Efeito do ��cido alfa-lip��ico sobre biomarcadores de estresse oxidativo, inflama����o e fatores de risco cardiovascular em hipertensos

Alpha-lipoic acid (ALA) is a potent antioxidant with favourable anti-inflammatory, metabolic and endothelial effects, and has been widely investigated due to its potential against cardiovascular risk factors. This study aimed to evaluate the effect of oral ALA supplementation on oxidative stress biomarkers, inflammation and cardiovascular risk factors in patients with hypertension. This is a double-blind placebo-controlled randomized clinical trial, where the intervention was evaluated prospectively comparing results in both groups. The sample consisted of 64 hypertensive patients who were randomly distributed into ALA group (n = 32), receiving 600 mg / day ALA for twelve weeks and control group (n = 32), receiving placebo for the same period. The following parameters were evaluated before and after intervention: lipid peroxidation, content of reduced glutathione (GSH), enzymatic activities of glutathione peroxidase (GPx) and superoxide dismustase, ultrasensitive C-reactive protein (hs-CRP), triglycerides, total cholesterol and fractions, fasting glucose and anthropometric indicators. There was a statistically significant reduction (p <0.05) in serum concentrations of total cholesterol, very low density lipoprotein (VLDL), high density lipoprotein (HDL), triglycerides and blood glucose. There was a reduction in body weight and waist, abdominal and hip circumferences in the group that received ALA. In addition, there was a statistically significant increase (p <0.05) in the contents of reduced glutathione (GSH) and glutathione peroxidase (GPx) in the group receiving ALA. Oral administration of ALA appears to be a valuable adjuvant therapy, which may contribute to decrease the damage caused by oxidative stress and other risk factors associated with the atherosclerotic process

��lcera de press��o em pacientes internados em um hospital universit��rio em Natal/RN: condi����es predisponentes e fatores de risco

The pressure ulcers (PU), also known as decubitus ulcers, are defined as injuries caused by the constant pressure exerted on a particular point of the body, causing impairment of blood supply with a decrease or interruption of tissue irrigation, causing occlusion of blood vessels and capillaries, ischemia and cell death. This is a descriptive study with longitudinal design, and panel type, with quantitative approach that aimed to examine the association between predisposing conditions (PC), intrinsic factors (IF) and extrinsic factors (EF) with the occurrence of PU, in hospitalized patients in the Intensive Care Unit (ICU), pain clinical, surgical clinical and neurology wards of a university hospital. The study population was composed of all patients who were restricted to bed during the period from December 2007 to February 2008. The study was approved by the Ethics Committee of HUOL / UFRN (No 135/07). The data-collection took place through a structured formulary of observation, data from medical records and physical examination of patients skins. The results were organized in SPSS 15.0 software, tabulated, categorized and analyzed by descriptive and inferential statistics. Of the 30 patients studied, 43.3% had been hospitalized in the pain clinical and surgical clinic wards, 20.0% in the ICU, 20.0% in the ICU / ward and 16.7% in neurology, being the length of hospitalization in those units of 7 to 18 days (63.3%) and from 19 to 30 days (36.7%), predominantly female and aged &#8805; 60 years (60.0%). 19 PU were diagnosed in 43.3% of patients monitored, being 38.5% with one PU between 7 to 18 days and 46.2% with two or more between 19 to 30 days of hospitalization, showing significant relationship (&#961;-value = 0029) between length of hospital stay and the number of PU. Was found an association of 35.7% of the PC (cardio-respiratory, hematological, metabolic and psychogenic), IF (age group, oedema, skin changes in humidity and change of body temperature) and EF (type of mattress and strength of body pressure) for all patients studied, statistically significant (&#961;-value = 0001), between the average scores in patients with and without PU, with reason chance to 12.0 for the development of PU and there was moderate correlation ( r = 0618) in the presence of this association. Results show the influence of the multiplicity of factors and conditions on the occurrence of PU, which brings us to reflect on the assistance focused on prevention and reduction of these injuries which will encourage the reduction of hospitalization length, physical and psychological suffering, and the possibility of improving the clinical condition of the patient.

Hipertens��o arterial e fatores de risco em servidores atendidos pelo departamento de assist��ncia da Universidade Federal do Rio Grande do Norte

Systemic arterial hypertension is a multifactorial disease that contributes to the country��s high cardiovascular morbi-mortality rates. Considering that hypertension affects individuals in their most productive age while facing work and living risk factors, it is important to investigate its occurrence and predisposing factors in different occupational segments. The objective of this study was to identify the prevalence of hypertension among workers attended to in a medical service of a public university, their hypertension levels, the risk factors present, and their knowledge of the factors that influence the arterial pressure. The epidemiologic study was conducted in the Health Department of the Federal University of Rio Grande do Norte with 102 workers that sought care in the medical clinic during the months of March to May 2009. Data were collected by means of a questionnaire and measurements of systolic and diastolic arterial pressure (SAP and DAP) that were classified in stages according to the Brazilian Society of Hypertension and the degree of risk for cardiovascular events according to the criteria of the Brazilian Society for Cardiology. Data were analyzed using descriptive statistics. The workers were, on average, 54 years of age; the majority (67%) was male and had primary or middle educational level; they worked mainly in supplemental units and deanship offices conducting different functions such as security guards, administrative assistants, health auxiliaries and constructions workers; 48 (47%) of the workers identified themselves as hypertensive for 8 years on average, with the majority executing hard labor and administrative functions. Among the workers with hypertension, the number of the pressure levels classified as pre-hypertensive, stage I and II were: (12% in the SAP and 20% in the DAP); (16% in the SAP and 9% in the DAP); and (15% in the SAP and 5% in the DAP), respectively. The workers that did not identify themselves as hypertensive presented classifications with greater frequencies were: normal (16% in the SAP and 30% in the DAP); and pre-hypertensive (21% in the SAP and 16% in the DAP). The risk factors identified in more than 50% of the workers were: tobacco smoking, alcohol consumption and indices of being overweight, although physical activities are also present. Of the 48 workers diagnosed as hypertensive, those that had 5 risk factors present and limitrophic pressure levels (12%), in stage I hypertension (16%) and stage II hypertension (15��%) were categorized as being in high risk for vascular events. The number of workers that indicated they had knowledge of the factors that influence their hypertension was less than 39% for each factor. It is concluded that there is a high prevalence of systemic arterial hypertension in the university workers, even amongst those already under treatment. They constitute a population at risk considering their age group, their work functions, and their inadequate life habits. Health care of these hypertensive workers that seek attention in the Health Department is an important aspect of the internal workers health policy in the institution. Educational interventions are recommended for the improvement of quality of life and of work in these workers

Hipossaliva����o e seus fatores de risco em idosos funcionalmente independentes e n��o institucionalizados

The aim of this study was to investigate the risk factors related to hyposalivation among non-institutionalized independently living elderly people, living in Natal-RN, Brazil. The study was a control-case type and the data collection was accomplished by carrying a questionnaire, oral examination and a non-stimulated and stimulated sialometry. The cases were identified by values of salivary flow rate <0,1mL/min and stimulated &#8804; 0,5 mL/min, and the controls were by observing the values of sialometry that were bigger than the previously defined parameters. Age and gender were used as pairing variables. The data were analyzed using X2 (&#945; = 0,05) and odds ratio. The sample was composed of 98,1% female and 1,9% male, with mean age 68. There was not association between hyposalivation and the following studied variables: income, schooling, profession, dwelling conditions, domiciliary density, illness, number of teeth and use of prothesis. However, a link was found between hyposalivation and smoking frequency in the passet (OR=5,14), indicating that, referring to elderly people, the tabagism frequency habit was a risk factor to the studied condition. Therefore, refering to non-institutionalized independently elderly people, economic-social-demographic conditions, general and bucal health, diet and habits such as alcoholism have been not risk factors to hyposalivation. However, people that have been smoking have more risk to have the studied conditions

Edentulismo funcional e seus fatores de risco em adultos

The purpose of this study was to investigate the risk factors to the functional edentulism in adults aged 35 a 44 years old of Natal-RN, 278 adults took part in the study. They were all selected from a previous dental loss prevalence study thus being complemented by an active research. The study was a case-control based and data collection was made though a survey as well as with a clinical examination. The cases were identified through individuals with 20 or more teeth. Age and gender were used as variables of pairing off. The data was analyzed through chi-square, significant level of 95% to the checking of its force associations. The independent variables were grouped in three levels. The first one, more macro, is related to the region where the individual lives, which was also related to the second level, the family-based one, linked with a third level, at this low socio-economical level, where the domiciliary density was favorable, living in capital cities, regions with prime sanitary condicitions, with predominant possibility of accessing the public dental service, but in despite of this, only looking for this service when tooth ache is felt, where preferentially an aid dressing treatment is executed in detriment of preventive procedures. From all the samples, less than 25% of the individuals make use of tobacco and alcoholic beverages for quite a number of years. There was an association of functional edentulism with all the studied variables in a regional method. In the family-based with Crit��rio Brasil (OR=4,45) and monthly wages (OR=9,62) and to an to an individual level, the associations took place with the current use of kind of attendance (OR=1,78), looks for dressing treatment (OR=2,51), does not look for preventive treatment (OR=3,31), pain as the main cause of demand (OR=1,92), previous treatment as the demanding reason for dental service (OR+0,28), interval of the last visit to the dental service (OR=1,35) and when advise was received (OR=1,66). It was noticed from the results that the functional edentulism is much more expressive in those families which live in environments with precarious social economical sanitary conditions. Such conditions seem to have a direct influence upon the family social economical conditions which are also shown in detriment to functional edentulism. In the same way, the collection of variants influence the social economical conditions of the individual, as well as the kind of dental service searched by them, the reason of the search and the interval of the last visit to the dental service were strong determiners to the functional edentulism. Beyond that, individual habits like the use of tobacco and its frequency on its previous use influenced in a significant way the existence of functional edentulism in the studied population

Preval��ncia e fatores de risco �� persist��ncia de h��bitos bucais de suc����o n��o nutritiva em crian��as de 3 a 5 anos de idade

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior

Influ��ncia de fatores de risco na preval��ncia de h��bitos bucais delet��rios em crian��as de 0 a 5 anos na cidade do Natal-RN

Literature has demonstrated to the narrow relation between deleterious habits and the occurrence of malocclusion in minors of 5 years. The existence of these habits, however, already considered as risk factors, having also, its determinative ones, which present cultural dimensions and economic social, many of them related to the parents of the child, having in account that such habits if develop in phases in which the child establish a narrow relation of dependence. This study it had an objective to investigate the prevalence of deleterious buccal habits in children and its relation with the economic social and characteristics of the parents. It was developed an epidemiologist study of transversal character with interview, through daily pay-tested form, with 218 parents in the day of the National Campaign of Vaccination. In the cast of the variable that had composed the study, they had been used, as changeable dependents, the use of the baby's bottle, bottle and the digital suction, being considered as outcomes of the research. Amongst the independent variable, the economic social factors (type of occupation, number of children, civil state, sort, schooling and age) and staffs of the parents (self perception in oral health) had entered as the variable to be analyzed in the problems of the infantile odontology. The collected data had been submitted to the analysis descriptive and inferential statistics, being used the test qui-square and the analysis of the possibility reasons. As main results, it was found that breast feeding before the six months if presents as one of the main factors of risk for the use of baby's bottle (p< 0.001, OR= 2.8, I.C= 1.589 4.906), bottle (p< 0.001, OR= 3.7, I.C.= 2.076 6.624) and digital suction (p< 0.014, OR= 3.5, I.C.= 1.225 10.181). From the data found, one concludes that breast-feeding is considered a primordial factor for not the installation of deleterious oral habits and that the economic social and cultural factors can reflect in central way in the performance of this act

S��ndrome de Guillain-Barr��: epidemiologia, progn��stico e fatores de risco

Introduction. Guillain-Barr�� syndrome (GBS) is an immune-mediated polyneuropathy and the principal cause of acute neuromuscular paralysis. The most prominent GBS subtypes are: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN) and Fisher syndrome (FS). Differences in geographical distribution of variants have been reported. In Brazil, there are few studies describing the characteristics of GBS, but none on the frequency of GBS variants and their clinical manifestations. Infection-induced aberrant immune response resulting from molecular mimicry and formation of cross-reacting antibodies, contribute to complement activation. Functional biallelic polymorphism in immunoglobulin receptors that influence the affinity of IgG subclasses and the type of immune response have been described, suggesting genetic susceptibility to developing disease. It remains unclear whether individuals carrying different FCGR alleles have differential risk for GBS and���or disease severity. The goals of this study were: (1) To characterize GBS and describe the clinical findings in a cohort of patients with GBS from the state of Rio Grande do Norte, Brazil; (2) to determine whether polymorphism in FCGR were associated with development of GBS, and (3) to tease out whether the global gene expression studies could be a tool to identify pathways and transcriptional networks which could be regulated and decrease the time of disease. Methods. Clinical and laboratory data for 149 cases of GBS diagnosed from 1994 to 2013 were analyzed. Genomic DNA and total RNA were extracted from whole blood. Antigangliosides antibodies were determined in the sera. In addition, we also assessed whether FCGR polymorphism are present in GBS (n=141) and blood donors (n=364), and global gene expressions were determined for 12 participants with GBS. Blood samples were collected at the diagnosis and post-recovery. Results. AIDP was the most frequent variant (81.8%) of GBS, followed by AMAN (14.7%) and AMSAN (3.3%). The incidence of GBS was 0.3 ��� 100,000 people for the state of Rio Grande do Norte and cases occurred at a younger age. GBS was preceded by infections, with the axonal variant associated with episodes of diarrhea (P = 0.025). Proximal weakness was more frequent in AIDP, and distal weakness predominant in the axonal variant. Compared to 42.4% of cases with AIDP (P<0.0001), 84.6% of cases with the axonal variant had nadir in <10 days. Individuals with the axonal variant took longer to recover deambulation (P<0.0001). The mortality of GBS was 5.3%. A worse outcome was related to an axonal variant (OR17.063; P=0.03) and time required to improve one point in the Hughes functional scale (OR 1.028; P=0.03). The FCGR genotypes and allele frequencies did not differ significantly between the patients with GBS and the controls (FCGR2A p=0.367 and FCGR3A p=0.2430). Global gene expression using RNAseq showed variation in transcript coding for protein isoforms during acute phase of disease. Conclusions. The annual incidence of GBS was 0.3 per 100,00 and there was no seasonal pattern. A predominance of the AIDP variant was seen, and the incidence of the disease decreased with age. The distribution of weakness is a function of the clinical variants, and individuals with the axonal variant had a poorer prognosis. Early diagnosis and variant identification leads to proper intervention decreasing in long-term morbidity. FCGR polymorphisms do not seem to influence susceptibility to GBS in this population. This study found deregulated genes and signs of transcriptional network alterations during the acute and recovery phases in GBS. Identification of pathways altered during disease might be target for immune regulation and with potential to ameliorate symptoms.

Irregularidade do ciclo menstrual no Menacme como marcador para fatores de risco cardiovasculares na p��s-menopausa

A associa����o entre fatores de risco cardiovascular (FRCV) na p��smenopausa e o antecedente de irregularidade menstrual no menacme foi avaliado em estudo caso-controle envolvendo 414 mulheres na p��smenopausa com idade de 60,4 �� 5,5 anos e IMC de 25,3 �� 4,7 kg/m2. As vari��veis consideradas foram: caracteriza����o do ciclo menstrual entre 20 e 35 anos (independente) e relato atual sobre ocorr��ncia de hipertens��o arterial, dislipidemia, diabetes mellitus e doen��a arterial coronariana (dependentes). Utilizou-se o teste qui-quadrado e modelos de regress��o log��stica, ajustados para outras vari��veis implicadas no risco para doen��as CV, com n��vel de signific��ncia 5%. Observou-se que mulheres que relataram irregularidade menstrual pr��via estiveram associadas com risco aumentado para ocorr��ncia de algum FRCV [odds ratio ajustado (OR)= 2,14; IC-95%= 1,02���4,48], quando comparadas ��quelas com ciclos regulares. An��lise estratificada demonstrou as seguintes associa����es significativas com o antecedente de irregularidade menstrual: hipertens��o arterial (OR= 2,4; 95% IC= 1,39���5,41), hipercolesterolemia (OR= 2,32; 95% IC= 1,17���4,59), hipertrigliceridemia (OR= 2,09; 95% IC= 1,10���4,33) e angioplastia coronariana (OR= 6,82; 95% IC= 1,44���32,18). Os dados sugerem que o antecedente de irregularidade menstrual, indicativo da ocorr��ncia da s��ndrome dos ov��rios polic��sticos na idade reprodutiva, pode estar relacionado com aumento do risco para doen��as CV na p��s-menopausa __________________________________________________ABSTRACT Menstrual Cycle Irregularity as a Marker of Cardiovascular Risk Factors at Postmenopausal Years.To evaluate the association between cardiovascular risk factors (CVRF)during postmenopausal years and previous menstrual irregularity during reproductive years, we performed a case-control study in 414 postmenopausal women (mean age 60.4 �� 5.5 years; BMI 25.3 �� 4.7 kg/m2). The variables assessed were: menstrual cycle characteristics at age 20���35y (independent) and records of arterial hypertension, dyslipidemia, diabetes mellitus, and coronary heart disease (dependent). Statistical analysis used the chi-square test and logistic regression, adjusting for potential confounders for cardiovascular risk, with significance set at 5%. Women reporting previous menstrual irregularity were associated with increased risk for some CVRF [adjusted odds ratio (OR) 2.14; CI-95%= 1.02���4.48], when compared with those reporting regular menstrual cycles. Stratified analysis demonstrated significant associations of previous menstrual irregularity with: arterial hypertension [OR= 2.74; CI-95%= 1.39���5.41), hypercholesterolemia (OR= 2.32; CI-95%= 1.17���4.59), hypertriglyceridemia (OR= 2.09; CI-95%=1.10���4.33), and coronary angioplasty (OR= 6.82; CI-95%= 1.44���32.18). These data suggest that a prior history of menstrual irregularity, as indicative of polycystic ovary syndrome, may be related to increased risk for CVD during postmenopausal years

Incid��ncia e fatores de risco da retinopatia diab��tica em pacientes do Hospital Universit��rio Onofre Lopes, Natal-RN

Estudar a incid��ncia e fatores de risco (tempo de doen��a e presen��a de hipertens��o arterial sist��mica) para retinopatia diab��tica em 1002 pacientes encaminhados pelo Programa de Diabetes do Hospital Universit��rio Onofre Lopes no per��odo de 1992 ��� 1995. M��todos: Estudo retrospectivo de pacientes com diagn��stico de diabetes mellitus encaminhados ao Setor de Retina do Departamento de Oftalmologia pelo Programa de Diabetes do Hospital Universit��rio e submetido, sob a supervis��o do autor, a exame oftalmol��gico, incluindo medida da acuidade visual corrigida (tabela de Snellen), biomicroscopia do segmento anterior e posterior, tonometria de aplana����o e oftalmoscopia binocular indireta sob midr��ase(tropicamida 1% + fenilefrina 10%). Foi realizada an��lise dos prontu��rios referente ao tempo de doen��as e diagnostico cl��nico de hipertens��o arterial sist��mica. Resultados: Dos 1002 diab��ticos examinados (em 24 deles a fundoscopia foi invi��vel), 978 foram separados em 4 grupos: sem retinopatia diab��tica (SRD), 675 casos (69,01%); com retinopatia diab��tica n��o proliferativa (RDNP), 207 casos (21,16%); com retinopatia diab��tica proliferativa (RDP), 70 casos (7,15%); e pacientes j�� fotocoagulados (JFC), 26 casos (2,65%). Do total, 291 eram do sexo masculino (29%) e 711 do sexo feminino (71%). Os 4 grupos foram ainda avaliados quanto ao sexo, a faixa et��ria, a acuidade visual, tempo de doen��a, presen��a de catarata e hipertens��o arterial sist��mica e comparados entre si. Com rela����o ao tipo de diabetes, 95 eram do tipo I (9,4%), 870 pacientes eram do tipo II (86,8%), e em 37 casos(3,7%) o tipo de diabetes n��o foi determinado. Conclus��es: Comprovou-se que os pacientes com maior tempo de doen��a tinham maior probabilidade de desenvolver retinopatia diab��tica, e que a hipertens��o arterial sist��mica n��o constituiu fator de risco em rela����o �� diminui����o da acuidade visual nos pacientes hipertensos

Marcadores de risco cardiovasculares bioqu��micos e antropom��tricos em idosos hipertensos e aparentemente saudaveis

Idosos apresentam preval��ncia aumentada de Hipertens��o Arterial Sist��mica - HAS al��m de multiplicidade de fatores de risco cardiovasculares adicionais relacionados a maus h��bitos de vida. Este �� um estudo transversal que teve como objetivos comparar e correlacionar marcadores bioqu��micos e antropom��tricos e h��bitos de vida indicadores de risco cardiovascular em idosos hipertensos e predominantemente saud��veis, sedent��rios e praticantes de atividade f��sica. A amostra foi composta por 322 idosos, e distribu��da em 2 grupos: G1: hipertensos e G2: predominatemente saud��veis. A coleta de dados constou de anamnese e avalia����es bioqu��mica (perfil lip��dico e Prote��na C-Reativa - PCR) e antropom��trica (��ndice de Massa Corp��rea - IMC, Circunfer��ncia da Cintura - CC, Circunfer��ncia abdominal - CA e Rela����o Cintura- Quadril - RCQ). Na an��lise dos dados utilizou-se estat��stica descritiva, Teste t de Student, an��lise de vari��ncia (ANOVA One-Way) e correla����o de Pearson. Os resultados mostram que no G1: 100% eram hipertensos, sendo que 31,55% eram diab��ticos e hipertensos e 0% era exclusivamente diab��tico, no G2: 28,86% eram hipertensos, sendo que 13,40% eram diab��ticos e hipertensos, 5,15% eram exclusivamente diab��ticos e 65,99% n��o apresentam qualquer processo patol��gico ativo. Com rela����o aos h��bitos e estilo de vida, no G1: 58,22% eram sedent��rios; 2,6% fumantes e 1,7% etilistas. No G2: 5,15% eram sedent��rios; 7,21% fumantes e 8,24% etilistas. Com rela����o ao estado nutricional, verificou-se que no G1: 10,52% dos homens apresentaram Sobrepeso - SP e 14,03% Obesidade - OB, j�� entre as mulheres, 25,59% apresentaram SP e 20,23% OB. No G2: 6,06% dos homens apresentaram SP e 9,09% OB, e entre as mulheres, 15,87% apresentaram SP e 22,22% OB. Na an��lise da RCQ, apresentaram valores acima dos recomendados: 24,56% dos homens e 82,14% das mulheres do G1 e 12,12% dos homens e 74,60% das mulheres do G2. Com rela����o a CC e CA, apresentaram valores indicativos de risco, respectivamente: no G1 (52,63% e 29,82% dos homens e 91,66% e 87,5% das mulheres) e no G2 (9,09% e 9,09% dos homens, e 80,95% e 55,55% das mulheres). Com rela����o �� idade, as freq����ncias de SP e OB no G1(n=225) foram: SP (A1=11,11%, A2=8%, A3=1,77%), OB (A1=8,44%, A2=8,88%, A3=1,33%), e no G2(n=97) foram: SP (A1= 5,15%, A2= 5,15%, A3= 2,06%) e OB (A1=9,27%, A2=7,21%, A3=0%). Na compara����o entre G1 e G2 observou-se diferen��a estat��sticamente significativa entre as seguintes m��dias: IMC: [G1=27,23 e G2=23,26 x (p=0,0344)]; CA: [G1=99,09 e G2=89,51 (p<0,0001)]; CC: [G1=93,64 e G2=86,37 (p<0,0001)] e RCQ: [G1=93,64 e G2=86,37 (p<0,0001)]. Na correla����o, verificou-se associa����o considerada como fraca positiva (p<0,05) entre PCR e as vari��veis antropom��tricas e o perfil lip��dico. Os resultados apontam para maior freq����ncia e intensidade de fatores de risco cardiovasculares adicionais a hipertens��o em mulheres em rela����o aos homens, nas faixas et��rias relativamente mais jovens, A1 e A2, em rela����o a mais velha, A3, e no grupo de idosos hipertensos, G1, em rela����o ao de idosos predominantemente saud��veis, G2. Observou-se correla����o, considerada fraca positiva (r>0,30), entre PCR, perf��l lip��dico e vari��veis antropom��trica (p<0,05). Esta tese apresenta uma rela����o de interface multidisciplinar, tendo o seu conte��do uma aplica����o nos campos da Fisioterapia, Educa����o F��sica, Medicina, Nutri����o e da Bioqu��mica

S��ndrome metab��lica e risco cardiovascular na p��s- menopausa: avalia����o por diferentes crit��rios diagn��sticos e influ��ncia de fatores s��cio-econ��micos

The metabolic syndrome (MetS) involves a group of risk factors and is associated with a significantly higher risk of developing cardiovascular diseases (CVD) and type 2 diabetes. Recent studies have shown the importance of preventing CVD through early diagnosis and treatment of patients with MetS. The objective of our study was to determine the prevalence of MetS by different diagnostic criteria in postmenopausal women and analyze the influence of socioeconomic factors on cardiovascular risk in this sample of the population. A cross-sectional study involving 127 postmenopausal women (45 to 64 years) from Natal and Mossor��, Brazil. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte. The experimental protocol consisted of applying structured interview, clinical examination and implementation of dosages blood. The diagnosis of MetS was based on NCEP-ATP III (National Cholesterol Education Program-Adult Treatment Panel III) and IDF (International Diabetes Federation) criteria. The research was accomplished with the participation of an interdisciplinary team in their several phases. The result of the sample studied had mean age of 53.9 �� 4.6 years and per capita income of 54.5 dollars. The prevalence of MetS, according to NCEP-ATP III and IDF criteria, was 52.8% and 61.4$, respectively. The agreement rate between NCEP-ATP III and IDF criteria was 81.9%, with a kappa value of 0.63 (CI 95%, 0.49-0.76), indicating good agreement between the two definitions. The most prevalent cardiovascular risk factor was HDL < 50 mg/dl, observed in 96.1% of the women analyzed, followed by increased waist circumference (&#8805; 80 cm) in 78.0%, elevated blood pressure in 51.2%, triglycerides &#8805; 150 mg/dl in 40.9% and glycemia &#8805; 100 mg/dl in 37.0% of the women. The occurrence of MetS was significantly associated with schooling and body mass index (BMI). High blood pressure was significantly associated with low family income, low schooling and weight gain. There was no significant association between the intensity of climacteric symptomatology and the occurrence of MetS. The conclusions of the research were that MetS and its individual components show a high prevalence in postmenopausal Brazilian women, and significant associations with weight gain and low socioeconomic indicators. The data point to the need for an interdisciplinary approach at the basic health care level, directed toward the early identification of risk factors and the promotion of cardiovascular health of climacteric women.

Risco de doen��a cardiovascular em mulheres com hist��ria de dist��rbio hipertensivo da gravidez

OBJECTIVE: Preeclampsia is a disease that can lead to a high maternal and infant morbidity. Worldwide, the incidence of this disease is highly variable and there is no data on this disorder in the Brazilian population. This study aimed at determining incidence and risk factors in the hypertensive disorders during pregnancy in a neighborhood of Natal, in addition to observing the evolution of these disorders one year and five years after delivery. METHODS: Prospective cohort study to assess the outcome of pregnancies of 242 women who became pregnant between 2004-2007 in the neighborhood of Bom Pastor in the city of Natal, state of RN, Brazil. Five years after delivery, there was an active search of thirty-nine (39) women who became pregnant and had a hypertensive disorder during pregnancy and/or pr��-ecl��mpsia, out of the total of 242 participants in the initial study. We administered a structured questionnaire to obtain basic information about the current clinical situation of patients and occurrences of subsequent pregnancy and presence of hypertensive disorders during pregnancy. We also searched for information on the use of hypotensive drugs and contraceptives. The following characteristics were checked and recorded: a) current weight, b) blood pressure c) body mass index - BMI, and we collected biological samples (blood and urine) for measurement of biochemical parameters and evaluation of microalbumin��ria. Finally, we monitored the ambulatory blood pressure (ABP), which uses the method of automatic measurement of heart rate, systolic and diastolic blood pressure and an average of the two for the period of 24 hours. RESULTS: Out of 218 women who completed the study, the incidence of hypertensive disorders was of 16.9% (37 out of 218), while the incidence of preeclampsia was 13.8% (30 of 218). Women with preeclampsia had a BMI (body mass index) averaged of 25.3 (�� 4.8) while this ratio in normotensive women was of 23.5 (�� 3.7), p = 0.02. The risk of preeclampsia rises with age (OR 1084 p = 0.0034) and with a family history of hypertension (OR 2.6 p = 0.01). The follow-up one year after delivery revealed that 50% of women with hypertensive disorders in pregnancy remained hypertensive. High BMI was also observed after 5 years of delivery. CONCLUSIONS: an elevated BMI, age above 35 years and excessive weight gain during pregnancy were associated with hypertension in the long term in patients with prior preeclampsia. History of preeclampsia increases the risk of chronic hypertension

S��ndrome metab��lica e fatores associados: estudo comparativo com mulheres que apresentaram pr��-ecl��mpsia e gravidez normal, acompanhadas cinco anos ap��s o parto

Preeclampsia is defined as an extremely serious complication of the pregnancy-puerperium cycle with delayed emergence of cardiovascular risk factors, including metabolic syndrome. The research aimed estimate the prevalences of metabolic syndrome and associated factors in women with preeclampsia and normal pregnancy followed five years after childbirth. This is a cross-sectional observational study using a quantitative approach, conducted at a maternity school in the city of Natal in Rio Grande do Norte state. The sample was composed of 70 women with previous preeclampsia and 75 normal selected by simple random probability sampling. Subjects were analyzed for sociodemographic, obstetric, clinical, anthropometric and biochemical parameters. International Diabetes Federation criteria were adopted to diagnose metabol ic syndrome. The Kolmogorov-Smirnov, Mann-Whitney, Student s t, Pearson s chi-squared, and Fisher s exact tests, in addition to simple logistic regression, were used for data analysis, at a 5% significance level (p &#8804; 0.05). Statistical tests demonstrated elevated body mass index (p = 0.001), predominance of family history of diabetes mellitus (p = 0.022) and significantly higher prevalence of metabolic syndrome in the preeclampsia group (37.1%) when compared to normal (22.7%) (p = 0.042). Intergroup comparison showed a high number of metabolic syndrome components in women with previous preeclampsia. Altered systolic and diastolic blood pressure (p < 0.001) was the most prevalent, followed by low concentrations of high-density lipoproteins (p = 0.049), and hyperglycemia (p=0.030). There was a predominance of the metabolic syndrome in women with schooling 0-9 years (42.4%) (p = 0.005), body mass index above 30Kg.m 2 (52.3%) (p < 0.001), uric acid high (62.5%) (p = 0.050 and family history of hypertension (38.5%) (p< 0.001). Multivariate analysis of the data showed that the body mass index above 30 kg.m2, education level less than 10 years of study (p < 0.001) and family history of hypertension (p = 0.002) remained associated with the metabolic syndrome after multivariate analysis of the data. It is considered Women with previous preeclampsia exhibited high prevalence of metabolic syndrome and their individual components in relation to normal, especially, altered systolic and diastolic blood pressure, low concentrations of high-density lipoproteins and hyperglycemia. The factors associated to this ou tcome were obesity, less than 10 years of schooling, and family history of hypertension. Overall, this study identified young women with a history of PE exposed to a higher cardiovascular risk than normal

Fatores de riscos cardiovasculares em adolescentes da cidade do Natal-RN

Estudos t��m demonstrado elevada preval��ncia de fatores de risco cardiovascular em adolescentes a redor do mundo, entretanto, �� poss��vel que esses fatores de risco se comportem de modo diferente em diferentes localidades. Objetivos: Examinar a preval��ncia do sobrepeso/obesidade e sua associa����o com outros fatores de risco cardiovasculares, em adolescentes, da cidade do Natal-Brasil. M��todos: Estudo observacional de delineamento transversal, realizado em 626 adolescentes (10 a 19 anos) de ambos os sexos. Foram estudadas as vari��veis: peso, idade, g��nero, cor, escolaridade, renda familiar, h��bitos de vida, hist��ria familiar, peso, estatura, ��ndice de massa corporal, rela����o cintura/quadril, press��o arterial, perfil lip��dico, Glicose e Insulina de jejum e p��s Dextrosol. Resultados: Foram avaliados 273 (43,6%) adolescentes do sexo masculino e 353 (56,4%) feminino. 26,4% dos adolescentes apresentaram sobrepeso/obesidade. A presen��a de obesidade familiar foi relatada por mais de 30 % da nossa amostra. Na an��lise de regress��o log��stica m��ltipla; Idade, renda familiar, percentil de press��o sist��lica, hist��ria familiar de hipertens��o e obesidade, triglicer��deos, HDL colesterol, e HOMA RI mostraram-se associados com sobrepeso/obesidade. A rela����o cintura quadril apresentou-se mais elevada nas mulheres, e encontramos 10,9 % dos adolescentes com percentil de press��o sist��lica (PAS) 95, e 7,4 % com percentil de press��o diast��lica (PAD) 95. As dosagens de triglicer��deos, colesterol HDL e HOMA-RI alterados foram mais prevalentes nos que apresentavam IMC aumentado. As altera����es do xi colesterol total, triglicer��dios, glicemia p��s dextrosol e HOMA teste, tiveram maior preval��ncia no g��nero feminino. Na regress��o log��stica bin��ria, foram observadas associa����es do sobrepeso / obesidade com idade; OR 0,85, IC de 95% (0,78-0,92); p<0,001, press��o arterial sist��lica; OR 2,65, IC de 95% (1,18- 5,94); p< 0,020, renda familiar; OR 2,34, IC de 95% (1,53-3,58); p< 0,001, hist��ria familiar de hipertens��o arterial; OR 1,76, IC de 95% (1,15-2,71); p< 0,009, hist��ria familiar de obesidade; OR 1,50, IC de 95% (1,09-2,27); p< 0,04, aumento dos trigliceridios; OR 2,74, IC de 95% (1,69-4,43); p< 0,001, redu����o do colesterol; HDL OR 0,58, IC de 95% (0,38-0,87); p< 0,009 e o aumento do HOMA OR 3,16, IC de 95% (1,64 - 6,02); p<0,001. Conclus��o: A preval��ncia de fatores de risco cardiovascular em Natal ��� Brasil se constitui em grave problema de sa��de p��blica, atingindo n��veis que se igualam ou at�� superam os de outras cidades tanto no Brasil, como em outros pa��ses