Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension

Abstract Background Cardiovascular disease is the main cause of death worldwide. There is a lack of studies addressing this issue in women and its risk factors, such as hypertension. Objective To evaluate the clinical and therapeutic profile of women with hypertension and to determine which factors are related to treatment adherence and blood pressure control. Methods Cross-sectional study of 181 hypertensive women treated at an outpatient referral clinic. Data were obtained from medical records, face-to-face interviews, and physical examination, using a standardized form. Statistical analysis was performed with prevalence ratio, chi-square and Student's t test. Significance was accepted at p<0.05. Results Most patients were mixed-race or black (91.7%) and the mean age was 66.09 years. Only 44.2% of patients had controlled blood pressure. The prevalence of stroke was 14.9%, whereas the prevalence of coronary artery disease was 19.3%. The mean number of oral antihypertensive drugs prescribed to each individual was 3.41. A history of stroke was more often found in patients with uncontrolled blood pressure (p=0.013) and in those using three or more antihypertensives (p=0.023). Eighty patients (44.2%) had high treatment adherence. Depression was more frequently reported by patients with poorer adherence to treatment (p=0.026). Conclusion Women with hypertension presented a high prevalence of cardiovascular risk factors and cardiovascular events, including a significantly higher prevalence of stroke in those with uncontrolled hypertension. Self-reported depression may help identify patients at risk of nonadherence to treatment.

Episódios de Alta Frequência Atrial e sua Associação com Eventos Isquêmicos Cerebrais em Pacientes Chagásicos / Atrial High-Rate Episodes and Their Association with Cerebral Ischemic Events in Chagasic Patients

Resumo Fundamento Episódios de alta frequência atrial (EAFAs) estão associados a um risco elevado de eventos isquêmicos cerebrais, porém não existem estudos relacionados com a presença de EAFAs e eventos isquêmicos cerebrais em pacientes chagásicos. Objetivo Investigar a associação entre a presença de EAFAs ≥ 6 minutos e eventos isquêmicos cerebrais em pacientes chagásicos. Métodos Estudo de coorte com pacientes chagásicos, portadores de dispositivos cardíacos eletrônicos implantáveis (DCEIs), acompanhados no ambulatório de arritmias de um hospital universitário, na cidade de Salvador/BA, entre maio de 2016 e junho de 2017. Pacientes com diagnóstico de flutter atrial/fibrilação atrial, com DCEI unicameral e em uso de anticoagulação oral foram excluídos. Foram considerados EAFAs com frequência atrial ≥ 190 batimentos por minuto e duração ≥ 6 minutos (min), e os eventos isquêmicos cerebrais foram identificados por meio de tomografia computadorizada (TC) de crânio. Resultados Os 67 participantes da pesquisa (67,2% do sexo feminino, com idade média de 63,6 ± 9,2 anos) foram acompanhados por 98 ± 28,8 dias e 11,9% dos pacientes apresentaram EAFAs ≥ 6 minutos. A TC de crânio evidenciou eventos isquêmicos cerebrais silenciosos em 16,4% dos pacientes, sendo que, destes, 63,6% haviam apresentado os EAFAs ≥ 6 minutos na análise dos DCEIs. A idade avançada (OR 1,12 [IC 95% 1,03-1,21; p=0,009) e a presença de EAFAs ≥ 6 minutos (OR 96,2 [IC 95% 9,4-987,4; p<0,001]) foram preditores independentes para eventos isquêmicos. Conclusão EAFAs detectados por DCEIs estavam associados à presença de eventos isquêmicos cerebrais silenciosos em pacientes chagásicos. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Atrial high-rate episodes (AHREs) are associated with an increased risk of cerebral ischemic events; however, there are no studies related to the presence of AHREs and cerebral ischemic events in Chagasic patients. Objective To investigate the association between the presence of AHREs ≥ 6 minutes and cerebral ischemic events in Chagasic patients. Methods Cohort study with Chagasic patients with implantable electronic cardiac devices (IECDs), followed at the Arrhythmia Outpatient Clinic of a University Hospital, in the city of Salvador, state of Bahia, Brazil, between May 2016 and June 2017.. Patients diagnosed with atrial flutter / atrial fibrillation, with unicameral IECD and using oral anticoagulation were excluded. AHREs with atrial frequency ≥ 190 beats per minute and duration ≥ 6 minutes (min) were considered, and cerebral ischemic events were identified by computed tomography (CT) of the skull. Results The 67 research participants (67.2% females, mean age 63.6 ± 9.2 years) were followed for 98 ± 28.8 days and 11.9% of the patients had AHREs ≥ 6 min. Skull CT showed silent cerebral ischemic events in 16.4% of the patients, 63.6% of whom had AHREs ≥ 6 min in the analysis of IECDs. Advanced age [OR 1.12 (95% CI 1.03-1.21; p=0.009] and the presence of AHREs ≥ 6 minutes [OR 96.2 (95% CI 9.4-987.4; p <0.001)] were independent predictors for ischemic events. Conclusion AHREs detected by IECDs were associated with the presence of silent cerebral ischemic events in Chagasic patients. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Risk factors for Charcot foot

Objective Diabetes mellitus is the main cause of Charcot neuroarthropathy and is clinically classified as follows: Charcot foot, acute Charcot foot (ACF) when there is inflammation, and inactive Charcot foot when inflammatory signs are absent. The aim of this study was to identify the risk factors for ACF in patients with type 2 diabetes mellitus.Materials and methods A matched case-control study was conducted to assess the factors associated with acute Charcot foot from February 2000 until September 2012. Four controls for each case were selected 47 cases of ACF and 188 controls without ACF were included. Cases and controls were matched by year of initialization of treatment. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs).Results In multivariate analysis, patients having less than 55 years of age (adjusted OR = 4.10, 95% CI = 1.69 – 9.94), literate education age (adjusted OR = 3.73, 95% CI = 1.40 – 9.92), living alone (adjusted OR = 5.84, 95% CI = 1.49 – 22.86), previous ulceration (adjusted OR = 4.84, 95% CI = 1.62 – 14.51) were at increased risk of ACF. However, peripheral arterial disease (adjusted OR = 0.16, 95% CI = 0.05 – 0.52) of 6.25 (1.92 – 20.0) was a protective factor.Discussion The results suggest that PCA in type 2 diabetes primarily affects patients under 55 who live alone, are literate, and have a prior history of ulcers, and that peripheral arterial disease is a protective factor. Arch Endocrinol Metab. 2015;59(3):226-30.

Avaliação clínica na atenção primária e infectologia dos pacientes com doença de chagas na forma crônica / Clinical assessment in primary and infectious disease care in patients with cardiac form of chagas diseases / Evaluación clínica en primaria y infecciosas de pacientes com enfermedad de las heridas crónicas en forma

A doença de chagas é a terceira doença parasitária mais prevalente no mundo e ocorre, muitas vezes, em indivíduos mais jovens, implicando em incapacidade, aposentadoria precoce e morte. O objetivo deste artigo é descrever alterações clínicas, laboratoriais, eletrocardiográficas e de bioimagem de pacientes com doença de Chagas na forma crônica cardíaca na atenção primária e infectologia. A metodologia adotada é o corte transversal, com análise retrospectiva de prontuários dos pacientes atendidos em ambulatórios de Clínica Médica e Infectologia de janeiro a dezembro de 2008. Os resultados apontam que os dados demográficosdos 21 pacientes foram: 57,1 por cento do sexo feminino; 42,9 por cento do sexo masculino; idade média de 58,5 anos; comorbidades 57,1 por cento. A maior parte apresentava a forma crônica cardíaca recente e leve (B1) baseada no Consenso Brasileiro de Doença de Chagas da Sociedade Brasileira de Medicina Tropical. As alterações mais frequentes no Eletrocardiograma foram: bloqueio do ramo direito, alteração de repolarização ventricular, bloqueio divisional anterossuperior esquerdo e bradicardia sinusal. Na radiografia de tórax, 35,3 por cento apresentaram aumento do índice cardiotorácico. Ao Ecocardiograma bidimensional com doppler foi observada uma fração de ejeção média de 66,7 por cento; 64,7 por cento deles apresentaram as seguintes alterações: disfunção diastólica de ventrículo esquerdo e insuficiência de válvula mitral. Ao comparar os pacientes com e sem comorbidades, foi observado que os achados dos exames complementares não apresentaram diferenças significativas entre os grupos. Concluiu-se que os pacientes com Doença de Chagas na forma crônica cardíaca leve apresentam idade mais avançada. Houve uma elevada porcentagem de comorbidades, podendo-se inferir que as alterações eletrocardiográficas, ecocardiográficas e radiográficas podem não sofrer influência das comorbidades.

Chagas disease is the third most prevalent parasitic disease in the world and it often occurs in younger individuals, resulting in disability, early retirement, and death. The aim of this study was to describe clinical, laboratory, electrocardiographic and bioimage changes in patients with Chronic Chagas heart disease. The methodology adopted is a cross-sectional study with retrospective analysis of records of patients from the infectious disease and parasitological hospitals centers, between January and December of 2008. The results indicate that the demographic data of 21 patients were: female (57.1 percent), male (42.9 percent), the average agewas 58.5 years, and 57.1 percent with co-morbidities. Most of the population studied had recent and/or mild chronic cardiac (B1) manifestations based on the Brazilian Consensus on Chagas disease from the Brazilian Society of Tropical Medicine. The most frequent changes in the electrocardiogram (ECG) were: Right bundle branch block (RBBB), ST-T changes, Left BundleBranch Block and Sinus Bradycardia. The most frequent change in chest radiography was the enlargementf cardiothoracic index (35.3 percent). Through the bidimensional echocardiography we observed an ejection fraction with 66.7 percent average and 64.7 percent of the patients presented the following changes: Left Ventricular Diastolic Dysfunction and Mitral Valve Insufficiency. When comparing the patients with and without co-morbidities, the findings of the electrocardiogram, echocardiogram and chest radiography, did not provide significant difference between thegroups. It can be concluded that the patients with heart Chagas disease patients presented a higher age. There was a high percentage of co- morbidities in the studied population and it can be inferred that the electrocardiographic, echocardiographic and radiographic changesmay not be impacted by the co-morbidities.

La enfermedad de Chagas es la tercera enfermedad parasitaria más frecuente en el mundo y, con frecuencia, afecyta a individuos más jóvenes, resultando en incapacidad, jubilación anticipada y la muerte. El objetivo de este artículo es describir alteraciones clínicas, de laboratorio, electrocardiográficas y de bioimagen de pacientes con enfermedad deChagas en su forma crónica cardiaca en la atención primaria e infectología. La metodología adoptada es de enfoque transversal con análisis retrospectiva de los históricos clínicos de los pacientes atendidos, de enero a diciembre de 2008, en una Clínica Médica ambulatorial y Enfermedades Infecciosas. Con relación a datos demográficos, los resultados muestran que de los 21 pacientes: 57,1 por ciento eran del sexo femenino, el 42,9 por ciento del sexo masculino con edad media de 58,5 años, y el 57,1 por ciento, co-mórbidos. Co base en el Consenso brasileñobasado en Enfermedad de Chagas de la Sociedad Brasileña de Medicina Tropical, la mayor parte presentaba la forma crónica cardiaca, reciente y leve (B1). Las alteraciones más frecuentes en el electrocardiograma fueron: bloqueo de la rama derecha, alteraciones de la repolarización ventricular, bloqueo divisional anterosuperior izquierdo y bradicardiasinusal.

Risk factors for dementia in a rural area of Northeastern Brazil / Fatores de risco para demência em uma área rural do nordeste do Brasil

OBJECTIVE: To identify risk factors for dementia among the elderly in a rural area of Northeastern Brazil. METHOD: The subjects assessed were all 60 years old or older, and lived in a rural region of Bahia, a Northeastern State of Brazil. CAMDEX, a structured clinical evaluation protocol, was used for diagnosis, and applied at the home of the subjects. RESULTS: The risk factors identified were divided in accordance with socio-demographic characteristics, the presence of co-morbid conditions, and the use of medications. The variables with strong association with dementia were age, history of stroke, arterial hypertension, and sight impairment. CONCLUSION: Advanced age, arterial hypertension, and vascular brain injury were the main risk factors associated with dementia, which suggests that public health measures adopted to prevent and control modifiable risk factors can mitigate the prevalence of high rates of dementia.

OBJETIVO: Identificar fatores de risco para demência entre idosos de uma área rural do nordeste do Brasil. MÉTODO: Os indivíduos avaliados tinham 60 anos ou mais e viviam numa região rural na Bahia, Estado do nordeste brasileiro. Um protocolo de avaliação clínica estruturada - CAMDEX - foi utilizado para diagnóstico e aplicado no domicílio dos indivíduos participantes. RESULTADOS: Os fatores de risco identificados foram divididos de acordo com características sócio-demográficas, a presença de comorbidades e o uso de medicações. As variáveis com forte associação para demência foram idade, história de acidente vascular encefálico, hipertensão arterial e comprometimento visual. CONCLUSÃO: Idade avançada, hipertensão arterial e lesão vascular cerebral foram os principais fatores de risco associados com demência, o que sugere que medidas de saúde pública adotadas para prevenir e controlar fatores de risco modificáveis podem diminuir a prevalência de altas taxas de demência.

Aspectos clínicos e terapêuticos da insuficiência cardíaca por doença de Chagas / Clinical and therapeutics aspects of heart failure due to Chagas disease

OBJETIVO: Descrever as características clínicas e terapêuticas de pacientes com insuficiência cardíaca (IC) secundária a miocardiopatia chagásica crônica, bem como avaliar se estas são diferentes nas demais etiologias. MÉTODOS: Foram analisados prospectivamente pacientes atendidos no período de agosto de 2003 a junho de 2004, em um ambulatório de referência para IC. RESULTADOS: Foram incluídos 356 pacientes com o diagnóstico de IC. Miocardiopatia chagásica foi a etiologia mais freqüente, (48 por cento dos casos). Outras etiologias foram miocardiopatia hipertensiva em 19 por cento, dilatada idiopática em 11 por cento, e isquêmica em 9 por cento. Pacientes com IC secundária a miocardiopatia chagásica tinham com maior freqüência etnia não-branca (88 x 75 por cento; p = 0,002), história familiar de doença de Chagas (57 x 21 por cento; p = 0,001), maior tempo de doença (71 x 56 meses; p = 0,034), menor escolaridade (4,4 ± 4,1 x 5,7 ± 4,2 anos de estudo; p = 0,004), menor freqüência cardíaca (69 ± 12 x 73 ± 13; p = 0,03) e pressão arterial sistólica (121 ± 25 x 129 ± 28 mmHg; p = 0,006). Utilizavam com maior freqüência amiodarona (22 x 13 por cento; p = 0,036) marcapassos artificiais (15 x 1 por cento; p = 0,001) e com menor freqüência drogas betabloqueadoras (39 x 59 por cento; p = 0,001). CONCLUSÃO: Nessa amostra de pacientes ambulatoriais com IC, em um estado com alta prevalência de doença de Chagas, miocardiopatia chagásica foi a etiologia mais freqüente, apresentando algumas características clínicas e terapêuticas diferentes dos demais pacientes.

Cerebral infarction in autopsies of chagasic patients with heart failure

OBJECTIVE: To determine the frequency of encephalic infarction and its contribution to lethality in patients with Chagas' disease and heart failure. METHODS: Medical records and autopsy reports of patients with Chagas' disease complicated by heart failure, who died at the Professor Edgar Santos Hospital of the Federal University of Bahia in the past 45 years were retrospectively analyzed. Data comprised information regarding the clinical history on hospital admission, complementary and anatomicopathological examinations, including the presence of encephalic infarction, the impaired region, and the cause of death. RESULTS: Of the 5,447 autopsies performed, 524 were in patients with heart failure due to Chagas' disease. The mean age was 45.7 years, and 51 (63 percent) patients were of the male sex. The frequency of encephalic infarction was 17.5 percent, corresponding to 92 events in 92 individuals, 82 (15.8 percent) of which involved the brain, 8 (1.5 percent) involved the cerebellum, and 2 (0.4 percent) involved the hypophysis. CONCLUSION: Cerebral infarction has been a frequent finding in autopsies of chagasic patients with heart failure, and it has been an important cause of death in our region. The presence of cerebral infarction and its complications have been associated with death in 52 percent of the cases studied

Prevalence of Chagas' disease in Mulungu do Morro Northeastern Brazil

OBJECTIVE - The aim of this paper is to describe the prevalence of T. Cruzi infection in patients of from Mulungu do Morro, a rural tropical region of Northeastern Brazil. METHODS - A cross-sectional study was performed. After randomly selecting samples of the population, and obtaining their consents , patients completed pretested epidemiological and clinical questionnaires. Serum samples from all patients were collected and screened for the presence of T. cruzi antibodies. RESULTS - Of 694 patients examined, 174 patients (25.1 percent) tested had a positive serology for Chagas' disease. Of the study population, 341 patients were male with 27 percent Chagas' disease prevalence, without a statistical difference. Illiteracy was the only variable related to T. cruzi infection in our population. CONCLUSION - In conclusion, our study points to the high prevalence of Chagas' disease among patients in Mulungu do Morro, suggesting that this region has a high frequency of infection and probably active vectorial transmission