Publications by authors named "Maria Siqueira"

55 Publications

Effects of silver nanoparticles prenatal exposure on rat offspring development.

Environ Toxicol Pharmacol 2021 Jan 10;81:103546. Epub 2020 Nov 10.

Programa de Pós-Graduação em Biotecnologia (PPG-Biotec), Centro de Ciências Exatas e Tecnologia (CCET), Universidade Federal de São Carlos (UFSCar), Rodovia Washington Luís, km 235, 13565-905, São Carlos, SP, Brazil; EMBRAPA Instrumentação, Rua XV de Novembro, 1452, 13560-970, São Carlos, SP, Brazil. Electronic address:

Many types of nanocomposites employed in food packaging are based on silver nanoparticles (AgNP) because of their antibacterial properties, which can increase food shelf-life. As the commercialization of AgNP products has been expanding, the released of such nanoparticles in the environment has caused enormous concern, once they can pose potential risks to the environment and human beings. For instance, exposure of the maternal environment to nanomaterials during pregnancy may impact the health of the dam, fetus and offspring. In this context, here we investigated the effects of prenatal exposure of AgNP on the pregnancy outcomes of dams and postnatal development of their offspring. Pregnant Wistar rats were exposed to distinct AgNP concentrations (0, 1, 3 and 5 μg/kg/day) from beginning to the end of pregnancy. At parturition, newborns were observed regarding clinical signs of toxicity and survival rate. The offspring was examined by evaluating developmental endpoints. A delay in time for vaginal opening and testes descent were detected in the offspring exposed to AgNP during embryonic development. Our results indicate that prenatal exposure to AgNP can compromise neonatal rats' postnatal development, especially the reproductive features.
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http://dx.doi.org/10.1016/j.etap.2020.103546DOI Listing
January 2021

Glycogen storage cardiomyopathy (PRKAG2): diagnostic findings of standard and advanced echocardiography techniques.

Eur Heart J Cardiovasc Imaging 2020 Aug 3. Epub 2020 Aug 3.

Post Graduation Department Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias 275 30130-110, Belo Horizonte, Brazil.

Aims : Describe the findings obtained using standard echocardiography (Echo) and deformation indices (2D and 3D speckle tracking strain) in patients (Pts) with PRKAG2 cardiomyopathy. Seek to identify any peculiar characteristics and possible strain patterns that may distinguish this condition from other causes of left ventricular hypertrophy (LVH).

Methods And Results : Thirty Pts with genetically proven PRKAG2 (R302Q and H401Q), 16 (53.3%) male, mean age 39.1± 15.4 years old, were examined using standard, speckle tracking (STE), and 3D Echo. Pacemaker (PM) had been implanted in 12 (40%) Pts with a mean age of 38.1 ± 13 years. Hypertrophy was found in varying degrees in 18 (86%) Pts. Seven Pts (24%) presented 3D ejection fraction (EF) below normal limits. Diastolic function was abnormal in 17 (63%) Pts. Global longitudinal strain (GLS) on 2D measured -16.4% ± 5.3%. GLS measured -13.2% ± 4.8%, global radial strain 40.8% ± 13.8%, global circumferential strain (GCS) -16.1% ± 4.4%, and global area strain -26.1% ± 6.7% by 3D Echo offline analyses. Pts with PM presented lower EF and GCS compared with those without PM. EF/GLS measured 3.65 ± 1.00. In the bull's eye map, a strain pattern similar to stripes in 18 (60%) Pts was identified, which might be a differentiating signal among LVH.

Conclusion : Echocardiography is a valuable tool in detecting diffuse and focal myocardial abnormalities in PRKAG2 cardiomyopathy. The deformation indices are especially revealing because they may help distinguish this rare infiltrative disease, thereby favouring early diagnosis, enhanced treatment, and improved outcome.
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http://dx.doi.org/10.1093/ehjci/jeaa176DOI Listing
August 2020

Comparison of automated and manual protocols for magnetic resonance imaging assessment of liver iron concentration.

Radiol Bras 2020 May-Jun;53(3):148-154

Radiology and Diagnostic Imaging, Hospital Mater Dei, Pós-Graduação Ciências Médicas de Minas Gerais (PGCM-MG), Belo Horizonte, MG, Brazil.

Objective: To compare automated and manual magnetic resonance imaging protocols for estimating liver iron concentrations at 1.5 T.

Materials And Methods: Magnetic resonance imaging examination of the liver was performed in 53 patients with clinically suspected hepatic iron overload and in 21 control subjects. Liver iron concentrations were then estimated by two examiners who were blinded to the groups. The examiners employed automated T2* and T1 mapping, as well as manual T2* and signal-intensity-ratio method. We analyzed accuracy by using ROC curves. Interobserver and intraobserver agreement were analyzed by calculating two-way intraclass correlation coefficients.

Results: The area under the ROC curve (to discriminate between patients and controls) was 0.912 for automated T2* mapping, 0.934 for the signal-intensity-ratio method, 0.908 for manual T2*, and 0.80 for T1 mapping, the last method differing significantly from the other three. The level of interobserver and intraobserver agreement was good (intraclass correlation coefficient, 0.938-0.998; < 0.05). Correlations involving T1 mapping, although still significant, were lower.

Conclusion: At 1.5 T, T2* mapping is a rapid tool that shows promise for the diagnosis of liver iron overload, whereas T1 mapping shows less accuracy. The performance of T1 mapping is poorer than is that of T2* methods.
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http://dx.doi.org/10.1590/0100-3984.2019.0029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302902PMC
June 2020

Oral health literacy, sociodemographic, family, and clinical predictors of dental visits among Brazilian early adolescents.

Int J Paediatr Dent 2021 Mar 29;31(2):204-211. Epub 2020 May 29.

Graduate Program in Dentistry, School of Dentistry, State University of Paraiba (UEPB), Campina Grande, Brazil.

Background: The prevalence of dental caries is high in adolescents worldwide, and a large percentage have never been to a dentist or have not had regular dental appointments.

Aim: To evaluate the influence of oral health literacy and sociodemographic, clinical, and family factors on dental visits among early adolescents.

Design: A cross-sectional study was conducted with 740 12-year-old students in Campina Grande, Brazil. Students answered about their level of oral health literacy (BREALD-30), levels of family adaptability and cohesion (FACES III), and visits to the dentist sometime in life. Dental caries experience was evaluated using Nyvad criteria. Robust Poisson regression for complex samples was performed.

Results: A higher level of oral health literacy (PR = 1.01; 95% CI: 1.01-1.03), high social class (PR = 1.28; 95% CI: 1.09-1.50), higher mother's schooling (PR = 1.58; 95% CI: 1.37-1.83), family cohesion classified as enmeshed (PR = 1.55; 95% CI: 1.19-2.02) and connected (PR = 1.22; 95% CI: 1.02-1.44), and the absence of toothache (PR = 1.18; 95% CI: 1.01-1.38) remained associated with having visited a dentist.

Conclusions: Oral health literacy and sociodemographic, family, and clinical factors were predictors of having visited a dentist among early adolescents.
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http://dx.doi.org/10.1111/ipd.12660DOI Listing
March 2021

Pesticide Exposure Assessment Paradigm for Stingless Bees.

Environ Entomol 2019 02;48(1):36-48

Federal University of Bahia (UFBA), Salvador, BA, Brazil.

Although the importance of bees as the pollinators responsible for maintaining gene flow for many native and cultivated plants in ecosystems around the world is recognized, much of their biodiversity and behavior remains to be discovered. Stingless bees are considered key pollinators for several plant species in tropical and subtropical ecosystems and they also provide pollination services for economically important agricultural crops. Many countries are using the honey bee (Apis mellifera Linnaeus, 1758, Hymenoptera: Apidae) as a surrogate to evaluate the risk of pesticides to all species of bees. However, there is uncertainty regarding the extent to which honey bees can serve as surrogates for non-Apis bee species in the risk assessment for pesticides. This paper provides a short overview of the life history traits relevant in risk assessment of stingless bees. It summarizes what is known about stingless bee exposure to pesticides compared to that of honey bees and presents criteria for potential candidate species from Brazil for use in pesticide risk assessment in tropical environments. This paper also identifies gaps in knowledge of bee biology and pesticide exposure routes not covered by the current honey bee exposure assessment paradigm. Based on these gaps, research is needed on life history traits, estimates of nectar and pollen consumption, mud, resin, and water collection and available protocols to adequately assess toxic effects of pesticides to stingless bees. This review is part of a series of papers on the risk of exposure of non-Apis bees to pesticides.
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http://dx.doi.org/10.1093/ee/nvy137DOI Listing
February 2019

Cytotoxic and genotoxic effects of silver nanoparticle/carboxymethyl cellulose on Allium cepa.

Environ Monit Assess 2017 Jul 24;189(7):352. Epub 2017 Jun 24.

Programa de Pós-Graduação em Biotecnologia (PPGBiotec), Centro de Ciências Exatas e Tecnologia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, 13565-905, Brazil.

Several mutagenic agents may be present in substances released in the environment, which may cause serious environmental impacts. Among these substances, there is a special concern regarding the widespread use of silver nanoparticles (AgNP) in several products due to their widely known bactericidal properties, including in the medical field and the food industry (e.g., active packaging). The assessment of the effects of AgNP released in the environment, having different concentrations, sizes, and being associated or not to other types of materials, including polymers, is therefore essential. In this research, the objective was to evaluate the genotoxic and cytotoxic effects of AgNP (size range between 2 and 8 nm) on root meristematic cells of Allium cepa (A. cepa). Tests were carried out in the presence of colloidal solution of AgNP and AgNP mixed with carboxymethylcellulose (CMC), using distinct concentrations of AgNP. As a result, when compared to control samples, AgNP induced a mitotic index decrease and an increase of chromosomal aberration number for two studied concentrations. When AgNP was in the presence of CMC, no cytotoxic potential was verified, but only the genotoxic potential for AgNP dispersion having concentration of 12.4 ppm.
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http://dx.doi.org/10.1007/s10661-017-6062-8DOI Listing
July 2017

Cardiac Magnetic Resonance-Verified Myocardial Fibrosis in Chagas Disease: Clinical Correlates and Risk Stratification.

Arq Bras Cardiol 2016 Nov;107(5):460-466

Setor de Ressonância Magnética Cardiovascular do Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP.

Background:: Chagas disease (CD) is an important cause of heart failure and mortality, mainly in Latin America. This study evaluated the morphological and functional characteristics of the heart as well the extent of myocardial fibrosis (MF) in patients with CD by cardiac magnetic resonance (CMR). The prognostic value of MF evaluated by myocardial-delayed enhancement (MDE) was compared with that via Rassi score.

Methods:: This study assessed 39 patients divided into 2 groups: 28 asymptomatic patients as indeterminate form group (IND); and symptomatic patients as Chagas Heart Disease (CHD) group. All patients underwent CMR using the techniques of cine-MRI and MDE, and the amount of MF was compared with the Rassi score.

Results:: Regarding the morphological and functional analysis, significant differences were observed between both groups (p < 0.001). Furthermore, there was a strong correlation between the extent of MF and the Rassi score (r = 0.76).

Conclusions:: CMR is an important technique for evaluating patients with CD, stressing morphological and functional differences in all clinical presentations. The strong correlation with the Rassi score and the extent of MF detected by CMR emphasizes its role in the prognostic stratification of patients with CD.

Fundamento:: A doença de Chagas (DC) é importante causa de insuficiência cardíaca e mortalidade, principalmente na América Latina. Este estudo avaliou as características morfológicas e funcionais do coração, assim como a extensão da fibrose miocárdica (FM) em pacientes com DC através de ressonância magnética cardíaca (RMC). O valor prognóstico da FM avaliada por realce tardio miocárdico (RTM) foi comparado àquele do escore de Rassi.

Métodos:: Avaliação de 39 pacientes divididos em 2 grupos: grupo 'forma indeterminada' (IND), 28 pacientes assintomáticos; e grupo 'cardiopatia chagásica' (CC), pacientes sintomáticos. Todos os pacientes foram submetidos a RMC com as técnicas de cine-RM e RTM, sendo a quantidade de FM evidenciada ao exame comparada ao escore de Rassi.

Resultados:: As análises morfológica e funcional mostraram significativas diferenças entre os 2 grupos (p < 0,001). Houve ainda uma forte correlação entre a extensão da FM e o escore de Rassi (r = 0,76).

Conclusões:: A RMC é uma importante técnica para avaliar pacientes com DC, ressaltando as diferenças morfológicas e funcionais em todas as apresentações clínicas. A forte correlação entre o escore de Rassi e a extensão da FM detectada por RMC enfatiza seu papel na estratificação prognóstica de pacientes com DC.
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http://dx.doi.org/10.5935/abc.20160168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5137391PMC
November 2016

Asymptomatic large aortic root thrombus after left ventricular assist device implantation detected by cardiac computed tomography.

J Cardiovasc Comput Tomogr 2017 Jan - Feb;11(1):72-73. Epub 2016 Nov 3.

The Mount Sinai Hospital, Icahn School of Medicine, Manhattan, New York, NY, USA.

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http://dx.doi.org/10.1016/j.jcct.2016.10.004DOI Listing
June 2017

Characterization and clinical significance of right ventricular mechanics in pulmonary hypertension evaluated with cardiovascular magnetic resonance feature tracking.

J Cardiovasc Magn Reson 2016 06 16;18(1):39. Epub 2016 Jun 16.

The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Background: Prognosis in pulmonary hypertension (PH) is related to right ventricular (RV) function. Quantification of RV mechanics may offer additive value. The objective of our study is to determine the feasibility and clinical and prognostic value of RV strain analysis by cardiovascular magnetic resonance (CMR) based feature tracking (FT) in PH.

Methods: We retrospectively enrolled 116 patients (age 52.2 ± 12 years, 73.6 % women) referred to CMR for PH evaluation who underwent right heart catheterization within 1 month. Using dedicated FT software, peak global longitudinal and circumferential RV strain and strain rates (GLS, GCS, GLSR, and GCSR, respectively) were quantified from standard cine images. Using multivariate regression analysis, we evaluated the associations of strain with a composite endpoint of death, lung transplantation, or functional class deterioration.

Results: RV strain analysis was feasible in 110 (95 %) patients. Patients were classified into: Group A (no PH, normal right ventricular ejection fraction [RVEF]; n = 17), Group B (PH, normal RVEF; n = 26), or Group C (PH, abnormal RVEF; n = 67). All strain and strain rate values were reduced in Group C. Furthermore, GCSR was significantly reduced in Group B (-0.92 [-1.0/-0.7]; p < 0.001) compared to Group A (-1.12 [-1.3/-0.9]; p < 0.001). After adjustment for six clinically meaningful covariates, GLS (hazard ratio 1.06; p = 0.026), GLSR (hazard ratio 2.52; p = 0.04), and GCSR (hazard ratio 4.5; p = 0.01) were independently associated with the composite endpoint. GCSR successfully discriminated patients with and without events (p = 0.01).

Conclusions: Quantification of RV strain with CMR-FT is feasible in the majority of patients, correlates with disease severity, and is independently associated with poor outcomes in PH.
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http://dx.doi.org/10.1186/s12968-016-0258-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910232PMC
June 2016

Parental influence on children's answers to an oral-health-related quality of life questionnaire.

Braz Oral Res 2016 15;30. Epub 2016 Mar 15.

Department of Dentistry, Universidade Estadual da Paraíba, Campina Grande, PB, Brazil.

The aim of the study was to evaluate parental influence on children's answers to an oral health-related quality of life (OHRQoL) questionnaire. A cross-sectional study was conducted with a non-probabilistic sample of 84 pairs of 5-year-olds and parents/guardians. The participants were selected from a primary family healthcare center in Campina Grande, Brazil. First, the children and parents answered respective versions of the Scale of Oral Health Outcomes for Five-Year-Old Children (SOHO-5). Seven days later, the children answered their version of the SOHO-5, without the presence of their parents/guardians, and underwent a clinical exam of dental caries, traumatic dental injury and malocclusion, by a previously calibrated researcher. Statistical analysis involved a comparison of mean scores and the calculation of the intraclass correlation coefficient (ICC). Poisson regression models were used to associate the variables (α = 5%). No significant differences were found between the mean SOHO-5 scores of the children when alone or accompanied by parents/guardians (p > 0.05). The ICC between the answers of the children alone or accompanied was 0.84. White spot (PR = 6.32; 95%CI: 1.36 - 29.40) and cavitated lesions (PR = 9.81; 95%CI: 3.22 - 29.85) had an impact on OHRQoL, according to the children's self-report, whereas cavitated lesions (PR = 90.52; 95%CI: 13.26 - 617.74) and anterior open bite (PR = 1.95; 95%IC: 1.07 - 3.53) remained on the final model, according to the parents' version of the SOHO-5. In conclusion, parents did not influence the children's responses, and dental caries are the oral health problem exerting the greatest impact on the children's OHRQoL.
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http://dx.doi.org/10.1590/1807-3107BOR-2016.vol30.0014DOI Listing
May 2016

Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients.

Eur Heart J Cardiovasc Imaging 2017 Jan 28;18(1):54-61. Epub 2016 Feb 28.

Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

Aims: We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes.

Methods And Results: Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient.

Conclusion: In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients.
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http://dx.doi.org/10.1093/ehjci/jew021DOI Listing
January 2017

MSCT Identification of Vulnerable Plaque.

JACC Cardiovasc Imaging 2016 Feb;9(2):207-9

Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.

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http://dx.doi.org/10.1016/j.jcmg.2015.01.027DOI Listing
February 2016

Prognostic value of coronary computed tomography in patients with non-significant perfusion defects by myocardial perfusion SPECT.

Acta Cardiol 2015 Dec;70(6):647-52

Aims: Myocardial perfusion scintigraphy (MPS) is an important diagnostic tool in the management of patients with suspected coronary artery disease (CAD). However, the presence of mild-moderate perfusion defects can be challenging and may lead to unnecessary cardiac catheterization. Coronary computed tomography angiography (CCTA) is a method with excellent accuracy in the evaluation of CAD, but its role in this setting of patients has not been fully defined. This study aims to assess the potential of CCTA in the prediction of cardiac adverse events in patients with suspected CAD with non-significant perfusion defects by MPS.

Methods And Results: We conducted a cohort study in 292 patients presenting with non-significant perfusion defects by MPS undergoing a CCTA. The patients were followed for a mean of 34 months for occurrence of major cardiac adverse events - MACE. The majority of the patients (64.7%) were male, with a mean age of 57.9 ± 12.6 years. During the follow-up there were 37 MACE. In multivariate Cox proportional hazards model, hypertension and CCTA were independent predictors of MACE. The patients who presented a significant coronary obstruction by CCTA had a high risk of MACE (HR 15.3; 95% CI 4.06 to 57.90; P < 0.001). Kaplan-Meier curve showed a significant difference (log-rank χ²; P < 0.001) using CCTA in predicting MACE.

Conclusion: CCTA carries a powerful prognostic value in predicting adverse events in patients with suspected CAD and MPS with mild-moderate perfusion defects and may be useful in risk stratification of these patients.
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http://dx.doi.org/10.2143/AC.70.6.3120176DOI Listing
December 2015

Impact of traumatic dental injury on the quality of life of young children: a case-control study.

Int Dent J 2015 Oct 27;65(5):261-8. Epub 2015 Aug 27.

Department of Dentistry, Dental School, State University of Paraíba, Campina Grande, Brazil.

There are no longitudinal studies that assess the impact of traumatic dental injury (TDI) on the oral health-related quality of life (OHRQoL) of preschool children. To investigate the impact of TDI on OHRQoL among preschool children, a population-based case-control study was carried out with a representative sample of 335 children, 3-5 years of age, enrolled at public and private preschools in the city of Campina Grande, Brazil. The case group and the control group were matched for age, gender, type of preschool and monthly household income at a ratio of 1:4 (67 cases and 286 controls). Impact on the OHRQoL of children was assessed through administration of the Early Childhood Oral Health Impact Scale (ECOHIS). The occurrence of TDI was determined through clinical examinations performed by three calibrated dentists. Data analysis involved descriptive statistics, McNemar's test, the chi-square test with linear trend and conditional logistic regression analysis [P≤0.05; 95% confidence interval (95% CI)]. The most frequent responses were 'felt pain' (19.4%) and 'difficulty eating' (16.4%). The prevalence of TDI was 37.3% in the case group and 33.9% in the control group. No statistically significant differences were found between case and control groups regarding the presence of TDI (odds ratio=1.16; 95% CI: 0.66-2.02). TDI had no impact on the quality of life of preschool children.
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http://dx.doi.org/10.1111/idj.12182DOI Listing
October 2015

Biopesticide-induced behavioral and morphological alterations in the stingless bee Melipona quadrifasciata.

Environ Toxicol Chem 2015 Sep 30;34(9):2149-58. Epub 2015 Jul 30.

Departamento de Entomologia, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil.

Because of their natural origin, biopesticides are assumed to be less harmful to beneficial insects, including bees, and therefore their use has been widely encouraged for crop protection. There is little evidence, however, to support this ingrained notion of biopesticide safety to pollinators. Because larval exposure is still largely unexplored in ecotoxicology and risk assessment on bees, an investigation was performed on the lethal and sublethal effects of a diet treated with 2 bioinsecticides, azadirachtin and spinosad, on the stingless bee, Melipona quadrifasciata, which is one of the most important pollinators in the Neotropics. Survival of stingless bee larvae was significantly compromised at doses above 210 ng a.i./bee for azadirachtin and 114 ng a.i./bee for spinosad. No sublethal effect was observed on larvae developmental time, but doses of both compounds negatively affected pupal body mass. Azadirachtin produced deformed pupae and adults as a result of its insect growth regulator properties, but spinosad was more harmful and produced greater numbers of deformed individuals. Only spinosad compromised walking activity of the adult workers at doses as low as 2.29 ng a.i./bee, which is 1/5000 of the maximum field recommended rate. In conclusion, the results demonstrated that bioinsecticides can pose significant risks to native pollinators with lethal and sublethal effects; future investigations are needed on the likelihood of such effects under field conditions.
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http://dx.doi.org/10.1002/etc.3053DOI Listing
September 2015

Diagnostic accuracy of coronary ct for the quantification of the syntax score in patients with left main and/or 3-vessel coronary disease. Comparison with invasive angiography.

Int J Cardiol 2015 Mar 6;182:549-56. Epub 2015 Jan 6.

The Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, NY, USA. Electronic address:

Background: The SYNTAX score helps in the treatment decision in multivessel coronary disease. Coronary computed tomography angiography (CTA) can measure the SYNTAX score but has been used in few patients with multivessel disease. Our aim was to assess the feasibility, accuracy and reproducibility of SYNTAX score with CCTA compared with invasive coronary angiography (ICA) in de novo left main and/or 3-vessel disease.

Methods: 57 patients with new left main and/or 3-vessel disease on ICA and a CCTA performed within the previous month were included. The SYNTAX score was calculated retrospectively for both modalities. Agreement for the global score, vessel score, different components and inter-readers was evaluated with intraclass correlation coefficient (ICC). The ability to classify SYNTAX score categories (low, intermediate and high) was assessed using weighted kappa (K) coefficient.

Results: CCTA-based SYNTAX score showed an acceptable concordance (ICC=0.64) and good correlation (r=0.65, p<0.001) with ICA. ICC per vessel and component ranged from 0 to 0.73. There was good agreement classifying the SYNTAX score categories (K=0.53) and interobserver reproducibility (ICC=0.85). CCTA demonstrated high diagnostic accuracy (0.84) for detecting patients in the high score group. No patient with a high CCTA SYNTAX score had a low risk score by ICA that would suggest benefit from percutaneous revascularization.

Conclusions: CCTA showed good correlation, acceptable concordance, and high reproducibility for the quantification of the SYNTAX score in de novo left main and/or 3-vessel coronary disease. A high CCTA SYNTAX score identified a group of patients less likely to benefit from percutaneous coronary intervention.
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http://dx.doi.org/10.1016/j.ijcard.2015.01.014DOI Listing
March 2015

[II Guidelines on Cardiovascular Magnetic Resonance and Computed Tomography of the Brazilian Society of Cardiology and the Brazilian College of Radiology].

Arq Bras Cardiol 2014 Dec 1;103(6 Suppl 3):1-86. Epub 2014 Dec 1.

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http://dx.doi.org/10.5935/abc.2014S006DOI Listing
December 2014

Role of coronary artery calcium score for risk stratification in patients with non significant perfusion defects by myocardial perfusion single photon emission computed tomography.

Cardiol J 2015 ;22(3):330-5

Background: Myocardial perfusion scintigraphy (MPS) is an important diagnostic tool in the management of patients with suspected coronary artery disease (CAD). However, the presence of mild-moderate perfusion defects can be challenging and may lead to unnecessary cardiac catheterization. The coronary artery calcium (CAC) score is a method with excellent negative predictive value in the evaluation of CAD, but its role in this setting of patients has not been fully defined. This study aims to assess the potential of CAC in the prediction of cardiac adverse events in patients with suspected CAD with mild-moderate perfusion by MPS.

Methods And Results: We conducted a cohort study in 292 patients presenting with mild-moderate perfusion defects by MPS undergoing a CAC measurement. The patients were followed for a mean of 34 months for occurrence of major cardiac adverse events (MACE). The majority of the patients (64.7%) were male, mean age of 57.9 ± 12.6 years. During the follow-up there were 37 MACE. In multivariate Cox proportional hazards model, hypertension and CAC were independent predictors of MACE. The patients who presented a CAC score of ≥ 400 had a high risk of MACE (HR 20.9; 95% CI 4.79-91.42; p < 0.001). Kaplan-Meier curve showed a significant difference (log-rank χ²; p< 0.001) using CAC scores in predicting MACE.

Conclusions: CAC score carries a powerful prognostic value in predicting adverse events in patients with suspected CAD and MPS with mild-moderate perfusion defects and may be useful in risk stratification of these patients.
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http://dx.doi.org/10.5603/CJ.a2014.0084DOI Listing
September 2016

Low- vs. standard-dose coronary artery calcium scanning.

Eur Heart J Cardiovasc Imaging 2015 Apr 7;16(4):358-63. Epub 2014 Nov 7.

Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA.

Aims: This study was designed to assess the accuracy of coronary artery calcium scans (CACS) acquired at radiation doses below mammography and low-dose lung scanning, compared with standard-dose CACS.

Methods And Results: CACS was performed in 102 consecutive patients at 120 kVp; all were imaged at standard-dose mAs levels ranging from 30 to 80 mAs determined by their weight, with iterative reconstruction (IR) level 3, and at 50% of the standard-dose mAs with IR level 7 to compensate for the expected increased noise with lower mAs. The low- vs. standard-dose mAs was 24.5 ± 8.8 vs. 48.5 ± 17.8 mAs (P < 0.0001), and the radiation exposure was 0.37 ± 0.16 vs. 0.76 + 0.34 mSv (P < 0.0001). The Agatston score correlation between the low and high dose was excellent (r = 0.998, P < 0.0001) over a range of scores from 0 to 2512. The weighted kappa for agreement of standard CAC risk categories was 0.95 (95% CI 0.83-0.97). The mean of the differences between individual low- and standard-dose Agatston scores was 17.4 ± 25.8, lower than the reported variability of two scans performed with the same mAs.

Conclusion: There was excellent agreement of CACS-based risk classification at low and standard doses, with lower interscan variability than with reported identical doses. The low-dose CACS radiation exposure was less than the approved screening tools of mammography and low-dose lung scanning.
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http://dx.doi.org/10.1093/ehjci/jeu218DOI Listing
April 2015

Crystal structure of bis-{μ-4-methyl-N'-[3-(oxido-imino)-butan-2-yl-idene]benzene-sulfono-hydrazidato}bis-[(dimethyl sulfoxide-κO)copper(II)].

Acta Crystallogr Sect E Struct Rep Online 2014 Sep 1;70(Pt 9):m316-7. Epub 2014 Aug 1.

Departamento de Química, Universidade Federal de Sergipe, Av. Marechal Rondon s/n, Campus, 49100-000, São Cristóvão, SE, Brazil.

In the title compound, [Cu2(C11H13N3O3S)2(C2H6OS)2], the Cu(II) cation is N,N',O-chelated by a deprotonated hy-droxy-imino-tosyl-hydrazone ligand and coordinated by a dimethyl sulfoxide mol-ecule. One O atom from the adjacent hy-droxy-imino-tosyl-hydrazone ligand bridges the Cu(II) cation, forming the centrosymmetric dimeric complex. The cation is in an overall distorted N2O3 square-pyramidal coordination environment. The methyl-benzene ring is twisted with respect to the hydrazine fragment, with a dihedral angle of 89.54 (9)° between the planes. An intra-molecular C-H⋯O hydrogen bond occurs. In the crystal, mol-ecules are linked by weak C-H⋯O and C-H⋯S inter-actions. Weak π-π stacking is also observed between parallel benzene rings of adjacent mol-ecules, the centroid-centroid distance being 3.9592 (17) Å.
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http://dx.doi.org/10.1107/S1600536814016651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4186093PMC
September 2014

Value of CMR for the differential diagnosis of cardiac masses.

JACC Cardiovasc Imaging 2014 Sep 13;7(9):896-905. Epub 2014 Aug 13.

The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York. Electronic address:

Objectives: The goal of this study was to evaluate the diagnostic value of CMR features for the differential diagnosis of cardiac masses.

Background: Differentiation of cardiac tumors and thrombi and differentiation of benign from malignant cardiac neoplasms is often challenging but important in clinical practice. Studies assessing the value of cardiac magnetic resonance (CMR) in this regard are scarce.

Methods: We reviewed the CMR scans of patients with a definite cardiac thrombus or tumor. Mass characteristics on cine, T1-weighted turbo spin echo (T1w-TSE) and T2-weighted turbo spin echo (T2w-TSE), contrast first-pass perfusion (FPP), post-contrast inversion time (TI) scout, and late gadolinium enhancement (LGE) sequences were analyzed.

Results: There were 84 thrombi, 17 benign tumors, and 25 malignant tumors in 116 patients. Morphologically, thrombi were smaller (median area 1.6 vs. 8.5 cm(2); p < 0.0001), more homogeneous (99% vs. 46%; p < 0.0001), and less mobile (13% vs. 33%; p = 0.007) than tumors. Hyperintensity compared with normal myocardium on T2w-TSE, FPP, and LGE were more common in tumors than in thrombi (85% vs. 42%, 70% vs. 4%, and 71% vs. 5%, respectively; all p < 0.0001). A pattern of hyperintensity/isointensity (compared with normal myocardium) with short TI and hypointensity with long TI was very frequent in thrombi (94%), rare in tumors (2%), and had the highest accuracy (95%) for the differentiation of both entities. Regarding the characterization of neoplastic masses, malignant tumors were larger (median area 11.9 vs. 6.3 cm(2); p = 0.006) and more frequently exhibited FPP (84% vs. 47%; p = 0.03) and LGE (92% vs. 41%; p = 0.001). The ability of CMR features to distinguish benign from malignant neoplasms was moderate, with LGE showing the highest accuracy (79%).

Conclusions: CMR features demonstrated excellent accuracy for the differentiation of cardiac thrombi from tumors and can be helpful for the distinction of benign versus malignant neoplasms.
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http://dx.doi.org/10.1016/j.jcmg.2014.05.009DOI Listing
September 2014

Prediction factors for failure to seek treatment following traumatic dental injuries to primary teeth.

Braz Oral Res 2014 11;28. Epub 2014 Jun 11.

Department of Pediatrics, School of Dentistry, Universidade Estadual da Paraíba, Campina Grande, PB, Brazil.

The objective of this study was to evaluate prediction factors for failure to seek treatment following a traumatic dental injury (TDI) to primary teeth among preschool children in the city of Campina Grande, Brazil. A cross-sectional study was carried out involving 277 children 3 to 5 years of age, with TDI, enrolled in public and private preschools. Parents filled out a form addressing demographic data and whether or not they had sought treatment. Clinical examinations were performed by three dentists who had undergone a calibration exercise (Kappa: 0.85 to 0.90) for the evaluation of TDI. Bivariate and multivariate Poisson regression models were constructed (α=5%). Enamel fracture was the most prevalent type of TDI (48.7%) and the upper central incisors were the most affected teeth (88.4%). The frequency of seeking dental treatment was low (9.7%). The following variables were associated with failure to seek treatment following TDI: a household income greater than one minimum wage (PR=1.170; 95%CI 1.018-1.341), parents/caregivers' perception of a child's oral health as poor (PR=1.100; 95%CI 1.026-1.176), and the non-perception of TDI by parents/caregivers (PR=1.250; 95%CI 1.142-1.360). In the present study, the frequency of seeking treatment following TDI was low, and parents/caregivers with a higher income, a poor perception of their child's oral health and a lack of awareness regarding the trauma were more likely to fail to seek treatment following TDI to primary teeth.
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http://dx.doi.org/10.1590/1807-3107bor-2014.vol28.0005DOI Listing
July 2014

Evaluation of antimicrobial activity of silver nanoparticles for carboxymethylcellulose film applications in food packaging.

J Nanosci Nanotechnol 2014 Jul;14(7):5512-7

In this study, silver nanoparticles were prepared and incorporated into carboxymethylcellulose films to evaluate the antimicrobial activity for food packaging applications. The techniques carried out for material characterization were: infrared spectroscopy and thermal analysis for the silver nanoparticles and films, as well as particle size distribution for the nanoparticles and water vapor permeability for the films. The antimicrobial activity of silver nanoparticles prepared by casting method was investigated. The minimum inhibitory concentration (MIC) value of the silver nanoparticles to test Gram-positive (Enterococcus faecalis) and Gram-negative (Escherichia coli) microorganisms was carried out by the serial dilution technique, tested in triplicate to confirm the concentration used. The results were developed using the Mcfarland scale which indicates that the presence or absence of turbidity tube demonstrates the inhibition of bacteria in relation to the substance inoculated. It was found that the silver nanoparticles inhibited the growth of the tested microorganisms. The carboxymethylcellulose film embedded with silver nanoparticles showed the best antimicrobial effect against Gram-positive (E. faecalis) and Gram-negative (E. coli) bacteria (0.1 microg cm(-3)).
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http://dx.doi.org/10.1166/jnn.2014.8991DOI Listing
July 2014

Predisposing factors for traumatic dental injury in primary teeth and seeking of post-trauma care.

Braz Dent J 2013 Nov-Dec;24(6):647-54

Department of Pediatric and Orthodontic Dentistry, UFMG - Federal University of Minas Gerais, Belo HorizonteMG, Brazil.

The aim of the present study was to investigate predisposing factors for traumatic dental injury (TDI) in the primary dentition and seeking of dental care after the occurrence of TDI. A randomized population-based cross-sectional study was carried out with 814 children aged 3 to 5 years enrolled at public and private preschools in the city of Campina Grande, PB, Brazil. Parents were asked to fill out a questionnaire on demographic data and the child's history of TDI. TDI was evaluated by clinical examinations performed by three previously calibrated dentists (Kappa: 0.85 to 0.90). Bivariate and multivariate Poisson regression models were constructed for TDI and the parent-reported search for dental care (α=0.05). The prevalence of TDI was 34.6%. The most common type of TDI was enamel fracture (55.0%). The central incisors were the most frequently affected teeth (87.5%). Predictors for TDI in the primary dentition were household income >U$312.50 (PR: 1.355; 95% CI: 1.050-1.724) and overjet >2 mm (PR: 1.539; 95% CI: 1.219-1.942). The predictor for seeking dental care following TDI was parent's age >30 years (PR: 1.753; 95% CI: 1.039-2.960). Household income and overjet were associated with TDI. Among children having suffered TDI, parent's age is a crucial determinant for seeking dental care.
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http://dx.doi.org/10.1590/0103-6440201302352DOI Listing
September 2015

Alcohol consumption among adolescents: attitudes, behaviors and associated factors.

Cien Saude Colet 2014 Jan;19(1):7-16

The scope of this paper is to assess the attitudes and behaviors regarding alcohol use and analyze associated factors among schoolchildren in public schools of Campina Grande in the state of Paraíba. A cross-sectional study was carried out involving 574 adolescents, with the application of a semi-structured questionnaire. The chi-square test and Fisher's exact test were used (5% level of significance). Among the adolescents 54.5% had drunk alcohol and 6.7% of them were heavy drinkers. The majority of them drank alcohol between 11 and 14 years of age (42.8%); 26.3% of the adolescents purchased alcoholic beverages; and beer was the most drink most consumed (43.8%). The risk of alcohol drinking was higher between 16 and 19 years of age (OR = 4.44; p < 0.001), among those without religious affiliation (OR = 4.36; p = 0.002), among those who worked (OR = 2.13; p = 0.012) and among those who had a fair to poor relationship with their father (OR = 2.18; p = 0.010). The results of this study underscore the complexity of this issue and the need to pay particular attention to the adolescent population. Public policies alone are not sufficient. Support from family, school and society is essential to curtail early alcohol use and its consequences.
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http://dx.doi.org/10.1590/1413-81232014191.1989DOI Listing
January 2014

Impact of traumatic dental injury on the quality of life of Brazilian preschool children.

Int J Environ Res Public Health 2013 Nov 28;10(12):6422-41. Epub 2013 Nov 28.

Department of Dentistry, School of Dentistry, State University of Paraíba, Av. das Baraúnas, 351, Campina Grande, Paraiba 58109753, Brazil.

This study aimed to assess the impact of traumatic dental injury (TDI) on the quality of life of preschoolers and their families. A cross-sectional study was carried out, with a sample of 814 children, aged three to five years old, in Campina Grande, Brazil. Parents/caregivers were asked to complete the Brazilian Early Childhood Oral Health Impact Scale and a questionnaire on socio-demographic data. Oral examinations of the children were performed by three previously calibrated dentists. Bivariate and multiple Poisson regression analyses were performed (α = 5%). The prevalence of negative impact from oral conditions on quality of life was 31.1% among the children and 24.7% among the families. TDI was not associated with a negative impact on quality of life. Parent/caregiver's assessment of the child's oral health (PR = 1.210; 95% CI: 1.027-1.426) and history of toothache (PR = 4.997; 95% CI: 2.943-8.493) remained in the final model for the child section, whereas only a history of toothache (PR = 2.791; 95% CI: 1.801-4.325) remained in the final model for the family section. TDI exerted no negative impact on quality of life in the present sample. A history of toothache was the only variable associated with a negative impact on the quality of life of the preschoolers and their families.
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http://dx.doi.org/10.3390/ijerph10126422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881123PMC
November 2013

Use of a colorimetric (DELI) test for the evaluation of chemoresistance of Plasmodium falciparum and Plasmodium vivax to commonly used anti-plasmodial drugs in the Brazilian Amazon.

Malar J 2013 Aug 12;12:281. Epub 2013 Aug 12.

Laboratório de Pesquisas em Malária, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ, Brazil CEP: 21040-900.

Background: The emergence and spread of Plasmodium falciparum and Plasmodium vivax resistance to available anti-malarial drugs represents a major drawback in the control of malaria and its associated morbidity and mortality. The aim of this study was to evaluate the chemoresistance profile of P. falciparum and P. vivax to commonly used anti-plasmodial drugs in a malaria-endemic area in the Brazilian Amazon.

Methods: The study was carried out in Manaus (Amazonas state), in the Brazilian Amazon. A total of 88 P. falciparum and 178 P. vivax isolates was collected from 2004 to 2007. The sensitivity of P. falciparum isolates was determined to chloroquine, quinine, mefloquine and artesunate and the sensitivity of P. vivax isolates was determined to chloroquine and mefloquine, by using the colorimetric DELI test.

Results: As expected, a high prevalence of P. falciparum isolates resistant to chloroquine (78.1%) was observed. The prevalence of isolates with profile of resistance or decreased sensitivity for quinine, mefloquine and artesunate was 12.7, 21.2 and 11.7%, respectively. In the case of P. vivax, the prevalence of isolates with profile of resistance for chloroquine and mefloquine was 9.8 and 28%, respectively. No differences in the frequencies of isolates with profile of resistance or geometric mean IC50s were seen when comparing the data obtained in 2004, 2005, 2006 and 2007, for all tested anti-malarials.

Conclusions: The great majority of P. falciparum isolates in the Brazilian malaria-endemic area remain resistant to chloroquine, and the decreased sensitivity to quinine, mefloquine and artesunate observed in 10-20% of the isolates must be taken with concern, especially for artesunate. Plasmodium vivax isolates also showed a significant proportion of isolates with decreased sensitivity to chloroquine (first-line drug) and mainly to mefloquine. The data presented here also confirm the usefulness of the DELI test to generate results able to impact on public health policies.
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http://dx.doi.org/10.1186/1475-2875-12-281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765867PMC
August 2013

[Methodology and social, demographic, cognitive, and frailty profiles of community-dwelling elderly from seven Brazilian cities: the FIBRA Study].

Cad Saude Publica 2013 Apr;29(4):778-92

Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brasil.

A study was designed to identify conditions of frailty in relation to social, demographic, health, cognitive, functional, and psychosocial variables in community-dwelling elderly. The article presents the methodology and preliminary data. A total of 3,478 elderly (65 years and older) were selected from probabilistic samples of seven Brazilian cities chosen by convenience and participated in a data collection session in a community setting. The following characteristics predominated: women (67.7%), married (48%) or widowed (36.4%), living with a son or daughter and family (52.6%), head of family (64.5%), and 1-4 years of schooling (49%); 28.8% were illiterate and 24.8% presented a cognitive deficit; 9.1% were frail, 51.8% pre-frail, and 39.1% non-frail. There were more frail individuals among women, those 80 years or older, the widowed, the illiterate, those who had never attended school, and those with cognitive deficit. In general, the social and demographic data corroborate Brazilian epidemiological studies, while those on frailty, cognitive status, and schooling corroborate the international literature.
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April 2013

Plasmatic higher levels of homocysteine in non-alcoholic fatty liver disease (NAFLD).

Nutr J 2013 Apr 2;12:37. Epub 2013 Apr 2.

School of Medicine, University of Pernambuco, Pernambuco, Brazil.

Background: Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease, which includes a spectrum of hepatic pathology such as simple steatosis, steatohepatitis, fibrosis and cirrhosis. The increased serum levels of homocysteine (Hcy) may be associated with hepatic fat accumulation. Genetic mutations in the folate route may only mildly impair Hcy metabolism. The aim of this study was to investigate the relation between liver steatosis with plasma homocysteine level and MTHFR C677T and A1298C polymorphisms in Brazilian patients with NAFLD.

Methods: Thirty-five patients diagnosed with NAFLD by liver biopsy and forty-five healthy controls neither age nor sex matched were genotyped for C677T and A1298C MTHFR polymorphisms using PCR-RFLP and PCR-ASA, respectively, and Hcy was determined by HPLC. All patients were negative for markers of Wilson's, hemochromatosis and autoimmune diseases. Their daily alcohol intake was less than 100 g/week. A set of metabolic and serum lipid markers were also measured at the time of liver biopsies.

Results: The plasma Hcy level was higher in NAFLD patients compared to the control group (p = 0.0341). No statistical difference for genotypes 677C/T (p = 0.110) and 1298A/C (p = 0.343) in patients with NAFLD and control subjects was observed. The genotypes distribution was in Hardy-Weinberg equilibrium (677C/T p = 0.694 and 1298 A/C p = 0.188). The group of patients and controls showed a statistically significant difference (p < 0.001) for BMI and HOMA_IR, similarly to HDL cholesterol levels (p < 0,006), AST, ALT, γGT, AP and triglycerides levels (p < 0.001). A negative correlation was observed between levels of vitamin B12 and Hcy concentration (p = 0.005).

Conclusion: Our results indicate that plasma Hcy was higher in NAFLD than controls. The MTHFR C677T and A1298C polymorphisms did not differ significantly between groups, despite the 677TT homozygous frequency was higher in patients (17.14%) than in controls (677TT = 4.44%) (p > 0.05). The suggested genetic susceptibility to the MTHFR C677T and A1298C should be confirmed in large population based studies.
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http://dx.doi.org/10.1186/1475-2891-12-37DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626579PMC
April 2013

Coronary tomography for predicting adverse events in patients with suspected coronary disease.

Arq Bras Cardiol 2012 Dec 30;99(6):1142-8. Epub 2012 Nov 30.

Hospital Mater Dei, MG, Brasil.

Background: Although studies have demonstrated a high diagnostic accuracy of multi-detector Coronary CT (MDCT) in the detection of Coronary Artery Disease (CAD), data on the prognostic value of this method are limited.

Objective: Determine the value of MDCT in predicting adverse clinical outcomes in patients with suspected CAD.

Methods: We prospectively evaluated 355 consecutive patients (mean age 58 ± 12 years, 252 males) with suspected CAD between January 2008 and June 2010. CAD at MDCT was defined as the presence of atheromatous plaque observed in any coronary artery. The adverse clinical outcomes were defined as death, myocardial infarction, unstable angina or myocardial revascularization.

Results: During a mean follow-up of 15 months, there were 55 cardiac events. In the multivariate analysis using the Cox regression model, NYHA functional class, diabetes, smoking and atherosclerosis at the MDCT were predictors of adverse clinical outcome, and the presence of plaque at the MDCT was strongly associated with adverse clinical outcomes, regardless of established risk factors for CAD (hazard ratio 5.29; 95% confidence interval: 2.4 -11.8, p <0.001).

Conclusion: The presence of atherosclerosis demonstrated by MDCT in patients with suspected CAD showed independent and incremental value when compared to conventional risk factors in the prediction of adverse clinical outcomes, and may prove useful in risk stratification of these patients.
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http://dx.doi.org/10.1590/s0066-782x2012005000113DOI Listing
December 2012