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1.
Einstein (Sao Paulo) ; 16(3): eAO4228, 2018 Sep 21.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30281761

RESUMO

OBJECTIVE: To describe first medical students' profile of the Faculdade Israelita de Ciências da Saúde Albert Einstein. METHODS: Data were collected using an electronic questionnaire during the Biostatistics course in August of 2016. The students were inquired about demographic characteristics, data on their secondary education and college entrance exams, practice of physical exercise, leisure activities done, to have a physician in the family, and specialty that they intended to pursue as a career. RESULTS: Most of the students were women aged 18 to 21 years and who were originally from the state of São Paulo, had received secondary education in a private school, took a course to prepare for college entrance exam, and participated in more than 5 college entrance exams in the same year they entered in the School of Medicine. The majority of participants practiced physical exercise regularly and were engaged in common leisure activities. Most of students (58%) had a physician in the family and more than half (52%) did not know which specialty to pursue as career. There was no association between relationship with a physician and the student's choice of a specialty (p=0.390). CONCLUSION: Although it was the first group of student of School of Medicine at Faculdade Israelita de Ciências da Saúde Albert Einstein who took a different admission process, our data showed that students' profile is similar to students from other colleges.


Assuntos
Faculdades de Medicina/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Adolescente , Escolha da Profissão , Estudos Transversais , Feminino , Humanos , Estilo de Vida , Masculino , Distribuição por Sexo , Fatores Sociológicos , Estudantes de Medicina/psicologia , Inquéritos e Questionários , Adulto Jovem
2.
Nutrition ; 48: 105-110, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29469010

RESUMO

OBJECTIVE: To test the hypothesis that low blood thiamine concentrations in malnourished critically ill children are associated with higher risk of 30-d mortality. METHODS: Prospective cohort study in 202 consecutively admitted children who had whole blood thiamine concentrations assessed on admission and on days 5 and 10 of intensive care unit (ICU) stay. The primary outcome variable was 30-d mortality. Mean blood thiamine concentrations within the first 10 d of ICU stay, age, sex, malnutrition, C-reactive protein concentration, Pediatric Index of Mortality 2 score, and severe sepsis/septic shock were the main potential exposure variables for outcome. RESULTS: Thiamine deficiency was detected in 61 patients within the first 10 d of ICU stay, 57 cases being diagnosed on admission and 4 new cases on the 5th d. C-reactive protein concentration during ICU stay was independently associated with decreased blood thiamine concentrations (P = 0.003). There was a significant statistical interaction between mean blood thiamine concentrations and malnutrition on the risk of 30-d mortality (P = 0.002). In an adjusted analysis, mean blood thiamine concentrations were associated with a decrease in the mortality risk in malnourished patients (odds ratio = 0.85; 95% confidence interval [CI]: 0.73-0.98; P = 0.029), whereas no effect was noted for well-nourished patients (odds ratio: 1.03; 95% CI: 0.94-1.13; P = 0.46). CONCLUSIONS: Blood thiamine concentration probably has a protective effect on the risk of 30-d mortality in malnourished patients but not in those who were well nourished.

3.
Einstein (Säo Paulo) ; 16(3): eAO4228, 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-953179

RESUMO

ABSTRACT Objective: To describe first medical students' profile of the Faculdade Israelita de Ciências da Saúde Albert Einstein. Methods: Data were collected using an electronic questionnaire during the Biostatistics course in August of 2016. The students were inquired about demographic characteristics, data on their secondary education and college entrance exams, practice of physical exercise, leisure activities done, to have a physician in the family, and specialty that they intended to pursue as a career. Results: Most of the students were women aged 18 to 21 years and who were originally from the state of São Paulo, had received secondary education in a private school, took a course to prepare for college entrance exam, and participated in more than 5 college entrance exams in the same year they entered in the School of Medicine. The majority of participants practiced physical exercise regularly and were engaged in common leisure activities. Most of students (58%) had a physician in the family and more than half (52%) did not know which specialty to pursue as career. There was no association between relationship with a physician and the student's choice of a specialty (p=0.390). Conclusion: Although it was the first group of student of School of Medicine at Faculdade Israelita de Ciências da Saúde Albert Einstein who took a different admission process, our data showed that students' profile is similar to students from other colleges.


RESUMO Objetivo: Descrever o perfil dos estudantes de Medicina ingressantes na primeira turma do curso de graduação em Medicina da Faculdade Israelita de Ciências da Saúde Albert Einstein. Métodos: Os dados foram coletados a partir de uma pesquisa realizada pela internet durante o curso de Bioestatística, em agosto de 2016. A pesquisa abordou características sociodemográficas, dados do ensino médio e dos vestibulares, prática de atividade física, lazer, parentesco médico e especialidade que pretendia seguir. Resultados: A maioria dos estudantes de Medicina era do sexo feminino, procedente do Estado de São Paulo, com idade entre 18 a 21 anos, estudou o Ensino Médio em escola particular, fez cursinho pré-vestibular e prestou mais de cinco vestibulares no ano de ingresso na faculdade. Em geral, realizavam atividade física regularmente e tinham atividades de lazer comuns à essa faixa etária. A maior parte (58%) tinha algum parentesco médico e mais da metade (52%) não sabia qual especialidade seguir. Não houve associação entre parentesco médico e escolha da especialidade (p = 0,390). Conclusão: Apesar de ser a primeira turma e de ter passado por um processo seletivo diferenciado, os dados mostraram que o perfil dos alunos era semelhante ao encontrado em outras faculdades.

4.
Med Teach ; 39(10): 1033-1039, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28681649

RESUMO

PURPOSE: Evaluation of non-cognitive skills never has been used in Brazil. This study aims to evaluate Multiple Mini Interviews (MMI) in the admission process of a School of Medicine in São Paulo, Brazil. METHODS: The population of the study comprised 240 applicants summoned for the interviews, and 96 raters. MMI contributed to 25% of the applicants' final grade. Eight scenarios were created with the aim of evaluating different non-cognitive skills, each one had two raters. At the end of the interviews, the applicants and raters described their impressions about MMI. The reliability of the MMI was analyzed using the Theory of Generalization and Many-Facet Rasch Model (MFRM). RESULTS: The G-study showed that the general reliability of the process was satisfactory (coefficient G = 0.743). The MMI grades were not affected by the raters' profile, time of interview (p = 0.715), and randomization group (p = 0.353). The Rasch analysis showed that there was no misfitting effects or inconsistent stations or raters. A significant majority of the applicants (98%) and all the raters believed MMIs were important in selecting students with a more adequate profile to study medicine. CONCLUSIONS: The general reliability of the selection process was excellent, and it was fully accepted by the applicants and raters.


Assuntos
Entrevistas como Assunto , Critérios de Admissão Escolar , Faculdades de Medicina , Brasil , Humanos , Reprodutibilidade dos Testes , Estudantes
5.
Rev Saude Publica ; 50: 44, 2016 Aug 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-27509010

RESUMO

OBJECTIVE: To analyze if characteristics of managers, schools, and curriculum are associated with the implementation of programs for drug abuse prevention in elementary and high schools. METHODS: Cross-sectional study, with random sample of 263 school managers. Data were collected between 2012 and 2013 by a program that sends forms via internet. A closed self-filling questionnaire was applied online. Statistical analysis included Chi-square tests and logistic regression models. The outcome variable was the presence of program for drug abuse prevention inserted in the daily life and educational program of the school. The explanatory variables were divided into: demographic data of the manager; characteristics of the school and of the curriculum; health education; and drug use in the school. RESULTS: We found that 42.5% (95%CI 36.1-49.1) of the evaluated schools had programs for drug abuse prevention. With the multiple logistic regression model, we observed that the more time the manager has worked with education, the chance of the school having a program increased at about 4.0%. Experimenting with innovative teaching techniques also increased at about six times the chance of the school developing a program for drug abuse prevention. The difficulties in the implementation of the programs were more present in state and municipal schools, when compared with private schools, due to, for instance: lack of teaching materials, lack of money, and competing demands for teaching other subjects. CONCLUSIONS: The implementation of programs for drug abuse prevention in the city of Sao Paulo is associated with the experience of the manager in education and with the teaching strategies of the school. OBJETIVO: Analisar se características dos dirigentes, das escolas e do currículo escolar estão associadas à implantação de programas de prevenção ao uso de drogas nas escolas do ciclo fundamental II e médio. MÉTODOS: Estudo transversal, com amostra aleatória sistemática de 263 dirigentes escolares. Os dados foram coletados nos anos de 2012 e 2013 por meio de um programa de envio de formulários pela internet. Aplicou-se questionário fechado, de autopreenchimento on-line. A análise estatística incluiu testes Qui-quadrado e modelos de regressão logística. A variável desfecho foi a presença de programa de prevenção ao uso de drogas inserido no cotidiano e no programa pedagógico da escola. As variáveis explicativas foram divididas em: dados demográficos do dirigente; características da escola e do currículo; educação em saúde; e consumo de drogas na escola. RESULTADOS: Constatou-se que 42,5% (IC95% 36,1-49,1) das escolas avaliadas possuíam programa de prevenção ao uso de drogas. Com o modelo de regressão logística múltipla, observou-se que, a cada ano de atuação do dirigente na educação, a chance de a escola ter um programa aumentava em aproximadamente 4,0%. O fato de experimentar técnicas de ensino inovadoras também aumentou em cerca de seis vezes a chance de a escola desenvolver um programa de prevenção ao uso de drogas. As dificuldades na implantação dos programas foram mais presentes nas redes estadual e municipal, quando comparadas à rede privada, destacando-se: a falta de material didático, a falta de dinheiro e as demandas concorrentes para ensino de outras disciplinas. CONCLUSÕES: A implantação de programas de prevenção ao uso de drogas no município de São Paulo está associada à experiência do dirigente escolar na educação e nas estratégias de ensino da escola.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Educação em Saúde/métodos , Papel Profissional , Instituições Acadêmicas , Prevenção do Hábito de Fumar , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Feminino , Promoção da Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Instituições Acadêmicas/estatística & dados numéricos , Fumar/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários
6.
PLoS One ; 11(3): e0151019, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26963624

RESUMO

BACKGROUND: There is a growing body of evidence linking micronutrient deficiencies and malaria incidence arising mostly from P. falciparum endemic areas. We assessed the impact of micronutrient deficiencies on malaria incidence and vice versa in the Brazilian state of Amazonas. METHODOLOGY/PRINCIPAL FINDINGS: We evaluated children <10 years old living in rural communities in the state of Amazonas, Brazil, from May 2010 to May 2011. All children were assessed for sociodemographic, anthropometric and laboratory parameters, including vitamin A, beta-carotene, zinc and iron serum levels at the beginning of the study (May 2010) and one year later (May 2011). Children were followed in between using passive surveillance for detection of symptomatic malaria. Those living in the study area at the completion of the observation period were reassessed for micronutrient levels. Univariate Cox-proportional Hazards models were used to assess whether micronutrient deficiencies had an impact on time to first P. vivax malaria episode. We included 95 children median age 4.8 years (interquartile range [IQR]: 2.3-6.6), mostly males (60.0%) and with high maternal illiteracy (72.6%). Vitamin A deficiencies were found in 36% of children, beta-carotene deficiency in 63%, zinc deficiency in 61% and iron deficiency in 51%. Most children (80%) had at least one intestinal parasite. During follow-up, 16 cases of vivax malaria were diagnosed amongst 13 individuals. Micronutrient deficiencies were not associated with increased malaria incidence: vitamin A deficiency [Hazard ratio (HR): 1.51; P-value: 0.45]; beta-carotene [HR: 0.47; P-value: 0.19]; zinc [HR: 1.41; P-value: 0.57] and iron [HR: 2.31; P-value: 0.16]). Upon reevaluation, children with al least one episode of malaria did not present significant changes in micronutrient levels. CONCLUSION: Micronutrient serum levels were not associated with a higher malaria incidence nor the malaria episode influenced micronutrient levels. Future studies targeting larger populations to assess micronutrients levels in P. vivax endemic areas are warranted in order to validate these results.


Assuntos
Ferro/deficiência , Malária Vivax/epidemiologia , Micronutrientes/deficiência , Plasmodium vivax/isolamento & purificação , Deficiência de Vitamina A/complicações , Zinco/deficiência , beta Caroteno/deficiência , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Ferro/sangue , Malária Vivax/sangue , Malária Vivax/diagnóstico , Masculino , Micronutrientes/sangue , Avaliação Nutricional , Modelos de Riscos Proporcionais , População Rural , Deficiência de Vitamina A/sangue , Zinco/sangue , beta Caroteno/sangue
7.
Artigo em Inglês | LILACS-Express | ID: biblio-962201

RESUMO

ABSTRACT OBJECTIVE To analyze if characteristics of managers, schools, and curriculum are associated with the implementation of programs for drug abuse prevention in elementary and high schools. METHODS Cross-sectional study, with random sample of 263 school managers. Data were collected between 2012 and 2013 by a program that sends forms via internet. A closed self-filling questionnaire was applied online. Statistical analysis included Chi-square tests and logistic regression models. The outcome variable was the presence of program for drug abuse prevention inserted in the daily life and educational program of the school. The explanatory variables were divided into: demographic data of the manager; characteristics of the school and of the curriculum; health education; and drug use in the school. RESULTS We found that 42.5% (95%CI 36.1-49.1) of the evaluated schools had programs for drug abuse prevention. With the multiple logistic regression model, we observed that the more time the manager has worked with education, the chance of the school having a program increased at about 4.0%. Experimenting with innovative teaching techniques also increased at about six times the chance of the school developing a program for drug abuse prevention. The difficulties in the implementation of the programs were more present in state and municipal schools, when compared with private schools, due to, for instance: lack of teaching materials, lack of money, and competing demands for teaching other subjects. CONCLUSIONS The implementation of programs for drug abuse prevention in the city of Sao Paulo is associated with the experience of the manager in education and with the teaching strategies of the school.


RESUMO OBJETIVO Analisar se características dos dirigentes, das escolas e do currículo escolar estão associadas à implantação de programas de prevenção ao uso de drogas nas escolas do ciclo fundamental II e médio. MÉTODOS Estudo transversal, com amostra aleatória sistemática de 263 dirigentes escolares. Os dados foram coletados nos anos de 2012 e 2013 por meio de um programa de envio de formulários pela internet. Aplicou-se questionário fechado, de autopreenchimento on-line. A análise estatística incluiu testes Qui-quadrado e modelos de regressão logística. A variável desfecho foi a presença de programa de prevenção ao uso de drogas inserido no cotidiano e no programa pedagógico da escola. As variáveis explicativas foram divididas em: dados demográficos do dirigente; características da escola e do currículo; educação em saúde; e consumo de drogas na escola. RESULTADOS Constatou-se que 42,5% (IC95% 36,1-49,1) das escolas avaliadas possuíam programa de prevenção ao uso de drogas. Com o modelo de regressão logística múltipla, observou-se que, a cada ano de atuação do dirigente na educação, a chance de a escola ter um programa aumentava em aproximadamente 4,0%. O fato de experimentar técnicas de ensino inovadoras também aumentou em cerca de seis vezes a chance de a escola desenvolver um programa de prevenção ao uso de drogas. As dificuldades na implantação dos programas foram mais presentes nas redes estadual e municipal, quando comparadas à rede privada, destacando-se: a falta de material didático, a falta de dinheiro e as demandas concorrentes para ensino de outras disciplinas. CONCLUSÕES A implantação de programas de prevenção ao uso de drogas no município de São Paulo está associada à experiência do dirigente escolar na educação e nas estratégias de ensino da escola.

8.
Acta Ortop Bras ; 22(5): 278-82, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25328438

RESUMO

OBJECTIVE: To measure and compare tibial torsion values as assessed by goniometry and three-dimensional kinematics. In addition, the impact of each one of these measurements on kinematic and kinetic results for normal gait was determined. METHODS: Twenty-three healthy and fully ambulatory patients were assessed, 11 women and 12 men, from 20 to 40 years old. Data were collected at a laboratory for the three-dimensional analysis of movement with 10 cameras and two force plates. Tibial torsion measurements were obtained using goniometry and three-dimensional kinematics based on the Plug-in Gait model. Afterwards, both procedures were compared, and the impact of each result was assessed on the kinematic and kinetic modeling of the knee and ankle. RESULTS: Pearson's linear correlation coefficient (r=0,504) showed a moderate correlation between the three-dimensional kinematics and goniometry, and between the changes in the measurements. Regarding the processed kinematic and kinetic results for every torsion position, no significant differences were noticed among any of the studied variables (p>0.05). CONCLUSION: Although statistical correlation among tibial torsion angles by goniometry and three-dimensional kinematic were moderate, kinematic and kinetic analysis of the joints did not reveal any significant changes. Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test.

9.
Acta ortop. bras ; 22(5): 278-282, Sep-Oct/2014. ilus, tab, graf
Artigo em Inglês, Português | LILACS | ID: lil-783277

RESUMO

Medir e comparar os valores de torção tibial avaliadospor goniometria e cinemática tridimensional. O impacto de cadamedida sobre os resultados cinemáticos e cinéticos para a marchanormal foi determinado. Métodos: Vinte e três pacientes saudáveise independentes para locomoção foram avaliados, 11 mulheres e12 homens, entre 20 a 40 anos de idade. Os dados foram coletadosno Laboratório de Análise do Movimento com 10 câmeras eduas plataformas de força. Medições da torção tibial foram obtidasutilizando a goniometria e a cinemática tridimensional oriunda domodelo de plug-in gait. Posteriormente, ambos os procedimentosforam comparados, e o impacto de cada resultado foi avaliado nacinemática e cinética do joelho e tornozelo. Resultados: o coeficientede correlação linear de Pearson (r = 0,504) mostrou umacorrelação moderada entre a cinemática tridimensional e goniometriae entre as mudanças nas medidas. Em relação aos resultadoscinemáticos e cinéticos processados para cada posiçãode torção, não foram observadas diferenças significativas entrenenhuma das variáveis estudadas (p ≥ 0,05). Conclusão: Apesarde correlação estatística entre os ângulos de torção da tíbia porgoniometria e cinemática tridimensional terem sido moderada, aanálise cinemática e cinética das articulações não revelou altera-ções significativas. Nível de Evidência I, Estudos Diagnósticos- Investigação de Um Exame Para Diagnóstico...


To measure and compare tibial torsion values as assessedby goniometry and three-dimensional kinematics. In addition,the impact of each one of these measurements on kinematic andkinetic results for normal gait was determined. Methods: Twenty--three healthy and fully ambulatory patients were assessed, 11women and 12 men, from 20 to 40 years old. Data were collectedat a laboratory for the three-dimensional analysis of movement with10 cameras and two force plates. Tibial torsion measurementswere obtained using goniometry and three-dimensional kinematicsbased on the Plug-in Gait model. Afterwards, both procedureswere compared, and the impact of each result was assessed onthe kinematic and kinetic modeling of the knee and ankle. Results:Pearson’s linear correlation coefficient (r=0,504) showed amoderate correlation between the three-dimensional kinematicsand goniometry, and between the changes in the measurements.Regarding the processed kinematic and kinetic results for everytorsion position, no significant differences were noticed amongany of the studied variables (p≥0.05). Conclusion: Although statisticalcorrelation among tibial torsion angles by goniometry andthree-dimensional kinematic were moderate, kinematic and kineticanalysis of the joints did not reveal any significant changes.Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test...


Assuntos
Humanos , Masculino , Feminino , Adulto , Articulação do Tornozelo , Fenômenos Biomecânicos , Marcha , Articulação do Joelho , Tíbia , Anormalidade Torcional
10.
Acta ortop. bras ; 22(5): 278-282, Sep-Oct/2014. tab, graf
Artigo em Inglês | LILACS-Express | ID: lil-723812

RESUMO

Objective: To measure and compare tibial torsion values as assessed by goniometry and three-dimensional kinematics. In addition, the impact of each one of these measurements on kinematic and kinetic results for normal gait was determined. Methods: Twenty-three healthy and fully ambulatory patients were assessed, 11 women and 12 men, from 20 to 40 years old. Data were collected at a laboratory for the three-dimensional analysis of movement with 10 cameras and two force plates. Tibial torsion measurements were obtained using goniometry and three-dimensional kinematics based on the Plug-in Gait model. Afterwards, both procedures were compared, and the impact of each result was assessed on the kinematic and kinetic modeling of the knee and ankle. Results: Pearson's linear correlation coefficient (r=0,504) showed a moderate correlation between the three-dimensional kinematics and goniometry, and between the changes in the measurements. Regarding the processed kinematic and kinetic results for every torsion position, no significant differences were noticed among any of the studied variables (p>0.05). Conclusion: Although statistical correlation among tibial torsion angles by goniometry and three-dimensional kinematic were moderate, kinematic and kinetic analysis of the joints did not reveal any significant changes. Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test. .

11.
Crit Care ; 18(3): R101, 2014 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-24886623

RESUMO

INTRODUCTION: Low plasma selenium concentrations are frequent in critically ill patients. However, whether this is due to systemic inflammation, a deficient nutritional state or both is still not clear. We aimed to determine the factors associated with low plasma selenium in critically ill children while considering the inflammatory response and nutritional status. METHOD: A prospective study was conducted in 173 children (median age 34 months) with systemic inflammatory response who had plasma selenium concentrations assessed 48 hours after admission and on the 5th day of ICU stay. The normal reference range was 0.58 µmol/L to 1.6 µmol/L. The outcome variable was 'low plasma selenium', which was defined as plasma selenium values below the distribution median during this period. The main explanatory variables were age, malnutrition, sepsis, C-reactive protein (CRP), and clinical severity scores. The data were analyzed using a Binomial Generalized Estimating Equations model, which includes the correlation between admission and 5th day responses. RESULTS: Malnutrition and CRP were associated with low plasma selenium. The interaction effect between these two variables was significant. When CRP values were less than or equal to 40 mg/L, malnutrition was associated with low plasma selenium levels (odds ratio (OR) = 3.25, 95% confidence interval (CI) 1.39 to 7.63, P = 0.007; OR = 2.98, 95% CI 1.26 to 7.06, P = 0.013; OR = 2.49, 95% CI 1.01 to 6.17, P = 0.049, for CRP = 10, 20 and 40 mg/L, respectively). This effect decreased as CRP concentrations increased and there was loose significance when CRP values were >40 mg/L. Similarly, the effect of CRP on low plasma selenium was significant for well-nourished patients (OR = 1.13; 95% CI 1.06 to 1.22, P <0.001) but not for the malnourished (OR = 1.03; 95% CI 0.99 to 1.08, P = 0.16). CONCLUSIONS: There is a significant interaction between the magnitude of the inflammatory response and malnutrition on low plasma selenium. This interaction should be considered when interpreting plasma concentrations as an index of selenium status in patients with systemic inflammation as well as in the decision on selenium supplementation.


Assuntos
Proteína C-Reativa/metabolismo , Transtornos da Nutrição Infantil/sangue , Estado Terminal , Selênio/sangue , Selênio/deficiência , Biomarcadores/sangue , Criança , Transtornos da Nutrição Infantil/diagnóstico , Pré-Escolar , Feminino , Humanos , Lactente , Inflamação/sangue , Inflamação/diagnóstico , Masculino , Estudos Prospectivos
12.
JACC Cardiovasc Interv ; 6(11): 1203-9, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24262620

RESUMO

OBJECTIVES: This study sought to randomly compare cerebral protection with ANGIOGUARD (Cordis Corporation, Bridgewater, New Jersey) with Mo.Ma (Invatec/Medtronic Vascular Inc, Santa Rosa, California) during carotid artery stenting (CAS), using diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic cerebral lesions. The number, size, and location of lesions were analyzed. BACKGROUND: The choice of the type of cerebral protection during CAS is controversial. METHODS: From July 2008 to July 2011, 60 patients undergoing CAS were randomized to ANGIOGUARD or Mo.Ma, distributed by chance, 30 patients for each group. All patients underwent DW-MRI before and after CAS. An independent neuroradiologist blinded to the cerebral protection used analyzed the images. Univariate and multivariate logistic models were fitted to analyze new ischemic lesions. Alternatively, a propensity score approach was used to reduce the bias due to differences between the groups. For the number of lesions, we used Poisson regression models. RESULTS: New ischemic lesions seen on DW-MRI were present in 63.3% of the ANGIOGUARD group versus 66.7% of the Mo.Ma cohort (p = 0.787). The number of ischemic cerebral lesions per patient, when present, was significantly lower in the Mo.Ma group (a median of 6 lesions per patient vs. a median of 10 in the ANGIOGUARD, p < 0.001). Most lesions were small (<0.5 mm) and localized in the ipsilateral territory. One patient in the ANGIOGUARD group had a minor stroke during CAS (1.66%). CONCLUSIONS: New ischemic lesions seen on DW-MRI were present in both groups in >60%, but the number of lesions per patient was greater in the ANGIOGUARD group. No death or disabling stroke occurred during at least 1 year of follow-up in both cohorts.


Assuntos
Angioplastia/instrumentação , Isquemia Encefálica/prevenção & controle , Estenose das Carótidas/terapia , Circulação Cerebrovascular , Dispositivos de Proteção Embólica , Stents , Idoso , Angioplastia/efeitos adversos , Doenças Assintomáticas , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Brasil , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/fisiopatologia , Distribuição de Qui-Quadrado , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Pontuação de Propensão , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo , Resultado do Tratamento
13.
Einstein (Sao Paulo) ; 11(2): 158-62, 2013 Apr-Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23843054

RESUMO

OBJECTIVE: To investigate how often physicians identify and treat tobacco dependence and whether characteristics as gender, age, marital status, medical specialty and smoking status can influence their attitude towards this question. METHODS: A cross-sectional study was performed on 515 physicians working in a private hospital in São Paulo, Brazil, using a confidential voluntary questionnaire sent and answered electronically. RESULTS: We found that 89% of physicians who answered the research questionnaire often or always asked their patients about smoking habits, but only 39% often or always treated patients' tobacco dependence. In our sample, 5.8% of individuals were current smokers. Tobacco dependent physicians provided less treatment for smoking dependence compared with those who had never smoked, or were former smokers. Being a clinician was associated with higher probability to treat tobacco dependence. CONCLUSION: Physicians should not only address patients' smoking habits but also provide treatment whenever tobacco dependence is diagnosed. To understand physicians' attitude towards smoking may help to develop strategies to stimulate patients' treatment. The development of smoking cessation programs meant specifically for physicians may also be a strategy to enhance patients' treatment.


Assuntos
Corpo Clínico Hospitalar/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Tabagismo/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Brasil/epidemiologia , Estudos Transversais , Feminino , Hospitais Privados , Humanos , Masculino , Corpo Clínico Hospitalar/psicologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Tabagismo/prevenção & controle
14.
Einstein (Säo Paulo) ; 11(2): 158-162, Apr.-June 2013. tab
Artigo em Inglês | LILACS | ID: lil-679257

RESUMO

OBJECTIVE: To investigate how often physicians identify and treat tobacco dependence and whether characteristics as gender, age, marital status, medical specialty and smoking status can influence their attitude towards this question. METHODS: A cross-sectional study was performed on 515 physicians working in a private hospital in São Paulo, Brazil, using a confidential voluntary questionnaire sent and answered electronically. RESULTS: We found that 89% of physicians who answered the research questionnaire often or always asked their patients about smoking habits, but only 39% often or always treated patients' tobacco dependence. In our sample, 5.8% of individuals were current smokers. Tobacco dependent physicians provided less treatment for smoking dependence compared with those who had never smoked, or were former smokers. Being a clinician was associated with higher probability to treat tobacco dependence. CONCLUSION: Physicians should not only address patients' smoking habits but also provide treatment whenever tobacco dependence is diagnosed. To understand physicians' attitude towards smoking may help to develop strategies to stimulate patients' treatment. The development of smoking cessation programs meant specifically for physicians may also be a strategy to enhance patients' treatment.


OBJETIVO: Observar se os médicos identificam e se tratam o tabagismo de seus pacientes, bem como investigar possíveis associações entre essas práticas e os seguintes fatores: gênero, idade, estado civil, especialidade médica e tabagismo do médico. MÉTODOS: Estudo transversal realizado com 515 médicos atuantes em um hospital particular da cidade de São Paulo, por meio de um questionário confidencial enviado e respondido por e-mail. RESULTADOS: Dentre os médicos, 89% frequentemente ou sempre pergunta se seus pacientes fumam, enquanto apenas 39% respondeu que frequentemente ou sempre trata essa condição. A taxa observada de tabagismo entre os médicos foi de 5,8%. Entre os fatores estudados, observou-se que o tabagismo do médico está associado a menor frequência de tratamento do tabagismo dos pacientes e que ser de especialidade clínica é um fator associado a maior probabilidade de tratar o tabagismo dos pacientes. CONCLUSÃO: Além de identificar o tabagismo dos pacientes, é fundamental que os médicos ofereçam tratamento para essa condição. O conhecimento da atitude dos médicos a respeito da dependência de tabaco pode auxiliar no desenvolvimento de estratégias que resultem em aumento da oferta de tratamento aos pacientes. O desenvolvimento de programas de tratamento para médicos tabagistas também pode ser uma medida com impacto positivo na oferta de tratamento aos pacientes.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Fumar/terapia , Tabaco
15.
Diagn Microbiol Infect Dis ; 76(3): 266-71, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23711530

RESUMO

Biomarkers such as procalcitonin (PCT) have been studied to guide duration of antibiotic therapy. We aimed to assess whether a decrease in PCT levels could be used to reduce the duration of antibiotic therapy in intensive care unit (ICU) patients with a proven infection without risking a worse outcome. We assessed 265 patients with suspected sepsis, severe sepsis, or septic shock in our ICU. Of those, we randomized 81 patients with a proven bacterial infection into 2 groups: an intervention group in which the duration of the antibiotic therapy was guided by a PCT protocol and a control group in which there was no PCT guidance. In the per-protocol analysis, the median antibiotic duration was 9 days in the PCT group (n = 20) versus 13 days in the non-PCT group (n = 31), P = 0.008. This study demonstrates that PCT can be a useful tool for limiting antimicrobial therapy in ICU patients with documented bacterial infection.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/sangue , Calcitonina/sangue , Precursores de Proteínas/sangue , Choque Séptico/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/economia , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/economia , Infecções Bacterianas/mortalidade , Biomarcadores/sangue , Peptídeo Relacionado com Gene de Calcitonina , Redução de Custos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Choque Séptico/sangue , Choque Séptico/economia , Choque Séptico/mortalidade , Resultado do Tratamento
16.
JACC cardiovasc. interv. ; 06(11): 1203-1209, 2013. tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-29924

RESUMO

Objectives This study sought to randomly compare cerebral protection with ANGIOGUARD (CordisCorporation, Bridgewater, New Jersey) with Mo.Ma (Invatec/Medtronic Vascular Inc, Santa Rosa,California) during carotid artery stenting (CAS), using diffusion-weighted magnetic resonance imaging(DW-MRI) to detect new ischemic cerebral lesions. The number, size, and location of lesions wereanalyzed.Background The choice of the type of cerebral protection during CAS is controversial.Methods From July 2008 to July 2011, 60 patients undergoing CAS were randomized toANGIOGUARD or Mo.Ma, distributed by chance, 30 patients for each group. All patients underwentDW-MRI before and after CAS. An independent neuroradiologist blinded to the cerebral protectionused analyzed the images. Univariate and multivariate logistic models were fitted to analyze newischemic lesions. Alternatively, a propensity score approach was used to reduce the bias due todifferences between the groups. For the number of lesions, we used Poisson regression models.Results New ischemic lesions seen on DW-MRI were present in 63.3% of the ANGIOGUARD groupversus 66.7% of the Mo.Ma cohort (p ¼ 0.787). The number of ischemic cerebral lesions per patient,when present, was significantly lower in the Mo.Ma group (a median of 6 lesions per patient vs.a median of 10 in the ANGIOGUARD, p < 0.001). Most lesions were small (<0.5 mm) and localized inthe ipsilateral territory. One patient in the ANGIOGUARD group had a minor stroke during CAS (1.66%).Conclusions New ischemic lesions seen on DW-MRI were present in both groups in >60%, but thenumber of lesions per patient was greater in the ANGIOGUARD group. No death or disabling strokeoccurred during at least 1 year of follow-up in both cohorts. (AU)


Assuntos
Stents , Espectroscopia de Ressonância Magnética , Acidente Vascular Cerebral
17.
Einstein (Sao Paulo) ; 10(1): 57-61, 2012 Jan-Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23045827

RESUMO

OBJECTIVE: To compare low and high MELD scores and investigate whether existing renal dysfunction has an effect on transplant outcome. METHODS: Data was prospectively collected among 237 liver transplants (216 patients) between March 2003 and March 2009. Patients with cirrhotic disease submitted to transplantation were divided into three groups: MELD > or = 30, MELD < 30, and hepatocellular carcinoma. Renal failure was defined as a +/- 25% decline in estimated glomerular filtration rate as observed 1 week after the transplant. Median MELD scores were 35, 21, and 13 for groups MELD > or = 30, MELD < 30, and hepatocellular carcinoma, respectively. RESULTS: Recipients with MELD > or = 30 had more days in Intensive Care Unit, longer hospital stay, and received more blood product transfusions. Moreover, their renal function improved after liver transplant. All other groups presented with impairment of renal function. Mortality was similar in all groups, but renal function was the most important variable associated with morbidity and length of hospital stay. CONCLUSION: High MELD score recipients had an improvement in the glomerular filtration rate after 1 week of liver transplantation.


Assuntos
Transplante de Fígado/estatística & dados numéricos , Índice de Gravidade de Doença , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Brasil/epidemiologia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/cirurgia , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Nefropatias/complicações , Tempo de Internação/estatística & dados numéricos , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
18.
Einstein (Säo Paulo) ; 10(1)jan.-mar. 2012. tab
Artigo em Inglês, Português | LILACS | ID: lil-621510

RESUMO

Objective: To compare low and high MELD scores and investigate whether existing renal dysfunction has an effect on transplant outcome. Methods: Data was prospectively collected among 237 liver transplants (216 patients) between March 2003 and March 2009. Patients with cirrhotic disease submitted to transplantation were divided into three groups: MELD greater than or equal to 30, MELD < 30, and hepatocellular carcinoma. Renal failure was defined as a ± 25% decline in estimated glomerular filtration rate as observed 1 week after the transplant. Median MELD scores were 35, 21, and 13 for groups MELD greater than or equal to 30, MELD < 30, and hepatocellular carcinoma, respectively. Results: Recipients with MELD greater than or equal to 30 had more days in Intensive Care Unit, longer hospital stay, and received more blood product transfusions. Moreover, their renal function improved after liver transplant. All other groups presented with impairment of renal function. Mortality was similar in all groups, but renal function was the most important variable associated with morbidity and length of hospital stay. Conclusion: High MELD score recipients had an improvement in the glomerular filtration rate after 1 week of liver transplantation.


Objetivo: Comparar MELDs altos e baixos, sua relação com a disfunção renal e o efeito no resultado do transplante. Métodos: Realizou-se coleta prospectiva de dados em 237 transplantes de fígado (216 pacientes) entre março de 2003 e março de 2009. Pacientes com cirrose submetidos a transplante foram divididos em três grupos: MELD maior ou igual a 30, MELD < 30, e carcinoma hepatocelular. Insuficiência renal foi definida como uma diminuição de ± 25% na taxa de filtração glomerular estimada, observada 1 semana após o transplante. As medianas do MELD foram 35, 21, e 13 para os grupos MELD maior ou igual a 30, MELD < 30, e de carcinoma hepatocelular, respectivamente. Resultados: Receptores com MELD maior ou igual a 30 tiveram mais dias na Unidade de Terapia Intensiva, maior período de internação, e receberam mais transfusões de sangue. Além disso, sua função renal melhorou após o transplante de fígado. Os demais grupos apresentaram diminuição da função renal. A mortalidade foi semelhante em todos os grupos, mas a função renal foi a variável mais importante associada com morbidade e tempo de internação hospitalar. Conclusão: Em receptores com escores MELD altos houve melhora da taxa de filtração glomerular 1 semana após o transplante de fígado.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Fígado/estatística & dados numéricos , Índice de Gravidade de Doença , Transfusão de Sangue/estatística & dados numéricos , Brasil/epidemiologia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/cirurgia , Creatinina/sangue , Taxa de Filtração Glomerular , Unidades de Terapia Intensiva/estatística & dados numéricos , Nefropatias/complicações , Tempo de Internação/estatística & dados numéricos , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Estudos Prospectivos , Resultado do Tratamento
19.
J Glaucoma ; 21(5): 342-8, 2012 Jun-Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21423036

RESUMO

PURPOSE: To compare the effect on intraocular pressure (IOP) of the silicone Ahmed glaucoma valve with and without an intravitreal injection of triamcinolone acetonide. PATIENTS AND METHODS: Forty-nine patients with clinically uncontrolled neovascular glaucoma were included in the study; 22 were randomly assigned to the study group (silicone Ahmed glaucoma valve implant with intravitreal triamcinolone acetonide) and 27 to the control group (silicone Ahmed glaucoma valve). IOP was the primary outcome measure in this study. The secondary outcome measure was success, defined by IOP lower than 22 mm Hg and higher than 5 mm Hg, and no serious complications. Success rates in both the groups were compared using Kaplan-Meier survival curves and the log-rank test. IOP levels were compared using mixed linear model analysis to correct for repeated measures correlation. RESULTS: Forty-three patients, 18 in the study group and 25 in the control group, completed the study (follow-up of 12 mo). The mean IOP was significantly lower after 1 year in both the groups (P<0.001). The mean IOP in the first month of follow-up was lower in the study group (control; 20.4±9.7, study; 13.6±6.5, P<0.01). The success rate at 1 year was 78% for the study group and 76% for the control group (P=0.82). Complication rates were not different between the groups. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide in neovascular glaucoma did not affect the intermediate-term success of the silicone Ahmed valve nor reduce the incidence of complications. The mean IOP spike in the first month was lower in the triamcinolone group.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma Neovascular/terapia , Glucocorticoides/administração & dosagem , Triancinolona Acetonida/administração & dosagem , Terapia Combinada , Feminino , Glaucoma Neovascular/tratamento farmacológico , Glaucoma Neovascular/cirurgia , Humanos , Pressão Intraocular/fisiologia , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Resultado do Tratamento , Acuidade Visual/fisiologia
20.
Clin Ophthalmol ; 5: 991-7, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21792290

RESUMO

PURPOSE: Evaluation of the neuroprotective effect of weekly glatiramer acetate (GA) on retinal structure and function in diabetic patients who underwent panretinal photocoagulation (PRP). PATIENTS AND METHODS: patients with severe nonproliferative or early diabetic proliferative retinopathy and no previous laser treatment were randomly divided into two groups: (1) those who received four GA treatments and (2) those who received placebo treatment. The subcutaneous injections were administered 1 week prior to laser and weekly in the subsequent three sessions of PRP in both groups. All patients underwent a full ophthalmic examination (best-corrected logMAR visual acuity, slit lamp examination, applanation tonometry, fundus biomicroscopy and indirect fundus examination); functional examination (standard automated perimetry, electroretinography and frequency-doubling technology C-20 visual field) and anatomic examination (color photography, optical coherence tomography (OCT) and Heidelberg retinal tomography). The examinations were performed before the photocoagulation and repeated 1,3,6, and 12 months after treatment (in a double-masked manner). To compare the two groups, generalized estimating equation models were performed to account for the dependence between eyes of the same patient. RESULTS: Thirteen patients (23 eyes) were included in the study group and 13 patients (24 eyes) were included in the control group. OCT showed a statistically significant difference in retinal nerve fiber layer (RNFL) thickness in the inferior peripapillary region and average thickness with thinner measurements in the control group at 1-year post-PRP. Functional analysis demonstrated a difference between groups, but it did not reach statistical significance. CONCLUSION: The results of this study suggest that weekly GA treatment has a potential neuro-protective effect on the RNFL following photocoagulation for diabetic retinopathy.

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