Natália Ribeiro Mandarino

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.

Efeito da perda ponderal induzida pela cirurgia bariátrica sobre a prevalência de síndrome metabólica

BACKGROUND Metabolic Syndrome (MS) is often linked to overweight/obesity and can improve after weight loss, such improvement is expected to be proportional to the intensity of weight loss. OBJECTIVE The aim of this study was to evaluate the impact of weight loss induced by bariatric surgery (BS) on the prevalence of MS in a middle-term period. METHODS Thirty-five (35) patients who underwent surgical Rouxs Y gastrojejunal by-pass from October 2001 until October 2005 in our University Hospital were evaluated. 88.5% were female, with a mean age at the time of surgery of 37.8+/-11.1 years and a mean BMI of 45.0+/-6.2 Kg/m(2). During the first stage of our study demographic and clinical-anthropomorphic data were collected prior to the BC procedure, including those criteria needed for the diagnosis of MS, according to the guidelines of the US NCEP. The second stage consisted of reevaluation of those patients in the post-surgical period in order to determine the prevalence of MS in an outpatient setting. RESULTS Prior to surgery, MS was diagnosed in 27 patients (77.1%). When those patients were reevaluated 34.4+/-15 months after surgery, a reduction of mean BMI to 28.3+/-5.0 Kg/m(2) and MS was identified in only two patients (5.7%) (p<0.001). Prevalence of individual criteria such as abdominal circumference, fasting glucose levels, arterial blood pressure, HDL-cholesterol and triglycerides had a reduction of 45.8%, 83%, 87.5%, 57.13% and 94% respectively. CONCLUSION MS is a rather common feature in obese patients enrolled for BS and this procedure has been proved to be extremely efficient reversing the metabolic syndrome, with an expressive reduction of prevalence of each and all of the NCEP criteria.FUNDAMENTO: A sindrome metabolica (SM) esta frequentemente ligada ao excesso de peso e melhora com a perda ponderal, sendo esperado que essa melhora seja proporcional a intensidade dessa perda. OBJETIVO: Avaliar o impacto da perda ponderal induzida pela cirurgia bariatrica (CB) sobre a prevalencia da SM, em medio prazo. METODOS: Foram analisados 35 pacientes submetidos a cirurgia de by-pass gastrojejunal em Y de Roux, no periodo de outubro de 2001 a outubro de 2005, em nosso HU, sendo 88,5% do sexo feminino, com uma media de idade de 37,8±11,1 anos e um IMC medio de 45,0±6,2 kg/m2. Na primeira etapa da pesquisa, foram obtidos dados demograficos e clinico-antropometricos antes da realizacao da CB, incluindo os criterios para o diagnostico da SM, de acordo com as diretrizes do NCEP dos Estados Unidos. Na segunda etapa, os pacientes operados foram reavaliados ambulatorialmente quanto a prevalencia da SM. RESULTADOS:Antes da cirurgia, a SM foi diagnosticada em 27 pacientes (77,1%). Em reavaliacao 34,4±15 meses apos a cirurgia, observou-se uma queda do IMC medio para 28,3±5,0 kg/m2 e a SM foi detectada em apenas dois pacientes (5,7%) (p<0,001). A prevalencia dos criterios cintura abdominal, glicemia, pressao arterial, HDL-colesterol e triglicerideos foi reduzida em, respectivamente, 45,8%, 83%, 87,5%, 57,13% e 94%. CONCLUSAO: A SM e ocorrencia comum em obesos candidatos a CB e esse procedimento se mostrou extremamente eficaz na inducao da regressao da sindrome, verificando-se reducao expressiva da prevalencia de todos os criterios do NCEP.

Is Vitamin D Deficiency a New Risk Factor for Cardiovascular Disease

The role of vitamin D in the regulation of bone metabolism has been well established. However, in recent years, many studies have demonstrated that its role extends far beyond bone health. Growing evidence has shown a strong association between vitamin D deficiency and hypertension, metabolic syndrome, diabetes mellitus and atherosclerosis. The mechanisms by which vitamin D exerts its cardiovascular protective effects are still not completely understood, but there is evidence that it participates in the regulation of renin-angiotensin system and the mechanisms of insulin sensitivity and activity of inflammatory cytokines, besides its direct cardiovascular actions. In this review, several studies linking vitamin D deficiency with cardiometabolic risk as well as small randomized trials that have evaluated the cardiovascular effects of its supplementation are presented. However, large randomized placebo-controlled studies are still needed before we can definitively establish the role of vitamin D supplementation in the prevention and control of cardiovascular disease.

Prevalência de verdadeiras crises hipertensivas e adequação da conduta médica em pacientes atendidos em um pronto-socorro geral com pressão arterial elevada

BACKGROUND High blood pressure is a common reason for patients to seek an emergency room, and many of them may possibly be wrongly diagnosed with hypertensive crisis and, consequently, be inappropriately treated. OBJECTIVE To analyze the cases of patients seen in a general emergency room because of high blood pressure as for meeting the criteria for the diagnosis of hypertensive crisis and the appropriateness of medical management. METHODS Of the 1012 patients consecutively seen in a private referral general emergency room in the city of São Luís, State of Maranhão, between August and November 2003, 198 (19.56%) had a main diagnosis of high blood pressure in that visit. Of these, proper information could only be obtained from the patient charts of 169 patients; 54.4% of them were females with a mean age of 53.3 +/- 15.2 years. Data regarding patients and the attendant physicians were collected, and each case was classified as an urgency, emergency or pseudohypertensive crisis; the medical management was classified as appropriate or inappropriate. We also sought to identify the factors associated with the medical management and with the use of antihypertensive medication. RESULTS Criteria for the characterization of a hypertensive crisis were present in only 27 patients (16%), and all were classified as urgencies. Medical management was considered appropriate in 72 cases (42.6%), and was neither influenced by specialty (p=0.5) nor by the physicians experience (p=0.9). Blood pressure levels, but not the presence or absence of symptoms, were predictive of the use of antihypertensive medication (p<0.001). CONCLUSION In the population analyzed, less than one fifth of the patients seen in an emergency room with a presumed hypertensive crisis met defined criteria for this diagnosis. Medical management was considered appropriate in less than half of the occurrences.

Effects of weight loss induced by bariatric surgery on the prevalence of metabolic syndrome

BACKGROUND Metabolic Syndrome (MS) is often linked to overweight/obesity and can improve after weight loss, such improvement is expected to be proportional to the intensity of weight loss. OBJECTIVE The aim of this study was to evaluate the impact of weight loss induced by bariatric surgery (BS) on the prevalence of MS in a middle-term period. METHODS Thirty-five (35) patients who underwent surgical Rouxs Y gastrojejunal by-pass from October 2001 until October 2005 in our University Hospital were evaluated. 88.5% were female, with a mean age at the time of surgery of 37.8+/-11.1 years and a mean BMI of 45.0+/-6.2 Kg/m(2). During the first stage of our study demographic and clinical-anthropomorphic data were collected prior to the BC procedure, including those criteria needed for the diagnosis of MS, according to the guidelines of the US NCEP. The second stage consisted of reevaluation of those patients in the post-surgical period in order to determine the prevalence of MS in an outpatient setting. RESULTS Prior to surgery, MS was diagnosed in 27 patients (77.1%). When those patients were reevaluated 34.4+/-15 months after surgery, a reduction of mean BMI to 28.3+/-5.0 Kg/m(2) and MS was identified in only two patients (5.7%) (p<0.001). Prevalence of individual criteria such as abdominal circumference, fasting glucose levels, arterial blood pressure, HDL-cholesterol and triglycerides had a reduction of 45.8%, 83%, 87.5%, 57.13% and 94% respectively. CONCLUSION MS is a rather common feature in obese patients enrolled for BS and this procedure has been proved to be extremely efficient reversing the metabolic syndrome, with an expressive reduction of prevalence of each and all of the NCEP criteria.FUNDAMENTO: A sindrome metabolica (SM) esta frequentemente ligada ao excesso de peso e melhora com a perda ponderal, sendo esperado que essa melhora seja proporcional a intensidade dessa perda. OBJETIVO: Avaliar o impacto da perda ponderal induzida pela cirurgia bariatrica (CB) sobre a prevalencia da SM, em medio prazo. METODOS: Foram analisados 35 pacientes submetidos a cirurgia de by-pass gastrojejunal em Y de Roux, no periodo de outubro de 2001 a outubro de 2005, em nosso HU, sendo 88,5% do sexo feminino, com uma media de idade de 37,8±11,1 anos e um IMC medio de 45,0±6,2 kg/m2. Na primeira etapa da pesquisa, foram obtidos dados demograficos e clinico-antropometricos antes da realizacao da CB, incluindo os criterios para o diagnostico da SM, de acordo com as diretrizes do NCEP dos Estados Unidos. Na segunda etapa, os pacientes operados foram reavaliados ambulatorialmente quanto a prevalencia da SM. RESULTADOS:Antes da cirurgia, a SM foi diagnosticada em 27 pacientes (77,1%). Em reavaliacao 34,4±15 meses apos a cirurgia, observou-se uma queda do IMC medio para 28,3±5,0 kg/m2 e a SM foi detectada em apenas dois pacientes (5,7%) (p<0,001). A prevalencia dos criterios cintura abdominal, glicemia, pressao arterial, HDL-colesterol e triglicerideos foi reduzida em, respectivamente, 45,8%, 83%, 87,5%, 57,13% e 94%. CONCLUSAO: A SM e ocorrencia comum em obesos candidatos a CB e esse procedimento se mostrou extremamente eficaz na inducao da regressao da sindrome, verificando-se reducao expressiva da prevalencia de todos os criterios do NCEP.

Prevalência de aterosclerose subclínica e reclassificação de risco cardiovascular pela medida da espessura íntimo-medial carotídea em pacientes hipertensos ambulatoriais

INTRODUCTION AND OBJECTIVES Although carotid intima-media thickness (CIMT) is considered a surrogate marker of subclinical atherosclerosis, with known value in risk stratification, its routine use in hypertensive patients is not recommended. The aim of this study was to determine the prevalence of subclinical atherosclerosis through measurement of CIMT and its impact on reclassification of risk in hypertensive patients. METHODS This was a cross-sectional study of 94 middle-aged (56.99±11.89 years) hypertensive outpatients without overt cardiovascular disease, 68.1% female. All participants underwent clinical examination, biochemical tests, echocardiogram and measurement of CIMT by high-resolution ultrasound. RESULTS Although the majority of patients were stratified as low (63.5%) or intermediate risk (23%) according to their Framingham score, a high prevalence (75.3%) of increased CIMT was observed in the overall sample, including in the low (61%) and intermediate risk groups (93.8%). CIMT measurement resulted in risk reclassification of 70.31% of the patients, 61% of those at low risk being reclassified as intermediate risk and 93.8% of those at intermediate risk being reclassified as high risk. CONCLUSION In these hypertensive outpatients, predominantly middle-aged and female, CIMT measurement revealed a high prevalence of subclinical atherosclerosis and resulted in risk reclassification in the majority of cases.

Efecto de la pérdida ponderal inducida por la cirugía bariátrica sobre la prevalencia de síndrome metabólico

BACKGROUND Metabolic Syndrome (MS) is often linked to overweight/obesity and can improve after weight loss, such improvement is expected to be proportional to the intensity of weight loss. OBJECTIVE The aim of this study was to evaluate the impact of weight loss induced by bariatric surgery (BS) on the prevalence of MS in a middle-term period. METHODS Thirty-five (35) patients who underwent surgical Rouxs Y gastrojejunal by-pass from October 2001 until October 2005 in our University Hospital were evaluated. 88.5% were female, with a mean age at the time of surgery of 37.8+/-11.1 years and a mean BMI of 45.0+/-6.2 Kg/m(2). During the first stage of our study demographic and clinical-anthropomorphic data were collected prior to the BC procedure, including those criteria needed for the diagnosis of MS, according to the guidelines of the US NCEP. The second stage consisted of reevaluation of those patients in the post-surgical period in order to determine the prevalence of MS in an outpatient setting. RESULTS Prior to surgery, MS was diagnosed in 27 patients (77.1%). When those patients were reevaluated 34.4+/-15 months after surgery, a reduction of mean BMI to 28.3+/-5.0 Kg/m(2) and MS was identified in only two patients (5.7%) (p<0.001). Prevalence of individual criteria such as abdominal circumference, fasting glucose levels, arterial blood pressure, HDL-cholesterol and triglycerides had a reduction of 45.8%, 83%, 87.5%, 57.13% and 94% respectively. CONCLUSION MS is a rather common feature in obese patients enrolled for BS and this procedure has been proved to be extremely efficient reversing the metabolic syndrome, with an expressive reduction of prevalence of each and all of the NCEP criteria.FUNDAMENTO: A sindrome metabolica (SM) esta frequentemente ligada ao excesso de peso e melhora com a perda ponderal, sendo esperado que essa melhora seja proporcional a intensidade dessa perda. OBJETIVO: Avaliar o impacto da perda ponderal induzida pela cirurgia bariatrica (CB) sobre a prevalencia da SM, em medio prazo. METODOS: Foram analisados 35 pacientes submetidos a cirurgia de by-pass gastrojejunal em Y de Roux, no periodo de outubro de 2001 a outubro de 2005, em nosso HU, sendo 88,5% do sexo feminino, com uma media de idade de 37,8±11,1 anos e um IMC medio de 45,0±6,2 kg/m2. Na primeira etapa da pesquisa, foram obtidos dados demograficos e clinico-antropometricos antes da realizacao da CB, incluindo os criterios para o diagnostico da SM, de acordo com as diretrizes do NCEP dos Estados Unidos. Na segunda etapa, os pacientes operados foram reavaliados ambulatorialmente quanto a prevalencia da SM. RESULTADOS:Antes da cirurgia, a SM foi diagnosticada em 27 pacientes (77,1%). Em reavaliacao 34,4±15 meses apos a cirurgia, observou-se uma queda do IMC medio para 28,3±5,0 kg/m2 e a SM foi detectada em apenas dois pacientes (5,7%) (p<0,001). A prevalencia dos criterios cintura abdominal, glicemia, pressao arterial, HDL-colesterol e triglicerideos foi reduzida em, respectivamente, 45,8%, 83%, 87,5%, 57,13% e 94%. CONCLUSAO: A SM e ocorrencia comum em obesos candidatos a CB e esse procedimento se mostrou extremamente eficaz na inducao da regressao da sindrome, verificando-se reducao expressiva da prevalencia de todos os criterios do NCEP.