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Albuquerque CP, Reis APMG, Vargas Santos AB, Bértolo MB, Júnior PL, Neubarth Giorgi RD, Radominski SC, Guimarães MFBR, Bonfiglioli KR, L Cunha Sauma MDF, Pereira IA, Brenol CV, Henrique Mota LM, Santos-Neto L, Castelar Pinheiro GR. Do it fast! Early access to specialized care improved long-term outcomes in rheumatoid arthritis: data from the REAL multicenter observational study. Adv Rheumatol 2023; 63:17. [PMID: 37095556 DOI: 10.1186/s42358-023-00301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/12/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Early rheumatoid arthritis (RA) offers an opportunity for better treatment outcomes. In real-life settings, grasping this opportunity might depend on access to specialized care. We evaluated the effects of early versus late assessment by the rheumatologist on the diagnosis, treatment initiation and long-term outcomes of RA under real-life conditions. METHODS Adults meeting the ACR/EULAR (2010) or ARA (1987) criteria for RA were included. Structured interviews were conducted. The specialized assessment was deemed "early" when the rheumatologist was the first or second physician consulted after symptoms onset, and "late" when performed afterwards. Delays in RA diagnosis and treatment were inquired. Disease activity (DAS28-CRP) and physical function (HAQ-DI) were evaluated. Student's t, Mann-Whitney U, chi-squared and correlation tests, and multiple linear regression were performed. For sensitivity analysis, a propensity score-matched subsample of early- vs. late-assessed participants was derived based on logistic regression. The study received ethical approval; all participants signed informed consent. RESULTS We included 1057 participants (89.4% female, 56.5% white); mean (SD) age: 56.9 (11.5) years; disease duration: 173.1 (114.5) months. Median (IQR) delays from symptoms onset to both RA diagnosis and initial treatment coincided: 12 (6-36) months, with no significant delay between diagnosis and treatment. Most participants (64.6%) first sought a general practitioner. Notwithstanding, 80.7% had the diagnosis established only by the rheumatologist. Only a minority (28.7%) attained early RA treatment (≤ 6 months of symptoms). Diagnostic and treatment delays were strongly correlated (rho 0.816; p < 0.001). The chances of missing early treatment more than doubled when the assessment by the rheumatologist was belated (OR 2.77; 95% CI: 1.93, 3.97). After long disease duration, late-assessed participants still presented lower chances of remission/low disease activity (OR 0.74; 95% CI: 0.55, 0.99), while the early-assessed ones showed better DAS28-CRP and HAQ-DI scores (difference in means [95% CI]: -0.25 [-0.46, -0.04] and - 0.196 [-0.306, -0.087] respectively). The results in the propensity-score matched subsample confirmed those observed in the original (whole) sample. CONCLUSIONS Early diagnosis and treatment initiation in patients with RA was critically dependent on early access to the rheumatologist; late specialized assessment was associated with worse long-term clinical outcomes.
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Affiliation(s)
- Cleandro Pires Albuquerque
- Rheumatology Service, Universidade de Brasília (UnB), Brasília, DF, Brazil.
- Universidade de Brasília / UnB, Campus Darcy Ribeiro, Brasília, CEP 70910-900, Federal District, Brazil.
| | | | - Ana Beatriz Vargas Santos
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | - Paulo Louzada Júnior
- School of Medicine, Universidade de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Rina Dalva Neubarth Giorgi
- Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, SP, Brazil
| | | | | | | | | | - Ivânio Alves Pereira
- Rheumatology, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Claiton Viegas Brenol
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Barros-Areal AF, Albuquerque CP, Silva NM, Pinho RDNL, Oliveira APRA, da Silva DLM, Gomes CM, de Oliveira FAR, Kurizky PS, Reis APMG, Talma Ferreira L, de Amorim RFB, Lima MP, Besch CS, Gatto GC, Costa TF, da Silva EN, Schulte HL, Espindola LS, da Mota LMH. Impact of COVID-19 on the mental health of public university hospital workers in Brazil: A cohort-based analysis of 32,691 workers. PLoS One 2022; 17:e0269318. [PMID: 35709187 PMCID: PMC9202958 DOI: 10.1371/journal.pone.0269318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background In early 2020, the COVID-19 pandemic paralyzed the world and exposed the fragility of health systems in the face of mass illness. Health professionals became protagonists, fulfilling their mission at the risk of physical and mental illness. The study aimed to evaluate absenteeism indirectly related to SARS-CoV-2 infection in a large population of health care professionals. Methods An observational longitudinal repeated measures study was performed, including workers linked to 40 public university hospitals in Brazil. All causes of absenteeism were analyzed, focusing on those not directly attributed to COVID-19. Results for the same population were compared over two equivalent time intervals: prepandemic and during the pandemic. Findings A total of 32,691 workers were included in the study, with health professionals comprising 82.5% of the sample. Comparison of the periods before and during the pandemic showed a 26.6% reduction in work absence for all causes, except for COVID-19 and mental health-related absence. Concerning work absence related to mental health, the odds ratio was 39.0% higher during the pandemic. At the onset of the pandemic, there was an increase in absenteeism (all causes), followed by a progressive reduction until the end of the observation period. Interpretation Work absence related to mental illness among health care professionals increased during the COVID-19 pandemic, highlighting the need for health care managers to prioritize and implement support strategies to minimize absenteeism.
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Affiliation(s)
- Adriana Ferreira Barros-Areal
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Secretaria de Estado de Saúde do Distrito Federal–SES DF, Brasília, Brazil
| | - Cleandro Pires Albuquerque
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | - Nayane Miranda Silva
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | - Rebeca da Nóbrega Lucena Pinho
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | | | - Dayde Lane Mendonça da Silva
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
- Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brazil
| | - Ciro Martins Gomes
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
- Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | | | - Patrícia Shu Kurizky
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | | | | | | | | | | | | | | | | | - Heidi Luise Schulte
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Laila Salmen Espindola
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Licia Maria Henrique da Mota
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
- * E-mail:
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Marques CDL, Kakehasi AM, Pinheiro MM, Mota LMH, Albuquerque CP, Silva CR, Santos GPJ, Reis-Neto ET, Matos P, Devide G, Dantas A, Giorgi RD, Marinho ADO, Valadares LDA, Melo AKG, Ribeiro FM, Ferreira GA, Santos FPDS, Ribeiro SLE, Andrade NPB, Yazbek MA, Souza VAD, Paiva ES, Azevedo VF, Freitas ABSBD, Provenza JR, Toledo RAD, Fontenelle S, Carneiro S, Xavier R, Pileggi GCS, Reis APMG. High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry. RMD Open 2021; 7:rmdopen-2020-001461. [PMID: 33510041 PMCID: PMC7844930 DOI: 10.1136/rmdopen-2020-001461] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/01/2020] [Accepted: 12/24/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19. METHODS Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study. RESULTS 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p<0.001) and pulse therapy with methylprednisolone (PR 1.38; 95% CI 1.14 to 1.67; p=0.001) remained significant; for hospitalisation, age >50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018). CONCLUSIONS Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process.
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Affiliation(s)
| | - Adriana Maria Kakehasi
- Musculoskeletal System Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | | | - Pedro Matos
- Rheumatology, Unifesp EPM, Sao Paulo, Brazil
| | | | - Andrea Dantas
- Hospital das Clinicas, Universidade Federal de Pernambuco, Recife, Brazil
| | | | | | | | - Ana Karla G Melo
- Rheumatology, Universidade Federal da Paraiba, Joao Pessoa, Brazil
| | | | | | | | | | | | | | | | - Eduardo S Paiva
- Department of Rheumatology, Universidade Federal do Paraná Hospital de Clínicas, Curitiba, Brazil
| | - Valderilio Feijo Azevedo
- Department of Rheumatology, Universidade Federal do Paraná Hospital de Clínicas, Curitiba, Brazil
| | | | | | - Ricardo Acayaba de Toledo
- Rheumatology, Fundação Faculdade Regional de Medicina de São José do Rio Preto (Hospital de Base), Ribeirão Preto, Brazil
| | | | - Sueli Carneiro
- Rheumatology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Xavier
- Rheumatology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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da Cruz Lage R, Marques CDL, Oliveira TL, Resende GG, Kohem CL, Saad CG, Ximenes AC, Gonçalves CR, Bianchi WA, de Souza Meirelles E, Keiserman MW, Chiereghin A, Campanholo CB, Lyrio AM, Schainberg CG, Pieruccetti LB, Yazbek MA, Palominos PE, Goncalves RSG, Assad RL, Bonfiglioli R, Lima SMAAL, Carneiro S, Azevedo VF, Albuquerque CP, Bernardo WM, Sampaio-Barros PD, de Medeiros Pinheiro M. Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis. Adv Rheumatol 2021; 61:4. [PMID: 33468245 DOI: 10.1186/s42358-020-00160-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/29/2020] [Indexed: 01/04/2023] Open
Abstract
Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians' decision making, without taking out his/her autonomy when prescribing for an individual patient.
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Affiliation(s)
- Ricardo da Cruz Lage
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso 175, Ambulatório Bias Fortes, 2° andar, Belo Horizonte, MG, 30150-260, Brazil.
| | | | | | - Gustavo Gomes Resende
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso 175, Ambulatório Bias Fortes, 2° andar, Belo Horizonte, MG, 30150-260, Brazil
| | | | | | | | | | | | | | | | - Adriano Chiereghin
- Pontifícia Universidade Católica (PUC) de Sorocaba, Sorocaba, SP, Brazil
| | | | - André Marun Lyrio
- Pontifícia Universidade Católica (PUC) de Campinas, Campinas, SP, Brazil
| | | | | | | | | | | | | | - Rubens Bonfiglioli
- Pontifícia Universidade Católica (PUC) de Campinas, Campinas, SP, Brazil
| | | | - Sueli Carneiro
- Universidade Federal do Rio De Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Albuquerque CP, Dos Santos-Neto LL. Development of rheumatology training in Brazil: the option for a medical residency program. Rev Bras Reumatol Engl Ed 2016; 57:507-513. [PMID: 29173687 DOI: 10.1016/j.rbre.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/09/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To describe the characteristics and progression of the supply of new rheumatologists in Brazil, from 2000 to 2015. METHODS Consultations to databases and official documents of institutions related to training and certification of rheumatologists in Brazil took place. The data were compared, summarized and presented descriptively. RESULTS From 2000 to 2015, Brazil qualified 1091 physicians as rheumatologists, of which 76.9% (n=839) completed a medical residency program in rheumatology (MRPR); the others (n=252) achieved this title without MRPR training. There was an expansion of MRPR positions. At the same time, there was a change in the profile of the newly qualified doctors. Early in the series, the fraction of new rheumatologists without MRPR, entering the market annually, was approaching 50%, dropping to about 15% in recent years. In 2015, Brazil offered 49 MRPR accredited programs, with 120 positions per year for access. There was an imbalance in the distribution of MRPR positions across the country, with a strong concentration in the southeast region, which in 2015 held 59.2% of the positions. Public institutions accounted for 94% (n=789) of graduates in MRPR during the study period, while still maintaining 93.3% (n=112) of seats for admission in 2015. CONCLUSIONS In the last sixteen years, in parallel with the expansion of places of access, MRPR has established itself as the preferred route for rheumatology training in Brazil, mainly supported by public funds. Regional inequalities in the provision of MRPR positions still persist, as challenges that must be faced.
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Mansur AJ, Abud AS, Albuquerque CP. [Publication trends in quarterly, bimonthly and monthly cycles of publication during the five decades of Brazilian Archives of Cardiology]. Arq Bras Cardiol 2000; 75:1-7. [PMID: 10983015 DOI: 10.1590/s0066-782x2000000700001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To study trends in selected manuscript characteristics of articles published in the Brazilian Archives of Cardiology from March 1948, to February 1998, in the quarterly, bimonthly and monthly cycles of publication. METHODS A random sample of 25% of all issues of the journal comprised the study sample: 13 issues (11.5%) from the quarterly, 27 (23,5%) from the bimonthly, and 58 (65%) from the monthly publication cycle. We studied the type of manuscript, number of authors, geographical distribution, language of publication and references. RESULTS A total of 1204 articles were studied, 90 (7.5%) from the quarterly, 238 (19,8%) from the bimonthly, and 876 (72.8%) from the monthly publication cycle. The most frequent published articles were original contributions (353), reviews (350) and case reports (205). No significant difference occurred in the proportion of original articles, reviews and case reports; the number of authors was higher in the monthly period;a geographical concentration of the contributions occurred (72% from three Brazilian States); manuscripts in languages other than Portuguese decreased. The mean number of Brazilian references cited was less than 4.7 and the mean number of international references cited was greater than 16.7. CONCLUSION The analysis of the trends over five decades of publication revealed the need for further steps to be taken by the Brazilian Archives of Cardiology, to meet international publication standards for biomedical journals as well as authors' and readers' demands.
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Affiliation(s)
- A J Mansur
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP.
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Silva LK, Costa TP, Reis AF, Iamada NO, Azevedo AP, Albuquerque CP. [Assessment of quality of obstetric hospital care: use of corticoid in preterm labor]. CAD SAUDE PUBLICA 1999; 15:817-29. [PMID: 10633204 DOI: 10.1590/s0102-311x1999000400016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to assess quality of obstetric care for preterm labor patients, using referents, indicators, and standards derived from scientific evidence, focusing on antenatal corticotherapy. Available meta-analyses and randomized controlled trials were examined to establish referents, defining indicators and estimating process and outcome standards for the present study. Data from hospital discharge summaries of seven public maternity hospitals in Rio de Janeiro were analyzed. The standard of process used was 100%. It was not possible to estimate outcome standards, since the necessary adjustment for gestational age was not feasible. Utilization of antenatal corticotherapy in the present study was very low, about 4% and 2%, considering patients up to 33 weeks and 6 days and 36 weeks and 6 days, respectively. Failure to use antenatal corticotherapy when formally indicated deserves attention by health planners and managers, considering: a) the ease in incorporating such a technology, in contrast to the adequate incorporation of special/intensive neonatal care; b) benefits and costs associated with this technology compared to those of delivering neonatal care to premature babies.
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Affiliation(s)
- L K Silva
- Centro de Avaliação de Programas, Serviços e Tecnologias de Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, sala 708, Rio de Janeiro, RJ 21045-900, Brasil
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Kalil R, Bocchi EA, Ferreira BM, de Lourdes Higuchi M, Lopes NH, Magalhães AC, Mady C, Pereira Barretto AC, Albuquerque CP, Bellotti G. [Magnetic resonance imaging in chronic Chagas cardiopathy. Correlation with endomyocardial biopsy findings]. Arq Bras Cardiol 1995; 65:413-6. [PMID: 8729858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To study the correlation between magnetic resonance imaging of the heart and right ventricle endomyocardial biopsy results in chronic Chagas' heart disease. METHODS Ten patients with Chagas' disease, mean age 47 +/- 7 years, all males, in congestive heart failure with New York Heart Association class II (2 patients), III (6) and IV (2) were studied. Mean left ventricular ejection fraction was at echocardiogram 36 +/- 6%. The patients were submitted to right ventricular endomyocardial biopsy and magnetic resonance imaging of the heart. The results of this group were compared with a control group of patients with idiopathic dilated cardiomyopathy, with mean age of 46 +/- 10 years and left ventricular ejection fraction of 30 +/- 4%, in heart failure with functional class II (1 patient), III (5) and IV (1). RESULTS All patients with Chagas' heart disease presented an increase in magnetic ressonance imaging signal of the heart after gadolinium use. The septal signal intensity changed from 0.87 +/- 0.06 to 1.54 +/- 0.16 (p < 0.001). In the control group the mean septal signal intensity was 0.93 +/- 0.07 before and 0.89 +/- 0.06 after the gadolinium (p = ns). Eight patients of the Chagas' disease group had biopsy proven myocarditis and two had borderline myocarditis. However, only one patient of the control group had diagnosis of borderline myocarditis. CONCLUSION Myocarditis is frequently found in Chagas' heart disease patients and who unlike controls present a significant increase in myocardial signal intensity after gadolinium infusion. The magnetic resonance imaging of the heart seems a promising alternative method for the diagnosis of an inflammatory process in Chagas' heart disease.
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Affiliation(s)
- R Kalil
- Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo
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Tranchesi Júnior B, Caramelli B, Gebara OC, Albuquerque CP, Bellotti G, Jatene AD, Pileggi F. [ST segment as an arterial recanalization indicator after thrombolytic therapy in myocardial infarction]. Arq Bras Cardiol 1990; 55:233-6. [PMID: 2078136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the importance of the segment ST in the identification of coronary recanalization in patients submitted to intravenous thrombolysis during acute myocardial infarction (MI). PATIENTS AND METHODS Seventy four patients with MI, 62 male with mean age of 52.6 +/- 10 years. All patients had angiographically demonstrated occlusion of the infarct-related artery (IRA) before the thrombolytic treatment with intravenous "in bolus" infusion of 50 mg, 60 mg and 70 mg of rt-PA. The recanalization of the IRA was assessed 90 minutes later. The real status of the IRA in the angiograms was compared with the ST segment changes between the ECGs obtained before and after the thrombolytic therapy. RESULTS Fifty six (75.6%) patients presented a significant reduction in the ST segment elevation (groups I and II). Of these, 47 possessed an opened IRA. From the 18 patients who did not show ST segment decrement (group III), 13 had an occluded IRA, and 5 an opened one. The method presented sensitivity of 90.3% and a specificity of 59.1%, positive predictive value of 83.9% and negative predictive value of 72.2%. CONCLUSIONS The ST segment is an important marker of coronary recanalization or not following intravenous thrombolytic therapy.
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