Patients with Chagas Disease and Cardiac Arrest Treated at the Emergency Department of a Reference Hospital in Brazil

People with Chagas disease are at a higher risk of death due to cardiac arrest (CA). Considering that Chagas disease remains a serious health problem in Latin America, studies in this regard are still needed. The aim of this study was to present 2 patients with Chagas that developed CA and were treated at the emergency department of a reference hospital in Brazil (Sao Paulo city). Case one: Male (73 years old and Caucasian) with a history of systemic arterial hypertension, diabetes mellitus, liver cirrhosis, and Chagas disease associated with megacolon and megaesophagus. After cardiac collapse and 30 minutes of cardiopulmonary resuscitation (CPR), unfortunately the patient died. Case two: A female patient (64 years old and Caucasian), with a history of systemic arterial hypertension, obesity, and Chagas disease. After 23 days of hospitalization, pharmacological therapy, and implantation of a cardioverter defibrillator, the patient was discharged. People with Chagas disease are at a higher risk of CA. The researchers believe that a prompt and efficient treatment (advanced life support) allied with educational programs on CA recognition targeted at health professionals and caregivers (basic life support knowledge) could improve the prognoses of these patients.UFES, CEFD, Espirito Santo, ES, BrazilUniv Fed Sao Paulo UNIFESP, Escola Paulista Enfermagem, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Fisiol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Escola Paulista Med, Sao Paulo, SP, BrazilUniv Fed Goias, Setor Fisiol Humana & Exercicio, Goiania, Go, BrazilUniv Fed Sao Paulo UNIFESP, Escola Paulista Enfermagem, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Fisiol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Escola Paulista Med, Sao Paulo, SP, BrazilWeb of Scienc

Estatinas para a progressão da estenose da valva aórtica e a melhor evidência para tomar decisões em saúde

In the Western world, calcified aortic valve stenosis is the most common form of valvular heart disease, affecting up to 3% of adults over the age of 75 years. It is a gradually progressive disease, characterized by a long asymptomatic phase that may last for several decades, followed by a short symptomatic phase associated with severe restriction of the valve orifice. Investigations on treatments for aortic valve stenosis are still in progress. Thus, it is believed that calcification of aortic valve stenosis is similar to the process of atherosclerosis that occurs in coronary artery disease. Recent studies have suggested that cholesterol lowering through the use of station may have a salutary effect on the progression of aortic valve stenosis.Fac Med Marilia Famema, Sao Paulo, BrazilUniv Fed Sao Paulo Escola Paulista Med Unifesp EP, Hosp Sao Paulo, Dept Emergency Serv, Sao Paulo, BrazilUniv Fed Sao Paulo Escola Paulista Med Unifesp EP, Hosp Sao Paulo, Emergency Intens Care Unit, Sao Paulo, BrazilBrazilian Cochrane Ctr, Sao Paulo, BrazilUniv Fed Sao Paulo Escola Paulista Med Unifesp EP, Hosp Sao Paulo, Dept Emergency Serv, Sao Paulo, BrazilUniv Fed Sao Paulo Escola Paulista Med Unifesp EP, Hosp Sao Paulo, Emergency Intens Care Unit, Sao Paulo, BrazilWeb of Scienc

Statins for aortic valve stenosis

Background Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. Objectives To evaluate the effectiveness and safety of statins in aortic valve stenosis. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS ‐ IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions. Selection criteria Randomised controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalisation for any reason, overall mortality, adverse events and patient quality of life. Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. Main results We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low‐quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) ‐0.54, 95% confidence interval (CI) ‐1.88 to 0.80; participants = 1935; studies = 2), valve area (MD ‐0.07, 95% CI ‐0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD ‐0.06, 95% CI ‐0.26 to 0.14; participants = 155; study = 1). Moderate‐quality evidence showed no effect on freedom from valve replacement with statins (risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies = 4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75 to 1.09; participants = 2204; studies = 3; moderate‐quality evidence). Low‐ and very low‐quality evidence showed uncertainty around the effect of statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15; participants = 2297; studies = 3; low‐quality evidence) and hospitalisation for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants = 155; study = 1; very low‐quality evidence). None of the four included studies reported on overall mortality and patient quality of life. Authors' conclusions Result findings showed uncertainty surrounding the effect of statins for aortic valve stenosis.The quality of evidence from the reported outcomes ranged from moderate to very low. These results give support to European and USA guidelines (2012 and 2014, respectively) that so far there is no clinical treatment option for aortic valve stenosis.Brazilian Cochrane Centre, Federal University of Sao Paulo and Marilia Medical, BrazilDepartment of Education in Health Sciences,Marilia Medical School, Marilia, BrazilDepartment of Psychiatry and Evidence BasedHealth Actions, Marilia Medical School, Marilia, BrazilInstitute of Health Informatics, University College London, London, UK.Brazilian Cochrane Centre, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, BrazilBrazilian Cochrane Centre, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 598, BR-04039001 Sao Paulo, BrazilBrazilian Cochrane Centre, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 598, BR-04039001 Sao Paulo, BrazilWeb of Scienc

Characterization of cardiac arrest in the emergency department of a Brazilian University Reference Hospital: A prospective study

Background & objectives: Sudden cardiac arrest (CA) represents one of the greatest challenges for medicine due to the vast number of cases and its social and economic impact. Despite advances in cardiopulmonary resuscitation (CPR) techniques, mortality rates have not significantly decreased over decades. This study was undertaken to characterize patients that have suffered CA and to identify factors related to mortality. Methods: This prospective study was conducted at Emergency Department of Sao Paulo Hospital, Brazil. Two hundred and eighty five patients were followed for one year after treatment for CA. The mean age was 66.3 +/- 17.2 yr, and they were predominantly male (55.8%) and Caucasian (71.9%). Mortality rate and factors associated with mortality were the primary and secondary outcome measures. Data were collected using an in-hospital Utstein-style report. A logistic regression analysis was used to determine which variables were related to mortality. Results: Regarding the characteristics of CPR, 76.5 per cent occurred in hospital, respiratory failure was the most common presumed immediate cause of CA (30.8%) and pulseless electrical activity was the most frequent initial rhythm (58.7%). All attempts at CPR utilized chest compressions and ventilation and the most utilized interventions were epinephrine (97.2%) and intubation (68.5%). Of all patients treated, 95.4 per cent died. Patients with pulseless electrical activity had a higher risk of death than those patients with ventricular fibrillation. Interpretation & conclusions: The findings of the study highlighted that the mortality rate among CA patients was high. The variable that best explained mortality was the initial CA rhythm.Univ Fed Sao Paulo, Paulista Sch Nursing, 754 Napoleao Barros St, BR-04024002 Sao Paulo, SP, BrazilUniv Fed Espirito Santo, 173 Feliciano Bicudo St, BR-02301020 Sao Paulo, SP, BrazilUniv Fed Goias, BR-74001970 Goiania, Go, BrazilUniv Fed Sao Paulo, 862 Botucatu St, BR-04023062 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, 740 Botucatu St, BR-04023062 Sao Paulo, SP, BrazilPaulista School of Nursing/Universidade Federal de São Paulo (UNIFESP), 754 Napoleao de Barros Street, São Paulo, SP 04024-002, BrazilUniversidade Federal de São Paulo (UNIFESP), 862 Botucatu Street, Sao Paulo, SP 04023-062, BrazilPaulista School of Medicine/ Universidade Federal de São Paulo (UNIFESP), 740 Botucatu Street, Sao Paulo, SP 04023-062, BrazilWeb of Scienc