Luciano Passamani Diogo

Risk Factors among Stroke Subtypes in Brazil

Stroke is a leading cause of mortality and disability in Brazil. Among the risk factors for cerebrovascular disease, some have more influence than others in certain stroke subtypes. Little data are available in the literature on the prevalence of stroke subtypes in Latin America. We analyzed data from 688 patients with acute ischemic stroke (52.3% women; mean age, 65.7 years) who were enrolled in a stroke data bank. Standardized data assessment and stroke subtype classification were used. The most common stroke subtype was large-artery atherosclerosis (n = 223; 32.4%), followed by cardioembolism (n = 195; 28.3%), and microangiopathy (n = 127; 18.5%). Stroke risk factors differ among stroke subtypes. The population of South America is ethnically diverse, and few previous studies have describe the distribution of risk factors among stroke subtypes in this population. In this study, the most important risk factors were hypertension and dyslipidemia.

Blood–Brain Barrier Breakdown in Reduced Uterine Perfusion Pressure: A Possible Model of Posterior Reversible Encephalopathy Syndrome

BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a clinical entity characterized by headaches, altered mental status, seizures, and visual disturbances and is associated with white matter vasogenic edema. There are no experimental models to study PRES brain changes. METHODS Twenty-eight pregnant Wistar rats were divided into 4 groups of 7: (1) pregnant-control; (2) reduced uterine perfusion pressure (RUPP); (3) invasive blood pressure (IBP); and (4) reduced uterine perfusion pressure plus invasive blood pressure (RUPP-IBP). The RUPP and RUPP-IBP groups were submitted to a reduction of uterine perfusion pressure at pregnancy days 13 to 15. The invasive mean arterial pressure of the IBP and RUPP-IBP groups was measured on day 20. The blood-brain barriers (BBBs) of all groups were analyzed using 2% Evans Blue dye on day 21. RESULTS RUPP rats had higher blood pressures and increased BBB permeability to Evans Blue dye compared with the control animals. Brain staining occurred in 11 of 14 RUPP rats and in none of the control groups (P < .0001). CONCLUSIONS The physiopathology of PRES remains unclear. Here, we described the use of RUPP rats as a potential model to better comprehend this syndrome.

Is there an association between non-steroidal anti-inflammatory drugs and contrast nephropathy?

FUNDAMENTO: A associacao entre o uso de anti-inflamatorios nao-esteroides (AINEs) e insuficiencia renal aguda ou cronica e bem documentada, mas evidencias sobre a associacao entre AINEs e nefropatia induzida por contraste (NIC) nao sao encontradas na literatura. OBJETIVO: Avaliar uma possivel associacao entre AINEs e NIC. METODOS: Em um estudo de coorte, atraves da entrevista clinica de pacientes que foram submetidos a cateterizacao cardiaca, analisamos o uso de AINEs e sua associacao com desenvolvimento de NIC, atraves da alteracao dos niveis de creatinina serica ou taxa de filtracao glomerular em 48 ou 72 horas. RESULTADOS: No periodo de julho de 2005 a julho de 2006, 236 pacientes foram incluidos no estudo, dos quais 29 foram posteriormente excluidos. A incidencia de NIC foi 10,37% (20 de 207) e 42% dos pacientes estavam recebendo AINEs ate o momento da avaliacao. Nao houve associacao entre o uso de AINEs e o desenvolvimento de NIC com OR de 1,293; IC95% (0,46-4,2). O estudo detectou fatores de risco conhecidos para o desenvolvimento de NIC, tais como diabete, com OR de 2,77; IC95% (1,05-7,47) e insuficiencia renal cronica com OR de 3,48; IC95% (1,1-11,07) e tambem sugeriu uma acao protetora da hidratacao com solucao salina com OR de 0,166; IC95% (0,03-0,92). CONCLUSAO: Com base nos dados obtidos, concluimos que nao houve associacao entre NIC e uso previo de AINEs, pelo menos com um OR > 2,85, o qual nossa amostra detectou.BACKGROUND The association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acute or chronic renal failure is well documented, but evidence of such association between NSAIDs and Contrast-Induced Nephropathies (CIN) is not found in the indexed literature. OBJECTIVE To evaluate the possible association between NSAIDs and CIN. METHODS In a cohort study, through clinical interviews of patients that underwent cardiac catheterization, we analyzed the use of NSAIDs and its association with the development of CIN, through alterations in serum creatinine or glomerular filtration rate in 48 or 72 hours. RESULTS From July 2005 to July 2006, 236 patients were enrolled in the study, of which 29 were later excluded. The incidence of CIN was 10.37% (20 of 207) and 42% of the patients were using NSAIDs until the moment of the evaluation. There was no association between the use of NSAIDs and the development of CIN with OR of 1.293 95% CI (0.46-4.2). The study detected known risk factors for the development of CIN, such as diabetes with OR of 2.77 95%CI (1.05-7.47) and chronic renal failure with OR 3.48 95%CI (1.1-11.07). A protective action of saline solution hydration is also suggested, with OR of 0.166 95%CI (0.03-0.92). CONCLUSION Based on the data obtained, we conclude that there was no association between CIN and previous use of NSAIDs, at least with an OR higher then 2.85, which our sample detected.

Computerized Tomography Contrast Induced Nephropathy (CIN) among adult inpatients

INTRODUCTION Contrast induced nephropathy (CIN) is one of the complications of the use of intravascular contrast agents, being defined as a reduction of the glomerular filtration rate caused by the iodinated contrast. Most CIN data derive from the cardiovascular literature, which identified as the most consistent risk factors pre-existing chronic renal insufficiency and diabetes mellitus. However, these studies limit their conclusions to a more specific patient population. Computerized tomography as a cause of CIN has been studied less often. OBJECTIVE To report on the incidence of computerized tomography contrast induced nephropathy (CIN) in an inpatient population of a tertiary general hospital, identifying potentially avoidable risk factors. METHODS We performed a prospective cohort study with inpatients admitted at a tertiary hospital requiring contrast-induced CT. The primary outcome was the development of CIN, measure by the alteration of serum creatinine or glomerular filtration rate in 48 or 72 hours. Through clinical interview, we verified possible risk factors and preventive measures instituted by the medical team and their association with development of CIN. RESULTS Of a total of 410 patients, 35 (8.5%) developed CIN. There was a positive correlation between CIN and the presence of diabetes mellitus (OR = 2.15; 95%CI 1.35-4.06; p = 0.02), heart failure (OR = 2.23; 95%CI 1.18-8.8; p = 0.022), and renal failure (OR = 3.36; 95%CI 1.57- 7.17; p = 0.002) CONCLUSION: Incidence of CIN varies according to the population. Diabetes mellitus, heart failure and renal failure were independent risk factors for the development of CT-associated CIN. Further studies are needed to better understand and treat CT-associated CIN.

Há uma associação entre anti-inflamatórios não-esteroides e nefropatia induzida por contraste?

FUNDAMENTO: A associacao entre o uso de anti-inflamatorios nao-esteroides (AINEs) e insuficiencia renal aguda ou cronica e bem documentada, mas evidencias sobre a associacao entre AINEs e nefropatia induzida por contraste (NIC) nao sao encontradas na literatura. OBJETIVO: Avaliar uma possivel associacao entre AINEs e NIC. METODOS: Em um estudo de coorte, atraves da entrevista clinica de pacientes que foram submetidos a cateterizacao cardiaca, analisamos o uso de AINEs e sua associacao com desenvolvimento de NIC, atraves da alteracao dos niveis de creatinina serica ou taxa de filtracao glomerular em 48 ou 72 horas. RESULTADOS: No periodo de julho de 2005 a julho de 2006, 236 pacientes foram incluidos no estudo, dos quais 29 foram posteriormente excluidos. A incidencia de NIC foi 10,37% (20 de 207) e 42% dos pacientes estavam recebendo AINEs ate o momento da avaliacao. Nao houve associacao entre o uso de AINEs e o desenvolvimento de NIC com OR de 1,293; IC95% (0,46-4,2). O estudo detectou fatores de risco conhecidos para o desenvolvimento de NIC, tais como diabete, com OR de 2,77; IC95% (1,05-7,47) e insuficiencia renal cronica com OR de 3,48; IC95% (1,1-11,07) e tambem sugeriu uma acao protetora da hidratacao com solucao salina com OR de 0,166; IC95% (0,03-0,92). CONCLUSAO: Com base nos dados obtidos, concluimos que nao houve associacao entre NIC e uso previo de AINEs, pelo menos com um OR > 2,85, o qual nossa amostra detectou.BACKGROUND The association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acute or chronic renal failure is well documented, but evidence of such association between NSAIDs and Contrast-Induced Nephropathies (CIN) is not found in the indexed literature. OBJECTIVE To evaluate the possible association between NSAIDs and CIN. METHODS In a cohort study, through clinical interviews of patients that underwent cardiac catheterization, we analyzed the use of NSAIDs and its association with the development of CIN, through alterations in serum creatinine or glomerular filtration rate in 48 or 72 hours. RESULTS From July 2005 to July 2006, 236 patients were enrolled in the study, of which 29 were later excluded. The incidence of CIN was 10.37% (20 of 207) and 42% of the patients were using NSAIDs until the moment of the evaluation. There was no association between the use of NSAIDs and the development of CIN with OR of 1.293 95% CI (0.46-4.2). The study detected known risk factors for the development of CIN, such as diabetes with OR of 2.77 95%CI (1.05-7.47) and chronic renal failure with OR 3.48 95%CI (1.1-11.07). A protective action of saline solution hydration is also suggested, with OR of 0.166 95%CI (0.03-0.92). CONCLUSION Based on the data obtained, we conclude that there was no association between CIN and previous use of NSAIDs, at least with an OR higher then 2.85, which our sample detected.

Risk factors for acute kidney injury in patients treated with polymyxin B at a Tertiary Care Medical Center

INTRODUCTION Polimyxins were originally abandoned due to high rates of nephrotoxicity. However they have been recently reintroduced due to activity against carbapenem-resistant Gram-negative organisms. Recent literature suggests a lower rate of nephrotoxicity than historically reported. OBJECTIVE To determine the rate of polymixins-associated nephrotoxicity as defined by the RIFLE criteria. METHODS A retrospective cohort of all adult patients who received polymixin B at a terciary hospital from December 2010 to March 2011was performed. RESULTS 61 patients (43%) fulfilled the RIFLE criteria for renal injury and 28 patients (13.7%) needed dialysis. Independent predictors for nephrotoxicity were hypotension (OR, 2.79; CI 1.14-5.8; p = 0.006) and concomitant use of vancomycin (OR, 2.86; CI, 1.27-6.4; p = 0.011). CONCLUSIONS In this retrospective cohort, nephrotoxicity (as defined by RIFLE criteria) occurred among 43% of treated patients. The concomitant use of vancomycin and hypotension were independent risk factors of nephropathy. Further studies are needed, particularly with polymyxin B, to clarify if the characteristics of this drug and colistin are overlapping.

Hay una asociación entre antiinflamatorios no esteroides y nefropatía inducida por contraste

FUNDAMENTO: A associacao entre o uso de anti-inflamatorios nao-esteroides (AINEs) e insuficiencia renal aguda ou cronica e bem documentada, mas evidencias sobre a associacao entre AINEs e nefropatia induzida por contraste (NIC) nao sao encontradas na literatura. OBJETIVO: Avaliar uma possivel associacao entre AINEs e NIC. METODOS: Em um estudo de coorte, atraves da entrevista clinica de pacientes que foram submetidos a cateterizacao cardiaca, analisamos o uso de AINEs e sua associacao com desenvolvimento de NIC, atraves da alteracao dos niveis de creatinina serica ou taxa de filtracao glomerular em 48 ou 72 horas. RESULTADOS: No periodo de julho de 2005 a julho de 2006, 236 pacientes foram incluidos no estudo, dos quais 29 foram posteriormente excluidos. A incidencia de NIC foi 10,37% (20 de 207) e 42% dos pacientes estavam recebendo AINEs ate o momento da avaliacao. Nao houve associacao entre o uso de AINEs e o desenvolvimento de NIC com OR de 1,293; IC95% (0,46-4,2). O estudo detectou fatores de risco conhecidos para o desenvolvimento de NIC, tais como diabete, com OR de 2,77; IC95% (1,05-7,47) e insuficiencia renal cronica com OR de 3,48; IC95% (1,1-11,07) e tambem sugeriu uma acao protetora da hidratacao com solucao salina com OR de 0,166; IC95% (0,03-0,92). CONCLUSAO: Com base nos dados obtidos, concluimos que nao houve associacao entre NIC e uso previo de AINEs, pelo menos com um OR > 2,85, o qual nossa amostra detectou.BACKGROUND The association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acute or chronic renal failure is well documented, but evidence of such association between NSAIDs and Contrast-Induced Nephropathies (CIN) is not found in the indexed literature. OBJECTIVE To evaluate the possible association between NSAIDs and CIN. METHODS In a cohort study, through clinical interviews of patients that underwent cardiac catheterization, we analyzed the use of NSAIDs and its association with the development of CIN, through alterations in serum creatinine or glomerular filtration rate in 48 or 72 hours. RESULTS From July 2005 to July 2006, 236 patients were enrolled in the study, of which 29 were later excluded. The incidence of CIN was 10.37% (20 of 207) and 42% of the patients were using NSAIDs until the moment of the evaluation. There was no association between the use of NSAIDs and the development of CIN with OR of 1.293 95% CI (0.46-4.2). The study detected known risk factors for the development of CIN, such as diabetes with OR of 2.77 95%CI (1.05-7.47) and chronic renal failure with OR 3.48 95%CI (1.1-11.07). A protective action of saline solution hydration is also suggested, with OR of 0.166 95%CI (0.03-0.92). CONCLUSION Based on the data obtained, we conclude that there was no association between CIN and previous use of NSAIDs, at least with an OR higher then 2.85, which our sample detected.

Prevalence and record of alcoholism among emergency department patients.

OBJECTIVES: The purpose of this study was to investigate the prevalence of alcoholism among inpatients, to identify social and demographic factors associated with this prevalence and to determine its rate of recognition by the medical team. METHODS: The study population consisted of all patients admitted to the emergency room at Hospital São Lucas, Porto Alegre, Brazil, between July and September of 2005. The data were collected in two steps: an interview with the patient and a review of the medical records to investigate the cases of alcoholism recorded by the medical team. The questionnaire consisted of questions concerning social and demographic data, smoking habits and Alcohol Use Disorders Identification Test. RESULTS: We interviewed 248 patients. Twenty-eight (11.3%) were identified as alcoholics. Compared to the patients with a negative Alcohol Use Disorders Identification Test value (less than 8), those with a positive Alcohol Use Disorders Identification Test were more likely to be male, illiterate and smokers. The medical records of 217 (87.5%) patients were reviewed. Only 5 (20.0%) of the 25 patients with a positive Alcohol Use Disorders Identification Test whose medical records were reviewed were identified as alcoholics by the medical team. The diagnosis made by the medical team, compared to Alcohol Use Disorders Identification Test, shows only a 20% sensitivity, 93% specificity and positive and negative predictive values of 29% and 90%, respectively. CONCLUSION: Alcoholism has been underrecognized in patients who are hospitalized, and, as such, this opportunity for possible early intervention is often lost. Key social and demographic factors could provide physicians with risk factors and, when used together with a standardized diagnostic instrument, could significantly improve the rate of identification of alcoholic patients.

Redução de mortalidade em pacientes internados por doenças respiratórias após a implementação de unidade de cuidados intensivos em hospital secundário do interior do Brasil

Objective To evaluate the association between the in-hospital mortality of patients hospitalized due to respiratory diseases and the availability of intensive care units. Methods This retrospective cohort study evaluated a database from a hospital medicine service involving patients hospitalized due to respiratory non-terminal diseases. Data on clinical characteristics and risk factors associated with mortality, such as Charlson score and length of hospital stay, were collected. The following analyses were performed: univariate analysis with simple stratification using the Mantel Haenszel test, chi squared test, Student’s t test, Mann-Whitney test, and logistic regression. Results Three hundred thirteen patients were selected, including 98 (31.3%) before installation of the intensive care unit and 215 (68.7%) after installation of the intensive care unit. No significant differences in the clinical and anthropometric characteristics or risk factors were observed between the groups. The mortality rate was 18/95 (18.9%) before the installation of the intensive care unit and 21/206 (10.2%) after the installation of the intensive care unit. Logistic regression analysis indicated that the probability of death after the installation of the intensive care unit decreased by 58% (OR: 0.42; 95%CI 0.205 -0.879; p = 0.021). Conclusion Considering the limitations of the study, the results suggest a benefit, with a decrease of one death per every 11 patients treated for respiratory diseases after the installation of an intensive care unit in our hospital. The results corroborate the benefits of the implementation of intensive care units in secondary hospitals.