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Mair V, Santos FRA, Pereira HG, Pastore CA, Samesima N, Diniz LJ, Takada JY, Mansur AP, Nakagawa NK. Education and lifestyle measures for awareness of syncope prodroms to prevent syncope recurrence in schoolchildren. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Syncope is a transient loss of consciousness secondary to cerebral hypoperfusion and is characterized by a sudden onset, short duration and spontaneous recovery. The prevalence of syncope is between 30 to 50% in children and adolescents, 75% of them could corresponding to neuromediated reflex syncope (NRS) and to postural orthostatic tachycardic syndrome (POTS). The efficacy of education and lifestyle measures to prevent syncope prodromes in schoolchildren is still little known.
Objective
The aim of this study was to assess the education and lifestyle measures (syncope prodromes recognition, frequent water intake, counter-pressure maneuvers and physical activity) for preventing syncope prodromes in schoolchildren over 12 months.
Methods
We included 123 children and, at baseline, we assessed clinical parameters such as heart rate (HR), and systolic and diastolic blood pressure (SBP and DBP, respectively), and oriented how to recognize syncope prodromes and triggers as well as to take lifestyle and other measures (frequent water intake, counter-pressure maneuvers and physical activity). We performed statistical analysis using ANOVA for continuous variables and Qui-Square Test or Fisher Exact Test for categorical variables, when appropriate.
Results
Children were divided in three groups: no NRS-POTS (noNRS-POTS; n=103, mean age: 10.0 years, 49 male, height: ∼1.42 m, weight: ∼60.9 kg, HR: ∼63 bpm, SBP: ∼100,1 mmHg and DBP: ∼65.8 mmHg), NRS (n=5, mean age: 10.4 years, 2 male, height: ∼1.39 m, weight: ∼63.9 kg, HR: ∼68 bpm, SBP: ∼107,2 mmHg and DBP: ∼69.8 mmHg), and POTS (n=15, mean age: 10.47 years, 6 male, height: ∼1.39 m, weight: ∼69.0 kg, HR: ∼53 bpm, SBP: ∼100,7 mmHg and DBP: ∼63.6 mmHg). From 123 children, 95% (n=117) had history of syncope prodromes and 13.8% (n=17) had syncope history. Over the 12-month, only 10.6% of them (n=13) continued to have syncope prodromes and, most interesting, none of them had a new syncope event.
Conclusion
Education and lifestyle measures were effective to significantly reduce syncope prodromes and to prevent any new syncope event.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University of Sao Paulo
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Affiliation(s)
- V Mair
- University of Sao Paulo, Sao Paulo, Brazil
| | | | - H G Pereira
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - C A Pastore
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - N Samesima
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - L J Diniz
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - J Y Takada
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - A P Mansur
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
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Caribé PMV, Villar CC, Romito GA, Takada JY, Pacanaro AP, Strunz CMC, César LAM, Mansur ADP. Prospective, case-controlled study evaluating serum concentration of sirtuin-1 and mannose-binding lectin in patients with and without periodontal and coronary artery disease. Ther Adv Chronic Dis 2020; 11:2040622320919621. [PMID: 32435441 PMCID: PMC7223200 DOI: 10.1177/2040622320919621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/25/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Atherosclerosis and periodontal disease (PD) are inflammatory diseases that have been shown in studies to have a direct association. Mannose-binding lectin (MBL) is an immune system protein that binds to periodontal pathogens favoring phagocytosis. Conversely, increased serum sirtuin-1 (SIRT1) concentration reduces the inflammatory process. Methods: This was a prospective, case-controlled study that analyzed serum concentration of biomarkers in patients with or without coronary artery disease (CAD) and PD. A total of 78 patients were evaluated: 20 healthy individuals, 18 patients with CAD, 20 patients with PD, and 20 patients with both PD and CAD. Clinical and laboratory characteristics were analyzed before and after nonsurgical treatment of PD and also at two equivalent times in patients without PD. Serum MBL and SIRT1 concentration were analyzed by enzyme-linked immunosorbent assay. Results: A negative correlation was observed between changes in serum concentration of MBL and SIRT1 (r = −0.30; p = 0.006). Comparison between pre- and post-treatment of PD showed a reduction in MBL levels (886.27 ± 906.72 versus 689.94 ± 808.36; p = 0.002) and an increase in SIRT1 values (0.80 ± 1.01 versus 1.49 ± 1.55; p = 0.005) in patients with PD and without CAD. The same result was observed in patients with PD and CAD for MBL and SIRT1, respectively, of 1312.43 ± 898.21 versus 1032.90 ± 602.52 (p = 0.010) and 1.32 ± 1.0 versus 1.82 ± 1.75 (p = 0.044). Conclusion: PD treatment reduced MBL serum concentration and increased SIRT1 serum concentration in patients with and without CAD.
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Affiliation(s)
| | - Cristina Cunha Villar
- Division of Periodontology, Stomatology Department, Dental School, University of São Paulo, São Paulo, Brazil
| | - Guiseppe Alexandre Romito
- Division of Periodontology, Stomatology Department, Dental School, University of São Paulo, São Paulo, Brazil
| | - Júlio Yoshio Takada
- Clinical Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Ana Paula Pacanaro
- Clinical Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Antonio de Padua Mansur
- Clinical Department, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas C. Aguiar, 44, CEP, São Paulo, 05403-000, Brazil
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Caribé PMV, Villar CC, Romito GA, Pacanaro AP, Strunz CMC, Takada JY, Cesar LAM, Mansur ADP. Influence of the treatment of periodontal disease in serum concentration of sirtuin 1 and mannose-binding lectin. J Periodontol 2020; 91:900-905. [PMID: 31749165 DOI: 10.1002/jper.19-0236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/02/2019] [Accepted: 09/05/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Increased levels of periodontal pathogens disrupt the homeostasis between the host and its microbiota and increase susceptibility to periodontal diseases. Periodontitis increases the serum concentration of mannose-binding lectin (MBL), which exacerbates local inflammatory processes. In animal studies, sirtuin 1 (SIRT1) was associated with protection against inflammation. This study analyzed the influence of non-surgical periodontal treatment on serum levels of MBL and SIRT1. METHODS Forty patients with periodontitis and 38 periodontally healthy individuals (aged 45 to 79 years) were included. Periodontitis patients received scaling and root planing using machine driven and hand instruments. Clinical parameters, inflammatory biomarkers, MBL, and SIRT1 levels were measured at baseline and at post-treatment. RESULTS For all patients, an inverse correlation was observed between serum concentrations of MBL and SIRT1 (r = -0.30; P = 0.006). Periodontal treatment reduced serum concentrations of MBL (1,099.35 ± 916.59 to 861.42 ± 724.82 ng/mL; P < 0.001) and C-reactive protein (6.05 ± 8.99 to 2.49 ± 2.89 mg/L; P = 0.009). By contrast, SIRT1 serum levels increased (1.06 ± 1.03 to 1.66 ± 1.64 ng/mL; P < 0.001) following periodontal treatment. CONCLUSIONS Periodontal treatment was associated with decreased serum concentrations of MBL and CRP and increased serum levels of SIRT1. Prospective studies are needed to assess the impact of these biomarkers on pathophysiology of periodontitis.
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Affiliation(s)
- Pérola Michelle Vasconcelos Caribé
- Clinical Department, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.,Division of Periodontology, Stomatology Department, Dental School, University of Sao Paulo, Sao Paulo, Brazil PhD thesis of the Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Cristina Cunha Villar
- Division of Periodontology, Stomatology Department, Dental School, University of Sao Paulo, Sao Paulo, Brazil PhD thesis of the Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Giuseppe Alexandre Romito
- Division of Periodontology, Stomatology Department, Dental School, University of Sao Paulo, Sao Paulo, Brazil PhD thesis of the Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ana Paula Pacanaro
- Clinical Department, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Júlio Yoshio Takada
- Clinical Department, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Antonio de Padua Mansur
- Clinical Department, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
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Nakagawa NK, Diz MA, Kawauchi TS, de Andrade GN, Umeda IIK, Murakami FM, Oliveira-Maul JP, Nascimento JA, Nunes N, Takada JY, Mansur ADP, Cahalin LP. Risk Factors for Inspiratory Muscle Weakness in Chronic Heart Failure. Respir Care 2019; 65:507-516. [PMID: 31822596 DOI: 10.4187/respcare.06766] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic heart failure is commonly associated with inspiratory muscle weakness. However, few studies have investigated the risk factors for inspiratory muscle weakness in individuals with chronic heart failure and systolic dysfunction (left-ventricular ejection fraction [LVEF] <40%). METHODS Seventy subjects were recruited in a cardiac center. We assessed clinical parameters, smoking history, peripheral muscle strength, pulmonary function, echocardiographic variables, and brain natriuretic peptide. The subjects were classified with inspiratory muscle weakness when the maximum inspiratory pressure was <70% of predicted values. RESULTS Thirty-six subjects (51%) had inspiratory muscle weakness. The subjects with inspiratory muscle weakness and the subjects with no inspiratory muscle weakness were similar in age, sex, body mass index, medication use, and physical activity. However, the subjects with inspiratory muscle weakness had lower LVEF (P = .003), systolic blood pressure (P = .01), diastolic blood pressure (P = .042), quadriceps muscle strength (P = .02), lung function (P = .035), increased brain natriuretic peptide (P = .02), smoking history (P = .01), and pulmonary hypertension incidence (P = .03). Multivariate logistic regression analysis found a lower LVEF, increased smoking history, and lower systolic blood pressure as significant independent predictors for inspiratory muscle weakness. CONCLUSIONS The combination of lower LVEF, lower systolic blood pressure, and smoking history predicted inspiratory muscle weakness. Patients with suspected inspiratory muscle weakness should be examined and, if inspiratory muscle weakness exists, then inspiratory muscle training should be provided. Reducing inspiratory muscle weakness has the potential to improve many of the deleterious effects of chronic heart failure.
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Affiliation(s)
- Naomi Kondo Nakagawa
- Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Mariana Abreu Diz
- Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tatiana Satie Kawauchi
- Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Fernanda Murata Murakami
- Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Juliana Araújo Nascimento
- Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Newton Nunes
- Division of Cardiology, Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Júlio Yoshio Takada
- Division of Cardiology, Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Antonio de Padua Mansur
- Division of Cardiology, Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Mansur ADP, Roggerio A, Takada JY, Caribé PMV, Avakian SD, Strunz CMC. Gene mutations of platelet glycoproteins and response to tirofiban in acute coronary syndrome. SAO PAULO MED J 2016; 134:199-204. [PMID: 26786608 PMCID: PMC10496600 DOI: 10.1590/1516-3180.2015.00650808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 03/26/2015] [Accepted: 08/08/2015] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVES Glycoprotein inhibitors (abciximab, eptifibatide and tirofiban) are used in patients with unstable angina and non-ST-segment elevation myocardial infarction before percutaneous coronary intervention. Of these, tirofiban is the least effective. We hypothesized that the response to tirofiban might be associated with glycoprotein gene mutations. DESIGN AND SETTING Prospective study at Emergency Unit, Heart Institute (InCor), University of São Paulo. METHOD Intrahospital evolution and platelet aggregation in response to tirofiban were analyzed in relation to four glycoprotein mutations in 50 patients indicated for percutaneous coronary intervention: 17 (34%) with unstable angina and 33 (66%) with non-ST-segment elevation myocardial infarction. Platelet aggregation was analyzed using the Born method. Blood samples were obtained before and one hour after tirofiban infusion. Glycoproteins Ia (807C/T ), Ib (Thr/Met) , IIb (Ile/Ser ) and IIIa (PIA ) were the mutations selected. RESULTS Hypertension, dyslipidemia, diabetes, smoking, previous coronary artery disease and stroke were similar between the groups. Mutant glycoprotein IIIa genotypes had lower platelet aggregation before tirofiban administration than that of the wild genotype (41.0% ± 22.1% versus 55.9% ± 20.8%; P = 0.035). Mutant glycoprotein IIIa genotypes correlated moderately with lower platelet inhibition (r = -0.31; P = 0.030). After tirofiban administration, platelet glycoprotein Ia, Ib, IIb and IIIa mutations did not influence the degree of inhibition of platelet aggregation or intrahospital mortality. CONCLUSIONS Mutations of glycoproteins Ia, Ib, IIb and IIIa did not influence platelet aggregation in response to tirofiban in patients with unstable angina and non-ST-segment elevation myocardial infarction.
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Affiliation(s)
- Antonio de Padua Mansur
- MD, PhD. Associate Professor, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Alessandra Roggerio
- BSc, PhD. Biochemist, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Júlio Yoshio Takada
- MD, PhD. Attending Physician, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Pérola Michelle Vasconcelos Caribé
- MD, MSc. Doctoral Student, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Solange Desirée Avakian
- MD, PhD. Attending Physician, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Célia Maria Cassaro Strunz
- BSc. Central Laboratory Director, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Ramos RB, Takada JY, Junior JF, Silva TC, de Lourdes Silva e Cardoso C, Yanaguibashi G, Fornari LS, Jallad S, Strunz CMC, de Padua Mansur A. L 047 ASSOCIATION BETWEEN LIPID PROFILING AND B-TYPE NATRIURETIC PEPTIDE (BNP) LEVEL IN ADMISSION AND AFTER 1 YEAR IN PATIENTS WITH NON-ST ELEVATION ACUTE CORONARY SYNDROME (NSTE-ACS). ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71991-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Takada JY, Solimene MC, da Luz PL, Grupi CJ, Giorgi DMA, Rigonatti SP, Rumi DO, Gowdak LHW, Ramires JAF. Assessment of the cardiovascular effects of electroconvulsive therapy in individuals older than 50 years. Braz J Med Biol Res 2005; 38:1349-57. [PMID: 16138218 DOI: 10.1590/s0100-879x2005000900009] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To evaluate the impact of electroconvulsive therapy on arterial blood pressure, heart rate, heart rate variability, and the occurrence of ischemia or arrhythmias, 38 (18 men) depressive patients free from systemic diseases, 50 to 83 years old (mean: 64.7 +/- 8.6) underwent electroconvulsive therapy. All patients were studied with simultaneous 24-h ambulatory blood pressure and Holter monitoring, starting 18 h before and continuing for 3 h after electroconvulsive therapy. Blood pressure, heart rate, heart rate variability, arrhythmias, and ischemic episodes were recorded. Before each session of electroconvulsive therapy, blood pressure and heart rate were in the normal range; supraventricular ectopic beats occurred in all patients and ventricular ectopic beats in 27/38; 2 patients had non-sustained ventricular tachycardia. After shock, systolic, mean and diastolic blood pressure increased 29, 25, and 24% (P < 0.001), respectively, and returned to baseline values within 1 h. Maximum, mean and minimum heart rate increased 56, 52, and 49% (P < 0.001), respectively, followed by a significant decrease within 5 min; heart rate gradually increased again thereafter and remained elevated for 1 h. Analysis of heart rate variability showed increased sympathetic activity during shock with a decrease in both sympathetic and parasympathetic drive afterwards. No serious adverse effects occurred; electroconvulsive therapy did not trigger any malignant arrhythmias or ischemia. In middle-aged and elderly people free from systemic diseases, electroconvulsive therapy caused transitory increases in blood pressure and heart rate and a decrease in heart rate variability but these changes were not associated with serious adverse clinical events.
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Affiliation(s)
- J Y Takada
- Departamento de Cardiologia, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Rumi DO, Solimene MC, Takada JY, Grupi CJ, Giorgi DM, Rigonatti SP, Luz PLD, Ramires JAF. Electrocardiographic and blood pressure alterations during electroconvulsive therapy in young adults. Arq Bras Cardiol 2002; 79:149-60. [PMID: 12219189 DOI: 10.1590/s0066-782x2002001100007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To study cardiovascular alterations in young patients with no apparent organic disease who underwent electroconvulsive therapy. METHODS The study comprised 47 healthy patients (22 males and 25 females) with a mean age of 30.3 years, who underwent electroconvulsive therapy. Ambulatory blood pressure monitoring and continuous electrocardiographic monitoring (Holter monitor) were performed during 24 hours. Blood pressure and heart rate were assessed 4 hours prior to electric shock administration, during electric shock administration, and 3 hours after electric shock administration. Arrhythmias and alterations in the ST segment in 24 hours were recorded. RESULTS On electroconvulsive therapy, a significant increase in blood pressure and heart rate was observed and the measurements returned to basal values after 25 minutes. Three females had tracings with depression of the ST segment suggesting myocardial ischemia prior to and after electroconvulsive therapy. Coronary angiography was normal. No severe cardiac arrhythmias were diagnosed. CONCLUSION 1) Electroconvulsive therapy is a safe therapeutic modality in psychiatry; 2) it causes a significant increase in blood pressure and heart rate; 3) it may be associated with myocardial ischemia in the absence of coronary obstructive disease; 4) electroconvulsive therapy was not associated with the occurrence of severe cardiac arrhythmias.
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