Maria Júlia Silveira Souto

Acute norovirus gastroenteritis in children in a highly rotavirus-vaccinated population in Northeast Brazil

BACKGROUND Gastroenteritis is one of the most important causes of morbidity and mortality in children and an important etiological agent is norovirus. OBJECTIVE We describe the occurrence and characteristics of norovirus diarrhoea in children from Sergipe, Northeast-Brazil, over two consecutive periods of three years following rotavirus vaccine introduction. STUDY DESIGN A cross sectional hospital-based survey conducted from October-2006 to September-2009 and from July-2011 to January-2013. Acute diarrhoea cases had a stool sample collected and tested for norovirus by RT-PCR and positive samples were sequenced. RESULTS In total 280 (19.6%) of 1432 samples were norovirus positive, including 204 (18.3%) of 1113 samples collected during the first period and 76 (23.9%) of 318 collected during the second period. The proportion of children with norovirus infection increased significantly through the second study period (χ2 for trend=6.7; p=0.009), was more frequent in rotavirus vaccinated and in younger children (p<0.001). Of 280 norovirus-positive specimens, 188 (67.1%) were sequenced. Of these, 12 were genogroup I and 176 genogroup II. The main genotype was GII.4 (149/188, 79.3%), followed by GII.2 (6, 3.2%) and GII.6 (5, 2.6%). CONCLUSION Norovirus annual detection rates increased over the study period. The detection of norovirus was higher among young children.

Coronary lesions in patients with COPD (Global Initiative for Obstructive Lung Disease stages I–III) and suspected or confirmed coronary arterial disease

Background Systemic inflammation is the pathophysiological link between coronary artery disease (CAD) and COPD. However, the influence of subclinical COPD on patients with suspected or diagnosed CAD is largely unknown. Thus, this study was designed to evaluate the degree of coronary involvement in patients with COPD and suspected or confirmed CAD. Methods In this cross-sectional study, carried out between March 2015 and June 2017, 210 outpatients with suspected or confirmed CAD were examined by both spirometry and coronary angiography or multidetector computed tomography. These patients were divided into two groups: with and without COPD. Size, site, extent, and calcification of the coronary lesions, and the severity of COPD were analyzed. Results COPD patients (n = 101) presented with a higher frequency of obstructive coronary lesions ≥50% (n = 72, 71.3%), multivessels (n = 29, 28.7%), more lesions of the left coronary trunk (n = 18, 17.8%), and more calcified atherosclerotic plaques and higher Agatston coronary calcium score than the patients without COPD (P < 0.0001). The more severe the COPD in the Global Initiative for Obstructive Lung Disease stages, the more severe the CAD and the more calcified coronary plaques (P < 0.0001). However, there was no difference between the two groups with respect to the main risk factors for CAD. In the univariate analysis, COPD was an independent predictor of obstructive CAD (odds ratio [OR] 4.78; 95% confidence interval: 2.21–10.34; P < 0.001). Conclusion In patients with suspected CAD, comorbid COPD was associated with increased severity and extent of coronary lesions, calcific plaques, and elevated calcium score independent of the established risk factors for CAD. In addition, the more severe the COPD, the greater the severity of coronary lesions and calcification present.

Low to Moderate Alcohol Consumption and Myocardial Ischemia on Exercise Stress Echocardiography

Background: The impact of alcohol consumption on the development of myocardial ischemia remains uncertain. Studies diverge whether low to moderate alcohol consumption provides cardioprotection or whether it is a risk factor for myocardial ischemia. Objective: To study the relationship between low to moderate alcohol consumption and myocardial ischemia on exercise stress echocardiography (ESE). Methods: Cross-sectional study with 6632 patients with known or suspected coronary artery disease undergoing ESE between January/2000 and December/2015. The patients were divided into two groups: G1, composed of 2130 (32.1%) patients whose report showed maximal consumption of 1 drink per day on average for women or of 2 drinks per day for men; G2, composed of individuals denying any alcohol consumption. For comparing between the groups, Student t test was used for quantitative variables, and chi-square test or Fisher exact test, for categorical variables. The significance level adopted was p < 0.05. Logistic regression was also used to evaluate independent risk factors for myocardial ischemia. Results: G1 had a higher number of men (77.1%; p < 0.001), lower mean age (54.8 ± 10.3 years old; p < 0.001) and higher frequency of myocardial ischemia on ESE (p = 0.014). Age, male sex, dyslipidemia, systemic arterial hypertension, diabetes mellitus, smoking and family history were independently associated with myocardial ischemia on ESE. Independent association between low to moderate alcohol consumption and myocardial ischemia on ESE (OR 0.96; 95%CI: 0.83 to 1.11) was not observed. However, age, male sex, smoking and dyslipidemia were associated with alcohol consumption. Conclusion: Low to moderate alcohol consumption was not an independent predictor of myocardial ischemia on ESE. Nevertheless, we observed a predominance of the male sex, dyslipidemia and smoking habit, important predictors of myocardial ischemia, in the group of alcohol consumers. (Int J Cardiovasc Sci. 2018;31(3)235-243)

Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography

Background In view of the high mortality for cardiovascular diseases, it has become necessary to stratify the main risk factors and to choose the correct diagnostic modality. Studies have demonstrated that a zero calcium score (CS) is characteristic of a low risk for cardiovascular events. However, the prevalence of individuals with coronary atherosclerotic plaques and zero CS is conflicting in the specialized literature. Objective To evaluate the frequency of patients with coronary atherosclerotic plaques, their degree of obstruction and associated factors in patients with zero CS and indication for coronary computed tomography angiography (CCTA). Methods This is a cross-sectional, prospective study with 367 volunteers with zero CS at CCTA in four diagnostic imaging centers in the period from 2011 to 2016. A significance level of 5% and 95% confidence interval were adopted. Results The frequency of atherosclerotic plaque in the coronary arteries in 367 patients with zero CS was 9.3% (34 individuals). In this subgroup, mean age was 52 ± 10 years, 18 (52.9%) were women and 16 (47%) had significant coronary obstructions (> 50%), with involvement of two or more segments in 4 (25%) patients. The frequency of non-obese individuals (90.6% vs 73.9%, p = 0.037) and alcohol drinkers (55.9% vs 34.8%, p = 0.015) was significantly higher in patients with atherosclerotic plaques, with an odds ratio of 3.4 for each of this variable. Conclusions The frequency of atherosclerotic plaque with zero CS was relatively high, indicating that the absence of calcification does not exclude the presence of plaques, many of which obstructive, especially in non-obese subjects and alcohol drinkers.

A Decade of Lipid Profiles: A Gender Focus

Introduction and Objectives: The lipid profile is an important predictor of the risk of coronary heart disease (CHD). Higher rates of total cholesterol (TC) and cholesterol of low-density lipoprotein (LDL-C) increase the chances of developing this disease. However, it is known that women due to hormonal factors would have fewer cardiovascular events. The main objective of this article is to assess the association among different parameters of the lipid profile between the different sexes in the population of a city in Brazil. Methods: This is a descriptive, longitudinal and retrospective study based on secondary data collected in the period from 2003 to 2013 in a medical laboratory in Aracaju, Brazil. The lipid profile was determined using the following markers: total cholesterol (TC); high-density lipoprotein cholesterol (HDL-C); low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG). Statistical analysis was performed using measures of central tendency and variance. The inferential analysis was performed by student’s t test and the p-value was 0.05. Results: The sample consists of 63,396 people, 24,425 male and 38,971 female, with mean age of 42.02±17.38 years. The mean value of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglyceride was respectively, 193.39±43.62 mg/dl, 48.80±11.24 mg/dl, 118.35±36.75 mg/dl and 131.28±82.21 mg/dl. Between the genres, it was observed statistical significant differences between all parameters of lipid profile (p<0.0001). Conclusion: We concluded that women have higher rates of total cholesterol and low-density lipoprotein cholesterol; while men have lower rates of high-density lipoprotein cholesterol and higher of triglyceride, which predisposes males to the development of metabolic syndrome.

Cardiovascular Magnetic Resonance Imaging in the Evaluation of the Right Ventricle and its Pathologies

A ressonância magnética cardíaca (RMC) constitui método não invasivo e tridimensional que permite a avaliação morfológica e funcional de todas as câmaras do coração. Esse método tem ganhado importância na identificação e caracterização de cardiopatias primárias que envolvem o ventrículo direito (VD), além de doenças secundárias que levam à disfunção das câmaras direitas. Dessa forma, este trabalho objetiva elucidar a melhor metodologia no diagnóstico dessas doenças mediante a RMC.

Management of exogenous intoxication by carbamates and organophosphates at an emergency unit

OBJECTIVES to evaluate and indicate the procedure to be followed in the health unit, both for diagnosis and the treatment of acute exogenous intoxications by carbamates or organophosphates. METHODS a descriptive study based on retrospective analysis of the clinical history of patients diagnosed with intoxication by carbamates or organophosphates admitted at the emergency unit of the Hospital de Urgências de Sergipe Governador João Alves (HUSE) between January and December of 2012. Some criteria were evaluated, such as: intoxicating agent; patients age and gender; place of event, cause, circumstances and severity of the intoxication; as well as signs and symptoms of the muscarinic, nicotinic and neurological effects. RESULTS seventy patients (average age: 25 ± 19.97) formed the studys population. It was observed that 77.14% of them suffered carbamate intoxication. However, organophosphate intoxications were more severe, with 68.75% of patients presenting moderate to severe forms. Suicide attempt was the leading cause of poisoning, with 62 cases (88.57% of total). Atropine administration was an effective therapeutic approach for treating signs and symptoms, which included sialorrhea (p = 0.0006), nausea (p = 0. 0029) and emesis (p < 0.0001). The use of activated charcoal was shown effective, both in combating the signs and symptoms presented by both patient groups (p < 0.0001). CONCLUSION it is concluded that the use of atropine and activated charcoal is highly effective to treat the signs and symptoms developed by patients presenting acute exogenous intoxication by carbamates or organophosphates.

A morphometric study of ductus arteriosus and its implications for implant of occlusive devices

Introduction: The ductus arteriosus is a blood vessel which connects the pulmonary artery to the aortic arch. This binding occurs opposite to the origin of left subclavian artery. The pulmonary trunk is an artery that carries deoxygenated blood from the right ventricle to the lungs. Objective: Make a morphometric study on the aorta and pulmonary artery beyond ductus arteriosus in a population of individuals between 9-26 weeks of gestation, constituting a database that can assist interventional surgeons for closure of the ductus arteriosus. Methods: It was measured weight, vertex-rump, vertex-heel lengths, head and chest circumferences, and anatomical measures concerning the ductus arteriosus of 44 human fetuses with gestational ages ranging from nine to 26 weeks. Inferential analysis was performed by Student’s t test and Pearson ́s correlation (R) and the significance level was 0.05. Results: It was observed that, among the 44 fetuses, 22.72% had gestational age between nine and 14 weeks; 61.36% had between 15-20 weeks; and 15.90% had between 21-26 weeks of gestation. Regards morphological parameters, there are significant statistical differences for some parameters, such as diameter of the aorta+ pulmonary trunk (p < 0.0001); diameter of the aorta (p: 0.01); diameter of the pulmonary trunk (p: 0.007); diameter of the ductus base at the aorta (p < 0.0001). Conclusion: It is known that the earlier the correction of patent ductus arteriosus, increased patient survival. Therefore, it is necessary to develop instruments that allow the approach in extremely preterm infants with improved modes of treatment.

Drenagem venosa pulmonar anômala em gestante identificada pela ressonância magnética cardíaca

Anomalous pulmonary venous return (APVR) is a rare cardiac anomaly defined as one or more pulmonary veins draining into a structure other than the left atrium, with venous return directly or indirectly to the right atrium. The most common form is partial APVR, in which one to three pulmonary veins drain into systemic veins or into the right atrium. We report the case of a woman diagnosed with partial APVR by magnetic resonance imaging during pregnancy.