis and activity of ankylosing spondylitis (AS) in patients from the rheumatology outpatient clinic of the UFMS-affiliated hospital. Methods: Of 55 patients with AS, 42 were selected consecutively and compared to a control group (CG) in a cross-sectional study. Patients with diabetes, indigenous background and pregnant women were excluded. Quantitative variables were assessed by use of Student t test, while qualitative variables, by chi-square test. The patients underwent electrocardiography, echocardiography and carotid Doppler examination, measurement of serum lipid levels and inflammatory markers, and were stratified according to global cardiovascular risk. The AS activity and impairment were evaluated by use of the BASMI, BASDAI, BASFI and ASDAS. Results: Mean age, 42.87 ± 12.37 years; time since AS diagnosis, 10.76 ± 8.74 years. There was no difference in cardiovascular risk stratification between the groups, most of the patients being at high or moderate risk (AS: 64.3%, and CG: 52%, p = 0.134). The prevalence of manifest CVD (2%) showed no difference between the groups, except for right bundle-branch block (AS: 14%, and CG: 2%, p = 0.027). The prevalence of subclinical CVD showed no difference between the groups, except for higher carotid medial-intimal thickness (CIMT) in the AS group (AS: 1.82 ± 2.63, and CG: 0.67 ± 0.16, p = 0.018). There was no correlation between AS activity or inflammatory markers and CVD, but with time since AS diagnosis and CIMT (p = 0.039, r = 0.328). Conclusions: Prevalence of CVD and risk factors was similar in the groups. Subclinical atherosclerosis degree was higher in the AS group, related to the time since diagnosis, but was independent of the cardiovascular risk factors or inflammation. Most patients with AS are at high cardiovascular risk

Correlação entre a complexidade das lesões coronarianas e os níveis de Troponina ultrassensível em pacientes com Síndrome Coronariana Aguda / Correlation between the complexity of coronary lesions and high-sensitivity Troponin levels in patients with Acute Coronary Syndrome

Fundamento: As doenças cardiovasculares são a principal causa de morte no Brasil. Marcadores bioquímicos possuem importância diagnóstica e prognóstica nas síndromes coronarianas agudas (SCAs), sendo a troponina o biomarcador preferido. Estudos já demonstram relação positiva entre elevação da troponina ultrassensível (TnUs) e prognóstico. Entretanto, poucos relacionam seus níveis com a complexidade das lesões coronárias. Objetivos: Comparar níveis de TnUs com a complexidade das lesões coronarianas pelo escore SYNTAX e relacionar os escores TIMI e GRACE com os níveis desse biomarcador em pacientes com SCA. Métodos: Estudo retrospectivo, transversal com 174 indivíduos com SCA. A correlação entre as variáveis foi avaliada pelo teste de correlação linear não paramétrico de Spearman e a análise estatística realizada pelo programa SPSS, com nível de significância de 5%. Resultados: A média de idade foi 63 anos, predominando o sexo feminino (52,9%). A maioria dos pacientes era hipertensa, não diabética e não tabagista. Dos pacientes avaliados, 19,0% apresentaram IAM com SST, 43,1% IAM sem SST e 36,8% angina instável. A maioria encontrava-se em Killip 1 (82,8%). A mediana de TnUs foi de 67pg/ml. As medianas dos escores de risco foram de 3, 121 e 3 pontos nas escalas TIMI, GRACE e SYNTAX, respectivamente. Houve correlação da taxa de TnUs com os escores SYNTAX (p < 0,001, r = 0,440), TIMI (p < 0,001, r = 0,267) e GRACE (p = 0,001, r = 0,261). Conclusão: Encontrada correlação linear positiva entre os níveis de TnUs e complexidade das lesões coronarianas, assim como entre esse biomarcador e os escores clínicos TIMI e GRACE

Background: Cardiovascular diseases are the leading cause of death in Brazil. Biochemical markers have diagnostic and prognostic importance in acute coronary syndromes (ACSs), with troponin as the preferred biomarker. Studies have already demonstrated a positive relationship between increased levels of high-sensitivity troponin (hsTn) and prognosis. However, few studies have correlated hsTn levels with the complexity of coronary lesions. Objectives: To compare hsTn levels with the complexity of coronary lesions according to the SYNTAX score, and to correlate the levels of this biomarker with the TIMI and GRACE scores in patients with ACS. Methods: Retrospective, cross-sectional study with 174 patients with ACS. The correlation between variables was assessed by the nonparametric Spearman's rank correlation, and statistical analysis was performed by the SPSS program, with a significance level of 5%. Results: Mean age was 63 years, and most patients were women (52.9%), hypertensive, non-diabetic and non-smokers. Nineteen percent of the patients had STEMI, 43.1% NSTEMI, and 36.8% unstable angina. Most were in Killip 1 (82.8%). Median hsTn was 67 pg/mL. Median risk scores were 3, 121 and 3 in the TIMI, GRACE and SYNTAX scores, respectively. There was a correlation of hsTn with SYNTAX (p <0.001, r = 0.440), TIMI (p < 0.001, r = 0.267) and GRACE (p = 0.001, r = 0.261) scores. Conclusion: A positive linear correlation was found of hsTn levels with the complexity of coronary lesions, and with the TIMI and GRACE

Intoxicaçäo crônica por chumbo / Chronic lead poisoning

Os autores relatam o caso de paciente de 30 anos, do sexo masculino, proveniente de Apucarana-PR, que desenvolveu alteraçöes gastrintestinais neurológicas graves devido à exposiçäo ao chumbo durante 10 anos. Trabalhava em fábrica de baterias automotivas, mantendo durante este período contato cutâneo e inalatório com o produto.