Rachel Vilela de Abreu Haickel Nina

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.

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.

Pediatric cardiac surgery under the parents sight: a qualitative study

INTRODUCTION Congenital heart defects can often be corrected through surgery, providing for parents to expect a normal life, but the hospitalization experience often early, causes more pain, for which surgery is the worst moment. OBJECTIVE The aim of this study was to analyze the experience of families of children undergoing cardiac surgery and to identify the coping resources used by the families. METHODS A qualitative approach was the metodology of choice for this study, which took place with six semi-structured interviews and 100 hours of observation. Thematic analysis was used to understand the data. RESULTS The results were categorized into four themes: feelings and emotions facing the illness of the child; heart disease under the watchful mother, mother and child on the ICU and coping resources. The speech of mothers demonstrated the importance of the heart due to its symbolism that enhances their emotional fragility in the face of illness. Religiosity and a solid social network of support were contributing factors for the maintenance of the adaptive behaviors. The presence of mothers in all stages of the childs treatment contributed to minimizing the suffering generated by hospitalization. CONCLUSION The experience of families was characterized by ambivalent feelings such as fear of death, guilt and helplessness against the different stages of treatment. The anguish and anxiety prevailed in the face of unknown situations when information were required before therapeutic procedures, hospital routines and the actual life situation of the families.

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.

Remoção cirúrgica pós-traumática de corpo estranho intracardíaco em criança

The authors report the successful surgical removal of a foreign body (7 x 1 cm wooden stick) from the right atrial of a 8 year-old child 77 days after a transfixing chest trauma caused by falling over a fence. The clinical presentation was infective endocarditis confirmed by the presence of an intraatrial mass at echocardiography. The postoperative course was uneventful. At 6 months follow-up, the patient is in Function Class I (NYHA) and in complete remission of infection.

Reconstruction of the chest wall with external metal brace: alternative technique in poststernotomy mediastinitis

OBJECTIVE To demonstrate the experience with the reconstruction of the chest wall utilizing metal brace to reduce the tension in the suture lines of myocutaneous flap in cases of mediastinitis. METHODS From July 2001 to February 2006, 1389 heart surgeries were performed in our institution of which eight (0.6%) developed mediastinitis. Seven were male and the mean age was 56.7 years. The risk factors for infection were diabetes and obesity in seven and malnutrition in one case. Seven patients had been undergone CABG and one repair of a congenital heart disease. The chest wall reconstruction consisted of percutaneous insertion of Kirshner wires parallel to the edges of the wound for anchoring of sutures to the muscular plane in order to allow the reduction of tension in the free edges of the wound and subsequent closure of the subcutaneous tissue and skin. RESULTS There was one death in the immediate postoperative due to arrhythmia and one late death secondary to sepsis. The remaining patients presented satisfactory postoperative course with good healing of the wound after the removal of the metal braces on the 21st postoperative day and in the follow-up of 6 to 54 months. CONCLUSION The reconstruction of the chest wall utilizing temporary metal braces showed to be a safe and effective procedure with good aesthetic and functional outcomes in this group of patients.

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.

Congenital cardiac disease in childhood x socioeconomic conditions: a relationship to be considered in public health?

Introduction Congenital heart defects, cardiac malformations that occur in the embryonic period, constitute a serious health problem. They cover a proportion of 8-10 per 1000 live births and contribute to infant mortality. Objective To identify the socioeconomic status of children undergoing cardiac surgery at the Hospital Universitário da Universidade Federal do Maranhão, in São Luis, the existence of material elements that contribute to worsening conditions. Methods We conducted a retrospective study with a quantitative approach, descriptive and reflective, from the interviews conducted by the Social Service Social with families of children with heart disease from January 2011 to July 2012. Results A total of 95 interviews, the results reveal that (75.79%) of children have elements that suggest poor socioeconomic conditions. It also shows that only 66.33% lived in brick house, while (31.73%) in mud, adobe and straw houses. With regard to income, it showed that only 4.08% received 1-2 minimum wages, while the remaining (95.9%) with benchmarks oscillating half the minimum wage (27.55%), 1/4 of the minimum wage and (24.48%) and income below 70 dollars per person, featuring extreme poverty. On the social security situation prevailing at children with no ties to 61.22%. With respect to benefits, we found that only (12.24%) of children were in the enjoyment of the Continuous Cash Benefit - CCB. Conclusion Poor socioeconomic conditions listed as major obstacles in meeting the needs, resulting in the maintenance of health conditions and even allowing the aggravation of an existing pathology.

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.