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Kiuchi M.G.,Federal University of Fluminense | Kiuchi M.G.,Hospital Regional Darcy Vargas | Maia G.L.M.,Hospital Regional Darcy Vargas | De Queiroz Carreira M.A.M.,Hospital Regional Darcy Vargas | And 6 more authors.
European Heart Journal | Year: 2013

Aims: Evaluation of the safety and efficacy of renal denervation with a standard irrigated cardiac ablation catheter (SICAC) in chronic kidney disease (CKD) patients with refractory hypertension. Methods and results: Twenty-four patients were included and treated with a SICAC. Denervation was performed by a single operator following the standard technique. Patients included with CKD were on stages 2 (n = 16), 3 (n = 4), and 4 (n = 4). Data were obtained at baseline and monthly until 180th day of follow-up. Baseline values of blood pressure (mean ± SD) were 186 ± 19 mmHg/108 ± 13 mmHg in the office, and 151 ± 18 mmHg/92 ± 11 mmHg by 24 h ambulatory blood pressure monitoring (ABPM). Office blood pressure values at 180th day after the procedure were 135 ± 13 mmHg/88 ± 7 mmHg (P < 0.0001, for both comparisons). The mean ABPM decreased to 132 ± 15 mmHg/85 ± 11 mmHg at the 180th day after the procedure (P < 0.0001 for systolic and P = 0.0015 for diastolic). Estimated glomerular filtration (mean ± SD) increased from baseline (64.4 ± 23.9 mL/min/1.73 m 2) to the 180th day (85.4 ± 34.9 mL/min/1.73 m2, P < 0.0001) of follow-up. The median urine albumin:creatinine ratio decreased from baseline (48.5, IQR: 35.8-157.2 mg/g) to the 180th day after ablation (ACR = 15.7, IQR: 10.3-34.2 mg/g, P = 0.0017). No major complications were seen. Conclusion: The procedure using SICAC seemed to be feasible, effective, and safe resulting in a better control of BP, a short-term increase in estimated glomerular filtration rate, and reduced albuminuria. Although encouraging, our data are preliminary and need to be validated in the long term. © The Author 2013.

De Carvalho A.A.V.,Federal University of Fluminense | De Carvalho A.A.V.,Hospital Universitario Antonio Pedro | Carvalho J.A.,Federal University of Fluminense | Figueiredo I.,Federal University of Fluminense | And 2 more authors.
Prenatal Diagnosis | Year: 2013

Objective: To investigate the association between the midtrimester presence of short femur and short humerus and intrauterine growth restriction. Methods: This retrospective study included ultrasound examinations of 1043 fetuses. Fetuses with normal-length bones were compared with fetuses that had femoral or humeral lengths below the 5th percentile for gestational age by Student's t-test and the chi-squared test. The association between short bones and fetal growth restriction development was evaluated by Fisher's exact test. Fetuses with estimated weight below the 10th percentile for gestational age and abnormal umbilical artery flow were considered to have growth restriction. Results: Femoral and humeral lengths were normal in 974 (93.4%) fetuses; 19 (1.8%) fetuses had short femora, 65 (6.2%) had short humeri, and 15 (1.4%) had short femora and humeri combined. Of fetuses included in the analysis, 603 (57.8%) underwent Doppler examination. Short femur [odds ratio =9.7, 95% confidence interval=1.9-50.2, P=0.03] and short humerus (odds ratio=13, 95% confidence interval=4.9-34.6, P<0.001) were associated with fetal growth restriction. Conclusion: Fetuses with midtrimester short femur, short humerus, or short femur and humerus combined require more intensive surveillance for growth restriction development. © 2012 John Wiley & Sons, Ltd.

Coutinho B.M.,Federal University of Fluminense | Bordalo E.,Federal University of Fluminense | Nascimento O.J.M.,Hospital Universitario Antonio Pedro
Arquivos de Neuro-Psiquiatria | Year: 2013

There are few studies reporting the association between hepatitis C virus (HCV) infection and disautonomia. We have evaluated the autonomic cardiovascular function in 12 patients with sensory small-fiber polyneuropathy infected by HCV. The mean age was 49±13 years old. The mean infection time was 9.6 years in six (50%) patients. Thermal and pinprick hypoesthesia was observed in distal legs in all patients. Autonomic symptoms were referred by eight (66.7%) patients. Among patients with abnormal autonomic cardiovascular test, five (41.7%) showed abnormal results in two or more tests. Valsalva maneuver was abnormal in seven (58.3%) patients. We can consider that there is an association of both parasympathetic and sympathetic efferent cardiovascular dysfunction in this group of patients.

Fonseca S.C.,Federal University of Fluminense | Monteiro D.S.A.,Hospital Universitario Antonio Pedro | Pereira C.M.S.C.,Prefeitura Municipal Angra dos Reis | Scoralick A.C.D.,Prefeitura Municipal Angra dos Reis | And 2 more authors.
Ciencia e Saude Coletiva | Year: 2014

The scope of this article is to evaluate the association between adequate prenatal care and sociodemographic variables in Niterói in the state of Rio de Janeiro. It involved a cross-sectional study conducted between 2000 and 2009 evaluating 62,449 live births using data from the Brazilian Live Birth Information System (SINASC). Multivariate analysis by logistic regression was performed considering quantitatively adequate prenatal care - seven or more visits - as the dependent variable, and maternal age, educational level and skin color as independent variables. The time trends of mother's age, educational level and prenatal visits were also analyzed. The significance level was 5%. There was an improvement in educational level, reduction in adolescent pregnancy and an increase in mothers aged over 35 in Niterói. Women who attended seven or more prenatal visits remained above 80%, though with differences according to age, education and skin color. Adult women (OR = 1.4; IC95% 1.39-1.56). women with eight or more years of schooling (OR = 2.5; IC95% 2.45-2.70) and white women (OR = 2.4; IC95% 2.30-2.53) had more chances of adequate prenatal care. Health inequalities in maternal health care on offer in Niterói were identified, despite improvements in social and demographic indicators in the city.

De Jesus L.E.,Hospital Universitario Antonio Pedro | De Jesus L.E.,Federal University of Rio de Janeiro | Teixeira L.,Hospital Universitario Antonio Pedro | Bertelli A.,Hospital Universitario Antonio Pedro
International Braz J Urol | Year: 2016

Recurring priapism is rare in pre-pubertal children and may be attributed to multiple causes. We propose that voiding dysfunction (VD) may also justify this symptom and detail a clinical case of recurring stuttering priapism associated to overactive bladder that completely resolved after usage of anticholinergics and urotherapy. Sacral parasympathetic activity is responsible for detrusor contraction and for spontaneous erections and a relationship between erections and bladder status has been proved in healthy subjects (morning erections) and models of medullar trauma. High bladder pressures and/or volumes, voiding incoordination and posterior urethritis can potentially trigger reflex erections.

Neto G.H.,Federal University of Fluminense | Neto G.H.,Hospital Universitario Antonio Pedro
Revista Brasileira de Oftalmologia | Year: 2016

The author describes a case report of a patient with unilateral enophthalmia and deep palpebral sulcus probably induced by the topical use of Bimatoprost on the side of the collateral effects described.

Bozi L.C.F.,Hospital Universitario Antonio Pedro | de Melo A.S.A.,Federal University of Fluminense | Marchiori E.,Federal University of Fluminense | Marchiori E.,Federal University of Rio de Janeiro
Radiologia Brasileira | Year: 2012

The present report describes the case of a 48-year-old female patient suffering from chronic renal failure on dialysis for 13 years. She presented with hemoptysis, fever, productive cough and dyspnea. Chest radiography showed predominance of ill-defined opacities in the middle and lower lung fields, bilaterally. Chest computed tomography showed groundglass opacities associated with poorly defined centrilobular nodules with ground-glass attenuation. The patient was submitted to bronchoalveolar lavage that was negative for mycobacteria and fungi. On the basis of such findings, open lung biopsy was performed, which revealed metastatic pulmonary calcification. © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem.

Leal V.O.,Federal University of Fluminense | Leal V.O.,Hospital Universitario Antonio Pedro | Lobo J.C.,Federal University of Rio de Janeiro | Stockler-Pinto M.B.,Federal University of Rio de Janeiro | And 4 more authors.
Renal Failure | Year: 2012

Inflammation, oxidative stress, and obesity are important features associated with pathogenesis of cardiovascular disease, a major contributor to the mortality of hemodialysis (HD) patients. Apelin is an adipokine involved in a variety of physiological functions; however, little is known about apelin in chronic kidney disease (CKD). Thus, the purpose of this study was to analyze apelin plasma levels in HD patients and verify whether there is any relationship with inflammation, oxidative markers, and obesity. Twenty-four HD patients [53.6 ± 14.4 years, 14 men, and body mass index (BMI) of 25.0 ± 4.2 kg/m 2] were studied and compared with 15 healthy subjects (51.3 ± 13.5 years, 7 men, and BMI of 26.3 ± 3.7 kg/m 2). Plasma apelin-12 and -36 were measured using the enzyme immunometric assay method. Plasma electronegative low-density lipoprotein [LDL(-)] levels were measured using ELISA method, and tumor necrosis factor-α, interleukin-6, leptin, and plasminogen activator inhibitor-1 levels were measured by a multiplex assay kit. C-Reactive protein (CRP) was determined by immunoturbidimetry. Anthropometric data were also evaluated. There was no difference between apelin-36 levels in HD patients (0.82 ± 0.60 ng/mL) and healthy subjects (0.83 ± 0.23 ng/mL). In contrast, apelin-12 levels were significantly higher in patients (0.34 ± 0.15 ng/mL vs. 0.24 ± 0.13 ng/mL in healthy subjects). TNF-α, CRP, and LDL(-) levels were higher in patients; however, there was no correlation among apelin-12 or -36 and inflammatory or oxidative markers. The adiposity parameters were also not associated with apelin-12 or -36. In conclusion, plasma apelin seems to be not associated with cardiovascular risk in HD patients. Copyright © Informa Healthcare USA, Inc.

PubMed | Federal University of Fluminense and Hospital Universitario Antonio Pedro
Type: Journal Article | Journal: Case reports in gastroenterology | Year: 2016

Hepatorenal syndrome (HRS) is defined as a failure of renal function, potentially reversible, in patients with liver cirrhosis and ascites. Recently, a component of cardiomyopathy associated with HRS was described, but the use of positive inotropic medicine as part of the treatment of the acute phase has not been extensively evaluated. We report a second case in our hospital of a patient with HRS type I without previous heart disease, with secondary hemodynamic decompensation due to liver disease, in which the abnormalities in systolic function by speckle-tracking echocardiography were observed and could be reversed by the use of inotropes. After partial response to current therapies, the patient presented a clinical and laboratorial response with improvement of renal function after infusion of dobutamine. Clinical studies are needed for the therapy approach to HRS taking into account myocardial dysfunction as a major contributing factor for renal dysfunction.

PubMed | Hospital Universitario Antonio Pedro
Type: Journal Article | Journal: A & A case reports | Year: 2016

Aortic coarctation is a discrete narrowing of the proximal thoracic aorta. It is poorly tolerated during pregnancy because of its association with hypertension, cerebrovascular accident, and aortic rupture. We report a case of severe uncorrected congenital aortic coarctation in a 31-year-old symptomatic pregnant woman at 29 weeks of gestation who underwent successful cesarean delivery with an epidural anesthetic technique. Transthoracic echocardiography showed a gradient of 75mm Hg. To avoid undiagnosed arterial hypotension and inadequate uteroplacental flow distal to the coarctation, double (radial and femoral) invasive arterial blood pressure measurement was used to monitor both pre- and postcoarctation arterial blood pressure.

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