Clinical significance of cys-c and hs-crp in coronary heart disease patients undergoing percutaneous coronary intervention

Abstract Objective: To investigate the clinical significance of serum cystatin C (Cys-C) and high-sensitivity C-reactive protein (hs-CRP) in coronary heart disease (CHD) patients undergoing percutaneous coronary intervention (PCI). Methods: One hundred and twenty-eight CHD patients were divided into drug treatment (56 cases) and PCI treatment (72 cases) groups, receiving conventional drug treatment and PCI plus conventional drug treatment, respectively. At admission time and 4 weeks after treatment, the left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter, and left ventricular end systolic diameter were measured. At admission time and 24h, 72h, 1 week, and 4 weeks after treatment, the serum levels of Cys-C and hs-CRP were determined. Results: After 4 weeks of treatment, LVEF in the PCI treatment group was significantly higher than that before treatment (P<0.01) and it was significantly higher than in the drug treatment group at the same time (P<0.01). Cys-C and hs-CRP level in the PCI treatment group were significantly higher than in the drug treatment group 72h and 1 week after treatment (P<0.05 or P<0.01), respectively, but they were significantly lower than in the drug treatment group 4 weeks after treatment (P<0.01). There were obvious interaction effects between grouping factor and time factor in Cys-C (F=3.62, P<0.05) and hs-CRP (F=17.85, P<0.01). Conclusion: Serum levels of Cys-C and hs-CRP are closely related to the heart function in CHD patients undergoing PCI, and they may be used for predicting the outcome of PCI.

Consideraciones en torno a las Guías USA 2017 de hipertensión arterial / A word of caution about the 2017 hypertension management guidelines

The 2017 Guidelines on hypertension of the American College of Cardiology and American Heart Association, which proposed values of 130/80 mmHg as the cutoff points for the onset of hypertension, aroused great interest. This recommendation is based in the SPRINT study (The Systolic Pressure Intervention Trial), which included hypertensive patients over 50 years of age, non-diabetic, without a history of stroke and with a low representation of subjects with a history of coronary artery disease (16%). A group with intensive anti-hypertensive therapy (pressure achieved 121.5 mmHg) achieved a significantly lower cardiovascular risk as compared with a group with standard therapy (pressure achieved 134.6 mmHg). The Guide proposes immediate pharmacological therapy in diabetic hypertensive patients, in those with stage 3 chronic kidney disease or with persistent albuminuria, and in patients with atherosclerotic disease. The Guideline does not include the management of isolated systolic hypertension of the elderly and did not consider studies that show an increased risk when pressure is reduced below 130/80 mmHg in patients with coronary disease, peripheral vascular disease, diabetes mellitus or chronic renal failure. The new classification of hypertension would increase the number of hypertensive patients in our country by more than one million, would increase the risk associated with diastolic pressure reductions in older adults and ignores the evidence indicating a risk associated with reductions below 130/80 mmHg in patients with diabetes, with chronic renal failure or with atherosclerotic disease. Therefore, it is advisable to maintain a threshold of 140/90 mmHg and perform a careful and gradual management of blood pressure in the latter group of hypertensive patients.

Enfermedad renal crónica en hemodiálisis: concentración de enzimas cardíacas en ausencia de evidencia de cardiopatía isquémica aguda / Chronic Kidney Disease in hemodialysis: cardiac enzymes concentrations without evidence of acute coronary disease

Se trata de un estudio observacional, analítico y prospectivo cuyo objetivo es analizar la concentración de enzimas cardíacas en pacientes con enfermedad renal crónica en hemodiálisis sin evidencia clínica de cardiopatía isquémica aguda, hospitalizados en el Servicio de Medicina Interna del Hospital Universitario de Caracas, Venezuela durante el período 2014-2015. Métodos: Se tomó muestra de suero a 48 pacientes con enfermedad renal crónica en hemodiálisis sin evidencia de cardiopatía isquémica aguda, y se midieron las concentraciones de creatin quinasa (CK), creatin quinasa fracción MB (CK-MB) y Troponina I (Tn-I) antes y después de la diálisis. Resultados: la mediana de los valores obtenidos de CK fue 42 prediálisis y 38 postdiálisis (p = 0,434), CK-MB: 10 pre y postdiálisis (p = 0,629), con respecto a troponina I, la mediana fue 0,00 pre y postdiálisis (p = 0,586). Se obtuvo valores dentro de límites normales de CK en 91,1% pre y 93,3% postdiálisis, CKMB 93,3% prediálisis y postdiálisis y Troponina I en 97,67% pre y 95,35% postdiálisis. Conclusiones: no se evidenciaron cambios significativos en las concentraciones de CK, CK-MB y Troponina I tanto pre como postdiálisis, encontrándose dentro de la normalidad en más de 90% de los casos. No se encontró relación entre concentración Troponina I, CK y CK-MB según edad, sexo, factores de riesgo cardiovasculares (diabetes mellitus e hipertensión arterial) y tiempo de hemodiálisis. Cualquiera de las enzimas puede tener utilidad clínica, siendo de preferencia las más cardioespecíficas, individualizando cada caso según su clínica y sus valores basales de enzimas cardíacas(AU)

This is an observational, analytical prospective study aimed to analyze cardiac enzymes concentrations in chronic kidney disease patients in hemodialysis without evidence of acute coronary disease at Internal Medicine Service of Hospital Universitario de Caracas, Venezuela during 2014-2015. Methods: serum samples were taken in 46 patients' with chronic kidney disease in hemodialysis without evidence of acute coronary disease and creatin kinase (CK), creatin kinase fraction MB (CK-MB) and Troponin I (Tn-I) were measured before and after hemodialysis. Results: was 42 predialysis and 38 postdialysis (p = 0.434), CK-MB 10 predialysis and post-dialysis (p = 0.629) the median value of troponin I, was 0.00 before and after dialysis (p = 0.586). It was obtained values within normal range of CK in 91.1% and 93.3% pre and post-dialysis, CK-MB in 93.3% predialysis and postdialysis and Troponin I in 97.67% pre and 95.35 % postdialysis. Conclusions: No significant changes were found in concentrations of CK, CK-MB and Troponin I bothpre and post-dialysis, with normal values in over 90% of cases. No relationship between concentration of Troponin I, CK and CK-MB and age, sex, cardiovascular risk factors (diabetes and hypertension) or time in hemodialysis were found. Any of the enzymes may have clinical utility, being the cardiospecific ones preferably, individualizing each case based on clinical and baseline cardiac enzymes(AU)

Long-term, regular remote ischemic preconditioning improves endothelial function in patients with coronary heart disease

Remote ischemic preconditioning (RIPre) can prevent myocardial injury. The purpose of this study was to assess the beneficial effects of long-term regular RIPre on human arteries. Forty patients scheduled for coronary artery bypass graft (CABG) surgery were assigned randomly to a RIPre group (n=20) or coronary heart disease (CHD) group (n=20). Twenty patients scheduled for mastectomy were enrolled as a control group. RIPre was achieved by occluding arterial blood flow 5 min with a mercury sphygmomanometer followed by a 5-min reperfusion period, and this was repeated 4 times. The RIPre procedure was repeated 3 times a day for 20 days. In all patients, arterial fragments discarded during surgery were collected to evaluate endothelial function by flow-mediated dilation (FMD), CD34+ monocyte count, and endothelial nitric oxide synthase (eNOS expression). Phosphorylation levels of STAT-3 and Akt were also assayed to explore the underlying mechanisms. Compared with the CHD group, long-term regular RIPre significantly improved FMD after 20 days (8.5±2.4 vs 4.9±4.2%, P<0.05) and significantly reduced troponin after CABG surgery (0.72±0.31 and 1.64±0.19, P<0.05). RIPre activated STAT-3 and increased CD34+ endothelial progenitor cell counts found in arteries. Long-term, regular RIPre improved endothelial function in patients with CHD, possibly due to STAT-3 activation, and this may have led to an increase in endothelial progenitor cells.

Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012)

INTRODUCTION: The objective was to identify space and space-time risk clusters for the occurrence of deaths in a priority city for the control of tuberculosis (TB) in the Brazilian Northeast. METHODS: Ecological research was undertaken in the City of São Luis/Maranhão. Cases were considered that resulted in deaths in the population living in the urban region of the city with pulmonary TB as the basic cause, between 2008 and 2012. To detect space and space-time clusters of deaths due to pulmonary TB in the census sectors, the spatial analysis scan technique was used. RESULTS: In total, 221 deaths by TB occurred, 193 of which were due to pulmonary TB. Approximately 95% of the cases (n=183) were geocoded. Two significant spatial clusters were identified, the first of which showed a mortality rate of 5.8 deaths per 100,000 inhabitants per year and a high relative risk of 3.87. The second spatial cluster showed a mortality rate of 0.4 deaths per 100,000 inhabitants per year and a low relative risk of 0.10. A significant cluster was observed in the space-time analysis between 11/01/2008 and 04/30/2011, with a mortality rate of 8.10 deaths per 100,000 inhabitants per year and a high relative risk (3.0). CONCLUSIONS: The knowledge of priority sites for the occurrence of deaths can support public management to reduce inequities in the access to health services and permit an optimization of the resources and teams in the control of pulmonary TB, providing support for specific strategies focused on the most vulnerable populations. .

Acurácia dos escores GRACE e TIMI na predição da gravidade angiográfica da síndrome coronariana aguda / Accuracy of the GRACE and TIMI scores in predicting the angiographic severity of acute coronary syndrome

FUNDAMENTO: A acurácia dos escores GRACE e TIMI em predizer a extensão da doença coronariana em pacientes com síndromes coronarianas agudas sem supradesnivelamento do segmento ST (SCA) não está estabelecida. OBJETIVO: Testar a hipótese de que os escores de risco GRACE e TIMI predizem satisfatoriamente a extensão da doença coronariana, em pacientes com SCA submetidos a coronariografia. MÉTODOS: Indivíduos admitidos com critérios objetivos de SCA e que realizaram coronariografia durante o internamento foram consecutivamente analisados. A doença coronariana angiográfica foi descrita de três formas: quantificação da extensão da doença coronariana pelo escore de Gensini; presença de qualquer obstrução coronariana (> 70% ou > 50% quando tronco de coronária esquerda); presença de doença severa (triarterial ou tronco de coronária esquerda). RESULTADOS: Em 112 pacientes avaliados, observou-se correlação positiva do escore de Gensini com os escores GRACE (p = 0,017) e TIMI (p = 0,02), porém essa associação foi de fraca magnitude (r = 0,23 e r = 0,27; respectivamente). O escore GRACE não foi capaz de predizer doença coronariana obstrutiva (área abaixo da curva ROC = 0,57; 95%IC = 0,46 - 0,69), nem doença coronariana severa (ROC = 0,59; 95%IC = 0,48 -0,70). O Escore TIMI se mostrou modesto preditor em relação à presença de doença coronariana (ROC = 0,65; 95%IC = 0,55 - 0,76) e presença de doença severa (ROC = 0,66; 95%IC = 0,56 - 0,76). CONCLUSÃO: (1) Existe associação positiva entre o valor dos escores TIMI ou GRACE e a extensão da doença coronária em pacientes com SCA; (2) No entanto, o grau dessa associação não é suficiente para que esses escores sejam preditores acurados dos resultados da coronariografia.

BACKGROUND: The accuracy of the GRACE and TIMI scores in predicting coronary disease extension in patients with non-ST-elevation acute coronary syndromes (ACS) has not been established. OBJECTIVE: To assess the hypothesis that the GRACE and TIMI risk scores satisfactorily predict coronary disease extension in patients withnon-ST-elevation ACS undergoing coronary angiography. METHODS: Individuals meeting the objective criteria for ACS and undergoing coronary angiography during hospitalization were consecutively assessed. Angiographic coronary disease was described as follows: quantification of coronary disease extension by using Gensini score; presence of any coronary artery obstruction (> 70% or > 50% when affecting left main coronary artery); and presence of severe disease (three-vessel disease or affecting the left main coronary artery). RESULTS: Of 112 patients assessed, a positive correlation of the Gensini score was observed with the GRACE (p = 0.017) and TIMI (p = 0.02) scores, but that association was weak (r = 0.23 and r = 0.27; respectively). The GRACE score could predict neither obstructive coronary disease (area under the ROC curve = 0.57; 95% CI = 0.46 - 0.69), nor severe coronary disease (ROC = 0.59; 95% CI = 0.48 - 0.70). The TIMI score proved to be a modest predictor of coronary disease (ROC = 0.65; 95% CI = 0.55 - 0.76) and of severe coronary disease (ROC = 0.66; 95% CI = 0.56 - 0.76). CONCLUSION: (1) There is a positive association between the values of the TIMI or GRACE scores and the extension of coronary artery disease in patients with ACS; (2) however, the degree of that association is not sufficient to make those scores accurate predictors of coronary angiography results.

Comparação entre métodos de avaliação da modulação vagal cardíaca / Comparison of assessment methods of cardiac vagal modulation

FUNDAMENTO: Diversos métodos têm sido utilizados para avaliar a modulação vagal cardíaca; entretanto, há lacunas quanto a associação e acurácia desses métodos. OBJETIVO: Investigar a associação entre três métodos válidos, reprodutíveis e comumente utilizados para avaliação da modulação vagal cardíaca, e comparar as suas acurácias. MÉTODOS: Trinta homens saudáveis (23 ± 4 anos) e 15 homens com coronariopatia (61 ± 10 anos) foram avaliados em ordem contrabalanceada pela Variabilidade da Frequência Cardíaca (VFC; variáveis: domínio do tempo = pNN50, DPNN e RMSSD, domínio da frequência = AF ms² e AF u.n.), Arritmia Sinusal Respiratória (ASR) e Teste de Exercício de 4 segundos (T4s). RESULTADOS: Indivíduos saudáveis apresentaram maior modulação vagal nos três métodos (p < 0,05). No grupo saudável houve correlação (p < 0,05) entre os resultados da VFC (pNN50 e DPNN) e da ASR, mas não houve correlação entre o T4s e os outros dois métodos estudados. No grupo com coronariopatia houve correlação entre os resultados da VFC (pNN50, DPNN, RMSSD, AF ms² e AF u.n.) e da ASR. Em adição, houve correlação entre o T4s e a ASR. Por fim, os métodos ASR e T4s apresentaram tamanho do efeito mais preciso e melhor acurácia (p < 0,05) comparados à VFC. CONCLUSÃO: A VFC e a ASR geraram resultados parcialmente redundantes em indivíduos saudáveis e em pacientes com coronariopatia, enquanto o T4s gerou resultados complementares a VFC e ASR em indivíduos saudáveis. Além disso, os métodos ASR e T4s foram mais precisos para discriminar a modulação vagal cardíaca entre indivíduos saudáveis e pacientes com coronariopatia comparados à VFC.

BACKGROUND: Several methods have been used to assess cardiac vagal modulation, but there are gaps regarding the association and accuracy of these methods. OBJECTIVE: To investigate the association between three valid, reproducible and commonly methods used to assess cardiac vagal modulation and compare their accuracies. METHODS: Thirty healthy men (23 ± 4 years) and 15 men with coronary artery disease (61 ± 10 years) were evaluated in counterbalanced design by Heart Rate Variability (HRV; variables: the time domain = pNN50, SDNN and RMSSD, the frequency domain HF = ms² and HF n.u.), Respiratory Sinus Arrhythmia (RSA) and 4-second Exercise Test (T4s). Thirty healthy men (23 ± 4 years) and 15 men with coronary artery disease (61 ± 10 years) were evaluated in counterbalanced order by Heart Rate Variability (HRV; variables: the time domain = pNN50, SDNN and RMSSD, the frequency domain HF = ms² and HF n.u.), Respiratory Sinus Arrhythmia (RSA) and 4-second Exercise Test (T4s). RESULTS: Healthy subjects had higher vagal modulation by the three methods (p <0.05). There was a correlation in the healthy group (p <0.05) between the results of HRV (SDNN and pNN50 and RSA, but there was no correlation between the T4s and the other two methods. In the group with coronary artery disease, there was a correlation between the results of HRV (pNN50, SDNN, RMSSD, HF ms² and HF n.u.) and RSA. In addition, there was a correlation between the RSA and T4s. Finally, the T4s and RSA methods presented more accurate effect size and better accuracy (p <0.05), when compared to the HRV. CONCLUSION: HRV and RSA generated partially redundant results in healthy subjects and in patients with coronary artery disease, while the T4s generated results that were complementary to HRV and RSA in healthy subjects. In addition, RSA and T4s methods were more accurate when discriminating cardiac vagal modulation between healthy subjects and patients with coronary artery disease, when compared to HRV.

Validade e equivalência da versão em português do Veterans Specific Activity Questionnaire / Validity and equivalence of the Portuguese version of the Veterans Specific Activity Questionnaire / Validez y equivalencia de la versión en portugués del Veterans Specific Activity Questionnaire

FUNDAMENTO: O Veterans Specific Activity Questionnaire (VSAQ) tem sido utilizado para a individualização de testes ergométricos (TE) e para avaliar indiretamente a aptidão cardiorrespiratória (ACR) em estudos epidemiológicos. Apesar disso, ainda não há versão em português validada. OBJETIVO: Verificar a validade de critério da versão em português do VSAQ e examinar a equivalência de mensuração dessa versão em 95 indivíduos, sendo 8 mulheres (69 ± 7 anos), com indicação para a realização de TE. MÉTODOS: Os indivíduos realizaram teste cardiopulmonar de exercício progressivo máximo em ciclo-ergômetro. A correlação do escore do VSAQ com o MET Máximo Medido e Estimado foi comparada com os resultados de outros estudos. O Nomograma VSAQ foi calculado e seus resultados comparados com os valores reais da ACR por regressão linear. Limites de concordância e as diferenças médias (vieses) foram avaliados segundo a metodologia proposta por Bland e Altman. RESULTADOS: Os escores obtidos através do VSAQ correlacionaram-se de forma significativa com o MET máximo medido (r = 0,64) e estimado (r = 0,67), resultados equivalentes àqueles obtidos com versões originais. O nomograma VSAQ obteve resultados com R múltiplo de 0,78 (para MET medido) e 0,80 (para MET estimado). O nomograma, entretanto, parece subestimar os valores de indivíduos com ACR acima de 6 MET. CONCLUSÃO: A versão do VSAQ confirmou-se válida e equivalente à versão original, especialmente para avaliação de indivíduos cardiopatas e de idade avançada.

BACKGROUND: The Veterans Specific Activity Questionnaire (VSAQ) has been used to individualize exercise testing (ET) and to indirectly assess cardiorespiratory fitness (CRF) in epidemiological studies. Nevertheless, there is no validated Portuguese version. OBJECTIVE: To verify the criterion-related validity and the measurement equivalence of a Portuguese version of VSAQ in 95 individuals, 8 women (aged 69 ± 7 years) referred to ET. METHODS: The subjects performed a cardiopulmonary test with incremental to maximal exercise on a cycle ergometer. The correlation between VSAQ score and Maximum Measured and Estimated METs was compared to results from other studies. The VSAQ Nomogram was calculated and its results were compared to CRF real values by linear regression. Limits of concordance and mean differences (biases) were assessed according to the Bland Altman methodology. RESULTS: The VSAQ scores were significantly correlated to the Measured METs (r = 0.64) and Estimated METs (r = 0.67), results that were equivalent to those obtained by the original versions. The VSAQ Nomogram presented multiple R of 0.78 (Measured MET) and 0.80 (Estimated MET). However, the Nomogram seems to have underestimated CRF values greater than 6 METs. CONCLUSION: The VSAQ version confirmed its validity and equivalence to the original version, especially when evaluating individuals with coronary heart disease and older adults.

FUNDAMENTO: El Veterans Specific Activity Questionnaire (VSAQ) ha sido utilizado para la individualización de tests ergométricos (TE) y para evaluar indirectamente la aptitud cardiorrespiratoria (ACR) en estudios epidemiológicos. A pesar de eso, aun no hay versión en portugués validada. OBJETIVO: Verificar la validez de criterio de la versión en portugués del VSAQ y examinar la equivalencia de medición de esa versión en 95 individuos, siendo 8 mujeres (69 ± 7 años), con indicación para realización de TE. MÉTODOS: Los individuos realizaron test cardiopulmonar de ejercicio progresivo máximo en cicloergómetro. La correlación del escore del VSAQ con el MET máximo medido y estimado fue comparada con los resultados de otros estudios. El nomograma VSAQ fue calculado y sus resultados comparados con los valores reales de la ACR por regresión lineal. Límites de concordancia y las diferencias medias (sesgos) fueron evaluados según la metodología propuesta por Bland y Altman. RESULTADOS: Los escores obtenidos a través del VSAQ se correlacionaron de forma significativa con el MET máximo medido (r = 0,64) y estimado (r = 0,67), resultados equivalentes a aquellos obtenidos con versiones originales. El nomograma VSAQ obtuvo resultados con R múltiplo de 0,78 (para MET medido) y 0,80 (para MET estimado). El nomograma, entre tanto, parece subestimar los valores de individuos con ACR encima de 6 METs. CONCLUSIÓN: La versión del VSAQ se confirmó válida y equivalente a la versión original, especialmente para evaluación de individuos cardíacos y de edad avanzada.

Avaliando a atividade vagal cardíaca na eletrocardiografia convencional / Evaluating cardiac vagal activity on a conventional electrocardiogram

OBJETIVO: Determinar a viabilidade da utilização de traçado convencional de eletrocardiografia (ECG) para avaliação da atividade vagal cardíaca (AVC). MÉTODOS: Foram analisados, retrospectivamente, 1.395 indivíduos (995 homens), na faixa de idade de 46 + 17,2 anos (média ± desvio padrão), com traçados de ECG convencional para medida do Delta RR, que representa a diferença, em ms, entre o maior e o menor intervalo RR, e com resultados da avaliação autonômica parassimpática, o teste de exercício de quatro segundos (T4s), que quantifica a AVC por meio do índice vagal cardíaco (IVC). Foram obtidas curvas ROC para determinar os valores de Delta RR com melhor relação entre sensibilidade e especificidade para os pontos de corte de baixa e alta AVC, respectivamente, de 1,20 e 1,95. RESULTADOS: Os valores de delta RR correlacionaram-se significativamente com os de IVC (r = 0,40; p < 0,001). Foram identificados < 60 ms e > 120 ms como os melhores pontos de corte para baixa e alta AVC, com sensibilidade de 75 por cento e 57 por cento, especificidade de 62 por cento e 79 por cento e áreas das curvas ROC de 0,76 e 0,74, respectivamente. CONCLUSÃO: A medida visual do delta RR em um traçado de ECG parece ser válida para a avaliação clínica preliminar e rápida da AVC, podendo ser útil em consultórios, emergências ou situações nas quais o uso de métodos mais sofisticados de avaliação autonômica não seja viável, oportuno ou conveniente.

OBJECTIVE: To determine the viability of using a conventional electrocardiogram (ECG) tracing for assessment of CVA. METHODS: We retrospectively analyzed 1395 individuals (995 males), aged 46 ± 17.2 years (mean ± standard deviation) with conventional ECG tracings to measure the delta RR (which represents the difference in milliseconds (ms) between the greatest and smallest RR interval) and results of a second autonomic parasympathetic evaluation, the 4-second exercise test (T4s), that quantifies CVA by the cardiac vagal index (CVI). ROC curves were obtained to determine the values of Delta RR for a closer correlation with sensitivity and specificity for 1.20 and 1.95 ms, the low and high CVA cutoff points, respectively. RESULTS: The delta RR levels correlated significantly with those of the CVI (r=0.40; p<0.001). We identified < 60 and > 120 ms as the best cutoff points for low and high CVA. Sensitivity was 75 percent and 57 percent, specificity was 62 percent and 79 percent, and the areas of the ROC curves were 0.76 and 0.74, respectively. CONCLUSION: The visual measurement of delta RR on an ECG tracing seems to be a valid quick preliminary clinical evaluation of CVA and can be useful in medical offices, emergency units, or situations in which the use of more sophisticated methods may not be feasible, appropriate, or convenient.

Estrés oxidativo y depresión: ¿un posible rol etiológico? / Oxidative stress and depression: a possible etiologic role?

La prevalencia de la depresión, como concepto general de enfermedad, ha aumentado en todo el mundo, convirtiéndose en un grave problema de salud. A pesar de esto, no se conoce su causa. Sin embargo, un posible rol etiológico puede ser adjudicado al estrés oxidativo, ya que la evidencia actual demuestra que pacientes con dicho diagnóstico tienen elevados niveles de lipoperoxidación y disminuidas las defensas antioxidantes, es decir, presentan estrés oxidativo; este último se asocia a una disminución de los ácidos grasos omega-3, hecho que ha demostrado estar significativamente asociado con las depresiones mayor, menor y post parto. Por consiguiente es posible plantear que el estrés oxidativo puede tener un rol en la etiología del subtipo de depresión que se relaciona con disminución de los ácidos grasos omega-3. El propósito de este trabajo es relacionar el rol etiológico que tendría el estrés oxidativo en aquellas depresiones relacionadas con el déficit de ácidos grasos omega-3.

Helicobacter pylori: Nuevos conceptos acerca de una antigua enfermedad / Helicobacter pylori. New concepts about an ancient disease

Helicobacter pylori es quizá la infección bacteriana crónica más frecuente en el mundo. Se calcula que hasta un 50 por ciento de la población puede esta infectada, cifra que alcanza 100 por ciento en poblaciones con escasas condiciones sanitarias. El espectro clínico de la enfermedad es amplio, abarca desde la gastritis y úlcera péptica hasta el cáncer gástrico, pasando por asociaciones menos claras, como enfermedad coronaria, rosácea y retraso del crecimiento en niños. Los mecanismos fisiopatológicos responsables apenas se comienzan a comprender, modificando el antiguo concepto de ®no ácido, no úlcera¼, que aunque aún es válido, no es suficiente. Por lo anterior, tiene suma importancia establecer la presencia del germen y proporcionar el tratamiento correcto

Isquemia miocárdica e cardiopatia chagásica / Myocardial ischemia and chagasic cardiopathy

O objetivo do trabalho é analisar a ocorrência de isquemia miocárdica na cardiopatia chagásica crônica. Cinquenta e dois pacientes portadores da forma crônica da Doença de Chagas, submetidos ao teste de esforço, que apresentaram testes sugestivos de isquemia miocárdica, foram comparados com 21 pacientes chagásicos que apresentaram resultados normais. Foram analisados 24 parâmetros, que poderiam influenciar no resultado. A isquemia miocárdica na cardiopatia chagásica crônica ocorreria por alteraçöes na microcirculaçäo coronária, desencadeada pelos processos inflamatórios mais frequentes na forma II da Doença de Chagas. Conclui-se que na forma II, haveriam alteraçöes metabólicas que culminariam com alteraçöes no eletrocardiograma de repouso, além de alteraçöes dos seguintes parâmetros do teste de esforço: débito cardíaco, déficit aeróbico funcional, segmento ST no traçado eletrocardiográfico e precordialgia desencadeada pelo esforço

Isquemia miocárdica silenciosa: experiência com a monitorizaçäo eletrocardiográfica ambulatorial / Silent myocardial ischemia: experience with ambulatorial electrocardiographic monitoring

Os autores apresentam sua experiência com monitorizaçäo eletrocardiográfica ambulatorial (Holter) na detecçäo de isquemia miocárdica (IM) anginosa 159 pacientes com doença coronária crônica: 76 com infarto prévio, 66 com cirurgia para revascularizaçäo miocárdica, 13 com lesäo obstrutiva na coronariografia e 4 submetidos à coronarioplasita. Em 51 pacientes (32%) foram registrados episódios de IM, embora estivessem sob medicaçäo anginosa profilática. Em 44 pacientes (86%) todos episódios foram de IMS, 6 pacientes tiveram 16 episódios de IMS e 12 episódios de IMA e 1 paciente só teve 1 IMA. Houve um total de 119 episódios de IM, 106 de IMS (89,1%) e 13 de IMA (10,9%). A duraçäo total dos episódios de IMS por pacientes variou de 1 a 235 min e a duraçäo máxima de 1 IMS foi de 221 min. Nos 6 pacientes com IMS e IMA a duraçäo total dos episódios de IMS foi de 461 min e de IMA de 306 min. A incidência no nictemero da IMS foi: de 6 às 12 h - 33,3%, de 12 às 18 h - 31,4%, de 18 às 24 h - 27,6% e de 24 h às 6 h - 7,7%. A atividade dos pacientes durante a IMS em 89 episódios foi: atividade física 46%, sono (23,6%), repouso (22,4%) e outra (8%). A depressäo do segmento ST nos 106 episódios de IMS foi em média de -2,25 mm e nos 13 de IMA, de - 3,25 mm. Os autores ressaltam que a medicaçäo antianginosa profilática foi incapaz de prevenir a IM em 32% dos pacientes. Assim, nesses pacientes a medicaçäo era antianginosa mas näo anti-isquêmica. O tratamento da IMS deve ser feito em todos os pacientes...