Carlo Sasso Faccin

Oral contraceptives: a risk factor for uncontrolled blood pressure among hypertensive women

The objective of the study was to assess the association between systolic and diastolic blood pressure (SBP and DBP) and the use of oral contraceptives (OC) in hypertensive women. In a prospective cross-sectional study, we evaluated 171 women who were referred to the Hypertension Outpatient Clinic of Hospital de Clínicas de Porto Alegre; 66 current users of OC, 26 users of other contraceptive methods and 79 women who were not using contraception. The average of six blood pressure readings was used to establish the usual blood pressure of the participants. Current OC users were compared with users of other methods and with patients not using contraception. Main outcome measures were SBP and DBP among the different groups, and prevalence of uncontrolled hypertension (SBP >or= 140 mmHg and DBP >or= 90 mmHg). DBP was higher in OC users (100.2 +/- 15.9 mmHg) than in patients using other contraceptive methods (93.4 +/- 14.7 mmHg) and not using contraceptives (93.3 +/- 14.4 mmHg, p = 0.016). Women using OC for more than 8 years presented higher age-adjusted blood pressure levels than women using OC for shorter periods. Patients using OC had poor blood pressure control (p for trend = 0.046) and a higher proportion of them presented moderate-severe hypertension. These results were independent of antihypertensive drug use. In a logistic regression model, we found that current OC use was independently and significantly associated with prevalence of uncontrolled hypertension. It is concluded that hypertensive women using OC present a significant increase in DBP and poor blood pressure control, independent of age, weight and antihypertensive drug treatment.

Characteristics associated with the dropout of hypertensive patients followed up in an outpatient referral clinic

OBJECTIVE To determine the characteristics associated with the dropout of patients followed up in a Brazilian out patient clinic specializing in hypertension. METHODS Planned prospective cohort study of patients who were prescribed an antihypertensive treatment after an extensive initial evaluation. The following parameters were analyzed: sex, age, educational level, duration of disease, pressure level used for classifying the patient, previous treatment, physical activity, smoking, alcohol consumption, familial history of hypertension, and lesion in a target organ. RESULTS We studied 945 hypertensive patients, 533 (56%) of whom dropped out of the follow-up. The mean age was 52.3+/-12.9 years. The highest probabilities of dropout of the follow-up were associated with current smoking, relative risk of 1.46 (1.04-2.06); educational level equal to or below 5 years of schooling, relative risk of 1.52 (1.11-2.08); and hypertension duration below 5 years, relative risk of 1.78 (1.28-2.48). Age increase was associated with a higher probability of follow-up with a relative risk of 0.98 (0.97-0.99). CONCLUSION We identified a group at risk for dropping out the follow-up, which comprised patients with a lower educational level, a recent diagnosis of hypertension, and who were smokers. We think that measures assuring adherence to treatment should be directed to this group of patients.

Prevalência de lesão adrenal incidental em pacientes submetidos a tomografia computadorizada de tórax e abdome em um hospital geral brasileiro

Prevalence of Adrenal Incidentaloma at Computed Tomography (Chest and Abdominal) in a General Hospital in Brazil. O b j e c t i v e : To prospectively determine the prevalence of incidental adrenal lesions at computed tomography (CT) at an University Hospital in Brazil. Patients and Method: A cross-sectional prospective study was performed to evaluate 3,382 consecutive patients with no known adrenal disease or malignancies who underwent chest and abdominal CT scans over a ten-month period. The cases of adrenal incidentaloma were defined by the presence of any change in gland contour, size or density. Kappa values were calculated, evaluating the intra and inter-observer agreement. R e s u l t s : One hundred and one incidental adrenal masses were identified, corresponding to 83 cases and a prevalence of 2.5% (CI 95%: 1.0%‐3.2%). Male patients presented a higher prevalence of incidentaloma than female (3.3% vs. 1.5%; p= 0.01). There was a significant a s s o c i ation between older age and higher frequency of incidentaloma. Kappa of 0.76 and 0.83 (good and excellent agreement, respectively), were obtained in evaluating the intra and inter-observer agreements. C o n c l u s i o n s : The prevalence of adrenal incidentaloma detected by CT was similar to that of various published retrospective clinical series. The two factors that independently influenced the distribution of incidentalomas were older age and being male. (Arq Bras Endocrinol Metab 2005;49/5:769-775)

Profilaxia para tromboembolia venosa em uma unidade de tratamento intensivo

Objectives: To identify the degree of risk and the practice of prophylaxis to venous thromboembolism (VTE) in an intensive care unit (ICU). Methods: The subjects were patients admitted to the ICU between December 1997 and February 1998. Patients were excluded if they were in anticoagulant therapy or presented contra-indication to heparin. Determination of risk factors and classification of the degree of risk for VTE were done according to international consensus. The ICU medical staff did not know about the study. Results: The authors evaluated one hundred and eighty patients with a mean age of 58 years (±16.5). Risk factors more frequently found were: age ³ 40 years (85.0%), surgery (47.8%), thoracic or abdominal infection (22.8%). Two or more risk factors were present in 146 (81%) cases. In the evaluation of VTE risk, 142 (79%) patients were classified as moderate/high risk. Prophylactic measures were prescribed to 102 patients (57%), and heparin was used in 60% of moderate/high risk cases. There was a significant association between risk level and the number of risk factors with the use of prophylaxis (p < 0.05). Conclusion: VTE risk factors were frequent in the sample analyzed. However, 40% of patients considered moderate/high risk did not receive pharmacological prophylaxis for VTE.

Relação entre alterações funcionais e radiológicas em pacientes com fibrose cística

BACKGROUND: Cystic fibrosis (CF) is a disease marked by airway inflammation and airflow obstruction, resulting in air trapping in the lungs. OBJECTIVE: To assess the associations between airflow limitation, pulmonary volume and X-ray findings in patients with cystic fibrosis. METHOD: A cross-sectional retrospective study. Review of spirometric, plethysmographic, and chest X-ray findings of outpatients (age ³ 16 years). The airflow findings were classified as within normal limits or as airflow obstruction: mild, moderate or severe obstructive alteration. RESULTS: A total of 23 patients (15 male and eight female; mean age, 21 ± 5.9 years) were studied. Six of them were within normal limits, four had a mild, five had a moderate, and eight had a severe obstructive alteration. There was an association between airflow limitation and the increase of residual volume (p = 0.006) and also with the Brasfield score (p = 0.001), but not with the total lung capacity (p = 0.33). There was a correlation between residual volume and Brasfield score (r = 0,73, p = 0,002), but not with the total pulmonary capacity. Moreover, according to X-ray criteria, the air trapping was correlated only with the residual volume (p = 0.006). CONCLUSION: In patients with cystic fibrosis (age ³ 16 years), the progressive airflow limitation is accompanied by an increase in residual volume, while the total pulmonary capacity remains normal or tends to decrease. The X-ray score was associated with airflow limitation and residual volume, but not with total lung capacity.