OBJECTIVE:To assess the role of insulin-like growth factor-1 and cholesterol as predictors of acute kidney injury mortality in intensive care unit patients.
DESIGN:Prospective cohort study.
...SETTING:Multidisciplinary adult intensive care unit (24 beds).
PATIENTS:Adult patients with acute kidney injury at intensive care unit admission for an 11-month period were considered and a total of 56 patients were admitted in the study.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:At intensive care unit admission serum insulin-like growth factor-1 (ng/mL), total cholesterol (mg/dL), albumin (g/dL), transferrin (mg/dL), total lymphocyte count, triceps skinfold thickness, arm muscle area, and Subjective Global Nutritional Assessment were evaluated. Insulin-like growth factor-1 was significantly lower in nonsurviving as compared with surviving patients (48.5 ± 24.4 vs. 70.8 ± 39.9; p = 0.044), as well as cholesterol (80.3 ± 35.7 vs. 147.4 ± 53.1; p < 0.001) and albumin (1.9 ± 0.4 vs. 2.4 ± 0.7; p = 0.018). Groups were similar regarding transferrin, lymphocyte, triceps skinfold thickness, arm muscle area, and subjective global nutritional assessment. A binary logistic regression model based on insulin-like growth factor-1 ≤ median (50.6 ng/mL), presence of sepsis, oliguria, and cholesterol ≤ median (96 mg/dL) identified insulin-like growth factor-1 (odds ratio = 7.73; 95% confidence interval 1.19–49.87; p = 0.032), sepsis (odds ratio = 7.28; 95% confidence interval 1.29–40.89; p = 0.024), oliguria (odds ratio = 8.7; 95% confidence interval 1.10–68.77; p = 0.040) and cholesterol (odds ratio = 10.94; 95% confidence interval 1.89–63.29; p = 0.008) as independent covariate for death.
CONCLUSIONS:Decreased levels of insulin-like growth factor-1 and cholesterol were clearly related to higher mortality. The close correlation of insulin-like growth factor-1 with nutritional status, its serum stability, and short-half life makes it a suitable candidate for an early and sensitive marker for intensive care unit acute kidney injury mortality.
In the cancer of the esophagus, with recent technologic advances, self-expanding metal stents (SEMS) are at the forefront of the armamentarium for re-establishing luminal patency. Weighed against the ...numerous advantages of stents are the import conditions and the cost. In light of this, we tested new low cost prostheses having the basic needs and characteristics to aim a significant benefit to poor people having advanced esophageal cancer, in a Brazilian regional public hospital.
This initial experience included fifteen patients (eleven men and four women, 55 ± 6.17 years old), presenting esophageal cancer, located at the medium third of the thoracic esophagus, extending for 5.5-8 cm long, not suitable for surgical procedure because they had been staged on fourth grade of the disease, two of them having fistula communicating esophagus to respiratory tree. The stents were placed under endoscopic and fluoroscopic guidance, after attempting an esophageal dilatation. An appropriate covered stent was then deployed, twelve of 10 cm and three of 13 cm in length. A chest X-ray was done 2 h after the procedure and a barium swallow was performed within 12 hours. Seven days and monthly until complete a six month follow-up after the procedure the patients were questioned about presence of pain, regurgitation, heartburn, cough, and their alimentary behavior.
There were no severe complications and transient mild chest pain resolved until the seventh day after the stent deployment. Chest X-ray demonstrated expansion of the stent in all patients. In 2 cases of fistula, a barium swallow showed its complete sealing. The completion of the proposed follow-up was not achieved in three cases, limited by the patient's death until the third month, due to cancer progression. Recurrent dysphagia to paste food accounted for by tumor overgrowth proximal or distal to the stent and stent migration were not observed in the series.
The new low cost endoprostheses is effective and forthcoming increased experience and prospective trials including questionnaires to analyze quality of life will allow for more informed decisions tailoring to a particular patient situation or to unexpected complications.
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Hypertensive crisis (HC) stands out as a form of acute elevation of blood pressure (BP). It can manifest itself as hypertensive emergency (HE) or hypertensive urgency (HU), which is usually ...accompanied with levels of diastolic BP ≥120 mmHg. Angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism may influence manifestations of HC. Thus, this study evaluated the influence of ACE I/D polymorphism in individuals with HC. A total of 187 patients admitted with HC (HU n=69 and HE n=118) and 75 normotensive individuals were included in the study. Peripheral blood was drawn for a biochemical and genetic analysis of the ACE I/D polymorphism by Polymerase Chain Reaction. HC group showed higher systolic BP, body mass index (BMI), glycemia, creatinine, and lower high-density lipoprotein (HDL) cholesterol compared with normotensive individuals. The use of renin-angiotensin system (RAS) blockers was more frequent in the HU group than in the HE group (p=0.020). The II genotype was more predominant in normotensive and HU individuals than among HE individuals (18.7%, 11.6%, and 2.5%, respectively; p=0.004). Higher BMI and glycemia were associated with HC in the logistic regression model. ACE II genotype (odds ratio OR 0.14; 95% confidence interval CI 0.04-0.51) and HDL cholesterol were protective for the development of HE. ACE II genotype was present in the HU group, compared with the HE group (OR 0.18; 95% CI 0.04-0.88). This study shows an association between the low prevalence of ACE I/D polymorphism II genotype and a greater occurrence of HE in Brazilian individuals. The lower blockage of RAS, which was detected in the HE group, may interact with the low frequency of II genotype, conferring an increased risk for HE.
OBJECTIVESHypertension is a highly prevalent disease worldwide, constituting one of the main risk factors for cardiovascular morbidity and mortality. The aims of this study were to evaluate the level ...of awareness and control of hypertension comparing sex, socioeconomic and educational level, BMI and drug therapy in over 40-year-old patients. The cost-effectiveness of the main pharmacologic classes of antihypertensives, as monotherapy and combination therapy, was also assessed.
METHODSIn this randomized and cross-sectional populational study, a sample of 738 hypertensive adults with ages at least 40 years were evaluated. Of these, 345 (46.7%) were men and 393 (53.3%) were women.
RESULTSA total of 72.9% of the hypertensives knew about their disease. Women in the 40–49 and 50–59 age groups and obese individuals had a higher rate of awareness of their hypertensive status. The rates of awareness were similar in different social classes and educational levels, however, blood pressure control varied. β-Blockers were the most effective drugs to control blood pressure with no differences being observed between monotherapy and combinations. Diuretics were the most cost-effective.
CONCLUSIONApproximately half of the participants received monotherapy. The best percentage of control with monotherapy was obtained with β-blockers but the diuretics treatment was the most cost-effective. The levels of awareness and control were high compared with developed countries, most evident in the higher social classes and higher education levels.
Background. It has been shown that azithromycin improves cyclosporine-induced gingival hyperplasia (GH), but its efficacy was never compared against an efficient oral hygiene program (OHP). The aim ...of this study was to analyze the effects of azithromycin plus OHP versus OHP alone in patients with cyclosporine-induced GH. Methods. After periodontal evaluation, 20 renal transplant recipients received detailed oral hygiene instructions and a complete OHP, and were randomized to control (OHP) or azithromycin groups (OHP plus azithromycin). Patients were re-evaluated after 15 and 30 days. Both groups were similar in time after transplant, age, gender, cyclosporine dose, and cyclosporine through level and serum creatinine. The control group had fewer patients using calcium cannel blockers (10% vs. 70%, p = 0.02). Results. All patients improved in pain, halitosis, and gum bleeding after OHP. The control group did not improve plaque index (PI) or GH. In contrast, baseline PI decreased from 1.52 ± 0.28 to 0.50 ± 0.16 on day 15 (p < 0.01) and to 0.46 ± 0.14 on day 30 (p < 0.01) in the azithromycin group, and the GH score decreased from 1.9 ± 0.27 to 0.90 ± 0.27 on day 15 (p < 0.05) and to 0.70 ± 0.21 on day 30 (p < 0.01). Conclusion. Azithromycin associated to efficient OHP induced a striking reduction in cyclosporine-induced GH, while efficient OHP alone improved oral symptoms but did not decrease cyclosporine-induced GH.
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Systemic arterial hypertension (SAH) is one of the greatest problems of public health in Brazil. Its detection and early treatment should be a priority to reduce the morbimortality of the ...cardiovascular diseases.
This study aimed at assessing the prevalence of SAH and the sociodemographic factors in a population of hypertensive individuals from São José do Rio Preto, São Paulo, Brazil.
A cross-sectional study was carried out in a stratified sample of 1,717 people, representative of the urban adult population from the city of São José do Rio Preto, between 2004 and 2005.
The sample consisted of 1,717 people, with 762 of them (25.2%) being characterized as hypertensive. The following results were observed: 54.6% were women; 78.4% were caucasian; 66.1% were illiterate or had not finished Elementary School; 63.9% were married, 40.9% belonged to social classes D and E; 37.9% were self-employed or wage earners.
The results of study on SAH in the city of São José do Rio Preto shows the need for early-onset continuous educational interventions.
In a double-blind, multicenter trial, 502 patients hospitalized with community-acquired pneumonia were randomized to receive therapy with either ertapenem or ceftriaxone (for each, 1 g given ...intravenously once daily). After a minimum of 3 days, therapy could be switched to oral amoxicillin-clavulanate. The median duration of intravenously administered therapy for the 383 clinically evaluable patients was 4 days for both treatment groups; 345 patients (90.1%) had their treatment switched to orally administered therapy. Of the clinically evaluable patients, 168 (92.3%) in the ertapenem group and 183 (91.0%) in the ceftriaxone group had a favorable clinical response. Streptococcus pneumoniae was the most commonly isolated pathogen, and high cure rates were observed both for penicillin-susceptible and -nonsusceptible infections in the ertapenem group (28 87.5% of 32 patients versus 17 100% of 17 patients, respectively). Both treatment regimens were generally well tolerated; the most common drug-related adverse events reported were diarrhea (2.9% versus 2.7%) and nausea (0.8% versus 2.0%) in the ertapenem and ceftriaxone groups, respectively. These results suggest that ertapenem and ceftriaxone therapy have similar efficacy and safety in hospitalized patients with community-acquired pneumonia.
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FUNDAMENTO: A hipertensão arterial sistêmica (HAS) constitui um dos maiores problemas de saúde pública no Brasil. Sua detecção e tratamento precoce devem ser prioridades para reduzir a morbidade e ...mortalidade das doenças cardiovasculares. OBJETIVO: Neste estudo objetivou-se estimar a prevalência de hipertensão arterial sistêmica na população e identificar os fatores sociodemográficos dos hipertensos de São José do Rio Preto - SP/Brasil. MÉTODOS: Em 2004/2005, realizou-se um estudo transversal, em amostra de 1.717 indivíduos estratificada por faixa etária, representativa da população adulta e urbana da cidade de São José do Rio Preto - SP/Brasil. RESULTADOS: A amostra foi constituída por 1.717 indivíduos, dos quais 762 (25,2%) eram hipertensos: 54,6% eram mulheres; 78,4%, brancos; 66,1%, analfabetos/Ensino Fundamental incompleto; 63,9%, casados; 40,9%, classes sociais D e E; 37,9%, inseridos no mercado de trabalho como profissionais liberais ou assalariados. CONCLUSÃO: Os resultados do estudo da HAS em São José do Rio Preto indicam a necessidade de intervenções educacionais contínuas de início precoce.
Depression and migraine Galego, José Carlos Busto; Cipullo, José Paulo; Cordeiro, José Antonio ...
Arquivos de Neuro-Psiquiatria,
09/2004, Volume:
62, Issue:
3B
Journal Article
Peer reviewed
Open access
The objective of this study was to evaluate both the presence and intensity of depressive symptoms in patients with episodic migraine (EM) and transformed migraine (TM) or chronic migraine, comparing ...them with a control group. Beck Depression Inventory (BDI) was used for this purpose. The median of BDI score of the control group was significantly lower than the EM and TM groups (p<0.0005). Either the EM or the TM did not show any significant difference in relation to the median of BDI scores (p=0.12). The TM group showed a higher frequency of severe depression when analyzed qualitatively by dependence analysis. Symptoms of severe depression by means of qualitative analysis may strengthen a co-morbidity between depression and transformed migraine. This association might be considered rather a factor of TM perpetuation than a risk factor for the transformation of EM into TM.
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