Anatomia de la auriculilla izquierda: análisis comparativo por ecocardiografia transesofagica bidimensional y tridimensional

Introducción. La auriculilla izquierda es una estructura cardiaca que facilita la generación de trombos en su interior, favoreciendo la aparición de evento embolicos, por lo que su análisis a partir de imágenes bidimensionales y mas recientemente tridimensionales, adquieren cada vez mayor importancia Objetivo. Comparar los hallazgos anatómicos de la auriculilla izquierda obtenidos a través de la ecocardiografía tridimensional con respecto a los obtenidos por ecocardiografía bidimensional en un grupo de pacientes con ritmo sinusal y con fibrilación auricular. Métodos. Se trata de un estudio observacional analítico, transversal, en el que se compararan los resultados en las mediciones anatómicas obtenidas por ecocardiograma bidimensional en pacientes con rimo sinusal y fibrilación auricular, con los resultados de dichas mediciones obtenidas a través del ecocardiograma tridimensional en el mismo grupo de pacientes. Resultados. Se evaluaron 48 pacientes, 32 pacientes (66%) se encontraron en ritmo sinusal, la edad promedio fue de 58,2 años; 41,7% fueron mujeres y la mayoría, 32 pacientes (66,7%), tenían una o varias comorbilidades de importancia de riesgo cardiovascular, con evidencia de compromiso de la función sistólica en 20 paciente, encontrando una mayor homogeneidad en las variables área y profundidad de la auriculilla izquierda. Discusión. Los resultados nos permiten apoyar el concepto que las imágenes obtenidas por ecocardiografía tridimensional nos ofrecen una mejor evaluación de la auriculilla izquierda, observando una mayor homogeneidad con la ecocardiografía bidimensional en las variables área y profundidad, existiendo a su vez heterogeneidad en la variable longitud. Conclusión. El presente estudio demostró que la ecocardiografía tridimensional, es un aporte importante desde el punto de vista diagnostico tanto cualitativo como cuantitativo en el análisis de la auriculilla izquierda, permitiendo una fácil adquisición de imágenes en tiempo real y comparativas con las imágenes bidimensionales.

Comparación de la severidad y extensión de la enfermedad coronaria multivaso por Syntax Score en una poblaciòn de las Antillas Holandesas vs controles nacionales

En la Enfermedad Coronaria (EC) existen factores genéticos, socioculturales, medioambientales y raciales adicionales a los factores de riesgo cardiovascular mayores que podrían influir en su presentación. Se desconoce el impacto de la raza en la severidad de la enfermedad coronaria en los pacientes extranjeros que son enviados a nuestro Servicio. Objetivos: Comparar la severidad de la EC multivaso en una población de pacientes de las Antillas y Nacionales, pareados por la escala Framingham. Metodología: Realizamos un estudio de corte transversal, comparando pacientes colombianos contra pacientes provenientes de las Antillas holandesas con similares factores de riesgo según escala de Framingham, catalogándolos por grupos de riesgo bajo, intermedio, alto y muy alto. Todos con EC severa multivaso documentada por angiografía coronaria desde enero del 2009 hasta Junio de 2011. Se excluyeron pacientes con antecedentes de intervención percutánea o quirúrgica previa. Resultados: Ingresaron 115 pacientes internacionales y 115 pacientes nacionales. La relación hombres/mujeres 3:1. La proporción de grupos de riesgo fue de bajo riesgo 2.5%, intermedio 15%, alto 19.3%, y muy alto 63.4%. El Syntax Score en pacientes nacionales fue 14.3+/-7.4 y en internacionales 22.2+/-10.5 p: 0.002. Conclusiones: En pacientes provenientes de las Antillas Holandesas, valorados en nuestra institución, se observó una mayor severidad de la enfermedad coronaria comparada con una población nacional con factores de riesgo similares. Estos hallazgos sugieren la influencia de la raza y factores genéticos en la severidad y extensión de la EC

Primary Prevention and Screening Strategies for Colorectal Cancer: Which Strategy Should Take?

Objective: To explore and define the utility of different strategies for primary prevention (ASA, diet, physical activity) and strategies of screening test (FOBT, sigmoidoscopy, colonoscopy, etc.) for colorectal cancer. Data source: Databases consulted were MEDLINE (1966 to 2006), DARE (1980 to 2006), Cochrane Central Register of Controlled Trials, Cochrane Collaboration’s Registry of Clinical Trials, Cochrane Database of Systematic Reviews and LILACS. Study selection: Studies such clinical trial, cohort and case-control studies of the effectiveness of tests for screening and primary prevention adenoma and colorectal cancer were identified by two reviewers. Data Extraction: The extraction of data and its evaluation is done in most of the process so paired. Limitations: Not strictly complies with the methodology of a systematic review and therefore reproducibility is questionable, the conclusions of this study should be extrapolated with caution. Conclusions: The major strategy of screening on the effectiveness of early detection of premalignant lesions or cancer is colonoscopy every 5 years, however it is necessary to evaluate this measure cost-effectiveness studies. For primary prevention, aspirin and cyclooxygenase-2 inhibitors reduce the incidence of colorectal adenomas. Aspirin can reduce colorectal cancer incidence. However, these medications may be associated with a significant risk of cardiovascular events and gastrointestinal bleeding. The balance between risks and benefits must be evaluated in future studies.

Factores de riesgo del comportamiento y readiness de aficionados inscritos a carreras atléticas de fondo de 18-64 años en Bogotá D.C., 2014”

La participación en carreras atléticas de calle ha aumentado; esto requiere detectar riesgos previos al esfuerzo físico. Objetivo. Identificar factores de riesgo del comportamiento y readiness de inscritos a una carrera. Método. Estudio transversal en aficionados de 18-64 años. Encuesta digital con módulos de IPAQ, PARQ+ y STEP. Muestreo aleatorio sistemático con n=510, para una inactividad física esperada de 35% (±5%). Se evaluó nivel de actividad física, consumo de alcohol (peligroso), de fruta, verdura, tabaco y sal, y readiness. Resultados. El cumplimiento de actividad física fue 97,4%; 2,4% consume nivel óptimo de fruta o verdura (diferencias por edad, sexo y estrato), 3,7% fuma y 44,1% consumo peligroso de alcohol. El 19,8% reportó PARQ+ positivo y 5,7% requiere supervisión. Hay diferencias por trabajo y estudio. Discusión. Los aficionados cumplen el nivel de actividad física; pero no de otros factores. Una estrategia de seguridad en el atletismo de calle es evaluar los factores de riesgo relacionados con el estilo de vida así como el readiness.

Evaluación de intervención de alertas para riesgo cardiovascular por diclofenaco en afiliados al régimen contributivo 2014 -2015

El objetivo fue evaluar la intervención de las alertas en la prescripción de diclofenaco. Estudio observacional, comparativo, post intervención, de un antes después, en pacientes con prescripción de diclofenaco. Se evaluó la intervención de las alertas restrictivas antes y después de su implementación en los pacientes prescritos con diclofenaco y que tenían asociado un diagnóstico de riesgo cardiovascular según CIE 10 o eran mayores de 65 años. Un total de 315.135 transacciones con prescripción de diclofenaco, en 49.355 pacientes promedio mes. El 94,8% (298.674) de las transacciones fueron prescritas por médicos generales.

Resonancia magnética cardiaca: medidas lineales y volumétricas en adultos sanos

Introducción: La gran mayoría de las medidas de normalidad utilizadas para la interpretación de resonancia cardiaca son extrapoladas de las medidas de ecocardiografía. Los limitados registros de medidas de normalidad se encuentran ajustados en poblaciones extranjeras, no hay registros en latinoamericanos. Objetivo: Determinar las dimensiones cardiacas utilizando resonancia magnética en una población de personas sin antecedente médicos con repercusión cardiaca para lograr una muestra de valores que permitan ajustar las medidas de normalidad utilizadas por nuestro servicio. Materiales y métodos: se analizaron 45 sujetos sanos con edad comprendida entre los 21 y 45 años, las adquisiciones se realizaron utilizando un equipo de RM de 1,5 teslas, el análisis de las imágenes se realizó mediante el programa Cardiac Volume Vx. Se evaluaron múltiples parámetros morfofuncionales a través de análisis estadístico por medio del sistema SPSS versión 23. Resultados: Mediciones obtenidas de ventrículo izquierdo principales fueron volumen diastólico en mujeres de 62 ml +/- 7.1 y en hombres de 65 ml +/- 11.2 y fracción de eyección de 60 % +/- 5 en mujeres y de 62 % +/- 9 en hombres. En ventrículo derecho el volumen diastólico final se encontró 81.8 ml +/- 14.6 en mujeres y 100 ml +/- 24.8 en hombres y fracción de eyección de 53 % +/- 17 en mujeres y de 45 % +/- 12 en hombres. Volumen de fin de diástole de 50 +/- 12.7 ml en mujeres y de 49 ml +/- 19 ml en hombres y fracción de eyección de aurícula izquierda de 55 % +/- 0.08 en mujeres y de 50 % +/- 0.07 en hombres. Volumen de fin de diástole de 44.1 ml +/- 18.5 en mujeres y de 49.2 ml +/- 22.9 en hombres y fracción de eyección de aurícula derecha de 50 % +/- 11 en mujeres y de 45 % +/- 8 en hombres. Se obtuvieron otras medidas lineales y volumétricas adicionales de cavidades cardiacas y de grandes vasos supracardiacos. Conclusiones: se describen los valores de referencia de los parámetros morfofuncionales de las cavidades cardiacas y de vasos supracardiacos. El sexo fue tenido en cuenta como covariable relacionada con la modificación de los parámetros evaluados. Se sugieren variaciones en las medidas de cavidades cardiacas para la población estudiada relacionada con aclimatación crónica a la altitud de la ciudad de Bogotá.

Anti-platelet effect of aspirin is substantially reduced after administration of heparin during carotid endarterectomy

OBJECTIVES: Aspirin therapy is usually continued throughout the perioperative period to reduce the risk for thromboembolic stroke and myocardial infarction after carotid endarterectomy (CEA). Aspirin irreversibly binds cyclooxygenase-1, thereby reducing platelet aggregation for the lifetime of each platelet. However, recent research from this unit has shown that aggregation in response to arachidonic acid increases significantly, but transiently, during CEA, which suggests that the anti-platelet effect of aspirin is temporarily reversed. The purpose of the current study was to determine when this phenomenon occurs and to identify the possible mechanisms involved. METHODS: Platelet aggregation was measured in platelet-rich plasma from 41 patients undergoing CEA who were stabilized with 150 mg of aspirin daily. Blood was taken at 8 time points: before anesthesia, after anesthesia, before heparinization, 3 minutes after heparinization, 3 minutes after shunt insertion, 10 minutes after flow restoration, 4 hours postoperatively, and 24 hours postoperatively. Platelet aggregation was also measured at similar times in a group of 18 patients undergoing peripheral angioplasty without general anesthesia. RESULTS: All patient platelets were effectively inhibited by aspirin at the start of the operation. There was a significant intraoperative increase in platelet response to arachidonic acid in both groups of patients, which occurred within 3 minutes of administration of unfractionated heparin. In the CEA group this resulted in a greater than 10-fold increase in mean aggregation, to 5 mmol/L of arachidonic acid (5 mmol/L), rising from 3.9% +/- 2.2% preoperatively to 45.1% +/- 29.3% after administration of heparin ( P <.0001). This increased aggregation persisted into the early postoperative period, but by 24 hours post operation aggregation had returned to near preoperative values. Aggregation in response to other platelet agonists (adenosine diphosphate, thrombin receptor agonist peptide) showed only a small increase at the same time, which could be accounted for by a parallel increase in the level of spontaneous aggregation. CONCLUSION: Administration of heparin significantly increases platelet aggregation in response to arachidonic acid, despite adequate inhibition by aspirin administered preoperatively. This apparent reversal in anti-platelet activity persisted into the immediate early postoperative period, and could explain why a small proportion of patients are at increased risk for acute cardiovascular events after major vascular surgery, despite aspirin therapy.

A novel transport mechanism for MOMP in Chlamydophila pneumoniae and its putative role in immune-therapy

Major outer membrane proteins (MOMPs) of Gram negative bacteria are one of the most intensively studied membrane proteins. MOMPs are essential for maintaining the structural integrity of bacterial outer membranes and in adaptation of parasites to their hosts. There is evidence to suggest a role for purified MOMP from Chlamydophila pneumoniae and corresponding MOMP-derived peptides in immune-modulation, leading to a reduced atherosclerotic phenotype in apoE−/− mice via a characteristic dampening of MHC class II activity. The work reported herein tests this hypothesis by employing a combination of homology modelling and docking to examine the detailed molecular interactions that may be responsible. A three-dimensional homology model of the C. pneumoniae MOMP was constructed based on the 14 transmembrane β-barrel crystal structure of the fatty acid transporter from Escherichia coli, which provides a plausible transport mechanism for MOMP. Ligand docking experiments were used to provide details of the possible molecular interactions driving the binding of MOMP-derived peptides to MHC class II alleles known to be strongly associated with inflammation. The docking experiments were corroborated by predictions from conventional immuno-informatic algorithms. This work supports further the use of MOMP in C. pneumoniae as a possible vaccine target and the role of MOMP-derived peptides as vaccine candidates for immune-therapy in chronic inflammation that can result in cardiovascular events.

Influência dos marcadores inflamatórios sobre a evolução do estado nutricional e progressão da calcificação cardiovascular em pacientes portadores de doença renal crônica tratados por hemodiálise

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Spironolactone is secure and reduces left ventricular hypertrophy in hemodialysis patients

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Inibição sistêmica da NADPH oxidase: estudo do coração de ratos espontaneamente hipertensos com diabetes mellitus

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Inibição sistêmica da NADPH oxidase: estudo do coração de ratos espontaneamente hipertensos com diabetes mellitus

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Cardiovascular risk in Japanese-Brazilian subjects

Objective: To evaluate the prevalence of risk factors for cardiovascular disease in Japanese-Brazilian subjects. Subjects and methods: One hundred thirty-one residents of the Mombuca community were studied. Statistical analysis was based on the X-2 test, Fisher's Exact test, Student's t test, and ANOVA, at a 5% significance level. Results: The average age was 56.7 years-old; 76.3% had dyslipidemia, 24.4% pre-diabetes (PDM), 10.7% type 2 diabetes mellitus (T2DM), 46.6% hypertension, 52.7% abdominal obesity, and 35.8% metabolic syndrome (MS). There were significant correlations between HOMA-IR and MS diagnosis and obesity, while HOMA-beta levels were decreased in T2DM and PDM. The ankle-brachial index was positive for peripheral artery disease in 22.3% of the individuals. Electrocardiograms did not show increased evidence of myocardial ischemia. Conclusion: Subjects of this community are exposed to major cardiovascular risk factors, namely high prevalence of MS diagnoses and increased HOMA-IR. Arq Bras Endocrinol Metab. 2012; 56(9): 608-13

Surgical Treatment of Type 2 Diabetes in Patients with BMI Below 35: Mid-term Outcomes of the Laparoscopic Ileal Interposition Associated with a Sleeve Gastrectomy in 202 Consecutive Cases

The objective of this study was to evaluate the mid-term outcomes of the laparoscopic ileal interposition into the jejunum (JII-SG) or into the duodenum (DII-SG) associated with sleeve gastrectomy for type 2 diabetes mellitus (T2DM) patients with BMI below 35. The procedures were performed on 202 consecutive patients. Mean age was 52.2 +/- 7.5. Mean duration of T2DM was 9.8 +/- 5.2 years. Insulin therapy was used by 41.1%. Dyslipidemia was observed in 78.2%, hypertension in 67.3%, nephropathy in 49.5%, retinopathy in 31.2%, coronary heart disease in 11.9%, and other cardiovascular events in 12.9%. Mean follow-up was 39.1 months (range, 25-61). Early and late mortality was 0.99% and 1.0%, respectively. Early reoperation was performed in 2.5%. Early and late major complications were 8.4% and 3.5%. Early most frequent complications were pneumonia and ileus. Intestinal obstruction was diagnosed in 1.5%. Mean BMI decreased from 29.7 to 23.5 kg/m(2), mean fasting glucose from 202.1 to 112.2 mg/dl, and mean postprandial glucose from 263.3 to 130 mg/dl. Triglycerides diminished from a mean of 273.4 to 110.3 mg/dl and cholesterol from a mean of 204.7 to 160.1 mg/dl. Hypertension was resolved in 87.5%. Mean hemoglobin A(1c) (HbA(1c)) decreased from 8.7 to 6.2% after the JII-SG and to 5.9% following the DII-SG. HbA(1c) below 7% was seen in 89.9% of the patients and below 6.5% in 78.3%. Overall, 86.4% of patients were off antidiabetic medications. Both JII-SG and DII-SG demonstrated to be safe, effective, and long-lasting alternatives for the treatment of T2DM patients with BMI < 35. Beyond glycemic control, other benefits were achieved.

The role of myocardial scintigraphy in the assessment of cardiovascular risk in patients with end-stage chronic kidney disease on the waiting list for renal transplantation

The usefulness of stress myocardial perfusion scintigraphy for cardiovascular (CV) risk stratification in chronic kidney disease remains controversial. We tested the hypothesis that different clinical risk profiles influence the test. We assessed the prognostic value of myocardial scintigraphy in 892 consecutive renal transplant candidates classified into four risk groups: very high (aged epsilon 50 years, diabetes and CV disease), high (two factors), intermediate (one factor) and low (no factor). The incidence of CV events and death was 20 and 18, respectively (median follow-up 22 months). Altered stress testing was associated with an increased probability of cardiovascular events only in intermediate-risk (one risk factor) patients [30.3 versus 10, hazard ratio (HR) 2.37, confidence interval (CI) 1.693.33, P 0.0001]. Low-risk patients did well regardless of scan results. In patients with two or three risk factors, an altered stress test did not add to the already increased CV risk. Myocardial scintigraphy was related to overall mortality only in intermediate-risk patients (HR 2.8, CI 1.55.1, P 0.007). CV risk stratification based on myocardial stress testing is useful only in patients with just one risk factor. Screening may avoid unnecessary testing in 60 of patients, help stratifying for risk of events and provide an explanation for the inconsistent performance of myocardial scintigraphy.