Análise crítica da indicação da lavagem gástrica em intoxicações atendidas em um hospital de ensino / Critical analysis of gastric lavage indication for poisoning cases attended in a university hospital

Objetivo: Avaliar a indicação da lavagem gástrica no tratamento de intoxicações causadas por ingestão. Métodos: Todos os casos de intoxicação causada por ingestão que foram atendidos em dois hospitais do interior de São Paulo e submetidos à lavagem gástrica no período de 1° de janeiro de 2011 a 31 de dezembro de 2015 foram avaliados retrospectivamente quanto à indicação do procedimento, considerando o tempo entre ingestão e atendimento, a toxicidade da substância e as contraindicações para o procedimento. Resultados: Dos 587 casos atendidos, 338 (57,6%) foram submetidos à lavagem gástrica. Dentre esses casos, constatou-se a realização equivocada do procedimento em 95,8% casos. Conclusão: O número de pacientes submetidos à lavagem gástrica neste trabalho foi considerado elevado, mesmo quando orientado pelo centro de atendimento. Apesar da falta de evidências de que a lavagem gástrica traga benefícios nos casos de intoxicação, ela é largamente utilizada em virtude do desconhecimento das indicações e contraindicações desse procedimento por parte dos profissionais de saúde

Objective: To evaluate the indication of gastric lavage in the treatment of poisoning caused by ingestion. Methods: All cases of poisoning caused by ingestion that were treated in two hospitals in inland cities of São Paulo and subjected to gastric lavage from January 1, 2011 to December 31, 2015 were retrospectively assessed as for the indication of the procedure, considering the time between ingestion and care, substance toxicity, and procedure contraindications. Results: Of the 587 cases treated, 338 (57.6%) underwent gastric lavage. The procedure was considered incorrect in 95.8% of cases. Conclusion: The number of patients undergoing gastric lavage in this study was considered high, even when instructed by the center of attendance. Despite the lack of evidence that gastric lavage brings benefits in cases of poisoning, it is widely used due to the lack of knowledge by health professionals of the indications and contraindications of this procedure.

Prevalence of physical inactivity and its effects on blood pressure and metabolic parameters in a Brazilian Urban Population / Prevalência de inatividade física e seus efeitos na pressão arterial e parâmetros metabólicos em uma população urbana brasileira

Background: Cardiovascular disease is the leading cause of mortality in the world and physical inactivity represents an important risk factor. Objective: This study aimed to evaluate the prevalence of physical inactivity in the adult population and its effects on blood pressure, blood glucose and lipid profile. Methods: A population-based cross-sectional study with stratified simple random sampling was conducted in 1,717 adults divided by age groups: 18-39, 40-49, 50-59, 60-69 and ≥ 70 years. The participants answered the physical activity questionnaire and were classified as physically active or inactive. The bootstrap statistical method was used to assess physical activity, associated with lipid profile and blood glucose levels. The level of significance was 5%. Results:The prevalence of physical inactivity in the general population was 65.8%. There was a significant difference in the group older than 70 years. There was a significant decrease in physical activity in the group with lower educational level, with a significant difference between social classes AB and C. The prevalence of hypertension was 27.5% among physically inactive and 21.4% among active individuals (p = 0.04). The prevalence of metabolic syndrome was 26.1% in inactive and 16.7% in the active individuals (p = 0.007). Total cholesterol, low-density lipoprotein and triglycerides levels were more elevated in the physically inactive group, which was not observed with high-density lipoprotein levels. Blood glucose was also higher in the inactive group. Conclusion: This study shows a high prevalence of physical inactivity and a positive correlation between risk factors for cardiovascular disease, mainly blood pressure, glucose and lipids profiles

Prevalence of metabolic syndrome: association with risk factors and cardiovascular complications in an urban population.

INTRODUCTION: Metabolic syndrome (MS) is a set of cardiovascular risk factors and type 2 diabetes, responsible for a 2.5-fold increased cardiovascular mortality and a 5-fold higher risk of developing diabetes. OBJECTIVES: 1-to evaluate the prevalence of MS in individuals over 18 years associated with age, gender, socioeconomic status, educational levels, body mass index (BMI), HOMA index and physical activity; moreover, to compare it to other studies; 2-to compare the prevalence of elevated blood pressure (BP), high triglycerides and plasma glucose levels, low HDL cholesterol and high waist circumference among individuals with MS also according to gender; 3-to determine the number of risk factors in subjects with MS and prevalence of complications in individuals with and without MS aged over 40 years. METHODS: A cross-sectional study of 1369 Individuals, 667 males (48.7%) and 702 females (51.3%) was considered to evaluate the prevalence of MS and associated factors in the population. RESULTS: The study showed that 22.7% (95% CI: 19.4% to 26.0%) of the population has MS, which increases with age, higher BMI and sedentary lifestyle. There was no significant difference between genders until age ≥70 years and social classes. Higher prevalence of MS was observed in lower educational levels and higher prevalence of HOMA positive among individuals with MS. The most prevalent risk factors were elevated blood pressure (85%), low HDL cholesterol (83.1%) and increased waist circumference (82.5%). The prevalence of elevated BP, low HDL cholesterol and plasma glucose levels did not show significant difference between genders. Individuals with MS had higher risk of cardiovascular complications over 40 years. CONCLUSION: The prevalence of MS found is similar to that in developed countries, being influenced by age, body mass index, educational levels, physical activity, and leading to a higher prevalence of cardiovascular complications after the 4th decade of life.

Existem diferenças entre os diversos diuréticos? / Are there differences among the several diuretics?

Esse artigo faz uma breve revisão sobre as principais classes dos diuréticos e suas indicações. Aborda com detalhes os diuréticos tiazídicos, principal classe utilizada no tratamento da hipertensão arterial, abordando as diferenças entre eles em relação à estrutura, farmacodinâmica e farmacocinética. Posteriormente, avalia criteriosamente os principais trials clínicos, discutindo os efeitos dos tiazídicos na redução da pressão arterial, nos eventos cardiovasculares, incluindo acidente vascular encefálico, insuficiência cardíaca congestiva e doença arterial coronariana; além de abordar os efeitos sobre a glicemia. Finalmente, compara os principais diuréticos tiazídicos em relação à potência e efetividade na redução da pressão arterial.

This article is a brief review on the main classes of diuretics and indications. It discusses in detail the thiazide diuretics, the principal class used in the treatment of hypertension, addressing the differences between them in relation to structure, pharmacokinetics and pharmacodynamics. Afterwards, carefully assesses the key clinical trials, discussing the effects of thiazides in reducing blood pressure, cardiovascular events, including stroke, heart failure and coronary artery disease; in addition to addressing the effects on blood glucose. Finally, it compares the main thiazide diuretics in relation to the potency and effectiveness in lowering blood pressure.

Hipertensão arterial: aspectos farmacológicos e terapêuticos / Arterial Hypertension: pharmacological and therapeutics aspects

A hipertensão arterial sistêmica (HAS) é uma doença poli­gênica, multifatorial, caracterizada por aumento da resistência vascular, associada a alterações metabólicas e hormonais com repercussão em órgãos-alvo, sendo responsável por cerca de 40% de incapacitação e alta frequência de internações A prevalência da hipertensão arterial varia de 22% a 44% em diferentes países e regiões. Em estudo realizado em São José do Rio Preto (SP), na população adulta (maior e igual a 18 anos) a prevalência (populacional) de hipertensão arterial foi de 26% com a seguinte distribuição por faixas etárias: 18 a 39: 11%; 40-49: 24%; 50 a 59: 45%; 60 a 69: 66% e maior e igual a 70: 69%3. Sir George Pickering admitia a não existência de valores li­mítrofes entre a normotensão e hipertensão, mas, ao contrário, a relação entre pressão arterial e mortalidade é quantitativa, significando que quanto maior o nível pressórico, pior será o prognóstico, sendo qualquer valor divisório, arbitrário...