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1.
ScientificWorldJournal ; 2020: 8489238, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32327942

RESUMO

Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing. This study aimed to evaluate the prevalence of NAFLD, as diagnosed by ultrasound, in patients with acute coronary syndrome (ACS) and to assess whether NAFLD is associated with the severity of coronary obstruction as diagnosed by coronary angiography. Methods: We performed a prospective single-center study in patients hospitalized due to acute coronary syndrome who underwent diagnostic coronary angiography. Consecutive patients who presented to the emergency room were diagnosed with acute coronary syndrome and were included. All patients underwent ultrasonography of the upper abdomen to determine the presence or absence of NAFLD; NAFLD severity was graded from 0 to 3 based on a previously validated scale. All patients underwent diagnostic coronary angiography in the same hospital, with the same team of interventional cardiologists, who were blinded to the patients' clinical and ultrasonographic data. CAD was then angiographically graded from none to severe based on well-established angiographic criteria. Results: This study included 139 patients, of whom 83 (59.7%) were male, with a mean age of 59.7 years. Of the included patients, 107 (77%) patients had CAD, 63 (45%) with serious injury. Regarding the presence of NAFLD, 76 (55.2%) had NAFLD including 18 (23.6%) with grade III disease. In severe CAD, 47 (60.5%) are associated with NAFLD, and 15 (83.3%) of the patients had severe CAD and NAFLD grade III. Conclusions: NAFLD is common in patients with ACS. The intensity of NAFLD detected by ultrasonography is strongly associated with the severity of coronary artery obstruction on angiography.

2.
Stem Cells Int ; 2019: 1497898, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31662764

RESUMO

Objective: Achilles tendon pathologies occur frequently and have a significant socioeconomic impact. Currently, there is no evidence on the best treatment for these pathologies. Cell therapy has been studied in several animal models, and encouraging results have been observed with respect to tissue regeneration. This study is aimed at evaluating the functional and histological effects of bone marrow stem cell or platelet-rich plasma implantation compared to eccentric training in the treatment of Achilles tendinopathy in rats. Methods: Fourty-one male Wistar rats received collagenase injections into their bilateral Achilles tendons (collagenase-induced tendinopathy model). The rats were randomly divided into four groups: stem cells (SC), platelet-rich plasma (PRP), stem cells+platelet-rich plasma (SC+PRP), and control (eccentric training (ET)). After 4 weeks, the Achilles tendons were excised and subjected to biomechanical and histological analyses (Sirius red and hematoxylin-eosin staining). Results: Biomechanical assessments revealed no differences among the groups in ultimate tensile strength or yield strength of the tendons (p = 0.157), but there were significant differences in the elastic modulus (MPa; p = 0.044) and maximum tensile deformation (p = 0.005). The PRP group showed the greatest maximum deformation, and the SC group showed the highest Young's modulus (elasticity) measurement. In histological analysis (hematoxylin-eosin and Sirius red staining), there were no differences among the groups. Conclusion: PRP and SC+PRP yielded better biomechanical results than eccentric training, showing that these treatments offer better tend function outcomes. This theoretical rationale for the belief that cell therapies can serve as viable alternatives to current treatments chronic fibrotic opens the door for opportunities to continue this research.

3.
Am J Cardiovasc Dis ; 9(2): 8-17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31131153

RESUMO

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is considered as the most frequent cause of chronic hepatic disease in adults. It is strictly correlated with insulin resistance, frequently associated with components of metabolic syndrome, and, similarly to the latter, it has been correlated with high risk of developing type 2 diabetes and cardiovascular diseases. Systemic arterial hypertension has been suggested to be associated with NAFLD in approximately 40% of the cases, and NAFLD has been independently associated with an increased risk of arterial hypertension in observational studies. Therefore, we can infer that treating arterial hypertension in NAFLD carriers will be often necessary and that the potential beneficial effects of the antihypertensive might, in this context, influence the choice of the respective drug. The renin-angiotensin system has been correlated to the whole basic physiopathogenic mechanism of NAFLD in experimental models. Based on these findings, we conducted this study to evaluate the effects of the ACE-inhibitor ramipril, used preventively, in NAFLD induced in rabbits fed hyperlipidaemic diet. METHODS: Twenty-nine rabbits were divided into three groups (normal, placebo, and ramipril). The placebo and ramipril groups were fed a ration containing 0.925% cholesterol. The groups were orally administered 0.35 mg/kg/day of ramipril, and an equivalent volume of vehicle was administered to the placebo group. At the end of the 8th week, all rabbits underwent segmental hepatic resection and were euthanized. Blood samples were collected to determine glucose, insulin, creatinine, total cholesterol, triglycerides, HDL-C, and aminotransferase levels at baseline and euthanasia. Haematoxylin and eosin and Gomori trichrome-stained slides were analysed based on the histological scoring system for NAFLD. Sudan III-stained slides were analysed by morphometry and immunostained based on the Allred scoring system. RESULTS: When compared with placebo, ramipril significantly diminished the development of steatosis (P=0.032), lobular inflammation (P=0.006), hepatocellular ballooning (P=0.023), and fibrosis (P=0.02). Based on the NAFLD activity score (NAS), ramipril significantly reduced the development of non-alcoholic steatohepatitis (NASH) (P=0.003). CONCLUSIONS: The preventive use of ramipril in rabbits fed hyperlipidaemic diet, attenuates the development of the whole NAFLD histopathological spectrum and based on NAS, ramipril significantly reduced the development of NASH.

4.
Toxins (Basel) ; 10(10)2018 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-30249039

RESUMO

Uremic toxin (UT) retention in chronic kidney disease (CKD) affects biological systems. We aimed to identify the associations between UT, inflammatory biomarkers and biomarkers of the uremic cardiovascular response (BUCVR) and their impact on cardiovascular status as well as their roles as predictors of outcome in CKD patients. CKD patients stages 3, 4 and 5 (n = 67) were recruited and UT (indoxyl sulfate/IS, p-cresil sulfate/pCS and indole-3-acetic acid/IAA); inflammatory biomarkers [Interleukin-6 (IL-6), high sensitivity C reactive protein (hsCRP), monocyte chemoattractant protein-1 (MCP-1), soluble vascular adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble Fas (sFas)] and BUCVRs [soluble CD36 (sCD36), soluble receptor for advanced glycation end products (sRAGE), fractalkine] was measured. Patients were followed for 5.2 years and all causes of death was used as the primary outcome. Artery segments collected at the moment of transplantation were used for the immunohistochemistry analysis in a separate cohort. Estimated glomerular filtration rate (eGFR), circulating UT, plasma biomarkers of systemic and vascular inflammation and BUCVR were strongly interrelated. Patients with plaque presented higher signs of UT-induced inflammation and arteries from CKD patients presented higher fractalkine receptor (CX3CR1) tissue expression. Circulating IS (p = 0.03), pCS (p = 0.007), IL-6 (p = 0.026), sFas (p = 0.001), sCD36 (p = 0.01) and fractalkine (p = 0.02) were independent predictors of total mortality risk in CKD patients. Our results reinforce the important role of uremic toxicity in the pathogenesis of cardiovascular disease (CVD) in CKD patients through an inflammatory pathway.


Assuntos
Doenças Cardiovasculares/metabolismo , Cresóis/sangue , Indicã/sangue , Ácidos Indolacéticos/sangue , Inflamação/metabolismo , Insuficiência Renal Crônica/metabolismo , Ésteres do Ácido Sulfúrico/sangue , Toxinas Biológicas/sangue , Uremia/metabolismo , Adulto , Idoso , Biomarcadores/metabolismo , Antígenos CD36/metabolismo , Doenças Cardiovasculares/fisiopatologia , Citocinas/metabolismo , Feminino , Taxa de Filtração Glomerular , Humanos , Inflamação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Renal/metabolismo , Insuficiência Renal Crônica/fisiopatologia , Uremia/fisiopatologia
5.
Iran J Kidney Dis ; 12(4): 223-231, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30087217

RESUMO

INTRODUCTION: The vitamin D-receptor axis is involved in multiple physiological functions and altered states such as hypertension, mineral metabolism disorders, and inflammation. These disturbances are major risk factors for progression to end-stage kidney disease and cardiovascular disease. In addition, changes in internal systemic environment could be influencing the impact of survival in patients with kidney disease. This study aimed to evaluate the impact of vitamin D receptor (VDR) polymorphisms on hemodialysis patients' survival. MATERIAL AND METHODS: A total of 122 hemodialysis patients and 120 healthy controls were compared for VDR gene polymorphism. Markers for full coverage in the VDR gene were selected and genotyped. The hemodialysis patients were followed until death event, which was considered the primary endpoint for the survival analysis. RESULTS: Two tag SNPs (rs10875695 and rs11168293) showed significant differences between the hemodialysis and healthy patients. In survival analysis, the CC genotype for rs2248098, compared to the TT genotype, was associated with a worse mortality rate. After adjustments for age, sex, diabetes mellitus, and cardiovascular disease, the genotype CC (rs2248098) was associated with a higher risk of mortality in a multivariable analysis. CONCLUSIONS: Polymorphisms specific to patients with kidney disease could be influencing different conditions associated with mortality. Thus, these genetic markers, rs2248098 for example, would act in a specific time in the history of kidney disease and would bring different results of patient survival outcomes.


Assuntos
Interação Gene-Ambiente , Falência Renal Crônica/genética , Falência Renal Crônica/terapia , Polimorfismo de Nucleotídeo Único , Receptores de Calcitriol/genética , Diálise Renal , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Frequência do Gene , Estudos de Associação Genética , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Int. j. cardiovasc. sci. (Impr.) ; 31(4): 393-404, jul.-ago. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-954114

RESUMO

Physical exercise improves the survival and quality of life of coronary patients, but the ideal way of prescribing these exercises is still controversial. Objective: To create a new periodized model for the prescription of exercises for coronary patients and compare it with a conventional model. Methods: 62 coronary patients under pharmacological treatment were randomized into two groups: conventional (NPG, n = 33) and periodized (PG, n = 29) training. The two groups were submitted to the same exercises during the 36 sessions making up the program, but prescribed in different ways. All patients underwent an evaluation consisting of: medical admission consultancy, cardiopulmonary endurance testing, 1 maximum repetition test (1MR) and body composition evaluation. Results: The VO2 peak improved in both groups, although more effectively in the PG (4% against 1.7%, p < 0.001). In addition, the functional capacity of this group improved by 13%, and there was a significant reduction in the percent body fat (2.1%, p < 0.005) and body weight (1.9 kg, p < 0.005). The muscle strength of both groups improved as diagnosed by the 1RM test for six different muscle groups (quadriceps, hamstrings, brachial biceps, brachial triceps, pectoral and large dorsal), and showed no significant difference between the groups, evidencing that the two models had the same efficiency. Conclusions: The present study showed that periodization of the training of cardiac patients can improve their cardiorespiratory capacity and reduce the percent body fat more effectively than the conventional one


O exercício físico melhora a sobrevida e a qualidade de vida de pacientes coronarianos, mas a maneira ideal de prescrevê-lo é ainda controversa. Objetivo: Criar um modelo periodizado para prescrição de exercícios para pacientes coronarianos e compará-lo com o modelo convencional. Métodos: Randomização de 62 pacientes coronarianos em tratamento farmacológico em dois grupos: treinamento convencional, não periodizado (GNP, n = 33) e periodizado (GP, n = 29). Os dois grupos foram submetidos aos mesmos exercícios durante as 36 sessões do programa, mas prescritos de maneira diferente. Todos os pacientes foram submetidos à seguinte avaliação: consulta médica admissional, teste de esforço cardiopulmonar, teste de 1 repetição máxima (1RM) e avaliação da composição corporal. Resultados: O VO2 pico melhorou nos dois grupos, embora de maneira mais efetiva no GP (4% versus 1,7%, p < 0,001). Além disso, a capacidade funcional do GP aumentou em 13%, tendo havido significativa redução no percentual de gordura corporal (2,1%, p < 0,005) e no peso corporal (1,9 kg, p < 0,005). A força muscular nos dois grupos melhorou como diagnosticado pelo teste de 1RM para seis diferentes grupos musculares (quádriceps, isquiotibiais, bíceps, tríceps braquial, peitoral e grande dorsal), mas sem diferença significativa entre os grupos, tendo os dois modelos a mesma eficiência. Conclusões: O presente estudo mostrou que a periodização do treinamento de pacientes cardíacos pode melhorar a capacidade cardiorrespiratória e reduzir a porcentagem de gordura corporal mais efetivamente do que o modelo convencional


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Exercício Físico , Técnicas de Exercício e de Movimento/métodos , Terapia por Exercício/métodos , Consumo de Oxigênio , Atenção Secundária à Saúde/métodos , Composição Corporal , Ecocardiografia/métodos , Doenças Cardiovasculares/mortalidade , Ensaio Clínico Controlado Aleatório , Angioplastia/métodos , Eletrocardiografia/métodos , Intervenção Coronária Percutânea/métodos , Aptidão Cardiorrespiratória/fisiologia , Frequência Cardíaca
7.
Int. j. cardiovasc. sci. (Impr.) ; 31(4)jul.-ago. 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-910598

RESUMO

O exercício físico melhora a sobrevida e a qualidade de vida de pacientes coronarianos, mas a maneira ideal de prescrevê-lo é ainda controversa. Criar um modelo periodizado para prescrição de exercícios para pacientes coronarianos e compará-lo com o modelo convencional. Randomização de 62 pacientes coronarianos em tratamento farmacológico em dois grupos: treinamento convencional, não periodizado (GNP, n = 33) e periodizado (GP, n = 29). Os dois grupos foram submetidos aos mesmos exercícios durante as 36 sessões do programa, mas prescritos de maneira diferente. Todos os pacientes foram submetidos à seguinte avaliação: consulta médica admissional, teste de esforço cardiopulmonar, teste de 1 repetição máxima (1RM) e avaliação da composição corporal. O VO2 pico melhorou nos dois grupos, embora de maneira mais efetiva no GP (4% versus 1,7%, p < 0,001). Além disso, a capacidade funcional do GP aumentou em 13%, tendo havido significativa redução no percentual de gordura corporal (2,1%, p < 0,005) e no peso corporal (1,9 kg, p < 0,005). A força muscular nos dois grupos melhorou como diagnosticado pelo teste de 1RM para seis diferentes grupos musculares (quádriceps, isquiotibiais, bíceps, tríceps braquial, peitoral e grande dorsal), mas sem diferença significativa entre os grupos, tendo os dois modelos a mesma eficiência. O presente estudo mostrou que a periodização do treinamento de pacientes cardíacos pode melhorar a capacidade cardiorrespiratória e reduzir a porcentagem de gordura corporal mais efetivamente do que o modelo convencional


Physical exercise improves the survival and quality of life of coronary patients, but the ideal way of prescribing these exercises is still controversial. To create a new periodized model for the prescription of exercises for coronary patients and compare it with a conventional model. 62 coronary patients under pharmacological treatment were randomized into two groups: conventional (NPG, n = 33) and periodized (PG, n = 29) training. The two groups were submitted to the same exercises during the 36 sessions making up the program, but prescribed in different ways. All patients underwent an evaluation consisting of: medical admission consultancy, cardiopulmonary endurance testing, 1 maximum repetition test (1MR) and body composition evaluation. The VO2 peak improved in both groups, although more effectively in the PG (4% against 1.7%, p < 0.001). In addition, the functional capacity of this group improved by 13%, and there was a significant reduction in the percent body fat (2.1%, p < 0.005) and body weight (1.9 kg, p < 0.005). The muscle strength of both groups improved as diagnosed by the 1RM test for six different muscle groups (quadriceps, hamstrings, brachial biceps, brachial triceps, pectoral and large dorsal), and showed no significant difference between the groups, evidencing that the two models had the same efficiency. The present study showed that periodization of the training of cardiac patients can improve their cardiorespiratory capacity and reduce the percent body fat more effectively than the conventional one


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Exercício Físico , Técnicas de Exercício e de Movimento/métodos , Terapia por Exercício/métodos , Angioplastia/métodos , Composição Corporal , Aptidão Cardiorrespiratória/fisiologia , Doenças Cardiovasculares/mortalidade , Ecocardiografia/métodos , Eletrocardiografia/métodos , Frequência Cardíaca , Consumo de Oxigênio , Intervenção Coronária Percutânea/métodos , Ensaio Clínico Controlado Aleatório , Atenção Secundária à Saúde/métodos
8.
Stem Cells Int ; 2018: 5412478, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29760727

RESUMO

Pharmacological approaches are partially effective in limiting infarct size. Cell therapies using a cell population enriched with endothelial progenitor cells (EPCs) CD133+ have opened new perspectives for the treatment of ischemic areas after infarction. This preclinical study evaluated the effect of intramyocardial transplantation of purified or expanded human umbilical cord blood-derived CD133+ cells on the recovery of rats following acute myocardial infarction (AMI). Histology studies, electrocardiogram, and fluorescence in situ hybridization (FISH) were used to evaluate heart recovery. Purified CD133+ cells, enriched in endothelial progenitor cells, when expanded in vitro acquired an endothelial-like cell phenotype expressing CD31 and von Willebrand factor (vWF). The group of infarcted rats that received expanded CD133+ cells had a more significant recovery of contraction performance and less heart remodeling than the group that received purified CD133+ cells. Either purified or expanded CD133+ cells were able to induce neovascularization in the infarcted myocardium in an equivalent manner. Few human cells were detected in the infarcted myocardium of the rats 28 days after transplantation suggesting that the effects observed might be related primarily to paracrine activity. Although both cell populations ameliorated the infarcted heart and are suitable for regeneration of the vascular system, expanded CD133+ cells are more beneficial and promising candidates for vascular regeneration.

9.
Stem Cells Int ; 2018: 5102630, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29681948

RESUMO

Background: Surgical correction of tracheal defects is a complex procedure when the gold standard treatment with primary end-to-end anastomosis is not possible. An alternative treatment may be the use of porcine small intestinal submucosa (SIS). It has been used as graft material for bioengineering applications and to promote tissue regeneration. The aim of this study was to evaluate whether SIS grafts improved tracheal tissue regeneration in a rabbit model of experimental tracheostomy. Methods: Sixteen rabbits were randomized into two groups. Animals in the control group underwent only surgical tracheostomy, while animals in the SIS group underwent surgical tracheostomy with an SIS graft covering the defect. We examined tissues at the site of tracheostomy 60 days after surgery using histological analysis with hematoxylin and eosin (H&E) staining and analyzed the perimeter and area of the defect with Image-Pro® PLUS 4.5 (Media Cybernetics). Results: The average perimeter and area of the defects were smaller by 15.3% (p = 0.034) and 21.8% (p = 0.151), respectively, in the SIS group than in the control group. Histological analysis revealed immature cartilage, pseudostratified ciliated epithelium, and connective tissue in 54.5% (p = 0.018) of the SIS group, while no cartilaginous regeneration was observed in the control group. Conclusions: Although tracheal SIS engraftment could not prevent stenosis in a rabbit model of tracheal injury, it produced some remarkable changes, efficiently facilitating neovascularization, reepithelialization, and neoformation of immature cartilage.

10.
Artif Organs ; 42(6): 655-663, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29574805

RESUMO

Neuromuscular electrical stimulation (NMES) is a common tool that is used in clinical and laboratory experiments and can be combined with mechanomyography (MMG) for biofeedback in neuroprostheses. However, it is not clear if the electrical current applied to neuromuscular tissues influences the MMG signal in submaximal contractions. The objective of this study is to investigate whether the electrical stimulation frequency influences the mechanomyographic frequency response of the rectus femoris muscle during submaximal contractions. Thirteen male participants performed three maximal voluntary isometric contractions (MVIC) recorded in isometric conditions to determine the maximal force of knee extensors. This was followed by the application of nine modulated NMES frequencies (20, 25, 30, 35, 40, 45, 50, 75, and 100 Hz) to evoke 5% MVIC. Muscle behavior was monitored by the analysis of MMG signals, which were decomposed into frequency bands by using a Cauchy wavelet transform. For each applied electrical stimulus frequency, the mean MMG spectral/frequency response was estimated for each axis (X, Y, and Z axes) of the MMG sensor with the values of the frequency bands used as weights (weighted mean). Only with respect to the Z (perpendicular) axis of the MMG signal, the stimulus frequency of 20 Hz did not exhibit any difference with the weighted mean (P = 0.666). For the frequencies of 20 and 25 Hz, the MMG signal displayed the bands between 12 and 16 Hz in the three axes (P < 0.050). In the frequencies from 30 to 100 Hz, the muscle presented a higher concentration of the MMG signal between the 22 and 29 Hz bands for the X and Z axes, and between 16 and 34 Hz bands for the Y axis (P < 0.050 for all cases). We observed that MMG signals are not dependent on the applied NMES frequency, because their frequency contents tend to mainly remain between the 20- and 25-Hz bands. Hence, NMES does not interfere with the use of MMG in neuroprosthesis.


Assuntos
Estimulação Elétrica , Contração Muscular , Músculo Esquelético/fisiologia , Adolescente , Adulto , Fenômenos Biomecânicos , Eletromiografia , Humanos , Masculino , Análise de Ondaletas , Adulto Jovem
11.
J Clin Lipidol ; 12(2): 403-408, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29429893

RESUMO

BACKGROUND: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder with an estimated worldwide prevalence ranging from 1 in 200 individuals to 1 in 500 individuals in its heterozygous form. Individuals with FH exhibit high low-density lipoprotein cholesterol (LDLc) levels from birth, which leads to premature cardiovascular events. In Brazil, like in most countries around the world, FH is considered a public health problem but remains underdiagnosed and undertreated. OBJECTIVE: The aim of this study was to evaluate the prevalence of LDLc or non-high-density lipoprotein cholesterol (non-HDLc) levels suggestive of FH among Brazilian adolescents. METHODS: The Study of Cardiovascular Risk in Adolescents (ERICA) was a nationwide, school-based, cross-sectional study that assessed the prevalence of cardiovascular risk factors in approximately 75,000 adolescents between 12 and 17 years old. Data were analyzed according to sex, age, type of school (public or private), and geographic regions of Brazil. Adolescents with untreated fasting LDLc levels of 160 mg/dL or higher or non-HDLc levels of 190 mg/dL or higher were suspected to have FH. We also evaluated the prevalence of LDLc levels of 190 mg/dL or higher, which is highly suggestive of a diagnosis of FH in this age group. RESULTS: A total of 38,069 adolescents were evaluated; more than half (59.9%) were female and most (74%) attended public schools. The prevalence of LDLc levels of 160 mg/dL or higher or non-HDLc levels of 190 mg/dL or higher among the adolescents was 0.49% (95% confidence interval: 0.34-0.71; n = 209). Moreover, 0.12% of the adolescents (95% confidence interval: 0.04-0.34; n = 44) had LDLc levels of 190 mg/dL or higher. We estimate that approximately 100,000 (1 in 200) Brazilian adolescents aged 12 to 17 years are suspected to have FH on the basis of LDLc and non-HDLc levels. CONCLUSION: We identified a significant prevalence of cholesterol levels suggestive of FH among Brazilian adolescents. Further evaluation is needed to confirm the diagnoses among the students. Our results reinforce the importance of universal screening as a critical tool for early diagnosis and treatment of FH.


Assuntos
Doenças Cardiovasculares/sangue , LDL-Colesterol/sangue , Hiperlipoproteinemia Tipo II/sangue , Estudantes/estatística & dados numéricos , Adolescente , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Criança , Cidades , Feminino , Humanos , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/epidemiologia , Masculino , Prevalência , Fatores de Risco , Instituições Acadêmicas
12.
Intest Res ; 16(1): 62-68, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29422799

RESUMO

Background/Aims: The use of anti-tumor necrosis factor (anti-TNF) agents seems to reduce surgical rates and delay surgical procedures in prospective trials and population-based studies in the management of Crohn's disease (CD). This study aimed to identify whether preoperative anti-TNF agents influence the time from diagnosis to surgery. Methods: An observational retrospective cohort study was conducted on patients with CD submitted to intestinal resections due to complications or medical therapy failure in a period of 7 years. The patients were allocated into 2 groups according to their previous exposure to anti-TNF agents in the preoperative period. Epidemiological aspects regarding age at diagnosis, smoking, perianal disease, and preoperative conventional therapy were considered. A Kaplan-Meier survival analysis was used to outline possible differences between the groups regarding the time to surgery. Results: A total of 123 patients were included (71 and 52 with and without previous exposure to biologics, respectively). The overall time to surgery was 108±6.9 months (maximum, 276 months). The survival estimation revealed no difference in the mean time to intestinal resection between the groups (99.78±10.62 months in the patients without and 114.01±9.07 months in those with previous anti-TNF use) (log-rank P=0.35). There was no significant difference in the time to surgery regarding perianal CD (P=0.49), smoking (P=0.63), preoperative azathioprine (P=0.073) and steroid use (P=0.58). Conclusions: The time from diagnosis to surgery was not influenced by the preoperative use of anti-TNF therapy in this cohort of patients.

13.
Cranio ; 36(3): 161-166, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28446077

RESUMO

OBJECTIVE: MMP-13 performs digestion of collagen, which is a primary component of the temporomandibular joint (TMJ) articular disc. This study evaluated the expression of MMP-13 in patients with anterior disc displacement with (ADDwR) and without reduction (ADDwoR), and in the presence of TMJ osteoarthrosis. METHODS: Thirty-nine human temporomandibular joint disc samples were collected and divided in two ways: ADDwR (21 samples), ADDwoR (10 samples), and a control group (8 samples); and with osteoarthrosis (10 samples) and without osteoarthrosis (29 samples). Immunostaining of the TMJ discs was statistically compared between the groups. RESULTS: There was no statistically significant difference for the area of MMP-13 immunostaining between the control group, ADDwR, and ADDwoR, nor between groups with and without osteoarthrosis. CONCLUSION: This study suggests MMP-13 is not significantly involved in collagen degradation in human TMJ disc displacement or osteoarthrosis.


Assuntos
Metaloproteinase 13 da Matriz/metabolismo , Osteoartrite/metabolismo , Transtornos da Articulação Temporomandibular/metabolismo , Adolescente , Adulto , Progressão da Doença , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Nephrology (Carlton) ; 23(3): 253-258, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28010053

RESUMO

AIM: Since the impact of peritonitis on long-term non-infectious mortality has not been investigated until the present, the aim of this study was to analyze the impact of peritonitis on long-term cardiovascular (CV) mortality in a large peritoneal dialysis (PD) cohort. METHODS: The analysis was based on BRAZPD II, a national prospective cohort study that recruited patients in Brazilian centres from December 2004 to January 2011. Incident adult PD patients with at least 90 days on treatment were included in the analysis. Cardiovascular death occurring after a minimum of 30 days after a peritonitis episode was considered the primary endpoint. Cox regression analysis for time-dependent variables was used for the adjustments. RESULTS: There were 2405 episodes of peritonitis in 5707 patients (48% males, 44% diabetes, 73% hypertensive). Patients with one episode of peritonitis presented a 22% increase in the hazard ratio of late CV mortality compared to those who never experienced peritonitis (HR1.22; CI95%1.01-1.47). Adjusted hazard for CV mortality showed a stepwise negative effect on survival for each additional peritonitis episode of infection: two episodes (HR1.78; CI95%1.31-2.42), three episodes (HR2.81; CI95%1.83-4.32) and four episodes (HR3.84; CI95%2.01-7.32). CONCLUSION: Peritonitis was an independent predictor of CV mortality and the frequency of peritonitis was strongly associated with an increase in this risk. This is the first study to demonstrate the impact of peritonitis on late cardiovascular mortality of PD patients, suggesting a link between acute inflammation and cardiovascular outcomes.


Assuntos
Doenças Cardiovasculares/mortalidade , Nefropatias/terapia , Diálise Peritoneal/mortalidade , Peritonite/mortalidade , Adulto , Idoso , Brasil/epidemiologia , Doenças Cardiovasculares/diagnóstico , Causas de Morte , Comorbidade , Feminino , Humanos , Nefropatias/diagnóstico , Nefropatias/mortalidade , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Peritonite/diagnóstico , Prevalência , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Perit Dial Int ; 38(1): 24-29, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28765166

RESUMO

BACKGROUND: Simple and low-cost tools to monitor the risk profile of patients on peritoneal dialysis (PD) at high risk of complications and mortality are scarce. One of the tools available to monitor the variation in vitality and dependence levels is the Karnofsky performance status (KPS). This study analyzed the average trends and variation of KPS during the 12 months before death and its independent value in predicting patients' survival. METHODS: The data were compiled from the BRAZPD II multicenter study, performed in Brazil between 2004 and 2011. For the analysis of KPS dynamics, we included patients with at least 12 months of follow-up on PD and who had a fatal event during the follow-up. The following covariables were evaluated: age, gender, ethnicity, educational level, and presence of diabetes. We used the linear regression model to present the results: the log (time) before death was represented by the regression variable and KPS was the response. We also analyzed the independent impact of baseline KPS on patients' survival. RESULTS: From the population of 9,905 patients enrolled in the BRAZPD study, 4,133 survived 12 months on PD and were included in the analysis. There was a gradual decline in the KPS scores, which accelerated in the last 2 months before death. These changes were similar irrespective of age, race, family income, gender, diabetes, PD modality, and education level. We observed 989 fatal events in this population during the observation period, and the KPS score was identified as an independent predictor for mortality in this cohort. CONCLUSIONS: This study demonstrates for the first time the dynamics of KPS before death in PD patients, indicating a progressive and accelerated decline of KPS in the 12 months before patients died. In addition, KPS was an independent predictor of mortality in this population.


Assuntos
Avaliação de Estado de Karnofsky/estatística & dados numéricos , Diálise Peritoneal/efeitos adversos , Insuficiência Renal Crônica/terapia , Adulto , Idoso , Brasil , Estudos de Coortes , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/mortalidade , Medição de Risco/métodos
16.
Arq. bras. cardiol ; 109(6): 509-515, Dec. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-887982

RESUMO

Abstract Background: The prevalence of childhood obesity and associated conditions, such as hypertension, has become a major problem of public health. Although waist circumference (WC) is a marker of cardiovascular risk in adults, it is unclear whether this index is associated with cardiovascular risk factors in children. Objective: Our aim was to evaluate the association between increased WC and elevated blood pressure (BP) in children with normal body mass index (BMI) ranges. Methods: Cross-sectional evaluation of students between 6 and 11 years with normal BMI. WC was categorized by quartile for each age group. Normal BP was defined as values < 90th percentile, and levels above this range were considered elevated. Values of p < 0.05 were considered statistically significant. Results: Of the 5,037 children initially assessed, 404 (8%) were excluded for being underweight and 1,216 (24.1%) were excluded for being overweight or obese. A final sample of 3,417 children was evaluated. The prevalence of elevated BP was 10.7%. In children with WC in the lowest quartile, the prevalence of elevated BP was 8.1%. This prevalence increased in upper quartiles: 10.6% in the second, 12.4% in third and 12.1% in the upper quartile. So, in this group, being in the highest WC quartile was associated with a 57% higher likelihood to present elevated BP when compared to those in the lowest quartile (Q4 vs Q1; OR 1.57 - 95%CI 1.14 - 2.17). Conclusion: In children aged 6 to 11 years, increased waist circumference is associated with elevated BP even when BMI is normal.


Resumo Fundamento: A prevalência da obesidade infantil e condições associadas, tal como a hipertensão, tornou-se um grande problema de saúde pública. Embora a circunferência da cintura (CC) seja um marcador de risco cardiovascular em adultos, não está claro se esse índice está associado a fatores de risco cardiovascular em crianças. Objetivo: Avaliar a associação entre CC aumentada e pressão arterial (PA) elevada em crianças com índice de massa corpórea (IMC) normal. Métodos: Avaliação transversal de estudantes com idade entre 6 e 11 anos com IMC normal. A CC foi categorizada por quartil para cada faixa etária. PA normal foi definida como valores < percentil 90. Níveis acima dessa faixa foram considerados elevados. Valores de p<0,05 foram considerados estatisticamente significantes. Resultados: Das 5037 crianças inicialmente avaliadas, 404 (8%) foram excluídas por estarem abaixo do peso e 1216 (24,1%) foram excluídas por estarem com sobrepeso ou obesidade. Uma amostra final de 3417 crianças foi avaliada. A prevalência de PA elevada foi de 10,7%. Em crianças com CC no quartil mais baixo, a prevalência de PA elevada foi de 8,1%. Essa prevalência aumentou em quartis superiores: 10,6% no segundo, 12,4% no terceiro e 12,1% no quartil mais alto. Assim, nesse grupo, estar no quartil mais alto de CC associou-se com uma probabilidade 57% maior de apresentar PA elevada em comparação aos quartis mais baixos (Q4 vs. Q1; OR 1,57 - IC95% 1,14 - 2,17). Conclusão: Em crianças de 6 a 11 anos, circunferência da cintura aumentada está associada à PA elevada, mesmo quando o IMC é normal. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

17.
Arq. gastroenterol ; 54(4): 321-327, Oct.-Dec. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-888220

RESUMO

ABSTRACT BACKGROUND: Adalimumab is a monoclonal antibody, tumor necrosis factor-alpha (TNFα) inhibitor that has efficacy for inducing and maintaining remission in moderate-to-severe ulcerative colitis. Real world studies with adalimumab in Latin American ulcerative colitis patients are scarce. OBJECTIVE: To assess the clinical remission rates in induction and maintenance with adalimumab therapy in ulcerative colitis. METHODS: Observational, multicenter and retrospective study on a case series of patients with moderate-to-severe ulcerative colitis under adalimumab therapy. The variables analyzed were: demographic data, previous infliximab status, concomitant drugs, the Montreal Classification, disease activity (Mayo score) at weeks 0, 8, 26 and 52, or until the last follow-up. Clinical remission was defined as a partial Mayo score ≤2 and Last observation carried forward (LOCF) and Non responder imputation (NRI) analysis were used. RESULTS: Thirty-six patients were included in the study. With LOCF analysis, remission rates at weeks 8, 26 e 52 were of 41.7%, 47.2% and 47.2%, respectively. With NRI analysis, remission rates at weeks 8, 26 and 52 were of 41.7%, 41.7% and 27.8%, respectively. CONCLUSION: Adalimumab was effective in the treatment of moderate-to-severe ulcerative colitis. Clinical remission was observed in approximately 40% of the patients at weeks 8 and 26, and in almost a quarter of the patients after 1 year of follow up.


RESUMO CONTEXTO: O adalimumabe é um anticorpo monoclonal, inibidor do TNF alfa, que tem eficácia comprovada na indução e manutenção da remissão na retocolite ulcerativa inespecífica moderada à severa. Há escassez de dados sobre o uso do adalimumabe na retocolite ulcerativa inespecífica em pacientes latino-americanos. OBJETIVO: Analisar as taxas de remissão clínica na indução e manutenção do tratamento da retocolite ulcerativa inespecífica com adalimumabe. MÉTODOS: Estudo observacional, multicêntrico e retrospectivo de uma série de casos de portadores de retocolite ulcerativa inespecífica moderada à grave que utilizaram adalimumabe. Variáveis analisadas: dados demográficos, uso prévio de infliximabe, medicações concomitantes, Classificação de Montreal, atividade da doença (escore parcial de Mayo) nas semanas 0, 8, 26 e 52, ou até o maior tempo de seguimento atingido. Remissão clínica foi definida como escore parcial de Mayo ≤2 e foi avaliada pelos métodos. Abordagem com base na observação mais recente (LOCF) e Imputação de não respondedores (NRI). RESULTADOS: Trinta e seis pacientes foram incluídos no estudo. Pela análise LOCF, as taxas de remissão nas semanas 8, 26 e 52 foram de 41,7%, 47,2% e 47,2%, respectivamente. Pela análise NRI, as taxas nas semanas 8, 26 e 52 foram de 41,7%, 41,7% e 27,8%, respectivamente. CONCLUSÃO: Adalimumabe foi eficaz no manejo da retocolite ulcerativa inespecífica moderada a grave. A remissão clínica foi observada em cerca de 40% dos pacientes nas semanas 8 e 26, e em cerca de 1/4 dos pacientes após 1 ano de seguimento.

18.
Arq Bras Cardiol ; 109(6): 509-515, 2017 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29185613

RESUMO

BACKGROUND: The prevalence of childhood obesity and associated conditions, such as hypertension, has become a major problem of public health. Although waist circumference (WC) is a marker of cardiovascular risk in adults, it is unclear whether this index is associated with cardiovascular risk factors in children. OBJECTIVE: Our aim was to evaluate the association between increased WC and elevated blood pressure (BP) in children with normal body mass index (BMI) ranges. METHODS: Cross-sectional evaluation of students between 6 and 11 years with normal BMI. WC was categorized by quartile for each age group. Normal BP was defined as values < 90th percentile, and levels above this range were considered elevated. Values of p < 0.05 were considered statistically significant. RESULTS: Of the 5,037 children initially assessed, 404 (8%) were excluded for being underweight and 1,216 (24.1%) were excluded for being overweight or obese. A final sample of 3,417 children was evaluated. The prevalence of elevated BP was 10.7%. In children with WC in the lowest quartile, the prevalence of elevated BP was 8.1%. This prevalence increased in upper quartiles: 10.6% in the second, 12.4% in third and 12.1% in the upper quartile. So, in this group, being in the highest WC quartile was associated with a 57% higher likelihood to present elevated BP when compared to those in the lowest quartile (Q4 vs Q1; OR 1.57 - 95%CI 1.14 - 2.17). CONCLUSION: In children aged 6 to 11 years, increased waist circumference is associated with elevated BP even when BMI is normal.


Assuntos
Hipertensão/etiologia , Obesidade Abdominal/complicações , Obesidade Pediátrica/complicações , Circunferência da Cintura , Pressão Sanguínea , Índice de Massa Corporal , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Obesidade Abdominal/epidemiologia , Obesidade Pediátrica/epidemiologia , Prevalência , Fatores de Risco , População Urbana
19.
Colorectal Dis ; 2017 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-29053220

RESUMO

BACKGROUND: data are scarce regarding the effect of preoperative Adalimumab (ADA) in postoperative complications in Crohn's disease (CD) patients. AIM: to compare the rates of postoperative complications after intestinal resections in CD, with and without previous exposure to ADA. METHOD: case-matched retrospective observational study of patients submitted to intestinal resections for CD. The patients were allocated to 2 groups, according to their previous exposure to ADA before surgery. The patients under ADA therapy were matched with controls (patients without previous biologics) with the propensity score method (PSM), according to age at surgery, CD location (Montreal L) and phenotype (Montreal B). Medical and surgical complications were compared. RESULTS: 123 patients were initially considered, 71 with previous biologics (32 under ADA therapy) and 52 without. The PSM selected 25 ADA patients to be matched with 25 controls from the non-biologics group. There was no difference regarding overall surgical complications (40% in the control vs 36% in the ADA group; p = 1.0000) or medical complications (36% vs 12% in the control and ADA groups, respectively; p = 0.095). In univariate analysis, previous ADA was not considered a risk factor for higher postoperative complication rates. Stomas were considered a risk factor for surgical complications, and previous steroids were associated to higher medical complication rates. CONCLUSIONS: preoperative ADA did not influence the rates of medical and surgical complications after elective intestinal resections for CD. This was the first study to include exclusively patients under ADA therapy. This article is protected by copyright. All rights reserved.

20.
Arq Gastroenterol ; 54(4): 321-327, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28977114

RESUMO

BACKGROUND: Adalimumab is a monoclonal antibody, tumor necrosis factor-alpha (TNFα) inhibitor that has efficacy for inducing and maintaining remission in moderate-to-severe ulcerative colitis. Real world studies with adalimumab in Latin American ulcerative colitis patients are scarce. OBJECTIVE: To assess the clinical remission rates in induction and maintenance with adalimumab therapy in ulcerative colitis. METHODS: Observational, multicenter and retrospective study on a case series of patients with moderate-to-severe ulcerative colitis under adalimumab therapy. The variables analyzed were: demographic data, previous infliximab status, concomitant drugs, the Montreal Classification, disease activity (Mayo score) at weeks 0, 8, 26 and 52, or until the last follow-up. Clinical remission was defined as a partial Mayo score ≤2 and Last observation carried forward (LOCF) and Non responder imputation (NRI) analysis were used. RESULTS: Thirty-six patients were included in the study. With LOCF analysis, remission rates at weeks 8, 26 e 52 were of 41.7%, 47.2% and 47.2%, respectively. With NRI analysis, remission rates at weeks 8, 26 and 52 were of 41.7%, 41.7% and 27.8%, respectively. CONCLUSION: Adalimumab was effective in the treatment of moderate-to-severe ulcerative colitis. Clinical remission was observed in approximately 40% of the patients at weeks 8 and 26, and in almost a quarter of the patients after 1 year of follow up.


Assuntos
Adalimumab/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Adolescente , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
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