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2.
J. health med. sci. (Print) ; 6(1): 37-43, ene.-mar. 2020. ilus, tab
Article in Spanish | LILACS (Americas) | ID: biblio-1096714

ABSTRACT

El objetivo de este trabajo fue caracterizar epidemiológica y sociodemográficamente a las personas atendidas en la Unidad de Baja Visión y Rehabilitación Visual del Hospital Clínico de la Universidad de Chile. El método utilizado fue un estudio descriptivo, transversal y retrospectivo de los registros clínicos de las personas atendidas en la Unidad, entre marzo de 2015 a octubre de 2016. Para el análisis se utilizó el software MS Excel, calculando las frecuencias relativas y medidas de posición central y dispersión. En los resultados se observaron un mayor número de pacientes de sexo femenino (55,5%), y adultos mayores de 60 años o más (53,3%). El 73,3% de los pacientes pertenecieron al sistema de salud público y un 35,6% poseían menos de 8 años de estudio. El 80 % de las personas atendidas se encuentra en edad laboral, de éstos un 63,9% se encontraban laboralmente inactivos. Las enfermedades oftalmológicas con mayor frecuencia correspondieron a las enfermedades genéticas del ojo (22,2%) y la degeneración macular relacionada con la edad (17,8%). Un 57,8% de los pacientes presentó alguna patología sistémica asociada a baja visión. Sólo un 6,0% recibió rehabilitación visual anteriormente. Se concluyó que la mayor prevalencia de enfermedades oculares asociadas al envejecimiento como la degeneración macular relacionada con la edad y enfermedades genéticas del ojo, sumado a las características sociodemográficas y en particular a que un 94% de los pacientes no habían tenido acceso a rehabilitación visual, constituyen un perfil que desafía al desarrollo de medidas de salud pública que resguarden la prevención, acceso y rehabilitación, siendo la formación de equipos multidisciplinarios especialistas una necesidad imperiosa.


This work aimed to do a characterization, epidemiological and socio demographical, to the people attended in a Low Vision and Rehabilitation Unit from a Clinical Hospital of the Universidad de Chile. A descriptive, transversal and retrospective method was used for the clinical registers of the people attended in the Unit, between March 2015 to October 2016. For the analysis, a MS Excel software was used, calculating the relative and measured frequencies of central position and dispersion. In the results, a greater number of feminine patients (55. 5%) were observed, and seniors of 60 years or more (53.3%). 73.3% of the patients belonging to the Public Health Care System and 35.6% had less than 8 years of studies. The 80% of attended patients were in working age, from this 63,9% were unemployed. The ophthalmological diseases with more frequency belonged to eye genetic diseases (22.2%) and macular degeneration related to age (17.8%). 57.8% of the patients presented a systematic pathology associated with low vision. Just 6.0% received previous visual rehabilitation. We concluded that the greater prevalence of ocular diseases associated to aging such as macular degeneration related to age and eye genetic diseases added to the sociodemographic features and particularly a 94% of the patients did not have access to visual rehabilitation, represent a profile that challenges the development public health care measures that safeguard the prevention, access, and rehabilitation, being an imperative need the making of specialist multidisciplinary teams.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Vision, Low/rehabilitation , Vision, Low/epidemiology , Socioeconomic Factors , Vision Disorders/rehabilitation , Vision Disorders/epidemiology , Comorbidity , Chile/epidemiology , Diabetes Mellitus/epidemiology , Hypertension/epidemiology
3.
Rev. Hosp. Ital. B. Aires (2004) ; 39(4): 108-114, dic. 2019. ilus, tab
Article in Spanish | LILACS (Americas) | ID: biblio-1099618

ABSTRACT

En la Argentina no existen datos epidemiológicos sobre displasia fibromuscular. La realización de un registro nacional puede aportar información que conduzca a una actualización de los consensos y recomendaciones para un correcto diagnóstico, evaluación y tratamiento. El Registro Argentino de Displasia Fibromuscular (SAHARA-DF) inició su actividad de recopilación de datos en octubre de 2015. Al año 2019 se confirmaron 49 pacientes (44 mujeres, 38 hipertensos, edad 45,3 ± 17,2 años, 12 con presentación neurológica). Veintidós pacientes tuvieron lesiones vasculares en más de un sitio, a pesar del sesgo diagnóstico por falta de estudios complementarios en casi la mitad de los casos. El sitio afectado más frecuente fue el renovascular, seguido por el carotídeo y el ilíaco, y las lesiones multifocales fueron más frecuentes que las unifocales (35 versus 14, respectivamente). Se constató la presencia de aneurismas asociados en 13 casos y disección arterial en 4 casos. De las 22 angioplastias renales realizadas, 14 fueron con colocación de stent (endoprótesis). En este estudio preliminar de una población argentina se evidencia el carácter sistémico de la enfermedad y se plantea un llamado a actuar en cuanto a la necesidad de debatir el algoritmo diagnóstico y el método de tratamiento. (AU)


In Argentina there are no epidemiological data regarding fibromuscular dysplasia. Building a National Registry may provide information leading to updated consensus and recommendations for a correct diagnosis, assessment and treatment. Data gathering for the Argentine Registry of Fibromuscular Dysplasia (SAHARA-DF) was initiated in October 2015. By 2019, 49 patients were confirmed (44 women, 38 hypertensives, age 45.3 ± 17.2 years, 12 with a neurological presentation). Twenty-two patients had multi-site vascular lesions, in spite of a diagnosis bias due to lack of supporting studies in almost half of the cases. The renovascular site was the most affected, followed by the carotid and iliac sites, and multifocal lesions were more frequent than unifocal (35 versus 14, respectively). Associated aneurysms were found in 13 cases, and arterial dissection in 4. Twenty-two renal angioplasties were performed, 14 with stent placement. In this preliminary study of an Argentinian population, the systemic nature of the disease is evidenced, and a call for action arises regarding the need for discussing the diagnostic algorithm and treatment method. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Records/statistics & numerical data , Fibromuscular Dysplasia/diagnosis , Argentina/epidemiology , Algorithms , Bias , Sex Factors , Cross-Sectional Studies , Risk Factors , Age Factors , Angioplasty/methods , Anthropological Factors , Vascular System Injuries/diagnostic imaging , Fibromuscular Dysplasia/classification , Fibromuscular Dysplasia/etiology , Fibromuscular Dysplasia/therapy , Fibromuscular Dysplasia/epidemiology , Hypertension/epidemiology , Aneurysm, Dissecting/diagnostic imaging
5.
J. bras. nefrol ; 41(3): 400-411, July-Sept. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1040253

ABSTRACT

Abstract Hypertension (blood pressure > 140/90 mm Hg) is very common in patients undergoing regular dialysis, with a prevalence of 70-80%, and only the minority has adequate blood pressure (BP) control. In contrast to the unclear association of predialytic BP recordings with cardiovascular mortality, prospective studies showed that interdialytic BP, recorded as home BP or by ambulatory blood pressure monitoring in hemodialysis patients, associates more closely with mortality and cardiovascular events. Although BP is measured frequently in the dialysis treatment environment, aspects related to the measurement technique traditionally employed may be unsatisfactory. Several other tools are now available and being used in clinical trials and in clinical practice to evaluate and treat elevated BP in chronic kidney disease (CKD) patients. While we wait for the ongoing review of the CKD Blood Pressure KIDGO guidelines, there is no guideline for the dialysis population addressing this important issue. Thus, the objective of this review is to provide a critical analysis of the information available on the epidemiology, pathogenic mechanisms, and the main pillars involved in the management of blood pressure in stage 5-D CKD, based on current knowledge.


Resumo A hipertensão (pressão arterial > 140/90 mmHg) é muito comum em pacientes submetidos à diálise regular, com uma prevalência de 70-80%, e apenas a minoria tem controle adequado da pressão arterial (PA). Em contraste com a associação incerta entre de PA pré-dialítica com mortalidade cardiovascular, estudos prospectivos mostraram que a PA interdialítica, registrada como PA domiciliar ou pela monitorização ambulatorial da pressão arterial em pacientes em hemodiálise, está mais relacionada à mortalidade e eventos cardiovasculares. Embora a PA seja medida com frequência no ambiente de tratamento de diálise, aspectos relacionados à técnica de medição tradicionalmente empregada podem ser insatisfatórios. Várias outras ferramentas estão agora disponíveis, e estão sendo usadas em ensaios clínicos e na prática clínica para avaliar e tratar a PA elevada em pacientes com doença renal crônica (DRC). Enquanto esperamos pela revisão das diretrizes do KIDGO para a pressão sanguíneana DRC, não há nenhuma diretriz para a população em diálise abordando essa importante questão. Assim, o objetivo desta revisão é fornecer uma análise crítica das informações disponíveis sobre a epidemiologia, os mecanismos patogênicos e os principais pilares sustentadores do manejo da pressão arterial no estágio 5-D da DRC, com base no conhecimento atual.


Subject(s)
Humans , Peritoneal Dialysis , Hypertension/therapy , Hypertension/epidemiology , Prevalence , Risk Factors , Blood Pressure Monitoring, Ambulatory , Diet, Sodium-Restricted , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Hypertension/diagnosis , Hypertension/physiopathology , Antihypertensive Agents/therapeutic use
6.
Rev. medica electron ; 41(3): 698-707, mayo.-jun. 2019.
Article in Spanish | LILACS (Americas) | ID: biblio-1094077

ABSTRACT

RESUMEN El debate alrededor de las cifras de tensión arterial, y sobre todo las cifras a obtener mediante el tratamiento es en la actualidad un grave problema de salud. Se realizó una revisión sistemática en inglés y español de los principales artículos publicados en PubMed, Scielo y MEDLINE durante el periodo comprendido desde el año 2012 hasta 2018, acerca de la definición, evaluación y manejó de la tensión arterial. Todas las guías están de acuerdo en la toma de múltiples medidas de la tensión arterial para el diagnóstico, pero no para definir el control de la tensión, definir el control de la tensión arterial debe incluir una dimensión en el tiempo en un año por lo menos, y una proporción mínima de medidas donde debe pensar en la mitad de todas las medidas por lo menos, con medidas de tensión arterial tomadas por lo menos cada tres meses, por lo que sugerimos que un perfil anual de las cifras de tensión arterial debe ser considerado como un requisito mínimo para evaluar el control de la hipertensión arterial, este trabajo ha perfilado dos de los factores menos reconocidos: la necesidad de la intensificación del tratamiento después de la primera toma de tensión arterial por encima de las cifras deseadas, y el incremento de una nueva droga en vez de incrementar las dosis de las ya indicadas.


ABSTRACT The debate on the maintained arterial tension measure, and on the measure to obtain through the long term treatment, is currently a problem for the medical practitioner, due to the variation of arterial tension during the day at different hours because of the patients circadian cycle, and due to variations in different days according to the proper patient's situations or the environment around it, and the different seasons of the year. They make it difficult to know when arterial tension is within the parameters accepted as "controlled". The authors carried out a systematic review of documents published in PubMed, Scielo and MEDLINE in the period 2012-2018, both in English and Spanish, on the arterial tension definition, evaluation and management. The guidelines agree in taking arterial tension measures in different moments for the diagnosis, but not in defining tension control. Defining tension control should include a time dimension of at least a year, and a minimal proportion of measures within the parameters recognized as non-pathological or optimal on the basis of measures taken at least every three months. Therefore, the authors suggest that an annual profile of the arterial tension parameters should be considered as a minimal requirement to evaluate arterial hypertension control.


Subject(s)
Humans , Treatment Outcome , Practice Guidelines as Topic/standards , Symptom Assessment , Time-to-Treatment/organization & administration , Hypertension/diagnosis , Hypertension/etiology , Hypertension/prevention & control , Hypertension/drug therapy , Hypertension/epidemiology , Primary Health Care , Health Records, Personal
7.
J. bras. nefrol ; 41(2): 266-274, Apr.-June 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1012534

ABSTRACT

Abstract Refractory hypertension (RfH) is an extreme phenotype of resistant hypertension (RH), being considered an uncontrolled blood pressure besides the use of 5 or more antihypertensive medications, including a long-acting thiazide diuretic and a mineralocorticoid antagonist. RH is common, with 10-20% of the general hypertensives, and its associated with renin angiotensin aldosterone system hyperactivity and excess fluid retention. RfH comprises 5-8% of the RH and seems to be influenced by increased sympathetic activity. RH patients are older and more obese than general hypertensives. It is strongly associated with diabetes, obstructive sleep apnea, and hyperaldosteronism status. RfH is more frequent in women, younger patients and Afro-americans compared to RFs. Both are associated with increased albuminuria, left ventricular hypertrophy, chronic kidney diseases, stroke, and cardiovascular diseases. The magnitude of the white-coat effect seems to be higher among RH patients. Intensification of diuretic therapy is indicated in RH, while in RfH, therapy failure imposes new treatment alternatives such as the use of sympatholytic therapies. In conclusion, both RH and RfH constitute challenges in clinical practice and should be addressed as distinct clinical entities by trained professionals who are capable to identify comorbidities and provide specific, diversified, and individualized treatment.


Resumo A Hipertensão Arterial Refratária (HARf) representa um fenótipo extremo da hipertensão arterial resistente (HAR), sendo considerada a falência ao tratamento apesar do uso de 5 ou mais classes de anti-hipertensivos, incluindo um diurético tiazídico de longa ação e um antagonista mineralocorticoide. A HAR é comum (10-20%) entre os hipertensos em geral, sendo decorrente de hiperatividade do Sistema Renina Angiotensina Aldosterona e retenção hidrossalina. Aqueles com HARf correspondem a 5-8% dos resistentes e parecem sofrer maior influência catecolaminérgica. Os resistentes tendem a ter maior idade, ao sobrepeso e à obesidade. Comorbidades incluem diabetes, apneia obstrutiva do sono e status de hiperaldosteronismo. Refratários são afro-americanos em maior proporção, mais jovens e, predominantemente, mulheres. Ambos são fortemente associados à elevada albuminúria, HVE, doenças cardio e cerebrovasculares, além da doença renal crônica. O fenômeno do jaleco branco parece ser mais evidente nos resistentes. Quanto ao tratamento, a intensificação da terapia diurética está indicada nos resistentes, enquanto na HARf, a falência à terapia impôs novas alternativas de tratamento ("simpaticolíticas"). Em conclusão, tanto a HAR quanto a HARf constituem-se desafios na prática clínica e devem ser abordadas como entidades clínicas distintas por profissionais especialistas que identifiquem comorbidades e venham a prover um tratamento específico, diversificado e individualizado.


Subject(s)
Humans , Drug Resistance , Hypertension/drug therapy , Hypertension/epidemiology , Phenotype , Sympatholytics/therapeutic use , Blood Pressure/drug effects , Complementary Therapies , Alcohol Drinking/adverse effects , Exercise , Smoking/adverse effects , Prevalence , Blood Pressure Monitoring, Ambulatory , Diet, Sodium-Restricted , Diuretics/pharmacology , Dietary Approaches To Stop Hypertension , Hypertension/diagnosis , Hypertension/physiopathology , Antihypertensive Agents/pharmacology
8.
An. bras. dermatol ; 94(2): 192-197, Mar.-Apr. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1001127

ABSTRACT

Abstract BACKGROUND: Psoriasis and obesity are somewhat related to a low-grade systemic inflammatory response. OBJECTIVES: To determine leptin and adiponectin levels in psoriasis patients compared to control patients matched for weight. METHODS: A case-control study was performed, evaluating 113 psoriasis patients and 41 controls with other dermatologic diseases. RESULTS: The prevalence of obesity was 33% in cases and 21.9% in controls. All evaluated comorbidities were more prevalent among cases. When stratified by weight, the comorbidities were more frequent in overweight patients. We found no correlation between being overweight (p=0.25), leptin (p=0.18) or adiponectin (p=0.762) levels and psoriasis severity. When overweight cases and controls were compared, we found differences in the adiponectin values (p= 0.04). The overweight cases had lower adiponectin levels than the overweight controls. We found no differences in the leptin dosage between cases and controls. The overweight cases had higher leptin values than the normal weight cases (p<0.001). STUDY LIMITATIONS: Several patients used systemic anti-inflammatory medication. CONCLUSIONS: The prevalence of obesity among psoriasis cases (33%) was higher than in the general population (17.4%). We did not find any correlation between severity of psoriasis and inflammatory cytokines and the condition of being overweight. The overweight cases had lower values of adiponectin than the overweight controls. It seems, therefore, that there is a relationship between adiponectin and psoriasis, but this relationship depends on the presence of obesity.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Psoriasis/epidemiology , Leptin/blood , Adiponectin/blood , Hypertension/epidemiology , Obesity/epidemiology , Psoriasis/blood , Severity of Illness Index , Body Weight , Body Mass Index , Case-Control Studies , Comorbidity , Prevalence , Cytokines/blood , Overweight/blood , Obesity/blood
9.
Rev. habanera cienc. méd ; 18(2): 217-230, mar.-abr. 2019. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1014164

ABSTRACT

Introducción: La hipertensión arterial es un poderoso factor de riesgo de daño renal. La prevalencia es muy alta entre los pacientes con Enfermedad Renal Crónica. Objetivo: Determinar la presencia de Microalbuminuria y su valor como marcador de daño renal en pacientes con diagnóstico de Hipertensión arterial. Material y Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de 123 pacientes. Se determinó edad, sexo, cifras de colesterol, triglicéridos, creatinina y microalbuminuria y factores de riesgo vascular. Se utilizó la estadística descriptiva e inferencial. Resultados: El 40,7 Microalbuminuria as a marker of kidney damage in patients with arterial hypertension de los pacientes pertenecen al grupo de más de 70 años con predominio del sexo masculino (65 por ciento), 62,6 Microalbuminuria as a marker of kidney damage in patients with arterial hypertension presentaron microalbuminuria, 97,3 Microalbuminuria as a marker of kidney damage in patients with arterial hypertension tenían factores de riesgo asociados con prevalencia aumentada del tabaquismo, dislipidemia, obesidad y enfermedades vasculares asociadas con RP>1. Predominó el grupo mayor de 70 años, del sexo masculino, con presencia de microalbuminuria. La presencia de más de tres factores de riesgo se asoció a la microalbuminuria. La presencia de microalbuminuria aumentó con los años de evolución de la enfermedad. Predominó el estadio 3 de la Enfermedad Renal Crónica en los pacientes con hipertensión arterial y microalbuminuria y se relacionó directamente con los años de evolución de la hipertensión arterial. Conclusiones: La determinación de la microalbuminuria en los pacientes con hipertensión arterial es un marcador de riesgo importante y sencillo para determinar el daño renal subclínico y está muy relacionado con el incremento de la edad del paciente, años de hipertensión y asociación con otros factores de riesgo vasculares(AU)


Introduction: Arterial hypertension is a powerful risk factor for kidney damage. The prevalence is very high among patients with chronic kidney disease. Objective: To determine the presence of microalbuminuria as a marker of kidney damage in patients with arterial hypertension admitted between September 2016 and September 2017. Material and Methods: A descriptive, longitudinal, prospective study was conducted in 123 patients. Age; sex; cholesterol, triglycerides, creatinine and microalbuminuria levels and vascular risk factors were determined. Descriptive and inferential statistics were used. Results: The 40.7 percent of patients belong to the group of patients of age more than 70 years, predominating the male sex (65 percent); 62.6 percent of them presented microalbuminuria and 97.3 percent had risk factors associated with an increased prevalence of smoking, dyslipidemia, obesity, and vascular diseases associated with RP> 1. The group of patients older than 70 years, male, and with presence of microalbuminuria predominated in the study. The presence of more than three risk factors was associated with microalbuminuria. The presence of microalbuminuria increased with the years of evolution of the disease. Stage 3 of chronic kidney disease predominated in patients with arterial hypertension and microalbuminuria and it was directly related to the years of evolution of arterial hypertension. Conclusions: The determination of microalbuminuria in patients with arterial hypertension is a simple and important risk marker to determine subclinical kidney damage and it is closely related to the increase in the age of the patient, the years of hypertension, and the association with other risk factors for vascular disease(AU)


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Albuminuria/complications , Renal Insufficiency, Chronic/etiology , Hypertension/complications , Risk Factors , Albuminuria/diagnosis , Hypertension/epidemiology
10.
J. bras. nefrol ; 41(1): 29-37, Jan.-Mar. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1002428

ABSTRACT

ABSTRACT Introduction: Chronic kidney disease (CKD) is an independent risk factor for several unfavorable outcomes including cardiovascular disease (CVD), particularly in the elderly, who represent the most rapidly growing segment of the end-stage kidney disease (ESKD) population. Portugal has the highest European unadjusted incidence and prevalence rates of ESKD. In 2012, we started to follow a cohort of elderly CKD patients, we describe their baseline characteristics, risk profile, and cardiovascular disease burden. Methods: All CKD patients aged 65 years and older referred to our department during 2012 were enrolled. Baseline data included: demographic, CKD stage, medication, comorbid conditions. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI formula. Results: A total of 416 patients, 50% referred by primary care physicians, aged 77 ± 7 years, 52% male, with a median eGFR of 32 mL/min/1.73m2 participated in the study. Fifty percent had diabetes (DM), 85% dyslipidemia, 96% hypertension; 26% were current/former smokers, and 24% had a body mass index > 30 kg/m2. The prevalence of CVD was 62% and higher in stage 4-5 patients; in diabetics, it gradually increased with CKD progression (stage 3a < stage 3b < stage 4-5) (39, 58, 82%; p < 0.001). Conclusions: At baseline, our CKD elderly cohort had a higher burden of CVD. The prevalence of CVD was greater than in other European CKD cohorts. Lower level of eGFR was associated with a greater burden of CVD and was more pronounced in diabetics, highlighting the importance of strategically targeting cardiovascular risk reduction in these patients.


RESUMO Introdução: Doença renal crônica (DRC) é fator de risco independente para vários desfechos desfavoráveis, incluindo doença cardiovascular (DCV), particularmente em idosos, o segmento de crescimento mais rápido da população com doença renal terminal (DRT). Portugal tem a maior incidência europeia não-ajustada e a maior prevalência de DRT. Neste artigo caracterizamos uma coorte de idosos com DRC, referenciados para a nefrologia, com particular ênfase para o risco e carga de doença cardiovascular. Métodos: Foram incluídos todos os pacientes com DRC com 65 anos ou mais encaminhados ao nosso departamento em 2012. Os dados basais incluíram: demografia, estágio da DRC, medicação e comorbidades. A taxa de filtração glomerular (TFGe) foi calculada pela fórmula CKD-EPI. Resultados: Metade dos 416 pacientes incluídos foram encaminhados por médicos da atenção primária; sua idade era 77 ± 7 anos; 52% eram homens; a TFGe mediana era de 32 mL /min/1,73 m2. Metade tinha diabetes (DM), 85% dislipidemia, 96% hipertensão; 26% eram fumantes atuais/ antigos; 24% tinham índice de massa corporal > 30 kg/m2. A prevalência de DCV foi de 62%, sendo maior entre pacientes nos estágios 4-5; em diabéticos, aumentou gradualmente com a progressão da DRC (estágio 3a < estágio 3b < estágio 4-5) (39%, 58%, 82%; p < 0,001). Conclusões: A coorte de idosos com DRC apresentava inicialmente maior carga de DCV. A prevalência de DCV foi maior que em outras coortes europeias com DRC. Níveis menores de TFGe foram associados a carga maior de DCV e foram mais pronunciados entre diabéticos, destacando a importância de objetivar estrategicamente a redução do risco cardiovascular nesses pacientes.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aging/physiology , Cardiovascular Diseases/epidemiology , Renal Insufficiency, Chronic/epidemiology , Kidney Failure, Chronic/epidemiology , Portugal/epidemiology , Cardiovascular Diseases/etiology , Body Mass Index , Comorbidity , Incidence , Prevalence , Risk Factors , Follow-Up Studies , Longitudinal Studies , Creatinine/blood , Diabetes Mellitus/epidemiology , Renal Insufficiency, Chronic/complications , Dyslipidemias/epidemiology , Cognitive Dysfunction/epidemiology , Glomerular Filtration Rate , Hypertension/epidemiology , Kidney Failure, Chronic/etiology
11.
Rev. habanera cienc. méd ; 18(1): 45-59, ene.-feb. 2019. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1004121

ABSTRACT

Introducción: Como problema de la práctica de la profesión, la comorbilidad implica mayor complejidad en el plano del diagnóstico, el tratamiento, la creación de protocolos de atención y en la investigación. Es necesario identificar la comorbilidad del paciente hipertenso atendido en salas de medicina interna y su ordenamiento en mecanismos etiopatogénicos, fisiopatológicos y terapéuticos. Objetivo: Identificar la magnitud de la comorbilidad en pacientes con diagnóstico de hipertensión arterial ingresados en salas de Medicina interna. Material y Métodos: Se realizó una investigación descriptiva y prospectiva de 144 pacientes hipertensos. Se recogió la información necesaria a partir de la entrevista y examen clínico de los enfermos, las historias clínicas y la discusión con los médicos de asistencia. Los datos obtenidos se registraron en la planilla confeccionada al efecto y luego fueron vertidos en la base de datos del paquete estadístico SPSS versión 11.5. Resultados: Las comorbilidades más frecuentes fueron la diabetes mellitus tipo 2 en el 72,9 por ciento; la cardiopatía isquémica 54,9 por ciento y la enfermedad cerebrovascular 36,1 por ciento-. Conclusiones: La magnitud de la comorbilidad en los hipertensos que ingresan en salas de Medicina interna tiene como asociación etiopatogénica más importante a la diabetes mellitus tipo 2 y a las complicaciones ateroscleróticas derivadas de ambas entidades como las asociaciones fisiopatológicas más relevantes(AU)


Introduction: Comorbidity, as a problem in the practice of the medical profession, implies greater complexity in terms of diagnosis, treatment, creation of care protocols, and research. It is necessary to identify comorbidity in the hypertensive patient treated in internal medicine wards and establish etiopathogenic, pathophysiological, and therapeutic mechanisms. Objective: To identify the magnitude of comorbidity in patients with arterial hypertension admitted to the Internal Medicine wards. Material and Methods: A descriptive and prospective research was carried out on 144 hypertensive patients. The necessary information was collected from medical interviews, patients´ clinical exams, clinical histories, and case discussions with the doctors that were providing medical care to these patients. The data obtained were recorded in the database of Statistical Package SPSS software version 11.5. Results: The most frequent comorbidities were type 2 diabetes mellitus in a 72.9 percent; ischemic heart disease in a 54.9 percent, and cerebrovascular disease in a 36.1 percent. Conclusions: The magnitude of comorbidity in hypertensive patients admitted to Internal Medicine Wards recognizes Type 2 Diabetes Mellitus and atherosclerotic complications derived from both entities, as the most relevant pathophysiological associations(AU)


Subject(s)
Humans , Male , Female , Comorbidity , Hospitalization , Hypertension/epidemiology , Epidemiology, Descriptive , Prospective Studies , Hypertension/diagnosis
12.
Rev. gaúch. enferm ; 40: e20180200, 2019. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1014143

ABSTRACT

Resumo OBJETIVO Verificar o perfil clínico-cirúrgico e os resultados de pacientes acompanhados em um ambulatório de ferida operatória após cirurgia cardíaca. MÉTODOS Coorte histórica com pacientes submetidos à cirurgia cardíaca e acompanhados por um ano em um ambulatório de feridas de um hospital especializado em cardiologia. Foram analisados os micro-organismos predominantes nas infecções, os produtos utilizados nos curativos, tempo de acompanhamento e o tipo de terapêutica instituída nos curativos. RESULTADOS Entre os 150 pacientes, predominaram sexagenários (61,7 ± 11,4 anos), hipertensos (75%), diabéticos (44,7%). Evidenciou-se 12 pacientes com mediastinite (8%) e 44 com infecção de sítio cirúrgico (29,3%). Utilizou-se para realização dos curativos os ácidos graxos (80%) e alginato de cálcio (19%). O tempo de acompanhamento foi de 35 ±71 dias. CONCLUSÃO Pacientes sexagenários, hipertensos, diabéticos e revascularizados constituíram a população acompanhada no ambulatório de feridas. As taxas de ISC e mediastinite encontradas foram aceitáveis e semelhantes às da literatura.


Resumen OBJETIVO Verificar el perfil clínico-quirúrgico y los resultados de pacientes acompañados en un ambulatorio de heridas operatorias después de cirugía cardiaca. MÉTODO Cohorte histórica con pacientes sometidos a la cirugía cardiaca y acompañados por un año en el ambulatorio de heridas de un hospital especializado en cardiología. Fueron analizados los microorganismos predominantes en las infecciones, los productos utilizados en las curaciones, el tiempo de seguimiento, o el tipo de tratamiento utilizado en las curaciones. RESULTADOS Entre los 150 pacientes predominaron el sexo masculino (58%), sexagenarios (61,7 ± 11,4 años), hipertensos (75%), diabéticos (44.7%). Se evidenciaron 12 pacientes con mediastinitis (8%) y 44 con infección en el sitio quirúrgico (29.3%). Se utilizó en las curaciones fueron los ácidos grasos (80%) y el alginato de calcio (19%). El tiempo medio de seguimiento fue de 35 ± 71 días. CONCLUSIÓN Los pacientes sexagenarios, hipertensos, diabéticos y revascularizados constituyeron la población acompañada en el ambulatorio de heridas. Las tasas de ISC y mediastinitis encontradas fueron aceptables y similares a las de la literatura.


Abstract OBJECTIVE Verifying the clinical-surgical profile and the results of patients monitored in an surgical wound ambulatory after a cardiac surgeries. METHODS This is a historical cohort research with patients submitted to cardiac surgery and monitored for a year in an outpatient surgical wound clinic from a hospital specialized in cardiology. The study analyzed the prevalent microorganisms in infections, the products used in the dressings, the time of follow-up, and the type of therapy established in the dressings. RESULTS Among the 150 patients, most were sexagenarians (61.7 ± 11.4 years), hypertensive patients (75%), and diabetic (44.7%). There were 12 patients with mediastinitis (8%) and 44 with surgical site infection (29.3%). Fatty acids (80%) and calcium alginate (19%) were used for wound healing. The mean follow-up time was 35 ± 71 days. CONCLUSION Sexagenary, hypertensive, diabetic and revascularized patients constituted the population monitored in the wounds outpatient clinic. The SSI and mediastinitis rates found were acceptable and similar to those in literature.


Subject(s)
Humans , Male , Female , Aged , Surgical Wound Infection/microbiology , Surgical Wound Infection/therapy , Bandages , Cardiac Surgical Procedures/adverse effects , Saphenous Vein/surgery , Surgical Wound Infection/epidemiology , Wound Healing , Fatty Acids, Essential/therapeutic use , Cohort Studies , Follow-Up Studies , Diabetes Mellitus/epidemiology , Alginates/therapeutic use , Sternotomy/adverse effects , Ambulatory Care Facilities , Hypertension/epidemiology , Mediastinitis/epidemiology , Middle Aged
14.
Rev. latinoam. enferm. (Online) ; 27: e3150, 2019. tab, graf
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1004254

ABSTRACT

Objetivo: avaliar indicadores antropométricos e demográficos associados à pressão arterial elevada em crianças de 6 a 10 anos de idade de áreas urbana e rural de Minas Gerais. Método: estudo transversal realizado com 335 crianças. Foram coletados dados antropométricos, demográficos e de pressão arterial. As análises foram realizadas por meio dos testes Qui-quadrado, t student, Mann-Whitney e regressão logística, com cálculo do odds ratio como medida de associação. Resultados: a prevalência de pressão arterial elevada foi significativamente maior entre as crianças da área rural. Na área urbana, a chance de pressão arterial elevada foi maior nas crianças que possuíam o índice de massa corporal elevado (2,97 [1,13-7,67]) e, na área rural, naquelas que possuíam a circunferência da cintura aumentada (35,4 [3,0-406,2]) e faixa etária de 9-10 anos (4,29 [1,46-12,6]). Conclusão: o índice de massa corporal e a circunferência da cintura elevados foram importantes indicadores antropométricos para a pressão arterial elevada, assim como a idade em crianças residentes na área rural. A avaliação do índice de massa corporal e da circunferência da cintura, para além das avaliações nutricionais, representa importante ação para o rastreio de pressão arterial elevada em crianças de diferentes contextos territoriais.


Objective: to evaluate anthropometric and demographic indicators associated with high blood pressure in children aged 6 to 10 years in urban and rural areas of Minas Gerais. Method: this is a cross-sectional study with 335 children. Anthropometric, demographic and blood pressure data were collected. The statistics analyzes were performed using the chi-square, t-student, Mann-Whitney and logistic regression tests, and the odds ratio was the association measure. Results: the prevalence of high blood pressure was significantly higher among rural children. In the urban area, the chance of high blood pressure was higher in children who had a high body mass index (2.97 [1.13-7.67]) and in the rural area, in those who had increased waist circumference (35.4 [3.0-406.2]) and the age range of 9-10 years (4.29 [1.46-12.6]). Conclusion: elevated body mass index and waist circumference were important anthropometric indicators for high blood pressure, as well as age in children living in rural area. The evaluation of body mass index and waist circumference, in addition to nutritional assessments, represents an important action for the screening of high blood pressure in children from different territorial contexts.


Objetivo: evaluar los indicadores antropométricos y demográficos asociados a la presión arterial elevada de niños entre 6 y 10 años de edad en zonas urbana y rurale de Minas Gerais. Método: se trata de un estudio transversal realizado entre 335 niños. Se recopilaron datos antropométricos, demográficos y de presión arterial. Los análisis se realizaron con las pruebas de Chi-cuadrado, t de Student, Mann-Whitney y regresión logística, considerando el odds ratio como medida de asociación. Resultados: la prevalencia de la presión arterial elevada era significativamente más alta entre los niños de las zonas rurales. En la zona urbana, la probabilidad era mayor en los niños con índice alto de masa corporal [2,97(1,13-7,67)] y en la zona rural, en los que tenían más perímetro de cintura [35,4(3,0-406,2)] y grupo de edad de 9-10 años [4,29(1,46-12,6)]. Conclusión: el índice de masa corporal y la circunferencia de la cintura altos fueron indicadores antropométricos importantes para la presión arterial elevada, así como la edad en niños residentes de la zona rural. La evaluación del índice de masa corporal y del perímetro de la cintura, además de las evaluaciones nutricionales, son factores importantes para el sondeo de la hipertensión arterial en niños de diferentes contextos territoriales.


Subject(s)
Humans , Male , Female , Child , Body Mass Index , Anthropometry , Risk Factors , Hypertension/epidemiology , Blood Pressure/physiology , Brazil/epidemiology , Cross-Sectional Studies , Waist Circumference
16.
Cad. Saúde Pública (Online) ; 35(2): e00016418, 2019. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-984133

ABSTRACT

O objetivo foi verificar se a percepção das desordens físicas e sociais da vizinhança está associada a uma maior pressão arterial sistólica (PAS) e diastólica (PAD), bem como examinar a influência do nível socioeconômico do setor censitário de residência sobre essa associação. Trata-se de um estudo transversal que incluiu uma amostra representativa de 1.720 adultos de 20 a 59 anos, residentes em Florianópolis, Santa Catarina, Brasil. Foram realizadas duas medidas de pressão arterial e coletadas informações referentes à percepção das desordens no bairro de moradia. A variável contextual utilizada foi a média de anos de escolaridade do chefe da família dos setores censitários investigados. A análise estatística incluiu modelos multiníveis, com o primeiro nível representado pelos indivíduos e o segundo, pelos setores censitários. Termos de interação entre os tercis de escolaridade do setor censitário e os tercis de percepção de desordens de vizinhança sobre a pressão arterial foram examinados. Não foram identificadas associações estatisticamente significativas globais entre desordens de bairro e PAS ou PAD. Entretanto, foi identificada uma média de PAS 7,88mmHg (IC95%: 1,38; 14,40) maior entre os respondentes que percebiam mais desordens de vizinhança e residiam em um setor com menor escolaridade, quando comparados com a categoria de referência. As políticas públicas que visam a reduzir ou que tenham impacto sobre os níveis pressóricos sistólico e diastólico na população também devem considerar as características do contexto em que a população está inserida, especificamente aqueles marcados por menores níveis de escolaridade.


El objetivo de este trabajo fue verificar si la percepción de desórdenes físicos y sociales en el vecindario está asociada a una mayor presión arterial sistólica (PAS) y diastólica (PAD), así como examinar la influencia del nivel socioeconómico del sector censal de residencia sobre esta asociación. Se trata de un estudio transversal, que incluyó una muestra representativa de 1.720 adultos de 20 a 59 años, residentes en Florianópolis, Santa Catarina, Brasil. Se realizaron dos medidas de presión arterial y se recogió información referente a la percepción de desórdenes en el barrio de residencia. La variable contextual utilizada fue la media de años de escolaridad del jefe de familia en los sectores censales investigados. El análisis estadístico incluyó modelos multiniveles, con un primer nivel representado por individuos y, el segundo, por los sectores censales. Se examinaron los términos de interacción entre los terciles de escolaridad del sector censal y los terciles de percepción de desórdenes en el vecindario sobre la presión arterial. No se identificaron asociaciones estadísticamente significativas globales entre los desórdenes en el barrio y la PAS o PAD. No obstante, se identificó una media de PAS de 7,88mmHg (IC95%: 1,38; 14,40) mayor entre quienes respondían que percibían más desórdenes en el vecindario y residían en un sector con menor escolaridad, si se comparan con la categoría de referencia. Las políticas públicas que tienen como fin reducir o tener impacto sobre los niveles de presión sistólico y diastólico en la población, también deben considerar las características del contexto en el que la población está ubicada, específicamente aquellos espacios marcados por sus menores niveles de escolaridad.


The aim of this study was to verify whether the perception of neighborhood physical and social disorder is associated with increased systolic (SBP) and diastolic blood pressure (DBP), as well as to examine the influence of the residential census tract's socioeconomic status on this association. This was a cross-sectional study that included a representative sample of 1,720 adults 20 to 59 years of age living in Florianópolis, Santa Catarina State, Brazil. Two blood pressure measurements were taken, and information was collected on the perception of neighborhood disorder. The contextual variable was the mean head-of-household's years of schooling in the selected census tracts. Statistical analysis included multilevel models with the first level represented by individuals and the second by census tracts. Interaction terms were examined between schooling tertiles in the census tract and tertiles of perception of neighborhood disorder on blood pressure. No statistically significant overall associations were identified between neighborhood disorder and SBP or DBP. However, the study showed a mean increase in SBP of 7.88mmHg (95%CI: 1.38; 14.40) in subjects that perceived more neighborhood disorder and lived in census tracts with less schooling, when compared to the reference category. Public policies aimed at lowering or that have an impact on SBP and DBP in the population should also address the characteristics of the context where the population lives, specifically in contexts marked by lower levels of schooling.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Residence Characteristics/statistics & numerical data , Hypertension/epidemiology , Self Concept , Socioeconomic Factors , Blood Pressure , Brazil/epidemiology , Urban Health , Cross-Sectional Studies , Community-Based Participatory Research , Hypertension/prevention & control
17.
Article in English | AIM (Africa) | ID: afr-200291

ABSTRACT

Background: Hypertension is an important worldwide public health challenge because of its high prevalence and concomitant risks of cardiovascular and kidney diseases. The risk factors for hypertension are well known, and screening, diagnosis and treatment of hypertension have been well researched. However, this knowledge has not been translated into community practice as there remains a huge knowledge gap between the academics, health workers and the communities. There is need for community participation in developing and implementation of health interventions among marginalised communities.Aim: The aim of this project was to improve the community’s knowledge about hypertension by positively influencing beliefs and behaviours, leading to improved community hypertension outcomes.Setting: The study was undertaken in Ward 14, a rural area situated south-west of Gwanda District, Matebeleland South Province in Zimbabwe.Methods: We conducted a health services research utilising qualitative methods by using a community-based participatory approach using a cooperative inquiry group.Results: There was improvement in knowledge about awareness and primary prevention of hypertension. Community hypertension care was established through competence training of village health workers (VHWs) and more persons living with hypertension were enrolled into care. Pill pickup rate and treatment compliance improved and the community’s confidence in VHWs was restored. Community hypertension screening, treatment registers and health facility referrals were established.Conclusion: The community was empowered; the VHW was established as a key link between the community and the formal health delivery. This was a sustainable form of improving community hypertension health outcomes.


Subject(s)
Hypertension/prevention & control , Hypertension/epidemiology , Hypertension/diagnosis , Hypertension/therapy , Residence Characteristics , Zimbabwe
18.
Medisan ; 22(9)nov.-dic. 2018. tab
Article in Spanish | LILACS (Americas) | ID: biblio-976173

ABSTRACT

Se realizó un estudio observacional, descriptivo y transversal de 27 adultos con hipertensión arterial controlada, seleccionados aleatoriamente en el Consultorio del Médico de la Familia No. 6 del Policlínico Docente Armando García Aspurú en Santiago de Cuba, durante el periodo de septiembre de 2015 a igual mes de 2016, con vistas a determinar la alteración de la rigidez arterial en ellos. En la serie se obtuvo un predominio del sexo femenino (69,2 por ciento) en relación con el masculino (30,7 por ciento) y la edad media fue de 48,96 años; igualmente, se identificó un elevado porcentaje con obesidad premórbida (48,1), a la cual le siguió el sobrepeso, con 33,3 por ciento), y el peso normal, con 18,3 por ciento). Se encontró 19,0 por ciento) con índice de rigidez grave; condición más sensible y alarmante que el índice tobillo-brazo como marcador de daño vascular.


An observational, descriptive and cross-sectional study of 27 adults with controlled hypertension, ramdomly selected in the family's physician No. 6 of Armando García Aspurú Teaching Polyclinic in Santiago de Cuba was carried out during the period of September, 2015 to same month in 2016, aimed at determining the change of arterial stiffness in them. In the series a prevalence of the female sex was obtained (69.2 percent) in connection with the male sex (30.7 percent) and the mean age was of 48.96 years; equally, a high percentage was identified with premorbid obesity (48.1), followed by overweight, with 33.3 percent, and normal weight, 18.3 percent. A 19.0 percent with severe stiffness index was found; a more sensitive and alarming condition than the index ankle-arm as marker of vascular damage.


Subject(s)
Humans , Male , Female , Adult , Vascular Stiffness , Hypertension/epidemiology , Hemodynamics
19.
Int. arch. otorhinolaryngol. (Impr.) ; 22(4): 337-341, Oct.-Dec. 2018. tab
Article in English | LILACS (Americas) | ID: biblio-975597

ABSTRACT

Abstract Introduction The aging process causes changes in body structure in a continuous manner, and contributes to clinical disorders. Life expectancy is increasing, especially in developing countries. Objective To assess the prevalence of hearing loss and its possible association with hypertension and diabetes mellitus (DM) in the elderly. Methods A cross-sectional study with 519 elderly individuals aged over 60 years who underwent an audiological evaluation (pure tone audiometry), and answered a comorbidity questionnaire that included questions about age, gender, tinnitus and medical history, with data concerning DM. The dependent variable was the presence of hearing loss. The independent variables were age, gender, DM and hypertension. The variables were presented in absolute numbers and proportions, and enabled us to estimate the prevalence. The statistical analysis was performed through multiple logistic regression with 95% confidence intervals and values of p< 0.05 for the hearing loss and its associated factors. Results A total of 519 subjects of both genders with a median age of 69 years were evaluated, and the individuals who did not attend the audiometric test were excluded from the study, so the final sample was composed of 498 subjects. Sensorineural hearing loss was more prevalent (66.26%) of most frequently with bilateral hearing loss of 91.56% and 26.50% with mild degree. The statistical analysis showed that the variable DM was associated with the high frequency of hearing loss in the elderly, and according to the multiple logistic regression, the risk factors are independent of the hearing loss only for age and exposure to occupational noise. Conclusions There was a statistically significant difference between hearing loss at high frequencies and the risk factors, that is, age and DM.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Diabetes Complications , Hearing Loss/complications , Hypertension/complications , Audiometry, Pure-Tone , Comorbidity , Prevalence , Cross-Sectional Studies , Diabetes Mellitus/epidemiology , Hearing Loss/epidemiology , Hypertension/epidemiology
20.
Rev. chil. cardiol ; 37(3): 161-169, dic. 2018. tab
Article in Spanish | LILACS (Americas) | ID: biblio-977997

ABSTRACT

Resumen: Objetivo: Describir el perfil de usuarios con diabetes mellitus (DM) e hipertensión arterial (HTA) y su relación con indicadores de resultado clínico. Sujetos y métodos: Estudio transversal, correlacional en usuarios con DM y/o HTA, reclutados desde 4 centros de salud de un Servicio de Salud del centro sur de Chile. Los instrumentos y mediciones incluyeron: cuestionario de variables biodemográficas, "Evaluación de la atención de enfermedades crónicas para pacientes", hemoglobina glicosilada (HbA1c), presión arterial sistólica (PAS) y diastólica (PAD). Resultados: Se evaluaron 222 personas con HTA y/o DM con edad promedio 53,9 (DE 7,5) años, la mayoría mujeres (67,6%). Se encontró un predominio de HTA (53,6%), seguido de DM+HTA (31,1%) y DM (15.3%). El promedio de PAS y de HbA1c fue levemente superior en usuarios con patología mixta (DM+HTA). El promedio de la evaluación de la atención desde la perspectiva del paciente fue 2,61 (DE 1,13), siendo mejor evaluado el "Diseño de un sistema de entrega de cuidados/Apoyo a la decisión". Se encontró relación significativa en usuarios con HTA entre PAS y n° de fármacos (p=0,026); en personas con DM entre HbA1c y años de enfermedad (p=0,002) y en usuarios con multimorbilidad (HTA+ DM) entre años de enfermedad con HbA1c (p=0,01) y con PAS (p=0,01). Conclusión: La evaluación de la atención sugiere la necesidad de mayor esfuerzo en el control de los parámetros terapéuticos, incorporando mejoras en la atención proporcionada. Se necesita más investigación para definir la relación entre el perfil de usuarios con enfermedades crónicas y los resultados clínicos.


Abstracts: Aim: To decribe the profile of users of a health program for chronic diseases (CD), especifically Diabetes Mellitus (DM) and Hypertension (HT), and its relation to indicators of clinical results. Subjects and methods: The subjects had DM and/or HT and were randomly selected form 4 health centers in southern Chile. Questionaires exploring demographic variables, Patient Assessement of Chronic Illness Care (PACIC) measurements of HbA1c, systolic (SBP) and diastolic (DBP) pressures were used as indicators of clinical results. Results: 222 subjects with DM and/or HT were evaluated. Mean age was 53.9 years-old (SD 7.5), 67.6% were females. The prevalence of CD was 53.6% for HT, 31.1% for DM+HT and 15.3% for DM. Mean BP and mean HbA1c were slightly higher in users with DM+HT. As perceived by the patient, the evaluation of care had a mean score 2.61 (SD 1.13). "Design of a method of care delivery / decission support" obtained the highest score. In subjects with HT there was a significant correlation between SBP and the number of drugs being received (p=0.03). Also, a significant correlation between HbA1c and disease duration was found in subjects with DM (p=0.02). In subjects with DM+HT significant correlation (p=0.01) existed between disease duration and both HbA1c and SBP. Conclusion: The evaluation of care suggests the need for a stronger effort in controlling therapeutic measures. Further studies are needed to refine the relation of user profile and clinical results.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Diabetes Mellitus, Type 2/therapy , Health Services/statistics & numerical data , Hypertension/therapy , Health Profile , Chile/epidemiology , Cross-Sectional Studies , Surveys and Questionnaires , Outcome Assessment, Health Care , Diabetes Mellitus/epidemiology , Hypertension/epidemiology
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