Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Fatores De Risco"

Navegando por Palavras-chave "Fatores De Risco"

Agora exibindo 1 - 11 de 11

Acesso aberto (Open Access)
Análise comparativa de parâmetros de função pulmonar entre escolares nascidos prematuros e a termo
(Universidade Federal de São Paulo (UNIFESP), 2019-10-22) Gonzaga, Ana Damaris [UNIFESP]; Santos, Amelia Miyashiro Nunes Dos [UNIFESP]; Vieira, Josy Davidson Okida[UNIFESP]; Goulart, Ana Lucia[UNIFESP]; http://lattes.cnpq.br/6101587222452300; http://lattes.cnpq.br/5519219079407797; http://lattes.cnpq.br/9925075057283150; http://lattes.cnpq.br/3127161613738999; Universidade Federal de São Paulo (UNIFESP)
Objectives: To compare pulmonary function parameters in children born preterm and at full-term and to identify factors associated with altered lung function and pulmonary function parameters. Methods: Cross-sectional study with two groups of 6-9 year-old children matched by age and sex and submitted to pulmonary function tests. Inclusion criteria: Preterm group: children born with gestational age (GA) <37 weeks and birthweight <2000 grams and followed up at the Outpatient Clinic for preterm infants of Unifesp. Term group: children born at term and recruited at two public elementary schools. Exclusion criteria: congenital malformations, cognitive deficit, neuromuscular diseases and respiratory problems in the last 15 days. Perinatal and post-natal demographic and clinical data and anthropometric measures were collected. At study entry, the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was applied and the pulmonary function was evaluated using the interrupter technique (Rint) and spirometry, with analysis of the parameters expressed in z-score. Factors associated with pulmonary function parameters and altered pulmonary function were analyzed by linear and logistic regressions, respectively. Results: A total of 112 children were included in each group. Preterm infants had GA of 30.8±2.8 weeks and birth weight of 1349±334g, being 35.7% small for gestational age (SGA), 46.4% presented respiratory distress syndrome (RDS), 20,7% neonatal sepsis, 19.6% bronchopulmonary dysplasia, 9.8% oxygen dependence at 36 weeks of corrected age (O2 dep 36wks), 65.2% received mechanical ventilation and were hospitalized for 37 days in median. At study entry, preterm and full term infants were similar in age (7.7±0.9 vs. 7.8±0.9 years), weight (27.8±7.9 vs. 28.8±7.9kg), height (130.0±9.1 vs. 130.6±7.6cm), respectively. The diagnosis of asthma by ISAAC was more frequent in premature infants (14.3% vs. 6.0%, p=0.048). The values of pulmonary function parameters (z-scores) in preterm and term infants were: Rint (-0,65±1,82 vs. -1,50±1.33; p=0.007), FVC (-0.39±1.27 vs. -0.15±1.03; p=0.106), FEV1/FVC (-0.23±1.22 vs. 0.14±1.11; p=0.003), FEV1 (- 0.48±1.29 vs. -0.04±1.08; p=0.071) and FEF25-75 (1.16±1.37 vs. 2.08±1.26; p=0.005). The prevalence of altered lung function was higher in preterm infants (26.8% vs. 13.4%, p=0.012). Factors associated with pulmonary function parameters (in z-scores) were: 1) Rint post bronchodilator = GA<34wks (0.134; p=0.005), SGA (0.129; p=0.002) and days of mechanical ventilation (0.005; p=0.011); 2); FVC = BW<1500g (-0.168; p=0.050) and z-score height/age (0,087; p<0.001); 3) FEV1/FVC = O2 dep 36wks (-5.073; p=0.017), previous bronquiolitis (-3.395, p=0.019); and physical activities <4x/week (-3,315, p=0.020); 4) FEV1 = GA <34wks (-0.241; p=0.003), SGA (-0.190; p=0.008) and z-score height/age (0.077; p=0.001); 5) FEF25-75 = O2 dep 36wks (-0.458; p=0.004), previous bronquiolitis (-0.269, p=0.014) and z-score height/age (0.069; p=0.063). Factors associated with altered lung function were: need for mechanical ventilation (OR: 2.426, p=0.046) and wheezing in the last year (OR: 3.195, p=0.041). Conclusions: Compared to children born at term, preterm infants had a higher prevalence of pulmonary alterations, higher parameters of Rint and lower z-scores of FEV1/FVC, FEV1 e FEF25-75.Mechanical ventilation and wheezing in the last 12 months increased the chance of altered lung function. Lower GA, O2 dep 36wks, days of mechanical ventilation, lower z-scores height/age, previous bronquiolitis, astma and lower physical activities were associated with pulmonary function parameters.
Acesso aberto (Open Access)
Associação dos polimorfismos de DNA dos genes dos colágenos 1 e 3 e o prolapso de órgãos pélvicos em mulheres brasileiras
(Universidade Federal de São Paulo (UNIFESP), 2019-12-10) Batista, Nilce Coimbra [UNIFESP]; Castro, Rodrigo De Aquino [UNIFESP]; Bortolini, Maria Augusta Tezelli [UNIFESP]; Dias, Marcia Maria [UNIFESP]; http://lattes.cnpq.br/1150368284144393; http://lattes.cnpq.br/2533347189752809; http://lattes.cnpq.br/6590913930590292; http://lattes.cnpq.br/0498522647671838; Universidade Federal de São Paulo (UNIFESP)
Introduction: Pelvic organ prolapse (POP) has a multifactorial etiology that includes environmental and genetic factors. Several studies have investigated the association between COL1A1 and COL3A1 and POP polymorphisms. However, the results presented show differences between the populations analyzed. Objective: To compare the presence and frequency of COL1A1 and COL3A1 polymorphisms in patients with advanced POP (stages III and IV) and in women without POP in the Brazilian population. Methods: A case-control study that included 826 patients was divided into case (n = 348) and control (n = 286) groups. Peripheral blood DNA was extracted and the real-time polymerase chain reaction (RT-PCR) technique was used to determine genotyping of the samples. The programs SPSS (Chicago, USA) and GraphPad Prism 5.0 (California, USA) were used for statistical analysis, considering p <0.05 as statistically significant. Results: The case group had a mean age (68.03 years) higher than the control group (60.39 years) with p <0.0001. Regarding obstetric history, we observed a higher number of pregnancies, number of vaginal deliveries (normal and forceps) and higher newborn weight in women in the case group compared to the control group, p<0.05. On the other hand, women in the control group had a higher number of cesarean deliveries, p<0.0001. Regarding the COL1A1 and COL3A1 genotypes, no differences were observed in univariate and multivariate analyzes (p> 0.05). In the analysis of clinical factors, it was observed that women who had systemic arterial hypertension (SAH) [OR = 2.16; p=<0.0001], Diabetes Mellitus (DM) [OR = 2.48; p=<0.0001], varicose veins [OR = 1.60; p=0.016], heart disease [OR = 2.92; p=0.016] and family history (AFPOP) [OR = 1.82; p=0.010] had an increased risk for POP. Logistic regression model 1 reinforced vaginal delivery [OR = 10,582; p=0.000], the presence of heart disease [OR = 3.082; p=0.005), DM [OR = 2.509; p=0.016], AFPOP [OR = 2.493; p=0.007], HAS [OR = 2.118; p=0.013] and the number of pregnancies [OR = 1.225; p=0.001] as risk factors for POP. Regression model 2, on the other hand, showed that vaginal delivery [OR = 11,236; p=0.000], AFPOP [OR = 2.072; p=0.002], the number of pregnancies [OR = 1.283; p=0.000] and age [OR=1,096; p=0,000 as risk factors for POP. Meanwhile, Caesarean delivery was considered a protective factor for POP [OR = 0.431; p=0.000]. Conclusion: The distribution of COL1A1 polymorphism (rs1800012) and COL3A1 (rs1800255) wasn’t considered a risk factor for this disease. However, vaginal delivery, AFPOP, number of pregnancies, DM, and age were considered risk factors, and cesarean delivery was a protective factor for the development of POP.
Embargo
Avaliação do papel do nível plasmático de citocinas e de alguns polimorfismos dos genes de citocinas no risco de tromboembolismo venoso
(Universidade Federal de São Paulo (UNIFESP), 2009-11-25) Matos, Marinez Farana [UNIFESP]; Morelli, Vania Maris [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
thromboembolism (VTE). However, clinical studies are few and show controversial results regarding the role of cytokines, acute-phase proteins and polymorphisms of cytokine genes on the risk of VTE. Objectives: the aims of this case-control study were to (1) investigate the association between the risk of VTE and plasma levels of IL-1beta, IL-6, IL-8, MCP-1 and acute-phase proteins; (2) evaluate the effect of some demographic and clinical variables as well as polymorphisms on the risk of VTE and whether these variables could influence cytokines levels; (3) investigate a possible correlation between levels of cytokines, acute-phase proteins and markers of blood coagulation and fibrinolysis in patients with VTE. Patients and methods: 122 patients (96 women, 79%) with a first objectively confirmed episode of VTE and a median age of 39.5 years were included. Exclusion criteria were malignancy, autoimmune diseases, antiphospholipid syndrome, chronic renal or liver disease and arterial thrombosis. Patients were seen at least 1 month after the discontinuation of the anticoagulant treatment and > 7 months after the event of VTE. Control group was comprised of 131 healthy subjects (105 women, 80%), with median age of 38 years. The following polymorphism were investigated: IL-1 beta -511CT, IL-1 beta -31TC, IL-6 -174GC, IL-8 -251 AT and MCP-1 -2518AG Results: gender, age and body mass index (BMI) were significantly associated with cytokine and acute-phase proteins levels. Elevated levels (> 90th percentile of controls) of IL-6 [Odds ratio (OR) = 3.64; 95% confidence interval (CI) 1.82 – 7.30] and IL-8 (OR = 2.42; 95%CI 1.15 – 5. 08) had a significant impact on the risk of VTE that remained after adjustment for sex, age, BMI and C-reactive protein. No correlation was found between the time since the event of VTE and levels of IL-6 (r = 0.064; P = 0.485) and IL-8 (r = 0.070; P = 0.442). There was a positive correlation between IL-8 and prothrombin fragment 1 + 2 levels (r = 0.203; P = 0.025). Median levels of d-dimer were significantly higher among patients with detectable levels of IL-1 beta (P < 0.0001). Except for the polymorphism IL-1 beta -31TC in controls, none of the polymorphisms were able to influence cytokine levels. Furthermore no polymorphism influenced thrombosis risk. Conclusion: elevated levels of IL-6 and IL-8 had a significant impact on the risk of VTE in a relatively young population of patients. No association was found between the time since the event and the level of these cytokines, which could suggest that inflammation is not only a consequence of the thrombosis. The relationship between IL-8 and IL-1 beta with markers of blood coagulation and fibrinolysis might indicate a possible procoagulant role of these cytokine in patients with VTE.
Somente Metadadados
Delirium na unidade de terapia intensiva: análise das medidas preventivas não farmacológicas e dos fatores de risco
(Universidade Federal de São Paulo (UNIFESP), 2019-09-26) Bersaneti, Mariana Davies Ribeiro [UNIFESP]; Whitaker, Iveth Yamaguchi [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objectives: To verify the association between non-pharmacological strategies (presence of caregiver, mobilization, absence of physical restraint and natural light) and occurrence of delirium; to verify the association of demographic variables, previous health conditions, hospitalization and clinical conditions with delirium, and to identify risk factors for delirium, considering the patients of Intensive Care Unit (ICU). Method: Observational, prospective cohort study performed at the General ICU of the Sociedade Beneficente de Senhoras Hospital Sírio-Libanês, during 2016. The sample included patients older than 18 years, length of ICU stay longer than 24 hours, and who did not present delirium at ICU admission. Delirium was identified through the application of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU). The Mann-Whitney and Chi-square tests were applied to verify the association between the variables studied and delirium. The multivariate logistic regression model using stepwise procedure was used to identify risk factors. The significance level of 5% and 95% confidence intervals were adopted. Results: The sample consisted of 356 patients, 55.9% were males and the median age was 69 years. Delirium was observed in 64 patients (18%). Delirium was associated with the presence of caregiver, mobilization and physical restraint. In addition, the following variables were associated: age, health status before ICU (origin and admission category), hospitalization (length of ICU and hospital stay, discharge from ICU) and clinical conditions (severity of disease and of organic dysfunction, sedation, mechanical ventilation, number of devices). The risk factors associated with delirium were length of ICU stay and age. The protective factors for delirium were the presence of caregiver and mobilization, indicanting that the patient's chance of presenting delirium decreases. Conclusions: The findings pointed to multiple variables associated with delirium in ICU patients, revealing the age and length of ICU stay as risk factors. The presence of caregiver and patient mobilization were identified as protective factors for delirium, which make them important preventive actions that can subsidize the implementation of care programs and safe clinical practices to reduce delirium in the ICU.
Somente Metadadados
Fatores de risco e proteção para o comportamento suicida em adolescentes e sua relação com adesão ao tratamento
(Universidade Federal de São Paulo (UNIFESP), 2020-12-04) Rufino, Natalia Cruz [UNIFESP]; Silveira Filho, Dartiu Xavier Da [UNIFESP]; Universidade Federal de São Paulo
Suicide is responsible for approximately 6% of all youth deaths in the world, being the second cause of death among women and the third among men. There is a large variation in suicide rates between countries and within countries, related to cultural and socioeconomic issues. And therefor, most cases occur with low or medium income countries. Suicidal behavior in adolescence is a public health problem in terms of morbidity and mortality, as well as psychosocial evolution, and it is increasing in the world. In this sense, this thesis aims to contribute to the comprehension of suicidal behavior in adolescents through the comparison of two clinical samples of adolescents with suicidal behavior in Brazil and France and the study of risk and protective factors already related with treatment compliance after an adolescent suicide attempt. Adherence to treatment in these settings can be understood as an important factor in preventing the progression of suicidal behavior. In order to study the risk and protective factors associated with adherence to treatment in adolescent suicidal behavior, a systematic review of the scientific production of the last three decades was conducted. To compare the clinical samples of adolescents in both countries, standardized instruments were used in order to explore clinical, environmental, and cultural factors that may contribute to the understanding of the psychopathological mechanisms involved in adolescent suicidal behavior. Despite the great variability in methodology, follow-up time, and sample sizes found in the articles reviewed, it can be seen that effective planning for treatment compliance should consider sociocultural, family, and individual factors, as well as specialized emergency care. In the comparison between adolescents from both countries, after a suicide attempt, it was found that Brazilian adolescents, despite presenting a psychopathology similar to French adolescents with suicidal behavior, still presented a higher level of psychopathology, in addition, they presented a more insecure style of attachment and a greater use of a spiritual coping style, probably linked to their own style of attachment and the lack of other resources, absent in developing countries. The findings of the thesis reinforce the importance of understanding risk and protective factors, taking into account socio-economic, cultural and individual particularities for planning effective treatment to achieve better compliance and prevent further attempts. Style of attachment and religiosity seem to play an important role in the psychopathology of suicidal behavior in the Brazilian adolescents in the study. They should be deeper investigated in the future.
Acesso aberto (Open Access)
Fatores de risco para celulite em adolescentes
(Universidade Federal de São Paulo (UNIFESP), 2019-06-27) Soares, Juliana Laudiceia Marques [UNIFESP]; Bagatin, Edileia [UNIFESP]; Miot, Hélio Amante [UNIFESP]; http://lattes.cnpq.br/2543633050941005; http://lattes.cnpq.br/6478900066830476; http://lattes.cnpq.br/2325812049415017; Universidade Federal de São Paulo (UNIFESP)
Introduction. The cellulite is characterized as an irregular appearance of skin surface, with a "padded" or "orange peel" aspect on the thighs and gluteal regions and, less frequently, on the arms and abdomen, predominantly in women after puberty. Although the etiopathogenesis is still not fully understood, cellulite is considered a multifactorial disorder, involving primary, anatomic or structural alterations of the adipose tissue and alterations of the dermal connective tissue. The most relevant factors include: fat herniation towards the dermal connective tissue, facilitated by the presence of fine and perpendicular hypodermic fibrous septa; the biochemical and metabolic differences in relation to normal fat and the architectural changes related to sex in different regions of the body. Objective: To evaluate the risk factors for the appearance of cellulite and its impact on quality of life. Methods: This is a cross-sectional observational study. A total of 184 adolescents aged 12 to 18 years, mean of 15 years were included. Genetic familial, gynecological hormonal factors, physical activity, nutrition, body composition and anthropometry were evaluated as well as cellulite severity and its impact on quality of life. Results: The variables that showed significant as a risk factor for cellulite were: BMI (p˂0.001), time since menarche (p = 0.037), carbohydrate by energy (p = 0.006), water consumption per day (p = 0.037), family history (p = 0.003) and weekly physical activity (p˂0.001). Conclusion: Genetic familial, gynecological hormonal, nutritional, anthropometric factors and physical activity showed direct relation to development and severity of cellulite, which reinforces its multifactorial character. The disclosure of this study will be important to point out possible physiopathological mechanisms and to alert the adolescents about the risk factors associated with the onset and worsening of this condition.
Acesso aberto (Open Access)
Fatores de risco para eventos adversos respiratórios em adultos submetidos à cirurgias não cardíacas e não torácicas
(Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Badessa, Marianne Peixoto Sobral Giroldo [UNIFESP]; Falcão, Luiz Fernando Dos Reis [UNIFESP]; http://lattes.cnpq.br/4912142925978355; http://lattes.cnpq.br/6387047589841035; Universidade Federal de São Paulo (UNIFESP)
Justifications and objects: Adverse respiratory event is the highest class of anesthesia complications associated with high mortality. Therefore, it is important to identify the risk factors associated with these complications. This study was made to establish the principal factors of risk in intraoperative respiratory complications. Method: This retrospective descriptive research was combined with anesthesiology reports performed in the University Hospital complex in the city of São Paulo during a 6-year period. The presence of bronchospasm, apnea, dyspnea, hypoventilation, hypoxia, pneumothorax, re-intubation or accidental extubation were considered as adverse intraoperative respiratory events. Incompleted anesthesia reports with adverse events were excluded. The univariate and multivariate analysis were performed by the logistic regression model considering the stepwise variable selection technique. The significance threshold was set at p<0,05. Results: A total of 43,383 anesthetics for noncardiac and non-thoracic surgeries were performed in patients aged 18 years or older. There was a record of 401 (0.92%) anesthesias in which there was at least one intraoperative respiratory adverse event. The most frequent respiratory events were bronchospasm (n = 157, 39.2%), hypoxia (n = 110, 27.4%) and hypoventilation (n = 81, 20.2%). The following were identified as risk factors for the presence of adverse events (p <0.05): male gender (OR 1.68; IC95% 1,13- 2,51), physical health ASA P3 (OR 1.862; IC95% 1,470-2,360), ASA P4 (OR 3.266; IC95% 2.326-4.585), ASA P5 (OR 5.642; IC 95% 3.201-9.945), head and neck surgery (OR 2.927; IC 95% 2.060-4.157, gastrointestinal surgery (OR 1.591; IC95% 1.237-2.046), otorhinolaryngological surgery (OR 1.821; IC95% 1.295-2.561), general anesthesia (OR 2.934; IC95% 2.30-3.742) and presence of the first year resident of anesthesiology. Conclusions: The incidence of adverse intraoperative respiratory events in adult patients undergoing noncardiac and non-thoracic surgeries is low. It is essential that the risk factors intrinsic to the patients, anesthetic technique and surgical specialty is tracked in the preoperative period in order to plan strategies to reduce such intraoperative events.
Somente Metadadados
Fatores de risco para infecção por Klebsiella Pneumoniae Carbapenemase em pacientes submetidos a transplante renal
(Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Ribeiro, Jecielle Cerqueira De Oliveira [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objective - Infection is the second most frequent cause of mortality among renal transplant patients. The objective of the study was to analyze the outcome of Carbapenemase-producing Klebsiella pneumoniae (KPC) infection, to identify the risk factors for graft and renal transplant patient survival with KPC infection and to compare the results obtained with other services. Method - Observational study, retrospective cohort in subjects submitted to renal transplantation by deceased donor in the year 2014 and analyzed during the first and second year after transplantation. Patients older than 18 years, on the first transplant of the recipient, who received a deceased donor organ and only renal transplantation were included. A descriptive analysis was performed considering demographic, clinical, laboratorial variables and parameters related to the treatment. The primary outcome was KPC infection. The variables were tested using the chi-square test or Fisher's exact test and the association between continuous variables and the presence of infection was done using “t” Student's or Mann-Whitney's tests. In the analysis of the associations, the odds ratios were calculated with the respective confidence intervals at the 95% level. The tests used were bi-caudal and the level of significance was alpha <0.05. Results – A total of 852 records were reviewed and of these, 164 did not meet the inclusion criteria. Eighteen patients presented positive culture for KPC and 34 presented other pathogens. KPC infection according to the site of infection showed that the largest number occurred in the urinary tract (9.8%), followed by bloodstream (2.3%) and respiratory tract (1.5%). The highest risk for mortality or loss of graft was associated with Diabetes Mellitus, Systemic Hypertension, alcoholism, use of Central Venous Catheter and presence of KPC infection in the first 2 years after transplantation. Conclusion – Klebsiella pneumoniae infections resistant to carbapenem KPC in kidney transplant patients are progressively increasing and are associated with worse outcomes. Risk factors and therapeutic strategies need to be better defined. As for KPC infection according to the site, it was observed that the largest number occurred in the urinary tract, followed by bloodstream and respiratory tract, and no case was recorded in an operative wound. Individuals with a history of DM, hypertension, alcoholism and CVC were more likely to develop KPC infection when compared to individuals who did not present infection during the analyzed period. Renal transplant therapy presented a higher risk for mortality when associated with DM, hypertension, alcoholism, CVC use and presence of KPC infection in the first 2 years after transplantation.
Somente Metadadados
Incidência e fatores de risco relacionados ao delirium em crianças gravemente enfermas
(Universidade Federal de São Paulo (UNIFESP), 2020-04-30) Reinoso, Alexandra Elizabeth Flores [UNIFESP]; Kusahara, Denise Miyuki [UNIFESP]; Universidade Federal de São Paulo
Introduction: Delirium is a syndrome of organic brain dysfunction with acute and fluctuating onset, characterized by a global deterioration of cognitive functions, depression of the level of consciousness, disturbances of attention and psychomotor activity, and disorder in the sleep-vigil cycle. Children in intensive care can be exposed to precipitating conditions of delirium, so early detection and recognition of risk factors for the occurrence of this condition are necessary for prevention and early intervention, in order to reduce morbidity and mortality and future complications resulting from treatment intensive implemented. Objectives: To identify the incidence of delirium in a Pediatric Intensive Care Unit (PICU); to verify the risk factors related to the occurrence of delirium and the agreement between two scales used for the detection of pediatric delirium in critically ill children. Method: Longitudinal study, carried out in a PICU of a university hospital. The sample consisted of 65 seriously ill children admitted to the PICU, with more than 24 hours of hospitalization, excluding children with neurological or cognitive impairment, hearing and visual impairment, chronic encephalopathy and declining consent to participate in the study. The outcome variable was defined as the occurrence of delirium identified through the daily application of two scales, Cornell Assessment of Pediatric Delirium (CAPD) and Sophia Observation withdrawal Symptoms-Pediatric Delirium Scale (SOS_PD), in the morning and afternoon. Exposure variables related to the children's demographic characteristics, clinical conditions and intensive care implemented were investigated. Descriptive and inferential statistical analysis was performed using the SPSS software, with a significance level of 5%. Results: Most of the children included in the study were girls (53.8%), with a mean age of 47.6 months; admitted to the unit for clinical conditions (67.7%). Among all 22 (33.8%) of the children had respiratory pathologies. As for the devices used, 47 (72.3%) of the children used central intravenous catheter, 36 (55.4%) peripheral venous catheter, and 32 (49.2%) used probes. The mean time of mechanical ventilation was 8.71 days and the length of stay in the PICU was 3.2 days. Delirium was identified in 7.7% of children, with the duration of the disorder for approximately 2 days. The agreement between the two scales was considered very good (Kappa = 1). a value of 1 was obtained, very good agreement (p-value <0.001). There was a statistical association between the occurrence of delirium and age less than 2 years (p = 0.060); female gender (p = 0.057); use of mechanical pulmonary ventilation (p = 0.034); antiemetics (p = 0.002); anticholinergics (p = 0.044), and changes in serum sodium and potassium (p = 0.053). Conclusion: The prevalence of delirium in children in the PICU was 7.7%, a rate below those identified in the literature. Demographic, clinical, and pharmacological conditions have been associated with the occurrence of delirium. The scales used to identify delirium showed satisfactory agreement. The use of these observation tools favors the early detection of delirium in children admitted to the intensive care unit, allowing for timely intervention after diagnosis and continuous monitoring that can contribute to the reduction of negative consequences that may arise in the long term.
Somente Metadadados
Preditores de readmissão hospitalar em até 30 dias após cirurgia de revascularização do miocárdio
(Universidade Federal de São Paulo (UNIFESP), 2019-10-31) Chiorino, Camilla Do Rosario Nicolino [UNIFESP]; Lopes, Camila Takao [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Introduction: The frequency of hospital readmission within 30 days can reach 23.6% following coronary artery bypass grafting (CABG), which increases costs to the health care system. Studies have investigated predictors of readmission after CABG, in order to support planning of interventions that can reduce this outcome and promote reduction of associated costs. However, there are no robust Brazilian studies that have conducted such an investigation. Objective: To identify predictors of hospital readmission within 30 days after CABG. Method: A secondary database analysis was performed at Beneficência Portuguesa de São Paulo. The population consisted of data from the electronic database REVASC (Myocardial ReVAScularization Registry), which includes 3,010 patients undergoing CABG from July 2009 to July 2010. Data from patients 18 years old or older who had been submitted to isolated CABG and discharged alive after a hospital stay of up to 10 days were included. The antecedent variables included those related to the patient (demographic, anthropometric and clinical characteristics) and variables related to the surgical procedure (preoperative, intraoperative and postoperative aspects). The outcome variable was all-cause hospital readmission within 30 days following isolated CABG. The selection of variables was based on the authors' clinical experience and the results of an integrative literature review (ten studies published between 2013 and 2018 in Pubmed, Virtual Health Library and CINAHL). The relationship of the clinical and demographic variables with the outcome was investigated throug Student's t-test (or Mann-Whitney) for quantitative variables or by Pearson’s Chi-square or Fisher's exact test for qualitative variables. The relationship between the variables with a p-value≤0.2 in the univariate tests and the outcome was investigated through a multiple logistic regression model. A p-value ≤0.05 was considered significatn. The project was approved by the Research Ethics Committee of the Federal University of São Paulo (Opinion 2.795.813) and Beneficência Portuguesa (Opinion 2.933.217). Results: Data from 2,272 patients were included, with a readmission incidence of 8.6%. The readmission predictors were brown ethnicity [ExpB=1.613; 95% CI 1.047- 2.458; p=0.030], black ethnicity [ExpB=0.136; 95% CI 0.19-0.988; p=0.049], chronic kidney failure (CRF) [ExpB=2.214; 95% CI 1.269-3.855; p=0.005], postoperative use of blood components [ExpB=1.515; 95% CI 1.102.086; p=0.011], chronic obstructive pulmonary disease (DPOC) [ExpB=2.095; 95% CI 1.244-3.419; p=0.003] and the use of acetylsalicylic acid (AAS) [ExpB = 1.418; 95% CI 1,000-2,011; p = 0.05]. Preoperative antibiotic use [ExpB =0.742; 95% CI 0.547-1.007; p=0.055] reached marginal significance. Conclusion: After CABG, brown ethnicity - compared to white ethnicity - having CKF, receiving postoperative blood transfusion, having COPD and having used ASA were associated with a higher chance of readmission within 30 days. Black ethnicity - compared to white ethnicity - and preoperative antibiotic prophylaxis are associated with a lower chance of this outcome. The predictors identified are easily obtainable variables, which facilitates predicting readmission risk as patients are admitted and allows for individualized planning for safe discharge and more rigorous postoperative follow-up.
Acesso aberto (Open Access)
Rejeição aguda no transplante renal pediátrico: epidemiologia, fatores de risco e impacto sobre a função renal
(Universidade Federal de São Paulo (UNIFESP), 2019-02-14) Pereira, Luiza Do Nascimento Ghizoni [UNIFESP]; Nogueira, Paulo Cesar Koch [UNIFESP]; http://lattes.cnpq.br/4980474480271642; http://lattes.cnpq.br/5455156333461375; Universidade Federal de São Paulo (UNIFESP)
Objectives: To evaluate the incidence of acute rejection in pediatric patients submitted to kidney transplantation, as well as the related risk factors and impact of this outcome in allograft function and survival during follow up. Methods: Retrospective cohort including all pediatric patients submitted to kidney transplant between 2011 and 2015. The effects of possible risk factors for acute rejection were tested by Competing Risk Analysis. To estimate the impact of this outcome in allograft, we evaluated graft survival adjusted for acute rejection occurrence and variability in the glomerular filtration rate by Schwartz’s formula during the follow up. Results: The cohort included 230 patients, and rejection free survival rate was 72.5% in one year and 54.8% in five years. The risk factors to this outcome were number of mismatches (SHR 1.36 CI 1.14 – 1.63 p=0.001), immunosuppression based on cyclosporine, prednisone and azathioprine (SHR 2.22 CI 1.14 – 4.33 p=0.018), delayed graft function (SHR 2.49 CI 1.57-3.93 p<0.001), CMV infection (SHR 5.52 CI 2.77 – 11.0 p<0.001) and bad-adherence (SHR 2.28 CI 1.70 – 4.66 p<0.001). Death censored graft survival in one and five years were respectively 92.5% and 72.1%, and the risk factors for this outcome were number of mismatches (HR 1.51 CI 1.07 – 2.13 p=0.01), age over 12 years old (HR 2.66 CI 1.07 – 6.59 p=0.03) and panel reactive antibody between 1 and 50% (HR 2.67 CI 1.24 – 5.73 p=0.01). Despite the occurrence of acute rejection did not influence 5 years graft survival, it presented a negative impact on glomerular filtration rate. Conclusion: Acute rejection is a frequent outcome in our patients, being related to number of mismatches, immunosuppression with cyclosporine, prednisone and azathioprine, delayed graft function, CMV infection and bad adherence, and it has some impact in GFR during follow up.

Navegando por Palavras-chave "Fatores De Risco"

Resultados por página

Opções de Ordenação