Yara Juliano

O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade

To assess the influence of age and education on cognitive performance in our population, 530 adults were interviewed using the MMSE (Mini-Mental Status Examination). Education level, classified as illiterate, elementary and middle ( 8 years), was a significant predictor of performance (p or = 65 years). The reference cut-off values were taken from the fifth percent lowest score for each group: illiterate, 13; elementary and middle, 18; and high, 26. When compared to 94 pacients with cognitive impairment, our cut-off values achieved high sensitivity (82.4% for illiterates; 75.6% for elementary and middle; 80% for high) and specificity (97.5% for illiterate; 96.6% for elementary and middle; 95.6% for high educational level). Education-specific reference values for the MMSE are necessary in interpreting individual test results in populations of low educational level, in order to reduce the false positive results.

Anemia in infancy: etiology and prevalence

OBJECTIVE To verify the prevalence of anemia, iron deficiency anemia and iron deficiency in infants, at a Public Health Unit in the city of Goiânia-Brazil; to analyze and to correlate the hematologic and biochemical variables. METHODS A cross-sectional study was carried out. One hundred and ten full-term infants of the 120 mothers interviewed were included. The infants aged between six and twelve months and there were not twins. Socioeconomic and hematologic data was obtained. Venous blood was taken from fasting infants in order to carry out a complete hemogram through electronic cell counting, serum iron, serum ferritin and C-reactive protein, which were used in the evaluation of the etiology of iron deficiency in the anemic infants. Children with hemoglobin <11 g/dL were considered anemic. RESULTS The prevalence of anemia was 60.9%. In the diagnosis of the iron deficiency etiology in infants without an inflammation process, when considering the alteration of hemoglobin plus two more indices among mean corpuscular volume (MCV) or mean corpuscular hemoglobin (MCH) or serum ferritin or serum iron, the prevalence of the iron deficiency was 87%. Nevertheless, when red cell distribution width (RDW) was included in the indices, the prevalence was 97.8%. In the non-anemic infants, considering ferritin and RDW, the prevalence of iron deficiency observed was 28%. The best correlation among hematologic and biochemical variables were between hemoglobin and hematocrit (r=0.946), and MCH with MCV (r=0.950). CONCLUSIONS The main etiology in infants was iron deficiency anemia and its prevalence varied according to different parameters and criteria.

Comparação da freqüência cardíaca máxima medida com as fórmulas de predição propostas por Karvonen e Tanaka

BACKGROUND Equations for predicting maximal heart rate (HRmax) are widely used in exercise testing and for training prescription, but their efficacy remains controversial in the literature. OBJECTIVE To compare maximal heart rate during cardiopulmonary exercise testing (CPET) using the prediction equations developed by Karvonen and Tanaka. METHODS Of the 24,120 maximal treadmill graded exercise tests stored in the CEMAFE database from 1994 to 2006, 2047 HRmax values were analyzed, 1091 of which were from male and 956 from female sedentary subjects. These data were used as a gold standard to compare Karvonens and Tanakas prediction formulas. RESULTS Mean measured maximal heart rates were 181.0 +/- 14.0; 180.6 +/- 13.0, and 180.8 +/- 13.8 for men, women, and both genders combined, respectively. Likewise, mean values from Karvonens equation were 182.0 +/- 11.4; 183.7 +/- 11.5, and 183.9 +/- 11.7; and from Tanakas, 182.0 +/- 8.0; 182.6 +/- 8.0, and 182.7 +/- 8.2. Karvonens and Tanakas equations yielded the same correlation coefficients, as compared with measured maximal heart rate (r = 0.72). CONCLUSION Karvonens and Tanakas equations are similar in predicting maximal heart rate and show good correlation with measured maximal heart rate.FUNDAMENTO: Formulas de predicao da frequencia cardiaca maxima sao amplamente utilizadas em servicos de ergometria e para prescricao de treinamento, contudo ha controversia na literatura sobre a eficacia delas. OBJETIVO: Comparar a frequencia cardiaca maxima obtida pelo teste ergoespirometrico com as equacoes propostas por Karvonen e Tanaka. METODOS: Dos 24.120 testes ergoespirometricos maximos, com protocolo de cargas crescentes, realizados em esteira rolante e armazenados no banco de dados do Cemafe, no periodo de 1994 a 2006, foram resgatados 1.091 resultados da frequencia cardiaca maxima de individuos sedentarios do sexo masculino e 956 do feminino. Esses dados foram utilizados como padrao-ouro na comparacao com as formulas de predicao propostas por Karvonen e Tanaka. RESULTADOS: Os valores medios da frequencia cardiaca maxima medida foram: 181,0 ± 14,0, 180,6 ± 13,0 e 180,8 ± 13,8, para o sexo masculino, feminino e ambos os sexos, respectivamente. Seguindo o mesmo padrao, os valores para equacao de Karvonen foram de 182,0 ± 11,4, 183,7 ± 11,5 e 183,9 ± 11,7; e os de Tanaka 182,0 ± 8,0, 182,6 ± 8,0 e 182,7 ± 8,2. A equacao de Karvonen apresentou valores de correlacao iguais a de Tanaka, quando comparadas com a frequencia cardiaca maxima medida, r = 0,72. CONCLUSAO: As equacoes de Karvonen e Tanaka sao semelhantes para predicao da frequencia cardiaca maxima e apresentam boa correlacao com a frequencia cardiaca maxima medida.

Povidone iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial.

Sir:One of the most important risk factors for surgical-site infection is the presence of bacteria in the wound at the time of surgery. Thus, the purpose of preoperative skin preparation is to reduce bacteria on the skin before making an incision.1,2The antiseptics most commonly used for antisepsis

Neurological outcome in coronary artery surgery with and without cardiopulmonary bypass

Introduction– The neurological complications of coronary artery surgery with cardiopulmonary bypass (CPB) have been extensively studied, but to our knowledge those without CPB (NCPB) have not been defined. Patients & methods– We prospectively examined 81 patients, before and up to seven days after surgery, to compare the neurological morbidity between patients subjected to coronary artery bypass graft (CABG) surgery with and without CPB. We analyzed demographic variables, risk factors and neurological examination including neuropsychological (NPS) tests using chi‐square and non‐parametric analysis (Mann‐Whitney and Kruskal‐Wallis). Results– Forty‐eight patients (34M; median age = 62 yrs; median number of grafts = 3 and median total surgery duration = 300 min) operated with CPB and 33 without CPB (23M; median age = 64 yrs; median number of grafts = 2 and median total surgery duration = 240 min) differed only in relation to number of grafts (p = 0.0001) and surgery duration (p = 0.0001). Conclusion– We found no difference in early neurological outcome in patients subjected to CABG with or without CPB.

A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis

Autoimmunity has been associated with vitamin D deficiency and resistance, with gene polymorphisms related to vitamin D metabolism frequently described in affected patients. High doses of vitamin D3 may conceivably compensate for inherited resistance to its biological effects. This study aimed to assess the efficacy and safety of prolonged high-dose vitamin D3 treatment of patients with psoriasis and vitiligo. Nine patients with psoriasis and 16 patients with vitiligo received vitamin D3 35,000 IU once daily for six months in association with a low-calcium diet (avoiding dairy products and calcium-enriched foods like oat, rice or soya “milk”) and hydration (minimum 2.5 L daily). All psoriasis patients were scored according to “Psoriasis Area and Severity Index” (PASI) at baseline and after treatment. Evaluation of clinical response of vitiligo patients required a quartile grading scale. All patients presented low vitamin D status (serum 25(OH)D3 ≤ 30 ng/mL) at baseline. After treatment 25(OH)D3 levels significantly increased (from 14.9 ± 7.4 to 106.3 ± 31.9 ng/mL and from 18.4 ± 8.9 to 132.5 ± 37.0 ng/mL) and PTH levels significantly decreased (from 57.8 ± 16.7 to 28.9 ± 8.2 pg/mL and from 55.3 ± 25.0 to 25.4 ± 10.7 pg/mL) in patients with psoriasis and vitiligo respectively. PTH and 25(OH)D3 serum concentrations correlated inversely. The PASI score significantly improved in all nine patients with psoriasis. Fourteen of 16 patients with vitiligo had 25–75% repigmentation. Serum urea, creatinine and calcium (total and ionized) did not change and urinary calcium excretion increased within the normal range. High-dose vitamin D3 therapy may be effective and safe for vitiligo and psoriasis patients.

Eating attitudes and body image in ethnic Japanese and Caucasian adolescent girls in the city of São Paulo, Brazil

OBJECTIVE: Despite investigations into the rapid increase in eating disorders across diverse ethnic groups, conclusions concerning ethnicity and eating disorders are contradictory. The objective of the present study was to investigate eating attitudes in ethnic Japanese and Caucasian adolescents in Brazil. The influence of body mass index (BMI), menarche and social-affective relationships on the development of eating disorders was also assessed. METHODS: Questionnaires evaluating the incidence of eating disorders and the influence of social-affective relationships were applied to 544 Japanese-Brazilian and Caucasian adolescent girls: 10 to 11-year-old Japanese-Brazilian (n = 122) and Caucasian (n = 176) pre-menarcheal adolescents, and 16 to 17-year-old Japanese-Brazilian (n = 71) and Caucasian (n = 175) post-menarcheal adolescents. RESULTS: Caucasian girls obtained higher scores on the Eating Attitudes Test (EAT-26), showed greater body image dissatisfaction, dieted more often and had more diet models introduced by their mothers and peers than the Japanese-Brazilian girls. CONCLUSION: The Caucasian adolescents overall appeared to be more sensitive to aesthetic and social pressures regarding body image than the Japanese adolescents. The high incidence of EAT-26 scores above 20 in the Caucasian pre-menarcheal group indicates that individual body image concerns are developing at an earlier age. Multiple logistic regression revealed several associations between mother-teen interactions and the development of abnormal eating attitudes.

Alterações funcionais respiratórias na colecistectomia por via laparoscópica

Objective: The aim of this study was to measure the changes in lung volume, pulmonary ventilation, maximum respiratory muscle strength, and the incidence of pulmonary complications in patients undergoing elective laparoscopic cholecystectomy. Type of study: Prospective study. Material and methods: Twenty patients (7 men and 13 women) with mean age of 42.7 years with normal respiratory function were studied. All patients in the preoperative period answered a long questionnaire, had a physical examination done, and had their lung volumes, respiratory muscle strength, diaphragmatic index and pulse oximetry determined. All measurements were repeated on the 1st, 2nd, 3rd and 6th postoperative days. Results: Patients showed a significant decrease (p < 0.05) on the first postoperative day: 26% ± 13% in tidal volume; 20% ± 14% in minute volume; 36% ± 17% in vital capacity; 47% ± 17% in maximum inspiratory pressure, 39% ± 27% in the maximum expiratory pressure and 36% ± 25% in diaphragmatic index. Tidal volume, minute volume and maximum expiratory pressure returned to their basal values on the third postoperative day; vital capacity, maximum inspiratory pressure and diaphragmatic index returned to their basal values between the 4th and 6th postoperative days. Among the 20 patients pulmonary complication was observed in just one patient (lobar atelectasis); there was a full recovery by the third postoperative day with the use of chest physical therapy techniques. Conclusion: The authors conclude that patients undergoing a laparoscopic cholecystectomy show a significant decrease in lung volume and in respiratory muscle strength on the first postoperative day. But, when these measurements are compared to the literature, return to their basal values is faster (between the 4th and 6th postoperative days) than with conventional surgery.

Evaluations of the aesthetic results and patient satisfaction with the late pedicled TRAM flap breast reconstruction

With the goal of evaluating the aesthetic results, testing the reliability of the rating systems used, and determining the patients’ level of satisfaction with their breast reconstruction, pedicled transverse rectus abdominis musculocutaneous flap reconstruction was performed in 20 patients who had undergone mastectomy. The results were evaluated and compared 3, 6, and 12 months after reconstruction using the patients’ own assessments (a rating of 0–10 points) and scoring by two senior plastic surgeons (using 0–10-point global rating scales as well as the five subscales of the modified Garbay system). The interrater and intrarater agreement was poor to fair for the majority of the subscales. When evaluating by grades, there was significant difference (p < 0.001) between the patients and the raters at postoperative months 3 and 6. At month 12, one of the raters attributed significantly lower grades (p < 0.001) than the patients and the other rater. The authors observed a higher level of satisfaction by the patients than by the raters.

Ischemic Preconditioning Prevents Apoptotic Cell Death and Necrosis in Early and Intermediate Phases of Liver Ischemia-Reperfusion Injury in Rats

Ischemic preconditioning (IPC) may be useful in attenuating the hepatic ischemia reperfusion (IR) syndrome by means of improving cell resistance to anoxia and reoxygenation and preventing cell death. Since there are insufficient data available regarding the chronology of preconditioning effects, we investigated the role of IPC, to test the hypothesis that liver protection would occur during the early and intermediate phases of the reperfusion period. Wistar rats (n = 72) were randomly assigned into six experimental groups, 12 animals each. A 40-min ischemia to the left lateral and median liver lobes was induced by selective hepatic pedicle clamping followed by 30 min or 240 min of reperfusion (IR30 and IR240). IPC groups (IPC30 and IPC240) underwent a 10 min of ischemia followed by 10 min of reperfusion preceding the definitive 40-min ischemic period. Sham-operated animals were followed for 30 and 240 min. Hepatic enzymes and histological evaluation were performed after the reperfusion period. Hepatic ischemia–reperfusion (IR30 and IR240) induced marked increases in liver enzymes levels after 30 min and particularly after 240 min. IPC effectively attenuated those enzymatic increases. Microvesicular steatosis was observed after 30 min, but not 240 min, of reperfusion in both IPC and IR livers. Necrosis was detected in 66.7% of IR240 and only in 8.3% of IPC240. Both hepatocyte and sinusoidal apoptosis were markedly attenuated by IPC. We conclude that IPC provided protection against hepatic ischemia reperfusion injury in early and intermediate phases of the reperfusion period, reducing hepatic enzymatic leakage and ameliorating hepatic apoptosis and necrosis.