Revista da Associa??o Médica Brasileira (English Edition)最新文献

Depression and cardiovascular diseases (CVD) are both common illnesses. Several studies demonstrated that depressed individuals have higher mortality compared to age- and gender-matched population, with an excess of cardiovascular deaths. There is a bidirectional association between depression and CVD. Several factors can interact and influence this relationship: poverty and social inequality, reduced accessibility to health care, biological alterations (as reduced heart rate variability, endothelial dysfunction, increased inflam-mation and platelet function, and hyperactivity of hypothalamic-pituitary-adrenal axis), side effects of psychiatric medication, lower adherence to medical treatments, and higher frequency of cardiovascularrisk factors (higher tobacco use, physical inactivity, obesity, dia-betes mellitus). This article aims to update the current evidence of the possible mechanisms involved in the association between depression and CVD.

Objective

To evaluate the results of the arthroscopic treatment of refractory adhesive capsulitis of the shoulder with two to nine years of follow-up, comparing the pre- and postoperative range of motion.

Methods

This was an observational study (case series) of 18patients who underwent arthroscopic capsular release for refractory shoulder stiffness. The mean age was of 53.6 years (range: 39 to 68), with female predominance (77.77%) and nine cases left shoulders. There were 6 primary (33.33%) and 12 secondary cases (66.67%). Arthroscopic capsular release was performed in all patients after a mean of 9.33 months of physical therapy (range: 6 to 20 months) with a minimum follow-up of two years (range: 26 to 110 months).

Results

The mean active and passive forward flexion, external rotation and internal rotation increased from 94.4°/103.3°, 11.9°/21.9°, and S1/L5 vertebral level, respectively, to 151.1°/153.8°, 57.2°/64.4°, and T12/T10 vertebral level, respectively. There was a significant difference between the pre- and postoperative range of motion (p < 0.001). According to the Constant-Murley functional score (ROM), the value increased from 14 (preoperative mean) to 30 points (postoperative mean). Postoperatively, all patients showed diminished shoulder pain (none or mild/15 or 10 points in the Constant-Murley score).

Conclusion

Arthroscopic treatment is an effective treatment for refractory shoulder stiffness.

Objective

The study aimed to compare the prevalence of overweight and obesity according to three growth curves, created by the World Health Organization (WHO/2006), by the National Center for Health Statistics (NCHS/1977), and by the Centers for Disease Control and Prevention (CDC/2000) in children with cardiovascular risk factors.

Methods

Data from 118 children and adolescents, aged between 2 and 19 years, treated between the years 2001 to 2009 at the Pediatric Preventive Cardiology Outpatient Clinic of the Instituto de Cardiologia de Porto Alegre were evaluated. The variables analyzed were: weight, height, age, and gender. Variables were classified according to the following criteria: weight/age, height/age, and body mass index (BMI). The cutoff points used were obtained from the three growth curves: WHO/2006, NCHS/1977, and CDC/2000.

Results

Regarding the criterion weight/age by the NCHS curve, 18% of the children were classified as having normal weight, and 82% had excess weight; by the CDC curve, 28% had normal and 72% had excess weight; by the WHO curve, 16.0% had normal weight and 84% had excess weight. According to the BMI, 0.8% of the population was underweight. 7.6% and 6.8% had normal weight; 26.3% and 11.9% were overweight; and 65.3% and 80.5% were obese, according to the CDC and WHO curves, respectively. Regarding the height/age criterion, there was no significant difference between the references and, on average, 98.3% of the population showed adequate height for age.

Conclusion

The new WHO curves are more sensitive to identify obesity in a population at risk, which has important implications for preventive and therapeutic management.

Objective

To determine the influence of maternal education (ME) on early initiation of breastfeeding (BF) and its maintenance during the first two months of the infant's life, as well as to understand the influence of ME on the reasons for BF discontinuation.

Methods

This was a multicenter observational study carried out with primiparous women in four hospitals of Andalucía during 2011. Data was collected through interviews and from clinical charts. Raw and adjusted odds ratios were estimated during the analysis.

Results

Mothers who attended ME classes showed early initiation of BF (aOR = 1.78, 95% CI = 1.14–2.78) and maintenance of BF (aOR = 1.73, 95% CI = 1.15–2.61). There were no differences related to women's reasons to discontinue BF.

Conclusions

ME positively impacts the initiation and maintenance of BF. El inicio precoz de la lactancia maternal se ve favorecido por la realización de la educación maternal

This review analyzes the available literature on the impact of intermittent fasting (IF), a nutritional intervention, on different aspects of metabolism. The epidemic of metabolic disturbances, such as obesity, metabolic syndrome (MS), and diabetes mellitus type 2 has led to an increase in the prevalence of cardiovascular diseases, and affected patients might significantly benefit from modifications in nutritional habits. Recent experimental studies have elucidated some of the metabolic mechanisms involved with IF. Animal models have shown positive changes in glucose (lower plasma glucose and insulin levels) and in lipid metabolism (reduced visceral fat tissue and increased plasma adiponectin level), and an increased resistance to stress. Despite the limited number of samples studied, positive results have been reported on the impact of IF for human health. IF is reported to improve the lipid profile; to decrease inflammatory responses, reflected by changes in serum adipokine levels; and to change the expression of genes related to inflammatory response and other factors. Studies on obese individuals have shown that patient compliance was greater for IF than other traditional nutritional approaches (calorie restriction), and IF was found to be associated with low oxidative stress. Recent reports suggest that IF exerts a positive impact on the metabolic derangements commonly associated with cardiovascular diseases, and that it may be a viable and accessible intervention for most individuals. Therefore, further clinical studies are essential to test the effectiveness of IF in preventing and controlling metabolic and cardiovascular diseases.

Objective

The aim of this study was to evaluate the association of serum magnesium levels with proton pump inhibitors (PPIs) use and other factors.

Methods

This was a cross-sectional study of 151 patients admitted with acute diseases in the Internal Medicine Division of the Hospital de Clinicas de Porto Alegre, after the exclusion of conditions that are commonly associated with hypomagnesemia: diarrhea; vomiting; chronic alcohol use; severely uncompensated diabetes mellitus; and chronic use of laxatives, diuretics or other drugs causing magnesium deficiency.

Results

All patients had normal serum magnesium levels. Serum albumin and creatinine levels were positively associated with serum magnesium levels, after adjusting for con-founders. There was no difference between mean serum magnesium levels of PPI users and non-users, nor between men and women; there was also no correlation among age, serum phosphorus, and potassium levels with serum magnesium levels. Limitations of this study include the absence of an instrument for measuring adherence to PPI use and the sample size.

Conclusion

The association of PPI use and hypomagnesemia is uncommon. Congenital defects in the metabolism of magnesium may be responsible for hypomagnesemia in some patients using this drug class.