El electrocardiograma en el diagnóstico de la hipertrofia ventricular de pacientes con enfermedad renal crónica

BACKGROUND: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk, and its characterization and prevalence in chronic renal disease (CRD) should be further studied. OBJECTIVE: To establish the diagnosis of LVH in patients with stage-5 CRD using six different electrocardiographic criteria, and to correlate them with left ventricular mass index (LVMI) as obtained by echocardiography. METHODS: Cross-sectional study including 100 patients (58 men and 42 women, mean age 46.2 ± 14.0 years) with CRD of all causes undergoing hemodialysis (HD) for at least six months. Electrocardiography (ECG) and echocardiography were performed in all patients, always up to one hour after the end of the HD sessions. RESULTS: LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) the eccentric pattern of LVH. Diagnostic sensitivity, specificity and accuracy of all the electrocardiographic methods studied were higher than 50%. Using Pearson's linear correlation for LVMI, only the Sokolow-Lyon voltage criterion did not show a > 0.50 coefficient. Calculation of the likelihood ratio, in turn, showed that ECG has a discriminatory power for the diagnosis of LVH in the population studied, with emphasis on the Cornell-product and Romhilt-Estes criteria. No correlation was observed between LVMI and QTc and QTc dispersion. CONCLUSION: ECG is a useful, efficient, and highly reproducible method for the diagnosis of LVH in HD patients. In this population, the Cornell-product proved to be the most reliable criterion for the detection of LVH.FUNDAMENTO: La hipertrofia ventricular izquierda (HVI) es un factor predictor independiente de riesgo cardiovascular y su caracterización y prevalencia en la enfermedad renal crónica (ERC) carecen de mejor estudio. OBJETIVO: Establecer el diagnóstico de HVI en pacientes con ERC en estadio 5 por seis diferentes criterios electrocardiográficos, correlacionándolos al índice de masa del ventrículo izquierdo (IMVI) que se obtuvo mediante el ecocardiograma. MÉTODOS: Estudio transversal que incluyó a 100 pacientes (58 varones y 42 mujeres, edad de 46,2 ± 14,0 años) con ERC de todas las etiologías, desde hace al menos 6 meses en hemodiálisis (HD). Se obtuvieron electrocardiograma (ECG) y ecocardiograma de los pacientes, siempre hasta una hora tras el término de las sesiones de HD. RESULTADOS: La HVI se detectó en 83 pacientes (83%), de los que 56 (67,4%) presentaban el estándar concéntrico y 27 (32,6%) el estándar excéntrico de HVI. Todos los métodos electrocardiográficos estudiados tuvieron sensibilidad, especificidad y exactitud diagnósticas superiores al 50%. Mediante la correlación lineal de Pearson con el IMVI, solamente el criterio de Sokolow-Lyon voltaje no presentó coeficiente > 0,50. Sin embargo, el cálculo de la razón de verosimilitud evidenció que el ECG tiene poder discriminatorio para diagnóstico de HVI en la población estudiada, con énfasis para los criterios de Producto de Cornell y Romhilt-Estes. No hubo correlación entre IMVI con el QTc y su dispersión. CONCLUSIÓN: El ECG es un método útil, eficaz y de alta reproductibilidad en el diagnóstico de HVI de los pacientes en HD. En esa población, el criterio de Producto de Cornell fue más fiable para la detección de HVI.FUNDAMENTO: A hipertrofia ventricular esquerda (HVE) é um fator preditor independente de risco cardiovascular e sua caracterização e prevalência na doença renal crônica (DRC) carecem de melhor estudo. OBJETIVO: Estabelecer o diagnóstico de HVE em pacientes com DRC em estágio 5 por seis diferentes critérios eletrocardiográficos, correlacionando-os com o índice de massa do ventrículo esquerdo (IMVE) obtido pelo ecocardiograma. MÉTODOS: Estudo transversal que incluiu 100 pacientes (58 homens e 42 mulheres, idade de 46,2 ± 14,0 anos) com DRC de todas as etiologias, há pelo menos seis meses em hemodiálise (HD). Foram obtidos eletrocardiograma (ECG) e ecocardiograma dos pacientes, sempre até uma hora após o término das sessões de HD. RESULTADOS: A HVE foi detectada em 83 pacientes (83%), dos quais 56 (67,4%) apresentavam o padrão concêntrico e 27 (32,6%) o padrão excêntrico de HVE. Todos os métodos eletrocardiográficos estudados tiveram sensibilidade, especificidade e acurácia diagnósticas acima de 50%. Pela correlação linear de Pearson com o IMVE, apenas o critério de Sokolow-Lyon voltagem não apresentou coeficiente > 0,50. Já o cálculo da razão de verossimilhança mostrou que o ECG possui poder discriminatório para diagnóstico de HVE na população estudada, com ênfase para os critérios de Cornell produto e Romhilt-Estes. Não houve correlação entre IMVE com o QTc e sua dispersão. CONCLUSÃO: O ECG é um método útil, eficaz e de alta reprodutibilidade no diagnóstico de HVE dos pacientes em HD. Nessa população, o critério de Cornell produto mostrou-se o mais fidedigno para a detecção de HVE.Universidade Estadual de Ciências da Saúde de AlagoasUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Combination of Melatonin and Metformin Hydrochloride for Treatment Polycystic Ovarian in Female Rats

Background: Polycystic ovary syndrome (PCOS) is a gynecological endocrine disorder, results in menstrual abnormalities, androgynism and infertility. In the case of women or others animals with PCOS wishing to treat infertility with the aim of becoming pregnant, the most commonly used is metformin hydrochloride. Recent studies have analyzed the combination of metformin hydrochloride with melatonin in oncological treatment but not to treatment of polycystic ovary syndrome (PCOS). The aim of the present study was to analyze the effectiveness of the combination of metformin hydrochloride and melatonin in the treatment of PCOS to improve the fertility of rats and your hormonal alterations.Materials, Methods & Results: This study was carried out in strict accordance with the recommendations in the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health. The protocol was approved by the Committee on the Ethics of Animal Experiments of the University of Federal Rural of Pernambuco (Permit Number: 23081.009130/2010). A total of 50 albino Wistar rats were used. The animal laboratory of an academic research environment, were randomly separated into five groups consisting of 10 females each. After inducing PCOS, the rats were treated with metformin hydrochloride, and/or melatonin, and the results compared with standard and ultrasound confirmed. The physiological similarities were confirmed by our academic researchers morphological science, and published to the association results of effects syndrome induction through constant lighting in reputable magazine recently. This article was analyzed histological of the implantation sites and ovaries, and the estradiol and progesterone levels on the seventh day of gestation, and the other rats for monitoring pregnancy and morphological identification of possible fetal abnormalities, weight measurement and quantification of offspring. The rats were anaesthetized with intraperitoneal injections of ketamine hydrochloride (80 mg/kg) and xylazine (6 mg/kg) to allow analysis of the reproductive organs. Main outcome measures: The study included histopathology, histochemical and quantitative (of the implantation sites) tests, ultrasound analysis, weight benchmarking and ovarian histology tests, as well as comparison of serum estradiol and progesterone levels, and the morphological assessment of offspring. Results paper shows pharmacological treatment reduced the time needed for pregnancy, increased the plasma progesterone levels, the number and weight of offspring, and reduced plasma estrogen levels and collagen fiber grade, improving blastocyst-endometrium interaction and fetal development.Discussion: Our team of researchers confirmed in a previous paper; in addition, the main experimental model used in research about PCOS in recent years, and considered appropriate combination of the drugs caused a physiological reaction similar to responses identified in healthy rats without induction of the POS control group. However, the clinical and physiological effectiveness of the combination should be further explored, especially with respect to the possible side effects on offspring. The treatment with a combination of metformin hydrochloride and melatonin was more effective against hormonal alterations produced by PCOS, allowing a normalization of biochemical parameters during pregnancy, than monotherapeutic treatment with these drugs. In conclusion, proposed drug combination is a viable option to treatment of polycystic ovary syndrome and improved fetal development. This article allows suggest that further research should be conducted to examine effects associated with these drugs in the treatment of diseases of the female reproductive system experimentally. Only such treatment later in animals and humans suggest

Pretreatment hemoglobin level as a prognostic factor in patients with locally advanced head and neck squamous cell carcinoma

AimEvaluate pretreatment hemoglobin values as a prognostic factor in patients with locally advanced head and neck squamous cell carcinoma treated with concurrent chemoradiotherapy.BackgroundAnemia is one of the most prevalent laboratory abnormalities in oncological disease. It leads to a decrease in cellular oxygen supply, altering radiosensitivity of tumor cells and compromising therapeutic outcomes.Materials and MethodsRetrospective evaluation of patients with HNSCC treated with cCRT. Primary and secondary endpoint was to evaluate the correlation of Hb levels (≥12.5g/dL o

SPECTRA OF MOTHERS OF PREMATURE CHILDREN ABOUT THE EDUCATIVE CIRCLE OF CULTURE

Abstract We sought to know the spectra of mothers of premature children regarding their experience with circle of culture of educational character and identifying the learning provided by the circle of culture about newborn care after hospital discharge. A descriptive study was performed in a hospital located in Fortaleza, Brazil. Three meetings of a circle of culture with 17 mothers of premature newborns were performed. The interpretation of the corpus was performed using thematic analysis. Emerged from the categories: Maternal experience in a circle of culture; Promoted social support among mothers through the circle of culture; and Learning provided by the circle of culture. It was concluded that teaching parents during the hospitalization of the child should be held in a way to involve parents in the care of the newborn, provide moments of health education, opportunities for support and dialogue between professionals and family

Regulatory lymphoid and myeloid cells determine the cardiac immunopathogenesis of Trypanosoma cruzi infection

Chagas disease is a multisystemic disorder caused by the protozoan parasite Trypanosoma cruzi, which affects ~8 million people in Latin America, killing 7,000 people annually. Chagas disease is one of the main causes of death in the endemic area and the leading cause of infectious myocarditis in the world. T. cruzi infection induces two phases, acute and chronic, where the infection is initially asymptomatic and the majority of patients will remain clinically indeterminate for life. However, over a period of 10-30 years, ~30% of infected individuals will develop irreversible, potentially fatal cardiac syndromes (chronic chagasic cardiomyopathy [CCC]), and/or dilatation of the gastro-int estinal tract (megacolon or megaesophagus). Myocarditis is the most serious and frequent manifestation of chronic Chagas heart disease and appears in about 30% of infected individuals several years after infection occurs. Myocarditis is characterized by a mononuclear cell infiltrate that includes different types of myeloid and lymphoid cells and it can occur also in the acute phase. T. cruzi infects and replicates in macrophages and cardiomyocytes as well as in other nucleated cells. The pathogenesis of the chronic phase is thought to be dependent on an immune-inflammatory reaction to a low-grade replicative infection. It is known that cytokines produced by type 1 helper CD4+ T cells are able to control infection. However, the role that infiltrating lymphoid and myeloid cells may play in experimental and natural Chagas disease pathogenesis has not been completely elucidated, and several reports indicate that it depends on the mouse genetic background and parasite strain and/or inoculum. Here, we review the role that T cell CD4+ subsets, myeloid subclasses including myeloid-derived suppressor cells may play in the immunopathogenesis of Chagas disease with special focus on myocarditis, by comparing results obtained with different experimental animal modelsThis work was supported by NG grant from Ministerio de Economía y competitividad SAF2015-63868-R (MINECO/FEDER); by MF grants from Ministerio de Economía y competitividad SAF2016-75988-R (MINECO/FEDER), Red de Investigación de Centros de Enfermedades Tropicales (RICET RD12/0018/0004), Comunidad de Madrid (S-2010/BMD-2332) and Fundación Ramón Arece

COMPLEXIDADE RACIAL: mitos e realidades em duas freguesias de Salvador em 1775

A partir da análise minuciosa dos dados do Censo de 1775 sobre duas freguesias de Salvador (São Pedro e Penha), são colocados em questão cinco mitos dominantes sobre a escravidão no imaginário nacional: (1) o domínio total do trabalho escravo na sociedade; (2) uma sociedade formada apenas por senhores e escravos; (3) uma sociedade constituída, por um lado, por um segmento de dominantes e exploradores e, por outro, por dominados e explorados; (4) uma sociedade urbana segregada; (5) uma sociedade patriarcal, em que as mulheres eram submissas e economicamente subordinadas. Os resultados do censo, portanto, levantam novas questões para o entendimento da complexidade do nosso passado, o que ajuda a entender a manutenção das extremas desigualdades atuais, além de evidenciar a existência de diferenciações espaciais na cidade. PALAVRAS-CHAVE: escravos, libertos, agregados, freguesias, Salvador.RACIAL COMPLEXITY: myth and reality in two Salvador freguesias in 1775 Pedro de Almeida Vasconcelos The meticulous analysis of data from the Census of 1775 on two freguesias of Salvador (São Pedro and Penha), bring doubt to five dominant myths on slavery in the national imaginary: (1) the exclusivity of slave work in the society; (2) a society just formed by slave owners and slaves; (3) a society where, on one side, live a segment of dominant exploiters and, on the other, dominated explored people; (4) a segregated urban society; (5) a patriarchal society, in which women were submissive and economically subordinates. The results of the census, therefore, bring new subjects to understanding the complexity of our past, what helps to understand the maintenance of the extreme current inequalities, besides showing the existence of space differentiations in the city. KEYWORDS: slaves, freed men, agregados, freguesias, Salvador.COMPLEXITÉ RACIALE: mythes et réalités dans deux paroisses de Salvador en 1775 Pedro de Almeida Vasconcelos A partir de l’analyse minutieuse des données du recensement de 1775 concernant deux paroisses de Salvador (São Pedro et Penha) sont remis en question cinq mythes dominants à propos de l’esclavage dans l’imaginaire national: (1) l’exclusivité du travail esclave dans la société; (2) une société formée uniquement de seigneurs et d’esclaves; (3) une société constituée d’une part par un segment de dominants et d’exploiteurs et d’autre part de dominés et d’exploités; (4) une société urbaine ségréguée; (5) une société patriarcale où les femmes étaient soumises et subordonnées économiquement. Les résultats de ce recensement soulèvent donc de nouvelles questions pour la compréhension de la complexité de notre passé, ceci permet de comprendre le maintien d’extrêmes inégalités actuelles et de mettre aussi en évidence l’existence de différenciations spatiales dans la ville. MOTS-CLÉS: esclaves, personnes libres, domestiques, paroisses, Salvador. Publicação Online do Caderno CRH: http://www.cadernocrh.ufba.b

A IMPORTÂNCIA DA CLASSIFICAÇÃO ASA NOS DESFECHOS CIRÚRGICOS: UM ARTIGO DE REVISÃO

This article aims to carry out a review of the current medical literature on the relationship The classification of physical status made by the American Society of Anesthesiologists (ASA classification) aims to categorize the surgical risk that the patient will be subject to according to his clinical status.  There are studies that associate the ASA classification with postoperative complications and morbidity and mortality, while others state that this parameter is not so adequate. This article aims to analyze other literature and define how to use the ASA classification to measure favorable surgical outcomes. To this end, the authors conducted a systematic review of studies indexed in the PubMed database, using descriptors related to the theme proposed in this study. The articles were carefully selected, aiming at the veracity and reliability of this work. The selected studies addressed both favorable and unfavorable characteristics of the ASA classification and its use. Thus, several studies have proven the effectiveness of the score and it can be used in conjunction with the collection of a good history. However, there are specific procedures that do not benefit as much from classification and, therefore, other tools to assist in the screening of high-risk patients can be used.A classificação do estado físico feita pela Sociedade Americana de Anestesiologistas (classificação ASA) visa categorizar o risco cirúrgico que o doente estará sujeito mediante seu estado clínico.  Há estudos que associam a classificação ASA com complicações pós-operatórias e morbimortalidade, enquanto outros afirmam que esse parâmetro não é tão adequado. O presente artigo busca analisar outras literaturas e definir como utilizar a classificação ASA para mensurar os desfechos cirúrgicos favoráveis. Para tanto, os autores realizaram uma revisão sistemática de trabalhos indexados na base de dados PubMed,  utilizando  descritores  relacionados  ao  tema  proposto  neste estudo.  Os  artigos foram  selecionados  de  forma  criteriosa,  almejando  a  veracidade  e  confiabilidade  deste trabalho. Os estudos selecionados abordaram tanto características favoráveis quanto desfavoráveis da classificação ASA e da sua utilização. Dessa forma, diversos estudos comprovaram a eficácia do escore e ele pode ser usado em conjunto com a coleta de uma boa história. Entretanto há procedimentos específicos que não se beneficiam tanto da classificação e, portanto, outras ferramentas de auxílio na triagem de pacientes de alto risco podem ser utilizadas.&nbsp

Espirais para pensar temas, perguntas e procedimentos metodológicos em pesquisa: Sobrejustaposições na interface corpo/educação/visualidades

http://dx.doi.org/10.5902/1983734810731O artigo busca, inicialmente, lançar mão de uma visualidade para falar de pesquisa em educação – a intervenção artística Espiral do Conhecimento de André Dalmazzo – tentando operar com tais campos no que tange às temáticas, perguntas e procedimentos metodológicos com os quais nos relacionamos constantemente em empreitadas investigativas. Na materialidade da trajetória formativa e da atual investigação de um dos autores, o artigo busca operar com alguns conceitos sobrejustapostos na interface corpo/educação/visualidades. A composição com sobras resultantes de experiências formativas e de pesquisa é assumida como procedimento que institui um complexo capaz de colocar o pensamento em funcionamento em encontros produtivos. Recebido em: 23/09/2013 Aprovado em: 15/10/2013