Cardiorespiratory optimal point in post-COVID-19 patients: a cross-sectional study

ABSTRACT The varied clinical presentations of SARS-CoV-2 infection have raised concerns about long-term consequences, especially "long-COVID" or "post-COVID-19 syndrome." In this context, the cardiorespiratory optimal point (COP) within the Cardiopulmonary Exercise Test (CPET) emerges as a crucial metric for evaluating functional capacities and detecting cardiovascular and pulmonary anomalies post-COVID-19. This study aimed to assess COP values among post-COVID-19 patients and categorized them based on the initial severity of their disease. In this cross-sectional study conducted in the Northeast Brazil, 80 patients (26 females and 54 males) previously infected with SARS-CoV-2 underwent CPET. We clinically stratified patients into mild, moderate, or severe COVID-19 categories and assessed COP values and other cardiorespiratory metrics. We found differences in the predicted COP between patients with mild and severe COVID-19 (p=0.042). Additionally, patients with moderate and severe COVID-19 record had an average COP value exceeding 22. Other parameters, including respiratory exchange ratio, heart rate, and oxygen uptake efficiency slope, did not differ across the groups. Patients with a history of severe COVID-19 showed altered COP values, suggesting potential discrepancies in cardiovascular and respiratory system integration. The outcomes emphasize the importance of continuous monitoring and assessment of the cardiorespiratory domain for post-COVID-19 patients. Further research is needed to understand the relationship between elevated COP in post-severe COVID-19 and its long-term prognostic implications.

Religiosity and Spirituality: The Relationship Between Psychosocial Factors and Cardiovascular Health

Abstract Background: Religiosity and Spirituality (R/S), despite being different entities, are multidimensional constructs, whose influence on cardiovascular health has been increasingly studied in recent decades. Objectives: To discriminate patients into subgroups according to R/S levels, in order to compare them regarding the distribution of cardiovascular comorbidities and clinical events. Methods: This is an observational, cross-sectional, analytical study. Two R/S scales were applied to a sample of patients seen at cardiology outpatient clinics. A cluster analysis was used to discriminate individuals into subgroups regarding R/S levels, which were subsequently compared regarding the frequencies of clinical variables related to cardiovascular health. A significance level of 5% was set for the statistical tests. Results: The sample included 237 patients with a mean age of 60.8 years (±10.7), of which 132 were female (55.7%). Cluster analysis (C) distinguished two groups: C1, with lower levels of R/S, and C2, with higher levels of R/S (p<0.001). C2 had a lower frequency of alcohol consumption (29.5% vs. 76.0%; p<0.001), smoking (12.9% vs. 51.0%; p<0.001), systemic arterial hypertension (SAH — 65.5% vs. 82.3%; p=0.005), dyslipidemia (58.3% vs. 77.1%; p=0.003), chronic coronary syndrome (36.7% vs. 58.3%; p=0.001), and prior cardiovascular events (15.8% vs. 36.5%; p<0.001) when compared to C1. There was also a higher frequency of females in C2 (82.0% vs. 17.7%; p<0.001). Conclusions: A better cardiovascular morbidity profile was observed in the group of patients with higher R/S levels, suggesting a probable positive relationship between R/S and cardiovascular health.

Non-Targeted Self-Measured Blood Pressure and Hypertension Control in Public and Private Health Systems in Brazil

Abstract Background: It is estimated that more than 30% of the Brazilian population has systemic arterial hypertension (SAH), and mostly as an uncontrolled disease. The most recent Brazilian Guideline of Hypertension recommends the practice of self-measurement of blood pressure (BP) as one of the strategies for a better control of SAH, but there is no consensus about the efficiency of this tool. Objective: To assess the control of SAH and the practice of non-targeted self-measured BP (SMBP) among hypertensive users of the Unified Health System (SUS) and the Supplementary Network (SN). Methods: This is a cross-sectional, observational, analytical study, with a stratified probability sample. One thousand volunteers were investigated, being 500 from SUS and 500 from the SN. Uni and multivariate analyses were performed considering a 5% significance level. Results: Patients from SUS presented inferior sociodemographic data (schooling, social status) in relation to those of the SN (p < 0.001), and showed lower control of SAH (p = 0.014), as well as more visits to the emergency room in the past year due to hypertension (p = 0.002), and fewer regular appointments with the cardiologist (p = 0.004). SMBP was equally present in both assessed groups (p = 0.567), even though users of the SN have been more advised to not conduct such a practice (p = 0.002). SMBP (p < 0.001) was an independent factor for uncontrolled SAH both in SUS (OR = 3.424) and in the SN (OR = 3.474). Conclusion: Patients in SUS presented lower SAH control. The practice of SMBP, mostly practiced with an uncalibrated digital device, was equally present in both groups and became an independent factor of uncontrolled SAH.

Resposta Exagerada da Pressão Arterial Sistólica ao Exercício e Isquemia Miocárdica à Ecocardiografia sob Estresse Físico / Exaggerated Systolic Blood Pressure Increase with Exercise and Myocardial Ischemia on Exercise Stress Echocardiography

Resumo Fundamento A associação entre resposta exagerada da pressão arterial sistólica ao exercício (REPASE) e isquemia miocárdica é controversa e pouco estudada em indivíduos com síndrome coronariana crônica estabelecida ou suspeita. Objetivo Verificar a relação entre isquemia miocárdica e REPASE em indivíduos submetidos à ecocardiografia sob estresse físico (EEF). Métodos Trata-se de estudo transversal com 14.367 indivíduos submetidos à EEF, de janeiro de 2000 a janeiro de 2022, divididos em dois grupos: G1 - composto por pacientes cuja pressão sistólica de pico apresentou incremento ≥ 90 mmHg (valor correspondente ao percentil 95 da população estudada) -, e G2 - formado por indivíduos que não apresentaram resposta hipertensiva exagerada. Os grupos foram comparados mediante os testes t de Student e qui-quadrado. Foram considerados significativos os valores de p < 0,05. Realizou-se, também, regressão logística para identificação de fatores de risco independentes para isquemia miocárdica, REPASE, queixa de precordialgia típica prévia ao exame e angina durante o teste. Resultados Dos 14.367 pacientes, 1.500 (10,4%) desenvolveram REPASE e 7.471 (52,0%) eram do sexo feminino. Os percentuais de queixa prévia de precordialgia típica, angina durante o teste e isquemia miocárdica dos pacientes com REPASE foram de 5,8%, 2,4% e 18,1% contra 7,4%, 3,9% e 24,2%, em indivíduos sem REPASE, respectivamente (p = 0,021, p = 0,004, p < 0,001). Na análise multivariada, a REPASE foi associada, independentemente, a uma menor probabilidade de isquemia miocárdica (odds ratio: 0,73; intervalo de confiança de 95%: 0,58 a 0,93; p = 0,009). Conclusão O incremento exagerado da pressão arterial sistólica durante a EEF pode ser um marcador de exclusão de isquemia miocárdica.

Abstract Background The association between exaggerated systolic blood pressure response to exercise (ESBPRE) and myocardial ischemia is controversial and little studied in patients with established or suspected chronic coronary syndrome. Objective To verify the relationship between myocardial ischemia and ESBPRE in patients undergoing exercise stress echocardiography (ESE). Methods This is a cross-sectional study with 14,367 patients undergoing ESE, from January 2000 to January 2022, divided into the following 2 groups: G1, composed of patients whose peak systolic pressure increased ≥ 90 mmHg (value corresponding to the 95th percentile of the study population), and G2, patients who did not demonstrate an exaggerated hypertensive response. The groups were compared using Student's t and chi-square tests. P values < 0.05 were considered significant. Logistic regression was also performed to identify independent risk factors for myocardial ischemia, ESBPRE, complaints of typical chest pain prior to the exam, and angina during the test. Results Of the 14,367 patients, 1,500 (10.4%) developed ESBPRE, and 7,471 (52.0%) were female. The percentages of previous complaints of typical chest pain, angina during the test, and myocardial ischemia in patients with ESBPRE were 5.8%, 2.4% and 18.1%, compared to 7.4%, 3.9%, and 24.2%, in patients without ESBPRE, respectively (p = 0.021,p = 0.004, p < 0.001). In multivariate analysis, ESBPRE was independently associated with a lower probability of myocardial ischemia (odds ratio: 0.73; 95% confidence interval: 0.58 to 0.93; p = 0.009). Conclusion Exaggerated increase in systolic blood pressure during ESE may be a marker for excluding myocardial ischemia.

Subclinical Systolic Dysfunction during Chemotherapy for Breast Cancer

Abstract Background Cardiotoxicity is the main complication related to cancer therapy. Studies indicate that global longitudinal strain is an early detector of subclinical dysfunction of the left ventricle, preceding the decline in ejection fraction (EF). However, the reproducibility of such methodology has not been tested outside specialized centers. Objectives To assess the frequency of subclinical cardiotoxicity and to compare global longitudinal strain and EF measurements during the clinical course of patients undergoing chemotherapy for breast cancer. Methods This was an observational prospective study of 78 adult women who underwent serial echocardiograms (baseline and 1, 3, and 6 months after the beginning of chemotherapy), to evaluate biplane and 3D EF and global longitudinal strain. Cardiotoxicity and subclinical dysfunction were defined according to American Society of Echocardiography/European Association of Cardiovascular Imaging criteria. Statistical significance was set at p < 0.05. Results The mean age of the patients was 50.1 ± 11.48 years. The frequency of subclinical cardiotoxicity (defined by global longitudinal strain) was 14.9% after 30 days of chemotherapy, 16.7% after 3 months, and 19.7% after 6 months, compared to 4.5%, 3%, and 6.6%, respectively, when clinical cardiotoxicity was determined according to EF. The group that developed subclinical cardiotoxicity by 30 days (group A) had a higher frequency of clinical cardiotoxicity at 3 months (p=0.028) and a lower mean biplane EF after 30 days (p= 0.036) than the group that showed no evidence of subclinical cardiotoxicity (group B). Conclusion Subclinical cardiotoxicity was frequent and began early, being associated with a drop in EF during the clinical course.

Grau de conhecimento das gestantes do serviço público sobre parto humanizado / Level of knowledge of pregnant women in the public service about humanized birth

INTRODUÇÃO: A conscientização das gestantes é fundamental para experiências positivas de parto. OBJETIVO: Avaliar o grau de conhecimento das gestantes em dois serviços públicos sobre parto humanizado. Caracterizar epidemiologicamente a população estudada. MÉTODOS: Estudo descritivo realizado entre julho e agosto de 2017. Amostra com 297 gestantes foram selecionadas 200 após aplicação dos critérios de exclusão. Utilizados testes estatísticos de associações de variáveis (Qui-quadrado e Exato de Fisher). RESULTADOS: A média de idade das gestantes foi 26,6 anos. A maioria era procedente do interior do estado (72,5%), com renda até um salário mínimo (90,5%), e com mais de oito anos de estudo (62,5%). 71% iniciaram pré-natal até o primeiro trimestre e o pré-natal foi conduzido por médico em 72% dos casos. 71% preferiam parto normal e 44% tinha medo de cesárea. Profissional pré-natalista não ofereceu informações para 66,5%. 30,5% conhecia parto humanizado, destas 83,6% apresentaram conceito adequado. Houve associação entre conhecimento sobre parto humanizado e procedência (Aracaju) (p=0,03), maior renda (p=0,02), menor ocorrência de aborto (p=0,04), médico pré-natalista (p=0,04) preferência pelo parto vaginal (p=0,04). Dentre as que não conheciam o parto humanizado houve associação de respostas corretas com a maior renda (p=0,03) e anos estudados (p=0,02) e médico pré-natalista (p=0,01). CONCLUSÃO: A maioria desconhecia o parto humanizado, era procedente do interior com menor renda, preferência por parto normal, sem informações quanto aos tipos de parto pelo profissional executante (na maioria médicos), quem conhecia adequadamente. Conceitos adequados sobre parto humanizado mesmo na ausência de informação prévia associaram-se às variáveis socioeconômico e pré-natal.

INTRODUCTION: The awareness of pregnant women is fundamental to positive birth experiences. OBJECTIVE: To analyze the level of knowledge on humanized birth of pregnant women from two public services and characterize the sample epidemiologically. METHODS: Descriptive study using questionnaire between June and August 2017. Sample with 297 pregnant women being selected 200 after applying the exclusion criteria. Association test of variables were used (Chi-square and Fisher's exact test). RRESULTS: Mean age was 26.6 years. Majority were from countryside (72.5%), income up to a minimum wage (90.5%) and more of eight years of education (62.5%). 71% started prenatal care in the first trimester and it was conducted by physician in 71% of cases. 71% preferred vaginal delivery and 44% related fear of cesarean. Prenatal professional in charge did not provide information for 66.5%. 30.5% have heard about humanized childbirth, among these, 83.6% showed adequate concepts. Associations were observed between prior knowledge of humanized childbirth and origin (Aracaju) (p=0.03), higher income (p=0.02), lower abortion incidence (p=0.04), prenatal physician (p=0.04) and preference for normal childbirth (p=0.04). Among women without previous knowledge on humanized childbirth there association of correct concept with higher income (p=0.03), schooling (p=0.02) and prenatal physician (p=0.01). CONCLUSION: The majority did not know about humanized delivery, were from the countryside with lower income, preference for normal birth, were not informed on the types of delivery by the professional practitioner (in majority doctors), whom knew properly. Adequate concepts about humanized childbirth, even in the absence of prior information, were associated to socio-economic and prenatal variables.

Burnout Syndrome in medical internship students and its prevention with Balint Group

SUMMARY BACKGROUND: We intend to estimate the Burnout Syndrome prevalence and its associated factors among medical internship students at a public university in northeastern Brasil, besides investigating the Balint Group (BG) contribution in its prevention. METHODS: We conducted a cross-sectional study in February/2018 with Medical Internship Students at the University researched. We applied a structured questionnaire developed by the authors about socio-demographic data, educational process with BG participation, and current psycho-emotional experiences, in addition to the Maslach Burnout Inventory - Student Survey (MBI-SS), for Burnout Syndrome screening. We performed descriptive data analysis, logistic regression, and cluster analysis. RESULTS: A total of 184 students (98%) participated in the study, with a mean age of 25.9±3.9 years, of which 54.9% were men. The prevalence of Burnout Syndrome was 10.3% based on the three-dimensional criterion and 35.9% on two-dimensional criterion (Exhaustion and Cynicism); it was higher in those who thought about quitting the program (OR=2.14), were dissatisfied with the teaching strategies (OR=2.67) and their performance (OR=2.64) and made use of licit drugs (OR=2.37). The variables associated with Burnout Syndrome allowed individuals to be discriminated, classifying them into three subgroups. Burnout Syndrome prevalence decreased, and vulnerability factors were attenuated when there was a higher frequency of students participating in BG. CONCLUSIONS: The prevalence of two-dimensional Burnout Syndrome was high, with factors associated with the educational process. Participation in BG was associated with a lower Burnout rate prevalence. Longitudinal studies should be conducted.

RESUMO OBJETIVO: Estimar a prevalência de Síndrome de Burnout (SB) e fatores associados entre os internos de medicina de uma universidade pública no Nordeste do Brasil, além de investigar a contribuição do Grupo Balint (GB) na sua prevenção. MÉTODOS: Estudo transversal em fevereiro/2018 com os internos de medicina da universidade pesquisada. Aplicou-se um questionário estruturado elaborado pelos autores sobre características sociodemográficas, processo educacional com participação do GB e vivências psicoemocionais atuais, além do Maslach Burnout Inventory - Student Survey (MBI-SS) para triagem de SB. Realizaram-se análise descritiva, regressão logística e análise de agrupamentos. RESULTADOS: Participaram 184 estudantes (98%), com idade média de 25,9±3,9 anos, sendo 54,9% do sexo masculino. A prevalência de SB foi 10,3% pelo critério tridimensional e 35,9% pelo bidimensional (Exaustão e Descrença), sendo maior naqueles que pensaram em abandonar o curso (OR=2,14), estavam insatisfeitos com as estratégias de ensino (OR=2,67) e com seu desempenho acadêmico (OR=2,64) e faziam uso de drogas lícitas (OR=2,37). As variáveis associadas à SB permitiram discriminar os indivíduos classificando-os em três subgrupos. A prevalência de SB diminuiu e fatores de vulnerabilidade foram atenuados quando houve maior frequência de estudantes participantes do GB. CONCLUSÕES: A prevalência de SB pelo critério bidimensional foi alta, com fatores associados ao processo educacional. A participação no GB foi associada à menor prevalência de SB. Estudos longitudinais devem ser realizados.

Consumo leve a moderado de álcool e isquemia miocárdica à ecocardiografia sob estresse físico / Low to moderate alcohol consuption and myocardial ischemia on exercise stress echocardiography

Fundamento: O impacto do consumo de álcool na evolução da isquemia miocárdica permanece incerto. Os estudos divergem quanto a um eventual efeito cardioprotetor ou a um fator de risco cardiovascular desse consumo de maneira leve a moderada. Objetivo: Estudar a relação do consumo leve a moderado de álcool com a isquemia miocárdica à ecocardiografia sob estresse físico (EEF). Métodos: Estudo transversal composto por 6632 pacientes submetidos à EEF, de janeiro de 2000 a dezembro de 2015. Dividiram-se dois grupos: G1 - composto por 2130 (32,1%) pacientes com relato de consumo médio igual ou inferior a 1 dose de bebida alcoólica por dia para mulheres ou de 2 doses para homens; e G2 - formado por 4502 (67,9%) indivíduos que negaram consumo de álcool. A comparação entre os grupos foi feita mediante teste t de Student para variáveis quantitativas, e teste qui-quadrado ou teste de Fisher para as variáveis categóricas. Foram considerados significativos os valores de p < 0,05. Realizou-se, também, regressão logística para identificação de fatores de risco independentes para isquemia miocárdica. Resultados: G1 apresentou maior frequência de indivíduos do sexo masculino (77,1%; p < 0,001), menor idade média (54,8 ± 10,3 anos; p < 0,001) e maior frequência de isquemia miocárdica à EEF (p = 0,014). Idade, sexo masculino, dislipidemia, hipertensão arterial sistêmica, diabete melito, tabagismo e história familiar positiva apresentaram-se independentemente associados à presença de isquemia miocárdica à EEF. Não foi observada associação independente entre etilismo leve a moderado e isquemia miocárdica (OR 0,96; IC 95%: 0,83-1,11). No entanto, observou-se associação entre idade, sexo masculino, tabagismo e dislipidemia com o consumo de álcool. Conclusão: Etilismo leve a moderado não se apresentou como preditor independente de presença de isquemia miocárdica à EEF. Observou-se, no grupo dos etilistas, um predomínio de homens, dislipidêmicos e tabagistas, importantes variáveis preditoras de isquemia miocárdica

Background: The impact of alcohol consumption on the development of myocardial ischemia remains uncertain. Studies diverge whether low to moderate alcohol consumption provides cardioprotection or whether it is a risk factor for myocardial ischemia. Objective: To study the relationship between low to moderate alcohol consumption and myocardial ischemia on exercise stress echocardiography (ESE). Methods: Cross-sectional study with 6632 patients with known or suspected coronary artery disease undergoing ESE between January/2000 and December/2015. The patients were divided into two groups: G1, composed of 2130 (32.1%) patients whose report showed maximal consumption of 1 drink per day on average for women or of 2 drinks per day for men; G2, composed of individuals denying any alcohol consumption. For comparing between the groups, Student t test was used for quantitative variables, and chi-square test or Fisher exact test, for categorical variables. The significance level adopted was p < 0.05. Logistic regression was also used to evaluate independent risk factors for myocardial ischemia. Results: G1 had a higher number of men (77.1%; p < 0.001), lower mean age (54.8 ± 10.3 years old; p < 0.001) and higher frequency of myocardial ischemia on ESE (p = 0.014). Age, male sex, dyslipidemia, systemic arterial hypertension, diabetes mellitus, smoking and family history were independently associated with myocardial ischemia on ESE. Independent association between low to moderate alcohol consumption and myocardial ischemia on ESE (OR 0.96; 95%CI: 0.83 to 1.11) was not observed. However, age, male sex, smoking and dyslipidemia were associated with alcohol consumption. Conclusion: Low to moderate alcohol consumption was not an independent predictor of myocardial ischemia on ESE. Nevertheless, we observed a predominance of the male sex, dyslipidemia and smoking habit, important predictors of myocardial ischemia, in the group of alcohol consumers

Caracterização clínica dos pacientes com hemoglobinopatia atendidos no Hemocentro de Sergipe / Clinical characterization of patients with hemoglobinopathy at Sergipe's Hemocentro

Descrever as características clínicas dos pacientes com hemoglobinopatias do Hemocentro de Sergipe. Neste estudo transversal foram coletados dados clínicos dos pacientes portadores de hemoglobinopatias através da leitura dos prontuários. Realizou-se estatística descritiva e análise de variáveis utilizando-se o teste ANOVA para comparação de médias e o teste exato de Fisher para associação, utilizando em ambos uma significância com p<0,05. Foram coletados os dados de 96 pacientes. A principal hemoglobinopatia encontrada foi a SS (85,4%), seguida da SC (11,5%) e ßtalassemia (3,1%). A principal complicação encontrada foi a hiperferritinemia (50,7%), que teve uma relação direta com a hemotransfusão (p=0,039) e os pacientes com mais complicações tinham uma maior idade (p=0,026). A hemotransfusão foi necessária em 71,9% dos pacientes, enquanto que a hidroxiureia e o deserafirox em 40,6% e 13,5%, respectivamente. A principal hemoglobinopatia encontrada foi SS, teve como principal complicação a hiperferritinemia e o principal tratamento realizado foi a hemotransfusão.

To describe the clinical characteristics of patients with hemoglobinopathies at the Blood Center of Sergipe. In this cross-sectional study, clinical data were collected from patients with hemoglobinopathies by reading the medical records. Descriptive statistics and variable analysis were performed using the ANOVA test for comparison of means and Fisher's exact test for association, using a significance level of p<0.05. Data were collected from 96 patients. The main hemoglobinopathy found was SS (85.4%), followed by SC (11.5%) and ß-thalassemia (3.1%). The main complication was hyperferritinemia (50.7%), which had a direct relationship with blood transfusion (p=0.039) and patients with more complications had an older age (p=0.026). Hemotransfusion was required in 71.9% of the patients, whereas hydroxyurea and deserafirox in 40.6% and 13.5%, respectively. The main hemoglobinopathy found was SS, the main complication was hyperferritinemia and the main treatment was hemotransfusion.

Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography / Placa Aterosclerótica à Angiotomografia de Coronárias em Pacientes com Escore de Cálcio Zero

Abstract Background: In view of the high mortality for cardiovascular diseases, it has become necessary to stratify the main risk factors and to choose the correct diagnostic modality. Studies have demonstrated that a zero calcium score (CS) is characteristic of a low risk for cardiovascular events. However, the prevalence of individuals with coronary atherosclerotic plaques and zero CS is conflicting in the specialized literature. Objective: To evaluate the frequency of patients with coronary atherosclerotic plaques, their degree of obstruction and associated factors in patients with zero CS and indication for coronary computed tomography angiography (CCTA). Methods: This is a cross-sectional, prospective study with 367 volunteers with zero CS at CCTA in four diagnostic imaging centers in the period from 2011 to 2016. A significance level of 5% and 95% confidence interval were adopted. Results: The frequency of atherosclerotic plaque in the coronary arteries in 367 patients with zero CS was 9.3% (34 individuals). In this subgroup, mean age was 52 ± 10 years, 18 (52.9%) were women and 16 (47%) had significant coronary obstructions (> 50%), with involvement of two or more segments in 4 (25%) patients. The frequency of non-obese individuals (90.6% vs 73.9%, p = 0.037) and alcohol drinkers (55.9% vs 34.8%, p = 0.015) was significantly higher in patients with atherosclerotic plaques, with an odds ratio of 3.4 for each of this variable. Conclusions: The frequency of atherosclerotic plaque with zero CS was relatively high, indicating that the absence of calcification does not exclude the presence of plaques, many of which obstructive, especially in non-obese subjects and alcohol drinkers.

Resumo Fundamento: Diante da alta mortalidade por doenças cardiovasculares, faz-se necessária a estratificação dos principais fatores de riscos e escolha correta da modalidade diagnóstica. Estudos demonstraram que escore de cálcio (EC) zero caracteriza baixo risco de eventos cardiovasculares. No entanto, a frequência de portadores de placa aterosclerótica coronária com EC zero é conflitante na literatura especializada. Objetivo: Avaliar a frequência de pacientes com placa aterosclerótica coronária, seu grau de obstrução e fatores associados em pacientes com EC zero e indicação para angiotomografia computadorizada de coronárias (ATCC). Métodos: Trata-se de estudo transversal, prospectivo, com 367 voluntários portadores de EC zero, mediante a ATCC, no período de 2011-16, em quatro centros de diagnóstico por imagem. Foi assumido nível de significância 5% e intervalo de confiança de 95%. Resultados: A frequência de placa aterosclerótica nas artérias coronárias dos 367 pacientes com EC zero foi de 9,3% (34 indivíduos); neste subgrupo, a média de idade foi 52 ± 10 anos, 18 (52,9%) eram mulheres e 16 (47%) exibiam obstruções coronarianas significativas (> 50%), dos quais 4 (25%) apresentaram placas em pelo menos dois segmentos. A frequência de não obesos (90,6% vs. 73,9%; p = 0,037) e de etilistas (55,9% vs. 34,8%; p = 0,015) foi significativamente maior nos portadores de placa, apresentando, cada variável, odds ratio de 3,4 para o desenvolvimento das referidas placas. Conclusões: A frequência de placa aterosclerótica com EC zero foi considerável, evidenciando, portanto, que a ausência de calcificação não exclui placa, muitas das quais obstrutivas, principalmente nos não obesos e etilistas.

Cardiopulmonary exercise testing in patients with left bundle branch block and preserved ejection fraction / Teste de Esforço cardiopulmonar em portadores de bloqueio do ramo esquerdo e fração de ejeção preservada

BACKGROUND: Left bundle branch block (LBBB) has prognostic significance in patients with congestive heart failure. However, its influence is not well established in patients with preserved systolic ventricular function. OBJECTIVE: To evaluate the implications of LBBB presence in the cardiovascular performance of patients with preserved left ventricular systolic function (LVEF). METHODS: 26 LBBB patients (61.3 ± 8.2 years of age) and 23 healthy individuals (58 ± 6.8 years of age) with LVEF > 0.5 underwent cardiopulmonary exercise testing (CPET). RESULTS: CPET analysis revealed: peak oxygen consumption (VO2 ) predicted in the LBBB group was 87.2 ± 15.0% versus 105.0 ± 15.6% (p < 0.0001); peak oxygen pulse predicted in LBBB group was 98.6 ± 18.6% vs 109.9 ± 13.5% (p = 0.02); VO2 predicted anaerobic threshold in LBBB group was 67.9 ± 13.6% vs 70.2 ± 12.8% (p = 0.55); ΔVO2 /Δload in the LBBB group was 15.5 ± 5.51 versus 20.7 ± 7.3 ml.min-1.watts-1 (p = 0.006); ventilation / carbon dioxide production (VE/VCO2 slope) in LBBB group was 29.8 ± 2.9 versus 26.2 ± 2.9 (p = 0.0001) and VO2 recovery time in the LBBB group was 85.2 ± 11.8 vs. 71.5 ± 11.0 seconds (p = 0.0001). LBBB was an independent marker for VE/VCO2 slope increase. CONCLUSION: LBBB presence in individuals with preserved LVEF did not affect cardiovascular performance, but there was an increase of the VE/VCO2 slope in comparison to the control group.

FUNDAMENTO: O bloqueio do ramo esquerdo (BRE) tem importância prognóstica em portadores de insuficiência cardíaca congestiva. Todavia, a sua influência não está bem estabelecida em pacientes com função ventricular sistólica preservada. OBJETIVO: Avaliar as implicações da presença do BRE no desempenho cardiovascular em pacientes com função sistólica do ventrículo esquerdo (FEVE) preservada. MÉTODOS: Foram submetidos ao teste de esforço cardiopulmonar (TECP), 26 portadores de BRE (61,3 ± 8,2 anos) e 23 indivíduos saudáveis (58 ± 6,8 anos), com FEVE > 0,5. RESULTADOS: A análise do TECP revelou: consumo de oxigênio (VO2 ) pico predito no grupo BRE foi de 87,2 ± 15,0% versus 105,0 ± 15,6% (p < 0,0001); pulso de oxigênio pico predito no grupo BRE foi de 98,6 ± 18,6% versus 109,9 ± 13,5%, (p = 0,02); VO2 predito limiar anaeróbico no grupo BRE foi de 67,9 ± 13,6 % versus 70,2 ± 12,8% (p = 0,55); ∆VO2 /∆carga no grupo BRE foi de 15,5 ± 5,51 versus 20,7 ± 7,3 ml.min-1.watts-1 (p = 0,006); relação ventilação/produção de dióxido de carbono (VE/VCO2 slope) no grupo BRE foi de 29,8 ± 2,9 versus 26,2 ± 2,9 (p = 0,0001) e tempo de recuperação do VO2 no grupo BRE foi de 85,2 ± 11,8 versus 71,5 ± 11,0 segundos (p = 0,0001). O BRE foi marcador independente para o aumento do VE/VCO2 slope. CONCLUSÃO: A presença de BRE em indivíduos com FEVE preservada não comprometeu o desempenho cardiovascular, mas houve aumento do VE/VCO2 slope em relação ao grupo controle.

Saúde Mental de Estudantes de Escolas Médicas com Diferentes Modelos de Ensino / Medical Students’ Mental Health under Different Educational Models

RESUMO Objetivos Avaliar a saúde mental dos estudantes, estratégias defensivas, fontes de estresse e alívio associadas a diferentes processos educacionais. Método Estudo qualitativo e transversal realizado em fevereiro de 2014 por meio de grupos focais e questionário semiestruturado com 78 estudantes do terceiro semestre de duas escolas médicas numa mesma universidade pública: uma com 53 anos, na capital, com modelo de ensino tradicional, e a outra com três anos, no interior,com modelo de Aprendizagem Baseada em Problemas (ABP). Foi realizada análise descritiva dos dados sociodemográficos, psicoemocionais e processo educacional do questionário e análise de conteúdo temática, além de interpretação psicodinâmica dos dados dos grupos focais. Resultados Responderam ao questionário 38 alunos da escola tradicionale 40 daABP, sendo a maioria do sexo masculino (52,6%), com idade 22+2 anos e solteiros (85%). Dois grupos focais com oito alunos de cada escola revelaram motivações, fontes de estresse e de alívio semelhantes entre os alunos, porém sofrimento psíquico menor nos alunos da ABP, que também referiram maior aproximação de seus professores e pactuação das tarefas. Conclusão O processo educacional foi associado a sofrimento psíquico por alunos de ambos os grupos.

ABSTRACT Objectives To evaluate student mental health, defensive strategies, sources of stress, and relief associated with different educational processes. Methods A qualitative and cross-sectional study was carried out in February 2014 through focus groups and semi-structured questionnaireson 78 students in the 3rd semester at two medical schools in the same public university: one with a 53-year history based in the state capital and that uses traditional teaching models, and the other founded only 3 years ago, located in the interior of the state and using Problem Based Learning (PBL). We carried out a descriptive analysis of the dataemergent from the questionnaire andperformed thematic content analysis, along with a psychodynamicinterpretationof data fromfocus groups. Results 38 students from the traditional school and 40 students from the PBL school answered the questionnaire. Most were men(52.6%) aged 22+2years and single(85%). Twofocus groups with8students fromeach schoolrevealedsimilar motivations, sources of stress andreliefamong students, but less psychological distresswas registered inPBLstudents,who reported greatercloseness with teachersand agreementon tasks. Conclusion Educationalprocesseswere associated withpsychological distress amongstudentsin both groups.

Preditores de Placa Aterosclerótica em Assintomáticos Isquêmicos à Ecocardiografia sob Estresse Físico / Predictors of Atherosclerotic Plaque in Individuals with Asymptomatic Ischemia on Physical Stress Echocardiography

A isquemia miocárdica pode ocorrer em pacientes assintomáticos e sem história de doença arterial coronariana (DAC). A ecocardiografia sob estresse físico (EEF) é um método de boa acurácia diagnóstica, enquanto a cineangiocoronariografia (CATE) é o método padrão-ouro para detecção de DAC obstrutiva. Todavia, muitos portadores de isquemia em testes funcionais apresentam lesões não obstrutivas à CATE. Objetivo: Identificar a presença de preditores de placas ateroscleróticas obstrutivas à CATE em indivíduos assintomáticos com EEF positiva para isquemia miocárdica. Métodos: Estudo transversal com 278 pacientes assintomáticos submetidos à EEF e à CATE, divididos em grupo G1 (lesões ateroscleróticas obstrutivas ≥ 50%) e G2 (placas inferiores a 50% ou inexistentes). Variáveis quantitativas foram comparadas com os testes t de Student ou Mann-Whitney para grupos independentes, segundo a normalidade da amostra. Para variáveis categóricas, utilizou-se os testes do qui-quadrado ou exato de Fisher, quando apropriado. Para identificação de preditores independentes de lesão aterosclerótica, foi utilizada regressão logística. Resultados: O número de pacientes nos grupos G1 e G2 foi de 233 (83,3%) e 45 (16,2%), respectivamente. A média de idade foi maior no G1 (60,9 ± 9,56 anos versus 51,8 ± 10,05 anos, respectivamente, p < 0,001). O G1 em comparação ao G2 apresentou mais pacientes hipertensos (65,2% versus 48,9%, p = 0,03) e dislipidêmicos (77,3% versus 57,8%, respectivamente, p = 0,006). O G2 em comparação ao G1 apresentou maior frequência de obesidade leve (33,3% versus 14,2%, respectivamente, p = 0,002), que demonstrou ser um fator protetor para lesão aterosclerótica. Conclusão: Os preditores de placa aterosclerótica em assintomáticos isquêmicos à EEF foram idade, gênero masculino e isquemia do tipo fixa.

Myocardial ischemia may occur in asymptomatic patients without a history of coronary artery disease (CAD). Stress echocardiography (SE) is a method with good diagnostic accuracy, while coronary cineangiography (CCA) is the gold standard method to detect obstructive CAD. However, many patients with ischemia on functional tests show nonobstructive lesions on CCA. Objective: To assess the presence of predictors of obstructive atherosclerotic plaques in asymptomatic individuals with an SE positive for myocardial ischemia. Methods: Cross-sectional study with 278 asymptomatic individuals who underwent SE and CCA, divided into groups G1 (obstructive atherosclerotic lesions ≥ 50%) and G2 (plaques below 50% or nonexistent). Quantitative variables were compared with Student's t test or Mann-Whitney test for independent groups, according to the normality of the sample. For categorical variables, we used the chi-square test or Fisher's exact test, as appropriate. Logistic regression was used to identify independent predictors of atherosclerotic lesions. Results: The numbers of patients in G1 and G2 were 233 (83.3%) and 45 (16.2%), respectively. The mean age was higher in G1 (60.9 ± 9.56 years versus 51.8 ± 10.05 years, p < 0.001). G1, when compared with G2, had more patients with hypertension (65.2% versus 48.9%, respectively, p = 0.03) and dyslipidemia (77.3% versus 57.8%, respectively, p = 0.006). G2, when compared with G1, had a higher frequency of mild obesity (33.3% versus 14.2%, respectively, p = 0.002), which emerged as a protective factor for atherosclerotic lesions. Conclusion: The predictors of atherosclerotic plaques in asymptomatic patients with ischemia on SE were age, male gender, and fixed ischemia.

Low Prevalance of Major Events Adverse to Exercise Stress Echocardiography / Baixa Prevalência de Eventos Adversos Maiores à Ecocardiografia sob Estresse Físico

Abstract Background: Stress echocardiography is well validated for diagnosis and risk stratification of coronary artery disease. Exercise stress echocardiography (ESE) has been shown to be the most physiological among the modalities of stress, but its safety is not well established. Objective: To study the complications related to ESE and clinical and echocardiographic variables most commonly associated with their occurrence. Methods: Cross-sectional study consisting of 10250 patients submitted to ESE for convenience, from January 2000 to June 2014. Cardiac Arrhythmias (CA) were the most frequent complications observed during the examination. The volunteers were divided into two groups according to the occurrence of CA during ESE: G1 group, composed of patients who have CA, and G2 formed by individuals who did not show such complication. Results: Group G1, consisting of 2843 patients (27.7%), and Group G2 consisting of 7407 patients (72.3%). There was no death, acute myocardial infarction, ventricular fibrillation or asystole. Predominant CAs were: supraventricular extrasystoles (13.7%), and ventricular extrasystoles (11.5%). G1 group had a higher mean age, higher frequency of hypertension and smoking, larger aortic roots and left atrium (LA) and lower ejection fraction than G2. G1 group also had more ischemic changes (p < 0.001). The predictor variables were age (RR 1.04; [CI] 95% from 1.038 to 1.049) and LA (RR 1.64; [CI] 95% from 1.448 to 1.872). Conclusion: ESE proved to be a safe modality of stress, with non-fatal complications only. Advanced age and enlargement of the left atrium are predictive of cardiac arrhythmias.

Resumo Fundamento: A ecocardiografia sob estresse constitui metodologia validada para diagnóstico e estratificação de risco da doença arterial coronária. A ecocardiografia sob estresse físico (EEF) tem se destacado como a mais fisiológica dentre as modalidades de estresse, todavia sua segurança não está bem estabelecida. Objetivo: Estudar as complicações relacionadas à EEF e as variáveis clínicas e ecocardiográficas preditoras dessas ocorrências. Método: Estudo transversal composto por 10250 pacientes submetidos à EEF por conveniência, de janeiro de 2000 a junho de 2014. As arritmias cardíacas (AC) foram as complicações mais frequentemente encontradas durante o exame. Os voluntários foramdivididos em dois grupos, de acordo com a ocorrência de AC à EEF: grupo G1 - composto por pacientes que apresentaram AC e grupo G2 - formado por indivíduos que não exibiram tal complicação. Resultados: O grupo G1 com 2843 (27,7%) pacientes, e grupo G2 formado por 7407 (72,3%). Não foram registrados óbitos, infarto agudo do miocárdio, assistolia ou fibrilação ventricular. As extrassístoles supraventriculares (13,7%) e as ventriculares (11,5%) foram as AC predominantes. O grupo G1 apresentou idade média mais elevada, maior frequência de hipertensão arterial sistêmica e tabagismo, maiores dimensões da raiz da aorta e do átrio esquerdo (AE) e menor fração de ejeção do ventrículo esquerdo que o G2. O grupo G1 exibiu também, mais alterações isquêmicas (p < 0,001). As variáveis preditoras foram idade (RR 1,04; [IC] 95% 1,038 - 1,049) e AE (RR 1,64; [IC] 95% 1,448 - 1,872). Conclusão: A presente investigação demonstrou que a EEF é uma modalidade segura, ocorrendo apenas complicações não-fatais. Idade avançada e aumento da dimensão do AE são preditores da presença de arritmias cardíacas.

Level of Physical Activity and In-Hospital Course of Patients with Acute Coronary Syndrome / Nível de Atividade Física e Evolução Intra-Hospitalar de Pacientes com Síndrome Coronariana Aguda

Abstract Background: Acute coronary syndrome (ACS) is one of the main causes of morbidity and mortality in the modern world. A sedentary lifestyle, present in 85% of the Brazilian population, is considered a risk factor for the development of coronary artery disease. However, the correlation of a sedentary lifestyle with cardiovascular events (CVE) during hospitalization for ACS is not well established. Objective: To evaluate the association between physical activity level, assessed with the International Physical Activity Questionnaire (IPAQ), with in-hospital prognosis in patients with ACS. Methods: Observational, cross-sectional, and analytical study with 215 subjects with a diagnosis of ACS consecutively admitted to a referral hospital for cardiac patients between July 2009 and February 2011. All volunteers answered the short version of the IPAQ and were observed for the occurrence of CVE during hospitalization with a standardized assessment conducted by the researcher and corroborated by data from medical records. Results: The patients were admitted with diagnoses of unstable angina (34.4%), acute myocardial infarction (AMI) without ST elevation (41.4%), and AMI with ST elevation (24.2%). According to the level of physical activity, the patients were classified as non-active (56.3%) and active (43.7%). A CVE occurred in 35.3% of the cohort. The occurrence of in-hospital complications was associated with the length of hospital stay (odds ratio [OR] = 1.15) and physical inactivity (OR = 2.54), and was independent of age, systolic blood pressure, and prior congestive heart failure. Conclusion: A physically active lifestyle reduces the risk of CVE during hospitalization in patients with ACS.

Resumo Fundamento: A síndrome coronariana aguda (SCA) constitui uma das principais causas de morbimortalidade no mundo moderno. O sedentarismo, presente em 85% da população brasileira, é considerado fator de risco para o surgimento de doença arterial coronariana. Porém, não está bem estabelecida a correlação do sedentarismo com a ocorrência de eventos cardiovasculares (ECV) durante o internamento de portadores da SCA. Objetivo: Determinar o grau de atividade física de portadores de SCA, mediante a utilização do Questionário Internacional de Atividade Física (IPAQ), associando com o prognóstico intra-hospitalar. Métodos: Estudo observacional, transversal e analítico com 215 sujeitos admitidos consecutivamente com diagnóstico de SCA em um hospital de referência cardiológica no período de julho de 2009 a fevereiro de 2011. Todos os voluntários responderam à versão curta do IPAQ e foram seguidos quanto ao aparecimento de ECV durante o internamento, a partir de avaliação padronizada administrada pelo pesquisador, corroborada com dados do prontuário médico. Resultados: Os pacientes foram internados com diagnósticos de angina instável (34,4%), infarto agudo do miocárdio (IAM) sem supradesnivelamento de ST (41,4%) e IAM com supradesnivelamento de ST (24,2%). De acordo com o nível de atividade física, foram classificados em não ativos (56,3%) e ativos (43,7%). Constatou-se a presença de ECV em 35,3% da amostra. A ocorrência de complicação intra-hospitalar esteve associada ao tempo de internamento (odds ratio [OR] = 1,15) e inatividade física (OR = 2,54) e foi independente da idade, pressão arterial sistólica e insuficiência cardíaca congestiva prévia. Conclusão: Estilo de vida fisicamente ativo reduz o risco de ECV durante o internamento em pacientes com SCA.

Prevalence and Factors Associated at Presence of Central Nervous System Congenital Malformations.

Introduction: Congenital malformations are currently an important cause of morbidity and mortality in many countries, though in most cases their etiology is unknown. The central nervous system (CNS) is involved in many of these defects. Objective: To study the factors associated with CNS congenital malformations and their prevalence in infants born at a high risk maternity hospital in Northeastern Brazil. Materials and Methods: A case-control study performed from January 2010 to December 2011, with data from The Latin American Collaborative Study of Congenital Malformations. Results: Among the 8.405 registered births, 187 were malformed newborns (2.2%). Nervous system malformations were diagnosed in 61 patients (32.6% (CI = 95% 27.5 to 38.0)), the most frequent being neural tube defects and congenital hydrocephaly. Previous history of miscarriage and/or stillbirth (p = 0.008), family history of malformations (p < 0.001) and parental consanguinity (p = 0.028) are associated with CNS malformation. Environmental factors such as maternal chronic diseases, smoking, exposure to teratogenic drugs and alcohol presented no statistically significant differences. Conclusions: The genetic component was an important contributing factor to the etiology of the malformations studied.

Disfunções cardiovasculares em traumatismo raquimedular / Cardiovascular dysfunction in spinal cord trauma

Objetivo: Analisar frequência, tratamento e prognóstico das disfunções cardiovasculares em pacientes vítimas de traumatismo raquimedular (TRM). Métodos: Estudo longitudinal observacional, analítico e retrospectivo. Os dados foram coletados, retrospectivamente, de 49 pacientes da Unidade de Trauma, Hospital de Urgência de Sergipe, no período entre janeiro e dezembro de 2010. Resultados: A média de idade foi de 34,7 ± 17,2 anos, sendo 30 (61,2%) pacientes entre 20 e 60 anos. O gênero masculinofoi o mais acometido, sendo 44 (89,8%). O tempo médio de internação foi de 22,5 dias ± 21. As principais causas de TRM foram: 18 quedas (37%), 15 ferimentos por arma de fogo (31%) e 12 acidentes automobilísticos (24%). O TRM foi classificado em nível alto em 31 (63,3%) casos e nível baixo em 18 (36,7%). Durante a internação, cinco (10,2%) evoluíram com bradicardia e 13 (26,5%) apresentaram hipotensão arterial. Todos os casos de bradicardia tiveram hipotensão arterial associada. A média das PA sistólicas durante internação foi 109,1 ± 19,6 mmHg. A sobrevida global da amostra foi de 77,3% ± 7,5% em 20 dias. Os pacientes que apresentaram hipotensão arterial tiveram sobrevida menor em relação aos que não apresentaram. Nos pacientes com TRM nível alto, a sobrevida em 20 dias foi de 69,6% ± 9,8% e nível baixo de 88,9% ± 10,5%. Conclusões: Bradicardia e hipotensão arterial são as disfunções cardiovasculares mais frequentes e estão associadas ao TRM nível alto, tendo pior prognóstico no tipo lesão completa

Objective: Analyze frequency, treatment and prognosis of cardiovascular dysfunction in patients suffering from spinal cord trauma (TRM). Methods: Longitudinal observational, analytical and retrospective. Data were collected retrospectively from 49 patients of the Trauma Unit, Hospital Emergency Sergipe, in the period between January and December 2010. Results: Mean age was 34.7 ± 17.2, and 30 (61.2%) patients were between 20 and 60 years. The male was involved in 44 (89.8%). The mean hospital stay was 22.5 days ± 21. The main causes of TRM were 18 falls (37%), gunshot wounds 15 (31%) and motor vehicle accidents 12 (24%). The TRM was rated highest level in 31 (63.3%) cases and low 18 (36.7%). During hospitalization, five (10.2%) developed bradycardia and 13 (26.5%) had hypotension. All cases had bradycardia associated with hypotension. The average systolic BP during hospitalization was 109.1 ± 19.6 mmHg. The overall survival rate of the sample was 77.3% ± 7.5% in 20 days. Patientswho developed hypotension had lower survival than those who did not. In patients with high-level TRM survival at 20 days was 69.6% ± 9.8% and low level of 88.9% ± 10.5%. Conclusions: Bradycardia and hypotension are the most common cardiovascular disorders and are associated with high TRM level, with poorer prognosis in complete lesion type.

Common mental disorders and associated factors among final-year healthcare students / Transtornos mentais comuns e fatores associados entre estudantes de saúde do último ano

Objective: to assess the prevalence of common mental disorder (CMD) and to identify potential associated factors among medical, dental and nursing students. Methods: a cross-sectional study conducted in a public university in Northeast Brazil with 172 undergraduate students of the last three semesters of the medicine, dentistry and nursing courses, in February 2010, using the Self Reporting Questionnaire (SRQ-20) and a structured questionnaire developed by the authors. Logistic regression was performed for data analysis. Results: the prevalence of CMD was 33.7%. The courses presented no differences in CMD prevalence. The logistic regression analysis showed a strong association of the following variables with CMD: female (OR=4.34), lack of good expectations regarding the future (OR=5.83), course as not a source of pleasure (OR=7.52) and feeling emotionally tense (OR=11.23). Conclusion: the high prevalence suggests that immediate preventive measures should be implemented, such as the setting up of psycho-pedagogic support services for students, and teacher development programs. .

Objetivo: determinar a prevalência de transtorno mental comum (TMC) e identificar potenciais fatores associados entre estudantes de medicina, odontologia e enfermagem. Métodos: estudo transversal realizado em uma universidade pública no Nordeste do Brasil com 172 alunos de graduação dos últimos três semestres de Medicina, Odontologia e Enfermagem, em fevereiro de 2010, utilizando o Self Reporting Questionnaire (SRQ-20) e um questionário estruturado desenvolvido pelos autores. A análise dos dados foi realizada por regressão logística. Resultados: a prevalência de TMC foi de 33,7%. Os cursos não apresentaram diferenças na prevalência de TMC. A regressão logística mostrou uma forte associação entre as seguintes variáveis com TMC: sexo feminino (OR=4,34), não ter boas expectativas em relação ao futuro (OR=5,83), curso não ser uma fonte de prazer (OR=7,52) e sentir-se emocionalmente tenso (OR=11,23). Conclusão: a alta prevalência de TMC sugere que medidas preventivas imediatas devam ser implementadas, como: a criação de serviços de apoio psicopedagógico para alunos e programas de desenvolvimento docente. .

Preterm newborns at Kangaroo Mother Care: a cohort follow-up from birth to six months / Recién nacidos prematuros asistidos por el Método Canguro: evaluación de una cohorte del nacimiento a los seis meses / Recém-nascidos prematuros assistidos pelo Método Canguru: avaliação de uma coorte do nascimento aos seis meses

To evaluate clinical outcomes, growth and exclusive breastfeeding rates in premature infants assisted by Kangaroo Mother Care at birth, at discharge and at six months of life. METHODS: Prospective study of a premature infants cohort assisted by Kangaroo Mother Care in a tertiary public maternity in Northeast Brazil with birth weight ≤1750g and with clinical conditions for Kangaroo care. RESULTS: The sample was composed by 137 premature infants, being 62.8% female, with average birth weight of 1365±283g, average gestational age of 32±3 weeks and 26.2% were adequate for gestational age. They have been admitted in the Kangaroo Ward with a median of 13 days of life, weighing 1430±167g and, at this time, 57.7% were classified as small for corrected gestational age. They were discharged with 36.8±21.8 days of chronological age, weighing 1780±165g and 67.9% were small for corrected gestational age. At six months of life (n=76), they had an average weight of 5954±971g, and 68.4% presented corrected weight for gestational age between percentiles 15 and 85 of the World Health Organization (WHO) weight curve. Exclusive breastfeeding rate at discharge was 56.2% and, at six months of life, 14.4%. CONCLUSIONS: In the studied sample, almost two thirds of the children assisted by Kangaroo Mother Care were, at six months of life, between percentiles 15 and 85 of the WHO weight curves. The frequency of exclusive breastfeeding at six months was low...

Evaluar la evolución clínica, el crecimiento y la tasa de lactancia materna exclusiva de recién nacidos prematuros asistidos por el Método Canguro, al nacimiento, en el alta y a los seis meses de edad. MÉTODOS: Estudio prospectivo de una cohorte de prematuros atendidos por el Método Canguro, en una maternidad pública de nivel terciario en el Nordeste de Brasil, con peso al nacer ≤1750g y en condiciones clínicas necesarias a la aplicación del método. RESULTADOS: La muestra se constituyó por 137 recién nacidos prematuros, siendo el 62,8% del sexo femenino, con peso mediano al nacer de 1365±283g, edad gestacional mediana de 32±3 semanas y 26,2% eran adecuados para la edad gestacional. Se admitieron en la Enfermería Canguro con mediana de 13 días de vida, pesando 1430±167g en promedio, siendo que, en ese momento, el 57,7% fueron clasificados como pequeño para la edad gestacional corregida. Tuvieron alta hospitalaria con 36,8±21,8 días de vida, pesando 1780±165g y el 67,9% eran pequeños para la edad gestacional corregida. A los seis meses de edad cronológica (n=76), tenían peso mediano de 5954±971g, estando el 68,4% con peso corregido para la edad gestacional entre los percentiles 15 y 85 de la curva de la Organización Mundial de la Salud (OMS). La frecuencia de lactancia materna exclusiva en el alta fue del 56,2% y, a los seis meses de edad cronológica, del 14,4%. CONCLUSIONES: En la muestra estudiada, aproximadamente dos tercios de los niños asistidos por el Método Canguro se encontraban, a los seis meses de edad cronológica, entre los percentiles 15 y 85 de la curva de peso corporal de OMS. La frecuencia de lactancia exclusiva a los seis meses fue baja...

Avaliar a evolução clínica, o crescimento e a taxa de aleitamento materno exclusivo de recém-nascidos prematuros assistidos pelo Método Canguru, ao nascimento, na alta e aos seis meses de idade. MÉTODOS: Estudo prospectivo de uma coorte de prematuros atendidos pelo Método Canguru, em uma maternidade pública de nível terciário do Nordeste do Brasil, com peso ao nascer ≤1750g e em condições clínicas necessárias para se aplicar o método. RESULTADOS: A amostra constituiu-se de 137 recém-nascidos prematuros, sendo 62,8% do sexo feminino, com peso médio ao nascer de 1365±283g, idade gestacional média de 32±3 semanas e 26,2% eram adequados para a idade gestacional. Foram admitidos na Enfermaria Canguru com mediana de 13 dias de vida, pesando 1430±167g, sendo que, nesse momento, 57,7% foram classificados como pequeno, para a idade gestacional corrigida. Tiveram alta hospitalar com 36,8±21,8 dias de vida, pesando 1780±165g e 67,9% eram pequenos para a idade gestacional corrigida. Aos seis meses de idade cronológica (n=76), tinham peso médio de 5954±971g, estando 68,4% com peso corrigido para a idade gestacional entre os percentis 15 e 85 da curva da Organização Mundial da Saúde (OMS). A frequência de aleitamento materno exclusivo na alta foi de 56,2% e, aos seis meses de idade cronológica, de 14,4%. CONCLUSÕES: Na amostra estudada, aproximadamente dois terços das crianças assistidas pelo Método Canguru encontravam-se, aos seis meses de idade cronológica, entre os percentis 15 e 85 da curva de peso corporal da OMS. A frequência de aleitamento exclusivo aos seis meses foi baixa...

Evaluation of anxiety and depression prevalence in patients with primary severe hyperhidrosis

BACKGROUND: Primary hyperhidrosis (PH) can lead to mood changes due to the inconveniences it causes. OBJECTIVE: This study aimed to examine the existence of anxiety and depression in patients with severe primary hyperhidrosis who sought treatment at a medical office. METHODS: The questionnaire "Hospital Anxiety and Depression Scale" was used for 197 individuals, in addition to the chi square test and Fisher exact test, p <0.05. RESULTS: There was an increased prevalence of anxiety (49.6%) but not of depression (11.2%) among patients with PH, with no link to gender, age or amount of affected areas. Palmar and plantar primary hyperhidrosis were the most frequent but when associated with the presence of anxiety, the most frequent were the axillary (p = 0.02) and craniofacial (p = 0.02) forms. There was an association between patients with depression and anxiety (p = 0.001). CONCLUSIONS: the involvement of Primary hyperhidrosis was responsible for a higher prevalence of anxiety than that described among the general population and patients with other chronic diseases. Depression had a low prevalence rate, while mild and moderate forms were the most common and frequently associated with anxiety. The degree of anxiety was higher in mild and moderate types than in the severe form. .