The association between total mortality, lipoproteinS, and inflammatory markers, and their implications with aging and longevity are often controversial. Among the most often studied markers are low HDL cholesterol and high C-reactive protein. Particularly in octogenarians, it is expected that the impact of the inclusion of HDL cholesterol and C-reactive protein will improve the stratification of absolute cardiovascular risk. In the present study, we performed a literature review in PubMed about the relation between HDL cholesterol, inflammation and longevity. Applying the inclusion and exclusion criteria adopted, we selected 30 studies, among which one systematic review on the relation between HDL cholesterol and stroke, one meta-analysis on the relation between total cholesterol and HDL cholesterol with mortality, 22 longitudinal studies, and six cross-sectional studies. The results show an inverse association between HDL cholesterol and total mortality, and between cardiovascular mortality and C-reactive protein, as well as a positive association between C-reactive protein and mortality in longevous individuals. C-reactive protein and HDL cholesterol displayed promising characteristics as predictors of cardiovascular mortality in longevous elderly persons.

A sepse durante a gestação é uma complicação rara. O comprometimento fetal resulta principalmente da descompensação materna, por conseguinte, o tratamento deve ser direcionado ao bem-estar da mãe. Poucas evidências permitem extrapolar o tratamento de pacientes não gestantes para as gestantes, porém, o tratamento baseado no Surviving Sepsis Campaing parece adequado e prático. O objetivo deste estudo foi rever o tratamento da sepse na gestação e relatar um caso de gestante com sepse grave que evoluiu favoravelmente. RELATO DO CASO: Paciente com 22 anos, primigesta, na 27ª semana de gestação foi internada com diagnóstico de pielonefrite aguda. Um dia após a internação apresentou quadro de sepse, com hipoxemia refratária às medidas não-invasivas necessitando de intubação traqueal. Após a intubação evoluiu com hipotensão refratária à expansão volêmica necessitando de fármaco vasoativo. Foi interrompido o uso de noradrenalina no mesmo dia e prescrito cefepima. Evoluiu com importante melhora dos padrões ventilatórios, sendo extubada e recebeu alta hospitalar logo após completar o tratamento com antibiótico. Ao completar a 42ª semana de gestação foi internada para indução do trabalho de parto, sendo realizado parto vaginal, sem intercorrências. CONCLUSÕES: A sepse na gestação, mesmo sendo rara Sepse durante a Gestação. Relato de Caso* Sepsis during Pregnancy. Case Report

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Background: Identifying the risk factors for dementia is very important in order to avoid the onset of illness. Some risk markers such as elevated homocysteine, 25(OH)D, CRP, HDL-Col. a renal function is very prevalent in the aged, potentially modifiable and can be risk factors for dementia.Objectives: To evaluate through cluster analysis the relationship between cognitive function and the risk markers homocysteine, CRP, eGFR, 25(OH)D and HDL-Col., and to validate formed clusters relating them to the incidence of dementia, stroke and death.Design: A longitudinal study of 156 Oldest-Old (age 80-95 years) free of cognitive impairment at baseline. Data applied to cluster analysis by two steps method. The formed clusters were compared with respect to demographic variables, neuro-cognitive assessments and serum biochemical markers obtained at baseline. To validate the cluster, we evaluated the incidence of dementia, stroke and occurrence of death in the period of 2010 to 2016. Results:The initial cognitive tests among the three formed clusters differed only on the clock drawing test. During the six years follow-up 13.5% of all participants developed dementia, 5.1% Stroke and 10.9% died. The incidence of dementia, stroke and deaths in this period was significantly lower in cluster 2(p=0.005), which had intermediate values of homocysteine and eGFR, and the highest CRP, HDL-Col. and 25(OH)D. The cluster 1 had the lowest eGFR, HDL-Col. and 25(OH)D, intermediate levels of CRP and the highest levels of homocysteine, and showed the highest incidence of dementia, stroke and death. Conclusion:The combination of eGFR greater than 45mL/min/1.73m2, HDL-Col greater than 60mg/dL, 25(OH)D greater than 20mmol/L and CRP and homocysteine near their respective reference values defined a profile associated with a lower risk of dementia, stroke and death.