127 research outputs found
The supplementation of L-carnitine in septic shock patients: Systematic review and meta-analysis
Background: Sepsis and septic shock are severe and difficult-to-treat conditions with high lethality. There is interest in identifying new adjunct therapies that are effective in reducing mortality. In this context, L-carnitine has been investigated in trials as a potentially beneficial drug. Therefore, the aim of this systematic review was to assess the clinical evidence to support the use of L-carnitine in septic shock patients to reduce the risk of mortality. The objective of this review was to evaluate the effect of L-carnitine compared to placebo or Usual Care (UC) on the mortality rate in hospitalized adult septic shock patients.
Methods: The authors exclusively included randomized clinical trials that compared the use of L-carnitine versus placebo in adult (> 18 years old) septic shock patients. The outcome was a mortality rate of 28 days. This systematic review and meta-analysis were performed following the PRISMA guidelines and registered in PROSPERO with the ID CRD42020180499.
Results: Following the initial search, 4007 citations were identified, with 2701 remaining after duplicate removal. Eight citations were selected for body text reading, and two were selected for inclusion. The studies enrolled 275 patients, with 186 in the carnitine arm and 89 in the placebo arm. The effect of L-carnitine uses in septic shock patients showed a difference risk of -0.03 (95% Confidence Interval: -0.15–0.10, I2 = 77%, p = 0.69) compared to placebo/in mortality rate with low quality of evidence.
Conclusions: There is low-quality evidence that the use of L-carnitine has no significant effect on reducing 28-day mortality in septic shock patients
Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease
OBJECTIVES: The prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease according to disease severity has not yet been established. The aim of this study was to assess the prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease patients according to disease severity. METHODS: The study included 25 mild/moderate chronic obstructive pulmonary disease patients and 25 severe/very severe chronic obstructive pulmonary disease patients. All participants underwent clinical evaluation, spirometry and electrocardiography/echocardiography. RESULTS: Electrocardiography and echocardiography showed Q-wave alterations and segmental contractility in five (10%) patients. The most frequent echocardiographic finding was mild left diastolic dysfunction (88%), independent of chronic obstructive pulmonary disease stage. The proportion of right ventricular overload (
Association between phase angle, anthropometric measurements, and lipid profile in HCV-infected patients
OBJECTIVE: The objective of this study was to investigate the associations between phase angle, anthropometric measurements, and lipid profile in patients chronically infected with the hepatitis C virus. METHODS: A total of 160 consecutive patients chronically infected with the hepatitis C virus and who received treatment at the hepatitis C outpatient unit of our hospital from April 2010 to May 2011 were prospectively evaluated. Bioelectrical impedance analysis, anthropometric measurements, and serum lipid profile analysis were performed. RESULTS: Twenty-five patients were excluded. A total of 135 patients with a mean age of 49.8¡11.4 years were studied. Among these patients, 60% were male. The phase angle and BMI means were 6.5¡0.8°and 26.5¡4.8 kg/ m2, respectively. Regarding anthropometric variables, mid-arm circumference, mid-arm muscle circumference, and arm muscle area had a positive correlation with phase angle. In contrast, when analyzing the lipid profile, only HDL was inversely correlated with phase angle. However, in multiple regression models adjusted for age and gender, only mid-arm circumference (p = 0.005), mid-arm muscle circumference (p = 0.003), and arm muscle circumference (p = 0.001) were associated with phase angle in hepatitis C virus-infected patients.CONCLUSIONS: In conclusion, phase angle is positively correlated with anthropometric measures in our study. However, there is no association between phase angle and lipid profile in these patients. Our results suggest that phase angle is related to lean body mass in patients chronically infected with hepatitis C virus
Clinical and echocardiographic predictors of left ventricular remodeling following anterior acute myocardial infarction
OBJECTIVES: Coronary artery disease is the primary cause of death and is responsible for a high number of hospitalizations worldwide. Ventricular remodeling is associated with worse prognosis following ST-segment elevation myocardial infarction (STEMI) and is a risk factor for ventricular dysfunction and heart failure. This study aimed to identify the predictors of ventricular remodeling following STEMI. Additionally, we evaluated the clinical, laboratory, and echocardiographic characteristics of patients with anterior wall STEMI who underwent primary percutaneous intervention in the acute phase and at 6 months after the infarction. METHODS: This prospective, observational, and longitudinal study included 50 patients with anterior wall STEMI who were admitted to the coronary care unit (CCU) of a tertiary hospital in Brazil between July 2017 and August 2018. During the CCU stay, patients were evaluated daily and underwent echocardiogram within the first three days following STEMI. After six months, the patients underwent clinical evaluation and echocardiogram according to the local protocol. RESULTS: Differences were noted between those who developed ventricular remodeling and those who did not in the mean±standard deviation levels of creatine phosphokinase MB isoenzyme (CKMB) peak (no remodeling group: 323.7±228.2 U/L; remodeling group: 522.4±201.6 U/L; p=0.008) and the median and interquartile range of E/E’ ratio (no remodeling group: 9.20 [8.50–11.25] and remodeling group: 12.60 [10.74–14.40]; p=0.004). This difference was also observed in multivariate logistic regression. CONCLUSIONS: Diastolic dysfunction and CKMB peak in the acute phase of STEMI can be predictors of ventricular remodeling following STEMI
Challenges in adapting a stroke unit in a middle-income country: warning about costs and underfunding to achieve the Brazilian Ministry of Health’s benchmark
BackgroundSince the implementation of the stroke care line in Brazil, the relationship (adequacy) of costs spent during hospitalization with the Brazilian Ministry of Health indicators for a stroke unit have not yet been analyzed.AimsThis study aimed to assess the adequacy of a comprehensive stroke center for key performance indicators and analyze the costs involved in hospitalization. We verified the association between stroke severity at admission and care costs during hospitalization.MethodsA retrospective medical chart review of 451 patients was performed using semiautomatic electronic data from a single comprehensive stroke center in Brazil between July 2018 and January 2020. Clinical and resource utilization data were collected, and the mean acute treatment cost per person was calculated. The Kruskal–Wallis test with Dunn’s post-test was used to compare the total costs between stroke types and reperfusion therapies. A robust linear regression test was used to verify the association between stroke severity at hospital admission and the total hospitalization costs. Good adequacy rates were observed for several indicators.ResultsData from 451 patients were analyzed. The stroke unit had good adaptation to key performance indicators, but some critical points needed revision and improvement to adapt to the requirements of the Ministry of Health. The average total cost of the patient’s stay was the USD 2,637.3, with the daily hospitalization, procedure, operating room, and materials/medication costs equating to USD 2,011.1, USD 220.7, USD 234.1, and USD 98.8, respectively. There was a positive association between the total cost and length of hospital stay (p < 0.001).ConclusionThe stroke unit complied with most of the main performance indicators proposed by the Brazilian Ministry of Health. Underfunding of the costs involved in the hospitalization of patients was verified, and high costs were associated with the length of stay, stroke severity, and mechanical thrombectomy
InfluĂŞncia da restrição dietĂ©tica de vitamina A na redemodelação cardĂaca pĂłs-infarto
o objetivo de nosso estud a a Isa _ alimentar de vitamina A sobre a remodelação cardĂaca a miocárdio em ratos. MĂ©todos: Foram utilizadas ratas previamente hĂgidas, submetidas durante a gestação e lactação a duas dieta AIN-93 isenta de vitamina A + 4 REfg de dieta (dose fisiolĂłgica); 2) dieta AIN-93 isenta de vitamina A. ApĂłs o nascimento dos filhotes, os machos foram separados em gaiolas individuais. Os filhotes das ratas tratadas com dieta com dose fisiolĂłgica de vitamina A continuaram recebendo 4REfg de dieta e os filhotes das ratas tratadas com dieta isenta de vitamina A receberam 0.18 RE{g de dieta. Quando atingiram, aproximadamente 220 g, os ratos foram submetidos ao infarto experimental. ApĂłs 24 horas do procedimento os ratos foram divididos em grupo controle (Grupo C, nThe aim of this study was to ana vitamin A ingestion on cardiac remodeling after myocardial infarction in rats. Methods: wistar female rats during pregnancy and lactation were fed with two diets: 1) AIN-93 vitamin A sufficient diet (4 RE/g af diet) and 2) AIN-93 vitamin A free diet. After born, male rats were studied. Newborns from dams fed with AIN93 vitamin A ft-ee diet, aftet- weaning received AIN-93 with 0,18 RE(g of diet. Newborns from dams fed with AIN-93 vitamin A sufficient diet, after weaning, received the same diet until they were around 220 g~With 220 g the animaIs were submitted to myocardial infarction. After 24 hours from the procedure, the surviving rats were divided into two groups: contrai group (C group, n=25) that remain receiving AIN-93 vitamin A sufficient diet; and reduced vitamin A group (RVA group, n=26) that remain receiving AIN-93 with O,lB REfg of diet. The groups were observed during 3 months. After this period, they were submitted to morphometric, functional and biochemical analysis. Statistical analysis was performed with Student t-test and Mann-Whitney for comparisons between two groups when variables were continuous, and x2 when variables were categorical. The significant leveI was 5%. Results: There was no difference in weight at infarction moment and infarct size between the two groups (C=36,9 ± 9,6 %; RVA=36,3 ± B,9 %; p=O,BB). The mortality during the 3 months period after infarction was not different between the groups (C=4B%; RVA=50%, p=0,B91). RVA group showed higher aorta diameter [C=3,4 (3,1-3,6) mm; RVA=3,5 (3,43,9) mm, p=0,04], left ventricle diastolic diameter (C=9,4 ± 1,4 mm; RVA=10,5 ± 1,2 mm, p=0,04) and diastolic area in short axes(body weight(C=l,B ± 0,4 cm2fkg; RVA=2,1 ± 0,3 cm2fkg, p=0,03) than C group. Cansidering the variables that represent diastolic function, RVA group showed lower TRIV(RRO,5than C group... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de NĂvel Superior (CAPES
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