285 research outputs found

    Situação atual do tratamento da insuficiência cardíaca no Brasil

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    Optimization of Aqueous Extraction of Anthocyanins from Hibiscus sabdariffa L. Calyces for Food Application

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    Aqueous extracts of Hibiscus sabdariffa calyces are worldwide used for the production of several products such as polyphenolic-antioxidant containing beverages. However, optima conditions for extraction of polyphenolics such as anthocyanins from this plant species were unknown. For this, the influence of particle size and calyx/water ratio on the anthocyanins extraction and biochemical composition during extraction were investigated using bright red and dark red Hibiscus sabdariffa calyces.Results showed that the pH of the bright red calyces was 2.24 ± 0.01 corresponding to 12.66 ± 0.15 g/100g dry weight (DW) titratable acidity equivalent of malic acid. The pH of the dark red calyces was 2.15 ± 0.01 corresponding to 15.44 ± 0.15 g/100g DW titratable acidity equivalent malic acid. Total sugars content was 3.24±0.04 and 3.13±0.06 g/100g DW for bright red and dark red, respectively. Proteins content ranged from 4.56 ± 0.04 to 6.96 ± 0.17 g/100g DW. The level of the total phenols ranged from 3.82 ± 0.33 to 5.22 ± 0.08 g/100g DW. Average anthocyanins content was 2.61 ± 0.11 and 2.98 ± 0.02 g/100g DW for dark red and bright red calyces, respectively. Calyces were found to show an antioxidant capacity of up to 300 µmolTrolox equivalent/100g. For all calyx/water ratios, the anthocyanins content increased with extraction time till 60 min and remained almost stable thereafter.The optimization of the aqueous extraction was obtained at the ratio 1/10 (calyx/water) for the production of roselle concentrated extract, using calyces size less than 250 µm,at 30°C, for one hour percolation. Keywords: Hibiscus sabdariffa L, anthocyanins water, calyx/water ratio, particle size, optimization, extraction

    Aortic distensibility measured by pulse-wave velocity is not modified in patients with Chagas' disease

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    Abstract\ud \ud \ud \ud Background\ud \ud Experimental studies demonstrate that infection with trypanosoma cruzi causes vasculitis. The inflammatory lesion process could hypothetically lead to decreased distensibility of large and small arteries in advanced Chagas' disease. We tested this hypothesis.\ud \ud \ud \ud Methods and results\ud \ud We evaluated carotid-femoral pulse-wave velocity (PWV) in 53 Chagas' disease patients compared with 31 healthy volunteers (control group). The 53 patients were classified into 3 groups: 1) 16 with indeterminate form of Chagas' disease; 2) 18 with Chagas' disease, electrocardiographic abnormalities, and normal systolic function; 3) 19 with Chagas' disease, systolic dysfunction, and mild-to-moderate congestive heart failure. No difference was noted between the 4 groups regarding carotid-femoral PWV (8.4 ± 1.1 vs 8.2 ± 1.5 vs 8.2 ± 1.4 vs 8.7 ± 1.6 m/s, P = 0.6) or pulse pressure (39.5 ± 7.6 vs 39.3 ± 8.1 vs 39.5 ± 7.4 vs 39.7 ± 6.9 mm Hg, P = 0.9). A positive, significant, similar correlation occurred between PWV and age in patients with Chagas' disease (r = 0.42, P = 0.002), in controls (r = 0.48, P = 0.006), and also between PWV and systolic blood pressure in both groups (patients with Chagas' disease, r = 0.38, P = 0.005; healthy subjects, r = 0.36, P = 0.043).\ud \ud \ud \ud Conclusion\ud \ud Carotid femoral pulse-wave velocity is not modified in patients with Chagas' disease, suggesting that elastic properties of large arteries are not affected in this disorder.The authors thank Professor Kathleen A. Dracup, University of California, San Francisco, for reviewing the manuscript.The authors thank Professor Kathleen A. Dracup, University of California, San Francisco, for reviewing the manuscript

    Treatment of left main coronary artery lesion after late thoracic radiotherapy

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    A prevenção de complicações cardiovasculares tardias após radioterapia (RT) para tratamento de um tumor maligno é um desafio. Relatamos o caso de um jovem paciente com linfoma de Hodgkin submetido a tratamento com RT que desenvolveu doença cardíaca isquêmica no seguimento, embora não apresentasse fatores de risco cardiovasculares. Concluímos que pacientes submetidos a RT que apresentam dor torácica deveriam ser criteriosamente avaliados em relação à doença arterial coronariana.Prevention of late cardiovascular complications after radiation therapy (RT) for treatment of a malignant tumor is challenging. We report the case of a young male patient with Hodgkin's lymphoma treated with RT, who developed ischemic heart disease during follow-up, although he had no cardiovascular risk factors. We conclude that patients undergoing RT who experience chest pain should be fully investigated for coronary artery disease

    Asociación de betabloqueantes y entrenamiento físico en la insuficiencia cardíaca de ratones

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    BACKGROUND: Currently there are several types of interventions for the treatment of heart failure (HF). Among these are beta-blocker therapy (BB) and physical training (PT). However, the effects of the combination of these therapies are poorly studied. OBJECTIVE: To investigate the effects of BB treatment with metoprolol (M) and carvedilol (C) associated with PT in mice with HF. METHODS: We used a genetic model of sympathetic hyperactivity-induced heart failure in mice. Initially, we divided the HF animals into three groups: sedentary (S); trained (T); treated with M (138 mg/kg) (M); or C (65 mg/kg) (C). In the second part, we divided the groups into three subgroups: sedentary (S); trained and treated with M (TM); and trained and treated with C (CT). The PT consisted of aerobic training on a treadmill for 8 weeks. Exercise tolerance was assessed by maximal graded test, and fractional shortening (FS) was assessed by echocardiography. Cardiomyocyte diameter and collagen volume fraction were evaluated by histological analysis. Data were compared by one way ANOVA and post hoc Duncan test. The significance level was set at p < 0.05. RESULTS: As to FS and cardiac remodeling, we found that, in isolation, T, M, and C showed an improvement of the variables analyzed. As to therapy combination, after the intervention period, we observed an increase in exercise tolerance in MT and CT (43.0% and 33.0% respectively). There was also a reduction in cardiomyocyte diameter (10.0% and 9.0% respectively) and in collagen volume fraction (52.0% and 63.0%) after the intervention. However, only CT significantly improved FS. CONCLUSION: The association of PT with M or C therapies provided benefits on cardiac function and remodeling in HF mice.FUNDAMENTO: El tratamiento de la insuficiencia cardiaca (IC) cuenta actualmente con diversos tipos de intervenciones. De entre ellas podemos destacar la terapia con betabloqueantes (BB) y el entrenamiento físico (EF). Con todo, los efectos de la asociación de estas terapias son poco estudiados. OBJETIVO: Verificar los efectos del tratamiento con BB, metoprolol (M) y carvedilol (C) asociados al EF en la IC en ratones. MÉTODOS: Utilizamos modelo genético de IC inducida en ratones por hiperactividad simpática. Inicialmente, dividimos los animales con IC en: sedentarios (S); entrenados (E); tratados con M (138 mg/kg) (M) o C (65 mg/kg) (C). En la segunda parte, dividimos los grupos en S; entrenado y tratado con M (ME) y entrenado y tratado con C (CE). El EF consistió en entrenamiento aeróbico en estera por 8 semanas. La tolerancia al esfuerzo se evaluó por prueba progresivo máxima y la fracción de acortamiento se evaluó (FE) por ecocardiografía. El diámetro de los cardiomiocitos y la fracción de colágeno fueron evaluados por medio de análisis histológico. Los dados fueron comparados por ANOVA de un camino con post hoc de Duncan. El nivel de significancia se consideró como p < 0,05. RESULTADOS: Destacando FE y remodelación cardíaca, verificamos que, aisladamente, E, M y C presentaron mejora de las variables. En la asociación, tras el período de intervención, observamos aumento de la tolerancia al esfuerzo en ME y CE (el 43% y el 33%, respectivamente). Hubo también reducción del diámetro de los cardiomiocitos (el 10% y el 9%, respectivamente) y de la fracción de colágeno (el 52% y el 63%), tras la intervención. Sin embargo, solamente CE mejoró significantemente la FE. CONCLUSIÓN: La asociación del EF a las terapias con M o C proporcionó beneficios sobre la función y remodelación cardíaca en ratones con IC.</FUNDAMENTO: O tratamento da insuficiência cardíaca (IC) conta atualmente com diversos tipos de intervenções. Dentre elas, destacam-se a terapia com betabloqueadores (BB) e o treinamento físico (TF). Contudo, os efeitos da associação dessas terapias são pouco estudados. OBJETIVO: Verificar os efeitos do tratamento com BB, metoprolol (M) e carvedilol (C) associados ao TF na IC em camundongos. MÉTODOS: Utilizamos modelo genético de IC induzida em camundongos por hiperatividade simpática. Inicialmente, dividimos os animais com IC em: sedentários (S); treinados (T); tratados com M (138 mg/kg) (M) ou C (65 mg/kg) (C). Na segunda parte, dividimos os grupos em S; treinado e tratado com M (MT) e treinado e tratado com C (CT). O TF consistiu em treinamento aeróbico em esteira por 8 semanas. A tolerância ao esforço foi avaliada por teste progressivo máximo e a fração de encurtamento foi avaliada (FE) por ecocardiografia. O diâmetro dos cardiomiócitos e a fração de colágeno foram avaliados por meio de análise histológica. Os dados foram comparados por ANOVA de um caminho com post hoc de Duncan. O nível de significância foi considerado p < 0,05. RESULTADOS: Destacando FE e remodelação cardíaca, verificamos que, isoladamente, T, M e C apresentaram melhora das variáveis. Na associação, após o período de intervenção, observamos aumento da tolerância ao esforço em MT e CT (43,0% e 33,0%, respectivamente). Houve também redução do diâmetro dos cardiomiócitos (10,0% e 9,0%, respectivamente) e da fração de colágeno (52,0% e 63,0%), após a intervenção. Porém, somente CT melhorou significantemente a FE. CONCLUSÃO: A associação do TF às terapias com M ou C proporcionou benefícios sobre a função e remodelação cardíaca em camundongos com IC.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade de São Paulo Escola de Educação FísicaUniversidade de São Paulo Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

    A doença de Chagas como um modelo mecanicista para testar uma nova hipótese

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    The association between depression and cardiovascular disease is well documented. Nevertheless, the process through which they are linked remains unknown, as does the direction of this relationship. Studies have suggested both that depression is a risk factor for heart disease and that heart disease is a risk factor for depression. A number of studies have established that a relationship exists between depression and inflammation, with alterations in the levels of inflammatory markers (IL-1, IL-6, TNF-alpha and others). Depressive symptoms have also been identified in many diseases characterized by inflammatory processes e.g. rheumatoid arthritis, bronchial asthma, diabetes, tuberculosis and cardiovascular diseases. In this brief viewpoint, we explain and propose how to use Chagas disease, a disorder characterized by inflammatory processes and leading to cardiovascular and autonomic problems, as a model for studying the directionality of the relationship between heart disease and depression.A associação entre depressão e doença cardiovascular está bem documentada. Não obstante, o processo pelo qual está associada permanece desconhecido, assim como o sentido desta associação. Estudos têm sugerido que tanto a depressão é um fator de risco para a doença cardiovascular quanto esta o é para a depressão. Uma série de trabalhos tem estabelecido que uma relação existe entre depressão e inflamação, com alterações evidenciadas por marcadores de inflamação (IL-1, IL-6, TNF alfa e outros). Sintomas de depressão também têm sido identificados em diversas doenças caracterizadas por processos inflamatórios, tais como artrite reumatoide, asma brônquica, diabete, tuberculose e doenças cardiovasculares. Nesta breve opinião é explicitado e proposto como empregar a doença de Chagas, um agravo caracterizado por processos inflamatórios e indutor de problemas cardiovasculares e autonômicos, como um modelo de estudo da direcionalidade da relação entre doença cardíaca e depressão

    Metabolism of a Lipid Nanoemulsion Resembling Low-Density Lipoprotein in Patients with Grade III Obesity

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    INTRODUCTION: Obesity increases triglyceride levels and decreases high-density lipoprotein concentrations in plasma. Artificial emulsions resembling lipidic plasma lipoprotein structures have been used to evaluate low-density lipoprotein metabolism. In grade III obesity, low density lipoprotein metabolism is poorly understood. OBJECTIVE: To evaluate the kinetics with which a cholesterol-rich emulsion (called a low-density emulsion) binds to low-density lipoprotein receptors in a group of patients with grade III obesity by the fractional clearance rate. METHODS: A low-density emulsion was labeled with [14C]-cholesterol ester and [³H]-triglycerides and injected intravenously into ten normolipidemic non-diabetic patients with grade III obesity &#91;body mass index higher than 40 kg/m²&#93; and into ten non-obese healthy controls. Blood samples were collected over 24 hours to determine the plasma decay curve and to calculate the fractional clearance rate. RESULTS: There was no difference regarding plasma levels of total cholesterol or low-density lipoprotein cholesterol between the two groups. The fractional clearance rate of triglycerides was 0.086 ± 0.044 in the obese group and 0.122 ± 0.026 in the controls (p = 0.040), and the fractional clearance rate of cholesterol ester (h-1) was 0.052 ± 0.021 in the obese subjects and 0.058 ± 0.015 (p = 0.971) in the controls. CONCLUSION: Grade III obese subjects exhibited normal low-density lipoprotein removal from plasma as tested by the nanoemulsion method, but triglyceride removal was slower

    Cardiac pacing in hypertrophic cardiomyopathy: a cohort with 24 years of follow-up

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    FUNDAMENTO: O benefício da estimulação cardíaca em pacientes portadores de cardiomiopatia hipertrófica (CMH) tem sido questionado, sendo escassas as pesquisas sobre este assunto no Brasil. OBJETIVO: Descrever a indicação, a resposta clínica, as complicações e a sobrevida relacionadas ao implante de marcapasso em pacientes portadores de CMH. MÉTODOS: Foram estudados, retrospectivamente, 39 pacientes portadores de cardiomiopatia hipertrófica (41% do sexo masculino) submetidos a implante de marcapasso, no período de maio de 1980 a novembro de 2003. RESULTADOS: Houve 27 portadores da forma obstrutiva e 12 portadores da forma não-obstrutiva com média de idade de 46,4 anos (14-77 anos) seguidos por 6,4 ± 4,1 anos. As principais indicações para implante foram: bloqueio atrioventricular espontâneo ou induzido (54%), refratariedade à terapêutica associada a gradiente elevado (33%), suporte para terapia medicamentosa por bradicardia (8%) e prevenção de fibrilação atrial (5%). Houve melhora na classe funcional de 2,41±0,87 para 1,97±0,92 (p = 0,008), bem como redução do número de sintomas referidos, sem ter havido diferença na utilização da terapia medicamentosa. Não houve óbitos relacionados ao procedimento que, apesar de demonstrar-se seguro, não foi isento de complicações (6 pacientes - 15,4%). Ocorreram três óbitos durante o seguimento, todos em pacientes mulheres, portadoras de fibrilação atrial e com evidências de deterioração funcional. Observou-se uma forte associação de piora clínica com surgimento de fibrilação atrial ou flutter. CONCLUSÃO: A estimulação cardíaca artificial em pacientes com CMH foi bem-sucedida, com evidências de alívio sintomático em pacientes portadores da forma obstrutiva. Não se observou melhora funcional para a forma não-obstrutiva.BACKGROUND: The benefits of heart stimulation in hypertrophic cardiomyopathy (HCM) patients have been questioned. Research work available in Brazil on those benefits is scarce. OBJECTIVE: To describe the indication, clinical response, complications and survival time related to pacemaker implant in HCM patients. METHODS: Thirty-nine hypertrophic cardiomyopathy patients were studied (41% males) and submitted to pacemaker implant from May, 1980 through November, 2003. RESULTS: Twenty-seven patients presented obstructive hypertrophic cardiomyopathy, and 12, non-obstructive. Mean age was 46.4 years of age (range 14 - 77), with follow-up of 6.4 ± 4.1 years. Major indications for implant were: spontaneous or induced atrioventricular block (54%), refractoriness to therapeutic conduct associated to high gradient (33%), support for drug therapy to treat bradychardia (8%), and atrial fibrillation prevention (5%). Functional class was shown to improve from 2.41±0.87 to 1.97±0.92 (p = 0.008), and symptoms referred were reduced. No change was made in drug therapy administration. No procedure-related deaths were reported. Although shown to be safe, the procedure was not free from complications (6 patients - 15.4%). Three deaths occurred in the follow-up period - the three of them were atrial fibrillation female patients, with evidence of functional deterioration. A close association was observed between clinical condition worsening and the onset of atrial fibrillation or flutter. CONCLUSION: Cardiac pacing in HCM patients was successful, with evidence of symptoms relief in obstructive HCM patients. No functional improvement was observed in non-obstructive patients
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