Correlaçao entre eletrocardiograma e funçao sistólica na presença de bloqueio de ramo esquerdo

FUNDAMENTO: O bloqueio de ramo esquerdo (BRE) está associado à disfunçao sistólica e diastólica. Entretanto, o BRE pode ser registrado na ausência de disfunçao ventricular. OBJETIVO: Avaliar a correlaçao entre alteraçoes eletrocardiográficas em pacientes com BRE e a funçao sistólica. MÉTODOS:Dados arquivados de pacientes com BRE, que realizaram ECG e ecocardiograma, com avaliaçao da funçao ventricular e medida da fraçao de ejeçao (FE). Disfunçao sistólica foi considerada quando a FE RESULTADOS: 105 pacientes estudados, com 65, 4 ± 13,8 anos, QRS de 150,1 ± 24,2; 72 (69%) com disfunçao e 33 (31%) com funçao ventricular preservada. Os seguintes parâmetros apresentaram correlaçao com a FE: duraçao do QRS (> 160 ms), desvio do eixo para esquerda ou direita (> -30° ou > +90° PF), sobrecarga atrial esquerda-SAE (onda P > 0,12 s e/ou fase negativa em V1 > 1 mm2), amplitude da onda S em V3 e V4 e entalhe no QRS nas derivaçoes inferiores. Na análise multivariada duraçao do QRS, SAE e S de V4 se correlacionam com a FE. A presença de duas ou três das alteraçoes apresentou VPP de 98,0% e VPN de 60,4% para predizer FE reduzida. CONCLUSAO: A duraçao do QRS (> 160 ms), SAE e S em V4 > 12 mm apresentam correlaçao com disfunçao sistólica em pacientes com BRE. A presença > 2 das alteraçoes é um marcador de disfunçao ventricular

Correlaçao entre eletrocardiograma e funçao sistólica na presença de bloqueio de ramo esquerdo

FUNDAMENTO: O bloqueio de ramo esquerdo (BRE) está associado à disfunçao sistólica e diastólica. Entretanto, o BRE pode ser registrado na ausência de disfunçao ventricular. OBJETIVO: Avaliar a correlaçao entre alteraçoes eletrocardiográficas em pacientes com BRE e a funçao sistólica. MÉTODOS:Dados arquivados de pacientes com BRE, que realizaram ECG e ecocardiograma, com avaliaçao da funçao ventricular e medida da fraçao de ejeçao (FE). Disfunçao sistólica foi considerada quando a FE RESULTADOS: 105 pacientes estudados, com 65, 4 ± 13,8 anos, QRS de 150,1 ± 24,2; 72 (69%) com disfunçao e 33 (31%) com funçao ventricular preservada. Os seguintes parâmetros apresentaram correlaçao com a FE: duraçao do QRS (> 160 ms), desvio do eixo para esquerda ou direita (> -30° ou > +90° PF), sobrecarga atrial esquerda-SAE (onda P > 0,12 s e/ou fase negativa em V1 > 1 mm2), amplitude da onda S em V3 e V4 e entalhe no QRS nas derivaçoes inferiores. Na análise multivariada duraçao do QRS, SAE e S de V4 se correlacionam com a FE. A presença de duas ou três das alteraçoes apresentou VPP de 98,0% e VPN de 60,4% para predizer FE reduzida. CONCLUSAO: A duraçao do QRS (> 160 ms), SAE e S em V4 > 12 mm apresentam correlaçao com disfunçao sistólica em pacientes com BRE. A presença > 2 das alteraçoes é um marcador de disfunçao ventricular

Transfusion practices in brazilian Intensive Care Units (pelo FUNDO-AMIB)

BACKGROUND AND OBJECTIVES: Anemia of critical illness is a multifactorial condition caused by blood loss, frequent phlebotomies and inadequate production of red blood cells (RBC). Controversy surrounds the most appropriate hemoglobin concentration trigger for transfusion of RBC. We aimed to evaluate transfusion practices in Brazilian ICUs. METHODS: A prospective study throughout a 2-week period in 19 Brazilian ICUs. Hemoglobin (Hb) level, transfusion rate, organ dysfunction assessment and 28-day mortality were evaluated. Primary indication for transfusion and pretransfusion hemoglobin level were collected for each transfusion. RESULTS: Two hundred thirty-one patients with an ICU length of stay longer than 48h were included. An Hb level lower than 10 g/dL was found in 33% on admission in the ICU. A total of 348 RBC units were transfused in 86 patients (36.5%). The mean pretransfusion hemoglobin level was 7.7 ± 1.1 g/dL. Transfused-patients had significantly higher SOFA score (7.9 ± 4.6 vs 5.6 ± 3.8, p < 0.05, respectively), days on mechanical ventilation (10.7 ± 8.2 vs 7.2 ± 6.4, p < 0.05) and days on vasoactive drugs (6.7 ± 6.4 vs 4.2 ± 4.0, p < 0.05) than non-transfused patients despite similar APACHE II scores (15.2 ± 8.1 vs 14.2 ± 8.1, NS). Transfused patients had higher mortality rate (43.5%) than non-transfused patients (36.3%) (RR 0.60-1.15, NS). Only one patient (0.28%) had febrile non-hemolytic transfusion and urticarial reactions. CONCLUSIONS: Anemia is common in critically ill patients.It seems from the present study that transfusion practices in Brazil have had a more restrictive approach with a lower limit transfusion trigger.JUSTIFICATIVA E OBJETIVOS: A anemia é uma condição comum em pacientes graves. A transfusão de hemoderivados aumenta de forma significativa o risco de transmissão de agentes infecciosos e afeta o perfil imunológico. O objetivo deste estudo foi avaliar a incidência de anemia e a prática de transfusão de hemácias em UTI brasileiras. MÉTODO: Estudo prospectivo, multicêntrico, realizado em 19 UTI em um período de duas semanas. A presença de anemia, as indicações e a utilização de concentrados de hemácias, foram avaliadas diariamente. As complicações que ocorreram durante a internação na UTI e após a transfusão da primeira unidade de concentrado de hemácias foram registradas. RESULTADOS: Um total de 33% apresentava anemia na admissão na UTI e esta proporção aumentou para 55% no final de sete dias de internação. Um total de 348 unidades de concentrado de hemácias foi transfundido em 86 pacientes (36,5%). A média de suas unidades por paciente foi 4,1 ± 3,3 U. O nível de hemoglobina limiar para a transfusão de CH foi 7,7 ± 1,1 g/dL. Pacientes transfundidos tinham mais disfunções orgânicas avaliadas pelo escore SOFA (7,9 ± 4,6 versus 5,6 ± 3,8, transfundidos versus não transfundidos, p < 0,05). As taxas de mortalidade foram 43,5% e 36,3% em pacientes transfundidos e não transfundidos, respectivamente (RR 0,61-11,7, NS). Pacientes transfundidos tiveram número maior de complicações (1,58 ± 0,66 versus 1,33 ± 0,49, p = 0,0001). CONCLUSÕES: A anemia é comum em UTI brasileiras. O limiar transfusional de hemoglobina foi menor do que o observado em outros paises.Faculdade de Medicina de São José do Rio PretoUniversidade de São PauloUFRGS Departamento de Medicina Interna HC de Porto AlegreUniversidade Paris VIUFRJ CTI dos Hospitais Cardiotrauma Ipanema e São LucasAMIBUniversidade Estadual de LondrinaUFRGS FAMED HCPAFaculdade de Medicina de CatanduvaUNIFESP-EPMFundação Padre Albino UTI do Complexo HospitalarUniversidade Federal de São Paulo (UNIFESP) Disciplina de Anestesiologia, Dor e Terapia Intensiva Setor de TerapiaSanta Casa de Misericórdia de São PauloHospital Unimed de LimeiraUTI do Hospital Regional de AssisAMIB Departamento de MedicinaAmerican CollegeFundação Getúlio VargasHospital Pró CardíacoUNIRIOFGVHospital Santa Helena de GoiâniaHospital evangélico de Cachoeiro de Itapemirim Unidade coronarianaSBNHospital Evangélico Cachoeiro de Itapemirim UTI Adulto e CoronarianaUFRJUFRN Hospital Onofre Lopes UTIHospital Novo AtibaiaUNIFESP, EPMUNIFESP, Disciplina de Anestesiologia, Dor e Terapia Intensiva Setor de TerapiaSciEL

Ciprofibrate therapy in patients with hypertriglyceridemia and low high density lipoprotein (HDL)-cholesterol: greater reduction of non-HDL cholesterol in subjects with excess body weight (The CIPROAMLAT study)

BACKGROUND: Hypertriglyceridemia in combination with low HDL cholesterol levels is a risk factor for cardiovascular disease. Our objective was to evaluate the efficacy of ciprofibrate for the treatment of this form of dyslipidemia and to identify factors associated with better treatment response. METHODS: Multicenter, international, open-label study. Four hundred and thirty seven patients were included. The plasma lipid levels at inclusion were fasting triglyceride concentrations between 1.6–3.9 mM/l and HDL cholesterol ≤ 1.05 mM/l for women and ≤ 0.9 mM/l for men. The LDL cholesterol was below 4.2 mM/l. All patients received ciprofibrate 100 mg/d. Efficacy and safety parameters were assessed at baseline and at the end of the treatment. The primary efficacy parameter of the study was percentage change in triglycerides from baseline. RESULTS: After 4 months, plasma triglyceride concentrations were decreased by 44% (p < 0.001). HDL cholesterol concentrations were increased by 10% (p < 0.001). Non-HDL cholesterol was decreased by 19%. A greater HDL cholesterol response was observed in lean patients (body mass index < 25 kg/m(2)) compared to the rest of the population (8.2 vs 19.7%, p < 0.001). In contrast, cases with excess body weight had a larger decrease in non-HDL cholesterol levels (-20.8 vs -10.8%, p < 0.001). There were no significant complications resulting from treatment with ciprofibrate. CONCLUSIONS: Ciprofibrate is efficacious for the correction of hypertriglyceridemia / low HDL cholesterol. A greater decrease in non-HDL cholesterol was found among cases with excess body weight. The mechanism of action of ciprofibrate may be influenced by the pathophysiology of the disorder being treated

Atorvastatin decreases bone loss, inflammation and oxidative stress in experimental periodontitis.

The aim of this study is to determine the effects of Atorvastatin treatment, an inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, in periodontal disease. Male Wistar albino rats were randomly divided into five groups of ten rats each: (1) non-ligated treatment (NL), (2) ligature only (L), (3) ligature plus 1 mg/kg Atorvastatin daily for 10 days, (4) ligature plus 5 mg/kg Atorvastatin daily for 10 days, and (5) ligature plus 10 mg/kg Atorvastatin daily for 10 days. Following the treatment course, the periodontal tissue of the animals was analyzed by Measurement of alveolar bone loss, Histopathology and immunohistochemistry to determine of the expression of COX-2, MMP-2, MMP9, and RANKL/RANK/OPG. ELISA assay was used to quantitate the levels of IL-1β, IL-10, TNF-α, myeloperoxidase, malondialdehyde, and glutathione. The periodontal group treated with 10 mg/kg of Atorvastatin (3.9±0.9 mm; p<0.05) showed reverse the alveolar bone loss caused Experimental Periodontal Disease compared to (L) (7.02±0.17 mm). The periodontal group treated with 10 mg/kg of Atorvastatin showed a significant reduction in MPO and MDA (p<0.05) compared to ligature only group (L). Similarly in this group, the levels of the proinflammatory cytokines IL-1β and TNF-α were significantly decreased (p<0.05). Furthermore, MMP-2, MMP-9, RANKL/RANK, and COX-2 were all downregulated by Atorvastatin treatment, while OPG expression was increased. The findings support a role of Atorvastatin for reducing the bone loss, inflammatory response, oxidative stress, and expression of extracellular matrix proteins, while reducing RANK/RANKL and increase OPG in periodontal disease

Effect of Atorvastatin treatment on alveolar bone loss associated with experimental periodontitis Disease (EPD) in rats.

<p>Values are expressed as means± SEM (###p<0.001, *p<0.05; determined with ANOVA and Tukey'stest).</p

Microscopic analysis.

<p>(A) Normal periodontium and (B) periodontium from a rat presenting with periodontitis (treated with saline) showing alveolar bone and cementumresorption and inflammatory cell infiltration. (C) Reduced inflammation and alveolar bone loss in the periodontium of rats treated with Atorvastatin (10 mg/kg) for 10 days. Sections were stained with H&E. Microscopic original magnification at 40×. Scale bars = 100 µm. G = gingiva; PL = Periodontal ligament; D = dentin; AB = alveolar bone; C = Cementum; a = increased bone loss in AB; b = resorption of cementum; c = inflammatory process in PL and intense destruction of collagen fibers in the PL; e = decreased inflammation process in PL anddiscrete destruction ofcollagen fibers in PL; f = decreasedbone loss in AB.</p

Clinical characteristics of teeth and periodontal tissue.

<p>(A) Samples from the NL group, with no resorption of the alveolar bone. (B) Samples from the L group, where severe bone resorption with root exposure is observed (Arrows). (C) Samples from the L group treated with Atorvastatin 10 mg/Kg, where decreased bone resorption is observed (Arrows). Images were obtained at an original magnification of 1.7×.</p