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[SciELO Preprints] - Guidelines on the Diagnosis and Treatment of Hypertrophic Cardiomyopathy – 2024
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Fernandes, Fabio Simões, Marcus V. Correia, Edileide de Barros Marcondes-Braga, Fabiana G. Coelho-Filho, Otavio Rizzi Mesquita, Cláudio Tinoco Mathias-Junior, Wilson Rochitte, Carlos Eduardo Ramires, Felix José Alvarez Alves, Silvia Marinho Martins Montera, Marcelo Westerlund Lopes, Renato Delascio Oliveira-Junior, Mucio Tavares Scolari, Fernando L. Avila, Walkiria Samuel Canesin, Manoel Fernandes Bacal, Fernando Bocchi, Edimar Alcides Moura, Lídia Ana Zytynski Saad, Eduardo Benchimol Scanavacca, Mauricio I. Valdigem, Bruno Pereira Cano , Manuel Nicolas Abizaid , Alexandre Ribeiro, Henrique Barbosa Lemos-Neto, Pedro Alves Ribeiro, Gustavo Calado de Aguiar Jatene, Fabio Biscegli Dias, Ricardo Ribeiro Beck-da-Silva, Luis Rohde, Luis Eduardo P. Bittencourt, Marcelo Imbroinise Pereira, Alexandre Krieger, José Eduardo Villacorta, Humberto Martins, Wolney de Andrade Figueiredo-Neto, José Albuquerque de Cardoso , Juliano Novaes Pastore, Carlos Alberto Jatene, Ieda Biscegli Tanaka, Ana Cristina Sayuri Hotta, Viviane Tiemi Romano, Minna Moreira Dias Albuquerque, Denilson Campos de Mourilhe-Rocha, Ricardo Hajjar, Ludhmila Abrahão Brito, Fabio Sandoli de Caramelli , Bruno Calderaro, Daniela Farsky, Pedro Silvio Colafranceschi , Alexandre Siciliano Pinto, Ibraim Masciarelli Vieira , Marcelo Luiz Campos Danzmann, Luiz Claudio Barberato , Silvio Henrique Mady, Charles Martinelli-Filho, Martino Torbey , Ana Flavia Malheiros Schwartzmann, Pedro Vellosa Macedo, Ariane Vieira Scarlatelli Ferreira , Silvia Moreira Ayub Schmidt, Andre Melo , Marcelo Dantas Tavares de Lima-Filho, Moysés Oliveira Sposito, Andrei C. Brito, Flavio de Souza Biolo, Andreia Madrini-Junior, Vagner Rizk, Stéphanie Itala Mesquita, Evandro Tinoco

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Publication date: 2024-04-08

Abstract: Pt Es En

A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura > 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (> 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE.   Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI).

La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor > 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (> 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).

Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness > 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (> 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.

https://doi.org/10.1590/SciELOPreprints.8394

Atherosclerosis risk factor management - what's new for the neurologist?
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Bichuette, Luciana Dornfeld

; Lottenberg, Marcos Pita

; Cardozo, Francisco Akira Malta

; Calderaro, Daniela

Arquivos de Neuro-Psiquiatria

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may 2022, Volume 80 N. 5 Pages 88 - 93

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

RESUMO O acidente vascular cerebral (AVC) é a segunda causa de morte no mundo e, em grande parte, pode ser atribuído a fatores de risco modificáveis, principalmente comportamentais e metabólicos. Os seis principais fatores de risco responsáveis pela mortalidade cardiovascular no Brasil em 2019 foram pressão arterial sistólica elevada, exposição alimentar inadequada, índice de massa corporal elevado, LDL -colesterol elevado, níveis alterados de glicemia e tabagismo. Pretendemos discutir neste artigo as evidências e recomendações na abordagem de três fatores de risco essenciais para pacientes com histórico de AVC: dislipidemia, hipertensão e diabetes.

ABSTRACT Stroke is the second leading cause of death worldwide and the vast majority can be attributed to modifiable risk factors, mainly behavioral and metabolic. The top six risk factors responsible for cardiovascular mortality in Brazil in 2019 were high systolic blood pressure, inadequate dietary exposure, high body mass index, high LDL cholesterol, high fasting blood glucose levels, and tobacco. We intend to discuss in this paper the evidence and recommendations in the approach of three essential risk factors for patients with a history of stroke: dyslipidemia, hypertension and diabetes.

https://doi.org/10.1590/0004-282x-anp-2022-s102

Atualização da Diretriz de Avaliação Cardiovascular Perioperatória da Sociedade Brasileira de Cardiologia: Foco em Manejo dos Pacientes com Intervenção Coronária Percutânea – 2022
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Calderaro, Daniela

; Bichuette, Luciana Dornfeld

; Maciel, Pamela Camara

; Cardozo, Francisco Akira Malta

; Ribeiro, Henrique Barbosa

; Gualandro, Danielle Menosi

; Baracioli, Luciano Moreira

; Soeiro, Alexandre de Matos

; Serrano Jr., Carlos Vicente

; Costa, Ricardo Alves da

; Caramelli, Bruno

Arquivos Brasileiros de Cardiologia

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2022, Volume 118 N. 2 Pages 536 - 547

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

https://doi.org/10.36660/abc.20220039

Hemodynamic depression after carotid surgery: Incidence, risk factors and outcomes
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Bogniotti, Lauro A.C.

; Teivelis, Marcelo P.

; Cardozo, Francisco A.M.

; Caramelli, Bruno

; Wolosker, Nelson

; Puech-Leão, Pedro

; Luccia, Nelson De

; Calderaro, Daniela

Clinics

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2022, Volume 77 elocation 100090

Abstract: En | Text: En | PDF: En

Abstract Introduction: Hemodynamic Depression (HD) characterized by hypotension and bradycardia is a complication of carotid surgery due to direct autonomic stimulation in the carotid sinus. The authors believe the incidence of HD is high and possibly related to major cardiac complications. Methods: Analysis of patient records during admissions for carotid surgery between January 2014 and December 2018 in two hospitals. HD was defined as bradycardia or hypotension in the first 24 postoperative hours. Bradycardia was defined as heart rate < 50bpm; hypotension as systolic blood pressure < 90 mmHg, continuous use of vasopressors, or a drop in SBP > 20% compared to preoperative values. Myocardial infarction, stroke, and cardiovascular death were defined as adverse events. Results: Overall, 237 carotid surgeries (178 endarterectomies, 59 angioplasties) were studied, and the global incidence of HD was 54.4% (hypotension in 50.2%, bradycardia in 11.0%, and hypotension and bradycardia in 6.8%). The independent predictors of HD were asymptomatic carotid stenosis (OR = 1.824; 95% CI 1.014 −3.280; p = 0.045), endovascular surgery (OR = 3.319; 95% CI 1.675−6.576; p = 0.001) and intraoperative hypotension or bradycardia (OR = 2.144; 95% CI 1.222−3.762; p = 0.008). Hypotension requiring continuous vasopressor infusion was the only factor independently associated with adverse cardiovascular events (OR = 5.504; 95% CI 1.729-17.529; p = 0.004). Discussion/conclusion: Incidence of Hemodynamic Depression after carotid surgery is high and independently associated with surgical technique, symptomatic repercussion of the carotid stenosis, and intraoperative hypotension or bradycardia. Hypotension requiring the continuous infusion of vasopressors was independently associated with the occurrence of MACE.

https://doi.org/10.1016/j.clinsp.2022.100090

Atualização no Tratamento da Hipertensão Arterial Pulmonar
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Fernandes, Caio J.

; Calderaro, Daniela

; Assad, Ana Paula Luppino

; Salibe-Filho, William

; Kato-Morinaga, Luciana Tamie

; Hoette, Susana

; Piloto, Bruna

; Castro, Marcela Araújo

; Lisboa, Roberta Pontes

; Silva, Taysa Antonia Felix da

; Martins, Murillo de Araújo

; Alves-Jr, Jose L.

; Jardim, Carlos

; Terra-Filho, Mario

; Souza, Rogerio de

Arquivos Brasileiros de Cardiologia

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oct 2021, Volume 117 N. 4 Pages 750 - 764

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

Resumo Muitos avanços ocorreram nas últimas décadas na terapêutica da hipertensão arterial pulmonar (HAP), uma doença grave, progressiva, incurável e potencialmente fatal. Para seu tratamento adequado, são fundamentais o diagnóstico hemodinâmico e a classificação de sua etiologia, em que várias delas (colagenoses, hipertensão portal, cardiopatia congênitas, esquistossomose) requerem medidas específicas, além do tratamento farmacológico característico para HAP. O tratamento com fármacos-alvo para HAP baseia-se em produtos farmacêuticos que interferem em três vias fisiopatológicas moleculares: da prostaciclina, da endotelina e do óxido nítrico. Tais fármacos apresentam múltiplas apresentações (oral, endovenosa, subcutânea e inalatória) e mudaram a história da HAP. Essas medicações e suas estratégias de uso, assim como particularidades das diferentes formas de HAP, são o foco desta revisão.

Abstract In the last decades, important advances have been made in the treatment of pulmonary arterial hypertension (PAH), a severe, progressive, incurable, and potentially fatal disease. For an adequate therapy, correct hemodynamic diagnosis and etiology classification are fundamental. Many etiologies – rheumatic disease, portal hypertension, congenital heart diseases, schistosomiasis – require specific measures, in addition to drug therapy for PAH. The specific therapy for PAH is based on medications that act on three pathophysiological pathways – prostacyclin, endothelin, and nitric oxide pathways. These drugs have multiple presentations (oral, intravenous, subcutaneous, and inhaled) and have changed the history of PAH. This review presents an overview of drug therapy strategies and different forms and peculiarities of PAH.

https://doi.org/10.36660/abc.20200702 140 downloads

Cardiology referral during the COVID-19 pandemic
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Santorio, Nathalia Conci

; Cardozo, Francisco Akira Malta

; Miada, Rodrigo Freddi

; Pitta, Fabio Grunspun

; Tavares, Caio de Assis Moura

; Habrum, Fabio Cetinic

; Pinesi, Henrique Trombini

; Magalhães, Iuri Resedá

; Menezes, Maria Clara Saad

; Caramelli, Bruno

; Calderaro, Daniela

Clinics

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2021, Volume 76 elocation e3538

Abstract: En | Text: En | PDF: En

OBJECTIVES: This study presents the cardiology referral model adopted at the University of São Paulo-Hospital das Clínicas complex during the initial period of the coronavirus disease (COVID-19) pandemic, main reasons for requesting a cardiologic evaluation, and clinical profile of and prognostic predictors in patients with COVID-19. METHODS: In this observational study, data of all cardiology referral requests between March 30, 2020 and July 6, 2020 were collected prospectively. A descriptive analysis of the reasons for cardiologic evaluation requests and the most common cardiologic diagnoses was performed. A multivariable model was used to identify independent predictors of in-hospital mortality among patients with COVID-19. RESULTS: Cardiologic evaluation was requested for 206 patients admitted to the ICHC-COVID. A diagnosis of COVID-19 was confirmed for 180 patients. Cardiologic complications occurred in 77.7% of the patients. Among these, decompensated heart failure was the most common complication (38.8%), followed by myocardial injury (35%), and arrhythmias, especially high ventricular response atrial fibrillation (17.7%). Advanced age, greater need of ventilatory support on admission, and pre-existing heart failure were independently associated with in-hospital mortality. CONCLUSIONS: A hybrid model combining in-person referral with remote discussion and teaching is a viable alternative to overcome COVID-19 limitations. Cardiologic evaluation remains important during the pandemic, as patients with COVID-19 frequently develop cardiovascular complications or decompensation of the underlying heart disease.

https://doi.org/10.6061/clinics/2021/e3538

Pulmonary Hypertension in General Cardiology Practice
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Calderaro, Daniela

; Alves Junior, José Leonidas

; Fernandes, Caio Júlio César dos Santos

; Souza, Rogério

Arquivos Brasileiros de Cardiologia

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sep 2019, Volume 113 N. 3 Pages 419 - 428

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

Resumo O achado de hipertensão pulmonar (HP) em avaliação ecocardiográfica é frequente e preocupante. No entanto, o ecocardiograma é apenas um exame sugestivo e não diagnóstico de HP. Quando se suspeita de acometimento direto da circulação pulmonar, está indicada medida hemodinâmica invasiva para estabelecer o diagnóstico. Essa avaliação permite, além da confirmação diagnóstica, a correta identificação do território vascular predominantemente acometido (arterial pulmonar ou pós-capilar). O tratamento com as medicações específicas de HP (inibidores da fosfodiestarese 5, antagonistas do receptor de endotelina, análogos da prostaciclina e estimulador da guanilil ciclase solúvel) é comprovadamente eficaz para pacientes com hipertensão arterial pulmonar, mas seu uso em pacientes com HP decorrente de doença cardíaca de câmaras esquerdas pode até mesmo ser prejudicial. Discutiremos nesta revisão o critério diagnóstico, a maneira de proceder a investigação etiológica, a classificação clínica e, finalmente, as recomendações terapêuticas na HP.

Abstract The finding of pulmonary hypertension (PH) by echocardiography is common and of concern. However, echocardiography is just a suggestive and non-diagnostic assessment of PH. When direct involvement of pulmonary circulation is suspected, invasive hemodynamic monitoring is recommended to establish the diagnosis. This assessent provides, in addition to the diagnostic confirmation, the correct identification of the vascular territory predominantly involved (arterial pulmonary or postcapillary). Treatment with specific medication for PH (phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and prostacyclin analogues) has been proven effective in patients with pulmonary arterial hypertension, but its use in patients with PH due to left heart disease can even be damaging. In this review, we discuss the diagnosis criteria, how etiological investigation should be carried out, the clinical classification and, finally, the therapeutic recommendations for PH.

https://doi.org/10.5935/abc.20190188 6519 downloads

3rd Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology
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Gualandro, Danielle Menosi

; Yu, Pai Ching

; Caramelli, Bruno

; Marques, André Coelho

; Calderaro, Daniela

; Fornari, Luciana Savoy

; Pinho, Claudio

; Feitosa, Alina Coutinho Rodrigues

; Polanczyk, Carisi Anne

; Rochitte, Carlos Eduardo

; Jardim, Carlos

; Vieira, Carolina L. Z.

; Nakamura, Debora Y. M.

; Iezzi, Denise

; Schreen, Dirk

; Adam, Eduardo Leal

; D’Amico, Elbio Antonio

; Lima, Emerson Q. de

; Burdmann, Emmanuel de Almeida

; Mateo, Enrique Indalecio Pachón

; Marcondes-Braga, Fabiana Goulart

; Machado, Fabio S.

; Paula, Flavio J. de

; Carmo, Gabriel Assis Lopes do

; Feitosa-Filho, Gilson Soares

; Prado, Gustavo Faibischew

; Lopes, Heno Ferreira

; Fernandes, João R. C.

; Lima, José J. G. de

; Sacilotto, Luciana

; Drager, Luciano Ferreira

; Vacanti, Luciano Janussi

; Rohde, Luis Eduardo Paim

; Prada, Luis F. L.

; Gowdak, Luis Henrique Wolff

; Vieira, Marcelo Luiz Campos

; Monachini, Maristela Camargo

; Macatrão-Costa, Milena Frota

; Paixão, Milena Ribeiro

; Oliveira Junior, Mucio Tavares de

; Cury, Patricia

; Villaça, Paula R.

; Farsky, Pedro Silvio

; Siciliano, Rinaldo F.

; Heinisch, Roberto Henrique

; Souza, Rogerio

; Gualandro, Sandra F.M.

; Accorsi, Tarso Augusto Duenhas

; Mathias Júnior, Wilson

Arquivos Brasileiros de Cardiologia

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sep 2017, Volume 109 N. 3 Pages 1 - 104

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

https://doi.org/10.5935/abc.20170140 100302 downloads

Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose – 2017
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Faludi, André Arpad

; Izar, Maria Cristina de Oliveira

; Saraiva, José Francisco Kerr

; Chacra, Ana Paula Marte

; Bianco, Henrique Tria

; Afiune Neto, Abrahão

; Bertolami, Adriana

; Pereira, Alexandre C.

; Lottenberg, Ana Maria

; Sposito, Andrei C.

; Chagas, Antonio Carlos Palandri

; Casella Filho, Antonio

; Simão, Antônio Felipe

; Alencar Filho, Aristóteles Comte de

; Caramelli, Bruno

; Magalhães, Carlos Costa

; Negrão, Carlos Eduardo

; Ferreira, Carlos Eduardo dos Santos

; Scherr, Carlos

; Feio, Claudine Maria Alves

; Kovacs, Cristiane

; Araújo, Daniel Branco de

; Magnoni, Daniel

; Calderaro, Daniela

; Gualandro, Danielle Menosi

; Mello Junior, Edgard Pessoa de

; Alexandre, Elizabeth Regina Giunco

; Sato, Emília Inoue

; Moriguchi, Emilio Hideyuki

; Rached, Fabiana Hanna

; Santos, Fábio César dos

; Cesena, Fernando Henpin Yue

; Fonseca, Francisco Antonio Helfenstein

; Fonseca, Henrique Andrade Rodrigues da

; Xavier, Hermes Toros

; Mota, Isabela Cardoso Pimentel

; Giuliano, Isabela de Carlos Back

; Issa, Jaqueline Scholz

; Diament, Jayme

; Pesquero, João Bosco

; Santos, José Ernesto dos

; Faria Neto, José Rocha

; Melo Filho, José Xavier de

; Kato, Juliana Tieko

; Torres, Kerginaldo Paulo

; Bertolami, Marcelo Chiara

; Assad, Marcelo Heitor Vieira

; Miname, Márcio Hiroshi

; Scartezini, Marileia

; Forti, Neusa Assumpta

; Coelho, Otávio Rizzi

; Maranhão, Raul Cavalcante

; Santos Filho, Raul Dias dos

; Alves, Renato Jorge

; Cassani, Roberta Lara

; Betti, Roberto Tadeu Barcellos

; Carvalho, Tales de

; Martinez, Tânia Leme da Rocha

; Giraldez, Viviane Zorzanelli Rocha

; Salgado Filho, Wilson

Arquivos Brasileiros de Cardiologia

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aug 2017, Volume 109 N. 2 Pages 1 - 76

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.5935/abc.20170121 199102 downloads

10.

Characterization of Streptococcus suis through serotyping, SE-AFLP and virulence profile
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Calderaro, Franco F.

; Moreno, Luisa Z.

; Doto, Daniela S.

; Matajira, Carlos E.C.

; Gomes, Vasco T.M.

; Ferreira, Thais S.P.

; Mesquita, Renan E.

; Moreno, Andrea M.

Pesquisa Veterinária Brasileira

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aug 2016, Volume 36 N. 8 Pages 701 - 704

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

Resumo: Streptococcus suis é um dos patógenos de maior importância para indústria suinícola mundial. Apesar de sua importância, a caracterização de isolados de S. suis na América do Sul ainda é pouco descrita. O presente estudo descreve a avaliação de isolados de S. suis provenientes de diferentes Estados brasileiros, e sua caracterização sorológica e molecular. Foram avaliados 174 isolados de S. suis e os mesmos foram submetidos a SE-AFLP e pesquisa de marcadores de virulência. Os sorotipos 1, 2, 3, 4, 7, 18, 22 e 32 foram identificados dentre os isolados estudados e apenas 4% foram caracterizados como não tipáveis. O perfil de virulência mrp+/epf+/sly+ foi o mais frequente. A análise do SE-AFLP resultou em 29 perfis distribuídos em três grupos principais com mais de 65% de similaridade genética. Os isolados apresentaram tendência de se agrupar segundo origem e sorotipo; no entanto, não foi observada correlação entre os grupamentos e os perfis de virulência.

Abstract: Streptococcus suis is one of most important pathogens in the swine industry worldwide. Despite its importance, studies of S. suis characterization in South America are still rare. This study evaluates S. suis isolates from distinct Brazilian states, from 1999 to 2004, and its molecular and serological characterization. A total of 174 isolates were studied. S. suis identification was confirmed by PCR and isolates were further serotyped and genotyped by SE-AFLP and amplification of virulence markers. Serotype 1, 2, 3, 4, 7, 18, 22 and 32 were identified among the studied isolates, and only 4% were characterized as non-typeable. The mrp+/epf+/sly+ genotype was the most frequent. The SE-AFLP analysis resulted in 29 patterns distributed in three main clusters with over 65% of genetic similarity. Isolates presented a slight tendency to cluster according to serotype and origin; however, no further correlation with virulence genotypes was observed.

https://doi.org/10.1590/S0100-736X2016000800004 779 downloads

11.

Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations
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Marques, André C.

; Calderaro, Daniela

; Yu, Pai C.

; Gualandro, Danielle M.

; Carmo, Gabriel A.L.

; Azevedo, Fernanda R.

; Pastana, Adriana F.

; Lima, Eneas M.O.

; Monachini, Maristela

; Caramelli, Bruno

Clinics

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dec 2014, Volume 69 N. 10 Pages 666 - 671

Abstract: En | Text: En | PDF: En

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

12.

I Diretriz sobre Aspectos Específicos de Diabetes (tipo 2) Relacionados à Cardiologia
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Soeiro, Alexandre de Matos

; Mansur, Antonio de Pádua

; Schaan, Beatriz D.

; Caramelli, Bruno

; Rochitte, Carlos Eduardo

; Serrano Jr., Carlos Vicente

; Garzillo, Cibele Larrosa

; Calderaro, Daniela

; Gualandro, Danielle M.

; Lima, Eduardo Gomes

; Marcondes-Braga, Fabiana G.

; Lima, Felipe Gallego

; Oliveira, Felipe Martins de

; Azevedo, Fernanda Reis

; Chauhan, Hiteshi

; Salles, João Eduardo Nunes

; Soares Junior, José

; Cardoso, Juliano Novaes

; Pellanda, Lucia Campos

; Sacilotto, Luciana

; Baracioli, Luciano

; Bortolotto, Luiz A.

; César, Luiz Antonio Machado

; Ochiai, Marcelo Eidi

; Minami, Marcio H.

; Pinheiro, Martina Battistini

; Moretti, Miguel Antonio

; Oliveira, Mucio Tavares de

; Rezende, Paulo Cury

; Lemos Neto, Pedro Alves

; Admoni, Sharon Nina

; Lottenberg, Simão Augusto

; Rocha, Viviane Z.

; Hueb, Whady

; Mathias Jr., Wilson

Arquivos Brasileiros de Cardiologia

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may 2014, Volume 102 N. 5 Pages 1 - 41

Abstract: En | Text: En | PDF: En

https://doi.org/10.5935/abc.2014S002 9799 downloads

13.

Infarto agudo do miocárdio após operações não cardíacas
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Gualandro, Danielle Menosi

; Calderaro, Daniela

; Yu, Pai Ching

; Caramelli, Bruno

Arquivos Brasileiros de Cardiologia

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nov 2012, Volume 99 N. 5 Pages 1060 - 1067

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

Em todo o mundo, são realizadas mais de 230 milhões de operações por ano e as complicações cardíacas são as causas mais comuns de morbidade e mortalidade pós-operatórias. Com o aumento da expectativa de vida da população mundial, um número crescente de pacientes com múltiplas comorbidades tem sido submetido a operações não cardíacas. Em consequência, é esperado um aumento de complicações cardiovasculares associadas a tais procedimentos e o infarto agudo do miocárdio (IAM) perioperatório poderá se tornar um problema frequente. No Brasil, o número de operações não cardíacas também está aumentando, sendo realizadas aproximadamente três milhões de cirurgias por ano. Apesar dos avanços nas técnicas cirúrgicas e anestésicas, a mortalidade e o custo relacionados a estes procedimentos também estão aumentando, sendo fundamental o desenvolvimento de estratégias para a redução da mortalidade. A ocorrência de um IAM perioperatório prolonga a necessidade de terapia intensiva, a estadia hospitalar, aumenta o custo da internação e diminui a sobrevida a longo prazo. Esta revisão aborda a fisiopatologia, a incidência, o diagnóstico e o tratamento do IAM perioperatório, baseado nas evidências atuais.

Over 230 million surgeries are performed annually worldwide, cardiac complications being the most common causes of postoperative morbidity and mortality. As life expectancy has extended worldwide, a growing number of patients with multiple comorbidities have undergone noncardiac surgeries. Consequently, cardiovascular complications associated with those procedures are expected to increase, and perioperative acute myocardial infarction (AMI) might become a frequent problem. In Brazil, the number of noncardiac surgical procedures has also increased, and approximately three million surgeries are performed annually. Despite advances in surgical and anesthetic techniques, mortality and costs related to those procedures have also increased, thus, requiring the development of strategies to reduce mortality4. The occurrence of perioperative AMI prolongs the need for intensive care and the hospital length of stay, increases the cost of hospitalization, and reduces long-term survival. This literature review approaches the pathophysiology, incidence, diagnosis and treatment of perioperative AMI based on current evidence.

16208 downloads Cited 1 time in SciELO

14.

Improving cardiovascular prevention through patient awareness
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Chang, Veronica Y. P.

; Handa, Karen K.

; Fernandes, Marcos

; Yacoub, Carolina

; Pastana, Adriana

; Caramelli, Bruno

; Calderaro, Daniela

Revista da Associação Médica Brasileira

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oct 2012, Volume 58 N. 5 Pages 550 - 556

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

OBJETIVO: Pacientes com doença arterial periférica (DAP) ou doença arterial coronariana (DAC) necessitam de um controle rigoroso dos seus fatores de risco, mas essa prática ainda está muito aquém da ideal. O objetivo deste estudo foi verificar como é feita a prevenção cardiovascular nesses pacientes em um hospital universitário no Brasil e identificar os preditores de melhor prevenção secundária. MÉTODOS: Trata-se de estudo transversal, com 192 pacientes portadores de DAC ou DAP. Foram analisadas seis metas a serem atingidas: 1) pressão arterial sistólica < 140 mmHg; 2) pressão arterial diastólica < 90 mmHg; 3) LDL < 100 mg/dL; 4) HDL > 40 mg/dL para homens/> 50 mg/dL para mulheres; 5) não fumar; 6) prática de exercício físico aeróbico regular. RESULTADOS: A idade média dos pacientes é 65,7 anos e 60% são do sexo masculino. A porcentagem dos pacientes que atingiram de 1 a 6 metas foi 57,3%; 67,2%; 40,1%; 27,6%; 88,5% e 25%, respectivamente. O número médio de metas atingidas por paciente foi 2,67 e 3,46 para os pacientes com DAP e DAC, respectivamente. Os preditores independentes de maior número de metas/paciente foram: sexo masculino (p = 0,011), estar internado (p < 0,001), diagnóstico de DAC (p = 0,011), saber o motivo do tratamento (p = 0,028) e receber prescrição de β-bloqueador (p = 0,011). CONCLUSÃO: Mesmo em um hospital universitário, a prevenção encontra-se longe da ideal. Esforços para aumentar a conscientização do paciente devem ser estimulados e podem possivelmente melhorar a efetividade das medidas preventivas.

OBJECTIVE: Patients with peripheral artery disease (PAD) or coronary artery disease (CAD) must have their risk factors rigorously controlled, but there is a gap between practice and ideal. This study aimed to demonstrate how cardiovascular prevention is performed for these patients in a Brazilian university hospital, and to identify predictors of good practice. METHODS: 192 patients with CAD or PAD were included in this transversal study. Six prevention goals were analyzed: 1) systolic blood pressure < 140 mmHg; 2) diastolic blood pressure < 90 mmHg; 3) LDL < 100 mg/dL; 4) HDL > 40 mg/dL for men/ > 50 mg/dL for women; 5) not smoking; 6) regular practice of aerobic exercise. RESULTS: The mean age of the patients was 65.7 years, and 60% were men. The percentage of patients that achieved goals 1 to 6 was 57.3%, 67.2%, 40.1%, 27.6%, 88.5%, and 25%, respectively. The average number of goals achieved by patients was 3.06 ± 1.31. When asked about the reason for being treated, 182(94.8%) patients claimed to know about their disease, but when the diagnosis reported by the patients with the physician's diagnosis were compared, it was discordant in 12% of cases. The average number of goals achieved by patients was 2.67 and 3.46 for the PAD and the CAD group, respectively. The independent predictors of a higher number of goals/patient were: male gender (p = 0.011), hospitalization (p < 0.0001), CAD diagnosis (p = 0.011), knowing the reason for treatment (p = 0.028), and receiving prescription of β -blocker (p = 0.011). CONCLUSION: Even in an university hospital, prevention is far from ideal. Efforts to increase patients' awareness should be stimulated, and can possibly improve the effectiveness of preventive measures.

2640 downloads

15.

Bradicardia sinusal persistente por nove dias após angioplastia carotídea com stent
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Krutman, Mariana

; Calderaro, Daniela

; Casella, Ivan Benaduce

; Caramelli, Bruno

; Wolosker, Nelson

; Puech-Leão, Pedro

Arquivos Brasileiros de Cardiologia

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sep 2012, Volume 99 N. 3 Pages e134 - e136

Abstract: Pt | Text: Pt | PDF: Pt

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