Navegando por Palavras-chave "mortalidade"

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    Abordagem estereotáxica guiada por imagem de lesões do sistema nervoso central: precisão diagnóstica, morbidade, mortalidade
    (Academia Brasileira de Neurologia - ABNEURO, 1999-09-01) Hisatugo, Marcelo Ken-iti; Stávale, João Norberto [UNIFESP]; Bidó, José Orlando; Ferraz, Fernando Patriani [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    We studied seventy-five patients with brain lesions biopsied by stereotaxis from March 1993 to December 1998 at Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina. The three most frequent lesions were: metastasis, low grade astrocytomas and glioblastoma multiforme. The morbidity rate was 2.66% due to: one case of scalp infection in a patient with thalamic cyst; and a partial seizure during surgery in a patient with lynphoma. The mortality rate was 1.33% due to increasing of cerebral edema after biopsy and the patient died after one week. The diagnostic accuracy was 89.33%.
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    Albumina sérica como marcador nutricional de pacientes em hemodiálise
    (Pontifícia Universidade Católica de Campinas, 2004-09-01) Santos, Nelma Scheyla José dos; Draibe, Sergio Antonio [UNIFESP]; Kamimura, Maria Ayako [UNIFESP]; Cuppari, Lilian [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The prevalence of protein-energy malnutrition is high in patients with chronic renal failure on long-term hemodialysis therapy. Among several parameters available for the assessment of nutritional status, albumin has been the most commonly used given its strong association with morbidity and mortality in those patients. However, many factors such as age, comorbidities, hypervolemia and body losses, can affect the serum albumin concentration. Furthermore, the albumin metabolism can be altered in the presence of inflammation, a common condition in this group of patients. Thus, this communication aimed to address the general aspects of albumin and discuss its usefulness for assessing nutritional status in chronic renal failure patients undergoing hemodialysis.
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    Avaliacao da espessura medio-intimal em pacientes com doenca renal cronica nao dialitica: estudo prospectivo de 24 meses
    (Sociedade Brasileira de Nefrologia, 2014-03-01) Marcos, Andrea Gaspar; Watanabe, Renato; Lemos, Marcelo Montebello [UNIFESP]; Canziani, Maria Eugênia Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction:Increased carotid intima-media thickness (IMT) is considered a marker of early-onset atherosclerosis and it seems to predict cardiovascular events in general population. The prognostic value of IMT in patients with early-stage chronic kidney disease (CKD) has not been clearly established.Objective:We aimed to evaluate the association between IMT and cardiovascular (CV) events and mortality in CKD patients.Methods:A cohort of CKD patients in stage 2-4 was evaluated the occurrence of CV events and death in a 24 months follow-up. Laboratory data, carotid ultrasound and coronary computed tomography were performed at baseline.Results:A total of 117 patients (57 ± 11 years-old, 61% male) were evaluated. Mean glomerular filtration rate (eGFR) was 36 ± 17 mL/min, 96% of patients had hypertension, 23% diabetes and 27% were obese. Coronary calcification was found in 48% of the patients, with higher prevalence among CKD stage 4 (p = 0.02). The median value of IMT was 0.6 mm (0.4-0.7 mm). When compared to patients with IMT ≤ 0.6 mm, those with IMT > 0.6 mm were older (p = 0.001), had higher prevalence of male (p = 0.001) and had lower eGFR (p = 0.01). These patients also had higher prevalence of coronary calcification (p = 0.001). During the follow-up, there were no differences in the occurrence of cardiovascular events and deaths between the two groups.Conclusion:IMT in early-stage CKD patients was related to coronary calcification, but not with the occurrence of cardiovascular events or death.
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    Avaliação epidemiologica dos pacientes do Hospital do Servidor Publico Estadual de São Paulo (HSPE-SP) com lesão renal aguda e insuficiência renal crônica agudizada
    (Universidade Federal de São Paulo (UNIFESP), 2015-08-31) Azedo, Franciana Aguiar [UNIFESP]; Schor, Nestor Schor [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Lesão renal aguda (LRA) é uma complicação frequente em pacientes hospitalizados e com pior desfecho clínico, com diferenças importantes nas etiologias e evolução, dependendo do local estudado. Objetivos: Identificar o perfil epidemiológico e etiológico das LRAs dos pacientes avaliados pelo grupo de IRA do HSPE (GIRAHSPE) no período de 03/2012 a 02/2013 e comparar com dados epidemiológicos e demográficos de períodos anteriores. CASUISTICA: Estudo prospectivo avaliando: idade, sexo, etiologia, clinicas de origem, doenças associadas (DA), evolução e mortalidade. Fatores de exclusão: pacientes dialíticos, incluídos em outros estudos e idade menor que 18 anos. Analise estatística: Testes de distribuição de frequência e variância (ANOVA), Qui Quadrado e Kruskal-Wallis. Resultados: os dados do nosso estudo foram comparados com os 2 períodos anteriores acompanhados pelo GIRAHSPE estudo 1 de 01/2000 a 12/2001, com 560 pacientes: 372 LRA e 188 IRCag e estudo 2, de 01/2003 a 12/2004, com 981 pacientes, 477 LRA e 504 IRCag; e nosso estudo (3) com 277 LRA e 450 IRCag. HAS foi a comorbidade mais prevalente nos 3 estudos. A diálise foi mais indicada no estudo 3, 48% dos pacientes LRA e 51% IRCag, a mortalidade foi maior no estudo 2 com 27% LRA e 41,5% IRCag. Houve um aumento de IRC agudizada X LRA com o decorrer dos anos chegando a inversão no último período e a gravidade dos pacientes não foi linear, não permitindo assim a conclusão de fatores prevalentes semelhantes no desencadeamento de LRA ou IRCag nos três períodos de estudo.
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    Complicações nos períodos intra e pósoperatório de cirurgia de crânio eletiva e de urgência/emergência
    (Universidade Federal de São Paulo (UNIFESP), 2013-03-27) Pires, Ellen Maria de Campos [UNIFESP]; Diccini, Solange Diccini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To evaluate the incidence of neurological and systemic complications, adverse events and mortality among patients undergoing an elective cranial surgery and urgent/emergency surgery during the intra and post-operative periods. Methods: This was a prospective study in patients, who underwent elective cranial surgery and urgent/emergency surgery, aged equal to or above 18 years, of both genders and were followed daily from the surgical procedure until hospital discharge or death. Results: 127 patients were included in the elective group, with a mean age of 49,2 years with 45,7% being men and 75 patients were in the urgent/emergency group, with a mean age of 51,5 years and 64% being men. In the intraoperative period, the incidence of neurological complications was 12,7% in the elective group and 63.5% in the urgent/emergency group (p<0.0001) and systemic complications was 95,4% in the elective group and 82,7% in the urgent/emergency group (p=0,017). Patients in the urgent/emergency group presented more intracranial hypertension (ICH) (p=0,001) and arterial hypotension was more frequent in the elective group (p=0,001). In the immediate post-operative period (POI) the incidence of neurological complications was 45,5% in the elective group and 52,9% in the urgent/emergency group (p=0,402); systemic complications was 98,3% in the elective group and 98,5% in the urgent/emergency group (p=1,000) and adverse events was 19,7% in the elective group and 9,3% in the urgent/emergency group (p=0,071). The patients in the elective group had more vomiting (p=0,010), pain (p=0,003) and loss of arterial catheter (p=0,047) and patients in the urgent/emergency group showed more ICH (p=0,013), anisocoria (p=0,002), use of vasoactive drugs (DVA) (p=0,001), abnormal potassium (p=0,022) and hyperthermia (p=0,026). In the post-operatively mediate (POM) the incidence of neurological complications was 71,7% in the elective group and 79,7% in the urgent/emergency group (p=0,241), systemic complications was 99,2% in the elective group and 98,6% in the urgent/emergency group (p=1,000) and adverse events was 72,4% in the elective group and 81,3% in the urgent/emergency group (p=0,176). The patients in the elective group presented more pain (p<0.001) and patients in urgent/emergency group presented more ICH (p=0,001), vasospasm (p=0,043), pupils with no fotomotora reaction (p=0,006), re-operation (p=0,046), hypotension (p=0,001), use of vasoactive drugs (p<0,001), bradycardia (p=0,001), tachycardia (p=0,033), cardiopulmonary arrest (p=0,001), gastric reflux (p=0,001), acute renal failure (p=0,014), potassium electrolyte abnormalities (p=0,001), calcium (p=0,008) and sodium (p=0,001), hypoglycemia (p=0,001), hyperthermia (p=0,002), pulmonary infection (p<0,001), loss of arterial catheter (p=0,001), loss of gastric cateter (p=0,037), loss of enteral tube (p=0,001) and pressure ulcers (p=0,001). The mortality rate was 5,5% in the elective surgery group and 26,7% in the urgent/emergency surgery group (p<0,001). Conclusions: In the intra-operative period, the patients in the urgent/emergency surgery group presented more neurological complications such as ICH. In POI, patients in the elective surgery group presented more systemic complications and adverse events and neurological complications were more frequent in patients in the urgent/emergency surgery group. In POM, the patients of the urgent/emergency surgery group presented more neurological and systemic complications, adverse events than the patients in the elective surgery group. Mortality was higher among patients undergoing surgery of the cranium in the urgent/emergency surgery group.
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    Diarreia persistente: ainda um importante desafio para o pediatra
    (Sociedade Brasileira de Pediatria, 2011-06-01) Andrade, Jacy Alves Braga de [UNIFESP]; Fagundes-Neto, Ulysses [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To provide recent guidelines to reduce the incidence of diarrheal diseases. We discuss the definition, clinical aspects, pathophysiology, diagnosis, management, and prevention of persistent diarrhea. SOURCES: Electronic search of the MEDLINE database, Google search. SUMMARY OF THE FINDINGS: Acute diarrhea may be caused by a variety of agents, including bacterial, viral, and protozoan pathogens. The top priority in treatment of diarrhea is replacement of fluid and electrolytes losses, particularly at the acute stage, and, under certain circumstances, eradication of the enteropathogenic agent. On the other hand, treatment of persistent diarrhea should focus on prevention and management of food intolerance and malnutrition. CONCLUSIONS: Promotion of breastfeeding, adequate interventions in the treatment of acute diarrheal episodes, introduction of safe dietary strategies for prevention of malnutrition, and improvements in sanitation and hygiene conditions, including sewage and clean water, are essential measures for the reduction of diarrheal morbidity and mortality rates in children under 5 years of age.
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    Dieta e câncer: um enfoque epidemiológico
    (Pontifícia Universidade Católica de Campinas, 2004-12-01) Garófolo, Adriana [UNIFESP]; Avesani, Carla Maria [UNIFESP]; Camargo, Kátia Gavranich [UNIFESP]; Barros, Maria Elisa [UNIFESP]; Silva, Sandra Regina Justino [UNIFESP]; Taddei, Jose Augusto de Aguiar Carrazedo [UNIFESP]; Sigulem, Dirce Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Santo Amaro Disciplina Saúde Pública
    Recent data have shown that the prevalence of cancer in the world has significantly risen in the last century. Cancer epidemiologists believe that it is related to the industrialization and urbanization that occurred during this period. In fact, the cancer incidence and mortality observed in developed countries are higher than in non-developed countries. Moreover, some specific sites of cancer such as colon-rectum, prostate and female mama are more pronounced in developed countries, whereas others as stomach, esophagus and cervix are prevalent in non-developed countries. Different patterns of cancer are also observed among migrants when they migrate to a new country or region. Based on epidemiological data, the association between cancer and diet was analyzed, as well as the changes in some food intake patterns and how they can prevent some types of cancer in the future.
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    Espessura média intima como preditor de evento cardiovascular na insuficiência renal crônica
    (Universidade Federal de São Paulo (UNIFESP), 2014-01-31) Marcos, Andrea Gaspar [UNIFESP]; Canziani, Maria Eugenia Fernandes Canziani [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Fundamento: O aumento da espessura mediointimal avaliada por ultrassom, considerado um indicador precoce de aterosclerose, é um preditor de risco cardiovascular na população geral. Porém, em pacientes com doença renal crônica nos estágios iniciais, essa associação ainda não está bem estabelecida. Objetivo: Avaliar a associação da espessura mediointimal com a ocorrência de eventos cardiovasculares e mortalidade em pacientes nos estágios iniciais da doença renal crônica. Métodos: A análise post hoc de uma coorte de pacientes nos estágios 2 ? 5 da DRC. Foram avaliados dados laboratoriais, ultrassom da artéria carótida e tomografia coronariana no início do estudo e a ocorrência de eventos cardiovasculares e óbito, em um seguimento de 24 meses. Resultados: Um total de 117 pacientes (57 ± 11 anos, 61% sexo masculino) foram avaliados. A taxa de filtração glomerular foi 36 ± 17 mL/min, 96% dos pacientes eram hipertensos, 23% diabéticos e 27% obesos. Calcificação arterial coronariana esteve presente em 48% dos pacientes, sendo mais prevalente naqueles em estágios mais avançados da DRC (p=0,02). A espessura mediointimal (EMI) foi 0,6 mm (0,4 -­? 0,7mm). Comparado aos pacientes com EMI < 0,6mm, aqueles com EMI ? 0,6 mm eram mais velhos (p=0,001), apresentavam maior prevalência do sexo masculino (p=0,001), menor taxa de filtração glomerular (p=0,01) e maior proporção de pacientes com calcificação coronariana (p=0,001). Não foi observada relação entre a EMI e a ocorrência de evento cardiovascular ou óbito. Conclusão: A espessura mediointimal em pacientes nos estágios iniciais da DRC se associou a calcificação coronariana, mas não à ocorrência de eventos cardiovasculares e óbito, em um seguimento de 24 meses.
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    Estudo das causas múltiplas de morte na artrite reumatoide
    (Universidade Federal de São Paulo (UNIFESP), 2014-09-25) Pinheiro, Frederico Augusto Gurgel [UNIFESP]; Sato, Emilia Inoue Sato [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: Avaliar as taxas de mortalidade e as causas múltiplas de morte vinculadas à AR no Estado de São Paulo no período de 1996 a 2010. Material e Métodos: Os dados sobre a mortalidade foram fornecidos pela Fundação SEADE sendo selecionadas as declarações de óbito (DO) que contivessem o termo AR em qualquer linha do certificado. Foram selecionados 3.955 DO com menção de AR, sendo avaliadas as taxas de mortalidade por milhão de habitantes. Em relação às causas de morte, foram analisadas as DO com idade de morte acima de 19 anos, sendo descrito um total de 3.938 DO, sendo 1.091 com AR descrita como causa básica (CB) e 2.847 como causa não básica de morte (CNB). Realizou-se análises em relação ao gênero, idade, comparações entre subperíodos 1996 a 2000 e 2006 a 2010, e a razão entre óbitos observados/esperados (razão O/E). P<0,05 foram considerados significantes. Resultados: As taxas de mortalidade padronizadas permaneceram estáveis no período. Dentre as DO, 923 eram do sexo masculino e 3.015 do feminino, com uma razão M:F de 1:3,26. A média de idade de morte tendo AR como CB e CNB foi de 67,12±13,3 e 67,92±13 anos, respectivamente. As principais CNB quando AR como CB foram pneumonia (38,8%), sepse (29,7%), doença intersticial pulmonar (10,9%) e insuficiência cardíaca (IC) (9,1%). Quanto aos subperíodos, observou-se aumento dos casos de doenças infecciosas (pneumonia e sepse) e redução de IC. As CB mais frequentes quando AR esteve relatada como CNB foram relacionadas ao sistema circulatório (35,1%) e respiratório (21,8%). A razão O/E esteve aumentada para sepse, micoses profundas, síndrome de Cushing, doença pulmonar obstrutiva crônica, pneumonia, úlcera de decúbito, artrite piogênica e insuficiência renal. Nos óbitos com idade ≥ 50 anos, a média de idade foi crescente ao longo dos anos para a população geral (p<0,001 e R=0,993), enquanto que, de forma inesperada, nas DO com menção de AR, a curva foi decrescente (p<0,001 e R=-0,795). Conclusão: A doença cardiovascular permanece como importante causa de óbito na AR, justificando o controle rigoroso dos seus fatores de risco. Pacientes com AR têm apresentado aumento no número de relatos de doenças infecciosas,sugerindo a possibilidade de nexo causal com a intensificação do uso de terapia imunodepressora, conforme últimas diretrizes terapêuticas.
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    Estudo prospectivo de 2151 pacientes com doença renal crônica em tratamento conservador com abordagem multidisciplinar no Vale do Paraíba, SP
    (Sociedade Brasileira de Nefrologia, 2012-09-01) Luciano, Eduardo de Paiva; Luconi, Paulo Sérgio [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]; Melaragno, Claudio Santiago [UNIFESP]; Abreu, Patricia Ferreira [UNIFESP]; Reis, Sandra Ferreira Stanisck; Furtado, Rejane Maria Spindola; Ruivo, Gilson Fernandes; Centro Estadual para Tratamento de Doenças Renais do Vale do Paraíba; Universidade Federal de São Paulo (UNIFESP); Universidade de Taubaté
    INTRODUCTION: Chronic Kidney Disease (CKD) is common, severe and treatable. Its detection involves low cost tests. AIM: To evaluate the effect of a multidisciplinary (nephrologist, social worker, nurse, nutritionist, and psychologist) intervention comparing clinical and laboratory parameters in patients with CKD. METHODS: A prospective study with 2,151 patients attended at the State Center for Kidney Diseases of the Vale do Paraiba, São Paulo, from February 2008 to March 2011. The kidney function was measured using albuminuria and estimated glomerular filtration rate (eGRF) using the MDRD formula The clinical outcomes were the occurrence of cardiovascular disease (CAD), hospitalization episodes, need of renal replacement therapy (RRT) and death. RESULTS: Participants had a mean (range) age of 62 years (14-101), a mean follow-up of 546 days (90-1540) and the majority was in the stage 3 of CKD (59%). The most common primary diagnoses were hypertension (41.2%) and diabetes (32.4%). Mean blood pressure values at the beginning and at the end of treatment were 143 ± 26 mmHg x 87 ± 14 mmHg and 123 ± 16 mmHg x 79 ± 9 mmHg, respectively (p < 0.001); the eGRF decreased from 58.5 ± 31 ml/min. to 56.3 ± 23 ml/min (p < 0.01). Mean value of proteinuria decreased from 1.04 ± 1.44 g/day to 0.61 ± 1.12 g/day, p < 0.001, and the fasting glicemia decreased from 137 ± 73 mg/dl to 116 ± 42 mg/dl. One hundred and twenty-two patients (5.7%) had a CAD episode, the hospitalization rate was 6.6% (n = 143 patients), 7.3% patients died (n = 156), and 1.1% (n = 23) patients needed to start RRT. The risk of cardiovascular events, hospitalization, or death was inversely related to eGRF, and the rates of these events were low compared with the international literature. CONCLUSION: The multidisciplinary care with well defined targets is effective for the preservation of renal function and reduction in morbidity and mortality of CKD patients.
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    Fatores associados à sintomatologia depressiva numa coorte urbana de idosos
    (Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro, 2009-01-01) Lima, Márcio Tomita Da Rocha [UNIFESP]; Silva, Rebeca de Souza e [UNIFESP]; Ramos, Luiz Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION: The process of population aging in Brazil has been fast and intense, increasing the prevalence of chronic diseases and psychological and mental problems, mainly depression, which is associated with functional losses of the aged one. OBJECTIVE: To analyse the association between depressive symptomatology and other indicators of functional capacity, and with mortality after 15 years of follow-up, in an urban cohort of elderly. METHODS: 1667 aged (> 65 years-old) residents in Clementino Village in São Paulo city were studied through a multidimensional evaluation of the functional capacity, as well as the death certificate of the deaths occurred between 1991 (beginning of the study) and April of 2006. In univaried analysis we calculated odds ratio and its significance statistics was evaluated by the reliable interval (95%). The logistic regression was used in the multiple analysis. RESULTS: 21,1% of the elderly were depressed in 1991. In univaried analysis the highest ratios of depressed people were found in the feminine sex, aged older than 80 years-old, illiterates, widowers or bachelors, high level of physical dependence, cognitive deficit, users of more medicines and among those who died in the period of 15 years. In multivaried analysis, controlling by sex and age, physical dependence and the users of more medicines are associated to depression. CONCLUSIONS: The worse levels of disability answer, by an expressive way, to the occurrence of depressive symptomatology between the aged ones.
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    Incidência de antigenemia positiva para citomegalovírus em pacientes com doenças reumáticas autoimunes: um estudo retrospectivo de três anos em ambiente hospitalar
    (Universidade Federal de São Paulo (UNIFESP), 2015-09-30) Santos, Rebeka Paulo [UNIFESP]; Pinheiro, Marcelo de Medeiros Pinheiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: Determinar a incidência de antigenemia positiva para CMV e descrever o perfil clínico e laboratorial de pacientes com doenças reumáticas autoimunes (DRAI) internados em um hospital terciário da cidade de São Paulo/SP, bem como os locais de acometimento da infecção viral e identificar os principais fatores de risco para o óbito. Pacientes e Métodos: Foram incluídos nesse estudo retrospectivo todos os pacientes internados em um hospital terciário da cidade de São Paulo/SP, de 01 de janeiro de 2011 a 31 de dezembro de 2014, com diagnóstico de DRAI e antigenemia positiva para o CMV. Foram documentados dados clínicos e laboratoriais, incluindo a evolução, comorbidades, terapêutica instituída e desfechos de cada paciente. A infecção pelo CMV foi definida pela antigenemia (Ag) positiva para, pelo menos, uma célula. Resultados: Um total de 443 pacientes com DRAI foram internados no período do estudo. A Ag para CMV foi solicitada em 70 deles, sendo positiva em 24 (34,3%), com incidência de Ag positiva para CMV de 4,97% (IC 95% 3,1%-7,4%). O lúpus eritematoso sistêmico (LES) (59%), sobretudo o de início recente (53,8% com menos de 12 meses de doença), seguido pelas vasculites ANCA associadas (18,2%) e artrite reumatoide (9%) foram as doenças que mais se associaram com a presença de Ag positiva para o CMV. No momento da infecção, os pacientes com LES apresentavam atividade de doença de moderada a grave, com elevada frequência do anticorpo anti-dsDNA positivo (69,2%) e consumo de complemento (61,5%), além de estarem em uso de elevadas doses de glicocorticoesteroides e outros imunossupressores. Os principais sítios de envolvimento pelo CMV foram pulmão (45,5%), sistema hematopoiético (citopenias) (40,9%) e trato gastrointestinal (27,3%). Quinze (68,2%) pacientes foram tratados com ganciclovir e, de modo interessante, aqueles tratados apresentaram tendência a maior número de núcleos positivos na Ag do que aqueles não tratados durante a evolução [16 (1-500) vs. 1 (1-4) p=0,05]. A mortalidade foi de 45,5%, mas sem diferença estatística quanto à idade, média dos números de núcleos positivos, sítio de acometimento viral, tempo de sintomas até a solicitação da primeira antigenemia, realização de pulsoterapia nos últimos seis meses e uso de ganciclovir entre pacientes que sobreviveram ou foram a óbito. Houve tendência a maior dose de corticosteroide oral (107±55,4 vs. 71,7±46,3; p=0,069) e a menor número absoluto de linfócitos no sangue periférico dos pacientes que foram a óbito (309±368,2/?l vs. 821±692,9/?l; p=0,059). Na análise univariada, o maior tempo de internação se associou a menor chance de morte [OR 0,957 (0,915-0,999); p=0,048)]. Conclusão: Nossos dados mostraram elevada incidência de Ag para o CMV em pacientes com DRAI em ambiente hospitalar, particularmente naqueles com LES e associação com maior gravidade da doença e maior mortalidade. Assim, a possibilidade de CMV deve ser incluída no diagnóstico diferencial de causas de infecção em pacientes com DRAI.
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    Indicação e composição de nutrição parenteral em hospital terciário
    (Universidade Federal de São Paulo (UNIFESP), 2013-02-27) Gomes, Daniela Franca [UNIFESP]; Oliveira, Fernanda Luisa Ceragioli Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introdução: A terapia nutricional parenteral está indicada na impossibilidade de uso do trato gastrointestinal ou quando oferta calórica por via enteral for insuficiente. A determinação da necessidade energética total administrada via parenteral deve levar em consideração a doença de base, o grau de estresse e o diagnóstico nutricional. A administração de oferta calórica insuficiente ou excessiva pode ter impacto na morbimortalidade do paciente recebendo nutrição parenteral. Objetivo- Avaliar o impacto da oferta calórica na mortalidade de pacientes em terapia nutricional parenteral.Método- Estudo clínico retrospectivo em pacientes adultos internados em hospital universitário de nível terciário, avaliando o desfecho clínico mortalidade e a adequação de oferta calórica nas prescrições de nutrição parenteral, sendo considerado como adequado receber de 20 a 25 Kcal/kg nos pacientes internados em unidade de terapia intensiva e de 20 a 35 Kcal/kg, em enfermaria. Resultados- A mortalidade dos pacientes estudados foi de 59,1% e foi analisada de acordo com o estado nutricional. Proporcionalmente foi maior nos pacientes desnutridos (p=0,015). Os pacientes desnutridos receberam, em média, 60,3% dos dias valor calórico acima do recomendado, enquanto que os eutróficos e os sobrepesos receberam 52,1% e 37,1%, respectivamente. Nenhum paciente obeso recebeu valor calórico acima do recomendado. Pacientes desnutridos receberam significativa oferta calórica maior que os pacientes eutróficos (p = 0,051). Observou-se maior percentual de mediana nos pacientes eutróficos que foram a óbito (p = 0,007). Nos pacientes desnutridos, não se obteve diferença significativa entre as variáveis estudadas (p= 0,613). Conclusão- A oferta calórica acima da recomendada por este estudo pode ser considerada como fator de risco isolado para aumento da mortalidade, porém ela não deve ser analisada de maneira isolada, pois pode ser influenciada por outros fatores como o estado nutricional do paciente.
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    Mortality in children with severe epilepsy: 10 years of follow-up
    (Academia Brasileira de Neurologia - ABNEURO, 2011-10-01) Terra, Vera Cristina; Scorza, Fulvio Alexandre [UNIFESP]; Arida, Ricardo Mario [UNIFESP]; Fernandes, Regina Maria França; Wichert-Ana, Lauro; Machado, Helio Rubens; Sakamoto, Américo Ceiki [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    Epilepsy is the main neurological condition in children and adolescents. Unfortunately patients with medical refractory epilepsy are more susceptible for clinical complications and death. We report a prospectively evaluated cohort of children followed for approximately 10 years. Fifty-three of 1012 patients died. Forty-two patients died due to epilepsy or its clinical complications and the main causes of death were pneumonia (in 16 cases), sepses (in 9 patients), status epilepticus (in 8 patients). In 11 patients cause of death was sudden unexpected death in epilepsy (SUDEP). Mental retardation was significantly more frequent in patients who did not die from SUDEP. SUDEP may be a significant condition associated with mortality in children and adolescents with epilepsy.
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    Mortality rates due to amyotrophic lateral sclerosis in São Paulo City from 2002 to 2006
    (Academia Brasileira de Neurologia - ABNEURO, 2011-12-01) Matos, Sheila Evangelista de [UNIFESP]; Conde, Mônica Tilli Reis Pessoa [UNIFESP]; Fávero, Francis Meire [UNIFESP]; Taniguchi, Mauro; Quadros, Abrahão Augusto Juviniano [UNIFESP]; Fontes, Sissy Veloso [UNIFESP]; Oliveira, Acary Souza Bulle [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Secretary of Health Program for the Improvement of Mortality Information
    OBJECTIVE: To describe the mortality rates of amyotrophic lateral sclerosis (ALS) in the city of São Paulo as a function of demographics, year, and region. METHOD: This was a retrospective descriptive study. Information was obtained from death certificates registered at the Program for the Improvement of Mortality Information, Municipal Health Department (PRO-AIM/SMS), coded as G12.2 according to International Classification of Diseases (ICD-10), from 2002 to 2006. RESULTS: Over the studied time, were found 326 deaths (51.6% women, overall mean age of 64.1 years). Highest deaths percentages happened in those from 60 to 69 and 70 to 79 years and in white individuals. ALS mortality rates ranged 0.44/100,000 in 2002 and 0.76/100,000 in 2006. No significant changes overtime in administrative districts were found. CONCLUSION: ALS mortality rates in São Paulo were lower in comparison to other countries, however any risk factor in our environment, lifestyle or genetic characteristics were found.
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    Neuropatia autonômica cardiovascular diabética: fatores de risco, impacto clínico e diagnóstico precoce
    (Sociedade Brasileira de Cardiologia - SBC, 2008-04-01) Rolim, Luiz Clemente de Souza Pereira [UNIFESP]; Sá, João Roberto de [UNIFESP]; Chacra, Antonio Roberto [UNIFESP]; Dib, Sergio Atala [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Cardiovascular autonomic neuropathy (CAN) is one of the most clinically significant complications of diabetes mellitus (DM), but one of the least frequently diagnosed. In this review, we discuss the major risk factors for the development and progression of CAN in patients with DM, the natural history of autonomic neuropathy and its impact on cardiovascular disease in DM, as well as the tests for the early diagnosis and staging of CAN in the clinical practice. The bibliographic research was based on two databases: Medline and Tripdatabase, with the following descriptors: diabetic cardiovascular autonomic neuropathy and cardiovascular autonomic neuropathy and diabetes. We selected English and German articles, written between 1998 and 2007. In its initial stages (early and intermediate), CAN may be diagnosed and reversed. However, in advanced cases (severe stage), the only treatment that remains is a symptomatic one. CAN is associated with higher cardiovascular morbidity and mortality rates and poor quality of life in diabetic individuals.
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    Prescrição de terapias baseadas em evidências para pacientes de alto risco cardiovascular: estudo REACT
    (Sociedade Brasileira de Cardiologia - SBC, 2013-03-01) Berwanger, Otávio [UNIFESP]; Mattos, Luiz Alberto Piva e; Martin, José Fernando Vilela; Lopes, Renato Delascio [UNIFESP]; Figueiredo, Estevão Lanna; Magnoni, Daniel; Precoma, Dalton Bertolim; Machado, Carlos Alberto; Guimarães, Jorge Ilha; Andrade, Jadelson Pinheiro de; Hospital do Coração; Sociedade Brasileira de Cardiologia; Instituto Dante Pazzanese de Cardiologia; Rede D'Or Unidades de Hemodinâmica e Intervenção Cardiovascular; Hospital de Base; Universidade Federal de São Paulo (UNIFESP); Hospital Lifecenter; Sociedade Hospitalar Angelina Caron; Ambulatório Médico de Especialidades Maria Zélia; Hospital da Bahia
    BACKGROUND: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient. OBJECTIVE: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies. METHODS: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed. RESULTS: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease. CONCLUSION: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.
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    Sarcopenia, em pacientes com doença renal crônica: prevalência e associação com mortalidade
    (Universidade Federal de São Paulo (UNIFESP), 2014-09-30) Pereira, Raissa Antunes [UNIFESP]; Kaneko, Maria Ayako Kamimura Kaneko [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: In chronic kidney disease (CKD) multiple metabolic and nutritional abnormalities contribute to impairment of skeletal muscle mass and function thus predisposing patients to the condition of sarcopenia. Herein, we investigated the prevalence and mortality predictive power of sarcopenia, defined by three different methods, in non-dialysis-dependent (NDD) CKD patients. Methods: We evaluated 287 NDD-CKD patients stage 3-5 [59.9±10.5 years; 62% men; 49% diabetics; glomerular filtration rate (GFR) 25.0±15.8 ml/min/1.73m2]. Sarcopenia was defined as reduced muscle function assessed by handgrip strength (<30th percentile of a population-based reference adjusted for sex and age) plus diminished muscle mass assessed by three different methods: A) midarm muscle circumference <90% of reference value; B) muscle wasting by subjective global assessment; and C) reduced skeletal muscle mass index (<10.76kg/m² men; <6.76kg/m² women) estimated by bioelectrical impedance analysis (BIA). Patients were followed for up to 40 months for all-cause mortality and there was no loss of follow-up. Results: The prevalence of sarcopenia was 9.8% (A), 9.4% (B) and 5.9% (C). The kappa agreement between the methods were 0.69 (A vs B), 0.49 (A vs C) and 0.46 (B vs C). During follow-up, 51 patients (18%) died, and the frequency of sarcopenia was significantly higher among non-survivors.In crude Cox analysis, sarcopenia diagnosed by the three methods was associated with a higher hazard for mortality; however, only sarcopenia diagnosed by method C remained as a predictor of mortality after multivariate adjustment. Conclusions: The prevalence of sarcopenia in CKD patients on conservative therapy varies according to the method applied. Sarcopenia defined as reduced handgrip strength and low skeletal muscle mass index estimated by BIA was an independent predictor of mortality in these patients.