925 resultados para Major cardiovascular events
Resumo:
The k-means cluster technique is used to examine 43 yr of daily winter Northern Hemisphere (NH) polar stratospheric data from the 40-yr ECMWF Re-Analysis (ERA-40). The results show that the NH winter stratosphere exists in two natural well-separated states. In total, 10% of the analyzed days exhibit a warm disturbed state that is typical of sudden stratospheric warming events. The remaining 90% of the days are in a state typical of a colder undisturbed vortex. These states are determined objectively, with no preconceived notion of the groups. The two stratospheric states are described and compared with alternative indicators of the polar winter flow, such as the northern annular mode. It is shown that the zonally averaged zonal winds in the polar upper stratosphere at 7 hPa can best distinguish between the two states, using a threshold value of 4 m s−1, which is remarkably close to the standard WMO criterion for major warming events. The analysis also determines that there are no further divisions within the warm state, indicating that there is no well-designated threshold between major and minor warmings, nor between split and displaced vortex events. These different manifestations are simply members of a continuum of warming events.
Resumo:
Background N-3 polyunsaturated fatty acids (PUFAs) from oily fish protect against death from cardiovascular disease. We aimed to assess the hypothesis that incorporation of n-3 and n-6 PUFAs into advanced atherosclerotic plaques increases and decreases plaque stability, respectively. Methods We did a randomised controlled trial of patients awaiting carotid endarterectomy. We randomly allocated patients control, sunflower oil (n-6), or fish-oil (n-3) capsules until surgery. Primary outcome was plaque morphology indicative of stability or instability, and outcome measures were concentrations of EPA, DHA, and linoleic acid in carotid plaques; plaque morphology; and presence of macrophages in plaques. Analysis was per protocol. Findings 188 patients were enrolled and randomised; 18 withdrew and eight were excluded. Duration of oil treatment was 7-189 days (median 42) and did not differ between groups. The proportions of EPA and DHA were higher in carotid plaque fractions in patients receiving fish oil compared with those receiving control (absolute difference 0.5 [95% CI 0.3-0.7], 0.4 [0.1-0.6], and 0.2 [0.1-0.4] g/100 g total fatty acids for EPA; and 0.3 [0.0-0.8], 0.4 [0.1-0.7], and 0.3 [0.1-0.6] g/100 g total fatty acids for DHA; in plaque phospholipids, cholesteryl esters, and triacylglycerols, respectively). Sunflower oil had little effect on the fatty acid composition of lipid fractions. Fewer plaques from patients being treated with fish oil had thin fibrous caps and signs of inflammation and more plaques had thick fibrous caps and no signs of inflammation, compared with plaques in patients in the control and sunflower oil groups (odds ratio 0.52 [95% CI 0.24-0.89] and 1.19 [1.02-1.57] vs control; 0.49 [0.23-0.90] and 1.16 [1.01-1.53] vs sunflower oil). The number of macrophages in plaques from patients receiving fish oil was lower than in the other two groups. Carotid plaque morphology and infiltration by macrophages did not differ between control and sunflower oil groups. Interpretation Atherosclerotic plaques readily incorporate n-3 PUFAs from fish-oil supplementation, inducing changes that can enhance stability of atherosclerotic plaques. By contrast, increased consumption of n-6 PUFAs does not affect carotid plaque fatty-acid composition or stability over the time course studied here. Stability of plaques could explain reductions in non-fatal and fatal cardiovascular events associated with increased n-3 PUFA intake.
Resumo:
Endothelial dysfunction and an associated increase in vascular tone are risk factors for cardiovascular disease and highly predictive of future cardiovascular events. A part of the benefits associated with increased intake of the long chain (LC) n-3 polyunsaturated fatty acids (PUFA), eicosapentaenoic acid and docosahexaenoic acid, found in fish oils is a positive impact on cardiovascular health. Here, the recent evidence from human observational and intervention trials are reviewed, and an insight into potential mechanisms underlying the impact of LC n-3 PUFA on vascular reactivity is provided.
Resumo:
In addition to their expected effects on lipid profile, lipid-lowering agents may reduce cardiovascular events because of effects on nonclassic risk factors such as insulin resistance and inflammation. Ezetimibe specifically blocks the absorption of dietary and biliary cholesterol as well as plant sterols. Although it is known that an additional reduction of low-density lipoprotein cholesterol (LDL-C) levels can be induced by the combination of ezetimibe with statins, it is not known if this can enhance some pleiotropic effects, which may be useful in slowing the atherosclerotic process. This study assessed the effects of simvastatin and ezetimibe, in monotherapy or in combination, on markers of endothelial function and insulin sensitivity. Fifty prediabetic subjects with normo- or mild-to-moderate hypercholesterolemia were randomly allocated to 2 groups receiving either ezetimibe (10 mg/d) or simvastatin (20 mg/d) for 12 weeks, after which the drugs were combined for both groups for an additional 12-week period. Clinical and laboratory parameters were measured at baseline and after 12 and 24 weeks of therapy. Homeostasis model assessment of insulin resistance index and the area under the curve of insulin were calculated. As expected, both groups receiving drugs in isolation significantly reduced total cholesterol, LDL-C, apolipoprotein B, and triglyceride levels; and additional reductions were found after the combination period (P <.05). After 12 weeks of monotherapy, plasminogen activator inhibitor-1 levels and urinary albumin excretion were lower in the simvastatin than in the ezetimibe group. No change in homeostasis model assessment of insulin resistance index, area under the curve of insulin, and adiponectin levels was observed tiller either the monotherapies or the combined therapy. However, simvastatin combined with ezetimibe provoked significant reductions in E-selectin and intravascular cellular adhesion molecule-1 levels that were independent of LDL-C changes. Our findings support claims that simvastatin may be beneficial in preserving endothelial function in prediabetic subjects with normo- or mild-to-moderate hypercholesterolemia. Alternatively, a deleterious effect of ezetimibe on the endothelial function is suggested, considering the increase in intravascular cellular adhesion molecule I and E-selectin levels. Simvastatin and ezetimibe, in isolation or in combination, do not interfere with insulin sensitivity. (C) 2010 Elsevier Inc. All rights reserved.
Resumo:
There have been only a few reports on the sympathoadrenal and renin-angiotensin systems in children of small gestational age. The purpose of the present study was to investigate plasma levels of ACE (angiotensin-converting enzyme) activity, angiotensin and catecholamines in 8- to 13-year-old children and to determine whether there are correlations between the components of these systems with both birthweight and BP (blood pressure) levels. This clinical study included 66 children (35 boys and 31 girls) in two groups: those born at term with an appropriate birthweight [AGA (appropriate-for-gestational age) group, n = 31] and those born at term but with a small birthweight for gestational age [SGA (small-for-gestational age) group, n = 35]. Concentrations of angiotensin, catecholamines and ACE activity were determined in plasma. Circulating noradrenaline levels were significantly elevated in SGA girls compared with AGA girls (P = 0.036). In addition, angiotensin 11 and ACE activity were higher in SGA boys (P = 0.024 and P = 0.050 respectively). There was a significant association of the circulating levels of both angiotensin 11 and ACE activity with BP levels in our study population. Although the underlying mechanisms that link restricted fetal growth with later cardiovascular events are not fully understood, the findings in the present study support the link between low birthweight and overactivity of both sympathoadrenal and renin-angiotensin systems into later childhood.
Resumo:
Severe climate changes culminating in at least three major glacial events have been recognized in the Neoproterozoic sedimentary record from many parts of the world Supportive to the global nature of these climatic shifts a considerable amount of data have been acquired from deposits exposed in Pan-African orogenic belts in southwestern and western Africa By comparison published data from the Pan-African belts in Central Africa are scarce We report here evidence of possibly two glacial events recorded in the Mintom Formation that is located on the margin of the Pan-African orogenic Yaounde belt in South-East Cameroon In the absence of reliable radiometric data only maximum and minimum age limits of 640 and 580 Ma respectively can at present be applied to the Mintom Formation The formation consists of two lithostratigraphic ensembles each subdivided in two members (i e in ascending stratigraphic order the Kol Metou Momibole and Atog Adjap Members) The basal ensemble exhibits a typical glacial to post-glacial succession It includes diamictites comprising cobbles and boulders in a massive argillaceous siltstone matrix and laminated siltstones followed by in sharp contact a 2 m-thick massive dolostone that yielded negative delta(13)C values (<-3 parts per thousand. V-PDB) similar to those reported for Marinoan cap carbonates elsewhere However uncertainty remains regarding the glacial influence on the siliciclastic facies because the diamictite is better explained as a mass-flow deposit and diagnostic features such as dropstones have not been seen in the overlying siltstones The Mintom Formation may thus provide an example of an unusual succession of non-glacial diamictite overlain by a truly glacial melt-related cap-carbonate We also report the recent discovery of ice-striated pavements on the structural surface cut in the Mintom Formation suggesting that glaciers developed after the latter had been deposited and deformed during the Pan-African orogeny Striations which consistently exhibit two principal orientations (N60 and N110) were identified in two different localities in the west of the study area on siltstones of the Kol Member and in the east on limestones of the Atog Adjap Member respectively N60-oriented striae indicate ice flow towards the WSW Assigning an age to these features remains problematical because they were not found associated with glaciogenic deposits Two hypotheses can equally be envisaged e either the striated surfaces are correlated (1) to the Gaskiers (or Neoproterozoic post-Gaskiers) glaciation and represent the youngest Ediacaran glacial event documented in the southern Yaounde belt or (2) to the Late Ordovician Hirnantian (Saharan) glaciation thereby providing new data about Hirnantian ice flows in Central Africa (C) 2010 Elsevier Ltd All rights reserved
Resumo:
A paleomagnetic study was carried out on the Late Jurassic Sarmiento Ophiolitic Complex (SOC) exposed in the Magallanes fold and thrust belt in the southern Patagonian Andes (southern Chile). This complex, mainly consisting of a thick succession of pillow-lavas, sheeted dikes and gabbros, is a seafloor remnant of the Late Jurassic to Early Cretaceous Rocas Verdes basin that developed along the south-western margin of South America. Stepwise thermal and alternating field demagnetization permitted the isolation of a post-folding characteristic remanence, apparently carried by fine grain (SD?) magnetite, both in the pillow-lavas and dikes. The mean ""in situ"" direction for the SOC is Dec: 286.9 degrees, Inc: -58.5 degrees, alpha-95: 6.9 degrees, N: 11 (sites). Rock magnetic properties, petrography and whole-rock K-Ar ages in the same rocks are interpreted as evidence of correlation between remanence acquisition and a greenschist facies metamorphic overprint that must have occurred during latest stages or after closure and tectonic inversion of the basin in the Late Cretaceous. The mean remanence direction is anomalous relative to the expected Late Cretaceous direction from stable South America. Particularly, a declination anomaly over 50 degrees is suggestively similar to paleomagnetically interpreted counter clockwise rotations found in thrust slices of the Jurassic El Quemado Fm. located over 100 km north of the study area in Argentina. Nevertheless, a significant ccw rotation of the whole SOC is difficult to reconcile with geologic evidence and paleogeographic models that suggest a narrow back-arc basin sub-parallel to the continental margin. A rigid-body 30 degrees westward tilting of the SOC block around a horizontal axis trending NNW, is considered a much simpler explanation, being consistent with geologic evidence. This may have occurred as a consequence of inverse reactivation of old normal faults, which limit both the SOC exposures and the Cordillera Sarmiento to the East. The age of tilting is unknown but it must postdate remanence acquisition in the Late Cretaceous. Two major orogenic events of the southern Patagonian Andes, in the Eocene (ca. 42 Ma) and Middle Miocene (ca. 12 Ma), respectively, could have caused the proposed tilting. (C) 2008 Elsevier B.V. All rights reserved.
Resumo:
This thesis has the aim to evaluate the role of gay spaces in Gran Canaria as a gay tourists destination with particular reference to gay exclusive resorts. The validation of the gay identity is a key motivation for homosexuals to travel, in order to connect with other homosexuals and experience the gay life that they might not be able to experience at home. Gay spaces have been defined both as liberated areas as well as ghettos, where the homosexuals are, in a way, restrained. The method chosen, a small number of semi- structured interviews with managers of gay exclusive resorts in Maspalomas, the hub of gay life in Gran Canaria, where major LGBT events are held, there is a gay friendly environment, a thriving gay scene and many gay exclusive resorts. In the case of Gran Canaria the gay-specific offer is complementary to the ‘regular’ tourism offer, as they coexist, complement and at times overlap. Nevertheless the gay centric holiday is still predominant amongst gay men, and it is likely to continue to be according to the informants. This is because gay tourists seek freedom and a sense of inclusion that they would not be able to find in mixed environments.
Resumo:
Stora idrottsevenemang är till stor del beroende av de intäkter som kommer från sponsrandeföretag. Inför skid-VM i Falun 2015 startade organisationen Beyond Skiing Foundation ABett projekt i form av ett sponsornätverk. Projektet kom att kallas Beyond Skiing och syftet varatt försöka locka regionala- företag, kommuner och organisationer att sponsra skid-VM.Tanken med sponsornätverket var att ge ett värde till projektets medlemmar som ville varamed och sponsra skid-VM, men som inte ville betala den summa pengar som krävdes för attbli huvudsponsorer till evenemanget.Syftet med denna undersökning är att förklara varför en heterogen grupp sponsorer utspriddaöver en stor region ingick i ett regionalt sponsornätverk. Urvalet bestod av medlemmarna iBeyond Skiing. Vidare gjordes ett urval att medlemmarna skulle vara lokaliserade i Dalarna,men utanför Falun. Anledningen till varför regionala sponsorer utan direkt geografiskkoppling till Falun valdes, var att kopplingen mellan deras sponsring av skid-VM kan påförhand ses som mer komplex och onaturlig jämfört med sponsorer från Falun, eftersomsponsring i mindre skala tenderar att röra samarbeten med sponsrade enheter inom samma ort.Data till studien samlades in genom fem kvalitativa telefonintervjuer. Resultatet indikerar påatt medlemmarna i Beyond Skiing hade tydliga kommersiella mål med sin sponsring av skid-VM och att sponsra endast genom goodwill var i detta fall mindre förekommande. Studien harvisat att sponsringssamarbetes specifika erbjudanden och regionala motiv har varit tvåbidragande orsaker till varför sponsorerna ville sponsra skid-VM. Särskilt nöjda varsponsorerna med nätverksträffarna som Beyond Skiing Foundation anordnade förmedlemmarna inom Beyond Skiing.
Resumo:
Introdução: Estudos sobre implicações clínicas da nova definição de infarto do miocárdio (IAM), incorporando novos marcadores de lesão miocárdica, são escassos na literatura. A prevalência de IAM e das suas complicações são diretamente dependentes do critério diagnóstico utilizado. Objetivo: Avaliar o impacto diagnóstico, prognóstico e econômico da nova definição de IAM proposta pela AHA/ ESC usando troponina T (TnT) como marcador de lesão cardíaca. Métodos: Um total de 740 pacientes com dor torácica admitidos na Emergência do Hospital de Clínicas de Porto Alegre no período de julho/ 1999 a janeiro/ 2002 foram incluídos no estudo. Creatina quinase total (CK), CK-MB atividade e TnT foram dosados em uma amostra de 363 pacientes, representativa de toda a coorte. Para redefinição de IAM foram utilizados como ponto de corte valores pico de TnT > 0,2 mg/dl. Os desfechos avaliados foram classificados como eventos cardíacos maiores (angina recorrente, insuficiência cardíaca congestiva, choque cardiogênico e óbito) e como procedimentos de revascularização. Também foram avaliados o manejo prescrito, os custos e o faturamento hospitalar. Resultados: Nos 363 pacientes com marcadores dosados, foram diagnosticados 59 casos de IAM (16%) pelos critérios clássicos; enquanto 40 pacientes (11%) tiveram o diagnóstico de IAM pelo critério redefinido, o que corresponde a um incremento de 71% na incidência. Pacientes com IAM redefinido eram significativamente mais idosos e do sexo masculino, apresentaram mais dor atípica e diabetes mellitus. Na análise multivariada, pacientes com infarto redefinido tiveram um risco 5,1 [IC 95% 1,0-28] vezes maior para óbito hospitalar e 3,4 [IC 95% 1,1-10] vezes maior para eventos combinados em relação aqueles sem IAM. O manejo dos casos de IAM redefinido foi semelhante ao manejo daqueles com IAM tradicional, exceto pelos procedimentos de revascularização que foram menos freqüentes (25% vs. 51%, P < 0,001). O grupo com IAM redefinido permaneceu mais tempo internado e foi submetido a procedimentos mais tardiamente. Do ponto de vista institucional, o uso dos novos critérios para IAM poderia resultar em um aumento de 9% (mais R$ 2.756,00 por grupo de 100 pacientes avaliados) no faturamento baseado em diagnóstico segundo a tabela do SUS. Conclusões: O novo diagnóstico de IAM acrescenta um número expressivo de indivíduos com infarto aos serviços de emergência. A incorporação deste critério é importante na medida que estes pacientes têm um prognóstico semelhante aos demais casos tradicionalmente diagnosticados. Como a identificação destes casos poderia resultar em um manejo mais qualificado e eficiente destes pacientes, esforços deveriam ser adotados para reforçar a adoção da redefinição de IAM.
Resumo:
A disfunção endotelial, avaliada através da vasodilatação mediada pelo fluxo (FMD) e não mediada pelo fluxo (NFMD), está associada à ocorrência de eventos cardiovasculares. Enquanto o consumo moderado de bebidas alcoólicas está associado com baixo risco para doenças cardiovasculares, a ingestão de doses mais altas predispõe a arritmias cardíacas, acidente vascular encefálico e outros eventos, que têm maior incidência no período da manhã. A investigação dos efeitos do álcool sobre a função endotelial pode trazer um melhor entendimento para esta associação. O presente estudo tem por objetivo avaliar, em uma amostra homogênea, o efeito de uma dose relativamente elevada de álcool sobre parâmetros vasculares e de função endotelial. O diâmetro da artéria braquial (DAB), a FMD e a NFMD foram mensurados em três horários (17h, 22h e 7h), em 100 indivíduos do sexo masculino, hígidos, com idades entre 18 e 25 anos (média de 20,74 anos), por ecodoppler da artéria braquial (segundo o protocolo da International Brachial Artery Reactivity Task Force). Os indivíduos foram randomizados para ingerir uma bebida contendo álcool ou uma bebida similar não alcoólica, às 18h. O grupo que consumiu álcool apresentou um aumento no DAB entre as 17h (4,03 mm) e 22h (4,41 mm). Ocorreu uma redução da FMD para 2,43% e da NFMD para 6,30% às 22h, quando comparados com os valores anteriores à ingestão (FMD = 4,22% e NFMD = 13,7%). Foi constatado um efeito bifásico para a pressão arterial sistólica (PAS) e diastólica (PAD), com redução às 22h (PAS = 105,18 mmHg; PAD = 60,14 mmHg), seguida de elevação às 7h (PAS = 117,50 mmHg; PAD = 70,98 mmHg). Conclui-se que, após um período inicial de vasodilatação, a ingestão aguda de álcool não afeta a função endotelial, comparado ao placebo.
Resumo:
Este estudo analisa o indivíduo que atua na linha de frente do RIO 2016, um programa social do Governo do Estado do Rio de Janeiro que opera 800 unidades de atendimento no Estado, com gestão da Secretaria de Estado de Esporte e Lazer. O indivíduo analisado nesta pesquisa é denominado Integrador de Núcleo Esportivo e é o responsável pela gestão de uma dessas unidades — Núcleo Esportivo — que atende em média 50 alunos de uma comunidade carente no Estado do Rio de Janeiro. Essa pesquisa analisa o Integrador de Núcleo Esportivo sob uma perspectiva inédita, entendendo-o como um agente que atua além do seu escopo burocrático de trabalho. Para esse estudo foram consideradas teorias sobre burocracia organizacional, lançando mão da literatura de Michel Crozier ―The Bureaucratic Phenomenon‖ (1964), que analisa as relações entre pessoas, grupos e poder para entender a influência da organização burocrática no indivíduo. O termo ―sociological citizen‖,desenvolvido por Silbey (2009), também foi considerado para classificar esse indivíduo que se mostra mais aplicado que outros nos serviço de seu mandato organizacional e legal. Silbey aplica também o termo ―relational regulation‖ para denominar esta forma particular de prática da ―cidadania sociológica‖ (tradução do autor), por meio da qual os agentes ―governam a lacuna existente entre as expectativas regulatórias e o desempenho requerido‖.
Resumo:
Systemic arterial hypertension is a multifactorial disease that contributes to the country´s high cardiovascular morbi-mortality rates. Considering that hypertension affects individuals in their most productive age while facing work and living risk factors, it is important to investigate its occurrence and predisposing factors in different occupational segments. The objective of this study was to identify the prevalence of hypertension among workers attended to in a medical service of a public university, their hypertension levels, the risk factors present, and their knowledge of the factors that influence the arterial pressure. The epidemiologic study was conducted in the Health Department of the Federal University of Rio Grande do Norte with 102 workers that sought care in the medical clinic during the months of March to May 2009. Data were collected by means of a questionnaire and measurements of systolic and diastolic arterial pressure (SAP and DAP) that were classified in stages according to the Brazilian Society of Hypertension and the degree of risk for cardiovascular events according to the criteria of the Brazilian Society for Cardiology. Data were analyzed using descriptive statistics. The workers were, on average, 54 years of age; the majority (67%) was male and had primary or middle educational level; they worked mainly in supplemental units and deanship offices conducting different functions such as security guards, administrative assistants, health auxiliaries and constructions workers; 48 (47%) of the workers identified themselves as hypertensive for 8 years on average, with the majority executing hard labor and administrative functions. Among the workers with hypertension, the number of the pressure levels classified as pre-hypertensive, stage I and II were: (12% in the SAP and 20% in the DAP); (16% in the SAP and 9% in the DAP); and (15% in the SAP and 5% in the DAP), respectively. The workers that did not identify themselves as hypertensive presented classifications with greater frequencies were: normal (16% in the SAP and 30% in the DAP); and pre-hypertensive (21% in the SAP and 16% in the DAP). The risk factors identified in more than 50% of the workers were: tobacco smoking, alcohol consumption and indices of being overweight, although physical activities are also present. Of the 48 workers diagnosed as hypertensive, those that had 5 risk factors present and limitrophic pressure levels (12%), in stage I hypertension (16%) and stage II hypertension (15¨%) were categorized as being in high risk for vascular events. The number of workers that indicated they had knowledge of the factors that influence their hypertension was less than 39% for each factor. It is concluded that there is a high prevalence of systemic arterial hypertension in the university workers, even amongst those already under treatment. They constitute a population at risk considering their age group, their work functions, and their inadequate life habits. Health care of these hypertensive workers that seek attention in the Health Department is an important aspect of the internal workers health policy in the institution. Educational interventions are recommended for the improvement of quality of life and of work in these workers
Resumo:
Objective: HIV infection is exacerbated through additional pro-atherogenic mechanisms related to the processes of immune activation, inflammation, coagulation, and the modification of lipoproteins (e.g., particles of high density lipoprotein), contributing to increased cardiovascular risk. The aim of this study was to analyze the serum concentrations of myeloperoxidase (MPO) and other laboratory parameters in HIV-infected patients treated or not with antiretroviral drugs compared to non-infected individuals.Materials/Methods: The study included 154 volunteers: 47 non-infected individuals (control group - CON), 27 infected and untreated individuals (NTARv group) and 80 treated individuals (TARV group). We analyzed the counts of CD4+ lymphocytes and the viral load of the infected patients, along with the blood count, fasting glucose, total serum cholesterol (CHOL), HDL cholesterol, LDL cholesterol, triglycerides, MPO and high-sensitivity C-reactive protein (CRP) of all study participants.Results: There were significant increases in glucose, CHOL, LDL cholesterol, and triglycerides in the TARV group and significant reductions in the levels of HDL cholesterol for the TARV and NTARV groups. Significantly elevated levels of Hs-CRP were observed only in the TARV group, while levels of MPO were significantly higher in the TARV and NTARV groups compared to the control group. A correlation of MPO with Hs-CRP (r = 0.21, p = 0.032) was observed for HIV-infected patients, but MPO did not correlate significantly with the other analyzed parameters.Conclusions: The investigation of early biomarkers for cardiovascular risk evaluation, such as MPO, contributes to the clinical monitoring of HIV-infected individuals. The serum levels of MPO correlated with Hs-CRP and were high in HIV-infected individuals, indicating a possible predictor of cardiovascular events in these patients. (c) 2012 Elsevier B.V. All rights reserved.
Resumo:
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)