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A hemoterapia é uma área em constante evolução, exigindo que os profissionais atuantes estejam em constante aprendizado. Nesse sentido, o conhecimento histórico torna-se uma importante base de dados, que permite o aprendizado. No que se refere à hemoterapia brasileira há poucos documentos atualizados que se comprometam a relatar os principais avanços realizados no Brasil, desde sua colonização, sendo, portanto, o objetivo deste artigo realizar uma revisão bibliográfica sobre os avanços da medicina transfusional brasileira de 1500 até 2020. Para atingir esse objetivo, pesquisamos nas plataformas NCBI (National Center of Biotechnology Information), LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde), SCIELO (Scientific Eletronic Library Online), BVS (Biblioteca Virtual em Saúde) e Google Scholar (Google Acadêmico), as palavras chaves “Hemoterapia História”, “Hemoterapia brasileira”, “transfusão Brasil” e “Sangue Brasil Colonial”. A análise da literatura mostrou que o principal incentivo dos avanços na medicina brasileira foram os conflitos políticos e sociais, além da vinda da corte portuguesa ao Brasil, o que permitiu a organização dos cirurgiões, sangradores e a criação de faculdades de Medicina. Os investimentos em pesquisa, ensino e saúde permitiram que a primeira transfusão brasileira fosse realizada em 1879, enquanto as mudanças políticas internas e externas ao País promoveram investimentos na modernização e organização da hemoterapia. A partir de 1980, houve uma forte restruturação nas políticas nacionais, que findou as doações pagas, construiu o SUS e estabeleceram os critérios para o tratamento do sangue, seguindo o fluxo dos avanços. O Brasil se dedicou a produção de kits de testes diagnósticos próprios para utilização na hemorede, com adaptação de suas diretrizes frente a situações de epidemias e pandemias e atualizações em seus regimentos que são seguidos até hoje e seguem em aperfeiçoamento.

A síndrome de Sézary (SS) é uma variante leucêmica rara dos linfomas cutâneos de células T (LCCT), que se manifesta principalmente com eritrodermia pruriginosa. Relatamos o caso de um paciente do sexo masculino, 58 anos, portador desse raro linfoma, sem comprometimento da medula óssea pelo tumor, evidenciado por biópsia, apesar da leucocitose extrema. Fizemos uma breve revisão da Literatura de casos semelhantes, apresentações clínicas, critérios diagnósticos e estadiamento. Ênfase foi dada às alterações morfológicas no sangue periférico. Afinal, a análise das alterações morfológicas no sangue periférico mostrou-se um importante guia para o diagnóstico e suspeição da doença.

Background: Hypertension is responsible for a substantial number of deaths due to cardiovascular disease and stroke. A crucial step toward its control is the identification of modifiable predictors of hypertension. Objectives: To estimate the relationship between salt intake, serum uric acid and incident hypertension in a primary care setting. Methods: Retrospective cohort of the CAMELIA study in which a non-randomized sample of 1098 participants who were ≥ 20 year-old was recruited from a primary care program. Originally, the sample consisted of hypertensive, diabetic and non-diabetic/non-hypertensive subjects. For the analysis, 258 participants with blood pressure (BP) lower than 140/90 mm Hg not using antihypertensive drugs and without diabetes mellitus were included. Five years after the first visit, their medical records were reviewed. Patients were divided into two groups according to BP in the first visit: normal BP group (systolic BP ≤ 120 mm Hg and diastolic BP ≤ 80 mm Hg) and high-normal BP group (systolic BP 121-139 mm Hg and/or diastolic BP 81-89 mm Hg). Results: In multivariate analysis, high-normal BP, hyperuricemia and salt intake ≥ 6 g/day predicted incident hypertension. In participants of thenormal BP group, high salt intake conferred the highest risk. In the high-normal BP group, smoking and serum uric acid were found to be the most important ones. Conclusion: In a healthy, multiethnic, and normotensive population from an urban primary care program, high-normal BP, hyperuricemia and high salt intake were found to be predictors of incident hypertension. Resumen: Antecedentes: La hipertensión es responsable de un gran número de muertes debido a cardiopatías e ictus. Un paso esencial para su control es la identificación de factores modificables predictivos de la hipertensión. Objetivos: Calcular la relación entre ingesta de sal, ácido úrico sérico e hipertensión incidental en un centro de atención primaria. Métodos: Cohorte retrospectiva del estudio CAMELIA, en el que se incluyó una muestra no aleatorizada de 1.098 participantes con edades ≥ 20 años, obtenida de un programa de atención primaria. Originalmente, la muestra incluía sujetos hipertensos, diabéticos y no diabéticos/no hipertensos. Para el análisis, se estudiaron 258 participantes con presión arterial (PA) inferior a 140/90 mm Hg, sin prescripción de fármacos antihipertensivos, y no diabéticos. Transcurridos cinco años de la primera visita, se revisaron sus historias médicas. Se dividió a los pacientes en dos grupos, con arreglo a su PA en la primera visita: grupo con PA normal (PA sistólica ≤ 120 mm Hg y PA diastólica ≤ 80 mm Hg), y grupo con PA alta-normal BP (PA sistólica 121-139 mm Hg y/o PA diastólica 81-89 mm Hg). Resultados: En el análisis multivariante, la PA alta-normal, hiperuricemia e ingesta de sal ≥ 6 g/día predijeron la hipertensión incidental. En los participantes del grupo de PA normal, la ingesta elevada de sal confirió el mayor riesgo. En el grupo de PA alta-normal, el tabaquismo y el ácido úrico sérico fueron los factores más importantes. Conclusión: En una población sana, multiétnica y normotensa, procedente de un programa de atención primaria urbana la PA alta-normal, hiperuricemia e ingesta elevada de sal constituyeron los factores predictivos de la hipertensión incidental.

SUMMARY OBJECTIVE The scientific community is constantly assessing the clinical and laboratory manifestations of COVID-19 in the organism. In view of the fragmentation of the large amount of information, knowledge gaps in relation to laboratory markers, and scarcity of papers in Portuguese, we propose a Literature review on laboratory changes observed in patients infected with SARS-CoV-2. METHODS Analysis of articles published between December 2019 and May 2020 on the PubMed and SciELO databases. The articles were identified, filtered, and evaluated based on the approach to the subject, language, and impact. Then, the articles were subjected to a thorough reading, in full, by 4 (four) independent researchers. RESULTS Leukopenia and lymphopenia were included in most studies, even in case definitions. Platelet count and platelet-lymphocyte ratio, at peak platelet, were associated with advanced age and longer hospital stay. Eosinopenia showed a sensitivity of 74.7% and specificity of 68.7% and, together with increased CRP, these are one of the future prospects for screening for disease. A high level of procalcitonin may indicate bacterial co-infection, leading to a worse prognosis. COVID-19 manifests itself with increased levels of many inflammatory markers such as IL-1, IL-2, IL-6, IL-7, IL-12, IP10, IFN-γ, MIP1A, MCP1, GSCF, TNF-α, and MCP1/CCL2, as well as LDH, ESR, D-dimer, CK, ALT, and AST. CONCLUSION There is a need for further studies on the new SARS-CoV-2. So far, there is no consensus regarding laboratory findings and their usefulness, whether as a prognostic marker, mortality, or disease severity. RESUMO OBJETIVO A comunidade científica avalia a todo momento, as manifestações clínicas e laboratoriais da COVID-19 no organismo e, em vista da fragmentação da grande quantidade de informações, lacunas de conhecimento em relação aos marcadores laboratoriais e escassez de trabalhos em português, propomos uma revisão de Literatura sobre alterações laboratoriais observadas em pacientes infectados por SARS-CoV-2. MÉTODOS Análise de artigos publicados entre dezembro de 2019 a maio de 2020 nas plataformas PubMed e SciELO. Os artigos foram identificados, filtrados e avaliados com base na abordagem ao assunto, idioma e impacto. Depois, os artigos foram submetidos a uma minuciosa leitura, na íntegra, por 4 (quatro) pesquisadores independentes. RESULTADOS A leucopenia e a linfopenia constaram na maioria dos trabalhos, presente até em definições de caso. A contagem de plaquetas e a razão plaquetas-linfócitos, no pico plaquetário, foram associados à idade avançada e maior tempo de hospitalização. A eosinopenia apresentou sensibilidade de 74,7% e especificidade de 68,7% e, juntamente com aumento da PCR, são uma das perspectivas futuras de triagem para doença. O alto nível de procalcitonina pode indicar uma co-infecção bacteriana, levando a pior prognóstico. A COVID-19 se manifesta com níveis aumentados de muitos marcadores inflamatórios como IL-1, IL-2, IL-6, IL-7, IL-12, IP10, IFN-γ, MIP1A, MCP1, GSCF, TNF-α e MCP1/CCL2, bem como LDH, VHS, dímero-D, CK, ALT e AST. CONCLUSÃO Há necessidade de estudos adicionais sobre o novo SARS-CoV-2. Até agora, não há unanimidade em relação aos achados laboratoriais e sua utilidade, seja como marcador prognóstico, de mortalidade, ou de severidade de doença.

The objective of the study was to investigate whether a diagnosis of posttraumatic stress disorder (PTSD; full or partial) or specific PTSD symptom clusters predicted failure in quitting smoking in a trauma-exposed population.

Papillary renal cell carcinoma is an uncommon malignant tumor, which rarely metastases to the bladder and/or omentum. We report the case of a 71-year-old woman with macrohematuria for two years and a large mass on the right flank. Thus, we present a brief review of the literature regarding the classification, clinical manifestations, diagnosis, immunohistochemical profile, and treatment of this neoplasm. Special attention was given to the role of immunohistochemistry, which was decisive for the determination of multiple metastases, as well as the study by imaging exams, which defined the best surgical approach.

Patient: Female, 49-year-old Final Diagnosis: Hereditary haemorrhagic telangiectasia Symptoms: Anemia • dyspnea • epistaxis • lipothymia • melena • weakness Medication:— Clinical Procedure: Electrofulguration Specialty: Gastroenterology and Hepatology • Genetics • Radiology Objective: Rare disease Background: Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is a rare autosomal dominant disease. Case Report: Here, we report a case of a 49-year-old Brazilian woman with a history of multiple hospitalizations, sometimes life-threatening anemia, and uncommon clinical manifestations. Conclusions: We provide a brief literature review regarding the most common signs and symptoms, history, diagnosis, and treatment. Special attention is given to the techniques for identifying hemorrhagic areas, to the presence of angiodysplasia in gastric tissue, and the identification of sickle cell trait, this being an unprecedented hematological condition in the presentation of the disease. Thus, further studies on the relationship between sickle cell trait and the syndrome are needed.

Objective: To evaluate the presence of anemia in patients with chronic lower limb ulcers based on profile and hematometric indices. Method: This is a cross-sectional study carried out in a university hospital in Rio de Janeiro. The sample was composed of 64 participants with lower limb ulcers and evolution time greater than 12 weeks. Data was collected between May/2016 and December/2017 from hematological analyses, records from medical records, and wound assessment form. Results: 36 (56.2%) were male; 38 (59.4%) between 60 and 80 years old; 56 (87.5%) with chronic diseases and 52 (81.2%) with venous ulcers. 6 years mean of active ulceration. Anemia was detected in 36 (56.2%), 27 (75%) of which were normochromic and normocytic; 14 (38.8%) had deficiency anemia recorded in their medical chart. Conclusion: The low hemoglobin concentration is recurrent among the participants characterizing an anemia condition, whose profile reveals congruence to the anemia of chronic disease. RESUMEN Objetivo: Evaluar la presencia de anemia en pacientes con úlceras crónicas de miembros inferiores desde el perfil e índices hematimétricos Método: Este estudio seccional transcurrió en un hospital universitario de Río de Janeiro, con una muestra de 64 participantes con úlceras en los miembros inferiores y tiempo de evolución superior a 12 semanas. Los datos se recopilaron entre mayo/2016 y diciembre/2017 investigando los análisis hematológicos, registros en las historias clínicas y formularios de evaluación de la herida. Resultados: 36 (56,2%) eran hombres; 38 (59,4%) tenían entre 60 y 80 años; 56 (87,5%) padecían de enfermedades crónicas y 52 (81,2%), de úlceras venosas. El promedio era de 6 años de úlcera activa. Se detectó anemia en 36 (56,2%), siendo que en 27 (75%) era normocrómica/normocítica; 14 (38,8%) presentaban anemia carencial registrada en la historia clínica. Conclusión: La baja concentración de hemoglobina es recurrente entre los participantes caracterizando un cuadro de anemia que coincide con el de anemia de enfermedad crónica. RESUMO Objetivo: Avaliar a presença de anemia em pacientes com úlceras crônicas de membros inferiores a partir do perfil e dos índices hematimétricos. Método: Estudo seccional realizado em um hospital universitário do Rio de Janeiro. Amostra composta por 64 participantes com úlceras de membros inferiores e tempo de evolução maior que 12 semanas. Dados coletados entre maio/2016 e dezembro/2017, a partir de análises hematológicas, registros nos prontuários e em formulário de avaliação da ferida. Resultados: 36 (56,2%) eram do sexo masculino; 38 (59,4%) entre 60 e 80 anos; 56 (87,5%) com doenças crônicas e 52 (81,2%) com úlceras venosas. Média de 6 anos de úlcera ativa. Detectou-se anemia em 36 (56,2%), sendo 27 (75%) normocrômica e normocítica; 14 (38,8%) apresentavam anemia carencial registrada em prontuário. Conclusão: A baixa concentração de hemoglobina é recorrente entre os participantes, caracterizando um quadro de anemia cujo perfil revela congruência ao da anemia da doença crônica.

Background: Dyspnea is the most common symptom in heart failure. In the elderly, it is common in chronic obstructive pulmonary disease and depression. Objective: To estimate the prevalence of dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea and its association with chronic diseases in primary care. Methods: A cross-sectional study, part of the Digitalis Study, including 633 individuals, between 45 to 99 years old, registered in a primary care program in Niteroi, Brazil. All participants underwent clinical evaluations, blood and urine collection, and responded to a questionnaire in a single day. Self-reports were used for the diagnosis of diseases. Results: Of the 633 individuals, 30% had dyspnea. In the crude analysis, chronic obstructive pulmonary disease showed the strongest associations with the three types of dyspnea, followed by depression and heart failure. Chronic obstructive pulmonary disease alone did not present any cases of paroxysmal nocturnal dyspnea, and heart failure alone showed a very strong relationship with this type of dyspnea. Conclusions: The different behavior of the associations of the types of dyspnea with major chronic diseases in patients in primary care can help in the better characterization of patients with heart failure. Resumen: Introducción: La disnea es el síntoma más común en la insuficiencia cardíaca. En los ancianos es común en la enfermedad pulmonar obstructiva crónica y la depresión. Objetivo: Estimar la prevalencia de disnea de esfuerzo, ortopnea y disnea paroxística nocturna y su asociación con enfermedades crónicas en la atención primaria. Métodos: Estudio transversal, parte del estudio Digitalis, que incluyó a 633 individuos, entre 45 y 99 años de edad, registrados en un programa de atención primaria en Niterói, Brasil. Todos los participantes se sometieron a evaluaciones clínicas, recolección de sangre y orina, y respondieron a un cuestionario en un solo día. Se usaron autorrelatos para el diagnóstico de las enfermedades. Resultados: De los 633 individuos, el 30% presentó disnea. En el análisis crudo la enfermedad pulmonar obstructiva crónica mostró las asociaciones más fuertes con los tres tipos de disnea, seguidos por la depresión y la insuficiencia cardíaca. La enfermedad pulmonar obstructiva crónica, evaluada de forma aislada, no presentó ningún caso de disnea paroxística nocturna, y la insuficiencia cardíaca por sí sola mostró una relación muy fuerte con este tipo de disnea. Conclusiones: El comportamiento diferente de las asociaciones de los tipos de disnea con las principales enfermedades crónicas en pacientes en atención primaria puede ayudar a una mejor caracterización de los pacientes con insuficiencia cardíaca. Keywords: Dyspnea, Heart Failure, Depression, Chronic obstructive pulmonary disease, Paroxysmal nocturnal dyspnea, Palabras clave: Disnea, Insuficiencia cardíaca, Depresión, Enfermedad pulmonar obstructiva crónica, Disnea paroxística nocturna

Introdução: O dímero-D é um produto de degradação da fibrina, sendo marcador indireto da fibrinólise. Se um indivíduo infectado por SARS-COV 2 evolui com agravamento, o resultado igual ou superior a quatro vezes o valor de referência deste marcador no momento da internação é considerado um preditor de mortalidade. O exame ganhou maior importância desde o início da pandemia, devido às manifestações trombóticas decorrentes da infecção. Objetivo: Avaliar a variação no quantitativo de solicitações médicas para dosagem do dímero-D em um dado Hospital Universitário e seu perfil na primeira onda da pandemia da COVID-19. Metodologia: Foi realizado um estudo observacional transversal, onde foram quantificados e analisados exames de pacientes com perfil de COVID-19 identificados no Laboratório de Urgências de um Hospital Universitário, foram consideradas solicitações médicas para dosagem de dímero-D no período de 03/01/2020 a 03/07/2020. Resultados: No primeiro semestre de 2020 observamos 1017 solicitações. Comparando o 1° trimestre com o 2° trimestre do mesmo ano verificou-se um aumento abrupto de 1274% no total de solicitações de um trimestre para o outro, uma vez que no 1º foram detectadas apenas 69 solicitações com mediana 2231 ng/mL (intervalo interquartil 175-15605), já no 2º trimestre esse número saltou para um total de 948 solicitações com mediana 2020 ng/mL (intervalo interquartil 99-97026). Conclusão: Embora o dímero-D não tenha sua especificidade elevada enquanto ferramenta de diagnóstico, tem sido muito útil como preditor de gravidade para COVID 19. A despeito de o enorme impacto causado pelo aumento substancial na demanda de solicitações de dímero-D neste Hospital Universitário não ter provocado solução de continuidade na prestação dos serviços, maiores estudos em gestão de riscos e de calamidades seriam oportunos, a fim de se aprimorar o fluxo resolutivo para situações que, infelizmente, possam vir a ocorrer.

Essential thrombocythemia is a myeloproliferative neoplasm characterized by thrombocytosis and possible complications such as thrombosis, hemorrhage, splenomegaly, bone marrow failure and acute leukemia. In the myeloproliferatives neoplasms, there is an increase number of dysplastic megakaryocytes, known as micromegakaryocytes and there is an association between the high expression of the JAK2V617F mutation and the presence of micromegakaryocytes in bone marrow. To date, reports and researches involving essential thrombocythemia and micromegakaryocytes are exceedingly scarce. We report a peculiar and unique case of a death of a 55-year-old man, due to stroke and carotid thrombosis, preceded by successive thrombotic events in a patient with essential thrombocythemia, JAK2 positive, with no additional risk factor, who did not respond well to standard treatment and had a high amount of circulating micromegakaryocytes in peripheral blood. This case goes beyond the known prognosis of ET and raises the discussion of new prognostic markers, such as the quantification of micromegakaryocytes and reaffirms the importance of the JAK2 mutation in the evolution of the disease. We also discuss the involvement of micromegakaryocytes in the probable mechanisms leading to our patient’s thrombotic state.

The potential of antioxidants as tools for lowering the incidence of diseases, including cardiovascular events, is of growing interest. Some antioxidants (e.g. vitamin E and acetyl-salicylic acid) have been described as effective on cardiovascular diseases with mechanisms that differ from other scavenging agents. Currently, vitamin C is used to open occluded long-term central venous catheters, which avoids the process of reinserting a new one and injuring the patient. In this work, we investigated the vitamin C antihemostatic profile by evaluating its effects on the coagulation process. We used different assays, including prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT) and ancrod time tests. We also examined the overall pH disturbance caused by vitamin C at different concentrations and its effect on the thrombin-initiated fibrin polymerization assay. Our results revealed a significant anticoagulant activity of vitamin C at high plasma concentrations (surpassing the normal 100 ?mol/L ratio) in a cell-independent mechanism. Our results suggest that vitamin C may affect blood coagulation by a direct impairment of fibrin assembly and further formation of a cohesive clot microstructure. This study supports the literature that points to the antihemostatic ability of antioxidant agents, and clarifies the mechanism of vitamin C in opening occluded long-term central venous catheters.

Serum creatinine (sCr) is usually higher among black people in the United States due to increased muscle mass, justifying the addition of race adjustment in creatinine-based formulas to estimate glomerular filtration rate (eGFR). We aimed to assess if sCr levels are different in low-income communities in Brazil according to their race. A total of 1,303 participants were enrolled (58% females, 50±14 years-old, 33% self-defined as white, 41% as mixed race, and 26% as black). No significant differences in sCr were found between racial groups and no influence of race on sCr was seen in the linear regression analysis. The eGFR, calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula with no race adjustment, was no different between whites, mixed race and blacks. However, using such adjustment, eGFR for mixed race and black individuals was significantly higher than for whites (p < 0.001). In conclusion, no significant differences in sCr levels were found between racial groups, raising doubts as to whether race adjustment in eGFR formula should be used in that population.

Background: Heart failure (HF) is a major public health issue with implications on health-related quality of life (HRQL). Objective: To compare HRQL, estimated by the Short-Form Health Survey (SF-36), in patients with and without HF in the community. Methods: Cross-sectional study including 633 consecutive individuals aged 45 years or older, registered in primary care. The subjects were selected from a random sample representative of the population studied. They were divided into two groups: group I, HF patients (n = 59); and group II, patients without HF (n = 574). The HF group was divided into HF with preserved ejection fraction (HFpEF - n = 35) and HF with reduced ejection fraction (HFrEF - n = 24). Results: Patients without HF had a mean SF-36 score significantly greater than those with HF (499.8 ± 139.1 vs 445.4 ± 123.8; p = 0.008). Functional capacity - ability and difficulty to perform common activities of everyday life - was significantly worse (p < 0.0001) in patients with HF independently of sex and age. There was no difference between HFpEF and HFrEF. Conclusion: Patients with HF had low quality of life regardless of the syndrome presentation (HFpEF or HFrEF phenotype). Quality of life evaluation in primary care could help identify patients who would benefit from a proactive care program with more emphasis on multidisciplinary and social support. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0) Resumo Fundamento: A insuficiência cardíaca (IC) é um importante problema de saúde pública, com implicações na qualidade de vida relacionada à saúde (QVRS). Objetivo: Comparar a QVRS, estimada através do Questionário SF-36 (Short-Form Health Survey), em pacientes com e sem IC na comunidade. Métodos: Estudo transversal incluindo 633 indivíduos consecutivos com idade igual ou superior a 45 anos, registrados na atenção primária e selecionados de uma amostra aleatória representativa da população estudada. Foram divididos em dois grupos: grupo I, pacientes com IC (n = 59); e grupo II, pacientes sem IC (n = 574). O grupo I foi dividido em pacientes com IC com fração de ejeção preservada (ICFEP - n = 35) e pacientes com IC com fração de ejeção reduzida (ICFER - n = 24). Resultados: Pacientes sem IC tiveram um escore médio do SF-36 significativamente maior do que aqueles com IC (499,8 ± 139,1 vs 445,4 ± 123,8; p = 0,008). A capacidade funcional - habilidade e dificuldade para realizar atividades comuns da vida diária - foi significativamente pior (p < 0,0001) nos pacientes com IC independentemente de sexo e idade. Não houve diferença entre ICFEP e ICFER. Conclusão: Pacientes com IC mostraram baixa qualidade de vida a despeito da apresentação da síndrome (fenótipo ICFEP ou ICFER). A avaliação da qualidade de vida na atenção primária poderia auxiliar a identificar pacientes que se beneficiariam de um programa de atenção à saúde pró-ativo com maior ênfase em suporte multidisciplinar e social. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Background Cardiovascular diseases are the most frequent cause of morbidity and mortality worldwide. Among the most important cardiovascular diseases are atherothrombosis and venous thromboembolism that present platelet aggregation as a key event. Currently, the commercial antiplatelet agents display several undesirable effects, which prompt the search for new compounds with better therapeutic index, more efficient body distribution and mechanism. Methods In this work we characterized in vivo and in vitro the antithrombotic and toxicological profiles of novel antiplatelet N -substituted-phenylamino-5-methyl-1H-1,2,3-triazole-4-carbohydrazides derivatives also comparing them with aspirin. In addition we also analyzed the stability of the more active compound after encapsulation in PLGA or PCL nanoparticles and the release profile of these new nanosystems. Results The biological results revealed not only the selective effect against arachidonic acid-induced platelet aggregation mainly for compounds 2c, 2e and 2 h but also their in vivo active profile on thromboembolism pulmonary animal model with better survival rates (e.g. 82%) than aspirin (33%). The overall toxicological profile was determined by in vitro (MTT reduction tests, neutral red uptake in kidney VERO cells and hemolysis assays) and in vivo (pulmonary embolism) assays that pointed 2c as the most promising derivative with potential as a lead compound. By using the nanoprecipitation technique 2c was loaded into PLGA and PCL nanoparticles showing controlled release profile over 21 days according to our drug release tests. Conclusion According to our results compound 2c is the most interesting derivative for further studies as it showed the best activity and toxicological profile also allowing the nanoencapsulation process. Thus 2c may assist in determining a new potential therapy with favorable pharmacokinetics for treatment of thrombotic disorders.

Introduction: Cardiovascular disease (CVD) is especially prevalent in patients with chronic kidney disease (CKD). Objective: To evaluate the role of CKD and metabolic syndrome (MS), which is a cluster of risk factors for CVD, as predictors of CVD. Methods: Observational, cross-sectional study with a random sample aged 45 or more years extracted from the population assisted by the primary care program in Niterói city in the state of Rio de Janeiro, Brazil. CKD was diagnosed by the K/DOQI guidelines and MS, by the harmonized criteria. CVD was said to be present if the participant had one or more of the following findings: echocardiographic abnormalities, and history of myocardial infarction, stroke or heart failure. A logistic regression model was developed to analyze risk factors for CVD using CKD as the variable of primary interest. Results: Fifty hundred and eighty-one participants (38.2% male) with a mean age of 59.4 ± 10.2 years were analyzed. The prevalence rate of CKD was 27.9%. In participants without CKD, MS was associated with a slight but statistically significant increase in the risk for CVD (OR = 1.52, p = 0.037); in those with CKD but without MS the risk for CVD was also statistically significant and at a greater magnitude (OR = 2.42, p = 0.003); when both were present the risk for CVD was substantially higher (OR = 5.13, p < 0.001). Conclusion: In this study involving a population assisted by a primary care program, CKD was confirmed as an independent risk factor for CVD. The presence of MS concurrent with CKD substantially amplified the risk for CVD. Resumo Introdução: A doença cardiovascular (DCV) é especialmente prevalente em pacientes com doença renal crônica (DRC). Objetivo: Avaliar o papel da DRC e da síndrome metabólica (SM), que é um conjunto de fatores de risco para DCV, como previsores de DCV. Métodos: Estudo observacional, transversal, com uma amostra representativa da população assistida pelo programa de atenção primária em Niterói, RJ, Brasil, incluindo pacientes com idade igual ou maior do que 45 anos. A DRC foi diagnosticada segundo o K/DOQI e a SM, pelo critério harmonizado. A DCV foi dita estar presente diante de um ou mais dos seguintes achados: anormalidades ecocardiográficas ou história de infarto do miocárdio, acidente vascular cerebral ou insuficiência cardíaca. Um modelo de regressão logística foi desenvolvido para analisar os fatores de risco cardiovasculares usando a DRC como a variável de interesse primário. Resultados: Foram analisados 581 participantes (38,2% homens), com idade média de 59,4 ± 10,2 anos. A taxa de prevalência da DRC foi de 27,9%. Em participantes sem DRC, a SM foi associada com um ligeiro, mas estatisticamente significativo aumento no risco cardiovascular (OR = 1,52, p = 0,04); naqueles com DRC, mas sem SM, o risco para DCV também foi estatisticamente significativo e com maior magnitude (OR = 2,42, p = 0,003); quando ambos estavam presentes, o risco para DCV foi substancialmente mais elevado (OR = 5,13, p < 0,001). Conclusão: Neste estudo, envolvendo uma população assistida por um programa de atenção primária, a DRC foi confirmada como um fator de risco independente para DCV. A presença da SM concomitante com a DRC ampliou substancialmente esse risco.

Introduction: Dyspnea is the symptom most commonly reported by patients with heart failure (HF) and/or pulmonary disease, the obese and the elderly. Recently ‘bendopnea’ (shortness of breath when bending forward) has been described in patients with HF. Objective: To determine the association of exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea and bendopnea with chronic disease, especially heart failure, and their phenotypes in primary care. Methods: This cross-sectional study included 633 individuals aged between 45 and 99 years enrolled in a primary care program in Niteroi, Brazil. Participants underwent clinical assessment and laboratory tests and completed a questionnaire, all on the same day. Results: Paroxysmal nocturnal dyspnea and bendopnea were associated with HF (unadjusted OR 2.42, 95% CI 1.10-5.29 and OR 2.59, 95% CI 1.52-4.44, respectively). In multivariate models, chronic obstructive pulmonary disease, coronary heart disease and myocardial infarction were not associated with bendopnea. Conclusion: Bendopnea was the only type of dyspnea not linked to respiratory disease or coronary heart disease. Even after adjusting for depression and body mass index, the association remained with HF with or without preserved ejection fraction, and bendopnea thus appears to be a promising symptom to differentiate HF from the other two disease groups. Resumo: Introdução: A dispneia é o sintoma mais comummente reportado por pacientes com insuficiência cardíaca, doenças pulmonares, obesos e idosos. Recentemente, a dispneia na anteflexão do tórax − flexopneia − foi descrita entre os pacientes com insuficiência cardíaca. Objetivo: Estimar a associação da dispneia aos esforços, ortopneia, dispneia paroxística noturna e flexopneia com as doenças crônicas não transmissíveis e, especialmente, com a insuficiência cardíaca e seus fenótipos na atenção primária. Métodos: Estudo transversal que incluiu 633 indivíduos de 45-99 anos, sorteados entre os cadastrados no programa Médico de Família de Niterói, Brasil. Os participantes foram submetidos a questionário estruturado, avaliação clínica, exames laboratoriais, eletrocardiograma e ecocardiograma, em único dia. Resultados: A dispneia paroxística noturna e a flexopneia apresentaram associação com a insuficiência cardíaca antes do ajuste (ORb = 2,42; IC 95% = 1,10-5,29 e ORb = 2,59; IC 95% = 1,52-4,44, respectivamente). Nos modelos múltiplos, a doença pulmonar obstrutiva crônica, angina pectoris e o infarto do miocárdio não mostraram associação com a flexopneia. Conclusão: A flexopneia foi a única que não se associou com as doenças respiratórias e as doenças coronarianas. Mesmo após o controle pela depressão e índice de massa corporal, manteve associação com a insuficiência cardíaca e com a insuficiência cardíaca com fração de ejeção preservada, mostrando-se como um sintoma promissor para diferenciar a insuficiência cardíaca dos outros dois grupos de doença. Keywords: Heart failure, Primary care, Dyspnea, Paroxysmal nocturnal dyspnea, Bendopnea, Palavras-chave: Insuficiência cardíaca, Cuidados de saúde primários, Dispneia, Dispneia paroxística noturna, Flexopneia

Background In most individuals, obesity and insulin resistance coexist. However, some individuals have excessive adipose tissue mass but remain insulin sensitive. Moreover, lean individuals can develop acute inflammation-induced insulin resistance, even without excess adipose tissue mass. Objective Our aim was to compare inflammatory markers in overweight, insulin-sensitive and lean, insulin-resistant healthy subjects. Methods A cross-sectional study with 1098 participants (CAMELIA project) was conducted in family doctor primary care program at Niteroi, RJ, Brazil. In the present substudy, we have selected non-obese healthy subjects (n = 203). Insulin resistance was defined by a homeostatic model assessment (HOMA-IR) >2.6, and overweight subject BMIs were 25

Objective: The aim of this study is to estimate the association of shortness of breath (SOB), fatigue and bilateral lower limb edema (LLE) – typical symptoms of HF – with quality of life (QOL) dimensions, measured by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Methods: This cross-sectional study was conducted as part of the CAMELIA study (Cardiometabolic Renal Familial Study), which involved families covered by the Family Doctor Program (FDP) in Niteroi, Rio de Janeiro, Brazil. The study included 455 patients aged 30 and over, assessed by questionnaire, medical consultation, and blood and urine tests. Results: The prevalence of symptoms was: fatigue 56.9%, SOB 22.6% and LLE 16.9%. There were independent and statistically significant associations between SOB and fatigue and all SF-36 dimensions, excepting emotional performance and SOB (p

An increase in cardiovascular (CV) disease has been observed in prehypertensive subjects who frequently carry other cardiovascular risk factors. In Brazil, little is known about prehypertension and its association with cardiovascular risk factors.To estimate the association between prehypertension and cardiovascular risk factors in a public primary healthcare programme.Associations in this cross-sectional study were estimated on the basis of generalized estimating equations. Results are expressed as odds ratio (OR) or adjusted odds ratio (OR(a)) with 95% confidence interval (CI).The 357 participants were classified as normotensive (64.4%) or prehypertensive (35.6%). In a univariate analysis, prehypertension was statistically associated with male gender, age, table salt use, diabetes, body mass index (BMI), uric acid, and all lipids except high-density lipoprotein cholesterol. When analysis was performed adjusting for gender, age, and table salt use, the association of each metabolic parameter with prehypertension, remained significant for BMI (OR(a) = 1.097; 95% CI 1.035-1.162), triglycerides (OR(a) = 1.008; 95% CI 1.003-1.013), and uric acid (OR(a) = 1.269; 95% CI 1.023- .576). To check for their independence of obesity, associations of triglycerides and uric acid with prehypertension were reanalysed after adjustment for BMI. The association of triglycerides remained statistically significant. A trend of association was present for uric acid. The prevalence of prehypertension paralleled the increase of the number of risk factors.Prehypertension in Brazil is associated with well-recognized cardiovascular risk factors even in a continuously monitored population such the one under study. Prehypertension can be a valuable clue to alert health professionals to treat underlying perturbations to prevent overt cardiovascular disease.

Cardiovascular diseases are the most frequent cause of morbidity and mortality worldwide. Among the most important cardiovascular diseases are atherothrombosis and venous thromboembolism that present platelet aggregation as a key event. Currently, the commercial antiplatelet agents display several undesirable effects, which prompt the search for new compounds with better therapeutic index, more efficient body distribution and mechanism.In this work we characterized in vivo and in vitro the antithrombotic and toxicological profiles of novel antiplatelet N-substituted-phenylamino-5-methyl-1H-1,2,3-triazole-4-carbohydrazides derivatives also comparing them with aspirin. In addition we also analyzed the stability of the more active compound after encapsulation in PLGA or PCL nanoparticles and the release profile of these new nanosystems.The biological results revealed not only the selective effect against arachidonic acid-induced platelet aggregation mainly for compounds 2c, 2e and 2h but also their in vivo active profile on thromboembolism pulmonary animal model with better survival rates (e.g. 82%) than aspirin (33%). The overall toxicological profile was determined by in vitro (MTT reduction tests, neutral red uptake in kidney VERO cells and hemolysis assays) and in vivo (pulmonary embolism) assays that pointed 2c as the most promising derivative with potential as a lead compound. By using the nanoprecipitation technique 2c was loaded into PLGA and PCL nanoparticles showing controlled release profile over 21days according to our drug release tests.According to our results compound 2c is the most interesting derivative for further studies as it showed the best activity and toxicological profile also allowing the nanoencapsulation process. Thus 2c may assist in determining a new potential therapy with favorable pharmacokinetics for treatment of thrombotic disorders.

OBJETIVO: O presente estudo visa testar a possibilidade de que indivíduos não diabéticos, com glicemia de jejum < 126 mg/dL e com HbA1c alterada, já apresentem diminuição na filtração glomerular estimada (FGe) e aumento do MCP-1, em comparação com aqueles com HbA1c normal, independente de outras alterações metabólicas. MATERIAIS E MÉTODOS: Este estudo utilizou dados do Estudo CAMELIA (cardiometabólico renal familiar), de julho de 2006 a dezembro de 2007, com visitas aos módulos do Programa Médico de Família (PMF) de Niterói, RJ. RESULTADOS: Verificamos associação independente entre a alteração da HbA1c (≥ 5,7 e < 6,5% versus < 5,7%) e diminuição da taxa de filtração glomerular estimada. A HbA1c mostrou ser um marcador subclínico de alterações metabólicas em pacientes não diabéticos e com glicemia de jejum < 126 mg/dL, em especial na população de mulheres e de indivíduos com a cor da pele preta. CONCLUSÃO: Essas observações indicam a possibilidade de se utilizar a HbA1c no intuito de se triar grupos de risco, visando propor estratégias de intervenção precoce e, assim, promover a prevenção de doenças crônicas, como diabetes e doença renal crônica.

This study aims investigate if nondiabetic subjects with fasting glucose126 mg/dL but altered HbA1c already have lower estimated glomerular filtration (eGFR) and high serum MCP-1 levels in comparison to nondiabetics with normal HbA1c, independent of other metabolic changes.Data were derived from the database of the CAMELIA (cardio-metabolic-renal family) study, a cross sectional study performed between July 2006 and December 2007, with participants recruited from the Family Doctor Program, Niterói, RJ.An independent association between changes in HbA1c (≥ 5.7 and6.5% versus5.7%) and decreased eGFR rate was found. The HbA1c was shown to be a marker of metabolic changes in nondiabetic subjects with fasting glucose126 mg/dL, particularly in women and blacks.These observations support the use of HbA1c levels in strategies for early intervention and prevention of chronic diseases such as diabetes mellitus and chronic kidney disease.

Blacks show higher levels of HbA1c in studies with different populations and are disproportionately affected by most diabetes-related complications.The study aims to investigate if the prevalence of altered glycated hemoglobin (HbA1c) varies with skin color and if there is a familial aggregation of either skin color and HbA1c.The study used the CAMELIA study (Cardio-Metabolic-Renal familiar) population, conducted between June 2006 and December 2007 (cross sectional). Families were recruited from 13 Family Doctor Program Unities of Niteroi, Brazil, a highly miscegenated population. The visits included questionnaire, medical consultation, anthropometric and nutritional assessment. Blood pressure, blood/urine samples were collected. The dosage of HbA1c was performed by immunoturbidimetry in Labmax 240 equipment.We compare data of 241 (25.5%) Blacks, versus 422 (44.7%) Mulattos or 272 (28.8%) Whites. The groups did not differ significantly with regard to most measures. Blacks had the lowest levels of income/education, higher frequency of diabetes and hypertension (p0.20) as higher levels of HbA1c (p0.05) that persisted after adjusting for possible confounders. Among blacks, the correlations between siblings of HbA1c were higher than among white/mulatto, reaching 86% versus 50%, respectively.Those results indicate that Brazilian Blacks patients must have more attention, focusing on diabetes preventive care. Longitudinal studies are needed to address the question if the altered level of HbA1c has a real clinical impact.

Vitamin C is empirically used by nurses to unblock long-term venous catheters. The study aims at analyzing the action of vitamin C in the coagulation process, establishing an in vitro coagulation model and fibrinolysis. It is an in vitro experimental study of the total blood of 10 healthy volunteers and 13 pools of citrated plasma. The results showed reduction of serum D-dimer with statistical significance when treated with vitamin C before and after clot formation. The weight of clots in blood presented significant reduction only when treated with vitamin C before the clotting process. However, when using vitamin C after clot formation a change is noticed in its structure and consistency. There were no significant differences in the weight of fibrin clots. It was concluded that vitamin C acts with greater intensity during the pre-clot formation phase and with less intensity in the two subsequent hours.

The sickle cell nephropathy is described as a homozygous sickle cell disease. However, there is no consensus as to the heterozygotes, thus other investigations are required to provide further information on this topic. This study aimed at determining the frequency of sickle cell trait in a population of chronic renal failure patients in the city of Niterói. A nefropatia falciforme é descrita entre os homozigotos da doença falcêmica, entretanto, para os heterozigotos, ainda não há um consenso, sendo necessários mais estudos que possam fornecer essas informações. Este estudo teve como objetivo determinar a frequência de traço falcêmico em uma população de doentes renais crônicos da cidade de Niterói.