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Search Results: 1 - 10 of 230392 matches for " Ivan Carlos Ferreira;Poli-de-Figueiredo "
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Dilata??o mediada por fluxo no diagnóstico diferencial da síndrome de pré-eclampsia
Cunha Filho, Edson Vieira da;Mohr, Carolina;Acauan Filho, Breno José;Gadonski, Giovani;Paula, Leticia Germany;Antonello, Ivan Carlos Ferreira;Poli-de-Figueiredo, Carlos Eduardo;Pinheiro-da-Costa, Bartira Ercilia;
Arquivos Brasileiros de Cardiologia , 2010, DOI: 10.1590/S0066-782X2010000200009
Abstract: background: the preeclampsia syndrome is associated with endothelial dysfunction and the differential diagnosis between pure preeclampsia (pe) and superimposed preeclampsia (spe) can be only be attained 12 weeks after delivery. objective: to compare the assessment of endothelial function through flow-mediated dilatation in pregnant women with pure preeclampsia and superimposed preeclampsia. methods: the flow-mediated dilatation of the brachial artery was carried out according to the recommendations of the international brachial artery reactivity task force in pregnant women with preeclampsia syndrome. pe (n=14) and spe (n=13) were diagnosed in the postpartum period according to the definitions of the national high blood pressure education program working group on high blood pressure in pregnancy. results: the median of the flow-mediated dilatation (fmd) in spe (6.0%; 1.9-10.3) was decreased in comparison with the pe (13.6%;4.4-17.1), an apparently relevant difference , but not statistically significant (p = 0.08). the fmd < 10% was detected in 30.8% of the pe cases and in 69.2% of the spe cases (p = 0.057). significant differences could not be detected in the morphology of the uterine arteries between the pe and spe cases through the doppler spectrum. conclusion: the fmd of the brachial artery of patients with preeclampsia syndrome was not capable of differentiating between pe and spe. however, the data suggest that spe is associated with worse endothelial function i comparison to pe.
Validade preditiva de instrumento para identifica??o do idoso em risco de hospitaliza??o
Dutra,Michel Machado; Moriguchi,Emilio Hideyuki; Lampert,Melissa Agostini; Poli-de-Figueiredo,Carlos Eduardo;
Revista de Saúde Pública , 2011, DOI: 10.1590/S0034-89102011000100012
Abstract: objective: to test the predictive validity of the probability of repeated hospital admissions questionnaire among older adults. methods: a population-based cohort study with a 6-month follow-up was implemented with 515 non-institutionalized older people (>60 years) cared for by the family health strategy in the city of progresso, southern brazil, in 2005. participants answered eight objective questions that were entered in a logistic regression model to estimate the risk of future hospital admission, by risk strata. survival analysis and the receiver operating characteristics curve were utilized to assess instrument validity. results: among participants, 56.1% were women and 10.1% were hospitalized. the high-risk group had a 6.5 times greater frequency of hospitalization in comparison to the low-risk category. conclusions: the instrument is effective in assessing the risk of hospitalization among older adults attended by the family health program of the national unified health care system.
Hipertens o em situa es especiais
Carlos E Poli-de-Figueiredo,Agostinho Tavares,Elizabete Viana de Freitas,Emmanuel de Almeida Burdmann
Jornal Brasileiro de Nefrologia , 2010, DOI: 10.1590/s0101-28002010000500010
Abstract:
Is depression a risk factor for mortality in chronic hemodialysis patients?
Diefenthaeler, Edgar C;Wagner, Mário Bernardes;Poli-de-Figueiredo, Carlos Eduardo;Zimmermann, Paulo R;Saitovitch, David;
Revista Brasileira de Psiquiatria , 2008, DOI: 10.1590/S1516-44462008000200003
Abstract: objective: the present study was conducted to assess the association between depressive symptomatology and mortality in chronic hemodialysis. method: a cohort of 40 patients was followed for a median period of 10.5 months. the beck depression inventory was used to classify patients as exposed to depression (beck depression inventory score > 14) or not (beck depression inventory < 14). kaplan-meier survival curves were used to compare the mortality rate between the two groups. the effects of potential confounding factors were adjusted using cox proportional hazards model. results: after 24 months of follow-up, survival rates were 39% for exposed and 95% for non-exposed patients (p = 0.029). the cox proportional hazards model showed results similar to those of the bivariate analysis, indicating that depressive symptomatology tended to be associated with mortality (hr = 6.5, 95%ci: 0.8-55.6; p = 0.085). other study variables, including age, concurrent systemic diseases, and biochemical markers, were not significantly associated with mortality. exposed patients remained on dialysis longer and received kidney transplants less frequently (9% vs. 50% for non-exposed patients). when kidney transplantation was included in the cox regression model, the hazard ratio of mortality for exposed as compared to non-exposed patients lost statistical significance (hr = 4.5; 95%ci: 0.5-40.0; p = 0.17). conclusions: our study suggests that the presence of depressive symptoms may act as an independent risk factor for mortality in chronic hemodialysis patients. however, this finding needs further investigations.
Baixa resposta da vacina??o intradérmica contra hepatite B em pacientes incidentes em hemodiálise
Medeiros, Regina H.;Figueiredo, Ana Elizabeth PL;Poli-de-Figueiredo, Carlos Eduardo;d'Avila, Domingos Otávio;de los Santos, Carlos Abaeté;
Jornal Brasileiro de Nefrologia , 2011, DOI: 10.1590/S0101-28002011000100006
Abstract: introduction: hepatitis b (hb) may progress to cirrhosis and liver carcinoma. its prevalence is estimated at 3.2 % in hemodialysis (hd) patients. hb vaccine when applied intramuscularly (im) in end-stage renal disease patients often does not induce appropriate antibody titers. however, there has been suggestion for intradermal (id) to be a more effective inoculation method. objective: to compare the immune response to im or id vaccine administration on hd patients. patients and methods: thirty one incident hd patients were randomly assigned alternately to im or id vaccine inoculation. vaccine doses were applied at three monthly intervals, with patients being followed-up for six months. sixteen patients were assigned to im (40 mg/dose) and 15 to id (4 mg/dose) vaccine administration. hb-virus surface antibody titer, hematimetric parameters, serum urea level and kt/v were monthly evaluated. c-reactive protein, parathormone, ferritin, aminotransferases and albumin serum levels were evaluated before and at the sixth month of the initial inoculation. results: urea levels were significantly higher in the id group (p(1) = 0.031); ferritin levels were higher in the im (p(2) = 0.037) and c-reactive protein levels tended to be higher in the id group. an interim evaluation by the safety monitoring committee recommended discontinuing the study as im vaccination had converted 62.5% of the exposed subjects, while id inoculation converted only 13.3%. conclusion: as performed, id applied vaccine was inferior to the im inoculation. such result may depend on the inoculated doses or some other factor, such as inflammation.
Association of Proteinuria Threshold in Pre-Eclampsia with Maternal and Perinatal Outcomes: A Nested Case Control Cohort of High Risk Women
Kate Bramham, Carlos E. Poli-de-Figueiredo, Paul T. Seed, Annette L. Briley, Lucilla Poston, Andrew H. Shennan, Lucy C. Chappell
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0076083
Abstract: Objectives To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499mg and ≥500mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension. Design Secondary analysis of the Vitamins in Pre-Eclampsia Trial. Setting 25 UK hospitals in ten geographical areas. Population 946 women with pre-existing risk factors for pre-eclampsia. Methods Women with pre-eclampsia and proteinuria 300-499mg/24h (PE300, referent group, n=60) or proteinuria ≥500 mg/24h (PE500, n=161) were compared with two groups of non-proteinuric women with chronic hypertension (CHT, n=615) or gestational hypertension (GH, n=110). Main Outcome Measures Maternal: progression to severe hypertension. Perinatal: small for gestational age (SGA) <5th centile, gestation at delivery. Results Severe hypertension occurred more frequently in PE500 (35%) and PE300 (27%) than CHT (5.9%; P≤0.01) and GH (10%; p≤0.001). Gestation at delivery was earlier in PE500 (33.2w) than PE300 (37.3w; P≤0.001), and later in CHT (38.3w; P≤0.05) and GH (39.1w; P≤0.001). SGA infants were more frequent in PE300 (32%) than in CHT (13.3%; P≤0.001) and GH (16.5%; P≤0.05). Women in PE500 were more likely to have a caesarean section than PE300 (78% vs. 48%; P≤0.001), and to receive magnesium sulphate (17% vs. 1.7%, P≤0.05). Conclusion Women with PE300 have complication rates above those of women managed as out-patients (GH and CHT), meriting closer surveillance and confirming 300 mg/d as an appropriate threshold for determining in-patient management. Adverse perinatal outcomes are higher still in women with PE500.
Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial
Raquel Wanzuita, Luiz F Poli-de-Figueiredo, Felipe Pfuetzenreiter, Alexandre Cavalcanti, Glauco Westphal
Critical Care , 2012, DOI: 10.1186/cc11250
Abstract: A double-blind randomized controlled trial was conducted in the adult intensive care units (ICUs) of four general hospitals in Brazil. The 75 patients, who met the criteria for weaning from MV and had been using fentanyl for more than five consecutive days, were randomized to the methadone (MG) or control group (CG). Within the first 24 hours after study enrollment, both groups received 80% of the original dose of fentanyl, the MG received enteral methadone and the CG received an enteral placebo. After the first 24 hours, the MG received an intravenous (IV) saline solution (placebo), while the CG received IV fentanyl. For both groups, the IV solution was reduced by 20% every 24 hours. The groups were compared by evaluating the MV weaning time and the duration of MV, as well as the ICU stay and the hospital stay.Of the 75 patients randomized, seven were excluded and 68 were analyzed: 37 from the MG and 31 from the CG. There was a higher probability of early extubation in the MG, but the difference was not significant (hazard ratio: 1.52 (95% confidence interval (CI) 0.87 to 2.64; P = 0.11). The probability of successful weaning by the fifth day was significantly higher in the MG (hazard ratio: 2.64 (95% CI: 1.22 to 5.69; P < 0.02). Among the 54 patients who were successfully weaned (29 from the MG and 25 from the CG), the MV weaning time was significantly lower in the MG (hazard ratio: 2.06; 95% CI 1.17 to 3.63; P < 0.004).The introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients resulted in a decrease in the weaning time from MV.Critically ill patients are often subjected to procedures that cause pain and anxiety [1,2]. These procedures may also result in the increased activity of endogenous catecholamines, higher global and myocardial oxygen consumption, hypercoagulability and immunosuppression [3]. The use of potent analgesics, such as opioids, provides comfort and facilitates adaptation to mechanical vent
Low hematocrit impairs gastric mucosal CO2 removal during experimental severe normovolemic hemodilution
Perin, Daniel;Cruz Jr, Ruy J.;Silva, Eliezer;Poli-de-Figueiredo, Luiz Francisco;
Clinics , 2006, DOI: 10.1590/S1807-59322006000500012
Abstract: objective: the net effects of acute normovolemic hemodilution with different hemoglobin levels on splanchnic perfusion have not been elucidated. the hypothesis that during moderate and severe normovolemic hemodilution, systemic and splanchnic hemodynamic parameters, oxygen-derived variables, and biochemical markers of anaerobic metabolism do not reflect the adequacy of gastric mucosa, was tested in this study. methods: twenty one anesthetized mongrel dogs (16 ± 1 kg) were randomized to controls (ct, n = 7, no hemodilution), moderate hemodilution (hematocrit 2 5% ± 3%, n = 7) or severe hemodilution (severe hemodilution, hematocrit 15% ± 3%, n = 7), through an isovolemic exchange of whole blood and 6% hydroxyethyl starch, at a 20 ml/min rate, to the target hematocrit. the animals were followed for 120 min after hemodilution. cardiac output (co, l/min), portal vein blood flow (pvf, ml/min), portal vein-arterial and gastric mucosa-arterial co2 gradients (pv-artco2 and pco2 gap, mm hg, respectively) were measured throughout the experiment. results: exchange blood volumes were 33.9 ± 3.3 and 61.5 ± 5.8 ml/kg for moderate hemodilution and severe hemodilution, respectively. arterial pressure and systemic and regional lactate levels remained stable in all groups. there were initial increases in cardiac output and portal vein blood flow in both moderate hemodilution and severe hemodilution; systemic and regional oxygen consumption remained stable largely due to increases in oxygen extraction rate. there was a significant increase in the pco2-gap value only in severe hemodilution animals. conclusion: global and regional hemodynamic stability were maintained after moderate and severe hemodilution. however, a very low hematocrit induced gastric mucosal acidosis, suggesting that gastric mucosal co2 monitoring may be useful during major surgery or following trauma.
Measurement of S-100B for risk classification of victims sustaining minor head injury: first pilot study in Brazil
Poli-de-Figueiredo Luiz F,Biberthaler Peter,Simao Filho Charles,Hauser Christopher
Clinics , 2006,
Abstract: BACKGROUND: Release of the neuronal protein S-100B into the circulation has been suggested as a specific indication of neuronal damage. The hypothesis that S-100B is a useful and cost-effective screening tool for the management of minor head injuries was tested. METHODS: Fifty consecutive patients sustaining isolated minor head injury were prospectively evaluated in the emergency room of a Brazilian hospital by routine cranial computed tomography scan. Venous blood samples (processed to serum) were assssayed for S-100B using a newly developed immunoassay test kit. Twenty-one normal healthy individuals served as negative controls. Data are presented as median and 25 to 75 percentiles. RESULTS: Patients reached the emergency room an average of 45 minutes (range: 30-62 minutes) after minor head injury. Six of 50 patients (12%) showed relevant posttraumatic lesions in the initial cranial computed tomography scan and were counted as positive. The median systemic concentration of S-100B in those patients was 0.75 μg/L (range: 0.66-6.5 μg/L), which was significantly different (U-test, P < .05) from the median concentration of 0.26 μg/L (range: 0.12-0.65 μg/L), of patients without posttraumatic lesions as counted by the cranial computed tomography. A sensitivity of 100%, a specificity of 20%, a positive predictive value of 15%, and a negative predictive value of 100% was calculated for the detection of patients suffering from intracranial lesions. CONCLUSIONS: Protein S-100B had a very high sensitivity and negative predictive value and could have an important role in ruling out the need for cranial computed tomography scan after minor head injury. This appears to be of substantial clinical relevance, particularly in countries where trauma incidence is high and medical resources are limited, such as in Brazil.
Avalia??o inicial dos gradientes sistêmicos e regionais da pCO2 como marcadores de hipoperfus?o mesentérica
Cruz Jr., Ruy J.;Correia, Cristiano J.;Poli-de-Figueiredo, Luiz F.;Rocha-e-Silva, Mauricio;
Arquivos de Gastroenterologia , 2006, DOI: 10.1590/S0004-28032006000100015
Abstract: background: mesenteric ischemia is a life-threatening emergency with a mortality rates still ranging between 60% and 100%. aim: to evaluate the systemic and regional pco2 gradients changes induced by mesenteric ischemia-reperfusion injury. in addition, we sought to determine if other systemic marker of splanchnic hypoperfusion could detect the initial changes in intestinal mucosal microcirculation after superior mesenteric artery occlusion. methods: seven pentobarbital anesthetized mongrel dogs (20.6 ± 1.1 kg) were subjected to superior mesenteric artery occlusion for 45 minutes, and followed for an additional 120 minutes. systemic hemodynamic was evaluated through a swan-ganz and arterial catheters, while gastrointestinal tract perfusion by superior mesenteric vein and jejunal serosal blood flows (ultrasonic flowprobe). intestinal oxygen delivery, extraction and consumption (do2intest, ero2intest and vo2intest, respectively), intramucosal ph (gas tonometry), and mesenteric-arterial and mucosal arterial pco2 gradients (dvm-apco2 and dt-apco2, respectively) were calculated. results: superior mesenteric artery occlusion was not associated with significant changes on systemic hemodynamics parameters. a significant increase of dvm-apco2 (1.7 ± 0.5 to 5.7 ± 1.8 mm hg) and dt-apco2 (8.2 ± 4.8 to 48.7 ± 4.6 mm hg) were detected. during the reperfusion period a significant decrease on do2intest (67.7 ± 9.9 to 38.8 ± 5.3 ml/min) and a compensatory increase on ero2intest from 5.0 ± 1.1% to 12.4 ± 2.7% was observed. conclusion: we conclude that gas tonometry can detect the mesenteric blood flow disturbances sooner than other analyzed parameters. additionally, we demonstrated that changes on systemic or regional pco2 gradients are not able to detect the magnitude of intestinal mucosal blood flow reduction after mesenteric ischemia-reperfusion injury.
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