Tontura em idosos institucionalizados da cidade do NATAL/RN: Um estudo caso-controle em vestibulopatas e não-vestibulopatas

the institutionalized elderly presents for being more fragile a lot of body balance s changes, which can induce falls and health frailty. One of the consequences of it is the appearance of dizziness, vestibular or not. This study aims to identify the risk factors related to dizziness in institutionalized elderly, with and without vestibular disorders, in the city of Natal-RN. Method: a case-control study realized in 12 regulated by Health Surveillance Long Term Care Institutions for the elderly in Natal-RN. Elected seniors with good cognitive level and able to walk, totaling 115 individuals, and of these, 102 were selected according to the presence of dizziness in the last year (n = 51) and their controls (n = 51), paired by sex and age. The 51 elderly patients with dizziness were divided into 3 groups case: case one, for elderly with dizziness and without vestibulopathy (n=38); case two, for elderly with dizziness and vestibulopathy (n=13) and case three, for all the seniors with dizziness, or added to the case 1 case 2 (n=51). The 51 seniors who served as controls were also divided into three groups, according to the number of individuals of each case: control 1, n = 38, control 2, n = 13 control and 3 (sum of 1 control with control 2), n = 51. As possible risk factors were analyzed variables related to characteristics of the institution, to the habits of life of older people and those concerned with the health of the elderly. For statistical analysis, we used the chi-square or Fisher exact test for a significance level of 5% and calculating the association magnitude between variables by measuring the Odds Ratio. Results: as risk factors for dizziness without vestibular disorders were found the presence of hypertension and cardiovascular disease, as well as the presence of three or more disorders for elderly and use of gastric protector drugs. For the elderly group from case two were found no associated risk factor. For elderly patients with dizziness in the case group three, we observed the same risk factors found for the elderly in the case group one, plus the presence of osteoarthritis pathology, which was also significant for this group. Conclusion: dizziness in institutionalized elderly is associated with systemic common diseases in this age group and the vestibulopathy presents itself as pathology on an isolated way, not being possible, with our data, associate it with non-risk factors

Estudo da descelularização tecidual na produção de arcabouços biológicos para enxertos

The regeneration of bone defects with loss of substance remains as a therapeutic challenge in the medical field. There are basically four types of grafts: autologous, allogenic, xenogenic and isogenic. It is a consensus that autologous bone is the most suitable material for this purpose, but there are limitations to its use, especially the insufficient amount in the donor. Surveys show that the components of the extracellular matrix (ECM) are generally conserved between different species and are well tolerated even in xenogenic recipient. Thus, several studies have been conducted in the search for a replacement for autogenous bone scaffold using the technique of decellularization. To obtain these scaffolds, tissue must undergo a process of cell removal that causes minimal adverse effects on the composition, biological activity and mechanical integrity of the remaining extracellular matrix. There is not, however, a conformity among researchers about the best protocol for decellularization, since each of these treatments interfere differently in biochemical composition, ultrastructure and mechanical properties of the extracellular matrix, affecting the type of immune response to the material. Further down the arsenal of research involving decellularization bone tissue represents another obstacle to the arrival of a consensus protocol. The present study aimed to evaluate the influence of decellularization methods in the production of biological scaffolds from skeletal organs of mice, for their use for grafting. This was a laboratory study, sequenced in two distinct stages. In the first phase 12 mice hemi-calvariae were evaluated, divided into three groups (n = 4) and submitted to three different decellularization protocols (SDS [group I], trypsin [Group II], Triton X-100 [Group III]). We tried to identify the one that promotes most efficient cell removal, simultaneously to the best structural preservation of the bone extracellular matrix. Therefore, we performed quantitative analysis of the number of remaining cells and descriptive analysis of the scaffolds, made possible by microscopy. In the second stage, a study was conducted to evaluate the in vitro adhesion of mice bone marrow mesenchymal cells, cultured on these scaffolds, previously decellularized. Through manual counting of cells on scaffolds there was a complete cell removal in Group II, Group I showed a practically complete cell removal, and Group III displayed cell remains. The findings allowed us to observe a significant difference only between Groups II and III (p = 0.042). Better maintenance of the collagen structure was obtained with Triton X-100, whereas the decellularization with Trypsin was responsible for the major structural changes in the scaffolds. After culture, the adhesion of mesenchymal cells was only observed in specimens deccelularized with Trypsin. Due to the potential for total removal of cells and the ability to allow adherence of these, the protocol based on the use of Trypsin (Group II) was considered the most suitable for use in future experiments involving bone grafting decellularized scaffolds

Prevalência de incontinência urinária e fatores associados em idosos institucionalizados

Urinary incontinence (UI) is a geriatric syndrome that is especially prevalent in institutionalized individuals, and that causes economic and social impacts derived from treatment costs and overload of caregiver. UI also entails physical consequences to the health of the elderly, such as urinary tract infections or pressure ulcers, among other health problems. However, the existing national research on this condition is still scarce and comprises serious methodological biases. Therefore, the objective of this study is to determine the prevalence of urinary incontinence and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted between October and December, 2013 and carried out in 10 nursing homes in the city of Natal (Northeast Brazil). UI was verified through the program Minimum Data Set version 3.0, which was also used to assess fecal incontinence, urinary devices and UI control programs. Data collection included sociodemographic information, UI characterization, as well as variables related to the institution itself and to health conditions (comorbidities, medication, pelvic floor surgery, Barthel Index for functional capacity and Pfeiffer test for cognitive status). Bivariate analysis was performed using the Chi-Square Test (or Fisher‟s Exact Test) and the Linear Chi-Square Test, calculating the prevalence ratio with 95% confidence interval. Variables with p value under 0.20 were included in the multivariate analysis, which was performed using the Stepwise Forward logistic regression. The inclusion of variables in the final model depended on the likelihood ratio test, absence of multicollinearity and on the Hosmer-Lemeshow test. A statistical significance level of 0.05 was considered. Six (1.8%) hospitalized elderly, one individual in palliative care (0.3%) and one (0.3%) individual under the age of 60 were excluded from the study. The final sample consisted of 321 elderly, mostly females, with a mean age of 81.5 years. The prevalence of UI was 59.43% and the final model revealed statistically a significant association between UI and white race, physical inactivity, stroke, mobility constraints and cognitive decline. The most frequent UI type was functional UI due to physical or cognitive disability, and incontinence control measures were applied only to a minority of residents (approximately 8%). It is concluded that UI is a health issue that affects more than half of the institutionalized elderly, and is associated with white race, physical inactivity, stroke and other geriatric syndromes such as immobility and cognitive disability. Most of these associated factors are modifiable and therefore the findings of this study highlight the importance of UI prevention and treatment in nursing homes, which include general measures, such as physical and psychosocial activities, and specific measures, such as prompted voiding

Prevalência e fatores associados ao risco e a desnutrição em idosos institucionalizados

One of the most important problems in the elderly is a nutritional deficiency. Several physiological changes and the use of multiple drugs interfere with appetite, food intake and absorption of nutrients, which can lead to the risk and malnutrition in the elderly, especially among institutionalized. The present study aimed to evaluate the prevalence of malnutrition and risk for malnutrition and its associated factors in institutionalized elderly. The same can be characterized by the type individual, observational and cross-sectional. Obtaining the sample was through the records of individuals of long-stay institutions for the elderly in the city of Natal, RN. The elderly were evaluated through the Mini Nutritional Assessment (MNA) and triceps skinfold (TSF) and each senior or caregiver answered a questionnaire about information like type and dietary restrictions, accessibility to food, use of alcohol and tobacco, practice physical activity and appetite. Variables such as age, gender, education, marital status, time that the elderly living in the institution, the reason for the institutionalization and comorbidities were taken from the records of each senior. The frequency of food consumption of various food groups was assessed from the questionnaire frequency of feeding study Health, Wellbeing and Aging (HWA). Data were presented as means and standard deviations, absolute and relative frequencies. To analyze the frequency of consumption, there was a factor analysis with extraction of factors from the principal components analysis with varimax rotation. A bivariate analysis was performed using the chi-square and the magnitude of the effect observed by prevalence ratio (95% CI). The Poisson regression assessed the net effect of independent variables on the two outcomes, considering a significance level of 5%. We studied twelve Homes for the Aged totaling 381 seniors eligible for the study. The prevalence of risk of malnutrition was 46.1% (45.9 to 46.2) and malnutrition was 31.4% (31.2 to 31.5). The risk of malnutrition was significantly associated with the presence of urinary incontinence (RP = 1.444, 1.113 to 1.874) was associated with malnutrition and lack of appetite (RP = 1.757, 1.246 to 2.476), the fact that the individuals do not have access to food outside the institution (RP = 0.565, 0.337 to 0.946), low water consumption (RP = 1.646, 1.101 to 2.459) and dementia (PR = 1.537, 1.072 to 2.204). The high prevalence of malnutrition and risk of malnutrition in the study suggests that we should pay attention to information related to eating habits and the presence of comorbidities, as these can influence the nutritional status of this population

As relações de gênero no trabalho: uma análise da inserção das mulheres e homens na rede de fast food

The purpose of this study was investigate the sexual division of the work in a chain of fast food, in Natal, RN. These aspects were analyzed with the ways of organization of the work, being made a case study. The main objective of this survey was to analyze the influence of gender relations in the insertion of men and women in the job market and to analyze the question of feminine submission in the professional world. These questions were analyzed considering the current period of the worldwide capitalism, from the characteristics of productive process and the growth of the service sectors. The research was made with a group of workers on the production sectors; attendance, management and human resources at restfood store, where six clerks were interviewed. Through our research, it is possible to perceive the permanence of the sexual division at the job in the interior of the productive processes at Restfood, that puts the woman in a subordinate position in relation to the man. This result can be confirmed if we considerate that the women, on this chain of food, occupy in first place the function of waitress and on this, trere s no functional progression, while her workmates (the men) for occupying other functions can progress inside the company. It was also evidenced that in a context of globalization of the capital, deregulation and disrespect of labor laws, the capital acts without any respect to workers. That was what we observed at the interviewer speech; the scarcity of the conditions of work and the constant disrespect of the labor laws. This way, we could evidence that the scarcity of work conditions hit men and women, but it has a crueler face with the women, and this one reproduces itself, day by day in the process of social reproduction, through family life, insertion in the world of the work, information and received social education. So, the capital explores all of them, but the gender relations create to the capital, the possibility of a different degree of exploration, becoming this way, the women main victims herself

A Relação formação profissional / Mercado de Trabalho: percepção dos assistentes sociais não-inseridos no mercado de trabalho do Serviço Social em Natal/RN

The study is about the non-insertion of the Social Assistant in the work market of Natal/RN, emphasizing the perception those Social Assistants have about this problem. We try to analyze the relation that those workers figure out about their non-insertion in the work market and their professional formation. The problem is related to the present unemployment rates in our society, which results of the changes that have affected the world of work as a whole in the wake of the Productive Restructuring and State Reformation supported by the neo-liberalism ideological system. We realize that these factors have deeply affected the configurations of the work market in general; especially those related to professions whose challenges multiply obstacles not only to the insertion of new workers, but to their staying in their job. We note that the reality of the work market has been built up on the decrease of the work force opportunities and the increase of the selectivity criteria to insertion of new workers. In consequence, unemployment rates increase everywhere, regardless of place, profession or education level of the workers. Work and management changes have brought about new challenges to professional formation. The presence of neo-liberalism productive and market logic demands a more adequate professional formation to work market from their candidates to a job. Due to the numberless difficulties workers face nowadays to enter the world of work, society itself and workers in general begin to question the profession of their choice, the kind of formation they have got, and frequently they lay the blame of their professional difficulties on it. This result has come out from the research we did with some social assistants not inserted in the professional work market in Natal/RN. The research reveals too that those unemployed professionals see their difficulties connected to their professional formation and they happen to say that the main challenge they face today is to get acknowledgment to the significance and importance of their profession

A política de assistência estudantil no contexto de expansão do ensino superior: as particularidades do Programa de Pós-Graduação em Serviço Social da UFRN

A dissertação versa sobre a Política de Assistência Estudantil e o processo de luta pela democratização do acesso à universidade, no contexto de expansão do ensino superior em tempos de crise estrutural do capital. Apresenta como unidade de análise as particularidades da pós-graduação em Serviço Social da UFRN e tem como objetivo principal apreender e analisar as condições de permanência disponibilizadas pela UFRN aos discentes de pós-graduação no contexto de expansão do Ensino Superior. O percurso teórico-metodológico de análise adotado na pesquisa se fundamentou numa perspectiva crítica do objeto de estudo a partir de uma concepção de totalidade, que pressupõe apreender as determinações socioeconômicas e políticas que incidem sobre a política de ensino superior e as condições de vida dos discentes do Programa de Pós-Graduação em Serviço Social (PPGSS). As análises fundamentaram-se em pesquisa bibliográfica como base teórico-metodológica da investigação, articulada com as reflexões que resultaram dos dados empíricos da pesquisa de campo na perspectiva de apreensão do objeto, em sua densidade histórica e num quadro de múltiplas determinações. Do ponto de vista metodológico foram entrevistados 26 discentes e realizada análise documental referentes a leis e documentos da política educacional em nível federal e dos organismos internacionais. A luta por ampliação do acesso à universidade está na agenda dos movimentos sociais no âmbito da educação, no entanto na conjuntura dos governos de Luis Inácio Lula da Silva (2003 a 2010) e Dilma Rousseff (2011 a 2012) a tendência tem sido seguir as orientações dos organismos internacionais e promover expansão de vagas sem assegurar estratégias de permanência compatíveis com as exigências de excelência acadêmica postas, por exemplo, na pós-graduação. Discentes entrevistados acessam o ensino superior e os cursos de pós-graduação e vivenciam dificuldades diárias para atender com qualidade às exigências acadêmicas em face de suas condições materiais de vida e de trabalho e dos limites da política de assistência estudantil que tem um perfil de programas e ações localizadas

A assistência estudantil e as cotas sociais nas universidades estaduais do nordeste: as faces do acesso ao direito

This paper discusses about the higher education in Brazilian society highlighting the struggle of the working class, as concerning the access to public universities, as well as highlights the contradictions implicit in social quotas adopted by Higher Education Institutions (HEIs) . The aim of this paper is on presenting the analysis of student assistance of the state universities in the Northeast that adopt quotas as social criteria of access for its students , presenting investigative locus as the following universities : UERN , UEPB , UPE and UNEAL . The paper presents the results of a qualitative study , based on a documentary analysis , based on dialectical and historical materialism in which she performed the reading of data from the following analytical categories: Higher Education, Social Quotas and Student Assistance. As main results, it is emphasized that the implementation of quotas as a means of access to higher education was not decisive for the form of planning and implementation of student assistance the university investigated; latent heterogeneity is that universities deal with actions to support student residence. And it is this heterogeneity and the variation in the conduct and understanding of student assistance , reflecting the lack of prioritization with the actions of the context of HEIs ; support programs are to stay focused on central campuses which are located the administrative offices of the universities, penalizing students enrolled in advanced units; also highlight that there is no link between the programs and projects related to student assistance with actions related to teaching, research and extension in universities investigated , which ultimately characterize the student assistance as an isolated action and punctual

O problema do caixeiro viajante alugador : um estudo algorítmico

The Car Rental Salesman Problem (CaRS) is a variant of the classical Traveling Salesman Problem which was not described in the literature where a tour of visits can be decomposed into contiguous paths that may be performed in different rental cars. The aim is to determine the Hamiltonian cycle that results in a final minimum cost, considering the cost of the route added to the cost of an expected penalty paid for each exchange of vehicles on the route. This penalty is due to the return of the car dropped to the base. This paper introduces the general problem and illustrates some examples, also featuring some of its associated variants. An overview of the complexity of this combinatorial problem is also outlined, to justify their classification in the NPhard class. A database of instances for the problem is presented, describing the methodology of its constitution. The presented problem is also the subject of a study based on experimental algorithmic implementation of six metaheuristic solutions, representing adaptations of the best of state-of-the-art heuristic programming. New neighborhoods, construction procedures, search operators, evolutionary agents, cooperation by multi-pheromone are created for this problem. Furtermore, computational experiments and comparative performance tests are conducted on a sample of 60 instances of the created database, aiming to offer a algorithm with an efficient solution for this problem. These results will illustrate the best performance reached by the transgenetic algorithm in all instances of the dataset

O símbolo esvaziado: a teoria do romance do jovem György Lukács

O presente artigo investiga como A teoria do romance (1916) de G. Lukács, um texto fragmentado e de ocasião, tornou-se um clássico da reflexão sobre a modernidade. Para Lukács, o romance é a forma artística que corresponde à fratura entre o sujeito e o mundo, vivida pelo homem contemporâneo. Utilizando o conceito de símbolo esvaziado este texto apreende em que medida o autor ao rever as classificações anteriores sobre o gênero romance, perpetua a tradição romântica ou rompe com ela, elaborando conceitos originais para a compreensão da modernidade na literatura.

Injeção inadvertida de metoclopramida no espaço subaracnóideo: relato de caso

JUSTIFICATIVA E OBJETIVOS: Injeção inadvertida de medicamentos de uso não espinhal nos espaços peridural e subaracnóideo é uma complicação anestésica passível de ocorrer. Este relato apresenta um caso de injeção inadvertida de metoclopramida no espaço subaracnóideo. RELATO do CASO: Paciente do sexo feminino, 17 anos, 69 kg, IMC de 26.2, estado físico ASA I, 36 semanas e 4 dias de gestação, com diagnóstico de sofrimento fetal agudo, e indicação de cesariana. Apresentava freqüência cardíaca de 82 bpm, pressão arterial de 130 x 70 mmHg, SpO2 de 97%, ritmo cardíaco sinusal regular. A anestesia foi por via subaracnóidea com a associação de anestésico local e opióide, 15 mg de bupivacaína hiperbárica a 0,5% e 25 µg de fentanil. Após 5 minutos da instalação do bloqueio, a paciente referiu mal estar inespecífico. Aferidas pressão arterial, 190 x 120 mmHg, freqüência cardíaca, 145 bpm, e SpO2, 95%. Verificando-se as ampolas cujos conteúdos foram administrados encontrou-se uma de bupivacaína e uma de metoclopramida. O quadro se apresentou com cefaléia frontal intensa, visão turva, náuseas, vômitos e agitação inicial, que evoluiu para sonolência e torpor, além de hipertensão arterial e taquicardia. Foram administrados tramadol, dipirona, ondansetron e medidas de suporte. Após 30 minutos, a paciente apresentava-se assintomática, com PA de 150 x 100 mmHg e FC de 120 bpm. Recebeu alta para a enfermaria 140 minutos após permanência na SRPA, com total reversão dos bloqueios motor, sensitivo e autonômico, e normalização dos parâmetros hemodinâmicos. Recebeu alta hospitalar 48 horas após, sem apresentar seqüelas neurológicas, juntamente com o recém-nascido. CONCLUSÕES: Máxima atenção deve ser dada a qualquer medicamento administrado, seja qual for à via utilizada. Padronização de cores de ampolas, e dos locais de depósito, com o intuito de diminuir este tipo de acidente é recomendável.

Eficácia analgésica da dexmedetomidina comparada ao sufentanil em cirurgias intraperitoneais: estudo comparativo

JUSTIFICATIVA E OBJETIVOS: A dexmedetomidina, agonista alfa2-adrenérgico com especificidade alfa1:alfa2 1:1620, não determina depressão respiratória, sendo utilizada no intra-operatório como sedativo e analgésico. Esse fármaco tem sido empregado com os opióides em anestesia de procedimentos com elevado estímulo doloroso, como os abdominais intraperitoneais, não havendo referências sobre seu uso como analgésico único. Comparou-se a dexmedetomidina ao sufentanil em procedimentos intraperitoneais, de pacientes com mais de 60 anos de idade. MÉTODO: Foram estudados 41 pacientes divididos aleatoriamente em dois grupos: GS (n = 21), que recebeu sufentanil, e GD (n = 20), dexmedetomidina, ambos na indução e manutenção da anestesia. Os pacientes receberam etomidato (GS e GD) com midazolam (GD) na indução, isoflurano e óxido nitroso na manutenção da anestesia. Foram avaliados os atributos hemodinâmicos (pressão arterial média e freqüência cardíaca), tempos de despertar e de extubação ao final da anestesia, locais onde os pacientes foram extubados - sala de operação (SO) ou sala de recuperação pós-anestésica (SRPA), tempo de permanência na SRPA, necessidade de analgesia suplementar e antiemético na SRPA, complicações apresentadas na SO e SRPA, índice de Aldrete-Kroulik na alta da SRPA e a necessidade de máscara de oxigênio na alta da SRPA. RESULTADOS: Não houve diferença quanto à estabilidade hemodinâmica e GD apresentou menor tempo de permanência na SRPA e menor necessidade de máscara de oxigênio na alta da SRPA. CONCLUSÕES: A dexmedetomidina pode ser utilizada como analgésico isolado em operações intraperitoneais em pacientes com mais de 60 anos, determinando estabilidade hemodinâmica semelhante à do sufentanil, com melhores características de recuperação.

Avaliação do atendimento anestésico da criança e do adolescente em um hospital universitário

JUSTIFICATIVA E OBJETIVOS: Qualidade em anestesia e na satisfação dos pacientes têm tido acentuado destaque. O objetivo foi avaliar o atendimento anestésico de crianças e adolescentes, entrevistando seus responsáveis. MÉTODO: Foram entrevistados 230 responsáveis por crianças e adolescentes submetidos à anestesia no período compreendido entre abril e dezembro de 2003. Realizou-se entrevista na visita pós-operatória através de questionário com quatro itens: identificação das crianças e de adolescentes e seus responsáveis (item 1); esclarecimentos na visita pré-anestésica (item 2), quanto à anestesia (item 3) e à recuperação pós-anestésica (SRPA) (item 4), determinando-se quem dera as informações aos entrevistados e se houvera complicação no pós-anestésico. O responsável atribuiu nota de 0 a 10 ao Serviço de Anestesiologia. RESULTADOS: A pesquisa foi respondida pela mãe em 189 (82,2%) casos. A maioria dos entrevistados, 114 (75,6%), tinha entre 20 e 39 anos, era casada (148 a 64,3%) e 140 (60,9%) não tinham ocupação. Para 89%, o anestesiologista se identificou; para 37% e 77,4%, esclareceu sobre importância e tempo do jejum; 82%, sobre anemia; 90%, alergia; 46,8%, importância da SRPA; 42,2%, tempo de permanência; 72,9%, estado de saúde de sua criança. Não houve apreensões para 49%, 58% e 58%, respectivamente, no pré, intra e pós-anestésico. Gostariam de ter estado com sua criança/adolescente na chegada à SRPA 78,9%. Foram relacionadas preocupações no período pré, intra e pós-anestésico com o sexo e a idade do paciente - não ter tido nenhuma preocupação - maioria dos entrevistados - e com a escolaridade do entrevistado - quanto mais completa, menor foi o número e a variedade das preocupações relatadas. As notas atribuídas ao Serviço de Anestesiologia tiveram maior freqüência entre 7 e 10 (97,4%). CONCLUSÕES: Considera-se que o Serviço de Anestesiologia desenvolve bom trabalho, apesar de falhas na comunicação, que são de solução simples e dependem mais da vontade do serviço que de seu conhecimento científico.

PUPSI :uma proposta de processo unificado para políticas de segurança da informação

The way to deal with information assets means nowadays the main factor not only for the success but also for keeping the companies in the global world. The number of information security incidents has grown for the last years. The establishment of information security policies that search to keep the security requirements of assets in the desired degrees is the major priority for the companies. This dissertation suggests a unified process for elaboration, maintenance and development of information security policies, the Processo Unificado para Políticas de Segurança da Informação - PUPSI. The elaboration of this proposal started with the construction of a structure of knowledge based on documents and official rules, published in the last two decades, about security policies and information security. It's a model based on the examined documents which defines the needed security policies to be established in the organization, its work flow and identifies the sequence of hierarchy among them. It's also made a model of the entities participating in the process. Being the problem treated by the model so complex, which involves all security policies that the company must have. PUPSI has an interative and developing approach. This approach was obtained from the instantiation of the RUP - Rational Unified Process model. RUP is a platform for software development object oriented, of Rational Software (IBM group). Which uses the best practice known by the market. PUPSI got from RUP a structure of process that offers functionality, diffusion capacity and comprehension, performance and agility for the process adjustment, offering yet capacity of adjustment to technological and structural charges of the market and the company

Anticoagulação oral em portadores de próteses valvares cardíacas mecânicas: experiência de dez anos

INTRODUÇÃO: Dados da literatura sugerem que as taxas de tromboembolismo e sangramento em pacientes com próteses valvares cardíacas mecânicas podem ser muito reduzidas se a terapia anticoagulante for otimizada. OBJETIVOS: Avaliar a ocorrência de complicações em portadores de próteses valvares cardíacas mecânicas submetidos à terapêutica anticoagulante, otimizada por meio de ambulatório especializado. MÉTODOS: Estudou-se a ocorrência de complicações ao longo de 10 anos em 261 pacientes com próteses valvares cardíacas mecânicas, anticoagulados e acompanhados em ambulatório especializado. Esses pacientes foram divididos em dois grupos conforme porcentual de consultas com tempo de protrombina (RNI) dentro do intervalo desejado: G1-0% a 50,00% e G2-50,01% a 100% das consultas. Foram avaliadas as ocorrências de complicações tromboembólicas e hemorrágicas na sua totalidade, ou subdivididas em maiores e menores, de acordo com a gravidade. Os resultados estão apresentados sob forma de estudo atuarial e de frequência linearizada de ocorrência de eventos. RESULTADOS: O estudo atuarial mostrou que, ao longo do tempo, no grupo G2 (com 50,01% a 100% das consultas com a RNI no intervalo desejado) maior número de pacientes esteve livre da ocorrência de qualquer tipo de evento, de eventos hemorrágicos menores ou da elevação exacerbada da RNI. As frequências linearizadas de ocorrência, em todos os tipos eventos, também foram menores nos pacientes do grupo G2. CONCLUSÕES: O tempo de permanência dentro do intervalo de anticoagulação desejado está diretamente relacionado com a ocorrência de complicações. Entretanto, mesmo com acompanhamento otimizado por meio de ambulatório especializado, apenas cerca de um terço dos pacientes apresentaram nível de anticoagulação adequado em mais da metade das consultas.