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Progression of valve heart disease in a cohort of patients undergoing renal replacement therapy
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Tompson, Maria Eduarda Cavalcanti

; Pimentel, José Arthur Viana de Oliveira

; Silva, Manuella de Amorim

; Santos-Veloso, Marcelo Antônio Oliveira

; Lordsleem, Andrea Bezerra de Melo da Silveira

; Lima, Sandro Gonçalves de

Brazilian Journal of Nephrology

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jun 2024, Volume 46 N. 2 elocation e20230036

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: Doenças cardiovasculares são uma causa significativa de morte em pacientes com Doença Renal Crônica (DRC). A calcificação valvar é preditor de mortalidade cardiovascular e doença arterial coronariana. Objetivo: Avaliar a frequência, fatores associados e progressão de valvopatias em pacientes com DRC. Métodos: Coorte retrospectiva com 291 pacientes ambulatoriais no Hospital das Clínicas de Pernambuco. Inclusão: ≥18 anos com DRC e valvopatia; exclusão: tratamento conservador ou dados incompletos. Variáveis clínicas e laboratoriais foram comparadas e categorizadas por tempo de terapia dialítica (TTD): <5 anos, 5–10 anos, >10 anos. Foram aplicados os testes Qui-quadrado, exato de Fisher, ANOVA, Kruskal-Wallis. Associação entre valvopatia e TTD foi avaliada por regressão binária. Significância foi definida como p < 0,05. Resultados: A valvopatia mitral foi encontrada em 82,5% (240) dos casos, seguida da aórtica (65,6%; 86). Houve progressão da doença valvar em 106 (36,4%) pacientes. Não houve associação entre valvopatias aórtica, pulmonar, mitral ou tricúspide e TTD. Hiperparatireoidismo secundário foi a única variável explicativa significativa na regressão para valvopatia mitral (OR 2,59 [IC95%: 1,09–6,18]; p = 0,031). Conclusão: Encontramos alta frequência de valvopatias, especialmente mitral e aórtica, aem pacientes com DRC. Não houve associação entre TTD e valvopatia. Introdução . (DRC) coronariana Objetivo Métodos 29 Pernambuco Inclusão 18 ≥1 exclusão incompletos (TTD) 5 510 10 5–1 >1 Quiquadrado, Quiquadrado Qui quadrado, quadrado Qui-quadrado Fisher ANOVA KruskalWallis. KruskalWallis Kruskal Wallis. Wallis Kruskal-Wallis binária 005 0 05 0,05 Resultados 825 82 82,5 240 (240 casos 65,6% 656 65 6 (65,6% 86. 86 86) 36,4% 364 36 4 (36,4% pulmonar OR 259 2 59 2,5 IC95% IC95 IC [IC95% 1,09–6,18 109618 1 09 1,09–6,18] 0,031. 0031 0,031 031 0,031) Conclusão (DRC ≥ (TTD 51 5– > 00 0,0 8 82, 24 (24 65,6 (65,6 36,4 3 (36,4 25 2, IC9 [IC95 1,09–6,1 10961 003 0,03 03 0, (2 65, (65, 36, (36, [IC9 1,09–6, 1096 ( (65 (36 [IC 1,09–6 109 (6 (3 1,09– 1,09 1,0 1,

Abstract Introduction: Cardiovascular disease is an important cause of death among patients with chronic kidney disease (CKD). Valve calcification is a predictor of cardiovascular mortality and coronary artery disease. Objective: To assess heart valve disease frequency, associated factors, and progression in CKD patients. Methods: We conducted a retrospective study on 291 CKD patients at Hospital das Clínicas de Pernambuco. Inclusion criteria were age ≥ 18 with CKD and valve disease, while those on conservative management or with missing data were excluded. Clinical and laboratory variables were compared, and patients were categorized by dialysis duration (<5 years; 5–10 years; >10 years). Statistical tests, including chi-square, Fisher’s exact, ANOVA, and Kruskal-Wallis, were employed as needed. Simple and multivariate binary regression models were used to analyze valve disease associations with dialysis duration. Significance was defined as p < 0.05. Results: Mitral valve disease was present in 82.5% (240) of patients, followed by aortic valve disease (65.6%; 86). Over time, 106 (36.4%) patients developed valve disease. No significant association was found between aortic, pulmonary, mitral, or tricuspid valve disease and dialysis duration. Secondary hyperparathyroidism was the sole statistically significant factor for mitral valve disease in the regression model (OR 2.59 [95% CI: 1.09–6.18]; p = 0.031). Conclusion: CKD patients on renal replacement therapy exhibit a high frequency of valve disease, particularly mitral and aortic valve disease. However, no link was established between dialysis duration and valve disease occurrence or progression. Introduction CKD. . (CKD) Objective factors Methods 29 Pernambuco 1 excluded compared <5 5 (< years 510 10 5–1 >1 years. years) tests chisquare, chisquare chi square, square chi-square Fishers Fisher s exact ANOVA KruskalWallis, KruskalWallis Kruskal Wallis, Wallis Kruskal-Wallis needed 005 0 05 0.05 Results 825 82 82.5 240 (240 65.6% 656 65 6 (65.6% 86. 86 86) time 36.4% 364 36 4 (36.4% pulmonary OR 259 2 59 2.5 95% 95 [95 CI 1.09–6.18 109618 09 1.09–6.18] 0.031. 0031 0.031 031 0.031) Conclusion However (CKD ( 51 5– > 00 0.0 8 82. 24 (24 65.6 (65.6 36.4 3 (36.4 25 2. 9 [9 1.09–6.1 10961 003 0.03 03 0. (2 65. (65. 36. (36. [ 1.09–6. 1096 (65 (36 1.09–6 109 (6 (3 1.09– 1.09 1.0 1.

https://doi.org/10.1590/2175-8239-jbn-2023-0036en

Diretrizes Brasileiras de Medidas da Pressão Arterial Dentro e Fora do Consultório – 2023 202 20 2
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Feitosa, Audes Diogenes de Magalhães

; Barroso, Weimar Kunz Sebba

; Mion Junior, Decio

; Nobre, Fernando

; Mota-Gomes, Marco Antonio

; Jardim, Paulo Cesar Brandão Veiga

; Amodeo, Celso

; Oliveira, Adriana Camargo

; Alessi, Alexandre

; Sousa, Ana Luiza Lima

; Brandão, Andréa Araujo

; Pio-Abreu, Andrea

; Sposito, Andrei C.

; Pierin, Angela Maria Geraldo

; Paiva, Annelise Machado Gomes de

; Spinelli, Antonio Carlos de Souza

; Machado, Carlos Alberto

; Poli-de-Figueiredo, Carlos Eduardo

; Rodrigues, Cibele Isaac Saad

; Forjaz, Claudia Lucia de Moraes

; Sampaio, Diogo Pereira Santos

; Barbosa, Eduardo Costa Duarte

; Freitas, Elizabete Viana de

; Cestario, Elizabeth do Espirito Santo

; Muxfeldt, Elizabeth Silaid

; Lima Júnior, Emilton

; Campana, Erika Maria Gonçalves

; Feitosa, Fabiana Gomes Aragão Magalhães

; Consolim-Colombo, Fernanda Marciano

; Almeida, Fernando Antônio de

; Silva, Giovanio Vieira da

; Moreno Júnior, Heitor

; Finimundi, Helius Carlos

; Guimarães, Isabel Cristina Britto

; Gemelli, João Roberto

; Barreto-Filho, José Augusto Soares

; Vilela-Martin, José Fernando

; Ribeiro, José Marcio

; Yugar-Toledo, Juan Carlos

; Magalhães, Lucélia Batista Neves Cunha

; Drager, Luciano F.

; Bortolotto, Luiz Aparecido

; Alves, Marco Antonio de Melo

; Malachias, Marcus Vinícius Bolívar

; Neves, Mario Fritsch Toros

; Santos, Mayara Cedrim

; Dinamarco, Nelson

; Moreira Filho, Osni

; Passarelli Júnior, Oswaldo

; Vitorino, Priscila Valverde de Oliveira

; Miranda, Roberto Dischinger

; Bezerra, Rodrigo

; Pedrosa, Rodrigo Pinto

; Paula, Rogerio Baumgratz de

; Okawa, Rogério Toshiro Passos

; Póvoa, Rui Manuel dos Santos

; Fuchs, Sandra C.

; Lima, Sandro Gonçalves de

; Inuzuka, Sayuri

; Ferreira-Filho, Sebastião Rodrigues

; Fillho, Silvio Hock de Paffer

; Jardim, Thiago de Souza Veiga

; Guimarães Neto, Vanildo da Silva

; Koch, Vera Hermina Kalika

; Gusmão, Waléria Dantas Pereira

; Oigman, Wille

; Nadruz Junior, Wilson

Arquivos Brasileiros de Cardiologia

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2024, Volume 121 N. 4 elocation e20240113

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.36660/abc.20240113

Repercussões da pandemia de Covid-19 na saúde mental nos estudantes de Medicina de Pernambuco Covid19 Covid 19 Covid-1 Covid1 1 Covid-
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Brito, Ederline Suelly Vanini de

; Silva, Lyvia Nayá Bezerra da

; Oliveira, Taísa Melânia Moreira

; Santos-Veloso, Marcelo Antônio Oliveira

; Lima, Sandro Gonçalves de

Revista Brasileira de Educação Médica

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2023, Volume 47 N. 3 elocation e082

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo: Introdução: As pandemias, como a de Covid-19, resultam em perturbação psicossocial que pode romper os limites da capacidade de enfrentamento, de modo a gerar tensões e angústias que se expressam variavelmente entre os envolvidos. Objetivo: analisar as repercussões da pandemia de Covid-19 na saúde mental de estudantes de Medicina do estado de Pernambuco. Método: estudo transversal e descritivo-analítico realizado entre julho e agosto de 2021 com estudantes de Medicina das 11 faculdades de Pernambuco. Como variáveis dependentes, foram analisados os escores de ansiedade e depressão. Quanto às variáveis independentes, foram estudadas: escore de resiliência, características sociodemográficas e comportamentais, e condições de saúde. A coleta dos dados foi realizada por meio da plataforma Google Forms. Aplicaram-se o Inventário de Beck para ansiedade e depressão e a escala de resiliência de Wagnild e Young. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Centro Universitário Maurício de Nassau, e os participantes concordaram o Termo de Consentimento Livre e Esclarecido. Os dados foram analisados pelo programa SPSS 25, considerando significativo valor p < 0,05. Resultado: participaram da pesquisa 416 estudantes. A amostra foi composta predominantemente por mulheres (60,9%), com idade média de 25 anos, das quais 73,8% tinham residência fixa no município da faculdade. Sintomas de ansiedade moderada e grave foram verificados em 27,2% e 10,3% dos avaliados, respectivamente. Observaram-se sintomas depressivos moderados em 17,8% dos estudantes. Cerca de 25% da amostra apresentou grau de resiliência baixo ou muito baixo. Resiliência alta (razão de chances [RC] = 0,18 [0,08-0,41]; p < 0,001) e suporte psicológico anterior à pandemia (RC = 0,36 [0,14-0,95]; p = 0,04) foram fatores de proteção; e cursar o ciclo clínico (quinto-oitavo períodos) foi fator de risco independente (RC = 1,95 [1,07-3,55]; p = 0,02) para ansiedade de moderada a grave. Resiliência alta (RC = 0,01 [0,02-0,11]; p < 0,001 e retornar à cidade natal durante a suspensão das aulas (RC = 0,41 [0,18-0,91]; p = 0,02) foram fatores protetores; e cursar o ciclo clínico foi fator de risco independente (RC = 2,74 [1,26-5,93]; p = 0,01) para depressão de moderada a grave. Conclusão: verificou-se uma alta prevalência de sintomas de ansiedade de moderada e grave, bem como de sintomas depressivos moderados. Um alta proporção dos estudantes apresentou grau de resiliência baixo ou muito baixo. Resumo Introdução pandemias Covid19, Covid19 Covid 19, 19 enfrentamento envolvidos Objetivo Covid-1 Pernambuco Método descritivoanalítico descritivo analítico 202 1 dependentes independentes estudadas comportamentais Forms Aplicaramse Aplicaram Young Nassau Esclarecido 005 0 05 0,05 Resultado 41 60,9%, 609 60,9% , 60 9 (60,9%) 2 anos 738 73 8 73,8 faculdade 272 27 27,2 103 10 3 10,3 avaliados respectivamente Observaramse Observaram 178 17 17,8 razão RC [RC 018 18 0,1 0,080,41 008041 0,08 08 [0,08-0,41] 0001 001 036 36 0,3 0,140,95 014095 0,14 0,95 14 95 [0,14-0,95] 0,04 004 04 proteção quintooitavo quinto oitavo períodos 195 1,9 1,073,55 107355 1,07 3,55 07 55 [1,07-3,55] 0,02 002 02 01 0,0 0,020,11 002011 0,11 [0,02-0,11] 0,00 041 0,4 0,180,91 018091 0,91 91 [0,18-0,91] protetores 274 74 2,7 1,265,93 126593 1,26 5,93 26 5 93 [1,26-5,93] Conclusão verificouse verificou Covid1 Covid- 20 00 4 60,9 6 (60,9% 7 73, 27, 10, 17, 0, 080 0,080,4 00804 008 [0,08-0,41 000 03 140 0,140,9 01409 014 095 0,9 [0,14-0,95 1, 073 1,073,5 10735 107 1,0 355 3,5 [1,07-3,55 020 0,020,1 00201 011 [0,02-0,11 180 0,180,9 01809 091 [0,18-0,91 2, 265 1,265,9 12659 126 1,2 593 5,9 [1,26-5,93 60, (60,9 0,080, 0080 [0,08-0,4 0,140, 0140 09 [0,14-0,9 1,073, 1073 35 3, [1,07-3,5 0,020, 0020 [0,02-0,1 0,180, 0180 [0,18-0,9 1,265, 1265 12 59 5, [1,26-5,9 (60, 0,080 [0,08-0, 0,140 [0,14-0, 1,073 [1,07-3, 0,020 [0,02-0, 0,180 [0,18-0, 1,265 [1,26-5, (60 [0,08-0 [0,14-0 [1,07-3 [0,02-0 [0,18-0 [1,26-5 (6 [0,08- [0,14- [1,07- [0,02- [0,18- [1,26- ( [0,08 [0,14 [1,07 [0,02 [0,18 [1,26 [0,0 [0,1 [1,0 [1,2 [0, [1, [0 [1 [

Abstract: Introduction: The occurrence of pandemics, such as Covid-19, leads to a psychosocial disturbance that can break the limits of the population’s coping capacity, generating tensions and anxieties that are expressed in various degrees among those involved. Objective: To analyze the repercussions of the COVID-19 pandemic on the mental health of medical students in the State of Pernambuco. Methods: Cross-sectional analytical study conducted between July and August 2021 with medical students from 11 universities in Pernambuco. The dependent variables analyzed were the scores of anxiety, depression; the independent variables were resilience score, socio-demographic, behavioral characteristics and health conditions. The data were collected through Google Forms. Beck’s Anxiety and Depression Inventories, and Wagnild and Young’s Resilience Scale were applied. The study was approved by the local ethics committee and informed consent was sought and given. The data were analyzed using SPSS 25, considering as significant a p-value < 0,05. Result: 416 participants were included, the majority (60.9%) of the students were women, the average age was 25 years, and 73.8% of them lived in the municipality of their university. Moderate and severe anxiety symptoms were found in 27.2% and 10.3% of the sample, respectively. Moderate depressive symptoms were observed in 17.8% of the students. About 25% of the sample reported a low or very low degree of resilience. High resilience (Odds Ratio [OR] 0.18 [0.08-0.41]; p <0.001) and psychological support prior to the pandemic (OR 0.36 [0.14-0.95]; p = 0 .04) were protective factors and attending the clinical cycle (2nd-3rd year) was an independent risk factor (OR 1.95 [1.07-3.55]; p = 0.02) for moderate to severe anxiety. High resilience (OR 0.01 [0.02-0.11]; p < 0.001 and returning to one’s hometown during the suspension of classes (OR 0.41 [0.18-0.91]; p = 0.02) were protective factors and attending the clinical cycle was an independent risk factor (OR 2.74 [1.26-5.93]; p = 0.01) for moderate to severe depression. Conclusion: We found a high prevalence of moderate and severe anxiety symptoms, as well as moderate depressive symptoms. A high proportion of students demonstrated a low or very low degree of resilience. Abstract Introduction pandemics Covid19, Covid19 Covid 19, 19 Covid-19 populations population s capacity involved Objective COVID19 COVID COVID-1 Pernambuco Methods Crosssectional Cross sectional 202 1 depression score sociodemographic, sociodemographic socio demographic, demographic socio-demographic conditions Forms Becks Beck Inventories Youngs Young applied given pvalue value 005 05 0,05 Result 41 included 60.9% 609 60 9 (60.9% women 2 years 738 73 8 73.8 university 272 27 27.2 103 10 3 10.3 respectively 178 17 17.8 Odds OR [OR 018 18 0.1 0.080.41 008041 0.08 08 [0.08-0.41] <0.001 0001 001 036 36 0.3 0.140.95 014095 0.14 0.95 14 95 [0.14-0.95] .04 04 2nd3rd ndrd 2nd 3rd nd rd year 195 1.9 1.073.55 107355 1.07 3.55 07 55 [1.07-3.55] 0.02 002 02 01 0.0 0.020.11 002011 0.11 [0.02-0.11] 0.00 ones one 041 0.4 0.180.91 018091 0.91 91 [0.18-0.91] 274 74 2.7 1.265.93 126593 1.26 5.93 26 5 93 [1.26-5.93] Conclusion Covid1 Covid-1 COVID1 COVID- 20 00 0,0 4 60.9 6 (60.9 7 73. 27. 10. 17. 0. 080 0.080.4 00804 008 [0.08-0.41 <0.00 000 03 140 0.140.9 01409 014 095 0.9 [0.14-0.95 .0 1. 073 1.073.5 10735 107 1.0 355 3.5 [1.07-3.55 020 0.020.1 00201 011 [0.02-0.11 180 0.180.9 01809 091 [0.18-0.91 2. 265 1.265.9 12659 126 1.2 593 5.9 [1.26-5.93 Covid- 0, 60. (60. 0.080. 0080 [0.08-0.4 <0.0 0.140. 0140 09 [0.14-0.9 . 1.073. 1073 35 3. [1.07-3.5 0.020. 0020 [0.02-0.1 0.180. 0180 [0.18-0.9 1.265. 1265 12 59 5. [1.26-5.9 (60 0.080 [0.08-0. <0. 0.140 [0.14-0. 1.073 [1.07-3. 0.020 [0.02-0. 0.180 [0.18-0. 1.265 [1.26-5. (6 [0.08-0 <0 [0.14-0 [1.07-3 [0.02-0 [0.18-0 [1.26-5 ( [0.08- [0.14- [1.07- [0.02- [0.18- [1.26- [0.08 [0.14 [1.07 [0.02 [0.18 [1.26 [0.0 [0.1 [1.0 [1.2 [0. [1. [0 [1 [

https://doi.org/10.1590/1981-5271v47.3-2022-0315

ICD indication in hypertrophic cardiomyopathy: which algorithm to use?
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Santos-Veloso, Marcelo Antônio Oliveira

; Chaves, Ândrea Virgínia Ferreira

; Calado, Eveline Barros

; Markman, Manuel

; Bezerra, Lucas Soares

; Lima, Sandro Gonçalves de

; Markman Filho, Brivaldo

; Oliveira, Dinaldo Cavalcanti de

Revista da Associação Médica Brasileira

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aug 2022, Volume 68 N. 8 Pages 1059 - 1063

Abstract: En | Text: En | PDF: En

SUMMARY OBJECTIVE: This study aimed to evaluate the agreement in the indication of implantable cardioverter-defibrillators in patients with Hypertrophic cardiomyopathy, as per the 2014 European Society of Cardiology and 2020 American Heart Association recommendations, and evaluate fragmented QRS as a predictor of cardiovascular outcome. METHODS: Retrospective cohort with 81 patients was evaluated between 2019 and 2021. Patients with hypertrophic cardiomyopathy ≥16 years old were included. Exclusion criteria include secondary myocardiopathy and follow-up <1 year. Kappa coefficient was used to determine the agreement. Survival and incidence curves were determined by Kaplan-Meier method. A p<0.05 was considered significant. RESULTS: The fragmented QRS was identified in 44.4% of patients. There were no differences between patients with and without fragmented QRS regarding clinical parameters, echocardiography, fibrosis, and sudden cardiac death risk. During follow-up of 4.8±3.4 years, there was no sudden cardiac death, but 20.6% patients with implantable cardioverter-defibrillator had at least one appropriate shock. Three of the seven appropriate shocks occurred in European Society of Cardiology low- to moderate-risk patients. Three shocks occurred in moderate-risk patients and four in American Heart Association high-risk patients. Overall recommendations agreement was 64% with a kappa of 0.270 (p=0.007). C-statistic showed no differences regarding the incidence of appropriate shock (p=0.644). CONCLUSION: sudden cardiac death risk stratification algorithms present discrepancies in implantable cardioverter-defibrillator indication, both with low accuracy.

https://doi.org/10.1590/1806-9282.20220199

Lutembacher Syndrome with Sinus Venosus-Type Interatrial Communication: An Educational Presentation VenosusType Venosus Type Communication
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Lordsleem, Andréa Bezerra de Melo da Silveira

; Lima, Sandro Gonçalves de

; Bezerra, Lucas Soares

; Calado, Eveline Barros

; Granja, Fabio Antônio Amando

; Markman-Filho, Brivaldo

Brazilian Journal of Cardiovascular Surgery

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aug 2022, Volume 37 N. 4 Pages 591 - 594

Abstract: En | Text: En | PDF: En

https://doi.org/10.21470/1678-9741-2021-0323

Reperfusão Coronariana no Infarto Agudo do Miocárdio: Tentar o Ótimo. Executar o Possível
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Markman Filho, Brivaldo

; Lima, Sandro Gonçalves de

Arquivos Brasileiros de Cardiologia

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jul 2021, Volume 117 N. 1 Pages 130 - 131

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20210500 164 downloads

Association between hyperuricemia and hypertension: a case-control study
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Bezerra, Talma Tallyane Dantas

; Bezerra, Lucas Soares

; Santos-Veloso, Marcelo Antônio Oliveira

; Lordsleem, Andrea Bezerra de Melo da Silveira

; Lima, Sandro Gonçalves de

Revista da Associação Médica Brasileira

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jun 2021, Volume 67 N. 6 Pages 828 - 832

Abstract: En | Text: En | PDF: En

SUMMARY OBJECTIVE: The aim of this study was to evaluate the association between hyperuricemia and systemic arterial hypertension. METHODS: This was a case-control study where individuals aged >18 years were included, who were divided into hypertensive and non-hypertensive groups, excluding those with incomplete information in medical records or with the chronic kidney disease epidemiology collaboration <60 mL/min/1.73 m³. Systemic arterial hypertension was categorized as a dependent variable, while the independent variables were hyperuricemia (i.e., primary variable), sex, education, the practice of physical activity, alcoholism, smoking, diabetes mellitus, chronic kidney disease, a family history of systemic arterial hypertension, age, isolated hyperlipidemia, and mixed hyperlipidemia. Statistical analysis included the univariate and multivariate data analysis, performed by adjusting the logistic regression models using the software R (R Core Team [2018]). RESULTS: Out of 103 patients evaluated, 75 patients were included in this study. In hypertensive patients, hyperuricemia was more frequent (p=0.029), being present in 18.9% individuals. In the univariate analysis, a statistically significant association was found between hyperuricemia and systemic arterial hypertension (OR 10.9; 95%CI 1.29-1420.0; p=0.023); however, in the multivariate analysis, when adjustment was made for age, the only control variable that persisted in the model, this association ceased to be significant (OR 8.5; 95%CI 0.87-1157.0; p=0.070). CONCLUSIONS: There was no independent association between hyperuricemia and systemic arterial hypertension. The latter was associated with diabetes mellitus, chronic kidney disease, and age.

https://doi.org/10.1590/1806-9282.20210021 68 downloads

Antifungal Efficacy of Amphotericin B in Candida Albicans Endocarditis Therapy: Systematic Review
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Bezerra, Lucas Soares

; Silva, Janielli Assis da

; Santos-Veloso, Marcelo Antônio Oliveira

; Lima, Sandro Gonçalves de

; Chaves-Markman, Ândrea Virgínia

; Jucá, Moacir Batista

Brazilian Journal of Cardiovascular Surgery

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oct 2020, Volume 35 N. 5 Pages 789 - 796

Abstract: En | Text: En | PDF: En

Abstract Introduction: Although it is the most common agent among the fungal causes of endocarditis, Candida albicans endocarditis is rare. Objective: To evaluate the efficacy of amphotericin B in the treatment of C. albicans endocarditis beyond a systematic review. Data search: Articles in English, Spanish and Portuguese, conducted in the following databases: MEDLINE, LILACS, IBECS and SciELO, in humans and published in the last 25 years. Study selection: Observational studies, clinical trials, and case series providing data on the amphotericin B use in patients with a C. albicans endocarditis diagnosis without age limitations. Data synthesis: From the initial search (n=79), 25 articles were fully evaluated, of which 19 were excluded for meeting one or more exclusion criteria, remaining five articles (two observational studies and three case series). Patients using amphotericin B demonstrated improvement in survival rates, and its main use was in association with the surgical method as well as with caspofungin association. Conclusion: Literature lacks evidence to conclude about efficacy and safety of amphotericin B in the treatment of fungal endocarditis. Randomized clinical trials are necessary to provide better evidence on the subject.

https://doi.org/10.21470/1678-9741-2019-0159 405 downloads

Aspirin with or without statin in the treatment of endotheliitis, thrombosis, and ischemia in coronavirus disease
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Florêncio, Francisco Kleyton Zacarias

; Tenório, Maiza de Oliveira

; Macedo Júnior, Aluísio Roberto Andrade

; Lima, Sandro Gonçalves de

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20200472

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: In the genesis of coronavirus disease (COVID-19), there is a process of endotheliitis associated with thrombotic changes, no studies have reported the use of acetylsalicylic acid (ASA) as a possible therapeutic approach. Statins could potentiate the ASA therapy. METHODS: This is a series of 14 cases with a laboratory-confirmed diagnosis of COVID-19. All patients underwent the ASA therapy. Those who had risk factors for vascular disease also underwent the high-potency statin therapy. When symptoms were totally or practically resolved, patients were discharged and advised to continue medications for a complementary time, according to the clinical evolution of each patient. RESULTS: The mean age of monitored patients was 48.6 years. A total of 78.6% patients presented with at least one comorbidity, which could have contributed as a risk factor for a poor prognosis in the evolution of COVID-19. Four patients had secondary bacterial infections; three patients needed hospitalization. None of the cases progress to stage III, and all patients had remission of symptoms, with 100% survival. CONCLUSIONS: the process of endothelial dysfunction in COVID-19 involves disseminated thrombosis, initially microvascular and later expansion into larger vessels. ASA could act as a secondary prophylaxis and prevent thrombosis from developing and reaching stage III of the disease. As this was a case series, we cannot provide definitive conclusions; however, this study allows us to formulate hypotheses and support clinical trials to evaluate benefits of the ASA therapy in the treatment of COVID-19.

https://doi.org/10.1590/0037-8682-0472-2020 2832 downloads

10.

GLA Gene Mutation in Hypertrophic Cardiomyopathy with a New Variant Description: Is it Fabry's Disease?
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Chaves-Markman, Ândrea Virgínia

; Markman, Manuel

; Calado, Eveline Barros

; Pires, Ricardo Flores

; Santos-Veloso, Marcelo Antônio Oliveira

; Pereira, Catarina Maria Fonseca

; Lordsleem, Andréa Bezerra de Melo da Silveira

; Lima, Sandro Gonçalves de

; Markman Filho, Brivaldo

; Oliveira, Dinaldo Cavalcanti de

Arquivos Brasileiros de Cardiologia

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jul 2019, Volume 113 N. 1 Pages 77 - 84

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: A doença de Fabry (DF) é uma doença de armazenamento lisossômico ligada ao cromossomo X, devido a mutações no gene da alfa galactosidase A (GLA), levando a deficiência enzimática de alfa-galactosidase (α-Gal A) e acúmulo de globotriaosilceramida (Gb3) e globotriaosilsulfingosina (liso-Gb3), causando disfunção de múltiplos órgãos. Objetivo: realizar a triagem do gene GLA em um grupo de pacientes com diagnóstico ecocardiográfico de cardiomiopatia hipertrófica (CMH). Métodos: estudo transversal realizado com pacientes com CMH em um hospital universitário. Pacientes com doença arterial coronariana e valvopatias foram excluídos. Foi realizada análise de mutação do gene GLA. Em indivíduos do sexo masculino, a análise foi realizada após evidência de baixa atividade de α-Gal A. Resultados: Foram incluídos 60 pacientes com diagnostico ecocardiográfico de CMH. A idade variou de 12 a 85 anos e 60% eram mulheres. O percentual médio de fibrose miocárdica na RM foi 10,7 ± 13,1% e a espessura ventricular média foi 18,7 ± 6,7 mm. Quatro pacientes tinham as seguintes mutações do GLA: c.967C>A (p.Pro323Thr), ainda não descrita na literatura; c.937G>T (p.Asp313Tyr); e c.352C>T (p.Arg118Cys). Todos os pacientes apresentavam níveis normais de liso-Gb3 e fibrose miocárdica não isquêmica na ressonância magnética; um paciente apresentou proteinúria; um paciente apresentou taquicardia ventricular. Conclusão: Neste estudo, a frequência de mutação no gene GLA em pacientes com CMH foi 6,7%. Uma nova mutação no exon 6 do gene GLA, c.967C>A (p.Pro323Thr), foi identificada. Pacientes com CMH podem ter mutações do GLA e a DF deve ser excluída. Os níveis plasmáticos de (liso-Gb3) não parecem ser suficientes para fazer um diagnóstico e biópsia de órgãos deve ser considerada.

Abstract Background: Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in the alpha galactosidase A gene (GLA) that lead to the enzymatic deficiency of alpha galactosidase (α-Gal A), resulting in the accumulation of globotriaosylceramide (Gb3) and globotriaosylsphingosine (lyso-Gb3), causing multiple organ dysfunctions. Objective: To perform GLA gene screening in a group of patients with echocardiographic diagnosis of hypertrophic cardiomyopathy (HCM). Methods: a cross-sectional study was conducted with HCM patients from a university hospital. Patients with coronary artery disease and valvulopathies were excluded. Mutation analysis of the GLA gene was performed. In male subjects, the analysis was performed after evidence of low α-Gal A activity. Results: 60 patients with echocardiographic diagnosis of HCM were included. Age ranged from 12 to 85 years and 60% were women. Mean myocardial fibrosis percentage on MRI was 10.7 ± 13.1% and mean ventricular thickness was18.7 ± 6.7 mm. Four patients had the following GLA gene mutations: c.967C>A (p.Pro323Thr), not yet described in the literature; c.937G>T (p.Asp313Tyr); and c.352C>T (p.Arg118Cys). All patients had normal levels of lyso-Gb3 and non-ischemic myocardial fibrosis on magnetic resonance imaging; one patient had proteinuria and one patient had ventricular tachycardia. Conclusion: in this study, the frequency of mutation in the GLA gene in patients with HCM was 6.7%. A novel mutation in exon 6 of the GLA gene, c.967C>A (p.Pro323Thr), was identified. Patients with HCM may have GLA mutations and FD should be ruled out. Plasma (lyso-Gb3) levels do not seem to be sufficient to attain a diagnosis and organ biopsy should be considered.

https://doi.org/10.5935/abc.20190112 1265 downloads

11.

Prevalence of depression and anxiety and their association with cardiovascular risk factors in Northeast Brasil primary care patients
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Santos-Veloso, Marcelo Antônio Oliveira

; Melo, Maria Isa Souza Lacerda de

; Cavalcanti, Roberta Azevedo Neves

; Bezerra, Lucas Soares

; Chaves-Markman, Ândrea Virgínia

; Lima, Sandro Gonçalves de

Revista da Associação Médica Brasileira

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jun 2019, Volume 65 N. 6 Pages 801 - 809

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO INTRODUÇÃO: Transtornos de ansiedade e depressão (TAD) são os distúrbios psiquiátricos mais comuns no mundo. Dentre a população adulta atendida na atenção básica, estima-se que a depressão afete cerca de 14,3% desses indivíduos mundialmente, podendo este valor ir de 21,4% a 31% no Brasil. A ansiedade afeta até 33,7% da população durante sua vida. OBJETIVO: Estimar a prevalência de TAD em pacientes da atenção primária em um município do Nordeste brasileiro e associar sua ocorrência com fatores de risco cardiovasculares. MÉTODOS: Um estudo de coorte transversal com análise de prontuário de pacientes atendidos em unidades de saúde da família de Jaboatão dos Guararapes, Pernambuco. Foram incluídos pacientes ≥18 anos e acompanhados regularmente. Critérios de exclusão: história de trauma crânio encefálico, abuso de álcool e drogas, acidente vascular cerebral prévio, doenças ou medicações que mimetizem sintomas de TAD. Os indivíduos foram divididos em dois grupos, a depender da presença ou não de TAD, e os fatores de risco cardiovascular foram comparados entre os grupos. RESULTADOS: De um total de 1.030 indivíduos recrutados, 215 (20%) foram excluídos. O grupo não TAD apresentou mais história de infarto do miocárdio e etilismo. A prevalência de depressão foi de 10,3%, a de ansiedade foi de 27,1% e a associação entre os dois foi de 4,5%. Houve associação significativa entre TAD e hipertensão (OR = 2,11; IC95: 1,16-3,84; p=0,01), obesidade (OR = 4,47; IC95%: 1,74-11,46; p=0,002) e dislipidemia (OR = 3,88; IC95%: 1,81-8,3; p<0,001). CONCLUSÃO: TAD estão associados com maior risco de hipertensão arterial, obesidade e dislipidemia.

SUMMARY BACKGROUND: Depression and anxiety disorders (DAD) are the most prevalent mental health conditions worldwide. Among the adult population served in basic care, it is estimated that depression affects about 14.3% of these individuals worldwide, and between 21.4% and 31% in Brasil. Anxiety affects up to 33.7% of the population during their lifetimes. OBJECTIVES: estimate the prevalence proportions of DAD among patients in a municipality in Northeast Brasil and study the association between DAD and cardiovascular risk factors. METHODS: a cross-sectional study with the medical records of patients from primary care centers in Jaboatão dos Guararapes, Pernambuco. Patients aged ≥ 18 years and regularly followed-up were included. Exclusion criteria: a history of traumatic brain injury, alcohol or drug abuse, previous stroke, medical conditions or medications that mimic DAD symptoms. Subjects were divided into two groups depending on the presence or absence of DAD, and cardiovascular risk factors were compared between groups. RESULTS: A total of 1030 subjects were initially included, of whom 215 (20%) were excluded. No-DAD subjects had more history of myocardial infarction and alcoholism. The prevalence of depression was 10.3%, anxiety disorder was 27.1%, and mixed DAD represented 4.5%. There was a significant association between DAD and hypertension (OR = 2.11; 95%CI: 1.16 –3.84; p=0.01), obesity (OR = 4.47; 95%CI: 1.74 –11.46; p=0.002), and hyperlipidemia (OR = 3.88; 95%CI: 1.81-8.3; p<0.001). CONCLUSION: DAD were associated with an increased risk for arterial hypertension, obesity, and hyperlipidemia.

https://doi.org/10.1590/1806-9282.65.6.801 2727 downloads

12.

Long-Term Traumatic and Asymptomatic Aorto-Right Atrial Fistula
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Lima, Sandro Gonçalves de

; Lordsleem, Andréa Bezerra de Melo da Silveira

; Campos, Kaique Leal

; Silva, Juliana Guedes

; Santos, Marcelo Antônio Oliveira

; Markman Filho, Brivaldo

Brazilian Journal of Cardiovascular Surgery

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feb 2019, Volume 34 N. 1 Pages 101 - 103

Abstract: En | Text: En | PDF: En

Abstract Aorto-atrial fistulas due to cardiac trauma are rare, and survivors require immediate surgical correction. Here, we report a case of an aorto-right atrial fistula due to penetrating trauma after a 16-year evolution, which developed symptoms of acute coronary syndrome and was treated with myocardial revascularization and correction of the aorto-cameral fistula.

https://doi.org/10.21470/1678-9741-2018-0296 404 downloads

13.

Obstructive sleep apnea and quality of life in elderly patients with a pacemaker
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Lima, Tatiana Albuquerque Gonçalves de

; Brito, Evandro Cabral de

; Martins, Robson

; Lima, Sandro Gonçalves de

; Pedrosa, Rodrigo Pinto

Jornal Brasileiro de Pneumologia

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2019, Volume 45 N. 1 elocation e20170333

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar a qualidade de vida em idosos portadores de marca-passo e apneia obstrutiva do sono (AOS). Métodos: Estudo de corte transversal com idosos (idade ≥ 60 anos) portadores de marca-passo cardíaco. A variável dependente foi qualidade de vida, avaliada por meio do Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Dados sociodemográficos e clínicos foram analisados como variáveis independentes, entre os quais ansiedade e depressão (por meio da Hospital Anxiety and Depression Scale), assim como presença de AOS (definida como um índice de apneia-hipopneia ≥ 15 eventos/h). Pacientes com déficits cognitivos/neurológicos ou descompensação cardíaca foram excluídos. Resultados: A amostra foi composta por 72 pacientes, 17 dos quais (23,6%) apresentaram AOS - 9 homens (52,9%). A média de idade foi de 72,3 ± 9,3 anos. Não houve associações de presença de AOS com sexo (p = 0,132), idade (p = 0,294) e índice de massa corpórea (p = 0,790). Não foram observadas diferenças dos domínios do SF-36 entre os grupos com e sem AOS. Em relação à ansiedade, 14 pacientes (19,4%) apresentaram sintomas moderados ou graves, dos quais apenas 3 (21,4%) tinham AOS (p = 0,89 vs. sem AOS). No tocante à depressão, 12 pacientes (16,6%) apresentaram sintomas moderados ou graves, dos quais 2 (16,6%) tinham AOS (p = 0,73 vs. sem AOS). Conclusões: Nesta amostra em idosos portadores de marca-passo, a presença de AOS não foi associada a qualidade de vida e sintomas de ansiedade e depressão.

ABSTRACT Objective: To evaluate quality of life in elderly patients with obstructive sleep apnea (OSA) who have a pacemaker. Methods: This was a cross-sectional study involving elderly patients (≥ 60 years of age) with a pacemaker. The dependent variable was quality of life, as evaluated with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Sociodemographic and clinical parameters, including anxiety and depression (Hospital Anxiety and Depression Scale score), as well as the presence of OSA (defined as an apnea-hypopnea index ≥ 15 events/h), were analyzed as independent variables. Patients with cognitive/neurological deficits or decompensated heart failure were excluded. Results: We evaluated 72 patients, 17 (23.6%) of whom presented OSA. Of those 17 patients, 9 (52.9%) were male. The mean age was 72.3 ± 9.3 years. A diagnosis of OSA was not associated with gender (p = 0.132), age (p = 0.294), or body mass index (p = 0.790). There were no differences between the patients with OSA and those without, in terms of the SF-36 domain scores. Fourteen patients (19.4%) presented moderate or severe anxiety. Of those 14 patients, only 3 (21.4%) had OSA (p = 0.89 vs. no OSA). Twelve patients (16.6%) had moderate or severe depression. Of those 12 patients, only 2 (16.6%) had OSA (p = 0.73 vs. no OSA). Conclusions: In elderly patients with a pacemaker, OSA was not found to be associated with quality of life or with symptoms of anxiety or depression.

https://doi.org/10.1590/1806-3713/e20170333 1825 downloads

14.

Fatores associados ao aumento da vulnerabilidade de participantes de pesquisa
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Lima, Sandro Gonçalves de

; Maia, Luna Gama

; Dourado, Aline Tenório

; Silva, Lívia Cristina Gomes

; Lima, Tatiana Albuquerque Gonçalves de

; Medeiros, Zulma Maria de

; Feitosa, Saulo Ferreira

; Oliveira, Daniel Alexandre de

; Welkovic Junior, Stefan

Revista Bioética

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aug 2017, Volume 25 N. 2 Pages 358 - 370

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo Trata-se de estudo de corte transversal cujo objetivo foi avaliar a prevalência de fatores associados ao aumento da vulnerabilidade de participantes de pesquisas. Foram entrevistados 116 pacientes e 18 médicos. Entre os pacientes, 15% eram analfabetos, 27% desconheciam o motivo do seu internamento e 45% não sabiam qual tratamento estavam recebendo. Do total da amostra, 43% procediam de zona rural e 70% haviam cursado, no máximo, ensino fundamental, fatores que tornam essa população especialmente vulnerável. Os percentuais de acerto em questões relacionadas à compreensão do termo de consentimento livre e esclarecido e de prescrição médica foram, respectivamente, 12% e 7%. Entre os médicos, 44% não conheciam todas as pesquisas realizadas na enfermaria pela qual eram responsáveis e 17% afirmaram que a permanência hospitalar de pacientes que participam de pesquisas é maior. É elevada a prevalência de fatores que aumentam a vulnerabilidade de participantes em pesquisas médicas.

Abstract A cross-sectional study was carried out that aimed to assess the prevalence of factors associated with the increased vulnerability of research subjects. A total of 116 patients and 18 doctors were interviewed. A proportion of 15% of patients were illiterate, 27% did not know the reason for their hospitalization and 45% did not know what treatment they were receiving. Of the total sample, 43% were from rural areas and 70% had at most an elementary level education, factors that make this population especially vulnerable. The percentage of correct answers on issues related to the understanding of free and informed consent and prescriptions were 12% and 7%, respectively. Among the doctors, 44% were not aware of all the research projects being carried out in the ward for which they were responsible, and 17% said that the hospital stays of patients participating in research were longer. The prevalence of factors that increased the vulnerability of subjects in medical research was high.

Se trata de un estudio de corte transversal que tuvo como objetivo evaluar la prevalencia de los factores asociados con el aumento de vulnerabilidad de los participantes de investigación. Fueron entrevistados 116 pacientes y 18 médicos. Entre los pacientes, el 15% eran analfabetos, el 27% desconocía el motivo de su hospitalización y el 45% no sabía qué tratamiento estaba recibiendo. Del total de la muestra, el 43% era de zonas rurales, y el 70% había cursado, como máximo, la educación básica, factores que tornan a esta población especialmente vulnerable. El porcentaje de respuestas correctas en cuestiones relacionadas con la comprensión del consentimiento libre e informado y de la prescripción médica fue de, respectivamente, 12% y 7%. Entre los médicos, el 44% no conocía todas las investigaciones realizadas en la enfermería de la cual eran responsables y el 17% afirmó que la permanencia hospitalaria de los pacientes que participan de investigaciones es mayor. Es elevada la prevalencia de factores que aumentan la vulnerabilidad de los participantes en investigaciones médicas.

https://doi.org/10.1590/1983-80422017252196 2378 downloads

15.

Pre-hospital attitudes adopted by patients faced with the symptoms of acute myocardial infarction
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Gouveia, Viviane de Araújo

; Victor, Edgar Guimarães

; Lima, Sandro Gonçalves de

Revista Latino-Americana de Enfermagem

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oct 2011, Volume 19 N. 5 Pages 1080 - 1087

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Esta série de casos teve o objetivo de avaliar as condutas adotadas pelos pacientes, durante a fase pré-hospitalar do infarto agudo do miocárdio (IAM). Avaliaram-se 115 indivíduos portadores de IAM, com supradesnivelamento do segmento ST. Foi aplicado o teste qui-quadrado e o teste exato de Fisher. Os indivíduos que não associaram os sintomas à doença cardiovascular atribuíram, mais frequentemente, às seguintes origens: gastrointestinal (38%), osteomuscular (29,7%), intoxicação alimentar e/ou medicamentosa (8,5%) e decorrentes do aparelho respiratório (6,3%). A proporção de desfechos maiores e de pacientes que chegaram à emergência após 12 horas foi mais elevada entre mulheres, indivíduos com renda mensal de até um salário mínimo, que usaram analgésicos e não associaram os sintomas à doença cardiovascular. Constatou-se que indivíduos em condições socio-conômicas desfavoráveis, que interpretaram os sintomas de forma incorreta, chegaram mais tardiamente à emergência e apresentaram piores desfechos intra-hospitalares.

This case series aimed to evaluate the behavior adopted by patients during the pre-hospital phase of acute myocardial infarction (AMI). A total of 115 AMI sufferers with ST-segment elevation were evaluated. The chi-square and Fisher's exact tests were applied. The individuals that did not associate the symptoms with cardiovascular disease most often attributed them to the following sources: gastrointestinal (38%), musculoskeletal (29.7%), food and/or medication poisoning (8.5%) and arising from the respiratory apparatus (6.3%). The proportion of major outcomes and of patients that arrived in the emergency department after 12 hours was higher among women, individuals with monthly income of up to one minimum wage, those who used analgesics and did not associate the symptoms with cardiovascular disease. It was found that individuals in unfavorable socioeconomic conditions, who interpreted the symptoms incorrectly, arrived later at the emergency department and had worse intra-hospital outcomes.

Esta serie de casos tuvo el objetivo de evaluar las conductas adoptadas por los pacientes durante la fase prehospitalaria del infarto agudo del miocardio (IAM). Se evaluaron 115 individuos portadores de IAM con el segmento ST supradesnivelado. Fue aplicada la prueba Chi-cuadrado y la prueba exacta de Fisher. Los individuos que no asociaron los síntomas a la enfermedad cardiovascular la atribuyeron más frecuentemente a los siguientes orígenes: gastrointestinal (38%), osteomuscular (29,7%), intoxicación alimentar y/o medicamentosa (8,5%) y provenientes del aparato respiratorio (6,3%). La proporción de resultados más graves y de pacientes que llegaron a la emergencia después de 12 horas fue más elevada entre mujeres, individuos con renta mensual de hasta un salario mínimo, que usaron analgésicos y no asociaron los síntomas a la enfermedad cardiovascular. Se constató que individuos en condiciones socioeconómicas desfavorables, que interpretaron los síntomas de forma incorrecta, llegaron más tarde a la emergencia y presentaron peores resultados intrahospitalarios.

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