José Albuquerque de Figueiredo Neto

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.

Aspects related to choice of type of delivery: a comparative study of two maternity hospitals in São Luís, State of Maranhão, Brazil

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.

Prevalência da hipertensão arterial em adultos e fatores associados em São Luís - MA

BACKGROUND Little is known about the prevalence of arterial hypertension (AH) and its risk factors in the less developed regions of Brazil. OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSION 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.

Prevalência e fatores de risco para insuficiência renal aguda no pós-operatório de revascularização do miocárdio

OBJECTIVE To determine the prevalence, risk factors, and the clinical outcome of patients undergone coronary artery bypass grafting who progressed with Acute Renal Failure (ARF). METHODS A retrospective cohort prospective study was performed from data of 186 patients undergone surgery from January 2003 through June 2006. The stored data were analyzed using the software STATA 9.0. RESULTS The prevalence of ARF was of 30.6% (57/186). In 7.0% (4/57) dialysis therapy was needed. The mean age of patients with and without ARF progression was 62.8 (+/-9.4) years and 61.3 (+/-8.8) years respectively (P=NS). CPB time >115 min (p= 0.011) and cross-clamp time >85 min (p=0.044) were related to ARF by the univariate analysis. The need for intra-aortic balloon (P= 0.049), mechanical ventilation >24h (P = 0.006), Intensive Care Unit (ICU) stay > three days (P< 0.0001), bradycardia (P= 0.002), hypotension (P= 0.045), arrhythmia (P=0.005) and inotropic infusion (P= 0.0001) were higher in the ARF group. Only the ICU stay longer > 3 days showed statistical correlation with ARF by the multivariate analysis (P=0.018). The mortality rate with and without ARF was 8.8% (five cases) and 0.8% (one case) respectively (P=0.016), but it reached 50% (2/4) in dialytic patients. CONCLUSION ARF was a frequent and severe postoperative complication associated with higher mortality and longer ICU stay, which presented as risk factors: longer CPB and cross-clamp times, mechanical ventilation > 24h and hemodynamic instability.

Association between Chronic Apical Periodontitis and Coronary Artery Disease

INTRODUCTION Studies have shown that periodontal disease is independently associated with coronary artery disease. However, this same association has not been demonstrated with chronic apical periodontitis. The goal of this study was to establish the relationship between chronic apical periodontitis and coronary artery disease. METHODS This cross-sectional study included 103 patients who underwent coronary angiography at the University Hospital Presidente Dutra, Federal University of Maranhão, São Luís-Maranhão, Brazil. The patients answered a structured questionnaire and underwent physical and laboratory examinations. For each patient, a full-mouth set of periapical radiographs was taken. To compare numerical data, Students t test for independent samples or the Mann-Whitney U test (nonparametric) was used. The homogeneity of variance was assessed by using Levenes test. For comparison of categorical data, the chi-square test or Fishers exact test was used. The logistic regression analysis was performed to identify the independent predictors of coronary artery disease. The criterion for statistical significance was set at 5%. Statistical analysis was conducted by using SAS version 6.11 software. RESULTS The study comprised 103 patients (52 men, 51 women; mean age, 61.9 years); 31.1% were literate, and 55.3% were married. In the study sample, the prevalence of chronic apical periodontitis was 41.7% and of coronary artery disease, it was 65%. The patients with chronic apical periodontitis had a 2.79 times higher risk of developing coronary artery disease. CONCLUSIONS In these study patients, chronic apical periodontitis was independently associated with coronary artery disease.

Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial

BackgroundBlood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage.MethodsThis is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.DiscussionThe early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.Trial RegistrationClinical Trials NCT00970931.

O escore de risco ajustado para cirurgia em cardiopatias congênitas (RACHS-1) pode ser aplicado em nosso meio?

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.

Aspiração de corpo estranho por menores de 15 anos: experiência de um centro de referência do Brasil

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%), fishbone (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.

Effectiveness of Chlorthalidone Plus Amiloride for the Prevention of Hypertension: The PREVER‐Prevention Randomized Clinical Trial

Background Prehypertension is associated with higher cardiovascular risk, target organ damage, and incidence of hypertension. The Prevention of Hypertension in Patients with PreHypertension (PREVER‐Prevention) trial aimed to evaluate the efficacy and safety of a low‐dose diuretic for the prevention of hypertension and end‐organ damage. Methods and Results This randomized, parallel, double‐blind, placebo‐controlled trial was conducted in 21 Brazilian academic medical centers. Participants with prehypertension who were aged 30 to 70 years and who did not reach optimal blood pressure after 3 months of lifestyle intervention were randomized to a chlorthalidone/amiloride combination pill or placebo and were evaluated every 3 months during 18 months of treatment. The primary outcome was incidence of hypertension. Development or worsening of microalbuminuria, new‐onset diabetes mellitus, and reduction of left ventricular mass were secondary outcomes. Participant characteristics were evenly distributed by trial arms. The incidence of hypertension was significantly lower in 372 study participants allocated to diuretics compared with 358 allocated to placebo (hazard ratio 0.56, 95% CI 0.38–0.82), resulting in a cumulative incidence of 11.7% in the diuretic arm versus 19.5% in the placebo arm (P=0.004). Adverse events; levels of blood glucose, glycosylated hemoglobin, creatinine, and microalbuminuria; and incidence of diabetes mellitus were no different between the 2 arms. Left ventricular mass assessed through Sokolow‐Lyon voltage and voltage‐duration product decreased to a greater extent in participants allocated to diuretic therapy compared with placebo (P=0.02). Conclusions A combination of low‐dose chlorthalidone and amiloride effectively reduces the risk of incident hypertension and beneficially affects left ventricular mass in patients with prehypertension. Clinical Trial Registration URL: http://www.ClinicalTrials.gov, www.ensaiosclinicos.gov. Unique identifiers: NCT00970931, RBR‐74rr6s.