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Resumo Fundamento Os antagonistas da vitamina K (AVKs) são o tratamento de primeira linha recomendado para trombo ventricular esquerdo (TVE); entretanto, os anticoagulantes orais diretos (AODs) têm sido considerados uma terapia alternativa. Objetivos Avaliar a eficácia e a segurança dos AODs em comparação com a terapia com AVKs em pacientes com TVE. Métodos PubMed, Embase e Cochrane foram sistematicamente pesquisados em busca de ensaios clínicos randomizados ou estudos de coorte que comparassem AODs versus AVKs para TVE. As razões de risco (RR) foram calculadas para desfechos binários, com intervalos de confiança (IC) de 95%. A significância estatística foi definida como valor de p < 0,05. Resultados Foram incluídos um total de 4 ensaios clínicos randomizados e 29 estudos de coorte, com 4.450 pacientes designados para AODs ou AVKs. Não houve diferença significativa entre os grupos para acidente vascular cerebral ou eventos embólicos sistêmicos (AVC/EES) (RR 0,84; IC 95% 0,65 a 1,07; p = 0,157), acidente vascular cerebral (RR 0,73; IC 95% 0,48 a 1,11; p = 0,140), eventos embólicos sistêmicos (EES) (RR 0,69; IC 95% 0,40 a 1,17; p = 0,166), resolução do trombo (RR 1,05; IC 95% 0,99 a 1,11; p = 0,077), qualquer sangramento (RR 0,78; IC 95% 0,60 a 1,00; p = 0,054), sangramento clinicamente relevante (RR 0,69; IC 95% 0,46 a 1,03; p = 0,066), sangramento menor (RR 0,73; IC 95% 0,43 a 1,23; p = 0,234), sangramento maior (RR 0,87; IC 95% 0,42 a 1,80; p = 0,705) e mortalidade por todas as causas (RR 1,05; IC 95% 0,79 a 1,39; p = 0,752). Em comparação com AVKs, a rivaroxabana reduziu significativamente AVC/EES (RR 0,35; IC 95% 0,16 a 0,91; p = 0,029) e EES (RR 0,39; IC 95% 0,16 a 0,95; p = 0,037). Conclusões Os AODs tiveram uma taxa semelhante de eventos tromboembólicos e hemorrágicos, bem como de resolução do trombo, em comparação com os AVKs no tratamento de TVE. A terapia com rivaroxabana teve uma redução significativa nos eventos tromboembólicos, em comparação com os AVKs.

FUNDAMENTO: Cresce o uso da Telemedicina, especialmente no envio e na avaliação de eletrocardiograma (ECG). É um procedimento de baixo custo, com alto potencial de salvar vidas. OBJETIVO: Descrever a forma de análise sistemática e o perfil do usuário da Rede Catarinense de Telemedicina quando o laudo era emitido de forma livre. MÉTODOS: Estudo observacional, transversal, determinando as associações entre características dos pacientes e diagnósticos eletrocardiográficos emitidos, dentre os usuários da Rede Catarinense de Telemedicina quando o laudo era fornecido de forma livre. Esse sistema estava conectado a 287 cidades de Santa Catarina, os exames eram feitos nos locais de origem e emitidos os laudos em três hospitais terciários. Entre 2005 e 2010, os laudos eram emitidos de forma livre e foi criado um método probabilístico para análise dos dados. Um cardiologista experiente avaliou todos os ECG para aferir a chance de anormalidade. RESULTADOS: Foram avaliados 243.363 ECG. A maioria (58%) foi realizada em pacientes com mais de 50 anos e proveniente da atenção primária (72%). Houve diferenças de frequência por região, parcialmente relacionado com número de cardiologistas/região (r = -0,551), com a distância dos centros terciários e com possíveis diferenças de aceitação do método. Cerca de 53% do ECG foram anormais, com maior frequência quanto maior a idade (r2 = 0,8166), e com diferenças regionais também significantes (p < 0,0001). CONCLUSÃO: Foi construído um sistema de análise dos dados integrando termos prevalentes, análise probabilística e dicionários especializados. O sistema tem atendido uma parcela significativa da população catarinense, principalmente idosos, da rede básica e de regiões remotas do estado.BACKGROUND: A growing use of telemedicine has been observed, especially as regards the sending and evaluation of electrocardiograms (ECG); this is a low-cost procedure with a high potential to save lives. OBJECTIVES: To describe the form of systematic analysis and user profile of the Telemedicine Network of Santa Catarina during the time when the report was issued freely. METHODS: Observational cross-sectional study determining the associations between patient characteristics and electrocardiographic diagnoses issued among users of the Telemedicine Network of Santa Catarina during the time when the report was issued freely. This system was connected to 287 cities in Santa Catarina; the tests were done in the places of origin and the reports were issued in three tertiary-care hospitals. From 2005 to 2010 the reports were issued freely and a probabilistic method for data analysis was created. An experienced cardiologist evaluated all ECGs to assess the chances of abnormality. RESULTS: 243,363 ECGs were evaluated. The majority (58%) was performed on patients older than 50 years from primary care services (72%). There were differences in the frequency per region; this was partly related to the number of cardiologists/region (r = -0.551), to the distance from tertiary-care centers and potential differences of acceptance of the method. Approximately 53% of the ECGs were abnormal with greater frequency with increasing age (r² = 0.8166) and with significant regional differences (p < 0.0001). CONCLUSIONS: We built a data analysis system integrating prevalent terms, probabilistic analysis and specialized dictionaries. The system has covered a significant portion of the population of Santa Catarina, mainly elderly patients from the network of primary healthcare centers and remote regions of the State.

O objetivo deste estudo foi estimar a prevalência, o conhecimento, o tratamento e o controle de hipertensão arterial sistêmica (HAS) na população urbana adulta de Tubarão, Santa Catarina, Brasil. Foi realizado um estudo transversal, com uma amostra estratificada a partir de uma listagem dos pontos de luz, do qual participaram 707 indivíduos maiores de 18 anos. Foi aplicado um questionário, aferidas duas medidas da pressão arterial por manômetro de mercúrio, em uma visita domiciliar conduzida por estudantes de medicina. A prevalência de HAS pelo critério do The Seventh Report of The Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (pressão arterial > 140 x 90mmHg) foi de 36,4% e de 40,5% quando acrescentados os indivíduos em uso de anti-hipertensivos. Tinham conhecimento da hipertensão 55,6%; estavam em tratamento farmacológico 46,8% e estavam com a pressão arterial controlada 10,1% dos hipertensos. A elevada prevalência estimada de hipertensão arterial e os percentuais de conhecimento sobre o diagnóstico, tratamento e controle aquém do ideal apontam para necessidade de ações preventivas em Tubarão.The aim of this study was to estimate the prevalence, awareness, treatment, and control of systemic arterial hypertension in the adult urban population of Tubarão, Santa Catarina, Brazil. The cross-sectional approach used a stratified sample, based on an initial list of electric power connections, resulting in the selection of 707 individuals over 18 years of age. A questionnaire was applied and arterial blood pressure was measured twice by medical students during home visits, using a mercury sphygmomanometer. The prevalence of arterial hypertension based on the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (arterial pressure > 140 x 90mmHg) was 36.4%, increasing to 40.5% when including individuals on anti-hypertensive medication. Of the patients with high blood pressure, 55.6% were aware of their hypertension, 46.8% were on medication, and 10.1% had their blood pressure under control. The high estimated prevalence of hypertension, low level of unawareness, and less than ideal treatment and control levels emphasize the need for preventive measures in Tubarão.

OBJETIVO: Determinar a distribuição dos lipídeos séricos em crianças e adolescentes de Florianópolis, SC. Determinar a associação entre colesterol não-desejável (>170 mg/dL) e outros fatores de risco para aterosclerose. MÉTODOS: Amostra aleatória estratificada (por idade e tipo de escola) de alunos da rede escolar de Florianópolis. Dados sobre fatores de risco, antropometria, pressão arterial e concentração sérica de lípides foram coletados. RESULTADOS: Participaram 1.053 indivíduos com idade entre 7 e 18 anos. A concentração sérica do colesterol (média±DP) foi 162±28 mg/dL; dos triglicerídeos 93±47 mg/dL; do HDL-colesterol 53±10 mg/dL; do LDL-colesterol 92±24 mg/dL e do colesterol não-HDL 109± 26 mg/dL. As médias das relações CT/HDL e LDL/HDL foram, respectivamente, 3,1±0,6 e 1,8±0,5. Os lípides foram mais elevados nas crianças de escola privada, nos menores de 10 anos, no sexo feminino e nos de cor negra. O modelo de regressão logística que melhor previu os níveis de colesterol anormal incluía: obesidade, história familiar de acidente vascular cerebral ou infarto do miocárdio, sexo feminino, idade inferior a 10 anos e a imagem corporal definida pelo médico como sobrepeso/obesidade. CONCLUSÃO: As concentrações de lipídeos em crianças e adolescentes mostraram valores intermediários quando comparados a estudos semelhantes. Uma grande parcela dos indivíduos apresenta níveis de colesterol sérico classificados como não-desejáveis para idade. Pela significância da associação do colesterol com o excesso de peso, o controle deste fator na infância deve ser tomado como prioridade nos programas de prevenção primordial com o objetivo de reduzir a incidência das doenças relacionadas à aterosclerose na idade adulta.OBJECTIVE: To determine the distribution of serum lipids in children and adolescents of Florianopolis, Santa Catarina State, Brazil. To determine the association between undesirable levels for total cholesterol (>170 mg/dL) and others coronary heart disease risks factors. METHODS: A questionnaire, physical examination and blood analyses were collected from randomized sample from school kids aged range from 7 to 18 years old. RESULTS: 1,053 students participated, aged between 7 and 18 years old. They presented a total cholesterol mean of 162±28 mg/dl, triglyceride mean of 93±47 mg/dl, HDL-cholesterol mean of 53±10 mg/dl, LDL-cholesterol mean of 92±24 mg/dl and non-HDL cholesterol mean of 109±26 mg/dl. The TC/HDL and LDL/HDL mean rates were, respectively, 3.1±0.6 and 1.8±0.5. Findings showed that private school children, 10 years old or less, girls and black children had higher lipids values. Overall findings suggest that the best logistic regression model which explained abnormal total cholesterol levels included: obesity, stroke and heart attack familial history, feminine gender, age of 10 years old or less and overweight body image determined on inspection. CONCLUSION: In comparison to international literature, our results, showed intermediated total cholesterol, lower LDL-cholesterol and non-HDL-cholesterol and higher HDL-cholesterol. Therefore, primary prevention programs are needed to be carrying out, especially among overweight children and adolescents so to prevent ischemic heart disease as adulthood.

A Hipertensão Arterial Sistêmica é a mais freqüente das doenças cardiovasculares . são cerca de 17 milhões de portadores de hipertensão arterial no Brasil. Apresenta características específicas do processo de cronicidade e multiplicidade de fatores associados; longo curso assintomático, além da evolução para complicações. Portanto, cada vez mais se comprova a necessidade de uma abordagem coletiva e multidisciplinar para se obter resultados mais consistentes e duradouros no controle da hipertensão arterial. Esse trabalho objetiva avaliar o perfil dos participantes do grupo de hipertensos segundo o sexo, a faixa etária, a renda familiar e per capita, a ocupação, a participação em grupos comunitários, o tipo de serviço de saúde ao qual recorreria em caso de doença, a freqüência no grupo de hipertensos e a influência deste grupo no que se refere ao controle da pressão arterial. Foram utilizadas as fichas A, a ata de reuniões do grupo de hipertensos e dados do levantamento do Sistema de Informação de Atenção Básica (SIAB) para obtenção dos dados das pessoas da amostra estudada, do bairro Vila Ipiranga, em Montes Claros (MG). Além disso, aplicou-se questionário para avaliar a influência do grupo no controle da pressão. Após análise dos dados, percebeu-se uma prevalência de mulheres no perfil dos participantes do grupo de hipertensos; uma idade média superior a 60 anos; mais da metade recorreriam à Unidade de Saúde em primeira instância em caso de doença; a ocupação predominante é aposentado/ pensionista e a maioria participa de grupo religioso. Quanto à renda familiar e à per capita, predominam as faixas de um a dois salários mínimos e menor que um salário mínimo, respectivamente. O grupo mostrou-se efetivo, já que todos os entrevistados relataram que ele contribuiu para o controle da pressão arterial, funcionando como importante instrumento no sentido de fornecer esclarecimentos acerca da doença, influenciar na mudança de hábitos de vida e conscientização quanto à importância de seguir o tratamento corretamente. Quando se faz uma avaliação longitudinal, selecionando os usuários que participaram três ou mais vezes, percebe-se que, dos 13, 10 (76,92%) evoluíram com diminuição dos níveis pressóricos e controle da PA, corroborando a influência positiva do grupo no controle da PA.

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OBJECTIVE: The intracellular Gram-negative bacterium Chlamydia pneumoniae has been associated with atherosclerosis. The presence of Chlamydia pneumoniae has been investigated in fragments of the arterial wall with a technique for DNA identification. METHODS: Arterial fragments obtained from vascular surgical procedures in 58 patients were analyzed. From these patients, 39 were males and the mean age was 65±6 years. The polymerase chain reaction was used to identify the bacterial DNA with a pair of primers that codify the major outer membrane protein (MOMP) of Chlamydia pneumoniae. The amplified product was visualized by electrophoresis in the 2% agarose gel stained with ethidium bromide, and it was considered positive when migrating in the band of molecular weight of the positive controls. RESULTS: Seven (12%) out of the 58 patients showed positive results for Chlamydia pneumoniae. CONCLUSION: DNA from Chlamydia pneumoniae was identified in the arterial wall of a substantial number of patients with atherosclerosis. This association, which has already been described in other countries, corroborates the evidence favoring a role played by Chlamydia pneumoniae in atherogenesis.

Background: Vitamin K antagonists (VKAs) are the recommended first-line treatment for left ventricular thrombus (LVT); however, direct oral anticoagulants (DOACs) have been considered an alternative therapy., Objectives: To evaluate the efficacy and safety of DOACs compared with VKAs therapy in patients with LVT., Methods: PubMed, Embase, and Cochrane were systematically searched for randomized clinical trials or cohort studies that compared DOACs versus VKAs for LVT. Risk ratios (RRs) were computed for binary endpoints, with 95% confidence intervals (95% CIs). Statistical significance was defined as p value < 0.05., Results: A total of 4 randomized clinical trials and 29 cohort studies were included, with 4,450 patients assigned to either DOACs or VKAs. There was no significant difference between groups for stroke or systemic embolic (SSE) events (RR 0.84; 95% CI 0.65 to 1.07; p = 0.157), stroke (RR 0.73; 95% CI 0.48 to 1.11; p = 0.140), systemic embolic (SE) events (RR 0.69; 95% CI 0.40 to 1.17; p = 0.166), thrombus resolution (RR 1.05; 95% CI 0.99 to 1.11; p = 0.077), any bleeding (RR 0.78; 95% CI 0.60 to 1.00; p = 0.054), clinically relevant bleeding (RR 0.69; 95% CI 0.46 to 1.03; p = 0.066), minor bleeding (RR 0.73; 95% CI 0.43 to 1.23; p = 0.234), major bleeding (RR 0.87; 95% CI 0.42 to 1.80; p = 0.705), and all-cause mortality (RR 1.05; 95% CI 0.79 to 1.39; p = 0.752). Compared with VKAs, rivaroxaban significantly reduced SSE events (RR 0.35; 95% CI 0.16 to 0.91; p = 0.029) and SE events (RR 0.39; 95% CI 0.16 to 0.95; p = 0.037)., Conclusions: DOACs had a similar rate of thromboembolic and hemorrhagic events, as well as thrombus resolution, compared to VKAs in the treatment of LVTs. Rivaroxaban therapy had a significant reduction in thromboembolic events, compared to VKAs.

Background: A growing use of telemedicine has been observed, especially as regards the sending and evaluation of electrocardiograms (ECG); this is a low-cost procedure with a high potential to save lives., Objectives: To describe the form of systematic analysis and user profile of the Telemedicine Network of Santa Catarina during the time when the report was issued freely., Methods: Observational cross-sectional study determining the associations between patient characteristics and electrocardiographic diagnoses issued among users of the Telemedicine Network of Santa Catarina during the time when the report was issued freely. This system was connected to 287 cities in Santa Catarina; the tests were done in the places of origin and the reports were issued in three tertiary-care hospitals. From 2005 to 2010 the reports were issued freely and a probabilistic method for data analysis was created. An experienced cardiologist evaluated all ECGs to assess the chances of abnormality., Results: 243,363 ECGs were evaluated. The majority (58%) was performed on patients older than 50 years from primary care services (72%). There were differences in the frequency per region; this was partly related to the number of cardiologists/region (r = -0.551), to the distance from tertiary-care centers and potential differences of acceptance of the method. Approximately 53% of the ECGs were abnormal with greater frequency with increasing age (r(2) = 0.8166) and with significant regional differences (p < 0.0001)., Conclusions: We built a data analysis system integrating prevalent terms, probabilistic analysis and specialized dictionaries. The system has covered a significant portion of the population of Santa Catarina, mainly elderly patients from the network of primary healthcare centers and remote regions of the State.

The aim of this study was to estimate the prevalence, awareness, treatment, and control of systemic arterial hypertension in the adult urban population of Tubarão, Santa Catarina, Brazil. The cross-sectional approach used a stratified sample, based on an initial list of electric power connections, resulting in the selection of 707 individuals over 18 years of age. A questionnaire was applied and arterial blood pressure was measured twice by medical students during home visits, using a mercury sphygmomanometer. The prevalence of arterial hypertension based on the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (arterial pressure > 140 x 90 mmHg) was 36.4%, increasing to 40.5% when including individuals on anti-hypertensive medication. Of the patients with high blood pressure, 55.6% were aware of their hypertension, 46.8% were on medication, and 10.1% had their blood pressure under control. The high estimated prevalence of hypertension, low level of unawareness, and less than ideal treatment and control levels emphasize the need for preventive measures in Tubarão.

Objective: To determine the distribution of serum lipids in children and adolescents of Florianopolis, Santa Catarina State, Brazil. To determine the association between undesirable levels for total cholesterol (>170 mg/dL) and others coronary heart disease risks factors., Methods: A questionnaire, physical examination and blood analyses were collected from randomized sample from school kids aged range from 7 to 18 years old., Results: 1,053 students participated, aged between 7 and 18 years old. They presented a total cholesterol mean of 162+/-28 mg/dl, triglyceride mean of 93+/-47 mg/dl, HDL-cholesterol mean of 53+/-10 mg/dl, LDL-cholesterol mean of 92+/-24 mg/dl and non-HDL cholesterol mean of 109+/-26 mg/dl. The TC/HDL and LDL/HDL mean rates were, respectively, 3.1+/-0.6 and 1.8+/-0.5. Findings showed that private school children, 10 years old or less, girls and black children had higher lipids values. Overall findings suggest that the best logistic regression model which explained abnormal total cholesterol levels included: obesity, stroke and heart attack familial history, feminine gender, age of 10 years old or less and overweight body image determined on inspection., Conclusion: In comparison to international literature, our results, showed intermediated total cholesterol, lower LDL-cholesterol and non-HDL-cholesterol and higher HDL-cholesterol. Therefore, primary prevention programs are needed to be carrying out, especially among overweight children and adolescents so to prevent ischemic heart disease as adulthood.