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1.
Platelets ; : 1-4, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31538834

RESUMO

Human platelet antigen (HPA) polymorphisms are considered to be a risk factor for cardiac and vascular diseases, but the role of HPA in chronic Chagas disease cardiomyopathy (CCC) is not available. Therefore, the aim of this study was to investigate the association of HPA polymorphisms, HPA-1, HPA-2, HPA-3, HPA-5 and HPA-15, in the severity of left ventricular systolic dysfunction (LVSD) in CCC patients. For this, 229 CCC patients were separated into three groups: without LVSD, mild/moderate LVSD and severe LVSD. PCR-SSP was performed for HPA genotyping and the risk was assessed using SNPStats software. HPA-1 allele and genotype frequencies were lower in mild/moderate LVSD patients compared to other groups, without statistical significance. After stratified analyzes, the HPA-3a/3b genotype frequency was lower in women with severe LVSD compared to those without LVSD (OR:0.29; 95% CI: 0.10-0.84). In conclusion, HPA-3 variant could be a protection factor for CCC in the female patients.

2.
Adv Physiol Educ ; 43(4): 451-457, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31460778

RESUMO

Over the years, much criticism against animal use for physiology teaching has been made. Hence, replacement by suitable alternatives has increased in several pedagogical approaches. This study examined students' perceptions of animal versus virtual (video/computer) laboratory classes in physiological sciences associated with the effectiveness of the problem-based learning (PBL) hybrid curriculum. Three cohorts of medical students from the University of Ribeirão Preto, who participated in animal or virtual physiology classes or both, were asked to fill out a 5-point Likert questionnaire about knowledge acquisition/motivation, importance to PBL learning goals, skills acquired, need for animal use, academic formation, learning impairment, and alternative methods. We also assessed their grades in the final exam. A total of 350 students were included, in which 108 participated only in virtual classes, 120 only in practical animal laboratory classes, and 122 in both approaches. The majority agreed that the two methods improved their knowledge acquisition/motivation and helped to reinforce tutorial goals and to acquire skills. However, the cohort who experienced both approaches favored animal laboratory. Students believe animal use is needed and did not impair their learning. Conversely, their opinion about academic formation without animal laboratory classes was divided, as was whether this approach inspired them to seek alternative methods. Despite the different perceptions, there was no difference among the groups' final grades (7.3 ± 1 vs. 7.2 ± 1 vs. 7.2 ± 2 for virtual or practical animal laboratory classes or both, respectively). Therefore, virtual activities are not as effective as animal use in the opinions of the students, but they are successful strategies in physiology learning that can be used in practical classes in a hybrid PBL curriculum.

4.
Arq Bras Cardiol ; 111(3): 436-539, 2018 Sep.
Artigo em Português | MEDLINE | ID: mdl-30379264
5.
Molecules ; 23(2)2018 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-29385675

RESUMO

Gastric cancer is one of the most frequent malignant tumors in the world. The majority of patients are diagnosed with metastatic gastric cancer, which has a low survival rate. These data reinforce the importance of studying the anticancer activity of new molecules with the potential to suppress gastric cancer metastasis. Curcumin is a well-studied compound that has demonstrated anti-metastatic effects. Here we investigated if CH-5, a curcumin derivative compound, has anti-metastatic properties in the human gastric cancer cell line HGC-27. Firstly, we found that CH-5 decreased viability and induced apoptosis in HGC-27 cells in a dose-dependent manner. Additionally, CH-5 suppressed the migration and invasion of HGC-27 cells by downregulating the expression and collagenase activity of matrix metalloproteinase 2 in a dose-dependent manner. In conclusion, CH-5 showed anticancer activities, including the induction of apoptosis, and the suppression of migration and invasion in HGC-27 cells, suggesting that CH-5 can be a lead molecule for the development of anti-metastatic drugs for gastric cancer therapy.


Assuntos
Antineoplásicos , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Curcumina , Neoplasias Gástricas/tratamento farmacológico , Antineoplásicos/química , Antineoplásicos/farmacologia , Linhagem Celular Tumoral , Curcumina/análogos & derivados , Curcumina/química , Curcumina/farmacologia , Relação Dose-Resposta a Droga , Humanos , Invasividade Neoplásica , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patologia
7.
J Am Coll Cardiol ; 70(12): 1510-1524, 2017 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-28911515

RESUMO

Trypanosoma cruzi (T. cruzi) infection is endemic in Latin America and is becoming a worldwide health burden. It may lead to heterogeneous phenotypes. Early diagnosis of T. cruzi infection is crucial. Several biomarkers have been reported in Chagas heart disease (ChHD), but most are nonspecific for T. cruzi infection. Prognosis of ChHD patients is worse compared with other etiologies, with sudden cardiac death as an important mode of death. Most ChHD patients display diffuse myocarditis with fibrosis and hypertrophy. The remodeling process seems to be associated with etiopathogenic mechanisms and neurohormonal activation. Pharmacological treatment and antiarrhythmic therapy for ChHD is mostly based on results for other etiologies. Heart transplantation is an established, valuable therapeutic option in refractory ChHD. Implantable cardioverter-defibrillators are indicated for prevention of secondary sudden cardiac death. Specific etiological treatments should be revisited and reserved for select patients. Understanding and management of ChHD need improvement, including development of randomized trials.


Assuntos
Cardiomiopatia Chagásica/etiologia , Cardiomiopatia Chagásica/terapia , Arritmias Cardíacas/etiologia , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/diagnóstico , Doença Crônica , Insuficiência Cardíaca/etiologia , Humanos , Prognóstico
8.
J Immunol Res ; 2017: 1017621, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28470012

RESUMO

The aim of this study was to investigate possible associations between genetic polymorphisms of IL17A G197A (rs2275913) and IL17F T7488C (rs763780) with Chagas Disease (CD) and/or the severity of left ventricular systolic dysfunction (LVSD) in patients with chronic Chagas cardiomyopathy (CCC). The study with 260 patients and 150 controls was conducted in the South and Southeast regions of Brazil. The genotyping was performed by PCR-RFLP. The A allele and A/A genotype of IL17A were significantly increased in patients and their subgroups (patients with CCC; patients with CCC and LVSD; and patients with CCC and severe LVSD) when compared to the control group. The analysis according to the gender showed that the A/A genotype of IL17A was more frequent in female with LVSD and mild to moderate LVSD and also in male patients with LVSD. The frequency of IL17F T/C genotype was higher in male patients with CCC and severe LVSD and in female with mild to moderate LVSD. The results suggest the possible involvement of the polymorphisms of IL17A and IL17F in the susceptibility to chronic Chagas disease and in development and progression of cardiomyopathy.


Assuntos
Doença de Chagas/genética , Predisposição Genética para Doença , Interleucina-17/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idoso , Idoso de 80 Anos ou mais , Alelos , Brasil/epidemiologia , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/parasitologia , Doença de Chagas/complicações , Doença de Chagas/epidemiologia , Doença de Chagas/parasitologia , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Caracteres Sexuais , Trypanosoma cruzi/isolamento & purificação , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/parasitologia
9.
Cytokine ; 91: 51-56, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28002786

RESUMO

The aim of this study was to investigate the plasma levels of the CCL3 and CCL4 chemokines in patients with the cardiac and digestive clinical forms of chronic Chagas disease and in cardiac patients with and without left ventricular systolic dysfunction (LVSD). Plasma samples from 75 patients were evaluated by enzyme-linked immunosorbent assay (ELISA) to confirm infection by T. cruzi. Plasma levels of the CCL3 and CCL4 chemokines were measured using Milliplex® MAP assay (Millipore). There were no significant differences in the levels of CCL3 and CCL4 between patients with the digestive and cardiac clinical forms of Chagas disease. Moreover, no significant differences were found between patients without LVSD and those with LVSD. Higher CCL3 and CCL4 plasma levels were found in patients with LVSD compared to those with the digestive form of the disease. The CCL3 and CCL4 chemokines might not be involved in differential susceptibility to the digestive and cardiac clinical forms of chronic Chagas disease, and it seems they do not influence the development of LVSD.


Assuntos
Doença de Chagas/sangue , Quimiocina CCL3/sangue , Quimiocina CCL4/sangue , Gastroenteropatias/sangue , Trypanosoma cruzi , Disfunção Ventricular Esquerda/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Infect Genet Evol ; 45: 170-175, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27566333

RESUMO

Chagas disease, caused by Trypanosoma cruzi, can affect the heart, esophagus and colon. The reasons that some patients develop different clinical forms or remain asymptomatic are unclear. It is believed that tissue immunogenetic markers influence the tropism of T. cruzi for different organs. ABO, Secretor and Lewis histo-blood group systems express a variety of tissue carbohydrate antigens that influence the susceptibility or resistance to diseases. This study aimed to examine the association of ABO, secretor and Lewis histo-blood systems with the clinical forms of Chagas disease. We enrolled 339 consecutive adult patients with chronic Chagas disease regardless of gender (cardiomyopathy: n=154; megaesophagus: n=119; megacolon: n=66). The control group was composed by 488 healthy blood donors. IgG anti-T. cruzi antibodies were detected by ELISA. ABO and Lewis phenotypes were defined by standard hemagglutination tests. Secretor (FUT2) and Lewis (FUT3) genotypes, determined by Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), were used to infer the correct histo-blood group antigens expressed in the gastrointestinal tract. The proportions between groups were compared using the χ2 test with Yates correction and Fisher's exact test and the Odds Ratio (OR) and 95% Confidence Interval (95% CI) were calculated. An alpha error of 5% was considered significant with p-values <0.05 being corrected for multiple comparisons (pc). No statistically significant differences were found for the ABO (X2: 2.635; p-value=0.451), Secretor (X2: 0.056; p-value=0.812) or Lewis (X2: 2.092; p-value=0.351) histo-blood group phenotypes between patients and controls. However, B plus AB Secretor phenotypes were prevalent in pooled data from megaesophagus and megacolon patients (OR: 5.381; 95% CI: 1.230-23.529; p-value=0.011; pc=0.022) in comparison to A plus O Secretor phenotypes. The tissue antigen variability resulting from the combined action of ABO and Secretor histo-blood systems is associated with the digestive forms of Chagas disease.


Assuntos
Sistema do Grupo Sanguíneo ABO , Doença de Chagas/epidemiologia , Fucosiltransferases/genética , Sistema do Grupo Sanguíneo de Lewis , Adulto , Idoso , Estudos de Casos e Controles , Doença de Chagas/genética , Doença de Chagas/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
PLoS One ; 10(11): e0141847, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26599761

RESUMO

The clinical manifestations of chronic Chagas disease include the cardiac form of the disease and the digestive form. Not all the factors that act in the variable clinical course of this disease are known. This study investigated whether the CCR5Δ32 (rs333) and CCR5 59029 A/G (promoter region--rs1799987) polymorphisms of the CCR5 gene are associated with different clinical forms of chronic Chagas disease and with the severity of left ventricular systolic dysfunction in patients with chronic Chagas heart disease (CCHD). The antibodies anti-T. cruzi were identified by ELISA. PCR and PCR-RFLP were used to identify the CCR5Δ32 and CCR5 59029 A/G polymorphisms. The chi-square test was used to compare variables between groups. There was a higher frequency of the AA genotype in patients with CCHD compared with patients with the digestive form of the disease and the control group. The results also showed a high frequency of the AG genotype in patients with the digestive form of the disease compared to the other groups. The results of this study show that the CCR5Δ32 polymorphism does not seem to influence the different clinical manifestations of Chagas disease but there is involvement of the CCR5 59029 A/G polymorphism in susceptibility to the different forms of chronic Chagas disease. Besides, these polymorphisms do not influence left ventricular systolic dysfunction in patients with CCHD.


Assuntos
Cardiomiopatia Chagásica/genética , Doença de Chagas/genética , Doenças do Sistema Digestório/genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único/genética , Receptores CCR5/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Cardiomiopatia Chagásica/fisiopatologia , Doença de Chagas/fisiopatologia , Doença Crônica , Feminino , Frequência do Gene/genética , Genes Dominantes , Ventrículos do Coração/fisiopatologia , Humanos , Padrões de Herança/genética , Masculino , Pessoa de Meia-Idade , Modelos Genéticos , Sístole
14.
Arq. bras. cardiol ; 103(6): 538-545, 12/2014. graf
Artigo em Inglês | LILACS | ID: lil-732167

RESUMO

Our knowledge regarding the anatomophysiology of the cardiovascular system (CVS) has progressed since the fourth millennium BC. In Egypt (3500 BC), it was believed that a set of channels are interconnected to the heart, transporting air, urine, air, blood, and the soul. One thousand years later, the heart was established as the center of the CVS by the Hippocratic Corpus in the medical school of Kos, and some of the CVS anatomical characteristics were defined. The CVS was known to transport blood via the right ventricle through veins and the pneuma via the left ventricle through arteries. Two hundred years later, in Alexandria, following the development of human anatomical dissection, Herophilus discovered that arteries were 6 times thicker than veins, and Erasistratus described the semilunar valves, emphasizing that arteries were filled with blood when ventricles were empty. Further, 200 years later, Galen demonstrated that arteries contained blood and not air. With the decline of the Roman Empire, Greco-Roman medical knowledge about the CVS was preserved in Persia, and later in Islam where, Ibn Nafis inaccurately described pulmonary circulation. The resurgence of dissection of the human body in Europe in the 14th century was associated with the revival of the knowledge pertaining to the CVS. The main findings were the description of pulmonary circulation by Servetus, the anatomical discoveries of Vesalius, the demonstration of pulmonary circulation by Colombo, and the discovery of valves in veins by Fabricius. Following these developments, Harvey described blood circulation.


O conhecimento da anatomofisiologia do Sistema Cardiovascular (SCV) progride desde o quarto milênio AC. No Egito (3500 AC), acreditava-se que um conjunto de canais conectava-se ao coração, transportando ar, urina, ar, sangue e a alma. Mil anos após, o Corpo Hipocrático, na escola médica de Kós, estabeleceu o coração como o centro do SCV, definindo algumas características deste órgão. O SCV transportava sangue via ventrículo direito pelas veias, e o pneuma via ventrículo esquerdo pelas artérias. Duzentos anos depois, em Alexandria, com o aparecimento da dissecção anatômica do corpo humano, Herophilus descobriu que as artérias eram seis vezes mais espessas que as veias, enquanto que Erasistratus descreveu as válvulas semilunares, enfatizando que as artérias eram preenchidas por sangue quando o ventrículo esquerdo se esvaziava. Duzentos anos depois, Galeno demonstrou que as artérias continham sangue, não ar. Com o declínio do Império Romano, todo o conhecimento médico Greco-romano do SCV foi preservado na Pérsia, e posteriormente no Islã, onde Ibn-Nafis descreveu incompletamente a circulação pulmonar. Aqui, deve-se enfatizar a incompleta descrição da circulação pulmonar por Ibn-Nafis. A ressurgência da dissecção do corpo humano na Europa no século XIV é associada ao renascimento do conhecimento do SCV. Os principais marcos foram a descrição da circulação pulmonar por Servetus, as descobertas anatômicas de Vesalius, a demonstração da circulação pulmonar por Colombo, e a descoberta das válvulas das veias por Fabricius. Tal contexto abriu o caminho para Harvey descobrir a circulação do sangue.


Assuntos
História Antiga , História Medieval , Humanos , Anatomia/história , Fenômenos Fisiológicos Cardiovasculares , Sistema Cardiovascular/anatomia & histologia , Fisiologia/história , Cardiologia/história , Egito , Grécia , Ilustração Médica , Mundo Romano
15.
Med Educ Online ; 19: 24366, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24931596

RESUMO

BACKGROUND: Despite being a well-established pedagogical approach in medical education, the implementation of problem-based learning (PBL) approaches hinges not only on educational aspects of the medical curriculum but also on the characteristics and necessities of the health system and the medical labor market within which it is situated. AIM: To report our experiences implementing a PBL-based approach in a region of Brazil where: 1) all pre-university education and the vast majority of medical courses are based on traditional, lecture-based instructions; and 2) students' career interests in primary care, arguably the prototypical PBL trainee, are heavily disfavored because of economics. RESULTS: Brazilian guidelines require that clinical training take place during the last 2 years of the medical program and include intensive, supervised, inpatient and outpatient rotations in pediatrics, family medicine, obstetrics and gynecology, internal medicine, and surgery. Throughout the pre-clinical curriculum, then, students learn to deal with progressively more difficult and complex cases--typically through the use of PBL tutors in a primary care context. However, because of curricular time constraints in the clerkships, and students' general preoccupation with specialty practice, the continuation of PBL-based approaches in the pre-clinical years--and the expansion of PBL into the clerkships--has become exceedingly difficult. DISCUSSION AND CONCLUSION: Our experience illustrates the importance of context (both cultural and structural) in implementing certain pedagogies within one Brazilian training program. We plan to address these barriers by: 1) integrating units, whenever possible, within a spiral curriculum; 2) introducing real patients earlier in students' pre-clinical coursework (primarily in a primary care setting); and 3) using subject experts as PBL tutors to better motivate students.


Assuntos
Educação Médica/organização & administração , Médicos de Atenção Primária/educação , Aprendizagem Baseada em Problemas/organização & administração , Brasil , Competência Clínica , Cultura , Currículo , Humanos , Integração de Sistemas , Universidades
16.
Arq Bras Cardiol ; 103(6): 538-45, 2014 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25590934

RESUMO

Our knowledge regarding the anatomophysiology of the cardiovascular system (CVS) has progressed since the fourth millennium BC. In Egypt (3500 BC), it was believed that a set of channels are interconnected to the heart, transporting air, urine, air, blood, and the soul. One thousand years later, the heart was established as the center of the CVS by the Hippocratic Corpus in the medical school of Kos, and some of the CVS anatomical characteristics were defined. The CVS was known to transport blood via the right ventricle through veins and the pneuma via the left ventricle through arteries. Two hundred years later, in Alexandria, following the development of human anatomical dissection, Herophilus discovered that arteries were 6 times thicker than veins, and Erasistratus described the semilunar valves, emphasizing that arteries were filled with blood when ventricles were empty. Further, 200 years later, Galen demonstrated that arteries contained blood and not air. With the decline of the Roman Empire, Greco-Roman medical knowledge about the CVS was preserved in Persia, and later in Islam where, Ibn Nafis inaccurately described pulmonary circulation. The resurgence of dissection of the human body in Europe in the 14th century was associated with the revival of the knowledge pertaining to the CVS. The main findings were the description of pulmonary circulation by Servetus, the anatomical discoveries of Vesalius, the demonstration of pulmonary circulation by Colombo, and the discovery of valves in veins by Fabricius. Following these developments, Harvey described blood circulation.


Assuntos
Anatomia/história , Fenômenos Fisiológicos Cardiovasculares , Sistema Cardiovascular/anatomia & histologia , Fisiologia/história , Cardiologia/história , Egito , Grécia , História Antiga , História Medieval , Humanos , Ilustração Médica , Mundo Romano
17.
Med. reabil ; 31(3): 55-59, set.-dez. 2012. graf
Artigo em Português | LILACS | ID: lil-775898

RESUMO

Objetivos: Avaliar a qualidade de vida, desempenho ocupacional e independência funcional. Métodos: Estudo transversal qualitativo e quantitativo. Instrumentos utilizados: ficha de identificação; questionário de qualidade de vida WHOQOL - BREF; Medida Canadense de Desempenho Ocupacional - COPM; e Medida de Independência Funcional - MIF. Resultados: Participaram 40 pacientes com diagnóstico de Insuficiência Cardíaca, com média de idade 60+-14, em acompanhamento ambulatorial, dos quais 57,5% (23) eram homens, 42,5% (17) mulheres; 77,5% (31) não fumantes, 22,5% (9) fumantes; 57,5% (23) possuíam cuidador, 42,5% (17) não. Com relação à qualidade de vida, a média total entre os participantes foi de 63,58+-12. Entre as dificuldades citadas, 67,5% queixaram-se do auto-cuidado; 47,5% da produtividade; e 50% do lazer. Com relação à independência funcional a média total foi de 119+-8,5. Conclusão: Este estudo sugere a necessidade de uma maior atenção às atividades de vida diária e instrumental, as quais foram apresentadas em quantidade razoável pelos pacientes.


Assuntos
Humanos , Masculino , Feminino , Idoso , Atividades Cotidianas , Avaliação da Deficiência , Insuficiência Cardíaca , Terapia Ocupacional , Qualidade de Vida , Inquéritos e Questionários
18.
Arq. bras. cardiol ; 97(6): 517-525, dez. 2011. graf, tab
Artigo em Português | LILACS | ID: lil-610397

RESUMO

FUNDAMENTO: Pouco se sabe sobre o desfecho dos pacientes com cardiopatia chagásica, em comparação aos pacientes com miocardiopatia dilatada idiopática na era contemporânea. OBJETIVO: Comparar o desfecho dos pacientes chagásicos com insuficiência cardíaca sistólica crônica decorrente da cardiopatia chagásica ao observado em pacientes com MDI na era contemporânea. MÉTODOS: Foi incluído um total de 352 pacientes (246 com cardiomiopatia chagásica e 106 com miocardiopatia dilatada idiopática), seguidos prospectivamente em nossa Instituição, de janeiro de 2000 a janeiro de 2008. Todos os pacientes receberam tratamento clínico contemporâneo padrão. RESULTADOS: Na análise multivariada com o modelo de risco proporcional de Cox, o uso da digoxina (relação de risco = 3,17; intervalo de confiança de 95 por cento, de 1,62 a 6,18; p = 0,001) necessitou de suporte inotrópico (relação de risco = 2,08; intervalo de confiança de 95 por cento, de 1,43 a 3,02; p < 0,005). A fração de ejeção do ventrículo esquerdo (relação de risco = 0,97; intervalo de confiança de 95 por cento, de 0,95 a 0,99; p < 0,005) e a etiologia da cardiopatia chagásica (relação de risco = 3,29; intervalo de confiança de 95 por cento, de 1,89 a 5,73; p < 0,005) foram associadas positivamente à mortalidade, enquanto a terapia com betabloqueadores (relação de risco = 0,39; intervalo de confiança de 95 por cento, de 0,26 a 0,56; p < 0,005) foi associada negativamente à mortalidade. A probabilidade de sobrevida para pacientes com cardiomiopatia chagásica em oito, 24 e 49 meses foi de 83 por cento, 61 por cento e 41 por cento, respectivamente. Já para pacientes com cardiomiopatia dilatada idiopática, foi de 97 por cento, 92 por cento e 82 por cento, respectivamente (p < 0,005). CONCLUSÃO: Na era atual do tratamento da insuficiência cardíaca, os pacientes com cardiomiopatia chagásica têm um desfecho pior em comparação aos pacientes com cardiomiopatia dilatada idiopática.


BACKGROUND: Little is known about the outcome of patients with Chagas cardiomyopathy in comparison to that of patients with Idiopathic Dilated Cardiomyopathy in the contemporary era. OBJECTIVE: To compare the outcome of chagasic patients with chronic systolic heart failure secondary to Chagas cardiomyopathy with that observed in patients with IDC in the contemporary era. METHODS: A total of 352 patients (246 with Chagas cardiomyopathy, 106 with Idiopathic Dilated Cardiomyopathy) prospectively followed at our Institution from January, 2000 to January, 2008 were included. All patients received standard contemporary medical therapy. RESULTS: In Cox proportional hazards model multivariate analysis, digoxin use (Hazard Ratio=3.17; 95 percent Confidence Interval 1.62 to 6.18; p=0.001), need of inotropic support (Hazard Ratio=2.08; 95 percent Confidence Interval 1.43 to 3.02; p<0.005), left ventricular ejection fraction (Hazard Ratio=0.97; 95 percent Confidence Interval 0.95 to 0.99; p<0.005), and Chagas cardiomyopathy etiology (Hazard Ratio=3.29; 95 percent Confidence Interval 1.89 to 5.73; p<0.005) were positively associated with mortality, whereas Beta-Blocker therapy (Hazard Ratio=0.39; 95 percent Confidence Interval 0.26 to 0.56; p<0.005) was negatively associated with mortality. Survival probability for patients with Chagas cardiomyopathy at 8, 24, and 49 months was 83 percent, 61 percent, and 41 percent, respectively, and for patients with Idiopathic Dilated cardiomyopathy 97 percent, 92 percent, and 82 percent, respectively (p<0.005). CONCLUSION: In the current era of heart failure therapy, patients with Chagas cardiomyopathy have a poorer outcome in comparison to patients with Idiopathic Dilated Cardiomyopathy.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Chagásica/mortalidade , Antagonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/uso terapêutico , Cardiomiopatia Dilatada/tratamento farmacológico , Cardiomiopatia Dilatada , Cardiomiopatia Chagásica/tratamento farmacológico , Cardiomiopatia Chagásica , Digoxina/efeitos adversos , Digoxina/uso terapêutico , Métodos Epidemiológicos , Prognóstico , Resultado do Tratamento
19.
Arq Bras Cardiol ; 97(6): 517-25, 2011 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22030565

RESUMO

BACKGROUND: Little is known about the outcome of patients with Chagas cardiomyopathy in comparison to that of patients with idiopathic dilated cardiomyopathy in the contemporary era. OBJECTIVE: To compare the outcome of chagasic patients with chronic systolic heart failure secondary to Chagas cardiomyopathy with that observed in patients with IDC in the contemporary era. METHODS: A total of 352 patients (246 with Chagas cardiomyopathy, 106 with idiopathic dilated cardiomyopathy) prospectively followed at our Institution from January, 2000 to January, 2008 were included. All patients received standard contemporary medical therapy. RESULTS: In Cox proportional hazards model multivariate analysis, digoxin use (Hazard Ratio=3.17; 95% Confidence Interval 1.62 to 6.18; p=0.001), need of inotropic support (Hazard Ratio=2.08; 95% Confidence Interval 1.43 to 3.02; p<0.005), left ventricular ejection fraction (Hazard Ratio=0.97; 95% Confidence Interval 0.95 to 0.99; p<0.005), and Chagas cardiomyopathy etiology (Hazard Ratio=3.29; 95% Confidence Interval 1.89 to 5.73; p<0.005) were positively associated with mortality, whereas beta-blocker therapy (Hazard Ratio=0.39; 95% Confidence Interval 0.26 to 0.56; p<0.005) was negatively associated with mortality. Survival probability for patients with Chagas cardiomyopathy at 8, 24, and 49 months was 83%, 61%, and 41%, respectively, and for patients with idiopathic dilated cardiomyopathy 97%, 92%, and 82%, respectively (p<0.005). CONCLUSION: In the current era of heart failure therapy, patients with Chagas cardiomyopathy have a poorer outcome in comparison to patients with idiopathic dilated cardiomyopathy.


Assuntos
Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Chagásica/mortalidade , Antagonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/uso terapêutico , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/tratamento farmacológico , Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/tratamento farmacológico , Digoxina/efeitos adversos , Digoxina/uso terapêutico , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Resultado do Tratamento , Ultrassonografia
20.
Rev Soc Bras Med Trop ; 43(5): 496-9, 2010 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21085856

RESUMO

INTRODUCTION: The purpose of this study was to determine digoxin serum concentrations in patients with Chagas' cardiomyopathy with chronic heart failure, because little is known concerning this laboratory test in patients with this condition. METHODS: This study focuses on 29 (29%) out of 101 patients with chronic heart failure secondary to Chagas' cardiomyopathy receiving digoxin therapy. Digoxin was measured by the immune-enzymatic method. RESULTS: New York Heart Association Functional Class III/IV was noted in 13 (45%) patients. The mean potassium serum level was 4.3 ± 0.5 mEq/L, mean creatinine serum levels 1.4± 0.3dg/100ml, and left ventricular ejection fraction 34.7 ± 13.8%. The median digoxin serum level was 1.27 (0.55; 1.79)ng/ml. Sixteen (55%) patients had digoxin serum levels higher than 1.0 ng/ml. Abnormal digoxin serum levels were verified in 13 (45%) patients. Digoxin serum levels correlated moderately with creatinine serum levels (r = 0.39; p < 0.03) and negatively with sodium serum levels (r= -0.38; p= 0.03). CONCLUSIONS: Digoxin serum concentration should be measured in patients with Chagas' cardiomyopathy with chronic heart failure receiving digoxin therapy due to the potential for digoxin toxicity.


Assuntos
Cardiotônicos/sangue , Cardiomiopatia Chagásica/sangue , Digoxina/sangue , Insuficiência Cardíaca/sangue , Idoso , Cardiotônicos/uso terapêutico , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/tratamento farmacológico , Doença Crônica , Creatinina/sangue , Estudos Transversais , Digoxina/uso terapêutico , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Humanos , Imunoensaio , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Prevalência , Índice de Gravidade de Doença
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