Manifestações Cardíacas nas Doenças Neuromusculares

RESUMO As distrofi as musculares são um grupo heterogéneo de doenças que se associam a alterações cardíacas (cardiomiopatia, arritmias), que podem ser determinantes no prognóstico destes doentes. O objectivo desta revisão foi apresentar as manifestações cardíacas de várias doenças neuromusculares, a estratégia actual de tratamento e as recomendações para a periodicidade e modo de avaliação cardíaca

Procedimentos para o controle higiênico-sanitário da castanha-do-brasil na floresta.

Aspectos gerais da legislação na floresta, Registro de dados na etapa da floresta, Medidas de prevenção e redução da contaminação da castanha por aflatoxinas, Medidas de prevenção no transporte, Medidas de prevenção na coleta, Medidas de prevenção no armazenamento primário, Medidas de prevenção na quebra dos ouriços, Medidas de prevenção no transporte primário, Medidas de prevenção na secagem, Medidas de prevenção no armazenamento secundário.bitstream/item/114988/1/24416.pd

Prognostic impact of hemoglobin drop during hospital stay in patients with acute coronary syndromes

INTRODUCTION: Bleeding is currently the most common non-cardiac complication of therapy in patients with acute coronary syndromes (ACS), and may itself be associated with adverse outcomes. The aim of this study was to determine the effect of hemoglobin drop during hospital stay on outcome among patients with ACS. METHODS: Using Cox proportional-hazards modeling, we examined the association between hemoglobin drop and death or myocardial infarction (MI) at 6 months in 1172 patients admitted with ACS to an intensive cardiac care unit. Patients were stratified according to quartiles of hemoglobin drop: Q1, or = 2.4 g/dL. We also identified independent predictors of increased hemoglobin drop (> or =2.4 g/dL) using multivariate logistic regression analysis. RESULTS: Median nadir hemoglobin concentration was 1.5 g/dL lower (IQR 0.8-2.3) compared with baseline hemoglobin (p < 0.0001). Independent predictors of increased hemoglobin drop included older Sage, renal dysfunction, lower weight, and use of thrombolytic therapy, glycoprotein IIb/IIIa inhibitors, nitrates, and percutaneous coronary intervention. Higher levels of hemoglobin drop were associated with increased rates of 6-month mortality (8.0% vs. 9.4% vs. 9.6% vs. 15.7%; p for trend = 0.014) and 6-month death/ MI (12.4% vs. 17.0% vs. 17.2% vs. 22.1%; p for trend = 0.021). Using Q1 as reference group, the adjusted hazard ratio (HR) for 6-month mortality and 6-month death/MI among patients in the highest quartile of hemoglobin drop was 1.83 (95% confidence interval [CI] 1.08-3.11; p = 0.026) and 1.60 (95% CI 1.04-2.44; p = 0.031) respectively. Considered as a continuous variable, the adjusted HR for 6-month mortality was 1.16 (95% CI 1.01-1.32; p = 0.030) per 1 g/dL increase in hemoglobin drop. CONCLUSIONS: A decrease in hemoglobin frequently occurs during hospitalization for ACS and is independently associated with adverse outcomes

Contrast-induced nephropathy after an acute coronary syndrome.

Purpose: Contrast-induced nephropathy (CIN) is a form of hospital-acquired acute renal failure that sometimes develops after giving iodinated radiocontrast agents. The growing number of patients who undergo coronary angiography and percutaneous revascularization after acute coronary syndrome (ACS) brought more relevance to this entity. It’s actually one of the most frequent forms of hospital-acquired acute renal failure. The purpose of this study was to define the predictors and prognostic value of CIN in a population of patients admitted with ACS. Methods: A total of 558 patients consecutively admitted with ACS and submitted to cardiac catheterization procedure, from January 2004 to April 2006, were reviewed. CIN was defined as impairment of renal function occurring within 48 hours after administration of contrast media and manifested by an absolute increase in the serum creatinine level of at least 0.5 mg/dL or by a relative increase of at least 25% over the baseline value (in the absence of another cause). The patients were classified in 2 groups according to the occurrence of CIN. The primary endpoint was in-hospital mortality. Results: Of the 558 patients reviewed, 5% (n=28) developed CIN. Patients with CIN were older (69.6 ± 10.5 vs 61.5 ± 11.7; p <0.001) and more often had diabetes mellitus (42.9% vs 24%; p=0.02) and renal insufficiency (48% vs 14.7%; p <0.001). There were no differences regarding ACS presentation (with or without elevation in the ST segment) and in-hospital medical treatment. Patients with CIN had higher in-hospital mortality (10.7% vs 0.6%; p <0.001). After adjustment for confounding variables by multivariate analysis (age, renal insufficiency, heart rate on admission, systolic blood pressure on admission and Killip class on admission), CIN remained an independent predictor of in-hospital mortality. Conclusions: CIN occurred in 5% of our patients admitted with ACS. Risk factors associated with CIN were advanced age, diabetes and pre-existing renal insufficiency. CIN was an independent predictor of in-hospital mortality

Deteção molecular de Mycobacterium avium subsp. paratuberculosis em duas lontras (Lutra lutra, Linnaeus, 1758)

Deteção molecular de Mycobacterium avium subsp. paratuberculosis em duas lontras (Lutra lutra, Linnaeus, 1758)

Impact of atrial fibrillation in acute coronary syndrome

INTRODUCTION: Atrial fibrillation (AF) is a relatively common arrhythmia in the context of acute coronary syndromes (ACS). However, the impact of AF on these patients' survival is not well established. The present study aimed to estimate the prevalence of AF in ACS patients and to evaluate its impact on in-hospital and six-month post-event mortality, from any cause. METHODS: This was a retrospective cohort study that included 1183 patients admitted consecutively to a Coronary Care Unit with ACS. Demographic and clinical data and information from various complementary exams were collected and occurrence of AF during the first 48 hours of hospitalization was analyzed. Six-month follow-up was achieved in 95.9% of the patients. Logistic regression statistical analysis was used to identify independent predictors of in-hospital and six-month post-event mortality. RESULTS: AF was diagnosed in 140 patients (11.8%); these patients were older (73.89 +/- 8.69 vs. 63.20 +/- 12.73 years; p75 years, severe left ventricular dysfunction and heart failure. The performance of coronary angiography correlated with improved prognosis. CONCLUSIONS: AF in the context of ACS is an independent predictor of increased in-hospital and six-month mortality. These findings should be taken into consideration in the management and treatment of such patients