Jacqueline da Costa Escobar Piccoli

A score proposal to evaluate surgical risk in patients submitted to myocardial revascularization surgery

INTRODUCTIONnScores to predict surgical risk in patients submitted to myocardial revascularization surgery are broadly used.nnnOBJECTIVEnTo develop a score capable to predict mortality in patients submitted to myocardial revascularization surgery.nnnMETHODSnFrom January 1996 to December 2007, data were collected from 2809 patients submitted to myocardial revascularization surgery at PUC-RS São Lucas Hospital. In 2/3 of the sample (n = 1875), the score was developed, after uni and mutivariated analyses. In the remaining 1/3 (n = 934) the score was validated. The final score was developed with the total sample, using the same variables (n = 2809). The accuracy of the model was tested using the area under the ROC curve.nnnRESULTSnThe mean age was 61.3 ± 10.1 years and 34% were women. The risk factors identified as independent predictors of surgical mortality and used for score development (parentheses) were: age > 60 years (2), female (2), extracardiac vasculopathy (2), heart failure functional class III and IV (3), ejection fraction<45% (2), atrial fibrillation (2), chronic obstructive pulmonary disease (3), aortic stenosis (3), creatinine 1.5-2.4 (2), creatinine > 2.5 or dialysis (4), emergency/urgency surgery (16). The area obtained under the ROC curve was 0.86 (CI 0.81-0.9).nnnCONCLUSIONnThe score developed, using clinical variables easy to obtain (age, sex, extracardiac vasculopathy, functional class, ejection fraction, atrial fibrillation, chronic obstructive pulmonary disease, aortic stenosis, creatinine and emergency/urgency surgery) showed capability to predict mortality in patients submitted to myocardial revascularization surgery in our Hospital.

The use of inhibitors of angiotensin-converting enzyme and its relation to events in the postoperative period of CABG

BACKGROUNDnAngiotensin-converting enzyme (ACE) inhibitors reduce the chance of death, myocardial infarction (MI) and cerebrovascular accident (CVA) in patients with coronary disease. However there is no consensus as to its indication in patients undergoing coronary artery bypass grafting (CABG).nnnOBJECTIVEnTo assess the relationship between preoperative use of ACE inhibitors and clinical outcomes after CABG.nnnMETHODSnRetrospective cohort study. We included data from 3,139 consecutive patients undergoing isolated CABG in Brazilian tertiary care hospital between January 1996 and December 2009. Follow-up was until discharge or death. Clinical outcomes after surgery were analyzed between users and nonusers of ACE inhibitors preoperatively.nnnRESULTSnFifty-two percent (n=1,635) of patients received ACE inhibitors preoperatively. The use of ACE inhibitors was an independent predictor of need for inotropic support (OR 1.24, 95% CI 1.01 to 1.47, P = 0.01), acute renal failure (OR 1.23, 95% CI 1.01 to 1.73, P = 0.04) and progression to atrial fibrillation (OR 1.32, 95% CI 1.02 to 1.7, P = 0.03) postoperatively. The mortality rate among patients receiving or not preoperative ACE inhibitors was similar (10.3% vs. 9.4%, P = 0.436), as well as the incidence of myocardial infarction and stroke (15.6% vs. 15.0%, P = 0.694 and 3.4% vs. 3.5%, P = 0.963, respectively).nnnCONCLUSIONnThe use of preoperative ACE inhibitors was associated with increased need for inotropic support and higher incidence of acute renal failure and postoperative atrial fibrillation, not associated with increased rates of myocardial infarction, stroke or death.

Atrioventricular block in the postoperative period of heart valve surgery: incidence, risk factors and hospital evolution

INTRODUCTIONnDisturbances of the cardiac conduction system are potential complications after cardiac valve surgery.nnnOBJECTIVESnThis study was designed to investigate the association between perioperative factors and atrio-ventricular block, the need for temporary cardiac artificial pacing and, if necessary, permanent pacemaker implantation after cardiac valve surgery.nnnMETHODSnRetrospective analysis of the Cardiac Surgery Database - Hospital São Lucas/PUCRS. The data are collected prospectively and analyzed retrospectively.nnnRESULTSnBetween January 1996 and December 2008 were included 1102 valve surgical procedures: 718 aortic valves (65.2%), 407 (36.9%) mitral valve and 190 (17.2%) coronar artery bypass grafting combined with valve repair and 23 (2.1%) aortic and mitral combined surgery. 187 patients (17%) showed clinical and electrocardiographic pattern of atrio-ventricular block requiring artificial temporary pacing. Of these, 14 patients (7.5%) required permanent pacemaker implantation (1.27% of the total valve surgery patients). Multivariate analysis showed association of the incidence of atrio-ventricular block and temporary pacing with mitral valve surgery (OR 1,76; CI 95% 1.08-2.37; P = 0.002), implantation of bioprosthetic devices (OR 1.59; CI 95% 1.02-3.91; P = 0,039), age over 60 years (OR 1.99; CI 95% 1.352.85; P < 0.001), prior use of anti-arrhythmic drugs (OR 1.86; CI 95% 1.04-3.14; P = 0.026) and previous use of b-blocker (OR 1.76; CI 95% 1.25-2.54; P = 0.002). Remarkably the presence of atrio-ventricular block did not significantly show association with increased mortality, but significantly prolonged (P < 0.0001) hospital length-of-stay and, therefore, hospital costs.nnnCONCLUSIONSnOur study presents a group of predictive factors referring to a specific patient profile by which high risk of atrio-ventricular block and the need of temporary cardiac pacing after cardiac valve surgery it is determined.

Association of alcohol consumption with coronary artery disease severity.

BACKGROUND & AIMSnThe ingestion of small to moderate alcohol consumption amounts has been associated to cardiovascular protection. This study aimed to evaluate the association between alcohol consumption and coronary artery disease severity.nnnMATERIAL AND METHODSnCross-sectional Study with patients undergoing coronary angiography. Age, cardiovascular risk factors (smoking, systemic arterial hypertension, dyslipidemia and diabetes) and alcohol drinking habit were investigated. Alcohol consumption was divided in three categories: nondrinker, moderate alcohol consumption (less than 15xa0g ethanol/day for women or 30xa0g ethanol/day for men) and heavy alcohol consumption. Coronary artery disease severity was assessed through the Friesinger Score (FS) in the coronary angiography, by interventional cardiologists blinded to alcohol consumption.nnnRESULTSnThe final sample included 363 adults; of those, 228 were men (62.81%). Mean age was 60.5xa0±xa010.9xa0y. Unadjusted analyses identified sex, age, hypertension, diabetes, dyslipidemia and alcohol consumption as the main covariates associated with the Friesinger score. Lower Friesinger scores were also observed in moderate alcohol consumption when comparing to those who do not drink (RR 0.86; 95% CI 0.79-0.95).nnnCONCLUSIONnAmong patients with suspected coronary artery disease undergoing coronary angiography, moderate alcohol consumption is associated to a lower coronary artery disease severity than heavy drinking.

Behavioral and dopaminergic damage induced by acute iron toxicity in Caenorhabditis elegans

Iron (Fe) is an important metal to organism homeostasis and exists abundantly in the environment. Moderate levels of Fe obtained from food are necessary for normal cell physiology; however, abnormally high levels of Fe may have toxic effects by reducing H2O2 to the highly cytotoxic hydroxyl radical (OH˙) (Fenton catalysis). Fe is a ubiquitous toxicant to the environment and also widely used in food products; however, its effects on the nervous system are not well understood. Herein, we evaluated the toxic effects of Fe using C. elegans and investigated various parameters in order to contribute to the understanding of Fe-induced toxicity and to validate this model. The Fe LD50 of acute exposure (30 min) was 1.2 mM, and we verified that worms readily take up this metal. Furthermore, sublethal Fe concentrations significantly decreased the worms’ lifespan and brood size compared to non-exposed worms. We also observed that animals exposed to Fe had decreased locomotor activity and decreased mechanical sensitivity, suggesting the possible dysfunction of the nervous system. In agreement, we found cholinergic and dopaminergic alterations in the worms. In summary, we suggest that Fe leads to selective neuronal damage, which might be the underlying cause of altered behavior and reproductive defects.

Occupational exposure to pesticides in family agriculture and the oxidative, biochemical and hematological profile in this agricultural model

Aims: Family agriculture represents 80% of the Brazilian rural population, and rural workers linked to this agricultural model are also occupationally exposed to pesticides, which causes health risks for this part of the population. Thus, assessing health conditions becomes important and necessary as a form of biomonitoring of markers that can be used in effective health programs for agricultural workers. Materials and methods: A total of 152 farmers, with an average age of 52 years, who answered the questionnaire and performed anthropometric, blood pressure, and blood dosages to determine the biochemical profile, hematological, markers of oxidative stress and mutagenicity. The sample was divided according to the interview report in two groups: volunteers who use pesticides in agricultural work (n = 84), and volunteers who do not use pesticides (n = 68). Key findings: The group that uses pesticides presented higher values for measuring the circumference of the neck, and significant changes for the markers of oxidative stress, TBARS and Carbonyl, as well as significant reduction of antioxidant enzymes SOD, GPx e GSH, and in the dosages of total cholesterol, alkaline phosphatase, albumin, total leukocytes, monocytes and platelets. No mutagenic damage was verified according to the micronucleus test (MN). Significance: The parameters that presented changes for the group that uses pesticides prove that even the low exposure can cause alteration of biomarkers, likely to compromise the health of the rural population. The results indicate the need for biomonitoring, and evaluation of its long‐term impacts on farmers health. Graphical abstract: Figure. No caption available.

ADIPOQ + 45T≥G Polymorphism, Food Ingestion, and Metabolic Syndrome in Elderly Persons

ABSTRACT Introduction: The current nutritional transition process contributes further to accelerate the onset of metabolic disorders, as do a number of environmental factors that lead to the diagnosis of chronic diseases, as a diet of low nutritional value, is possibly related to the incidence of metabolic syndrome. In addition to these factors, metabolic syndrome may also be related to genetic factors, the ADIPOQ + 45T> G polymorphism has been associated with serum adiponectin levels, insulin sensitivity, and obesity, which affects adiponectin levels act as protective factor for cardiovascular disease. In this way, the present study aimed to analyze the possible association between the ADIPOQ + 45T> G gene polymorphism, usual diet and metabolic syndrome in the elderly. Methods: We evaluated inflammatory and biochemical markers compared with older age groups (age 60 years) with and without metabolic syndrome. In addition to the anthropometric measurements of weight, height and waist circumference, the ADIPOQ + 45T> G gene polymorphism was determined by PCR- RFLP, and food consumption was investigated using a food frequency questionnaire. Results: The study included 111 elderly individuals. Our main results show that there was a significant relationship between the habitual consumption of milk for the group that had metabolic syndrome (p < 0.05). HDL-c levels, glucose, triglycerides, diastolic blood pressure and weight, height and waist circumference had to be altered in patients with metabolic syndrome. There was an association between habitual dietary intake of white meat with haplotypes TG and GG. Conclusion: We conclude that the relationship between the habitual consumption of certain food groups and ADIPOQ indicates the need for further studies to develop a better understanding of this relationship; however, there was no association between the ADIPOQ + 45T> G gene polymorphism and metabolic syndrome in the group of elderly studied.

Metabolites of nitric oxide as a marker cardiometabolic in blacks.

Background The black population has a high cardiometabolic risk, however low incidence of metabolic syndrome (MetS). In this context, there seems to be a paradox related to the diagnostic criteria of MetS, which makes the presence of the same is underestimated in blacks. This condition brings the need to look for a more reliable markers of actual pathological conditions and cardiometabolic risk of these individuals. A possible marker is nitric oxide (NO). The dosage metabolites nitrite/nitrate (NOx) have been shown to be associated with some criteria of the metabolic syndrome, such as obesity and diabetes, however the literature lacks more specific studies to assess whether altered levels of nitric oxide are associated with metabolic and cardiovascular disease among blacks.

Evaluation of hypoglycemic, hypolipidemic and antioxidant effects in vivo of extracts hydroalcoholic of Yacon (Smallanthus sonchifolius)

Background Cardiovascular diseases are the leading cause of death worldwide, and dyslipidemia a major risk factor. Feeding is recognized as the most important intervention in the prevention of diseases and plants are considered the best source of natural antioxidants. Yacon, a tuberous root, originates in the Andean region with fructooligosaccharides as the main reserve carbohydrate. In addition to these compounds, Yacon presents significant amount of polyphenols in both roots and leaves.