820 resultados para Age-adjusted comorbidity index


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The objectives of the current study were to investigate the additive genetic associations between heifer pregnancy at 16 months of age (HP16) and age at first calving (AFC) with weight gain from birth to weaning (WG), yearling weight (YW) and mature weight (MW), in order to verify the possibility of using the traits measured directly in females as selection criteria for the genetic improvement of sexual precocity in Nelore cattle. (Co)variance components were estimated by Bayesian inference using a linear animal model for AFC, WG, YW and MW and a nonlinear (threshold) animal model for HP16. The posterior means of direct heritability estimates were: 0.45 +/- 0.02; 0.10 +/- 0.01; 023 +/- 0.02; 0.36 +/- 0.01 and 0.39 +/- 0.04, for HP16, AFC, WG, YW and MW, respectively. Maternal heritability estimate for WG was 0.07 +/- 0.01. Genetic correlations estimated between HP16 and WG, YW and MW were 0.19 +/- 0.04; 0.25 +/- 0.06 and 0.14 +/- 0.05, respectively. The genetic correlations of AFC with WG, YW and MW were low to moderate and negative, with values of -0.18 +/- 0.06; -0.22 +/- 0.05 and -0.12 +/- 0.05, respectively. The high heritability estimated for HP16 suggests that this trait seem to be a better selection criterion for females sexual precocity than AFC. Long-term selection for animals that are heavier at young ages tends to improve the heifers sexual precocity evaluated by HP16 or AFC. Predicted breeding values for HP16 can be used to select bulls and it can lead to an improvement in sexual precocity. The inclusion of HP16 in a selection index will result in small or no response for females mature weight. (C) 2011 Elsevier B.V. All rights reserved.

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Background: Regardless significant therapeutic advances, mortality and morbidity after myocardial infarction (MI) are still high. For a long time, the importance of right ventricle (RV) function has been neglected. Recently, RV dysfunction has also been associated with poor outcomes in the setting of heart failure. The shape, location, and contraction conditions make the RV chamber assessment technically challenging.Methods: Our study identified clinical characteristics and left ventricle (LV) echocardiographic data performed 3-5 days after MI that could be associated with RV dysfunction (RV fractional area change [FAC] < 35%) 6 months after MI.Results: The RV dysfunction group consisted of 11 patients (RV FAC 29.4% +/- 5.2) and the no RV dysfunction group of 71 patients (RV FAC 43.7% +/- 5.1); (P < 0.001). Both groups presented the same baseline clinical characteristics. Left atrium (LA), interventricular septum (IVS), and left ventricular posterior wall (LVPW) were larger in RV dysfunction than in no RV dysfunction. Conversely, E wave deceleration time (EDT) was lower in RV dysfunction when compared with no RV dysfunction. Left atrium(adj) (adjusted by gender, age, infarct size, and body mass index) (odds ratio [OR], 1.22; confidence interval [CI], 1.016-1.47; P = 0.032), interventricular septum(adj) (OR, 1.49; CI, 1.01-2.23; P = 0.044), and E wave deceleration time(adj) (OR, 0.98; CI, 0.97-0.98; P = 0.029) assessed soon after MI predicted RV failure after 6-months.Conclusions: LV diastolic dysfunction, resulting from anterior MI and assessed 3-5 days after the event, may play an important role in predicting RV dysfunction 6 months later.

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FUNDAMENTOS: Acrocórdons são lesões dermatológicas comuns na população e estão associados ao diabetes mellitus, à obesidade, à resistência insulínica e à aterosclerose. A identificação precoce de pacientes com resistência insulínica pode ter papel preventivo primário. OBJETIVO: Avaliar a associação entre presença de acrocórdons cervicais ou axilares e resistência insulínica. MÉTODOS: Estudo transversal com pacientes dermatológicos adultos atendidos em hospital universitário. Casos foram definidos como portadores de mais de cinco acrocórdons cervicais e/ou axilares. A resistência insulínica foi estimada pelo índice HOMA-IR. Resultados foram ajustados pelas demais covariáveis de risco para resistência insulínica conhecidos, a partir de regressão logística múltipla. RESULTADOS: Avaliaram-se 98 casos e 103 controles, que não diferiram entre si quanto à idade ou ao gênero. Acrocórdons se associaram diretamente aos valores de HOMA-IR (Odds Ratio = 1,4), hipertrigliceridemia e índice de massa corpórea, independentemente do ajuste por diabetes mellitus, idade, fototipo, gênero, história de diabetes mellitus familiar e relação cintura/quadril. Níveis qualitativamente elevados de HOMA-IR (> 3,8) também evidenciaram associação significativa (Índice de probabilidade = 7,5). CONCLUSÕES: Presença de múltiplos acrocórdons se associou à resistência insulínica, independentemente dos demais fatores de risco.

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Little evidence-based guidance is available to aid clinicians in determining short-term prognoses in very severe COPD patients. Therefore, the present study was designed to provide a prospective assessment (1) of the mortality rates and (2) whether the baseline measurements may be determinants of 1-year mortality in hypoxemic COPD patients receiving long-term oxygen therapy (LTOT).Seventy-eight clinically stable patients with advanced COPD treated using LTOT were enrolled in a prospective cohort study. Outcome variable: first-year mortality. Baseline measurements: categorical variables: age (<60 or >= 60 years); gender; body mass index (<20 or >= 20 kg/m(2)); fat-free mass (FFM) index (<16 [men] and <15kg/m(2) [women]; baseline dyspnea index (BDI) (<= 3 or >3); and corticosteroid use. Continuous variables: smoking history; lung function; FFM; fat mass; hemoglobin; hematocrit; arterial blood gases; forearm muscle strength; St. George's Respiratory Questionnaire (SGRQ); and comorbidity score. By the end of 1-year of follow-up, 12 patients (15.4%) had died. Kaplan-Meier curves showed that BDI <= 3 was the only variable associated with higher mortality. Cox proportional hazards analysis revealed that tower PaO2 and SPO2, higher PaCO2 and SGRQ scores were associated with reduced survival. In the multivariate analysis, BDI remained predictive of mortality (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.31-0.81), as did PaO2 (HR, 0.49; 95% CI, 0.26-0.95). These data suggest that readily available parameters as dyspnea intensity and hypoxemia severity may be useful in predicting first-year survival rates in advanced COPD patients receiving LTOT (C) 2007 Elsevier Ltd. All rights reserved.

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The objective of this study was to determine the effect of maternal hydration with oral isotonic solution and water on the amniotic fluid (AF) index of women with normohydramnios. Women with a normal AF index and gestational age between 33 and 36 weeks without maternal complications were randomized into three groups [isotonic solution (Gatorade (R)), water, control]. The isotonic solution and water groups were instructed to drink 1.5 L of the respective solution and the control group was instructed to drink 200 mL water over a period of 2 to 4 h. AF index was measured before and after hydration by Doppler ultrasonography. The investigator performing the AF index measurement was blind to the subject's group. Ninety-nine women completed the study without any adverse maternal effects. The median increase in AF index after hydration was significantly greater for the isotonic solution and water groups than for the control group. There was no significant difference between the isotonic solution and water groups. Hydration with isotonic solution and water caused a 10-fold (95% CI: 2.09-49.89) and 6-fold (95% CI: 1.16-30.95) increase in the chance of a 20% increase of AF index, respectively. Maternal hydration with isotonic solution or water increased the AF index in women with normohydramnios.

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OBJECTIVE: We sought to compare the rates of superimposed preeclampsia and adverse outcomes in women with chronic hypertension with or without prior preeclampsia.STUDY DESIGN: We conducted secondary analysis of 369 women with chronic hypertension (104 with prior preeclampsia) enrolled at 12-19 weeks as part of a multisite trial of antioxidants to prevent preeclampsia (no reduction was found). Outcome measures were rates of superimposed preeclampsia and other adverse perinatal outcomes.RESULTS: Prepregnancy body mass index, blood pressure, and smoking status at enrollment were similar between groups. The rates of superimposed preeclampsia (17.3% vs 17.7%), abruptio placentae (1.0% vs 3.1%), perinatal death (6.7% vs 8.7%), and small for gestational age (18.4% vs 14.3%) were similar between groups, but preterm delivery <37 weeks was higher in the prior preeclampsia group (36.9% vs 27.1%; adjusted risk ratio, 1.46; 95% confidence interval, 1.05-2.03; P = .032).CONCLUSION: In women with chronic hypertension, a history of preeclampsia does not increase the rate of superimposed preeclampsia, but is associated with an increased rate of delivery at <37 weeks.

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Background: The objective was to present a new ovarian response prediction index (ORPI), which was based on anti-Mullerian hormone (AMH) levels, antral follicle count (AFC) and age, and to verify whether it could be a reliable predictor of the ovarian stimulation response.Methods: A total of 101 patients enrolled in the ICSI programme were included. The ORPI values were calculated by multiplying the AMH level (ng/ml) by the number of antral follicles (2-9 mm), and the result was divided by the age (years) of the patient (ORPI=(AMH x AFC)/Patient age).Results: The regression analysis demonstrated significant (P<0.0001) positive correlations between the ORPI and the total number of oocytes and of MII oocytes collected. The logistic regression revealed that the ORPI values were significantly associated with the likelihood of pregnancy (odds ratio (OR): 1.86; P=0.006) and collecting greater than or equal to 4 oocytes (OR: 49.25; P<0.0001), greater than or equal to 4 MII oocytes (OR: 6.26; P<0.0001) and greater than or equal to 15 oocytes (OR: 6.10; P<0.0001). Regarding the probability of collecting greater than or equal to 4 oocytes according to the ORPI value, the ROC curve showed an area under the curve (AUC) of 0.91 and an efficacy of 88% at a cut-off of 0.2. In relation to the probability of collecting greater than or equal to 4 MII oocytes according to the ORPI value, the ROC curve had an AUC of 0.84 and an efficacy of 81% at a cut-off of 0.3. The ROC curve for the probability of collecting greater than or equal to 15 oocytes resulted in an AUC of 0.89 and an efficacy of 82% at a cut-off of 0.9. Finally, regarding the probability of pregnancy occurrence according to the ORPI value, the ROC curve showed an AUC of 0.74 and an efficacy of 62% at a cut-off of 0.3.Conclusions: The ORPI exhibited an excellent ability to predict a low ovarian response and a good ability to predict a collection of greater than or equal to 4 MII oocytes, an excessive ovarian response and the occurrence of pregnancy in infertile women. The ORPI might be used to improve the cost-benefit ratio of ovarian stimulation regimens by guiding the selection of medications and by modulating the doses and regimens according to the actual needs of the patients.

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The buffalo population in Brazil increased about 12.9% between 1998 and 2003, to 2.8 million head, evidencing the importance of this species for the country. The objective this work was evaluation of animal growth using multivariate analysis. The data were from 2,944 water buffalo from 10 herds raised in pasture conditions in Brazil. Principal components and genetic distances were estimated using proc PRINCOMP and proc CANDISC in SAS (SAS Inst. Inc. Cary, NC, USA). Variables analyzed were birth weight (BW), age at weaning (AW), weaning weight (WT), weight adjusted to 205 d (W205), total gain between BW and WT (TG), daily gain between BW and WT (DG), weight adjusted to 365 d (W365), total gain between WT and W365 (TG3), daily gain between WT and W365 (TGD3), weight adjusted to 550 d (W550) and weight adjusted to 730 d (W730). Means and standard deviations for each variable were 39.4 +/- 3.2 kg, 225.6 +/- 38.8 d, 209.4 +/- 39.4 kg, 195.4 +/- 30.2 kg, 157.4 +/- 32.0 kg, 0.77 +/- 0.16 kg/d, 282.0 +/- 43.5 kg, 73.9 +/- 33.9 kg, 0.53 +/- 0.21 kg/d, 406.8 +/- 67.9 kg, and 468.2 +/- 70.6 kg, respectively. The eigenvalues to four first principal components were 5.29, 2.54, 1.66, 1.01, and justify 48%, 23%, 15% and 9%, respectively, with a total cumulative 95%. We created an index using the first principal component which is Y. 0.0552 BW + 0.0438 AW + 0.3142 WT + 0.3549 W205 + 0.3426 TG + 0.3426 DG + 0.4070 W365- 0.1531 TG3 - 0.2059 TGD3 - 0.3833 W550 - 0.3966 W730. This index accounted for 48% the variation in the correlation matrix. This principal component emphasizes early growth of the animal. Estimates the pair-wise squared distances between herds, D2(i vertical bar j)= ((x) over bar (i)-(x) over bar (j))' cov(-1)((x) over bar (i)-(x) over bar (j)), using with basis the average of weight of animals, showed the largest distance between herds eight (Murrah: DF) and seven (Murrah: Amazon) and the closest distance between herds one (Mediterranean - RS) and five (Jafarabadi - SP).

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Genetic parameters for the relation between the traits of milk yield (MY), age at first calving (AFC) and interval between first and second calving (IBFSC) were estimated in milk buffaloes of the Murrah breed. In the study, data of 1578 buffaloes at first lactation, with calvings from 1974 to 2006 were analyzed. The MTDFREML system was used in the analyses with models for the MY, IBFSC traits which included the fixed effects of herd-year-season of calving, linear and quadratic terms of calving age as covariate and the random animal effects and error. The model for AFC consisted of the herd-year-season fixed effects of calving and the random effects of animal and error. Heritability estimates MY, AFC and IBFSC traits were 0.20, 0.07 and 0.14, respectively. Genetic and phenotypic correlations between the traits were: MY and AFC = -0.12 and -0.15, MY and IBFSC = 0.07 and 0.30, AFC and IBFSC = 0.35 and 0.37, respectively. Genetic correlation between MY and AFC traits showed desirable negative association, suggesting that the daughters of the bulls with high breeding value for MY could be physiological maturity to a precocious age. Genetic correlation between MY and IBFSC showed that the selection of the animals that increased milk yield is also those that tend to intervals of bigger calving.

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The objectives this paper were to estimate genetic parameters and genetic and phenotypic trends of birth weight (BWT) and weights adjusted to 205 (WT205), 365 (WT365) and 550 (P550) days of age of beef buffaloes born from 1985 to 2003 in Brazil. For BWT and WT205 the model included direct and maternal genetic and maternal environment as random effects and contemporary and genetic groups as fixed effects. For WT365 and WT550 the same model was used except without direct maternal and maternal environmental effects. The genetic and phenotypic trends were estimated by regression of means of dependent variables on birth year of animals Regressions were obtained by using two methodologies: 1) linear regression; and 2) non-parametric splined regression. The direct heritability estimates were 0.09, 0.45, 0.46 and 0.58 for BWT, WT205, WT365 and WT550, respectively. The direct genetic trends from linear regression were 0.01, 0.23, 0.58 and 1.40 kg per year for PN, WT205, VVT365 and WT550, respectively (P<0.001 for all). Phenotypic trends were strongly positive while genetic trends were consistently positive but small. Genetic parameters indicate potential for increased rate of genetic change with full implementation of genetic improvement programs.

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The aim of this study was to analyze the weight at birth (BW) and adjusted at 205 (W205), 365 (W365) and 550 (W55O) days in beef buffaloes from Brazil, using two approaches: parametric, by normal distribution, and non-parametric, by kernel function, and thus estimating the genetic, environmental and phenotypic correlation among traits. Information of 5,169 animals at birth (BW), 3,792 at 205 days (W205), 3.883 at 365 days (W365) and 1,524 at 550 days of age (W550) were used. The birth weight distribution presented an evident discrepancy in relation to the normal distribution. However, W205, W365 and W550 presented normal distributions. The birth weight presented weak genetic, environmental, and phenotypic associations with the other weight measurements. on the other hand, the weight traits at 205, 365, 550 days of age showed a high genetic correlation.

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Objective. The purpose of this study was to evaluate the effect of total abdominal hysterectomy on ovarian blood supply using transvaginal color Doppler ultrasonography in women of reproductive age. Methods. This prospective study included 61 women aged 40 years or younger who were divided into 2 groups: group 1, comprising 31 patients who underwent total abdominal hysterectomy (TAH), and group 2, comprising 30 women with no abnormalities. Inclusion criteria included normal ovarian function at baseline, with basal follicle-stimulating hormone levels of less than 15 mUI/mL, normal body weight, no tobacco use, and no history of laparotomy or ovarian disease. Ovarian arterial blood supply by determination of the pulsatility index (PI) on Doppler analysis and ovarian volume on transvaginal ultrasonography were assessed at baseline and at 6 and 12 postoperative months. The Student t test, profile analysis, and Friedman and Mann-Whitney tests were used in the statistical analysis of data. Results. Statistical analysis of baseline data revealed that both groups were homogeneous. At months 6 and 12, greater ovarian volumes and lower PI values were observed in patients who underwent TAH (P < .05). By the end of the study, in 8 of the 31 patients who underwent TAH (25.5%), benign ovarian cysts were observed. in the control group, all the parameters studied remained unchanged. Conclusions. The reduced PI values observed on Doppler ultrasonography suggested a decrease in the resistance flow in the ovarian arteries in women of reproductive age who underwent TAH.

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Three hundred and twenty samples of subgingival plaque were obtained from 80 caucasian girls, ranging from 10 to 13 years of age. The samples were analyzed to verify the influence of age upon colonization of the gingival sulcus by microorganisms potentially pathogenic to the periodontal tissues. The gingival and plaque status were evaluated through the gingival index (GI) and plaque index (PlI) and the microflora was assessed by the enzymatic method benzoyl-arginine-naphthylamide (BANA). The results of the BANA test were positive for 62.50% of the tested individuals and 40% of the examined sites. The influence of age was statistically significant on BANA reactivity, and the number of positive sites was greater at 11 (57.5%) than at 12 years (28.8%).