ABSTRACT
ntroducción: la hipertensión arterial continúa siendo un desafío para la salud pública del Paraguay. La falta de adherencia a los tratamientos es un problema desde los puntos de vista médico, económico y psicosocial. Objetivo: promover la adherencia al tratamiento farmacológico antihipertensivo en pacientes con hiperten-sión que asisten a servicio de salud público, mediante un servicio de atención farmacéutica apoyado en el uso de telefonía móvil. Materiales y métodos: estudio cuasiexperimental en pacientes mayores de 18 años de ambos sexos con hipertensión arterial, en quienes se aplicaron intervenciones farmacéuticas apoyadas con el uso de telefonía móvil (llamada, mensajería sms y WhatsApp) y en quienes se evaluó la adherencia al tratamiento mediante el cuestionario de Morisky-Green, junto con preguntas complementarias para cono-cer las causas de no adherencia. Resultados: participaron 60 pacientes. Al inicio, el 68.3 % (n = 41) mostró adherencia al tratamiento según el cuestionario de Morisky-Green, y el 31.7 % (n = 19) no cumplió con la indicación. Después de las intervenciones se ha encontrado una mayor adherencia al tratamiento, al llegar al 96.7 % los cumplidores (p < 0.001). Entre las causas de no adherencia a la farmacoterapia están el olvido (28.3 %; n = 17), la falta de disponibilidad del medicamento en el hospital (20 %; n = 12) y el costo (10 %; n = 6). Conclusión: la utilización de telefonía móvil como apoyo a la atención farmacéutica podría constituirse en una herramienta para la promoción de la adherencia en pacientes con hipertensión arterial.
Introduction: Arterial hypertension remains a public health challenge in Paraguay; lack of adherence to treatment poses medical, economic, and psychosocial concerns. Information and communication tech-nologies (ICT) are valuable tools in monitoring patients and improving adherence to drug treatment. Objective: Promote adherence to antihypertensive drug treatment among hypertensive patients who attend a public health service by implementing a pharmaceutical care service supported by mobile phones. Materials and methods: A quasi-experimental study was conducted in male and female patients aged 18 years and older with arterial hypertension, in which pharmaceutical interventions supported by mobile telephony (calls, SMS messaging, and WhatsApp) were applied and adherence to treatment was assessed using the Morisky-Green questionnaire with complementary questions to identify the reasons for non-adherence. The research protocol was approved by a Research Ethics Committee of the FCQ-UNA (714/2021). Results: A total of 60 patients participated. Initially, 68.3% (n=41) showed adhe-rence to treatment according to the Morisky-Green questionnaire, while 31.7% (n=19) did not adhere to the indication. After the interventions, an increase in adherence to treatment was observed, with a compliance of 96.7% (p<0.001). Reasons non-adherence to pharmacotherapy included forgetfulness 28.3% (n=17), unavailability of drugs at the hospital 20% (n=12) and cost 10% (n=6).Conclusion: The use of mobile phones to support pharmaceutical care has the potential to serve as a tool for promoting adherence in patients with arterial hypertension
Introdução: A hipertensão arterial continua a ser um desafio para a saúde pública no Paraguai; a falta de adesão aos tratamentos é um problema do ponto de vista médico, econômico e psicossocial. Objetivo:Promover a adesão ao tratamento farmacológico anti-hipertensivo nos doentes com hipertensão que frequentam os serviços públicos de saúde, através de um serviço de assistência farmacêutica apoiado na utilização de telefonia móvel. Materiais e métodos: Estudo quase experimental realizado em pacientes maiores de 18 anos de ambos os sexos com hipertensão arterial; em que foram aplicadas intervenções farmacêuticas apoiadas no uso da telefonia móvel (chamada, mensagem sms e WhatsApp) e a adesão ao tratamento foi avaliada por meio do questionário Morisky-Green, juntamente com perguntas comple-mentares para determinar as causas da não adesão. Resultados. 60 pacientes participaram. No início, 68,3% (n = 41) apresentaram adesão ao tratamento conforme questionário de Morisky-Green e 31,7% (n = 19) não cumpriram a indicação. Após as intervenções constatou-se maior adesão ao tratamento, com adesão chegando a 96,7% (p < 0,001), as causas da não adesão à farmacoterapia foram esquecimento em 28,3% dos casos (n = 17), falta de disponibilidade de medicamentos no hospital 20% (n = 12) e custo 10% (n = 6). Conclusão: a utilização de telefonia móvel para apoio à assistência farmacêutica poderá tornar-se uma ferramenta para promover a adesão ao tratamento em pacientes com hipertensão.
Subject(s)
HumansABSTRACT
Introducción: Paraguay asumió el reto de lograr cobertura universal mediante redes basadas en Atención Primaria de la Salud con Unidades de Salud de la Familia (USF) en el primer nivel de atención. Un desafío es la atención integral ante enfermedades no transmisibles, principal causa de mortalidad en el país. Objetivo: analizar la capacidad de las USF para la atención de personas con hipertensión arterial y diabetes en el sistema nacional de salud. El diseño fue no experimental, cuantitativo, transversal, descriptivo con componente analítico. Metodología: Incluyó a 761 USF de 12 regiones sanitarias agrupados en 4 ejes territoriales. Se adaptó el método de evaluación SARA de la OMS con 75 variables, aplicando un cuestionario a profesionales de salud entre noviembre y diciembre de 2022. Se calculó índices de disponibilidad y preparación así como un índice que los integra. La medida continua de estos índices se categorizó en 3 grupos: suficiente >0,75 a 1; intermedio 0,5 a 0,75 y bajo <0,5. Resultados: Solo en el 38 % de las USF el índice de disponibilidad fue suficiente, en el 31,5 % para el índice de preparación y en el 31,1 % para el índice integrador SARA DM/HTA. El desempeño se asoció de forma significativa con el eje territorial no así con el área ni con la cobertura a población indígena Discusión: las USF presentaron limitaciones para la atención de personas con diabetes e hipertensión en estas regiones del país.
Introduction: Paraguay assumed the challenge of achieving universal coverage through networks based on Primary Health Care with Family Health Units (USF) at the first level of care. One challenge is comprehensive care for non-communicable diseases, the main cause of mortality in the country. Objective: to analyze the capacity of the USF to care for people with high blood pressure and diabetes in the national health system. The design was non-experimental, quantitative, cross-sectional, descriptive with an analytical component. Methods: It included 761 USF from 12 health regions grouped into 4 territorial axes. The WHO SARA evaluation method was adapted with 75 variables, applying a questionnaire to health professionals between November and December 2022. Availability and preparation indices were calculated as well as an index that integrates them. The continuous measurement of these indices was categorized into 3 groups: sufficient >0.75 to 1; intermediate 0.5 to 0.75 and low <0.5. Results: Only in 38.0% of the USF the availability index was sufficient, in 31.5% for the readiness index and in 31.1% for the SARA DM/HTA integrating index. The performance was significantly associated with the territorial axis, but not with the area or with the coverage of the indigenous population. Discussion: the USF presented limitations for the care of people with diabetes and hypertension in these regions of the country.
ABSTRACT
El feocromocitoma y el paraganglioma son tumores neuroendocrinos secretores de catecolaminas. Los feocromocitomas se originan en la médula suprarrenal, mientras que los paragangliomas son extraadrenales. Se describe una serie de casos de niños con diagnóstico anatomopatológico de feocromocitoma o paraganglioma que consultaron en un hospital pediátrico de alta complejidad de Argentina. Se incluyeron 21 pacientes, 14 varones, con una mediana de edad de 11,4 años; 8 casos con feocromocitoma y 13 casos con paraganglioma. Se presentaron con hipertensión arterial 14/21. La mayoría de los paragangliomas tuvieron localización paraaórtica (9/13). Debido a que representan una causa potencialmente curable de hipertensión arterial, la sospecha clínica es muy importante. El diagnóstico temprano y la instauración de un tratamiento antihipertensivo adecuado, que permita afrontar la cirugía con normotensión arterial, aseguran la curación en la mayoría de los casos si la resección tumoral es completa.
Pheochromocytomas and paragangliomas are neuroendocrine tumors producing catecholamines. Pheochromocytomas occur in the adrenal medulla, while paragangliomas are those that occur outside the adrenal gland. Here we describe a case series of children with a pathological diagnosis of pheochromocytoma or paraganglioma who consulted at a tertiary care children's hospital in Argentina. A total of 21 patients (14 males) were included; their median age was 11.4 years; 8 children had pheochromocytoma and 13, paraganglioma. Arterial hypertension was observed in 14/21. Most paragangliomas were para-aortic (9/13). Since they are a potentially curable cause of hypertension, clinical suspicion is very important. An early diagnosis and the initiation of an adequate antihypertensive treatment, which allows the patient to undergo surgery with normal blood pressure, ensure a cure in most cases if tumor resection is complete.
Subject(s)
Humans , Child , Paraganglioma/complications , Paraganglioma/diagnosis , Pheochromocytoma/complications , Pheochromocytoma/diagnosis , Adrenal Gland Neoplasms/diagnosis , Adrenal Gland Neoplasms/therapy , Hypertension/diagnosis , Argentina , HospitalsABSTRACT
Introdução: A hipertensão arterial sistêmica é uma das doenças crônicas de maior prevalência no Brasil, sendo esta, juntamente com outras doenças crônicas, o foco de atenção das unidades primárias de saúde. Desta forma, atividades de educação em saúde relacionadas à prevenção e combate a hipertensão arterial sistêmica são de grande importância para reduzir a incidência dessa doença na população. Objetivo: Nesse sentido, o presente relato possui uma abordagem qualitativa descritiva exploratória, de uma experiência dos membros de uma liga acadêmica de medicina de uma universidade no Sul de Santa Catarina. Metodologia: A abordagem do público se deu através de um projeto social no ambulatório de especialidades médicas da universidade, realizado no dia nacional de combate à hipertensão arterial de 2023, com duração de 11 horas. Neste projeto, contou com 12 membros da liga e 79 pacientes com idade média de 42 anos, foram distribuídos panfletos com informações importantes sobre hipertensão, além de outras ações, como: esclarecimento de dúvidas, distribuição demudas frutíferas e frutas, aferições de pressão arterial, encaminhamentos para consultas com clínico geral e nutricionista. Resultados: A maioria das Pressões Arteriais aferidas estava dentro da normalidade; no entanto, foram identificados alguns casos de pré-hipertensão e hipertensão ainda não diagnosticadas, além de casos em que a pressão arterial estava descompensada mesmo com tratamento farmacológico(50% dos pacientes hipertensos), incluindo um caso de crise hipertensiva, também foi possível perceber o desconhecimento do público sobre a PA e seus riscos a saúde. Conclusões: Conclui-se que é necessária a conscientização e educação em saúde das pessoas a respeito do que é a hipertensão arterial sistêmica, uma vez que, cerca de, 49%dos pacientes estavam com Índice de Massa Corporal acima de25e 37% com pressão arterial acima de 120x80mmHg (AU).
Introduction: Systemic arterial hypertension is one of the most prevalent chronic diseases in Brazil. Together with other chronic diseases, this condition is the focus of attention in the primary health units. Therefore, health education with view at preventing and controlling systemic arterial hypertension is of great importance to reduce the incidence of this disease in the population.Objective:, the present report is an exploratory descriptive qualitative approach of an Academic Medical League's members' experience at a university in the south of Santa Catarina.Methodology: The target audience was approached through a social project held at the university's medical specialty outpatient clinic on the national day of high blood pressure control in 2023 with an 11 hours duration. This project involved 12 members of the League and 79 patients. Patients' average age was 42 years. Leaflets containing important information about hypertension were distributed. Further initiatives included answering questions, fruit seedlings and fruits distribution, assessment of blood pressure, referring people to a general practitioner and to a nutritionist. Results: Blood pressure of most of the individuals who had their blood pressure measured at the event was within normal range; however, some cases of undiagnosed pre-hypertension and hypertension were identified, in addition to cases in which blood pressure was decompensated despite pharmacological treatment (50% of hypertensive patients); this included one case of hypertensive crisis. It was also evident the audience's lack of knowledge about blood pressure and its health risks.Conclusions: it is necessary to raise awareness and improve health education among people regarding what systemic arterial hypertension is, since approximately 49% of patients had a body mass index above 25 and 37% had a blood pressure above 120x80 mmHg (AU).
Introducción: La hipertensión arterial sistémica es una de las enfermedades crónicas más prevalentes en Brasil. Junto con otras enfermedades crónicas, es foco de atención en las unidades primarias de salud. Por lo tanto, las actividades de educación sanitaria relacionadas con la prevención y el combate de la hipertensión arterial sistémica son de gran importancia para reducir la incidencia de esta enfermedad en la población.Objetivo: El presente relato tiene un enfoque cualitativo descriptivo exploratorio basado en una experiencia de miembros de una liga médica académica de la universidad del sur de Santa Catarina.Metodología: Se acercó al público a través de un proyecto social realizado en el ambulatorio de especialidades médicas de la universidad, en el día nacional de combate a la hipertensión arterial del año 2023, que tuve una duración de 11 horas. En este proyecto participaron 12 integrantes de la liga y 79 pacientes con promedio de 42 años; se distribuyeron folletos con información importante sobre la hipertensión, además de otras iniciativas como: aclarar dudas, repartir plantones y frutas, medir la presión arterial, derivaciones para consultas con médico general y nutricionista. Resultados: La mayoría de las presiones medidas estuvieron dentro de los límites normales; sin embargo, se identificaron algunos casos de prehipertensión e hipertensión no diagnosticadas, además de casos en los que la presión arterial se descompensaba incluso con tratamiento farmacológico (50% de los hipertensos); hubo un caso de crisis hipertensiva. También se pudo notar la falta de conocimiento delpúblico sobre la PA y sus riesgos para la salud. Conclusiones: Se concluye que es necesario generar conciencia y educación en salud en las personas respecto de la hipertensión arterial sistémica, ya que aproximadamente el 49% de los pacientes tenían un Índice de Masa Corporal superior a 25 y el 37% tenían una presión superior a 120x80 mmHg (AU).
Subject(s)
Humans , Male , Female , Adult , Primary Health Care , Health Education , Chronic Disease/prevention & control , Hypertension/prevention & control , Students, Medical , Epidemiology, DescriptiveABSTRACT
Introdução: As Doenças Crônicas não Transmissíveis constituem-se em um grande desafio de saúde pública. Dentro deste grupo, a Hipertensão Arterial e o Diabetes Mellitus merecem destaque, pois seu enfrentamento requer bastante dos serviços de saúde. Na realidade da Atenção Básica, tem-se destaque para as atividades educativas, em especial para a Educação Popular em Saúde, como a "Calçada Amiga". Objetivo: Abordar a experiência da atividade de educação popular em saúde intitulada "Calçada Amiga" como instrumento de proteção, prevenção e promoção da saúde na Hipertensão Arterial e no Diabetes Mellitus em um serviço de Atenção Primária à Saúde. Metodologia: Trata-se de um relato de Experiência de uma atividade de educação popular em saúde desenvolvida no território de uma Unidade Básica de Saúde do Município de Mossoró/Rio Grande do Norte, durante o ano de 2022.Resultados e Discussões: Foram realizadas 13 ações. Sobre a Hipertensão Arterial e o Diabetes Mellitus, notou-se uma certa dificuldade na adesão ao tratamento, com relatos tanto na prática do exercício físico quanto na alimentação adequada, além do uso das medicações. Ainda sobre as dificuldades na adesão, muitos deles afirmavam uma subutilização dos serviços de saúde, em especial a UBS. Foi possível observar a validade da Educação Popular em Saúde por meio de afirmações de avaliação positiva sobre o método adotado para as atividades, com boa aceitação, frequência e retorno da comunidade. Conclusões: A atividade permitiu o fortalecimento do vínculo entre a Unidade Básica de Saúde e a comunidade por meio da imersão no território com momentos de diálogos horizontais e escuta ativa, facilitando a compreensão por parte dos profissionais sobre a realidade dos sujeitos assistidos no serviço. Para a comunidade, permitiu um momento de fala e escuta, expressando seus anseios, medos e dificuldades sobre as condições, tornando-se ativa no processo de saúde/doença (AU).
Introduction: Chronic non-communicable diseases are a major public health challenge. Within this group, Hypertension and Diabetes Mellitus deserve to be highlighted, because coping with it requires a lot of health services. In the reality of Primary Care, there is emphasis on educational activities, especially for Popular Health Education, such as "Calçada Amiga".Objective:To address the experience of popular health education activity entitled "Calçada Amiga" as an instrument of protection, prevention and health promotion in Hypertension and Diabetes Mellitus in a Primary Health Care service.Methodology:This is an experience report of a popular health education activity developed in the territory of a Basic Health Unit of the Municipalityof Mossoró/ Rio Grande do Norte during the year 2022.Results and Discussion:13 actions were performed. Regarding Hypertension and Diabetes Mellitus, there was some difficulty in adherence to treatment, with reports both in the practice of physical exercise and in proper nutrition, in addition to the use of medications. Still on the difficulties in adherence, many of them stated an underutilization of health services, especially the UBS. It was possible to observe the validity of Popular Health Education through affirmations of positive evaluation of the method adopted for the activities, with good acceptance, frequency and community return.Conclusions:The activity allowed the strengthening of the bond between the Basic Health Unit and the community through immersion in the territory with moments of horizontal dialogues and active listening, professionals about the reality of the subjects assisted in the service. For the community, it allowed a moment of speech and listening, expressing their desires,fears and difficulties about the conditions, becoming active in the health/disease process (AU).
Introducción: Las Enfermedades Crónicas no Transmisibles se constituyen en un gran desafío de salud pública. Dentro de este grupo, la Hipertensión Arterial y el Diabetes Mellitus merecen destaque, pues su enfrentamiento requiere bastante de los servicios de salud. En realidad de la Atención Básica, se ha destacado para las actividades educativas, en especial para la Educación Popular en Salud, como la "Calçada Amiga". Objetivo: Abordar la experiencia de la actividad de educación popular en salud titulada "Calçada Amiga" como instrumento de protección, prevención y promoción de la salud en la Hipertensión Arterial y en la Diabetes Mellitus en un servicio de Atención Primaria de Salud.Metodología: Se trata de un relato de experiencia de una actividad de educación popular en salud desarrollada en el territorio de una Unidad Básica de Salud del Municipio de Mossoró/ Rio Grande do Norte durante el año 2022.Resultados y Discusión: Fueron realizadas 13 acciones. Sobre la Hipertensión Arterial y la Diabetes Mellitus, se notó una cierta dificultad en la adhesión del tratamiento, con relatos tanto en la práctica del ejercicio físico como en la alimentación adecuada, además del uso de las medicaciones. También sobre las dificultades en la adhesión, muchos de ellos afirmaban una infrautilización de los servicios de salud, en especial la UBS. Fue posible observar la validez de la Educación Popular en Salud por medio de afirmaciones de evaluación positiva sobre el método adoptado para las actividades, con buena aceptación, frecuencia y retorno de la comunidad.Conclusiones: La actividad permitió el fortalecimiento del vínculo entre la Unidad Básica de Salud y la comunidad por medio de la inmersión en el territorio con momentos de diálogos horizontales y escucha activa, facilitando la comprensión por parte de los profesionales de la realidad de los sujetos asistidos en el servicio. Para la comunidad, permitió un momento de habla y escucha, expresando sus anhelos, miedos y dificultades sobre las condiciones, haciéndose activa en el proceso de salud/enfermedad (AU).
Subject(s)
Primary Health Care , Health Education , Diabetes Mellitus/pathology , Hypertension/prevention & control , Epidemiology, Descriptive , Qualitative Research , Evaluation Studies as Topic , Noncommunicable DiseasesABSTRACT
Systemic Arterial Hypertension is a multifactorial clinical condition associated with severe outcomes such as stroke and death. One of the main modifiable risk factor for hypertension is an unhealthy diet, often characterized by the consumption of ultraprocessed foods such as sweetened beverages. We aimed to investigate the relationship between the consumption of sweetened beverages, both sugar-sweetened and artificially sweetened, and the prevalence of hypertension in adults. A cross-sectional, household, population-based study with 1,162 adults from two Brazilian cities were carried out. The consumption of food groups and sweetened beverages was obtained by food frequency questionnaire and other data were self-reported. Weight, height, and waist circumference were measured. The association between sweetened beverages consumption and hypertension was analyzed using Poisson regression models, expressed as Prevalence Ratio. The prevalence of hypertension was 16.7%, with no significant difference between genders. The prevalence of consumption of sweetened beverages was 70.3% in men and 54.6% in women, being significantly higher in men. Women who consumed sugar-sweetened and artificially sweetened beverages 6 to 7 days per week had 92% higher prevalence of hypertension compared to those who did not consume or consumed at a lower frequency. Furthermore, women who consumed artificially sweetened beverages at least 1 time per week had 3.36 times higher prevalence of hypertension. The habitual consumption of sweetened beverages may be an important risk factor for hypertension, especially the consumption of diet beverages, which are often marketed as healthier than sugar-sweetened beverages.
La Hipertensión Arterial Sistémica es una condición clínica multifactorial asociada a resultados graves como el ictus y la muerte. Uno de los principales factores de riesgo modificables de la hipertensión es una dieta poco saludable, a menudo caracterizada por el consumo de alimentos ultraprocesados como las bebidas endulzadas. Nuestro objetivo fue investigar la relación entre el consumo de bebidas endulzadas, tanto azucaradas como edulcoradas artificialmente, y la prevalencia de hipertensión en adultos. Se realizó un estudio transversal, domiciliario y poblacional con 1,162 adultos de dos ciudades brasileñas. El consumo de grupos de alimentos y bebidas endulzadas se obtuvo mediante cuestionario de frecuencia de alimentos y los demás datos fueron autoinformados. Se midieron el peso, la talla y el perímetro de la cintura. La asociación entre el consumo de bebidas endulzadas y la hipertensión se analizó mediante modelos de regresión de Poisson, expresados como Ratio de Prevalencia. La prevalencia de hipertensión fue del 16,7%, sin diferencias significativas entre géneros. La prevalencia de consumo de bebidas endulzadas fue del 70,3% en los hombres y del 54,6% en las mujeres, siendo significativamente mayor en los hombres. Las mujeres que consumían bebidas azucaradas y edulcoradas artificialmente entre 6 y 7 días a la semana tenían 92% mayor prevalencia de hipertensión que las que no consumían o consumían con una frecuencia menor. Además, las mujeres que consumían bebidas edulcoradas al menos 1 vez por semana tenían una prevalencia de hipertensión 3,36 veces mayor. Así pues, el consumo habitual de bebidas endulzadas puede ser un importante factor de riesgo de hipertensión, especialmente el consumo de bebidas dietéticas, que a menudo se comercializan como más saludables que las bebidas azucaradas.
ABSTRACT
The treatment of arterial hypertension (AH) contributes to the reduction of morbidity and mortality. Gender differences are likely to play a role, as non-treatment is associated with clinical and sociodemographic aspects. The aim of this study was to investigate the factors associated with non-treatment of AH and gender differences in hypertensive individuals from the ELSA-Brasil cohort. The study was conducted with 5,743 baseline hypertensive cohort participants. AH was considered if there was a previous diagnosis or if systolic blood pressure (SBP) was ≥140 and/or diastolic BP (DBP) was ≥90 mmHg. Sociodemographic and anthropometric data, lifestyle, comorbidities, and use of antihypertensive medications were evaluated through interviews and in-person measurements. Treatment with renin-angiotensin-aldosterone system inhibitors (RAASi) or other antihypertensive medications and non-treatment were evaluated with multivariate logistic regression. Non-treatment was observed in 32.8% of hypertensive individuals. Of the 67.7% treated individuals, 41.1% received RAASi. Non-treatment was associated with alcohol consumption in women (OR=1.41; 95%CI: 1.15-1.73; P=0.001), lowest schooling level in men (OR=1.70; 95%CI: 1.32-2.19; P<0.001), and younger age groups in men and women (strongest association in males aged 35-44 years: OR=4.58, 95%CI: 3.17-6.6, P<0.001). Among those using RAASi, a higher proportion of white, older individuals, and with more comorbidities was observed. The high percentage of non-treatment, even in this civil servant population, indicated the need to improve the treatment cascade for AH. Public health policies should consider giving special attention to gender roles in groups at higher risk of non-treatment to reduce inequities related to AH in Brazil.
ABSTRACT
En los últimos años, la trombosis de la vena porta entre los pacientes cirróticos se ha comportado como una entidad reconocida y cada vez más estudiada, no solo por su creciente incidencia, sino por la asociación con gravedad y mal pronóstico en cirrosis. Asimismo, se hacen objeto de estudio las terapias disponibles para el manejo tanto médico como quirúrgico de estos pacientes, lo que ha dado un papel importante a la derivación portosistémica transyugular intrahepática (TIPS). El uso de TIPS en esta población se posiciona como una alternativa de manejo aceptable, no solo por brindar mejoría en las complicaciones derivadas de la hipertensión portal, sino también por sus resultados prometedores en diferentes estudios sobre el flujo y la recanalización portal, y por su perfil de seguridad. Sin embargo, la eficacia, los efectos adversos a largo plazo y el pronóstico de dicha intervención en la compleja fisiopatología de la cirrosis deben continuar en estudio. El objetivo de este artículo es revisar los avances del uso de TIPS en el manejo de pacientes con cirrosis hepática y trombosis portal.
In recent years, portal vein thrombosis among cirrhotic patients has been a well-recognized and continuously studied entity, not only because of its increasing incidence but also because of its association with severity and poor prognosis in cirrhosis. Likewise, therapies available for both medical and surgical management in these patients are being studied, which has given an important role to the transjugular intrahepatic portosystemic shunt (TIPS). The use of TIPS in this population is positioned as an acceptable management alternative, not only because it provides improvement in complications derived from portal hypertension, but also because of its promising results in different studies on portal flow and recanalization upgrade, and for its safety. However, the efficacy, long-term adverse effects, and prognosis of this intervention in the complex pathophysiology of cirrhosis must continue to be studied. The objective of this article is to review the advances in the use of TIPS in the management of patients with liver cirrhosis and portal vein thrombosis.
ABSTRACT
El síndrome de Eisenmenger es la forma más severa de presentación de hipertensión arterial pulmonar secundaria a defectos cardíacos congénitos no reparados, aunque su prevalencia es baja, continúa siendo un reto para los sistemas de salud de los países en vías de desarrollo por su complejidad en el manejo. Presentación del caso. Paciente femenina sin antecedentes médicos conocidos quien consulta por disnea relacionada a los esfuerzos y policitemia. Intervención terapéutica. Se realiza ecocardiograma transesofágico que arroja la presencia de defecto interatrial tipo ostium secundum e hipertensión arterial pulmonar severa, con cortocircuito de derecha a izquierda, se inicia oxigenoterapia y terapia farmacológica. Evolución clínica. Paciente permaneció ingresada presentando notable mejora a la disnea, se le dio de alta con referencia a la clínica de cardiopatías congénitas del adulto en Hospital Nacional Rosales.
Eisenmenger syndrome is the most severe form of pulmonary arterial hypertension secondary to an unrepaired congenital heart disease. Despite the low prevalence, it remains a challenge for the public health service of developing countries due to the complexity of the treatment. Case presentation. A female patient without known medical history, who consults with dyspnea on exertion and polycythemia. Treatment. A transesophageal echocardiogram was performed, showing an ostium secundum atrial septal defect and severe pulmonary arterial hypertension with a right-left shunt. Supplemental oxygen was administrated and pharmacological treatment was started. Outcome. The patient presented remarkable clinical improvement to dyspnea, she was discharged with medical reference to the Adult Congenital Heart Disease clinic at Rosales National Hospital.
Subject(s)
Humans , Female , Adult , El SalvadorABSTRACT
Introducción: el tratamiento nutricional está afectado por la conducta de los sujetos para generar adherencia. Objetivo: determinar factores que influyen en la no adherencia al tratamiento nutricional en pacientes hipertensos que acuden al Hospital Regional de Coronel Oviedo, 2021. Metodología: estudio descriptivo transversal. La población estuvo comprendida por pacientes registrados en el Programa de hipertensión arterial/Departamento cardiovascular del Hospital Regional de Coronel Oviedo. Se estudiaron los datos sociodemográficos, los factores de tratamiento nutricional y el grado de adherencia al tratamiento nutricional. Resultados: participaron del estudio 206 sujetos, el 53,4 % poseía 55 años o menos y el 81,1 % fue del sexo femenino. Se pudo hallar que solo el 3,8 % de los pacientes se adhieren al tratamiento. La no adherencia al factor conocimiento estuvo relacionado con el bajo nivel educativo (p=0,032), al factor equipo de salud con provenir del área rural y tener un bajo nivel educativo (p=0,006, p=0,002), al factor paciente con provenir del área rural (p=0.002), ser de bajo nivel educativo (p=0,008) y poseer obesidad grado II y III (p=0,036). La no adherencia global estuvo relacionada a estar casado (p=0.001) y realizar trabajos domésticos (p=0,009). Conclusiones: la adherencia al tratamiento es baja en la población de estudio.
Introduction: nutritional treatment is affected by the behavior of the subjects to generate adherence. This study was carried out to determine factors that influence non-adherence to nutritional treatment in hypertensive patients who attend the Coronel Oviedo Regional Hospital, 2021. Methodology: this was a cross-sectional descriptive observational study. The population was comprised of patients registered in the hypertension department of the Coronel Oviedo Regional Hospital. Sociodemographic data, nutritional treatment factors and the degree of adherence to nutritional treatment were studied. Results: 206 subjects participated in the study, 53.4 % were 55 years old or younger and 81.1 % were female. We found that only 3.8 % of patients adhere to treatment. Non-adherence due to the knowledge factor was related to low educational level (p=0.032), to the health team factor with coming from a rural area and having a low educational level (p=0.006, p=0.002), to the patient factor with coming from a rural area (p=0.002), to have a low educational level (p=0.008) and to have obesity grade II and III (p=0.036). Global non-adherence was related to being married (p=0.001) and doing housework (p=0.009). Conclusions: adherence to treatment is low in the study population.
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Introducción. La hipertensión portal (HTP) se define como una elevación anormal de la presión venosa en el sistema portal que lleva al desarrollo de vías colaterales para desviar el flujo sanguíneo de la zona. Dentro de su etiología están las relacionadas con la cirrosis hepática y otras causas denominadas no cirróticas. El objetivo de este estudio fue evaluar los principales hallazgos demográficos, clínicos y paraclínicos en un grupo de pacientes con HTP, y determinar el uso de ayudas invasivas y no invasivas, y su disponibilidad para el diagnóstico y seguimiento de los pacientes en los centros que no cuentan con laboratorio de hemodinamia hepática, reflejando la dinámica de múltiples escenarios en Colombia. Metodología. Se realizó un estudio descriptivo de corte transversal, retrospectivo, en pacientes atendidos en una institución de tercer nivel del sur de Colombia, entre enero del año 2015 y diciembre del año 2020. Resultados. Se obtuvo una muestra de 61 pacientes en donde la mayoría de casos correspondían a hombres en la séptima década de la vida, procedentes del área urbana. La principal causa de consulta fue el sangrado digestivo (39,3 %), asociado a la presencia de telangiectasias (arañas vasculares) en el 37,2 %, seguido de circulación colateral (31,3 %) e ictericia (19,7 %). En la ecografía abdominal (realizada en el 57,4 % de los pacientes) predominaron la cirrosis (68 %) y la presencia de esplenomegalia (14,2 %), y en lospacientes con Doppler portal (realizado en el 16,4 %) se encontró hígado cirrótico (80 %) y dilatación portal (40 %). Con respecto a los hallazgos en la esofagogastroduodenoscopia predominó la presencia de várices esofágicas y gastritis crónica. Conclusión. El principal motivo de consulta fue el sangrado digestivo, en tanto que la cirrosis fue el antecedente y el hallazgo imagenológico más frecuente, seguido de las várices esofágicas. Se encontró que el uso de paraclínicos, ecografía abdominal, ecografía con Doppler portal y esofagogastroduodenoscopia fueron los más utilizados en el contexto clínico de los pacientes con el diagnóstico de HTP.
Introduction. Portal hypertension (PHT) is defined as an abnormal elevation of venous pressure in the portal system that leads to the development of collateral pathways to divert blood flow from the area. Within its etiology are those related to liver cirrhosis and other so-called non cirrhotic causes. The aim of this study was to evaluate the main demographic, clinical and paraclinical findings in a group of patients with PHT, and to determine the use of invasive and non-invasive aids, and their availability for the diagnosis and follow-up of patients in centers that do not have a hepatic hemodynamics laboratory, reflecting the dynamics of multiple scenarios in Colombia. Methodology. A descriptive, retrospective, cross-sectional, retrospective study was conducted in patients attended in a third level institution in Southern Colombia, between January 2015 and December 2020. Results. A sample of 61 patients was obtained where the majority of cases corresponded to men in the seventh decade of life, from the urban area. The main cause of consultation was digestive bleeding (39.3%), associated with the presence of telangiectasias (spider veins) in 37.2%, followed by collateral circulation (31.3%) and jaundice (19.7%). In abdominal ultrasound (performed in 57.4% of the patients), cirrhosis (68%) and the presence of splenomegaly (14.2%) predominated, and in patients with portal Doppler (performed in 16.4%), cirrhotic liver (80%) and portal dilatation (40%) were found. With respect to the findings in the esophagogastroduodenoscopy, esophageal varices and chronic gastritis were predominant. Conclusion. The main reason for consultation was gastrointestinal bleeding, while cirrhosis was the most frequent history and imaging finding, followed by esophageal varices. It was found that the use of paraclinics, abdominal ultrasound, ultrasound with portal Doppler and esophagogastroduodenoscopy were the most used in the clinical context of patients diagnosed with PHT.
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ABSTRACT We report a case of bilateral acute depigmentation of the iris in which satisfactory intraocular pressure control was obtained after resolution of the acute disease with a trabecular implant (iStent®). A 62-year-old woman presented with bilateral simultaneous acute eye pain, photophobia, increased intraocular pressure (34 mmHg), circulating pigment in the anterior chamber, areas of depigmentation in the iris, and posterior synechiae. She had received oral amoxicillin-clavulanate and moxifloxacin for pneumonia 2 months previously. Bilateral acute depigmentation of the iris was suspected as well as a viral etiology. She received oral acetazolamide, aciclovir, and prednisone, besides topical prednisolone, betaxolol, brimonidine, dorzolamide, and atropine. The disease gradually resolved in 4 months but, after 1 year, she developed bilateral cataracts, and still needed three drugs for intraocular pressure control (16/18 mmHg). Cataract-iStent® combined surgery was performed in both eyes. One year after surgery, intraocular pressure was 11/12 mmHg, without medication. iStent® was safe and effective on this secondary glaucoma.
RESUMO Relatamos um caso de despigmentação aguda bilateral da íris, no qual obtivemos adequado controle da pressão intraocular com o implante do iStent®, após resolução da fase aguda da doença. Paciente feminina, 62 anos, atendida com quadro agudo, bilateral e simultâneo de dor ocular, fotofobia, hipertensão ocular (34 mmHg), pigmentos circulantes na câmara anterior, áreas de despigmentação iriana e sinéquias posteriores. Havia recebido amoxicilina-clavulanato e moxifloxacina orais para pneumonia 2 meses antes. Suspeitando-se de despigmentação aguda bilateral da íris ou de etiologia viral, recebeu acetazolamida, aciclovir e prednisona orais, e colírios prednisolona, betaxolol, brimonidina, dorzolamida e atropina. O quadro se resolveu gradualmente em 4 meses, porém, após 1 ano, desenvolveu catarata bilateral e ainda usava 3 colírios hipotensores (pressão intraocular 16/18 mmHg). A cirurgia combinada de catarata-iStent® foi realizada em ambos os olhos. Um ano depois, a pressão intraocular mantinha-se 11/12 mmHg, sem medicação. O iStent® foi seguro e eficaz no controle deste glaucoma secundário.
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ABSTRACT Purpose: To evaluate the influence of atmospheric pressure changes on the behavior of intraocular pressure of healthy military individuals-students and instructors of the National Navy's Diving & Rescue School at the "ARC BOLÍVAR" naval base-during a simulated immersion in the hyperbaric chamber of the Naval Hospital of Cartagena. Methods: A descriptive exploratory study was performed. The intraocular pressure was measured at different atmospheric pressures during 60-min sessions in the hyperbaric chamber while breathing compressed air. The maximum simulated depth was 60 feet. Participants were students and instructors of the Naval Base's Diving and Rescue Department. Results: A total of 48 eyes from 24 divers were studied, of which 22 (91.7%) were male. The mean age of the participants was 30.6 (SD=5.5) years, ranging from 23 to 40. No participant had a history of glaucoma or ocular hypertension. The mean base intraocular pressure at sea level was 14 mmHg, which decreased to 13.1 mmHg (decreased by 1.2 mmHg) at 60 feet deep (p=0.0012). However, during the safety stop at 30 feet, the mean IOP kept decreasing until reaching 11.9 mmHg (p<0.001). By the end of the session, the mean intraocular pressure reached 13.1 mmHg, which is inferior and statistically significant when compared with the intraocular pressure base mean (p=0.012). Conclusions: In healthy individuals, the intraocular pressure decreases when reaching a depth of 60 feet (2.8 absolute atmosphere pressure) and it decreases even more during ascension at 30 feet. Measurements at both points were significantly different when compared with base intraocular pressure. The final intraocular pressure was lower than the baseline intraocular pressure, suggesting a residual and prolonged effect of the atmospheric pressure on intraocular pressure.
RESUMO Objetivo: Avaliar a influência das alterações da pressão atmosférica no comportamento da pressão intraocular de indivíduos militares saudáveis-alunos e instrutores da Escola de Mergulho e Resgate da Marinha Nacional na base naval "ARC BOLÍVAR"-durante uma imersão simulada na câmara hiperbárica do Hospital da Marinha de Cartagena. Métodos: Realizamos um estudo exploratório descritivo. A pressão intraocular foi medida em diferentes pressões atmosféricas durante sessões de 60 minutos na câmara hiperbárica respirando ar comprimido. A profundidade máxima simulada foi de 60 pés. Os participantes eram alunos e instrutores do Departamento de Mergulho e Resgate da Base Naval. Resultados: Quarenta e oito olhos de 24 mergulhadores foram estudados. Vinte e dois participantes (91,7%) eram do sexo masculino. A média de idade dos participantes foi de 30,6 (DP=5,5) anos, variando de 23 a 40. Nenhum participante tinha histórico de glaucoma ou hipertensão ocular. A média de base da pressão intraocular ao nível do mar foi de 14 mmHg, diminuindo para 13,1 mmHg (queda de 1,2 mmHg) a 60 pés de profundidade (p=0,0012). Entretanto, durante a parada de segurança a 30 pés, a pressão intraocular média continuou diminuindo até atingir 11,9 mmHg (p<0,001). Ao final da sessão, a pressão intraocular média atingiu 13,1 mmHg, valor inferior e estatisticamente significativo quando comparada à média de base da pressão intraocular (p=0,012). Conclusões: Em indivíduos saudáveis, a pressão intraocular diminui ao atingir uma profundidade de 60 pés (2,8 de pressão atmosférica absoluta) e diminui ainda mais durante a ascensão a 30 pés. As medidas em ambos os pontos foram significativamente diferentes quando comparadas à pressão intraocular de base. A pressão intraocular final foi menor do que a pressão intraocular de base, sugerindo um efeito residual e prolongado da pressão atmosférica sobre a pressão intraocular.
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Abstract We report the case of a patient with symptomatic pulmonary hypertension (PH) associated with diffuse systemic sclerosis (SSc) whose initial assessment suggested a group 3 (clinical classification) PH. The patient had a history of drugs/toxins consumption, which contributed to the development of intrinsic pulmonary vascular disease. This changed the panorama towards the diagnosis of pulmonary arterial hypertension (PAH), with important therapeutic and prognostic implications. In fact, the excellent clinical, laboratory and hemodynamic response to therapy confirmed the hypothesis of a case of drug-associated PAH (DPAH) in a patient with diffuse SSc and lung disease. Considering the presence of DPAH, it was deemed necessary to assess acute vasoreactivity during right heart catheterization (RHC). If criteria were met, the clinical scenario may change towards a favorable and sustained clinical and hemodynamic response with oral calcium channel blockers. However, the response to inhaled nitric oxide was negative in our patient and the therapeutic strategy with dual oral combination therapy with tadalafil and ambrisentan was continued. After six-months of therapy the patient significantly improved, from a high to a low risk of one-year mortality.
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Abstract Background Arterial hypertension affects around 30% of the Brazilian adult population, showing a direct and progressive relationship with an increased risk of cardiovascular diseases (CVDs). In this context, adjustments in the calibration and physical constitution of sphygmomanometers are essential conditions for obtaining correct blood pressure (BP) measurements. Objectives Analyze the profile and quality of sphygmomanometers used in various sectors of a health education institution in Belo Horizonte, Minas Gerais. Methods The present study conducted a cross-sectional, observational, and non-interventional study to assess adherence to various quality parameters of the sphygmomanometers available in the outpatient clinic, emergency department, and ward of an educational institution in the municipality of Belo Horizonte. Results We analyzed 78 devices, in which high rates of adherence were identified for velcro/pins, 93.5% (73/78); bulbs/rubbers, 92.1% (70/76); valves, 93.4% (71/76); the seal of the National Institute of Metrology, Quality, and Technology (INMETRO), 97.4% (76/78); and the clock, 92.1% (70/76). However, these parameters showed no statistical significance. Institutions (hospital/outpatient clinic) recorded higher calibration rates, 75% (39/52, p<0.001), in accordance with the deadlines stipulated by INMETRO, and the cuff/equipment compatibility showed its highest value (52%) among students (32/61, p = 0.004). Conclusion Our study showed that 38.4% (30/78) of the devices did not presented some type of inadequacy, with outpatient-owned devices had the highest compliance rate (p = 0.015). These findings are worrisome, as they can lead to inaccurate BP measurements.
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Introducción: La hipertensión arterial es una enfermedad de alta prevalencia y complicaciones mortales. Debido a ello, se necesitan un adecuado manejo en la atención primaria y estrategias preventivas y de intervención, como la iniciativa HEARTS en las Américas. Se sabe también que entre los trabajadores de la Universidad de Ciencias Médicas de Matanzas existe una elevada prevalencia de hipertensos. Objetivo: Identificar el comportamiento del control de la enfermedad y la estratificación de riesgo cardiovascular global. Materiales y métodos: Estudio descriptivo transversal en el que se incluyeron los primeros 80 pacientes hipertensos valorados en la consulta de la mencionada institución. Los métodos empleados fueron el analítico-sintético, el inductivo-deductivo, el histórico-lógico y los estadísticos. Resultados: De 808 trabajadores, 276 eran hipertensos, para una prevalencia de 34,1 %. Dentro de los inadecuados estilos de vida, predominó el sedentarismo, con 59 pacientes (73,7 %); 40 de los 80 pacientes estudiados tenían un riesgo cardiovascular cuantitativo igual o mayor del 10 %, mientras que el riesgo cardiovascular cualitativo mostró que 68 (85 %) tenían un riesgo medio o alto. Dentro del daño en órganos diana predominaron las enfermedades cardiovasculares, con un 16,2 %. Conclusiones: La hipertensión arterial sigue siendo uno de los factores de riesgo más importantes de enfermedad cardiovascular y cerebrovascular. Su pesquisa, control y estimación del riesgo constituyen una prioridad de la atención médica a nivel primario.
Introduction: Arterial hypertension is a disease of high prevalence and fatal complications. Due to this, an adequate management is needed in the primary care, and also preventive and intervention strategies, as the HEARTS initiative in the Americas. It is also known that there is a high prevalence of hypertensive patients among the working staff of the Matanzas University of Medical Sciences. Objective: To identify the behavior of disease control and global cardiovascular risk stratification. Materials and methods: Cross-sectional descriptive study in which the first 80 hypertensive patients evaluated in the consultation of the aforementioned institution were included. The methods used were analytical-synthetic, inductive-deductive, historical-logical and statistical. Results: Of 808 workers, 276 were hypertensive, for a prevalence of 34.1%. Among the inadequate lifestyles, sedentary lifestyle predominated, with 59 patients (73.7%); 40 of the 80 patients studied had a quantitative cardiovascular risk equal to or greater than 10%, while qualitative cardiovascular risk showed that 68 (85%) had a medium or high risk. Cardiovascular diseases predominated within target organ damage, with 16.2%. Conclusions: Arterial hypertension continuous to be one of the most important risk factors for cardiovascular and cerebrovascular diseases. Its screening, control and risk assessment are a priority of the medical care at the primary level.
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RESUMEN Propósito de la revisión. HEARTS en las Américas es la adaptación regional de la iniciativa mundial HEARTS, de la Organización Mundial de la Salud, para la prevención y el control de las enfermedades cardiovasculares (ECV). Su objetivo general es impulsar el cambio de la práctica clínica y de la gestión en los entornos de atención primaria, por parte de los servicios de salud, a fin de mejorar el control de la hipertensión y reducir el riesgo de ECV. En esta revisión se describe la iniciativa HEARTS en las Américas. En primer lugar, se resume la situación epidemiológica regional en cuanto a la mortalidad por ECV y las tendencias en el control de la hipertensión a nivel poblacional; a continuación, se explica la razón de ser de los principales componentes de la intervención: el sistema de manejo orientado a la atención primaria y la vía clínica de HEARTS. Por último, se examinan los factores clave para acelerar la expansión de HEARTS: los medicamentos, la atención basada en el trabajo en equipo y un sistema de monitoreo y evaluación. Resultados recientes. Hasta el momento, 33 países y territorios de América Latina y el Caribe se han comprometido a integrar este programa en toda su red de atención primaria de salud para el 2025. El aumento de la cobertura y del control de la hipertensión en los entornos de atención primaria de salud (en comparación con el modelo tradicional) es prometedor y confirma que las intervenciones que se promueven como parte de HEARTS son factibles y resultan aceptables para las comunidades, los pacientes, los prestadores de servicios de salud, los responsables de la toma de decisiones y los financiadores. En esta revisión se destacan algunos casos de implementación satisfactoria. Conclusiones. Ampliar el uso de un tratamiento eficaz de la hipertensión y optimizar el control del riesgo de ECV es una forma pragmática de acelerar la reducción de la mortalidad por ECV y, al mismo tiempo, de fortalecer los sistemas de atención primaria de salud para responder con calidad y de manera eficaz y equitativa al desafío que entrañan las enfermedades no transmisibles, no solo en los países de ingresos bajos o medianos, sino en todas las comunidades a nivel mundial.
ABSTRACT Purpose of review. HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation. Recent findings. Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation. Summary. Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.
RESUMO Propósito da revisão. HEARTS nas Américas é uma adaptação regional da iniciativa mundial HEARTS, da Organização Mundial da Saúde, voltada para prevenção e controle das doenças cardiovasculares (DCV) na Região das Américas. Seu objetivo geral é promover mudanças na prática clínica e na gestão da atenção primária pelos serviços de saúde a fim de melhorar o controle da hipertensão arterial e reduzir o risco de DCV. Esta revisão descreve a iniciativa HEARTS nas Américas. Primeiro, é apresentado um resumo da situação epidemiológica regional relativa à mortalidade por DCV e das tendências no controle da hipertensão arterial em nível populacional. Em seguida, são explicados os motivos por trás dos principais componentes da intervenção: o sistema de manejo focado na atenção primária e o componente clínico da HEARTS. Por fim, são examinados os principais fatores para acelerar a ampliação da HEARTS: medicamentos, atenção baseada no trabalho em equipe e um sistema de monitoramento e avaliação. Resultados recentes. Até o momento, 33 países e territórios da América Latina e do Caribe se comprometeram a integrar esse programa em toda sua rede de atenção primária à saúde até 2025. Comparado com o modelo tradicional, o aumento da cobertura e do controle da hipertensão arterial nos ambientes de atenção primária à saúde é promissor e confirma que as intervenções promovidas pela HEARTS são exequíveis e aceitas por comunidades, pacientes, prestadores de serviços de saúde, tomadores de decisão e financiadores. Nesta revisão, destacamos alguns casos nos quais a implementação foi satisfatória. Conclusões. Ampliar a aplicação de um tratamento eficaz contra a hipertensão arterial e otimizar o controle do risco de DCV são medidas pragmáticas para acelerar a redução da mortalidade por DCV e, ao mesmo tempo, fortalecer os sistemas de atenção primária à saúde para responder com qualidade, eficácia e equidade ao desafio apresentado pelas doenças não transmissíveis, não apenas nos países de baixa ou média renda, mas no mundo todo.
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ABSTRACT BACKGROUND: Among the complications related to chronic kidney disease (CKD), those of a neurological nature stand out, and for a better quality of life for patients, the diagnosis and treatment of these complications is fundamental. OBJECTIVES: This study aimed to assess the effect of hemodialysis on intracranial pressure waveform (ICPw) in patients with chronic kidney disease undergoing hemodialysis and those who are not yet undergoing substitutive therapy. DESIGN AND SETTING: An observational study was conducted in two stages at a kidney replacement therapy center in Brazil. The first was a longitudinal study and the second was a cross-sectional study. METHODS: Forty-two patients on hemodialysis were included in the first stage of the study. In the second stage, 226 participants were included. Of these, 186 were individuals with chronic kidney disease (who were not undergoing substitutive therapy), and 40 did not have the disease (control group). The participants' intracranial compliance was assessed using the non-invasive Brain4care method, and the results were compared between the groups. RESULTS: There was a significant difference between the hemodialysis and non-hemodialysis groups, with the former having better ICPw conditions. CONCLUSIONS: Hemodialysis influenced the improvement in ICPw, probably due to the decrease in the patients' extra-and intracellular volumes. Furthermore, ICPw monitoring can be a new parameter to consider when defining the moment to start substitutive therapy.
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Introdução: analisar a prevalência e os fatores associados à doença renal crônica em pessoas com hipertensão arterial (HAS) cadastrados na Estratégia de Saúde da Família em Rio Branco, Acre. Método: Trata-se de um estudo transversal realizado com hipertensos cadastrados nas Estratégias de Saúde da Família (ESF), na zona urbana de Rio Branco, Acre, em 2019. A DRC foi definida por TFG < 60 ml/1,72m², estimada a partir da fórmula Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), ou presença de albuminúria > 29 mg/g. Medidas de associação foram estimadas por regressão logística, com grau de confiança de 95%. Resultados: A prevalência de DRC foi de 27,3% em pessoas com HAS. Observou-se associação estatisticamente significativa nos pacientes hipertensos entre DRC e escolaridade (ensino fundamental OR: 1,56; IC95%:1,09; 2,23; sem escolaridade OR:1,87; IC95%: 1,14; 3,07), não controle da pressão arterial (OR: 2,39; IC95%: 1,45; 3,94), sedentarismo (OR: 1,63; IC95%: 1,02; 2,60). Conclusão: A DRC apresenta alta prevalência nos hipertensos, evidenciando a necessidade de medidas em saúde pública para prevenção de complicações mediante melhor controle da doença e mudanças no estilo de vida.
Introduction: To analyze the prevalence and factors associated with chronic kidney disease in people with hypertension (SAH) registered in the Family Health Strategy in Rio Branco, Acre. Method: This is a cross-sectional study carried out with hypertensive patients registered in the Family Health Strategies (ESF), in the urban area of Rio Branco, Acre, in 2019. CKD was defined by GFR < 60 ml/1.72m², estimated from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, or presence of albuminuria > 29 mg/g. Association measures were estimated using logistic regression, with a 95% confidence level. Results: The prevalence of CKD was 27.3% in people with hypertension. A statistically significant association was observed in hypertensive patients between CKD and education (primary education OR: 1.56; 95% CI: 1.09; 2.23; no education OR: 1.87; 95% CI: 1.14; 3.07), lack of blood pressure control (OR: 2.39; 95% CI: 1.45; 3.94), sedentary lifestyle (OR: 1.63; 95% CI: 1.02; 2.60). Conclusion: CKD has a high prevalence in hypertensive patients, highlighting the need for public health measures to prevent complications through better control of the disease and changes in lifestyle.
Introducción: Se analizó la prevalencia y los factores asociados a la enfermedad renal crónica (ERC) en personas con hipertensión arterial (HTA) inscritas en la Estrategia de Salud Familiar en Rio Branco, Acre. Método: Estudio transversal con hipertensos inscritos en las Estrategias de Salud Familiar (ESF) en la zona urbana de Rio Branco, Acre, en 2019. La ERC se definió por un FG <60 ml/1,72m², estimado a partir de la fórmula de Colaboración de Epidemiología de Enfermedades Renales Crónicas (CKD-EPI), o la presencia de albuminuria >29 mg/g. Se estimaron medidas de asociación mediante regresión logística, con un nivel de confianza del 95%. Resultados: La prevalencia de ERC fue del 27,3% en personas con HTA. Se observó una asociación estadísticamente significativa entre la ERC y la escolaridad (educación primaria OR: 1,56; IC95%: 1,09; 2,23; sin escolaridad OR: 1,87; IC95%: 1,14; 3,07), falta de control de la presión arterial (OR: 2,39; IC95%: 1,45; 3,94), y sedentarismo (OR: 1,63; IC95%: 1,02; 2,60) en pacientes hipertensos. Conclusión: La ERC presenta una alta prevalencia en pacientes hipertensos, lo que destaca la necesidad de medidas de salud pública para prevenir complicaciones mediante un mejor control de la enfermedad y cambios en el estilo de vida.