RESUMEN
INTRODUCTION: The retrolabyrinthine approach provides shorter working distance and less cerebellar retraction compared with the retrosigmoid approach to the internal acoustic canal (IAC) and cerebellopontine angle cistern. However, exposure of the ventral surface of the brainstem and petroclival region may be restricted. Trautmann's triangle (TT), an area intimately related to this region, demonstrates significant anatomical variability, which may adversely affect the ease of the approach. The aim of this study is to evaluate anatomic parameters of the posterior fossa that may anticipate a challenging situation in approaching the IAC and the petroclival region through the retrolabyrinthine approach. METHODS: It was performed a radioanatomic analysis of 75 cerebral angiotomography exams to identify parameters that could potentially reduce areas of surgical exposure. RESULTS: Large variations were observed in the area of exposure of the TT (553%) and the height of the jugular bulb (234%). Shorter distances from the sigmoid sinus to the posterior semicircular canal and high-riding jugular bulb were associated with smaller areas of exposure. Dominant and laterally positioned sigmoid sinuses and less pneumatized mastoids were associated with potentially unfavorable conditions, including a narrower angle of attack to the IAC. Increased petrous slopes and petroclival angles were associated with smaller petroclival areas and shallower clival depths. CONCLUSIONS: This study of the posterior fossa reveals remarkable anatomic variation in the region. These findings should be taken into consideration during the preoperative planning of retrolabyrinthine approaches in order to offer safer and more effective surgical procedures.
Asunto(s)
Fosa Craneal Posterior , Procedimientos Neuroquirúrgicos , Humanos , Fosa Craneal Posterior/cirugía , Fosa Craneal Posterior/anatomía & histología , Fosa Craneal Posterior/diagnóstico por imagen , Femenino , Masculino , Procedimientos Neuroquirúrgicos/métodos , Persona de Mediana Edad , Adulto , Oído Interno/anatomía & histología , Oído Interno/diagnóstico por imagen , Oído Interno/cirugía , Anciano , Hueso Petroso/anatomía & histología , Hueso Petroso/cirugía , Hueso Petroso/diagnóstico por imagen , Angiografía Cerebral/métodos , Ángulo Pontocerebeloso/anatomía & histología , Ángulo Pontocerebeloso/cirugía , Ángulo Pontocerebeloso/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVE: The aim of this study was to assess the performance of the CALL Score tool in predicting the death outcome in COVID-19 patients. METHODS: A total of 897 patients were analyzed. Univariate and multivariate logistic regression analyses were conducted to determine the association between characteristics of the CALL Score and the occurrence of death. The relationship between CALL Score risk classification and the occurrence of death was also examined. Receiver operating characteristic curve analysis was performed to identify optimal cutoff points for the CALL Score and the outcome. RESULTS: The study revealed that age>60 years, DHL>500, and lymphocyte count ≤1000 emerged as independent predictors of death. Higher risk classifications of the CALL Score were associated with an increased likelihood of death. The optimal CALL Score cutoff point for predicting the death outcome was 9.5 (≥9.5), with a sensitivity of 70.4%, specificity of 80.3%, and accuracy of 80%. CONCLUSION: The CALL Score showed promising discriminatory ability for death outcomes in COVID-19 patients. Age, DHL level, and lymphocyte count were identified as independent predictors. Further validation and external evaluation are necessary to establish the robustness and generalizability of the CALL Score in diverse clinical settings.
Asunto(s)
COVID-19 , Humanos , Persona de Mediana Edad , Recuento de Linfocitos , Pacientes , Curva ROCRESUMEN
SUMMARY OBJECTIVE: The aim of this study was to assess the performance of the CALL Score tool in predicting the death outcome in COVID-19 patients. METHODS: A total of 897 patients were analyzed. Univariate and multivariate logistic regression analyses were conducted to determine the association between characteristics of the CALL Score and the occurrence of death. The relationship between CALL Score risk classification and the occurrence of death was also examined. Receiver operating characteristic curve analysis was performed to identify optimal cutoff points for the CALL Score and the outcome. RESULTS: The study revealed that age>60 years, DHL>500, and lymphocyte count ≤1000 emerged as independent predictors of death. Higher risk classifications of the CALL Score were associated with an increased likelihood of death. The optimal CALL Score cutoff point for predicting the death outcome was 9.5 (≥9.5), with a sensitivity of 70.4%, specificity of 80.3%, and accuracy of 80%. CONCLUSION: The CALL Score showed promising discriminatory ability for death outcomes in COVID-19 patients. Age, DHL level, and lymphocyte count were identified as independent predictors. Further validation and external evaluation are necessary to establish the robustness and generalizability of the CALL Score in diverse clinical settings.
RESUMEN
INTRODUCTION: Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS: We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS: A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS: Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.
Asunto(s)
Enfermedad de Chagas/genética , Insuficiencia Cardíaca/fisiopatología , Peptidil-Dipeptidasa A/genética , Polimorfismo Genético/genética , Adulto , Inhibidores de la Enzima Convertidora de Angiotensina , Brasil , Estudios de Casos y Controles , Enfermedad de Chagas/fisiopatología , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Genotipo , Insuficiencia Cardíaca/genética , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Abstract Background Heart failure (HF) is worldwide known as a public health issue with high morbimortality. One of the issues related to the evolution of HF is the high rate of hospital readmission caused by decompensation of the clinical condition, with high costs and worsening of ventricular function. Objective To quantify the readmission rate and identify the predictors of rehospitalization in patients with acute decompensated heart failure. Methods Hospital-based historic cohort of patients admitted with acute decompensated HF in a private hospital from Recife/PE, from January 2008 to February 2016, followed-up for at least 30 days after discharge. Demographic and clinical data of admission, hospitalization, and clinical and late outcomes were analyzed. Logistic regression was used as a strategy to identify the predictors of independent risks. Results 312 followed-up patients, average age 73 (± 14), 61% males, 51% NYHA Class III, and 58% ischemic etiology. Thirty-day readmission rate was 23%. Multivariate analysis identified the independent predictors ejection fraction < 40% (OR = 2.1; p = 0.009), hyponatremia (OR = 2.9; p = 0.022) and acute coronary syndrome (ACS) as the cause of decompensation (OR = 1.1; p = 0,026). The final model using those three variables presented reasonable discriminatory power (C-Statistics = 0.655 - HF 95%: 0.582 - 0.728) and good calibration (Hosmer-Lemeshow p = 0.925). Conclusions Among hospitalized patients with acute decompensated heart failure, the rate of readmission was high. Hyponatremia, reduced ejection fraction and ACS as causes of decompensation were robust markers for the prediction of hospital readmission within 30 days of discharge. (Int J Cardiovasc Sci. 2020; 33(2):175-184)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Readmisión del Paciente , Insuficiencia Cardíaca/terapia , Hospitalización , Pronóstico , Volumen Sistólico , Estudios Retrospectivos , Síndrome Coronario Agudo/complicaciones , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/prevención & control , HiponatremiaRESUMEN
Abstract Background: Recently, a new HF entity, with LVEF between 40-49%, was presented to comprehend and seek better therapy for HF with preserved LVEF (HFpEF) and borderline, in the means that HF with reduced LVEF (HFrEF) already has well-defined therapy in the literature. Objective: To compare the clinical-therapeutic profile of patients with HF with mid-range LVEF (HFmrEF) with HFpEF and HFrEF and to verify predictors of hospital mortality. Method: Historical cohort of patients admitted with decompensated HF at a supplementary hospital in Recife/PE between April/2007 - August/2017, stratified by LVEF (< 40%/40 - 49/≥ 50%), based on the guideline of the European Society of Cardiology (ESC) 2016. The groups were compared and Logistic Regression was used to identify predictors of independent risk for in-hospital death. Results: A sample of 493 patients, most with HFrEF (43%), HFpEF (30%) and HFmrEF (26%). Average age of 73 (± 14) years, 59% men. Hospital mortality 14%, readmission within 30 days 19%. In therapeutics, it presented statistical significance among the 3 groups, spironolactone, in HFrEF patients. Hospital death and readmission within 30 days did not make difference. In the HFmrEF group, factors independently associated with death were: valve disease (OR: 4.17, CI: 1.01-9.13), altered urea at admission (OR: 6.18, CI: 1.78-11.45) and beta-blocker hospitalization (OR: 0.29, CI: 0.08-0.97). In HFrEF, predictors were: prior renal disease (OR: 2.84, CI: 1.19-6.79), beta-blocker at admission (OR: 0.29, CI: 0.12-0.72) and ACEI/ ARB (OR: 0.21, CI: 0.09-0.49). In HFpEF, only valve disease (OR: 4.61, CI: 1.33-15.96) and kidney disease (OR: 5.18, CI: 1.68-11.98) were relevant. Conclusion: In general, HFmrEF presented intermediate characteristics between HFrEF and HFpEF. Independent predictors of mortality may support risk stratification and management of this group.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/mortalidad , Volumen Sistólico/fisiología , Estudios Retrospectivos , Mortalidad Hospitalaria , Insuficiencia Cardíaca/epidemiologíaRESUMEN
Abstract INTRODUCTION: Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS: We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS: A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS: Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Polimorfismo Genético/genética , Enfermedad de Chagas/genética , Peptidil-Dipeptidasa A/genética , Insuficiencia Cardíaca/fisiopatología , Brasil , Inhibidores de la Enzima Convertidora de Angiotensina , Estudios de Casos y Controles , Estudios de Cohortes , Enfermedad de Chagas/fisiopatología , Progresión de la Enfermedad , Genotipo , Insuficiencia Cardíaca/genética , Persona de Mediana EdadRESUMEN
Objective To compare initial brain computed tomography (CT) scans with follow-up CT scans at one year in children with congenital Zika syndrome, focusing on cerebral calcifications.Design Case series study.Setting Barão de Lucena Hospital, Pernambuco state, Brazil.Participants 37 children with probable or confirmed congenital Zika syndrome during the microcephaly outbreak in 2015 who underwent brain CT shortly after birth and at one year follow-up.Main outcome measure Differences in cerebral calcification patterns between initial and follow-up scans.Results 37 children were evaluated. All presented cerebral calcifications on the initial scan, predominantly at cortical-white matter junction. At follow-up the calcifications had diminished in number, size, or density, or a combination in 34 of the children (92%, 95% confidence interval 79% to 97%), were no longer visible in one child, and remained unchanged in two children. No child showed an increase in calcifications. The calcifications at the cortical-white matter junction which were no longer visible at follow-up occurred predominately in the parietal and occipital lobes. These imaging changes were not associated with any clear clinical improvements.Conclusion The detection of cerebral calcifications should not be considered a major criterion for late diagnosis of congenital Zika syndrome, nor should the absence of calcifications be used to exclude the diagnosis.
Asunto(s)
Encéfalo/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Infección por el Virus Zika/diagnóstico , Virus Zika/aislamiento & purificación , Encéfalo/patología , Encéfalo/virología , Brasil , Calcinosis/virología , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Microcefalia/diagnóstico por imagen , Microcefalia/metabolismo , Microcefalia/virología , Neuroimagen/métodos , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico por imagen , Complicaciones Infecciosas del Embarazo/metabolismo , Complicaciones Infecciosas del Embarazo/virología , Síndrome , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patología , Sustancia Blanca/virología , Virus Zika/inmunología , Infección por el Virus Zika/congénito , Infección por el Virus Zika/metabolismo , Infección por el Virus Zika/virologíaRESUMEN
Fundamentos: A doença isquêmica do coração é a principal causa de morte entre homens e mulheres no Brasil e em vários países de diferentes continentes. Verifica-se um crescimento acelerado da mortalidade nos países em desenvolvimento, sendo esta considerada uma das questões mais relevantes em saúde pública atualmente. Objetivo: Analisar e comparar o perfil clínico-epidemiológico de homens e mulheres na síndrome coronariana aguda.Métodos: Avaliado o perfil clínico-epidemiológico de 927 pacientes (60,0% homens), com média de idade 67,0±12,0 anos com diagnóstico de síndrome coronariana aguda (SCA), internados na unidade coronariana de um hospital da rede suplementar de saúde, de referência em cardiologia, na cidade de Recife, PE, Brasil, no período de setembro de 2009 a dezembro de 2012.Resultados: Dentre os fatores de risco, a hipertensão arterial sistêmica e o sedentarismo foram mais frequentes nas mulheres (p=0,001), enquanto o tabagismo e o alcoolismo foram mais frequentes nos homens (p=0,01). Ainda nos homens foram mais frequentes: o infarto agudo do miocárdio com supradesnivelamento do segmento do ST ou cirurgia de revascularização do miocárdio prévios (p=0,011) e também os níveis de troponina (p=0,006). Durante a hospitalização, os desfechos adversos e óbito foram mais frequentes nas mulheres (p=0,177).Conclusão: As mulheres com SCA apresentaram maior prevalência de hipertensão arterial sistêmica e sedentarismo e a maior ocorrência de desfechos adversos, indicando a necessidade de intervir mais precocemente e estimular o controle nos fatores de risco, visando a reduzir as complicações e a mortalidade hospitalar.
Background: Ischemic heart disease is the leading cause of death among men and women in Brazil and in several countries on different continents. A sharp upsurge in mortality rates has been noted in the developing countries, today constituting a major public health issue.Objective: To analyze and compare the clinical and epidemiological profiles of men and women with acute coronary syndrome.Methods: We studied 927 patients (60.0% men) with an average age of 67.0±12.0 years diagnosed with acute coronary syndrome (ACS) and admitted to the coronary unit of a cardiology reference hospital in the supplementary healthcare network between September 2009 and December 2012 in the city of Recife, Pernambuco State, Brazil.Results: Among the risk factors, hypertension and sedentary lifestyles were more frequent among women (p=0.001), while smoking and alcoholism were more frequent among men (p=0.01). Men also had more frequent acute myocardial infarctions with elevation of the ST segment or previous coronary artery bypass grafting (p=0.011) and higher troponin levels (p=0.006). During hospitalization, adverse outcomes and deaths were more frequent among women (p=0.177).Conclusion: Women with ACS present higher rates for hypertension and sedentary lifestyles, with more adverse outcomes among women underscoring the need for earlier intervention and encouragement for controlling risk factors, in order to lower in-hospital mortality rates with fewer complications.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Perfil de Salud , Hombres , Salud Complementaria , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/mortalidad , Mujeres , Enfermedades Cardiovasculares/economía , Hipertensión/complicaciones , Infarto del Miocardio/complicaciones , Estudio Observacional , Prevalencia , Factores de Riesgo , Conducta Sedentaria , Factores SexualesRESUMEN
PURPOSE: To evaluate the impact of visual impairment on the quality of life of the elderly population living in the western countryside of Pernambuco State, located in northeast of Brazil. METHODS: Five hundred and eighty subjects over 59 years of age were interviewed using the Visual Functioning Questionnaire (VFQ). All subjects underwent complete eye examination. The results of the quantitative parameters were expressed by mean ± SD. The results of categorical parameters were expressed by their frequencies. RESULTS: Mean age was of 70 ± 8.1 years. About 86% of the interviewed elderly were illiterate or had incomplete education. The mean complaints were low visual acuity (71.1%) and itching/burning (69.0%). The visual acuity was not normal in 37.4% of the elderly. About 75.0% of the subjects reported to have regular or bad health, and 77.0% reported to have regular or bad vision. The reported quality of life decreased according to the worsening of the visual acuity. CONCLUSION: Visual impairment had a negative impact on the quality of life of the elderly population from the western countryside of Pernambuco State.
Asunto(s)
Programas Nacionales de Salud , Calidad de Vida , Trastornos de la Visión , Factores de Edad , Anciano , Anciano de 80 o más Años , Brasil , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Salud Pública , Factores Sexuales , Factores Socioeconómicos , Agudeza VisualRESUMEN
OBJETIVOS: Identificar precocemente a prevalência de aterosclerose, por causa do espessamento do complexo médio-intimal das carótidas comuns e do índice tornozelo-braço. Essas medidas foram relacionadas com os fatores de risco clássicos de aterosclerose e os específicos dos infectados pelo HIV (tempo de doença, tempo de tratamento, tipo de tratamento, tipo de terapia antirretroviral utilizada, CD4 e carga viral). MÉTODOS: Setenta casos infectados com o HIV foram avaliados pela medida automática do complexo médio-intimal nas carótidas e do índice tornozelo-braço. Consideraram-se os fatores de risco clássicos de aterosclerose (idade, sexo, hipertensão arterial sistêmica, tabagismo, hipercolesterolemia, hipertrigliceridemia, obesidade e história familiar de evento cardiovascular), as medidas antropométricas e as variáveis relacionadas ao HIV. O nível de significância assumido foi de 5%. RESULTADOS: O tempo médio de diagnóstico do HIV foi de 104,9 meses e de tratamento foi de 97,9 meses. Quanto ao tipo de tratamento, 47 (67,1%) fizeram uso de inibidor de protease por mais de seis meses e 36 (51,4%) estão em uso atualmente. O índice tornozelo-braço estava aumentado em um único paciente (0,7%) e não se evidenciou espessamento do complexo médio-intimal em nenhum indivíduo. Não existiu associação significante da medida do complexo médio-intimal da carótida comum direita com nenhuma das variáveis analisadas. CONCLUSÕES: Indivíduos jovens, sob o uso de terapia antirretroviral por cinco anos ou mais, não apresentaram espessamento do complexo médio-intimal ou aumento do índice tornozelo-braço. Não houve diferença do espessamento do complexo médio-intimal associada ao tipo de esquema antirretroviral utilizado ou nível de carga viral.
OBJECTIVES: To precociously identify the prevalence of atherosclerosis caused by thickening of the intima-media complex of the common carotid arteries and of the ankle brachial index. These measurements were associated with the classical risk factors of atherosclerosis and the specific factors of those infected by HIV (duration of disease, length of treatment, kind of treatment, kind of antiretroviral therapy used, CD4 and viral load). METHODS: Seventy cases infected by HIV were assessed by automatic measurement of the intima-media complex in the carotids and of the ankle brachial index. The classical risk factors of atherosclerosis (age, gender, systemic arterial hypertension, smoking, hypercholesterolemia, hypertriglyceridemia, obesity, and family history of cardiovascular events), anthropometric measurements and the variables related to HIV were taken into consideration. The adopted level of significance was 5%. RESULTS: The mean time of HIV diagnosis was 104.9 months, mean duration of treatment was 97.9 months. As regard to the type of treatment, 47 (67.1%) used protease inhibitor for more than six months and 36 (51.4%) are using it recently. The ankle brachial index was increased in one patient (0.7%), and the intima-media complex was not thickened in any individual. There was no significant association of the measurement of the intima-media complex of the right common carotid with any of the variables analyzed. CONCLUSIONS: Young individuals under the use of antiretroviral therapy for five years or more did not show increase in thickness of the intima-media complex or increase in the ankle brachial index, and there was no difference in the intima-media complex thickness associated with the therapeutical scheme of antiretroviral used or the viral load level.
Asunto(s)
Humanos , Masculino , Adulto , Índice Tobillo Braquial , Antirretrovirales/uso terapéutico , Enfermedades de las Arterias Carótidas/complicaciones , Prevalencia , VIH , Estudios Prospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
OBJETIVO: Avaliar o impacto das doenças oculares sobre a qualidade de vida de uma população idosa do sertão de Pernambuco, localizado na região nordeste do Brasil. MÉTODOS: Foram entrevistados 580 indivíduos acima de 59 anos, por meio do questionário de avaliação de qualidade de vida "Visual Functioning Questionnaire" (VFQ). Todos os indivíduos foram submetidos a exame oftalmológico completo. Os resultados das variáveis quantitativas foram expressos por suas médias e desvios- padrão. Os resultados das variáveis qualitativas foram expressos por suas frequências absolutas e relativas. RESULTADOS: A média de idade foi de 70 ± 8,1 anos. Cerca de 86,0% dos entrevistados declararam ser analfabetos ou ter o ensino fundamental incompleto. As principais queixas foram: baixa visual (71,1%) e ardor/prurido (69,0%). A acuidade visual não era normal em 37,4% dos idosos. Por volta de 75,0% dos entrevistados relataram ter saúde regular ou ruim, e 77,0% diziam ter uma visão regular ou ruim. A qualidade de vida foi considerada pior conforme a piora da condição visual do idoso. CONCLUSÃO: O déficit visual representou um impacto negativo sobre a qualidade de vida dos idosos do sertão Pernambucano.
PURPOSE: To evaluate the impact of visual impairment on the quality of life of the elderly population living in the western countryside of Pernambuco State, located in northeast of Brazil. METHODS: Five hundred and eighty subjects over 59 years of age were interviewed using the Visual Functioning Questionnaire (VFQ). All subjects underwent complete eye examination. The results of the quantitative parameters were expressed by mean ± SD. The results of categorical parameters were expressed by their frequencies. RESULTS: Mean age was of 70 ± 8.1 years. About 86% of the interviewed elderly were illiterate or had incomplete education. The mean complaints were low visual acuity (71.1%) and itching/burning (69.0%). The visual acuity was not normal in 37.4% of the elderly. About 75.0% of the subjects reported to have regular or bad health, and 77.0% reported to have regular or bad vision. The reported quality of life decreased according to the worsening of the visual acuity. CONCLUSION: Visual impairment had a negative impact on the quality of life of the elderly population from the western countryside of Pernambuco State.
Asunto(s)
Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Calidad de Vida , Trastornos de la Visión , Factores de Edad , Brasil , Estado de Salud , Salud Pública , Factores Sexuales , Factores Socioeconómicos , Agudeza VisualRESUMEN
BACKGROUND: A correlation between the levels of serum globulins and the hepatic fibrosis degree in chronic hepatitis was described, but reports in schistosomiasis mansoni have not been found. OBJECTIVE: To evaluate the serum globulins and IgG levels, and periportal fibrosis intensity measured by ultrasound in patients with schistosomiasis mansoni. METHODS: Between November, 2006 and February 2007, 41 patients which were eligible, filled them a questionnaire and had their levels of serum IgG measured by immunoturbidimetry and globulins indirectly measured by the Biuret method. The ultrasound was carried out by a single researcher, according to the Cairo and Niamey protocols. RESULTS: The average age was 41 years old and 25 female patients (61%). Ten patients (24%) from 41 showed serum globulins levels raised and 21 (51%) presented elevated IgG levels. According to the Cairo classification, 21 patients showed grade I of fibrosis, 18 grade II and 2 grade III; and by the Niamey classification 8 showed standard C, 20 D, and 13 E. Those with grade II or III of fibrosis had higher IgG levels than the ones with grade I (P = 0.047), as well as those who showed standards D and E as compared to C (P = 0.011). There was no association between the globulins levels and the intensity of fibrosis. CONCLUSION: In patients with schistosomiasis mansoni, an increase of the IgG serum levels was observed according to the progression from periportal fibrosis intensity, but the same was not founded with globulins levels.
Asunto(s)
Inmunoglobulina G/sangre , Cirrosis Hepática/sangre , Parasitosis Hepáticas/sangre , Esquistosomiasis mansoni/sangre , Seroglobulinas/análisis , Adulto , Anciano , Biomarcadores/sangre , Femenino , Humanos , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/patología , Parasitosis Hepáticas/diagnóstico por imagen , Parasitosis Hepáticas/patología , Masculino , Persona de Mediana Edad , Nefelometría y Turbidimetría , Esquistosomiasis mansoni/diagnóstico por imagen , Esquistosomiasis mansoni/patología , Índice de Severidad de la Enfermedad , Ultrasonografía , Adulto JovenRESUMEN
CONTEXTO: Tem sido descrita correlação entre os níveis séricos de globulinas e o grau de fibrose hepática nas hepatites crônicas, mas não se encontram relatos na esquistossomose mansônica. OBJETIVO: Avaliar os níveis séricos de globulinas e de IgG, e a intensidade da fibrose periportal mensurada pela ultrassonografia em pacientes com esquistossomose mansônica. MÉTODOS: Entre novembro de 2006 e fevereiro de 2007, foram estudados 41 pacientes que preencheram ficha clínica e realizaram dosagens de IgG por imunoturbidimetria e de globulinas indiretamente pelo método do biureto. A ultrassonografia foi realizada por um único pesquisador, seguindo os protocolos do Cairo e de Niamey. RESULTADOS: A média de idade foi 41 anos, sendo 25 pacientes (61 por cento) do sexo feminino. Dez dos 41 pacientes (24 por cento) apresentaram elevação dos níveis séricos de globulinas e 21 (51 por cento) dos de IgG. Conforme a classificação do Cairo, 21 pacientes apresentaram grau I de fibrose, 18 grau II e 2 grau III, e pela classificação de Niamey 8 apresentavam padrão C, 20 D e 13 E. Aqueles com graus II ou III de fibrose tiveram maiores níveis de IgG do que os de grau I (P = 0,047), assim como aqueles que apresentaram padrões D e E em relação ao C (P = 0,011). Não houve associação entre os níveis de globulinas e o grau ou padrão de fibrose. CONCLUSÃO: Em pacientes com esquistossomose mansônica, observou-se elevação dos níveis séricos de IgG de acordo com a progressão do grau e do padrão de fibrose periportal, mas o mesmo não se observou com os níveis de globulinas.
BACKGROUND: A correlation between the levels of serum globulins and the hepatic fibrosis degree in chronic hepatitis was described, but reports in schistosomiasis mansoni have not been found. OBJECTIVE: To evaluate the serum globulins and IgG levels, and periportal fibrosis intensity measured by ultrasound in patients with schistosomiasis mansoni. METHODS: Between November, 2006 and February 2007, 41 patients which were eligible, filled them a questionnaire and had their levels of serum IgG measured by immunoturbidimetry and globulins indirectly measured by the Biuret method. The ultrasound was carried out by a single researcher, according to the Cairo and Niamey protocols. RESULTS: The average age was 41 years old and 25 female patients (61 percent). Ten patients (24 percent) from 41 showed serum globulins levels raised and 21 (51 percent) presented elevated IgG levels. According to the Cairo classification, 21 patients showed grade I of fibrosis, 18 grade II and 2 grade III; and by the Niamey classification 8 showed standard C, 20 D, and 13 E. Those with grade II or III of fibrosis had higher IgG levels than the ones with grade I (P = 0,047), as well as those who showed standards D and E as compared to C (P = 0,011). There was no association between the globulins levels and the intensity of fibrosis. CONCLUSION: In patients with schistosomiasis mansoni, an increase of the IgG serum levels was observed according to the progression from periportal fibrosis intensity, but the same was not founded with globulins levels.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Inmunoglobulina G/sangre , Cirrosis Hepática/sangre , Parasitosis Hepáticas/sangre , Esquistosomiasis mansoni/sangre , Seroglobulinas/análisis , Biomarcadores/sangre , Cirrosis Hepática/patología , Cirrosis Hepática , Parasitosis Hepáticas/patología , Parasitosis Hepáticas , Nefelometría y Turbidimetría , Índice de Severidad de la Enfermedad , Esquistosomiasis mansoni/patología , Esquistosomiasis mansoni , Adulto JovenRESUMEN
Com o objetivo de mapear a saúde visual dos idosos atendidos pelo Sistema Único de Saúde, em Pernambuco, a Fundação Altino Ventura iniciou o desafio pela cidade de Salgueiro Sertão do Estado. Foram envolvidos nesta investigação preliminar, 434 idosos, de ambos os sexos, que atenderam, de forma aleatória, ao convite. O tamanho da amostra foi representativo da população de idosos do município; tanto da zona urbana como rural. Inicialmente, foram descritos os dados epidemiológicos para descrição do perfil desses cidadãos. A seguir, foram aferidos os dados antropométricos e de pressão arterial que são objeto do presente estudo. A análise dos dados demonstra que os idosos residentes na cidade de Salgueiro apresentam, predominantemente, estatura mediana ou baixa (média 1,55±0,08m), têm alta freqüência de sobrepeso e obesidade (62,2), aproximadamente a metade deles com perímetro abdominal aumentado. A freqüência de hipertensão arterial sistêmica é muito alta (81 e, na grande maioria, não controlada. Os dados antropométricos indicam que esses idosos, embora pobres, apresentam características da transição epidemiológica que vem ocorrendo nos países desenvolvidos e, também, no Brasil. A alta prevalência de hipertensão arterial nesses cidadãos pode indicar baixo grau de instrução e pouca procura aos serviços de saúde, assistência médica deficiente, particularmente no que diz respeito à prevenção. Por outro lado, indica a necessidade de maior assistência do Estado e da sociedade.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano , Antropometría , Hipertensión/epidemiología , Oftalmopatías/epidemiología , Sistema Único de Salud , Transición de la Salud , Obesidad , PobrezaRESUMEN
Com o objetivo de mapear a saúde visual do idoso, usuário do Sistema Único de Saúde, em Pernambuco, a Fundação Altino Ventura iniciou essa investigação em Salgueiro. Foram envolvidos no estudo 434 indivíduos, de ambos os sexos, com idade igual ou superior a 60 anos, residentes neste município, sertão do Estado de Pernambuco, Brasil. Trata-se de um estudo observacional de corte transversal, que teve como base o Sistema de Informação da Atenção Básica (SIAB) do município; tendo as cotas das amostras definidas pelo número de idosos por cada PSF (Programa de Saúde da Família), tanto da zona urbana quanto da rural. As estimativas da amostra foram dimensionadas para estimar a prevalência das doenças oculares consideradas como mais freqüentes em produzir cegueira em idosos; catarata, glaucoma, doença macular relacionada à idade e retinopatia diabética. Os dados epidemiológicos destes indivíduos foram analisados com o objetivo de caracterizar este perfil. O perfil epidemiológico médio do idoso residente no município de Salgueiro, atendido pelo sistema SUS, é de um cidadão pobre, predominantemente pardo, com pouco estudo formal, cristão e com família grande estruturada. As mulheres atenderam ao chamado em maior número e tendem a buscar mais os cuidados com a saúde. Estas características indicam cidadãos com menor probabilidade de consumir serviços de saúde, quando comparado com os mais ricos e com maior nível de educação. A longevidade alcançada por eles, particularmente na zona rural, poderá cursar sem qualidade de vida, sobrecarregando a seguridade social e o sistema SUS, além de apresentar retorno cada vez mais difícil. Os achados indicam a necessidade de uma ação mais efetiva do Estado e da sociedade para inclusão social e melhora da qualidade de vida desses cidadãos carentes.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Salud del Anciano , Perfil de Salud , Oftalmopatías/epidemiología , Sistema Único de Salud , Demografía , Factores SocioeconómicosRESUMEN
A total of 172 elderly individuals, divided into case and control groups based on the diagnosis of coronary artery disease, underwent coronary angiography to investigate the influence of age and coronary artery disease on homocysteine levels. The subjects were divided into three age ranges: 65-74 years, 75-79 years, and 80 years and older. Continuous homocysteinemia was associated with a risk ratio for coronary artery disease of 1.07 for each micromol/L increase in homocysteine level. Hyperhomocysteinemia (values above 14 micromol/L) constituted an independent risk factor for coronary artery disease, with a risk ratio of 2.03. There was a progression of homocysteine levels between the young old and the oldest old only among the case group elderly. There was no difference among the control group elderly. There were no significant differences in vitamin levels. The rise in homocysteine levels from the young old to the oldest old may be considered not a normal pattern, but rather a pattern associated with coronary artery disease.
Asunto(s)
Enfermedad de la Arteria Coronaria/epidemiología , Homocisteína/sangre , Hiperhomocisteinemia/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Estudios de Casos y Controles , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/etiología , Progresión de la Enfermedad , Femenino , Humanos , Hiperhomocisteinemia/sangre , Hiperhomocisteinemia/complicaciones , Modelos Logísticos , Masculino , Factores de RiesgoRESUMEN
A total of 172 elderly individuals, divided into case and control groups based on the diagnosis of coronary artery disease, underwent coronary angiography to investigate the influence of age and coronary artery disease on homocysteine levels. The subjects were divided into three age ranges: 6574 years, 7579 years, and 80 years and older. Continuous homocysteinemia was associated with a risk ratio for coronary artery disease of 1.07 for each ìmol/L increase in homocysteine level. Hyperhomocysteinemia (values above 14 ìmol/L) constituted an independent risk factor for coronary artery disease, with a risk ratio of 2.03. There was a progression of homocysteine levels between the young old and the oldest old only among the case group elderly. There was no difference among the control group elderly. There were no significant differences in vitamin levels. The rise in homocysteine levels from the young old to the oldest old may be considered not a normal pattern, but rather a pattern associated with coronary artery disease. (AJGC. 2006;15:165173)
Asunto(s)
Anciano , Anciano de 80 o más Años , Humanos , Angiografía Coronaria , Enfermedad de la Arteria Coronaria , Homocisteína/análisisRESUMEN
OBJECTIVE: To investigate whether hyperhomocysteinemia is an independent risk factor for atherosclerotic disease in elderly individuals. METHODS: A case-control study with 172 elderly individuals, 88 belonging to control group and 84 to case group, who showed coronary angiography requested for clinical indications. Quantitative coronary angiography was performed in 91% of the patients. Homocysteinemia was assessed in a continuous and categorized way, through univariate and multivariate analysis. RESULTS: When analyzed continuously, in univariate analysis, it was verified that case group elderly individuals showed an average homocysteinemia levels significantly higher than the control group individuals' (14.33 +/- 4.59 micromol/l against 11.99 +/- 4.59 micromol/l, p = 0.015). In multivariate analysis, continuous homocysteinemia was associated to the risk rate for coronary artery disease of 1.07 for each 1 micromol/l increase of homocysteine level. Na increase of 5 micromol/l corresponded to the risk rate of 1.40. When analyzed in categorized way, the values found over percentile 75 of control group (14 micromol/l) were defined as hyperhomocysteinemia. Hyperhomocysteinemia was found in 34% of elderly individuals, being 37.3% in control group and 62.7% in case group (p = 0.009). In multivariate analysis, hyperhomocysteinemia constituted an independent risk factor for coronary atherosclerotic disease for elderly individuals, with a risk rate for coronary artery disease of 2.03, confidence interval 95%, 1.02-4.03. CONCLUSION: Hyperhomocysteinemia was an independent risk factor for coronary artery disease in elderly individuals.