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Importance: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors improve outcomes in patients with type 2 diabetes, heart failure, and chronic kidney disease, but their effect on outcomes of critically ill patients with organ failure is unknown. Objective: To determine whether the addition of dapagliflozin, an SGLT-2 inhibitor, to standard intensive care unit (ICU) care improves outcomes in a critically ill population with acute organ dysfunction. Design, Setting, and Participants: Multicenter, randomized, open-label, clinical trial conducted at 22 ICUs in Brazil. Participants with unplanned ICU admission and presenting with at least 1 organ dysfunction (respiratory, cardiovascular, or kidney) were enrolled between November 22, 2022, and August 30, 2023, with follow-up through September 27, 2023. Intervention: Participants were randomized to 10 mg of dapagliflozin (intervention, n = 248) plus standard care or to standard care alone (control, n = 259) for up to 14 days or until ICU discharge, whichever occurred first. Main Outcomes and Measures: The primary outcome was a hierarchical composite of hospital mortality, initiation of kidney replacement therapy, and ICU length of stay through 28 days, analyzed using the win ratio method. Secondary outcomes included the individual components of the hierarchical outcome, duration of organ support-free days, ICU, and hospital stay, assessed using bayesian regression models. Results: Among 507 randomized participants (mean age, 63.9 [SD, 15] years; 46.9%, women), 39.6% had an ICU admission due to suspected infection. The median time from ICU admission to randomization was 1 day (IQR, 0-1). The win ratio for dapagliflozin for the primary outcome was 1.01 (95% CI, 0.90 to 1.13; P = .89). Among all secondary outcomes, the highest probability of benefit found was 0.90 for dapagliflozin regarding use of kidney replacement therapy among 27 patients (10.9%) in the dapagliflozin group vs 39 (15.1%) in the control group. Conclusion and Relevance: The addition of dapagliflozin to standard care for critically ill patients and acute organ dysfunction did not improve clinical outcomes; however, confidence intervals were wide and could not exclude relevant benefits or harms for dapagliflozin. Trial Registration: ClinicalTrials.gov Identifier: NCT05558098.
Assuntos
Compostos Benzidrílicos , Estado Terminal , Glucosídeos , Insuficiência de Múltiplos Órgãos , Inibidores do Transportador 2 de Sódio-Glicose , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Benzidrílicos/uso terapêutico , Estado Terminal/terapia , Glucosídeos/uso terapêutico , Glucosídeos/efeitos adversos , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Tempo de Internação , Insuficiência de Múltiplos Órgãos/tratamento farmacológico , Insuficiência de Múltiplos Órgãos/mortalidade , Terapia de Substituição Renal , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , BrasilRESUMO
Objetivo Investigar se um curto programa de treinamento aeróbio poderia causar modificação na frequência cardíaca de repouso e alterações na modulação autonômica cardíaca de pré-adolescentes obesos. Métodos Estudo longitudinal que envolveu quinze crianças obesas sedentárias com idades entre 9 e 12 anos que foram submetidas a 12 sessões de treinamento aeróbio de 40 minutos, com intensidade equivalente a 65% da frequência cardíaca submáxima. Para a coleta dos dados de frequência cardíaca e da modulação autonômica cardíaca foram utilizados o monitor Polar S810i e o software Polar Precision Performance que analisa a variabilidade da frequência cardíaca. A análise estatística empregou-se o teste Anova, com nível de significância de p<0,05, para analisar os dados nos momentos pré, durante após o treinamento aeróbio. Resultados Os valores medianos de frequência cardíaca de repouso foram: pré treinamento aeróbio = 89bpm, após 6 sessões = 95bpm e após 12 sessões = 87,5bpm; e do índice pNN50 da variabilidade da frequência cardíaca estudado para avaliar a modulação autonômica cardíaca, mostrou: pré treinamento aeróbio = 4,95%; após 6 sessões = 3,45%, e após 12 sessões = 11,5%. O índice razão Baixa Frequência/Alta Frequência da Variabilidade da Frequência Cardíaca no domínio da frequência mostrou os seguintes valores: pré Treinamento Aeróbio = 1,28, após seis sessões = 1,22, e após 12 sessões = 0,87. Todos os valores dos índices analisados no estudo não se modificaram significativamente com o treinamento aeróbio. Conclusão O treinamento aeróbio de curta duração (12 sessões), na intensidade em que foi aplicado, não foi suficiente para promover significativa redução da frequência cardíaca de repouso e alterações no padrão da modulação autonômica cardíaca.
Objective To investigate whether a short aerobic training program could promote resting Heart Rate and Cardiac Autonomic Modulation changes in obese preadolescents. Methods A longitudinal study involving fifteen sedentary obese children and pre-adolescents aged 9 to 12 years who underwent 12 sessions of aerobic training of 40 minutes, with intensity equivalent to 65% of the submaximal heart rate. The Polar S810i monitor and the Polar Precision Performance software were used to collect, respectively Heart Rate and Cardiac Autonomic Modulation data, which analyzes heart rate variability. For the statistical analysis, the Anova test (Kruskall-Wallis) was used, with a significance level of p<0.05, to compare the data at the moments before, during and after the aerobic training. Results The median values of resting heart rate were: before aerobic training = 89bpm, after 6 sessions = 95bpm and after 12 sessions = 87.5 bpm, and the pNN50 index of time domain of Heart Rate Variability studied to analyze the cardiac autonomic modulation, showed: before aerobic training = 4.95%; after 6 sessions = 3.45%, and after 12 sessions = 11.5%. The low frequency/high frequency ratio index of Heart Rate Variability at frequency domain showed the following values: before aerobic training = 1.28, after 6 sessions = 1.22, and after 12 sessions = 0.87. None of the values of the indexes used in the present study changed significantly with the aerobic training. Conclusion The short duration aerobic training (12 sessions) at the intensity that was applied was not enough to promote a significant reduction in resting heart rate (resting bradycardia) and in the Cardiac Autonomic Modulation pattern.
Assuntos
Humanos , Masculino , Feminino , Criança , Sistema Nervoso Autônomo , Exercício Físico , Frequência Cardíaca , ObesidadeRESUMO
OBJECTIVE:: To evaluate the wheal diameter in allergy skin-prick tests (SPT) with cow's milk extract (CM) comparing tolerant and persistent patients. METHOD:: A retrospective cohort study involving database analysis of children with diagnosis of cow's milk protein allergy (CMPA) mediated by immunoglobulin E in a specialized outpatient clinic that regularly performed SPT between January 2000 and July 2015. Patients were allocated into two groups: tolerant or persistent. Comparisons were made at diagnosis and over time between tolerant and persistent patients using Fisher's, Mann-Whitney or Wilcoxon tests and significance level at 5%. RESULTS:: After applying inclusion and exclusion criteria, the sample includes 44 patients (29 tolerant and 15 who persisted with CMPA). In the tolerant group, the medians of SPT were: 6 mm at diagnosis and 2 mm at the development of tolerance; a significant difference (p<0.0001) was found. In the persistent group, the median SPT at diagnosis was 7 mm, while in the last SPT it was 5 mm, with no statistical difference (p=0.173). The comparison of medians in the last SPT between groups was significant (p=0.001), with a reduction greater than 50% in SPT in the tolerant group. CONCLUSION:: Serial SPTs were useful for diagnosis, and a decrease higher than 50% in diameter can indicate the moment to perform oral food challenge (OFC) tests, helping to detect tolerance in CMPA.
Assuntos
Imunoglobulina E/imunologia , Hipersensibilidade a Leite/diagnóstico , Testes Cutâneos/métodos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Imunoglobulina E/sangue , Lactente , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Summary Objective: To evaluate the wheal diameter in allergy skin-prick tests (SPT) with cow’s milk extract (CM) comparing tolerant and persistent patients. Method: A retrospective cohort study involving database analysis of children with diagnosis of cow’s milk protein allergy (CMPA) mediated by immunoglobulin E in a specialized outpatient clinic that regularly performed SPT between January 2000 and July 2015. Patients were allocated into two groups: tolerant or persistent. Comparisons were made at diagnosis and over time between tolerant and persistent patients using Fisher’s, Mann-Whitney or Wilcoxon tests and significance level at 5%. Results: After applying inclusion and exclusion criteria, the sample includes 44 patients (29 tolerant and 15 who persisted with CMPA). In the tolerant group, the medians of SPT were: 6 mm at diagnosis and 2 mm at the development of tolerance; a significant difference (p<0.0001) was found. In the persistent group, the median SPT at diagnosis was 7 mm, while in the last SPT it was 5 mm, with no statistical difference (p=0.173). The comparison of medians in the last SPT between groups was significant (p=0.001), with a reduction greater than 50% in SPT in the tolerant group. Conclusion: Serial SPTs were useful for diagnosis, and a decrease higher than 50% in diameter can indicate the moment to perform oral food challenge (OFC) tests, helping to detect tolerance in CMPA.
Resumo Objetivo: avaliar o diâmetro da pápula do teste cutâneo alérgico (TCA) com extrato de leite de vaca (LV) comparando pacientes tolerantes e persistentes. Método: estudo de coorte retrospectivo de análise de banco de dados de crianças com diagnóstico de alergia à proteína do leite de vaca (APLV) mediada pela imunoglobulina E, em ambulatório especializado, que realizaram TCA de forma evolutiva, sendo alocados em dois grupos: tolerantes ou persistentes, entre janeiro de 2000 e julho de 2015. As comparações foram realizadas ao diagnóstico e evolutivamente entre tolerantes e persistentes, pelos testes de Fisher, Mann-Whitney ou Wilcoxon, utilizando níveis de significância de 5%. Resultados: aplicando critérios de inclusão e exclusão, a amostra incluiu 44 pacientes (29 tolerantes e 15 que persistiram com APLV). No grupo tolerante, as medianas do TCA foram: ao diagnóstico, de 6 mm, e, no desenvolvimento de tolerância, de 2 mm, com diferença significante (p<0,0001). No grupo persistente, a mediana do TCA ao diagnóstico foi de 7 mm e no momento do último TCA, de 5 mm, sem diferença estatística (p=0,173). A comparação das medianas no último TCA entre os grupos mostrou-se significante (p=0,001), com redução maior de 50% no valor do TCA no grupo tolerante. Conclusão: os TCA seriados foram úteis para o diagnóstico, e a redução maior que 50% em seu diâmetro pode indicar o momento para realização de testes de provocação oral (TPO), auxiliando na detecção de tolerância na APLV.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Imunoglobulina E/imunologia , Testes Cutâneos/métodos , Hipersensibilidade a Leite/diagnóstico , Imunoglobulina E/sangue , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estudos de Coortes , Sensibilidade e EspecificidadeRESUMO
The aim of this study was to investigate the protective action of resveratrol against the reproductive damage caused by left-sided experimental varicocele. There was a reduction of testicular major axis in the varicocele group when compared with the other groups; the testicular volume was reduced in varicocele group in comparison to the sham-control and resveratrol groups. The frequency of morphologically abnormal sperm was higher in varicocele and varicocele treated with resveratrol groups than in sham-control and resveratrol groups. The frequency of sperm with 100% of mitochondrial activity and normal acrosome integrity were lower in varicocele group than in varicocele treated with resveratrol, sham-control and resveratrol groups. Sperm motility was also reduced in varicocele group than in other groups. The sperm DNA fragmentation was higher in varicocele group than in other groups. Testicular levels of malondialdehyde were higher in varicocele and varicocele treated with resveratrol groups. The varicocele and varicocele treated with resveratrol groups had a significantly higher frequency of TUNEL-positive cells than sham-control and resveratrol groups; however, immunolabeling of the testes from varicocele treated with resveratrol group showed a lower number of apoptotic germ cells in comparison with the left testis of rats of the varicocele group. Reproductive alterations produced by varicocele from peripuberty were reduced by resveratrol in adulthood. Resveratrol should be better investigated as an adjuvant in the treatment of varicocele. Daily administration of resveratrol to rats with varicocele from peripuberty improves sperm quality in the adulthood.
Assuntos
Infertilidade Masculina/prevenção & controle , Puberdade/fisiologia , Reprodução/fisiologia , Motilidade dos Espermatozoides/efeitos dos fármacos , Estilbenos/farmacologia , Testículo/fisiologia , Varicocele , Animais , Anti-Inflamatórios não Esteroides/farmacologia , Masculino , Ratos , Ratos Wistar , Resveratrol , Testículo/efeitos dos fármacosRESUMO
Biópsia percutânea guiada por tomografia computadorizada é uma alternativa segura e eficaz para avaliação de lesões intraorbitárias selecionadas, em que o diagnóstico pré-operatório é importante para o planejamento terapêutico. Descrevemos dois casos de pacientes com tumores orbitários incomuns em que o diagnóstico foi obtido por biópsia com agulha grossa guiada por tomografia computadorizada, dando ênfase para os aspectos técnicos do procedimento.
Computed tomography-guided percutaneous biopsy is a safe and effective alternative method for evaluating selected intra-orbital lesions where the preoperative diagnosis is important for the therapeutic planning. The authors describe two cases of patients with uncommon primary orbital tumors whose diagnosis was obtained by means of computed tomography-guided core needle biopsy, with emphasis on the technical aspects of the procedure.
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Background: When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values. Objective: To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance. Method: The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests. Results: All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities. Conclusion: HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice. .
Fundamento: Durante a manobra de Valsalva (MV), os valores de resistência expiratória utilizados por adultos são os mesmos aplicados em pré-adolescentes. Objetivo: Analisar as respostas da frequência cardíaca (FC) de pré-adolescentes durante a MV e propor nova metodologia para eleição da resistência expiratória. Métodos: Submeteram-se 45 pré-adolescentes com idades entre 9 e 12 anos à avaliação das pressões expiratórias máximas (PEmáx). Valores de 60%, 70% e 80% dessas PEmáx foram selecionados para ser aplicados nas MV, mantidas por 20 s. Batimentos cardíacos foram registrados antes, durante e após a manobra. Trinta dias após, todos os procedimentos foram repetidos, e os dados da primeira (A1) e da segunda (A2) avaliações foram comparados. As análises foram feitas com testes não paramétricos, destacando-se os momentos antes, durante (0-10 s e 10-20 s) e após as manobras. Resultados: Os 45 pré-adolescentes conseguiram realizar adequadamente a manobra à resistência de 60% da PEmáx, enquanto apenas 38 (84,4%) e 25 (55,5%) a realizaram com resistências de 70% e 80% da PEmáx, respectivamente. Os deltas de FC 0-10 s e 10-20 s, calculados durante o esforço, foram significativamente maiores quanto maior foi o esforço expiratório, revelando efetiva resposta autonômica cardíaca durante a manobra. Entretanto, o estudo sugere que essas intensidades não devam ser empregadas. Conclusão: A FC se elevou em todas as intensidades de esforço testadas durante a MV, porém somente quando foi realizada com resistência expiratória de 60% da PEmáx é que todos os participantes conseguiram realizá-la, sugerindo ser a intensidade ideal para ser empregada na prática clínica. .
Assuntos
Criança , Feminino , Humanos , Masculino , Expiração/fisiologia , Frequência Cardíaca/fisiologia , Manobra de Valsalva/fisiologia , Antropometria , Fluxo Expiratório Máximo , Estudos Prospectivos , Valores de Referência , Estatísticas não Paramétricas , Fatores de TempoRESUMO
BACKGROUND: When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values. OBJECTIVE: To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance. METHOD: The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests. RESULTS: All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities. CONCLUSION: HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice.
Assuntos
Expiração/fisiologia , Frequência Cardíaca/fisiologia , Manobra de Valsalva/fisiologia , Antropometria , Criança , Feminino , Humanos , Masculino , Fluxo Expiratório Máximo , Estudos Prospectivos , Valores de Referência , Estatísticas não Paramétricas , Fatores de TempoRESUMO
Computed tomography-guided percutaneous biopsy is a safe and effective alternative method for evaluating selected intra-orbital lesions where the preoperative diagnosis is important for the therapeutic planning. The authors describe two cases of patients with uncommon primary orbital tumors whose diagnosis was obtained by means of computed tomography-guided core needle biopsy, with emphasis on the technical aspects of the procedure.
Biópsia percutânea guiada por tomografia computadorizada é uma alternativa segura e eficaz para avaliação de lesões intraorbitárias selecionadas, em que o diagnóstico pré-operatório é importante para o planejamento terapêutico. Descrevemos dois casos de pacientes com tumores orbitários incomuns em que o diagnóstico foi obtido por biópsia com agulha grossa guiada por tomografia computadorizada, dando ênfase para os aspectos técnicos do procedimento.
RESUMO
BACKGROUND: During pregnancy, glucocorticoids are frequently used to accelerate fetal lung maturation in preterm delivery. However, prenatal administration of glucocorticoids has been shown to affect organs such as fetal liver, an important hematopoietic organ during fetal development. OBJECTIVE: The aim of this study was to document the qualitative and quantitative changes in erythroid and megakaryocytic cell populations found in fetal livers as well as the hematology profile in neonates after maternal glucocorticoid treatment in rats. METHODS: Pregnant female Wistar rats were treated with dexamethasone 21-phosphate from days 13 to 16 of gestation. On the 17th day of pregnancy, the fetuses were collected and their livers processed for light and transmission electron microscopy. Glycol methacrylate-embedded sections were stained with PAS to determine the erythroblast and megakaryocytic cell frequencies. Fetal liver pieces embedded in Spurr resin were analyzed by transmission electron microscopy for morphologic changes. A standard hematology profile was evaluated in neonatal rats. RESULTS: In the fetuses from treated dams, the total cell number of erythroid cells in livers was significantly reduced compared to control fetuses (P < .001), but erythroblasts did not present ultrastructural abnormalities. The degree of maturation in the megakaryocyte series tended to be increased. In neonates, there were elevated numbers of nucleated RBCs (P = .002), along with a higher HCT and HGB (P = .02). In addition, the platelet concentration was also significantly increased (P < .007). CONCLUSION: These results suggest that maternal dexamethasone treatment has quantitative effects on erythroid and megakaryocytic cells in fetal liver and the neonatal hematology profile in rats.
Assuntos
Dexametasona/análogos & derivados , Desenvolvimento Fetal/efeitos dos fármacos , Glucocorticoides/efeitos adversos , Fígado/efeitos dos fármacos , Animais , Animais Recém-Nascidos , Plaquetas/efeitos dos fármacos , Dexametasona/efeitos adversos , Dexametasona/uso terapêutico , Eritroblastos/efeitos dos fármacos , Eritropoese/efeitos dos fármacos , Feminino , Glucocorticoides/uso terapêutico , Testes Hematológicos/veterinária , Troca Materno-Fetal , Megacariócitos/efeitos dos fármacos , Microscopia Eletrônica de Transmissão/veterinária , Gravidez , Ratos , Ratos WistarRESUMO
Introducción La insuficiencia cardíaca con función sistólica preservada es un síndrome clínico con los mismos signos y síntomas de la insuficiencia cardíaca clásica. La enfermedad de Chagas es una causa importante de insuficiencia cardíaca en América Latina, que se asocia con miocardiopatía dilatada y deterioro progresivo de la función sistólica. No existen estudios previos que hayan evaluado pacientes con insuficiencia cardíaca y función sistólica preservada de una zona endémica en la cual la enfermedad de Chagas es la causa principal de insuficiencia cardíaca. Objetivo Comparar las características clínicas y la evolución de la insuficiencia cardíaca en pacientes con disfunción sistólica y con función sistólica preservada en una población con alta prevalencia de enfermedad de Chagas. Material y métodos Se realizó una evaluación prospectiva de los pacientes con diagnóstico clínico de insuficiencia cardíaca que ingresaron a un centro de referencia en Salvador, Bahía (Brasil). Se consideró función sistólica preservada a una fracción de eyección del ventrículo izquierdo mayor del 45% por ecocardiograma. Se realizó seguimiento al año a través de contacto telefónico o entrevista personal en el consultorio de insuficiencia cardíaca. Resultados Se incluyeron 383 pacientes durante un período de 16 meses; el 52,5% eran hombres y la edad media fue de 54,2 años. La función sistólica estuvo preservada en 138 pacientes (36%). La enfermedad de Chagas fue la principal etiología de ambos tipos de insuficiencia cardíaca (45,3% con disfunción sistólica y 44,2% con función sistólica preservada). El 93,5% (358) de los pacientes completaron un año de seguimiento. Los pacientes con enfermedad de Chagas y función sistólica preservada tuvieron menor mortalidad que los pacientes con disfunción sistólica (10% vs. 23,6%; p = 0,039). En los pacientes sin enfermedad de Chagas y función sistólica preservada, la mortalidad fue similar a la de aquellos con disfunción sistólica (10,4% vs. 15,8%; p = 0,307). Conclusiones La función sistólica preservada fue muy frecuente en nuestra población. La enfermedad de Chagas es la principal etiología de insuficiencia cardíaca independientemente de la fracción de eyección del ventrículo izquierdo. Los pacientes con enfermedad de Chagas y función sistólica preservada tienen mejor pronóstico que aquellos con disfunción sistólica, probablemente porque se encuentran en la fase inicial del compromiso cardíaco.(AU)
Background Heart failure with preserved systolic function is a clinical syndrome with the same signs and symptoms of classic heart failure. Chagas disease is a major cause of heart failure in Latin America, associated with dilated cardiomyopathy and progressive deterioration of systolic function. There are no previous assessment studies of patients with heart failure and preserved systolic function in an endemic area in which Chagas disease is the leading cause of heart failure. Objective The aim of this study was to compare clinical characteristics and evolution of heart failure in patients with systolic dysfunction and with preserved systolic function in a population with high prevalence of Chagas disease. Methods A prospective assessment was performed in patients with clinical diagnosis of heart failure admitted to a referral center in Salvador, Bahia (Brazil). Left ventricular ejection fraction > 45% by echocardiogram was considered as preserved systolic function. A one year follow-up was conducted through telephone or personal interview at the heart failure clinic. Results Three hundred and eighty three patients, 52.5% of whom were male, with an average age of 54.2 years, were included in this study over a period of 16 months. Systolic function was preserved in 138 patients (36%). Chagas disease was the main etiology of both types of heart failure (45.3% with systolic dysfunction and 44.2% with preserved systolic function). One year follow-up was completed by 93.5% (358) of patients. Patients with Chagas disease and preserved systolic function had lower mortality than patients with systolic dysfunction (10% vs. 23.6%; p=0.039). In patients without Chagas disease and preserved systolic function, mortality was similar to that of those with systolic dysfunction (10.4% vs. 15.8%; p=0.307). Conclusions Preserved systolic function was very common in our population. Chagas disease is the leading cause of heart failure irrespective of left ventricular ejection fraction. Patients with Chagas disease and preserved systolic function have a better prognosis than those with systolic dysfunction, probably because they are in the initial phase of cardiac involvement.(AU)
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Introducción La insuficiencia cardíaca con función sistólica preservada es un síndrome clínico con los mismos signos y síntomas de la insuficiencia cardíaca clásica. La enfermedad de Chagas es una causa importante de insuficiencia cardíaca en América Latina, que se asocia con miocardiopatía dilatada y deterioro progresivo de la función sistólica. No existen estudios previos que hayan evaluado pacientes con insuficiencia cardíaca y función sistólica preservada de una zona endémica en la cual la enfermedad de Chagas es la causa principal de insuficiencia cardíaca. Objetivo Comparar las características clínicas y la evolución de la insuficiencia cardíaca en pacientes con disfunción sistólica y con función sistólica preservada en una población con alta prevalencia de enfermedad de Chagas. Material y métodos Se realizó una evaluación prospectiva de los pacientes con diagnóstico clínico de insuficiencia cardíaca que ingresaron a un centro de referencia en Salvador, Bahía (Brasil). Se consideró función sistólica preservada a una fracción de eyección del ventrículo izquierdo mayor del 45% por ecocardiograma. Se realizó seguimiento al año a través de contacto telefónico o entrevista personal en el consultorio de insuficiencia cardíaca. Resultados Se incluyeron 383 pacientes durante un período de 16 meses; el 52,5% eran hombres y la edad media fue de 54,2 años. La función sistólica estuvo preservada en 138 pacientes (36%). La enfermedad de Chagas fue la principal etiología de ambos tipos de insuficiencia cardíaca (45,3% con disfunción sistólica y 44,2% con función sistólica preservada). El 93,5% (358) de los pacientes completaron un año de seguimiento. Los pacientes con enfermedad de Chagas y función sistólica preservada tuvieron menor mortalidad que los pacientes con disfunción sistólica (10% vs. 23,6%; p = 0,039). En los pacientes sin enfermedad de Chagas y función sistólica preservada, la mortalidad fue similar a la de aquellos con disfunción sistólica (10,4% vs. 15,8%; p = 0,307). Conclusiones La función sistólica preservada fue muy frecuente en nuestra población. La enfermedad de Chagas es la principal etiología de insuficiencia cardíaca independientemente de la fracción de eyección del ventrículo izquierdo. Los pacientes con enfermedad de Chagas y función sistólica preservada tienen mejor pronóstico que aquellos con disfunción sistólica, probablemente porque se encuentran en la fase inicial del compromiso cardíaco.
Background Heart failure with preserved systolic function is a clinical syndrome with the same signs and symptoms of classic heart failure. Chagas disease is a major cause of heart failure in Latin America, associated with dilated cardiomyopathy and progressive deterioration of systolic function. There are no previous assessment studies of patients with heart failure and preserved systolic function in an endemic area in which Chagas disease is the leading cause of heart failure. Objective The aim of this study was to compare clinical characteristics and evolution of heart failure in patients with systolic dysfunction and with preserved systolic function in a population with high prevalence of Chagas disease. Methods A prospective assessment was performed in patients with clinical diagnosis of heart failure admitted to a referral center in Salvador, Bahia (Brazil). Left ventricular ejection fraction > 45% by echocardiogram was considered as preserved systolic function. A one year follow-up was conducted through telephone or personal interview at the heart failure clinic. Results Three hundred and eighty three patients, 52.5% of whom were male, with an average age of 54.2 years, were included in this study over a period of 16 months. Systolic function was preserved in 138 patients (36%). Chagas disease was the main etiology of both types of heart failure (45.3% with systolic dysfunction and 44.2% with preserved systolic function). One year follow-up was completed by 93.5% (358) of patients. Patients with Chagas disease and preserved systolic function had lower mortality than patients with systolic dysfunction (10% vs. 23.6%; p=0.039). In patients without Chagas disease and preserved systolic function, mortality was similar to that of those with systolic dysfunction (10.4% vs. 15.8%; p=0.307). Conclusions Preserved systolic function was very common in our population. Chagas' disease is the leading cause of heart failure irrespective of left ventricular ejection fraction. Patients with Chagas disease and preserved systolic function have a better prognosis than those with systolic dysfunction, probably because they are in the initial phase of cardiac involvement.
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BACKGROUND/AIMS: Epidemiological studies suggest that stress has an impact on asthmatic exacerbations. We evaluated if repeated stress, induced by forced swimming, modulates lung mechanics, distal airway inflammation and extracellular matrix remodeling in guinea pigs with chronic allergic inflammation. METHODS: Guinea pigs were submitted to 7 ovalbumin or saline aerosols (1-5 mg/ml during 4 weeks; OVA and SAL groups). Twenty-four hours after the 4th inhalation, guinea pigs were submitted to the stress protocol 5 times a week during 2 weeks (SAL-S and OVA-S groups). Seventy-two hours after the 7th inhalation, guinea pigs were anesthetized and mechanically ventilated. Resistance and elastance of the respiratory system were obtained at baseline and after ovalbumin challenge. Lungs were removed, and inflammatory and extracellular matrix remodeling of distal airways was assessed by morphometry. Adrenals were removed and weighed. RESULTS: The relative adrenal weight was greater in stressed guinea pigs compared to non-stressed animals (p < 0.001). Repeated stress increased the percent elastance of the respiratory system after antigen challenge and eosinophils and lymphocytes in the OVA-S compared to the OVA group (p < 0.001, p = 0.003 and p < 0.001). Neither collagen nor elastic fiber contents were modified by stress in sensitized animals. CONCLUSIONS: In this animal model, repeated stress amplified bronchoconstriction and inflammatory response in distal airways without interfering with extracellular matrix remodeling.
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Hipersensibilidade/etiologia , Inflamação/complicações , Transtornos Respiratórios/complicações , Transtornos Respiratórios/patologia , Estresse Psicológico/patologia , Estresse Psicológico/fisiopatologia , Administração por Inalação , Glândulas Suprarrenais/patologia , Análise de Variância , Animais , Modelos Animais de Doenças , Matriz Extracelular/metabolismo , Cobaias , Inflamação/induzido quimicamente , Masculino , Infiltração de Neutrófilos , Tamanho do Órgão , Ovalbumina/efeitos adversos , Estimulação Física/efeitos adversos , Transtornos Respiratórios/induzido quimicamente , Natação/psicologiaRESUMO
BACKGROUND: Heart Failure (HF) is a common disease with a high rate of mortality. Anemia and renal failure (RF) are often found in patients with HF associated with higher severity of the heart disease and a worse prognosis. OBJECTIVE: To evaluate the prevalence of anemia and RF, as well as the association between these two conditions, in non-hospitalized patients with HF. METHODS: Patients treated at the HF Outpatient Clinic of a university hospital were followed from July 2003 to November 2006. Anemia was defined as hemoglobin levels < 13 mg/dl for men and 12 mg/dl for women. Renal function was assessed by the glomerular filtration rate (GFR), calculated by the simplified formula of the MDRD (Modification of Diet in Renal Disease) study. RESULTS: Of the 345 patients included in this study, 26.4% (n = 91) had anemia and 29.6% had moderate to severe renal failure (GFR < 60 ml/min). The association between anemia and a higher prevalence of renal failure was statistically significant (41.8% vs. 25.2%; p = 0.005). The patients at functional class III and IV presented a higher incidence of anemia (39.0% vs. 19.4%; p <0.001) and renal failure (38.2% vs. 24.8%; p = 0.007). No association was observed between anemia or renal failure and history of hypertension, diabetes, systolic function or etiology of HF. CONCLUSION: The prevalence of anemia and renal failure was high in this population and was associated with the severity of the HF (functional classes III and IV).
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Anemia/epidemiologia , Insuficiência Cardíaca/complicações , Pacientes Ambulatoriais/estatística & dados numéricos , Insuficiência Renal/epidemiologia , Anemia/complicações , Brasil/epidemiologia , Estudos Transversais , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Insuficiência Renal/complicaçõesRESUMO
FUNDAMENTOS: Insuficiência cardíaca (IC) é uma doença comum com alta taxa de mortalidade. Anemia e insuficiência renal (IR) são frequentemente encontradas em portadores de IC associadas com maior gravidade da doença cardíaca e pior prognóstico. OBJETIVO: Avaliar a prevalência de anemia e insuficiência renal, bem como a associação entre esses dois quadros, em portadores de IC não hospitalizados. MÉTODOS: Foram observados pacientes acompanhandos na clínica de IC de um hospital universitário de julho de 2003 a novembro de 2006. Anemia foi definida como níveis de hemoglobina abaixo de 13 mg/dl para homens e de 12 mg/dl para mulheres. A função renal foi avaliada por meio da taxa de filtração glomerular (TFG), calculada pela fórmula simplificada do estudo MDRD (Modification of Diet in Renal Disease). RESULTADOS: Dos trezentos e quarenta e cinco pacientes incluídos neste estudo, 26,4 por cento (n = 91) tinham anemia e 29,6 por cento tinham insuficiência renal moderada a grave (TFG < 60 ml/min). A associação entre anemia e maior prevalência de insuficiência renal foi estatisticamente significante (41,8 por cento vs. 25,2 por cento; p = 0,005). Os pacientes em classe funcional III e IV apresentaram maior incidência de anemia (39,0 por cento vs. 19,4 por cento; p <0,001) e insuficiência renal (38,2 por cento vs. 24,8 por cento; p = 0,007). Não foi observada associação entre anemia ou insuficiência renal e história de hipertensão, diabetes, função sistólica ou etiologia de insuficiência cardíaca. CONCLUSÃO: A prevalência de anemia e insuficiência renal foi elevada nessa população e foi associada com a gravidade da insuficiência cardíaca (classes funcionais III e IV).
BACKGROUND: Heart Failure (HF) is a common disease with a high rate of mortality. Anemia and renal failure (RF) are often found in patients with HF associated with higher severity of the heart disease and a worse prognosis. OBJECTIVE: To evaluate the prevalence of anemia and RF, as well as the association between these two conditions, in non-hospitalized patients with HF. METHODS: Patients treated at the HF Outpatient Clinic of a university hospital were followed from July 2003 to November 2006. Anemia was defined as hemoglobin levels < 13 mg/dl for men and 12 mg/dl for women. Renal function was assessed by the glomerular filtration rate (GFR), calculated by the simplified formula of the MDRD (Modification of Diet in Renal Disease) study. RESULTS: Of the 345 patients included in this study, 26.4 percent (n = 91) had anemia and 29.6 percent had moderate to severe renal failure (GFR < 60 ml/min). The association between anemia and a higher prevalence of renal failure was statistically significant (41.8 percent vs. 25.2 percent; p = 0.005). The patients at functional class III and IV presented a higher incidence of anemia (39.0 percent vs. 19.4 percent; p <0.001) and renal failure (38.2 percent vs. 24.8 percent; p = 0.007). No association was observed between anemia or renal failure and history of hypertension, diabetes, systolic function or etiology of HF. CONCLUSION: The prevalence of anemia and renal failure was high in this population and was associated with the severity of the HF (functional classes III and IV).
FUNDAMENTO: La insuficiencia cardiaca (IC) es una enfermedad común con alta tasa de mortalidad. La anemia y la insuficiencia renal (IR), encontradas frecuentemente en portadores de IC, son asociadas a mayor severidad de la enfermedad cardiaca y peor pronóstico. OBJETIVO: Evaluar la prevalencia de anemia e insuficiencia renal, así como la asociación entre esos dos cuadros, en portadores de IC no hospitalizados. MÉTODOS: Se observaron a pacientes seguidos en la clínica de IC de un hospital universitario de julio de 2003 a noviembre de 2006. Se definió la anemia como niveles de hemoglobina abajo de 13 mg/dl para varones y de 12 mg/dl para mujeres. La función renal se evaluó por medio de la tasa de filtración glomerular (TFG), calculada por la fórmula simplificada del estudio MDRD (Modification of Diet in Renal Disease). RESULTADOS: Teniendo en cuenta los trescientos y cuarenta y cinco pacientes incluidos en este estudio, el 26,4 por ciento (n = 91) tenía anemia y el 29,6 por ciento presentaba insuficiencia renal de moderada a severa (TFG < 60 ml/min). La asociación entre anemia y mayor prevalencia de insuficiencia renal fue estadísticamente significante (el 41,8 por ciento vs el 25,2 por ciento; p = 0,005). Los pacientes en clase funcional III e IV presentaron mayor incidencia de anemia (el 39,0 por ciento vs el 19,4 por ciento; p <0,001) e insuficiencia renal (el 38,2 por ciento vs el 24,8 por ciento; p = 0,007). No se observó asociación entre anemia o insuficiencia renal e historia de hipertensión, diabetes, función sistólica o etiología de insuficiencia cardiaca. CONCLUSIÓN: La prevalencia de anemia e insuficiencia renal se elevó en esa población y se asoció con la severidad de la insuficiencia cardiaca (clases funcionales III e IV).
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Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anemia/epidemiologia , Insuficiência Cardíaca/complicações , Pacientes Ambulatoriais/estatística & dados numéricos , Insuficiência Renal/epidemiologia , Anemia/complicações , Brasil/epidemiologia , Estudos Transversais , Insuficiência Cardíaca/epidemiologia , Prevalência , Valores de Referência , Insuficiência Renal/complicaçõesRESUMO
OBJETIVOS: A medicina intensiva é especialidade relativamente nova que apresentou grande desenvolvimento no Brasil nos últimos anos. No entanto, existe pouca procura por parte dos médicos em realizar este tipo de especialização. O objetivo deste estudo foi descrever os motivos pelos quais os médicos residentes de Salvador-BA pretendem ou não realizar residência médica em medicina intensiva. MÉTODOS: Trata-se de um estudo transversal e descritivo, em que foi aplicado um questionário, durante o período de outubro a dezembro de 2007, a todos os médicos residentes das especialidades pré-requisito para medicina intensiva (clínica médica, cirurgia geral e anestesiologia). RESULTADOS: Foram incluídos no estudo 165 médicos residentes (89,7 por cento do total), sendo 51,5 por cento residentes de clínica médica, 25,5 por cento de cirurgia geral e 23 por cento de anestesiologia. Dos entrevistados, 14 (9,1 por cento) pretendem fazer residência de medicina intensiva, embora 90 (54,5 por cento) pretendam ser plantonistas de unidades de terapia intensiva após a residência. O principal motivo destacado para se especializar em medicina intensiva foi gostar de trabalhar com pacientes graves (92,9 por cento). Já os principais motivos para não se especializar em medicina intensiva estão relacionados à pior qualidade de vida ou de trabalho. Os médicos residentes que fizeram algum estágio em unidade de terapia intensiva durante a graduação são mais propensos a serem plantonistas de unidades de terapia intensiva após a residência. CONCLUSÕES: A população avaliada demonstrou baixo interesse em se especializar em medicina intensiva. Os principais motivos apontados foram os fatores relacionados à qualidade de vida dos intensivistas e ao ambiente de trabalho. Um levantamento nacional se faz necessário para identificar quais as intervenções são adequadas para incentivar esta especialização.
OBJECTIVES: Critical Care Medicine is a relatively new specialty, which in recent years has made significant progress in Brazil. However, few physicians are willing to acquire this specialization. The main objective of this study was to describe the factors associated with choice of Critical Care Medicine as a specialty by medical residents of Salvador-BA. METHODS: A cross-sectional and descriptive study, in which a questionnaire was submitted to all residents of the specialties that are a prerequisite for Critical Care Medicine (Clinical Medicine, General Surgery and Anesthesiology), between October and December 2007. RESULTS: The study included 165 residents (89.7 percent of the total), in which 51.5 percent were clinical medicine residents, 25.5 percent were general surgery residents, and 23.0 percent were anesthesiology residents. Of the respondents, 14 (9.1 percent) intended to enter Critical Care Medicine residency, although 90 (54.5 percent) were willing to become intensive care unit physicians after their regular residency. The main reason stated to specialize in critical care medicine was to like work with critically ill patients (92.9 percent). The main reasons stated not to specialize in critical care medicine, however were related with the poorer quality of life and work. Residents who did intensive care unit initernship during medical studies were more likely to work in an intensive care units after residency. CONCLUSIONS: This population showed little interest to specialize in critical care medicine. The main reasons given for this limited interest were factors related to quality of life and intensive care unit environment. A national survey is required to identify the interventions needed to favor this specialization.
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INTRODUÇÃO: O ensino da Patologia tem papel fundamental na formação médica, por ser o principal elo entre as ciências básicas e a prática clínica, assim como referência para a pesquisa científica. A Patologia insere-se no grupo de disciplinas que passam por um processo de mudanças curriculares e incorporação de novas tecnologias, sendo tal processo iniciado há duas décadas nos EUA, Austrália e Europa. OBJETIVO: Discutir as vantagens e desvantagens das mudanças que atingem o ensino da Patologia no País, a partir da experiência internacional. RESULTADOS: Na presente revisão, discutimos preocupações atuais, que incluem a marginalização da Patologia no currículo médico, a falta de contato dos estudantes com a Anatomia Patológica e as possíveis lacunas na formação do futuro médico. CONSIDERAÇÕES FINAIS: A ausência de contato com a Anatomia Patológica no curso médico, ou sua participação meramente ilustrativa, cria os problemas adicionais de pouco incentivo à escolha desta especialidade médica e gera a dificuldade dos novos médicos em lidar com solicitações e interpretações de laudos anatomopatológicos.
BACKGROUND: Teaching of General Pathology plays a central role in basic medical education, because it forms the main link between the basic sciences and clinical practice, besides serving as a reference for scientific research. Pathology is one of a group of disciplines that have undergone important curriculum changes and incorporated new technologies, in a process that began 20 years ago in the United States, Australia, and Europe. OBJECTIVE:To discuss the advantages and disadvantages of changes in Pathology as part of medical education in Brazil, in light of the international experience. RESULTS:This review discusses current concerns, including the marginalization of Pathology in the medical curriculum, students' lack of contact with Pathological Anatomy, and resulting gaps in the training of future physicians. CONCLUSIONS:Students' lack of contact with Pathological Anatomy during rotation in medical school (or merely cursory participation on their part) creates additional problems, such as limited incentives for choosing this medical specialty as a career and difficulty by young physicians in ordering and reading pathology reports.
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Humanos , Educação Médica , Internacionalidade , Patologia/educação , Estudantes de MedicinaRESUMO
OBJETIVOS: Conhecer as necessidades e o grau de satisfação dos familiares de pacientes internados em unidades de terapia intensiva é uma parte essencial dos cuidados dos profissionais de saúde. O objetivo deste trabalho foi identificar o grau de satisfação dos familiares de pacientes internados em unidades de terapia intensiva. MÉTODOS: Foi realizado um estudo descritivo na unidade de terapia intensiva Geral Adulto do Hospital Português (Salvador-BA) durante o período de novembro de 2007 a janeiro de 2008. Para avaliação da satisfação dos familiares foi utilizada a versão modificada por Jonhson (1998) do Inventário de Necessidades de Familiares em Terapia Intensiva . RESULTADOS: Foram avaliados 53 familiares, com média de idade de 44 anos, sendo 68 por cento do sexo feminino. A mediana do nível de satisfação dos familiares foi de 11 (IIQ:9-13), numa escala de um a quatorze. As questões do Inventário de Necessidades de Familiares em Terapia Intensiva com maiores índices de satisfação foram as que afirmavam que os familiares sentiam que o melhor cuidado possível estava sendo oferecido ao paciente (96 por cento) e que as informações dadas foram honestas (96 por cento). As questões com índices menores de satisfação foram as que afirmavam que os familiares acreditavam que alguém da unidade de terapia intensiva demonstrou interesse em saber como estavam se sentindo (45 por cento) e que os funcionários do hospital explicaram como os equipamentos estão sendo usados (41 por cento). CONCLUSÕES: A maioria dos familiares avaliou positivamente os profissionais da unidade de terapia intensiva nas questões relacionadas à comunicação, atitude e cuidado médico com o paciente. No entanto, houve um percentual menor de satisfação nas questões relacionadas com a capacidade dos profissionais de confortar os familiares.
OBJECTIVES: To know the needs and level of family members' satisfaction is an essential part of the care provided to critically ill patients in intensive care units. The objective of this study was to identify the level of family members' satisfaction in an intensive care unit. METHODS: A descriptive survey was carried out in the general adult intensive care unit of the Hospital Português (Salvador - BA) from November 2007 to January 2008. Jonhson's 14-question modified version of the Critical Care Family Needs Inventory was used to evaluate satisfaction of family members. RESULTS: Fifty three family members were included, mean age was 44 years and 68 percent were female. The median of family members satisfaction level was 11 (IQI = 9-13). Critical Care Family Need Inventory, questions with higher percentiles of satisfaction were those stating that family members felt that the patient was receiving the best possible care (96 percent) and that the information provided was honest (96 percent). The questions with lower percentiles of satisfaction were those stating that family members believed that someone in the intensive care unit had shown interest in their feelings (45 percent) and that a healthcare professional had explained how the intensive care unit equipment was used (41 percent). CONCLUSIONS: Most family members positively evaluated the intensive care unit professionals in the questions related to communication, attitude and patient care. However, there was a lower level of satisfaction in the questions related to the intensive care unit professionals' ability to comfort family members.
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OBJECTIVE: Describe prevalence of the Burnout syndrome in intensive care physicians of Salvador, associated to demographic data and aspects of the work environment (psychological demand and job control). METHODS: This cross sectional study has investigated the association between work conditions and Burnout Syndrome in a population of 297 Intensive Care Physicians from Salvador, Bahia, Brazil. An individual, self-report questionnaire evaluated the physicians' psychological aspects of work, using the demand-control model (Job Content Questionnaire) and their mental health, using the Maslash Burnout Inventory (MBI). RESULTS: The study found work overload,a high proportion of on duty physicians and low income for the hours worked. Prevalence of the Burnout Syndrome was 7.4% and it was more closely associated with aspects of the job's psychological demand than with its control. CONCLUSION: Physicians under great stress (high demand and low control) presented prevalence of the Bornout Syndrome 10.2 times higher than those under low stress (low demand and high control) jobs.
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Esgotamento Profissional/epidemiologia , Cuidados Críticos/psicologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , Inquéritos e Questionários , Carga de Trabalho/psicologia , Adulto JovemRESUMO
OBJECTIVES: To know the needs and level of family members' satisfaction is an essential part of the care provided to critically ill patients in intensive care units. The objective of this study was to identify the level of family members' satisfaction in an intensive care unit. METHODS: A descriptive survey was carried out in the general adult intensive care unit of the Hospital Português (Salvador - BA) from November 2007 to January 2008. Jonhson's 14-question modified version of the Critical Care Family Needs Inventory was used to evaluate satisfaction of family members. RESULTS: Fifty three family members were included, mean age was 44 years and 68% were female. The median of family members satisfaction level was 11 (IQI = 9-13). Critical Care Family Need Inventory, questions with higher percentiles of satisfaction were those stating that family members felt that the patient was receiving the best possible care (96%) and that the information provided was honest (96%). The questions with lower percentiles of satisfaction were those stating that family members believed that someone in the intensive care unit had shown interest in their feelings (45%) and that a healthcare professional had explained how the intensive care unit equipment was used (41%). CONCLUSIONS: Most family members positively evaluated the intensive care unit professionals in the questions related to communication, attitude and patient care. However, there was a lower level of satisfaction in the questions related to the intensive care unit professionals' ability to comfort family members.