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[SciELO Preprints] - Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy
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Marin-Neto, José Antonio
Rassi Jr., Anis
Moraes Oliveira, Gláucia M.
Lemos Correia, Luís Claudio
Novaes Ramos Jr., Alberto
Hasslocher-Moreno, Alejandro Marcel
Luquetti Ostermayer, Alejandro
Sousa, Andréa Silvestre de
Amato Vincenzo de Paola, Angelo
Sobral de Sousa, Antonio Carlos
Pinho Ribeiro, Antonio Luiz
Correia Filho, Dalmo
Moraes de Souza, Dilma do Socorro
Cunha-Neto, Edecio
J. A. Ramires, Felix
Bacal, Fernando
Pereira Nunes, Maria do Carmo
Martinelli Filho, Martino
Ibrahim Scanavacca, Maurício
Magalhães Saraiva, Roberto
Alves de Oliveira Júnior, Wilson
M. Lorga-Filho, Adalberto
de Jesus Benevides de Almeida Guimarães, Adriana
Lopes Latado Braga, Adriana
Sarmento de Oliveira, Adriana
V. L. Sarabanda, Alvaro
Yecê das Neves Pinto, Ana
Assis Lopes do Carmo, André
Schmidt, André
Costa, Andréa Rodrigues da
Ianni, Barbara Maria
Markman Filho, Brivaldo
Eduardo Rochitte, Carlos
Thé Macedo, Carolina
Mady, Charles
Chevillard, Christophe
Bittencourt das Virgens, Cláudio Marcelo
Nery de Castro, Cleudson
De Paoli de Carvalho Britto, Constança Felícia
Pisani, Cristiano
do Carmo Rassi, Daniela
C. Sobral Filho, Dario
Rodrigues Almeida, Dirceu
A. Bocchi, Edimar
T. Mesquita, Evandro
de Souza Nogueira Sardinha Mendes, Fernanda
Pereira, Francisca Tatiana
Sperandio da Silva, Gilberto Marcelo
de Lima Peixoto, Giselle
Glotz de Lima, Gustavo
H. Veloso, Henrique
Turin Moreira, Henrique
Bellotti Lopes, Hugo
Masciarelli Francisco Pinto, Ibraim
Pinto Dias, João Carlos
Bemfica, João Marcos
Silva-Nunes, João Paulo
Soares Barreto-Filho, José Augusto
Kerr Saraiva, José Francisco
Lannes-Vieira, Joseli
Menezes Oliveira, Joselina Luzia
V. Armaganijan, Luciana
Martins, Luiz Cláudio
C. Sangenis, Luiz Henrique
Barbosa, Marco Paulo
Almeida-Santos, Marcos Antônio
Simões, Marcos Vinicius
Shikanai-Yasuda, Maria Aparecida
Vieira Moreira, Maria da Consolação
Higuchi, Maria de Lourdes
Costa Monteiro, Maria Rita de Cássia
Felix Mediano, Mauro Felippe
Maia Lima, Mayara
T. Oliveira, Maykon
Moreira Dias Romano , Minna
Nitz, Nadjar
de Tarso Jorge Medeiros, Paulo
Vieira Alves, Renato
Alkmim Teixeira, Ricardo
Coury Pedrosa, Roberto
Aras, Roque
Morais Torres, Rosália
dos Santos Povoa, Rui Manoel
Rassi, Sérgio Gabriel
Salles Xavier, Sérgio
Marinho Martins Alves , Silvia
B. N. Tavares, Suelene
Lima Palmeira, Swamy
da Silva Junior, Telêmaco Luiz
da Rocha Rodrigues, Thiago
Madrini Junior, Vagner
Maia da Costa , Veruska
Dutra, Walderez
This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.nbsp;
Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.
nbsp;
Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.nbsp;
The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.nbsp;
The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.nbsp; nbsp;nbsp;
Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.
Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou.
A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica.
Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas.
A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica.
A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.nbsp;nbsp;nbsp;
Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.nbsp;
2.
Gas exchange in yellow passion fruit under irrigation water salinity and nitrogen fertilization
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Wanderley, José A. C.
; Azevedo, Carlos A. V. de
; Brito, Marcos E. B.
; Ferreira, Fagner N.
; Cordão, Mailson A.
; Lima, Robson F. de
.
Revista Brasileira de Engenharia Agrícola e Ambiental
- Journal Metrics
RESUMO Objetivou-se avaliar as trocas gasosas de mudas de maracujá Redondo Amarelo sob a ação mitigadora da adubação nitrogenada sobre a salinidade da agua de irrigação. O experimento foi conduzido em casa de vegetação da Universidade Federal de Campina Grande, Campus Pombal, PB. O delineamento experimental foi em blocos casualizados, parcelas subdivididas, compreendendo cinco condutividades elétricas da água de irrigação (parcela) (CEa) (0.3; 1.0; 1.7; 2.4 e 3.1 dS m-1) e cinco doses de nitrogênio (subparcela) (60; 80; 100; 120 e 140% de 300 mg de N dm-3), em cinco blocos. As plantas foram cultivadas em citropotes com volume de 3.780 mL, preenchidos com solo, esterco bovino curtido e maravalha na proporção de 2:1:0,5 (base massa), respectivamente. A aplicação dos níveis de salinidade ocorreu no período de 40 a 85 dias após a semeadura. Mensurou-se, aos 55 e 70 dias após a semeadura a concentração interna de CO2, transpiração, condutância estomática e fotossíntese. Verificou-se efeito atenuante das doses de nitrogênio para as águas de irrigação de 1.7 e 2.4 dS m-1 sobre a fotossíntese aos 55 dias. A salinidade da água de irrigação reduz a maioria das variáveis avaliadas, sobretudo no maior nível estudado (3.1 dS m-1).
ABSTRACT The objective of this study was to evaluate the gas exchange of ‘Redondo Amarelo’ passion fruit seedlings under the mitigating action of nitrogen fertilization on the salinity of irrigation water. The experiment was carried out in a greenhouse of the Universidade Federal de Campina Grande (CCTA-UFCG), Campus of Pombal, PB, Brazil, The experimental design was in randomized blocks, split plots, comprising five irrigation water electrical conductivities (plot) (ECw) (0.3; 1.0; 1.7; 2.4 and 3.1 dS m-1) and five doses of nitrogen (subplot) (60; 80; 100; 120 and 140% of 300 mg of N dm-3), in five blocks. Plants were grown in pots (Citropote JKS®) with volume of 3.780 mL, filled with soil, bovine manure, wood shavings in a proportion of 2:1:0.5 (mass basis), respectively. Water with salinity levels was applied in the period from 40 to 85 days after sowing. The internal CO2 concentration, transpiration, stomatal conductance and photosynthesis were measured at 55 and 70 days after sowing. There was an attenuating effect of nitrogen doses at irrigation water electrical conductivities of 1.7 and 2.4 dS m-1 on photosynthesis at 55 DAS. Irrigation water salinity reduces most of the variables evaluated, especially at the highest level studied (3.1 dS m-1).
3.
Estudios colaborativos multicéntricos en cirugía: ¿qué sucede en Latinoamérica?
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Boccalatte, Luis A.
; Modolo, María Marta
; Calvache, José A.
; Lincango-Naranjo, Eddy P.
; Ataíde-Gomes, Gustavo M.
; Lima-Buarque, Igor
; Pérez-Rivera, Carlos J.
; Shu-Yip, Sebastián B.
; Vásquez-Ojeda, Ximena P.
; Olivos, Maricarmen
; Batista, Sylvia
; Aguilera-Arévalo, María Lorena
; Gómez-Fernández, Hugo
; Arévalo, Danilo
; Nepogodiev, Dimitri
; Picciochi, Maria
; Simoes, Joana
.
Abstract Background: GlobalSurg is an international group of researchers whose purpose is to conduct and disseminate robust collaborative, international and multicenter studies. Objective: To expose the necessary strategies and the barriers crossed in conducting massive multicenter studies in surgery. Method: During the second semester of 2020, the study Surg-Week Prospective International Cohort Study was carried out. Surg-Week has been the largest international study in the field of surgery to date, with 141,582 patients included. A total of 4975 mini-teams, of between 1 and 5 members, collected data from 116 countries on all continents. Results: The creation of an official website for the study, reports with relevant information via email or groups via WhatsApp, formation of a Dissemination Committee of the protocol, delivery of webinars on recent team publications, appointment of leaders at the national and international level, and outreach through partnerships, were the strategies used for the development of the research. However, the barriers turned out to involve different aspects. Conclusions: Collaborative work allows establishing networks between different professionals with the goal of improving the quality of management, health policies and care of our patients in a timely manner of constant change.
Resumen Antecedentes: GlobalSurg es un grupo internacional de investigadores que tiene como propósito la conducción y la diseminación de robustos estudios colaborativos, internacionales y multicéntricos. Objetivo: Exponer las estrategias necesarias y las barreras encontradas en la conducción de estudios multicéntricos masivos en cirugía. Método: Durante el segundo semestre del año 2020 se llevó a cabo el estudio Surg-Week Prospective International Cohort Study, hasta la fecha el estudio internacional más grande en el campo de la cirugía, con 141,582 pacientes incluidos. Un total de 4975 miniequipos, de uno a cinco integrantes, recopilaron datos de 116 países de todos los continentes. Resultados: La creación de un sitio web oficial del estudio, reportes con información relevante vía e-mail o grupos vía WhatsApp, conformación de un comité de diseminación del protocolo, dictado de webinars sobre publicaciones recientes del equipo, designación de líderes nacionales e internacionales, y la divulgación por medio de sociedades, fueron las estrategias utilizadas para el desarrollo de la investigación. Sin embargo, las barreras detectadas para llevar a cabo el estudio multicéntrico fueron variadas. Conclusiones: Los trabajos colaborativos permiten establecer redes entre diferentes profesionales con el fin de mejorar la calidad de la gestión, las políticas sanitarias y la atención a los pacientes en tiempos de constante cambio.
https://doi.org/10.24875/ciru.21000282
16 downloads
4.
Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital
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Fink, Thais T.
; Marques, Heloisa H.S.
; Gualano, Bruno
; Lindoso, Livia
; Bain, Vera
; Astley, Camilla
; Martins, Fernanda
; Matheus, Denise
; Matsuo, Olivia M.
; Suguita, Priscila
; Trindade, Vitor
; Paula, Camila S.Y.
; Farhat, Sylvia C.L.
; Palmeira, Patricia
; Leal, Gabriela N.
; Suzuki, Lisa
; Odone Filho, Vicente
; Carneiro-Sampaio, Magda
; Duarte, Alberto José S.
; Antonangelo, Leila
; Batisttella, Linamara R.
; Polanczyk, Guilherme V.
; Pereira, Rosa Maria R.
; Carvalho, Carlos Roberto R.
; Buchpiguel, Carlos A.
; Latronico, Ana Claudia
; Seelaender, Marilia
; Silva, Clovis Artur
; Pereira, Maria Fernanda B.
; Sallum, Adriana M. E.
; Brentani, Alexandra V. M.
; Neto, Álvaro José S.
; Ihara, Amanda
; Santos, Andrea R.
; Canton, Ana Pinheiro M.
; Watanabe, Andreia
; Santos, Angélica C. dos
; Pastorino, Antonio C.
; Franco, Bernadette D. G. M.
; Caruzo, Bruna
; Ceneviva, Carina
; Martins, Carolina C. M. F.
; Prado, Danilo
; Abellan, Deipara M.
; Benatti, Fabiana B.
; Smaria, Fabiana
; Gonçalves, Fernanda T.
; Penteado, Fernando D.
; Castro, Gabriela S. F. de
; Gonçalves, Guilherme S.
; Roschel, Hamilton
; Disi, Ilana R.
; Marques, Isabela G.
; Castro, Inar A.
; Buscatti, Izabel M.
; Faiad, Jaline Z.
; Fiamoncini, Jarlei
; Rodrigues, Joaquim C.
; Carneiro, Jorge D. A.
; Paz, Jose A.
; Ferreira, Juliana C.
; Ferreira, Juliana C. O.
; Silva, Katia R.
; Bastos, Karina L. M.
; Kozu, Katia
; Cristofani, Lilian M.
; Souza, Lucas V. B.
; Campos, Lucia M. A.
; Silva Filho, Luiz Vicente R. F.
; Sapienza, Marcelo T.
; Lima, Marcos S.
; Garanito, Marlene P.
; Santos, Márcia F. A.
; Dorna, Mayra B.
; Aikawa, Nadia E.
; Litvinov, Nadia
; Sakita, Neusa K.
; Gaiolla, Paula V. V.
; Pasqualucci, Paula
; Toma, Ricardo K.
; Correa-Silva, Simone
; Sieczkowska, Sofia M.
; Imamura, Marta
; Forsait, Silvana
; Santos, Vera A.
; Zheng, Yingying
.
OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.
5.
Recomendações para o Manejo de Dispositivos Cardíacos Eletrônicos Implantáveis Post Mortem
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Oliveira, Júlio César de
; Fagundes, Alexsandro Alves
; Alkmim-Teixeira, Ricardo
; Baggio Junior, José Mário
; Armaganijan, Luciana
; d’Avila, Andre
; Saad, Eduardo B.
; Andrade, Veridiana Silva de
; Moraes, Luis Gustavo Belo de
; Kuniyoshi, Ricardo
; Rezende, André Gustavo da Silva
; Pimentel, Mauricio
; Rodrigues, Thiago da Rocha
; Brito Junior, Helio Lima de
; Nadalin, Elenir
; Pisani, Cristiano Faria
; Arfelli, Elerson
; Cintra, Fatima Dumas
; Kalil, Carlos Antonio Abunader
; Melo, Sissy Lara de
; Cannavan, Priscila Moreno Sperling
.
Resumo O manejo de dispositivos cardíacos eletrônicos implantáveis de pacientes que evoluem a óbito tem sido motivo de controvérsia. Em nosso meio, não há recomendações uniformes, estando baseadas exclusivamente em protocolos institucionais e em costumes regionais. Quando o cadáver é submetido para cremação, além de outros cuidados, recomenda-se a retirada do dispositivo devido ao risco de explosão e dano do equipamento crematório. Principalmente no contexto da pandemia causada pelo SARS-Cov-2, a orientação e organização de unidades hospitalares e serviços funerários é imprescindível para minimizar o fluxo de pessoas em contato com fluidos corporais de indivíduos falecidos por COVID-19. Nesse sentido, a Sociedade Brasileira de Arritmias Cardíacas elaborou este documento com orientações práticas, tendo como base publicações internacionais e recomendação emitida pelo Conselho Federal de Medicina do Brasil.
Abstract The management of cardiac implantable electronic devices after death has become a source of controversy. There are no uniform recommendations for such management in Brazil; practices rely exclusively on institutional protocols and regional custom. When the cadaver is sent for cremation, it is recommended to remove the device due to the risk of explosion and damage to crematorium equipment, in addition to other precautions. Especially in the context of the SARS-CoV-2 pandemic, proper guidance and organization of hospital mortuary facilities and funeral services is essential to minimize the flow of people in contact with bodily fluids from individuals who have died with COVID-19. In this context, the Brazilian Society of Cardiac Arrhythmias has prepared this document with practical guidelines, based on international publications and a recommendation issued by the Brazilian Federal Medical Council.
https://doi.org/10.36660/abc.20200447
447 downloads
6.
Brazilian consensus in enuresis–recomendations for clinical practice
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Netto, José Murillo B.
; Rondon, Atila Victal
; Lima, George Rafael Martins de
; Zerati Filho, Miguel
; Schneider-Monteiro, Edison Daniel
; Molina, Carlos Augusto F
; Calado, Adriano de Almeida
; Barroso Jr., Ubirajara
.
ABSTRACT Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.
https://doi.org/10.1590/s1677-5538.ibju.2019.0080
1483 downloads
7.
Comment on the study Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the Bypass Registry that was presented at the 46th Congress of the Brazilian Society of Cardiovascular Surgery, Nova Lima, BH, Brazil, April 5 and 6, 2019
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Dallan, Luís Alberto O.
; Paez, Rodrigo Pereira
; Hossne Junior, Nelson Américo
; Santo, José Amalth do Espírito
; Berwanger, Otavio
; Santos, Renato Hideo Nakagawa
; Kalil, Renato Abdala Karam
; Jatene, Fabio B.
; Cavalcanti, Alexandre Biasi
; Zilli, Alexandre Cabral
; Bettiati Jr, Luiz Carlos
; Figueira, Fernando Augusto Marinho dos Santos
; D’Azevedo, Stephanie Steremberg Pires
; Soares, Marcelo José Ferreira
; Fernandes, Marcio Pimentel
; Ardito, Roberto Vito
; Bogdan, Renata Andrea Barberio
; Campagnucci, Valquíria Pelisser
; Nakasako, Diana
; Rodrigues, Clarissa Garcia
; Rodrigues Junior, Anilton Bezerra
; Cascudo, Marcelo Matos
; Atik, Fernando Antibas
; Lima, Elson Borges
; Nina, Vinicius José da Silva
; Heluy, Renato Albuquerque
; Azeredo, Lisandro Gonçalves
; Henrique Junior, Odilon Silva
; Mendonça, José Teles de
; Silva, Katharina Kelly de Oliveira Gama
; Pandolfo, Marcelo
; Lima Júnior, José Dantas de
; Faria, Renato Max
; Santos, Jonas Gonçalves dos
; Coelho, Guilherme Henrique Biachi
; Pereira, Sergio Nunes
; Senger, Roberta
; Buffolo, Enio
; Caputi, Guido Marco
; Oliveira, Juliana Aparecida Borges de
; Gomes, Walter J.
.
Brazilian Journal of Cardiovascular Surgery
- Journal Metrics
https://doi.org/10.21470/1678-9741-2019-0606
335 downloads
8.
Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry
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Paez, Rodrigo Pereira
; Hossne Junior, Nelson Américo
; Santo, José Amalth do Espírito
; Berwanger, Otavio
; Santos, Renato Hideo Nakagawa
; Kalil, Renato Abdala Karam
; Jatene, Fabio B.
; Cavalcanti, Alexandre Biasi
; Zilli, Alexandre Cabral
; Bettiati Jr, Luiz Carlos
; Figueira, Fernando Augusto Marinho dos Santos
; D'Azevedo, Stephanie Steremberg Pires
; Soares, Marcelo José Ferreira
; Fernandes, Marcio Pimentel
; Ardito, Roberto Vito
; Bogdan, Renata Andrea Barberio
; Campagnucci, Valquíria Pelisser
; Nakasako, Diana
; Rodrigues, Clarissa Garcia
; Rodrigues Junior, Anilton Bezerra
; Cascudo, Marcelo Matos
; Atik, Fernando Antibas
; Lima, Elson Borges
; Nina, Vinicius José da Silva
; Heluy, Renato Albuquerque
; Azeredo, Lisandro Gonçalves
; Henrique Junior, Odilon Silva
; Mendonça, José Teles de
; Silva, Katharina Kelly de Oliveira Gama
; Pandolfo, Marcelo
; Lima Júnior, José Dantas de
; Faria, Renato Max
; Santos, Jonas Gonçalves dos
; Coelho, Guilherme Henrique Biachi
; Pereira, Sergio Nunes
; Senger, Roberta
; Buffolo, Enio
; Caputi, Guido Marco
; Oliveira, Juliana Aparecida Borges de
; Gomes, Walter J.
.
Brazilian Journal of Cardiovascular Surgery
- Journal Metrics
Abstract Introduction: Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. Objective: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods: A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results: Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. Conclusion: CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.
https://doi.org/10.21470/1678-9741-2018-0313
1270 downloads
9.
Association between deep-water scale-worms (Annelida: Polynoidae) and black corals (Cnidaria: Antipatharia) in the Southwestern Atlantic
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De Assis, José Eriberto
; Souza, José Roberto B. de
; Lima, Manuela M. de
; Lima, Gislaine V. de
; Cordeiro, Ralf T.S.
; Pérez, Carlos D.
.
ABSTRACT Polynoid scale-worms have been found living as commensals with deep-water antipatharians (commonly known as black corals) in the Potiguar Basin, off Rio Grande do Norte State, Northeastern Brazil. In this paper two polychaete species and four black corals species are redescribed. Benhamipolynoe cf. antipathicola and Parahololepidella cf. greeffi, and the black coral Stylopathes adinocrada Opresko, 2006 are recorded for the Southwestern Atlantic. Benhamipolynoe cf. antipathicola was first described from off New Zealand and the Malay Archipelago, as symbiont with the black coral Stylopathes tenuispina (Silberfeld, 1909). It was later reported for the North Atlantic, off Florida, associated with Stylopathes columnaris (Duchassaing, 1870). In our study, B. cf. antipathicola was found in association with the black coral S. adinocrada. Parahololepidella cf. greeffi was first described as a free-living from shallow waters off São Tomé and Cabo Verde Islands, West Africa, and later reported as symbiont with the black coral Tanacetipathes cf. spinescens in the same location. Our data expand both the geographical distribution and the host range of this species which is reported for the first time as symbiont with Tanacetipathes barbadensis (Brook, 1889), T. tanacetum (Pourtalès, 1880) and T. thamnea (Warner, 1981) in Brazil. The aim of this study is to discuss commensal associations between two species of scale-worm polynoids and black corals found in the Southwestern Atlantic, and also reporting their global distribution. Finally, we provided an updated list of the commensal polynoids and their black coral hosts.
https://doi.org/10.3897/zoologia.36.e28714
1072 downloads
10.
Nitrogen fertilization to attenuate the damages caused by salinity on yellow passion fruit seedlings
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Wanderley, José A. C.
; Azevedo, Carlos A. V. de
; Brito, Marcos E. B.
; Cordão, Mailson A.
; Lima, Robson F. de
; Ferreira, Fagner N.
.
Revista Brasileira de Engenharia Agrícola e Ambiental
- Journal Metrics
RESUMO Objetivou-se avaliar o efeito atenuante do nitrogênio nos danos causados pela salinidade da água de irrigação na produção de mudas de maracujazeiro amarelo. Utilizou-se o delineamento de blocos casualizados, com tratamentos formados a partir de parcelas subdivididas, compreendendo cinco níveis de salinidade da água de irrigação (parcela) (0,3; 1,0; 1,7; 2,4 e 3,1 dS m-1) e cinco doses de adubação nitrogenada (subparcela) (180; 240; 300; 360 e 420 mg dm-3), com cinco repetições, perfazendo 125 unidades experimentais, com uma planta útil cada. As mudas foram formadas em tubetes de 3,780 mL, constituídos em lisímetros de drenagem, que recebiam uma lâmina de irrigação diária com base no balanço de água. Aos 85 dias após a semeadura, avaliaram-se os seguintes parâmetros de crescimento: diâmetro caulinar, altura de planta, número de folhas, taxa de crescimento relativo e os teores de pigmentos clorofila a, clorofila b, clorofila total e carotenoides. O incremento da salinidade da água de irrigação reduziu o diâmetro caulinar, altura de planta, número de folhas, clorofila a, clorofila b e clorofila total; as doses crescentes de nitrogênio também promoveram declínio linear no diâmetro caulinar e na altura de planta. A aplicação de doses crescentes de N não atenuou o efeito da salinidade sobre o crescimento e os teores de pigmentos.
ABSTRACT The study aimed to evaluate the mitigating effect of nitrogen (N) on the damages caused by irrigation water salinity, in the production of yellow passion fruit seedlings. A randomized block design in split plots was used, with five levels of irrigation water salinity (plot) (0.3, 1.0, 1.7, 2.4 and 3.1 dS m-1) and five doses of N fertilization (sub-plot) (180, 240, 300, 360 and 420 mg of N dm-3), with five replicates, totaling 125 experimental units, with one plant per plot. The seedlings were produced in 3.780 mL tubes, used as drainage lysimeter, which received a daily irrigation depth based on water balance. Growth and contents of chlorophyll and carotenoids were evaluated at 85 days after sowing. The increase in irrigation water salinity reduced stem diameter, plant height, number of leaves, chlorophyll a, chlorophyll b and total chlorophyll; increasing N doses also led to linear decline in stem diameter and plant height. Application of increasing doses of N did not attenuate the effect of salinity on growth and pigment contents.
https://doi.org/10.1590/1807-1929/agriambi.v22n8p541-546
1036 downloads
11.
Match internal load in youth elite soccer players is period, playing position and intermittent running capacity dependent
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Silva, Cristiano D. da
; Natali, Antônio José
; Carling, Christopher
; Lima, Jorge R. Perrout de
; Bara Filho, Mauricio G.
; Garcia, Emerson S.
; Marins, João Carlos B.
.
Abstract Aims: The aims of this study were: i) to verify whether player internal load (PIL) monitored via heart rate (HR) varies with game-time and playing position; ii) whether intermittent running capacity (IRC) is related to the maintenance of within-match PIL in elite youth (U-15) soccer players. Method: Twenty-one elite soccer players (14±0.5 yrs, 172±7 cm, 63±6 kg) had their heart rate monitored (beats/min) in five matches and were tested twice for IRC (Yo-YoIR2, distance [m]) over a seven-week competitive season. Percentage of maximal heart rate (%HRmax) and time spent (TS%) in five zones (Z1[<70%]; Z2[71-85%]; Z3[86-90%]; Z4[91-95%] and Z5[>96%]) were our PIL indexes. Data from three complete games in the same position of each player were analyzed and matches halves, time intervals (T1 to T6), and playing positions (fullbacks, central defenders and forwards [N=5 each], midfielders [N=6]) were compared, and the relationship between IRC and within-match PIL was determined. Results: PIL was higher in 1st (86±3%) than in the 2nd half (84±4%; p<.001). The 2nd half had more TS% in Z1 and Z2 (p<.05). PIL in T4 was the lowest (p<.01), and in T6, it was lower than T1 and T2 (p<.01). Fullbacks and midfielders showed higher PIL and higher TS% in Z4 (p<.05) than the other positional roles. The average IRC correlated with PIL in T6 (r=.56, p<.01) only. Conclusion: In conclusion, the internal load in elite youth (U-15) soccer players varies with game-time and playing position; and their IRC is related to the maintenance of within-match PIL.
https://doi.org/10.1590/s1980-6574201800040005
931 downloads
12.
The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients
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Gomes, Walter J.
; Moreira, Rita Simone
; Zilli, Alexandre Cabral
; Bettiati Jr, Luiz Carlos
; Figueira, Fernando Augusto Marinho dos Santos
; D' Azevedo, Stephanie Steremberg Pires
; Soares, Marcelo José Ferreira
; Fernandes, Marcio Pimentel
; Ardito, Roberto Vito
; Bogdan, Renata Andrea Barberio
; Campagnucci, Valquíria Pelisser
; Nakasako, Diana
; Kalil, Renato Abdala Karam
; Rodrigues, Clarissa Garcia
; Rodrigues Junior, Anilton Bezerra
; Cascudo, Marcelo Matos
; Atik, Fernando Antibas
; Lima, Elson Borges
; Nina, Vinicius José da Silva
; Heluy, Renato Albuquerque
; Azeredo, Lisandro Gonçalves
; Henrique Junior, Odilon Silva
; Mendonça, José Teles de
; Silva, Katharina Kelly de Oliveira Gama
; Pandolfo, Marcelo
; Lima Júnior, José Dantas de
; Faria, Renato Max
; Santos, Jonas Gonçalves dos
; Paez, Rodrigo Pereira
; Coelho, Guilherme Henrique Biachi
; Pereira, Sergio Nunes
; Senger, Roberta
; Buffolo, Enio
; Caputi, Guido Marco
; Santo, José Amalth do Espírito
; Oliveira, Juliana Aparecida Borges de
; Berwanger, Otavio
; Cavalcanti, Alexandre Biasi
; Jatene, Fabio B.
.
Abstract Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.
https://doi.org/10.21470/1678-9741-2017-0053
1883 downloads
13.
Qualidade de vida nas espondiloartrites: análise de uma grande coorte brasileira
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Ribeiro, Sandra L.E.
; Albuquerque, Elisa N.
; Bortoluzzo, Adriana B.
; Gonçalves, Célio R.
; Silva, José Antonio Braga da
; Ximenes, Antonio Carlos
; Bértolo, Manoel B.
; Keiserman, Mauro
; Menin, Rita
; Skare, Thelma L.
; Carneiro, Sueli
; Azevedo, Valderílio F.
; Vieira, Walber P.
; Bianchi, Washington A.
; Bonfiglioli, Rubens
; Campanholo, Cristiano
; Carvalho, Hellen M.S.
; Costa, Izaias P.
; Duarte, Angela L.B. Pinto
; Kohem, Charles L.
; Leite, Nocy H.
; Lima, Sonia A.L.
; Meirelles, Eduardo S.
; Pereira, Ivânio A.
; Pinheiro, Marcelo M.
; Polito, Elizandra
; Resende, Gustavo G.
; Rocha, Francisco Airton C.
; Santiago, Mittermayer B.
; Sauma, Maria de Fátima L.C.
; Valim, Valéria
; Sampaio-Barros, Percival D.
.
Resumo Objetivo: Analisar as variáveis demográficas e clínicas associadas à diminuição da qualidade de vida em uma grande coorte brasileira de pacientes com espondiloartrite (EpA). Métodos: Foi aplicado um protocolo de pesquisa único a 1.465 pacientes brasileiros classificados como tendo EpA de acordo com os critérios do European Spondyloarthropaties Study Group (ESSG), atendidos em 29 centros de referência em reumatologia do Brasil. Foram registradas as variáveis clínicas e demográficas. A qualidade de vida foi analisada por meio do questionário Ankylosing Spondylitis Quality of Life (ASQoL). Resultados: A pontuação média do ASQoL foi de 7,74 (+ 5,39). Ao analisar doenças específicas no grupo de EpA, as pontuações do ASQoL não apresentaram diferença estatisticamente significativa. Os dados demográficos mostraram piores escores de ASQoL associados ao gênero feminino (p = 0,014) e etnia negra (p < 0,001). Quanto aos sintomas clínicos, a dor na região glútea (p = 0,032), a dor cervical (p < 0,001) e a dor no quadril (p = 0,001), estiveram estatisticamente associadas a piores escores no ASQoL. O uso contínuo de fármacos anti-inflamatórios não esteroides (p < 0,001) e agentes biológicos (p = 0,044) esteve associado a escores mais elevados de ASQoL, enquanto outros medicamentos não interferiram nos escores do ASQoL. Conclusão: Nesta grande série de pacientes com EpA, o sexo feminino e a etnia negra, bem como sintomas predominantemente axiais, estiveram associados a uma qualidade de vida reduzida.
Abstract Objective: To analyze quality of life and demographic and clinical variables associated to its impairment in a large Brazilian cohort of patients with spondyloarthritis (SpA). Methods: A common protocol of investigation was applied to 1465 Brazilian patients classified as SpA according to the European Spondyloarthropaties Study Group (ESSG) criteria, attended at 29 reference centers for Rheumatology in Brazil. Clinical and demographic variables were recorded. Quality of life was analyzed through the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. Results: The mean ASQoL score was 7.74 (± 5.39). When analyzing the specific diseases in the SpA group, the ASQoL scores did not present statistical significance. Demographic data showed worse scores of ASQoL associated with female gender (p = 0.014) and African-Brazilian ethnicity (p < 0.001). Regarding clinical symptoms, buttock pain (p = 0.032), cervical pain (p < 0.001) and hip pain (p = 0.001), were statistically associated with worse scores of ASQoL. Continuous use of nonsteroidal anti-inflammatory drugs (p < 0.001) and biologic agents (p = 0.044) were associated with higher scores of ASQoL, while the other medications did not interfere with the ASQoL scores. Conclusion: In this large series of patients with SpA, female gender and African-Brazilian ethnicity, as well as predominant axial symptoms, were associated with impaired quality of life.
https://doi.org/10.1016/j.rbr.2015.03.003
3358 downloads
14.
ERICA: prevalences of hypertension and obesity in Brazilian adolescents
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Bloch, Katia Vergetti
; Klein, Carlos Henrique
; Szklo, Moyses
; Kuschnir, Maria Cristina C
; Abreu, Gabriela de Azevedo
; Barufaldi, Laura Augusta
; Veiga, Gloria Valeria da
; Schaan, Beatriz
; Silva, Thiago Luiz Nogueira da
; Moraes, Ana Julia Pantoja
; Oliveira, Ana Mayra Andrade de
; Tavares, Bruno Mendes
; Magliano, Erika da Silva
; Oliveira, Cecília Lacroix de
; Cunha, Cristiane de Freitas
; Giannini, Denise Tavares
; Belfort, Dilson Rodrigues
; Santos, Eduardo Lima
; Leon, Elisa Brosina de
; Oliveira, Elizabete Regina Araújo
; Fujimori, Elizabeth
; Borges, Ana Luíza
; Vasconcelos, Francisco de Assis Guedes
; Azevedo, George Dantas
; Brunken, Gisela Soares
; Guimarães, Isabel Cristina Britto
; Faria Neto, José Rocha
; Oliveira, Juliana Souza
; Carvalho, Kenia Mara B. de
; Gonçalves, Luis Gonzaga de Oliveira
; Monteiro, Maria Inês
; Santos, Marize M.
; Jardim, Paulo César B. Veiga
; Ferreira, Pedro Antônio Muniz
; Montenegro Jr., Renan Magalhães
; Gurgel, Ricardo Queiroz
; Vianna, Rodrigo Pinheiro
; Vasconcelos, Sandra Mary
; Goldberg, Tamara Beres Lederer
.
RESUMO OBJETIVO Estimar as prevalências de hipertensão arterial e obesidade e a fração atribuível populacional de hipertensão arterial devida à obesidade em adolescentes brasileiros. MÉTODOS Foram avaliados dados dos participantes do Estudo de Riscos Cardiovasculares em Adolescentes, estudo seccional l nacional de base escolar. A amostra foi dividida em 32 estratos geográficos e conglomerados de escolas e turmas, com representatividade nacional, macrorregional e de capitais. Obesidade foi classificada pelo índice de massa corporal segundo idade e sexo. Considerou-se hipertensão arterial a média da pressão arterial sistólica ou diastólica maior ou igual ao percentil 95 da curva de referência. Foram estimadas prevalências e intervalos de confiança de 95% (IC95%) de hipertensão arterial e de obesidade, nacionais e nas macrorregiões do País, por sexo e grupo etário, assim como as frações de hipertensão atribuíveis à obesidade na população. RESULTADOS Foram avaliados 73.399 estudantes, 55,4% do sexo feminino, com média de idade 14,7 anos (DP = 1,6). A prevalência de hipertensão arterial foi 9,6% (IC95% 9,0-10,3); sendo as mais baixas observadas nas regiões Norte, 8,4% (IC95% 7,7-9,2) e Nordeste, 8,4% (IC95% 7,6-9,2) e a mais alta na região Sul, 12,5% (IC95% 11,0-14,2). A prevalência de obesidade foi 8,4% (IC95% 7,9-8,9), mais baixa na região Norte e mais alta na Sul. As prevalências de hipertensão arterial e obesidade foram maiores no sexo masculino. Adolescentes com obesidade tiveram prevalência de hipertensão arterial mais elevada, 28,4% (IC95% 25,5-31,2), do que aqueles com sobrepeso, 15,4% (IC95% 13,8-17,0), ou eutróficos, 6,3% (IC95% 5,6-7,0). A fração de hipertensão arterial atribuível à obesidade foi de 17,8%. CONCLUSÕES O ERICA foi o primeiro estudo brasileiro com representatividade nacional a estimar a prevalência de hipertensão arterial aferida em adolescentes. A fração da prevalência de hipertensão arterial atribuível à obesidade mostrou que cerca de 1/5 dos hipertensos poderiam não ser hipertensos se não fossem obesos.
ABSTRACT OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.
https://doi.org/10.1590/s01518-8787.2016050006685
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15.
ERICA: prevalences of hypertension and obesity in Brazilian adolescents
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Bloch, Katia Vergetti
; Klein, Carlos Henrique
; Szklo, Moyses
; Kuschnir, Maria Cristina C
; Abreu, Gabriela de Azevedo
; Barufaldi, Laura Augusta
; Veiga, Gloria Valeria da
; Schaan, Beatriz
; Silva, Thiago Luiz Nogueira da
; Moraes, Ana Julia Pantoja
; Oliveira, Ana Mayra Andrade de
; Tavares, Bruno Mendes
; Magliano, Erika da Silva
; Oliveira, Cecília Lacroix de
; Cunha, Cristiane de Freitas
; Giannini, Denise Tavares
; Belfort, Dilson Rodrigues
; Santos, Eduardo Lima
; Leon, Elisa Brosina de
; Oliveira, Elizabete Regina Araújo
; Fujimori, Elizabeth
; Borges, Ana Luíza
; Vasconcelos, Francisco de Assis Guedes
; Azevedo, George Dantas
; Brunken, Gisela Soares
; Guimarães, Isabel Cristina Britto
; Faria Neto, José Rocha
; Oliveira, Juliana Souza
; Carvalho, Kenia Mara B. de
; Gonçalves, Luis Gonzaga de Oliveira
; Monteiro, Maria Inês
; Santos, Marize M.
; Jardim, Paulo César B. Veiga
; Ferreira, Pedro Antônio Muniz
; Montenegro Jr., Renan Magalhães
; Gurgel, Ricardo Queiroz
; Vianna, Rodrigo Pinheiro
; Vasconcelos, Sandra Mary
; Goldberg, Tamara Beres Lederer
.
RESUMO OBJETIVO Estimar as prevalências de hipertensão arterial e obesidade e a fração atribuível populacional de hipertensão arterial devida à obesidade em adolescentes brasileiros. MÉTODOS Foram avaliados dados dos participantes do Estudo de Riscos Cardiovasculares em Adolescentes, estudo seccional l nacional de base escolar. A amostra foi dividida em 32 estratos geográficos e conglomerados de escolas e turmas, com representatividade nacional, macrorregional e de capitais. Obesidade foi classificada pelo índice de massa corporal segundo idade e sexo. Considerou-se hipertensão arterial a média da pressão arterial sistólica ou diastólica maior ou igual ao percentil 95 da curva de referência. Foram estimadas prevalências e intervalos de confiança de 95% (IC95%) de hipertensão arterial e de obesidade, nacionais e nas macrorregiões do País, por sexo e grupo etário, assim como as frações de hipertensão atribuíveis à obesidade na população. RESULTADOS Foram avaliados 73.399 estudantes, 55,4% do sexo feminino, com média de idade 14,7 anos (DP = 1,6). A prevalência de hipertensão arterial foi 9,6% (IC95% 9,0-10,3); sendo as mais baixas observadas nas regiões Norte, 8,4% (IC95% 7,7-9,2) e Nordeste, 8,4% (IC95% 7,6-9,2) e a mais alta na região Sul, 12,5% (IC95% 11,0-14,2). A prevalência de obesidade foi 8,4% (IC95% 7,9-8,9), mais baixa na região Norte e mais alta na Sul. As prevalências de hipertensão arterial e obesidade foram maiores no sexo masculino. Adolescentes com obesidade tiveram prevalência de hipertensão arterial mais elevada, 28,4% (IC95% 25,5-31,2), do que aqueles com sobrepeso, 15,4% (IC95% 13,8-17,0), ou eutróficos, 6,3% (IC95% 5,6-7,0). A fração de hipertensão arterial atribuível à obesidade foi de 17,8%. CONCLUSÕES O ERICA foi o primeiro estudo brasileiro com representatividade nacional a estimar a prevalência de hipertensão arterial aferida em adolescentes. A fração da prevalência de hipertensão arterial atribuível à obesidade mostrou que cerca de 1/5 dos hipertensos poderiam não ser hipertensos se não fossem obesos.
ABSTRACT OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.
https://doi.org/10.1590/s01518-8787.2016050006685
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