JUSTIFICATIVA E OBJETIVOS: O controle glicêmico intensivo ocupa lugar de destaque no manuseio dos pacientes críticos. O objetivo desde estudo foi avaliar a efetividade e a segurança do protocolo de insulinoterapia por via venosa de Yale nos pacientes críticos internados em unidade de terapia intensiva geral em hospital comunitário. MÉTODO: Foi realizado um estudo retrospectivo e comparativo entre 2 coortes de pacientes críticos, antes e após a implantação do controle glicêmico intensivo. Os desfechos de interesse do estudo foram glicemia média durante o tratamento, tempo para atingir a faixa alvo de 80 a 140 mg/dL, percentual de glicemia
The coronary computed tomography angiography has recently emerged as an accurate
diagnostic tool in the evaluation of coronary artery disease, providing
diagnostic and prognostic data that correlate directly with the data provided by
invasive coronary angiography. The association of recent technological
developments has allowed improved temporal resolution and better spatial
coverage of the cardiac volume with significant reduction in radiation dose, and
with the crucial need for more effective protocols of risk stratification of
patients with chest pain in the emergency room, recent evaluation of the
computed tomography coronary angiography has been performed in the setting of
acute chest pain, as about two thirds of invasive coronary angiographies show no
significantly obstructive coronary artery disease. In daily practice, without
the use of more efficient technologies, such as coronary angiography by computed
tomography, safe and efficient stratification of patients with acute chest pain
remains a challenge to the medical team in the emergency room.Recently, several studies, including three randomized trials, showed favorable
results with the use of this technology in the emergency department for patients
with low to intermediate likelihood of coronary artery disease. In this review,
we show data resulting from coronary angiography by computed tomography in risk
stratification of patients with chest pain in the emergency room, its diagnostic
value, prognosis and cost-effectiveness and a critical analysis of recently
published multicenter studies.
In this original direct comparison, a DHP spiral protocol for coronary CT angiography acquisition in patients with atrial fibrillation resulted in lower radiation exposure and superior image quality compared with conventional spiral retrospective acquisition.
Background: Although associated with traditional cardiovascular risk factors, it is unclear whether obesity alone is associated with coronary artery disease (CAD).Objective: To investigate the role of obesity as a risk factor for CAD, defined by coronary computed tomography angiography (CCTA).Methods: This study retrospectively included 1,814 patients referred for CCTA in a hospital in São Paulo, from August 2010 to July 2012. CAD was identified by coronary calcium score and presence of coronary stenosis > 50%.Images were analyzed by two specialists, and the coronary findings were compared between obese and non-obese groups. A multivariate analysis model was used to assess obesity as an independent variable for the occurrence of obstructive CAD.Results: Among the study population, mean age was 58.5 +/-11.5 years, 22.8% were obese (BMI = 30 kg/m 2 ) and 66.3% were male. The prevalence of obstructive CAD was 18.4% in both groups. Obese patients had higher median calcium score compared to non-obese subjects (14.7 vs. 1.4, respectively, p = 0.019). In the multivariate analysis, obesity was not an independent factor for obstructive CAD (coefficient = -0.035, p = 0.102).
Conclusion:Although no differences were observed in the prevalence of obstructive CAD between obese and non-obese individuals, coronary calcium scores were significantly in lower the latter group.
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