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Salvador, Brazil

Correia L.C.L.,Portuguese Hospital | Andrade B.B.,Oswaldo Cruz Foundation | Borges V.M.,Oswaldo Cruz Foundation | Clarencio J.,Oswaldo Cruz Foundation | And 7 more authors.
Clinica Chimica Acta | Year: 2010

Background: Increased cytokine and chemokine levels are associated with cardiovascular events in patients with non-ST-elevation acute coronary syndromes (ACS), but the incremental prognostic value of these inflammatory markers is not known. We determined if cytokine and chemokine assessment adds prognostic information to the GRACE Score in patients with ACS. Methods: Five cytokines (interleukin (IL)-1β, IL-6, IL-10, IL-12p70, and tumor necrosis factor (TNF)-β soluble receptor I), five chemokines (IL-8, CCL5, CXCL9, CCL2, and CXCL10) and C-reactive protein (CRP) were measured at admission of 87 patients admitted with ACS. Results: During hospitalization, the incidence of cardiovascular events was 13% (7 deaths, 1 nonfatal acute myocardial infarction, and 3 refractory unstable angina). Individuals who developed events had significantly greater levels of CRP, IL-1β, IL-12, TNF-β, IL-8, CXCL9 and CCL2, compared with those free of events. Thus, these markers were used to build an Inflammatory Score, by the input of one point for each of these variables above the 75th percentile. After adjustment for the GRACE Score, the Inflammatory Score independently predicted events (OR=1.80; 95% CI=1.12-1.88). Incorporation of the Inflammatory Score into the GRACE Score promoted a C-statistics improvement from 0.77 (95% CI=0.58-0.96) to 0.85 (95% CI=0.71-1.0). Net reclassification improvement obtained with GRACE-Inflammatory Score was 13% (P=0.007), indicating a significant reclassification. When only CRP was incorporated into GRACE, the increase on C-statistics was not relevant (from 0.77 to 0.80). Conclusion: Cytokines and chemokines measured at admission add prognostic information to the GRACE Score in patients admitted with ACS. © 2010 Elsevier B.V. Source

Dantas J.F.C.,Portuguese Hospital | Neto J.N.N.,State University of Paraiba | De Carvalho S.H.G.,State University of Paraiba | Martins I.M.C.L.D.,Federal University of Paraiba | And 2 more authors.
International Journal of Oral and Maxillofacial Surgery | Year: 2015

The aim of this study was to compare the satisfaction of skeletal class III patients following treatment with three different methods of orthognathic surgery. Eighty-two patients were divided into three groups according to the surgical procedure performed to correct their class III dentofacial deformity, and answered a questionnaire designed to determine the patient's opinion of the aesthetic and functional treatment outcomes. Differences in the patterns of responses to questions in the questionnaire related to satisfaction between the three clinical groups were evaluated by χ2 and Fisher's exact tests (α = 5%). Eighty patients (97.6%) reported being satisfied with the treatment received. There was no significant difference in response patterns among clinical groups when assessing the improvement in facial appearance, chewing, speech, and socialization. Maxillary advancement led to higher levels of improvement in breathing (P < 0.0003). Class III patients treated by orthognathic surgery had high levels of satisfaction with the aesthetic and functional outcomes of their treatment. © 2014 International Association of Oral and Maxillofacial Surgeons. Source

Study Objective: We aimed to test the hypothesis that clinically suspected obstructive sleep apnea (OSA) independently predicts worse in-hospital outcome in patients with non-ST elevation acute coronary syndromes. Design: At admission, individuals were evaluated for clinical probability of OSA by the Berlin Questionnaire. Primary cardiovascular endpoint was defined as the composite of death, nonfatal myocardial infarction, or refractory angina during hospitalization. Setting: Coronary care unit. Patients: There were 168 consecutive patients admitted with unstable angina or non-ST elevation acute myocardial infarction. Measurements and Results: During a median hospitalization of 8 days, the incidence of cardiovascular events was 13% (12 deaths, 4 nonfatal myocardial infarctions, and 6 refractory anginas.) Incidence of the primary endpoint was 18% in individuals with high probability of OSA, compared with no events in individuals with low probability (P = 0.002). After logistic regression adjustment for the Global Registry of Acute Coronary Events (GRACE) risk score, anatomic severity of coronary disease, and hospital treatment, probability of OSA remained an independent predictor of events (odds ratio [OR] = 3.4; 95% confidence interval [CI] = 1.3 - 9.0; P = 0.015). Prognostic discrimination of the GRACE score, measured by a C-statistic of 0.72 (95% CI = 0.59-0.85), was significantly improved to 0.82 (95% CI = 0.73-0.92) after inclusion of OSA probability in the predictive model (P = 0.03). Conclusion: Considering the independent prognostic and incremental value of suspected OSA, this condition may represent an aggravating factor for patients with non-ST elevation acute coronary syndrome. Source

Moreira L.,Federal University of Bahia | Schinzel A.,University of Zurich | Baumer A.,University of Zurich | Pinto P.,Salvador University | And 4 more authors.
American Journal of Medical Genetics, Part A | Year: 2010

Rieger syndrome (RS; OMIM 180500) is a rare autosomal dominant disorder of morphogenesis, with ocular and systemic abnormalities and variability in phenotypic expression. Some patients with RS presented with a deletion of the band 4q25 to which the homeobox gene PITX2(former RIEG) wasmapped. To study the natural history and perform a genotype-phenotype correlation, we followed a girl with RS from the age of 1 year to puberty. The study included physical examination, clinical and psychological evaluation, and cytogenetic analysis withGTG -banded karyotype and array CGH. Additionally, molecular analysis using microsatellite markers for chromosome 4 (D4S427, D4S194 and D4S1615) was performed. Conventional chromosome analysis showed a 4q deletion, and aCGH con-firmed the determination of the breakpoints at 4q25 and 4q31. With the exception of the typical features of RS is the patient, the clinicalmanifestations were relatively mild, despite the relatively large size of the deleted chromosome segment. The patient was periodically re-evaluated for several years. The teeth are still abnormal, and she is still under orthodontic treatment. The facial features were attenuated with age. Currently, she is under constant monitoring of eye pressure. She benefited from early intervention program, and her tonus is normal. She attends a normal school with minor learning difficulties. In conclusion, this study offers a comprehensive phenotypic delineation of RS through almost two decades and may contribute to a more accurate genetic counseling in cases of this syndrome. © 2010 Wiley-Liss, Inc. Source

Esteves J.P.,Portuguese Hospital | Noya-Rabelo M.M.,San Rafael Hospital
Cardiology (Switzerland) | Year: 2012

Objective: We aimed to test the hypothesis that hemoglobin values add prognostic information to the Global Registry of Acute Coronary Events (GRACE) score at admission in patients with non-ST elevation acute coronary syndromes (ACS). Methods: A total of 225 consecutive patients with non-ST elevation ACS were studied. Hemoglobin was measured at admission, and its prognostic value was evaluated in relation to cardiovascular events during hospitalization, defined as the composite of death or myocardial infarction. Results: The incidence of major in-hospital events was 7% (10 deaths and 5 nonfatal myocardial infarctions). Hemoglobin significantly predicted events, with a C statistic of 0.67 [95% confidence interval (CI) 0.53-0.81; p = 0.03], with 12.1 g/dl as the cutoff point of best performance. After adjustment for the GRACE score, low hemoglobin (≤12.1 g/dl) remained an independent predictor of events (odds ratio 3.9, 95% CI 1.2-13; p = 0.028). The C statistic of the GRACE score for prediction of events improved from 0.80 to 0.84 after hemoglobin was taken into account. Finally, the addition of hemoglobin to the GRACE score promoted a net reclassification improvement of 16% in identifying high-risk patients (p = 0.025). Conclusions: The present study provides preliminary evidence that hemoglobin level independently predicts recurrent events during hospitalization and improves the prognostic performance of the GRACE score in patients with non-ST elevation ACS. Copyright © 2012 S. Karger AG. Source

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