Variação sazonal nas hospitalizações por insuficiência cardíaca em Niterói, RJ

O objetivo do estudo foi descrever a sazonalidade das hospitalizações por insuficiência cardíaca em climas tropicais, aspecto já conhecido em climas frios. Aplicou-se o Modelo Sazonal Auto-Regressivo Integrado de Médias Móveis a uma série histórica de 6.596 hospitalizações por insuficiência cardíaca no município de Niterói, RJ, de 1996 a 2004, obtida do Banco de Dados do Sistema Único de Saúde. A variação sazonal padrão foi obtida por meio da filtragem e cálculo da média-móvel dos dados. O menor número de hospitalizações por ano foi 507 (1997) e o maior 849 (2002); e por mês 419 (dezembro) e 681 (outrubro), respectivamente. Foram observados picos de internação no outono e inverno. Ainda que fraca, a sazonalidade observada mostra que uma pequena variação pode levar ao aumento de hospitalizações.El objetivo del estudio fue describir la estacionalidad de las hospitalizaciones por insuficiencia cardiaca en climas tropicales, aspecto ya conocido en climas fríos. Se aplicó el Modelo Estacional Auto-Regresivo Integrado de Promedios Móviles a una serie histórica de 6.596 hospitalizaciones por insuficiencia cardiaca en el municipio de Niteroi, Sureste de Brasil, de 1996 a 2004, obtenida del Banco de Datos del Sistema Único de Salud. La variación estacional estándar fue obtenida por medio de la filtración y cálculo del promedio-móvil de los datos. El menor número de hospitalizaciones por año fue 507 (1997) y el mayor 849 (2002); e por mes 419 (diciembre) y 681 (octubre), respectivamente. Se observaron picos de internación en otoño e invierno. A pesar de que fue débil, la estacionalidad observada muestra que una pequeña variación puede llevar al aumento de hospitalizaciones.The objective of the study was to describe seasonality of hospitalizations for heart failure in tropical climate as it has been described in cold climates. Seasonal Auto-regressive Integrated Moving-Average model was applied to time-series data of heart failure hospitalizations between 1996 and 2004 in Niteroi (Southeastern Brazil), collected from the Brazilian National Health Service Database. The standard seasonal variation was obtained by means of moving-average filtering and averaging data. The lowest and the highest annual hospital admissions were 507 (1997) and 849 (2002), respectively; the lowest and the highest monthly rates were 419 (December) and 681 (October), respectively. Peak admission rates were seen during the fall and winter. Although weak, the seasonality observed indicates that slight variations result in increased hospitalizations for heart failure

Intestinal fatty acid binding protein is associated with cardiac function and gut dysbiosis in chronic heart failure

Background: The gut microbiota in patients with chronic heart failure (HF) is characterized by low bacterial diversity and reduced ability to synthesize beneficial metabolites. These changes may facilitate leakage of whole bacteria or bacterial products from the gut into the bloodstream, which may activate the innate immune system and contribute to the low-grade inflammation seen in HF. In this exploratory cross-sectional study, we aimed to investigate relationships between gut microbiota diversity, markers of gut barrier dysfunction, inflammatory markers, and cardiac function in chronic HF patients. Methods: In total, 151 adult patients with stable HF and left ventricular ejection fraction (LVEF) < 40% were enrolled. We measured lipopolysaccharide (LPS), LPS-binding protein (LBP), intestinal fatty acid binding protein (I-FABP), and soluble cluster of differentiation 14 (sCD14) as markers of gut barrier dysfunction. N-terminal pro-B-type natriuretic peptide (NT-proBNP) level above median was used as a marker of severe HF. LVEF was measured by 2D-echocardiography. Stool samples were sequenced using 16S ribosomal RNA gene amplification. Shannon diversity index was used as a measure of microbiota diversity. Results: Patients with severe HF (NT-proBNP > 895 pg/ml) had increased I-FABP (p < 0.001) and LBP (p = 0.03) levels. ROC analysis for I-FABP yielded an AUC of 0.70 (95% CI 0.61–0.79, p < 0.001) for predicting severe HF. A multivariate logistic regression model showed increasing I-FABP levels across quartiles of NT-proBNP (OR 2.09, 95% CI 1.28−3.41, p = 0.003). I-FABP was negatively correlated with Shannon diversity index (rho = −0.30, p = <0.001), and the bacterial genera Ruminococcus gauvreauii group, Bifidobacterium, Clostridium sensu stricto, and Parasutterella, which were depleted in patients with severe HF. Conclusions: In patients with HF, I-FABP, a marker of enterocyte damage, is associated with HF severity and low microbial diversity as part of an altered gut microbiota composition. I-FABP may reflect dysbiosis and may be a marker of gut involvement in patients with HF

Intestinal fatty acid binding protein is associated with cardiac function and gut dysbiosis in chronic heart failure

BackgroundThe gut microbiota in patients with chronic heart failure (HF) is characterized by low bacterial diversity and reduced ability to synthesize beneficial metabolites. These changes may facilitate leakage of whole bacteria or bacterial products from the gut into the bloodstream, which may activate the innate immune system and contribute to the low-grade inflammation seen in HF. In this exploratory cross-sectional study, we aimed to investigate relationships between gut microbiota diversity, markers of gut barrier dysfunction, inflammatory markers, and cardiac function in chronic HF patients.MethodsIn total, 151 adult patients with stable HF and left ventricular ejection fraction (LVEF) &lt; 40% were enrolled. We measured lipopolysaccharide (LPS), LPS-binding protein (LBP), intestinal fatty acid binding protein (I-FABP), and soluble cluster of differentiation 14 (sCD14) as markers of gut barrier dysfunction. N-terminal pro-B-type natriuretic peptide (NT-proBNP) level above median was used as a marker of severe HF. LVEF was measured by 2D-echocardiography. Stool samples were sequenced using 16S ribosomal RNA gene amplification. Shannon diversity index was used as a measure of microbiota diversity.ResultsPatients with severe HF (NT-proBNP &gt; 895 pg/ml) had increased I-FABP (p &lt; 0.001) and LBP (p = 0.03) levels. ROC analysis for I-FABP yielded an AUC of 0.70 (95% CI 0.61–0.79, p &lt; 0.001) for predicting severe HF. A multivariate logistic regression model showed increasing I-FABP levels across quartiles of NT-proBNP (OR 2.09, 95% CI 1.28−3.41, p = 0.003). I-FABP was negatively correlated with Shannon diversity index (rho = −0.30, p = &lt;0.001), and the bacterial genera Ruminococcus gauvreauii group, Bifidobacterium, Clostridium sensu stricto, and Parasutterella, which were depleted in patients with severe HF.ConclusionsIn patients with HF, I-FABP, a marker of enterocyte damage, is associated with HF severity and low microbial diversity as part of an altered gut microbiota composition. I-FABP may reflect dysbiosis and may be a marker of gut involvement in patients with HF

Comparação do padrão inflamatório de indivíduos insulino-sensíveis com sobrepeso e indivíduos magros insulino-resistentes, assistidos pelo Programa Médico de Família

Fundamento: Na maioria das pessoas, obesidade e resistência insulínica coexistem. No entanto, um grupo particular de indivíduos com excesso de gordura corporal apresenta melhor sensibilidade à insulina do que a esperada para sua adiposidade. Por outro lado, indivíduos magros podem desenvolver resistência insulínica, mesmo sem excesso de gordura corporal, a partir de um processo agudo de inflamação. Objetivo: Descrever e comparar o padrão inflamatório de indivíduos insulino-sensíveis com sobrepeso e indivíduos magros insulino-resistentes atendidos pelo Programa Médico de Família de Niterói, RJ, Brasil. Métodos: Estudo transversal conduzido a partir do Estudo CAMELIA. Variáveis contínuas foram analisadas com o teste de Mann-Whitney. As associações foram estimadas através do modelo de Equações de Estimação Generalizadas. O nível de significância estatística adotado foi 0,05. Resultados: Foram incluídos 74 indivíduos no grupo com sobrepeso insulino-sensível, média de idade 39,2 +1,3; no grupo de magros com resistência insulínica, foram incluídos 18 indivíduos, com média de idade 31,9 +3,6. Níveis de PCR apresentaram uma correlação positiva com o IMC (r=0,666; p=0.003) no grupo de magros com resistência insulínica. Foi observada no modelo de regressão múltipla, uma associação positiva com o MCP-1 (OR:1,006; p=0,024) e com o IL-6 (OR:1,361; p=0,016), independente da idade, circunferência de cintura e níveis de hemoglobina glicada, resistina, adiponectina, proteína C reativa e PAI-1. Conclusão: Nossos dados sugerem que um indivíduo magro que apresenta isoladamente resistência insulínica tem maior chance de apresentar níveis mais elevados de marcadores pró-inflamatórios (MCP-1, IL-6 e resistina) que um indivíduo com sobrepesoBackground: In most people, obesity and insulin resistance coexist. However, a particular group of individuals with excessive body fat has better insulin sensitivity than would be expected for their adiposity. Moreover, lean individuals can develop insulin resistance provoked by an acute inflammation process, even without excess body fat. Objective: To describe and compare an inflammatory pattern of overweight insulinsensitive and lean insulin-resistant subjects, assisted by the Family Health Program in Niterói, RJ, Brazil. Methods: Cross-sectional study conducted from CAMELIA project. Continuous variables were analyzed using the Mann-Whitney test. Associations were estimated through the Generalized Estimation Equation models. The level of significance was 0.05. Results: We included 74 individuals in the overweight insulin-sensitive group, mean age 39.2 +1.3; and, in the lean insulin-resistance group, 18 individuals, mean age 31.9 +3.6. C-reactive protein levels were positively correlated with Body Mass Index (r = 0.666, p = 0.003) in the lean insulin-resistance group. In the multiple regression model, a positive association were observed with MCP-1 (OR: 1.006, p = 0.024) and IL-6 (OR: 1.361, p = 0.016), adjusted for age, waist circumference and glycated hemoglobin, resistin, adiponectin, C-reactive protein and PAI-1 levels. Conclusion: Our data suggest that a lean insulin-resistant subject has a significantly higher chance to present higher levels of pro-inflammatory markers (MCP-1, IL-6 and resistin) that an overweight insulin-sensible subject115f

Seasonal variation in hospitalizations due to heart failure in Niterói city, Southeastern Brazil

The objective of the study was to describe seasonality of hospitalizations for heart failure in tropical climate as it has been described in cold climates. Seasonal Auto-regressive Integrated Moving-Average model was applied to time-series data of heart failure hospitalizations between 1996 and 2004 in Niteroi (Southeastern Brazil), collected from the Brazilian National Health Service Database. The standard seasonal variation was obtained by means of moving-average filtering and averaging data. The lowest and the highest annual hospital admissions were 507 (1997) and 849 (2002), respectively; the lowest and the highest monthly rates were 419 (December) and 681 (October), respectively. Peak admission rates were seen during the fall and winter. Although weak, the seasonality observed indicates that slight variations result in increased hospitalizations for heart failure