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Biomedical subjects

Bruno Caramelli

Publications and source records attributed to Bruno Caramelli.

At least 19 recordsLinked to original sources
PubMed2007

Misuse of antithrombotic therapy in atrial fibrillation patients: frequent, pervasive and persistent.

PURPOSE: To assess the use of antithrombotic therapy among atrial fibrillation (AF) patients in a Brazilian University Heart Hospital (InCor). METHODS AND RESULTS: In a cross-sectional study we analyzed the charts of all patients treated at InCor in five separate days of 2002 (Phase 1). To assess the impact of admission to a cardiology hospital, a follow-up of the AF patients selected in Phase 1 was carried out after 1 year (Phase 2). The prevalence of AF in the 3,764 assessed charts was 8.0% (301 patients). In Phase 1, antiplatelets were prescribed to 21.2% and anticoagulant therapy (ACT) to 46.5% of AF patients; in Phase 2, to 19.9 and 57.8%, respectively. Thus, 32.2% (Phase 1) and 22.2% (Phase 2) of AF patients were not receiving any antithrombotic drug. Among AF patients with previous ischemic stroke (17.6%), only 49% (Phase 1) and 60.4% (Phase 2) were receiving ACT. As many as 34 and 22.6%, respectively, were not receiving any antithrombotic drug. After follow-up, a new acute embolic event was documented in 5.6% of patients, 17% died. CONCLUSIONS: Anticoagulation is underused in AF patients and neither the fact of being treated by cardiologists in a University Hospital, nor the learning time-window of 1 year seemed to improve the antithrombotic care significantly.

Adolescent↗
PubMed2006

[Hemodynamic instability in liver transplant: a challenge for the intensivist].

OBJECTIVES: Although of great importance for all those involved in liver transplant, in literature there is no consensual description on its hemodynamic behavior. This study intends to describe the hemodynamic behavior during and in the first 48 h after liver transplant . METHODS: A prospective and consecutive study of 61 patients was carried out; 50 were male, with average age of 49 years (18-70 years). Hemodynamic measurements were followed up at the beginning of the surgery, 30 minutes after revascularization of the graft and afterwards 6 hours up to 48 h post revascularization. Weight was obtained upon hospital admission and at 6 o'clock on the first and second postoperative days. RESULTS: mean arterial pressure starts to increase soon after surgery, reaching significantly higher values 24 h after revascularization. Cardiac index increases significantly soon after revascularization, progressively returning to preoperative values. Likewise the systemic vascular resistance falls significantly immediately after revascularization, reaching values similar to the preoperative ones 24 h after revascularization. The pulmonary wedge pressure rises significantly 6 hours after revascularization and there is a significant weight increase at the end of the first postoperative day. CONCLUSIONS: During the first hours after liver transplant an intense hemodynamic variation is noted with progressive increase in the systemic arterial pressures and in the pulmonary wedge pressure. Furthermore, significant although transitory variations of the cardiac index and of the systemic vascular resistance demand continuous surveillance to minimize their consequences.

Adolescent↗
PubMed2006

[Hypolipidemic therapy under special conditions: acquired immune deficiency syndrome].

Lipid alterations can be observed early among patients with AIDS disease. Commonly, these lipid abnormalities include low HDL-C and modest increase in triglyceride plasma levels. Highly Active Anti-Retroviral Therapy (HAART) in these patients may aggravate the dyslipidemia, with notable increases in triglycerides as well as in LDL-C. There are several mechanisms proposed to explain the mixed hyperlipidemia observed in these subjects, including different steps in lipid metabolism. The importance of the treatment of dyslipidemia became evident with the increased life expectancy and reports of cardiovascular complications in these individuals. There is an insulin resistance state in patients with AIDS disease under treatment with HAART, who present with lipodystrophy, hypertriglyceridemia, low levels of HDL-C. Antiretroviral drugs are metabolized by CYP P450 3A4 and interactions with some statins, especially with simvastatin are expected to occur. Treatment with lipid-lowering agents should be based on lipid profile and coronary risk. For hypertriglyceridemias, fibrates (mainly fenofibrate or bezafibrate) should be the drugs of choice, as well as statins (mainly pravastatin). Combined treatment using fibrates plus statins are recommended for severe mixed hyperlipidemias under very close monitoring for adverse effects.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Infection complication portends poor prognosis in acute myocardial infarction.

OBJECTIVE: To determine both the incidence and impact of infectious complications of acute myocardial infarction (AMI) on length of hospital stay and mortality. METHODS: This is a retrospective, case-control clinical trial involving medical records review. The study population consisted of patients admitted to the Coronary Care Unit (CCU) of the Hospital das Clínicas Heart Institute of the University of São Paulo Medical School--FMUSP--with AMI between January 1996 and December 1999. RESULTS: One thousand two hundred and twenty-seven patients were analyzed, and 60 (5%) met diagnostic criteria for infectious complication of AMI (infected group). The other 1167 patients served as control group. Mean age (67.5 versus 62.6), hospital length of stay (26.6 versus 12.0 days), and in-hospital mortality (45% versus 12%) were higher in the infected group. Mortality rate was higher among patients who underwent more than three invasive procedures (68% and 32%, p = 0.006). The most frequent infections were pulmonary (63%), urinary tract (37%) and positive blood cultures with no identifiable site of infection (8%). CONCLUSION: In the population studied, infectious complication rate was 5%. Prolonged hospital stay and high mortality rate suggest that infection complication has a great impact on AMI patients admitted to the coronary care unit.

Adult↗
PubMed2005

[Age and psychologic disorders. Variables associated to post-infarction sexual dysfunction].

OBJECTIVE: Data on sexual disfunction (SD) after myocardial infarction (MI) are sketchy, especially in our community and in regard to predictors. Both males and females, with active sexual life and no sexual dysfunction prior to MI were evaluated in order to investigate SD incidence after MI, as well as to identify the possible variables associated. METHODS: Forty-three patients were studied consecutively, through structured questionnaires for SD and psychological disorders (PD) diagnosis. The interference of classic risk factors was analysed for atherosclerosis, for PD and for the use of medications when SD was present up to month 6 after MI. RESULTS: After MI, 91% of patients resumed sexual activity. Twenty-six patients (60%) reported sexual dysfunction up to month 6 from hospital discharge (9 with precocious ejaculation (PE), 15 with erectile dysfunction (ED), and 20 with hypoactive sexual desire disorder (HSDD). PD patients reported sexual dysfunction at higher frequency as compared to those who did not report PD (100% x 47%, p=0.001). The sexual dysfunction group was significantly older than the group not reporting sexual dysfunction: 53+/-8.9 years of age versus 47+/-8.7 years of age (p=0.04). CONCLUSION: Patients reported significant reduction of sexual activity frequency and high incidence of SD after acute myocardial infarction (AMI). PD and older age were shown to be associated to higher incidence of post-infarction SD.

Adolescent↗
PubMed2004

Eggplant (Solanum melongena) extract does not alter serum lipid levels.

OBJECTIVE: To compare the effect of eggplant extract on serum lipid levels with that of lovastatin. METHODS: The study included 21 individuals of both sexes, with total cholesterol (TC) levels > 200 mg/dL, no diabetes, no contraindication for the use of statins, and no use of cholesterol-lowering drugs, divided into the following 3 groups: 1) the eggplant group (B), in which the patients drank 1 glass of eggplant extract with orange juice before breakfast each morning; 2) the statin group (E), in which the patients received 20 mg of lovastatin in the evening after dinner; 3) control group (C), in which the patients received no treatment. Total cholesterol and fractions (HDL, LDL), and triglycerides were measured 3 times at 3-week intervals. RESULTS: The baseline lipid levels were similar in the 3 groups. After 6 weeks, a significant reduction in TC levels (from 245.29 +/- 41.69 to 205.71 +/- 46.45; P=0.02) and in LDL-cholesterol levels (from 170.83 +/- 41.76 to 121.29 +/- 44.90; P=0.008) was observed in group E. In group B, total cholesterol (from 230.60 +/- 19.30 to 240.20 +/- 16.22; P=0.27) and LDL-cholesterol (from 139.60 +/- 21.49 to 154.40 +/- 9.66; P=0.06) showed no statistically significant variation, as in group C. No significant variation was observed in the HDL-cholesterol and triglyceride levels in the 3 groups throughout the study. CONCLUSION: The eggplant extract with orange juice is not to be considered an alternative to statins in reducing serum levels of cholesterol.

Anticholesteremic Agents↗
PubMed2004

Hemodynamic and tissue oxygenation responses to exercise and beta-adrenergic blockade in patients with hyperthyroidism.

BACKGROUND: Exercise-induced dyspnea is a frequent feature in patients with hyperthyroidism. HYPOTHESIS: Data from clinical studies to elucidate the origin of this symptom are lacking. In the current study, we examined the hemodynamic and oxygenation responses to exercise and beta-adrenergic blockade in patients with hyperthyroidism and their relationship with dyspnea. METHODS: Hemodynamic studies were performed under resting conditions and after isotonic exercise in 15 patients with hyperthyroidism and 11 control subjects. Exercise was applied using a bicycle ergometer, with progressive loads. In the hyperthyroid group, measurements were repeated at rest and during supine exercise after administering 15 mg of intravenous metoprolol. RESULTS: End-diastolic pulmonary artery pressure and cardiac index were higher in the hyperthyroid group than in controls (18.6 +/- 5.3 vs. 11.2 +/- 4.9 mmHg; p = 0.02, and 6.0 +/- 1.7 vs. 2.8 +/- 0.5 l/min/m2; p = 0.0001, respectively). After exercise, there was an increase in end-diastolic pulmonary artery pressure in the hyperthyroid group (18.6 +/- 5.3 to 25.5 +/- 9.9 mmHg; p = 0.02), revealing impaired cardiocirculatory reserve. Pulmonary arteriolar resistance increased significantly in parallel with end-diastolic pulmonary artery pressure after drug administration, suggesting an inadequate cardiovascular response after beta blockade in patients with hyperthyroidism. CONCLUSION: We observed that functional left ventricular reserve is impaired in patients with hyperthyroidism, suggesting an explanation for the frequent symptom of dyspnea and impaired exercise tolerance. Moreover, we also suggest that beta-adrenergic blockade may adversely affect cardiovascular function in patients with hyperthyroidism.

Adrenergic beta-Antagonists↗
PubMed2004

Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial.

OBJECTIVES: This prospective, randomized, placebo-controlled, double-blind clinical trial was performed to analyze the effect of atorvastatin compared with placebo on the occurrence of a 6-month composite of cardiovascular events after vascular surgery. Cardiovascular complications are the most important cause of perioperative morbidity and mortality among patients undergoing vascular surgery. Statin therapy may reduce perioperative cardiac events through stabilization of coronary plaques. METHODS: One hundred patients were randomly assigned to receive 20 mg atorvastatin or placebo once a day for 45 days, irrespective of their serum cholesterol concentration. Vascular surgery was performed on average 30 days after randomization, and patients were prospectively followed up over 6 months. The cardiovascular events studied were death from cardiac cause, nonfatal myocardial infarction, unstable angina, and stroke. RESULTS: Fifty patients received atorvastatin, and 50 received placebo. During the 6-month follow-up primary end points occurred in 17 patients, 4 in the atorvastatin group and 13 in the placebo group. The incidence of cardiac events was more than three times higher with placebo (26.0%) compared with atorvastatin (8.0%; P =.031). The risk for an event was compared between the groups with the Kaplan-Meier method, as event-free survival after vascular surgery. Patients given atorvastatin exhibited a significant decrease in the rate of cardiac events, compared with the placebo group, within 6 months after vascular surgery (P =.018). CONCLUSION: Short-term treatment with atorvastatin significantly reduces the incidence of major adverse cardiovascular events after vascular surgery.

Aged↗