Wednesday, February 28, 2007

neurological_disorders_report


Los trastornos neurológicos afectan a millones de personas en todo el mundo: informe de la OMS

27 DE FEBRERO DE 2007 | BRUSELAS/GINEBRA -- Según un nuevo informe de la Organización Mundial de la Salud (OMS), los trastornos neurológicos (desde la epilepsia y la enfermedad de Alzheimer o los accidentes cerebrovasculares hasta el dolor de cabeza) afectan en todo el mundo a unos mil millones de personas. Entre los trastornos neurológicos figuran también los traumatismos craneoencefálicos, las infecciones neurológicas, la esclerosis múltiple, y la enfermedad de Parkinson.

En el informe Neurological Disorders: Public health challenges (que próximamente se traducirá al español) se pone de manifiesto que en todo el mundo están afectadas unos mil millones de personas, 50 millones sufren epilepsia, y 24 millones padecen Alzheimer y otras demencias. Los trastornos neurológicos afectan a personas de todos los países, sin distinción de sexos, niveles de educación ni de ingresos.

Tuesday, February 27, 2007

Angina, “Normal” Coronary Angiography, and Vascular Dysfunction: Risk Assessment Strategies

PLoS Medicine - Angina, “Normal” Coronary Angiography, and Vascular Dysfunction: Risk Assessment Strategies
associated with coronary arteries that appear “normal.” Normal is defined here as no visible disease or luminal irregularities (less than 50%) as judged visually at coronary angiography. Normal angiography in patients with chest pain is five times more common in women than in men [1]. Among patients with chest pain and normal angiography, an unknown number are suffering from cardiac pain of ischemic origin. Uncertainty is often difficult to allay, for medical attendants as well as for patients, resulting in perpetuation of symptoms, difficulties in management, and establishment of risk of subsequent coronary events [2]. In this article, we discuss how to stratify risk in patients with chest pain and a normal coronary angiogram. We based our article on a literature review, using the key words “angina with normal angiography,” “angina with normal coronary arteries,” “non-obstructive coronary disease,” or “chest pain of non-cardiac origin,” plus “[a]etiology,” “pathophysiology,” “diagnosis,” “classification,” “prognosis,” or “therapy.” A longer, more detailed version of this paper is found in the supplementary file S1.

Use of Nonsteroidal Antiinflammatory Drugs. An Update for Clinicians. A Scientific Statement From the American Heart Association -- Antman et al., 10.1161/CIRCULATIONAHA.106.181424 -- Circulation

Use of Nonsteroidal Antiinflammatory Drugs. An Update for Clinicians. A Scientific Statement From the American Heart Association -- Antman et al., 10.1161/CIRCULATIONAHA.106.181424 -- Circulation
Clinical trial data have prompted questions about the degree to which patients and their physicians should consider an increased risk of cardiovascular or cerebrovascular events when selecting medications for pain relief. Since the 2005 publication of a Science Advisory on the use of nonsteroidal antiinflammatory drugs (NSAIDs) by the American Heart Association,1 several important events have occurred that have served as the catalyst for this update for clinicians. (1) Additional data from randomized controlled trials of cyclooxygenase (COX)-2–selective agents have been reported and summarized in meta-analyses, which has reinforced the concern about cardiovascular events with COX-2 inhibitors (coxibs; Figure 1). (2) Several reports have appeared that have identified an increased risk of cardiovascular events even with the nonselective NSAIDs, which has raised concern about the use of those agents as well (Table). (3) Regulatory authorities in several regions of the world have introduced warning statements and advisories to both healthcare professionals and the lay public about the use of various NSAIDs (Figures 2 and 3)./.../

Monday, February 26, 2007

Distribuição espacial da mortalidade por infarto agudo do miocárdio no Município do Rio de Janeiro, Brasil

O objetivo deste estudo é analisar a distribuição espacial da mortalidade por infarto agudo do miocárdio no Município do Rio de Janeiro, Brasil. Foram analisados dados sobre mortalidade por infarto agudo do miocárdio ocorrido em 2000, por meio do Sistema de Informação de Mortalidade. Utilizou-se o modelo bayesiano empírico de suavização a fim de minimizar a variabilidade aleatória dos coeficientes de mortalidade associada ao tamanho das unidades geográficas de análise. A distribuição dos óbitos por infarto agudo do miocárdio na cidade é heterogênea e obedece a um padrão espacial associado a um forte gradiente social. O padrão de sub-risco de mortalidade por infarto agudo do miocárdio observado na Zona Oeste não condiz com o perfil de desigualdade social e de acesso aos serviços de saúde observado na área. Acredita-se que o risco de morrer por infarto agudo do miocárdio foi subestimado em função da alta proporção de óbitos por causa mal definida na área. O padrão espacial de mortalidade apresentou uma concentração do risco de morrer de infarto nas áreas mais pobres da cidade. As diversas unidades de saúde apresentam áreas de influência para o atendimento ao infarto agudo do miocárdio.

Saturday, February 24, 2007

In the Stent Era, Heart Bypasses Get a New Look - New York Times

In the Stent Era, Heart Bypasses Get a New Look - New York Times
After more than a decade-long decline, is heart bypass surgery poised for a comeback?

Reconsidering Heart Bypass Surgery Some doctors say it may be time to give bypass operations a second look, including some cardiologists who specialize in the far more popular alternative — using stents to keep coronary arteries propped open.

No one is predicting a sudden surge back to bypass, which is still a far more invasive and initially riskier way to treat plaque-clogged heart arteries, a condition that afflicts millions of Americans.

The effect of statin therapy on infection-related mortality in patients with atherosclerotic diseases.

De: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]
Enviada em: sexta-feira, 23 de fevereiro de 2007 23:35

The effect of statin therapy on infection-related mortality in patients with atherosclerotic diseases.
Crit Care Med. 2007 Feb;35(2):372-8. Related Articles, Links

Almog Y, Novack V, Eisinger M, Porath A, Novack L, Gilutz H.

Medical Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel.

OBJECTIVE: Statins have pleiotropic effects that are independent of their lipid-lowering ability. We have previously shown that prior statin therapy is associated with a decreased risk of severe sepsis in patients admitted with acute bacterial infection. The aim of this study was to determine whether statin therapy is associated with a decreased risk of infection-related mortality. DESIGN: A prospective, observational, population-based study. SETTING: Tertiary university medical center. PATIENTS: Using a computerized database, 11,490 patients with atherosclerotic diseases were identified and followed for up to 3 yrs. Two groups of patients were compared: those receiving statins in the final month before follow-up termination and those who were not. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was infection-related mortality. Of the 11,362 patients included in the final analysis, 5,698 (50.1%) belonged to the statin group. Median follow-up was 19.8 months (interquartile range, 14.3-33.3). The risk of infection-related mortality was significantly lower in the statin compared with the no-statin group (0.9% vs. 4.1%), reflecting a relative risk of 0.22 (95% confidence interval, 0.17-0.28). Stepwise Cox proportional hazard survival analysis including a propensity score for receiving statins revealed that the protective effect of statins adjusted for all known potential confounders remained highly significant (hazard ratio, 0.37; 95% confidence interval, 0.27-0.52). CONCLUSIONS: Therapy with statins may be associated with a reduced risk of infection-related mortality. This protective effect is independent of all known comorbidities and dissipates when the medication is discontinued. If this finding is supported by prospective controlled trials, statins may play an important role in the primary prevention of infection-related mortality.

PMID: 17205009 [PubMed - in process]

Recommendations for the Standardization and Interpretation of the Electrocardiogram. Part I:

(Texto completo, bem como da parte II, a disposição para quem me enviar mensagem solicitandouma copia *pdf)
Recommendations for the Standardization and Interpretation of the Electrocardiogram. Part I: The Electrocardiogram and Its Technology. A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology
Paul Kligfield MD, FAHA, FACC, Leonard S. Gettes MD, FAHA, FACC, James J. Bailey MD, Rory Childers MD, Barbara J. Deal MD, FACC, E. William Hancock MD, FACC, Gerard van Herpen MD, PhD, Jan A. Kors PhD, Peter Macfarlane DSc, David M. Mirvis MD, FAHA, Olle Pahlm MD, PhD, Pentti Rautaharju MD, PhD, and Galen S. Wagner MD

Abstract--This statement examines the relation of the resting ECG to its technology. Its purpose is to foster understanding of how the modern ECG is derived and displayed and to establish standards that will improve the accuracy and usefulness of the ECG in practice. Derivation of representative waveforms and measurements based on global intervals are described. Special emphasis is placed on digital signal acquisition and computer-based signal processing, which provide automated measurements that lead to computer-generated diagnostic statements. Lead placement, recording methods, and waveform presentation are reviewed. Throughout the statement, recommendations for ECG standards are placed in context of the clinical implications of evolving ECG technology.

Wednesday, February 14, 2007

siesta for a healthy heart -

Embrace your siesta for a healthy heart - International Herald Tribune: "Could midday napping save your life?

If the experience of Greek men is any guide, the answer just may be yes.

In a study released yesterday, researchers at the Harvard School of Public Health and in Athens reported that Greeks who took regular 30-minute siestas were 37 percent less likely to die of heart disease over a six-year period than those who never napped. The scientists tracked more than 23,000 adults, finding that the benefits of napping were most pronounced for working men.

Researchers have long recognized that Mediterranean adults die of heart disease at a rate lower than Americans and Northern Europeans. Diets rich in olive oil and other heart-healthy foods have received some of the credit, but scientists have been intrigued by the potential role of napping.

The study, published in the Archives of Internal Medicine, concluded that napping was more likely than diet or physical activity to lower the incidence of heart attacks and other life-ending heart ailments."

Improved Cardiovascular Risk Predictor Developed for Women

Improved Cardiovascular Risk Predictor Developed for Women - CME Teaching Brief® - MedPage Today: "OSTON, Feb. 13 -- Two new risk factors added to the traditional risk model enhanced prediction of a woman's 10-year risk of cardiovascular disease or stroke, researchers reported.

Two versions of the revised model, with validated risk algorithms, reclassified 40% to 50% of women at 10-year risk into higher- or lower-risk categories, according to a report in the Feb. 14 issue of the Journal of the American Medical Association."

Monday, February 12, 2007

Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents: A Science Advisory From the American Hea

Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents: A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, With Representation From the American College of Physicians -- Grines et al. 115 (6): 813 -- Circulation: "Dual antiplatelet therapy with aspirin and a thienopyridine has been shown to reduce cardiac events after coronary stenting. However, many patients and healthcare providers prematurely discontinue dual antiplatelet therapy, which greatly increases the risk of stent thrombosis, myocardial infarction, and death. This advisory stresses the importance of 12 months of dual antiplatelet therapy after placement of a drug-eluting stent and educating the patient and healthcare providers about hazards of premature discontinuation. It also recommends postponing elective surgery for 1 year, and if surgery cannot be deferred, considering the continuation of aspirin during the perioperative period in high-risk patients with drug-eluting stents.

"

Educação Continuada

Educação Continuada
Revistas com acesso para sócios da SBC
Annals of Internal Medicine
American Heart Journal(AHJ)
Archives of Internal Medicine
Thrombosis, and Vascular Biology
BMJ
Cardiology in Review
Chest
Circulation
Circulation Research
Clinical Journal of Sport Medicine
Coronary Artery Disease
Critical Pathways in Cardiology
Current Opinion in Cardiology
Current Opinion in Endocrinology & Diabetes
Diabetes Care
Epidemiology
European Heart Journal
European Journal of Cardiovascular Prevention and Rehabilitation
Heart
Hypertension
JAMA
Journal of Cardiovascular Electrophysiology
Journal of Cardiovascular Pharmacology
Journal of Hypertension
Journal of the American Society of Echocardiography
New England Journal of Medicine
Pacing & Clinical Electrophysiology
Stroke

Wednesday, February 07, 2007

Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee -- Rosamond et al. 115 (5): e69 -- Circulation: "The American Heart Association (AHA) works with the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS); the National Heart, Lung, and Blood Institute (NHLBI); the National Institute of Neurological Disorders and Stroke (NINDS); and other government agencies to derive the annual statistics in this Update. This chapter describes the most important sources and the types of data we use from them. For more details and an alphabetical list of abbreviations, see Chapter 21 of this document, the Glossary and Abbreviation Guide."

Associations of Gestational Age and Intrauterine Growth With Systolic Blood Pressure in a Family-Based Study of 386 485 Men in 331 089 Families -- Law

Background— We conducted a family-based study to explore mechanisms underlying the associations of birth weight and gestational age with systolic blood pressure measured at 17 to 19 years of age.

Methods and Results— A record linkage study of 386 485 singleton-born men from 331 089 families was undertaken. Birth weight was inversely associated with systolic blood pressure within siblings, with a mean difference (adjusted for age at examination, examination center, and year of examination) within siblings per 1-SD difference in birth weight of –0.21 mm Hg (95% CI, –0.33 to –0.08) and between nonsiblings of –0.12 (95% CI, –0.16 to –0.08). Gestational age was inversely associated with systolic blood pressure within siblings (–0.18 mm Hg; 95% CI, –0.25 to –0.11, per week of gestational age) and between nonsiblings (–0.26 mm Hg; 95% CI, –0.29 to –0.24). Adjustment for socioeconomic position and maternal characteristics did not alter these within- or between-family associations. Furthermore, the associations were not affected by adjustment for paternal height, body mass index, or systolic blood pressure.

Conclusions— Our present findings suggest that the inverse associations of birth weight and gestational age with systolic blood pressure are not explained by confounding resulting from family socioeconomic position or other factors that are shared by siblings. Variations in maternal metabolic or vascular health during pregnancy or placental implantation and function may explain these associations.

Thursday, February 01, 2007

Management of congenital stenosis of a branch pulmonary artery with balloon dilation angioplasty. Report of 52 procedures

Twenty-four children, aged 4 months to 16 years (nine patients 2 years old or younger), underwent balloon dilation angioplasty of hypoplastic or stenotic branch pulmonary arteries between July, 1981, and April, 1984. Most children had tetralogy of Fallot, with or without pulmonary atresia, or isolated peripheral pulmonary artery stenosis. Fifty-two dilations were attempted, 44 in the catheterization laboratory and eight in the operating room. Of these, 26 (50%) were judged successful; the average vessel diameter on angiogram increased from 4.1 +/- 0.3 to 7.2 +/- 0.3 mm (76%), the gradient across the narrowed segment fell from 60 +/- 10 to 36 +/- 5 mm (40%), pressure in the main pulmonary artery or right ventricle proximal to the obstruction decreased from 83 +/- 10 to 66 +/- 6 mm Hg (20%), and the radionuclide-determined fraction of cardiac output directed to the lung ipsilateral to the dilated pulmonary artery increased from 40 +/- 4 to 51 +/- 4 (28%). All changes were significant at the p less than 0.005 level. Reasons for failure included inadequate technique (balloon too small, inability to position balloon or wire) in 14 and the refractory nature of the lesion itself in 11. Technical failures were age independent. Nondilatable lesions were more common in children more than 2 years old (10/25 versus 1/10) or with isolated peripheral pulmonary artery stenosis (5/7). Five of seven stenoses near previous shunts were nondilatable. One child exsanguinated when the pulmonary artery ruptured during dilation, but other complications were few. Eight dilations, followed up for an average of 6 months after dilation, showed angiographic persistence of improvement; two of four lesions were successfully redilated to a larger size. Balloon dilation angioplasty appears beneficial, both short and long term, for some patients with hypoplastic or stenotic branch pulmonary arteries, especially if performed early in life.