Our aim was to determine the frequencies of the angiotensin-converting enzyme (ACE) gene alleles D and I and any associations to cardiovascular risk factors in a population sample from Rio de Janeiro, Brazil. Eighty-four adults were selected consecutively during a 6-month period from a cohort subgroup of a previous large cross-sectional survey in Rio de Janeiro. Anthropometric data and blood pressure measurements, echocardiogram, albuminuria, glycemia, lipid profile, and ACE genotype and serum enzyme activity were determined. The frequency of the ACE*D and I alleles in the population under study, determined by PCR, was 0.59 and 0.41, respectively, and the frequencies of the DD, DI, and II genotypes were 0.33, 0.51, and 0.16, respectively. No association between hypertension and genotype was detected using the Kruskal-Wallis method. Mean plasma ACE activity (U/mL) in the DD (N = 28), DI (N = 45) and II (N = 13) groups was 43 (in males) and 52 (in females), 37 and 39, and 22 and 27, respectively; mean microalbuminuria (mg/dL) was 1.41 and 1.6, 0.85 and 0.9, and 0.6 and 0.63, respectively; mean HDL cholesterol (mg/dL) was 40 and 43, 37 and 45, and 41 and 49, respectively, and mean glucose (mg/dL) was 93 and 108, 107 and 98, and 85 and 124, respectively. A high level of ACE activity and albuminuria, and a low level of HDL cholesterol and glucose, were found to be associated with the DD genotype. Finally, the II genotype was found to be associated with variables related to glucose intolerance.
After an Acute Myocardial Infarction (AMI), the sooner the patient is approached, the greater are the chances that pharmacological therapy (using thrombolytics) be more effective than surgical intervention. Nevertheless, the thrombolytic therapy may have hazard effects on AMI patients that present any contraindication to it. As a consequence, paramedics usually hesitate about applying the thrombolytic therapy-preferring to immediately transfer patients to coronary care units (CCUs)-unless cardiologists support their decision. To cope with this scenario, we envision a ubiquitous telemedicine system for supporting cardiologists and paramedics in (i) the remote decision upon the eligibility of AMI patients to the thrombolytic therapy and (ii) the remote monitoring of patients being transferred. socalled In this paper, we present AToMS (AMI Teleconsultation & Monitoring), a system that makes extensive use of (possibly heterogeneous) wireless communication technology to allow its use by a paramedic at the location where the AMI patient is first assisted, thus reducing the delay between the onset of symptoms and the eventual application of proper treatment. All exchanged messages among paramedics and cardiologists are recorded, thus rendering a fully auditable system.
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