Association between endothelial biomarkers and lipid and glycemic levels: a cross-sectional study with diabetic patients

Background: Biomarkers can help understand the impact of achieving therapeutic goals in developing vascular diseases in diabetics. Aim: To assess the association between lipid and glycemic profiles and endothelial biomarkers in diabetics. Methods: Cross-sectional study that evaluated lipid and glycemic levels and biomarkers (VCAM-1, Sdc-1, FGF-23 and KIM-1 in diabetics. Results: Higher VCAM-1 levels were associated with higher low-density lipoprotein cholesterol and non-high-density lipoprotein (HDL) cholesterol levels (in the group with inadequate glycohemoglobin A1c [HbA1c] levels), with higher glycemic levels (in the group with inadequate HDL cholesterol levels) and with lower HDL cholesterol levels (both groups). VCAM-1 was independently associated with not achieving adequate HbA1c levels. Conclusion: In uncontrolled diabetics, VCAM-1 was independently associated with having inadequate HbA1c levels, suggesting they may already have endothelial damage.

New Diagnostic Criteria for Overmedication in Systemic Arterial Hypertension

BACKGROUND

Guidelines on managing arterial blood pressure have begun to include lower targets, despite the risk for overmedication-induced hypotension. Because there is no consensus as to what constitutes overmedication in the treatment of hypertension, we conducted a study to develop relevant diagnostic criteria.

METHODS

We used ambulatory monitoring during a 24-hour period to measure blood pressure in 567 patients with medication-controlled hypertension. We then divided this cohort into 3 groups. Group A (n = 413 [72.8%]) comprised patients in whom less than 10% of systolic blood pressure measurements were less than 100 mm Hg (no or mild hypotension). Group B (n = 154 [27.2%]) comprised patients in whom 10% or more of the measurements were less than 100 mm Hg, signifying overmedication. Group C comprised those patients in Group B in whom 20% or more of the measurements were less than 100 mm Hg (n = 74 [48.1%]; attributed to "accentuated" overmedication). Group C patients were prescribed significantly more antihypertensive drugs than were group A patients.

RESULTS

Our findings support a 2-part definition of overmedication in hypertension treatment: (1) mild overmedication, in which 10% or more but less than 20% of systolic blood pressure measurements are less than 100 mm Hg in the awake state and less than 90 mm Hg during sleep; and (2) accentuated overmedication, characterized by 20% or more of valid systolic blood pressure measurements less than 100 mm Hg in the awake state and less than 90 mm Hg during sleep, during a 24-hour period.

CONCLUSION

We think this guidance will help to avoid overmedicating and consequences such as fainting and falls when systolic blood pressure is too low.

Heart Disease and the Kidneys

Clinical Background: The heart can cause kidney disease, and the kidney can cause heart disease. As an example of the first situation, we can mention dilated cardiomyopathies, which can lead to renal failure of the pre-renal type due to the state of renal hypoflow. As an example of the second situation, we can remember that renal failure is a risk factor for cardiovascular diseases, such as coronary heart disease, due to the acceleration in the process of atherosclerosis that it promotes. Epidemiology: In this chapter, we will address what we consider to be the two main aspects of the interrelationships between heart and kidney disease that are "cardiorenal syndrome (CRS)" and "chronic kidney disease (CKD) and coronary heart disease (CHD)." Challenges: For CRS, we discuss its epidemiology, types, pathophysiological mechanisms common to CRS types 1, 2, 3 and 4 and pathogenesis of CSR type 5. Treatment: For "CKD and CHD" we discuss the association of CKD and CHD in community-based populations, traditional risk factor in CKD, non-traditional risk factor in CKD, reduced risk of CHD in patients with CKD, statin treatment, hypertension treatment, anti-platelet aggregation therapy, treatment of CHD in patients with CKD and prognosis of CHDF in CKD patients.

Avaliação do tratamento das dislipidemias em pacientes acompanhados no ambulatório de cardiologia do Hospital Universitário Walter Cantídio

Objetivos: realizar uma apreciação para o atingimento das metas lipídicas preconizadas na V Diretriz brasileira de dislipidemias e prevenção de aterosclerose. Metodologia: Realizou-se então uma pesquisa do tipo quantitativa com um estudo transversal retrospectivo feito por meio de uma coleta de dados nos prontuários de 148 pacientes acompanhados no ambulatório de cardiologia do Hospital Universitário Walter Cantídio (HUWC). Foram excluídos 90 prontuários devido à ausência de algum dado relevante para a análise estatística. Resultados: A análise estatística evidenciou que uma grande parcela dos pacientes acompanhados tinham níveis desejáveis (24,1%) ou ótimos (63,7%) de controle de LDL-c conforme o risco cardiovascular de cada indivíduo de acordo com a V Diretriz Brasileira de Dislipidemias e Prevenção de Aterosclerose da Sociedade Brasileira de Cardiologia. Considerando o conhecimento já estabelecido sobre a relação positiva entre os níveis de LDL-c e o risco de doença arterial coronariana, apenas uma minoria dos pacientes (5,1%) deste estudo acompanhados neste serviço encontravam-se sob risco elevado de eventos cardiovasculares adversos. Conclusão: Os resultados obtidos permitiram concluir que o diagnóstico precoce e o tratamento adequado dos pacientes com dislipidemias são tangíveis. E para tal, reforçamos a necessidade da participação do Estado em políticas públicas direcionadas para assegurar o tratamento integral dos pacientes de baixa renda.

História das placas de formatura da Faculdade de Medicina da Universidade Federal do Ceará

Até o ano de 1970, entrava apenas uma turma por ano através de seu concurso vestibular. A partir de 1971, passaram a entrar duas turmas por ano, o que acontece até hoje. A turma que entrou no segundo semestre de 1971 colou grau no final do primeiro semestre de 1977. Sendo assim, desde 1977, temos turma 1977.1, 1977.2, etc. No entanto, constava no arquivo da  coordenação do curso da FM-UFC duas  turmas anuais em 1973, 1974, 1975 e 1976, quando, na realidade, até 1976 só havia uma turma por ano. Passou a se colocar o número ordinal nas placas a partir da turma de 1988.1.  Baseado nas informações dos arquivos do curso, a comissão de formatura dessa turma escreveu na placa que essa era a  51a turma, quando na verdade essa é a  46a turma. A partir dessa placa, então,  todas as outras que tem o número ordinal até a turma de 2019.1 estão com esta informação incorreta. Devido a uma prolongada greve de professores, não houve turma se formando no primeiro semestre de 1985.

Avaliação da terapêutica em pacientes de alto risco cardiovascular

Segundo o estudo Global Burden of Diseases, para o ano de 2020, a doença cardiovascular (DCV) permanecerá como a principal causa de óbito e incapacidade em ambos os sexos, no Brasil e no mundo. Em nosso país, as DCV são responsáveis por alta frequência de internações, ocasionando altos custos médicos e socioeconômicos. Daí a necessidade de se melhorar a abordagem desses pacientes. Objetivo: registrar a prática clínica vigente na prescrição das intervenções farmacológicas baseadas em evidência. Metodologia: estudo observacional, transversal e descritivo desenvolvido entre os pacientes do HUWC, no período de abril de 2014 a maio de 2015, incluindo indivíduos de alto risco cardiovascular. Resultados: a faixa etária prevalente situou-se entre 50 e 70 anos; 64,7% eram mulheres; 68,5% eram pardos e 24,7% brancos. Hipertensão arterial sistêmica, dislipidemia e diabetes mellitus constituíram os principais fatores de risco cardiovasculares. Cerca de 64,6% dos pacientes apresentavam pressão arterial sob controle. Conclusão: O uso da terapia otimizada se encontra aquém da ideal; a maior parcela da população em estudo atingiu a meta para controle de PA.

Ansiedade cardíaca: uma análise em ambulatórios cardiológicos subespecializados

Objetivos: a condição clínica ansiedade cardíaca é o medo de sensações relacionadas ao coração por consequências negativas dos eventos cardíacos. O Questionário de Ansiedade Cardíaca (QAC) é uma ferramenta internacionalmente utilizada no rastreamento dessa ansiedade. Este artigo objetiva verificar as propriedades psicométricas da versão brasileira do instrumento QAC. Metodologia: o QAC foi aplicado em amostra de 239 pacientes distribuídos entre cinco ambulatórios de cardiologia (arritmia, hipertensão, miocardiopatia, doença coronariana e valvulopatia) para avaliação da confiabilidade e extração fatorial da amostra total e para a Análise Fatorial Multigrupo entre esses ambulatórios. Resultados: os resultados indicam que o QAC apresenta boa consistência interna (Alfa de Cronbach = 0,79) e quando da realização da análise fatorial, o modelo com quatro fatores mostrou ser o mais adequado, com uma explicação de 54,9% da variância total no geral. A estrutura fatorial do QAC apresentou a mesma importância para o construto de ansiedade cardíaca, independente do ambulatório. Ao comparar as médias fatoriais entre os ambulatórios, houve diferenças significativas apenas no fator evitação. Conclusão: Os resultados comprovam a utilidade da escala QAC para uso no contexto ambulatorial brasileiro, sendo fundamental para o desenvolvimento de estratégias de rastreio da ansiedade cardíaca, bem como para propostas de intervenções baseadas nessas medidas.

Análise do perfil terapêutico, clínico e epidemiológico de pacientes com hipertensão atendidos no serviço de cardiologia de um hospital terciário

Objetivo: Esse estudo analisa o perfil dos pacientes hipertensos atendidos no ambulatório de cardiologia do Hospital Universitário Walter Cantídio. Métodos: Foi realizado uma revisão de prontuários eletrônicos, analisando o tratamento de 774 pacientes. Os pacientes foram classificados conforme o número de anti-hipertensivos de classes distintas: monoterapia (uso de um fármaco); terapia dupla (uso de dois); terapia tripla (uso de três); terapia quadrupla (uso de quatro) e politerapia (maior que quatro). Resultados: 145 pacientes estavam em monoterapia, sendo que o medicamento mais usado foi a losartana (35 indivíduos). Das 288 pessoas em terapia dupla, a losartana e a hidroclorotiazida foram mais prevalentes com 45 usuários. Na terapia tripla, dos 244 pacientes os mais utilizados foram losartana, anlodipino e hidroclorotiazida com 33 pacientes. Dos 91 pacientes em terapia quádrupla, a associação foi losartana, hidroclorotiazida, anlodipino e atenolol. Na politerapia, 6 pacientes, a associação mais frequente foi losartana, hidroclorotiazida, anlodipino, atenolol, espironolactona, clonidina e hidralazina com 2 pacientes. Conclusão: Assim, observamos que o tratamento dos pacientes é limitado. Esse fato é justificado devido à condição socioeconômica dos usuários desse serviço, pois muitos não dispõem de uma renda que permita a aquisição de medicamentos. Assim, os profissionais desse serviço adequam os seus conhecimentos para trabalhar com pequeno espectro terapêutico.

Blood pressure measurement in hemodialysis: The importance of the measurement technique

Systemic arterial hypertension contributes to the high cardiovascular morbidity in hemodialysis (HD) patients, but the accuracy of blood pressure (BP) measurement in this population has not been well studied. To evaluate the agreement between BP measurement using the routine measurement technique (usual method) and the technique recommended by the VII Joint (standard method). This cross-sectional study enrolled 124 patients in a single center who had undergone dialysis for more than three months and were 18 years of age or older. The BP was verified at the start of dialysis by the nursing team (usual method) and by the researchers (standard method). The agreement between the systolic and diastolic BP (SBP and DBP) measurements was tested by the Bland-Altman analysis. A difference in BP measurement higher than ±5 mm Hg was considered clinically significant. The studied group had a mean age of 53.2 years. The average difference between routine and standard BP measurement was -6 mm Hg for SBP (limits of agreement: -40.1-28 mm Hg; P <0.001) and -5.6 mm Hg for DBP (limits of agreement: -33.1-21.8 mm Hg; P <0.001). A clinically significant difference in BP measured by both methods was observed in 69.4% of the patients for SBP and in 61.3% for DBP. The disagreement between the results of different BP measurement methods in HD patients was significant and the BP was underestimated using the usual BP method. BP measurement standardization should be encouraged to avoid errors in diagnosis and therapy.

Relaxin affects cell organization and early and late stages of spermatogenesis in a coculture of rat testicular cells

Relaxin and its receptor RXFP1 are co-expressed in Sertoli cells, and relaxin can stimulate proliferation of Sertoli cells. In this study, we investigated a role of relaxin in spermatogenesis, using a short-term culture of testicular cells of the rat that allowed differentiation of spermatogonia to spermatids. Sertoli, germ, and peritubular myoid cells were the predominant cell types in the culture. Sertoli and germ cells expressed RXFP1. Cultures were incubated without (control) or with 0.5% fetal bovine serum (FBS) or 100 ng/mL H2 relaxin (RLN) for 2 days. Cell organization, number, and differentiation were analyzed after 2 (D2), 5 (D5) or 8 (D8) days of culturing. Although the proportion of germ cells decayed from D2 to D5, the relative contribution of HC, 1C, 2C, and 4C germ cell populations remained constant in the control group during the whole culture. RLN did not affect the proportion of germ cell populations compared with control, but increased gene and/or protein expression of the undifferentiated and differentiated spermatogonia markers PLZF and c-KIT, and of the post-meiotic marker Odf2 in D5. RLN favored organization of cells in tubule-like structures, the arrangement of myoid cells around the tubules, arrangement of c-KIT-positive spermatogonia at the basal region of the tubules, and expression of the cell junction protein β-catenin close to the plasma membrane region. Knockdown of relaxin with small interfering RNA (siRNA) reduced expression of β-catenin at the cell junctions, and shifted its expression to the nucleus. We propose that relaxin may affect spermatogenesis by modulating spermatogonial self renewal and favoring cell contact.

Intensity and physiological responses to the 6-minute walk test in middle-aged and older adults: a comparison with cardiopulmonary exercise testing

The 6-minute walk test (6MWT) is a simple field test that is widely used in clinical settings to assess functional exercise capacity. However, studies with healthy subjects are scarce. We hypothesized that the 6MWT might be useful to assess exercise capacity in healthy subjects. The purpose of this study was to evaluate 6MWT intensity in middle-aged and older adults, as well as to develop a simple equation to predict oxygen uptake (V˙O2) from the 6-min walk distance (6MWD). Eighty-six participants, 40 men and 46 women, 40-74 years of age and with a mean body mass index of 28±6 kg/m², performed the 6MWT according to American Thoracic Society guidelines. Physiological responses were evaluated during the 6MWT using a K4b2 Cosmed telemetry gas analyzer. On a different occasion, the subjects performed ramp protocol cardiopulmonary exercise testing (CPET) on a treadmill. Peak V˙O2 in the 6MWT corresponded to 78±13% of the peak V˙O2 during CPET, and the maximum heart rate corresponded to 80±23% of that obtained in CPET. Peak V˙O2 in CPET was adequately predicted by the 6MWD by a linear regression equation: V˙O2 mL·min^-1·kg^-1 = -2.863 + (0.0563×6MWD_m) (R²=0.76). The 6MWT represents a moderate-to-high intensity activity in middle-aged and older adults and proved to be useful for predicting cardiorespiratory fitness in the present study. Our results suggest that the 6MWT may also be useful in asymptomatic individuals, and its use in walk-based conditioning programs should be encouraged.

Cobalt chloride induces metaphase when topically applied to larvae and pupae of the stingless bee Melipona scutellaris (Hymenoptera, Apidae, Meliponini)

In order to optimize preparations of bee metaphases, we tested cobalt chloride, which has been used as a metaphase inducer in other organisms, such as hamsters and fish. Four microliters of 65 mM cobalt chloride aqueous solution was topically applied to larval and pupal stages of the stingless bee Melipona scutellaris. The cerebral ganglion was removed after treatment and prepared for cytogenetic analysis. Identically manipulated untreated individuals were used as controls. The number of metaphases was increased 3-fold in treated individuals compared to controls. The micronucleus test showed no mutagenic effects of cobalt chloride on M. scutellaris cells. We concluded that cobalt chloride is a metaphase-inducing agent in M. scutellaris, thus being useful for cytogenetic analyses.

Preoperative glutamine infusion improves glycemia in heart surgery patients

PURPOSE: To evaluate the effects of pre-operative L-alanyl-glutamine (L-Ala-Gln) on blood glucose control in patients with coronary obstruction, selected for myocardial revascularization. METHODS: Twenty-two patients (63±8 years) were randomly assigned to receive 250ml of L-Ala-Gln 20% plus saline 750 ml (Group L- Ala-Gln, n=11) or saline 1000 ml (Group Saline, n=11) over 3 hours before operation. Pre-operative blood samples were collected 3h before (T-1) and at the beginning of the surgical procedure (T-2). Intra-operative samples were collected immediately before the start (T-3) and the end of extra-corporeal perfusion (T- 4). Post-operative samples were collected 12h (T-12) and 24h later (T-24). RESULTS: Glycemia decreased significantly in L-Ala-Gln treated patients during the intraoperative period. The same effect did not occur in saline patients. As the rate of insulin infusion, administered routinely to patients undergoing surgery with extracorporeal circulation was constant in both groups during surgery, the reduction of blood glucose in group L-Ala-Gln does not seem to be related to exogenous insulin. CONCLUSION: Pre-operative use of L-Ala-Gln improves glycemic control in patients with coronary artery occlusion, submitted to myocardial revascularization.

Blood pressure measurement in different outpatient clinics

The objective of this study is to investigate how blood pressure is measured in different outpatient clinics. This is a retrospective study performed with 1,000 patients, randomly selected among patients followed in different outpatient clinics in Fortaleza, Brazil. Among the 1,000 patients, 962 had available records. The older the patient, the greater the possibility of having had blood pressure measured. In subsequent visits, blood pressure was measured more often than in the first visits. Blood pressure was measured more often among patients with chronic disease. The specialty with the highest proportion of blood pressure measurement was cardiology (85%). At the surgery, dermatology and traumatology clinics, blood pressure was measured in less than 5% of visits, and at the ophthalmology, sexually transmitted diseases, psychiatry, proctology and otolaryngology clinics, blood pressure was not measured in any visit. Cardiology, endocrinology, nephrology, geriatrics and internal medicine were the specialties where blood pressure was more frequently measured. It is important to measure blood pressure in any medical specialty in order to give early diagnosis of hypertension and provide adequate blood pressure control.

The effect of the Rochagan on radiolabeling with (99m)Tc

Radionuclides are used in nuclear medicine by variety of diagnostic procedures. The labeling of red blood cells (RBC) with (99m)Tc is a current method applied in clinical nuclear medicine. Drugs can alter this labeling and modify the disposition of the radiopharmaceuticals. The influence of Rochagan on the labeling of blood constituents with (99m)Tc was reported. Samples of blood were incubated with different concentrations of Rochagan (0%; 6.25%; 12.5%; 25%; 50%; 100%). Stannous chloride and (99m)Tc (3.7MBq/mL) were added. Plasma (P) and (RBC) were isolated and precipitated with thricloroacetic acid 5%. The insoluble (IF) and soluble fractions (SF) were separated. The %ATI in RBC, IF-P and IF-RBC were calculated. The %ATI on RBC decreased significantly (p<0.05) from control to all concentrations of Rochagan, respectively: 90.15 + or - 0.14(control) to 70.80 + or - 4.21; to 64.36 + or - 0.33; to 57.30 + or - 1.56; to 50.28 + or - 2.71; to 42.41 + or - 2.24; on IF-RBC, respectively: 84.70 + or - 0.87(control) to 67.16 + or - 4.38; to 63.63 + or - 2.92; to 59.02 + or - 3.17; to 43.75 + or - 1.00; to 24.15 + or - 0.94 and also on IF-P, respectively: 83.46 + or - 1.09(control) to 50.90 + or - 3.36; to 35.46 + or - 4.13; to 35.78 + or - 2.31; to 28.74 + or - 3.09; to 19.66 + or - 1.34. The analyses were performed by T-Student and Mann Whitney tests, p<0.05. This effect was probably due to products present in Rochagan that may complex with ions or have a direct/indirect effect on intracellular stannous ion concentration.

Determination of microalbuminuria in hypertensive patients and in patients with coronary artery disease

BACKGROUND

The normal 24-hour albumin excretion rate is of 20 mg. A persistent rate of 30 to 300 mg/day is called microalbuminuria and is related to a higher prevalence of cardiovascular disease.

OBJECTIVE

1) To determine the prevalence of microalbuminuria in a group of hypertensive patients and in a group of patients with coronary artery disease; 2) To determine the relationship between the presence of microalbuminuria and hypertension, diabetes mellitus, dyslipidemia, smoking and obesity.

METHODS

The presence of microalbuminuria in a group of hypertensive patients (73 individuals) and in a group of patients with coronary artery disease (39 individuals) was determined and compared with a control group (43 individuals). Microalbuminuria was defined as an albumin/creatinine ratio higher than 30 and lower than 300 in a spot morning urine sample. The chi-square test and the Fishers exact test were used in the statistical analysis.

RESULTS

Microalbuminuria was present in 9.5% of the hypertensive individuals and in 33% of the patients with coronary artery disease, and was absent in individuals of the control group. When the occurrence of microalbuminuria was analyzed according to the different clinical parameters, regardless of the group involved, a statistically significant correlation was found with age, diabetes and dyslipidemia.

CONCLUSION

1) The prevalence of microalbuminuria in hypertensive individuals is high, and is even higher in patients with coronary artery disease; 2) There is a correlation of the presence of microalbuminuria with age, diabetes and dyslipidemia.

Biosensing hydrogen peroxide utilizing carbon paste electrodes containing peroxidases naturally immobilized on coconut (Cocus nucifera L.) fibers

A novel unmediated hydrogen peroxide biosensor based on the incorporation of fibrous tissue of coconut fruit in carbon paste matrix is presented. Cyclic voltammetry and amperometry were utilized to characterize the main electrochemical parameters and the performance of this new biosensor under different preparation and operation conditions. The resulting H2O2-sensitive biosensors respond rapidly (7 s to attain 90% of the signal), was operated at -0.15 V, presented linear response between 2.0x10(-4) and 3.4x10(-3) mol L(-1), the detection limit was estimated as 4.0x10(-5) mol L(-1). Its operation potential was situated between -0.2 and 0.1 V and the best pH was determined as 5.2. Electrodes containing 5% (w/w) of coconut fiber presented the best signal and their lifetime was extended to 3 months. The apparent Michaelis-Menten constant KM(app) and Vmax were estimated to be 8.90 mmol L(-1) and 6.92 mmol L(-1) microA(-1), respectively. The results obtained for determination of hydrogen peroxide in four pharmaceutical products (antiseptic solution, contact lenses cleaning solution, hair coloring cream and antiseptic dental rinse solution) were in agreement with those obtained by the spectrophotometric method. An additional advantage of these biosensors is the capacity to measure hydrogen peroxide even in samples with relatively low pH. To demonstrate the enzymatic activity of the coconut tissue, a very simple way was created during this work. Coconut fibers were immersed in H2O2 solution between two glass slides. Sequential images were taken to show the rapid generation of O2, attesting the high activity of the enzymes.

Thrombotic events in two siblings with thrombophilia

We describe the clinical case of two siblings with different presentations of thrombotic phenomena, in which prothrombin mutation was observed.

Schistosoma mansoni: continuous variation in susceptibility of the vector snail of schistosomiasis, Biomphalaria tenagophila I. Self-fertilization-lineage

Mascara, D., Kawano, T., Magnanelli, A. C., Silva, R. P. S., Sant' Anna, O. A., and Morgante, J. S. 1999. Schistosoma mansoni: continuous variation in susceptibility of the vector snail of schistosomiasis, Biomphalaria tenagophila I. Self-Fertilization-Lineage. Experimental Parasitology 93, 133-141. Artificial selection of Biomphalaria tenagophila snails for susceptibility to infection by Schistosoma mansoni (Brazilian SJ strain) was carried out from natural populations. After five self-fertilization generations, two lineages were isolated and were designated as SUSC (highly susceptible 93-100%) and RES (nonsusceptible 5-0%). Length of the prepatent period, cercarial production, and mortality of the hosts in postexposure were determined in all generations (F(1)-F(8)) and were analyzed as quantitative traits related to host susceptibility. Distribution patterns of frequencies were observed within snail families (samples derived from one F(0) snail), these traits showing a significant influence by selection applied to susceptibility. The multiple quantitative classes were described in terms of continuous variation. During the selection of SUSC lineage, classes with higher values of prepatent length and lower cercarial production were eliminated, and the heritability calculated for these two traits was 0.811 and 0.709, respectively. Experimental results were correlated with an increase in the level of susceptibility in the generations selected and are discussed in relation to inheritance patterns as well as the quantitative variation of susceptibility.