RESUMO
INTRODUÇÃO: O Pseudoaneurisma do ventrículo esquerdo (PSAVE), aneurisma de ventrículo esquerdo (VE) e trombo mural são ocorrências incomuns no infarto agudo do miocárdio (IAM), sendo o PSAVE uma complicação ainda mais rara, correspondendo a menos de 0,1% dos pacientes com diagnóstico de IAM e com alta letalidade. Decorrem de ruptura miocárdica por necrose e o tratamento definitivo cirúrgico modifica o curso natural da doença. RELATO DE CASO: Paciente masculino, 70 anos, com hipertensão e diabetes apresentou IAM com supradesnivelamento de ST (IAMCSST) de parede anterior, sem reperfusão e foi submetido à estratificação invasiva em outro serviço após 72 horas. Foi tratado com implante de Stent farmacológico na artéria descendente anterior. Procurou assistência médica após 2 meses devido a quadro de insuficiência cardíaca (IC). Realizado ecocardiograma transtorácico que evidenciou PSAVE, recebendo alta com orientação de procurar esta instituição. Nova ecocardiografia evidenciou fração de ejeção do VE de 22% e grande aneurisma da região apical do VE, trombo mural e PSAVE na região ínfero-apical. Recebeu manejo com inotrópico intravenoso e após melhora clínica foi encaminhado para aneurismectomia com reconstrução do VE roto e trombectomia. Recebeu alta da UTI com18 dias de pós-operatório. DISCUSSÃO: Complicações mecânicas decorrentes da rotura por necrose miocárdica estão associadas à elevada mortalidade e as apresentações tardias após o evento agudo são relatos de seleção natural e achados incidentais. São associadas à necessidade de tratamento cirúrgico, especialmente em casos agudos, quando a ruptura pode ser fatal em até 45% dos casos. Na fase crônica, os sintomas por vezes são inespecíficos, podendo se apresentar com IC, insuficiência mitral, embolia sistêmica e arritmias cardíacas. CONCLUSÃO: Até o presente momento, este representa o primeiro relato de caso de tripla ocorrência de complicações associadas à grande massa miocárdica necrótica na era contemporânea da intervenção coronária percutânea no Brasil. Reiteramos a relevância dos casos com IAMCSST serem tratados com reperfusão precoce, fator independente para redução de mortalidade e salvamento miocárdico, portanto com menor risco desenvolvimento dessas complicações em pacientes tratados com implante de stent coronario após IAM, porém associada à elevada morbimortalidade na fase aguda. Sua suspeição, diagnóstico precoce e tratamento cirúrgico são essenciais para um desfecho clínico favorável.
Assuntos
Humanos , Masculino , Idoso , Trombose , Infarto do MiocárdioRESUMO
INTRODUCTION: A polymorphism in the type 2 deiodinase (Thr92Ala-DIO2) gene has been associated with behavioral and cognitive dysfunction as well as neurodegeneration and oxidative stress in the central nervous system. OBJECTIVE: To test whether the minor allele (Ala92) frequency (MAF) is increased in children in the autism spectrum disorder (ASD), and whether carriers of the minor allele exhibit more severe symptoms and/or worse adaptive behavior. STUDY DESIGN: ASD children were evaluated at baseline and yearly throughout the study by psychologists using the following tools: autism behavior checklist, Vineland Adaptative Behaviour Scales II, non-verbal intelligence test SON-R 21/2-7, SON-R 6-40, Weschler scale for intelligence, and autism treatment evaluation checklist. SETTINGS: Academic outpatient mental health facility in Sao Paulo, Brazil. PARTICIPANTS: ASD boys and girls younger than 18 years of age. 132 consecutive ASD children, mostly boys (~ 80%); ~ 50% was classified as verbal. Exclusion criteria were coexistence of sensory and/or physical impairment, or any associated genetic syndromes. RESULTS: Median follow-up was for an uninterrupted period of 937 days (139-1375 days), which did not vary significantly among the genotypes. The MAF was 47% in ASD patients vs. 51% in a local reference population with similar ethnic background; the clinical severity and progression were not affected by the minor allele. Carriers of the minor allele exhibited higher adaptive behavior in the domains "daily living skills" and "communication", which correlated positively with the dose of the minor allele. CONCLUSION: The MAF is not different in ASD children, but carriers of the Thr92Ala-DIO2 polymorphism exhibited higher adaptive behavior.
Assuntos
Adaptação Psicológica/fisiologia , Transtorno do Espectro Autista , Iodeto Peroxidase/genética , Adolescente , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/genética , Transtorno do Espectro Autista/psicologia , Sintomas Comportamentais/diagnóstico , Sintomas Comportamentais/etiologia , Brasil/epidemiologia , Sistema Nervoso Central/metabolismo , Criança , Cognição/fisiologia , Feminino , Frequência do Gene , Hormônio Liberador de Gonadotropina , Humanos , Testes de Inteligência , Masculino , Estresse Oxidativo , Polimorfismo Genético , Iodotironina Desiodinase Tipo IIRESUMO
INTRODUÇÃO: No conceito do Continuo da Doença Cardiovascular, a sequência de eventos seria iniciada por vários fatores de riscos progredindo por vias e processos fisiopatológicos até o desenvolvimento da lesão cardíaca final, no caso a Insuficiência Cardíaca (IC) em fase avançada. Cuidado Paliativo (CP) é uma abordagem interdisciplinar de tratamento que se concentra em melhorar a qualidade de vida dos pacientes nos diferentes estágios da IC.O racional para implementação de CP com planejamento avançado de cuidados por toda a progressão da doença e no luto , em pacientes com IC avançada ,inclui os seguintes: prognóstico limitado , elevada carga de sintomas , rehospitalizações, baixa qualidade de vida, comorbidades e estresse dos cuidadores OBJETIVOS: Caracterizar o perfil clínico dos pacientes cardiopatas incluídos para abordagem paliativa (AP), associado ao tratamento farmacológico da IC. MÉTODOS: Análise de 116 pacientes com IC incluídos para uma AP, entre fevereiro de 2017 a dezembro de 2018. RESULTADOS: Idade média de 74±12,7 anos, com 54% do sexo masculino. Diagnósticos etiológicos da miocardiopatia: incluíram: isquêmica 27%, valvar 25%, arritmogênica 13%, hipertensiva 8,6%, chagásica 8,6% e congênita 2,5%. Diagnósticos mas relevantes no momento da AP foram: insuficiência renal 78%, choque séptico 39,6%, IC 41,4%, choque cardiogênico 30,1%, acidente vascular cerebral 18,1% e pós parada cardiorrespiratória 9,4%, a média de fração de ejeção do VE por ecocardiograma 40%±16,5%. Performances nas atividades cotidianas: 64,6% com dependência total na escala Kartz, 37,9% com necessidade de suporte de vida na escala Karnofsky e 34,5% com alta dependência de cuidados pela Palliative Performance Scala. O intervalo de tempo entre a hospitalização e o óbito vario entre 3 e 405 dias (média de 29 dias). O intervalo de tempo entre a internação e a solicitação e indicação de uma AP variou entre 1 a 177 dias(média de 15 dias). Desfechos clínicos: 12% receberam alta hospitalar, e 7,7% estão em seguimento clínico. CONCLUSÃO: Os pacientes alocados e incluídos no programa de AP encontravam-se em estádios avançado da IC, em fase final de vida, mostrando que a AP foi iniciada tardiamente, caracterizado pelo tempo prolongado de internação , alta dependência de cuidados. DESCRITORES: Cuidados Paliativos, Cardiologia, Cuidados Paliativos na fase final de vida, Insuficiência Cardíaca. (AU)
Assuntos
Humanos , Cuidados Paliativos , Insuficiência CardíacaRESUMO
Fractionation of the EtOH extract from aerial parts of Baccharis uncinella C. DC. (Asteraceae) led to isolation of caffeic and ferulic acids, which were identified from spectroscopic and spectrometric evidence. These compounds exhibit antioxidant and anti-inflammatory properties and have been shown to be effective in the prevention/treatment of metabolic syndrome. This study investigated whether the combined treatment of caffeic and ferulic acids exhibits a more significant beneficial effect in a mouse model with metabolic syndrome. The combination treatment with caffeic and ferulic acids was tested for 60 days in C57 mice kept on a high-fat (40%) diet. The data obtained indicated that treatment with caffeic and ferulic acids prevented gain in body weight induced by the high-fat diet and improved hyperglycemia, hypercholesterolemia and hypertriglyceridemia. The expression of a number of metabolically relevant genes was affected in the liver of these animals, showing that caffeic and ferulic acid treatment results in increased cholesterol uptake and reduced hepatic triglyceride synthesis in the liver, which is a likely explanation for the prevention of hepatic steatosis. In conclusion, the combined treatment of caffeic and ferulic acids displayed major positive effects towards prevention of multiple aspects of the metabolic syndrome and liver steatosis in an obese mouse model.
Assuntos
Animais , Masculino , Baccharis/química , Ácidos Cafeicos/administração & dosagem , Ácidos Cumáricos/administração & dosagem , Síndrome Metabólica/prevenção & controle , Substâncias Protetoras/administração & dosagem , Ácidos Cafeicos/química , Colesterol/metabolismo , Ácidos Cumáricos/química , Dieta Hiperlipídica/efeitos adversos , Quimioterapia Combinada/métodos , Fígado Gorduroso/metabolismo , Fígado Gorduroso/patologia , Síndrome Metabólica/tratamento farmacológico , Camundongos Endogâmicos C57BL , Modelos Animais , Substâncias Protetoras/química , Triglicerídeos/metabolismoRESUMO
Fractionation of the EtOH extract from aerial parts of Baccharis uncinella C. DC. (Asteraceae) led to isolation of caffeic and ferulic acids, which were identified from spectroscopic and spectrometric evidence. These compounds exhibit antioxidant and anti-inflammatory properties and have been shown to be effective in the prevention/treatment of metabolic syndrome. This study investigated whether the combined treatment of caffeic and ferulic acids exhibits a more significant beneficial effect in a mouse model with metabolic syndrome. The combination treatment with caffeic and ferulic acids was tested for 60 days in C57 mice kept on a high-fat (40%) diet. The data obtained indicated that treatment with caffeic and ferulic acids prevented gain in body weight induced by the high-fat diet and improved hyperglycemia, hypercholesterolemia and hypertriglyceridemia. The expression of a number of metabolically relevant genes was affected in the liver of these animals, showing that caffeic and ferulic acid treatment results in increased cholesterol uptake and reduced hepatic triglyceride synthesis in the liver, which is a likely explanation for the prevention of hepatic steatosis. In conclusion, the combined treatment of caffeic and ferulic acids displayed major positive effects towards prevention of multiple aspects of the metabolic syndrome and liver steatosis in an obese mouse model.
Assuntos
Baccharis/química , Ácidos Cafeicos/administração & dosagem , Ácidos Cumáricos/administração & dosagem , Síndrome Metabólica/prevenção & controle , Substâncias Protetoras/administração & dosagem , Animais , Ácidos Cafeicos/química , Colesterol/metabolismo , Ácidos Cumáricos/química , Dieta Hiperlipídica/efeitos adversos , Quimioterapia Combinada/métodos , Fígado Gorduroso/metabolismo , Fígado Gorduroso/patologia , Masculino , Síndrome Metabólica/tratamento farmacológico , Camundongos Endogâmicos C57BL , Modelos Animais , Substâncias Protetoras/química , Triglicerídeos/metabolismoRESUMO
OBJECTIVE: To analyze the early and late results of cardiopulmonary resuscitation in a cardiology hospital and to try to detect prognostic determinants of both short- and long-term survival. METHODS: A series of 557 patients who suffered cardiorespiratory arrest (CRA) at the Dante Pazzanese Cardiology Institute over a period of 5 years was analyzed to examine factors predicting successful resuscitation and long-term survival. RESULTS: Ressuscitation maneuvers were tried in 536 patients; 281 patients (52.4%) died immediately, and 164 patients (30.6%) survived for than 24 hours. The 87 patients who survived for more than 1 month after CRA were compared with nonsurvivors. Coronary disease, cardiomyopathy, and valvular disease had a better prognosis. Primary arrhythmia occurred in 73.5% of the >1-month survivor group and heart failure occurred in 12.6% of this group. In those patients in whom the initial mechanism of CRA was ventricular fibrillation, 33.3% survived for more than 1 month, but of those with ventricular asystole only 4.3% survived. None of the 10 patients with electromechanical dissociation survived. There was worse prognosis in patients included in the extreme age groups (zero to 10 years and 70 years or more). The best results occurred when the cardiac arrest took place in the catheterization laboratories. The worst results occurred in the intensive care unit and the hemodialysis room. CONCLUSION: The results in our series may serve as a helpful guide to physicians with the difficult task of deciding when not to resuscitate or when to stop resuscitation efforts.
Assuntos
Reanimação Cardiopulmonar/mortalidade , Parada Cardíaca/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/complicações , Brasil/epidemiologia , Baixo Débito Cardíaco/complicações , Criança , Pré-Escolar , Feminino , Seguimentos , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Análise de SobrevidaRESUMO
The cDNA of an uncoupling protein (UCP) homolog has been cloned from the swallow-tailed hummingbird, Eupetomena macroura. The hummingbird uncoupling protein (HmUCP) cDNA was amplified from pectoral muscle (flight muscle) using RT-PCR and primers for conserved domains of various known UCP homologs. The rapid amplification of cDNA ends (RACE) method was used to complete the cloning of the 5' and 3' ends of the open reading frame. The HmUCP coding region contains 915 nucleotides, and the deduced protein sequence consists of 304 amino acids, being approximately 72, 70, and 55% identical to human UCP3, UCP2, and UCP1, respectively. The uncoupling activity of this novel protein was characterized in yeast. In this expression system, the 12CA5-tagged HmUCP fusion protein was detected by Western blot in the enriched mitochondrial fraction. Similarly to rat UCP1, HmUCP decreased the mitochondrial membrane potential as measured in whole yeast by uptake of the fluorescent potential-sensitive dye 3',3-dihexyloxacarbocyanine iodide. The HmUCP mRNA is primarily expressed in skeletal muscle, but high levels can also be detected in heart and liver, as assessed by Northern blot analysis. Lowering the room's temperature to 12-14 degrees C triggered the cycle torpor/rewarming, typical of hummingbirds. Both in the pectoral muscle and heart, HmUCP mRNA levels were 1.5- to 3.4-fold higher during torpor. In conclusion, this is the first report of an UCP homolog in birds. The data indicate that HmUCP has the potential to function as an UCP and could play a thermogenic role during rewarming.
Assuntos
Aves/genética , Proteínas de Transporte/genética , Proteínas de Membrana/genética , Proteínas de Membrana Transportadoras , Proteínas Mitocondriais , Proteínas/genética , Sequência de Aminoácidos , Animais , Aves/fisiologia , Clonagem Molecular , Canais Iônicos , Potenciais da Membrana , Mitocôndrias/fisiologia , Dados de Sequência Molecular , Filogenia , RNA Mensageiro/biossíntese , Saccharomyces cerevisiae/fisiologia , Homologia de Sequência de Aminoácidos , Termogênese , Distribuição Tecidual , Proteína Desacopladora 1 , Proteína Desacopladora 2 , Proteína Desacopladora 3RESUMO
Two patients with growth hormone (GH) gene deletions were treated with recombinant insulin-like growth factor-I (IGF-I) (80-240 (microg/kg/day) and the effects on bone mass and body composition were compared to administration of GH (0.075 U/kg/day) to 8 patients with idiopathic GH deficiency. Bone mass and body composition were measured by dual photon X-ray absorptiometry (DEXA ) before and 3 and 6 months after treatment with GH or IGF-I. Similar increases in growth velocities were observed after GH and IGF-I treatment. Treatment with GH resulted in prompt and significant reduction in body fat percentage (basal, 3 and 6 months: 22+/-10, 17+/-9, and 16+/-9%) whereas body fat percentage remained unchanged after IGF-I therapy (basal, 3 and 6 months: 49, 52 and 48% in patient 1 and 45, 42 and 43% in patient 2, respectively). Fat percentage remained elevated after 18 months of IGF-I treatment in patients 1 (51%) and 2 (44%), respectively. Lean mass and bone mineral content increased with GH and IGF-I therapies. We conclude that reduction of body fat measured by DEXA, observed after administration of GH but not after IGF-I treatment in these children with GH deficiency, suggests that the GH effect on body fat mass is not mediated by circulating IGF-I.
Assuntos
Tecido Adiposo , Composição Corporal , Deleção de Genes , Hormônio do Crescimento Humano/deficiência , Hormônio do Crescimento Humano/genética , Fator de Crescimento Insulin-Like I/uso terapêutico , Absorciometria de Fóton , Criança , Feminino , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Masculino , Proteínas RecombinantesRESUMO
We studied vertebral morphometry and its relation to bone mineral density (BMD) in normal Brazilian women (n = 605). All women (age 22-97 years) were ambulatory and healthy. A lateral spine scan was done for morphometric X-ray absorptiometry using an imaging densitometer. In 429 of these women, BMD of the spine and proximal femur also were measured using dual-energy X-ray absorptiometry. All women were white with mean (+/- 1 SD) age of 53.7 (+/- 9.5) years. About 21% of the women over 50 years had a T score for spine BMD lower than -2.5 SD, and 7% had a femoral neck BMD below this osteoporosis threshold. Vertebral heights (anterior, HA; middle, HM; and posterior, HP) and ratios (HA/HP and HM/HP) were assessed. There was no systematic difference between younger (20-49 years) and older (50+ years) women in heights or ratios. The vertebral heights were normalized for those observed in each individual case for the L2-L4 sequence. This normalization was adequate for all vertebral heights; the Z score averaged about +0.1. The average Z score for HA/HP was +0.01, but that for the HM/HP was -0.72, indicating that the latter ratio might differ from the reference population used (white American and European women). We observed a small positive correlation between vertebral heights and spine or femur BMD, but this was due entirely to the influence of body size on BMD. On a group basis, the HM/HP showed a significant association with axial BMD; the 1 SD difference between the lowest and highest quartile was associated with a difference of 8-15% (0.5-1.0 SD) in axial BMD.
Assuntos
Densidade Óssea , Coluna Vertebral/diagnóstico por imagem , Absorciometria de Fóton , Adulto , Idoso , Idoso de 80 Anos ou mais , Estatura , Brasil , Feminino , Humanos , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Intact or surgically thyroidectomized (Tx) adult male Wistar rats, weighing 150-200 g, were fed a standard chow diet (approximately 1.8 Cal/g) or a high calorie (approximately 3.8 Cal/g) diet (cafeteria diet) for up to 30 days. Daily energy intake was about 5-fold higher in the rats fed the cafeteria diet regardless of their thyroid status. The cafeteria diet caused the retroperitoneal white fat pad to increase by approximately 2-fold, the volume of isolated white adipocytes to increase by 2-fold, and the total body fat to increase by a factor of approximately 3, again regardless of thyroid status. It also increased basal metabolic rate by about 20% in intact rats and by about 50% in Tx rats. The brown fat thermal response to norepinephrine (NE) infusion was approximately 2-fold increased in the intact rats fed the cafeteria diet. However, in the Tx rats, the brown fat thermal response to NE was blunted regardless of the dietary regimen adopted. In both intact and Tx rats, the cafeteria diet increased total brown fat mitochondria, uncoupling protein percentage, and total brown fat uncoupling protein by about 3-, 2-, and 5-fold, respectively. Serum leptin levels also increased approximately 4-fold in intact rats fed the cafeteria diet. However, in Tx rats, leptin levels did not change significantly during overfeeding. In conclusion, hypothyroidism caused the brown fat to become unresponsive to NE, even after 1 month on the cafeteria diet. However, these rats were able to increase basal metabolic rate and, as assessed by several different parameters, did not gain fat beyond that observed in intact controls kept on a similar overfeeding schedule.