2,906 research outputs found
Multiple Polyposis of the Gallbladder. Diagnostic Difficulties About One Case
Descreve-se um caso de uma doente de 52 anos de idade, submetida a colecistectomia com o diagnóstico de litiase biliar, baseado na colecistografia oral. No decurso do acto cirúrgico, em que não se palparam cálculos, o diagnóstico inicial foi posto em dúvida. A identificação da polipose múltipla só foi possÃvel após colecistectomia. Com base na experiência colhida neste caso, faz-se uma revisão dos critérios diagnósticos e fundamenta-se a orientação terapêutica, dado o potencial de malignidade destas lesões
Qual o Papel dos Bloqueadores-Beta numa Coorte de Tratamento Contemporânea de Doentes com SÃndrome Coronária Aguda? Análise de Emparelhamento de Score de Propensão
INTRODUCTION:
The evidence for beta-blocker use in patients after acute coronary syndrome (ACS), particularly in those with left ventricular (LV) dysfunction, dates from the late 1990s. We aimed to assess the role of beta-blockers in a contemporary population of patients with ACS.
METHODS:
Propensity-score matching (1:2) was performed for the use of beta-blockers in a population of consecutive patients admitted to our department with ACS. After matching, 1520 patients were analyzed. Cox regression analysis was used to assess the impact of beta-blocker use on the primary outcome (one-year all-cause mortality).
RESULTS:
Patients who did not receive beta-blockers were less aggressively treated with other pharmacological and invasive interventions and had higher one-year mortality (20.3% vs. 7.5%). Beta-blocker use was an independent predictor of mortality, with a significant relative risk reduction of 56%. The other independent predictors were age, diabetes, LV dysfunction, heart rate, systolic blood pressure and creatinine on admission. The impact of beta-blockers was significant for all classes of LV function, including patients with normal or mildly reduced ejection fraction.
CONCLUSIONS:
In a contemporary ACS population, we confirmed the benefits of beta-blocker use after ACS, including in patients with normal or mildly to moderately impaired LV function.info:eu-repo/semantics/publishedVersio
Prognostic Impact of Admission Blood Glucose for All-Cause Mortality in Patients with Acute Coronary Syndromes: Added Value on Top of GRACE Risk Score
BACKGROUND:
Abnormal glucose metabolism is a predictor of worse outcome after acute coronary syndrome (ACS). However, this parameter is not included in risk prediction scores, including GRACE risk score. We sought to evaluate whether the inclusion of blood glucose at admission in a model with GRACE risk score improves risk stratification.
METHODS:
Study of consecutive patients included in a single centre registry of ACS. Our primary endpoint was the occurrence of all-cause mortality at one-year follow-up. The ability of the two logistic regression models (GRACE risk score alone and in combination with blood glucose) to predict death was analysed. Continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI), with corresponding 95% confidence intervals (CIs), were also calculated.
RESULTS:
We included 2099 patients, with a mean age of 64 (SD=13) years, 69% males. In our sample, 55.1% presented with ST-segment elevation ACS and 13.1% in Killip class ≥ 2. Only 25% were known diabetic at admission. In-hospital mortality was 5.8% and 9.7% at one-year follow-up. The best cut-point for blood glucose was 160 mg/dl (sensitivity 62% and specificity 68%), and 35.2% of the patients had increased levels. This group was elderly, had more prevalence of cardiovascular risk factors, worse renal function and GRACE score as well as more frequently Killip class ≥2. Treatment was similar in both groups besides less frequent use of clopidogrel in high glycaemic patients. The hyperglycaemia group had higher one-year mortality (17.2% vs. 5.6%, p<0.001). Moreover, binary blood glucose remained a predictor of death independently of the GRACE risk score and the presence of diabetes (odds ratio (OR) 1.99, 95% CI 1.40-2.84, p<0.001). The inclusion of blood glucose, as a continuous variable, in a logistic regression model with GRACE score, increased the area under the ROC curve from 0.80 to 0.82 (p=0.018) as well as the goodness-of-fit and was associated with an improvement in both the NRI (37%) and the IDI (0.021), suggesting effective reclassification.
CONCLUSIONS:
A blood glucose level on admission ≥ 160 mg/dl is an independent predictor of mortality in medium-term follow-up. It offers an incremental predictive value when added to the GRACE risk score, although with a modest magnitude of improvement, probably due to the high predictive performance of the GRACE risk score alone.info:eu-repo/semantics/publishedVersio
Computational analysis of the interaction between transcription factors and the predicted secreted proteome of the yeast Kluyveromyces lactis
<p>Abstract</p> <p>Background</p> <p>Protein secretion is a cell translocation process of major biological and technological significance. The secretion and downstream processing of proteins by recombinant cells is of great commercial interest. The yeast <it>Kluyveromyces lactis </it>is considered a promising host for heterologous protein production. Because yeasts naturally do not secrete as many proteins as filamentous fungi, they can produce secreted recombinant proteins with few contaminants in the medium. An ideal system to address the secretion of a desired protein could be exploited among the native proteins in certain physiological conditions. By applying algorithms to the completed <it>K. lactis </it>genome sequence, such a system could be selected. To this end, we predicted protein subcellular locations and correlated the resulting extracellular secretome with the transcription factors that modulate the cellular response to a particular environmental stimulus.</p> <p>Results</p> <p>To explore the potential <it>Kluyveromyces lactis </it>extracellular secretome, four computational prediction algorithms were applied to 5076 predicted <it>K. lactis </it>proteins from the genome database. SignalP v3 identified 418 proteins with N-terminal signal peptides. From these 418 proteins, the Phobius algorithm predicted that 176 proteins have no transmembrane domains, and the big-PI Predictor identified 150 proteins as having no glycosylphosphatidylinositol (GPI) modification sites. WoLF PSORT predicted that the <it>K. lactis </it>secretome consists of 109 putative proteins, excluding subcellular targeting. The transcription regulators of the putative extracellular proteins were investigated by searching for DNA binding sites in their putative promoters. The conditions to favor expression were obtained by searching Gene Ontology terms and using graph theory.</p> <p>Conclusion</p> <p>A public database of <it>K. lactis </it>secreted proteins and their transcription factors are presented. It consists of 109 ORFs and 23 transcription factors. A graph created from this database shows 134 nodes and 884 edges, suggesting a vast number of relationships to be validated experimentally. Most of the transcription factors are related to responses to stress such as drug, acid and heat resistance, as well as nitrogen limitation, and may be useful for inducing maximal expression of potential extracellular proteins.</p
Is It Possible to Simplify Risk Stratification Scores for Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Angioplasty?
INTRODUCTION: There are several risk scores for stratification of patients with ST-segment elevation myocardial infarction (STEMI), the most widely used of which are the TIMI and GRACE scores. However, these are complex and require several variables. The aim of this study was to obtain a reduced model with fewer variables and similar predictive and discriminative ability.
METHODS: We studied 607 patients (age 62 years, SD=13; 76% male) who were admitted with STEMI and underwent successful primary angioplasty. Our endpoints were all-cause in-hospital and 30-day mortality. Considering all variables from the TIMI and GRACE risk scores, multivariate logistic regression models were fitted to the data to identify the variables that best predicted death.
RESULTS: Compared to the TIMI score, the GRACE score had better predictive and discriminative performance for in-hospital mortality, with similar results for 30-day mortality. After data modeling, the variables with highest predictive ability were age, serum creatinine, heart failure and the occurrence of cardiac arrest. The new predictive model was compared with the GRACE risk score, after internal validation using 10-fold cross validation. A similar discriminative performance was obtained and some improvement was achieved in estimates of probabilities of death (increased for patients who died and decreased for those who did not).
CONCLUSION: It is possible to simplify risk stratification scores for STEMI and primary angioplasty using only four variables (age, serum creatinine, heart failure and cardiac arrest). This simplified model maintained a good predictive and discriminative performance for short-term mortality
Adherence to Guidelines in the Treatment of Acute Coronary Syndromes: Progress Over Time
Introdução: O tratamento das SÃndromes
Coronárias Agudas (SCA) sofreu várias
alterações muito rápidas nos últimos anos,
traduzido nas múltiplas propostas de
recomendações pelo ACC/AHA/ESC, baseados
na evidência clÃnica. Avaliamos a
implementação destas recomendações,
comparando uma população de doentes de 2002, com uma população de 2005.
Métodos: Estudo retrospectivo de 368 doentes
admitidos em 2002 e 420 doentes admitidos em 2005 por SCA (com e sem elevação do segmento ST). Analisaram-se caracterÃsticas clÃnicas e estratégias de tratamento.
Resultados: Não se verificaram diferenças em
termos de idade, sexo masculino, factores de
risco para doença coronária ou história prévia de revascularização miocárdica. Verificou-se uma redução de doentes com antecedentes de enfarte do miocárdico e insuficiência renal e aumento da apresentação como enfarte com elevação do segmento ST. O tratamento com clopidogrel (6% versus 87%), bloqueador-beta(54% versus 79%), inibidores da enzima de conversão da angiotensina (72% versus 84%) e estatinas (78% versus 91%) aumentou (para todos p<0,001). Por outro lado, verificou-se um
pequeno decréscimo na utilização de ácido
acetilsalicÃlico (98% versus 95%, p=0,039)
(com maior utilização de clopidogrel) e a
ticlopidina deixou de ser utilizada (46% versus 0%, p<0,001). Os antagonistas dos receptores da glicoproteÃna IIb/IIIa não se alteraram significativamente (66% versus 67%, p=NS).
Aumentaram as intervenções coronárias
percutâneas (53% versus 67%, p<0,001). Não
se verificou diferença em termos de mortalidade hospitalar (8,2% versus 6,4%) e
aos 30 dias (9,0% versus. 8,6%), com redução
ao 1ºano de seguimento (17,1% versus 11,7%,
p=0,039). As estatinas e os bloqueadores beta
são preditores independentes de mortalidade,
com efeito de protecção.
Conclusões: Entre 2002 e 2005, o tratamento
das SCA melhorou significativamente de acordo com as recomendações existentes,
traduzindo-se numa melhoria da mortalidade
ao 1º ano de seguimento
Is Chronic Nitrate Therapy Associated with a Different Clinical Presentation of Acute Coronary Syndrome?
A terapêutica com nitratos pode induzir pré-condicionamento isquémico, com consequente aumento da tolerância a isquémia. No contexto de sÃndromes coronárias agudas (SCA), os nitratos podem condicionar uma diferente forma de apresentação, com maior protecção. Objectivos: Estudar numa população de doentes com SCA se a administração crónica prévia ao evento, de nitratos condiciona a forma de apresentação do SCA. Métodos: Estudo de 287 doentes (65 +- 13 anos, 66% sexo masculino) admitidos no nosso serviço por SCA (com e sem elevação do segmento ST) no primeiro semestre de 2005. Destes, 8% estavam sob terapêutica com nitratos prévia à admissão. Neste grupo 27% apresentaram-se como SCA com elevação do segmento ST e no grupo sem nitratos, este valor foi de 58% (p=0,005). Por análise univariada, a utilização de nitratos foi preditora da ocorrência preferencial de "SCA sem elevação do segmento ST" (OR 0,27, IC 95% 0,10-0,71, p=0,005). Após correcção para variáveis potencialmente influentes (idade, sexo, revascularização prévia, tabagismo) por análise multivariada de regressão logÃstica, a terapêutica com nitratos foi preditora limiar da apresentação clÃnica "SCA sem elevação do segmento ST" (OR 0,37, IC 95% 0,13-1,04), p=0,059. Conclusão: A utilização prévia à ocorrência de SCA associou-se com um desvio da apresentação para a forma de SCA sem elevação do segmento ST. Este achado pode ser justificado pela hipótese de que os nitratos podem induzir um pré-condicionamento farmacológico, reduzindo a extensão transmural do enfarte
Does Admission NT-ProBNP Increase the Prognostic Accuracy of GRACE Risk Score in the Prediction of Short-Term Mortality After Acute Coronary Syndromes?
BACKGROUND:
NT-proBNP has prognostic implications in heart failure. In acute coronary syndromes (ACS) setting, the prognostic significance of NT-proBNP is being sought. We studied short-term prognostic impact of admission NT-proBNP in patients admitted for ACS and in association with GRACE risk score (GRS).
METHODS AND RESULTS:
We studied 1035 patients admitted with ACS. Patients were divided in quartiles according to NT-proBNP levels on admission: Q1 <180 pg/ml; Q2 180-691 pg/ml; Q3 696-2664 pg/ml; Q4 2698-35 000 pg/ml. Groups were compared in terms of short-term all-cause mortality. Patients with higher NT-proBNP had worst GRS on admission. They also received less aggressive treatment. In-hospital mortality was 0.8%, 3.0%, 5.8% and 12.8% (P<0.001) and 30-day mortality 1.6%, 4.6%, 6.5% and 16.7% (P<0.001) respectively. In multivariate logistic regression analysis, NT-proBNP is an independent predictor of in-hospital (OR 2.35; 95% CI: 1.12-4.93, P=0.022) and 30-day mortality (OR 2.20; 95% CI: 1.17-4.12, P=0.014). However, NT-proBNP does not add any incremental benefit to GRS for prediction of outcome by ROC curve analysis.
CONCLUSIONS:
NT-proBNP is an independent predictor of in-hospital and 30-day mortality after ACS, independently of left ventricular function, but does not increase the prognostic accuracy of GRS.info:eu-repo/semantics/publishedVersio
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