Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment

Abstract Cardiac remodeling is defined as a group of molecular, cellular and interstitial changes that manifest clinically as changes in size, mass, geometry and function of the heart after injury. The process results in poor prognosis because of its association with ventricular dysfunction and malignant arrhythmias. Here, we discuss the concepts and clinical implications of cardiac remodeling, and the pathophysiological role of different factors, including cell death, energy metabolism, oxidative stress, inflammation, collagen, contractile proteins, calcium transport, geometry and neurohormonal activation. Finally, the article describes the pharmacological treatment of cardiac remodeling, which can be divided into three different stages of strategies: consolidated, promising and potential strategies.

Analysis Treatment Guideline versus Clinical Practice Protocol in Patients Hospitalized due to Heart Failure

Background: Despite the availability of guidelines for treatment of heart failure (HF), only a few studies have assessed how hospitals adhere to the recommended therapies. Objectives: Compare the rates of adherence to the prescription of angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers (ACEI/ARB) at hospital discharge, which is considered a quality indicator by the Joint Commission International, and to the prescription of beta-blockers at hospital discharge, which is recommended by national and international guidelines, in a hospital with a case management program to supervise the implementation of a clinical practice protocol (HCP) and another hospital that follows treatment guidelines (HCG). Methods: Prospective observational study that evaluated patients consecutively admitted to both hospitals due to decompensated HF between August 1st, 2006, and December 31st, 2008. We used as comparing parameters the prescription rates of beta-blockers and ACEI/ARB at hospital discharge and in-hospital mortality. Results: We analyzed 1,052 patients (30% female, mean age 70.6 ± 14.1 years), 381 (36%) of whom were seen at HCG and 781 (64%) at HCP. The prescription rates of beta-blockers at discharge at HCG and HCP were both 69% (p = 0.458), whereas those of ACEI/ARB were 83% and 86%, respectively (p = 0.162). In-hospital mortality rates were 16.5% at HCP and 27.8% at HCG (p < 0.001). Conclusion: There was no difference in prescription rates of beta-blocker and ACEI/ARB at hospital discharge between the institutions, but HCP had lower in-hospital mortality. This difference in mortality may be attributed to different clinical characteristics of the patients in both hospitals.

Technique and clinical applications of double balloon enteroscopy for the evaluation of small bowel diseases

Magdeburg, Univ., Med. Fak., Diss., 2012

"Eczema in psoriatico" : closing the gap between palmoplantar psoriasis and palmoplantar chronic contact dermatitis : a clinical, histological and immunohistological study

Magdeburg, Univ., Med. Fak., Diss., 2014

Multiple investigations in clinical trials

Magdeburg, Univ., Med. Fak., Habil.-Schr., 2014

Instruments for image guided procedures - IIGP : review summaries for minimal invasive and image guided technologies and clinical procedures : student review papers on selected topics

Michael Friebe, editor ; Otto-von-Guericke-Universität Magdeburg, Institut für Medizintechnik, Lehrstuhl Kathetertechnologie und bildgesteuerte Therapie (INKA - Intelligente Katheter), Forschungscampus STIMULATE (Solution Centre for Image Guided Local Therapies)

Dermatozoonosis by Culicoides' bite (Diptera, Ceratopogonidae) in Salvador, State of Bahia, Brazil: IV - A clinical study

A observação de 211 pacientes com reação intensa à picada do Culicoides, que procuraram tratamento na Clínica dermatológica do Hospital das Clínicas da Universidade da Bahia, durante os anos de 1959 e 1962, permitiu o estudo clínico dessa Dermatozoonose, cujos dados são aqui apresentados. A lesão parece ser de natureza alérgica e devido ao aspecto polimorfo pelo qual se apresenta, essa Dermatose pode lembrar o Prorigo, a Escabiose, as Lesões liquenoide; quando a manifestação é mais intensa torna-se uma verdadeira eczematização; quando há infecção secundária, lembra o impetigo folicular. O estudo histológico da lesão revelou ser ela a de uma inflamação crônica, com vascularites e preivascularites dermo-epidérmica, provàvelmente de natureza alérgica. Para que haja a formação da lesão, são necessários: a substância inoculada pelo inseto e o componente alérgico do indivíduo. Não se conhece a natureza da substância inoculada pelo inseto e as seguintes hipóteses são apresentadas para explicá-la: substâncias enzimáticas ou a histamina existentes nas glândulas salivares do Culicoides. Após a picada do Culicoisdes forma-se no local uma pequena área eritematosa que logo após se transforma em pápula; as pápulas podem desaparecer ou transformarem-se em vesículas; estas ao se romperem dilaceram a superfície cutânea, descamam-na ou pode advir uma infecção secundária e transformam-se em pústulas.

Development of cell mediated immunity to flagellar antigens and acquired resistance to infection by Trypanosoma cruzi in mice

Modulation by BCG and/or cyclophosphamide of sensitization of mice with flagellar fraction (a tubulin-enriched fraction) prevented death of mice challenged with T. cruzi CL strain trypomastigotes recovered from Vero cells. A methodology was ceveloped to assay specific antigens and to determine optimal doses for sensitization and elicitation of DTH in mice. CL strain is predominantly myotropic strain which does not produce important parasitism of mononuclear phagocyte cells; these cells appear to control infection when activated in vivo. Maximum protection was seen in this study when BCG and cyclophosphamide were associated, but protection was observed also when cyclophosphamide, that prevents supressor T cells, was applied 2 days before flagellar fraction sensitization in normal mice. These experiments suggested that the macrophage may have an important role in the early phases of infection particularly when nonspecific stimulation is associated with specific sensitization. A correlation betwen delayed hypersensitivity to parasite antigens and protection was observed.

Canine Visceral Leishmaniasis in Rio de Janeiro, Brazil: clinical, parasitological, therapeutical and epidemiological findings (1977-1983)

Forty dogs from the periphery of the city of Rio de Janeiro were studied. All dogs where diagnosed as positive for leishmaniasis either parasitologically and/or serologically. Among them, 19 came from areas where only Visceral Leishmaniasis (VL) occurs (Realengo, Bangu, Senador Camará). Clinical signs of the disease were seen in 36.8% of the cases, including emaciation - 100%, lymphadenopathy and depilation - 85.7%. The other 21 dogs came from an area (Campo Grande) where both diseases (VL, and American Cutaneous Leishmaniasis - ACL) occur. Clinical signs of the disease, mainly cutaneous or mucocutaneous ulcers were seen in 76.2% of the cases. Leishmania parasites were found in 39 cases: 22% in viscera, 42.5% in viscera and normal skin and 35% in cutaneous or mucocutaneous ulcers. All the Leishmania stocks isolated from dogs which came from Realengo, Bangu, Senador Camará (VL area), and from Campo Grande (VL + ACL area) were characterized as L. donovani (except in one case) according to their schizodeme, zymodeme and serodeme. The only stock characterized as L. b. braziliensis, was isolated from the lymph node of a dog from Campo Grande with visceral disease and without skin lesions. Antimony therapy attempted in eight Leishmania donovani positive dogs was unsuccessful.

Trials, tricks and transparency: how disclosure rules affect clinical knowledge

Scandals of selective reporting of clinical trial results by pharmaceutical firms have underlined the need for more transparency in clinical trials. We provide a theoretical framework which reproduces incentives for selective reporting and yields three key implications concerning regulation. First, a compulsory clinical trial registry complemented through a voluntary clinical trial results database can implement full transparency (the existence of all trials as well as their results is known). Second, full transparency comes at a price. It has a deterrence effect on the incentives to conduct clinical trials, as it reduces the firms'gains from trials. Third, in principle, a voluntary clinical trial results database without a compulsory registry is a superior regulatory tool; but we provide some qualified support for additional compulsory registries when medical decision-makers cannot anticipate correctly the drug companies' decisions whether to conduct trials. Keywords: pharmaceutical firms, strategic information transmission, clinical trials, registries, results databases, scientific knowledge JEL classification: D72, I18, L15