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1.
Medicina (B Aires) ; 79 Suppl 3: 29-32, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603840

RESUMO

Recent studies have demonstrated that while we are sleeping, our brain is very busy processing all information we have acquired along the day. Lack of sleep has shown to produce deficits in memory consolidation and plays an important role in brain development and brain plasticity in the several developmental stages of the human brain. At the cellular level, circadian cycles coordinate complex mechanism that "turn on and off" genes and cellular structures regulating individual cell functions to impact global organ and systems physiological activities. At the end a perfect and coordinated equilibrium in the mental, emotional and physiological is the goal of this complex process. Sleep impacts memory, learning, mood, behavior, immunological responses, metabolism, hormone levels, digestive process and many more physiological functions. We present a review of three basic aspects related with sleep: a. brain electrical activity during the sleep and neuroanatomic correlation with mechanism related with memory and learning; b. circadian cycles and impact in several physiological systems; c some examples of clinical disorders associated with sleep disorders and impact in learning and memory.


Assuntos
Ritmo Circadiano/fisiologia , Aprendizagem/fisiologia , Memória/fisiologia , Plasticidade Neuronal/fisiologia , Sono/fisiologia , Encéfalo/fisiologia , Emoções/fisiologia , Humanos , Transtornos do Sono-Vigília/fisiopatologia
2.
Medicina (B Aires) ; 79 Suppl 3: 33-36, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603841

RESUMO

The development and establishment of the normal sleep patterns are very important processes in the final anatomical and physiological architecture of the central nervous system. The relationship between sleep disturbances during childhood with neurodevelopmental disorders is complex and potentially synergistic. Sleep patterns are present since the fetal period but their structure and physiology is modified according with the maturation of the central nervous system. Sleep disorders and their relationship with attention deficit hyperactivity disorders(ADHD), autism spectrum disorders(ASD) and other neurodevelopmental disorders (TDN) are not well understood yet, but significant progresses have been made in understanding associations and potential etiological correlations. We reviewed sleep disturbances in NDT, in ADHD and in ASD. A greater understanding of the pleiotropic functions of the genes involved in sleepwake cycle disorders and deviations from neurological developme nt could lead to new diagnostic and therapeut ic strategies in an early stage in order to improve the quality of life of the patient, relatives and caregivers.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Espectro Autista/complicações , Transtornos do Sono-Vigília/complicações , Transtorno do Deficit de Atenção com Hiperatividade/genética , Transtorno do Espectro Autista/genética , Pré-Escolar , Ritmo Circadiano , Humanos , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/genética
3.
J Orofac Orthop ; 80(6): 336-347, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31650205

RESUMO

PURPOSE: The circadian clock plays an important role in many physiological states and pathologies. The significance of its core genes in bone formation and tooth development has already been demonstrated. However, regulation of these genes and their influence on periodontal and bone remodeling in periodontal ligament (PDL) fibroblasts remains to be elucidated. Our hypothesis was that the circadian clock influences markers for periodontal and bone remodeling and therefore orthodontic tooth movement itself. MATERIALS AND METHODS: Human PDL fibroblasts were cultured and synchronized in circadian rhythms with the help of a dexamethasone shock. Cells were harvested at 4 h intervals. Reverse transcription and quantitative RT PCR (real time polymerase chain reaction) were performed to assess the mRNA levels of the clock genes ARNTL, CLOCK1, PER1, and PER2. Subsequently, mRNA expression of important marker genes for periodontal and bone remodeling, OPG, RANKL, OCN, OPN, RUNX2, COL1A1, IL1ß, KI67, and POSTN, were examined at time points of ARNTL amplitude expression. RESULTS: Gene expression of core clock genes varied over 48 h in accordance with the circadian rhythm. Functional markers, except KI67, showed significant differences at time points of maximum fluctuation especially of ARNTL. CONCLUSIONS: PDL fibroblasts express circadian clock genes. Our results suggest that genes associated with bone and periodontal remodeling are influenced by the circadian rhythm. Further research will have to refine the understanding of this influence for orthodontic treatment.


Assuntos
Ritmo Circadiano , Ligamento Periodontal , Moléculas de Adesão Celular , Fibroblastos , Expressão Gênica , Humanos , Técnicas de Movimentação Dentária
5.
Bratisl Lek Listy ; 120(7): 523-526, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31602988

RESUMO

OBJECTIVES: Circadian rhythms modulate the activity of pain pathways. But there appears to be a lack of understanding of how the perception of pain varies in neonates during the day. To assess circadian variations in pain perception we analyzed intensities of pain at 3 h intervals in neonates (within 24 hours). We also followed up the nursing interventions practiced for pain reduction and their effectivity within a day. METHODS: We have analyzed the clinical observations of pain in 16 neonates during 62 days of hospitalization (with Mean = 3.87, Min = 1, Max = 19). The pain was assessed by a modification of the Comfort scale supplemented with Wong-Baker scale. Procedure used for acute pain elimination was administration of 24% sucrose to the neonates. This procedure was centralized and performed in an incubator or neonatal bed. RESULTS: We confirmed statistically significant difference in pain scores in our group of neonates at 10:00 am, 4:00 pm, 4:00 am as compared to 10:00 pm (p values being 0.02603; 0.02885, 0.01673). The pain score was highest at 10:00 pm (Mean = 18.86, Max = 34) and at 1:00 am (Mean = 18.89, Max = 33). There was no significant difference in the pain score at 10:00 pm and 1:00 am (p = 0.2951). CONCLUSION: The results of our studies provided further evidence of circadian rhythm in the pain scores in neonates. A better understanding of circadian control of pain in neonates can help promote a more frequent use of time-contingent pain treatment strategies to help improve neonates care (Tab. 1, Fig. 2, Ref. 28) Keywords: circadian rhythm, neonate, nursing care, pain, the Comfort scale.


Assuntos
Ritmo Circadiano , Medição da Dor , Dor/diagnóstico , Dor/enfermagem , Humanos , Recém-Nascido
6.
Science ; 365(6460): 1379-1380, 2019 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-31604257
7.
Ecol Lett ; 22(12): 2097-2102, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31617283

RESUMO

Maximising survival requires animals to balance the competing demands of maintaining energy balance and avoiding predation. Here, quantitative modelling shows that optimising the daily timing of activity and rest based on the encountered environmental conditions enables small mammals to maximise survival. Our model shows that nocturnality is typically beneficial when predation risk is higher during the day than during the night, but this is reversed by the energetic benefit of diurnality when food becomes scarce. Empirical testing under semi-natural conditions revealed that the daily timing of activity and rest in mice exposed to manipulations in energy availability and perceived predation risk is in line with the model's predictions. Low food availability and decreased perceived daytime predation risk promote diurnal activity patterns. Overall, our results identify temporal niche switching in small mammals as a strategy to maximise survival in response to environmental changes in food availability and perceived predation risk.


Assuntos
Ritmo Circadiano , Metabolismo Energético , Animais , Alimentos , Mamíferos , Camundongos
8.
Sheng Li Xue Bao ; 71(5): 783-791, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31646332

RESUMO

Circadian rhythms widely exist in living organisms, and they are regulated by the biological clock. Growing evidence has shown that circadian rhythms are tightly related to the physiological function of the cardiovascular system, including blood pressure, heart rate, metabolism of cardiomyocytes, function of endothelial cells, and vasoconstriction and vasodilation. In addition, disruption of circadian rhythms has been considered as one of the important risk factors for cardiovascular diseases, such as myocardial infarction. This review summarizes the recent research advances in the relationship between circadian clock and cardiovascular diseases, hoping to improve treatment strategies for patients with cardiovascular diseases according to the theory of biological clock.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Relógios Circadianos , Ritmo Circadiano , Pressão Sanguínea , Células Endoteliais/citologia , Frequência Cardíaca , Humanos , Miócitos Cardíacos/metabolismo , Vasoconstrição , Vasodilatação
9.
Rev Prat ; 69(5): 537-545, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31626464

RESUMO

Sleep is a physiological condition essential to life, present in all living organisms with a neuronal and glial network. Its functions, not fully understood, include the conservation of energy, the regulation of our immune system and brain function through the modulation of synaptic plasticity and the elimination of substances accumulated during wakefulness. Sleep in human is characterized by two exclusive states, the non-REM and the REM -paradoxical- sleep, whose occurrence is driven by a cyclic organi zation. Sleep and wakefulness result from complex mechanisms involving a hetero geneous transition of different brain structures from one physiological state to another. The sleep duration and distribution of sleep over 24 hours are regulated by complex interconnected mechanisms, involving both the need for sleep accumulated during wakefulness -homeostatic process- and biological rhythm -mainly the circadian process- under the influence of external synchronizers like light-dark cycle. The propensity to sleep at a given moment is regulated by a physiological signal, sleepiness, in connection with the level of vigilance. The characteristics of sleep are relatively stable for a given individual because of a strong genetic determinism, but varies in duration and architecture according to age, individual habits, sleep schedules and environmental constraints. An understanding of the physiology of sleep is important for the clinician, allowing a better understanding of sleep dysfunction, responsible for various and frequent sleep disorders equiring appropriate care.


Assuntos
Transtornos do Sono-Vigília , Sono , Ritmo Circadiano/fisiologia , Homeostase , Humanos , Sono/fisiologia , Sono REM/fisiologia , Vigília/fisiologia
10.
Zhonghua Yi Xue Za Zhi ; 99(34): 2687-2690, 2019 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-31505720

RESUMO

Objective: To explore the relationship between blood pressure load and sleep stability in hypertensive patients by cardiopulmonary coupling monitoring (CPC) and 24-hour ambulatory blood pressure monitoring. Methods: One hundred and fifty-five patients with essential hypertension were divided into high load group and low load group according to whether the blood pressure load was higher than 50%. The relationship between sleep stability and systolic blood pressure load was analyzed by logistic regression. Results: After adjusting for sex, age and body mass index (BMI), logistic regression analysis showed that stable sleep was the protective factor (OR=0.736,P=0.047) for the decrease of nocturnal blood pressure load, and unstable sleep was the risk factor for increasing day time blood pressure load (OR=1.336, P=0.037) in patients with hypertension. Conclusions: The effect of sleep stability on blood pressure load is different between day and night. Stable sleep is the protective factor of nocturnal systolic blood pressure load decrease, and unstable sleep is the harmful factor of daytime systolic blood pressure load increase. Increasing sleep stability helps to reduce systolic blood pressure load.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão Essencial , Pressão Sanguínea , Ritmo Circadiano , Humanos , Sono
11.
Med Lav ; 110(4): 285-292, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31475690

RESUMO

BACKGROUND: Shift work including night shifts is generally associated with chronic misalignment between the endogenous circadian timing system and behavior cycles, leading to metabolic disorders including metabolic syndrome (MS). OBJECTIVES: The purpose of this research was to analyze the latest developments in assessing and managing the occupational risk of MS in shift-healthcare workers (HCWs). METHODS: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, the authors used MEDLINE/Pubmed to perform a systematic review of literature from January 2008 to December 2018.  Results: Six studies were selected; the topics, discussed in order of frequency from highest to lowest, were: risk assessment, occurrence rates, and risk management. The main occupational determinants for MS were the cumulative shift work including night shifts and the number of nights worked per month per worker. With regard to cumulative lifetime exposure to shift work, the findings of our review suggest a dose-response relationship between increasing years of shift work history and MS in shift-HCWs. CONCLUSIONS: The findings suggest the need to better investigate the impact of sleep deprivation in the assessment of MS risk in shift-HCWs and clarify the role of such variables as confounders, mediators, or effect modifiers. Moreover, to date the data regarding management interventions focused on the risk of MS are inconsistent and therefore a special effort is required to detect strategic ways to minimize the likelihood of MS occurring in shift-HCWs.


Assuntos
Ritmo Circadiano , Pessoal de Saúde , Síndrome Metabólica , Tolerância ao Trabalho Programado , Humanos , Medição de Risco
12.
Genes Dev ; 33(17-18): 1136-1158, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31481537

RESUMO

Circadian rhythms are driven by a transcription-translation feedback loop that separates anabolic and catabolic processes across the Earth's 24-h light-dark cycle. Central pacemaker neurons that perceive light entrain a distributed clock network and are closely juxtaposed with hypothalamic neurons involved in regulation of sleep/wake and fast/feeding states. Gaps remain in identifying how pacemaker and extrapacemaker neurons communicate with energy-sensing neurons and the distinct role of circuit interactions versus transcriptionally driven cell-autonomous clocks in the timing of organismal bioenergetics. In this review, we discuss the reciprocal relationship through which the central clock drives appetitive behavior and metabolic homeostasis and the pathways through which nutrient state and sleep/wake behavior affect central clock function.


Assuntos
Relógios Circadianos/fisiologia , Metabolismo Energético/genética , Hipotálamo/metabolismo , Neurônios/fisiologia , Animais , Ritmo Circadiano/fisiologia , AMP Cíclico/metabolismo , Comportamento Alimentar/fisiologia , Humanos , Transdução de Sinais
13.
Adv Gerontol ; 32(3): 347-356, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31512420

RESUMO

We studied the effect of prolonged absence of a photoperiodic signal (constant lighting and constant darkness) on the changes of digestive enzymes' activity in late postnatal ontogenesis of rats. Age-related alterations are characterized as a change in activity of enzymes, as well as a redistribution of the functional activity between the amylo- and lipolytic links, the upper and lower divisions of the gastrointestinal tract. It was shown that along with age, the activity of enzymes is affected both by the absence of photoperiodism and by the level of melatonin associated with the light regime. In conditions of light deprivation the age-related changes characterizing the «aging¼ of the digestive system are observed later compared with standard illumination and especially constant illumination.


Assuntos
Escuridão , Enzimas , Trato Gastrointestinal , Melatonina , Fotoperíodo , Fatores Etários , Animais , Ritmo Circadiano , Ativação Enzimática , Enzimas/metabolismo , Trato Gastrointestinal/enzimologia , Trato Gastrointestinal/crescimento & desenvolvimento , Luz , Melatonina/metabolismo , Ratos
14.
Psychiatr Danub ; 31(Suppl 3): 497-502, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488779

RESUMO

BACKGROUND: A link between abnormalities in circadian rhythms and the development of eating disorders was extensively hypothesized, mainly in consideration of the influence of the circadian clock on eating behavior. The present review is aimed at summarizing the evidence about biological rhythms disruptions in eating disorders, possibly clarifying their impact on the psychopathological profile of such patients. METHODS: Electronic database MEDLINE/PubMed/Index Medicus was systematically searched for original articles examining the prevalence of circadian rhythms disruptions in eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder). RESULTS: Studies included in the review confirmed the hypothesis of a high prevalence of circadian disruptions in eating disorders. The analyzed research mainly focused on sleep-wake cycle, rest-activity abnormalities and hormonal secretion, whilst literature about other circadian rhythms was scanty. Altered biological rhythms presented higher association with specific psychopathological features, but such relationship was assessed in few studies. CONCLUSIONS: Circadian rhythms disruptions were confirmed to be relevant aspects in the context of eating disorders. Further research is needed in order to clarify the role of biological rhythms in such illnesses, in the attempt to address adjunctive treatment strategies with the possible focus of circadian abnormalities.


Assuntos
Transtornos Cronobiológicos/complicações , Transtornos Cronobiológicos/fisiopatologia , Ritmo Circadiano , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Anorexia Nervosa/complicações , Anorexia Nervosa/fisiopatologia , Transtorno da Compulsão Alimentar/complicações , Transtorno da Compulsão Alimentar/fisiopatologia , Bulimia Nervosa/complicações , Bulimia Nervosa/fisiopatologia , Humanos , Psicopatologia
15.
Sr Care Pharm ; 34(7): 419-431, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31383052

RESUMO

OBJECTIVE: To review clinical studies evaluating melatonin doses and their effects on sleep in adults 65 years of age and older. DATA SOURCES: The MEDLINE databases were searched (1946 to October 10, 2018) using the following Medical Subject Heading terms: melatonin and: sleep initiation and maintenance disorders, dyssomnia, sleep wake disorders, insomnia, sleep disorders intrinsic, and sleep disorders circadian rhythm. Sources were limited to English and human data. STUDY SELECTION/DATA EXTRACTION: An initial search resulted in 144 publications, with 25 included in this review. Studies were selected for full review based on design, mean age of participants, use of exogenous melatonin, and reports on any sleep-related outcome. DATA SYNTHESIS: Because of the side effect profiles of most prescription and nonprescription sleep aids, safe and effective alternative therapies are necessary. Based on the current literature, no dose-related response to sleep improvement has been identified for melatonin in older adults. Variations in melatonin formulation and dosages, as well as available tools to measure sleep outcomes, make it challenging to compare studies. CONCLUSIONS: This review evaluated a variety of melatonin doses, 0.5 mg to 10 mg, and their effects on sleep in older adults. The results varied, with some studies finding no difference in sleep outcomes when compared with placebo, while other studies found statistically significant improvements in sleep outcomes. Doses of melatonin between 1 mg and 6 mg appear to be effective for improving sleep in older adults; however, further studies are needed to find the optimal minimum effective dose.


Assuntos
Melatonina/administração & dosagem , Transtornos do Sono-Vigília , Ritmo Circadiano , Humanos , Sono
16.
Stud Health Technol Inform ; 264: 1631-1632, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438265

RESUMO

Monitoring circadian rhythms of social activity is crucial for preserving the health and wellness of ill elderly people. In this paper, we assess the ability of phones to be used as a temporal and social daily activity sensor from a passive and unobstructive measure of phone call activity. To this end, we introduce a methodology specifically designed to automatically measure both persistence and disruptions in circadian rhythms of phone call activity with 26 adults older than 65 years.


Assuntos
Atividades Cotidianas , Ritmo Circadiano , Idoso , Humanos , Comportamento Social
17.
Environ Pollut ; 254(Pt A): 112916, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376605

RESUMO

Light at night (LAN) negatively impacts the behaviour and physiology; however, very little is known about molecular correlates of LAN-induced effects in diurnal animals. Here, we assessed LAN-induced effects on behaviour and physiology, and examined molecular changes in the liver of diurnal zebra finches (Taeniopygia guttata). Birds were exposed to dim LAN (dLAN: 12L = 150 lux: 12D = 5 lux), with controls on 12L (150 lux): 12D (0 lux). dLAN altered daily activity-rest and eating patterns, induced nocturnal eating and caused body fattening and weight gain, and reduced nocturnal melatonin levels. Concomitant increased nighttime glucose levels, decreased daytime thyroxine and triglycerides levels, and hepatic lipid accumulation suggested the impairment of metabolism under dLAN. Transcriptional assays evidenced dLAN-induced negative effects on metabolism in the liver, the site of metabolic homeostasis. Particularly, increased g6pc and foxo1 mRNA expressions suggested an enhanced gluconeogenesis, while increased egr1 and star expressions suggested enhanced cholesterol biosynthesis and lipid metabolism, respectively. Similarly, overexpressed sirt1 indicated protection from the metabolic damage due to elevated gluconeogenesis and cholesterol biosynthesis under dLAN. However, no effect on genes involved in lipogenesis (fasn) and insulin signalling pathway (socs3 and insig1) might indicate for the post transcriptional/post translational modification effects or the involvement of other genetic pathways in LAN-induced effects. We also found daily rhythm in the hepatic expression of selected clock and clock-controlled genes (per2, bmal1 and reverb-beta), with an elevated mesor and amplitude of per2 oscillation, suggesting a role of per2 in the liver metabolism. These results demonstrate dLAN-induced negative effects on the behaviour and physiology, and provide molecular insights into metabolic risks of the exposure to illuminated nights to diurnal animals including humans in an urban setting.


Assuntos
Tentilhões/fisiologia , Luz , Animais , Ritmo Circadiano/fisiologia , Comportamento Alimentar , Masculino , Melatonina
18.
Hypertension ; 74(4): 756-766, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31446802

RESUMO

Mortality due to cardiovascular disease rises sharply in winter. Known as excess winter mortality, this phenomenon is partially explained by cold exposure-induced high blood pressure. Home blood pressure, especially in the morning, is closely associated with cardiovascular disease risk. We conducted the first large nationwide survey on home blood pressure and indoor temperature in 3775 participants (2095 households) who intended to conduct insulation retrofitting and were recruited by construction companies. Home blood pressure was measured twice in the morning and evening for 2 weeks. The relationship between home blood pressure and indoor temperature in winter was analyzed using a multilevel model with 3 levels: repeatedly measured day-level variables (eg, indoor ambient temperature and quality of sleep), nested within individual-level (eg, age and sex), and nested within household level. Cross-sectional analyses involving about 2900 participants (1840 households) showed that systolic blood pressure in the morning had significantly higher sensitivity to changes in indoor temperature (8.2 mm Hg increase/10°C decrease) than that in the evening (6.5 mm Hg increase/10°C decrease) in participants aged 57 years (mean age in this survey). We also found a nonlinear relationship between morning systolic blood pressure and indoor temperature, suggesting that the effect of indoor temperature on blood pressure varied depending on room temperature range. Interaction terms between age/women and indoor temperature were significant, indicating that systolic blood pressure in older residents and women was vulnerable to indoor temperature change. We expect that these results will be useful in determining optimum home temperature recommendations for men and women of each age group. Clinical Trial Registration- URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000030601.


Assuntos
Pressão Sanguínea/fisiologia , Habitação , Temperatura Ambiente , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano/fisiologia , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estações do Ano
19.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 227-233, ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182762

RESUMO

Objetivos: Este estudio analiza el control del ritmo en los servicios de urgencias (SUH) y sus resultados en pacientes con fibrilación auricular (FA) de reciente comienzo, para identificar áreas de mejora en el manejo. Método: Estudio multicéntrico, observacional, prospectivo y transversal desarrollado en 124 SUH representativos del sistema sanitario español basado en el registro HERMES-AF (estrategias de manejo en el servicio de urgencias hospitalario de la FA) del 23 de mayo al 5 de junio de 2011. Se incluyeron pacientes con FA sintomática con menos de 48 h de evolución en los cuales se tomó la decisión de restaurar el ritmo sinusal. Resultados: Se incluyeron 337 pacientes, se optó por cardioversión farmacológica en 311 pacientes (92,3%), y por cardioversión eléctrica en 52 (15%), la mitad de los casos tras fracaso de los fármacos. Se obtuvo ritmo sinusal (RS) en 278 pacientes (82,5%) y el alivio de los síntomas en 297 (94%), con una tasa de efectos adversos del 0,9%, ninguno grave. Amiodarona se asoció de manera independiente a una menor tasa de RS al alta (OR = 0,442; IC 95% 0,238-0,823; p = 0,01), al contrario que la cardioversión eléctrica (OR = 4,0; IC 95% 1,2-13,3; p = 0,024). Los fármacos I-C se asociaron con una mayor proporción de altas en < 6 h (OR 2,6; IC 95% 1,6-4,3; p < 0,001) y amiodarona con más estancias prolongadas de > 24 h (OR 2,7, IC 95% 1,5-4,8; p < 0,003). Conclusiones: En los SUH, la restauración del RS en la FA de reciente comienzo es segura, efectiva y asocia beneficios clínicos para los pacientes. Reemplazar amiodarona por técnicas más efectivas y rápidas como la cardioversión eléctrica o los fármacos I-C es un área de mejora de la calidad asistencial


Objectives: To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified. Methods: Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm. Results: We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238-0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2-13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6-4.3; P<.001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5-4.8; P<.003). Conclusions: Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cardioversão Elétrica/métodos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Serviços Médicos de Emergência , Ritmo Circadiano/efeitos dos fármacos , Sistema de Registros/normas , Cardioversão Elétrica/tendências , Estudos Prospectivos , Estudos Transversais , Espanha , Antiarrítmicos/administração & dosagem , Sistemas de Saúde/organização & administração
20.
JAMA ; 322(5): 409-420, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31386134

RESUMO

Importance: Blood pressure (BP) is a known risk factor for overall mortality and cardiovascular (CV)-specific fatal and nonfatal outcomes. It is uncertain which BP index is most strongly associated with these outcomes. Objective: To evaluate the association of BP indexes with death and a composite CV event. Design, Setting, and Participants: Longitudinal population-based cohort study of 11 135 adults from Europe, Asia, and South America with baseline observations collected from May 1988 to May 2010 (last follow-ups, August 2006-October 2016). Exposures: Blood pressure measured by an observer or an automated office machine; measured for 24 hours, during the day or the night; and the dipping ratio (nighttime divided by daytime readings). Main Outcomes and Measures: Multivariable-adjusted hazard ratios (HRs) expressed the risk of death or a CV event associated with BP increments of 20/10 mm Hg. Cardiovascular events included CV mortality combined with nonfatal coronary events, heart failure, and stroke. Improvement in model performance was assessed by the change in the area under the curve (AUC). Results: Among 11 135 participants (median age, 54.7 years, 49.3% women), 2836 participants died (18.5 per 1000 person-years) and 2049 (13.4 per 1000 person-years) experienced a CV event over a median of 13.8 years of follow-up. Both end points were significantly associated with all single systolic BP indexes (P < .001). For nighttime systolic BP level, the HR for total mortality was 1.23 (95% CI, 1.17-1.28) and for CV events, 1.36 (95% CI, 1.30-1.43). For the 24-hour systolic BP level, the HR for total mortality was 1.22 (95% CI, 1.16-1.28) and for CV events, 1.45 (95% CI, 1.37-1.54). With adjustment for any of the other systolic BP indexes, the associations of nighttime and 24-hour systolic BP with the primary outcomes remained statistically significant (HRs ranging from 1.17 [95% CI, 1.10-1.25] to 1.87 [95% CI, 1.62-2.16]). Base models that included single systolic BP indexes yielded an AUC of 0.83 for mortality and 0.84 for the CV outcomes. Adding 24-hour or nighttime systolic BP to base models that included other BP indexes resulted in incremental improvements in the AUC of 0.0013 to 0.0027 for mortality and 0.0031 to 0.0075 for the composite CV outcome. Adding any systolic BP index to models already including nighttime or 24-hour systolic BP did not significantly improve model performance. These findings were consistent for diastolic BP. Conclusions and Relevance: In this population-based cohort study, higher 24-hour and nighttime blood pressure measurements were significantly associated with greater risks of death and a composite CV outcome, even after adjusting for other office-based or ambulatory blood pressure measurements. Thus, 24-hour and nighttime blood pressure may be considered optimal measurements for estimating CV risk, although statistically, model improvement compared with other blood pressure indexes was small.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/epidemiologia , Hipertensão/complicações , Adulto , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Doenças Cardiovasculares/etiologia , Ritmo Circadiano , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
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