Eduardo Durans Figuerêdo

Metabolic syndrome and menopause: cross-sectional study in gynecology clinic

BACKGROUND 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. OBJECTIVE To determine the prevalence of metabolic syndrome and its components among climacteric women. METHODS 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 Programs (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. RESULTS 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. CONCLUSION 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.FUNDAMENTO: No Brasil, sao escassos os estudos sobre sindrome metabolica na populacao geral, mais raros sao os que a correlacionam ao climaterio. OBJETIVO: Determinar a prevalencia da sindrome metabolica e seus componentes em mulheres climatericas. METODOS: Estudo transversal com 323 mulheres climatericas, divididas em dois grupos: pre e pos-menopausadas. Foram avaliadas para presenca de sindrome metabolica, segundo os criterios do National Cholesterol Education Programs (NCEP) e da International Diabetes Federation (IDF). Foi verificada a associacao entre as variaveis estudadas e a sindrome metabolica por meio de analise uni e multivariada. Um p-valor < 0,05 foi considerado significante estatisticamente. RESULTADOS: A prevalencia de sindrome metabolica no climaterio foi de 34,7% (NCEP) e de 49,8% (IDF). Os componentes mais frequentes da sindrome metabolica foram o HDL-colesterol baixo, hipertensao arterial, obesidade abdominal, hipertrigliceridemia e diabete em ambos os criterios. A analise multivariada mostrou que a idade foi o fator de risco mais importante para o surgimento da sindrome metabolica (p < 0,001), que esteve presente em 44,4% (NCEP) e 61,5% (IDF) das mulheres menopausadas em comparacao a 24% (NCEP) e 37% (IDF) daquelas na pre-menopausa. CONCLUSAO: A prevalencia de sindrome metabolica foi maior nas mulheres menopausadas que naquelas na pre-menopausa. O principal fator de risco para o aumento dessa prevalencia foi a idade. A menopausa, quando analisada isoladamente, nao se constituiu um fator de risco para a sindrome metabolica.

Síndrome metabólica e menopausa: estudo transversal em ambulatório de ginecologia

BACKGROUND 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. OBJECTIVE To determine the prevalence of metabolic syndrome and its components among climacteric women. METHODS 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 Programs (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. RESULTS 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. CONCLUSION 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.FUNDAMENTO: No Brasil, sao escassos os estudos sobre sindrome metabolica na populacao geral, mais raros sao os que a correlacionam ao climaterio. OBJETIVO: Determinar a prevalencia da sindrome metabolica e seus componentes em mulheres climatericas. METODOS: Estudo transversal com 323 mulheres climatericas, divididas em dois grupos: pre e pos-menopausadas. Foram avaliadas para presenca de sindrome metabolica, segundo os criterios do National Cholesterol Education Programs (NCEP) e da International Diabetes Federation (IDF). Foi verificada a associacao entre as variaveis estudadas e a sindrome metabolica por meio de analise uni e multivariada. Um p-valor < 0,05 foi considerado significante estatisticamente. RESULTADOS: A prevalencia de sindrome metabolica no climaterio foi de 34,7% (NCEP) e de 49,8% (IDF). Os componentes mais frequentes da sindrome metabolica foram o HDL-colesterol baixo, hipertensao arterial, obesidade abdominal, hipertrigliceridemia e diabete em ambos os criterios. A analise multivariada mostrou que a idade foi o fator de risco mais importante para o surgimento da sindrome metabolica (p < 0,001), que esteve presente em 44,4% (NCEP) e 61,5% (IDF) das mulheres menopausadas em comparacao a 24% (NCEP) e 37% (IDF) daquelas na pre-menopausa. CONCLUSAO: A prevalencia de sindrome metabolica foi maior nas mulheres menopausadas que naquelas na pre-menopausa. O principal fator de risco para o aumento dessa prevalencia foi a idade. A menopausa, quando analisada isoladamente, nao se constituiu um fator de risco para a sindrome metabolica.

Effects of different PEEP levels on respiratory mechanics and oxygenation after coronary artery bypass grafting.

OBJECTIVE To compare the effects of different levels of positive end-expiratory pressure on respiratory mechanics and oxygenation indexes in the immediate postoperative period of coronary artery bypass grafting. METHODS Randomized clinical trial in which 136 patients underwent coronary artery bypass grafting between January 2011 and March 2012 were divided into three groups and admitted to mechanical ventilation with different positive end-expiratory pressure levels: Group A, 5 cmH2O (n=44), Group B, 8 cmH2O (n=47) and Group C, 10 cmH2O (n=45). Data about respiratory mechanics were obtained from mechanical ventilator monitor and oxygenation indexes from arterial blood gas samples, collected twenty minutes after intensive care unit admission. Patients with chronic obstructive pulmonary disease and patients submitted to off-pump, emergency or combined operations were not included. For statistical analysis, we used Kruskal-Wallis, G and Chi-square tests, considering results significant when P<0.05. RESULTS Groups were homogeneous in terms of demographic, clinical and surgical variables. Patients ventilated with positive end-expiratory pressure of 10 cmH2O (Group C) had best compliance (P=0.04) and airway resistance values, this, however, without statistical significance. They also had best oxygenation indexes, with statistical difference in all analyzed variables, and lower frequency of hypoxemia (P=0.03). CONCLUSION Higher levels of positive end-expiratory pressure in immediate postoperative period of coronary artery bypass grafting improved pulmonary compliance values and increased oxygenation indexes, resulting in lower frequency of hypoxemia.

Síndrome metabólica em ambulatório cardiológico

BACKGROUND: In Brazil, the prevalence of the metabolic syndrome (MS) is little known in several regions. OBJECTIVE: To analyze the prevalence of MS, its components and the agreement between two diagnostic definitions in a population aged > 13 years. METHODS: Cross-sectional study conducted from June to October 2007 in 719 patients of outpatient cardiology clinics in the city of Sao Luis, State of Maranhao, 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. RESULTS: 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). CONCLUSION: 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.

Assesment of CABDEAL score as predictor of neurological dysfunction after on-pump coronary artery bypass grafting surgery

INTRODUCTION Neurological dysfunction is a feared postoperative morbidity of cardiac surgery, an important cause of death and increased spending in hospitals. Its prediction, however, is still uncertain. OBJECTIVE To assess the applicability of a preoperative score as a predictor of neurological dysfunction after coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). METHODS Prospective study that evaluated 77 patients who underwent CABG from February to October 2011. Using the score CABDEAL (creatinine, age, body mass index, diabetes, emergency surgery, abnormality on ECG, lung disease), patients were grouped into high (CABDEAL > 4) and low risk (CABDEAL<4). The predictive value of the score was compared with intraoperative and postoperative variables (aortic clamping time, CPB and ventilation time) as predictors of encephalopathy and stroke. Data were analyzed with descriptive statistics and compared with the Fisher exact test. ROC curve analysis was performed to evaluate the accuracy of the model for the neurological outcomes. It was considered the significant value P<0.05. RESULTS The mortality rate was 2.6% (n=2). There were 2 episodes of stroke (2.6%) and 12 (15.5%) of encephalopathy. High risk CABDEAL (P=0.0009), ventilation time (P=0.014), CPB time (P=0.02) and aortic clamping time (P=0.006) were significantly associated with encephalopathy. The aortic clamping time was also associated with stroke (P=0.03) and death (P=0.006). CABDEAL score showed the largest area under the ROC curve rather than others variables. CONCLUSION In this study, the CABDEAL score stood out as the best predictor of encephalopathy after CABG when compared to the others intraoperative variables.

Síndrome metabólico y menopausia: estudio transversal en ambulatorio de ginecología

BACKGROUND 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. OBJECTIVE To determine the prevalence of metabolic syndrome and its components among climacteric women. METHODS 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 Programs (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. RESULTS 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. CONCLUSION 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.FUNDAMENTO: No Brasil, sao escassos os estudos sobre sindrome metabolica na populacao geral, mais raros sao os que a correlacionam ao climaterio. OBJETIVO: Determinar a prevalencia da sindrome metabolica e seus componentes em mulheres climatericas. METODOS: Estudo transversal com 323 mulheres climatericas, divididas em dois grupos: pre e pos-menopausadas. Foram avaliadas para presenca de sindrome metabolica, segundo os criterios do National Cholesterol Education Programs (NCEP) e da International Diabetes Federation (IDF). Foi verificada a associacao entre as variaveis estudadas e a sindrome metabolica por meio de analise uni e multivariada. Um p-valor < 0,05 foi considerado significante estatisticamente. RESULTADOS: A prevalencia de sindrome metabolica no climaterio foi de 34,7% (NCEP) e de 49,8% (IDF). Os componentes mais frequentes da sindrome metabolica foram o HDL-colesterol baixo, hipertensao arterial, obesidade abdominal, hipertrigliceridemia e diabete em ambos os criterios. A analise multivariada mostrou que a idade foi o fator de risco mais importante para o surgimento da sindrome metabolica (p < 0,001), que esteve presente em 44,4% (NCEP) e 61,5% (IDF) das mulheres menopausadas em comparacao a 24% (NCEP) e 37% (IDF) daquelas na pre-menopausa. CONCLUSAO: A prevalencia de sindrome metabolica foi maior nas mulheres menopausadas que naquelas na pre-menopausa. O principal fator de risco para o aumento dessa prevalencia foi a idade. A menopausa, quando analisada isoladamente, nao se constituiu um fator de risco para a sindrome metabolica.

Climacteric Symptoms and Sexual Dysfunction: Association between the Blatt-Kupperman Index and the Female Sexual Function Index

Objective To investigate the association between the intensity of climacteric symptoms and sexual dysfunction in women aged 40 to 65 years. Methods Observational, analytic, cross-sectional study conducted with 63 women aged 40 to 65 treated at the gynecology outpatient clinic of a public hospital in northeastern Brazil. A questionnaire was used to collect identification data, clinical information, gynecological-obstetric data, lifestyle traits and information on chronic diseases. Climacteric symptoms and sexual function were evaluated by means of the Blatt-Kupperman index and the Female Sexual Function Index (FSFI) respectively. The association between the two indices was investigated using the chi-squared test; the difference in mean scores on the FSFI as a function of menopausal status was evaluated by Students t-test. The significance level was set to p < 0.05. Results The mean value of the Blatt-Kupperman index was 26.42 (standard deviation [SD]: 4.52); 36.51% of the women exhibited severe symptoms. The mean score on the FSFI was 21.84 (SD: 4.11). More than half of the analyzed women (58.73%) exhibited sexual dysfunction (FSFI ≤ 26.5). Regarding the association between the Blatt-Kupperman index and the FSFI, the greater the intensity of the climacteric symptoms (Blatt-Kupperman), the higher the frequency of sexual dysfunction (FSFI). Sexual dysfunction was exhibited by 100% of the participants with severe climacteric symptoms, 70.59% of those with moderate symptoms, and only 9.09% with mild symptoms (p < 0.001). Conclusions The application of the Blatt-Kupperman index and of the FSFI allowed the detection of an association between the severity of climacteric symptoms and the prevalence of sexual dysfunction.

Permeabilidade tubária e gestação após reversão de laqueadura - doi:10.5020/18061230.2006.p209

This study aimed at verifying the frequencies of tube permeability and pregnancy in women submitted to microsurgical tubal ligation reversal by laparotomy at a private Clinical Center, in Sao Luis, Maranhao, from August, 1999 to April, 2003. Medical registers from 27 patients were retrospectively analyzed. Data referring to age, motive for tubal ligation reversal, obstetrical antecedents, age at the time of tube ligation, time since sterilization and results from surgical reversal (observed at least during six months) were collected. Data showed that the most frequent age group was 30-34 years old (44%; p 0.05), neither between the time since sterilization and the frequency of tube permeability (p>0.05).