Qualidade de Vida de pacientes hipertensos e comparação entre dois instrumentos de medida de QVRS

FUNDAMENTO: Medir Qualidade de Vida (QV) relacionada à saúde auxilia na avaliação da eficiência de um tratamento e identifica problemas de maior impacto na QV do paciente. No entanto, essas medidas são mais seguras se avaliadas por instrumentos genéricos e específicos conjuntamente, fazendo-se necessário verificar se há compatibilidade entre esses e evitar repetições e contradições entre os domínios. OBJETIVO: Descrever o perfil de qualidade de vida de pacientes hipertensos e avaliar a compatibilidade de um instrumento específico (MINICHAL) e outro genérico (SF-36). MÉTODOS: Cem pacientes hipertensos adultos em tratamento ambulatorial entrevistados. A média da QVRS medida pelo MINICHAL foi de 6,64 (DP 6,04) no estado mental e média de 5,03 (DP 4,11) no estado manifestações somáticas. As médias para o instrumento SF-36 foram por ordem de classificação: limitação por aspectos físicos 47,3 (DP 42,9), vitalidade 57,4 (DP 19,7), limitação por aspectos emocionais 58 (DP 44,7), capacidade funcional 58,7 (DP 27,8), dor 60,4 (DP 26,3), estado geral de saúde 60,7 (DP 22,7), saúde mental 66,8 (DP 22,1) e aspectos sociais 78 (DP 26,1). RESULTADOS: O MINICHAL apresentou correlação significativa (p < 0,001) com o SF-36 em todos os domínios. CONCLUSÃO: O MINICHAL provou ser um instrumento útil na avaliação da QVRS em pacientes hipertensos. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0)

Horas de sono e índice de massa corporal em pré-escolares do sul do Brasil

A prevenção e o tratamento do excesso de peso são particularmente complexos, reforçando a importância de estudos que visem esclarecer sua rede de causas e efeitos. Assim, o objetivo desse estudo foi avaliar a relação entre horas de sono noturnas e medidas antropométricas. Realizou-se uma análise transversal realizada a partir de dados de 348 crianças de 3 e 4 anos da cidade de São Leopoldo/ RS. As horas de sono noturnas foram relatadas pelas mães e as medidas de índice de massa corporal, circunferência da cintura e dobras cutâneas foram medidas de acordo com protocolo padrão. As análises foram ajustadas para consumo energético e horas de televisão assistidas. As crianças com excesso de peso apresentaram, em média, 0,39 horas a menos de sono em relação àquelas com peso adequado (9,77 ± 1,44 versus 10,17 ± 1,34; IC95% 0,03-0,76). Observou-se associação inversa entre horas de sono noturnas e valores de escore z de índice de massa corporal para idade (B = -0,12 IC95% -0,22--0,02). A circunferência da cintura e as dobras cutâneas apresentaram relação inversa com as horas de sono, porém sem diferença estatística. Em pré-escolares do sul do Brasil, menos horas de sono noturnas foram associadas com maiores valores de índice de massa corporal.

Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study

Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart®) system. Results: A total of 767 participants (461 men) with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat) was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001). After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample.

Serum Potassium Levels Inversely Correlate with D-Dimer In Patients with Acute-Onset Atrial Fibrillation

Background: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. Objective: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). Methods: To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. Results: Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = −0.21; p < 0.001), even after adjustments for age and sex (beta coefficient −94.8; p = 0.001). The relative risk for a positive D-dimer value attributed to hypokalemia was 1.64 (95% CI, 1.02 to 2.63; p = 0.040). The correlation remained statistically significant in patients free from antihypertensive drugs (r = −0.25; p = 0.018), but not in those taking angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, or diuretics. Conclusions: The inverse correlation between values of potassium and D-dimer in patients with AAF provides important and complementary information about the thromboembolic risk of these patients.

Circulatory and Ventilatory Power: Characterization in Patients with Coronary Artery Disease

Background:Circulatory power (CP) and ventilatory power (VP) are indices that have been used for the clinical evaluation of patients with heart failure; however, no study has evaluated these indices in patients with coronary artery disease (CAD) without heart failure.Objective:To characterize both indices in patients with CAD compared with healthy controls.Methods:Eighty-seven men [CAD group = 42 subjects and healthy control group (CG) = 45 subjects] aged 40–65 years were included. Cardiopulmonary exercise testing was performed on a treadmill and the following parameters were measured: 1) peak oxygen consumption (VO2), 2) peak heart rate (HR), 3) peak blood pressure (BP), 4) peak rate-pressure product (peak systolic HR x peak BP), 5) peak oxygen pulse (peak VO2/peak HR), 6) oxygen uptake efficiency (OUES), 7) carbon dioxide production efficiency (minute ventilation/carbon dioxide production slope), 8) CP (peak VO2 x peak systolic BP) and 9) VP (peak systolic BP/carbon dioxide production efficiency).Results:The CAD group had significantly lower values for peak VO2 (p < 0.001), peak HR (p < 0.001), peak systolic BP (p < 0.001), peak rate-pressure product (p < 0.001), peak oxygen pulse (p = 0.008), OUES (p < 0.001), CP (p < 0.001), and VP (p < 0.001) and significantly higher values for peak diastolic BP (p = 0.004) and carbon dioxide production efficiency (p < 0.001) compared with CG. Stepwise regression analysis showed that CP was influenced by group (R2 = 0.44, p < 0.001) and VP was influenced by both group and number of vessels with stenosis after treatment (interaction effects: R2 = 0.46, p < 0.001).Conclusion:The indices CP and VP were lower in men with CAD than healthy controls.

Clinical Differences between Subtypes of Atrial Fibrillation and Flutter: Cross-Sectional Registry of 407 Patients

Introduction:Atrial fibrillation and atrial flutter account for one third of hospitalizations due to arrhythmias, determining great social and economic impacts. In Brazil, data on hospital care of these patients is scarce.Objective:To investigate the arrhythmia subtype of atrial fibrillation and flutter patients in the emergency setting and compare the clinical profile, thromboembolic risk and anticoagulants use.Methods:Cross-sectional retrospective study, with data collection from medical records of every patient treated for atrial fibrillation and flutter in the emergency department of Instituto de Cardiologia do Rio Grande do Sul during the first trimester of 2012.Results:We included 407 patients (356 had atrial fibrillation and 51 had flutter). Patients with paroxysmal atrial fibrillation were in average 5 years younger than those with persistent atrial fibrillation. Compared to paroxysmal atrial fibrillation patients, those with persistent atrial fibrillation and flutter had larger atrial diameter (48.6 ± 7.2 vs. 47.2 ± 6.2 vs. 42.3 ± 6.4; p < 0.01) and lower left ventricular ejection fraction (66.8 ± 11 vs. 53.9 ± 17 vs. 57.4 ± 16; p < 0.01). The prevalence of stroke and heart failure was higher in persistent atrial fibrillation and flutter patients. Those with paroxysmal atrial fibrillation and flutter had higher prevalence of CHADS2 score of zero when compared to those with persistent atrial fibrillation (27.8% vs. 18% vs. 4.9%; p < 0.01). The prevalence of anticoagulation in patients with CHA2DS2-Vasc ≤ 2 was 40%.Conclusions:The population in our registry was similar in its comorbidities and demographic profile to those of North American and European registries. Despite the high thromboembolic risk, the use of anticoagulants was low, revealing difficulties for incorporating guideline recommendations. Public health strategies should be adopted in order to improve these rates.

Statistische Identifikation des Einflusses soziodemografischer Faktoren auf den Therapieerfolg in der Psychiatrie am Beispiel der Fachkliniken Bernburg und Uchtspringe der SALUS gGmbH

Diese Bachelorarbeit ist am SALUS-Institut in Magdeburg im Bereich "Simulation psychiatrischer Versorgung" entstanden. Mit Hilfe der vorliegenden Daten von Patienten der psychiatrischen Fachkliniken in Bernburg und Uchtspringe, sollen Aussagen bezüglich des Zusammenwirkens von soziodemografischen Daten, wie beispielsweise Geschlecht, Alter, Wohnort oder Familienstand, und dem Behandlungserfolg der Therapie getroffen werden. Letzterer wird deutlich gemacht durch ein neuartiges Instrument der Patientenbefragung, das helfen soll die Ergebnisqualität zu beurteilen. Durch die Erkenntnis, welche verschiedenen Faktoren in welcher Form einen Einfluss auf den Therapieerfolg ausüben, soll ein besseres Verständnis über die Wechselwirkungen zwischen den bekannten Variablen erlangt werden. Diese Arbeit zeigt, dass im Mittel für die Patienten ein positiver Verlauf zu verzeichnen ist, dass Unterschiede im Krankheitsprofil für Männer und Frauen sowie Personen unterschiedlichen Alters existieren und stellt die Unterschiede zwischen den Fachkliniken, die sich u.a. durch bessere Abschlusswerte für den Standort Uchtspringe äußert, dar. Dadurch können in Zukunft bessere Aussagen getroffen werden, wie lange ein neu eingewiesener Patient vorraussichtlich im Krankenhaus verbringen sollte und welche Erfolgsaussichten er hat, wenn bestimmte soziodemografische Faktoren, sowie seine Diagnose und die Werte der ersten Testbefragung bekannt sind.

Ethische Implikationen des Ultraschallscreenings : Untersuchungsmethoden zur Feststellung von Chromosomenanomalien am Beispiel des Down-Syndroms

[s.c.]

Kinderwunsch und Familienplanung bei Klientinnen der Jugendhilfe

[s.c.]

Einfluss der chronischen Reduktion des endogenen Neutrophins BDNF auf kognitive Prozesse im APP/PS1 Alzheimer-Mausmodell

Magdeburg, Univ., Fak. für Naturwiss., Diss., 2015

Sexual dimorphism in Liolaemus occipitalis (Iguania, Tropiduridae)

The sexual dimorphism in size, morphology and color of the lizard Liolaemus occipitalis Boulenger, 1885 was studied. Thirty-two adult males and twenty-eight adult females were sampled from a population in the Jardim do Éden beach, near Tramandaí, Rio Grande do Sul, Brazil. Size related sexual dimorphism occurred in all compared body dimensions. The largest female was 59.6 mm in snout-vent length, and the largest male was 69.3 mm. Males and females also presented differences in ventral and dorsal color pattern, and in the presence of pre-cloacal pores. The results suggest that, in Liolaemus occipitalis, sexual dimorphism in size is determined by sexual selection, competition between males and by the high energetic cost for females a few months after hatching.

The influence of shell species and size on the shell selection pattern of Paguristes tortugae (Decapoda, Diogenidae) from Anchieta Island (Ubatuba, Brazil)

Shell selection by the hermit crab Paguristes tortugae Schmitt, 1933 from Anchieta Island (Brazil) was analyzed using the six most frequently occupied shell species in the field and taking into account the sexual condition of the individuals, the shell size and the shell species. The experiments were conducted under laboratory conditions and the shell species preference was estimated on the basis of the frequency that each species was chosen by the individuals. The preferred shell species and size were determined by regression analysis. The highest correlation coefficients were obtained for the relations between the hermit dimensions and shell dry weight. The ovigerous females preferred shells with larger internal volume: Leucozonia nassa (Gmelin, 1791) and Cerithium atratum (Born, 1778). In the experiment of shell size, males preferred heavier shells whereas females selected the shape characteristics of the shell, such as the aperture and the internal volume, which are probably related to the growth and offspring guarantee, respectively. In general, and independent of sex condition, P. tortugae showed significant selection among all shells utilized. The results suggest that shell selection by P. tortugae involves sexual and reproductive condition preferences.

Skull morphometrics of adult male Antartic fur seal, Arctocephalus gazella, and South American fur seal A. australis

The skull morphometrics of adult male Antarctic fur seal, Arctocephalus gazella (Peters, 1875) and South American fur seal, A. australis (Zimmermann, 1783) were investigated using a collection of 45 and 38 skulls, respectively. Eighteen measurements were taken for each specimen. Comparative univariate and multivariate statistical analyses included standard statistics, one-way analysis of variance, principal component analysis and discriminant analysis. Individual variation was relatively high for some variables, as expressed by the coefficient of variation. Skulls of A. gazella were larger than those of A. australis for all but two variables: squamosal jugal suture and rostral length. Both species differed significantly as shown by both univariate and multivariate analyses. The discriminant function correctly classified all specimens. The standardized canonical coefficients showed that the variables which most contribute to the differentiation between species were, in decreasing order, the rostral length, palatal length, palatal width at postcanine 5 and braincase width. The present study corroborates that A. gazella and A. australis are phenotipically distinct species.