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2.
Br J Radiol ; 93(1115): 20200078, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32816561

RESUMO

OBJECTIVE: Qualitative and quantitative image analysis between Iopamidol-370 and Ioversol-320 in stents´ evaluation by coronary computed tomography angiography (CTA). METHODS: Sixty-five patients with low-risk stable angina undergoing stent follow-up with coronary CTA were assigned to Iopamidol I-370 (n = 33) or Ioversol I-320 (n = 32) in this prospective, double-blind, non-inferiority, randomized trial. Stent lumen image quality was graded by 5-point Likert Scale. Lumen mean attenuation was measured at native coronary segments: pre-stent, post-stent, distal segments and at coronary plaques. Lumen attenuation increase (LAI) ratio was calculated for all stents. Heart rate (HR) variation, premature heart beats (PHB), heat sensation (HS), blooming and beam hardening were also assessed. RESULTS: Image quality was similar between groups, with no significant difference (Likert score 4.48 ± 0.75 vs 4.54 ± 0.65, p = 0.5). There were similarities in LAI ratio between I-370 and I-320 (0.39 ± 0.42 vs 0.48 ± 0.44 HU, p = 0.08). Regarding lumen mean attenuation at native coronary segments, a significant difference was observed, with I-320 presenting lower values, including contrast mean attenuation in distal segments. After statistical multivariate analysis, three variables correlated with stent image quality: 1) stent diameter, 2) HR variation and 3) stent lumen LAI ratio. CONCLUSIONS: There was no significant difference between Iopamidol-370 mgI ml-1 and Ioversol-320 mgI ml-1 contrasts regarding overall stent lumen image quality, which was mainly influenced by stent diameter, HR and LAI ratio.Advances in knowledge:Coronary CTA allows adequate stents' visualization and image quality is influenced by stent diameter, HR variation and LAI ratio.Stents' image quality showed no difference between different concentration contrasts (I-370 vs. I-320); however, higher concentration contrasts may provide an improved overall visualization, especially regarding coronary distal segments.


Assuntos
Angina Estável/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste , Angiografia Coronária/métodos , Iopamidol , Stents , Ácidos Tri-Iodobenzoicos , Angina Estável/terapia , Artefatos , Complexos Cardíacos Prematuros , Angiografia por Tomografia Computadorizada/efeitos adversos , Angiografia por Tomografia Computadorizada/normas , Angiografia Coronária/efeitos adversos , Angiografia Coronária/normas , Método Duplo-Cego , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Stents/estatística & dados numéricos
4.
Ann Emerg Med ; 76(3): 255-265, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32245584

RESUMO

STUDY OBJECTIVE: We developed prediction models for hospital admission and prolonged length of stay in older adults admitted from the emergency department (ED). METHODS: This was a retrospective cohort study of patients aged 70 years or older who visited a geriatric ED in Brazil (N=5,025 visits). We randomly allocated participants to derivation and validation samples in a 2:1 ratio. We then selected 21 variables based on their clinical relevance and generated models to predict the following outcomes: hospital admission and prolonged length of stay, defined as the upper tertile of hospital stay. We used backward stepwise logistic regressions to select our final predictors and developed risk scoring systems based on the relative values of their ß coefficients. RESULTS: Overall, 57% of the participants were women, 31% were hospitalized, and 1% died in the hospital. The upper tertile of hospital stay was greater than 7 days. Hospital admission was best predicted by a model including male sex, aged 90 years or older, hospitalization in the previous 6 months, weight loss greater than or equal to 5% in the previous year, acute mental alteration, and acute functional decline. The prediction of prolonged length of stay retained the same variables, except male sex, which was substituted for fatigue. The final scoring system reached areas under the receiver operating characteristic curve of 0.74 for hospital admission and 0.79 for prolonged length of stay, and their accuracies were confirmed in the validation models. CONCLUSION: The PRO-AGE scoring system predicted hospital admission and prolonged length of stay in older adults with good accuracy, using a simple approach and only 7 easily obtained clinical variables.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Avaliação Geriátrica , Tempo de Internação , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos de Coortes , Feminino , Serviços de Saúde para Idosos , Humanos , Modelos Logísticos , Masculino , Modelos Teóricos , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores Sexuais
5.
Arq Bras Cardiol ; 113(3): 449-663, 2019 10 10.
Artigo em Português | MEDLINE | ID: mdl-31621787
6.
Bernoche, Claudia; Timerman, Sergio; Polastri, Thatiane Facholi; Giannetti, Natali Schiavo; Siqueira, Adailson Wagner da Silva; Piscopo, Agnaldo; Soeiro, Alexandre de Matos; Reis, Amélia Gorete Afonso da Costa; Tanaka, Ana Cristina Sayuri; Thomaz, Ana Maria; Quilici, Ana Paula; Catarino, Andrei Hilário; Ribeiro, Anna Christina de Lima; Barreto, Antonio Carlos Pereira; Azevedo, Antonio Fernando Barros de Filho; Pazin, Antonio Filho; Timerman, Ari; Scarpa, Bruna Romanelli; Timerman, Bruno; Tavares, Caio de Assis Moura; Martins, Cantidio Soares Lemos; Serrano, Carlos Vicente Junior; Malaque, Ceila Maria Sant'Ana; Pisani, Cristiano Faria; Batista, Daniel Valente; Leandro, Daniela Luana Fernandes; Szpilman, David; Gonçalves, Diego Manoel; Paiva, Edison Ferreira de; Osawa, Eduardo Atsushi; Lima, Eduardo Gomes; Adam, Eduardo Leal; Peixoto, Elaine; Evaristo, Eli Faria; Azeka, Estela; Silva, Fabio Bruno da; Wen, Fan Hui; Ferreira, Fatima Gil; Lima, Felipe Gallego; Fernandes, Felipe Lourenço; Ganem, Fernando; Galas, Filomena Regina Barbosa Gomes; Tarasoutchi, Flavio; Souza, Germano Emilio Conceição; Feitosa, Gilson Soares Filho; Foronda, Gustavo; Guimarães, Helio Penna; Abud, Isabela Cristina Kirnew; Leite, Ivanhoé Stuart Lima; Linhares, Jaime Paula Pessoa Filho; Moraes, Junior João Batista de Moura Xavier; Falcão, João Luiz Alencar de Araripe; Ramires, Jose Antônio Franchini; Cavalini, José Fernando; Saraiva, José Francisco Kerr; Abrão, Karen Cristine; Pinto, Lecio Figueira; Bianchi, Leonardo Luís Torres; Lopes, Leonardo Nícolau Geisler Daud; Piegas, Leopoldo Soares; Kopel, Liliane; Godoy, Lucas Colombo; Tobase, Lucia; Hajjar, Ludhmila Abrahão; Dallan, Luís Augusto Palma; Caneo, Luiz Fernando; Cardoso, Luiz Francisco; Canesin, Manoel Fernandes; Park, Marcelo; Rabelo, Marcia Maria Noya; Malachias, Marcus Vinícius Bolívar; Gonçalves, Maria Aparecida Batistão; Almeida, Maria Fernanda Branco de; Souza, Maria Francilene Silva; Favarato, Maria Helena Sampaio; Carrion, Maria Julia Machline; Gonzalez, Maria Margarita; Bortolotto, Maria Rita de Figueiredo Lemos; Macatrão-Costa, Milena Frota; Shimoda, Mônica Satsuki; Oliveira-Junior, Mucio Tavares de; Ikari, Nana Miura; Dutra, Oscar Pereira; Berwanger, Otávio; Pinheiro, Patricia Ana Paiva Corrêa; Reis, Patrícia Feitosa Frota dos; Cellia, Pedro Henrique Moraes; Santos Filho, Raul Dias dos; Gianotto-Oliveira, Renan; Kalil Filho, Roberto; Guinsburg, Ruth; Managini, Sandrigo; Lage, Silvia Helena Gelas; Yeu, So Pei; Franchi, Sonia Meiken; Shimoda-Sakano, Tania; Accorsi, Tarso Duenhas; Leal, Tatiana de Carvalho Andreucci; Guimarães, Vanessa; Sallai, Vanessa Santos; Ávila, Walkiria Samuel; Sako, Yara Kimiko.
Arq. bras. cardiol ; 113(3): 449-663, Sept. 2019. tab, graf
Artigo em Português | LILACS-Express | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1038561
7.
Blood Press Monit ; 21(2): 69-74, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26484743

RESUMO

INTRODUCTION: According to the published literature, blood pressure (BP) measurements performed in the outpatient clinical setting are often inaccurate. The white coat effect and improper technique are the main causes of this imprecision. Construction of a set of readings without them could improve the accuracy of BP measurement. OBJECTIVE: To evaluate the accuracy and agreement of successive office BP measurements using the awake blood pressure average (ABPa) as the gold standard. METHODS: BP was measured in 852 patients using three techniques: in office (OBPa); seven successive measurements performed by a nurse using an automatic device; and 24 h of ambulatory BP monitoring. BP averages (BPa) were obtained from the nurse's measurements: 1-2BPa (first and second), 3-7BPa (third to seventh), and 1-7BPa (first to seventh). OBPa and successive measurements were tested against ABPa by calculating the following: average difference in BP of 1-2BPa, 3-7BPa and OBPa, and the area under the curve. RESULTS: Among the 834 patients eligible, 374 (43.9%) were considered to be hypertensive on the basis of the ABPa (≥135/85 mmHg). 3-7BPa showed the lowest average difference (4/3 mmHg). By contrast, OBPa showed the highest result (21/11 mmHg). The mean difference with 1-2BPa was 8/4 mmHg. The areas under the curve were better with 3-7BPa (0.82-0.85) and 1-2BPa (0.82-0.83) than OBPa (0.67-0.71) for both systolic and diastolic BP. CONCLUSION: All means from successive measurements showed a better precision than OBPa, even the two first readings. However, more research needs to be carried out before recommendation of the use of this technique in routine practice.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade
8.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.545-569.
Monografia em Português | LILACS | ID: biblio-971555
10.
Acad Emerg Med ; 21(8): 886-91, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25155885

RESUMO

OBJECTIVES: Community members should be trained so that witnesses of cardiac arrests are able to trigger the emergency system and perform adequate resuscitation. In this study, the authors evaluated the results of cardiopulmonary resuscitation (CPR) training of communities in four Brazilian cities, using personal resuscitation manikins. METHODS: In total, 9,200 manikins were distributed in Apucarana, Itanhaém, Maringá, and São Carlos, which are cities where the populations range from 80,000 to 325,000 inhabitants. Elementary and secondary school teachers were trained on how to identify a cardiac arrest, trigger the emergency system, and perform chest compressions. The teachers were to transfer the training to their students, who would then train their families and friends. RESULTS: In total, 49,131 individuals were trained (6.7% of the population), but the original strategy of using teachers and students as multipliers was responsible for only 27.9% of the training. A total of 508 teachers were trained, and only 88 (17.3%) transferred the training to the students. Furthermore, the students have trained only 45 individuals of the population. In Maringá and São Carlos, the strategy was changed and professionals in the primary health care system were prepared and used as multipliers. This strategy proved extremely effective, especially in Maringá, where 39,041 individuals were trained (79.5% of the total number of trainings). Community health care providers were more effective in passing the training to students than the teachers (odds ratio [OR] = 7.12; 95% confidence interval [CI] = 4.74 to 10.69; p < 0.0001). CONCLUSIONS: Instruction of CPR using personal manikins by professionals in the primary health care system seems to be a more efficient strategy for training the community than creating a training network in the schools.


Assuntos
Reanimação Cardiopulmonar/educação , Educação não Profissionalizante/métodos , Parada Cardíaca/terapia , Manequins , Adolescente , Adulto , Brasil , Criança , Agentes Comunitários de Saúde , Educação não Profissionalizante/organização & administração , Docentes , Feminino , Parada Cardíaca/diagnóstico , Humanos , Masculino , Estudos Prospectivos , Instituições Acadêmicas , Estudantes
11.
Arq. bras. cardiol ; 101(6): 511-518, dez. 2013. ilus, tab
Artigo em Português | LILACS | ID: lil-701279

RESUMO

FUNDAMENTO: A ocorrência de sangramento aumenta a mortalidade intra-hospitalar em pacientes com síndromes coronarianas agudas (SCAs), e há uma boa correlação entre os escores de risco de sangramento e a incidência de eventos hemorrágicos. No entanto, o papel dos escores de risco de sangramento como fatores preditivos de mortalidade é pouco estudado. OBJETIVO: Analisar o papel do escore de risco de sangramento como fator preditivo de mortalidade intra-hospitalar numa coorte de pacientes com SCA tratados num centro terciário de cardiologia. MÉTODOS: Dos 1.655 pacientes com SCA (547 com SCA com supra de ST e 1.118 com SCA sem supra de ST), calculou-se o escore de risco de sangramento ACUITY/HORIZONS prospectivamente em 249 pacientes e retrospectivamente nos demais 1.416. Informações sobre mortalidade e complicações hemorrágicas também foram obtidas. RESULTADOS: A idade média da população estudada foi 64,3 ± 12,6 anos e o escore de risco de sangramento médio foi 18 ± 7,7. A correlação entre sangramento e mortalidade foi altamente significativa (p < 0,001; OR = 5,29), assim como a correlação entre escore de sangramento e hemorragia intra-hospitalar (p < 0,001; OR = 1,058), e entre escore de sangramento e mortalidade intra-hospitalar (OR ajustado = 1,121, p < 0,001, área sob a curva ROC 0,753; p < 0,001). O OR ajustado e a área sob a curva ROC para a população com SCA com supra de ST foram 1,046 (p = 0,046) e 0,686 ± 0,040 (p < 0,001), respectivamente, e para SCA sem supra de ST foram 1,150 (p < 0,001) e 0,769 ± 0,036 (p < 0,001), respectivamente. CONCLUSÃO: O escore de risco de sangramento é um fator preditivo muito útil e altamente confiável para mortalidade intra-hospitalar em uma grande variedade de pacientes com SCAs, especialmente aqueles com angina instável ou infarto agudo do miocárdio sem supra de ST.


BACKGROUND: It is well known that the occurrence of bleeding increases in-hospital mortality in patients with acute coronary syndromes (ACS), and there is a good correlation between bleeding risk scores and bleeding incidence. However, the role of bleeding risk score as mortality predictor is poorly studied. OBJECTIVE: The main purpose of this paper was to analyze the role of bleeding risk score as in-hospital mortality predictor in a cohort of patients with ACS treated in a single cardiology tertiary center. METHODS: Out of 1655 patients with ACS (547 with ST-elevation ACS and 1118 with non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score prospectively in 249 patients and retrospectively in the remaining 1416. Mortality information and hemorrhagic complications were also obtained. RESULTS: Among the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The correlation between bleeding and mortality was highly significant (p < 0.001, OR = 5.296), as well as the correlation between bleeding score and in-hospital bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p < 0.001). The adjusted OR and area under the ROC curve for the population with ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p < 0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p < 0.001) and 0.769 ± 0.036 (p < 0.001). CONCLUSIONS: Bleeding risk score is a very useful and highly reliable predictor of in-hospital mortality in a wide range of patients with acute coronary syndromes, especially in those with unstable angina or non-ST-elevation acute myocardial infarction.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/mortalidade , Mortalidade Hospitalar , Hemorragia/mortalidade , Infarto do Miocárdio/mortalidade , Angioplastia , Síndrome Coronariana Aguda/complicações , Brasil/epidemiologia , Fibrinolíticos/administração & dosagem , Hemorragia/complicações , Infarto do Miocárdio/tratamento farmacológico , Estudos Retrospectivos , Medição de Risco , Curva ROC
12.
Arq Bras Cardiol ; 101(6): 511-8, 2013 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-24217405

RESUMO

BACKGROUND: It is well known that the occurrence of bleeding increases in-hospital mortality in patients with acute coronary syndromes (ACS), and there is a good correlation between bleeding risk scores and bleeding incidence. However, the role of bleeding risk score as mortality predictor is poorly studied. OBJECTIVE: The main purpose of this paper was to analyze the role of bleeding risk score as in-hospital mortality predictor in a cohort of patients with ACS treated in a single cardiology tertiary center. METHODS: Out of 1655 patients with ACS (547 with ST-elevation ACS and 1118 with non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score prospectively in 249 patients and retrospectively in the remaining 1416. Mortality information and hemorrhagic complications were also obtained. RESULTS: Among the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The correlation between bleeding and mortality was highly significant (p < 0.001, OR = 5.296), as well as the correlation between bleeding score and in-hospital bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p < 0.001). The adjusted OR and area under the ROC curve for the population with ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p < 0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p < 0.001) and 0.769 ± 0.036 (p < 0.001). CONCLUSIONS: Bleeding risk score is a very useful and highly reliable predictor of in-hospital mortality in a wide range of patients with acute coronary syndromes, especially in those with unstable angina or non-ST-elevation acute myocardial infarction.


Assuntos
Síndrome Coronariana Aguda/mortalidade , Hemorragia/mortalidade , Mortalidade Hospitalar , Infarto do Miocárdio/mortalidade , Síndrome Coronariana Aguda/complicações , Adulto , Idoso , Angioplastia , Brasil/epidemiologia , Feminino , Fibrinolíticos/administração & dosagem , Hemorragia/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Curva ROC , Estudos Retrospectivos , Medição de Risco
13.
Rev Port Cardiol ; 32(4): 297-302, 2013 Apr.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23523395

RESUMO

INTRODUCTION: Monitoring of disease activity and the best therapeutic approach are a challenge in Takayasu arteritis (TA). When associated with acute coronary syndromes (ACS), the best interventional treatment has not been established. The objective of this study was to describe the baseline characteristics, clinical manifestations, treatment and long-term outcome of patients with TA and ACS. METHODS: We retrospectively analyzed eight patients between 2004 and 2010. The following data were obtained: age, gender, clinical and electrocardiographic manifestations, Killip class, risk factors for ACS, markers of myocardial necrosis (CK-MB and troponin), creatinine clearance, left ventricular ejection fraction, inflammatory markers (C-reactive protein and erythrocyte sedimentation rate [ESR]), medication during hospital stay, angiographic findings, treatment (medical, percutaneous or surgical) and long-term outcome. Statistical data were expressed as percentages and absolute values. RESULTS: All eight patients were women, median age 49 years. Typical chest pain was present in 37.5%. Elevated ESR was observed in 85.7%. Three patients underwent coronary artery bypass grafting, three underwent percutaneous coronary angioplasty (two with bare-metal stents and one with a drug-eluting stent) and two were treated medically. In-hospital mortality was 25%. There were no deaths during a mean follow-up of 30 months. CONCLUSIONS: In our study, patients who were discharged home had good outcomes in long-term follow-up with medical, percutaneous or surgical treatment. ESR appears to be associated with ACS in TA.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/terapia , Síndrome Coronariana Aguda/complicações , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Arterite de Takayasu/complicações , Fatores de Tempo , Resultado do Tratamento
14.
Arq Bras Cardiol ; 98(5): e78-81, 2012 May.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22858658

RESUMO

Systemic Lupus Erythematosus (SLE) is the most common systemic autoimmune disease, occurring more frequently in women, usually aged between 16 and 55 years 1, 2. Although classically the kidneys are the organs most affected in SLE, cardiopulmonary circulation and the heart may also be affected significantly 3. In this context, the occurrence of acute pulmonary edema associated with lupus myocarditis is rare and specific immunosuppressive therapy remains unclear.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Miocardite/etiologia , Edema Pulmonar/etiologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Miocardite/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Radiografia , Adulto Jovem
15.
Rev. med. (Säo Paulo) ; 91(2): 83-86, abr.-jun. 2012. ilus
Artigo em Português | LILACS | ID: lil-747350

RESUMO

O lupus eritematoso sistêmico (LES) é a mais comum das doenças auto-imunes sistêmicas. Embora os rins classicamente sejam os órgãos mais acometidos no LES, o coração também pode ser afetado de forma significativa. Entretanto, a ocorrência de edema agudo de pulmão associado à miocardite lúpica é rara e de tratamento imunossupressor específico ainda incerto. O presente relato de caso revisa a literatura quanto a manifestações lúpicas do sistema cardiopulmonar, seu diagnóstico e tratamento, e descreve uma paciente lúpica jovem que evoluiu com edema agudo de pulmão decorrente de uma miopericardite lúpica aguda. O rápido diagnóstico pôde permitir o emprego da terapêutica imunossupressora adequada com reversão completa da disfunção miocárdica. Em pacientes jovens com quadro sugestivo de edema agudo de pulmão, o diagnóstico de LES deve ser considerado. O uso de pulsoterapia com corticóide endovenoso mostrou-se eficaz e seguro para o tratamento da manifestação cardíaca extrema.


Systemic lupus erythematosus is the most common systemic autoimmune disease. Although kidneys are the mainorgans affected, heart may suffer injury too. However, acute pulmonary edema associated to lupic myocarditis is rare and its specific immunosuppressive treatment is still undefined. The present case report reviews literature about lupic manifestations in heart and lungs, their diagnosis and treatment, and describes an young lupic patient that had pulmonary edema due toacute lupic myopericarditis. Prompt diagnosis enabled correct immunosuppressive therapy that resulted in a complete reversion of myocardial disfunction. Lupus is a possible diagnosis in young patients with pulmonary edema. The use of intravenous pulse therapy with corticosteroids was safe and efficient to healing of this severe myocardial manifestation.


Assuntos
Humanos , Feminino , Adulto Jovem , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/terapia , Miocardite/diagnóstico , Edema Pulmonar , Doenças Autoimunes
16.
Arq. bras. cardiol ; 98(5): e78-e81, maio 2012. ilus
Artigo em Português | LILACS | ID: lil-643636

RESUMO

O lupus eritematoso sistêmico (LES) é a mais comum das doenças auto-imunes sistêmicas, ocorrendo com maior freqüência no sexo feminino, usualmente na faixa etária entre 16 e 55 anos1,2. Embora os rins classicamente sejam os órgãos mais acometidos no LES, o coração e a circulação cardiopulmonar também podem ser afetados de forma significativa3. Nesse contexto, a ocorrência de edema agudo de pulmão associado à miocardite lúpica é rara e de tratamento imunossupressor específico ainda incerto.


Systemic Lupus Erythematosus (SLE) is the most common systemic autoimmune disease, occurring more frequently in women, usually aged between 16 and 55 years1,2. Although classically the kidneys are the organs most affected in SLE, cardiopulmonary circulation and the heart may also be affected significantly3. In this context, the occurrence of acute pulmonary edema associated with lupus myocarditis is rare and specific immunosuppressive therapy remains unclear.


Assuntos
Feminino , Humanos , Adulto Jovem , Lúpus Eritematoso Sistêmico/complicações , Miocardite/etiologia , Edema Pulmonar/etiologia , Lúpus Eritematoso Sistêmico/diagnóstico , Miocardite , Edema Pulmonar
17.
Interact Cardiovasc Thorac Surg ; 12(5): 778-83, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21297144

RESUMO

OBJECTIVES: B-type natriuretic peptide (BNP) and inflammatory markers are implicated in the pathophysiology of both ischemic cardiomyopathy and complications after cardiac surgery with cardiopulmonary bypass (CPB). The purpose of this study was to assess preoperative and postoperative levels of BNP, interleukin-6 (IL-6), interleukin-8 (IL-8), P-selectin, intercellular adhesion molecule (ICAM), C-reactive protein (CRP) in patients undergoing cardiac surgery with CPB and investigate their variation and ability to correlate with immediate outcome. METHODS: Plasma levels of these markers were measured preoperatively, 6 and 24 h after CBP in 62 patients. Main endpoints were requirements for intra-aortic balloon pump, intensive care unit (ICU) stay longer than five days, ventilator dependence >24 h, requirement for dobutamine, hospital stay >10 days, clinical complications (infection, myocardial infarction, renal failure, stroke and ventricular arrhythmias) and in-hospital mortality. RESULTS: Preoperative BNP levels correlate with longer ICU stay (P = 0.003), longer ventilator use (P = 0.018) and duration of dobutamine use (P < 0.001). The receiver-operating characteristic curve demonstrated BNP levels >190 pg/ml as predictor of ICU >5 days and BNP levels >20.5 pg/ml correlated with dobutamine use, with areas under the curve of 0.712 and 0.842, respectively. Preoperative levels of ICAM-1 were associated with in-hospital mortality (P = 0.042). In the postoperative period, was found association between CRP, IL-6 and P-selectin with ventilation duration (P = 0.013, P = 0.006, P < 0.001, respectively) and P-selectin with ICU stay (P = 0.009). CONCLUSIONS: BNP correlates with clinical endpoints more than inflammatory markers and can be used as a predictor of early outcome after heart surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Mediadores da Inflamação/sangue , Inflamação/complicações , Peptídeo Natriurético Encefálico/sangue , Complicações Pós-Operatórias/etiologia , Acrilamidas/sangue , Idoso , Biomarcadores/sangue , Brasil , Proteína C-Reativa/metabolismo , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ponte Cardiopulmonar/efeitos adversos , Cardiotônicos/uso terapêutico , Distribuição de Qui-Quadrado , Dobutamina/uso terapêutico , Feminino , Mortalidade Hospitalar , Humanos , Inflamação/sangue , Inflamação/mortalidade , Unidades de Terapia Intensiva , Interleucina-6/sangue , Interleucina-8/sangue , Balão Intra-Aórtico , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Selectina-P/sangue , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Curva ROC , Respiração Artificial , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , beta-Alanina/análogos & derivados , beta-Alanina/sangue
18.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 19(4): 562-571, out.-dez. 2009. tab
Artigo em Português | LILACS | ID: lil-559943

RESUMO

Tromboembolismo venoso é um evento potencialmente fatal, que complica a evolução de 20 por cento dos pacientes com neoplasia, causando impacto significativo na qualidade de vida e nos desfechos clínicos desses pacientes. A fisiopatologia da associação entre trombose e câncer é complexa. As neoplasias estão associadas a estado de hipercoagulabilidade secundário à liberação de citocinas inflamatórias, ativação do sistema de coagulação, expressão de proteínas hemostáticas nas células tumorais, inibição de anticoagulantes naturais e alteração no processo fibrinolítico. Os fatores de risco associados ao tromboembolismo venoso podem ser relacionados ao paciente, à doença ou às intervenções terapêuticas. O uso profilático de heparinas e fondaparinux está indicado em pacientes selecionados de acordo com o tipo de neoplasia e da terapia utilizada. O tratamento dos pacientes oncológicos com tromboembolismo venoso é desafiador: as complicações associadas ao uso de anticoagulantes são significativamente maiores, podem interferir com o tratamento antineoplásico e têm impacto negativo na qualidade de vida.


Venous thromboembolism is a serious and potentially fatal disorder, which complicates the course of 20% of cancer patients, and has a significant impact on the quality of life and clinical outcomes of these patients. The pathophysiology of the association between thrombosis and cancer is complex. Malignancy is associated with a baseline hypercoagulable state secondary to the release of inflammatory cytokines, activation of the clotting system, expression of hemostatic proteins on tumor cells, inhibition of natural anticoagulants and impaired fibrinolysis. Several risk factors have been identified as contributing to venous thromboembolism and may be related to the patient characteristics, to the disease, and to the therapeutic interventions. The use of heparins and fondaparinux is indicated for selected cancer patients according to the types of malignancies and treatments. The treatment of venous thromboembolism in patients with cancer is challenging: the complications associated with the use of anticoagulants are significantly higher, may interfere with anticancer therapy and have a negative impact on quality of life.


Assuntos
Humanos , Masculino , Feminino , Idoso , Coagulação Sanguínea , Neoplasias/complicações , Tromboembolia Venosa/complicações , Tromboembolia Venosa/fisiopatologia , Qualidade de Vida , Fatores de Risco
19.
Arq. bras. cardiol ; 91(6): 377-381, dez. 2008. graf, tab
Artigo em Inglês, Português | LILACS | ID: lil-501794

RESUMO

FUNDAMENTO: Pouco se sabe, principalmente em nosso meio, sobre a influência dos planos de saúde na evolução a longo prazo pós-infarto agudo do miocárdio (IAM). OBJETIVO: Avaliar a evolução de pacientes com IAM usuários do SUS ou de outros convênios. MÉTODOS: Foram analisados 1588 pacientes com IAM (idade média de 63,3 ± 12,9 anos, 71,7 por cento homens), incluídos de forma prospectiva em banco de dados específico, e seguidos por até 7,55 anos. Deste total, 1003 foram alocados no "grupo SUS" e 585 no "outros convênios". Qui-quadrado, log-rank e Cox ("stepwise") foram aplicados nas diferentes análises estatísticas. O modelo multivariado a longo prazo, com mortalidade como variável dependente, incluiu 18 variáveis independentes. RESULTADOS: As mortalidades hospitalares nos grupos "outros convênios" e "SUS" foram de 11,4 por cento e 10,3 por cento, respectivamente (P=0,5); a longo prazo, as chances de sobrevivência nos grupos foram, respectivamente, de 70,4 por cento ± 2,9 e 56,4 por cento ± 4,0 (P=0,001, "hazard-ratio"=1,43, ou 43 por cento a mais de chance de óbito no grupo "SUS"). No modelo ajustado, o grupo "SUS" permaneceu com probabilidade significativamente maior de óbito (36 por cento a mais de chance, P=0,005), demonstrando-se ainda que cirurgia de revascularização miocárdica e angioplastia melhoraram o prognóstico dos pacientes, ao passo que idade e história de infarto prévio, diabete ou insuficiência cardíaca, pioraram o prognóstico dos mesmos. CONCLUSÃO: Em relação a usuários de outros convênios, o usuário SUS apresenta mortalidade similar durante a fase hospitalar, porém tem pior prognóstico a longo prazo, reforçando a necessidade de esforços adicionais no sentido de melhorar o nível de atendimento destes pacientes após a alta hospitalar.


BACKGROUND: Little is known, especially in our country, about the influence of health insurance plans on the long term outcome of patients after acute myocardial infarction (AMI). OBJECTIVE: To assess the outcome of patients with AMI who are covered by the National Health System (SUS) or other health insurance plans. METHODS: We analyzed 1,588 patients with AMI (mean age of 63.3 + 12.9 years, 71.7 percent male) who were included prospectively into a specific database and followed up for up to 7.55 years. Of this total, 1,003 were placed in the "SUS" group and 585 in the "other insurance plans" group. We applied chi-square, log-rank and Cox (stepwise) to the different statistical analyses. The long term multivariate model with mortality as a dependent variable included 18 independent variables. RESULTS: In-hospital mortality rates in the "other insurance plans" and "SUS" groups were 11.4 percent and 10.3 percent, respectively (p = 0.5); in the long term, survival chances in the groups were respectively, 70.4 percent + 2.9 and 56.4 percent + 4.0 (p = 0.001, hazard-ratio = 1.43, or a 43 percent higher chance of death in the "SUS" group). In the adjusted model, the "SUS" group had a significantly higher chance of death (a 36 percent higher chance, p = 0.005). Surgical revascularization and angioplasty improved the prognosis of these patients, whereas age and previous history of infarction, diabetes or heart failure worsened the prognosis. CONCLUSIONS: Relative to patients with other insurance plans, SUS users present similar mortality rates during hospital stay, but their prognosis is worse in the long term, thus reinforcing the need for additional efforts to improve the care provided to these patients after hospital discharge.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seguro Saúde , Infarto do Miocárdio/mortalidade , Programas Nacionais de Saúde , Brasil/epidemiologia , Métodos Epidemiológicos , Mortalidade Hospitalar , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Alta do Paciente , Prognóstico , Resultado do Tratamento
20.
Arq Bras Cardiol ; 91(6): 347-51, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19142360

RESUMO

BACKGROUND: Little is known, especially in our country, about the influence of health insurance plans on the long term outcome of patients after acute myocardial infarction (AMI). OBJECTIVE: To assess the outcome of patients with AMI who are covered by the National Health System (SUS) or other health insurance plans. METHODS: We analyzed 1,588 patients with AMI (mean age of 63.3 + 12.9 years, 71.7% male) who were included prospectively into a specific database and followed up for up to 7.55 years. Of this total, 1,003 were placed in the "SUS" group and 585 in the "other insurance plans" group. We applied chi-square, log-rank and Cox (stepwise) to the different statistical analyses. The long term multivariate model with mortality as a dependent variable included 18 independent variables. RESULTS: In-hospital mortality rates in the "other insurance plans" and "SUS" groups were 11.4% and 10.3%, respectively (p = 0.5); in the long term, survival chances in the groups were respectively, 70.4% + 2.9 and 56.4% + 4.0 (p = 0.001, hazard-ratio = 1.43, or a 43% higher chance of death in the "SUS" group). In the adjusted model, the 'SUS' group had a significantly higher chance of death (a 36% higher chance, p = 0.005). Surgical revascularization and angioplasty improved the prognosis of these patients, whereas age and previous history of infarction, diabetes or heart failure worsened the prognosis. CONCLUSIONS: Relative to patients with other insurance plans, SUS users present similar mortality rates during hospital stay, but their prognosis is worse in the long term, thus reinforcing the need for additional efforts to improve the care provided to these patients after hospital discharge.


Assuntos
Seguro Saúde , Infarto do Miocárdio/mortalidade , Programas Nacionais de Saúde , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Alta do Paciente , Prognóstico , Resultado do Tratamento
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