Perturbações Miccionais da Esclerose Múltipla

A esclerose múltipla apresenta-se sob diversas formas clínicas tendo um percurso muito variável e prognóstico pouco previsível. Mesmo antes do diagnóstico, as manifestações urinárias podem ser aparentes e são habitualmente relegadas para um segundo plano quando predominam as outras manifestações neurológicas, porventura mais graves. Os métodos terapêuticos das disfunções urinárias têm evoluído nos últimos anos, justificando uma avaliação e caracterização o mais pormenorizada possível

Hiperactividade de Esforço. Uma Forma de Incontinência

A incontinência urinária de esforço é geralmente diagnosticada segundo bases clínicas em que a perda resultante do esforço é a chave. Os mecanismos geralmente implicados são deficiência do suporte uretral e a insuficiência esfincteriana. No entanto, estas perdas podem surgir por verdadeiras contracções do detrusor desencadeadas pelo esforço. O reconhecimento desta causa é urodinâmico e tem implicações fisiopatológicas e terapêuticas importantes. Revimos uma série de exames urodinâmicos de mulheres incontinentes e encontrámos 16% de casos de contracções induzidas pelo esforço (hiperactividade de esforço) sendo a causa da incontinência em 6%

Overactive Bladder Syndrome Costs

Objectivo: A síndrome de bexiga hiperactiva é um problema crescente. Reconhece-se agora que tem um impacto bastante relevante na qualidade de vida dos doentes, que se agrava com a idade. Os custos para a comunidade não são e mais ainda, não serão negligenciáveis no futuro. Material e Métodos: Foi realizada uma pesquisa numa base de dados de publicações médicas (Pubmed, Medline), limitada aos últimos 10 anos e com as palavras-chave: “overactive bladder” e “costs”. Todas as publicações que cumpriam os critérios desta pesquisa foram contabilizadas, tendo-se registado as suas conclusões, com vista ao cálculo dos custos presumíveis no futuro, relativos à bexiga hiperactiva e aos seus efeitos secundários estudados nestes últimos anos. Resultados: Foram seleccionados 109 artigos, 31 dos quais, artigos de revisão. É interessante verificar que apenas um foi encontrado com data anterior ao ano 2000. Foram identificados vários efeitos secundários associados à bexiga hiperactiva, que se somam aos custos directamente relacionados com esta situação. Conclusões: Este problema é objecto de estudo desde há pouco tempo. O número crescente de publicações reflecte uma maior consciencialização da parte dos profissionais de saúde. Os custos associados ao tratamento da bexiga hiperactiva bem como os custos associados ao tratamento das complicações associadas sugerem a necessidade urgente de considerar melhores políticas de tratamento

The magnitude of the variation in glycemia: a new parameter for risk assessment in acute coronary syndrome?

INTRODUCTION AND OBJECTIVES: The aim was to evaluate the relationship between the magnitude of the variation in the level of glycemia during hospitalization and in-hospital and long-term mortality and postdischarge endpoints in two groups of patients with acute coronary syndrome: those with and those without a previous diagnosis of diabetes. METHODS: The study included 1210 patients admitted for acute coronary syndrome between May 2004 and July 2007. The study population was divided in two subgroups: patients with a previous diagnosis of diabetes (n=386) and nondiabetics (n=824). Each subgroup was further divided into four smaller groups according to the quartile of glycemia variation: diabetics (Q1: or=164 mg/dl) and nondiabetics (Q1: or=60 mg/dl). Patients were followed up for an average of 18 months after the occurrence of the acute coronary syndrome. RESULTS: In diabetic patients, there was no relationship between the magnitude of the glycemia variation and in-hospital or postdischarge endpoints. In nondiabetics, no significant difference was observed in in-hospital mortality or morbidity, but statistically significant clinical differences were found during follow-up. Multivariate regression analysis showed that Q4 versus Q1, age >or=70 years, and previous antiplatelet or angiotensin-converting enzyme inhibitor therapy were independent predictors of postdischarge endpoints in the nondiabetic group. CONCLUSIONS: In nondiabetic acute coronary syndrome patients, the magnitude of the variation in glycemia observed during hospitalization was a strong independent predictor of postdischarge clinical endpoints

Nicorandil preserves the function of the mitochondrial phosphorylative and oxidative system in an animal model of global ischemia-reperfusion

Ischemia followed by reperfusion (IR) negatively affects mitochondrial function. At the level of the oxidative-phosphorylative system, IR inhibits the respiratory complexes and ATP synthase, and increases the passive leak of protons through the inner mitochondrial membrane, uncoupling respiration from phosphorylation, decreasing mitochondrial potential and, consequently, ATP production. Drugs that minimize the mitochondrial damage induced by IR may prove to be clinically effective. In the present work, we analyzed the impact of nicorandil, a mitochondrial ATP-sensitive potassium channel agonist, on mitochondrial dysfunction at the level of the oxidative-phosphorylative system of rat hearts subjected to IR. The decrease in the respiratory control ratio (RCR) induced by IR leads to the conclusion that IR has a negative impact on the activity of the mitochondrial respiratory system, uncoupling oxidation from phosphorylation. This effect is reversed by nicorandil, which increases not only RCR, but also the ADP/O ratio. Regarding respiratory rate, state 3 rate was approximately the same for all the experimental groups, while state 4 rate was lower for the group where IR was induced in the presence of nicorandil. This result is in accordance with the data obtained for the RCR and ADP/O. State 4 rate is most affected by uncoupling, given that it is controlled by proton leak. Mitochondria subjected to IR in the presence of nicorandil have a lower state 4 rate, i.e. they are less uncoupled. From these results we conclude that nicorandil preserves the function of mitochondria subjected to IR in terms of both respiration and phosphorylative capacity

Prognostic value of CA125 in advanced heart failure patients

INTRODUCTION: Serum levels of CA125 are often high in advanced heart failure (AHF) patients. AIM: To determine the predictive value of CA125 in forecasting the occurrence of death or cardiac transplantation in an AHF population. METHODS: 88 AHF patients referred for heart transplantation were divided into 2 groups based on CA125 levels: normal (CA125/=38 U/mL). Events (death or heart transplant) were monitored over a period of 13+/-7 months after CA125 determination. RESULTS: Patients with elevated CA125 (n=65) had significantly lower blood pressure, body mass index, serum sodium and peak exercise oxygen consumption, while B-type natriuretic peptide levels were significantly higher. The combined primary endpoint (death or heart transplant) rate was 39.4% and 62.3% in normal and elevated CA125 groups, respectively (p=0.029). Multivariate regression analysis showed that CA125 and sodium levels were the only independent predictors of the combined endpoint. CONCLUSION: In AHF patients, plasma CA125 was an effective prognostic marker. Its determination may contribute to better risk stratification in this population

Scenarios for oil palm expansion in degraded and deforested lands in the Brazilian Amazon to meet biodiesel demand

Palm oil production for biodiesel in Brazil is characterized by its high productivity in some environmental conditions, under the Sustainable Palm Oil Production Program. The program seeks to avoid deforestation for oil palm cultivation, recover degraded lands, and focus on social inclusion and family farming. This paper assesses the possible socio-environmental impacts of the expansion of palm oil until 2030, focusing on land-use change and impacts. Land-use data came from the TerraClass initiative for the analysis of degraded forests using geoprocessing. We produced two oil expansion scenarios. The first one reflects current trends in palm oil production expansion and deforestation in Pará State (S1). The second one considers the exclusive use of deforested/degraded land for oil palm crops (S2). The results demonstrate that degraded/deforested land in the current palm oil-producing municipalities is only sufficient for the projected level of expansion for 2020, requiring a stronger public policy to recover degraded areas for oil palm cultivation with social inclusion of family farming.Palm oil production for biodiesel in Brazil is characterized by its high productivity in some environmental conditions, under the Sustainable Palm Oil Production Program. The program seeks to avoid deforestation for oil palm cultivation, recover degraded lands, and focus on social inclusion and family farming. This paper assesses the possible socio-environmental impacts of the expansion of palm oil until 2030, focusing on land-use change and impacts. Land-use data came from the TerraClass initiative for the analysis of degraded forests using geoprocessing. We produced two oil expansion scenarios. The first one reflects current trends in palm oil production expansion and deforestation in Pará State (S1). The second one considers the exclusive use of deforested/degraded land for oil palm crops (S2). The results demonstrate that degraded/deforested land in the current palm oil-producing municipalities is only sufficient for the projected level of expansion for 2020, requiring a stronger public policy to recover degraded areas for oil palm cultivation with social inclusion of family farming.Palm oil production for biodiesel in Brazil is characterized by its high productivity in some environmental conditions, under the Sustainable Palm Oil Production Program. The program seeks to avoid deforestation for oil palm cultivation, recover degraded lands, and focus on social inclusion and family farming. This paper assesses the possible socio-environmental impacts of the expansion of palm oil until 2030, focusing on land-use change and impacts. Land-use data came from the TerraClass initiative for the analysis of degraded forests using geoprocessing. We produced two oil expansion scenarios. The first one reflects current trends in palm oil production expansion and deforestation in Pará State (S1). The second one considers the exclusive use of deforested/degraded land for oil palm crops (S2). The results demonstrate that degraded/deforested land in the current palm oil-producing municipalities is only sufficient for the projected level of expansion for 2020, requiring a stronger public policy to recover degraded areas for oil palm cultivation with social inclusion of family farming.Palm oil production for biodiesel in Brazil is characterized by its high productivity in some environmental conditions, under the Sustainable Palm Oil Production Program. The program seeks to avoid deforestation for oil palm cultivation, recover degraded lands, and focus on social inclusion and family farming. This paper assesses the possible socio-environmental impacts of the expansion of palm oil until 2030, focusing on land-use change and impacts. Land-use data came from the TerraClass initiative for the analysis of degraded forests using geoprocessing. We produced two oil expansion scenarios. The first one reflects current trends in palm oil production expansion and deforestation in Pará State (S1). The second one considers the exclusive use of deforested/degraded land for oil palm crops (S2). The results demonstrate that degraded/deforested land in the current palm oil-producing municipalities is only sufficient for the projected level of expansion for 2020, requiring a stronger public policy to recover degraded areas for oil palm cultivation with social inclusion of family farming

Cardio-renal syndrome: the challenge in heart failure treatment

Heart failure is a chronic and progressive disease that is estimated to affect approximately 20 million people worldwide and is one of the major public health problems. Its prevalence is reaching epidemic levels with about 550,000 new cases diagnosed annually, partly due to increased life expectancy in developed countries. And as it is a systemic disease, it can cause dysfunction in various organs, but especially in the kidney. The renal failure is often associated with heart failure and, when present together, make the treatment more complex and the prognosis is worse. This is the cardio-renal syndrome. The definition of cardio-renal syndrome varies according to the working groups, and there isn't a consensus. The exact cause of deterioration of renal function and the mechanism behind this interaction are complex, multifactorial in nature and not fully known at present. The treatment available is the one used for the treatment of heart failure. It is necessary to maintain the normal function of filtration, secretion and reabsorption in kidney to have a real improvement of the clinical condition of the patient. Patients with higher risk of developing nephropathy and those who have diagnosed renal failure should have prescribed drugs that are handled very carefully. But as in many other clinical situations, there aren't perfect drugs available to treat cardio-renal syndrome and the existing ones may have serious side effects in medium/long term causing the deterioration of renal function and possibly an increased mortality. The treatment is truly challenging in patients with severe fluid overload that is refractory to diuretics. This article aims to present the existing definitions of cardio-renal syndrome, its epidemiology, describe the current knowledge about the pathophysiology and its relationship to therapeutic interventions, some actual strategies and future technologies in an attempt to preserve the kidney, mainly during the decompensation of chronic heart failure

Left ventricular end diastolic pressure and acute coronary syndromes

BACKGROUND: Data is lacking in the literature regarding the prognostic impact of left ventricular-end diastolic pressure (LVEDP) across acute coronary syndromes (ACS). OBJECTIVE: To assess LVEDP and its prognostic implications in ACS patients. METHODS: Prospective, longitudinal and continuous study of 1329 ACS patients from a single center between 2004 and 2006. Diastolic function was determined by LVEDP. Population was divided in two groups: A - LVEDP 26.5 mmHg (n = 226). RESULTS: There were no significant differences between groups with respect to risk factors for cardiovascular disease, medical history and medical therapy during admission. In group A, patients with non-ST elevation ACS were more frequent, as well as normal coronary angiograms. In-hospital mortality was similar between groups, but one-year survival was higher in group A patients (96.9 vs 91.2%, log rank p = 0.002). On a multivariate Cox regression model, a LVEDP > 26.5 mmHg (HR 2.45, 95%CI 1.05 - 5.74) remained an independent predictor for one-year mortality, when adjusted for age, LV systolic ejection fraction, ST elevation ACS, peak troponin, admission glycemia, and diuretics at 24 hours. Also, a LVEDP > 26.5 mmHg was an independent predictor for a future readmission due to congestive HF (HR 6.65 95%CI 1.74 - 25.5). CONCLUSION: In our selected population, LVEDP had a significant prognostic influence

Impact of renal function on mortality and incidence of major adverse cardiovascular events following acute coronary syndromes

BACKGROUND: Renal failure patients have a dismal prognosis in the setting of acute coronary syndromes (ACS). Several studies have shown that this population is undertreated, benefiting less frequently from cardiovascular agents and interventions. The aim of our study was to evaluate patients hospitalized for ACS who also presented renal dysfunction, identifying baseline clinical characteristics, treatment options and prognosis. We also assessed whether renal failure was an independent predictor of mortality and cardiovascular events. METHODS: We performed an observational, longitudinal, prospective and continuous study, including 1039 consecutive patients hospitalized in a single center for ACS. Two groups were compared according to estimated glomerular filtration rate (eGFR): eGFR > or = 60 ml/min (group A) and eGFR < 60 ml/min (group B). The mean follow-up was twelve months after discharge. Multivariate analysis was used to identify predictors of mortality and major adverse cardiovascular events (MACE) in this population. RESULTS: Group B patients were older and more frequently female, and presented a higher prevalence of cardiovascular risk factors and previous cardiovascular disease, and more severe coronary artery disease. Group B also had more cases of non-ST-elevation acute myocardial infarction, as well as higher blood glucose, higher heart rate on admission, and lower left ventricular ejection fraction. Patients in group B were less frequently treated with the main cardiovascular drugs or by an invasive strategy; this group also presented higher in-hospital mortality (9.1 vs. 2.5%, p < 0.001). During clinical follow-up, survival and MACE-free rates were significantly lower in group B patients (86.6 vs. 93.6%, p < 0.001, and 76.2 vs. 86.2%, p < 0.001, respectively). Multivariate analysis showed that eGFR of < 30 ml/min was an independent predictor of in-hospital mortality (OR 6.92; C statistic = 0.87) and that eGFR of < 60 ml/min was an independent predictor of MACE during follow-up (OR 2.19; C statistic = 0.71). CONCLUSION: We found that moderate to severe renal dysfunction is common in ACS patients, and this variable was an independent predictor of mortality and MACE. However, we also found that these patients are undertreated, which may contribute to their poor prognosis. Early identification of these high-risk patients is important so that the procedures recommended in the international guidelines can be more consistently implemented