Navegando por Palavras-chave "fator de risco"

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    Avaliação de fatores preditores para a sonolência excessiva residual em pacientes com apneia obstrutiva do sono em tratamento com CPAP
    (Universidade Federal de São Paulo (UNIFESP), 2016-08-30) Otuyama, Leonardo Jun [UNIFESP]; Poyares, Dalva Lucia Rollemberg [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Residual excessive sleepiness (RES) is associated with reduced quality of life and increased risk for accidents in CPAP-treated obstructive sleep apnea patients. We designed a prospective study to identify polysomnographic, clinical and demographic risk factors for RES incidence. Out of 218 consecutive patients, we included 202 with apnea/hypopnea index >20. At baseline, all participants underwent clinical interview, Epworth sleepiness scale and baseline and CPAP-titration polysomnographies. After one-year of CPAP treatment, sleepiness and treatment compliance were assessed. Multiple sleep latency test was used to rule out narcolepsy, and a further increase in CPAP pressure was applied to rule out undertitration if Epworth score >10. Participants were assigned to two groups [RES(+); RES(-)] according to presence of RES. We compared baseline characteristics between those groups and a regression model including 11 variables was conducted to predict RES. The analysis included 113 CPAP-compliant participants. Before treatment, RES(+) (12%) had significantly shorter sleep onset latency, lower N1% and higher Epworth score than RES(-). Regression analysis identified baseline Epworth score as a predictor of RES after treatment (b=0.19, 95%CI 0.06-0.33). In conclusion, we found that having higher baseline excessive sleepiness may be a risk factor for RES, suggesting that these patients need a sleepiness-specific treatment along with CPAP.
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    Fatores de risco e motivações entre os doadores de sangue com testes sorológicos reagentes para sífilis em São Paulo, Brasil
    (Universidade Federal de São Paulo (UNIFESP), 2014-11-12) Ferreira, Cuzete Cleusa [UNIFESP]; Sabino, Ester Cerdeira Sabino [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Syphilis is considered a curable sexually transmitted infection (STI); however, 12 million new cases arise each year worldwide, one quarter of which are in Latin America (WHO, 2001). The Brazilian Ministry of Health estimates that 1 million newcases of syphilis occur in the country annually. Sexual contact is the primary mode of syphilis transmission, andthenextmost commonmode is transfer of its agent, the spirochete Treponema pallidum, across the placenta.The risk of syphilis transmission through blood transfusion is almost negligible due to improved donor selection, serologic screening of blood donors, and an almost universal shift from transfusion of fresh blood to refrigerated blood components. Objective: To identify prevalence of DNA T. pallidum, the demographic characteristics, risk factors and motivations for donating among blood donors with reactive serologic tests for syphilis. Background: Post-donation interviews with syphilis seropositive blood donors improve recruitment and screening strategies. Methods: Laboratory screening was performed in between September 2007 and May 2009 using kits approved by the Brazilian Ministry of Health, including a competitive EIA (Enzygnost* syphilis, Dade Behring, Newark, DE, SA), VDRL test (Wiener lab, Rosario, Argentina) and fluorescent treponemal antibody-absorption test (FTA-ABS) Biolab-Merieux S/A, Rio de Janeiro, Brazil). This case?control study compares 75 Venereal Disease Research Laboratory (VDRL)>8, EIA+ (enzyme immunoassay) and FTA-ABS+ (fluorescent treponemal antibody); 80 VDRL?, EIA+ and FTA-ABS+; and 34 VDRL? and EIA? donors between 2004 and 2009. Donors were assessed by their demographic characteristics, sexual behaviour, history of alcohol and illicit drugs use, and motivations to donate. In parallel, we analyzed the polA gene of T. pallidum DNA, using Real Time PCR, from 197 samples VDRL>8 and 80 samples VDRL-. Results: The presence of Treponema pallidum DNA was assessed by real-time PCR in samples of blood donors with reactive serologic tests for syphilis. Treponema pallidum DNA was detected in two (1.02%) of 197 samples of VDRL>8, EIA+ and FTA-ABS+ donors, and in no sample from 80 VDRL-, EIA+ and FTA-ABS+ donors. Donors VDRL-, EIA+ and FTA-ABS+ lack demonstrable T. pallidum DNA in their blood and are unlike to transmit syphilis. Donors VDRL>8, EIA+ and FTA-ABS+ carry the risk of syphilis infectivity even in concomitance to antibodies detection. Serologic screening for syphilis may still play a role to prevent its transfusion transmission. The case-control study showed that donors with VDRL>8 were more likely to be divorced [AOR=12.53; 95% confidence interval (CI) 1.30?120.81], to have had more than six sexual partners (AOR=7.1; 95% CI 1.12?44.62) and to report male?male-sex in the past 12 months (AOR=8.18; 95% CI 1.78?37.60). Donors with VDRL?, EIA+ and FTA-ABS+ were less likely to be female (AOR=0.26; 95% CI 0.07?0.96), more likely to be older (AOR=10.2; 95% CI 2.45?42.58 ?39 and <60 years old) and to have had more than six sexual partners in the past 12 months (AOR=8.37; 95% CI 1.49?46.91). There was no significant difference among groups regarding illicit drugs use; 30·7% (VDRL>8) and 12·5% (VDRL?, EIA+ and FTA-ABS+) of donors reported that they had been at risk for HIV infection (P =0.004). One-third of donors came to the blood bank to help a friend or a relative who needed blood. Conclusion: In conclusion, blood donors with serological profile VDRL> 8 and EIA+, FTA-ABS+ has a higher risk of transmission of infection through transfusion. The presence of donor DNA VDRL> 8 indicates that some individuals do not lose their infectivity when antibodies are developed acute infection. And despite this finding using syphilis NAT is not required for routine donor because antibody tests are sufficient to prevent transmission by transfusion. The continuous monitoring of the risk factors associated with syphilis, can help bring improvements in screening of blood donors, and finally in blood safety. To understand the motivations of high-risk individuals, seeking blood banks instead of centers for voluntary counseling and testing is a subject for further research.
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    Fibrinogênio como fator de risco independente de doença vascular cerebral
    (Academia Brasileira de Neurologia - ABNEURO, 1997-01-01) Fukujima, Marcia Maiumi [UNIFESP]; Martinez, Tânia Leme da Rocha [UNIFESP]; Pinto, Leonor do Espírito Santo de Almeida [UNIFESP]; Auriemo, Caio R.c. [UNIFESP]; Andrade, Luiz Augusto Franco de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    We have studied fibrinogen levels (Clauss technique) in atherothrombotic ischemic stroke patients, in order to determine its role as a thombogenic risk factor. Twenty nine patients (20 men and 9 women) between 25 and 79 years old were studied; they all have had a atherothrombotic stroke. They were classified into two groups according to the result of their carotid doppler ultrasonography: g1 - without carotid flow reduction (n=l 9) and g2 - with carotid flow reduction (n=10). The fibrinogen mean value was 269mg/dl in gl and 353 mg/dl in g2. There were 47% of patients in gl and 80% of patients in g2 who presented levels >300 mg/dl. The proportions of the groups were significantly different (p<0,05). Considering the epidemiological value of 300 mg/dl, we conclude that the fibrinogen can be an independent risk factor for ischemic atherothrombotic stroke, specially in those whose carotid flow is reduced.