Bruno Fernandes de Oliveira Santos

Prevalence, genotypes and factors associated with HCV infection among prisoners in Northeastern Brazil.

AIM To determine hepatitis C virus (HCV) seroprevalence and its genotypes, and to identify the factors associated with HCV infection. METHODS This cross-sectional study, conducted in two prisons (one male and one female) in the State of Sergipe, Brazil, comprised 422 subjects. All of the prisoners underwent a rapid test for the detection of HCV antibodies. Patients with a positive result were tested for anti-HCV by enzyme linked immunosorbent assay and for HCV RNA by qualitative polymerase chain reaction (PCR). The virus genotype was defined in every serum sample that presented positive for PCR-HCV. In order to determine the factors independently associated with positive serology for HCV, multivariate logistic regression was used. RESULTS HCV seroprevalence was 3.1%. Of the 13 subjects with positive anti-HCV, 11 had viremia confirmed by PCR. Of these, 90.9% had genotype 1. A total of 43 (10.2%) were injecting drug users, and HCV seroprevalence in this subgroup was 20.6%. The variable most strongly associated with positive serology for HCV was use of injecting drugs [odds ratio (OR), 23.3; 95% confidence interval (CI), 6.0-90.8]. Age over 30 years (OR, 5.5; 95%CI, 1.1-29.2), history of syphilis (OR, 9.8; 95%CI, 1.7-55.2) and history of household contact with HCV positive individual (OR, 14.1; 95%CI, 2.3-85.4) were also independently associated with HCV infection. CONCLUSION Most of the HCV transmissions result from parenteral exposure. However, there is evidence to suggest a role for sex and household contact with an infected subject in virus transmission.

Parâmetros clínicos e ecocardiográficos associados a baixo índice cronotrópico em pacientes não idosos

BACKGROUND Despite abundant evidence of increased morbidity and mortality, chronotropic incompetence (CI) is not a routine diagnosis well defined in protocols of cardiac evaluation and its clinical importance is still underestimated. OBJECTIVE To evaluate the clinical and echocardiographic parameters associated with HF in non-elderly patients submitted to stress echocardiography (SE). METHODS One thousand seven hundred ninety-eight patients with a mean age of 48.4 ± 7.5 years, who underwent SE between January/2000 and August/2009 were evaluated. Patients with chronotropic index smaller than 0.8 were considered chronotropic incompetent as compared to competent patients as to clinical and echocardiographic characteristics. RESULTS The duration of the exercise was 9.3 ± 2.4 minutes on average. Two hundred and seventy (15%) patients were chronotropic incompetent. The chronotropic index of this group was 0.7 ± 0.1 vs. 1.0 ± 0.1 for competent patients. Multivariate logistic regression analysis identified the following parameters as independently associated with HF: dyspnea on examination [odds ratio (OR) = 4.27, p <0.0001], previous chest pain on medical history (OR = 1.51; p = 0.0111), higher left ventricular mass rate in incompetent patients (LVMI) (OR = 1.16, p = 0.0001), metabolic equivalents (METs) (OR = 0.70, p = 0 , 0001), ST segment depression (OR = 0.58, p = 0.0003) and high systolic blood pressure (ΔSBP) (OR = 0.87, p = 0.0011). Myocardial ischemia was not associated with HF. CONCLUSION HF is associated with functional parameters, such as dyspnea on exertion, history of chest pain and lower METS. It is also associated with structural benchmark index of left ventricular mass. In addition, chronotropic incompetence does not appear to increase the chance of myocardial ischemia in non-elderly patients.

Valor prognóstico da ecocardiografia sob estresse físico em portadores de bloqueio do ramo esquerdo

BACKGROUND The literature lacks studies about the prognostic value of exercise stress echocardiography (ESE) in patients with complete left bundle branch block (LBBB) of the bundle of His. OBJECTIVE To assess the prognostic value of ESE in patients with LBBB. METHODS This is a retrospective cohort that evaluated 135 patients with LBBB, from January 2001 to October 2009, of which 37.8% were men, mean age 63.6 ± 11.5 years submitted to ESE according to Bruce protocol on a treadmill. Cox regression was used, considering these outcomes: death from all causes and from cardiac events, defined as acute myocardial infarction (AMI), percutaneous angioplasty (PA), coronary artery bypass grafting (CABG) and death from cardiac causes. RESULTS Positive ESE was observed in 42 patients (31%). The mean follow-up was 45.8 ± 4.7 months. During this period, there were 9 deaths from all causes and 9 cardiac events (3 deaths from cardiac causes, 3 myocardial infarctions, 2 PA and one CABG). The mortality rate from all causes during five years was 16.1% in the group with positive ESE and 2.5% in the group with negative test (p = 0.171), whereas the rate of cardiac events in the same period was 15.1% for the positive ESE and 1.6% in the group with negative test (p = 0.009). CONCLUSION ESE showed to be a predictor of cardiac events in patients with LBBB.

Stress echocardiography and major cardiac events in patients with normal exercise test

Background Exercise test (ET) is the preferred initial noninvasive test for the diagnosis and risk stratification of coronary artery disease (CAD), however, its lower sensitivity may fail to identify patients at greater risk of adverse events. Objective To assess the value of stress echocardiography (SE) for predicting all-cause mortality and major cardiac events (MACE) in patients with intermediate pretest probability of CAD and a normal ET. Methods 397 patients with intermediate CAD pretest probability, estimated by the Morise score, and normal ET who underwent SE were studied. The patients were divided into two groups according to the absence (G1) or presence (G2) of myocardial ischemia on SE .End points evaluated were all-cause mortality and MACE, defined as cardiac death and nonfatal acute myocardial infarction (AMI). Results G1 group was comprised of 329 (82.8%) patients. The mean age of the patients was 57.37 ± 11 years and 44.1% were male. During a mean follow-up of 75.94 ± 17.24 months, 13 patients died, three of them due to cardiac causes, and 13 patients suffered nonfatal AMI. Myocardial ischemia remained an independent predictor of MACE (HR 2.49; [CI] 95% 1.74-3.58). The independent predictors for all-cause mortality were male gender (HR 9.83; [CI] 95% 2.15-44.97) and age over 60 years (HR 4.57; [CI] 95% 1.39-15.23). Conclusion Positive SE for myocardial ischemia is a predictor of MACE in the studied sample, which helps to identify a subgroup of patients at higher risk of events despite having normal ET.

Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia

Background Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1) or positive (G2) for myocardial ischemia. The endpoints analyzed were all‑cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results G2 comprised 205 patients (23.7%). During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 – 6.01; p = 0.016). The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 – 6.53; p = 0.022) and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively). Conclusion Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia.

Knowledge of health professionals about pain and analgesia

BACKGROUND AND OBJECTIVES: Pain relief is a basic human right and an ethical issue involving all health professionals. This study aimed at describing what professionals of a multidisciplinary hospital team know about pain and analgesia. METHODS: This is a descriptive, cross-sectional study with quantitative approach, carried out at the Teaching Hospital of the Federal University of Sergipe. Sample was made up of 33 physicians, 26 nurses, 10 physiotherapists, 8 pharmacists and 5 psychologists. Data collection tool was a self-applied questionnaire encompassing knowledge about definitions and types of pain, evaluation and measurement, pharmacological and non-pharmacological management, and professional qualification in pain. Data were analyzed by simple descriptive statistics and are presented as tables. RESULTS: Participants of the study were predominantly females (72.0%), young adults (40.2%), with residence as maximum qualification (53.7%). Pain was considered discomfort/unpleasant sensation (46.3%) and chronic pain was defined as a symptom 48.8%). Only one professional reported using multimodal treatment for pain relief. Most professionals stated having acquired knowledge about pain and analgesia after graduation (79.3%) and that they feel the need for specific qualification (70.7%). CONCLUSION: This study has provided a situational diagnosis of the knowledge of the multiprofessional team of the hospital, showing that there is inconsistency between participants’ theoretical basis and their role in handling pain and humanizing assistance.

Secular trends in the survival of patients with dialytic acute renal failure (ARF) in an intensive care unit (ICU)

In 1997, we started performing CVVH/HD in our ICU, which allowed us to improve the metabolic control of our dialysis patients. We sought to investigate the trends in mortality rates of ARF patients treated in our ICU from January 1992 to December 1998. The APACHEII score and risk of death of all patients (n = 10723, age 61 ± 18 years, 62% males) and of patients with ARF submitted to dialysis therapies (n = 256, age 61 ± 18 years, 70% males) are shown in the Table. Table In 1998, for the first time, the mortality in the ARF population was lower than the expected mortality (risk of death). Comparing the 1992-1996 period with 1997-1998, there was no reduction in the expected mortality (49% versus 44%; P = 0.46), but there was a significant reduction in the ICU mortality (62% versus 48%; P = 0.04). This improvement in survival could be due to an overall improvement in our standards of care or in the dialytic therapy.