Maria Luiza Garcia Rosa

Universidade Federal Fluminense, Vila Real da Praia Grande, Rio de Janeiro, Brazil

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Publications (40)41.28 Total impact

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    ABSTRACT: Background: Heart failure with preserved ejection fraction (HFPEF) is the most common form of heart failure (HF), its diagnosis being a challenge to the outpatient clinic practice. Objective: To describe and compare two strategies derived from algorithms of the European Society of Cardiology Diastology Guidelines for the diagnosis of HFPEF. Methods: Cross-sectional study with 166 consecutive ambulatory patients (67.9±11.7 years; 72% of women). The strategies to confirm HFPEF were established according to the European Society of Cardiology Diastology Guidelines criteria. In strategy 1 (S1), tissue Doppler echocardiography (TDE) and electrocardiography (ECG) were used; in strategy 2 (S2), B-type natriuretic peptide (BNP) measurement was included. Results: In S1, patients were divided into groups based on the E/E'ratio as follows: GI, E/E'> 15 (n = 16; 9%); GII, E/E'8 to 15 (n = 79; 48%); and GIII, E/E'< 8 (n = 71; 43%). HFPEF was confirmed in GI and excluded in GIII. In GII, TDE [left atrial volume index (LAVI) ≥ 40 mL/m2; left ventricular mass index LVMI) > 122 for women and > 149 g/m2 for men] and ECG (atrial fibrillation) parameters were assessed, confirming HFPEF in 33 more patients, adding up to 49 (29%). In S2, patients were divided into three groups based on BNP levels. GI (BNP > 200 pg/mL) consisted of 12 patients, HFPEF being confirmed in all of them. GII (BNP ranging from 100 to 200 pg/mL) consisted of 20 patients with LAVI > 29 mL/m2, or LVMI ≥ 96 g/m2 for women or ≥ 116 g/m2 for men, or E/E'≥ 8 or atrial fibrillation on ECG, and the diagnosis of HFPEF was confirmed in 15. GIII (BNP < 100 pg/mL) consisted of 134 patients, 26 of whom had the diagnosis of HFPEF confirmed when GII parameters were used. Measuring BNP levels in S2 identified 4 more patients (8%) with HFPEF as compared with those identified in S1. Conclusion: The association of BNP measurement and TDE data is better than the isolated use of those parameters. BNP can be useful in identifying patients whose diagnosis of HF had been previously excluded based only on TDE findings.
    Arquivos brasileiros de cardiologia. 08/2014;
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    ABSTRACT: The aim of this study was to investigate the association of Brazil's staple food, rice, beans and manioc, and the incidence of type 2 diabetes mellitus type 2 (T2DM) in adults assisted by a Brazilian Family Doctor Program (FDP). The baseline information was collected on visits to 13 units of the FDP from July 2006 to December 2007 (CAMELIA Study). The units were revisited by trained researchers between July and December 2011, who reviewed medical records of all participants of the baseline. Biochemical, anthropometrical and blood pressure measurements, new diagnoses, and medical prescriptions were collected. Individuals ages ≥20 y, who were non-diabetic at baseline were included (N = 409). Food consumption was estimated using a validated semi-quantitative food frequency questionnaire. Incident of diabetes was classified according to fasting serum glucose (≥126 mg/dL), individual's use of antidiabetic drugs, and/or diagnosis of diabetes described in the medical record. Individuals who were negative at baseline and also were negative for the above conditions were classified as non-diabetics. Individuals who developed T2DM (N = 30) reported higher consumption of red meat and beans and less consumption of cassava flour, independent of the interval between visits and other potential confounding variables. The cassava flour showed a protective effect (relative risk, 0.910; 95% confidence interval, 0.842-0.982). The consumption of cassava flour, a low-cost product, could be considered in diets for the prevention and control of diabetes. The hypothesis must be investigated in cohorts from different populations and tested in randomized controlled trials.
    Nutrition 03/2014; 30(3):365-368. · 2.86 Impact Factor
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    ABSTRACT: Ischemic stroke is a major cause of neurological sequelae and death. The correct use of thrombolytic therapy faces several barriers. The objective was to discuss barriers to thrombolytic therapy in a private hospital. This was a retrospective cohort study of patients with symptoms of acute ischemic stroke entering the emergency department of a private hospital in Rio de Janeiro, Brazil, from 2009 to 2011. 257 patients were admitted with suspected ischemic stroke. Among the 156 patients with confirmed diagnosis of ischemic stroke, 18 (11.5%) received thrombolytic therapy. Of the 30 patients with ischemic stroke within the therapeutic window and meeting NIHSS criteria for thrombolysis, 20 were not thrombolysed. Nine of these were due to administrative barriers (45%). In the current study, the thrombolysis rate was higher than in the United States, but barriers prevented treating 47.6% of patients with indication for thrombolysis. Importantly, this study was conducted in a private hospital, and the situation may be even more unfavorable in the public health system.
    Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 12/2013; 29(12):2487-96. · 0.83 Impact Factor
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    ABSTRACT: Heart failure with preserved ejection fraction (HFPEF) is a highly prevalent syndrome that is difficult to diagnose in outpatients. The measurement of B-type natriuretic peptide (BNP) may be useful in the diagnosis of HFPEF, but with a different cutoff from that used in the emergency room. The aim of this study was to identify the BNP cutoff for a diagnosis of HFPEF in outpatients. This prospective, observational study enrolled 161 outpatients (aged 68.1±11.5 years, 72% female) with suspected HFPEF. Patients underwent ECG, tissue Doppler imaging, and plasma BNP measurement, and were classified in accordance with algorithms for the diagnosis of HFPEF. HFPEF was confirmed in 49 patients, who presented higher BNP values (mean 144.4pg/ml, median 113pg/ml, vs. mean 27.6pg/ml, median 16.7pg/ml, p<0.0001). The results showed a significant correlation between BNP levels and left atrial volume index (r=0.554, p<0.0001), age (r=0.452; p<0.0001) and E/E' ratio (r=0.345, p<0.0001). The area under the ROC curve for BNP to detect HFPEF was 0.92 (95% confidence interval: 0.87-0.96; p<0.001), and 51pg/ml was identified as the best cutoff to detect HFPEF, with sensitivity of 86%, specificity of 86% and accuracy of 86%. BNP levels in outpatients with HFPEF are significantly higher than in those without. A cutoff value of 51pg/ml had the best diagnostic accuracy in outpatients.
    Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology. 08/2013;
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    ABSTRACT: This study aims investigate if nondiabetic subjects with fasting glucose < 126 mg/dL but altered HbA1c already have lower estimated glomerular filtration (eGFR) and high serum MCP-1 levels in comparison to nondiabetics with normal HbA1c, independent of other metabolic changes. Data were derived from the database of the CAMELIA (cardio-metabolic-renal family) study, a cross sectional study performed between July 2006 and December 2007, with participants recruited from the Family Doctor Program, Niterói, RJ. An independent association between changes in HbA1c (≥ 5.7 and < 6.5% versus < 5.7%) and decreased eGFR rate was found. The HbA1c was shown to be a marker of metabolic changes in nondiabetic subjects with fasting glucose < 126 mg/dL, particularly in women and blacks. These observations support the use of HbA1c levels in strategies for early intervention and prevention of chronic diseases such as diabetes mellitus and chronic kidney disease.
    Arquivos brasileiros de endocrinologia e metabologia 07/2013; 57(5):381-7. · 0.68 Impact Factor
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    ABSTRACT: The consolidation of nephrology as a medical specialty is relatively new and its denomination does not intuitively reflects its true scope. To assess the degree of knowledge from a population sample regarding the term "nephrology". We carried out a cross-sectional study in Niterói, RJ, with adult passerby individuals answering to the question "Do you know what nephrology is?". The variables recorded included: gender, age, skin-color, residence, income, educational level and kidneydisease history in the family. p values < 0.05 were considered significant. Of the 564 individuals asked, 504 were willing to answer. Of those who refused, 64% were males, 58% caucasians - from whom 85% were aged > 30 years. The mean age among participants was 39 (22-56) years, 49% were males and 56% caucasians. Twenty-eight percent of the interviewees knew the term "nephrology". Their knowledge came from school (39%) and family (30%). Those who knew about the term "nephrology" were older (42 ± 17 vs. 39 ± 17 years, p < 0.05), had higher income (R$ 4,522 vs. R$ 2,934, p < 0.05) and higher education (27% vs. 12% with complete higher education, p < 0.001). They were predominantly caucasians (64% vs. 53%, p = 0.001), and had a higher rate of renal disease in the family (55% vs. 36%, p < 0.001). In the multivariate analysis, associations were maintained for age (OR 1.02; 95% CI 1.00 to 1.03, p = 0.004); higher education (OR 10.60, 95% CI, 4.20 to 26.86, p < 0.001) and kidney disease in the family (OR 2.2, 95% CI, 1.40 to 3.41, p < 0.001). Only 28% knew the term "nephrology", illustrating the specialty's low penetration. We must strive to popularize this field of medicine aiming at better educating the population concerning the prevention and care of kidney diseases.
    Jornal Brasileiro de Nefrologia 06/2013; 35(2):107-111.
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    ABSTRACT: BACKGROUND: Blacks show higher levels of HbA1c in studies with different populations and are disproportionately affected by most diabetes-related complications. AIMS: The study aims to investigate if the prevalence of altered glycated hemoglobin (HbA1c) varies with skin color and if there is a familial aggregation of either skin color and HbA1c. METHODS: The study used the CAMELIA study (Cardio-Metabolic-Renal familiar) population, conducted between June 2006 and December 2007 (cross sectional). Families were recruited from 13 Family Doctor Program Unities of Niteroi, Brazil, a highly miscegenated population. The visits included questionnaire, medical consultation, anthropometric and nutritional assessment. Blood pressure, blood/urine samples were collected. The dosage of HbA1c was performed by immunoturbidimetry in Labmax 240 equipment. RESULTS: We compare data of 241 (25.5%) Blacks, versus 422 (44.7%) Mulattos or 272 (28.8%) Whites. The groups did not differ significantly with regard to most measures. Blacks had the lowest levels of income/education, higher frequency of diabetes and hypertension (p<0.20) as higher levels of HbA1c (p<0.05) that persisted after adjusting for possible confounders. Among blacks, the correlations between siblings of HbA1c were higher than among white/mulatto, reaching 86% versus 50%, respectively. CONCLUSION: Those results indicate that Brazilian Blacks patients must have more attention, focusing on diabetes preventive care. Longitudinal studies are needed to address the question if the altered level of HbA1c has a real clinical impact.
    Primary care diabetes. 02/2013;
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    ABSTRACT: BACKGROUND: Urolithiasis is a common and recurrent disease, whose prevalence rate has recently increased in parallel to obesity pandemic. OBJECTIVES: To estimate the prevalence of history of urolithiasis in a non-randomized sample of adults assisted by a community-based health program and to analyze its association with metabolic syndrome. METHODS: Cross-sectional study set in Niteroi, Rio de Janeiro, Brazil, including adults (non-diabetic hypertensives, diabetics or controls). Participants were assessed through a standardized questionnaire and underwent clinical and laboratory evaluation, including blood and urine samples. The diagnosis of metabolic syndrome was based on harmonized criteria. RESULTS: A total of 740 adults were enrolled (M: F = 0.85; 43±12 years; 30% white, and 70% non-white). Almost half of subjects (42.5%) had metabolic syndrome. The prevalence of urolithiasis in the sample was 10.1%. White skin colour, family history, and metabolic syndrome were independently associated with urolithiasis (P < 0.05). Subjects with the syndrome (excluding cases on diuretics) had more acidic urine (P = 0.014), increased natriuresis (P = 0.01) and higher uricosuria (P = 0.001) compared with non-affected ones. The prevalence of urolithiasis increased in proportion to the number of criteria for metabolic syndrome (P for trend <0.005). CONCLUSIONS: Metabolic syndrome is a modifiable factor associated with urolithiasis in a way that the frequency of positive history increases proportionally to the number of its diagnostic criteria. These findings reinforce the recent suggested link between urolithiasis and cardiovascular risk factors.
    Family Practice 11/2012; · 1.83 Impact Factor
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    ABSTRACT: BACKGROUND: The Family Medical Program is a health care system in the Rio de Janeiro state. Women's health services offered by the Family Medical Program include preventive exams and screening, family planning, and prenatal follow-up. Although cervical cancer screening is offered, barriers to care still hinder the full success of the program, and we are attempting to identify these barriers. METHODS: We undertook a cross-sectional and prospective study involving 351 women who were referred to the Family Medical Program between March 2009 and November 2010. Demographic data were obtained through a structured household questionnaire. The dependent variable was defined as the non-realization of the Pap smear test following the protocol of the Health Ministry. Cervical samples for screening were collected after clinical examination. RESULTS: Women who had undergone Pap smear testing at least once every 3 years comprised 282 of the participants (80.3 %). Most of the women had normal or inflammatory cytology (96.3 %). Illiteracy and the absence of symptomatic episodes of sexually transmitted disease were independent barriers to having cancer screening at regular intervals. Illiterate women were more likely to be older, not to be using any contraceptive method, and on average had more than two children, more than four pregnancies, and more than two abortions. Embarrassment was the greatest barrier to seeking professional care reported by all women, regardless of level of educational attainment. Other important barriers to seeking care and/or screening included time constraints, due to work or childcare. CONCLUSION: This study indicates that the Family Medical Program effectively provides cervical cancer screening coverage for its eligible population, at the level mandated by the WHO and the Brazilian Health Ministry. Fully 96.3 % of the women in our study had normal or benign inflammation on cytology. Understanding of barriers to care-seeking behavior that limit program adherence is one way to facilitate communication between providers and patients regarding the benefits of cancer screening.
    Archives of Gynecology 08/2012; · 0.91 Impact Factor
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    ABSTRACT: The aim of this study is to estimate the association of shortness of breath (SOB), fatigue and bilateral lower limb edema (LLE) - typical symptoms of HF - with quality of life (QOL) dimensions, measured by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). This cross-sectional study was conducted as part of the CAMELIA study (Cardiometabolic Renal Familial Study), which involved families covered by the Family Doctor Program (FDP) in Niteroi, Rio de Janeiro, Brazil. The study included 455 patients aged 30 and over, assessed by questionnaire, medical consultation, and blood and urine tests. The prevalence of symptoms was: fatigue 56.9%, SOB 22.6% and LLE 16.9%. There were independent and statistically significant associations between SOB and fatigue and all SF-36 dimensions, excepting emotional performance and SOB (p<0.10). The combination of SOB and fatigue with low QOL can increase the positive predictive value for a clinical diagnosis of HF and is a possible alternative for prioritizing patients for closer investigation in a primary care setting.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 08/2012; 31(9):559-65. · 0.59 Impact Factor
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    ABSTRACT: The pathophysiological model of heart failure (HF) with preserved ejection fraction (HFPEF) focuses on the presence of diastolic dysfunction, which causes left atrial (LA) structural and functional changes. The LA size, an indicator of the chronic elevation of the left ventricular (LV) filling pressure, can be used as a marker of the presence of HFPEF, and it is easily obtained. To estimate the accuracy of measuring the LA size by using indexed LA volume and diameter (ILAV and ILAD, respectively) for diagnosing HFPEF in ambulatory patients. This study assessed 142 patients (mean age, 67.3 ± 11.4 years; 75% of the female sex) suspected of having HF, divided into two groups: with HFPEF (n = 35) and without HFPEF (n = 107). The diastolic function, assessed by use of Doppler echocardiography, showed a significant difference between the groups regarding the parameters assessing ventricular relaxation (E': 6.9 ± 2.0 cm/s vs. 9.3 ± 2.5 cm/s; p < 0.0001) and LV filling pressure (E/E' ratio: 15.2 ± 6.4 vs. 7.6 ± 2.2; p < 0.0001). The ILAV cutoff point of 35 mL/m² best correlated with the diagnosis of HFPEF, showing sensitivity, specificity, and accuracy of 83%. The ILAD cutoff point of 2.4 cm/m² showed sensitivity of 71%, specificity of 66%, and accuracy of 67%. For diagnosing HFPEF in ambulatory patients, the ILAV proved to be a more accurate parameter than ILAD. On echocardiographic assessment, ILAV, rather than ILAD, should be routinely measured.
    Arquivos brasileiros de cardiologia 02/2012; 98(2):175-81. · 1.32 Impact Factor
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    ABSTRACT: Objective To estimate dietary habits and other factors associated with inadequate blood pressure (BP) control in hypertensive patients adherent to antihypertensive drug treatment assisted by a Brazilian Family Doctor Program (FDP).Design A cross-sectional study.Setting FDP units, Niterói, Rio de Janeiro, Brazil.Subjects We included data from both male and female participants aged ≥20 years. Participants completed a standardized questionnaire containing questions related to demographics, socio-economic factors, comorbidities and lifestyle, as well as a validated FFQ and eleven additional qualitative questions to investigate dietary habits. Food items were divided into sixteen groups. Medical consultations were performed, BP measurements were taken, blood and urine samples were assessed and anthropometric and nutritional status was evaluated.Results Individuals with inadequate BP control presented higher BMI values (prevalence ratio (PR) = 1·027, 95 % CI 1·009, 1·045) and also consumed more meat (PR = 1·091, 95 % CI 1·022, 1·165), which are potentially modifiable variables. Higher levels of serum creatinine (PR = 1·894, 95 % CI 1·241, 2·892) were also associated with inadequate BP control, as were skin colour (white). After inclusion of the Na excretion index, which is an indirect measure of salt intake, a slight decrease was observed in the PR for meat, which resulted in loss of statistical significance.Conclusions The results indicate that salt consumption, skin colour, BMI and serum creatinine are associated with inadequate BP control.
    Public Health Nutrition 11/2011; 14(12):2176 - 2184. · 2.25 Impact Factor
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    ABSTRACT: Aiming at improving the use of echocardiography tests, the Appropriateness Criteria (AC) were created by the American Society of Echocardiography (ASE)/American College of Cardiology (ACC). To compare the appropriateness profile of transthoracic echocardiography (TTE) requests in accordance with the AC, between a public University Hospital (UH) and a Private Hospital (PH), and verify which characteristics are associated with a better TTE request profile. We prospectively assessed 779 consecutive TTE requests in a PH (49.8%) and a UH (50.2%), with 55.6% of requests for women and 44.4% for men, aged 59.1 ± 15.7 years. The indications were classified as appropriate, inappropriate or non-classified, and adequacy to AC was correlated with age, patient gender, and the time since graduation of the requesting physician. The statistical analysis used Kappa coefficient and chi-square test. There was no significant difference regarding the adequacy profile of appropriate TTE requests in the two institutions (71% vs. 75%, p = 0.3). At PH, the factors associated with higher rates of appropriate tests were: female gender (p = 0.001) and age younger than 60 years (p <0.001). In the UH, physicians who had graduated between 5 and 10 years before had a higher rate of inappropriate requests (p = 0.02). The variables that were independent predictors of appropriate tests in the PH were: female sex (p = 0.001) and age <60 years (p = 0.001). In this evaluation, the PH and the UH profiles showed similar request appropriateness profiles. Female gender, time since graduation of the requesting physician and the patient's age influenced the appropriateness of requests.
    Arquivos brasileiros de cardiologia 10/2011; 97(4):281-8. · 1.32 Impact Factor
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    ABSTRACT: OBJECTIVE: To estimate the association between food intake and metabolic syndrome (MetS). DESIGN: Cross-sectional design conducted from July 2006 to December 2007. SETTING: Adolescents assisted by the Family Doctor Program (FDP) in Niterói, a metropolitan area in Rio de Janeiro State, Brazil. SUBJECTS: Survey of 210 adolescents. Individuals with three or more of the following components of MetS were classified as having this syndrome: TAG ≥ 110 mg/dl; HDL cholesterol < 50 mg/dl for girls aged 12-19 years and boys aged 12-14 years or <45 mg/dl for boys aged 15-19 years; waist circumference ≥75th percentile; serum glucose >100 mg/dl; and blood pressure ≥90th percentile. A semi-quantitative FFQ was used, and foods were grouped as: unprocessed or minimally processed foods (Group 1), processed culinary and food industry ingredients (Group 2) and ultra-processed foods (Group 3). The associations between food consumption and MetS were adjusted for sociodemographic, behavioural and family history covariates and were estimated using generalized estimation equations with the Poisson regression model. RESULTS: MetS was diagnosed in 6·7 % of the adolescents; the most frequent diagnostic criteria included the reduction of HDL cholesterol (46·7 %), elevated serum glucose (17·1 %) and the elevation of waist circumference (16·7 %). Crude analysis showed higher average daily intakes of energy, carbohydrates and ultra-processed foods among adolescents with MetS. After statistical adjustment, the intake of ultra-processed foods (≥3rd quartile) remained associated with MetS (prevalence ratio = 2·5; P = 0·012). CONCLUSIONS: High consumption of ultra-processed foods was associated with the prevalence of MetS in this adolescents group.
    Public Health Nutrition 07/2011; · 2.25 Impact Factor
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    ABSTRACT: The DSM-IV-TR postulates that PTSD symptoms are organized into 3 clusters. This assumption has been challenged by growing number of factor analytical studies, which tend to favor 4-factor, first-order models. Our objective was to investigate whether the clusters of PTSD symptoms identified in North American and European studies could be replicated in a Brazilian sample composed of 805 primary care patients living in hillside slums. Volunteers were asked to fill out the Brazilian version of the Posttraumatic Stress Disorder Checklist-Civilian Version and a confirmatory factor analysis of this scale was conducted with the software LISREL 8.80. Seven models were tested and a 4-factor, first-order solution including an emotional numbing cluster was found to provide the best fit. Although PTSD has been characterized by some critics as a Western culture-specific disorder lacking universal validity, our results seem to uphold the cross-cultural validity of the 4-factor, first-order model.
    Journal of anxiety disorders 06/2011; 25(7):950-63. · 2.68 Impact Factor
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    ABSTRACT: To estimate familial aggregation and the heritability of total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C) and high density lipoprotein-cholesterol (HDL-C) in families assisted by the Family Doctor Program in a Brazilian city, and to evaluate associations between some environmental factors and familial aggregation of these lipids. Cross-sectional familial study. The association of lipids with sociodemographic factors, lifestyle factors and comorbidities (e.g. physical activity, alcohol consumption, smoking, hypertension, impaired glucose tolerance, body mass index) was estimated using linear models and generalized estimating equations. Correlation of TC, LDL-C and HDL-C between pairs of relatives was estimated with the familial correlation procedure, and heritability was estimated with the ASSOC procedure. All associations were statistically significant. There was familial aggregation of TC (parent/offspring, r=0.33; sibling/sibling, r=0.37), LDL-C (parent/offspring, r=0.29; sibling/sibling, r=0.37) and HDL-C (parent/offspring, r=0.25; sibling/sibling, r=0.48), but less than 3%, 6% and 14%, respectively, which was explained by lifestyle factors. Correlation between pairs with genetic sharing (parent/offspring and sibling/sibling) was higher than that observed between father and mother. Heritability estimates ranged between 0.32 (HDL-C) and 0.50 (TC). Similar results were found for the two approaches used to estimate the contribution of genetic and environmental factors in the correlation of TC, LDL-C and HDL-C between the family pairs. The results showed that there is familial aggregation of TC, LDL-C and HDL-C, and point to the predominance of genetic factors because little influence of environmental variables was found.
    Public health 06/2011; 125(6):329-37. · 1.26 Impact Factor
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    ABSTRACT: The reduction in mortality from cardiovascular disease has been observed in Brazil for years, attributed to a fall in risk factors, improved treatment and reduced hospital mortality. To compare the mortality, the rate of hospitalization and hospital mortality in hospitals belonging to the Brazilian Public Health System, for ischemic heart disease (IHD), cerebrovascular diseases (CVD) and heart failure (HF), in Niterói, between 1998 and 2007. We used the number of deaths and hospitalizations and mortality of residents in Niterói for Chapter IX of ICD10 and specific causes available in Datasus, in population aged 30 and older. The difference between the magnitude of the indicators was calculated for men and women taking the average of the first three year period less the average of the second three year period. There was drop in population mortality rates in men and women for all age groups, in three groups of causes and for Chapter IX. The falling trend of rates decreased with age. For IHD there was a decrease in hospital mortality. For CVD and HF, there was an increase. The rates of hospitalization from IHD decreased, with exception of some ranges. This study has clarified some aspects of cardiovascular morbidity and mortality in Niterói. The reduction in population and hospital mortality from IHD indicates that there is a better approach in this condition. Increased mortality rate from cerebrovascular diseases and HF points to the need to give greater attention to the quality of hospital care for these groups of diseases.
    Arquivos brasileiros de cardiologia 04/2011; 96(6):477-83. · 1.32 Impact Factor
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    ABSTRACT: An increase in cardiovascular (CV) disease has been observed in prehypertensive subjects who frequently carry other cardiovascular risk factors. In Brazil, little is known about prehypertension and its association with cardiovascular risk factors. To estimate the association between prehypertension and cardiovascular risk factors in a public primary healthcare programme. Associations in this cross-sectional study were estimated on the basis of generalized estimating equations. Results are expressed as odds ratio (OR) or adjusted odds ratio (OR(a)) with 95% confidence interval (CI). The 357 participants were classified as normotensive (64.4%) or prehypertensive (35.6%). In a univariate analysis, prehypertension was statistically associated with male gender, age, table salt use, diabetes, body mass index (BMI), uric acid, and all lipids except high-density lipoprotein cholesterol. When analysis was performed adjusting for gender, age, and table salt use, the association of each metabolic parameter with prehypertension, remained significant for BMI (OR(a) = 1.097; 95% CI 1.035-1.162), triglycerides (OR(a) = 1.008; 95% CI 1.003-1.013), and uric acid (OR(a) = 1.269; 95% CI 1.023- .576). To check for their independence of obesity, associations of triglycerides and uric acid with prehypertension were reanalysed after adjustment for BMI. The association of triglycerides remained statistically significant. A trend of association was present for uric acid. The prevalence of prehypertension paralleled the increase of the number of risk factors. Prehypertension in Brazil is associated with well-recognized cardiovascular risk factors even in a continuously monitored population such the one under study. Prehypertension can be a valuable clue to alert health professionals to treat underlying perturbations to prevent overt cardiovascular disease.
    European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 04/2011; 18(2):233-9. · 2.51 Impact Factor
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    ABSTRACT: PURPOSE: To evaluate the quality of life of glaucoma patients comparing public health system, and private practice, through the questionnaire National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ). METHODS: A cross-sectional study, developed through the application of NEI-VFQ questionnaire in 83 non-consecutive glaucoma patients at different stages of the disease, and 51 from public health system, and 32 patients from private clinic. RESULTS: Statistically significant difference between groups was demonstrated in subdomains related to the "general health", "general vision", "ocular pain", "near activities", "distance activities", "mental health" and "role difficulties" no significant difference was demonstrated in "social functioning", "dependency", "driving", "color vision" and "peripheral vision". Regarding the overall score given by the questionnaire statistical difference was observed with an average of 73.13 in the public institutions and 86.07 in the private practice. CONCLUSION: The impact on quality of life was higher in patients from the public institution when compared to those of the private practice through the NEI-VFQ questionnaire.
    Revista brasileira de oftalmologia 12/2010; 69(6):378-382. · 0.16 Impact Factor
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    ABSTRACT: The aim of this study was to determine the prevalence and relationship of human papillomavirus (HPV) genotypes in cervical samples from 140 human immunodeficiency virus (HIV)-seropositive women routinely attending an outpatient public gynecological service in the state of Rio de Janeiro, Brazil. MY09/11 consensus primers were used to detect generic HPV DNA. HPV typification was performed by restriction fragment length polymorphism analysis following polymerase chain reaction amplification. The overall HPV prevalence was 60.0%. The identification of 24 different HPV genotypes including uncommon types was performed. A9 oncogenic genotypes were present in 54.02% of HIV-positive women. Abnormal cervical lesions, the time since HIV diagnosis and the number of sexual partners contributed independently to the high oncogenic HPV prevalence. The oncogenic and non-oncogenic group were similarly affected by risk factors in contrast to negative HPV women. The frequency of multiple infections was 20%; furthermore, all of them presented at least one oncogenic type. The analyzed sample represents an epidemiological source of uncommon infection. Due to high HPV prevalence, more frequent cytological screening and/or liberal colposcopic evaluations should be performed in HIV-positive patients.
    Archives of Gynecology 03/2010; 283(4):809-17. · 0.91 Impact Factor

Publication Stats

126 Citations
41.28 Total Impact Points

Institutions

  • 2004–2014
    • Universidade Federal Fluminense
      • • Departamento de Medicina Clínica (MMC)
      • • Faculdade de Medicina
      • • Instituto de Saúde da Comunidade
      Vila Real da Praia Grande, Rio de Janeiro, Brazil
  • 2013
    • Federal University of Rio de Janeiro
      Rio de Janeiro, Rio de Janeiro, Brazil
  • 2009
    • Tel Aviv University
      Tell Afif, Tel Aviv, Israel