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Prevalence of Conventional Cardiovascular Risk Factors in Patients with Acute Coronary Syndrome
Get PDFBackground: Primary prevention studies have shown that early detection and aggressive treatment of cardiovascular risk factors (CRF) prevent cardiovascular events. It is not well described the prevalence of CRF in patients, at the moment of admission due to acute coronary syndrome (ACS).
Aim: To determine the prevalence of CRF among patients admitted with ACS.
Methods: We analysed 4871 patients admitted consecutively in our coronary care unit with a diagnosis of ACS and included in a prospective registry, from January 2002 to October 2013. We studied the prevalence of conventional risk factors (diabetes, hypertension, smoking, dyslipidaemia) and compared findings according to gender and type of ACS: ACS with ST elevation (STEMI), ACS without ST elevation (NSTEMI).
Results: Men represented 75% (n=3658) of the total population, were younger than women (61.6±12,9 vs 70.9 ±11.8 years; p<0.001) and had more frequently body mass index ≥ 25 kg/m2 (70.9% vs 62.3%; p<0.001). The most frequent CRF was hypertension (62.4%; n=3038), followed by dyslipidaemia (50.6%, n=2467), smoking (43.2%; n=2106) and diabetes (27.2%; n=1324). In women, the more common CRF were hypertension (75%) and dyslipidaemia (51.2%), whereas in men were smoking (54.4%) and dyslipidaemia (50.5%). We identify, at least, one CRF in 92,4% of all patients and two or three risk factors in 58.1%. Women had more frequently 2 CRF than men (40.1% vs 36.3%; p=0.011), although mean had, more often, 4 CRF (8.9% vs 4.1%; p<0.001). Previous history of cerebrovascular disease was more observed in women (8.6% vs 6.1%; p=0.002), but men had more often history of previous revascularization (9.8% vs 6.8%; p<0.001). On admission men presented more frequently STEMI (50.8% vs 43.5%; p<0,001) and less frequently renal dysfunction (17.2% vs 39.6%; p<0.001) and anaemia (18.8% vs 33.3%; p<0.001). Hypertension was the most prevalent CFR as in patients STEMI (56.6%) as in NSTEMI patients (67.9%), followed by smoking (47.5%) in STEMI patients and by dyslipidaemia (55.7%) in NSTEMI patients.
Conclusion: We found at least one CRF in 92.8% of patients and two or three in more than half. Hypertension emerged as the major CRF in both forms of presentation of ACS
Cotard Syndrome without Depressive Symptoms in a Schizophrenic Patient.
Get PDFIntroduction. Cotard syndrome is a rare condition characterized by nihilistic delusions concerning body or life that can be found in several neuropsychiatry conditions. It is typically associated with depressive symptoms. Method. We present a case of Cotard syndrome without depressive symptoms in the context of known paranoid schizophrenia. A literature review of Cotard syndrome in schizophrenia was performed. Results. Although there are few descriptions of this syndrome in schizophrenia, patients usually present depressive mood and psychomotor retardation, features not seen in our patient. Loss of the sense of the inner self, present in schizophrenia, could explain patient's symptomatology but neurobiological bases of this syndrome remain unclear. Conclusion. Despite not being considered in actual classifications, Cotard syndrome is still relevant and psychiatric evaluation is critical to diagnosing and treating this condition in psychiatric patients
Are there differences on prognosis among patients with previous ischemic heart disease versus cerebrovascular disease admitted with acute coronary syndrome?
No full textBackground: It is known that patients with previous vascular disease (PVD) have a poorer outcome than those without these previous conditions, and prognosis worsens as the number of affected vascular beds increases.
Aim: To evaluate if there are differences in in-hospital and 6-month mortality among patients admitted with acute coronary syndromes with previous ischemic heart disease (IHD) versus cerebrovascular disease (CVD).
Methods: We analysed 4871 patients (pts) admitted consecutively in our coronary care unit with a diagnosis of acute coronary syndrome and included in a prospective registry, from January 2002 to October 2013. Patients were divided in 3 groups: group 1 - pts without PVD (n=3718, 76.3%); group 2 – pts with previous IHD (n=825, 16.9%); group 3 - pts with previous CVD (n=257, 5.3%). We excluded pts with previous IHD plus CVD (n=71, 1.5%). For each group we compared clinical features and adverse events. Primary endpoint was the occurrence of death at 6 months; follow-up was completed in 98% of patients.
Results: Pts in group 3 were older (63±13 vs 67±12 vs 71±11;p25kg/m2 (47.1% vs 52.5% vs 50.8%; p=0.016), dyslipidaemia (46% vs 69.3% vs 52.1%;p1 (19.6 % vs 29.6% vs 34.2%;p<0.001), anaemia (19.8% vs 28.6% vs 33.9%;p<0.001) and renal insufficiency (eGFR <60 ml/min) (19.2% vs 31% vs 40.9%;p<0,001). Group 2 presented more severe coronary artery disease (11.7% vs 22.2% vs 16.7%;p<0.001) and higher prevalence of left ventricular dysfunction (56.2% vs 61.8% vs 58.4%;p=0.03). ST-segment myocardial infarction was more prevalent in Group 1 (54.5% vs 25.6% vs 51%;p<0.001), while myocardial infarction without ST-elevation was more frequent in group 2 (41.2% vs 65% vs 45.5%;p<0.001). In-hospital (4.5% vs 4.7% vs 7.0%;p<0.001) and 6-month mortality (8.7% vs 10.6% vs 16.5%;p<0.001) were higher in patients with previous CVD. In multivariate analysis and after adjusting for different baseline characteristics, pts with previous CVD had higher risk of 6-month mortality compared to those without PVD [OR 1.67, 95% CI (1.06-2.63),p=0.026].
Conclusion: Previous CVD remained as a strong predictor of 6-month mortality in patients admitted with acute coronary syndrome
Incidence of in-stent restenosis over 13 years - a study based on a national registry
Get PDFBackground: In-stent restenosis (ISR) is one drawback of coronary angioplasty with stent implantation.
Purpose: We investigated the incidence of ISR, its clinical presentation and treatment from a national registry.
Methods: From all patients (pts) undergoing percutaneous coronary intervention (PCI) from 2002 to 2014, we selected those who had previous history of PCI (n=15326). ISR was defined as diameter stenosis ≥ 50% in stent segment, being selected the interventions in which, at least, 1 IRS lesion was treated (n=3069). They were divided in 3 temporal groups:2002-2003 (group 1, n=179, 5.8%)– bare metal stent era; 2004-2008 (group 2,n=816, 26.6%)– 1st generation stent era; 2009-2014 (group 3, n=2074, 67.6%)– 2nd generation stent era. For each group we compared clinical features and treatment.
Results: Over time, it has been observed a reduction in IRS incidence (24.8 vs 23.5 vs 18.6%;p for trend <0.001). Pts from group 3 were older (p=0.01), had higher prevalence of hypertension (63.7 vs 75.6 vs 78.4%;p<0.001), dyslipidemia (61.5 vs 68.5 vs 73.9%;p<0.001) and diabetes (31.3 vs 33.5 vs 38.5%;p=0.012). They also had more frequently history of previous myocardial infarction (p<0.001). Although admissions were more frequently due to stable angina (41% of total) or post non-ST segment myocardial infarction (16.3% of total); it was noticed, over time, an increase in admissions due to ST segment elevation myocardial infarction (1.1 vs 7.4 vs 11.4%;p<0.001) and unstable angina (1.1 vs 1.8 vs 3.7%;p<0.001). Most of pts presented with good systolic ventricular function, but an increase of pts with moderated (2.6 vs 9.0 vs 11.2%;p<0.001) and severe (1.3 vs 1.4 vs 4.7%;p<0.001) systolic dysfunction was observed. From 3069 PCI performed, a total of 3461 IRS lesions were treated. It was observed, at most, 3 IRS lesions for PCI. Over time, the most frequent presentation was 1 lesion for PCI (88.4% of total), being noticed a decreasing in number of multiple IRS lesions (15.1 vs 11.3 vs 9.6%;p=0.035). Incidence of ISR has increased in left descendant coronary artery (34.5 vs 39.8 vs 42.4%;p<0.001) and treatment was more frequently performed in more complex lesions (p<0.001). It was noticed a reduction in treatment with stent (72.7 vs 74.4 vs 52.8%;p<0.001) and an increasing use of only PCI balloon (39.3 vs 57.8 vs 45.8%;p=0.002) and trombectomy (0.0 vs 2.2 vs 8.2%;p<0.001).
Conclusion: In spite of increasing in risk profile of pts over time, it was observed a reduction of incidence of ISR and multiple ISR lesions. It also was observed an increasing number of interventions avoiding second stent implantation
Hyperosmolar hyperglycaemic state and diabetic ketoacidosis – a 5 year retrospective study in a university hospital
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Hipopituitarismo Pós-abortamento: a propósito de um caso clínico
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Experiência do Serviço de Endocrinologia do Hospital de Braga no Tratamento de Diabéticos Tipo 1 com Bombas Infusoras de Insulina
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Prevalence and predictors of alcohol and tobacco consumption in adolescence: The role of weight status, clinical status and psychosocial dimensions
Get PDFKikuchi´s disease of the xanthomathous type with cutaneous manifestation
Get PDFKikuchi's disease is a benign, self-limiting disease, whose pathogenesis remains unknown. Patients most often present with cervical lymphadenopathy, sometimes associated with fever and leukopenia. It has been reported that up to 40% of patients with Kikuchi's disease have also cutaneous eruptions, but no specific skin changes have been described. Kikuchi's disease can be subclassified into three histologic subtypes: a proliferative type, a necrotizing type and a xantomathous type. Most patients with Kikuchi's disease require no specific treatment, because the disease regresses spontaneously, within a few weeks to months. We report a case of a 31-year-old woman with xanthomatous type of Kikuchi's disease, whose first manifestation was the onset of erythematous papules with central suppuration on her face and on her left hand