Objective: This study aimed to evaluate the influence of fetal hemoglobin (Hb F) on hemolysis biomarkers in sickle cell anemia patients. Methods: Fifty adult sickle cell anemia patients were included in the study. All patients were taking hydroxyurea for at least six months and were followed at the outpatient clinic of a hospital in Fortaleza, Ceará, Brazil. The control group consisted of 20 hemoglobin AA individuals. The reticulocyte count was performed by an automated methodology, lactate dehydrogenase and uric acid were measured by spectrophotometry and arginase I by enzyme-linked immunosorbent assay (ELISA). The presence of Hb S was detected by high-performance liquid chromatography. The level of significance was set for a p-value <0.05. Results: A significant increase was observed in the reticulocyte count and lactate dehydrogenase, uric acid and arginase I levels in sickle cell anemia patients compared to the control group (p-value <0.05). Patients having Hb F levels greater than 10% showed a significant decrease in the reticulocyte count, arginase I and lactate dehydrogenase. A significant decrease was observed in arginase I levels in patients taking hydroxyurea at a dose greater than 20 mg/kg/day. Conclusion: The results of this study show that sickle cell anemia patients have increases in the hemolysis biomarkers, lactate dehydrogenase, reticulocyte count, arginase I, uric acid and increases in Hb F can reduce the reticulocyte count and arginase I and lactate dehydrogenase levels.

INTRODUÇÃO: Estudos prévios comparando stents farmacológicos (SFs) e stents não-farmacológicos sugerem eficácia e segurança dos SFs no tratamento de pacientes com infarto agudo do miocárdio (IAM). No entanto, a evolução tardia de pacientes com IAM tratados com SFs na prática diária permanece desconhecida. Este estudo teve como objetivo investigar o seguimento tardio de pacientes com IAM recente tratados com SFs na prática diária do mundo real. MÉTODOS: Entre maio de 2002 e junho de 2009, 3.018 pacientes não-selecionados com indicação de intervenção percutânea eletiva ou de emergência foram consecutivamente tratados com SFs em uma instituição clínica. O seguimento tardio de até sete anos foi realizado em 98%, com mediana de 3,4 anos. Os pacientes foram divididos em dois grupos: pacientes com IAM recente (< 30 dias) e pacientes sem IAM recente. RESULTADOS: Os pacientes com IAM recente tinham menos comorbidades e mais doença multiarterial (68,1% vs. 60,7%; P < 0,001), lesões com trombo (13,6% vs. 1,3%; P < 0,001), fluxo TIMI 0/1 (8,3% vs. 1,1%; P < 0,001) e disfunção moderada/grave do ventrículo esquerdo (23,2% vs. 10,9%; P < 0,001), comparativamente aos pacientes sem IAM recente. O grupo IAM recente recebeu 1,6 ± 0,8 stent/ paciente e mais inibidores da glicoproteína IIb/IIIa (19,6% vs. 2%; P < 0,001), mas o sucesso angiográfico foi similar nos dois grupos (> 99%). No seguimento tardio, a incidência de óbito cardíaco (6,4% vs. 2,7%; P < 0,001) e de trombose de stent (3,6% vs. 1,3%; P < 0,001) foi significativamente maior no grupo IAM recente. O IAM recente permaneceu como preditor independente de trombose de stent na análise multivariada (RR 2,96, IC 95% 1,62-5,41; P < 0,001). CONCLUSÕES: Pacientes com IAM < 30 dias tratados com SFs apresentaram pior prognóstico quando comparados aos pacientes sem IAM recente, incluindo aumento significativo do óbito cardíaco até sete anos de acompanhamento, e ocorrência 2,5 vezes maior das taxas de trombose de stent.

BACKGROUND: Previous studies comparing drug-eluting stents (DES) and bare-metal stents suggest efficacy and safety of the DES in the treatment of patients with myocardial infarction (MI). However, the late evolution of patients with MI treated with DES in the daily practice remains unknown. Our goal was to investigate the late follow-up of patients with MI recently treated with DES in the real world. METHODS: Between May 2002 and June 2009, 3,018 non-selected patients with indication for elective or urgent percutaneous coronary intervention have been consecutively treated with DES in a clinical institution. The 7-year follow-up was performed in 98% of these patients, with a median of 3.4 years. The patients were divided in two groups: patients with recent MI (< 30 days) and patients without recent MI. RESULTS: Patients with recent MI had less co-morbidities, but more multiarterial disease (68.1% vs. 60.7%; P < 0.001), lesions with thrombus (13.6% vs. 1.3%; P < 0.001), TIMI flow 0/1 (8.3% vs. 1.1%; P < 0.001), and moderate/severe LV dysfunction (23.2% vs. 10.9%; P < 0.001) when compared with patients without MI. The recent MI group received 1.6 ± 0.8 stents/patient and more glycoprotein IIb/IIIa inhibitors (19.6% vs. 2%; P < 0.001), but the angiographic success (> 99%) was similar between groups. In the late follow-up, the incidence of cardiac death (6.4% vs. 2.7%; P < 0.001) and stent thrombosis (3.6% vs. 1.3%; P < 0.001) was significantly greater in the recent MI group. Recent MI remained an independent predictor of stent thrombosis in multivariate analysis (HR 2.96, 95% CI 1.62-5.41; P < 0,001). CONCLUSIONS: Patients with MI < 30 days treated with DES had a worse prognosis when compared with patients without recent MI, including a higher incidence of cardiac death and a 2.5 times greater occurrence of stent thrombosis rate up to 7-year follow-up.

OBJECTIVE: To identify risk factors for acute myocardial infarction during the postoperative period after myocardial revascularization. METHODS: This was a case-control study paired for sex, age, number, type of graft used, coronary endarterectomy, type of myocardial protection, and use of extracorporeal circulation. We assessed 178 patients (89 patients in each group) undergoing myocardial revascularization, and the following variables were considered: dyslipidemia, systemic hypertension, smoking, diabetes mellitus, previous myocardial revascularization surgery, previous coronary angioplasty, and acute myocardial infarction. RESULTS: Baseline clinical characteristics did not differ in the groups, except for previous myocardial revascularization surgery, prevalent in the case group (34 patients vs. 12 patients; p = 0.0002). This was the only independent predictor of risk for acute myocardial infarction in the postoperative period, based on a multivariate logistic regression analysis (p=0.0001). Mortality and the time of hospital stay of the case group were significantly higher (19.1% vs. 1.1%; p<0.001 and 15.7 days vs. 10.6 days; p<0.05 respectively) than those of the control. CONCLUSION: Only previous myocardial revascularization was an independent predictor of acute myocardial infarction in the postoperative period, based on multivariate logistic regression analysis.