RESUMO
BACKGROUND: Silent myocardial ischemia is a growing world health problem. It has been related to factors that promote an increase in myocardial oxygen demand or affect coronary vasomotor tone. Coronary artery disease has shown an increasing trend in Mexico in this century. HYPOTHESIS: The aim of the study was to estimate the strength of the association between some risk factors and the occurrence of silent myocardial ischemia. METHODS: A cross-sectional study was conducted and 249 individuals were screened by 24-h Holter electrocardiogram. Silent myocardial ischemia was diagnosed in patients with painless transient ST-segment depression. All subjects were interviewed for coronary risk factors and total serum cholesterol was measured. RESULTS: Silent ischemia was diagnosed in 115 patients (46%), who were older (59 +/- 9 vs. 57 +/- 11 years; p = 0.01). In a logistic regression analysis, a lower risk for silent ischemia was found in patients with thrombolysis [odds ratio (OR) 0.28; 95% confidence interval (CI 95%) 0.14-0.53], or those who followed their medical treatment (OR 0.16; CI 95% 0.04-0.68). The major risk factors were hypercholesterolemia (OR 1.6; CI 95% 0.9-2.9) and more severe coronary artery disease (OR 2.5; CI 95% 1.1-5.7). CONCLUSIONS: Some coronary risk factors are related to silent ischemia. It is still important to diagnose this entity, but modification of its related risk factors should be kept in mind to diminish its occurrence and its severe consequences.
Assuntos
Isquemia Miocárdica/epidemiologia , Colesterol/sangue , Angiografia Coronária , Estudos Transversais , Eletrocardiografia Ambulatorial , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico , Razão de Chances , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
The main objective of this research was to compare the efficacy and security of bisoprolol (B), a new cardioselective beta-blocker, that does not have intrinsic sympathomimetic activity, and metoprolol associated to hydrochlorothiazide (HCTZ), in the treatment of patients with mild to moderate hypertension. Sixty-two hypertensive patients (47 females and 15 males) aged 20 to 70 years (mean 52.5 +/- 10.4) were included in a double-blind, placebo controlled and randomized clinical trial. After a two-weeks wash out period and a similar placebo phase, patients were randomly assigned to receive either a once-daily dosing of B (10 mg) with 6.25 mg of HCTZ, or M (100 mg) plus 6.25 mg of HCTZ during four-weeks. If there was no reduction below 90 mmHg at the end of this period, the dosing of either beta-blocker was doubled. After eight weeks of treatment, the mean decreases in systolic/diastolic blood pressures from baseline were 31.8/21.2 and 28.0/20.6 mmHg for B/HCTZ and M/HCTZ, respectively (p < 0.0001). There were no clinically significant changes from baseline in laboratory parameters in either group. Reduction in blood pressure with B/HCTZ is associated with adverse events and metabolic changes similar to those observed with other antihypertensive drugs.
Assuntos
Anti-Hipertensivos/uso terapêutico , Bisoprolol/uso terapêutico , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Metoprolol/uso terapêutico , Adulto , Idoso , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-IdadeRESUMO
We report a case of 41 year-old male who was operated on 24 times because of an entero-cutaneous fistula secondary to a gun shot wound. The patient was hospitalized during 23 months, most of which were spent fasting. He received parenteral nutrition during 16 months. The importance of nutritional support and the need to only operate when a patient's condition are optimal are stressed.