SummaryAtrial fibrillation (AF) is an arrhythmia frequently seen in the postoperative period of cardiac surgery. In this context, it is associated with the presence of comorbidities, longer length of hospital stay, and higher costs related to surgery.The mechanisms involved in the genesis of AF in the postoperative period of cardiac surgery (AFPO) are different from those causing paroxysmal AF. Knowledge of these mechanisms permits the use of efficient measures to reduce the incidence of this arrhythmia.According to recommendations of the literature, treatment is efficient and safe, because the rates of reversion to sinus rhythm are high and complications are reduced, and it is not associated with a high frequency of side effects.
BackgroundThe prevalence of atherosclerosis is higher in HIV-positive people, who also
experience it earlier than the general population.ObjectivesTo assess and compare the prevalence of atherosclerosis evaluated by the
intima-media thickness of carotid and femoral arteries, and by the
ankle-brachial pressure index (ABPI) in HIV patients treated or not treated
with protease inhibitors (PIs) and controls.MethodsEighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were
included in the study. Atherosclerosis was diagnosed by (carotid and
femoral) ITM measurement and ABPI. Classical risk factors for
atherosclerosis and HIV were compared between the groups by statistical
tests. A p ≤ 0.05 was considered significant.ResultsAn IMT > P75 or the presence of plaque was higher in the HIV+
than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis
showed a significant difference (p=0.014) in carotid IMT between HIV+ with
PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and
controls (0.59 ± 0.11 mm). There was no significant difference in
femoral IMT between the groups or in ABPI between HIV+ subjects and
controls. However, a significant difference (p=0.015) was found between HIV+
patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07
- 1.17]).ConclusionIn HIV patients, atherosclerosis is more prevalent and seems to occur earlier
with particular characteristics compared with HIV-negative subjects.
The adherence to antihypertensive drugs and low salt diet improved after the CEP. Preliminarily, this telehealth strategy suggests a positive impact on hypertensive patients.
Background
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by
mutations in the alpha galactosidase A gene (GLA) that lead to the enzymatic
deficiency of alpha galactosidase (α-Gal A), resulting in the
accumulation of globotriaosylceramide (Gb3) and globotriaosylsphingosine
(lyso-Gb3), causing multiple organ dysfunctions.
Objective
To perform GLA gene screening in a group of patients with echocardiographic
diagnosis of hypertrophic cardiomyopathy (HCM).
Methods
a cross-sectional study was conducted with HCM patients from a university
hospital. Patients with coronary artery disease and valvulopathies were
excluded. Mutation analysis of the GLA gene was performed. In male subjects,
the analysis was performed after evidence of low α-Gal A
activity.
Results
60 patients with echocardiographic diagnosis of HCM were included. Age ranged
from 12 to 85 years and 60% were women. Mean myocardial fibrosis percentage
on MRI was 10.7 ± 13.1% and mean ventricular thickness was18.7
± 6.7 mm. Four patients had the following GLA gene mutations:
c.967C>A (p.Pro323Thr), not yet described in the literature; c.937G>T
(p.Asp313Tyr); and c.352C>T (p.Arg118Cys). All patients had normal levels
of lyso-Gb3 and non-ischemic myocardial fibrosis on magnetic resonance
imaging; one patient had proteinuria and one patient had ventricular
tachycardia.
Conclusion
in this study, the frequency of mutation in the GLA gene in patients with HCM
was 6.7%. A novel mutation in exon 6 of the GLA gene, c.967C>A
(p.Pro323Thr), was identified. Patients with HCM may have GLA mutations and
FD should be ruled out. Plasma (lyso-Gb3) levels do not seem to be
sufficient to attain a diagnosis and organ biopsy should be considered.
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