1000 resultados para 12812-002


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Background: Patients with diabetes are in extract higher risk for fatal cardiovascular events. Objective: To evaluate major predictors of mortality in subjects with type 2 diabetes. Methods: A cohort of 323 individuals with type 2 diabetes from several regions of Brazil was followed for a long period. Baseline electrocardiograms, clinical and laboratory data obtained were used to determine hazard ratios (HR) and confidence interval (CI) related to cardiovascular and total mortality. Results: After 9.2 years of follow-up (median), 33 subjects died (17 from cardiovascular causes). Cardiovascular mortality was associated with male gender; smoking; prior myocardial infarction; long QTc interval; left ventricular hypertrophy; and eGFR <60 mL/min. These factors, in addition to obesity, were predictors of total mortality. Cardiovascular mortality was adjusted for age and gender, but remained associated with: smoking (HR = 3.8; 95% CI 1.3-11.8; p = 0.019); prior myocardial infarction (HR = 8.5; 95% CI 1.8-39.9; p = 0.007); eGFR < 60 mL/min (HR = 9.5; 95% CI 2.7-33.7; p = 0.001); long QTc interval (HR = 5.1; 95% CI 1.7-15.2; p = 0.004); and left ventricular hypertrophy (HR = 3.5; 95% CI 1.3-9.7; p = 0.002). Total mortality was associated with obesity (HR = 2.3; 95% CI 1.1-5.1; p = 0.030); smoking (HR = 2.5; 95% CI 1.0-6.1; p = 0.046); prior myocardial infarction (HR = 3.1; 95% CI 1.4-6.1; p = 0.005), and long QTc interval (HR = 3.1; 95% CI 1.4-6.1; p = 0.017). Conclusions: Biomarkers of simple measurement, particularly those related to target-organ lesions, were predictors of mortality in subjects with type 2 diabetes.

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Background: Cardiovascular diseases are the current leading causes of death and disability globally. Objective: To assess the effects of a basic educational program for cardiovascular prevention in an unselected outpatient population. Methods: All participants received an educational program to change to a healthy lifestyle. Assessments were conducted at study enrollment and during follow-up. Symptoms, habits, ATP III parameters for metabolic syndrome, and American Heart Association’s 2020 parameters of cardiovascular health were assessed. Results: A total of 15,073 participants aged ≥ 18 years entered the study. Data analysis was conducted in 3,009 patients who completed a second assessment. An improvement in weight (from 76.6 ± 15.3 to 76.4 ± 15.3 kg, p = 0.002), dyspnea on exertion NYHA grade II (from 23.4% to 21.0%) and grade III (from 15.8% to 14.0%) and a decrease in the proportion of current active smokers (from 3.6% to 2.9%, p = 0.002) could be documented. The proportion of patients with levels of triglycerides > 150 mg/dL (from 46.3% to 42.4%, p < 0.001) and LDL cholesterol > 100 mg/dL (from 69.3% to 65.5%, p < 0.001) improved. A ≥ 20% improvement of AHA 2020 metrics at the level graded as poor was found for smoking (-21.1%), diet (-29.8%), and cholesterol level (-23.6%). A large dropout as a surrogate indicator for low patient adherence was documented throughout the first 5 visits, 80% between the first and second assessments, 55.6% between the second and third assessments, 43.6% between the third and fourth assessments, and 38% between the fourth and fifth assessments. Conclusion: A simple, basic educational program may improve symptoms and modifiable cardiovascular risk factors, but shows low patient adherence.

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Background:Chagas disease is a cause of dilated cardiomyopathy, and information about left atrial (LA) function in this disease still lacks.Objective:To assess the different LA functions (reservoir, conduit and pump functions) and their correlation with the echocardiographic parameters of left ventricular (LV) systolic and diastolic functions.Methods:10 control subjects (CG), and patients with Chagas disease as follows: 26 with the indeterminate form (GI); 30 with ECG alterations (GII); and 19 with LV dysfunction (GIII). All patients underwent M-mode and two-dimensional echocardiography, pulsed-wave Doppler and tissue Doppler imaging.Results:Reservoir function (Total Emptying Fraction: TEF): (p <0.0001), lower in GIII as compared to CG (p = 0.003), GI (p <0.001) and GII (p <0.001). Conduit function (Passive Emptying Fraction: PEF): (p = 0.004), lower in GIII (GIII and CG, p = 0.06; GI and GII, p = 0.06; and GII and GIII, p = 0.07). Pump function (Active Emptying Fraction: AEF): (p = 0.0001), lower in GIII as compared to CG (p = 0.05), GI (p<0.0001) and GII (p = 0.002). There was a negative correlation of E/e’average with the reservoir and pump functions (TEF and AEF), and a positive correlation of e’average with s’ wave (both septal and lateral walls) and the reservoir, conduit and pump LA functions.Conclusion:An impairment of LA functions in Chagas cardiomyopathy was observed.

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AbstractBackground:The recording of arrhythmic events (AE) in renal transplant candidates (RTCs) undergoing dialysis is limited by conventional electrocardiography. However, continuous cardiac rhythm monitoring seems to be more appropriate due to automatic detection of arrhythmia, but this method has not been used.Objective:We aimed to investigate the incidence and predictors of AE in RTCs using an implantable loop recorder (ILR).Methods:A prospective observational study conducted from June 2009 to January 2011 included 100 consecutive ambulatory RTCs who underwent ILR and were followed-up for at least 1 year. Multivariate logistic regression was applied to define predictors of AE.Results:During a mean follow-up of 424 ± 127 days, AE could be detected in 98% of patients, and 92% had more than one type of arrhythmia, with most considered potentially not serious. Sustained atrial tachycardia and atrial fibrillation occurred in 7% and 13% of patients, respectively, and bradyarrhythmia and non-sustained or sustained ventricular tachycardia (VT) occurred in 25% and 57%, respectively. There were 18 deaths, of which 7 were sudden cardiac events: 3 bradyarrhythmias, 1 ventricular fibrillation, 1 myocardial infarction, and 2 undetermined. The presence of a long QTc (odds ratio [OR] = 7.28; 95% confidence interval [CI], 2.01–26.35; p = 0.002), and the duration of the PR interval (OR = 1.05; 95% CI, 1.02–1.08; p < 0.001) were independently associated with bradyarrhythmias. Left ventricular dilatation (LVD) was independently associated with non-sustained VT (OR = 2.83; 95% CI, 1.01–7.96; p = 0.041).Conclusions:In medium-term follow-up of RTCs, ILR helped detect a high incidence of AE, most of which did not have clinical relevance. The PR interval and presence of long QTc were predictive of bradyarrhythmias, whereas LVD was predictive of non-sustained VT.

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Abstract Background: Truck driver sleepiness is a primary cause of vehicle accidents. Several causes are associated with sleepiness in truck drivers. Obesity and metabolic syndrome (MetS) are associated with sleep disorders and with primary risk factors for cardiovascular diseases (CVD). We analyzed the relationship between these conditions and prevalence of sleepiness in truck drivers. Methods: We analyzed the major risk factors for CVD, anthropometric data and sleep disorders in 2228 male truck drivers from 148 road stops made by the Federal Highway Police from 2006 to 2011. Alcohol consumption, illicit drugs and overtime working hours were also analyzed. Sleepiness was assessed using the Epworth Sleepiness Scale. Results: Mean age was 43.1 ± 10.8 years. From 2006 to 2011, an increase in neck (p = 0.011) and abdominal circumference (p < 0.001), total cholesterol (p < 0.001), triglyceride plasma levels (p = 0.014), and sleepiness was observed (p < 0.001). In addition, a reduction in hypertension (39.6% to 25.9%, p < 0.001), alcohol consumption (32% to 23%, p = 0.033) and overtime hours (52.2% to 42.8%, p < 0.001) was found. Linear regression analysis showed that sleepiness correlated closely with body mass index (β = 0.19, Raj2 = 0.659, p = 0.031), abdominal circumference (β = 0.24, Raj2 = 0.826, p = 0.021), hypertension (β = -0.62, Raj2 = 0.901, p = 0.002), and triglycerides (β = 0.34, Raj2 = 0.936, p = 0.022). Linear multiple regression indicated that hypertension (p = 0.008) and abdominal circumference (p = 0.025) are independent variables for sleepiness. Conclusions: Increased prevalence of sleepiness was associated with major components of the MetS.

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Abstract Background: The association between periatrial adiposity and atrial arrhythmias has been shown in previous studies. However, there are not enough available data on the association between epicardial fat tissue (EFT) thickness and parameters of ventricular repolarization. Thus, we aimed to evaluate the association of EFT thickness with indices of ventricular repolarization by using T-peak to T-end (Tp-e) interval and Tp-e/QT ratio. Methods: The present study included 50 patients whose EFT thickness ≥ 9 mm (group 1) and 40 control subjects with EFT thickness < 9 mm (group 2). Transthoracic echocardiographic examination was performed in all participants. QT parameters, Tp-e intervals and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. Results: QTd (41.1 ± 2.5 vs 38.6 ± 3.2, p < 0.001) and corrected QTd (46.7 ± 4.7 vs 43.7 ± 4, p = 0.002) were significantly higher in group 1 when compared to group 2. The Tp-e interval (76.5 ± 6.3, 70.3 ± 6.8, p < 0.001), cTp-e interval (83.1 ± 4.3 vs. 76±4.9, p < 0.001), Tp-e/QT (0.20 ± 0.02 vs. 0.2 ± 0.02, p < 0.001) and Tp-e/QTc ratios (0.2 ± 0.01 vs. 0.18 ± 0.01, p < 0.001) were increased in group 1 in comparison to group 2. Significant positive correlations were found between EFT thickness and Tp-e interval (r = 0.548, p < 0.001), cTp-e interval (r = 0.259, p = 0.01), and Tp-e/QT (r = 0.662, p < 0.001) and Tp-e/QTc ratios (r = 0.560, p < 0.001). Conclusion: The present study shows that Tp-e and cTp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in subjects with increased EFT, which may suggest an increased risk of ventricular arrhythmia.

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Abstract Background: BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known. Objective: To determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods: A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality. Results: Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225) and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p < 0.0001). ROC curve disclosed 100 pg/mL as the best BNP cut-off value for mortality prediction (area under the curve = 0.789, 95% CI= 0.723-0.854), being a strong predictor of late mortality: BNP < 100 = 17.3% vs. BNP ≥ 100 = 65.0%, RR = 3.76 (95% CI = 2.49-5.63, p < 0.001). On logistic regression analysis, age >72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002), BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001) and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049) were independent late-mortality predictors. Conclusions: BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification.

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Abstract Background: The kinetics of high-sensitivity troponin T (hscTnT) release should be studied in different situations, including functional tests with transient ischemic abnormalities. Objective: To evaluate the release of hscTnT by serial measurements after exercise testing (ET), and to correlate hscTnT elevations with abnormalities suggestive of ischemia. Methods: Patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty were referred for ET 3 months after infarction. Blood samples were collected to measure basal hscTnT immediately before (TnT0h), 2 (TnT2h), 5 (TnT5h), and 8 hours (TnT8h) after ET. The outcomes were peak hscTnT, TnT5h/TnT0h ratio, and the area under the blood concentration-time curve (AUC) for hscTnT levels. Log-transformation was performed on hscTnT values, and comparisons were assessed with the geometric mean ratio, along with their 95% confidence intervals. Statistical significance was assessed by analysis of covariance with no adjustment, and then, adjusted for TnT0h, age and sex, followed by additional variables (metabolic equivalents, maximum heart rate achieved, anterior wall STEMI, and creatinine clearance). Results: This study included 95 patients. The highest geometric means were observed at 5 hours (TnT5h). After adjustments, peak hscTnT, TnT5h/TnT0h and AUC were 59% (p = 0.002), 59% (p = 0.003) and 45% (p = 0.003) higher, respectively, in patients with an abnormal ET as compared to those with normal tests. Conclusion: Higher elevations of hscTnT may occur after an abnormal ET as compared to a normal ET in patients with STEMI.

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Abstract Background: Idiopathic dilated cardiomyopathy (IDCM), most common cardiac cause of pediatric deaths, mortality descriptor: a low left ventricular ejection fraction (LVEF) and low functional capacity (FC). FC is never self reported by children. Objective: The aims of this study were (i) To evaluate whether functional classifications according to the children, parents and medical staff were associated. (iv) To evaluate whether there was correlation between VO2 max and Weber's classification. Method: Prepubertal children with IDCM and HF (by previous IDCM and preserved LVEF) were selected, evaluated and compared. All children were assessed by testing, CPET and functional class classification. Results: Chi-square test showed association between a CFm and CFp (1, n = 31) = 20.6; p = 0.002. There was no significant association between CFp and CFc (1, n = 31) = 6.7; p = 0.4. CFm and CFc were not associated as well (1, n = 31) = 1.7; p = 0.8. Weber's classification was associated to CFm (1, n = 19) = 11.8; p = 0.003, to CFp (1, n = 19) = 20.4; p = 0.0001and CFc (1, n = 19) = 6.4; p = 0.04). Conclusion: Drawing were helpful for children's self NYHA classification, which were associated to Weber's stratification.

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This paper describes the data obtained for the growth of sugar cane, Variety Co 419, and the amount and rate of absorption of nitrogen, phosphorus, potassium, calcium, magnesium, sulfur, and silicon, according to the age of the plant, in the soil and climate conditions of the state of S. Paulo, Brazil. An experiment was installed in the Estação Experimental de Cana de Açúcar "Dr. José Vizioli", at Piracicaba, state of S. Paulo, Brazil, and the soil "tèrra-roxa misturada" presented the following composition: Sand (more than 0,2 mm)........................................................................ 8.40 % Fine sand (from 0,2 to less than 0,02 mm)................................................. 24.90 % Silt (from 0,02 to less than 0,002 mm)...................................................... 16.40 % Clay (form 0,002 mm and less)................................................................ 50.20 % pH 10 g of soil and 25 ml of distilled water)..................................................... 5.20 %C (g of carbon per 100 g of soil)................................................................. 1.00 %N (g of nitrogen per 100 g of soil)............................................................... 0.15 P0(4)-³ (me. per 100 g of soil, soluble in 0,05 normal H2SO4) ............................... 0.06 K+ (exchangeable, me. per 100 g of soil)....... 0.18 Ca+² (exchangeable, me. per 100 g of soil)...... 2.00 Mg+² (exchangeable, me. per 100 g of soil)...... 0.66 The monthly rainfall and mean temperature from January 1956 to August 1957 are presented in Table 1, in Portuguese. The experiment consisted of 3 replications of the treatments: without fertilizer and with fertilizer (40 Kg of N, from ammonium sulfate; 100 Kg of P(2)0(5) from superphosphate and 40 Kg K2 O, from potassium chloride). Four complete stools (stalks and leaves) were harvested from each treatment, and the plants separated in stalks and leaves, weighed, dried and analysed every month from 6 up to 15 months of age. The data obtained for fresh and dry matter production are presented in table 2, and in figure land 2, in Portuguese. The curves for fresh and dry matter production showed that fertilized and no fertilized sugar cane with 6 months of age presents only 5% of its total weight at 15 months of age. The most intense period of growth in this experiment is located, between 8 and 12 months of age, that is between December 1956 and April 1957. The dry matter production of sugar cane with 8 and 12 months of age was, respectively, 12,5% and 87,5% of the total weight at 15 months of age. The growth of sugar cane in relation to its age follows a sigmoid curve, according to the figures 1, 2 and 3. The increase of dry matter production promoted by using fertilizer was 62,5% when sugar cane was 15 months of age. The concentration of the elements (tables 4 and 5 in Portuguese) present a general trend of decreasing as the cane grows older. In the stalks this is true for all elements studied in this experiment. But in the leaves, somme elements, like sulfur and silicon, appears to increase with the increasing of age. Others, like calcium and magnesium do not show large variations, and finally a third group, formed by nitrogen, phosphorus and potassium seems to decrease at the beginning and later presents a light increasing. The concentration of the elements was higher in the leaves than in the stalks from 6 up to 15 months of age. There were some exceptions. Potassium, magnesium and sulfur were higher in the stalks than in the leaves from 6 up to 8 or 9 months of age. After 9 months, the leaves presented more potassium, magnesium and sulfur than the stalks. The percentage of nitrogen in the leaves was lower in the plants that received fertilizer than in the plants without fertilizer with 6, 7, 8, 10, 11 and 13 months of age. This can be explained by "dilution effect". The uptake of elements by 4 stools (stalks and leaves) of sugar cane according to the plant age is showed in table 6, in Portuguese. The absorption of all studied elements, nitrogen, phosphorus, potassium, calcium, magnesium, sulfur and silicon, was higher in plants that received fertilizer. The trend of uptake of nitrogen and potassium is similar to the trend of production of dry matter, that is, the maximum absorption of those two nutrients occurs between 9 and 13 months of age. Finaly, the maxima amounts of elements absorbed by 4 stools (stalks and leaves) of sugar cane plants that received fertilizer are condensed in the following table: Element Maximum absorption in grams Age of the plants in months Nitrogen (N) 81.0 14 Phosphorus (P) 6.8 15 Potassium (K) 81.5 15 Calcium (Ca) 19.2 15 Magnesium (Mg) 13.9 13 Sulfur (S) 9.3 15 Silicon (Si) 61.8 15 It is very interesting to note the low absorption of phosphorus even with 100 kg of P2O5 per hectare, aplied as superphosphate. The uptake of phosphorus was lower than calcium, magnesium and sulfur. Also, it is noteworthy the large amount of silicon absorbed by sugar cane.

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Células de Saccharomyces carlsbergensis (IZ-1834) foram crescidas e adaptadas, progressivamente ao meio de caldo de cana esterilizado e contendo 0,001%, 0,002%, 0,003%, 0,004% e 0,00% de emulsan Al (v/v) além do tratamento testemunho isento de Emulsan Al. Estas células, levadas a Warburg fermentaram: glicose, rafinose. Não fermentaram: galactose, maltose e lactose. Não exibiram praticamente fermentação endógena. Glicose e caldo de cana tiveram seus rendimentos elevados, no caso das células utilizadas serem aquelas adaptadas aos diferentes teores de Emulsan Al. A fermentação da rafinose sofreu notável aceleração quando as células utilizadas foram adaptadas à Emulsan Al, sendo que a aceleração foi da ordem de 2 a 3 vêzes àquela observada no experimento com células crescidas em meio isento de Emulsan Al. A diferença da permeabilidade entre um e outro tipo de célula parece explicar o fenômeno.

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The reproductive pattern of Elachistocleis bicolor (Guérin Méneville, 1838) was studied at Serra da Bodoquena, from October 2000 to September 2001. Reproduction occurred in the wet season (October to April) and was correlated to high continuous pluviometric precipitation. The species presents sexual size dimorphism, with females larger than males. The number of mature eggs per ovary was 620 ± 251 (n=39) and mature eggs measured 1.15 ± 0.30 mm (n=40). Elachistocleis bicolor presented significant relations between snout-vent length and number of mature eggs (n=39; r²=0.25; p=0.001), individual weight and number of mature eggs (n=41, r²=0.30; p=0.002), snout-vent length and ovarian weight (n=35; r²=0.47; p<0.01), and individual weight and ovarian weight (n=36; r²=0.55; p<0.01). Weight and volume are better to study size-fecundity relationships than snout-vent length. The females invested 22.7 ± 6.3 % (n=35) of their weights in reproduction and the variance associated to this variable was high, related to the reproductive mode of the species.

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Devido à falta de estruturas rígidas para determinação de idade em crustáceos, métodos que se baseiam na determinação de idade através da distribuição da freqüência de comprimentos são comumente utilizados. Neste trabalho, foi comparado o crescimento do siri-azul, Callinectes sapidus Rathbun, 1896, em laboratório e a partir de indivíduos de campo. Os indivíduos de laboratório, após a coleta, tiveram seu crescimento acompanhado individualmente. A temperatura foi mantida constante (25±2°C) e a salinidade a 20±5. Os indivíduos do campo foram coletados entre 2002 e 2004 em pontos pré-determinados no estuário da Laguna dos Patos, com rede de portas. A biometria, nos dois casos, constou da medida da largura da carapaça (LC mm). As estimativas das curvas de crescimento, segundo o modelo de Bertalanffy para os indivíduos de campo, foram obtidas pelo acompanhamento do deslocamento modal (MPA). O tamanho máximo de largura de carapaça utilizado foi mantido fixo em todas as análises (157,78 mm para fêmeas e 162,71 mm para machos). Para os indivíduos mantidos em laboratório, os parâmetros e a longevidade obtidos foram k=0,001/dia; t o=-1,53; longevidade de 3117 dias (8,5 anos) para machos e k=0,002/dia; t o=-29,5; longevidade de 2795 dias para fêmeas (7,7 anos). Os parâmetros de crescimento e a longevidade estimados para os animais coletados em campo foram k=0,004/dia; t o=-4,23; 1267 dias (3,5 anos) para machos e k=0,004/dia; t o=-3,71; 1260 dias (3,45 anos) para fêmeas. Foram encontradas diferenças significativas entre animais de laboratório e de campo, sugerindo que a espécie responde de forma diferente ao ambiente em que está inserida.

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OBJECTIVE. The purpose of this study was to evaluate the prevalence of mesenteric venous thrombosis (MVT) in the Swiss Inflammatory Bowel Disease Cohort Study and to correlate MVT with clinical outcome. MATERIALS AND METHODS. Abdominal portal phase CT was used to examine patients with inflammatory bowel disease (IBD). Two experienced abdominal radiologists retrospectively analyzed the images, focusing on the superior and inferior mesenteric vein branches and looking for signs of acute or chronic thrombosis. The location of abnormalities was registered. The presence of MVT was correlated with IBD-related radiologic signs and complications. RESULTS. The cases of 160 patients with IBD (89 women, 71 men; Crohn disease [CD], 121 patients; ulcerative colitis [UC], 39 patients; median age at diagnosis, 27 years for patients with CD, 32 years for patients with UC) were analyzed. MVT was detected in 43 patients with IBD (26.8%). One of these patients had acute MVT; 38, chronic MVT; and four, both. The prevalence of MVT did not differ between CD (35/121 [28.9%]) and UC (8/39 [20.5%]) (p = 0.303). The location of thrombosis was different between CD and UC (CD, jejunal or ileal veins only [p = 0.005]; UC, rectocolic veins only [p = 0.001]). Almost all (41/43) cases of thrombosis were peripheral. MVT in CD patients was more frequently associated with bowel wall thickening (p = 0.013), mesenteric fat hypertrophy (p = 0.005), ascites (p = 0.002), and mesenteric lymph node enlargement (p = 0.036) and was associated with higher rate of bowel stenosis (p < 0.001) and more intestinal IBD-related surgery (p = 0.016) in the outcome. Statistical analyses for patients with UC were not relevant because of the limited population (n = 8). CONCLUSION. MVT is frequently found in patients with IBD. Among patients with CD, MVT is associated with bowel stenosis and CD-related intestinal surgery.