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OBJECTIVES: Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. METHODS: We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. RESULTS: Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99). CONCLUSIONS: Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.

https://doi.org/10.6061/clinics/2014(10)03 1144 downloads

II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia
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Feitosa, Alina Coutinho Rodrigues

; Marques, André Coelho

; Caramelli, Bruno

; Ayub, Beatriz

; Polanczyk, Carisi A.

; Jardim, Carlos

; Vieira, Carolina L. Zilli

; Pinho, Claudio

; Calderaro, Daniela

; Gualandro, Danielle Menosi

; Iezzi, Denise

; Ikeoka, Dimas T.

; Schreen, Dirk

; D'Amico, Elbio Antonio

; Pfeferman, Elcio

; Lima, Emerson Quintino de

; Burdmann, Emmanuel de A.

; Pachon, Enrique

; Machado, Fabio Santana

; Galas, Filomena Regina Barbosa Gomes

; Paula, Flávio Jota de

; Carvalho, Francine Corrêa de

; Feitosa-Filho, Gilson Soares

; Prado, Gustavo Faibischew

; Lopes, Heno F.

; Lima, José Jaime Galvão de

; Marchini, Julio Flavio Meirelles

; Fornari, Luciana S.

; Drager, Luciano F.

; Vacanti, Luciano Janussi

; Hajjar, Ludhmila Abrahão

; Rohde, Luis Eduardo P.

; Gowdak, Luís Henrique

; Cardoso, Luiz Francisco

; Vieira, Marcelo Luiz Campos

; Monachini, Maristela C.

; Macatrão, Milena

; Yu, Pai Ching

; Villaça, Paula Ribeiro

; Farsky, Pedro Silvio

; Lopes, Renato Delascio

; Bagnatori, Renato Scotti

; Heinisch, Roberto Henrique

; Gualandro, Sandra F. Menosi

; Accorsi, Tarso Augusto Duenhas

; Ávila, Walkiria Samuel

; Mathias Jr., Wilson

Arquivos Brasileiros de Cardiologia

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2011, Volume 96 N. 3 Pages 1 - 68

Abstract: Pt | Text: Pt | PDF: Pt

53329 downloads

Multicenter study of perioperative evaluation for noncardiac surgeries in Brazil (EMAPO)
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Pinho, Claudio

; Grandini, Paulo C

; Gualandro, Danielle M

; Calderaro, Daniela

; Monachini, Maristela

; Caramelli, Bruno

Clinics

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feb 2007, Volume 62 N. 1 Pages 17 - 22

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

INTRODUÇÃO: A precisão dos métodos de avaliação perioperatória disponíveis é melhor que o acaso, porém está longe do ideal. OBJETIVOS: Comparar um novo método de avaliação perioperatória (EMAPO) ao método do American College of Physicians para determinar o risco cardíaco em cirurgias não cardíacas e buscar novas variáveis envolvidas na determinação deste risco. MÉTODOS: O EMAPO e o método do American College of Physicians foram aplicados em 700 pacientes. A ocorrência de eventos cardíacos e de mortes foi documentada, a relação entre as variáveis de risco e as complicações foi estabelecida e os métodos foram comparados analisando as áreas sob a curva ROC. RESULTADOS: A mortalidade foi 3.4% e a incidência de complicações cardiovasculares 5.3%. A presença de insuficiência renal (p=0.01), cirurgia de grande porte (p=0.004) e cirurgia de emergência (p=0.003) se correlacionaram com a ocorrência de complicações cardiovasculares na análise multivariada. Não houve diferença entre os dois métodos. CONCLUSÕES: O EMAPO é tão eficaz quanto o método do American College of Physicians para determinar o risco de complicações cardiovasculares em cirurgias não cardíacas. Novas variáveis relacionadas com o risco perioperatório foram encontradas.

INTRODUCTION: The accuracy of perioperative evaluation methods available is better than chance, but their performance is not ideal. OBJECTIVES: To compare a new evaluation method (EMAPO) to the American College of Physicians method for determining the risk of cardiovascular complications in noncardiac surgeries and to look for new influencing variables. METHODS: Evaluations through EMAPO and the American College of Physicians method were employed for 700 patients. Cardiac events and deaths were recorded, the risk variables related to the occurrence of complications were verified, and the models were compared by analyzing the areas under the receiver operating characteristic curves. RESULTS: Mortality rate was 3.4%, and the incidence of cardiovascular complications was 5.3%. Renal failure (P = 0.01), major surgery (P = 0.004), and emergency surgery (P = 0.003) were independently related to the occurrence of cardiovascular complications. The two methods produced similar results. CONCLUSION: EMAPO is as good as the American College of Physicians method in determining the risk of cardiovascular complications in noncardiac surgeries. New variables related to surgical risk were identified.

14649 downloads Cited 11 times in SciELO

Consenso brasileiro de monitorização e suporte hemodinâmico - parte III: métodos alternativos de monitorização do débito cardíaco e da volemia
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Schettino, Guilherme

; Ederlon, Rezende

; Mendes, Ciro Leite

; Réa-Neto, Álvaro

; David, Cid Marcos

; Lobo, Suzana Margareth Ajeje

; Barros, Alberto

; Silva, Eliézer

; Friedman, Gilberto

; Amaral, José Luiz Gomes do

; Park, Marcelo

; Monachini, Maristela

; Oliveira, Mirella Cristine de

; Assunção, Murillo Santucci César

; Akamine, Nelson

; Mello, Patrícia Veiga C

; Pereira, Renata Andréa Pietro

; Costa Filho, Rubens

; Araújo, Sebastião

; Pinto, Sérgio Félix

; Ferreira, Sérgio

; Mitushima, Simone Mattoso

; Agareno, Sydney

; Brilhante, Yuzeth Nóbrega de Assis

Revista Brasileira de Terapia Intensiva

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mar 2006, Volume 18 N. 1 Pages 78 - 85

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

JUSTIFICATIVA E OBJETIVOS: A interpretação do débito cardíaco e da pré-carga como números absolutos não traz grandes informações sobre a hemodinâmica do paciente crítico. Em contrapartida, a monitorização da resposta do débito cardíaco à expansão volêmica ou suporte inotrópico é uma ferramenta muito útil na unidade de terapia intensiva, quando o paciente apresenta algum sinal de má perfusão tecidual. Apesar do CAP ser considerado como " padrão-ouro" na avaliação destes parâmetros, foram desenvolvidas tecnologias alternativas bastante confiáveis para a sua monitorização. MÉTODO: O processo de desenvolvimento de recomendações utilizou o método Delphi modificado para criar e quantificar o consenso entre os participantes. A AMIB determinou um coordenador para o consenso, o qual escolheu seis especialistas para comporem o comitê consultivo. Outros 18 peritos de diferentes regiões do país foram selecionados para completar o painel de 25 especialistas, médicos e enfermeiros. Um levantamento bibliográfico na MEDLINE de artigos na língua inglesa foi realizado no período de 1966 a 2004. RESULTADOS: Foram apresentadas recomendações referentes à análise da variação da pressão arterial durante ventilação mecânica, débito cardíaco contínuo por contorno de pulso arterial, débito cardíaco por diluição do lítio, Doppler transesofágico, bioimpedância transtorácica, ecocardiografia e reinalação parcial de gás carbônico. CONCLUSÕES: As novas e menos invasivas técnicas para medida do débito cardíaco, pré-carga e fluidoresponsividade apresentam adequada precisão e podem ser uma alternativa ao uso do CAP em pacientes graves.

BACKGROUND AND OBJECTIVES: Cardiac output and preload as absolute data do not offer helpful information about the hemodynamic of critically ill patients. However, monitoring the response of these variables to volume challenge or inotropic drugs is a very useful tool in the critical care setting, particularly for patients with signs of tissue hypoperfusion. Although PAC remains the " gold standard" to measure cardiac output and preload, new and alternative technologies were developed to evaluate these hemodynamic variables. METHODS: Modified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty three physician and two nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004. RESULTS: Recommendations regarding the use of arterial pulse pressure variation during mechanical ventilation, continuous arterial pulse contour and lithium dilution cardiac output measurements, esophageal Doppler waveform, thoracic electrical bioimpedance, echocardiography and partial CO2 rebreathing for monitoring cardiac output and preload were created. CONCLUSIONS: The new and less invasive techniques for the measurement of cardiac output, preload or fluid responsiveness are accurate and may be an alternative to PAC in critically ill patients.

22640 downloads

Parte II: monitorização hemodinâmica básica e cateter de artéria pulmonar
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Dias, Fernando Suparregui

; Rezende, Ederlon

; Mendes, Ciro Leite

; Réa-Neto, Álvaro

; David, Cid Marcos

; Schettino, Guilherme

; Lobo, Suzana Margareth Ajeje

; Barros, Alberto

; Silva, Eliézer

; Friedman, Gilberto

; Amaral, José Luiz Gomes do

; Park, Marcelo

; Monachini, Maristela

; Oliveira, Mirella Cristine de

; Assunção, Murillo Santucci César

; Akamine, Nelson

; Mello, Patrícia Veiga C

; Pereira, Renata Andréa Pietro

; Costa Filho, Rubens

; Araújo, Sebastião

; Félix Pinto, Sérgio

; Ferreira, Sérgio

; Mitushima, Simone Mattoso

; Agareno, Sydney

; Brilhante, Yuzeth Nóbrega de Assis

Revista Brasileira de Terapia Intensiva

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mar 2006, Volume 18 N. 1 Pages 63 - 77

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

JUSTIFICATIVA E OBJETIVOS: A monitorização de funções vitais é uma das mais importantes e essenciais ferramentas no manuseio de pacientes críticos na UTI. Hoje é possível detectar e analisar uma grande variedade de sinais fisiológicos através de diferentes técnicas, invasivas e não-invasivas. O intensivista deve ser capaz de selecionar e executar o método de monitorização mais apropriado de acordo com as necessidades individuais do paciente, considerando a relação risco-benefício da técnica. Apesar do rápido desenvolvimento de técnicas de monitorização não-invasiva, a monitorização hemodinâmica invasiva com o uso do cateter de artéria pulmonar (CAP) ainda é um dos procedimentos fundamentais em UTI. O objetivo destas recomendações é estabelecer diretrizes para o uso adequado dos métodos básicos de monitorização hemodinâmica e CAP. MÉTODO: O processo de desenvolvimento de recomendações utilizou o método Delphi modificado para criar e quantificar o consenso entre os participantes. A AMIB determinou um coordenador para o consenso, o qual escolheu seis especialistas para comporem o comitê consultivo. Outros 18 peritos de diferentes regiões do país foram selecionados para completar o painel de 25 especialistas, médicos e enfermeiros. Um levantamento bibliográfico na MedLine de artigos na língua inglesa foi realizado no período de 1966 a 2004. RESULTADOS: Foram apresentadas recomendações referentes a 55 questões sobre monitorização da pressão venosa central, pressão arterial invasiva e cateter de artéria pulmonar. Com relação ao CAP, além de recomendações quanto ao uso correto foram discutidas as indicações em diferentes situações clínicas. CONCLUSÕES: A avaliação da pressão venosa central e da pressão arterial, além das variáveis obtidas com o CAP permite o entendimento da fisiologia indispensável para o cuidado de pacientes graves. Entretanto, a correta utilização dessas ferramentas é fundamental para os possíveis benefícios decorrentes do uso.

BACKGROUND AND OBJECTIVES: Monitoring of vital functions is one of the most important tools in the management of critically ill patients. Nowadays is possible to detect and analyze a great deal of physiologic data using a lot of invasive and non-invasive methods. The intensivist must be able to select and carry out the most appropriate monitoring technique according to the patient requirements and taking into account the benefit/risk ratio. Despite the fast development of non invasive monitoring techniques, invasive hemodynamic monitoring using Pulmonary Artery Catheter still is one of the basic procedures in Critical Care. The aim was to define recommendations about clinical utility of basic hemodynamic monitoring methods and the Use of Pulmonary Artery Catheter. METHODS: Modified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty-five physicians and nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004. RESULTS: Recommendations were made based on 55 questions about the use of central venous pressure, invasive arterial pressure, pulmonary artery catheter and its indications in different settings. CONCLUSIONS: Evaluation of central venous pressure and invasive arterial pressure, besides variables obtained by the PAC allow the understanding of cardiovascular physiology that is of great value to the care of critically ill patients. However, the correct use of these tools is fundamental to achieve the benefits due to its use.

106416 downloads Cited 3 times in SciELO

Secular trends in a population with ischemic heart disease admitted to the Instituto do Coração in São Paulo
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Caramelli, Bruno

; Fornari, Luciana Savoy

; Monachini, Maristela

; Ballas, Dália

; Fachini, Nilson Roberto

; Mansur, Antônio de Pádua

; Ramires, José Antônio Franchini

Arquivos Brasileiros de Cardiologia

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oct 2003, Volume 81 N. 4 Pages 369 - 374

Abstract: En | Text: En | PDF: En

OBJECTIVE: To assess the clinical and demographic characteristics of a population with ischemic heart disease admitted in the final decades of the 20th century. METHODS: This study retrospectively assessed patients hospitalized with ischemic heart disease divided into the following 2 groups: acute group - 11.181 patients with acute myocardial infarction admitted from 1/1/82 to 12/31/94; and chronic group - 4.166 patients undergoing coronary artery bypass graft surgery from 1/1/84 to 12/31/94. RESULTS: In the acute group, an increase in the percentage of females (from 22.7% to 27.7%, P<0.001) and diabetic individuals (from 12.4% to 17.5%, P<0.001) was observed, as was an increase in age (from 57.4±11.5 to 59.9±12.1 years, P<0.05). In-hospital mortality was greater among females (27.8% and 15.7%, P=0.001), among diabetic individuals (24.2% and 17.8%, P=0.001), and among the elderly (60.9±15.2 and 57.7±11.8 years, P=0.0001). In the chronic group, an increase in the percentage of females (from 17.5% to 27.2%, P=0.001) was observed, as was an increase in age (from 56.3±8.6 to 60.5±9.6 years, P=0.0001). In-hospital mortality was greater among females (8.3% and 5.8%, P<0.05) and among the elderly (58.1±9.1 and 62.1±7.9 years, P=0.0001). CONCLUSION: The characteristics of the population studied with ischemic heart disease point towards a worse prognosis, due to the greater percentages of females, older patients, and diabetic patients, groups known to have greater in-hospital mortality.

1621 downloads Cited 2 times in SciELO

Demographic characteristics of the population undergoing cine coronary angiography at the Instituto do Coração of the Medical School of USP from 1986 to 1995
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Caramelli, Bruno

; Fornari, Luciana Savoy

; Monachini, Maristela

; Ballas, Dália

; Fachini, Nilson Roberto

; Mansur, Antônio de Pádua

; Ramires, José Antônio Franchini

Arquivos Brasileiros de Cardiologia

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sep 2003, Volume 81 N. 3 Pages 306 - 308

Abstract: En | Text: En | PDF: En

OBJECTIVE: To obtain information about the profile and behavior of a population with ischemic heart disease undergoing cine coronary angiography and to determine disease severity. METHODS: Retrospective study assessing patients hospitalized at InCor from 1986 to 1995, in which the variables age, sex, and number of major coronary arteries with obstruction degree > 40% were analyzed. RESULTS: We studied 18,221 patients and observed a significant increase in the number of females (22.8% to 25.2%, P=0.001) and an increase in age (57.1±29.3 to 60.4±10.7 years, P=0.0001). A significant increase in the incidence of multivessel disease was observed, which was more frequent among males (69.2% and 64.5%) and among the older patients (59.8±9.8 and 56.8±10.7 years, P=0.0001). A reduction in the incidence of single-vessel disease was also observed (66.2% vs 69.2% and 33.8% vs 30.5%, respectively, P<0.0001). CONCLUSION: A change in the profile of the population studied was observed as follows: patients undergoing cine coronary angiography at InCor were older, had a greater number of impaired major coronary arteries, and the number of females affected increased, leading to indices suggestive of a poorer prognosis.

1488 downloads

Alterações eletrocardiográficas e sua relação com os fatores de risco para doença isquêmica do coração em população da área metropolitana de São Paulo
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CARDOSO, ELISABETH

; MARTINS, IGNEZ SALAS

; FORNARI, LUCIANA

; MONACHINI, MARISTELA C.

; MANSUR, ANTONIO DE PÁDUA

; CARAMELLI, BRUNO

Revista da Associação Médica Brasileira

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sep 2002, Volume 48 N. 3 Pages 231 - 236

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

OBJETIVO: A doença isquêmica do coração apresenta altas taxas de mortalidade e é a mais prevalente entre as doenças cardiovasculares. É uma doença multifatorial, cuja prevenção depende do controle dos fatores de risco. O eletrocardiograma de repouso pode ser utilizado para detectar manifestações da doença isquêmica do coração quando o indivíduo ainda é assintomático. O objetivo do estudo foi o de analisar a relação entre as anormalidades eletrocardiográficas e os fatores de risco para doença isquêmica do coração em uma população adulta residente na área metropolitana de São Paulo. MÉTODOS: Realizou-se um estudo transversal com população do município de Cotia (SP). A amostra constou de 1067 indivíduos com idade acima de 20 anos, de ambos os sexos. Os dados foram obtidos por meio de entrevista com utilização de um questionário padronizado. As variáveis estudadas foram: sexo, idade, tabagismo, atividade física, índice de massa corpórea, relação cintura/quadril, pressão arterial, diabetes melito, dislipidemia (colesterol total, LDL-colesterol, HDL-colesterol e triglicérides) e alterações eletrocardiográficas. As alterações eletrocardiográficas foram agrupadas em três categorias: alterações de repolarização ventricular (ARV), sobrecarga do ventrículo esquerdo (SVE) e alterações não relacionadas à isquemia miocárdia ou sem alterações (NRI). RESULTADOS: A população de estudo era predominantemente jovem, sendo 79% abaixo de 50 anos, com idade de 39,8 anos ± 13,2 anos. Cerca de 59,3% dos indivíduos eram do sexo feminino. O eletrocardiograma mostrou que 9,5% da população apresentava ARV e 3,3% apresentava SVE. O sexo feminino, a idade de risco (acima de 65 anos para mulheres e acima de 55 anos para homens), a presença de diabetes, hipertensão arterial, colesterol total ³ a 200 mg/dl, LDL-colesterol ³ a 130 mg/dl, triglicérides acima de 200 mg/dl, índice de massa corpórea indicativo de sobrepeso ou obesidade (³25 Kg/m2),relação cintura/quadril alterada correlacionaram-se positivamente com ARV. O sexo masculino, diabetes, hipertensão arterial e o tabagismo foram correlacionados positivamente com SVE. Na presença de ARV no ECG encontramos uma razão de chance de 3,54 para a ocorrência do diagnóstico de hipertensão sistólica e de 1,83 para colesterol total ³ a 200 mg/dl. Na presença de SVE no ECG, a razão de chance para a ocorrência do diagnóstico de hipertensão sistólica observada foi de 5,92. Dos três fatores de risco correlacionados às alterações eletrocardiográficas associadas à isquemia miocárdia, dois são controláveis e ligados a condições nutricionais (hipertensão e colesterol ³ a 200 mg/dl), o que demonstra a importância da sua detecção precoce. Em estudos epidemiológicos e de intervenção nutricional, o eletrocardiograma, método simples e de baixo custo, pode auxiliar na identificação de fatores de risco cardiovascular. Seria importante que estas informações fossem confirmadas por estudos prospectivos que incluíssem a determinação dos valores preditivos do ECG nesta situação.

OBJETIVE: Ischemic heart disease is associated with high rates of mortality and it is the most prevalent among cardiovascular diseases. It is a multifactorial disease, and its prevention depends on control of risk factors. Resting electrocardiogram can be used to detect manifestations of ischemic heart disease, since some electrocardiographic abnormalities are indicative of coronary disease in asymptomatic subjects. The aim of the study was to analyze the relationship between electrocardiographic abnormalities and risk factors for ischemic heart disease in an adult population from the metropolitan area of São Paulo. METHODS: A cross-sectional study was carried out in an adult population (age 20 years and over) from Cotia, near São Paulo, southeastern of Brazil. The study population comprised 1067 subjects. The subjects were interviewed using a questionnaire. The variables studied were: gender, age, smoking behaviour, physical activity, body mass index, waist-to-hip ratio, blood pressure, diabetes mellitus, blood lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides) and electrocardiographic abnormalities. Electrocardiographic abnormalities were grouped according to the classification: ST-T changes, left ventricular hypertrophy and abnormalities non related to ischemic myocardial disease or without abnormalities. RESULTS: The population was relatively -young (79% younger than 50 years, mean age 39.8 ± 13.2 years old), and 59.3% were female. The resting electrocardiogram showed ST-T changes in 9.5% of the subjects and left ventricular hypertrophy in 3.3%. Female gender, age over 65 years for women and 55 years for men, diabetes, hypertension, total cholesterol > or = 200 mg/dl, LDL-cholesterol > or = 130 mg/dl, Triglycerides > or = 200 mg/dl, body mass index > or = 25 Kg/m² and abnormal waist-to-hip ratio, were positively related to ST-T changes. Male gender, diabetes, hypertension and smoking behaviour were positively related to left ventricular hypertrophy. In the presence of ST-T changes on the ECG, we observed an odds ratio of 3.54 for the diagnosis of systolic hypertension an of 1.83 for total cholesterol > or = 200 mg/dl. In the presence of left ventricular hypertrophy on the ECG, we found an odds ratio of 5.92 for systolic hypertension diagnosis. Among the three most important risk factors correlated to electrocardiographic abnormalities indicative of myocardial ischemia, two can be controlled by nutritional intervention (hypertension and total cholesterol > or = 200 mg/dl). This findings suggest the importance of its early detection. Future studies should determine the predictive value of the electrocardiogram, a simple and inexpensive method, suggesting the presence of cardiovascular risk factors in epidemiologycal and nutritional studies.

36537 downloads Cited 4 times in SciELO

10.

Qual o valor do Dímero D no diagnóstico do tromboembolismo pulmonar?
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MONACHINI, MARISTELA

Revista da Associação Médica Brasileira

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sep 2002, Volume 48 N. 3 Pages 189 - 189

Abstract: Pt | Text: Pt | PDF: Pt

422061 downloads

11.

Hyperlipidemia related to the use of HIV-protease inhibitors: natural history and results of treatment with fenofibrate
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Caramelli, Bruno

; Bernoche, Claudia Y.S.M. de

; Sartori, Ana M. C.

; Sposito, Andrei C.

; Santos, Raul D.

; Monachini, Maristela C.

; Strabelli, Tania

; Uip, Davi

Brazilian Journal of Infectious Diseases

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dec 2001, Volume 5 N. 6 Pages 332 - 338

Abstract: En | Text: En | PDF: En

Hyperlipidemia has been frequently recorded as a side effect of treating HIV patients with protease inhibitors (PI). This study was initiated to analyze the modifications on blood lipids in HIV-patients receiving PI and the safety and efficacy of the treatment with fenofibrate. Total (TC) and HDL-cholesterol, triglycerides (TG), and CD4+ T-cell counts were measured in 30 HAART-naive patients (Group I) before and after PI introduction. In a second phase of the study, the effects of fenofibrate on lipids, CPK, CD4+, and viral load were determined in 13 patients (Group II) with elevated TC or TG. In Group I, 60% of the patients showed TC or TG elevations. Average increments of 31% and 146% in TC and TG respectively (p<0.0006 and p<0.0001) were observed. In Group II, fenofibrate treatment was associated with decrements of 6.6% (TC) and 45.7% (TG) (p=0.07 and 0.0002) and no modifications on CPK, CD4+, and viral load. In conclusion, hyperlipidemia is common during the treatment of HIV with protease inhibitors, and fenofibrate appears to be an effective and safe choice for its treatment.

7040 downloads Cited 11 times in SciELO

12.

Ressonância nuclear magnética no diagnóstico de pseudoaneurisma de ventrículo esquerdo. Antigo problema, nova opção
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Alvarenga, Glaura S.

; Kopel, Liliane

; Dallan, Luís Alberto Oliveira

; Avila, Luiz Francisco

; Monachini, Maristela C.

; Lage, Silvia G.

Arquivos Brasileiros de Cardiologia

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oct 1997, Volume 69 N. 4 Pages 251 - 254

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

Paciente feminina, 67 anos, internada por infarto agudo do miocárdio de parede lateral, com edema agudo de pulmão e evolução para choque cardiogênico nas primeiras horas. Ecocardiograma transesofágico e ressonância nuclear magnética confirmaram o diagnóstico de pseudoaneurisma de ventrículo esquerdo. A paciente foi submetida a tratamento cirúrgico com sucesso.

We describe the case of a 61 year-old female patient admitted to the hospital with acute lateral myocardial infarction, in pulmonary edema, who evolved to cardiogenic shock in the first hours. Transesophageal echodopplercardiogram and nuclear magnetic resonance imaging showed the diagnosis of a left ventricular pseudoaneurysm. Surgical repair was successfully undertaken.

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