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1.
BMJ ; 368: l6794, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941657

RESUMO

OBJECTIVE: To investigate the impact of modifications to contemporary cancer protocols, which minimize exposures to cardiotoxic treatments and preserve long term health, on serious cardiac outcomes among adult survivors of childhood cancer. DESIGN: Retrospective cohort study. SETTING: 27 institutions participating in the Childhood Cancer Survivor Study. PARTICIPANTS: 23 462 five year survivors (6193 (26.4%) treated in the 1970s, 9363 (39.9%) treated in the 1980s, and 7906 (33.6%) treated in the 1990s) of leukemia, brain cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, renal tumors, neuroblastoma, soft tissue sarcomas, and bone sarcomas diagnosed prior to age 21 years between 1 January 1970 and 31 December 1999. Median age at diagnosis was 6.1 years (range 0-20.9) and 27.7 years (8.2-58.3) at last follow-up. A comparison group of 5057 siblings of cancer survivors were also included. MAIN OUTCOME MEASURES: Cumulative incidence and 95% confidence intervals of reported heart failure, coronary artery disease, valvular heart disease, pericardial disease, and arrhythmias by treatment decade. Events were graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events. Multivariable subdistribution hazard models were used to estimate hazard ratios by decade, and mediation analysis examined risks with and without exposure to cardiotoxic treatments. RESULTS: The 20 year cumulative incidence of heart failure (0.69% for those treated in the 1970s, 0.74% for those treated in the 1980s, 0.54% for those treated in the 1990s) and coronary artery disease (0.38%, 0.24%, 0.19%, respectively), decreased in more recent eras (P<0.01), though not for valvular disease (0.06%, 0.06%, 0.05%), pericardial disease (0.04%, 0.02%, 0.03%), or arrhythmias (0.08%, 0.09%, 0.13%). Compared with survivors with a diagnosis in the 1970s, the risk of heart failure, coronary artery disease, and valvular heart disease decreased in the 1980s and 1990s but only significantly for coronary artery disease (hazard ratio 0.65, 95% confidence interval 0.45 to 0.92 and 0.53, 0.36 to 0.77, respectively). The overall risk of coronary artery disease was attenuated by adjustment for cardiac radiation (0.90, 0.78 to 1.05), particularly among survivors of Hodgkin lymphoma (unadjusted for radiation: 0.77, 0.66 to 0.89; adjusted for radiation: 0.87, 0.69 to 1.10). CONCLUSIONS: Historical reductions in exposure to cardiac radiation have been associated with a reduced risk of coronary artery disease among adult survivors of childhood cancer. Additional follow-up is needed to investigate risk reductions for other cardiac outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT01120353.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Sobreviventes de Câncer/estatística & dados numéricos , Cardiopatias , Neoplasias , Radioterapia , Risco Ajustado , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cardiotoxicidade , Criança , Estudos de Coortes , Feminino , Cardiopatias/induzido quimicamente , Cardiopatias/classificação , Cardiopatias/epidemiologia , Humanos , Incidência , Masculino , Neoplasias/classificação , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Neoplasias/radioterapia , Modelos de Riscos Proporcionais , Radioterapia/efeitos adversos , Radioterapia/métodos , Estudos Retrospectivos , Risco Ajustado/métodos , Risco Ajustado/tendências , Estados Unidos/epidemiologia
3.
Mymensingh Med J ; 29(1): 43-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915334

RESUMO

Hypertension is a major public health challenge to population in socio-economic and epidemiological transition. It is a risk factor for cardiovascular mortality which accounts for 20-50 per cent of all deaths. Hypertension has been recognized among young adults more frequently in recent years. Data regarding hypertension in Bangladesh is often insufficient. The purpose of the study was to find out the risk factors of hypertension in young adults of Bangladesh. The study was conducted among 322 purposively selected young adults aged 20 to 49 years attending in the outpatient department of one public and five private hospitals of Mymensingh and Dhaka division of Bangladesh during the period of January 2018 to December 2018. More than half (54.4%) of the patients were at or below the age of 40 years. Mean age of the patients was 38.7±7.8 years and 58.7% were male. Maximum patients (87.6%) were married and with variable educational and occupational status. More than three fourth of the patients (76.7%) were from urban area whereas 14.3% from rural and 9.0% were from sub-urban area. Family history of hypertension was positive in 86.6% of patients. Blood pressure was categorized according to JNC 7. About half (49.4%) of the patients were stage I hypertensive; 22.4% were stage II hypertensive and 28.3% were pre-hypertensive. The major risk factor was tobacco smoking (46.0%), obesity (29.2%), dyslipidaemia (25.2%), high salt intake 21.8% and use of chewable tobacco (13.7%). Serum creatinine was found raised in 11.5%, cardiomegaly in 2.2% and concentric left ventricular hypertrophy in 18.6% of patients. In 38.5% patients hypertension was complicated affecting heart (27.0%) and kidney (11.5%). Common comorbidities were ischaemic heart diseases (20.5%) and diabetes mellitus (13.4%). Tobacco use, obesity, dyslipidaemia and high salt intake are the major modifiable risk factors found in hypertensive young adults. In addition to medication these factors should be addressed for prevention and effective control of hypertension.


Assuntos
Pressão Sanguínea/fisiologia , Diabetes Mellitus/epidemiologia , Cardiopatias/epidemiologia , Hipertensão/epidemiologia , Adulto , Bangladesh/epidemiologia , Comorbidade , Feminino , Humanos , Hipertensão/diagnóstico , Isquemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural/estatística & dados numéricos , Classe Social , População Urbana/estatística & dados numéricos , Adulto Jovem
4.
Int Heart J ; 60(6): 1253-1258, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666454

RESUMO

On March 11, 2011, a great earthquake, known as the Great East Japan Earthquake, hit northeastern Japan, resulting in a tsunami that caused a nuclear disaster, the Fukushima Daiichi Nuclear Power Plant accident, forcing about 160,000 people to evacuate. We, therefore, sought to examine the effects of this evacuation on the onset of cardiovascular diseases and sudden death (SD) in Fukushima Prefecture, three years after the earthquake. We divided the evacuation zone into two areas, whole evacuation zone (Area 1) and partial evacuation zone (Area 2), and we defined the north district of the prefecture as the control area (Area 3). We cross-referenced the death certificate data with data from the Fukushima Prefecture acute myocardial infarction registration survey. For each area, we tallied the number of people who fell into the SD, myocardial infarction (MI), and MI suspected groups. We calculated the age-adjusted incidence rates and analyzed the differences in the adjusted incidence rates across three years using a Poisson regression model. The age-adjusted death rate of the SD group was significantly higher in 2011 in all areas than in 2012 or 2013 (P < 0.05). The total death rate was higher in Area 1 in March 2011, just after the disaster, than in the other two areas. The rate of SD was also higher in Area 1 than in the other areas in March 2011. The incidence of sudden cardiac death might have increased just after the Great East Japan Earthquake in the evacuation area, but not in other areas in Fukushima Prefecture.


Assuntos
Morte Súbita/epidemiologia , Terremotos , Acidente Nuclear de Fukushima , Cardiopatias/epidemiologia , Tsunamis , Adulto , Idoso , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson
5.
High Blood Press Cardiovasc Prev ; 26(5): 361-373, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31650516

RESUMO

High blood pressure (BP) is becoming a growing health issue even in children and adolescents. Moreover, BP elevation in youth frequently translates into children and adult hypertension contributing to the development of cardiovascular disease. The detection of early markers of vascular damage, potentially leading to overt cardiovascular disease, is important for clinical decisions about if and how to treat hypertension and can be useful in monitoring the effectiveness of the treatment. The purpose of this review is to summarize the actual knowledge about subclinical organ damage (SOD) in hypertensive children and adolescents and its association with cardiovascular disease in children and young adults. Our focus is especially put on left ventricular mass, pulse wave velocity, carotid intima-media thickness and microalbuminuria. We also want to address the scientific evidence about possible regression of SOD and cardiovascular risk with the use of behavioural and specific anti-hypertensive therapy. Indications from current guidelines are critically discussed.


Assuntos
Albuminúria/epidemiologia , Pressão Sanguínea , Cardiopatias/epidemiologia , Hipertensão/epidemiologia , Nefropatias/epidemiologia , Doenças Vasculares/epidemiologia , Adolescente , Fatores Etários , Albuminúria/diagnóstico , Albuminúria/fisiopatologia , Doenças Assintomáticas , Criança , Feminino , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Masculino , Fatores de Risco , Doenças Vasculares/diagnóstico , Doenças Vasculares/fisiopatologia , Remodelação Vascular , Rigidez Vascular
6.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(9): 1130-1133, 2019 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-31594159

RESUMO

Objective: To investigate the relationship between maternal disease in early pregnancy of women of childbearing age and congenital heart disease of neonates. Methods: A cross-sectional design was used in this study and stratified multistage random sampling method was used. A questionnaire survey was conducted in the childbearing-aged women during 2010-2013 in Shaanxi province. Propensity score (PS) matched (1∶1) analysis was used to match participants with diseases to those without disease in early pregnancy. Through the control of the confounders step by step, a logistic regression model was established to evaluate the ORs of congenital heart disease according to the independent variable of maternal disease. Results: A total of 28 680 pairs of mothers and infants were included in this study, the proportion of the women with disease in early pregnancy was 20.25% (5 807). After PS matching, 5 436 pairs were matched. After adjusting all confounding factors, the multivariable logistic regression analysis results showed that maternal disease (OR=1.86, 95%CI: 1.23-2.81), especially cold (OR=2.19, 95%CI: 1.46-3.28), gynecological disease (OR=4.74, 95%CI: 2.03-11.09) and diabetes (OR=14.00, 95%CI: 1.64-119.21), in early pregnancy were the risk factors for congenital heart disease of neonate. Conclusion: In women of childbearing age, disease in early pregnancy, especially cold, gynecological disease and diabetes, can increase the risk of congenital heart disease in neonates.


Assuntos
Cardiopatias/epidemiologia , Mães , Estudos Transversais , Feminino , Cardiopatias/congênito , Humanos , Lactente , Recém-Nascido , Gravidez , Fatores de Risco , Inquéritos e Questionários
7.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190016.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596387

RESUMO

OBJECTIVE: To analyze the risk factors associated with the self-reported medical diagnosis of heart disease in Brazil. METHODS: This is a cross-sectional study, analyzing information from 60,202 adult participants of the Brazilian National Health Survey in 2013. Heart disease was defined by self-reported medical diagnosis of heart disease. We analyzed associations between the occurrence of disease and sociodemographic characteristics, health conditions and lifestyle. A hierarchical binary logistic regression model was used. RESULTS: The prevalence of self-reported diagnosis of heart disease in Brazil was 4.2% (confidence interval of 95% [95%CI] 4.0 ‒ 4.3) and was associated with females (odds ratio [OR] = 1.1; 95%CI 1.1 ‒ 1.1), people 65 years old or older (OR = 4.7; 95%CI 3.3 ‒ 5.6), poor or very poor health conditions (OR = 4.1; 95%CI 3.5 ‒ 4.6) and fair health conditions (OR = 2.4; 95%CI 2.2 ‒ 2.7), hypertensive individuals (OR = 2.4; 95%CI 2.2 ‒ 2.7), those with increased cholesterol (OR = 1.6; 95%CI 1.5 ‒ 1.8), overweight individuals (OR = 1.5; 95%CI 1.4 ‒ 1.8) and obese individuals (OR = 2.0; 95%CI 1.7 ‒ 2.2), sedentary behavior (OR = 1.5; 95%CI 1.02 ‒ 2.1), former smokers (OR = 1.4; 95%CI 1.3 ‒ 1.6) or current smokers (OR = 1.2; 95%CI 1.03 ‒ 1.3) and the consumption of fruits and vegetables 5 or more days each week (OR = 1.5; 95%CI 1.1 ‒ 1.5). CONCLUSION: The importance of knowledge on the prevalence of heart disease and associated risk factors in the present Brazilian epidemiological context must be emphasized because it guides actions to control and prevent cardiovascular diseases, the leading cause of death in Brazil and worldwide.


Assuntos
Autoavaliação Diagnóstica , Inquéritos Epidemiológicos/métodos , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Autorrelato/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Valores de Referência , Medição de Risco , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Adulto Jovem
8.
Medicine (Baltimore) ; 98(39): e16774, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574793

RESUMO

BACKGROUND: Total hip arthroplasty (THA) relieves pain and restores function in patients with severe rheumatoid arthritis and osteoarthritis. Over the past few decades, several authors have attempted to assess the efficacy and safety of simultaneous bilateral THA compared with staged bilateral THA. The purpose of this meta-analysis is to compare the mortalities and complications between simultaneous bilateral THA and staged bilateral THA. METHODS: A literature search to identify eligible studies was undertaken to identify all relevant articles published until August 2018. We included studies that compared simultaneous bilateral THA and staged bilateral THA and their effects on mortality and complications. The outcomes included mortality, the occurrence of deep venous thrombosis (DVT), the occurrence of pulmonary embolism (PE), respiratory complications, cardiovascular complications, digestive system complications and the occurrence of dislocation. Stata 12.0 was used for the meta-analysis. RESULTS: Nineteen studies involving 59,257 patients were identified; among them, 16,758 patients were selected for treatment with simultaneous bilateral THA, and 42,499 patients were chosen for the purpose of staged bilateral THA. The meta-analysis results demonstrated that there was no significant difference between simultaneous bilateral THA and staged bilateral THA in terms of mortality (risk ratio [RR] = 1.15, 95% CI = 0.76, 1.74; P = .520). Compared with staged bilateral THA, simultaneous bilateral THA was associated with a reduction in the occurrence of DVT, PE and respiratory complications (P < .05). There were no significant differences in the cardiovascular complications, digestive system complications or the occurrence of dislocation and infection (P = .057). CONCLUSIONS: We observed that the prevalence of DVT, PE and respiratory complications was considerably lower with the use of simultaneous bilateral THA than with the use of staged bilateral THA. Thus, simultaneous bilateral THA is a considerably safer procedure than staged bilateral THA in selected THA patients.


Assuntos
Artrite Reumatoide/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Osteoartrite do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Artroplastia de Quadril/mortalidade , Doenças do Sistema Digestório/epidemiologia , Cardiopatias/epidemiologia , Humanos , Luxações Articulares/epidemiologia , Prevalência , Embolia Pulmonar/epidemiologia , Transtornos Respiratórios/epidemiologia , Trombose Venosa/epidemiologia
9.
Pan Afr Med J ; 33: 156, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565118

RESUMO

Cardiac manifestations develop in the majority of patients with systemic lupus erythematosus (SLE) at some time during the course of their disease. This study was designed to assess cardiac abnormalities in patients with SLE by echocardiography and to compare the 2 groups of patients with and without cardiac manifestations. It was a transversal, descriptive study, conducted in the Internal Medicine Department at the Military Hospital of Tunis from January 2016 to June 2018. Eighty lupus patients, diagnosed on the basis of ACR (American college of rheumatology) criteria, were enrolled in the study and were evaluated by standard echocardiography with color Doppler. Out of 80 patients 42 (52%) had abnormal echocardiographic findings. Pericardial effusion was found in 55%, valvular abnormalities in 52% and 38% had pulmonary hypertension. Patients with pleural effusion (45 vs 15%) were more vulnerable to cardiac involvement as well as renal impairment (57 vs 44%). The difference, however, were not statistically significant (p>0.05) in the renal involvement. Active disease with low complement (80%) was associated with higher frequency of cardiac involvement than disease in remission (64%) but the result was not statistically significant (p=0.11). Cardiac abnormalities are very common in lupus patients even when clinically asymptomatic form. Echocardiography is an excellent non-invasive tool for cardiac evaluation. Their research must be systematic with echocardiography in order to reduce subsequent cardiac morbidity and mortality among the lupus patients.


Assuntos
Ecocardiografia/métodos , Cardiopatias/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/etiologia , Hospitais Militares , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/epidemiologia , Derrame Pericárdico/etiologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Tunísia
10.
West J Emerg Med ; 20(5): 810-817, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31539339

RESUMO

INTRODUCTION: Sudden cardiac death is a rare cause of death in young athletes. Current screening techniques include history and physical exam (H and P), with or without an electrocardiogram (ECG). Adding point of care cardiac ultrasound has demonstrated benefits, but there is limited data about implementing this technology. We evaluated the feasibility of adding ultrasound to preparticipation screening for collegiate athletes. METHODS: We prospectively enrolled 42 collegiate athletes randomly selected from several sports. All athletes were screened using a 14-point H and P based on 2014 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, ECG, and cardiac ultrasound. RESULTS: We screened 11 female and 31 male athletes. On ultrasound, male athletes demonstrated significantly larger interventricular septal wall thickness (p = 0.002), posterior wall thickness (p <0.001) and aortic root breadth (p = 0.002) compared to females. Based on H and P and ECGs alone and a combination of H and P with ECG, no athletes demonstrated a positive screening for cardiac abnormalities. However, with combined H and P, ECG, and cardiac ultrasound, one athlete demonstrated positive findings. CONCLUSIONS: We believe that adding point of care ultrasound to the preparticipation exam of college athletes is feasible. This workflow may provide a model for athletic departments' screening.


Assuntos
Atletas , Morte Súbita Cardíaca/prevenção & controle , Cardiopatias/diagnóstico , Programas de Rastreamento/métodos , Sociedades , Estudantes , Universidades , Adolescente , Morte Súbita Cardíaca/epidemiologia , Ecocardiografia , Eletrocardiografia , Feminino , Cardiopatias/epidemiologia , Humanos , Incidência , Masculino , Esportes , Estados Unidos/epidemiologia , Adulto Jovem
11.
Artigo em Alemão | MEDLINE | ID: mdl-31529181

RESUMO

Trends of frequent chronic diseases and health problems, e.g. allergic diseases, have already been published based on the KiGGS Wave 2 study as part of the health monitoring of children and adolescents in Germany. The present work complements these findings with results on less frequent noncommunicable diseases and the trend of communicable, vaccine-preventable diseases.Information from parents about diagnoses and diseases of their 0­ to 17-year-old children from the representative cross-sectional survey KiGGS Wave 2 (2014-2017) are compared with those from the KiGGS baseline survey (2003-2006) and KiGGS Wave 1 (2009-2012).The current KiGGS results show almost unchanged prevalences for the noncommunicable diseases epilepsy, migraine, and heart disease. However, the data from KiGGS Wave 2 are supportive of an increased prevalence of diabetes mellitus, which nevertheless continues to be relatively rare and predominantly type 1 diabetes in children and adolescents.The decline in measles, chicken pox, and whooping cough diseases related to changes in vaccination recommendations shows that preventive measures can effectively benefit children and adolescents.However, the data on vaccine-preventable diseases indicate regionally varying immunity gaps in certain age groups, so the prevention potential of the vaccination recommendations of the Standing Vaccination Commission (STIKO) at the Robert Koch Institute does not seem to have been sufficiently exploited.


Assuntos
Saúde do Adolescente/estatística & dados numéricos , Doença Crônica/epidemiologia , Viroses/epidemiologia , Adolescente , Varicela/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Epilepsia/epidemiologia , Alemanha/epidemiologia , Inquéritos Epidemiológicos , Cardiopatias/epidemiologia , Humanos , Lactente , Recém-Nascido , Sarampo/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Convulsões Febris/epidemiologia , Coqueluche/epidemiologia
12.
Pan Afr Med J ; 33: 114, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489092

RESUMO

Introduction: Sudden death that occurs during sporting activity affects patients with ignored heart disease. Black athlete's ECG has been little studied and the features of this ethnic group have been discussed. This study aims to study the epidemiological profile and the peculiarities of repolarization of black athletes. Methods: We conducted a descriptive study of black athletes selected among all the athletes followed in the sectoral Center of Sports Science and Medicine in Sousse over a period of 8 months from March to October 2014. Data were collected using a medical questionnaire. Results: Data on 35 athletes were collected, with a male predominance (94,28%), with an average age of 24,34 years. Four athletes had left ventricular hypertrophy on cardiac ultrasound. There were 8 athletes with atrioventricular block degree I and 8 athletes with electrical type of left ventricular hypertrophy (LVH). ST segment changes were more marked at the level of precordial leads. Five athletes (14.2%) had inverted T waves in V2 and V3. These were the same athletes who ST-segment depression in these same leads. Early repolarization was found in 3 athletes. All these cases had notch signaling. Conclusion: Black athletes have quite specific electrical modifications which are important to know. However, our sample is not sufficiently large to certify these results. A comparative study of white athletes would be very interesting.


Assuntos
Arritmias Cardíacas/diagnóstico , Atletas , Cardiopatias/diagnóstico , Hipertrofia Ventricular Esquerda/diagnóstico , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Arritmias Cardíacas/epidemiologia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/epidemiologia , Morte Súbita/prevenção & controle , Ecocardiografia , Eletrocardiografia/métodos , Feminino , Cardiopatias/epidemiologia , Humanos , Hipertrofia Ventricular Esquerda/epidemiologia , Masculino , Estudos Retrospectivos , Esportes , Inquéritos e Questionários , Adulto Jovem
13.
Int Heart J ; 60(5): 1106-1112, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484874

RESUMO

A useful biomarker for detecting cardiac amyloidosis (CA) has not been fully established. We aimed to investigate the utility of several biomarkers to detect CA in patients with amyloid light-chain (AL) amyloidosis.We examined the plasma levels of B-type natriuretic peptide (BNP), N-terminal fragment of the pro-brain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), serum amyloid A, and the difference between kappa and lambda free light chain (dFLC) between CA patients (n = 30, 47.6%) and non-CA patients (n = 33, 52.4%). Levels of BNP were significantly higher in the CA group compared to the non-CA group (1200.0 versus 224.0 pg/mL, P = 0.001). From the ROC analysis, the sensitivity and specificity of BNP for detecting CA (with a cut-off value of 412 pg/mL) were 83% and 70%, respectively, and the area under the receiver operating curve was 0.75 (95% CI 0.61-0.90, P < 0.001) in all AL amyloidosis patients (n = 63). In contrast, other markers such as NT-proBNP, hs-cTnT, serum amyloid A, and dFLC were not useful for detecting CA in AL amyloidosis patients. Additionally, in the Cox proportional hazard analysis, BNP was a predictor of all-cause mortality (hazard ratio 3.266, 95% confidence interval 1.498-7.119, P = 0.003).BNP is a useful biomarker for detecting cardiac involvement and predicting prognosis in AL amyloidosis patients.


Assuntos
Cardiopatias/sangue , Cardiopatias/epidemiologia , Amiloidose de Cadeia Leve de Imunoglobulina/sangue , Peptídeo Natriurético Encefálico/sangue , Troponina T/sangue , Idoso , Biomarcadores/sangue , Causas de Morte , Estudos de Coortes , Progressão da Doença , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Feminino , Cardiopatias/diagnóstico por imagem , Hospitais Universitários , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/fisiopatologia , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
14.
Res Vet Sci ; 126: 51-58, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31437776

RESUMO

Cardiopulmonary nematodes are among the most pathogenic parasites of domestic and wild canids. The aim of this study was to describe the species diversity, prevalence and infection intensity of these parasites in the Iberian wolf (Canis lupus signatus) and the red fox (Vulpes vulpes) in the northwest of the Iberian Peninsula. 257 foxes and 74 wolves were necropsied between 2008 and 2014. Four nematode species were identified: Angiostrongylus vasorum, Eucoleus aerophilus, Crenosoma vulpis and Filaroides hirthi. This last species was only found in wolves, being the first time that is cited worldwide in this wild canid. The overall parasite prevalence was significantly higher in foxes (70%) than in wolves (28%). Specifically, prevalences in foxes and wolves were, respectively, 43% and 22% for A. vasorum, 33% and 5% for E. aerophilus, and 30% and 9% for C. vulpis. The prevalence of F. hirthi was 16%. The A. vasorum intensity was significantly higher in foxes than in wolves. Differences between host species in the risk of infection would be associated to diverging feeding behavior, and possibly reflects a parasite-host adaptation related to host's hunting strategies and cardiorespiratory requirements. This study revealed an association between infection and environmental factors, and highlighted a wide variation in the spatial distribution of A. vasorum. Our results indicate that cardiopulmonary parasites are widespread in wild canids in northwest Spain, and further agrees with other studies indicating the expansion of A. vasorum in Europe and, therefore, the urgent need to investigate infection in dogs in sympatric areas.


Assuntos
Raposas/parasitologia , Cardiopatias/veterinária , Pneumopatias Parasitárias/veterinária , Infecções por Nematoides/veterinária , Lobos/parasitologia , Angiostrongylus , Animais , Animais Selvagens , Coração/parasitologia , Cardiopatias/epidemiologia , Cardiopatias/parasitologia , Pneumopatias Parasitárias/epidemiologia , Pneumopatias Parasitárias/parasitologia , Metastrongyloidea , Infecções por Nematoides/epidemiologia , Infecções por Nematoides/parasitologia , Prevalência , Espanha/epidemiologia
15.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31366685

RESUMO

Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients' management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model's feasibility, acceptability, and efficacy.


Assuntos
Cardiopatias/terapia , Unidades de Terapia Intensiva/organização & administração , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Criança , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Humanos , Lactente
16.
Urology ; 133: 121-128, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31377255

RESUMO

OBJECTIVE: To determine whether the association between male infertility and incident cardiometabolic disease is modified by socioeconomics, race, or geographic region. MATERIALS AND METHOD: Retrospective review of data from insurance claims from Optum's de-identified Clinformatics Data Mart Database. Subjects were men, 18-50 years old, with an associated diagnosis of infertility in the United States between 2003 and 2016. Analytical sample were men captured by the Optum's de-identified Clinformatics Data Mart Database with an associated diagnosis of infertility. Men were classified as either infertile, or not, based on diagnosis or procedural codes. Cardiometabolic health outcomes were then assessed using current procedural terminology codes for diabetes, hypertension, hyperlipidemia, and heart disease. Confounding factors were controlled for such as race, education, socioecomonic status, and region. The main outcomes were development of diabetes, hypertension, hyperlipidemia, and heart disease. RESULTS: A total of 76,343 males were diagnosed with male factor infertility, 60,072 males who underwent fertility testing, and 183,742 males that underwent vasectomy (control population). For all men, infertile men had a higher risk of incident hypertension, diabetes, hyperlipidemia, and heart disease when compared to those undergoing vasectomy. Identical associations were found across all education, income, racial, and geographic strata. CONCLUSION: Our study suggests that men with infertility have a higher risk of cardiometabolic disease in the years following a fertility evaluation regardless of race, region, or socioeconomic status.


Assuntos
Cardiopatias/epidemiologia , Infertilidade Masculina/complicações , Doenças Metabólicas/epidemiologia , Adolescente , Adulto , Demografia , Cardiopatias/etiologia , Humanos , Incidência , Masculino , Doenças Metabólicas/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
17.
J Cardiothorac Surg ; 14(1): 138, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331354

RESUMO

BACKGROUND: The donor's mode of brain death (BD), being associated with impairment of myocardial function and hemodynamic performance, impacts the prognosis of the heart transplantation (HTx) recipient. METHODS: All patients who underwent HTx between 1996 and 2017 were categorized according to donor's BD mechanism: traumatic BD (TBD) versus non-traumatic BD (NTBD). RESULTS: The TBD group included 105 recipients, and the NTBD group, 85 recipients. Kaplan-Meier survival analysis showed that overall survival was significantly higher for recipients of TBD hearts (10-year survival 58.1 vs. 37.6%, p = 0.044). Consistently, multivariate analysis showed that TBD was independently associated with a significant 43% reduction in mortality [95% confidence interval (CI) 0.42-0.75, p = 0.033]. Rejection rate was lower in the TBD group (total rejection score 0.44 ± 0.32 vs. 0.51 ± 0.38, p = 0.04; any rejection score 0.38 ± 0.26 vs. 0.45 ± 0.31, p = 0.030), and freedom from cardiac allograft vasculopathy (CAV) was significantly higher in recipients of traumatic vs. non-traumatic donors (10 years: 82.9 vs. 62.4%, log-rank p-value = 0.024). Multivariate analysis showed a significant 42% reduction in CAV [hazard ratio (HR) = 0.58, 95% CI 0.51-0.85, p = 0.022). CONCLUSION: Mode of brain death significantly impacts HTx outcomes, with TBD being associated with reduced mortality, rejections and CAV.


Assuntos
Morte Encefálica , Seleção do Doador/métodos , Transplante de Coração , Doadores de Tecidos , Ferimentos e Lesões , Adulto , Idoso , Idoso de 80 Anos ou mais , Seleção do Doador/normas , Feminino , Seguimentos , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/prevenção & controle , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Cardiopatias/prevenção & controle , Transplante de Coração/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Melhoria de Qualidade , Taxa de Sobrevida
19.
Crit Rev Oncol Hematol ; 141: 95-101, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31272046

RESUMO

BACKGROUND: Cancer and heart diseases are the leading causes of morbidity and mortality in many countries worldwide. Recent advancement in chemotherapy and targeted therapies has led to an improvement in cancer survival rates, but at a cost of higher cardiac side effects. However, report on antineoplastic-related cardiotoxicities incidence in Asia is lacking. METHODS: We systematically searched multiple databases to identify studies reporting incidence of antineoplastic-related cardiovascular toxicity in Asia published from inception to November 2018. Pre-specified subgroups were performed to explore heterogeneity and study quality assessed and reported according to PRISMA guidelines. RESULTS: A total of 61 studies across 11 countries in Asia reported 8 types of cardiovascular toxicities were included. These studies mostly reported on adult populations, and usually examined cardiotoxicities related to anthracycline use. The most frequently reported cardiotoxicities were heart failure, electrocardiogram abnormalities and left ventricular dysfunction. The pooled estimated incidence of cardiotoxicity was 4.27% (95% CI: 3.53-5.07). Subgroup analysis showed higher incidence in middle income countries compared to high income countries. CONCLUSIONS: Although robust incidence studies are sparse, cardiovascular complications affects approximately one in twenty cancer patients in Asia. This highlights a unique opportunity of cancer patients caring that need cardiologists and oncologist to become familiar with this emerging sub-specialty.


Assuntos
Antraciclinas/efeitos adversos , Antibióticos Antineoplásicos/efeitos adversos , Cardiopatias/induzido quimicamente , Neoplasias/tratamento farmacológico , Adulto , Antraciclinas/classificação , Antraciclinas/uso terapêutico , Antibióticos Antineoplásicos/classificação , Antibióticos Antineoplásicos/uso terapêutico , Ásia/epidemiologia , Cardiotoxicidade/epidemiologia , Cardiopatias/epidemiologia , Humanos , Incidência , Neoplasias/epidemiologia
20.
Br J Anaesth ; 123(4): 421-429, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31256916

RESUMO

BACKGROUND: The National Surgical Quality Improvement Program Myocardial Infarction & Cardiac Arrest (NSQIP MICA) calculator and the Revised Cardiac Risk Index (RCRI) were derived using currently outdated methods of diagnosing perioperative myocardial infarctions. We tested the external validity of these tools in a setting of a systematic perioperative cardiac biomarker measurement. METHODS: Analysis of routinely collected data nested in the Vascular Events In Noncardiac Surgery Patients Cohort Evaluation Study. A consecutive sample of patients ≥45 yr old undergoing in-hospital noncardiac surgery in a single tertiary care centre was enrolled. The predictive performance of the models was tested in terms of the occurrence of major cardiac complications defined as a composite of a nonfatal myocardial infarction, a nonfatal cardiac arrest, or a cardiac death within 30 days after surgery. The plasma concentration of high-sensitivity troponin T was measured before surgery, 6-12 h after operation, and on the first, second, and third days after surgery. Myocardial infarction was diagnosed according to the Third Universal Definition. RESULTS: The median age was 65 (59-72) yr, and 704/870 (80.9%) subjects were male. The primary outcome occurred in 76/870 (8.7%; 95% confidence interval [CI], 6.9-10.8%) patients. The c-statistic was 0.64 (95% CI, 0.57-0.70) for the NSQIP MICA and 0.60 (95% CI, 0.54-0.65) for the RCRI. Predicted risks were systematically underestimated in calibration belts (P<0.001). The RCRI and the NSQIP MICA showed no clinical utility before recalibration. CONCLUSIONS: The NSQIP and RCRI models had limited predictive performance in this at-risk population. The recently updated version of the RCRI was more reliable than the original index.


Assuntos
Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Cardiopatias/epidemiologia , Complicações Intraoperatórias/terapia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Complicações Pós-Operatórias/terapia , Medição de Risco/normas , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Estudos de Coortes , Morte Súbita Cardíaca/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Valor Preditivo dos Testes , Melhoria de Qualidade , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
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