Funding Acknowledgements Type of funding sources: None. Background The presence of carotid plaque has been associated with an increased risk for acute coronary events, and can be assessed with a low-cost and readily available study such as carotid ultrasound. This has a class IIa recommendation to reclassify patients with intermediate risk, but little is known about the prevalence of carotid disease in patients with acute coronary syndromes. Methods Observational study in patients admitted for STEMI in a tertiary care center, performing a carotid ultrasound before hospital discharge. We analyzed the differential characteristics according to the presence of carotid plaque, as well as the atherosclerotic burden assessed by the number of diseased vessels. Results We included 191 patients with STEMI, and 57 (29.8%) had carotid plaque. Their basal characteristics and outcomes are listed in the table. Patients with subclinical atherosclerotic disease were older, but other risk markers were similar, as was the use of aspirin and statins. The prevalence of carotid disease increased with the number of diseased vessels, as seen in the figure. Conclusion About 1 in 3 patients with STEMI had carotid plaque detectable by ultrasound. Most were young with an intermediate basal risk for cardiovascular disease, with only a minority treated with statins or aspirin, and could have been reclassified as high risk with a timely ultrasound. No other risk factors but age was associated with the presence of carotid plaque, emphasizing the importance of carotid ultrasound screening in older patients. Characteristics by carotid plaqueOverallCarotid plaque absentCarotid plaque presentpn17011357Age56.63 ± 10.9254.36 ± 9.9361.12 ± 11.48<0.001Males146 (85.9%)98 (86.7%)48 (84.2%)0.833Diabetes30 (17.8%)18 (16.1%)12 (21.1%)0.556Hypertension95 (55.9%)61 (54.0%)34 (59.6%)0.590Smoker122 (72.2%)85 (75.9%)37 (64.9%)0.185Obesity31 (18.2%)23 (20.4%)8 (14.0%)0.425LDL-cholesterol (mg/dl)115.97 ± 42.51117.84 ± 44.02110.78 ± 38.720.550Statin use31 (18.6%)19 (17.0%)12 (21.8%)0.585Aspirin use38 (22.6%)24 (21.2%)14 (25.5%)0.677GRACE score105.66 ± 29.30100.61 ± 27.63115.66 ± 30.250.005Stroke1 (0.6%)0 (0.0%)1 (1.8%)0.723Hospital mortality5 (3.1%)2 (1.9%)3 (5.5%)0.441Abstract Figure. Carotid plaque by diseased vessels.
Os desvios de conduta que ensejam a exclusão do policial militar devem ser considerados como estratégicos. Pois, além de macular a imagem da corporação e tender à uma possível sistematização, minam a efetividade operacional. O trabalho logrou em descobrir que mais da metade das exclusões são decorrentes de infrações com dano considerado predatório, tendentes à sistematização e interação com demais estruturas públicas e privadas. Foi realizado análise de risco de tais condutas corruptivas, identificando e categorizando as Unidades. Outrossim, foi feito a identificação em rede, apresentando o risco e influência de cada Unidade nas demais, com base no histórico de movimentações do policial excluído; os resultados sugerem que as Unidades tendem à homofilia e as métricas de rede podem ser utilizadas subsidiariamente na avaliação de risco.
Pooled immunoglobulin (Ig) is a scarce and expensive resource, hypertension is the leading cause of death worldwide (as of 2010) [1] as the new blood pressure guidelines in 2017 make note of [2], and there is something that can be done to address both. In this article, we summarize the salient developments in the treatment of hypertension as well as put forward the hypothesis that employing thiazides in patients on chronic Ig replacement therapy may provide the dual benefit of treating blood pressure as well as increasing plasma concentration of immunoglobulins. Furthermore, there may be a side benefit to public health by increasing the supply of pooled immunoglobulin.