Infection is a leading cause of death in hemodialysis patients, partly due to dysfunctional immunity. Frequent dialysis therapy improves patient outcomes and quality of life. We hypothesize that extended home hemodialysis (EHHD) also improves immune function compared to conventional in-hospital hemodialysis (CHD); therefore, we designed a prospective matching-cohort clinical study to assess serum inflammatory markers and the functional capacity of monocyte-derived dendritic cells (MDDCs) and T-lymphocytes. Serum CRP was decreased in EHHD patients suggesting that extended dialysis may decrease inflammatory solute/cytokine levels. Compared to controls, MDDCs from hemodialysis patients had similar endocytic capacity, expression of co-stimulatory molecules, and T-cell activation capacity. However, CHD was associated with the highest expression of CD83 and CD40. Activated T-cells in CHD patients also produced significantly more immunosuppressive IL-10 compared to EHHD patients and controls. Therefore, EHHD may improve immune function by decreasing inflammation, MDDC pre-activation, and synthesis of immunosuppressive cytokines.

Durante a transição menopausal e a pós-menopausa cerca de 75% das mulheres apresentam sintomas de hipoestrogenismo, tais como fogachos. O emprego de terapia hormonal (TH) para alívio dos sintomas da menopausa está bem estabelecido, mas seus efeitos cardiovasculares (CV) permanecem controversos. Dados de estudos recentes indicam a presença de duas populações distintas quanto aos efeitos CV da TH. Essa diferenciação estaria relacionada principalmente com a idade e o tempo de pós-menopausa. Evidências sugerem também que a presença de fatores de risco cardiovascular antes do início do TH, ou de uma associação de fatores de risco, podem ser determinantes dos efeitos CV do TH. Dose de medicação, via de administração e o tipo de progestogênio utilizado em associação com estrogênio para TH também vem sendo estudados como possíveis fatores relacionados ao impacto CV do TH. O presente trabalho é composto por: 1) Ensaio clínico randomizado, comparando os efeitos da via oral baixa dose e via não oral sobre variáveis relacionadas com risco CV em uma população de mulheres saudáveis na pósmenopausa recente; 2) Ensaio clínico randomizado, onde foram avaliados os efeitos da adição de progesterona natural micronizada ao estrogênio não oral durante TH em mulheres na pós-menopausa recente; e 3) Revisão sistemática e meta-análise, onde foram sistematicamente buscados todos os artigos com TH baixa dose que avaliassem os efeitos desta terapia sobre variáveis relacionadas com risco cardiovascular: peso, índice de massa corporal, pressão arterial, proteína C reativa e lipídios. Desenvolvemos ensaio clínico randomizado, cross-over, com objetivo de avaliar os efeitos de dois tipos de tratamento hormonal na menopausa: oral baixa dose, estradiol 1 mg e drospirenona 2 mg diário e não oral, estradiol 17 β gel 1.5 mg (ou nasal 300 mcg) diário e progesterona micronizada vaginal, 200 mg, 14 dias por mês, sobre peptídeo natriurético atrial, variáveis relacionadas com inflamação e função endotelial, perfil antropométrico e metabólico em mulheres na pós-menopausa recente e sem doença clínica evidente. 101 mulheres na pós-menopausa foram alocadas aleatoriamente para iniciar o TH por um dos dois grupos de tratamento: via oral baixa dose (n=50) ou via não oral (n=51). Todas as pacientes utilizaram ambos os TH de forma seqüencial. Após o primeiro período de 2 a 3 meses de TH a paciente passava para o segundo tratamento, sem período de washout. A avaliação laboratorial foi realizada antes e após cada um dos tratamentos. A amostra do estudo foi composta por mulheres com média etária de 51 ± 3 anos e tempo de amenorréia de 22 ± 10 meses. Oitenta e seis pacientes concluíram o estudo. Peso e índice de massa corporal não se modificaram, enquanto que a circunferência da cintura reduziu de forma similar em ambos os grupos de tratamento. Colesterol total e LDL-C reduziram após ambos os TH, e triglicerídeos reduziram somente após a TH não oral. Insulina e glicemia de jejum não se modificaram. Não foram observadas modificações nos níveis de fibrinogênio, fator von Willebrand (FvW) e proteína C reativa (PCR) após TH oral. Após TH não oral, observou-se redução significativa de fibrinogênio e FvW. Níveis de PCR não se modificaram. Houve redução do número de pacientes no maior tertil de PCR (alto risco CV) após TH não oral. Essas pacientes passaram a integrar os grupos de risco intermediário e baixo. Níveis de peptídeo natriurético atrial (PNA) mantiveram-se inalterados após os ambos os TH. Não houve modificações significativas na pressão arterial e esta não se correlacionou com valores de PNA. Realizamos análise adicional do TH não oral, quanto às diferenças entre a via nasal e a percutânea e quanto aos efeitos da adição de progesterona natural micronizada ao estrogênio. Não houve diferenças significativas para todas as variáveis estudadas entre a via nasal e a via percutânea. A adição de progesterona natural micronizada não modificou os efeitos metabólicos e CV do estrogênio não oral. Foi realizada busca sistemática de todos os artigos que incluíssem como TH estrogênio baixa dose e avaliassem os efeitos deste tratamento sobre as variáveis de interesse: peso, índice de massa corporal, pressão arterial, proteína C reativa e lipídeos. Foram consultadas as bases MEDLINE, Cochrane CENTRAL, EMBASE. Foram revisadas todas as referências dos artigos de interesse e revisões e metaanálises no assunto, em busca de artigos relevantes. Após exclusão dos artigos em duplicata, 8610 artigos foram revisados. Destes, 28 artigos foram selecionados para meta-análise. Desta análise foi possível concluir que pacientes em uso de TH baixa dose apresentaram em média menor peso corporal, colesterol total e LDL-C do que não usuárias. A TH baixa dose não apresentou efeitos deletérios sobre demais variáveis estudadas. Em conclusão, ambos os TH apresentaram efeitos neutros ou benéficos sobre variáveis relacionadas com risco CV em uma população de mulheres na pósmenopausa recente e sem evidência de doença CV. A adição de progesterona natural micronizada não modificou os efeitos do estrogênio não oral. Os resultados da metaanálise sobre TH baixa dose e variáveis relacionadas com risco CV também permitem concluir que a TH baixa dose não exerceu efeitos deletérios sobre lipídeos e pressão arterial, e foi observado um possível efeito benéfico deste tratamento sobre o peso corporal. / During the menopausal transition and postmenopause about 75% of women have symptoms of hypoestrogenism symptoms such as hot flushes. The use of hormone therapy (HT) for relief of menopausal symptoms is well established, but its cardiovascular effects (CV) remain controversial. Data from more recent studies suggest the presence of two distinct populations regarding the cardiovascular effects of HT. This differentiation is related mainly to age and time after menopause. Evidence also suggests that the presence of cardiovascular risk factors before the onset of HT, or a combination of risk factors may be determinants of CV effects of HT. Medication dose, route of administration and type of progestin used in combination with estrogen for HT has also been studied as possible factors related to the CV impact of HT. This work consists of: 1) Randomized clinical trial, comparing the effects of low dose oral and non-oral route of variables related to CV risk in a population of healthy women in early postmenopausal; 2) A randomized clinical trial, which we assessed the effects of the addition of natural micronized progesterone to non-oral estrogen for HT in women in early postmenopausal; and 3) systematic review and meta-analysis, which were systematically searched all items with low-dose HT to assess the effects of this therapy on variables related to cardiovascular risk: weight, body mass index, blood pressure, C-reactive protein and lipids. A cross-over, randomized clinical trial was designed in order to evaluate the effects of two types of HT: low dose oral treatment, estradiol oral 1 mg and drospirenone 2 mg, by day and non-oral treatment, estradiol 1.5 mg 17 β gel by percutaneous route (or nasal route 300 mcg) by day and vaginal micronized progesterone, 200 mg/d, 14 days by month on atrial natriuretic peptide, variables associated with inflammation and endothelial function, anthropometric and metabolic variables on early and healthy postmenopausal women. One hundred one women were randomly allocated to start with one of the treatments: low dose oral treatment (n=50) or non-oral treatment (n=51). At the end the first three months period, the patients were crossed over without washout for an additional three months. Laboratory evaluated were carried before and after oral and non-oral HT. The sample of the study included postmenopausal women with a mean age of 51 years and duration of amenorrhea of 22±10 months. Eighty-six patients completed the study. Weight and body mass index remained unchanged, while the waist circumference decreased similarly in both treatment groups. Total cholesterol and LDL-cholesterol reduced after both the HT and triglycerides reduced only after nonoral HT. Insulin and fasting glucose did not change. No changes were observed in the levels of fibrinogen, von Willebrand factor (vWF) and C-reactive protein (CRP) after oral HT. After non-oral HT, there was a significant reduction of fibrinogen and vWF. CRP levels did not change. There was a reduction in the number of patients in the highest tertile of CRP (high CV risk) after non-oral HT. These patients have joined the groups of intermediate and low risk. Levels of atrial natriuretic peptide, ANP, were unchanged after both HT. There were no significant changes on blood pressure and did not correlate with values of ANP. We performed additional analysis of nonoral HT, for the differences between nasal and percutaneous and about the effects of addition of natural micronized progesterone to estrogen. There were no significant differences for all the variables studied between the nasal and percutaneously. The addition of micronized natural progesterone did not modify the metabolic and CV effects of non-oral estrogen. Systematic search of all articles that include as TH low dose estrogen and evaluate the effects of this treatment on the variables of interest was taken: weight, body mass index, blood pressure, C-reactive protein and lipids. The MEDLINE, Cochrane CENTRAL, EMBASE databases were consulted. All references of interest and reviews and meta-analyzes on the subject, in search of relevant articles were reviewed. After removing duplicate articles, 8610 articles were reviewed. Of these, 28 articles were selected for meta-analysis. From this analysis it was concluded that patients using low-dose TH had on average lower body weight, total cholesterol and LDL-C than non-users. The TH low dose showed no deleterious effects on other variables. In conclusion, low-dose oral and non-oral treatments had neutral or beneficial effects on variables related to CV risk in a population of women in early post menopausal and without evidence of CV disease. The addition of micronized natural progesterone did not modify the effects of non-oral estrogen. The results of the metaanalysis of low dose and TH variables related CV risk also showed that the TH low dose did not exert deleterious effects on lipids and blood pressure, and a possible beneficial effect of this treatment on body weight was observed.

Os pacientes acometidos pela insuficiência renal crônica apresentam diminuição progressiva da função renal associada à redução da taxa de filtração glomerular. Possuem a resposta imune celular e humoral suprimidas e a existência de quaisquer alterações de saúde bucal pode representar focos de infecção a esses pacientes, os quais são extremamente susceptíveis a estas. A doença periodontal é uma doença inflamatória destrutiva que afeta os tecidos periodontais, e estudos têm mostrado que a prevalência desta é maior em pacientes com IRC quando comparados com a população em geral. Objetivo: Avaliar os parâmetros clínicos da doença periodontal em pacientes com doença renal crônica. Métodos: Foi realizado exame clínico periodontal de 125 indivíduos com alteração renal crônica que foram divididos em grupo controle (GC), grupo pré-diálise (GPD) e grupo hemodiálise (GHD), e os grupos foram subdivididos de acordo com a doença periodontal. Resultados: A perda de inserção clínica foi maior nos grupos GPD e GHD quando comparados ao controle (p=0,0058; p=0,0383), os demais parâmetros periodontais não apresentaram diferenças significantes. Os níveis de ácido úrico e ferritina foram estatisticamente maiores nos GPD e GHD com quando comparados ao GC (p<0,001); p=0,008; p=0,01); o nível de PCR foi maior no grupo GPD quando comparados aos grupos GC e GHD (p<0,05); e os níveis de fibrinogênio e triglicerídeos foram maiores no grupo GPD com doença periodontal quando comparados ao GC (p=0,01, p=0,008), o mesmo não ocorreu com os grupos sem doença periodontal. Conclusão: Assim sendo, conclui-se que a PIC e o número de dentes ausentes foi maior nos grupos testes quando comparados ao controle. Portanto, os profissionais de saúde devem ter uma atenção maior aos pacientes que apresentam a DRC no sentido de efetuar uma relação interdisciplinar para melhorar a condição de saúde deste. / Chronic renal failure (CRF) is a progressive and irreversible loss of renal function associated with a decline in the glomerular filtration rate. CRFs patients have a humoral and cellular immune responses suppressed and the existence of any oral complications may be outbreaks of such patients, which are extremely susceptible to these. Periodontal disease is a destructive inflammatory disease affecting periodontal tissues, and studies have shown that this is greater prevalence in patients with CRF compared to the general population. Aim: The aim of this study was to assess the clinical periodontal parameters CRFs patients. Methods: 125 CRFs patients were included in the study, and they were divided in control group (GC), foregoing dialysis group (GPD), and hemodialysis group (GHD), and the groups were subdivided in accordance with periodontitis. Results: Clinical attachment loss (CAL) was greater in GPD and GHD groups compared to the control (p = 0.0383; p = 0.0058), the other periodontal parameters did not provide significant differences. Uric acid and ferritin levels were statistically higher in GPD and GHD when compared to the GC (p<0.05); the PCR level was higher in GPD group when compared to the GC and HDG groups (p<0.05); and fibrinogen and triglycerides levels were greatest in the GPD with periodontitis than the GC (p = 0.01, p = 0.008), the same did not occur with groups without periodontitis. Conclusion: Accordingly, it is concluded that the clinical attachment loss and the number of dental lost of the tests groups were larger than the control group. Therefore, healthcare professionals must have an attention to CFRs patients to make a relationship interdisciplinary to improve the health condition.

O Brasil, que conta hoje com 7% de idosos, será a sexta maior população de idosos do Planeta em 2020. A doença cardiovascular aumenta significativamente com a idade e evidências indicam a importância do endotélio e da hipercolesterolemia na aterosclerose. Contudo, não está bem estabelecido, que o tratamento da dislipidemia em idosos melhora a função vasomotora. Objetivos: Analisar a resposta vasomotora e parâmetros metabólicos em idosos com hipercolesterolemia ao tratamento com estatina. Delineamento: Ensaio Clínico Randomizado Duplo Cego. Casuística e Métodos: 72 idosos com idade 65 anos [75 ± 7,7 (65 a 92)], 64% mulheres, excluídos diabéticos, hipertensos graves, obesos, corticoterapia, reposição hormonal, doença em estágio terminal; todos realizaram avaliação clínica, laboratorial (glicose, lípides, TGO, TGP, CPK, Proteina C reativa ultra-sensível (PCR)) e função vasomotora por ultra-sonografia de alta resolução da artéria braquial, com equipamento ATL HDI 5000 e transdutor multifreqüencial de 7 a 10 MHz, segundo Diretrizes. Utilizou-se hiperemia reativa para resposta vasomotora dependente do endotélio (DMF) e nitrato sub-lingual para a independente do endotélio (DNT). Destes, 47 pacientes apresentaram LDL 130 mg/dL e foram randomicamente designados para grupo placebo (GP) e grupo tratamento (GT); todos realizaram avaliação antes e depois da intervenção (placebo ou atorvastatina 20mg oral por 30 dias). Para a análise estatística, utilizaram-se testes paramétricos e não-paramétricos, valores de p 0,05 foram considerados estatisticamente significantes. Resultados: Os grupos foram semelhantes em suas características basais; a DMF não apresentou diferença estatisticamente significante entre o GP e GT após intervenção [6,2 ± 6,2 (-4,8 23,7) e mediana = 6,4 vs. 5,0±5,6 (-5,1 18,9) e mediana= 3,5 p = 0,551], o mesmo ocorrendo para a DNT [7,1 ± 4,7 (-1,3 21,2) e mediana = 6,8 vs. 8,6±5,0 (1,4 21,6) e mediana = 6,8 p = 0,373). A análise estratificada sugere potencial modificador de efeito das co-variáveis estratificadas sexos, estratos etários (<80 e 80 anos) e níveis de LDL (< 160mg/dL e 160mg/dL) em relação à associação atorvastatina e função vasomotora. A PCR diminuiu 64% no grupo estatina (mediana no GP = 0,3 mg/dL vs. GT = 0,1 mg/dL p = 0,014). A redução do colesterol total foi de 27%, LDL = 41%, VLDL = 20% e triglicérides = 34%; o HDL elevou 12% no GT. A maior elevação enzimática não ultrapassou 3 vezes o limite e não ocorreram mialgias. Conclusões: Apesar da diminuição dos lípides, não houve modificações significativas da função vasomotora, o que sugere alterações intrínsecas do vaso associado ao envelhecimento. Os níveis de PCR reduziram significativamente, sugerindo um provável efeito antiinflamatório / The Brazil, where old people make up 7% of the population, will have the sixth greatest population of elderly people in the world. Cardiovascular disease increases significantly as a person grows older and evidences show the importance of the endothelium and hypercholesterolemia in arteriosclerosis. However, it has not been established yet if treating dyslipidemia in the elderly will improve this function. Objectives: To evaluate vasomotor response in elders suffering from hypercholesterolemia to the treatment with statin and to evaluate their lipids, c-Reactive Protein (CRP). Design: Double-blind randomized clinical trial. Methods: Seventy-two elderly people aged >65 years old [75 ± 7.7 (65 to 92)], 65% of women, excluding those suffering from diabetes, serious hypertension, obesity, steroid use, hormone replacement, end-stage disease; all of them underwent clinical evaluation, laboratorial evaluation (glucose, lipids, liver enzymes, CPK, high sensitivity CRP (CRP). Vasomotor response was evaluated by means of ATL HDI 5000 high resolution ultrasound scan of the brachial artery and multifrequency transduction of 7 to 10 MHz. Reactive hyperemia was used for endothelium-dependent flow response (DMF) and sublingual nitrate for the endothelium-independent dilation (DNT). Out of those patients, 47 presented LDL 130 mg/dl and were ramdonly divided into placebo (n = 23) and treatment group (n = 24); all of them had underwent evaluation before and after intervention (placebo or atorvastatin 20 mg, orally, during 30 days); for statistic analysis parametric and non-parametric tests were used and p 0.05 values were considered statistically significant. Results: The groups were similar in their basal characteristics; DMF did not present any statistically significant difference between placebo and treatment group after intervention [6.2 ± 6.2 (-4,8 - 23.7) and median = 6.4 vs. 5.0 ± 5.6 (-5.1 - 18.9) and median = 3.5 p = 0.551], the same occurred to DNT [7.1 ± 4,7 (-1.3 - 21.2) and median = 6.8 vs. 8.6 ± 5.0 (1.4 - 21.6) and median = 6.8 p = 0.373). Stratified analysis suggests effect modifying factor of the gender, age strata (< 80 and 80 years of age) and LDL (< 160 mg/dL e 160 mg/dL). CRP diminished 64% in the treatment group (median in the placebo group = 0.3 mg/dL vs. treatment group = 0.1 mg/dL p = 0.014). The reduction of total cholesterol was 27%, LDL = 41%, VLDL = 20% and triglycerides = 34%; HDL raised 12% in the treatmente group in relation to the placebo group. The highest enzymatic elevation did not surpass 3 times the limit and there were no myalgia. Conclusions: In spite of a significant decrease in lipids, there were no significant changes in vasomotion response with statin therapy, suggesting intrinsic alterations of the vessel associated with ageing. However, CRP reduction suggested an anti-inflammatory effect

INTRODUÇÃO: A proteína C-reativa de alta sensibilidade (PCR-as) é comumente utilizada na prática clínica para avaliar o risco cardiovascular. O seio coronário (SC) é considerado o local ideal para estudos de marcadores inflamatórios e circulação coronária, até o momento. A correlação entre os níveis séricos de PCR-as (valores absolutos) periférico versus (vs.) central ainda não foi feita. Avaliou-se a correlação entre os níveis séricos de PCR-as (mg/L) em veia periférica do antebraço esquerdo (VPAE) vs. SC, em pacientes portadores de doença arterial coronária (DAC) aterosclerótica com diagnóstico de angina estável (AE) ou angina instável (AI). Avaliou-se, também, se os níveis de PCR-as na VPAE e no SC diferem na AE e AI. MÉTODOS e RESULTADOS: 40 pacientes com DAC e estenose >= 70 % do diâmetro da luz vascular em uma das principais artérias coronárias foram incluídos no estudo e classificados em AE (n = 20) e, AI (n = 20). Coletaram-se amostras de sangue simultaneamente na VPAE e no SC, antes da angiografia coronária. A média dos níveis séricos absolutos de PCR-as na VPAE nos pacientes com AE foi de 2,97 ± 2,66, log 0,53 ± 1,24 e, com AI foi de 3,04 ± 3,29, log 0,67 ± 0,94, p = 0,689; e no SC, na AE foi de 2,71 ± 2,46, log 0,46 ± 1,18 e na AI, foi de 2,65 ± 3,08, log 0,41 ± 0,97, p = 0,898 e, portanto, não foram observadas diferenças significativas. A análise de correlação entre os níveis séricos de PCR-as em VPAE vs. SC mostrou uma forte correlação linear tanto para AE (r = 0,993, p < 0,001), para AI (r = 0,976, p < 0,001) e em toda amostra (r = 0,985, p < 0,001). CONCLUSÃO: Os nossos dados sugeriram uma forte correlação linear entre os níveis séricos de PCR-as na VPAE vs. SC na AE e AI; e esses níveis na VPAE e no SC na AE e AI foram semelhantes e não revelaram diferentes influências biológicas / BACKGROUND: The high-sensitivity C-reactive protein (hs-CRP) is commonly used in clinical practice to assess cardiovascular risk. The coronary sinus (CS) is considered the ideal location for studies of inflammatory markers and coronary circulation, until the moment. The correlation between peripheral versus (vs.) central serum levels of hs-CRP (absolute values) has not been done. We evaluated the correlation between serum levels of hs-CRP (mg/L) in the left forearm peripheral vein (LFPV) vs. CS in patients with atherosclerotic coronary artery disease (CAD) and diagnosis of stable angina (SA) or unstable angina (UA). We also evaluated whether the hs-CRP levels in LFPV and CS differ in SA and UA. METHODS and RESULTS: 40 patients with CAD and >= 70 % stenosis of the diameter of the vascular lumen in one of the main coronary arteries were included in the study and, classified into SA (n = 20) and, UA (n = 20). Blood samples from in the LFPV and CS were simultaneously collected before coronary angiography. The mean serum levels of hs-CRP in LFPV in the patients with SA was 2.97 ± 2.66, log 0.53 ± 1.24 and, in the UA was 3.04 ± 3.29, log 0.67 ± 0.94, p = 0.689. In CS in SA, it was 2.71 ± 2.46, log 0.46 ± 1.18 and in UA it was 2.65 ± 3.08, log 0.41 ± 0.97, p = 0.898; therefore, no significant differences were observed. The correlation analysis between the serum levels of hs-CRP in LFPV vs. CS showed a strong linear correlation in both for SA (r = 0.993, p < 0.001), for UA (r = 0.976, p < 0.001) and in the whole sample (r = 0.985, p < 0.001). CONCLUSIONS: Our data suggested that in SA as well as in UA there was a strong linear correlation between the serum levels of hs-CRP in LFPV vs. CS and, these levels in VPAE and SC in AE and AI were similar and did not reveal different biological influences

A doença cardiovascular aterosclerótica é a principal causa de morte no hemisfério ocidental, portanto também no Brasil. A detecção não invasiva da aterosclerose é fundamental para prevenção. Objetivos: Correlacionar os fatores de risco (escore de Framingham), o perfil lipídico, a PCR-us, a espessura da íntima-média da carótida, a função endotelial, o índice tornozelo-braquial e o escore de cálcio pela tomografia computadorizada, com a extensão da doença coronariana determinada pelo índice de Friesinger, na cinecoronariografia. Casuística e métodos: Foram estudados 100 pacientes de ambos os sexos, com idade de 55,1±10,7 sendo 55% homens e 45% mulheres. Não foram incluídos pacientes com síndrome coronariana aguda, insuficiência renal dialítica, doença do colágeno e câncer. Todos se submeteram a avaliação clínica, laboratorial (glicemia, perfil lipídico e PCR-us), função endotelial da artéria braquial e ultrasonografia da artéria carótida por ultra-som de alta resolução, índice tornozelo-braquial e tomografia computadorizada coronária para determinação do escore de cálcio. Foram calculados o colesterol não HDL-c e a relação TG/HDL-c. Todos os pacientes foram submetidos à cinecoronariografia por indicação do médico assistente. Foram considerados normais pacientes sem lesão obstrutiva na cinecoronariografia. Resultados: Pela análise univariada, escore de cálcio (529,5 ± 930,9) um HDL-c (45,9±15,5), relação TG/HDL (5,5±9,2) e IMT (0,77±0,22) mostraram correlação significativa com o índice de Friesinger. Já por análise multivariada somente o escore de cálcio, relação TG/HDL-c aumentada e HDL-c baixo correlacionaram-se significativamente com a extensão da DAC. A PCR-s (3,4±3,5), LDL-c (122,8±51,5) e DMF (4,8±5,7) não se correlacionaram com o índice de Friensinger. Conclusão: Assim, é possível ter uma idéia aproximada da presença/extensão da DAC usando métodos não invasivos, especialmente escore de cálcio, relação TG/HDL-c e HDL-c baixo. / Background: Atherosclerotic cardiovascular disease is the leading cause of death in the western hemisphere including Brazil. Non-invasive detection of atherosclerosis is critical to prevention. Objectives: We correlated the risk factors (score of Framingham), lipid profile, PCR-us, carotid intima-media thickness, endothelial function, ankle-brachial index and calcium score by computed tomography with the extent of coronary disease determined by the Friesinger index, by coronary angiography. Methods: We studied 100 patients of both sexes, aged from 55.1 ± 10.7, 55% men and 45% women. Patients with acute coronary syndrome, renal dialitic, collagen disease and cancer were not included. All were submitted to clinical evaluation, laboratory (blood glucose, lipid profile and hs-CRP), endothelial function of brachial artery and ultra-sonography of carotid artery by high-resolution ultra-sound, ankle-brachial index and computed tomography for coronary determination of calcium score. We calculated the cholesterol not HDL-c and TG/HDL-c ratio. All patients were submitted to coronary angiography for indication by attending physician. We considered normal patients without obstructive lesion in coronary angiography. Results: By univariate analysis, calcium score, HDL-c, TG/HDL ratio and IMT showed significant correlation with Friesinger index. However, multivariate analysis only calcium score, increased TG/HDL-c and low HDL-c correlated significantly with the extension of the CAD. The hs-CRP, LDL-c and FMD, did not correlate Friensinger index. Conclusion: Thus, it is possible to have an approximate idea of the presence/extension of CAD by non-invasive methods, especially calcium score, TG/HDL-C ratio and HDL-c.

Objectives: This study investigated chronic changes in cell free DNA (cf-DNA) throughout a collegiate soccer season. The relationship between cf-DNA, C-reactive protein (CRP), creatine kinase (CK), testosterone (T), cortisol (C), testosterone-cortisol ratio (T:C), body mass and body composition were also examined. Design: Longitudinal study design with repeated measures and group comparisons.Methods: Twenty three NCAA Division I male soccer players were divided into two groups. Starters were placed in Group 1 (G1) and non-starters were placed in Group 2 (G2). cf-DNA, CRP, CK, T, C, T:C, body mass and body composition were taken three times, corresponding to pre-season, approximately mid-season and immediately after the concluding the season.Results: In G1, cf-DNA, CRP, CK, cf-DNA %∆, CRP %∆ and, CK %∆ were all statistically higher at T2 and T3 than T1. In G2, CRP %∆ was statistically higher at T2 than T1. In G2, cf-DNA %∆, CRP %∆ and CK %∆ were higher at T2 and T3 than T1.Conclusions: This suggests that cf-DNA may be a useful marker that can reflect accumulated soccer training and competitive stressors.

The primary purposes of this dissertation were to explore relationship between cell free DNA (cf-DNA), creatine kinase (CK), C-reactive protein (CRP), vertical jump testing delayed onset muscle soreness (DOMS) in response to a high-volume resistance training protocol, and to assess the sensitivity of cf-DNA to different resistance training volume loads. The secondary purpose was to examine the relationship between cf-DNA and relative strength. Study 1 was an exploratory attempt to discover relationships between cf-DNA, CK, CRP, delayed onset muscle soreness, and performance variables. Seventeen resistance trained males were recruited, 9 were randomly assigned to receive BCAAs while 8 received a placebo. Participants performed a high-volume resistance training session consisting of the back squat and bench press. Blood was drawn to measure serum cf-DNA, CK, and CRP levels prior to the training session, with cf-DNA collected immediately post, and CK and CRP at 24hr and 48hrs post. Self-reported DOMS on a scale of 1 to 10 was collected prior to training on day 2, day 3, and day 4. SJH, CMJH, and BOSCO were collected on day 1, day 3, and day 4. Fifty-seven correlations were run to explore the relationships between variables. Only the correlation between %Δ DOMS 48hr and %Δ CRP 48hr in the non-supplement group was significant (p = 0.02). The second study, designed to assess the sensitivity of cf-DNA to different resistance training volume loads, consisted of a high-volume resistance training protocol. Blood was drawn immediately before the resistance training session (T1), immediately after the third lifting set (T2), and immediately after the sixth lifting set (T3). cf-DNA increased significantly from T1 to T2 (p < 0.01) and T1 to T3 (p < 0.01). The linear regression model used to examine the capabilities of relative strength to predict %Δ cf-DNA from T1 to T3 was significant (p = 0.04). The results of this study demonstrate the short response time of cf-DNA in relation to variations in resistance training volume-load, suggesting it may be a valuable marker in monitoring the immune response to volume-load. Results also demonstrated the positive relationship between relative strength and %Δ cf-DNA.

Background: This study examined the association of 25-hydroxyvitamin D (25(OH)D) and C-reactive protein (CRP) with postoperative medical complications and one year mortality of elderly patients sustaining a low-energy cervical hip fracture scheduled for surgery. We hypothesized that vitamin D deficiency and CRP in these patients might be associated with an increased 1-year mortality. Methods: The prospective single-center cohort study included 209 patients with a low-energy medial femoral neck fracture; 164 women aged over 50 years and 45 men aged over 60 years. Referring to 1-year mortality and postoperative medical complications multiple logistic regression analysis including 10 co-variables (age, sex, BMI, ASA, creatinine, CRP, leukocytes hemoglobin, 25(OH)D, vitamin D supplementation at follow-up) was performed. Results: Vitamin D deficiency was prevalent in 87 % of all patients. In patients with severe (<10 ng/ml) and moderate (10–20 ng/ml) vitamin D deficiency one year mortality was 29 % and 13 %, respectively, compared to 9 % in patients with > 20 ng/ml 25(OH)D levels (p =0.027). Patients with a mild (CRP 10–39.9 mg/l) or active inflammatory response (CRP ≥ 40 mg/l) showed a higher one year mortality of 33 % and 40 % compared to 16 % in patients with no (CRP < 10 mg/l) inflammatory response (p = 0.002). Multiple logistic regression analysis identified CRP (OR 1.01, 95 % CI 1.00- 1.02; p = 0.007), but not 25(OH)D (OR 0.97, 95 % CI 0.89-1.05; p = 0.425) as an independent predictor for one year mortality. 20 % of patients suffered in-hospital postoperative medical complications (i.e. pneumonia, thromboembolic events, etc.). 25(OH)D (OR 0.89, 95 % CI 0.81–0.97; p = 0.010), but not CRP (OR 1.01, 95 % CI 1.00-1.02; p = 0.139), was identified as an independent risk factor. Conclusion: In elderly patients with low-energy cervical hip fracture, 25(OH)D is independently associated with postoperative medical complications and CRP is an independent predictor of one year mortality.

Introduction: The high transmissibility and lethality of the novel coronavirus SARS-CoV-2 (COVID-19) have been catastrophic. Acute kidney injury (AKI) is one of the frequent complications in patients with respiratory insufficiency caused by the virus. The pathogenic mechanism is based on the binding of its S-proteins to the angiotensin-converting enzyme (ACE) receptors, which will trigger a cellular damage. A podocyte and tubular compromise are found in the kidneys which can lead to tubular necrosis and the consequent AKI. Objectives: The objective of this report is to identify the main risk factor to develop AKI in patients infected with SARS-CoV-2 with critical acute respiratory distress. Patients and Methods: We performed this report study, collecting data from 48 ICU patients. Data from 13 of them who developed AKI and needed renal replacement therapy (RRT)were analyzed. Clinical characteristics and laboratory findings were reported using STATA 10.0. Results: AKI was present in 27.08% of patients, mostly male (92.3%) with a mean age of 63.8 years old. Hypertension, diabetes and obesity were the main comorbidities in those patients. Additionally, the meantime between admission and AKI diagnosis was 2.69 days. All patients showed fibrinogen, D-dimer, ALT and values above normal range. Mortality was seen in 61.5% of patients. Conclusion: This report tries to show AKI as an important clinical manifestation in critically ill patients infected with SARS-CoV-2, with high mortality. Further studies are needed to demonstrate if there are independent risk factors. / Revisión por pares