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ABSTRACT: In Brazil, there are few studies of the metabolic syndrome in the general population, and even fewer studies that establish a correlation between metabolic syndrome and climacteric.
To determine the prevalence of metabolic syndrome and its components among climacteric women.
Cross-sectional study with 323 climacteric women, divided into two groups: pre and post-menopausal. They were examined for the presence of metabolic syndrome, according to the criteria of National Cholesterol Education Program's (NCEP) and International Diabetes Federation (IDF). It was possible to notice the association between the variables under study and the metabolic syndrome by conducting a univariate analysis and a multivariate analysis. A p-value < 0.05 was considered statistically significant.
The prevalence of metabolic syndrome during the climacteric was 34.7% (NCEP) and 49.8% (IDF). The most frequent components of the metabolic syndrome were low HDL-cholesterol, hypertension, abdominal obesity, hypertriglyceridemia and diabetes in both criteria. The multivariate analysis showed that age was the most important risk factor for the development of metabolic syndrome (p < 0.001), which was present in 44.4% (NCEP) and 61.5% (IDF) of postmenopausal women compared to 24% (NCEP) and 37% (IDF) of premenopausal women.
The prevalence of metabolic syndrome was higher in postmenopausal women than in premenopausal women. The main risk factor for the increase in this prevalence was age. Menopause, when it is analyzed alone, did not constitute a risk factor for metabolic syndrome.
Arquivos brasileiros de cardiologia 09/2010; 95(3):339-45. · 1.32 Impact Factor
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ABSTRACT: Detection of hypertensive retinopathy (HR) with direct ophthalmoscopy is part of the assessment of hypertensive patients. Its use has been questioned because of its subjectivity and high interobserver variability.
To determine the prevalence of HR in hypertensive patients under outpatient monitoring, the correlation between diagnosis and ophthalmoscopy and angiography, and to correlate it with other target organ damages.
An observational, analytical and cross-sectional evaluation of 99 patients. Direct ophthalmoscopy and angiography performed by two investigators independently. Classification of RH, as described by Keith, Wagener and Barker.
The prevalence of HR of any grade was higher than 90.0% by both methods. On ophthalmoscopy, we observed grade I abnormalities in 51.0%, grade II in 43.0%, with one patient with grade III HR. On angiography, we observed grade I abnormalities in 42.0% and grade II in 52.0%. We detected three patients with grade III HR, two of which were not detected by ophthalmoscopy. Observers' agreement for the presence and severity of HR was poor with direct ophthalmoscopy and good with angiography. Renal dysfunction, ECG abnormalities (ventricular hypertrophy, pathological Q wave, repolarization abnormalities), and history of stroke were observed in 70.0%, 27.0% and 10.0% of patients, respectively. There was no relationship between the severity of HR and other target organ damages.
We observed a high prevalence of HR using both methods. Observers' agreement for the diagnosis and determination of the severity of HR was better with angiography. In our sample, there was no association of the severity of HR with other target organ damages.
Arquivos brasileiros de cardiologia 08/2010; 95(2):215-21. · 1.32 Impact Factor
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ABSTRACT: In Brazil, the prevalence of the metabolic syndrome (MS) is little known in several regions.
To analyze the prevalence of MS, its components and the agreement between two diagnostic definitions in a population aged > 13 years.
Cross-sectional study conducted from June to October 2007 in 719 patients of outpatient cardiology clinics in the city of São Luis, State of Maranhão, Brazil. Blood pressure (BP), weight, height, waist circumference and lipid profile were measured. Risk factors for MS were evaluated according to the International Diabetes Federation (IDF) definition. Prevalence ratios and 95% confidence intervals were estimated using Poisson regression.
The prevalence of MS was higher in both genders when using IDF definition (62.3% in men and 64.6% in women) than when using that of the National Cholesterol Education Program - Adult Treatment Prevention (NCEP ATPIII) (48.9% in men and 59% in women). The most prevalent MS components were: hypertension (87.2% and 86%); hypertriglyceridemia (84.4% and 82.5%); increased waist circumference (77.8% and 100%); low HDL-c (58.1% and 49.9%); and high blood glucose (59.9% and 51.9%), using NCEP ATPIII and IDF definitions, respectively. In the adjusted analysis, age > 60 years and body mass index (BMI) > 30 were associated with a higher risk of MS (p<0.001).
The prevalence of MS was much higher than in the overall population, and hypertension was the most prevalent component. There was good agreement between the two definitions, very good in the female gender and moderate in the male gender.
Arquivos brasileiros de cardiologia 01/2010; 94(1):46-54. · 1.32 Impact Factor
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ABSTRACT: This study aimed to analyze aspects related to choice of type of delivery in two maternity hospitals, one public and the other private, in São Luís, Maranhão State, Brazil. This cross-sectional study compared 163 primiparous women in a public maternity hospital and 89 in a private hospital, with mean ages of 21.63 +/- 5.24 and 28.8 +/- 5.41 years, respectively. In the public hospital, 79.1% of the women reported preferring vaginal deliveries, while in the private hospital 67.4% of the women preferred cesareans (p < 0.0001). Cesareans were performed in 46% of the women in the public maternity hospital and 97.8% of those in the private hospital (p < 0.0001). Patient satisfaction was high for both modes of delivery, but the desire to repeat the same mode was reported more frequently by women with vaginal deliveries (71.6% vs. 41.3% in the public maternity hospital and 100% vs. 65.5% in the private). In the public maternity hospital, the cesarean subgroup included more white and higher-income women. The cesarean rate was thus high in both maternity hospitals and was significantly higher in the private hospital; the study also showed a preference for vaginal delivery in the public hospital and cesareans in the private.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 08/2009; 25(7):1587-96. · 0.83 Impact Factor
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ABSTRACT: To describe the clinical, radiological and endoscopic characteristics of foreign body aspiration among individuals under the age of 15 treated at a referral center in the city of São Luís, Brazil.
This was a descriptive study using data from the medical charts of patients treated for foreign body aspiration at the Hospital Universitário Materno Infantil between 1995 and 2005. We investigated 72 confirmed cases of foreign body aspiration, evaluating the place of residence, as well as biological, clinical, radiological and endoscopic variables. We used the chi-square test to identify statistically significant differences in frequency among the variables studied.
The majority of the patients were from outlying areas (55.6%). The following variables presented the highest frequencies: 0-3 year age bracket (81.9%); male gender (63.9%); evolution > 24 h (66.7%); hypotransparency on chest X-ray (57.7%); foreign body in the right lung (41.2%) or in the larynx (20.5%); organic nature of the foreign body (83.3%); complication in the form of localized inflammation (59.4%); glottal edema as an endoscopic complication (47.6%); and seeds (46.6%), fishbone (28.3%) or plastics (25.5%) as the type of foreign body. There were no deaths.
Preventive care should be a priority for male children under the age of 3 living in outlying areas. Such children should not be given access to substances that can be aspirated, including certain foodstuffs. Simple and easily accessible radiological tests have been underused, which jeopardizes the quality of the initial treatment.
Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 08/2009; 35(7):653-9.
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ABSTRACT: Until recently, primary hyperaldosteronism was considered a rare cause of secondary hypertension. However, in recent years, many studies have suggested that this disease can affect up to 20% of hypertensive individuals.
To determine the prevalence of primary hyperaldosteronism in hypertensive patients treated at the hypertension league of a university hospital.
Serum aldosterone and plasma renin activity levels were measured in 105 patients while they were undergoing standard antihypertensive treatment, with the exception of those using betablockers and spironolactone, in fasting condition and after rest in the supine position for 20 minutes. Those with an aldosterone/plasma renin activity ratio > 25 were submitted to the saline suppression test and, after the confirmation of the autonomy of aldosterone secretion, a computed tomography of the adrenals was performed. The results are presented as percentages and means and standard deviations.
Of the 105 patients, 6.54% presented refractory hypertension. Nine presented an aldosterone/plasma renin activity ratio > 25 (8.5% of the total). Of these, 08 were submitted to the saline suppression test and 01 (with refractory hypertension) had the diagnosis of primary hyperaldosteronism confirmed (0.96% of the total). A computed tomography of the adrenals was performed, which showed normal results.
The prevalence of primary hyperaldosteronism in the studied sample was 0.96% of the total. However, when only the patients with refractory hypertension were evaluated, the prevalence was 14.3%.
Arquivos brasileiros de cardiologia 01/2009; 92(1):39-45. · 1.32 Impact Factor
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ABSTRACT: Little is known about the prevalence of arterial hypertension (AH) and its risk factors in the less developed regions of Brazil.
To estimate the prevalence of arterial hypertension and its associated factors in the population > 18 years in São Luís, state of Maranhão according to the Seventh Report of the Joint National Committee (JNC 7) criteria.
A cross-sectional study was conducted in São Luís, MA, from February to March 2003, with 835 individuals >18 years who completed a structured household questionnaire. Measurements of arterial pressure (AP), weight, height and waist circumference were taken, and other risk factors for cardiovascular disease were assessed. The Poisson regression method was used for the identification of factors associated with AH, with an estimate of the prevalence ratio (PR) and its corresponding 95% confidence interval.
Age varied from 18 and 94 years (mean age was 39.4 years), 293 (35.1%) individuals were normotensive and 313 (37.5%) were pre-hypertensive. The AH prevalence was 27.4% (95% CI--24.4% to 30.6%), and it was higher among men (32.1%) than among women (24.2%). In the adjusted analysis, the following remained independently associated with AH: male gender (PR 1.52, 95% CI, 1.25-1.84), age > or = 30 years, with PR=6.65, 95% CI, 4.40-10.05 for > or = 60 years of age, overweight (PR 2.09 95% CI 1.64-2.68), obesity (PR 2.68, 95% CI, 2.03-3.53) and diabetes (PR 1.56, 95% CI, 1.24-1.97).
These findings suggest the need to control overweight, obesity and diabetes, especially among women and individuals > or = 30 years of age in order to reduce the prevalence of arterial hypertension.
Arquivos brasileiros de cardiologia 11/2008; 91(4):236-42, 260-6. · 1.32 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the applicability of the RACHS-1 (Risk Adjustment in Congenital Heart Surgery) as a predictor of surgical mortality in a pediatric population of a public hospital of the Northeast of Brazil.
From June 2001 through June 2004, 145 patients undergone surgical treatment of CHD in our institution of whom 62% were female, and the mean age was 5.1 years. The RACHS-1 was used to classify the surgical procedures into categories of risk 1 to 6, and logistic regression analysis was used to identify the risk factors related to surgical death.
Age, type of CHD, pulmonary flow, surgical procedure, pump time and cross clamp time were identified as a risk factor for postoperative mortality (p<0.001). There was a linear correlation between the categories of the RACHS-1 and the mortality rate; however, the observed mortality was greater than the predicted figures by that scoring system.
Although the RACHS-1 is easily applicable, it can not be applicable in our scenario because it takes into account only the surgical procedure as a categorized variable, not considering others factors presented in our scenario that could interfere in the final surgical result.
Brazilian Journal of Cardiovascular Surgery 12/2007; 22(4):425-31.
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ABSTRACT: To study the effects of metoprolol tartrate therapy in patients with heart failure.
Fifty patients (36 males) aged 52+/-14.8 yrs, with functional class II to IV heart failure (HF) and left ventricular ejection fraction (LVFE) < 45%, assessed by radionuclide ventriculography, were evaluated in a retrospective study. Metoprolol tartrate was added to the usual therapy, with a starting dose of 12.5 mg, which was increased weekly to a maximum of 200 mg/day, according to patients tolerance. Clinical evaluation, electrocardiogram, Doppler echocardiogram, 24-h Holter monitoring and radionuclide ventriculography were carried out in the pre-treatment phase and repeated three and six months after the start of therapy.
At the end of six months, there was functional class (NYHA) improvement with a reduction from 3.04+/-0.11 to 1.66+/-0.06(p<0.001). Ejection fraction increased from 29.84+1.61% to 38.56+/-1.95% (p< 0.001). The left ventricular diastolic diameter showed a reduction from 67.70+/-1.31 mm to 63.96+/-1.29 mm (p<0.001), and the left ventricular systolic diameter showed a reduction from 54.80+/-1.67 mm to 48.58+/-1.38 (p<0.001). There was no alteration in noradrenaline levels during the six-month follow-up period (p>0.05). Cardiac frequency decreased from 78.84+/-1.68 to 67.48+/-1.86 b.p.m. (p<0.001).
The adding of metoprolol tartrate to the usual heart failure therapy is followed by an increase of ejection fraction, functional class improvement, and decrease of ventricular diameters and cardiac frequency. These results suggest anti-remodeling effects in patients with HF who utilize metoprolol tartrate in addition to the usual therapy.
Arquivos brasileiros de cardiologia 09/2006; 87(3):329-35. · 1.32 Impact Factor
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Journal of Cardiac Failure - J CARD FAIL. 01/2004; 10(4).
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ABSTRACT: Objective: To describe the clinical, radiological and endoscopic characteristics of foreign body aspiration among individuals under the age of 15 treated at a referral center in the city of São Luís, Brazil. Methods: This was a descriptive study using data from the medical charts of patients treated for foreign body aspiration at the Hospital Universitário Materno Infantil between 1995 and 2005. We investigated 72 confirmed cases of foreign body aspiration, evaluating the place of residence, as well as biological, clinical, radiological and endoscopic variables. We used the chi-square test to identify statistically significant differences in frequency among the variables studied. Results: The majority of the patients were from outlying areas (55.6%). The following variables presented the highest frequencies: 0-3 year age bracket (81.9%); male gender (63.9%); evolution > 24 h (66.7%); hypotransparency on chest X-ray (57.7%); foreign body in the right lung (41.2%) or in the larynx (20.5%); organic nature of the foreign body (83.3%); complication in the form of localized inflammation (59.4%); glottal edema as an endoscopic complication (47.6%); and seeds (46.6%), fish bone (28.3%) or plastics (25.5%) as the type of foreign body. There were no deaths. Conclusions: Preventive care should be a priority for male children under the age of 3 living in outlying areas. Such children should not be given access to substances that can be aspirated, including certain foodstuffs. Simple and easily accessible radiological tests have been underused, which jeopardizes the quality of the initial treatment.
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ABSTRACT: To compare the outcomes and costs of stress urinary incontinence (SUI) surgery using a hand-made sling (Marlex®) versus a commerciallyavailable suburethral polypropylene sling (Advantage®).
Thirty-nine women with SUI due to bladder neck hypermobility and/or sphincter incompetence diagnosed by clinical examination and urodynamic studies were divided into two groups: group 1 (n = 19) consisted of patients from an academic center (Department of Urology, University Hospital of Federal University of Maranhao, and group 2 (n = 20) patients from private practice. The hand-made polypropylene suburethral sling was used in group 1 and the commercial sling in group 2. The patients were evaluated 30, 60 and 90 days after surgery.
The mean duration of surgery was 43 min. in group 1 and 51 min. in group 2. No postoperative voiding difficulties were observed in group 1 (100%), as well as, in 94.7% of patients of group 2. A bladder catheter was not required in any of the patients of the two groups at the end of the study. The level of satisfaction was 100% in group 1, whereas, one patient of group 2 considered the surgery to be unsuccessful. Urodynamic studies showed low amplitude uninhibited contraction in 11.1% of patients of group 1 and 10.5% of group 2. No complications were observed in either group.
The hand-made polypropylene mesh (Marlex®) can be used for sling procedures, saving costs and yielding results similar to that obtained with commercial sling systems.
International braz j urol: official journal of the Brazilian Society of Urology 37(4):519-27.
