José Antônio Cordeiro

Prevalência e fatores sociodemográficos em hipertensos de São José do Rio Preto - SP

BACKGROUND: Systemic arterial hypertension (SAH) is one of the greatest problems of public health in Brazil. Its detection and early treatment should be a priority to reduce the morbimortality of the cardiovascular diseases. OBJECTIVE: This study aimed at assessing the prevalence of SAH and the sociodemographic factors in a population of hypertensive individuals from Sao Jose do Rio Preto, Sao Paulo, Brazil. METHODS: A cross-sectional study was carried out in a stratified sample of 1,717 people, representative of the urban adult population from the city of Sao Jose do Rio Preto, between 2004 and 2005. RESULTS: The sample consisted of 1,717 people, with 762 of them (25.2%) being characterized as hypertensive. The following results were observed: 54.6% were women; 78.4% were caucasian; 66.1% were illiterate or had not finished Elementary School; 63.9% were married, 40.9% belonged to social classes D and E; 37.9% were self-employed or wage earners. CONCLUSION: The results of study on SAH in the city of Sao Jose do Rio Preto shows the need for early-onset continuous educational interventions.BACKGROUND Systemic arterial hypertension (SAH) is one of the greatest problems of public health in Brazil. Its detection and early treatment should be a priority to reduce the morbimortality of the cardiovascular diseases. OBJECTIVE This study aimed at assessing the prevalence of SAH and the sociodemographic factors in a population of hypertensive individuals from São José do Rio Preto, São Paulo, Brazil. METHODS A cross-sectional study was carried out in a stratified sample of 1,717 people, representative of the urban adult population from the city of São José do Rio Preto, between 2004 and 2005. RESULTS The sample consisted of 1,717 people, with 762 of them (25.2%) being characterized as hypertensive. The following results were observed: 54.6% were women; 78.4% were caucasian; 66.1% were illiterate or had not finished Elementary School; 63.9% were married, 40.9% belonged to social classes D and E; 37.9% were self-employed or wage earners. CONCLUSION The results of study on SAH in the city of São José do Rio Preto shows the need for early-onset continuous educational interventions.

Perfil lipídico e fatores de risco para doenças cardiovasculares em estudantes de medicina

OBJECTIVE To analyze the lipid profile and its correlation with risk factors for cardiovascular diseases (CVD) among medicine students. METHODS We assessed 153 students, regardless of sex, with age between 18 and 31 years old, submitted to lipid profile analysis, including serum levels of total cholesterol (TC), fraction of cholesterol of low (LDLc), high (HDLc) and very low density (VLDLc) lipoproteins and triglycerides (TG), besides of life habits and anthropometric data. Statistic analysis was employed, including the test of Mann Whitney, chi-square test, Pearsons correlation and multivariate analysis, by adopting a significance level for a value of p<0.05. RESULTS Sedentary lifestyle (43.1%) and familial history for CVD, particularly hypertension (74.5%), were distinguished. The lipid profile showed desirable, although altered levels of TC, LDLc and TG were detected in 11.8%, 9.8% and 8.5% from the students, respectively, and reduced levels of HDLc in 12.4% of them. Women showed significantly reduced values for LDLc and high values for HDLc compared to mens (p=0.031 and p<0.0001, respectively). There was a significant association between lipid profile and, preferably, body mass index (BMI), sedentary lifestyle, ingestion of alcohol, contraceptive use, familial antecedents of cerebrovascular accident and dyslipidemia. CONCLUSION Familial history for CVD, sedentary lifestyle and contraceptive use among medicine students showed frequent and associated to the lipid profile, as well as ingestion of alcohol and BMI. Although with desirable lipid profile, regardless of sex, higher levels of LDLc and reduced levels of HDLc in male sex provide a disadvantage to men compared to women.

Switch from calcineurin inhibitors to sirolimus- induced renal recovery in heart transplant recipients in the midterm follow-up

Background. Calcineurin inhibitor (CI)-based immunosuppression has prolonged the survival of heart transplant recipients. However, CI-induced renal injury remains as a major problem in these patients. Sirolimus is an immunosuppressant with no significant impact on renal function. A limited number of recent papers have showed that the switch from CI to sirolimus improved renal function in late follow-up of heart transplant patients with CI-related nephrotoxicity. Methods. Ten heart transplant recipients with CI-induced nephrotoxicity (creatinine 3.9±1.8 mg/dl) at a median of 701 (465 to 1325) days posttransplant had CI switched to sirolimus (target though levels 10 to 14 ng/ml) while mycophenolate mofetil (MMF, 3g/day) was maintained and adjusted according to white blood cell count. Results. This maneuver caused a marked decrease in serum creatinine (P<0.00001) at 30 (1.2±0.4 mg/dl), 90 (1.3±0.4 mg/dl) and 180 (1.3±0.4 mg/dl) days postconversion and a significant decrease in serum potassium levels (5.1±0.5 at baseline vs. 3.9±0.3 at 180 days, P<0.00005). After the drugs switch no changes in hemoglobin levels, white blood cell count, platelets count, blood glucose and glutamic oxaloacetic transaminase plasma levels were observed. Total cholesterol increased from 242±28 to 290±117 mg/dl (P>0.05) after 90 days and decreased to 216±58 mg/dl at day 180 (P>0.05) after statins dose adjustment. Rejection and infection rates were not modified by sirolimus. Conclusions. Conversion to a sirolimus-based immunosuppression regimen associated with MMF allowed striking renal function recovery in heart transplant recipients with calcineurin inhibitor-induced renal impairment at midterm follow-up.

Prevalência e fatores de risco para hipertensão em uma população urbana brasileira

FUNDAMENTO: Os estudos disponiveis nao analisaram de modo abrangente os varios fatores envolvidos na genese da hipertensao (HT), especialmente a associacao entre pressao arterial, excrecao urinaria de sodio e disfuncao renal. OBJETIVO: Avaliar a prevalencia dos fatores de risco para HT em diferentes grupos etarios em uma amostra representativa da uma populacao urbana brasileira. METODOS: A populacao estudada (1.717 individuos adultos) foi avaliada por grupos etarios: 18 a 39 anos; 40 a 49; 50 a 59; 60 a 69 e > 70 anos. As medias das variaveis quantitativas e as variaveis categoricas dos grupos normotenso e hipertenso foram comparadas. RESULTADOS: A prevalencia geral ajustada para HT foi de 25,23%. A prevalencia aumentou com a idade e era mais alta em individuos com baixo nivel educacional. Indice de massa corporal e circunferencia abdominal aumentados estavam positivamente associados com uma maior prevalencia de HT. Havia uma associacao positiva significante entre HT e excrecao urinaria de sodio. Os individuos hipertensos apresentavam maior frequencia de disfuncao renal, definida como clearance de creatinina <60 ml/min/m2. A prevalencia de diabetes mellitus na populacao geral era de 5,6% e 14,5% nos individuos hipertensos. A hipertensao era uma condicao conhecida por 74,4% dos individuos hipertensos. Entre os individuos hipertensos tratados, 52,4% tinham a hipertensao controlada e apenas 34,3% dos pacientes hipertensos no geral (tratados ou nao) tinham a pressao arterial controlada. CONCLUSAO: Esse estudo de base populacional e especial devido ao fato de agregar diferentes fatores demograficos, epidemiologicos e de risco envolvidos na genese da hipertensao na avaliacao de uma unica amostra com um calculo populacional que pode ser extrapolado para outras populacoes hipertensas.BACKGROUND The available studies have not fully analyzed the several factors involved in the genesis of hypertension (HT), especially the association among blood pressure, urinary sodium excretion and renal dysfunction. OBJECTIVE To assess the HT prevalence and risk factors in different age groups in a representative sample of an urban Brazilian population. METHODS The studied population (1717 adult individuals) was evaluated by age groups: 18 to 39 years; 40 to 49; 50 to 59; 60 to 69 and > 70 years. Quantitative variable means and categorical variables of the hypertensive and normotensive groups were compared. RESULTS The adjusted overall prevalence of HT was 25.23%. The prevalence increased with age and was higher in individuals with low educational level. Increased body mass index and abdominal waist were positively related to a higher prevalence of HT. There was a significant positive association between HT and urinary sodium excretion. Hypertensive individuals presented higher frequency of renal dysfunction, defined as measured creatinine clearance <60 ml/min/m(2). The prevalence of diabetes mellitus was 5.6% in the overall population and 14.5% in hypertensive individuals. Hypertension was a known condition to 74.4% of the hypertensive individuals. Among treated hypertensive individuals, 52.4% achieved controlled blood pressure and only 34.3% of the overall hypertensive patients (treated or not) had blood pressure controlled. CONCLUSION This population-based is unique by gathering different demographic, epidemiologic and risk factors involved in the genesis of hypertension in a single sample assessment with a population calculation, which might be extrapolated to other hypertensive populations.

Early Determinants of Death Due to Multiple Organ Failure After Noncardiac Surgery in High-Risk Patients

BACKGROUND:Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. However, these patients frequently die as a consequence of primary or secondary multiple organ failure (MOF), often as a result of sepsis. We investigated the early perioperative risk factors for in-hospital death due to MOF in surgical patients. METHODS:This was a prospective, multicenter, observational cohort study performed in 21 Brazilian intensive care units (ICUs). Adult patients undergoing noncardiac surgery who were admitted to the ICU within 24 hours after operation were evaluated. MOF was characterized by the presence of at least 2 organ failures. To determine the relative risk (RR) of in-hospital death due to MOF, we performed a logistic regression multivariate analysis. RESULTS:A total of 587 patients were included (mean age, 62.4 ± 17 years). ICU and hospital mortality rates were 15% and 20.6%, respectively. The main cause of death was MOF (53%). Peritonitis (RR 4.17, 95% confidence interval [CI] 1.38–12.6), diabetes (RR 3.63, 95% CI 1.17–11.2), unplanned surgery (RR 3.62, 95% CI 1.18–11.0), age (RR 1.04, 95% CI 1 0.01–1.08), and elevated serum lactate concentrations (RR 1.52, 95% CI 1.14–2.02), a high central venous pressure (RR 1.12, 95% CI 1.04–1.22), a fast heart rate (RR 3.63, 95% CI 1.17–11.2) and pH (RR 0.04, 95% CI 0.0005–0.38) on the day of admission were independent predictors of death due to MOF. CONCLUSIONS:MOF is the main cause of death after surgery in high-risk patients. Awareness of the risk factors for death due to MOF may be important in risk stratification and can suggest routes for therapy.

Analysis of joint mobility patterns among preschool children

CONTEXT AND OBJECTIVE Standardization of normal joint mobility criteria is complex, especially for preschool children, for whom differentiation from hypermobility (JH) is even more difficult. This study aimed to investigate joint mobility of the fifth finger, wrist, elbow, knee and trunk among preschool children, estimate the incidence of JH and evaluate the effect of gender and age and the applicability of standard criteria for identifying JH among preschool children. DESIGN AND SETTING Cross-sectional descriptive and quantitative study, at São José do Rio Preto medical school. METHODS 1,120 healthy children (534 boys, 47.7%; 586 girls, 52.3%; age range: 4-7 years) were evaluated using Beighton scores. Passive extension of fifth finger (> 90 degrees), passive apposition of thumb to forearm, active extension of elbow and knee (> 10 degrees) and anterior trunk flexion placing flat hand on ground were assessed. One point was scored for each positive result (maximum: 9). Scores > 4 were considered to be JH. Students t test and variance analysis were used for statistical analysis. RESULTS JH was observed in 80% of wrists, 53.3% of fifth fingers, 36.6% of elbows, 14% of trunks and 12.5% of knees. Scores > 4 were found for 64.6% of the children. Females had higher angular values. Lower scores were associated with greater age. CONCLUSIONS JH is a common condition among preschool children and currently available methods are inadequate. New parameters and criteria should be developed for identifying JH among these children.CONTEXTO E OBJETIVO: A padronizacao dos criterios de mobilidade articular e complexa e nenhum estudo na literatura avaliou exclusivamente criancas pre-escolares, idade em que a diferenciacao entre a mobilidade articular normal e a hipermobilidade torna-se ainda mais dificil. Objetivamos investigar a mobilidade articular no quinto dedo, punho, cotovelo, joelho e tronco em pre-escolares; estimar a incidencia da hipermobilidade articular; avaliar o efeito da idade e do sexo nos resultados e a aplicabilidade dos criterios de Beighton e cols.3 para identificar a hipermobilidade articular em pre-escolares. TIPO DE ESTUDO E LOCAL: Transversal, descritivo e qualitativo, na Faculdade de Medicina de Sao Jose do Rio Preto. METODOS: 1.120 criancas saudaveis, 534 (47,7%) meninos e 586 (52,3%) meninas (idade entre quatro e sete anos), foram avaliadas de acordo com os escores de Beighton et al.3 para extensao passiva do quinto dedo (> 90°), posicao passiva do polegar ao antebraco, extensao ativa do cotovelo e do joelho (> 10°) e flexao anterior do tronco (colocacao das maos espalmadas no solo). Considerou-se um ponto para cada resultado positivo. O escore maximo foi 9. Foi considerado hipermovel a crianca com escore > 4. A hipermobilidade foi estimada e comparada com a idade e o sexo. O teste t de Student e a analise da variância foram usados para analise estatistica. RESULTADOS: A hipermobilidade articular foi identificada em 80% (punho), 53,3% (quinto dedo), 36,6% (cotovelo), 14% (tronco) e 12,5% (joelho). O escore > 4 foi encontrado em 64,6% das criancas, as meninas tiveram maiores valores angulares e menores escores foram associados com o aumento da idade. CONCLUSOES: A hipermobilidade articular e uma condicao comum neste grupo de idade e o metodo correntemente utilizado para avaliar e inadequado. Portanto, novos parâmetros e criterios devem ser desenvolvidos para identificar a hipermobilidade articular em pre-escolares.

Urban prevalence of epilepsy: populational study in São José do Rio Preto, a medium-sized city in Brazil

ANTECEDENTES: O objetivo deste estudo foi determinar a prevalencia da epilepsia na populacao urbana de Sao Jose do Rio Preto, com 336000 habitantes, localizada no noroeste do Estado de Sao Paulo/ Brasil. METODO: O estudo populacional, tipo corte transversal, em amostra aleatoria, constituiuse de uma fase de rastreamento, mediante um questionario. O padrao ouro para confirmacao diagnostica foi a historia clinica e o exame neurologico. Os testes do c2 e intervalo de confianca de 95% (IC95%) foram usados para analise dos resultados, tendo sido considerados significantes os de valor p< 0,05. RESULTADOS: A amostra estudada foi de 17293 pessoas, cuja distribuicao quanto ao sexo, a faixa etaria e a raca foram semelhantes a da populacao em geral. A prevalencia de epilepsia por 1000 hab. foi 18,6, sendo 8,2 para ativa considerandose, pelo menos, uma crise no periodo dos ultimos 2 anos. A prevalencia na faixa etaria de 0 a 4 anos foi 4,9, de 5 a 14, 11,7; de 15 a 64, 20,3; e acima dos 65 anos foi 32,8. CONCLUSAO: As prevalencias de epilepsia acumulada e ativa foram elevadas, semelhantes as dos paises em desenvolvimento, em particular, aos da America Latina. A prevalencia de epilepsia na infância foi baixa, enquanto que nos idosos foi elevada, semelhantes as observadas em paises desenvolvidos. Estes resultados sao relevantes no planejamento de medidas sanitarias, adequacao ao tratamento da populacao, considerando a alta prevalencia encontrada, para minimizar o impacto da epilepsia na populacao.UNLABELLED The aim of this study was to determine the prevalence of epilepsy in the urban population of São José do Rio Preto. This is a medium-sized city of 336000 inhabitants, located in the northwest of the state of São Paulo, Brazil. METHOD A cross-sectional epidemiological investigation with a randomized sample was performed in two phases, a screening phase and a confirmation of the diagnosis phase. The gold standard was a clinical investigation and neurological examination. The chi-square test was used in analysis of the results and p-value value < 0.05 was considered significant. Prevalence was calculated with 95% confidence interval. RESULTS The study sample size was 17293 individuals, with distributions of gender, age, and race similar to the general population. The prevalence per 1000 inhabitants of epilepsy was 18.6, of these 8.2 were active, defined as at least one seizure within the last two years. The prevalence per 1000 inhabitants for the age groups (years) was 4.9 (04), 11.7 (514), 20.3 (1564) and 32.8 (65 or over). CONCLUSION Prevalence of both accumulated and active epilepsy was elevated, comparable to other developing nations, in particular those of Latin America. However, the prevalence of epilepsy in childhood was low, whilst in aged individuals it was high similar to industrialized nations.

Epidemiology and control of frontier malaria in Brazil: lessons from community-based studies in rural Amazonia

We describe the epidemiology of malaria in a frontier agricultural settlement in Brazilian Amazonia. We analysed the incidence of slide-confirmed symptomatic infections diagnosed between 2001 and 2006 in a cohort of 531 individuals (2281.53 person-years of follow-up) and parasite prevalence data derived from four cross-sectional surveys. Overall, the incidence rates of Plasmodium vivax and P. falciparum were 20.6/100 and 6.8/100 person-years at risk, respectively, with a marked decline in the incidence of both species (81.4 and 56.8%, respectively) observed between 2001 and 2006. PCR revealed 5.4-fold more infections than conventional microscopy in population-wide cross-sectional surveys carried out between 2004 and 2006 (average prevalence, 11.3 vs. 2.0%). Only 27.2% of PCR-positive (but 73.3% of slide-positive) individuals had symptoms when enrolled, indicating that asymptomatic carriage of low-grade parasitaemias is a common phenomenon in frontier settlements. A circular cluster comprising 22.3% of the households, all situated in the area of most recent occupation, comprised 69.1% of all malaria infections diagnosed during the follow-up, with malaria incidence decreasing exponentially with distance from the cluster centre. By targeting one-quarter of the households, with selective indoor spraying or other house-protection measures, malaria incidence could be reduced by more than two-thirds in this community.

Hypertension prevalence and risk factors in a Brazilian urban population

FUNDAMENTO: Os estudos disponiveis nao analisaram de modo abrangente os varios fatores envolvidos na genese da hipertensao (HT), especialmente a associacao entre pressao arterial, excrecao urinaria de sodio e disfuncao renal. OBJETIVO: Avaliar a prevalencia dos fatores de risco para HT em diferentes grupos etarios em uma amostra representativa da uma populacao urbana brasileira. METODOS: A populacao estudada (1.717 individuos adultos) foi avaliada por grupos etarios: 18 a 39 anos; 40 a 49; 50 a 59; 60 a 69 e > 70 anos. As medias das variaveis quantitativas e as variaveis categoricas dos grupos normotenso e hipertenso foram comparadas. RESULTADOS: A prevalencia geral ajustada para HT foi de 25,23%. A prevalencia aumentou com a idade e era mais alta em individuos com baixo nivel educacional. Indice de massa corporal e circunferencia abdominal aumentados estavam positivamente associados com uma maior prevalencia de HT. Havia uma associacao positiva significante entre HT e excrecao urinaria de sodio. Os individuos hipertensos apresentavam maior frequencia de disfuncao renal, definida como clearance de creatinina <60 ml/min/m2. A prevalencia de diabetes mellitus na populacao geral era de 5,6% e 14,5% nos individuos hipertensos. A hipertensao era uma condicao conhecida por 74,4% dos individuos hipertensos. Entre os individuos hipertensos tratados, 52,4% tinham a hipertensao controlada e apenas 34,3% dos pacientes hipertensos no geral (tratados ou nao) tinham a pressao arterial controlada. CONCLUSAO: Esse estudo de base populacional e especial devido ao fato de agregar diferentes fatores demograficos, epidemiologicos e de risco envolvidos na genese da hipertensao na avaliacao de uma unica amostra com um calculo populacional que pode ser extrapolado para outras populacoes hipertensas.BACKGROUND The available studies have not fully analyzed the several factors involved in the genesis of hypertension (HT), especially the association among blood pressure, urinary sodium excretion and renal dysfunction. OBJECTIVE To assess the HT prevalence and risk factors in different age groups in a representative sample of an urban Brazilian population. METHODS The studied population (1717 adult individuals) was evaluated by age groups: 18 to 39 years; 40 to 49; 50 to 59; 60 to 69 and > 70 years. Quantitative variable means and categorical variables of the hypertensive and normotensive groups were compared. RESULTS The adjusted overall prevalence of HT was 25.23%. The prevalence increased with age and was higher in individuals with low educational level. Increased body mass index and abdominal waist were positively related to a higher prevalence of HT. There was a significant positive association between HT and urinary sodium excretion. Hypertensive individuals presented higher frequency of renal dysfunction, defined as measured creatinine clearance <60 ml/min/m(2). The prevalence of diabetes mellitus was 5.6% in the overall population and 14.5% in hypertensive individuals. Hypertension was a known condition to 74.4% of the hypertensive individuals. Among treated hypertensive individuals, 52.4% achieved controlled blood pressure and only 34.3% of the overall hypertensive patients (treated or not) had blood pressure controlled. CONCLUSION This population-based is unique by gathering different demographic, epidemiologic and risk factors involved in the genesis of hypertension in a single sample assessment with a population calculation, which might be extrapolated to other hypertensive populations.

Evaluation of the awareness, control and cost-effectiveness of hypertension treatment in a Brazilian city: populational study.

Objectives Hypertension is a highly prevalent disease worldwide, constituting one of the main risk factors for cardiovascular morbidity and mortality. The aims of this study were to evaluate the level of awareness and control of hypertension comparing sex, socioeconomic and educational level, BMI and drug therapy in over 40-year-old patients. The cost-effectiveness of the main pharmacologic classes of antihypertensives, as monotherapy and combination therapy, was also assessed. Methods In this randomized and cross-sectional populational study, a sample of 738 hypertensive adults with ages at least 40 years were evaluated. Of these, 345 (46.7%) were men and 393 (53.3%) were women. Results A total of 72.9% of the hypertensives knew about their disease. Women in the 40–49 and 50–59 age groups and obese individuals had a higher rate of awareness of their hypertensive status. The rates of awareness were similar in different social classes and educational levels, however, blood pressure control varied. β-Blockers were the most effective drugs to control blood pressure with no differences being observed between monotherapy and combinations. Diuretics were the most cost-effective. Conclusion Approximately half of the participants received monotherapy. The best percentage of control with monotherapy was obtained with β-blockers but the diuretics treatment was the most cost-effective. The levels of awareness and control were high compared with developed countries, most evident in the higher social classes and higher education levels.