Clarissa Berti

Acute Myocardial Infarction: The First Manifestation of Ischemic Heart Disease and Relation to Risk Factors

OBJECTIVE To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04) and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03). The remaining risk factors were not statistically significant. CONCLUSION Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

Terapêutica fotodinâmica com ácido delta-aminole-vulínico em neoplasias queratinocíticas superficiais

BACKGROUND: Photodynamic therapy (PDT) is a treatment technique in which photosensitizing substances are applied in tissues and excited with specific wavelengths of light energy to obtain cell destruction through photoactive cytotoxic substances. This method has been used in several skin neoplasms, with quite successful results. OBJECTIVES: To study the effects of one single session of topical delta-aminolevulinic acid (ALA) irradiated with incoherent light, in actinic keratosis (AK), superficial basal cell carcinoma (BCC) and Bowens disease (BD). PATIENT AND METHODS: Eighty skin lesions, in 52 patients, were treated with an incoherent light source prototype built by the Service of Biomedical Engineering of Hospital de Clinicas de Porto Alegre (HCPA), after the application of 20% ALA under occlusion. Thirty two (40%) were superficial BCC, 37 (46.3%) AK, and 11 (13.7%) BD. Diagnosis was confirmed by biopsy and histology in 23 cases (28.7%). RESULTS: Follow up was not available in five lesions. From the remaining 75, 41 (54.6%) were completely resolved, 22 (29.4%) showed partial remission, and 12 (16.0%) were considered as treatment failures. Considering the 35 treated AK, 23 (65.7%) presented complete response, 7 (20%) improved, and 5 (14.3%) showed no benefit after treatment. Thirty BCC were treated, 10 (33.3%) completely resolved, 13 (43.4%) improved, and 7 (23.3%) remained unaffected. From 10 treated BD, 8 (80%) resolved and 2 (20%) improved. Observed side effects were burning sensation in 24 lesions (32%), pain in 5 (6.7%), and itch in one case (1.3%). Most patients (60%) did not experience any important side effects. CONCLUSION: The results of this study are similar, in part, to the results of other studies present in the literature that used a single treatment with ALA/PDT for superficial keratinocytic neoplasms, especially for actinic keratosis and Bowens disease.