Pub Date : 2013-01-01DOI: 10.1016/S2255-4823(13)70463-6
Sérgio H. Loss , Cláudia B. Marchese , Márcio M. Boniatti , Iuri C. Wawrzeniak , Roselaine P. Oliveira , Luciana N. Nunes , Josué A. Victorino
Objective
To assess the incidence, costs, and mortality associated with chronic critical illness (CCI), and to identify clinical predictors of CCI in a general intensive care unit.
Methods
This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed.
Results
There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for CCI in the multivariate logistic regression model.
Conclusions
CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.
{"title":"Prediction of chronic critical illness in a general intensive care unit","authors":"Sérgio H. Loss , Cláudia B. Marchese , Márcio M. Boniatti , Iuri C. Wawrzeniak , Roselaine P. Oliveira , Luciana N. Nunes , Josué A. Victorino","doi":"10.1016/S2255-4823(13)70463-6","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70463-6","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the incidence, costs, and mortality associated with chronic critical illness (CCI), and to identify clinical predictors of CCI in a general intensive care unit.</p></div><div><h3>Methods</h3><p>This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed.</p></div><div><h3>Results</h3><p>There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for CCI in the multivariate logistic regression model.</p></div><div><h3>Conclusions</h3><p>CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 3","pages":"Pages 241-247"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70463-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137162139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-01-01DOI: 10.1016/S2255-4823(13)70466-1
Mariana Nassif Kerbauy , Fabio Ynoe de Moraes , Lucila Nassif Kerbauy , Lucieni de Oliveira Conterno , Silene El-Fakhouri
Objective
Routine thromboprophylaxis, despite its well-known effectiveness and the fact that venous thromboembolism is a potentially avoidable condition, is not fully established in clinical practice. The objectives of the present study were to determine how often thromboprophylaxis is used and the presence of thromboembolism risk factors, and to verify the appropriateness of its use in medical inpatients, assuming a long-standing national guideline as a parameter.
Methods
This was a retrospective cross-sectional study, involving inpatients with medical conditions in the adult general ward of a faculty hospital. The review was based on a defined guideline.
Results
146 patients were included in the review. At least one risk factor for venous thrombo embolism was found in 94.5%. In 130 (89%) patients, prophylactic heparin was indicated, and some kind of heparin was prescribed in 73.3%. Regarding the adequacy of prophylaxis, 53.4% of prescriptions were correct regarding prophylaxis indication and dose; 24% had incorrect dose or frequency of use; 19.2% had no prophylaxis prescription, although it was indicated; and in five cases (3.4%), the drug was prescribed, even though it was not indicated.
Conclusion
Thromboprophylaxis is underused in this population, and an inappropriate dose was prescribed in 50% of cases. Therefore, future studies and interventions should include an educational program started from the emergency department care, an essential step to bring evidence closer to clinical practice.
{"title":"Venous thromboprophylaxis in medical patients: an application review","authors":"Mariana Nassif Kerbauy , Fabio Ynoe de Moraes , Lucila Nassif Kerbauy , Lucieni de Oliveira Conterno , Silene El-Fakhouri","doi":"10.1016/S2255-4823(13)70466-1","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70466-1","url":null,"abstract":"<div><h3>Objective</h3><p>Routine thromboprophylaxis, despite its well-known effectiveness and the fact that venous thromboembolism is a potentially avoidable condition, is not fully established in clinical practice. The objectives of the present study were to determine how often thromboprophylaxis is used and the presence of thromboembolism risk factors, and to verify the appropriateness of its use in medical inpatients, assuming a long-standing national guideline as a parameter.</p></div><div><h3>Methods</h3><p>This was a retrospective cross-sectional study, involving inpatients with medical conditions in the adult general ward of a faculty hospital. The review was based on a defined guideline.</p></div><div><h3>Results</h3><p>146 patients were included in the review. At least one risk factor for venous thrombo embolism was found in 94.5%. In 130 (89%) patients, prophylactic heparin was indicated, and some kind of heparin was prescribed in 73.3%. Regarding the adequacy of prophylaxis, 53.4% of prescriptions were correct regarding prophylaxis indication and dose; 24% had incorrect dose or frequency of use; 19.2% had no prophylaxis prescription, although it was indicated; and in five cases (3.4%), the drug was prescribed, even though it was not indicated.</p></div><div><h3>Conclusion</h3><p>Thromboprophylaxis is underused in this population, and an inappropriate dose was prescribed in 50% of cases. Therefore, future studies and interventions should include an educational program started from the emergency department care, an essential step to bring evidence closer to clinical practice.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 3","pages":"Pages 258-264"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70466-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137161957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-01-01DOI: 10.1016/S2255-4823(13)70431-4
Leticia Esposito Sewaybricker , Maria Ângela R.G.M. Antonio , Roberto Teixeira Mendes , Antonio de Azevedo Barros Filho , Mariana Porto Zambon
Objective
To study the agreement among three distinct criteria for metabolic syndrome (MS) adapted to adolescents, and to identify associated factors for MS.
Methods
Cross-sectional study with 65 obese subjects aged 10 to 18 years, attended to at the Outpatient Clinic for Obese Children and Adolescents at the Clinical Hospital of the Universidade Estadual de Campinas (Unicamp). MS was defined using the criteria of the World Health Organization (WHO), the International Diabetes Federation (IDF), and the Adult Treatment Panel III (ATP III). Clinical, anthropometrical, and laboratorial data were associated to MS.
Results
From the 65 subjects, none had MS according to the WHO criteria, while 18 were diagnosed with MS (27.6%) according to the IDF, and 19 (29.2%) according to the ATP III. Agreement between IDF and ATP III was excellent (kappa 81%). In this study, puberty and triglycerides levels showed significant statistical difference when comparing subjects with and without MS, the first for ATP III (p = 0.03), and the second for IDF (p = 0.005) and ATP III (p = 0.001) criteria.
Conclusion
The WHO criteria does not seem to be adequate for adolescents. IDF and ATP III criteria had an excellent agreement. Puberty and triglycerides were associated with MS
目的研究青少年代谢综合征(MS)的三个不同标准之间的一致性，并确定MS的相关因素。方法对在坎皮纳斯国立大学临床医院肥胖儿童和青少年门诊就诊的65名年龄在10至18岁的肥胖患者进行横断面研究。根据世界卫生组织(WHO)、国际糖尿病联合会(IDF)和成人治疗小组III (ATP III)的标准定义多发性硬化症。临床、人体测量学和实验室数据与多发性硬化症相关。结果65名受试者中，根据WHO标准无多发性硬化症，而根据IDF诊断为多发性硬化症的有18人(27.6%)，根据ATP III诊断为多发性硬化症的有19人(29.2%)。IDF和ATP III之间的一致性非常好(kappa 81%)。在这项研究中，青春期和甘油三酯水平在有MS和没有MS的受试者中有显著的统计学差异，第一是ATP III (p = 0.03)，第二是IDF (p = 0.005)和ATP III (p = 0.001)标准。结论WHO的标准似乎并不适用于青少年。IDF和ATP III标准有很好的一致性。青春期和甘油三酯与多发性硬化症有关
{"title":"Metabolic syndrome in obese adolescents: what is enough?","authors":"Leticia Esposito Sewaybricker , Maria Ângela R.G.M. Antonio , Roberto Teixeira Mendes , Antonio de Azevedo Barros Filho , Mariana Porto Zambon","doi":"10.1016/S2255-4823(13)70431-4","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70431-4","url":null,"abstract":"<div><h3>Objective</h3><p>To study the agreement among three distinct criteria for metabolic syndrome (MS) adapted to adolescents, and to identify associated factors for MS.</p></div><div><h3>Methods</h3><p>Cross-sectional study with 65 obese subjects aged 10 to 18 years, attended to at the Outpatient Clinic for Obese Children and Adolescents at the Clinical Hospital of the Universidade Estadual de Campinas (Unicamp). MS was defined using the criteria of the World Health Organization (WHO), the International Diabetes Federation (IDF), and the Adult Treatment Panel III (ATP III). Clinical, anthropometrical, and laboratorial data were associated to MS.</p></div><div><h3>Results</h3><p>From the 65 subjects, none had MS according to the WHO criteria, while 18 were diagnosed with MS (27.6%) according to the IDF, and 19 (29.2%) according to the ATP III. Agreement between IDF and ATP III was excellent (kappa 81%). In this study, puberty and triglycerides levels showed significant statistical difference when comparing subjects with and without MS, the first for ATP III (p<!--> <!-->=<!--> <!-->0.03), and the second for IDF (p<!--> <!-->=<!--> <!-->0.005) and ATP III (p<!--> <!-->=<!--> <!-->0.001) criteria.</p></div><div><h3>Conclusion</h3><p>The WHO criteria does not seem to be adequate for adolescents. IDF and ATP III criteria had an excellent agreement. Puberty and triglycerides were associated with MS</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 1","pages":"Pages 64-71"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70431-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90018574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-01-01DOI: 10.1016/S2255-4823(13)70430-2
Lisiane Schilling Poeta , Maria de Fátima da Silva Duarte , Bruno Caramelli , Jorge Mota , Isabela de Carlos Back Giuliano
Objective
To analyze the effects of a supervised physical exercise and nutritional guidance program, conducted with a playful basis, on the cardiovascular risk profile of obese children.
Methods
Forty-four children aged between 8 and 11 years, divided into two groups, were paired by gender and age: intervention group (n = 22) and control group (n = 22). The following parameters were measured before and after the intervention: body mass, height, waist circumference, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, fasting glucose, high-sensitive C-reactive protein, blood pressure, and carotid intima-media thickness. Both groups continued their traditional medical treatment. The case group exercised with recreational activities three times a week during 12 weeks, and participated in a weekly nutritional guidance session. The control group did not participate in the intervention described. Descriptive statistics, paired and unpaired Student's t-test, Mann-Whitney's U test, and the Wilcoxon test were used, with a significance level of p < 0.05.
Results
32 children concluded the study (16 in each group). At the end of the study, the case group showed a significant reduction in the body mass index (BMI) (p = 0.001), total cholesterol (p = 0.001), LDL cholesterol (p = 0.001), diastolic blood pressure (p = 0.010), and average (p = 0.003) and maximum (p = 0.002) carotid intima-media thickness. The control group showed a significant increase in waist circumference (p = 0.001), blood glucose (p = 0.025), C-reactive protein (p = 0.016), a reduction of HDL cholesterol (p = 0.012) and total cholesterol (p = 0.042), and an increase in the average (p = 0.012) and maximum (p = 0.024) carotid intima-media thickness.
Conclusion
The program proved effective in the reduction of obesity indicators and of the intima-media thickness, a direct and early signal of atherosclerosis.
{"title":"Effects of physical exercises and nutritional guidance on the cardiovascular risk profile of obese children","authors":"Lisiane Schilling Poeta , Maria de Fátima da Silva Duarte , Bruno Caramelli , Jorge Mota , Isabela de Carlos Back Giuliano","doi":"10.1016/S2255-4823(13)70430-2","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70430-2","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the effects of a supervised physical exercise and nutritional guidance program, conducted with a playful basis, on the cardiovascular risk profile of obese children.</p></div><div><h3>Methods</h3><p>Forty-four children aged between 8 and 11 years, divided into two groups, were paired by gender and age: intervention group (n<!--> <!-->=<!--> <!-->22) and control group (n<!--> <!-->=<!--> <!-->22). The following parameters were measured before and after the intervention: body mass, height, waist circumference, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, fasting glucose, high-sensitive C-reactive protein, blood pressure, and carotid intima-media thickness. Both groups continued their traditional medical treatment. The case group exercised with recreational activities three times a week during 12 weeks, and participated in a weekly nutritional guidance session. The control group did not participate in the intervention described. Descriptive statistics, paired and unpaired Student's t-test, Mann-Whitney's U test, and the Wilcoxon test were used, with a significance level of p < 0.05.</p></div><div><h3>Results</h3><p>32 children concluded the study (16 in each group). At the end of the study, the case group showed a significant reduction in the body mass index (BMI) (p<!--> <!-->=<!--> <!-->0.001), total cholesterol (p<!--> <!-->=<!--> <!-->0.001), LDL cholesterol (p<!--> <!-->=<!--> <!-->0.001), diastolic blood pressure (p<!--> <!-->=<!--> <!-->0.010), and average (p<!--> <!-->=<!--> <!-->0.003) and maximum (p<!--> <!-->=<!--> <!-->0.002) carotid intima-media thickness. The control group showed a significant increase in waist circumference (p<!--> <!-->=<!--> <!-->0.001), blood glucose (p<!--> <!-->=<!--> <!-->0.025), C-reactive protein (p<!--> <!-->=<!--> <!-->0.016), a reduction of HDL cholesterol (p<!--> <!-->=<!--> <!-->0.012) and total cholesterol (p<!--> <!-->=<!--> <!-->0.042), and an increase in the average (p<!--> <!-->=<!--> <!-->0.012) and maximum (p<!--> <!-->=<!--> <!-->0.024) carotid intima-media thickness.</p></div><div><h3>Conclusion</h3><p>The program proved effective in the reduction of obesity indicators and of the intima-media thickness, a direct and early signal of atherosclerosis.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 1","pages":"Pages 56-63"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70430-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91682840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-01-01DOI: 10.1016/S2255-4823(13)70505-8
Claudia de Oliveira , Maura Seleme , Paula F. Cansi , Renata F.D.C. Consentino , Fernanda Y. Kumakura , Gizelle A. Moreira , Bary Berghmans
Objective
To investigate the occurrence of urinary incontinency (UI) in pregnant women and its relationship with socio-demographic variables and quality of life.
Methods
A descriptive cross-sectional multicenter study was conducted to investigate 495 women using the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF). The survey was conducted on the same day of delivery, with the volunteers still in the maternity ward. Statistical analysis of the comparison between groups 1 (incontinence) and 2 (continent) was done using chi-square test for comparison of proportions of women with and without urinary incontinency and logistic regression analysis.
Results
From the total of 495 women studied, 352 (71%) reported having had UI during the last four weeks of pregnancy. Group 1 presented the ICIQ-SF median score of 11 (range 3– 21), considered as severe impact in quality of life. Logistic regression analysis showed that there was a closer relation between the self-report of UI with the following variables: level of education below 8 years (OR: 2.99; p < 0.001), black women (OR: 2.32; p = 0.005), women with more than 3 children (OR: 4.93; p < 0.001), obese (OR: 4.22; p < 0.001) and normal vaginal delivery (OR: 2.59; p < 0.001).
Conclusion
The majority of pregnant women have UI, negatively affecting the quality of their lives.
{"title":"Urinary incontinence in pregnant women and its relation with socio-demographic variables and quality of life","authors":"Claudia de Oliveira , Maura Seleme , Paula F. Cansi , Renata F.D.C. Consentino , Fernanda Y. Kumakura , Gizelle A. Moreira , Bary Berghmans","doi":"10.1016/S2255-4823(13)70505-8","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70505-8","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the occurrence of urinary incontinency (UI) in pregnant women and its relationship with socio-demographic variables and quality of life.</p></div><div><h3>Methods</h3><p>A descriptive cross-sectional multicenter study was conducted to investigate 495 women using the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF). The survey was conducted on the same day of delivery, with the volunteers still in the maternity ward. Statistical analysis of the comparison between groups 1 (incontinence) and 2 (continent) was done using chi-square test for comparison of proportions of women with and without urinary incontinency and logistic regression analysis.</p></div><div><h3>Results</h3><p>From the total of 495 women studied, 352 (71%) reported having had UI during the last four weeks of pregnancy. Group 1 presented the ICIQ-SF median score of 11 (range 3– 21), considered as severe impact in quality of life. Logistic regression analysis showed that there was a closer relation between the self-report of UI with the following variables: level of education below 8 years (OR: 2.99; p<!--> <!--><<!--> <!-->0.001), black women (OR: 2.32; p<!--> <!-->=<!--> <!-->0.005), women with more than 3 children (OR: 4.93; p<!--> <!--><<!--> <!-->0.001), obese (OR: 4.22; p<!--> <!--><<!--> <!-->0.001) and normal vaginal delivery (OR: 2.59; p<!--> <!--><<!--> <!-->0.001).</p></div><div><h3>Conclusion</h3><p>The majority of pregnant women have UI, negatively affecting the quality of their lives.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 5","pages":"Pages 460-466"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70505-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72283421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-01-01DOI: 10.1016/S2255-4823(13)70501-0
Maura Cristina Porto Feitosa , Vanessa Batista de Sousa Lima , José Machado Moita Neto , Dilina do Nascimento Marreiro
Objective
In obesity, the excessive adipose tissue increases the synthesis of inflammatory cytokines, which appear to alter the metabolism of minerals, such as zinc. However, the mechanisms involved remain unclear. This study investigated whether the concentrations of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in plasma can to influence biochemical parameters of zinc in obese women.
Methods
Seventy-six pre-menopausal women, aged between 20 and 50 years, were divided into two groups: the case group, composed of obese women (n = 37) and the control group, composed of non-obese women (n = 39). Analysis of the plasmatic and erythrocytary zinc, and plasmatic cytokines were conducted by flame atomic absorption spectrophotometry and by ELISA, respectively.
Results
The plasmatic zinc and concentrations of IL-6 in plasma did not show significant differences between obese women and controls (p > 0.05). The erythrocytary zinc was 36.4 ± 15.0 μg/gHb in the case group, and 45.4 ± 14.3 μg/gHb (p = 0.025) in the control group. The concentrations of TNF-α in plasma were 42.0 ± 11.9 pg/mL and 19.0 ± 1.0 pg/mL in obese women and in controls, respectively (p < 0.001). The plasmatic zinc had a significant negative correlation with the values of TNF α (r = −0.44, p = 0.015).
Conclusion
Obese women presented lower concentrations of erythrocytary zinc than the control group. The study demonstrated a probable influence of the inflammatory process on metabolism of zinc in obese patients.
{"title":"Plasma concentration of IL-6 and TNF-α and its relationship with zincemia in obese women","authors":"Maura Cristina Porto Feitosa , Vanessa Batista de Sousa Lima , José Machado Moita Neto , Dilina do Nascimento Marreiro","doi":"10.1016/S2255-4823(13)70501-0","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70501-0","url":null,"abstract":"<div><h3>Objective</h3><p>In obesity, the excessive adipose tissue increases the synthesis of inflammatory cytokines, which appear to alter the metabolism of minerals, such as zinc. However, the mechanisms involved remain unclear. This study investigated whether the concentrations of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in plasma can to influence biochemical parameters of zinc in obese women.</p></div><div><h3>Methods</h3><p>Seventy-six pre-menopausal women, aged between 20 and 50 years, were divided into two groups: the case group, composed of obese women (n<!--> <!-->=<!--> <!-->37) and the control group, composed of non-obese women (n<!--> <!-->=<!--> <!-->39). Analysis of the plasmatic and erythrocytary zinc, and plasmatic cytokines were conducted by flame atomic absorption spectrophotometry and by ELISA, respectively.</p></div><div><h3>Results</h3><p>The plasmatic zinc and concentrations of IL-6 in plasma did not show significant differences between obese women and controls (p<!--> <!-->><!--> <!-->0.05). The erythrocytary zinc was 36.4<!--> <!-->±<!--> <!-->15.0<!--> <!-->μg/gHb in the case group, and 45.4<!--> <!-->±<!--> <!-->14.3<!--> <!-->μg/gHb (p<!--> <!-->=<!--> <!-->0.025) in the control group. The concentrations of TNF-α in plasma were 42.0<!--> <!-->±<!--> <!-->11.9<!--> <!-->pg/mL and 19.0<!--> <!-->±<!--> <!-->1.0<!--> <!-->pg/mL in obese women and in controls, respectively (p<!--> <!--><<!--> <!-->0.001). The plasmatic zinc had a significant negative correlation with the values of TNF α (r<!--> <!-->=<!--> <!-->−0.44, p<!--> <!-->=<!--> <!-->0.015).</p></div><div><h3>Conclusion</h3><p>Obese women presented lower concentrations of erythrocytary zinc than the control group. The study demonstrated a probable influence of the inflammatory process on metabolism of zinc in obese patients.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 5","pages":"Pages 429-434"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70501-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72283496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To study the Doppler velocimetry of the fetal middle cerebral artery in pregnancies complicated by placental insufficiency, and to verify its role in the prognosis of neonatal survival.
Methods
This was a prospective study of 93 pregnant women with diagnosis of placental insufficiency detected before the 34th week of pregnancy. Placental insufficiency was characterized by abnormal umbilical artery (UA) Doppler (> 95th percentile). The following parameters were analyzed: umbilical artery (UA) pulsatility index (PI); middle cerebral artery (MCA) PI; brain-placenta ratio – BPR (MCA-PI/UA-PI); MCA peak systolic velocity (MCA-PSV); and PI for veins (PIV) of ductus venosus (DV). The parameters were analyzed in terms of absolute values, z-scores (standard deviations from the mean), or multiples of the median (MoM). The outcome investigated was neonatal death during the hospitalization period after birth.
Results
Of the 93 pregnancies analyzed, there were 25 (26.9%) neonatal deaths. The group that died, when compared to the survival group, presented a significant association with the diagnosis of absent or reversed end-diastolic flow (88% vs. 23.6%, p < 0.001), with a higher median of UA PI (2.9 vs. 1.7, p < 0.001) and UA PI z-score (10.4 vs. 4.9, p < 0.001); higher MCA-PSV MoM (1.4 vs. 1.1, p = 0.012); lower BPR (0.4 vs. 0.7, p < 0.001); higher PIV-DV (1.2 vs. 0.8, p < 0.001) and DV z-score (3.6 vs. 0.6, p < 0.001). In the logistic regression, the independent variables predictive of neonatal death were: gestational age at birth (OR = 0.45; 95% CI: 0.3 to 0.7; p < 0.001) and UA PI z-score (OR = 1.14, 95% CI: 1.0 to 1.3, p = 0.046).
Conclusion
Despite the association verified by the univariate analysis between neonatal death and the parameters of fetal cerebral Doppler velocimetry, the multivariate analysis identified prematurity and degree of insufficiency of placental circulation as independent factors related to neonatal death in pregnancies complicated by placental insufficiency.
目的研究妊娠合并胎盘功能不全时胎儿大脑中动脉的多普勒血流速度测定，并验证其在新生儿生存预后中的作用。方法对93例妊娠34周前诊断为胎盘功能不全的孕妇进行前瞻性研究。胎盘功能不全的特征是异常的脐动脉（UA）多普勒（>；第95百分位）。分析了以下参数：脐动脉（UA）搏动指数（PI）；大脑中动脉（MCA）PI；脑胎盘比BPR（MCA-PI/UA-PI）；MCA峰值收缩速度（MCA-PSV）；静脉导管（DV）的静脉（PIV）的PI。根据绝对值、z评分（与平均值的标准差）或中位数的倍数（MoM）对参数进行分析。调查的结果是新生儿在出生后住院期间死亡。结果在分析的93例妊娠中，有25例（26.9%）新生儿死亡。与存活组相比，死亡组与舒张末期血流缺失或逆转的诊断有显著相关性（88%对23.6%，p＜0.001），UA PI中位数（2.9对1.7，p＜001）和UA PI z评分中位数（10.4对4.9，p＜0.001%）较高；MCA-PSV MoM较高（1.4对1.1，p=0.012）；较低的BPR（0.4对0.7，p＜0.001）；较高的PIV-DV（1.2对0.8，p＜0.001）和DV z评分（3.6对0.6，p＜001）。在逻辑回归中，预测新生儿死亡的自变量是：出生时的胎龄（OR=0.45；95%CI:0.3-0.7；p<；0.001）和UA PI z评分（OR=1.14，95%CI:1.0-1.3，p=0.046），多变量分析表明，早产和胎盘循环功能不全程度是导致妊娠合并胎盘功能不全新生儿死亡的独立因素。
{"title":"Doppler velocimetry of the fetal middle cerebral artery and other parameters of fetal well-being in neonatal survival during pregnancies with placental insufficiency","authors":"Roseli Mieko Yamamoto Nomura, Juliana Ikeda Niigaki, Flávia Thiemi Horigome, Rossana Pulcineli Vieira Francisco, Marcelo Zugaib","doi":"10.1016/S2255-4823(13)70493-4","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70493-4","url":null,"abstract":"<div><h3>Objective</h3><p>To study the Doppler velocimetry of the fetal middle cerebral artery in pregnancies complicated by placental insufficiency, and to verify its role in the prognosis of neonatal survival.</p></div><div><h3>Methods</h3><p>This was a prospective study of 93 pregnant women with diagnosis of placental insufficiency detected before the 34<sup>th</sup> week of pregnancy. Placental insufficiency was characterized by abnormal umbilical artery (UA) Doppler (> 95<sup>th</sup> percentile). The following parameters were analyzed: umbilical artery (UA) pulsatility index (PI); middle cerebral artery (MCA) PI; brain-placenta ratio – BPR (MCA-PI/UA-PI); MCA peak systolic velocity (MCA-PSV); and PI for veins (PIV) of ductus venosus (DV). The parameters were analyzed in terms of absolute values, z-scores (standard deviations from the mean), or multiples of the median (MoM). The outcome investigated was neonatal death during the hospitalization period after birth.</p></div><div><h3>Results</h3><p>Of the 93 pregnancies analyzed, there were 25 (26.9%) neonatal deaths. The group that died, when compared to the survival group, presented a significant association with the diagnosis of absent or reversed end-diastolic flow (88% vs. 23.6%, p<!--> <!--><<!--> <!-->0.001), with a higher median of UA PI (2.9 vs. 1.7, p<!--> <!--><<!--> <!-->0.001) and UA PI z-score (10.4 vs. 4.9, p<!--> <!--><<!--> <!-->0.001); higher MCA-PSV MoM (1.4 vs. 1.1, p<!--> <!-->=<!--> <!-->0.012); lower BPR (0.4 vs. 0.7, p<!--> <!--><<!--> <!-->0.001); higher PIV-DV (1.2 vs. 0.8, p<!--> <!--><<!--> <!-->0.001) and DV z-score (3.6 vs. 0.6, p<!--> <!--><<!--> <!-->0.001). In the logistic regression, the independent variables predictive of neonatal death were: gestational age at birth (OR<!--> <!-->=<!--> <!-->0.45; 95% CI: 0.3 to 0.7; p<!--> <!--><<!--> <!-->0.001) and UA PI z-score (OR<!--> <!-->=<!--> <!-->1.14, 95% CI: 1.0 to 1.3, p<!--> <!-->=<!--> <!-->0.046).</p></div><div><h3>Conclusion</h3><p>Despite the association verified by the univariate analysis between neonatal death and the parameters of fetal cerebral Doppler velocimetry, the multivariate analysis identified prematurity and degree of insufficiency of placental circulation as independent factors related to neonatal death in pregnancies complicated by placental insufficiency.</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 4","pages":"Pages 392-399"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70493-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72279336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-01-01DOI: 10.1016/S2255-4823(13)70526-5
Regina Ribeiro Parizi Carvalho , Paulo Antônio de Carvalho Fortes , Volnei Garrafa
Objective
To describe and analyze, from the perspective of Intervention Bioethics, the legal, institutional and ethical contexts, the conflicts and regulations of supplemental health care in Brazil, since the approval of the regulatory law in 1998 until 2010.
Methods
Qualitative research, using Intervention Bioethics as the theoretical reference. Bibliographical and documental study of the legislation, regulations and assistential framework, as well as interviews with members of the Supplemental Health Board.
Results
There was improvement in the records and rules of action in private health companies, as well as flow of information, contractual and financial guarantees provided to consumers. Conflicts persist regarding access to services and procedures, price increases, policies on autonomy and medical fees. There is a dispute with the public sector regarding the network of health services, with rising costs and no improvement in quality of care.
Discussion
Private participation in health demands comparative assessments and improvement of public-private care regulation, as well as promoting greater balance in the funding and reevaluation of the health care model.
Conclusion
It is necessary to review the regulatory framework considering the supplementary, complementary or duplicate characteristic of assistance, the social actors involved, bioethical and political issues regarding associations between Supplemental Health Care and the National Health System (SUS).
{"title":"Supplemental care from a bioethical perspective","authors":"Regina Ribeiro Parizi Carvalho , Paulo Antônio de Carvalho Fortes , Volnei Garrafa","doi":"10.1016/S2255-4823(13)70526-5","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70526-5","url":null,"abstract":"<div><h3>Objective</h3><p>To describe and analyze, from the perspective of Intervention Bioethics, the legal, institutional and ethical contexts, the conflicts and regulations of supplemental health care in Brazil, since the approval of the regulatory law in 1998 until 2010.</p></div><div><h3>Methods</h3><p>Qualitative research, using Intervention Bioethics as the theoretical reference. Bibliographical and documental study of the legislation, regulations and assistential framework, as well as interviews with members of the Supplemental Health Board.</p></div><div><h3>Results</h3><p>There was improvement in the records and rules of action in private health companies, as well as flow of information, contractual and financial guarantees provided to consumers. Conflicts persist regarding access to services and procedures, price increases, policies on autonomy and medical fees. There is a dispute with the public sector regarding the network of health services, with rising costs and no improvement in quality of care.</p></div><div><h3>Discussion</h3><p>Private participation in health demands comparative assessments and improvement of public-private care regulation, as well as promoting greater balance in the funding and reevaluation of the health care model.</p></div><div><h3>Conclusion</h3><p>It is necessary to review the regulatory framework considering the supplementary, complementary or duplicate characteristic of assistance, the social actors involved, bioethical and political issues regarding associations between Supplemental Health Care and the National Health System (SUS).</p></div>","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 6","pages":"Pages 600-606"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70526-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72282159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-01-01DOI: 10.1016/S2255-4823(13)70530-7
Marcus Zulian Teixeira
{"title":"Rebound effects of modern drugs: serious adverse events unknown by health professionals","authors":"Marcus Zulian Teixeira","doi":"10.1016/S2255-4823(13)70530-7","DOIUrl":"https://doi.org/10.1016/S2255-4823(13)70530-7","url":null,"abstract":"","PeriodicalId":101100,"journal":{"name":"Revista da Associa??o Médica Brasileira (English Edition)","volume":"59 6","pages":"629-638"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2255-4823(13)70530-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72282202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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