Trabalho financiado pela FAPEMIG. RESUMOIntrodução: as cardiopatias são a principal causa de morte e de alocação de recursos públicos em hospitalizações no Brasil. Levando-se em conta que o IMC é pouco descritivo quanto à distribuição de tecido adiposo/muscular, há outro método para obter a relação com riscos cardíacos: circunferência abdominal e cervical. A gordura visceral é vista como depósito patogênico, conferindo riscos metabólicos. Já a circunferência do pescoço reflete o acúmulo de gordura na parede das artérias carótidas. Considerando essa incidência, trabalhos que abordem esses aspectos demonstram relevância no contexto de obesidade e sedentarismo. Objetivos: evidenciar a relação entre as medidas das circunferências abdominal e do pescoço e a hipertensão arterial sistêmica. Metodologia: estudo realizado no CEM-MG, com medidas das circunferências do pescoço e abdome e IMC de 328 cardiopatas após TCLE e questionário. O nível de confiança é de 95%. Com fatores de inclusão/exclusão. Resultados: a circunferência abdominal acima do valor aumenta 3,87 vezes a chance de hipertensão (valor-p=0,000). Já a cervical aumenta 2,38 (1,09; 5,19) vezes (valor p=0,026). Conclusão: embora não interfiram diretamente sobre cardiopatias, as medidas analisadas têm papel secundário sobre estas. Isso porque foi comprovada com o estudo a significância de tais medidas para hipertensão, que representa um importante desencadeante para as demais cardiopatias. Assim, há forte relação das circunferências abdominal e cervical sobre as cardiopatias e os fatores de risco para desenvolvê-las. Essa mensuração mostra-se importante também para mapeamento da saúde dos pacientes. ABSTRACTIntroduction: Heart diseases are the leading cause of death and allocation of public resources in hospitalizations in Brazil. Given that BMI is little descriptive as to the distribution of adipose tissue and muscle, there is another method to obtain the relationship with heart risks: abdominal and neck circumference. Visceral fat is seen as pathogenic deposit, giving metabolic risks. Moreover neck circumference reflects the accumulation of fat in the wall of the carotid arteries. Considering this effect, work that approach these aspects demonstrate relevance in the context of obesity and sedentary lifestyle. Objectives: To demonstrate the relationship between measures of abdominal and neck circumferences and the presence of hypertension. Methodology: A study conducted in CEM-MG, with performance of the neck and abdomen circumference measurements and BMI of 328 cardiac patients after informed consent and questionnaire. The confidence level is 95%. With some inclusion and exclusion factors. Results: abdominal circumference circumference increases 3.87 times the odds for hypertension (p-value = 0.000). In
Background: The association between Diabetes Mellitus (DM) and Infective Endocarditis (IE) is controversial in the literature, since many controversial results have been published. However, when evaluating specifically the evidence on IE and individuals with DM using insulin, we found only two observational studies that considered this variable, with discordant results regarding the prognosis and prevalence of Staphylococcus sp in insulin users compared to non-users. Despite the lack of evidence, in clinical practice the insulin use could be interpreted as minor criteria "injection drug use", using the modified Duke criteria for IE diagnosis. Objectives: To compare the microbiological and valvar profile, as well as the outcome of non-diabetic and diabetic patients with IE who were insulin users or not. Methods: This was an observational, analytical and retrospective study of patients diagnosed with IE between 2003 and 2015 in three tertiary care centers. A total of 211 patients were included, of which 17 were diabetics and 9 were insulin users. Patients were compared using the Shapiro-Wilk normality test and Fisher's exact test, with a significance level of 5%. Results: The mortality from IE in diabetic individuals was higher than that of non-diabetic patients, but with no statistical significance (35.29% vs. 21.1%; p = 0.221), even when the groups were divided into insulin-user diabetic, non-insulin user diabetic and non-diabetic patients (33.3% vs. 37.5% vs. 21.1%, p = 0.229). There was a difference regarding the prevalence of IE caused by S. aureus (57.1% vs. 14.3% vs. 17.4%, p = 0.029) and the involvement of the tricuspid valve (33.3% vs. 0.00% vs. 10.0%, p = 0.034) among insulin users. Conclusion: In our sample, insulin use or the presence of DM did not mean higher in-hospital mortality from IE. It is not possible to generalize the microbiological and valvar findings due to the lack of studies evaluating insulin users in IE; however, particularities have been previously reported and may indicate a different behavior of IE in these patients. New studies considering the insulin use variable are required to elucidate the association between DM and IE.
With improved resources for the prevention, diagnosis, and treatment of infective endocarditis (IE), significant changes in the characteristics of the disease have been reported over time. If, on the one hand, the prevalence of IE due to rheumatic valve disease has decreased, on the other, there has been an increase in IE related to degenerative valve disease in older adults, valve replacement surgery, the implantation of intracardiac devices, and the use of injectables and hemodialysis.Coincidentally, IE cases due to Staphylococcus spp. have surpassed those of Streptococcus spp., and cases due to atypical microorganisms have also increased. 1,2 This microbiological change is attributed to medical progress and the resulting increase in invasive procedures. 3,4 Despite efforts to the contrary, IE is still considered a condition with persistently high morbimortality,
Microalbuminuria (MAU) is a predictor of cardiovascular mortality in patients with diabetes mellitus (DM) and hypertension (HTN) and also in an unselected population. The American Diabetes Association (ADA) and the National Kidney Foundation (NKF) define MAU as an albumin/creatinine ratio (ACR) between 30 and 300 µg/mg in both men and women. Aim: To evaluate the possible relationship among MAU, HTN and gender and ethnicity in Brazilian nondiabetic primary hypertensive patients. Design: Population-based study. Participants: Ninety-eight men and women, seventy-two black and twenty-six white nondiabetic primary hypertensive patients aged 20 years or older were selected. Forty healthy individuals, paired according to age, gender, and ethnics were used as controls. Methods: Early-morning midstream urine was used. Urinary albumin was spectrophotometrically measured with Coomassie Brillant Blue G-250. Creatinine was determined by a method based on Jaffe's reaction. ACR (µg albumin/mg creatinine) was calculated. Data are expressed as medians. Results: ACR level was significantly higher in 98 hypertensive patients (38.00) than in 40 control individuals (23.00) (P < 0.001). ACR level was significantly higher in 48 hypertensive male (46.00) than in 50 hypertensive female (34.00) (P = 0.008). No significant effect of ethnicity on ACR levels between 26 hypertensive Whites (35.50) and 72 hypertensive Blacks (38.00) was observed (P = 0.978). Conclusions: The ACR level, significantly higher in hypertensive patients than in control individuals, supports data from the literature. To our knowledge, this is the first study demonstrating that the ACR level is significantly higher in men than in women. The lack of an ethnicity effect supports what was already asserted, namely, that in Brazil, at an individual level, color, as determined by physical evaluation, is a poor predictor of genomic African * Corresponding author, retired professor. A. A. Belo et al. 237 ancestry, as estimated by molecular markers.
Objective -To study the effect of propafenone on the contractile function of latissimus dorsi muscle isolated from rats in an organ chamber. Methods -
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