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Yacon is an Andean plant that has been used in folk medicine for its medicinal properties. The beneficial effects of this plant are possibly due to the high content of phenolic compounds present in...

Hypertension is the leading contributor to cardiovascular disease worldwide; the prevalence of hypertension is higher among black adults than other racial/ethnic groups. One of the cellular defense mechanisms against reactive oxygen species are the antioxidants, such as the enzyme superoxide dismutase (SOD). Therefore, this study aimed to analyze the influence of the SNP Val16Ala of the SOD2 gene on oxidative stress and hypertension in a community population of self-declared black individuals in southern Brazil. The 158 participants declared themselves black (black/brown) regarding their skin color, being 89 (56.3%) self-declared black and 69 (43.7%) brown. A real-time polymerase chain reaction determined the MnSOD Ala16Val polymorphism, and oxidative stress marker levels were significant, in addition to differences in the hypertensive group regarding the levels of carbonyl (

Yacon is an Andean plant that has been used in folk medicine for its medicinal properties. The beneficial effects of this plant are possibly due to the high content of phenolic compounds present in its leaves and roots. This study evaluated the

Aims investigate the association between the +45T > G variant of the ADIPOQ gene and the metabolic syndrome (MS) in patients with sickle cell trait (SCT). 33 patients with SCT and 35 control group participated in the study. Lower levels of HDL and adiponectin were observed in patients with G allele and sickle cell trait. There were no differences between the prevalence of MS between the groups and there was no association between the +45T > G variant of the ADIPOQ gene and MS risk allele. Materials and methods Participants with and without sickle cell anemia answered a questionnaire, performed anthropometric and laboratory analyzes. They were genotyped for the +45T > G variant of the ADIPOQ gene and evaluated for the presence or absence of metabolic syndrome. The study was approved by the Research Ethics Committee of UNIPAMPA (RS/Brazil). Key findings The GG + TG genetic model, it was associated with lower levels of adiponectin and HDL cholesterol in the SCT group. There was no association between the other studied markers and MS. Significance For the first time, an association was demonstrated between the G allele of the +45T > G variant of the ADIPOQ gene and a worse cardiometabolic profile (lower serum concentrations of adiponectin and HDL cholesterol) in patients with sickle cell trait., Adiponectin; metabolic syndrome; sickle cell trait; rs 2241766; +45T > G variant in ADIPOQ gene.

Hypertension, a chronic non-transmissible multifactorial condition, it is highly frequent in Brazil, affecting about 32.5% of the population over 25 years of age. It is characterized by the sustained increase in systolic and diastolic blood pressure levels above 140 mmHg and 90 mmHg, respectively. It is the major aggravating factor in cardiovascular complications and the appearance of other comorbidities. Aiming to promote greater adherence to treatment and improve the population's access to basic medicament, in 2004 the Federal Government created the Programa Farmacia Popular do Brasil (PFPB); partnership with private institutions that provides the population with medicament to control hypertension, free of charge or subsidized at up to 90% of the value. The PFPB distributes the anti-hypertensives atenolol, captopril, enalapril, hydrochlorothiazide, losartan and propranolol. In this way, this work aims to evaluate the genotoxic potential of antihypertensives in human lymphocytes and macrophages, since they are widely used drugs and with few studies about their genotoxicological safety. The tests were developed from cell cultures treated with five different antihypertensive concentrations, all based on plasma peaks, evaluating cell viability, DNA damage index and DNA double strand breakdown. The results show that, as the concentration of captopril and enalapril maleate increased, cell viability decreased. In addition, a DNA damage was observed with the use Captopril and Enalapril in the higher concentrations. Hydrochlorothiazide also caused DNA damage in the five doses tested. Regarding the breaking of double strands of DNA, all the compounds showed increased ruptures. This decrease in dsDNA is dose dependent for all compounds tested. The set of results shows that the use although frequent still requires care and greater knowledge. In general, the antihypertensive drugs that proved to be safer in relation to the genetic damage tested were Losartan and Propranolol.

This study evaluated the protective effect of flaxseed oil (FO) and flaxseed lignan secoisolariciresinol diglucoside (SDG) against oxidative stress in rats with metabolic syndrome (MS). 48 rats were allocated into the following 6 groups: Groups 1 (control), 5 (FO), and 6 (SDG) received water and were treated daily orally with saline, FO, and SDG, respectively. Groups 2 (MS), 3 (MS+FO), and 4 (MS+SDG) received 30% fructose in drinking water for MS induction and were treated daily orally with saline, FO, and SDG, respectively. After 30 d, animals were sacrificed, and blood was collected for biochemical and oxidative analysis. Body weight was recorded weekly. Systolic blood pressure (SBP) was measured before and after treatment. Fructose could produce MS and oxidative stress. FO and SDG prevented changes in SBP, lipids, and glucose. FO and SDG prevented oxidative damage to lipids, and only FO prevented oxidative damage to proteins associated to MS. FO and SDG improved enzymatic antioxidants defenses and reduced glutathione levels, which was greater with SDG. Total polyphenol levels were enhanced in groups that received SDG. Thus, the results of this study demonstrated that treatment with a 30% fructose solution for 30 d is effective for MS induction and the oxidative stress is involved in the pathophysiology of MS induced by fructose‐rich diets. Furthermore, we demonstrated that the antioxidant effects attributed to flaxseed are mainly due to its high lignan content especially that of SDG, suggesting that this compound can be used in isolation to prevent oxidative stress associated with MS. We report that the antioxidant effects attributed to flaxseed are mainly due to its high lignan content, especially that of secoisolariciresinol diglucoside. This is significant because suggests that this compound can be used in isolation to prevent oxidative stress associated with MS. Furthermore, this study was the only one to perform a comparison of the abilities of 2 components of flaxseed to protect against oxidative stress in an MS model, which brings a great advance in the medicine's field, since it indicates another alternative for improve the health and the quality of life of patients with this disorder.

Summary Background & aims The ingestion of small to moderate alcohol consumption amounts has been associated to cardiovascular protection. This study aimed to evaluate the association between alcohol consumption and coronary artery disease severity. Material and methods Cross-sectional Study with patients undergoing coronary angiography. Age, cardiovascular risk factors (smoking, systemic arterial hypertension, dyslipidemia and diabetes) and alcohol drinking habit were investigated. Alcohol consumption was divided in three categories: nondrinker, moderate alcohol consumption (less than 15 g ethanol/day for women or 30 g ethanol/day for men) and heavy alcohol consumption. Coronary artery disease severity was assessed through the Friesinger Score (FS) in the coronary angiography, by interventional cardiologists blinded to alcohol consumption. Results The final sample included 363 adults; of those, 228 were men (62.81%). Mean age was 60.5 ± 10.9 y. Unadjusted analyses identified sex, age, hypertension, diabetes, dyslipidemia and alcohol consumption as the main covariates associated with the Friesinger score. Lower Friesinger scores were also observed in moderate alcohol consumption when comparing to those who do not drink (RR 0.86; 95% CI 0.79–0.95). Conclusion Among patients with suspected coronary artery disease undergoing coronary angiography, moderate alcohol consumption is associated to a lower coronary artery disease severity than heavy drinking.

Obesity reaches an epidemic level worldwide, and this condition is associated with chronic low-grade inflammation and secondary comorbidities, largely driven by global changes in lifestyle and diet. Various dietary approaches are proposed for the obesity treatment and its associated metabolic disorders. Good taste, antioxidant functions, and vitamins have been attributed to virgin coconut oil (VCO). However, VCO contains a large amount of saturated fatty acids, and the consumption of this fat is associated with a number of secondary diseases. We evaluate the effects of VCO supplementation on biochemical, inflammatory, and oxidative stress parameters in rats fed with high-fat diet (HFD). After feeding with HFD for 12 weeks, the animals were supplemented with VCO for 30 days. HFD+VCO group increased in diet intake, weight gain, low-density lipoprotein cholesterol level, and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. These findings were accompanied by increased in hepatic lipid profile and fat deposition in the liver. Adipocyte hypertrophy was observed in the HFD+VCO group, which was associated with elevated expression of tumor necrosis factor alpha (TNF-α) in adipose tissue. These results revealed that VCO associated with HFD induced important metabolic alterations, adipose inflammation, and hepatic lipid accumulation in rats.

Nitric oxide is a gaseous radical produced by the nitric oxide endothelial synthase (eNOS) whose most studied physiological action is the vasodilation. However, it also acts in the defense of the organism through the formation of cytotoxic radicals, which can potentiate the inflammatory lesion of the cells. The Glu298Asp is a single nucleotide polymorphism (SNP) in the eNOS gene related to the risk of cardiovascular disease. Blacks present a higher prevalence of hypertension and cardiovascular mortality. Then, we aimed to evaluate the influence of Glu298Asp polymorphism on inflammatory response in vitro and gene expression in blacks.Peripheral blood mononuclear cells (PBMC) from blacks with different Glu298Asp genotypes were treated with phytohemagglutinin (PHA), a mitogen and activator of T cells. Oxidative, inflammatory markers, and expression of inflammation genes were evaluated.The genotype frequencies were TT 6.7%; TG 29.3% and GG 64.0%. Activation of PBMCs with 125 μg of PHA modulated the expression of inflammatory genes and increased levels of inflammatory cytokines. The T allele showed increased susceptibility to inflammation (higher levels of interleukin 1, interleukin 6 and tumor necrosis factor alpha; p 0.001). The G allele exhibited protection through higher levels of nitric oxide (p 0.001) and fewer inflammatory cytokines.Despite methodological limitations related to in vitro assays, the whole of results suggested that Glu298Asp modulates inflammatory genes, the T allele is more susceptible to inflammation and the G allele is protective.

The effects of supplementation with blueberry (BE) extract (Vaccinium ashei Reade) for 14 consecutive days on biochemical, hematological, histopathological and oxidative parameters in hypercholesterolemic rats were investigated. After supplementation with lyophilized extract of BE, the levels of total cholesterol, low-density lipoprotein cholesterol and triglycerides were decreased. Histopathological analysis showed significant decrease (p

Introduction:Disturbances of the cardiac conduction system are frequent in the postoperative period of coronary artery bypass surgery. They are mostly reversible and associated with some injury of the conduction tissue, caused by the ischemic heart disease itself or by perioperative factors.Objective:Primary: investigate the association between perioperative factors and the emergence of atrioventricular block in the postoperative period of coronary artery bypass surgery. Secondary: determine the need for temporary pacing and of a permanent pacemaker in the postoperative period of coronary artery bypass surgery and the impact on hospital stay and hospital mortality.Methods:Analysis of a retrospective cohort of patients submitted to coronary artery bypass surgery from the database of the Postoperative Heart Surgery Unit of the Sao Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, using the logistic regression method.Results:In the period from January 1996 to December 2012, 3532 coronary artery bypass surgery were carried out. Two hundred and eighty-eight (8.15% of the total sample) patients had atrioventricular block during the postoperative period of coronary artery bypass surgery, requiring temporary pacing. Eight of those who had atrioventricular block progressed to implantation of a permanent pacemaker (0.23% of the total sample). Multivariate analysis revealed a significant association of atrioventricular block with age above 60 years (OR=2.34; CI 95% 1.75-3.12; P

Aims Family agriculture represents 80% of the Brazilian rural population, and rural workers linked to this agricultural model are also occupationally exposed to pesticides, which causes health risks for this part of the population. Thus, assessing health conditions becomes important and necessary as a form of biomonitoring of markers that can be used in effective health programs for agricultural workers. Materials and methods A total of 152 farmers, with an average age of 52 years, who answered the questionnaire and performed anthropometric, blood pressure, and blood dosages to determine the biochemical profile, hematological, markers of oxidative stress and mutagenicity. The sample was divided according to the interview report in two groups: volunteers who use pesticides in agricultural work (n = 84), and volunteers who do not use pesticides (n = 68). Key findings The group that uses pesticides presented higher values for measuring the circumference of the neck, and significant changes for the markers of oxidative stress, TBARS and Carbonyl, as well as significant reduction of antioxidant enzymes SOD, GPx e GSH, and in the dosages of total cholesterol, alkaline phosphatase, albumin, total leukocytes, monocytes and platelets. No mutagenic damage was verified according to the micronucleus test (MN). Significance The parameters that presented changes for the group that uses pesticides prove that even the low exposure can cause alteration of biomarkers, likely to compromise the health of the rural population. The results indicate the need for biomonitoring, and evaluation of its long-term impacts on farmers' health.

The current nutritional transition process contributes further to accelerate the onset of metabolic disorders, as do a number of environmental factors that lead to the diagnosis of chronic diseases, as a diet of low nutritional value, is possibly related to the incidence of metabolic syndrome. In addition to these factors, metabolic syndrome may also be related to genetic factors, the ADIPOQ + 45TG polymorphism has been associated with serum adiponectin levels, insulin sensitivity, and obesity, which affects adiponectin levels act as protective factor for cardiovascular disease. In this way, the present study aimed to analyze the possible association between the ADIPOQ + 45TG gene polymorphism, usual diet and metabolic syndrome in the elderly.We evaluated inflammatory and biochemical markers compared with older age groups (age 60 years) with and without metabolic syndrome. In addition to the anthropometric measurements of weight, height and waist circumference, the ADIPOQ + 45TG gene polymorphism was determined by PCR- RFLP, and food consumption was investigated using a food frequency questionnaire.The study included 111 elderly individuals. Our main results show that there was a significant relationship between the habitual consumption of milk for the group that had metabolic syndrome (p0.05). HDL-c levels, glucose, triglycerides, diastolic blood pressure and weight, height and waist circumference had to be altered in patients with metabolic syndrome. There was an association between habitual dietary intake of white meat with haplotypes TG and GG.We conclude that the relationship between the habitual consumption of certain food groups and ADIPOQ indicates the need for further studies to develop a better understanding of this relationship; however, there was no association between the ADIPOQ + 45TG gene polymorphism and metabolic syndrome in the group of elderly studied.

Iron (Fe) is an important metal to organism homeostasis and exists abundantly in the environment. Moderate levels of Fe obtained from food are necessary for normal cell physiology; however, abnormally high levels of Fe may have toxic effects by reducing H2O2 to the highly cytotoxic hydroxyl radical (OH˙) (Fenton catalysis). Fe is a ubiquitous toxicant to the environment and also widely used in food products; however, its effects on the nervous system are not well understood. Herein, we evaluated the toxic effects of Fe using C. elegans and investigated various parameters in order to contribute to the understanding of Fe-induced toxicity and to validate this model. The Fe LD50 of acute exposure (30 min) was 1.2 mM, and we verified that worms readily take up this metal. Furthermore, sublethal Fe concentrations significantly decreased the worms’ lifespan and brood size compared to non-exposed worms. We also observed that animals exposed to Fe had decreased locomotor activity and decreased mechanical sensitivity, suggesting the possible dysfunction of the nervous system. In agreement, we found cholinergic and dopaminergic alterations in the worms. In summary, we suggest that Fe leads to selective neuronal damage, which might be the underlying cause of altered behavior and reproductive defects.

Non-alcoholic fatty liver disease is a spectrum of liver changes, ranging from hepatic steatosis to hepatocellular carcinoma. The Citrus maxima (CM) has been shown to be beneficial to the organism, and these activities are attributed to the presence of phytochemical compounds. The objective of this study was to evaluate the n vitro antioxidant potential of the CM leaves extract and on Wistar rats submitted to hepatic steatosis induction by fructose-associated hyperlipid diet (FHD). For the evaluation of in vivo effects, the animals were distributed in G1 (normal diet - ND), G2 (FHD), G3 (ND + extract 50mg/kg) and G4 (FHD + extract 50 mg/kg). All the parameters were determined through classical methodologies. The extract showed a significant antioxidant potential in vitro. In the in vivo analysis, the diet used was able to induce the development of metabolic abnormalities that favored the formation of hepatic steatosis (G2). Changes in inflammatory markers, increase in markers of oxidative damage, and reduction of antioxidant defenses were also observed. In addition, the extract did not cause changes in the animals' weight gain and acted as an anti-inflammatory, since G4 animals exhibited significantly reduced levels of the inflammatory markers. In the liver, the extract significantly decreased the content of fat, cholesterol and triglycerides compared to G2. The extract also showed antioxidant activity (G4) when compared to G2. The results suggest that the extract of CM leaf showed hepatoprotective, hypolipidemic, anti-inflammatory and antioxidant activities and the presence of phenolic compounds is a probable cause for such activities.

Cardiovascular disease (CVD) are a major public health problem, as they are among the leading causes of mortality worldwide. Tripodanthus acutifolius (TA) is a hemiparasite plant used for medicinal purposes with great antioxidant capacity. However, little is known about its hypolipemic effect. Thus, the aim of this study was to evaluate the effects of the hydroalcoholic extract of Tripodanthus acutifolius leaves in hypercholesterolemic Wistar rats. The animals were divided into: (1) NC (Normocaloric Control); (2) HC (Hypercaloric Control); (3) Oral Simvastatin Suspension 10mg/kg (SIM); (4) TA extract 50mg/kg (TA 50mg/kg) and (5) TA 100mg/kg. The in vitro antioxidant activity assay demonstrated that TA shows high antioxidant capacity. The in vivo findings demonstrated that TA supplementation resulted in significant decreases (p

The bark tea of Ceiba speciosa, a tropical tree of the Malvaceae family, is used in the Northwestern Region of Rio Grande do Sul state, Brazil, to reduce blood cholesterol levels. However, there are no scientific data on the efficacy and safety of this plant. The aim of the present study was to evaluate the in vitro antioxidant and toxic potential of bark extracts of C. speciosa. We performed a preliminary phytochemical analysis by high-performance liquid chromatography-diode array detection (HPLC-DAD) and evaluated the oxidative damage to proteins and lipids, the radical scavenging effect, and genotoxicity of the lyophilized aqueous extract (LAECs) and the precipitate obtained from the raw ethanol extract (Cs1). The phytochemical profile demonstrated the presence of phenolic and flavonoid compounds. The LAECs and Cs1 prevented damage to lipids and proteins at concentrations of 50 and 10 µg/mL. They also showed a scavenging effect on 2,2-diphenyl-1-pricril-hydrazyl (DPPH) radicals in a concentration-dependent manner. Furthermore, no genotoxic effect was observed at concentrations of 10, 5 and 2 µg/mL in the Comet assay. The present study is the first evaluation regarding the characterization of C. speciosa and its safety, and the results demonstrate its antioxidant potential and suggest that its therapeutic use may be relatively safe.

Clozapine, atypical antipsychotic, can change oxidative stress parameters. It is known that reactive species, in excess, can have a crucial role in the etiology of diseases, as well as, can potentiating adverse effects induce by drugs. The nanocapsules have attracted attention as carriers of several drugs, with consequent reduction of adverse effects. This study aimed to evaluate histopathology and oxidative damage of biomolecules lipids, proteins and DNA in the brain of Wistar rats after treatment with nanocapsules containing clozapine. The study consisted of eight groups of male Wistar rats (n = 6): saline (SAL), free clozapine (CZP) (25 mg/Kg i.p.), blank uncoated nanocapsules (BNC), clozapine-loaded uncoated nanocapsules (CNC) (25 mg/Kg i.p.), blank chitosan-coated nanocapsules (BCSN), clozapine-loaded chitosan-coated nanocapsules (CCSN) (25 mg/Kg i.p.), blank polyethyleneglycol-coated nanocapsules (BPEGN), clozapine-loaded polyethyleneglycol-coated nanocapsules (CPEGN) (25 mg/Kg i.p.). The animals received the formulation once a day for seven consecutive days and euthanized in the eighth day. After euthanasia, the brain was collected and homogenate was processed for further analysis. The histopathology showed less brain tissue damage in nanocapsules-treated groups. The lipid peroxidation and carbonylation of proteins showed a significant increase (p < 0.05) induced by CZP. CNC and CPEGN groups obtained a reduction membrane of lipids damage and nanocapsules-treated groups showed significant improvement protein damage. CZP was able to induce genetic oxidative damage, while the nanocapsules causing less damage to DNA. The findings show that different coatings can act protecting target tissues decreasing oxidative damage, suggesting that the drug when linked to different nanocapsules is able to mitigate the harmful effects of clozapine.

Metabolic syndrome is a set of factors that can increase the mortality from cardiovascular disease. Thus, knowledge about the prevalence of MS in the elderly is important, since the risk factors tend to increase significantly with age. The aim of this study is analyze the prevalence of metabolic syndrome (MS) among elderly according to the IDF and NCEP criteria and determining its relation to Framingham Risk Score (FRS). Elderly people (60 years old or older) of both genders participated in the study. Volunteers signed a TCLE and were interviewed, as well as physical exams. The biochemical analyzis were performed on an automated analyzer LABTEST, LabMax 240 model with biochemical reagents Labtest brand. For the diagnosis of MS NCEP and IDF criteria were used and cardiovascular risk was estimated by calculating the FRS. Descriptive statistics were performed, chi-square test for ordinal variables and ANOVA or Student-t test for quantitative data. Multivariate analysis was performed by logistic regression (backward conditional method). Differences were considered statistically significant at p ≤ 0.05. The overall prevalence of MS found in the sample following the NCEP and IDF criteria was 55.8% and 60.8%, respectively. No associations were found between gender and diagnostic criteria. Individuals with high+moderate FRS had a higher risk of developing MS compared to those with low FRS. Logistic regression analysis showed an independent association of abdominal adiposity by the IDF criteria (OR 4.8, CI 1.0- 22.1; p = 0.04) and glycemia by NCEP criteria (OR 3.0, CI 1.1-8.4; p = 0.03) with moderate+high FRS. The prevalence of MS was high under both criteria, being more predominant in those patients with moderate+high FRS. Thus, the components of MS abdominal adiposity and glucose levels were associated with increased CRF, indicating that the control of these factors can be decisive in reducing cardiovascular risk in the elderly.

Background and Aims Endothelial rupture of coronary plaque can represent the pathomorphological substratum of acute coronary syndrome (ACS). Polymorphisms in the NOS3 gene (eNOS) –786T>C, 894G>T and intron 4 a/b VNTR can be associated with a higher susceptibility for ACS. The present study is focused on the investigation of the interaction of these polymorphisms and cardiovascular risk factors in 135 patients with ACS and 115 control subjects. Methods Case–control study where the allele and genotype frequencies of the polymorphisms –786T> C, 894G> T and intron 4 VNTR of the gene encoding eNOS were determined by PCR-RFLP associated with cardiovascular risk factors. Results An association of the 894TT genotype and 894GT+GG (OR 1.4; 95% CI 1.0–1.8) in ACS has been observed. Subjects without dyslipidemia and intron 4 a/b genotype present a lower chance for ACS development, whereas subjects without diabetes and 894TT genotype show a higher risk for ACS (OR 1.7; 95% CI 1.2–2.3). In patients without dyslipidemia, the 894GG genotype presented a tendency to behave as a protector factor against ACS. Also, the 894GG genotype has been a protective factor for ACS in females (OR 0.5; CI 95% 0.2–0.9). Conclusions Our results suggest that eNOS polymorphisms may be an additional risk factor in development of ACS.

Aims The aim of this study was to evaluate the potential protective effects of ad libitum black grape (Vitis labrusca) juice against liver oxidative damage in whole-body acute X-irradiated rats. Main methods Animals were fed ad libitum and drank voluntarily black grape juice or placebo (isocaloric glucose and fructose solution) for 6 days before and 15 days following a 6 Gy X-irradiation from a 200 kV machine. Key findings Irradiated animals receiving placebo showed a significant increase in the concentration of thiobarbituric acid-reactive substances (TBARS), a marker of lipid peroxidation, as well as a significant decrease in both Cu/Zn superoxide dismutase (Cu/ZnSOD) and glutathione peroxidase (GPx) activity and reduced glutathione concentration (GSH). Black grape juice supplementation resulted in a reversal of lipid peroxidation, Cu/ZnSOD activity, and GSH concentration, towards values not significantly differing from those in non-irradiated, placebo-supplemented rats. Poly(ADP-ribose) polymerase (PARP-1) and Cu/ZnSOD changes in protein expression were observed for irradiated rats. No change in p53 expression or DNA fragmentation was found. Significance Ad libitum black grape juice intake is able to restore the liver primary antioxidant system against adverse effects due to whole-body acute X-irradiation in rats after 15 days post-irradiation. The results support using antioxidant supplements as a preventive tool against radiation-induced harm.

INTRODUÇÃO: A mediastinite é uma grave complicação do pós-operatório de cirurgia cardíaca, com prevalência de 0,4 a 5% e mortalidade entre 14 e 47%. Vários modelos foram propostos para avaliar risco de mediastinite após cirurgia cardíaca. OBJETIVO: Desenvolver um modelo de escore de risco para prever mediastinite em pacientes submetidos à cirurgia de revascularização do miocárdio. MÉTODOS: A amostra do estudo inclui dados de 2.809 pacientes adultos que realizaram cirurgia de revascularização do miocárdio, entre janeiro de 1996 e dezembro de 2007, no Hospital São Lucas da PUCRS. Regressão logística foi usada para examinar a relação entre fatores de risco e o desenvolvimento de mediastinite. Dados de 1.889 pacientes foram usados para desenvolver o modelo e seu desempenho foi avaliado nos dados restantes (n=920). O modelo final foi criado com a análise dos dados de 2.809 pacientes. RESULTADOS: O índice de mediastinite foi de 3,3%, com mortalidade de 26,6%. Na análise multivariada, cinco variáveis permaneceram preditores independentes para o desfecho: doença pulmonar obstrutiva crônica, obesidade, reintervenção cirúrgica, politransfusão no pós-operatório e angina estável classe IV ou instável. A área sob a curva ROC foi 0,72 (IC 95%, 0,67-0,78) e P = 0,61. CONCLUSÃO: O escore de risco foi construído para uso na prática diária para calcular o índice de mediastinite após cirurgia de revascularização do miocárdio. O escore inclui variáveis coletadas rotineiramente e de fácil utilização. INTRODUCTION: The mediastinitis is a serious postoperative complication of cardiac surgery, with an incidence of 0.4 to 5% and mortality between 14 and 47%. Several models were proposed to assess risk of mediastinitis after cardiac surgery. However, most of these models do not evaluate the postoperative morbidity. OBJECTIVE: This study aims to develop a score risk model to predict the risk of mediastinitis for patients undergoing coronary artery bypass grafting. METHODS: The study sample included data from 2,809 adult patients undergoing coronary artery bypass grafting between January 1996 and December 2007 at Hospital São Lucas -PUCRS. Logistic regression was used to examine the relationship between risk factors and the development of mediastinitis. Data from 1,889 patients were used to develop the model and its performance was evaluated in the remaining data (n=920). The definitive model was created with the data analisys of 2,809 patients. RESULTS: The rate of mediastinitis was 3.3%, with mortality of 26.6%. In the multivariate analysis, five variables remained independent predictors of the outcome: chronic obstructive pulmonary disease, obesity, surgical reintervention, blood transfusion and stable angina class IV or unstable. The area under the ROC curve was 0.72 (95% CI, 0.67-0.78) and P = 0.61. CONCLUSION: The risk score was constructed for use in daily practice to calculate the rate of mediastinitis after coronary artery bypass grafting. The score includes routinely collected variables and is simple to use.

Background The black population has a high cardiometabolic risk, however low incidence of metabolic syndrome (MetS). In this context, there seems to be a paradox related to the diagnostic criteria of MetS, which makes the presence of the same is underestimated in blacks. This condition brings the need to look for a more reliable markers of actual pathological conditions and cardiometabolic risk of these individuals. A possible marker is nitric oxide (NO). The dosage metabolites nitrite/nitrate (NOx) have been shown to be associated with some criteria of the metabolic syndrome, such as obesity and diabetes, however the literature lacks more specific studies to assess whether altered levels of nitric oxide are associated with metabolic and cardiovascular disease among blacks.

FUNDAMENTO: Os inibidores da enzima conversora de angiotensina (IECA) reduzem o risco de obito, infarto agudo do miocardio (IAM) e acidente vascular encefalico (AVE) em portadores de doenca coronariana. No entanto, nao ha consenso quanto a sua indicacao em pacientes que serao submetidos a cirurgia de revascularizacao miocardica (CRM). OBJETIVO: Avaliar a relacao entre uso pre-operatorio de IECA e eventos clinicos apos realizacao da CRM. METODOS: Estudo de coorte retrospectivo. Foram incluidos dados de 3.139 pacientes consecutivos submetidos a CRM isolada em hospital terciario brasileiro, entre janeiro de 1996 e dezembro de 2009. O seguimento dos pacientes foi realizado ate a alta hospitalar ou obito. Desfechos clinicos no pos-operatorio foram analisados entre os usuarios e os nao-usuarios de IECA no pre-operatorio. RESULTADOS: Cinquenta e dois por cento (1.635) dos pacientes receberam IECA no pre-operatorio. O uso de IECA foi preditor independente da necessidade de suporte inotropico (RC 1,24, IC 1,01-1,47; P=0,01), de insuficiencia renal aguda (IRA, RC 1,23, IC 1,01-1,73; P=0,04) e de evolucao para fibrilacao atrial (FA, RC 1,32, IC 1,02-1,7; P=0,03) no pos-operatorio. A mortalidade entre os pacientes que receberam ou nao IECA no pre-operatorio foi semelhante (10,3 vs. 9,4%, P=0,436), bem como a incidencia de IAM e AVE (15,6 vs. 15,0%, P=0,694 e 3,4 vs. 3,5%, P=0,963, respectivamente). CONCLUSAO: O uso pre-operatorio de IECA foi associado a maior necessidade de suporte inotropico e maior incidencia de IRA e FA no pos-operatorio, nao estando associado ao aumento das taxas de IAM, AVE ou obito

Disturbances of the cardiac conduction system are potential complications after cardiac valve surgery.This study was designed to investigate the association between perioperative factors and atrio-ventricular block, the need for temporary cardiac artificial pacing and, if necessary, permanent pacemaker implantation after cardiac valve surgery.Retrospective analysis of the Cardiac Surgery Database - Hospital São Lucas/PUCRS. The data are collected prospectively and analyzed retrospectively.Between January 1996 and December 2008 were included 1102 valve surgical procedures: 718 aortic valves (65.2%), 407 (36.9%) mitral valve and 190 (17.2%) coronar artery bypass grafting combined with valve repair and 23 (2.1%) aortic and mitral combined surgery. 187 patients (17%) showed clinical and electrocardiographic pattern of atrio-ventricular block requiring artificial temporary pacing. Of these, 14 patients (7.5%) required permanent pacemaker implantation (1.27% of the total valve surgery patients). Multivariate analysis showed association of the incidence of atrio-ventricular block and temporary pacing with mitral valve surgery (OR 1,76; CI 95% 1.08-2.37; P = 0.002), implantation of bioprosthetic devices (OR 1.59; CI 95% 1.02-3.91; P = 0,039), age over 60 years (OR 1.99; CI 95% 1.352.85; P0.001), prior use of anti-arrhythmic drugs (OR 1.86; CI 95% 1.04-3.14; P = 0.026) and previous use of b-blocker (OR 1.76; CI 95% 1.25-2.54; P = 0.002). Remarkably the presence of atrio-ventricular block did not significantly show association with increased mortality, but significantly prolonged (P0.0001) hospital length-of-stay and, therefore, hospital costs.Our study presents a group of predictive factors referring to a specific patient profile by which high risk of atrio-ventricular block and the need of temporary cardiac pacing after cardiac valve surgery it is determined.

Angiotensin-converting enzyme (ACE) inhibitors reduce the chance of death, myocardial infarction (MI) and cerebrovascular accident (CVA) in patients with coronary disease. However there is no consensus as to its indication in patients undergoing coronary artery bypass grafting (CABG).To assess the relationship between preoperative use of ACE inhibitors and clinical outcomes after CABG.Retrospective cohort study. We included data from 3,139 consecutive patients undergoing isolated CABG in Brazilian tertiary care hospital between January 1996 and December 2009. Follow-up was until discharge or death. Clinical outcomes after surgery were analyzed between users and nonusers of ACE inhibitors preoperatively.Fifty-two percent (n=1,635) of patients received ACE inhibitors preoperatively. The use of ACE inhibitors was an independent predictor of need for inotropic support (OR 1.24, 95% CI 1.01 to 1.47, P = 0.01), acute renal failure (OR 1.23, 95% CI 1.01 to 1.73, P = 0.04) and progression to atrial fibrillation (OR 1.32, 95% CI 1.02 to 1.7, P = 0.03) postoperatively. The mortality rate among patients receiving or not preoperative ACE inhibitors was similar (10.3% vs. 9.4%, P = 0.436), as well as the incidence of myocardial infarction and stroke (15.6% vs. 15.0%, P = 0.694 and 3.4% vs. 3.5%, P = 0.963, respectively).The use of preoperative ACE inhibitors was associated with increased need for inotropic support and higher incidence of acute renal failure and postoperative atrial fibrillation, not associated with increased rates of myocardial infarction, stroke or death.

INTRODUÇÃO: Escores para avaliação de risco cirúrgico em pacientes submetidos à cirurgia de revascularização miocárdica são amplamente utilizados. OBJETIVO: Construir um escore capaz de predizer mortalidade em pacientes submetidos à cirurgia de revascularização miocárdica. MÉTODOS: No período entre janeiro de 1996 e dezembro de 2007, foram coletados dados de 2809 pacientes submetidos à cirurgia de revascularização miocárdica no Hospital São Lucas da PUC-RS. Em cerca de 2/3 da amostra (n=1875), foi construído o escore, após análises uni e multivariada. No restante (n=934), o escore foi validado. O escore final foi construído com a amostra total, utilizando as mesmas variáveis (n=2809). A acurácia do modelo foi testada utilizando-se a área sob a curva ROC. RESULTADOS: A idade média foi 61,3 ± 10,1 anos (desvio padrão) e 34% eram mulheres. Os fatores de risco identificados como preditores independentes de mortalidade cirúrgica e utilizados para montagem do escore (parênteses) foram: idade > 60 anos (2), sexo feminino (2), vasculopatia extracardíaca (2), insuficiência cardíaca classe funcional III e IV (3), fração de ejeção < 45% (2), fibrilação atrial (2), doença pulmonar obstrutiva crônica (3), estenose aórtica (3), creatinina 1,5-2,4 (2), creatinina > 2,5 ou diálise (4) e cirurgia de emergência/urgência (16). A área sob a curva ROC obtida foi de 0,86 (IC 0,81-0,9). CONCLUSÃO: O escore desenvolvido por meio de variáveis clínicas de fácil obtenção (idade, sexo, vasculopatia extracardíaca, classe funcional, fração de ejeção, fibrilação atrial, doença pulmonar obstrutiva crônica, estenose aórtica, creatinina e cirurgia de emergência/urgência) mostrou-se capaz de predizer mortalidade em pacientes submetidos à cirurgia de revascularização miocárdica no nosso Hospital. INTRODUCTION: Scores to predict surgical risk in patients submitted to myocardial revascularization surgery are broadly used. OBJECTIVE: To develop a score capable to predict mortality in patients submitted to myocardial revascularization surgery. METHODS: From January 1996 to December 2007, data were collected from 2809 patients submitted to myocardial revascularization surgery at PUC-RS São Lucas Hospital. In 2/3 of the sample (n=1875), the score was developed, after uni and mutivariated analyses. In the remaining 1/3 (n =934) the score was validated. The final score was developed with the total sample, using the same variables (n=2809). The accuracy of the model was tested using the area under the ROC curve. RESULTS: The mean age was 61.3 ±10.1 years and 34% were women. The risk factors identified as independent predictors of surgical mortality and used for score development (parentheses) were: age > 60 years (2), female (2), extracardiac vasculopathy (2), heart failure functional class III and IV (3), ejection fraction 2.5 or dialysis (4), emergency/urgency surgery (16). The area obtained under the ROC curve was 0.86 (CI 0.81-0.9). CONCLUSION: The score developed, using clinical variables easy to obtain (age, sex, extracardiac vasculopathy, functional class, ejection fraction, atrial fibrillation, chronic obstructive pulmonary disease, aortic stenosis, creatinine and emergency/urgency surgery) showed capability to predict mortality in patients submitted to myocardial revascularization surgery in our Hospital.

FUNDAMENTO: A síndrome metabólica está associada ao aumento de risco de eventos cardiovasculares. Marcadores inflamatórios e anticorpos anti-Chlamydia têm sido relacionados ao desenvolvimento e à progressão da aterosclerose e dos eventos cardiovasculares. OBJETIVO: Avaliar os marcadores inflamatórios interleucina-6 (IL-6) e fator de necrose tumoral-alfa (TNF-α) e os anticorpos anti-Chlamydia pneumoniae em pacientes com síndrome metabólica (SM), com e sem eventos cardiovasculares. MÉTODOS: Estudo transversal constituído por 147 indivíduos. Desses, 100 (68%) com SM e sem eventos cardiovasculares; e 47 (32%) com SM e com eventos cardiovasculares. Dos indivíduos que sofreram eventos cardiovasculares, 13 (6,11%) apresentam infarto agudo do miocárdio (IAM), e dez (4,7%), acidente vascular cerebral (AVC). O diagnóstico da SM foi determinado pelos critérios do NCEP-ATPIII. RESULTADOS: A média de idade dos sujeitos com eventos cardiovasculares foi de 61,26 ± 8,5 e de 59,32 ± 9,9 nos indivíduos sem esses eventos (p=0,279), havendo predomínio do sexo feminino. O grupo com SM e sem evento apresentou maior peso, altura, IMC e circunferência abdominal. Para os indivíduos com eventos cardiovasculares (p=0,001), os marcadores inflamatórios IL-6 e TNF-α e a doença vascular periférica foram significativamente maiores. Obtiveram-se níveis elevados de anticorpos IgG para Chlamydia pneumoniae no grupo SM, sem eventos e de IgA no grupo com eventos quando comparados os dois grupos. Com relação ao IAM e ao AVC, os anticorpos anti-Chlamydia pneumoniae não demonstraram significância estatística, comparados ao grupo sem eventos cardiovasculares. Associação foi observada com o uso de estatinas, hipoglicemiantes orais, injetáveis e anti-inflamatórios não esteroidais no grupo com esses eventos. CONCLUSÃO: Marcadores inflamatórios encontram-se significativamente elevados em pacientes com SM, com IAM e AVC. Anticorpos anti-Chlamydia não mostraram diferença significativa em pacientes com SM, com e sem eventos. BACKGROUND: The metabolic syndrome is associated with increased risk of cardiovascular events. Inflammatory markers and antichlamydial antibodies have been linked to the development and progression of atherosclerosis and cardiovascular events. OBJECTIVE: To evaluate the inflammatory markers interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), as well as anti-chlamydia pneumoniae antibodies, in patients with metabolic syndrome (MS), with and without cardiovascular events. METHODS: Cross sectional study consisting of 147 individuals. Out of these, 100 (68%) with MS and without cardiovascular events; and 47 (32%) with MS and with cardiovascular events. Among the individuals who had had cardiovascular events, 13 (6.11%) had acute myocardial infarction (AMI) and ten (4.7%) had cerebrovascular accident (CVA). The diagnosis of MS was determined by the criteria of NCEP-ATPIII. RESULTS: The mean age of subjects with cardiovascular events was 61.26 ± 8.5 and 59.32 ± 9.9 in subjects without such events (p = 0.279), with a predominance of females. The weight, height, BMI and waist circumference of the group with MS and without event was greater. Among individuals with cardiovascular events (p = 0.001), the inflammatory markers IL-6 and TNF-α and the peripheral vascular disease were significantly greater. There were high levels of IgG antibodies to C. pneumoniae in the SM group, without events, and of IgA antibodies in the group with events, when the two groups were compared. With respect to AMI and stroke, the anti-chlamydia pneumoniae antibodies showed no statistical significance, compared to the group without cardiovascular events. An association was observed with the use of statins, nonsteroidal anti-inflammatory drugs and injectable, oral hypoglycemic agents, in the group with these events. CONCLUSION: The inflammatory markers were significantly elevated in patients with MS, with acute myocardial infarction and stroke. There was no significant difference in anti-chlamydial antibodies in patients with MS, with and without events. FUNDAMENTO: El síndrome metabólico está asociado al aumento de riesgo de eventos cardiovasculares. Marcadores inflamatorios y anticuerpos anti-Chlamydia han sido relacionados al desarrollo y a la progresión de la aterosclerosis y de los eventos cardiovasculares. OBJETIVO: Evaluar los marcadores inflamatorios interleucina-6 (IL-6) y factor de necrosis tumoral-alfa (TNF-α) y los anticuerpos anti-Chlamydia pneumoniae en pacientes con síndrome metabólico (SM), con y sin eventos cardiovasculares. MÉTODOS: Estudio transversal constituido por 147 individuos. De estos, 100 (68%) con SM y sin eventos cardiovasculares; y 47 (32%) con SM y con eventos cardiovasculares. De los individuos que habían sufrido eventos cardiovasculares, 13 (6,11%) presentan infarto agudo de miocardio (IAM), y diez (4,7%), accidente cerebro vascular (ACV). El diagnóstico del SM fue determinado por los criterios del NCEP-ATPIII. RESULTADOS: La media de edad de los sujetos con eventos cardiovasculares fue de 61,26 ± 8,5 y de 59,32 ± 9,9 en los individuos sin esos eventos (p=0,279), habiendo predominio del sexo femenino. El grupo con SM y sin evento presentó mayor peso, altura, IMC y circunferencia abdominal. Para los individuos con eventos cardiovasculares (p=0,001), los marcadores inflamatorios IL-6 y TNF-α y la enfermedad vascular periférica fueron significativamente mayores. Se obtuvieron niveles elevados de anticuerpos IgG para Chlamydia pneumoniae en el grupo SM, sin eventos y de IgA en el grupo con eventos cuando fueron comparados los dos grupos. Con relación al IAM y al ACV, los anticuerpos anti-Chlamydia pneumoniae no demostraron significación estadística, comparados al grupo sin eventos cardiovasculares. Asociación fue observada con el uso de estatinas, hipoglicemiantes orales, inyectables y antiinflamatorios no esteroides en el grupo con esos eventos. CONCLUSIÓN: Marcadores inflamatorios se encuentran significativamente elevados en pacientes con SM, con IAM y ACV. Anticuerpos anti-Chlamydia no mostraron diferencia significativa en pacientes con SM, con y sin eventos.