��ndices de obesidade central e fatores de risco cardiovascular na s��ndrome dos ov��rios polic��sticos

Fundamento: A obesidade abdominal apresenta elevada preval��ncia em mulheres com s��ndrome dos ov��rios polic��sticos (SOP) e est�� associada a um aumento do risco cardiovascular. Objetivo: Verificar a acur��cia da circunfer��ncia da cintura (CC), da rela����o cintura-quadril (RCQ), da rela����o cinturaestatura (RCEST) e do ��ndice de conicidade (��ndice C), no que se refere �� detec����o de fatores de risco cardiovascular (FRCV) em mulheres com SOP. M��todos: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 �� 5 anos) com diagn��stico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicer��deos (TG), o LDL-colesterol (LDL-C), o HDLcolesterol (HDL-C), a glicemia de jejum, a glicemia ap��s teste oral de toler��ncia �� glicose (TOTG) e a press��o arterial (PA) foram avaliados em todas as pacientes, al��m das vari��veis antropom��tricas. Resultados: A rela����o cintura-estatura foi o marcador que apresentou correla����es positivas significativas com o maior n��mero de FRCV (PA, TG e glicemia ap��s TOTG), destacando-se ainda a correla����o negativa com HDL-C. Todos os marcadores antropom��tricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correla����o positiva tamb��m com TG. No tocante �� acur��cia para detec����o de FRCV, os indicadores antropom��tricos considerados apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEST, que apresentou sensibilidade superior a 70%. Conclus��o: A RCEST demonstrou ser o indicador antropom��trico com a melhor acur��cia para a predi����o de FRCV. Nesse sentido, prop��e-se a inclus��o desse par��metro de f��cil mensura����o na avalia����o cl��nica para o rastreamento de mulheres com SOP e FRCV----------------------ABSTRACT Background: Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. Objective: To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. Methods: The present transversal study allocated 102 women (26.5 �� 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. Results: The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60%, especially the WHtR, which had a sensibility > 70%. Conclusion: The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF

Estado nutricional antropom��trico, perfil lip��dico e consumo alimentar como fatores de risco para doen��a cardiovascular em adolescentes

The dyslipidemia and excess weight in adolescents, when combined, suggest a progression of risk factors for cardiovascular disease (CVD). Besides these, the dietary habits and lifestyle have also been considered unsuitable impacting the development of chronic diseases. The study objectives were: (1) estimate the prevalence of lipid profile and correlate with body mass index (BMI), waist circumference (WC) and waist / height ratio (WHR) in adolescents, considering the maturation sexual, (2) know the sources of variance in the diet and the number of days needed to estimate the usual diet of adolescents and (3) describe the dietary patterns and lifestyle of adolescents, family history of CVD and age correlates them with the patterns of risk for CVD, adjusted for sexual maturation. A cross-sectional study was performed with 432 adolescents, aged 10-19 years from public schools of the Natal city, Brazil. The dyslipidemias were evaluated considering the lipid profile, the index of I Castelli (TC / HDL) and II (LDL / HDL) and non-HDL cholesterol. Anthropometric indicators were BMI, WC and WHR. The intake of energy, nutrients including fiber, fatty acids and cholesterol was estimated from two 24-hour recalls (24HR). The variables of lipid profile, anthropometric and clinical data were used in the models of Pearson correlation and linear regression, considering the sexual maturation. The variance ratio of the diet was calculated from the component-person variance, determined by analysis of variance (ANOVA). The definition of the number of days to estimate the usual intake of each nutrient was obtained by taking the hypothetical correlation (r) &#8805; 0.9, between nutrient intake and the true observed. We used the principal component analysis as a method of extracting factors that 129 accounted for the dependent variables and known cardiovascular risk obtained from the lipid profile, the index for Castelli I and II, non-HDL cholesterol, BMI, and WC the WHR. Dietary patterns and lifestyle were obtained from the independent variables, based on nutrients consumed and physical activity weekly. In the study of principal component analysis (PCA) was investigated associations between the patterns of cardiovascular risk factors in dietary patterns and lifestyle, age and positive family history of CVD, through bivariate and multiple logistic regression adjusted for sexual maturation. The low HDL-C dyslipidemia was most prevalent (50.5%) for adolescents. Significant correlations were observed between hypercholesterolemia and positive family history of CVD (r = 0.19, p <0.01) and hypertriglyceridemia with BMI (r = 0.30, p <0.01), with the CC (r = 0.32, p <0.01) and WHR (r = 0.33, p <0.01). The linear model constructed with sexual maturation, age and BMI explained about 1 to 10.4% of the variation in the lipid profile. The sources of variance between individuals were greater for all nutrients in both sexes. The reasons for variances were &#61500; 1 for all nutrients were higher in females. The results suggest that to assess the diet of adolescents with greater precision, 2 days would be enough to R24h consumption of energy, carbohydrates, fiber, saturated and monounsaturated fatty acids. In contrast, 3 days would be recommended for protein, lipid, polyunsaturated fatty acids and cholesterol. Two cardiovascular risk factors as have been extracted in the ACP, referring to the dependent variables: the standard lipid profile (HDL-C and non-HDL cholesterol) and "standard anthropometric index (BMI, WC, WHR) with a power explaining 75% of the variance of the original data. The factors are representative of two independent variables led to dietary patterns, "pattern 130 western diet" and "pattern protein diet", and one on the lifestyle, "pattern energy balance". Together, these patterns provide an explanation power of 67%. Made adjustment for sexual maturation in males remained significant variables: the associations between puberty and be pattern anthropometric indicator (OR = 3.32, CI 1.34 to 8.17%), and between family history of CVD and the pattern lipid profile (OR = 2.62, CI 1.20 to 5.72%). In females adolescents, associations were identified between age after the first stage of puberty with anthropometric pattern (OR = 3.59, CI 1.58 to 8.17%) and lipid profile (OR = 0.33, CI 0.15 to 0.75%). Conclusions: The low HDL-C was the most prevalent dyslipidemia independent of sex and nutritional status of adolescents. Hypercholesterolemia was influenced by family history of CVD and sexual maturation, in turn, hypertriglyceridemia was closely associated with anthropometric indicators. The variance between the diets was greater for all nutrients. This fact reflected in a variance ratio less than 1 and consequently in a lower number of days requerid to estimate the usual diet of adolescents considering gender. The two dietary patterns were extracted and the pattern considered unhealthy lifestyle as healthy. The associations were found between the patterns of CVD risk with age and family history of CVD in the studied adolescents

N��veis press��ricos elevados em mulheres com s��ndrome dos ov��rios polic��sticos: preval��ncia e fatores de risco associados

investiga a preval��ncia de n��veis press��ricos elevados e avaliar a correla����o entre n��veis de press��o arterial (PA) e outros fatores de risco cardiovascular em pacientes com s��ndrome dos ov��rios polic��sticos (SOP).Por meio de estudo transversal foram comparados os n��veis de PA e par��metros antropom��tricos e bioqu��micos de risco cardiovascular em 113 mulheres com SOP (idade 26,2��4,3 anos) e num grupo controle constitu��do por 242 mulheres saud��veis da popula����o geral (26,8��5,0 anos). o grupo SOP apresentou preval��ncia de PA alterada (&#8805;130/85 mmHg) significativamente superior ao grupo controle (18,6% vs. 9,9%, respectivamente; p<0,05). Mulheres com SOP apresentaram valores m��dios superiores de PA sist��lica, ��ndice de massa corporal (IMC), circunfer��ncia da cintura (CC), triglicer��deos e glicemia de jejum, al��m de n��veis inferiores de HDL - colesterol, em compara����o ao grupo controle (p<0,01). No grupo SOP, os valores de PA sist��lica e diast��lica apresentaram correla����o positiva significativa com a idade, IMC, CC e triglicer��deos (p<0,05). A freq����ncia de mulheres com valores de PA acima do limite da normalidade foi significativamente maior no grupo SOP, em rela����o ao grupo controle. Adicionalmente, os valores de PA se correlacionaram positivamente com outros fatores de risco cardiovascular como obesidade e n��veis de triglicer��deos. Esses achados alertam para a relev��ncia de estrat��gias preventivas em mulheres com SOP, no sentido de evitar eventos m��rbidos relacionados ao sistema cardiovascular

��ndices de obesidade central e fatores de risco cardiovascular na s��ndrome dos ov��rios polic��sticos

Fundamento: A obesidade abdominal apresenta elevada preval��ncia em mulheres com s��ndrome dos ov��rios polic��sticos (SOP) e est�� associada a um aumento do risco cardiovascular. Objetivo: Verificar a acur��cia da circunfer��ncia da cintura (CC), da rela����o cintura-quadril (RCQ), da rela����o cinturaestatura (RCEST) e do ��ndice de conicidade (��ndice C), no que se refere �� detec����o de fatores de risco cardiovascular (FRCV) em mulheres com SOP. M��todos: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 �� 5 anos) com diagn��stico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicer��deos (TG), o LDL-colesterol (LDL-C), o HDLcolesterol (HDL-C), a glicemia de jejum, a glicemia ap��s teste oral de toler��ncia �� glicose (TOTG) e a press��o arterial (PA) foram avaliados em todas as pacientes, al��m das vari��veis antropom��tricas. Resultados: A rela����o cintura-estatura foi o marcador que apresentou correla����es positivas significativas com o maior n��mero de FRCV (PA, TG e glicemia ap��s TOTG), destacando-se ainda a correla����o negativa com HDL-C. Todos os marcadores antropom��tricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correla����o positiva tamb��m com TG. No tocante �� acur��cia para detec����o de FRCV, os indicadores antropom��tricos considerados apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEST, que apresentou sensibilidade superior a 70%. Conclus��o: A RCEST demonstrou ser o indicador antropom��trico com a melhor acur��cia para a predi����o de FRCV. Nesse sentido, prop��e-se a inclus��o desse par��metro de f��cil mensura����o na avalia����o cl��nica para o rastreamento de mulheres com SOP e FRCV----------------------ABSTRACT Background: Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. Objective: To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. Methods: The present transversal study allocated 102 women (26.5 �� 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. Results: The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60%, especially the WHtR, which had a sensibility > 70%. Conclusion: The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF

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 doenças 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 doenças 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

Acur��cia dos ��ndices antropom��tricos de obesidade central na determina����o de s��ndrome metab��lica e fatores de risco cardiovascular em mulheres com s��ndrome dos ov��rios polic��sticos

A s��ndrome dos ov��rios polic��sticos (SOP) �� a desordem end��crina mais comum em mulheres com idade reprodutiva. Seu diagn��stico �� firmado atrav��s do consenso de Rotterdam na presen��a de dois dos seguintes crit��rios: anovula����o cr��nica, sinais cl��nicos e/ou bioqu��micos de hiperandrogenismo e presen��a de micropolicistos nos ov��rios. Na SOP, al��m das caracter��sticas espec��ficas da s��ndrome �� comum a presen��a de marcadores de risco cardiovascular aumentado como dislipidemia, hipertens��o arterial, resist��ncia �� insulina e obesidade central Objetivos: Analisar a acur��cia diagn��stica da circunfer��ncia da cintura (CC), rela����o cintura-estatura (RCEst), raz��o cintura-quadril (RCQ) e ��ndice de conicidade (��ndice C) para detec����o de fatores de risco cardiovascular (FRCV) e s��ndrome metab��lica (SM) em mulheres com s��ndrome dos ov��rios polic��sticos (SOP). Metodologia: Foi realizado estudo transversal envolvendo 108 mulheres na faixa et��ria de 20-34 anos, com diagn��stico de SOP de acordo com o consenso de Rotterdam. Foram considerados par��metros cl��nicos, antropom��tricos e bioqu��micos de avalia����o do risco cardiovascular. A an��lise dos dados foi desenvolvida em duas etapas, conforme descrito a seguir. Fase 1: an��lise da acur��cia dos pontos de corte previamente determinados na literatura nacional para CC, RCEst, RCQ e ��ndice C, para predi����o de FRCV; Fase 2: determina����o de pontos de corte dos ��ndices antropom��tricos supracitados, espec��ficos para mulheres com SOP, para discrimina����o de SM, atrav��s da an��lise da curva ROC (Receiver Operating Characteristic). Resultados: Com base nos achados da fase 1 do estudo, a RCEst foi o marcador que apresentou correla����es positivas significativas com o xi maior n��mero de FRCV (press��o arterial, triglicer��deos e glicemia ap��s teste oral de toler��ncia �� glicose), al��m de correla����o negativa com HDL-colesterol. Os demais marcadores antropom��tricos se correlacionaram positivamente com press��o arterial, enquanto CC e RCQ apresentaram correla����o positiva tamb��m com triglicer��deos. Todos os indicadores antropom��tricos apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEst que apresentou sensibilidade superior a 70%. Na fase 2 da pesquisa observamos que a CC, RCEst e RCQ apresentaram desempenho semelhante na predi����o de SM, sendo superiores ao ��ndice C. Os valores de ponto de corte dos ��ndices antropom��tricos para discriminar SM foram: CC = 95 cm; RCEst = 0,59; RCQ = 0,88; e ��ndice C = 1,25. Utilizando esses pontos de corte as taxas de sensibilidade e especificidade da CC e RCEst foram superiores ��s observadas para RCQ e ��ndice C. Conclus��es: Nossos dados enfatizam a import��ncia da avalia����o antropom��trica no rastreamento do risco cardiovascular em mulheres com SOP, destacando-se a relev��ncia da RCEst na predi����o de FRCV cl��ssicos e a necessidade de considerar pontos de corte espec��ficos para mulheres com SOP para discrimina����o de SM

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

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 doenças 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 doenças 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 doenças 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

Acesso aos servi��os odontol��gicos e incid��ncia de c��rie em adolescentes e fatores de risco em munic��pio do Nordeste Brasileiro, 2006

The aims of this study were to analyze the access of dental services by child population, to determine the prevalence of dental caries, gingivitis and malocclusion in resident children from the municipal district of Sobral Cear�� and to evaluate the incidence of the dental decay in adolescents associated with the factors related to socioeconomic condition, access to health services and self-perception. This study had as main factor the multidisciplinary represented by the participation of health professional (doctors, dentists, nurses) in the development of the survey's initial reference; student from Human Sciences area to apply the structured questionnaire in domiciliary visits; statistics professionals in the orientation of the analysis to be held and family health team (community health agents, dentists and dental clinic assistants) in the scheduling of domiciliary visits and the accomplishment of oral exam. The sample was determined from the domicile record that included children born between 1990 and 1994 to develop the research Children health conditions in the municipal district of Sobral Cear�� . The first sample comprised 3425 parents of children from 5 to 9 years old, living in the urban area at the municipal district of Sobral Cear��, aiming at identifying the most important factors associated to the access to dental service. From this sample, 1021 children were selected in a systematic way, for the accomplishment to the epidemiological study of decay, gingivitis and malocclusion. In the study's third phase, in order to arrange the group to be followed, 688 adolescents were examined and interviewed, by means of the active search from the 1021 individuals that had been previously examined. It was observed that 50.9% of the children had access to dental service at least once in a lifetime. Of this total, 65.3% accomplished it during the last year, and 85.4% of these did in public services, what allows to identify the importance of this sector in the access to dental services. It was observed that the factors that most affected the access to dental 129 services were related to socioeconomic condition, such as the access to health plan, the possession of toothbrush, garbage collecting, mother s schooling, sewerage treatment and malnutrition. In relation to oral diseases, an increase in the DMF-T index according the age was observed, from 0.10 in five years old to 1.66 in the nine years old, while with the dmf-t index, the inverse happened, since the index decreased from 3.59 in five years old to 2.69 in nine years old. In relation to gingivitis, an average 32.7% of the children presented gum bleeding. In what concerns malocclusion, it was observed that 60.3% of the children didn't present any problem, 30.17% had light malocclusion and 9.5% severe malocclusion. The average incidence of dental caries was 1.86 teeth per youngster. Among the studied variables, tooth pain in the last six months, mother's income and school snack, adjusted by the perception about the need of treatment, the mother's schooling and the dentist's appointment at least once in a lifetime, were the variables that presented positive relationship with the high incidence of dental caries on this population by logistic regression. Variables of socioeconomic nature, related to the access to health services and behavior and biological variables presented a relationship with the high caries incidence. The study point out to the need of developing health actions in a humanized way, by an oral health team effectively bound to the population's interest, with the great objective to provide, with the public health services managers, adequate conditions to improve oral health

S��ndrome metab��lica e fatores de risco relacionados em crian��as e adolescentes com excesso de peso na cidade do Natal

Nas ��ltimas d��cadas, houve grande aumento da preval��ncia de obesidade, inclusive na faixa et��ria pedi��trica. Com isso, aumentou o n��mero de crian��as e adolescentes afetados por s��ndrome metab��lica (SM), diabetes tipo 2 (DM2) e doenças cardiovasculares (DCV), doenças anteriormente consideradas quase exclusivas de adultos. Os objetivos do estudo foram identificar e correlacionar marcadores antropom��tricos (IMC- ��ndice de massa corp��rea, CA- circunfer��ncia abdominal, RCQ- raz��o cintura/quadril, RCAraz��o cintura altura e PSE- prega subescapular), PAS e PAD- press��o arterial sist��lica e diast��lica, respectivamente, e laboratoriais (CT- colesterol total, HDL, LDL, TGL- triglic��rides, I/G- raz��o insulina glicose, HOMA- homeostatic model assessment for insulin resistance) de risco para o desenvolvimento de SM e observar a sua preval��ncia em crian��as e adolescentes com excesso de peso. Foi conduzido estudo transversal, em amostra aleat��ria, de conveni��ncia, onde foram avaliadas 60 crian��as e adolescentes com excesso de peso, atendidas no ambulat��rio de endocrinologia pedi��trica do Hospital de Pediatria da Universidade Federal do Rio Grande do Norte (UFRN) com idade m��nima e m��xima de 7 e 15 anos, de maio de 2009 a abril de 2010. Foram admitidos os indiv��duos que apresentavam sobrepeso (IMC P > 85 e < 95) ou obesidade (IMC P > 95) (CDC, 2000) e hist��ria familiar positiva para DM2 em parentes de primeiro ou segundo grau ou algum dos sinais de resist��ncia insul��nica (acantose, hipertens��o arterial, dislipidemia, s��ndrome de ov��rios polic��sticos). 2 O componente individual para SM mais prevalente foi o percentil da CA &#8805; 90 (58,3%), seguido de HDL &#8804; 40 mg/dl (36,6%). Na regress��o linear simples, observaram-se as varia����es para mais nos par��metros laboratoriais e de PA para cada unidade de aumento de IMC, CA, RCA, RCQ e PSE, sendo significantes as seguintes correla����es: CA com TGL, HOMA IR, I/G, PAS e PAD; RCQ com TGL, HOMA, I/G, LDL e glicemia; RCA com TGL; PSE com TGL, HOMA-IR, I/G e PAS; e IMC com HOMA IR, I/G, PAS e PAD. De acordo com os crit��rios da IDF (Federa����o Internacional de Diabetes International Diabetes Federation) 2007, o diagn��stico de SM foi encontrado em seis indiv��duos (10%). Do total, oito (13,3%), estavam em situa����o de sobrepeso e 52 (86,6%), obesos. As evid��ncias de correla����o CA e RCQ, medidas de obesidade centr��peta, com v��rios marcadores como TGL e HOMA, j�� sabidamente relacionados �� SM, chamam aten����o para a necessidade de utiliza����o dessas medidas de forma mais rotineira na pr��tica pedi��trica, por serem de f��cil obten����o, baixo custo e m��todo n��o invasivo. Os valores de CA, RCQ, RCA e PSE, quando elevados devem justificar maior detalhamento na avalia����o laboratorial de poss��vel resist��ncia insul��nica. �� importante a identifica����o de crian��as e adolescentes que preencham os requisitos para o diagn��stico da SM, pois s��o indiv��duos de maior risco metab��lico e devem ser adequadamente acompanhados.

Candid��ase vulvovaginal: sintomatologia, fatores de risco e coloniza����o anal concomitante

Post-menarche patients with clinical signs of vulvovaginitis were analyzed in this study, whose aims were the following: identify the frequency of C. albicans and non C. albicans species and negative results, correlate the vaginal culture for yeast with risk factors and symptomatology; compare positive and negative results for yeast in the vaginal and anal cultures; compare the positive results for C. albicans with other results found in the vaginal and anal cultures; and compare concomitant positivity for C. albicans and non C. albicans in the vaginal and anal cultures. Sample selection occurred between May, 2003 and May, 2005, and included 99 patients from Natal, Brazil. The laboratory methods used consisted of CHROMagar Candida culture medium, thermotolerance test at 42-45��C and hypertonic NaCL, in addition to the classic methods of carbohydrate assimilation and fermentation. We used absolute numbers, percentages, means of central tendency, chi-squared test (&#967;2) with Yates correction, Fisher s exact test and odds ratio for statistical analysis. The most frequent species was C. albicans in 69% of the cases. The positivity for Candida spp showed an association with the use of tight-fitting intimate clothing and/or synthetics, allergic diseases and the occurrence of itching, leukorrhea and erythema. Anal colonization increased the likelihood of vaginal contamination by 2.8 and 4.9 times, respectively, for Candida spp and C. albicans. When compared to the other species, C. albicans-positive anal colonization increased by 3.7 times the likelihood of vaginal positivity. These data suggest likely vaginal contamination originating in the anus

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

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.