Prevalence of oral anticoagulation in atrial fibrillation

OBJECTIVES: Atrial fibrillation is the most common sustained arrhythmia and is associated with poor outcomes, including stroke. The ability of anticoagulation therapy to reduce the risk of stroke has been well established; however, the prevalence of anticoagulation therapy use in the Public Health System is unknown. The aim of this study is to evaluate both the prevalence of anticoagulation therapy among patients with atrial fibrillation and the indications for the treatment. METHODS: In this cross-sectional study, we included consecutive patients who had atrial fibrillation documented by an electrocardiogram performed between September 2011 and March 2012 at a university hospital of the Public Health System. The variables analyzed included the risk of a thromboembolic event and/or bleeding, the use of antiplatelet or anticoagulation therapy, the location where the electrocardiogram report was initially reviewed and the specialty of the physician who initially reviewed it. RESULTS: We included 162 patients (mean age 68.9 years, 56% men). Hypertension (90.1%), heart failure (53.4%) and stroke (38.9%) were the most prevalent diseases found. Only 50.6% of the patients knew that they had atrial fibrillation. Regarding the use of therapy, only 37.6% of patients classified as high risk according to the CHADS2 scores and 35.5% according to the CHA2DS2VASc used oral anticoagulation. A presumptive diagnosis of heart failure and the fact that the electrocardiogram was evaluated by a cardiologist were the only independent predictors of the use of anticoagulants. CONCLUSIONS: Our study found a low prevalence of oral anticoagulation therapy among patients with atrial fibrillation and an indication for stroke prophylaxis for the use of this therapy, including among those with high CHADS2 and CHA2DS2VASc scores

VALIDAÇÃO DE PROTOCOLO ELETRÔNICO MULTIPROFISSIONAL PARA CIRURGIA DO APARELHO DIGESTIVO

Background: The creation of a computerized clinical database with the ability to collect prospective information from patients and with the possibility of rescue and crossing data enables scientific studies of higher quality and credibility in less time. Aim: To validate, in a single master protocol, the clinical data referring to Surgery of Digestive System in a multidisciplinary way, incorporating it in the SINPEâ platform, and to verify the incidence of digestive diseases based on the prospectively performed collections. Method: Organize in one software, in a standardized structure, all the pre-existing items in the SINPEâ database; the theoretical basis was computerized through the MIGRASINPEâ module creating a single multiprofessional master protocol for use as a whole. Results: The existing specific protocols were created and/or adapted – they correspond to the most prevalent digestive diseases - unifying them. The possibility of multiprofessional use was created by integrating all data collected from Medicine, Nursing, Physiotherapy, Nutrition and Health Management in a prospective way. The total was 4,281 collections, distributed as follows: extrahepatic biliary tract n=1,786; esophagus n=1015; anorectal n=736; colon n=550; small intestine n=86; pancreas n=71; stomach=23; liver n=14. Conclusions: The validation of the unification and structuring in a single master protocol of the clinical data referring to the Surgery of the Digestive System in a multiprofessional and prospective way was possible and the epidemiological study carried out allowed to identify the most prevalent digestive diseases in a tertiary university hospital.Racional: A criação de um banco de dados clínicos informatizado com a capacidade de coletar informações dos pacientes de forma prospectiva e com possibilidade de resgate e cruzamento viabiliza estudos científicos de maior qualidade e credibilidade em menor tempo. Objetivos: Validar em único protocolo mestre os dados clínicos referentes à Cirurgia do Aparelho Digestivo de forma multiprofissional incorporando-o na plataforma SINPEâ, e verificar a incidência das doenças digestivas com base nas coletas prospectivamente realizadas. Método: Organizar no software em estrutura padronizada todos os itens pré-existentes no banco de dados do SINPEâ, informatizou-se a base teórica através do módulo MIGRASINPE© criando-se um único protocolo mestre multiprofissional para uso como um todo. Resultados: Foram criados e/ou adaptados os protocolos específicos existentes - que correspondem às doenças mais prevalentes que assolam este aparelho – unificando-os. Criou-se a possibilidade de uso multiprofissional integrando todos os dados coletados da Medicina, Enfermagem, Fisioterapia, Nutrição e Gestão em Saúde de maneira prospectiva. O total foi de 4.281 coletas assim distribuídas: vias biliares extra-hepáticas n=1.786; esôfago n=1015; anorretais n=736; cólon n=550; intestino delgado n=86; pâncreas n=71; estômago=23; fígado n=14.  Conclusões: A validação da unificação e estruturação em único protocolo mestre dos dados clínicos referentes à Cirurgia do Aparelho Digestivo de forma multiprofissional e prospectiva foi possível e o estudo epidemiológico realizado permitiu identificar as doenças mais prevalentes nesse aparelho em um hospital universitário terciário

Comparação dos imuno-ensaios de fluorescência polarizada (TDx) e enzimático competitivo (EMIT 2000 ) na dosagem da concentração de ciclosporina A no sangue total

Evaluation of Cyclosporin A (CyA) blood concentration is imperative in solid organ transplantation in order to achieve maximal immunosuppression with the least side effects. We compared the results of whole blood concentrations of CyA in 50 blood samples simultaneously evaluated by the fluorescent polarization immune assay (TDx) and the enzymatic competitive immune assay (EMIT 2000). There was a strong correlation between both kits for any range of CyA blood concentration (R=0.99, pA avaliação da concentração sanguínea de ciclosporina A (CyA) é necessária em transplantes de órgãos sólidos para obter-se máxima imunosupressão e mínimos efeitos colaterais. Nós comparamos os resultados da concentração de CyA em 50 amostras sanguíneas analisadas pelos métodos dos imuno-ensaios de fluorescência polarizada (TDx) e enzimático competitivo (EMIT 2000). Houve uma forte correlação entre ambos métodos para qualquer faixa de concentração de CyA (R=0.99,

Do Diabetic Patients with Acute Coronary Syndromes Have a Higher Threshold for Ischemic Pain?

Background: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). Objective: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. Methods: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. Results: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). Conclusion: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset

Resgate vegetativo e propagação de cedro‑australiano por estaquia

The objective of this work was to evaluate vegetative rescue methods for the production of cuttings (clearcutting, full annealing, and half‑annealing) of red cedar (Toona ciliata var. australis) mature trees. The number of produced shoots was evaluated at 60, 120 and 180 days, as well as the correlation between stem mean diameter at breast height (DBH) and the number of sprouts. From the resulting sprouts of each method, cuttings were produced and subjected to cutting and removal of leaflets, and then received the application of indolbutyric acid (IBA) (0 and 6,000 mg L‑1). Evaluations were made for the influence of the following factors on plant survival and rooting: rescue method, collection time, number of leaflets of cuttings, and matrix tree, in the presence and absence of IBA. There was no correlation between the DBH of trees and the number of produced shoots. Clearcutting at 120 days provided the highest increase of shoots (15.31). Cuttings obtained from half‑annealing had higher survival (57.8%) and rooting (55.5%) rates. Cuttings with two pairs of preserved leaflets and treated with 6,000 mg L‑1 IBA showed higher rates of survival (65.5%) and rooting (56.7%). There was wide variation in survival and rooting capacity among matrix trees. The vegetative rescue and propagation by cuttings have potential for clonal multiplication of Australian red cedar mature trees.O objetivo deste trabalho foi avaliar métodos de resgate vegetativo para a produção de estacas (corte raso, anelamento total e semianelamento) de árvores adultas de cedro-australiano (Toona ciliata var. australis). Avaliou-se o número de brotos produzidos aos 60, 120 e 180 dias, bem como a correlação entre o diâmetro médio do tronco à altura do peito (DAP) e o número de brotos. Com as brotações resultantes de cada método, produziram-se estacas que foram submetidas à retirada e ao corte de folíolos, e então receberam a aplicação de ácido indolbutírico (AIB) (0 e 6.000 mg L‑1). Avaliou-se a influência dos fatores método de resgate, tempo de coleta, número de folíolos das estacas e planta matriz, em presença e ausência de AIB, na sobrevivência e no enraizamento das estacas. Não houve correlação entre o DAP das árvores e o número de brotações. O corte raso aos 120 dias proporcionou a maior produção de brotos (15,31). Estacas obtidas do semianelamento apresentaram maior sobrevivência (57,8%) e enraizamento (55,5%). Estacas com dois pares de folíolos inteiros e tratadas com 6.000 mg L‑1 de AIB apresentaram maior sobrevivência (65,5%) e enraizamento (56,7%). Houve grande variação na sobrevivência e no enraizamento entre plantas matrizes. O resgate vegetativo e a estaquia apresentam potencial para multiplicação clonal de árvores adultas de cedro‑australiano

Análise, mediante cromatografia/espectrometria de massas, da fumaça gerada por eletrocautério

Objective: to analyze the chemical components of the smoke from electrocautery from coagulating muscle and liver tissues of pigs. Methods: we collected smoke produced by electrocautery applied to porcine tissue in previously evacuated bottles, with qualitative and quantitative analysis of the compounds present through the hyphenated technique gas chromatography / mass spectrometry. Results: there was a majority of decanal aldehyde in the fumes from the subcutaneous, muscle and liver tissues. Fumes of subcutaneous and muscular tissues also showed the presence of hexanal and phenol. In the fumes of subcutaneous and liver tissues we also found toluene and limonene and, finally, nonanal smoke was present in the muscle and liver tissues. Conclusion: there is increasing evidence showing that smoke from electrocautery used in subcutaneous, muscle and liver tissue is harmful to human health. Thus, there is need to reduce exposure to it or wear masks with filters capable of retaining these particles.Objetivo: analisar quimicamente os componentes da fumaça do eletrocautério, provenientes da coagulação de tecidos, muscular e hepático de suino. Métodos: coleta de fumaça produzida por eletrocauterização de tecido porcino em frascos previamente evacuados com análise qualitativa e quantitativa dos compostos presentes, através de técnica hifenada, cromatografia a gás/espectrometria de massas. Resultados: houve presença majoritária do aldeído decanal nas fumaças provenientes dos tecidos subcutâneo, muscular e hepático. Fumaças dos tecidos subcutâneo e muscular mostraram também a presença de hexanal e fenol. Nas fumaças dos tecidos subcutâneo e hepático foram encontrados ainda tolueno e limoneno e, por fim, nonanal estava presente nas fumaças dos tecidos muscular e hepático. Conclusão: há número crescente de evidências mostrando que fumaça proveniente de eletrocauterização de tecidos subcutâneo, muscular e hepático é nociva à saúde de seres humanos. Portanto, há necessidade de reduzir a exposição a ela ou usar máscara com filtro capaz de reter essas partículas.43212412

Pericardial Fat Is Associated with Coronary Artery Calcification in Non-Dialysis Dependent Chronic Kidney Disease Patients

Pericardial fat (PF) a component of visceral adipose tissue has been consistently related to coronary atherosclerosis in the general population. This study evaluated the association between PF and coronary artery calcification (CAC) in non-dialysis dependent chronic kidney disease (CKD) patients. This is a post-hoc cross sectional analysis of the baseline of a prospective cohort of 117 outward CKD patients without manifest coronary artery disease (age, 56.9 +/- 11.0 years, 64.1% males, 95.1% hypertensives, 25.2% diabetics, 15.5% ever smokers, CKD stage 2 to 5 with estimated glomerular filtration rate 36.8 +/- 18.1 ml/min). CAC scores, PF volume and abdominal visceral fat (AVF) areas were measured by computed tomography. the association of PF as a continuous variable with the presence of CAC was analyzed by multivariate logistic regression. CAC (calcium score >0) was present in 59.2% patients. Those presenting CAC were on average 10 years older, had a higher proportion of male gender (78.7% vs. 42.9%, p<0.001), and had higher values of waist circumference (95.9 +/- 10.7 vs. 90.2 +/- 13.2 cm, p=0.02), PF volumes (224.8 +/- 107.6 vs. 139.1 +/- 85.0 cm(3), p<0.01) and AVF areas (109.2 +/- 81.5 vs. 70.2 +/- 62.9 cm(2), p=0.01). in the multivariate analysis, adjusting for age, gender, diabetes, smoking and, left ventricular concentric hypertrophy, PF was significantly associated with the presence of CAC (OR: 1.88 95% CI: 1.03-3.43 per standard deviation). PF remained associated with CAC even with additional adjustments for estimated glomerular filtration rate or serum phosphorus (OR: 1.85 95% CI: 1.00-3.42, p=0.05). PF is independently associated with CAC in non-dialysis dependent CKD patients.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ São Paulo, Sch Med, Lipid Clin Heart Inst InCor, São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, São Paulo, BrazilUniv São Paulo, Sch Med, Cardiovasc Magnet Resonance & Computed Tomog Sect, Heart Inst InCor, São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, São Paulo, BrazilFAPESP: 2011/14201-2Web of Scienc

Ablaçao por Cateter de Taquicardias Ventriculares em Pacientes sem Cardiopatia Estrutural

As taquicardias ventriculares idiopáticas ocorrem em pacientes com coraçao estruturalmente normal e podem se originar nos dois ventrículos ou em estruturas vizinhas. Essas arritmias sao classificadas usualmente conforme o seu local de origem, mecanismo eletrofisiológico e resposta à drogas, apresentando bom prognóstico na maioria dos casos. A ablaçao por cateter é uma opçao terapêutica importante, geralmente empregada após o manejo clínico inicial, sendo o tratamento guiado principalmente pelos sintomas. As técnicas de ablaçao tradicionais permitem tratar com sucesso a maioria das TV idiopáticas, com o auxílio de sistemas de mapeamento eletroanatômico em alguns casos