Hye Chung Kang

Prehypertension and cardiovascular risk factors in adults enrolled in a primary care programme

Background: An increase in cardiovascular (CV) disease has been observed in prehypertensive subjects who frequently carry other cardiovascular risk factors. In Brazil, little is known about prehypertension and its association with cardiovascular risk factors. Objective: To estimate the association between prehypertension and cardiovascular risk factors in a public primary healthcare programme. Methods: Associations in this cross-sectional study were estimated on the basis of generalized estimating equations. Results are expressed as odds ratio (OR) or adjusted odds ratio (ORa) with 95% confidence interval (CI). Results: The 357 participants were classified as normotensive (64.4%) or prehypertensive (35.6%). In a univariate analysis, prehypertension was statistically associated with male gender, age, table salt use, diabetes, body mass index (BMI), uric acid, and all lipids except high-density lipoprotein cholesterol. When analysis was performed adjusting for gender, age, and table salt use, the association of each metabolic parameter with prehypertension, remained significant for BMI (ORa = 1.097; 95% CI 1.035–1.162), triglycerides (ORa = 1.008; 95% CI 1.003–1.013), and uric acid (ORa = 1.269; 95% CI 1.023– .576). To check for their independence of obesity, associations of triglycerides and uric acid with prehypertension were reanalysed after adjustment for BMI. The association of triglycerides remained statistically significant. A trend of association was present for uric acid. The prevalence of prehypertension paralleled the increase of the number of risk factors. Conclusion: Prehypertension in Brazil is associated with well-recognized cardiovascular risk factors even in a continuously monitored population such the one under study. Prehypertension can be a valuable clue to alert health professionals to treat underlying perturbations to prevent overt cardiovascular disease.

In vitro and in vivo analysis of the antithrombotic and toxicological profile of new antiplatelets N-acylhydrazone derivatives and development of nanosystems: determination of novel NAH derivatives antiplatelet and nanotechnological approach.

BACKGROUND Cardiovascular diseases are the most frequent cause of morbidity and mortality worldwide. Among the most important cardiovascular diseases are atherothrombosis and venous thromboembolism that present platelet aggregation as a key event. Currently, the commercial antiplatelet agents display several undesirable effects, which prompt the search for new compounds with better therapeutic index, more efficient body distribution and mechanism. METHODS In this work we characterized in vivo and in vitro the antithrombotic and toxicological profiles of novel antiplatelet N-substituted-phenylamino-5-methyl-1H-1,2,3-triazole-4-carbohydrazides derivatives also comparing them with aspirin. In addition we also analyzed the stability of the more active compound after encapsulation in PLGA or PCL nanoparticles and the release profile of these new nanosystems. RESULTS The biological results revealed not only the selective effect against arachidonic acid-induced platelet aggregation mainly for compounds 2c, 2e and 2h but also their in vivo active profile on thromboembolism pulmonary animal model with better survival rates (e.g. 82%) than aspirin (33%). The overall toxicological profile was determined by in vitro (MTT reduction tests, neutral red uptake in kidney VERO cells and hemolysis assays) and in vivo (pulmonary embolism) assays that pointed 2c as the most promising derivative with potential as a lead compound. By using the nanoprecipitation technique 2c was loaded into PLGA and PCL nanoparticles showing controlled release profile over 21days according to our drug release tests. CONCLUSION According to our results compound 2c is the most interesting derivative for further studies as it showed the best activity and toxicological profile also allowing the nanoencapsulation process. Thus 2c may assist in determining a new potential therapy with favorable pharmacokinetics for treatment of thrombotic disorders.

Serum uric acid and disorders of glucose metabolism: the role of glycosuria

Hyperuricemia has been associated with hypertension, diabetes mellitus, and metabolic syndrome. We studied the association between hyperuricemia and glycemic status in a nonrandomized sample of primary care patients. This was a cross-sectional study of adults ≥20 years old who were members of a community-based health care program. Hyperuricemia was defined as a value >7.0 mg/dL for men and >6.0 mg/dL for women. The sample comprised 720 participants including controls (n=257) and patients who were hypertensive and euglycemic (n=118), prediabetic (n=222), or diabetic (n=123). The mean age was 42.4±12.5 years, 45% were male, and 30% were white. The prevalence of hyperuricemia increased from controls (3.9%) to euglycemic hypertension (7.6%) and prediabetic state (14.0%), with values in prediabetic patients being statistically different from controls. Overall, diabetic patients had an 11.4% prevalence of hyperuricemia, which was also statistically different from controls. Of note, diabetic subjects with glycosuria, who represented 24% of the diabetic participants, had a null prevalence of hyperuricemia, and statistically higher values for fractional excretion of uric acid, Na excretion index, and prevalence of microalbuminuria than those without glycosuria. Participants who were prediabetic or diabetic but without glycosuria had a similarly elevated prevalence of hyperuricemia. In contrast, diabetic patients with glycosuria had a null prevalence of hyperuricemia and excreted more uric acid and Na than diabetic subjects without glycosuria. The findings can be explained by enhanced proximal tubule reabsorption early in the course of dysglycemia that decreases with the ensuing glycosuria at the late stage of the disorder.

Racial differences in HbA1c: a cross-sectional analysis of a Brazilian public primary care population.

BACKGROUND Blacks show higher levels of HbA1c in studies with different populations and are disproportionately affected by most diabetes-related complications. AIMS The study aims to investigate if the prevalence of altered glycated hemoglobin (HbA1c) varies with skin color and if there is a familial aggregation of either skin color and HbA1c. METHODS The study used the CAMELIA study (Cardio-Metabolic-Renal familiar) population, conducted between June 2006 and December 2007 (cross sectional). Families were recruited from 13 Family Doctor Program Unities of Niteroi, Brazil, a highly miscegenated population. The visits included questionnaire, medical consultation, anthropometric and nutritional assessment. Blood pressure, blood/urine samples were collected. The dosage of HbA1c was performed by immunoturbidimetry in Labmax 240 equipment. RESULTS We compare data of 241 (25.5%) Blacks, versus 422 (44.7%) Mulattos or 272 (28.8%) Whites. The groups did not differ significantly with regard to most measures. Blacks had the lowest levels of income/education, higher frequency of diabetes and hypertension (p<0.20) as higher levels of HbA1c (p<0.05) that persisted after adjusting for possible confounders. Among blacks, the correlations between siblings of HbA1c were higher than among white/mulatto, reaching 86% versus 50%, respectively. CONCLUSION Those results indicate that Brazilian Blacks patients must have more attention, focusing on diabetes preventive care. Longitudinal studies are needed to address the question if the altered level of HbA1c has a real clinical impact.

Metabolic syndrome and associated urolithiasis in adults enrolled in a community-based health program

BACKGROUND Urolithiasis is a common and recurrent disease, whose prevalence rate has recently increased in parallel to obesity pandemic. OBJECTIVES To estimate the prevalence of history of urolithiasis in a non-randomized sample of adults assisted by a community-based health program and to analyze its association with metabolic syndrome. METHODS Cross-sectional study set in Niteroi, Rio de Janeiro, Brazil, including adults (non-diabetic hypertensives, diabetics or controls). Participants were assessed through a standardized questionnaire and underwent clinical and laboratory evaluation, including blood and urine samples. The diagnosis of metabolic syndrome was based on harmonized criteria. RESULTS A total of 740 adults were enrolled (M: F = 0.85; 43±12 years; 30% white, and 70% non-white). Almost half of subjects (42.5%) had metabolic syndrome. The prevalence of urolithiasis in the sample was 10.1%. White skin colour, family history, and metabolic syndrome were independently associated with urolithiasis (P < 0.05). Subjects with the syndrome (excluding cases on diuretics) had more acidic urine (P = 0.014), increased natriuresis (P = 0.01) and higher uricosuria (P = 0.001) compared with non-affected ones. The prevalence of urolithiasis increased in proportion to the number of criteria for metabolic syndrome (P for trend <0.005). CONCLUSIONS Metabolic syndrome is a modifiable factor associated with urolithiasis in a way that the frequency of positive history increases proportionally to the number of its diagnostic criteria. These findings reinforce the recent suggested link between urolithiasis and cardiovascular risk factors.

Comparison of serum creatinine levels in different color/race categories in a Brazilian population

Serum creatinine (sCr) is usually higher among black people in the United States due to increased muscle mass, justifying the addition of race adjustment in creatinine-based formulas to estimate glomerular filtration rate (eGFR). We aimed to assess if sCr levels are different in low-income communities in Brazil according to their race. A total of 1,303 participants were enrolled (58% females, 50±14 years-old, 33% self-defined as white, 41% as mixed race, and 26% as black). No significant differences in sCr were found between racial groups and no influence of race on sCr was seen in the linear regression analysis. The eGFR, calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula with no race adjustment, was no different between whites, mixed race and blacks. However, using such adjustment, eGFR for mixed race and black individuals was significantly higher than for whites (p < 0.001). In conclusion, no significant differences in sCr levels were found between racial groups, raising doubts as to whether race adjustment in eGFR formula should be used in that population.

Application of platelet-rich plasma in the treatment of chronic skin ulcer - Case report

The platelet-rich plasma (PRP) has proved promising regarding its applicability in dermatology, especially in the healing of chronic ulcers. The autologous platelet-rich plasma is obtained by centrifuging the blood, so that the components are separated by density gradient. The final product is a gel rich in growth factors that act in tissue repair by activating fibroblasts and inducing extracellular matrix remodeling.

New approaches in tail‐bleeding assay in mice: improving an important method for designing new anti‐thrombotic agents

This report describes a modified, simple, low‐cost and more sensitive method to determine bleeding patterns and haemoglobin concentration in a tail‐bleeding assay using BALB/c mice and tail tip amputation. The cut tail was immersed in Drabkins reagent to promote erythrocyte lysis and haemoglobin release, which was monitored over 30 min. The operator was blinded to individual conditions of the mice, which were treated with either saline (NaCl 0.15m), DMSO (0.5%) or clinical anti‐thrombotic drugs. Our experimental protocols showed good reproducibility and repeatability of results when using Drabkins reagent than water. Thus, the use of Drabkins reagent offered a simple and low‐cost method to observe and quantify the bleeding and rebleeding episodes. We also observed the bleeding pattern and total haemoglobin loss using untreated animals or those under anti‐coagulant therapy in order to validate the new Drabkin method and thus confirm that it is a useful protocol to quantify haemoglobin concentrations in tail‐bleeding assay. This modified method provided a more accurate results for bleeding patterns in mice and for identifying new anti‐thrombotic drugs.

Low quality of life as an additional criterion for the clinical diagnosis of heart failure in primary care

OBJECTIVE The aim of this study is to estimate the association of shortness of breath (SOB), fatigue and bilateral lower limb edema (LLE) - typical symptoms of HF - with quality of life (QOL) dimensions, measured by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). METHODS This cross-sectional study was conducted as part of the CAMELIA study (Cardiometabolic Renal Familial Study), which involved families covered by the Family Doctor Program (FDP) in Niteroi, Rio de Janeiro, Brazil. The study included 455 patients aged 30 and over, assessed by questionnaire, medical consultation, and blood and urine tests. RESULTS The prevalence of symptoms was: fatigue 56.9%, SOB 22.6% and LLE 16.9%. There were independent and statistically significant associations between SOB and fatigue and all SF-36 dimensions, excepting emotional performance and SOB (p<0.10). CONCLUSION The combination of SOB and fatigue with low QOL can increase the positive predictive value for a clinical diagnosis of HF and is a possible alternative for prioritizing patients for closer investigation in a primary care setting.

Chronic kidney disease and metabolic syndrome as risk factors forcardiovascular disease in a primary care program

Mycobacterium tuberculosis infection in renal transplant recipients is associated with significant morbidity and mortality. Genitourinary tuberculosis is a less frequent presentation and a high level of suspicion is needed to avoid treatment delay. Management is challenging due to the interaction of calcineurin inhibitors with antituberculous medications and the known side effects of these drugs, with higher prevalence in this population. The authors present a case of a renal transplant recipient with urinary and constitutional symptoms whom is diagnosed with tuberculosis after a prostatic biopsy in an already disseminated stage and develops hepatotoxicity to antituberculous therapy.INTRODUCTION Cardiovascular disease (CVD) is especially prevalent in patients with chronic kidney disease (CKD). OBJECTIVE To evaluate the role of CKD and metabolic syndrome (MS), which is a cluster of risk factors for CVD, as predictors of CVD. METHODS Observational, cross-sectional study with a random sample aged 45 or more years extracted from the population assisted by the primary care program in Niterói city in the state of Rio de Janeiro, Brazil. CKD was diagnosed by the K/DOQI guidelines and MS, by the harmonized criteria. CVD was said to be present if the participant had one or more of the following findings: echocardiographic abnormalities, and history of myocardial infarction, stroke or heart failure. A logistic regression model was developed to analyze risk factors for CVD using CKD as the variable of primary interest. RESULTS Fifty hundred and eighty-one participants (38.2% male) with a mean age of 59.4 ± 10.2 years were analyzed. The prevalence rate of CKD was 27.9%. In participants without CKD, MS was associated with a slight but statistically significant increase in the risk for CVD (OR = 1.52, p = 0.037); in those with CKD but without MS the risk for CVD was also statistically significant and at a greater magnitude (OR = 2.42, p = 0.003); when both were present the risk for CVD was substantially higher (OR = 5.13, p < 0.001). CONCLUSION In this study involving a population assisted by a primary care program, CKD was confirmed as an independent risk factor for CVD. The presence of MS concurrent with CKD substantially amplified the risk for CVD.