The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: A report from the Euro Heart Survey on Coronary Revascularisation

Objective: Self-perceived health status may be helpful in identifying patients at high risk for adverse outcomes. The Euro Heart Survey on Coronary Revascularization (EHS-CR) provided an opportunity to explore whether impaired health status was a predictor of 1-year mortality in patients with coronary artery disease (CAD) undergoing angiographic procedures. Methods: Data from the EHS-CR that included 5619 patients from 31 member countries of the European Society of Cardiology were used. Inclusion criteria for the current study were completion of a self-report measure of health status, the EuroQol Questionnaire (EQ-5D) at discharge and information on 1-year follow-up, resulting in a study population of 3786 patients. Results: The 1-year mortality was 3.2% (n = 120). Survivors reported fewer problems on the five dimensions of the EQ-5D as compared with non-survivors. A broad range of potential confounders were adjusted for, which reached a p<0.10 in the unadjusted analyses. In the adjusted analyses, problems with self-care (OR 3.45; 95% CI 2.14 to 5.59) and a low rating (≤ 60) on health status (OR 2.41; 95% CI 1.47 to 3.94) were the most powerful independent predictors of mortality, among the 22 clinical variables included in the analysis. Furthermore, patients who reported no problems on all five dimensions had significantly lower 1-year mortality rates (OR 0.47; 95% CI 0.28 to 0.81). Conclusions: This analysis shows that impaired health status is associated with a 2-3-fold increased risk of all-cause mortality in patients with CAD, independent of other conventional risk factors. These results highlight the importance of including patients' subjective experience of their own health status in the evaluation strategy to optimise risk stratification and management in clinical practice

Progression From Paroxysmal to Persistent Atrial Fibrillation. Clinical Correlates and Prognosis

Objectives: We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population. Background: Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF. Methods: We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified. Results: Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score &gt;5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events. Conclusions: A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future. \ua9 2010 American College of Cardiology Foundation

Effect of Systemic Hypertension With Versus Without Left Ventricular Hypertrophy on the Progression of Atrial Fibrillation (from the Euro Heart Survey).

Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, that is major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these end points. We aimed to assess this in low-risk AF patients, also assessing gender-related differences. We included 799 patients from the Euro Heart Survey with nonvalvular AF and a baseline echocardiogram. Patients with and without hypertension were included. End points after 1 year were occurrence of AF progression, that is paroxysmal AF becoming persistent and/or permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared with hypertensive patients without LVH (23.3% vs 8.8%, p = 0.011). In hypertensive AF patients, LVH was the most important multivariably adjusted determinant of AF progression on multivariable logistic regression (odds ratio 4.84, 95% confidence interval 1.70 to 13.78, p = 0.003). This effect was only seen in male patients (27.5% vs 5.8%, p = 0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs 15.0%, p = 0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women

Óleo de soja e óleo de soja residual em dietas para ovinos confinados: Parâmetros sanguíneos

The objective of this study was to evaluate the effects of 2 dietary lipid sources (soybean oil and residual soybean oil) on blood parameters of feedlot sheep. It were used 24 male lambs Santa Inês × Dorper, uncastrated, distributed in a randomized block design and assigned to three experimental diets: C= control diet, composed by forage concentrate ratio of 40:60, S= C with 6 % of soybean oil, and R= C with 6 % of frying oil. Corn silage was the roughage and concentrate was composed by whole corn grain, soybean hulls, sunflower meal, urea, mineral salt, limestone, and antioxidant. The animals were kept in individual pen for 105 days, and at day 59 blood samples were collected by jugular vein puncture for quantification of glucose, triglycerides, cholesterol, total protein, and liver enzymes AST (aspartate aminotransferase), GGT (gamma glutamyl transferase) and FAL (alkaline phosphatase). Inclusion of 6 % of soybean oil or frying oil in diet increased the concentration of cholesterol and AST (p<0.01); FAL tended (p= 0.06) to increase when residual oil was used. However, such changes are not sufficient to cause damage to animal health.Objetivou-se neste trabalho avaliar o efeito da inclusão de 2 fontes lipídicas (óleo de soja e óleo de soja residual) na dieta de ovinos confinados sobre os parâmetros sanguíneos. Foram utiliza- dos 24 borregos Santa Inês × Dorper, machos, não castrados, distribuídos em delineamento em blocos casualizados e submetidos a três dietas experimentais: C= dieta controle, volumoso:con- centrado na proporção de 40:60; S= C com inclusão de 6 % de óleo de soja; e R= C com inclusão de 6 % de óleo de soja residual de fritura. Silagem de milho foi utilizada como volumoso e o concentrado era composto por milho grão inteiro, casca de soja, farelo de girassol, ureia, sal mineral, calcário e antioxidante. Os animais foram confinados por 105 dias, sendo que no dia 59 foram realizadas colheitas de sangue através de punção da veia jugular para quantificação de glicose, triglicérides, colesterol e proteínas totais, além das enzimas hepáticas aspartato aminotransferase (AST), gama glutamiltransferase (GGT) e fosfatase alcalina (FAL). A inclusão de 6 % de óleo de soja ou de óleo residual na dieta aumentou as concentrações sanguíneas de colesterol e da AST (p<0,01), e a FAL tendeu a aumentar (p= 0,06) quando óleo residual foi utilizado. Porém, tais alterações não foram suficientes para causarem prejuízos na saúde animal

Use of acids as additives in sugarcane silage

Background: sugarcane silage often becomes a problem for the producers due to its high population of yeast and its high content of soluble carbohydrates. Objective: to evaluate the effect of formic and phosphoric acid on the chemical composition, fermentation characteristics, and digestibility of sugarcane silages. Methods: sugarcane was ensiled in experimental mini-silos. Five treatments were evaluated in the ensilage process (sugarcane added with 0.5 or 1% formic acid and 0.5 or 1% phosphoric acid, and a control treatment without additives). A completely randomized design was used. Results: the dry matter content of silages containing phosphoric acid was lower. Lower values of NDF, ADF, and hemicellulose were observed in the control and formic acid treatments. Conclusions: formic and phosphoric acids promote beneficial changes in the chemical composition of sugar cane silage.Antecedentes: devido à elevada presença de leveduras como também excessiva proporção de carboidratos, a silagem de cana apresenta problemas de manejo para os produtores. Objetivo: avaliar o efeito da adição do ácido fórmico e ácido fosfórico sobre composição química, características fermentativas e digestibilidade de silagens de cana-de-açúcar. Métodos: a cana-de-açúcar foi ensilada em mini silos. Foram avaliados cinco tratamentos no processo de ensilagem de cana de açúcar (cana-de-açúcar adicionada com 0,5 ou 1% de ácido fórmico ou com 0,5 ou 1% de ácido fosfórico, e um tratamento controle sem aditivos), utilizando um delineamento inteiramente casualizado. Resultados: os teores de matéria seca das silagens contendo ácido fosfórico foram menores. Menores valores de NDF, ADF e hemicelulose foram observados para as silagens de cana-de-açúcar in natura e adicionadas de ácido fórmico. Conclusões: o uso de ácido fórmico e fosfórico promove mudanças benéficas na composição química da silagem de cana de açúcar.Antecedentes: debido a la elevada presencia de levaduras y a la alta proporción de carbohidratos, el ensilaje de caña de azúcar presenta problemas de manejo para los productores. Objetivo: evaluar el efecto de la adición de ácidos fórmico y fosfórico sobre la composición química, características fermentativas y digestibilidad del ensilaje de caña de azúcar. Métodos: la caña de azúcar se ensiló en mini silos. Fueron evaluados cinco tratamientos en el proceso de ensilaje de caña de azúcar (caña de azúcar adicionada con 0,5 o 1% de ácido fórmico, o con 0,5 o 1% de ácido fosfórico, y un tratamiento control sin aditivos). Se utilizó un diseño completamente aleatorizado. Resultados: la proporción de materia seca de los ensilajes con ácido fosfórico fue menor. Se observaron menores proporciones de NDF, ADF y hemicelulosa en los ensilajes sin adición de ácido y en los adicionados con ácido fórmico. Conclusiones: el uso de ácidos fórmico y fosfórico en el ensilaje de caña de azúcar promueve modificaciones benéficas en su composición química

Kidney disease in HIV-infected patients

The introduction of highly active antiretroviral therapy (HAART) has reduced mortality and improved life expectancy of HIV-positive patients. However, increased survival is associated with increased prevalence of comorbidities, such as cardiovascular disease, hepatic and renal disease. Kidney disease, including HIV-associated nephropathy, acute renal failure and chronic kidney disease, represents one of the main causes of morbidity and mortality, especially if associated to other risk factors, i.e. hypertension, diabetes, older age, black race and hepatitis C coinfection. Careful evaluation of renal function may help identifying kidney disease in its early stages. In addition, proper management of hypertension and diabetes is recommended. Even if HAART has changed the natural course of HIV-associated nephropathy, reducing the risk of End-stage Renal Disease (ERDS), some antiretroviral regimens have been related with the development of acute or chronic kidney disease. Further studies are needed to optimize the management of renal disease among HIV-infected patients