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1.
Blood Purif ; 53(7): 565-573, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38330931

RESUMO

INTRODUCTION: Endothelial dysfunction (ED) is considered a marker of vascular complications, especially in patients with end-stage kidney disease (ESKD). Inflammation and the uremic state contribute to ED in patients undergoing hemodialysis (HD). Recently, the medium cut-off (MCO) dialysis membrane has been proposed to efficiently remove inflammatory cytokines and large, middle-sized uremic toxins, with the potential effect to improve endothelial function. This study aimed to compare the effect of dialysis with MCO or high-flux membranes on the endothelial function of patients on chronic HD. METHODS: A prospective, randomized, crossover study in which 32 patients with ESKD were dialyzed for 12 weeks with each membrane, including a 4-week washout period between treatments. Endothelial function was assessed by flow-mediated dilation (FMD) using brachial artery ultrasound at weeks 1, 12, 16, and 28. RESULTS: The population consisted of 59% men, 52.7 ± 13.4 years, 16% non-black, on HD for 8.8 (4.1-15.1) years, and 72% with arteriovenous fistula. Hypertension was the most common etiology of chronic kidney disease, and 34% of patients had previous cardiovascular disease. Patients were grouped, regardless of treatment sequence, into MCO or high-flux groups, since no carryover (p = 0.634) or sequence (p = 0.998) effects were observed in the FMD assessment. The ANOVA model with repeated measures showed no effects of treatment (p = 0.426), time (p = 0.972), or interaction (p = 0.413) in the comparison of FMD between the MCO and high-flux groups. CONCLUSION: Dialysis performed with MCO, or high-flux membranes, had no influence on endothelial function in patients undergoing HD. However, a trend towards increased FMD was observed with the use of the MCO membrane.


Assuntos
Estudos Cross-Over , Endotélio Vascular , Membranas Artificiais , Diálise Renal , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Diálise Renal/efeitos adversos , Endotélio Vascular/fisiopatologia , Adulto , Idoso , Estudos Prospectivos , Falência Renal Crônica/terapia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/complicações , Artéria Braquial/fisiopatologia , Vasodilatação
2.
Artigo em Inglês | MEDLINE | ID: mdl-38466890

RESUMO

CONTEXT: The outcomes related to cardiovascular risk (CVR) in patients with nonclassical form of congenital adrenal hyperplasia (NCAH) are unknown, especially those related to therapeutic options, including low doses of glucocorticoids (GCs) or oral contraceptive pills. OBJECTIVES: to analyze CVR by markers of atherosclerosis in females with nonclassical form according to therapeutic options. DESIGN AND SETTING: a cross-sectional study at a tertiary center. PATIENTS AND METHODS: Forty-seven females with NCAH (33.4 ± 10 years) were subdivided into: G1 (n = 28) treated with dexamethasone (0.14 ± 0.05 mg/m2/day); G2 (n = 19) with oral contraceptive pills; and G3 (30 matched controls). CVR was analyzed through serum lipids, HOMA-IR, inflammatory cytokines levels and quantitative image evaluations (pulse wave velocity-PWV, endothelial function by flow mediated dilatation-FMD, carotid intima media thickness-CIMT and visceral fat-VAT by abdominal tomography. RESULTS: There were no statistically significant differences in BMI, HOMA-IR, HDL-cholesterol, or triglyceride levels among groups (p > 0.05). Serum interleukin-6 levels ​​were higher in G1 than in G2 (p = 0.048), and interleukin-8 levels were higher in G1 than in G2/3 (p = 0.008). There were no statistically significant differences in VAT, PWV, FMD or CIMT among groups (p > 0.05). In multivariable regression analysis, there was no statistically significant association between glucocorticoid dose and evaluated outcomes. CONCLUSION: Adult females with NCAH did not show increased CVR using methodologies for detection of precocious atherosclerosis. Although patients receiving dexamethasone therapy had increased IL-6 and 8 levels, these data were not associated with radiological markers of atherosclerosis. Our cohort was composed of young adults and should be reevaluated in a long-term follow-up.

3.
J Endocr Soc ; 7(5): bvad040, 2023 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-37063700

RESUMO

Context: The effects of androgen therapy on arterial function in transgender men (TM) are not fully understood, particularly concerning long-term androgen treatment. Objective: To evaluate arterial stiffness in TM receiving long-term gender-affirming hormone therapy by carotid-femoral pulse wave velocity (cf-PWV). Methods: A cross-sectional case-control study at the Gender Dysphoria Unit of the Division of Endocrinology, HC-FMUSP, Sao Paulo, Brazil. Thirty-three TM receiving intramuscular testosterone esters as regular treatment for an average time of 14 ± 8 years were compared with 111 healthy cisgender men and women controls matched for age and body mass index. Aortic stiffness was evaluated by cf-PWV measurements using Complior device post-testosterone therapy. The main outcome measure was aortic stiffness by cf-PWV as a cardiovascular risk marker in TM and control group. Results: The cf-PWV after long-term testosterone therapy was significantly higher in TM (7.4 ± 0.9 m/s; range 5.8-8.9 m/s) than in cisgender men (6.6 ± 1.0 m/s; range 3.8-9.0 m/s, P < .01) and cisgender women controls (6.9 ± .9 m/s; range 4.8-9.1 m/s, P = .02). The cf-PWV was significantly and positively correlated with age. Analysis using blood pressure as a covariate showed a significant relationship between TM systolic blood pressure (SBP) and cf-PWV in relation to cisgender women but not to cisgender men. Age, SBP, and diagnosis of hypertension were independently associated with cf-PWV in the TM group. Conclusion: The TM group on long-term treatment with testosterone had higher aging-related aortic stiffening than the control groups. These findings indicate that aortic stiffness might be accelerated in the TM group receiving gender-affirming hormone treatment, and suggest a potential deleterious effect of testosterone on arterial function. Preventive measures in TM individuals receiving testosterone treatment, who are at higher risk for cardiovascular events, are highly recommended.

4.
Cad. Ter. Ocup. UFSCar (Impr.) ; 22(supl.esp): 27-35, jul. 2014. tab
Artigo em Português | LILACS, Index Psi Periódicos Técnico-Científicos | ID: lil-729115

RESUMO

INTRODUÇÃO: No contexto das drogas, o álcool é um dos maiores problemas de saúde pública. Objetivo: identificar o padrão de consumo de bebida alcoólica dos usuários de uma Unidade de Saúde da Família do interior paulista, durante o acolhimento. MÉTODOS: Estudo exploratório, transversal, de método quantitativo, com a utilização do Alcohol Use Disorders Identification Test (AUDIT) em 100 usuários adultos do serviço da rede de Atenção Primária à Saúde. Realizou-se análise estatística descritiva. RESULTADOS: Da amostra, 74% são mulheres, 85% fazem uso de bebida alcoólica em baixo risco, 19% são adultos jovens, o beber em excesso foi relatado pela minoria dos entrevistados. Da amostra, 42% dos católicos nunca fizeram uso de álcool em binge, seguidos pelos evangélicos, com 22%. CONCLUSÕES: Os profissionais de saúde precisam ter conhecimento sobre o padrão de consumo de álcool dos moradores do território de abrangência da sua unidade, para que possam desenvolver ações de prevenção e promoção da saúde


BACKGROUND: Within the context of drugs, alcoholism is one of the major problems in public health. OBJECTIVE: To identify the pattern of consumption of alcoholic beverages by users of a Family Health Unit in São Paulo state during reception. METHOD: Exploratory cross-sectionalstudy of quantitative methodology with the use of Alcohol Use Disorder Identification Test (AUDIT) in 100 adult users of a Primary Health Care network. Descriptive statistical analysis was carried out. RESULTS: Of the total sample, (74%) were women, (85%) made use of alcoholic beverages at low risk, and (19%) were young adults; binge drinking was reported by a minority of the interviewees. The Catholics in the sample (42%) reported never using alcohol excessively, followed by the Evangelicals with 22%. CONCLUSIONS: Health professionals need to have knowledge of the alcohol consumption pattern of the residents from the territory of their unit, so that they can develop prevention and health promotion programs


Assuntos
Humanos , Saúde Pública , Saúde da Família , Etanol , Alcoolismo
5.
Rev. enferm. UERJ ; 21(2,n.esp): 772-778, 2013.
Artigo em Português | LILACS, BDENF - enfermagem (Brasil) | ID: lil-748569

RESUMO

Este estudo objetivou analisar concepções de graduandos de enfermagem sobre o cuidado coletivo na atenção primária em saúde. Trata-se de um estudo de caso, com enfoque qualitativo e descritivo. A coleta de dados ocorreu em novembro de 2010, por meio de grupos focais com 11 graduandos de enfermagem de uma universidade pública do Estado de São Paulo. A análise dos resultados fundamentou-se na técnica de análise de conteúdo temático-categorial e destacou quatro categorias: o cuidado integral e a superação do modelo preventivista; a saúde da família é a grande sacada do Sistema Único de Saúde; a saúde da família possibilita a aproximação do contexto de vida e saúde da população; grupos educativos e vigilância em saúde caracterizam o cuidado coletivo. Concluiu-se que o processo de formação está propiciando a formulação de conceitos críticos sobre cuidado coletivo na atenção primária, porém, há necessidade de superação de perspectivas idealizadas.


This qualitative case study examined under graduate nursing students’ conceptions of collective care in primary health care. Data were collected in November 2010 through focus groups of 11 nursing students at a public university in São Paulo State, Brazil. The data was analyzed using theme/category content analysis. The analysis revealed four categories: comprehensive health care and going beyond the preventive model; family health is the key insight informing the Unified Health System; family health makes possible an approximation to the neighborhood context of life and health; and educational groups and health surveillance are characteristic of collective care. It was concluded that nursing training is fostering the formulation of critical concepts of collective care in primary health care, although there is a need to surmount idealistic outlooks.


Este estudio tuvo como objetivo analizar concepciones de estudiantes de enfermería sobre el cuidado colectivo en la atención primaria en salud. Se trata de un estudio de caso, de enfoque cualitativo y descriptivo. La recolección de datos ocurrió en noviembre de 2010 mediante grupos focales con 11 estudiantes de enfermería de una universidad pública del Estado de São Paulo, Brasil. El análisis de los datos fue fundamentado en la técnica de análisis temática y demostró cuatro categorias: el cuidado integral y la superación del modelo preventivista; la salud de la familia es la gran revelación del Sistema Único de Salud; la salud de la familia posibilita la aproximación de las condiciones de vida y de salud de la población; grupos educativos y vigilancia en salud definen el cuidado colectivo. Se concluye que el proceso de formación está propiciando conceptos críticos acerca del cuidado colectivo en la atención primária, pero es necesario superar perspectivas idealizadas.


Assuntos
Humanos , Masculino , Feminino , Atenção Primária à Saúde , Educação em Enfermagem , Enfermagem em Saúde Comunitária , Saúde da Família , Serviços de Saúde Comunitária , Brasil , Pesquisa
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