RESUMO
An analysis of health research in Chile is made, considering factors like exaggerated professional training during undergraduate studies and clinical residencies, and displacement of professionals from academic activities to more remunerative positions. Additionally, the limited role of the Ministry of Health in research promotion, evidenced by the almost absent participation of public hospitals in clinical research is discussed. Research investment, among a 0.6 to 0.8% of the GNP, is far from developed countries and Chile has not defined relevant health problems where a search effort would have an impact in public health. The marked centralism of the country attempts against regional application to financed projects. The following suggestions are made: to increase the financing for investigation, to reassign resources allowing the access of regional institutions, to financing, to discuss in the Chilean Association of Medical Faculties (ASOFAMECH) the creation of an academic degree by means of a thesis during the professional studies and to give facilities to develop research during clinical residencies. Also, the Ministry of Health should be involved, creating a national agenda or research priorities and increasing its association with Universities. Also training programs for professionals with a special interest in investigation should be devised.
Assuntos
Pesquisa/normas , Chile , Educação de Pós-Graduação em Medicina/normas , Educação de Graduação em Medicina/normas , Humanos , Apoio à Pesquisa como AssuntoRESUMO
BACKGROUND: There is not much evidence about the usefulness of digoxin or enalapril in the treatment of heart failure due to mitral insufficiency. AIM: To compare digoxin and enalapril in the treatment of heart failure due to mitral insufficiency. PATIENTS AND METHODS: Patients with mitral insufficiency, in sinus rhythm, with a heart failure grade II or III and with echocardiographic left ventricular dilatation were eligible for the study. They received sequentially, during 12 weeks each, digoxin 0.25 mg/day or enalapril in doses up to 20 mg/day, with a washout in-between period of 2 weeks. The order of the sequence was determined randomly. At the start and end of treatment, functional class according to NYHA and maximal exercise tolerance in the treadmill were assessed and a color Doppler echocardiogram was done to measure ventricular dimensions, function and degree of mitral insufficiency. RESULTS: Nine patients on enalapril and 12 on digoxin improved their functional capacity. Digoxin improved exercise time in 76 +/- 168 sec (p = 0.022), whereas this change was not significant with enalapril (38 +/- 158 sec; p = 0.2). With enalapril treatment, ventricular diastolic dimension decreased from 59.3 +/- 8.1 to 58 +/- 9.3 mm and the area of mitral insufficiency decreased from 8.1 +/- 3.5 to 6.6 +/- 3.1 cm2. Digoxin did not induce any significant echocardiographic change. CONCLUSIONS: In these patients, digoxin and enalapril improved functional class. Digoxin improved exercise time and enalapril reduced ventricular dimensions and mitral insufficiency.
Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Digoxina/uso terapêutico , Enalapril/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Insuficiência da Valva Mitral/complicações , Adulto , Método Duplo-Cego , Tolerância ao Exercício/efeitos dos fármacos , Feminino , Ventrículos do Coração/efeitos dos fármacos , Humanos , MasculinoRESUMO
BACKGROUND: Chilean aboriginal populations (Mapuche) predominantly live in the region of Araucanía, in the southern part of the country. Their cardiovascular risk factors have not been systematically assessed. AIM: To study the prevalence of cardiovascular risk factors in the Mapuche population. SUBJECTS AND METHODS: Blood pressure, weight, height, dietary habits, fasting serum total cholesterol, HDL cholesterol and triglycerides were measured in 1.948 adults living in 28 Mapuche communities. RESULTS: Thirteen percent of males and 16% of females had high blood pressure. Body mass index was 25.5 kg/m2 in males and 28.1 kg/m2 in females. Forty five percent of women and 24% of men were classified as obese. Mean serum total cholesterol was 186.7 +/- 9.6 mg/dl, HDL cholesterol was 58.7 +/- 30.7 mg/dl, total cholesterol/HDL cholesterol was 3.4 +/- 2 and triglycerides were 155.2 +/- 91.2 mg/dl. Twenty eight percent of males and 9.6% of females smoked. CONCLUSIONS: Mapuche individuals have higher levels of HDL cholesterol a better total cholesterol/HDL cholesterol ratio and lower frequency of smoking than non aboriginal Chileans subjects.
Assuntos
Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Indígenas Sul-Americanos , Lipídeos/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Colesterol/sangue , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Prevalência , Fatores de RiscoRESUMO
The benefits of digoxin in patients with atrial fibrillation may be reduced due to its limited effect on atrioventricular conduction. The aim of this work was to compare digoxin and atenolol on functional class, resting and exercise heart rate and exercise capacity in patients with atrial fibrillation. Thirteen subjects with this condition, normal echocardiographic left ventricular function and size, a resting heart rate less than 80 beats/min and with no contraindication for beta blocker or digoxin use were studied. Patients were randomly assigned to receive initially digoxin 0.25 mg o.d. or atenolol 100 mg o.d. in a double blind fashion. The doses were adjusted to obtain a heart rate between 60 and 80 beats/min at the end of the first week of treatment. After two weeks of treatment, outcomes were assessed, patients were left without treatment for one week and crossed over to the other drug after that. Resting heart rates achieved with digoxin and atenolol were similar (67 +/- 11 and 65 +/- 23 beats/min respectively). However, maximal exercise heart rates and maximal exercise time were higher during digoxin treatment (166 +/- 23 vs 135 +/- 27 beats/min and 9.95 +/- 1.68 vs 8.5 +/- 2 min respectively). NYHA functional class deteriorated in three patients receiving atenolol. We conclude that atenolol achieves a better control of heart rate during exercise but also reduces maximal exercise capacity.
Assuntos
Atenolol/farmacologia , Fibrilação Atrial/tratamento farmacológico , Digoxina/farmacologia , Adulto , Idoso , Análise de Variância , Atenolol/administração & dosagem , Fibrilação Atrial/fisiopatologia , Pressão Sanguínea/efeitos dos fármacos , Doença Crônica , Estudos Cross-Over , Digoxina/administração & dosagem , Ergometria , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Esforço Físico/fisiologia , Distribuição Aleatória , Descanso/fisiologia , Função Ventricular Direita/efeitos dos fármacosRESUMO
Due to differences in treatment effect in studies on the effectiveness of digoxin in patients with congestive heart failure in sinus rhythm, a cross-over placebo-controlled, randomized double blind clinical trial was performed. Thirty one patients, without previous treatment with digoxin, in New York Heart Association (NYHA) functional class II to IV, with a dilated left ventricle and/or ventricular systolic dysfunction were included. Patients received digoxin, adjusted for blood levels, or placebo, during an 8 week period, prior to crossing over to the other treatment for another 8 weeks. The order of treatments was randomly allocated. Outcome measurement were performed at the end of each 8 week period. Digoxin, compared with placebo, improved NYHA class, 6.9% vs 41.4% (p = 0.013) and increased the treadmill exercise time, 406 +/- 204 s vs 484 +/- 185 s (p = 0.003). During the digoxin treatment the left ventricular and systolic diameter was reduced from 52.9 +/- 8.9 to 50.1 +/- 9.7 mm (p = 0.016) and the shortening fraction increased from 21.4 +/- 8.3 to 24.8 +/- 8.1% (p = 0.009). No significant difference was observed in the left ventricular end diastolic diameter (LVED) of the left ventricle and in a estimation of quality of life. In conclusion, digoxin treatment produced a significant improvement in functional capacity, exercise time, and left ventricular performance.
Assuntos
Digoxina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Nó Sinoatrial/fisiopatologia , Adulto , Método Duplo-Cego , Teste de Esforço/métodos , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To determine the prognosis in patients with diphtherial myocarditis and bradyarrhythmias and to assess the results of ventricular pacing in those with third degree atrioventricular block. DESIGN: Case series. SETTING: Referral department of cardiology in a teaching hospital. PATIENTS: Twenty four out of 46 patients admitted with diphtherial myocarditis over 10 years had bradyarrhythmias. Six had sinus bradycardia, 15 atrioventricular or intraventricular conduction disturbances, and three atrioventricular dissociation. MAIN OUTCOME MEASURE: Death rate. RESULTS: Eleven patients died (46%): all seven patients with third degree atrioventricular block, the patient with bifascicular block, and three of the six patients with bundle branch block. Seven died of cardiogenic shock and four of ventricular fibrillation. All nine patients with sinus bradycardia or atrioventricular dissociation survived. CONCLUSION: Conduction system disturbances in patients with diphtherial myocarditis are markers of severe myocardial damage and a poor prognosis. In addition, ventricular pacing does not improve survival.
Assuntos
Bradicardia/complicações , Estimulação Cardíaca Artificial , Difteria/complicações , Miocardite/complicações , Adolescente , Bradicardia/mortalidade , Bradicardia/terapia , Criança , Pré-Escolar , Difteria/mortalidade , Difteria/terapia , Feminino , Bloqueio Cardíaco/mortalidade , Bloqueio Cardíaco/terapia , Humanos , Masculino , Miocardite/mortalidade , Miocardite/terapia , PrognósticoRESUMO
A random sample of 200 males from 25 to 64 years of age was surveyed for cardiovascular risk factors in Temuco, a city in Southern Chile. Blood pressure was 130 +/- 18/85 +/- 10 mmHg and total cholesterol was 193 +/- 50 mg/dl. 33% were smokers (mean of 8.2 cigarettes per day) and 34% were ex smokers. Prevalence of hypertension was 6.5% from 35 to 44 years of age, 15% from 45 to 54 and 31.9% from 55 to 64 (mean 15%). Cholesterol levels above 240 mg/dl were found in 11.8, 18.3 and 19.1%, respectively (mean 15.5%). Half of the hypertensive subjects were not aware of their high blood pressure and only 16.6% received therapy.
Assuntos
Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Fumar/epidemiologia , Adulto , Chile/epidemiologia , Enfermagem em Saúde Comunitária , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição Aleatória , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
A group of 102 patients (66 males, age 62 +/- 11 years) surviving an acute myocardial infarction was followed for 6 to 48 months. Survival was analyzed by the method of Kaplan Meier and Cox analysis was used to identify prognostic factors. Thirteen patients died during follow up: 3 had sudden death, 3 a stroke, 3 died from heart failure, 3 had reinfarction and cardiogenic shock and 1 died from cholangitis. Most deaths occurred in the first few months of follow up. Survival was 92% at 6 months, 90% at 1 year, 88% at 2 years and 86% at 3 years after infarction. Single variable analysis disclosed a 2 to 3 fold late mortality risk associated to the presence of age over 60 years, old myocardial infarction, hypertension, diabetes mellitus and ventricular tachycardia or fibrillation during the acute phase. Greater than 3 fold risk was seen for patients developing heart failure or shock during myocardial infarction. Heart failure was the only statistically significant risk factor identified by multivariate analysis.
Assuntos
Infarto do Miocárdio/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Taxa de SobrevidaRESUMO
Con el fin de evaluar la importancia de la contracción auricular en pacientes (pac.) con Marcapaso (MP) ventricular en pacientes con Insuficiencia Cardíaca (IC), se efectuó cateterismo cardíaco derecho y medición de Presión Arterial (PA) directa en 11 pac. con bloqueo a-v total y MP: 4 pac. sin IC y 7 con IC. Se efectuó medición de presiones y débito (DC): 1.- Basal (B); 2.- Con estimulación auricular secuencial (ES) con estimulador externo Medtronic 5325 y 3.- Con estimulación auricular intra QRS (EI). El DC. B. de 3.86 ñ 0.30 lt/min. aumentó a 4.53 ñ0.48 lt/min., con 17.3% de incremento en relación a DC.B (p< 0.0025). Con EI. el DC. bajó a 3.60 ñ 0.14 lt/min. que es 6.7% inferior a DC.B y 20.5% inferior a ES. (p.< 0.01). En los pacientes con IC. el aumento del DC con ES fue de 0.36 ñ 0.4 lt./min. (8% mayor que DC.B.), significativamente menor que el aumento de los pacientes sin IC.: 0.93 ñ 0.4 lt/min. que equivale a 23% (p <0.025). Al pasar de ES a EI la PA. descendió en promedio de 171/78 a 149/75 mm. de Hg. La PA. diferencial descendió 47% en los pac. sin IC y 15% en los pac. con IC., (diferencia significativa: p < 0.005). Hubo correlación lineal entre el cambio de presión y cambio de débito. Se concluye que la relación temporal P-QRS determina importantes cambios de DC y PA. Los pac. con IC tuvieron menor mejoría con ES, explicable en la IC avanzada en porción horizontal de curva de función ventricular. Ello y la amplia variación individual, justifican la metódica de estudio seguida antes de un implante de M.P. Secuencial