RESUMEN
Psychosocial evaluations are rarely conducted with community-dwelling individuals, especially those with higher risk of cardiovascular disease. This study aims to evaluate the perceptual stress and cardiovascular risk among women in a large cross-sectional study performed in Brazilian communities. Subjects aged over 18 years were included out of 500 public basic health units (BHU) in Brazil. All subjects were subjected to a clinical consultation and questionnaires application. Data were used to identify healthy lifestyle, smoking status, and self-perception of psychological stress. The National Health and Nutrition Examination Survey (NHANES) risk score (NRS) was used to estimate cardiovascular risk. Ethnicity information was self-reported, considering white versus non-white (black, brown, and mixed-race) women. A total of 93,605 patients were recruited from a primary care setting, of which 62,200 (66.4%) were women. Intense and severe auto-perception of stress was higher within non-white women at home (p < 0.001), at work (p = 0.008), socially (p < 0.001), and financially (p < 0.001) compared to white women. Therefore, the NRS indicates that non-white women had higher cardiovascular risk, lower physical activity, and lower daily vegetables/fruits consumption compared to white women (p < 0.001). Non-white women in Brazilian communities are susceptible to increased stress and cardiovascular disease risk, which adds up to disparities in access to the public health system.
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Enfermedades Cardiovasculares , Factores de Riesgo de Enfermedad Cardiaca , Factores Socioeconómicos , Estrés Psicológico , Humanos , Femenino , Estudios Transversales , Brasil/epidemiología , Estrés Psicológico/psicología , Estrés Psicológico/epidemiología , Adulto , Enfermedades Cardiovasculares/psicología , Enfermedades Cardiovasculares/epidemiología , Persona de Mediana Edad , Factores de Riesgo , Adulto Joven , Encuestas y Cuestionarios , AncianoRESUMEN
Abstract: Psychosocial evaluations are rarely conducted with community-dwelling individuals, especially those with higher risk of cardiovascular disease. This study aims to evaluate the perceptual stress and cardiovascular risk among women in a large cross-sectional study performed in Brazilian communities. Subjects aged over 18 years were included out of 500 public basic health units (BHU) in Brazil. All subjects were subjected to a clinical consultation and questionnaires application. Data were used to identify healthy lifestyle, smoking status, and self-perception of psychological stress. The National Health and Nutrition Examination Survey (NHANES) risk score (NRS) was used to estimate cardiovascular risk. Ethnicity information was self-reported, considering white versus non-white (black, brown, and mixed-race) women. A total of 93,605 patients were recruited from a primary care setting, of which 62,200 (66.4%) were women. Intense and severe auto-perception of stress was higher within non-white women at home (p < 0.001), at work (p = 0.008), socially (p < 0.001), and financially (p < 0.001) compared to white women. Therefore, the NRS indicates that non-white women had higher cardiovascular risk, lower physical activity, and lower daily vegetables/fruits consumption compared to white women (p < 0.001). Non-white women in Brazilian communities are susceptible to increased stress and cardiovascular disease risk, which adds up to disparities in access to the public health system.
Resumo: Avaliações psicossociais raramente são realizadas com indivíduos residentes na comunidade, especialmente aqueles com maior risco de doença cardiovascular. Este estudo tem como objetivo avaliar o estresse perceptivo e o risco cardiovascular entre mulheres em um grande estudo transversal realizado em comunidades brasileiras. Foram incluídas mulheres com idade superior a 18 anos de 500 unidades básicas de saúde (UBS) públicas do Brasil. Todas as participantes foram submetidas a consulta clínica e aplicação de questionários. Os dados foram utilizados para identificar estilo de vida saudável, tabagismo e autopercepção de estresse psicológico. O índice de risco (NRS) do National Health and Nutrition Examination Survey (NHANES) foi utilizado para estimar o risco cardiovascular. As informações de etnia foram autorreferidas, considerando mulheres brancas versus não brancas (negras, pardas e pardas). Um total de 93.605 pacientes foram recrutados em um ambiente de atenção primária, dos quais 62.200 (66,4%) eram mulheres. A autopercepção intensa e grave de estresse foi maior em mulheres não brancas em casa (p < 0,001), no trabalho (p = 0,008), socialmente (p < 0,001) e financeiramente (p < 0,001) em comparação com mulheres brancas. Portanto, a NRS indica que as mulheres não brancas apresentaram maior risco cardiovascular, menor atividade física e menor consumo diário de vegetais/frutas em comparação às mulheres brancas (p < 0,001). As mulheres não brancas nas comunidades brasileiras são suscetíveis ao aumento do estresse e do risco de doenças cardiovasculares, o que aumenta as disparidades no acesso ao sistema público de saúde.
Resumen: Raramente se realizan evaluaciones psicosociales con personas que viven en la comunidad, especialmente aquellas con mayor riesgo de enfermedad cardiovascular. Este estudio tiene como objetivo evaluar el estrés perceptivo y el riesgo cardiovascular entre las mujeres en un gran estudio transversal realizado en comunidades brasileñas. Se incluyeron mujeres mayores de 18 años de 500 unidades básicas de salud (UBS) públicas de Brasil. Todas las participantes fueron sometidas a una consulta clínica y aplicación de cuestionarios. Los datos se utilizaron para identificar el estilo de vida saludable, el tabaquismo y la autopercepción del estrés psicológico. Se utilizó la puntuación de riesgo (NRS) de la Encuesta Nacional de Examen de Salud y Nutrición (NHANES) para estimar el riesgo cardiovascular. La información étnica fue autoinformada, considerando mujeres blancas versus no blancas (negras, marrones y mestizas). Se reclutó a un total de 93.605 pacientes en un entorno de atención primaria, de los cuales 62.200 (66,4%) eran mujeres. La autopercepción intensa y severa del estrés fue mayor entre las mujeres no blancas en el hogar (p < 0,001), en el trabajo (p = 0,008), socialmente (p < 0,001) y financieramente (p < 0,001) en comparación con las mujeres blancas. Por lo tanto, el NRS indica que las mujeres no blancas tenían mayor riesgo cardiovascular, menor actividad física y menor consumo diario de verduras y frutas en comparación con las mujeres blancas (p < 0,001). Las mujeres no blancas en las comunidades brasileñas son susceptibles a un mayor estrés y riesgo de enfermedades cardiovasculares, lo que se suma a las disparidades en el acceso al sistema de salud pública.
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BACKGROUND: Children with heart disease frequently require anticoagulation for thromboprophylaxis. Current standard of care (SOC), vitamin K antagonists or low-molecular-weight heparin, has significant disadvantages. OBJECTIVES: The authors sought to describe safety, pharmacokinetics (PK), pharmacodynamics, and efficacy of apixaban, an oral, direct factor Xa inhibitor, for prevention of thromboembolism in children with congenital or acquired heart disease. METHODS: Phase 2, open-label trial in children (ages, 28 days to <18 years) with heart disease requiring thromboprophylaxis. Randomization 2:1 apixaban or SOC for 1 year with intention-to-treat analysis. PRIMARY ENDPOINT: a composite of adjudicated major or clinically relevant nonmajor bleeding. Secondary endpoints: PK, pharmacodynamics, quality of life, and exploration of efficacy. RESULTS: From 2017 to 2021, 192 participants were randomized, 129 apixaban and 63 SOC. Diagnoses included single ventricle (74%), Kawasaki disease (14%), and other heart disease (12%). One apixaban participant (0.8%) and 3 with SOC (4.8%) had major or clinically relevant nonmajor bleeding (% difference -4.0 [95% CI: -12.8 to 0.8]). Apixaban incidence rate for all bleeding events was nearly twice the rate of SOC (100.0 vs 58.2 per 100 person-years), driven by 12 participants with ≥4 minor bleeding events. No thromboembolic events or deaths occurred in either arm. Apixaban pediatric PK steady-state exposures were consistent with adult levels. CONCLUSIONS: In this pediatric multinational, randomized trial, bleeding and thromboembolism were infrequent on apixaban and SOC. Apixaban PK data correlated well with adult trials that demonstrated efficacy. These results support the use of apixaban as an alternative to SOC for thromboprophylaxis in pediatric heart disease. (A Study of the Safety and Pharmacokinetics of Apixaban Versus Vitamin K Antagonist [VKA] or Low Molecular Weight Heparin [LMWH] in Pediatric Subjects With Congenital or Acquired Heart Disease Requiring Anticoagulation; NCT02981472).
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Fibrinolíticos , Cardiopatías , Tromboembolia Venosa , Niño , Humanos , Recién Nacido , Anticoagulantes/uso terapéutico , Fibrinolíticos/uso terapéutico , Cardiopatías/complicaciones , Hemorragia/inducido químicamente , Heparina de Bajo-Peso-Molecular , Piridonas/uso terapéutico , Calidad de Vida , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Vitamina KRESUMEN
Background: Primary prevention of cardiovascular disease (CVD) remains a major challenge, especially in communities of low- and middle-income countries with poor medical assistance influenced by distinct local, financial, infrastructural, and resource-related factors. Objective: This a community-based study aimed to determine the proportion and prevalence of uncontrolled cardiovascular risk factors (CRF) in Brazilian communities. Methods: The EPICO study was an observational, cross-sectional, and community clinic-based study. Subjects were living in Brazilian communities and were of both sexes and ≥18 years old, without a history of a stroke or myocardial infarction but presenting at least one of the following cardiovascular risk factors: hypertension, diabetes mellitus and hypercholesterolemia. The study was carried out in Brazil, including 322 basic health units (BHU) in 32 cities. Results: A total of 7,724 subjects with at least one CRF were evaluated, and one clinical visit was performed. Mean age was 59.2 years-old (53.7% were >60 years old). A total of 66.7% were women. Of the total, 96.2% had hypertension, 78.8% had diabetes mellitus type II, 71.1% had dyslipidemia, and 76.6% of patients were overweight/obese. Controlled hypertension (defined by <130/80 mmHg or <140/90 mmHg) was observed in 34.9% and 55.5% patients among respective criteria, the rates of controlled blood glucose in patients taking antidiabetic medications was 29.5%, and among those with documented dyslipidemia who received any lipid-lowering medication, only 13.9% had LDL-c on target. For patients presenting three CRF less than 1.9% had LDL-c < 100 mg/dL once their BP and blood glucose were on target. High education level as associated with blood pressure (BP) target of less than 130 / 80mm Hg. The glucose and LDL-c levels on target were associated with the presence of hypertension and diabetes mellitus. Conclusion: In Brazilian community clinics, regarding most patients in primary prevention, the CRF such as BP, blood glucose, and lipid levels are poorly controlled, with a majority of patients not achieving guidelines/recommendations.
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Enfermedades Cardiovasculares , Dislipidemias , Hipertensión , Masculino , Humanos , Femenino , Persona de Mediana Edad , Adolescente , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/complicaciones , Brasil/epidemiología , Factores de Riesgo , LDL-Colesterol , Glucemia , Estudios Transversales , Hipertensión/epidemiología , Hipertensión/prevención & control , Hipertensión/complicaciones , Presión Sanguínea , Dislipidemias/epidemiología , Prevención Primaria/métodosRESUMEN
BACKGROUND: Primary prevention of cardiovascular disease (CVD) remains a major challenge, especially in communities of low- and middle-income countries with poor medical assistance influenced by distinct local, financial, infrastructural, and resource-related factors. OBJECTIVE: This a community-based study aimed to determine the proportion and prevalence of uncontrolled cardiovascular risk factors (CRF) in Brazilian communities. METHODS: The EPICO study was an observational, cross-sectional, and community clinic-based study. Subjects were living in Brazilian communities and were of both sexes and ≥18 years old, without a history of a stroke or myocardial infarction but presenting at least one of the following cardiovascular risk factors: hypertension, diabetes mellitus and hypercholesterolemia. The study was carried out in Brazil, including 322 basic health units (BHU) in 32 cities. RESULTS: A total of 7,724 subjects with at least one CRF were evaluated, and one clinical visit was performed. Mean age was 59.2 years-old (53.7% were >60 years old). A total of 66.7% were women. Of the total, 96.2% had hypertension, 78.8% had diabetes mellitus type II, 71.1% had dyslipidemia, and 76.6% of patients were overweight/obese. Controlled hypertension (defined by <130/80 mmHg or <140/90 mmHg) was observed in 34.9% and 55.5% patients among respective criteria, the rates of controlled blood glucose in patients taking antidiabetic medications was 29.5%, and among those with documented dyslipidemia who received any lipid-lowering medication, only 13.9% had LDL-c on target. For patients presenting three CRF less than 1.9% had LDL-c < 100 mg/dL once their BP and blood glucose were on target. High education level as associated with blood pressure (BP) target of less than 130 / 80mm Hg. The glucose and LDL-c levels on target were associated with the presence of hypertension and diabetes mellitus. CONCLUSION: In Brazilian community clinics, regarding most patients in primary prevention, the CRF such as BP, blood glucose, and lipid levels are poorly controlled, with a majority of patients not achieving guidelines/recommendations.
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Humanos , Masculino , Femenino , Adolescente , Persona de Mediana Edad , Dislipidemias/epidemiología , Hipertensión/prevención & control , Prevención Primaria/métodos , Glucemia , Presión Sanguínea , Brasil/epidemiología , Enfermedades Cardiovasculares , Colesterol , Estudios Transversales , Factores de Riesgo , DislipidemiasRESUMEN
The present work aims to analyze the effect of joint mobilization in patients with chronic ankle instability on the outcomes ofpain and dorsiflexion range of motion of the ankle after systematic review study with meta-analysis. The period for developingthe research and collection was from August 2022. The databases used for collection were CENTRAL, MEDLINE/PUBMED,EMBASE, CINAHL, PEDro and SPORTDiscus, and only randomized controlled trials were included. Studies that included theclinical question by PICO (P = chronic ankle instability; I = joint mobilization; C = placebo and minimal intervention; O = painand range of motion). The analysis was performed using the Review Manager 5.4.1. The I2 test was used for heterogeneity ofthe studies. A total of 6 studies were selected for the meta-analysis in which they measured the range of motion. The findingswere statistically significant for range of motion of dorsiflexion (mean difference MD = 0.86, 95%CI = 0.06;1.66, p = 0.04),however the findings became insignificant after the sensitivity analysis (MD = 0.58, 95%CI = -0.07;1.23, p = 0.08). There wasnot enough literature for the pain outcome. The study obtained a satisfactory result for joint mobilization when all studies inthe literature were grouped, but the result did not obtain statistical significance using better quality studies. Therefore, thereis a need for better quality of evidence for the joint mobilization technique, as well as studies with better methodologicalquality so that we can more accurately state the real effects of this technique. Systematic Review Registration: Prospectivelyregistered with PROSPERO (CRD42020193292).(AU)
El presente trabajo tiene como objetivo analizar el efecto de la movilización articular en pacientes con inestabilidad crónicadel tobillo sobre los resultados del dolor y el rango de movimiento de dorsiflexión del tobillo después de un estudio de revisión sistemática con metaanálisis. El período para el desarrollo de la investigación y la colección fue de Agosto de 2022. Lasbases de datos utilizadas para la recopilación fueron CENTRAL, MEDLINE / PUBMED, EMBASE, CINAHL, PEDro y SPORTDiscus,y solo se incluyeron ensayos controlados aleatorios. Estudios que incluyeron la pregunta clínica por PICO (P = inestabilidadcrónica del tobillo; I = movilización articular; C = placebo e intervención mínima; O = dolor y rango de movimiento). El análisisse realizó utilizando Review Manager 5.4.1. Se utilizó la prueba de I2 para determinar la heterogeneidad de los estudios. Seseleccionaron un total de 6 estudios para el metaanálisis en el que midieron el rango de movimiento. Los hallazgos fueronestadísticamente significativos para el rango de movimiento de la dorsiflexión (diferencia de medias - DM = 0,86, IC del95% = 0,06; 1,66, p = 0,04), sin embargo, los resultados se volvieron insignificantes después del análisis de sensibilidad(DM = 0,58, IC del 95% = -0,07; 1,23, p = 0,08). No hubo suficiente literatura sobre el resultado del dolor. El estudio obtuvo unresultado satisfactorio para la movilización articular cuando se agruparon todos los estudios de la literatura, pero el resultado noobtuvo significación estadística utilizando estudios de mejor calidad. Por lo tanto, se necesita una mejor calidad de evidenciapara la técnica de movilización articular, así como estudios con mejor calidad metodológica para que podamos enunciar conmayor precisión los efectos reales de esta técnica. Registro de revisión sistemática: PROSPERO (CRD42020193292).(AU)
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Humanos , Masculino , Femenino , Traumatismos del Tobillo , Articulación del Tobillo , Rango del Movimiento Articular , Inestabilidad de la Articulación , Manejo del Dolor , Medicina DeportivaRESUMEN
AIMS: To test the hypothesis of a semi-supervised home physical exercise programme that is likely to improve the functional mobility and quality of life (QOL) of elderly in the community. METHODS: This trial included elderly adults (88% female) aged 60 years or older and who were sedentary and without cognitive decline. The participants were randomly assigned to an intervention group (IG, home physical exercise and sleep hygiene) and a control group (CG, sleep hygiene). The International Questionnaire on Physical Activity, mental state mini-exam, World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) and the Timed Up and Go (TUG) tests were conducted before and after the 12-week intervention period. RESULTS: The study was concluded with 125 elderly participants. Anthropometric data were indicative of pre-obesity, with a mean body mass index of 27.3 ± 4, a low-income socio-economic profile (78% ≤ 2 SM) and low schooling rates (76% ≤ 3 years of study). Most of the elderly (87%) were considered physically active with IPAQ > 150 min/week. The group of elderly people who performed the home physical exercise programme showed a significant improvement in functional mobility according to the time of execution of the TUG test before (9.1 ± 2) and after (7.1 ± 1) with an average reduction of 2 ± 1 s (P < .01). The difference in the QOL of the elderly who participated in the exercise protocol was also observed, verified through the WHOQOL-OLD global score, which presented an initial score of 85 ± 10, changing to 90.4 ± 9 after the intervention. CONCLUSION: Semi-supervised physical home exercise is safe and effective in improving the functional mobility and QOL of sedentary elderly people in the community.
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Ejercicio Físico , Calidad de Vida , Anciano , Terapia por Ejercicio , Femenino , Humanos , Masculino , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
BACKGROUND AND OBJECTIVES: The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high-dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. METHODS: A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow-up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. RESULTS: Most conducts and management strategies reviewed were strongly recommended by the participants. CONCLUSIONS: Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.
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Exenteración Pélvica/normas , Neoplasias del Cuello Uterino/cirugía , Anastomosis Quirúrgica , Brasil , Colostomía/métodos , Diagnóstico por Imagen , Drenaje , Femenino , Humanos , Laparoscopía , Escisión del Ganglio Linfático , Evaluación Nutricional , Estomía , Cuidados Paliativos , Diafragma Pélvico/cirugía , Lavado Peritoneal , Cuidados Posoperatorios , Cuidados Preoperatorios , Sociedades Médicas , Colgajos Quirúrgicos , Catéteres Urinarios , Reservorios Urinarios Continentes , Vagina/cirugía , Grabación en VideoRESUMEN
This study determined the occurrence of potentially pathogenic free-living amoebae (FLA) and bacteria associated with amoebae in air-conditioning cooling towers in southern Brazil. Water samples were collected from 36 cooling systems from air-conditioning in the state of Rio Grande do Sul, Brazil. The organisms were identified using polymerase chain reaction (PCR) and sequencing automated. The results showed that these aquatic environments, with variable temperature, are potential "hot spots" for emerging human pathogens like free-living amoebae and bacteria associated. In total, 92% of the cooling-tower samples analyzed were positive for FLA, and Acanthamoeba was the dominant genus by culture and PCR. Amoebal isolates revealed intracellular bacteria in 39.3% of them and all were confirmed as members of the genus Pseudomonas. The results obtained show the important role of cooling towers as a source of amoebae-associated pathogens.
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Acanthamoeba/aislamiento & purificación , Acanthamoeba/microbiología , Pseudomonas/aislamiento & purificación , Microbiología del Agua , Aire Acondicionado , Brasil/epidemiología , Humanos , Reacción en Cadena de la Polimerasa , Prevalencia , Análisis de Secuencia de ADNRESUMEN
BACKGROUND: Violence against women is a serious social problem and affects mainly young women. This study aimed to evaluate sexual violence against women in Campina Grande, Brazil. METHODS: A retrospective study with analysis of 886 forensic medical reports of sexual violence from the Institute of Legal Medicine of Campina Grande, Brazil, was conducted between January 2005 and December 2009. Sociodemographic variables related to victims, offenders and aggressions were analyzed. Significance level of 5% was adopted. RESULTS: Two hundred and ninety-one cases of rape (32.8%) were confirmed, the majority of victims aged between 0 and 19 years (89.9%), were single (98.8%) and had low educational level (86.9%), with association with marital status (P = 0.02). The sex offender was known to the victim in 84.2% of cases and in 93.8% of cases, he acted alone. There was an association between rape and the relationship with the offenders (P = 0.01) and the age of the offenders (P = 0.03). The rape occurred in most cases at the home of victims (49.3%), with the use of violence in 72.3% of cases, but only 5.7% of the victims exhibited physical injuries. There was an association between rape and variables date of occurrence (P = 0.001), previous virginity (P = 0.001) and violence during practice (P = 0.001). CONCLUSION: Over one third of women were victims of rape, predominantly adolescents, unmarried and with low educational level. The offenders were known to the victims, and acted alone in most situations, making use of physical violence.
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The aim of this paper was to investigate the physicochemical characteristics and rheological behavior of some floral honeys from species of wild plants found in the Caatinga biome, as well as, correlate honey viscosities with its chemical composition. Thus, five honeys with floral predominance of typical plants foraged by honeybees in Caatinga were analyzed. Results showed that moisture content of honeys ranged from 17.45 to 21.50 g/100g. The samples exhibited higher fructose content (37.58 - 43.95 g/100g) and lower glucose content (27.41- 33.80 g/100g). The glucose-water ratio ranged from 1.55 to 1.80. Sucrose contents, excluding Croton campestris honey sample, exhibited values above the highest sucrose content (6.0 g/100g) allowed by Brazilian norm. The ash content ranged from 0.02 to 0.19 %. The insoluble solids content were above 0.1 g/100 g. The electrical conductivity ranged between 144.90 and 412.55 µS.cm-1. All the honey samples behaved as Newtonian fluids. The viscosity values, measured at 293 K, varied from 1.90 to 8.55 Pa.s. An empirical mathematical model adapted from the Arrhenius model provides a good description of honey viscosity as a function of combined effects of temperature and moisture content.
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Assessment of lipid profile parameters has been considered a cornerstone in classifying individuals and populations at risk for cardiovascular disease. Recently, however, preliminary data have raised the possibility of seasonal variations in these parameters, which may cause under- or overestimation. Biological rhythms and seasonal variation of lipid profile was investigated in 227 359 consecutive individuals who underwent health checkups in primary care centers between 2008 and 2010. Plasma low-density lipoprotein cholesterol (LDL-C) >130 mg/dL was 8% more prevalent during winter than summer, with a larger difference among women and middle-aged adults (p < 0.001). High-density lipoprotein cholesterol (HDL-C) <40 mg/dL and triglycerides (TG) >150 mg/dL were respectively 9% and 5% more prevalent during the summer (p < 0.001). Variation amplitude was 3.4 ± 0.3 mg/dL for HDL-C (p = 0.005), 7 ± 2 mg/dL for LDL-C (p = 0.047), and 12 ± 9 mg/dL for TG (p = 0.058). Based on a large population sample, this study confirms the existence of biological rhythms and seasonal variation in lipid profile. This finding must be particularly accounted for in cross-sectional analyses of relative risk, prevalence, or the rate of goal achievement for lipid parameters.
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Dislipidemias/epidemiología , Periodicidad , Estaciones del Año , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Brasil/epidemiología , Niño , Preescolar , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios Transversales , Dislipidemias/sangre , Dislipidemias/diagnóstico , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Dinámicas no Lineales , Prevalencia , Factores de Riesgo , Distribución por Sexo , Factores Sexuales , Factores de Tiempo , Triglicéridos/sangre , Adulto JovenRESUMEN
Hipertrigliceridemia e o HDL baixo são aspectos comuns em pacientes com insuficiência renal crônica. A mortalidade cardiovascular está substancialmente aumentada na presença de doença renal crônica (10-20 vezes maior). Existem evidências de estudos clínicos com estatinas sugerindo uma ação protetora dessas drogas na progressão da doença renal. Além disso, pacientes pós-transplante renal recebendo fluvastatina, experimentaram redução na incidência de infartos não fatais e de mortalidade cardíaca. Entretanto, um estudo recente com atorvastatina não demonstrou reduções na morbi-mortalidade cardiovascular entre pacientes diabéticos em hemodiálise. Estudos em andamento definirão o preciso papel das estatinas neste grupo especial de pacientes.
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Humanos , Fallo Renal Crónico/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Brasil/epidemiología , Diálisis Renal/efectos adversos , Dislipidemias/complicaciones , Dislipidemias/tratamiento farmacológico , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Fallo Renal Crónico/complicaciones , Factores de Riesgo , Riñón/efectos de los fármacos , Trasplante de Hígado/efectos adversosRESUMEN
Hypertriglyceridemia and low HDL-c are common features in patients with chronic renal failure. Cardiovascular mortality is substantially increased in the presence of chronic renal disease (10-20 times higher). There is evidence from clinical trials with statins suggesting their protective role in the progression of renal disease. In addition, reduced rates of non-fatal myocardial infarction and cardiac mortality were seen after renal transplant in patients receiving fluvastatin. However, a recent study with atorvastatin failed to demonstrate reduction in cardiovascular morbidity and mortality among diabetic patients on hemodialysis therapy. Ongoing trials will define the precise role of statins in this subset of patients.
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Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Fallo Renal Crónico/tratamiento farmacológico , Brasil/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Dislipidemias/complicaciones , Dislipidemias/tratamiento farmacológico , Humanos , Riñón/efectos de los fármacos , Fallo Renal Crónico/complicaciones , Trasplante de Hígado/efectos adversos , Diálisis Renal/efectos adversos , Factores de RiesgoRESUMEN
Experimental evidence suggests that acidosis may have a deleterious effect on protein metabolism. We evaluated 124 chronic dialysis patients (59 +/- 17 years) and defined acidosis as an anion gap >18 meq/L. A direct correlation (p < 0.0001 was found between anion gap and serum albumin (R = 0.402), BUN (R = 0.488), and serum creatinine (R = 0.473) concentrations. Acidotic patients (43%), when compared with nonacidotic patients, had greater serum albumin concentrations (3.95 +/- 0.50 vs. 3.60 +/- 0.48 g/dl, p = 0.0001, respectively), higher normalized protein catabolic rates (1.12 +/- 0.27 vs. 0.96 +/- 0.26 g/kg/d, respectively; p = 0.0004), and higher BUN (70 +/- 19 vs. 55 +/- 17 mg/dl, p = 0.0001) and serum creatinine (11.1 +/- 3.4 vs. 8.3 +/- 3.2, p = 0.0001 mg/dl) concentrations. However, no differences in midarm muscle circumference, fat free mass, or body cell mass were noted between groups when assessed by dialysis modality or acidosis status. In conclusion, mild chronic metabolic acidosis, likely caused by increased dietary protein intake, does not independently and adversely impact nutritional status in chronic dialysis patients.
Asunto(s)
Acidosis/metabolismo , Estado Nutricional , Diálisis Renal , Equilibrio Ácido-Base , Adulto , Anciano , Nitrógeno de la Urea Sanguínea , Composición Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Albúmina Sérica/análisisRESUMEN
Continuous ambulatory (CAPD) and continuous cyclic peritoneal dialysis (CCPD) differ in solute transport, and variances in mass balance could impact nutritional parameters. Chronic acidosis may decrease albumin synthesis and increase catabolism. We prospectively studied 50 peritoneal dialysis patients (age: 55 +/- 16 yrs; CAPD = 33; CCPD = 17) over 24 months. Acidosis was defined by an anion gap > 18 mEq/L. Bioimpedance analysis was used to estimate body cell mass and fat-free mass. Patients on CAPD had a lower body mass index than CCPD patients (27 +/- 5 kg/m2 vs. 29 +/- 9 kg/m2 respectively; P = 0.039). However no differences were observed in body cell mass (25 +/- 8 kg vs. 26 +/- 9 kg respectively; P = 0.787) or fat-free mass (53 +/- 14 kg vs. 50 +/- 18 kg respectively; P = 0.404). Urea kinetic modeling showed no differences in Kpt/V or nPCR (0.26 +/- 0.06 vs. 0.24 +/- 0.07; P = 0.709 and 0.67 +/- 0.29 g/kg per day vs. 0.65 +/- 0.23 g/kg per day; P = 0.709 for CAPD and CCPD respectively). When categorized by the presence of acidosis no differences were observed in body cell mass (24 +/- 8 kg vs. 27 +/- 9 kg respectively; P = 0.131) or fat-free mass (54 +/- 15 kg vs. 50 +/- 16 kg respectively; P = 0.348), while body mass index was greater in acidotic than nonacidotic individuals (30 +/- 8 kg/m2 vs. 26 +/- 6 kg/m2 respectively; P = 0.005). Dietary protein intake assessed as nPCR was similar in both groups (0.64 +/- 0.26 vs. 0.71 +/- 0.28 g/kg per day; P = 0.319, for CAPD and CCPD respectively). We conclude that over a 24-month period neither peritoneal dialysis modality nor the presence of acidosis has a detrimental influence on nutritional parameters in well dialyzed patients.
Asunto(s)
Acidosis/diagnóstico , Trastornos Nutricionales/etiología , Diálisis Peritoneal/métodos , Acidosis/etiología , Composición Corporal , Índice de Masa Corporal , Impedancia Eléctrica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Nutricionales/diagnóstico , Diálisis Peritoneal/efectos adversos , Diálisis Peritoneal Ambulatoria Continua , Estudios ProspectivosRESUMEN
Analisamos, retrospectivamente, 32 traçados cardiotocográficos basais, realizados em 32 grávidas normais, com idade gestacional (IG) que variou entre 29 semanas e seis dias a 41 semanas e cinco dias. Os exames foram divididos em dois grupos: o primeiro, pertencente a gestantes com IG inferior a 34 semanas; o segundo, com IG igual ou superior a esta. Avaliamos a duraçao da cardiotocografia basal (CB), o número de movimentos corpóreos fetais (MCF), o número de aceleraçoes transitórias (AT) da freqüência cardíaca fetal (FCF) decorrentes, bem como a porcentagem AT/MCF. Estabelecemos também o número de contraçoes uterinas (CUT) e as AT decorrentes, assim como a porcentagem A TICUT nos respectivos grupos. A duraçao da CB foi, em média, de 10,33 minutos nas gestaçoes inferiores a 34 semanas e de 10,73 minutos quando igual ou superior a esta IG. Nao encontramos diferença estatisticamente significante no número de MCF e de AT entre os dois grupos analisados. A relaçao entre os MCF e as AT resultou em coeficiente de correlaçao estatisticamente nao significante na populaçao abaixo de 34 semanas, ao contrário das gestaçoes acima desta idade. A porcentagem média de AT/MCF foi de 49,5 por cento no primeiro grupo e de 71,1 por cento no segundo, diferença estatisticamente significante. O percentual de AT/CUT foi zero nas gestantes com IG inferior a 34 semanas e de 23 por cento, quando acima deste limite. Concluímos que, apesar de nao ha ver diferença estatisticamente significante no número de MCF e de AT da FCF nas gestaçoes inferiores a 34 semanas, quando comparadas com IG igual ou superior a este limite, a partir da 34( semana de gestaçao, os MCF desencadeiam maior número de AT.
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Cardiotocografía , Movimiento Fetal/fisiología , Frecuencia Cardíaca Fetal/fisiología , Contracción Uterina/fisiología , Edad Gestacional , Estudios RetrospectivosRESUMEN
A resposta acelerativa da freqüência cardiaca fetal ao estímulo acústico (EA) na cardiotocografia anteparto, em gestantes normais, é analisada nos seguintes parâmetros: amplitude (em batimentos/ minuto), duraçao (em segundos), número de movimentos corpóreos fetais (MCF) e de aceleraçoes transitórias (AT) destes decorrentes, observados após a primeira resposta acelerativa e a porcentagem AT/MCF. Avaliamos os traçados cardiotocográficos obtidos de 28 gestantes, com idade gestacional (IG) que variou de 29 semanas e seis dias a 41 semanas e cinco dias e que foram divididos em dois grupos: o primeiro - composto por oito grávidas com IG inferior a 34 semanas; o segundo - por 20 gestantes com IG igual ou superior a 34 semanas. Nao foram encontradas diferenças estatisticamente significantes em amplitude e duraçao da resposta ao EA, número de MCF e de AT destes decorrentes, assim como na porcentagem AT/MCF, após a primeira resposta acelerativa. A correlaçao entre os MCF e as AT foi estatisticamente significante nos dois grupos. Concluímos que a resposta cárdio-acelerativa ao EA, em conceptos com IG entre 30 e 34 semanas incompletas, é semelhante à obtida em fetos com IG igual ou acima deste limite até o termo.
Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Adulto , Estimulación Acústica , Cardiotocografía , Frecuencia Cardíaca Fetal/fisiología , Peso al Nacer , Movimiento Fetal , Edad Gestacional , Paridad , Parto , Estudios RetrospectivosRESUMEN
The effects of carbon monoxide on the hemodynamics of the adult rat were investigated. A number of parameters were measured using an open-chest, chloralose-urethan anesthetized preparation. Our experiments showed this anesthetic agent to have several advantages over pentobarbital sodium. One group inhaled 150 ppm CO for 0.5-2 h, carboxyhemoglobin (HbCO) reaching 16%. Heart rate, cardiac output, cardiac index, dF/dtmax (aortic), and stroke volume rose significantly; mean arterial pressure, total peripheral resistance, and left ventricular systolic pressure fell, whereas stroke work, left ventricular dP/dtmax, and stroke power changed little. These effects were evident at a HbCO saturation as low as 7.5% (0.5 h). A second group inhaled 500 ppm CO for 5-48 h, HbCO reaching 35-38%. The same parameters changed in the same direction as in the first group, with mean arterial pressure and peripheral resistance remaining depressed, while heart rate, cardiac output, cardiac index, and stroke volume remained elevated. Heart rate and arterial systolic pressure were also monitored in conscious rats; rats in one group inhaled 500 ppm CO for 24 h, and rats in a second group were injected with a bubble of pure CO ip. In both cases heart rate was sharply elevated and blood pressure depressed as HbCO saturation increased. Both parameters recovered on CO washout. There was no significant difference between the response to inhaled vs. injected CO.