The supplementation of L-carnitine in septic shock patients: Systematic review and meta-analysis

Background: Sepsis and septic shock are severe and difficult-to-treat conditions with high lethality. There is interest in identifying new adjunct therapies that are effective in reducing mortality. In this context, L-carnitine has been investigated in trials as a potentially beneficial drug. Therefore, the aim of this systematic review was to assess the clinical evidence to support the use of L-carnitine in septic shock patients to reduce the risk of mortality. The objective of this review was to evaluate the effect of L-carnitine compared to placebo or Usual Care (UC) on the mortality rate in hospitalized adult septic shock patients. Methods: The authors exclusively included randomized clinical trials that compared the use of L-carnitine versus placebo in adult (> 18 years old) septic shock patients. The outcome was a mortality rate of 28 days. This systematic review and meta-analysis were performed following the PRISMA guidelines and registered in PROSPERO with the ID CRD42020180499. Results: Following the initial search, 4007 citations were identified, with 2701 remaining after duplicate removal. Eight citations were selected for body text reading, and two were selected for inclusion. The studies enrolled 275 patients, with 186 in the carnitine arm and 89 in the placebo arm. The effect of L-carnitine uses in septic shock patients showed a difference risk of -0.03 (95% Confidence Interval: -0.15–0.10, I2 = 77%, p = 0.69) compared to placebo/in mortality rate with low quality of evidence. Conclusions: There is low-quality evidence that the use of L-carnitine has no significant effect on reducing 28-day mortality in septic shock patients

Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease

OBJECTIVES: The prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease according to disease severity has not yet been established. The aim of this study was to assess the prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease patients according to disease severity. METHODS: The study included 25 mild/moderate chronic obstructive pulmonary disease patients and 25 severe/very severe chronic obstructive pulmonary disease patients. All participants underwent clinical evaluation, spirometry and electrocardiography/echocardiography. RESULTS: Electrocardiography and echocardiography showed Q-wave alterations and segmental contractility in five (10%) patients. The most frequent echocardiographic finding was mild left diastolic dysfunction (88%), independent of chronic obstructive pulmonary disease stage. The proportion of right ventricular overload (

Association between phase angle, anthropometric measurements, and lipid profile in HCV-infected patients

OBJECTIVE: The objective of this study was to investigate the associations between phase angle, anthropometric measurements, and lipid profile in patients chronically infected with the hepatitis C virus. METHODS: A total of 160 consecutive patients chronically infected with the hepatitis C virus and who received treatment at the hepatitis C outpatient unit of our hospital from April 2010 to May 2011 were prospectively evaluated. Bioelectrical impedance analysis, anthropometric measurements, and serum lipid profile analysis were performed. RESULTS: Twenty-five patients were excluded. A total of 135 patients with a mean age of 49.8¡11.4 years were studied. Among these patients, 60% were male. The phase angle and BMI means were 6.5¡0.8°and 26.5¡4.8 kg/ m2, respectively. Regarding anthropometric variables, mid-arm circumference, mid-arm muscle circumference, and arm muscle area had a positive correlation with phase angle. In contrast, when analyzing the lipid profile, only HDL was inversely correlated with phase angle. However, in multiple regression models adjusted for age and gender, only mid-arm circumference (p = 0.005), mid-arm muscle circumference (p = 0.003), and arm muscle circumference (p = 0.001) were associated with phase angle in hepatitis C virus-infected patients.CONCLUSIONS: In conclusion, phase angle is positively correlated with anthropometric measures in our study. However, there is no association between phase angle and lipid profile in these patients. Our results suggest that phase angle is related to lean body mass in patients chronically infected with hepatitis C virus

Clinical and echocardiographic predictors of left ventricular remodeling following anterior acute myocardial infarction

OBJECTIVES: Coronary artery disease is the primary cause of death and is responsible for a high number of hospitalizations worldwide. Ventricular remodeling is associated with worse prognosis following ST-segment elevation myocardial infarction (STEMI) and is a risk factor for ventricular dysfunction and heart failure. This study aimed to identify the predictors of ventricular remodeling following STEMI. Additionally, we evaluated the clinical, laboratory, and echocardiographic characteristics of patients with anterior wall STEMI who underwent primary percutaneous intervention in the acute phase and at 6 months after the infarction. METHODS: This prospective, observational, and longitudinal study included 50 patients with anterior wall STEMI who were admitted to the coronary care unit (CCU) of a tertiary hospital in Brazil between July 2017 and August 2018. During the CCU stay, patients were evaluated daily and underwent echocardiogram within the first three days following STEMI. After six months, the patients underwent clinical evaluation and echocardiogram according to the local protocol. RESULTS: Differences were noted between those who developed ventricular remodeling and those who did not in the mean±standard deviation levels of creatine phosphokinase MB isoenzyme (CKMB) peak (no remodeling group: 323.7±228.2 U/L; remodeling group: 522.4±201.6 U/L; p=0.008) and the median and interquartile range of E/E’ ratio (no remodeling group: 9.20 [8.50–11.25] and remodeling group: 12.60 [10.74–14.40]; p=0.004). This difference was also observed in multivariate logistic regression. CONCLUSIONS: Diastolic dysfunction and CKMB peak in the acute phase of STEMI can be predictors of ventricular remodeling following STEMI

Influência da restrição dietética de vitamina A na redemodelação cardíaca pós-infarto

o objetivo de nosso estud a a Isa _ alimentar de vitamina A sobre a remodelação cardíaca a miocárdio em ratos. Métodos: Foram utilizadas ratas previamente hígidas, submetidas durante a gestação e lactação a duas dieta AIN-93 isenta de vitamina A + 4 REfg de dieta (dose fisiológica); 2) dieta AIN-93 isenta de vitamina A. Após o nascimento dos filhotes, os machos foram separados em gaiolas individuais. Os filhotes das ratas tratadas com dieta com dose fisiológica de vitamina A continuaram recebendo 4REfg de dieta e os filhotes das ratas tratadas com dieta isenta de vitamina A receberam 0.18 RE{g de dieta. Quando atingiram, aproximadamente 220 g, os ratos foram submetidos ao infarto experimental. Após 24 horas do procedimento os ratos foram divididos em grupo controle (Grupo C, nThe aim of this study was to ana vitamin A ingestion on cardiac remodeling after myocardial infarction in rats. Methods: wistar female rats during pregnancy and lactation were fed with two diets: 1) AIN-93 vitamin A sufficient diet (4 RE/g af diet) and 2) AIN-93 vitamin A free diet. After born, male rats were studied. Newborns from dams fed with AIN93 vitamin A ft-ee diet, aftet- weaning received AIN-93 with 0,18 RE(g of diet. Newborns from dams fed with AIN-93 vitamin A sufficient diet, after weaning, received the same diet until they were around 220 g~With 220 g the animaIs were submitted to myocardial infarction. After 24 hours from the procedure, the surviving rats were divided into two groups: contrai group (C group, n=25) that remain receiving AIN-93 vitamin A sufficient diet; and reduced vitamin A group (RVA group, n=26) that remain receiving AIN-93 with O,lB REfg of diet. The groups were observed during 3 months. After this period, they were submitted to morphometric, functional and biochemical analysis. Statistical analysis was performed with Student t-test and Mann-Whitney for comparisons between two groups when variables were continuous, and x2 when variables were categorical. The significant leveI was 5%. Results: There was no difference in weight at infarction moment and infarct size between the two groups (C=36,9 ± 9,6 %; RVA=36,3 ± B,9 %; p=O,BB). The mortality during the 3 months period after infarction was not different between the groups (C=4B%; RVA=50%, p=0,B91). RVA group showed higher aorta diameter [C=3,4 (3,1-3,6) mm; RVA=3,5 (3,43,9) mm, p=0,04], left ventricle diastolic diameter (C=9,4 ± 1,4 mm; RVA=10,5 ± 1,2 mm, p=0,04) and diastolic area in short axes(body weight(C=l,B ± 0,4 cm2fkg; RVA=2,1 ± 0,3 cm2fkg, p=0,03) than C group. Cansidering the variables that represent diastolic function, RVA group showed lower TRIV(RRO,5than C group... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES