Estimación del riesgo cardiovascular global en mujeres diabéticas de edad mediana / Estimation of overall cardiovascular risk in middle-aged diabetic women

Antecedentes: la valoración del riesgo cardiovascular global es importante para establecer medidas preventivas en pacientes con alto riesgo de presentar enfermedad cardiovascular. Objetivo: estimar el riesgo cardiovascular global en mujeres diabéticas tipo 2 de edad mediana. Métodos: se realizó un estudio transversal y descriptivo con 458 mujeres en edad mediana (40 a 59 años), que ingresaron consecutivamente en el Centro de Atención al Diabético de Bayamo, Granma, desde el año 2010 a 2016. El riesgo cardiovascular global se determinó según los modelos propuestos por la Organización Mundial de la Salud para nuestro país. Resultados: el riesgo cardiovascular global de las mujeres diabéticas en edad mediana fue moderado en el 10,1 por ciento (46 pacientes), alto en el 3,1 por ciento (14 pacientes) y muy alto en el 2,4 por ciento (11 pacientes). Las mujeres posmenopáusicas exhibieron un riesgo cardiovascular global significativamente mayor que aquellas que no estaban en esta etapa (OR= 1,89; IC= 1,03-3,1; p= 0,0413). El riesgo se incrementó claramente a medida que aumentó el tiempo de ocurrencia de la menopausia (p= 0,0245). La prevalencia de hipertensión sistólica, hipercolesterolemia y hábito de fumar fue mayor en las mujeres posmenopáusicas, sin que llegara a ser estadísticamente relevante. Conclusiones: el riesgo cardiovascular global de las mujeres diabéticas tipo 2 en edad mediana, de nuestro medio, se incrementa con la menopausia y con el tiempo de ocurrencia de este evento(AU)

Background: the assessment of overall cardiovascular risk is important to establish preventive measures in patients with high risk of cardiovascular disease. Objective: to estimate the overall cardiovascular risk in type 2 diabetic middle-aged women. Methods: a transversal and descriptive study was carried out with 458 middle-aged women (40 to 59 years old) who consecutively attended the Diabetics Care Center of Bayamo, Granma from 2010 to 2016. The overall cardiovascular risk was determined according to the models proposed by the World Health Organization for our country. Results: the overall cardiovascular risk of diabetic middle-aged women was moderate in the 10.1 percent (46 patients), high in the 3.1 percent (14 patients), and very high in the 2.4 percent (11 patients). Postmenopausal women showed a significantly higher overall cardiovascular risk than those who were not in this stage (OR= 1.89, CI= 1.03-3.1, p= 0.0413). The risk clearly increased as the time of occurrence of the menopause increased (p= 0.0245). The prevalence of systolic hypertension, hypercholesterolemia and smoking habit was higher in postmenopausal women but this didn´t become statistically relevant. Conclusions: the overall cardiovascular risk of type 2 diabetic middle-aged women increases with the menopause and with the time of occurrence of this event(AU)

Depresión posparto valorada mediante la escala de Edimburgo / Postpartum depression assessed by the scale Edinburgh

Objetivo: Determinar la prevalencia de depresión posparto en puérperas atendidas en el Servicio de Obstetricia del Hospital General del Oeste “Dr. José Gregorio Hernández” de Caracas, durante el período comprendido entre junio y septiembre de 2013. Métodos: Se realizó una investigación de tipo descriptiva y prospectiva, con una muestra de 249 puérperas, aplicando la escala de depresión posparto de Edimburgo para detectar depresión posparto. Resultados: En el puerperio mediato hubo una prevalencia de depresión posparto de 84,2% en las adolescentes y de 81,5% en las adultas sin diferencia significativa entre ambos grupos. Conclusión: La prevalencia de depresión posparto fue elevada en adolescentes y en adultas, predominando la depresión posparto de grado moderada.

Objective: To determinate prevalence of depression in postpartum women attended in the Obstetric Service of General Hospital of the West “Dr. Jose Gregorio Hernandez” in Caracas, during June to September 2013. Methods: By means of a descriptive and prospective study, postpartum depression was investigated in a sample of 249 patients, applying the Edinburgh Postpartum Depression Scale. Results: In mediate puerperium there was postpartum depression prevalence of 84.2 % in adolescents and of 81.5 % in adults, without significant difference between both groups. Conclusion: The prevalence of postpartum depression was high in adolescents and adults, predominating postpartum depression of moderate grade.

Alfa-fetoproteína sérica en la predicción de parto pretérmino / Alpha-fetoprotein levels and prediction of preterm delivery

Objetivo: Relacionar las concentraciones de la alfafetoproteína (AFP) sérica con la ocurrencia de parto pre-término (PP) en embarazadas con y sin factores de riesgo (FR) atendidas en la Maternidad "Dr. Armando Castillo Plaza" en Maracaibo, Estado Zulia, Venezuela. Métodos: Investigación predictiva y comparativa aplicada, que incluyo 60 embarazadas con y sin FR para PP (n= 30 para cada grupo), a las que se les determinó la AFP sérica entre las 24-28 semanas de gestación, siguiéndose hasta la culminación del embarazo. Resultados: Las concentraciones de AFP en gestantes con FR fueron significativamente mayores (341,35 +/- 183,51 vs. 238,63 +/- 110,46; p<0,05); asimismo, el diagnóstico de PP se efectuó en 43,33 por ciento de las gestantes con FR y en 13,33 por ciento sin FR (p<0,05). Esta prueba presentó en gestantes con FR tasas más altas de sensibilidad (77 por ciento), especificidad (76 por ciento), valor predictivo positivo (71 por ciento) o negativo (81 por ciento), predicción total (77 por ciento); razón de verosimilitud positiva (3,27) y probabilidad post-test positiva (71 por ciento); mientras que la razón de verosimilitud negativa (0,30) y la probabilidad post-test negativa (19 por ciento) fueron bajas, en tanto que el riesgo de PP fue significativo (OR [IC95 por ciento%]= 10,833 [1,961-59,835]; p<0,05). Conclusión: Existe una relación entre la elevación de las concentraciones de AFP y la presencia de PP, mostrando esta prueba tener una alta capacidad diagnóstica y poder predictivo para la ocurrencia de esta patología en embarazadas con FR.

Objective: To relate the concentrations of alpha-fetoprotein (AFP) levels with the occurrence of preterm delivery (PP) in pregnant women with and without risk factors (RF) attending Motherhood "Dr. Armando Castillo Plaza" in Maracaibo, Zulia State, Venezuela. Methods: This research is a predictive and comparative type, which included 60 pregnant women with and without RF for PP (n = 30 for each group), which were determined from serum AFP 24-28 weeks of gestation, being followed until completion of pregnancy. Results: The concentrations of AFP in pregnancies with RF were significantly higher (341.35 +/- 183.51 vs. 238.63 +/- 110.46, p<0.05), also the diagnostic PP was performed in 43.33 percent of pregnant women with RF and non RF 13.33 percent (p<0.05). This test presented in RF pregnant with higher rates of sensitivity (77 percent), specificity (76 percent), positive predictive value (71percent or negative (81percent), total prediction (77 percent), positive likelihood ratio (3.27) and positive post-test probability (71 percent), whereas the negative likelihood ratio (0.30) and the post-test probability negative (19 percent) were low, while the risk of PP was significant (OR [95 percent CI] = 10.833 [1.961 to 59.835]; p<0.05). Conclusion: There is a relationship between elevated AFP levels and the presences of PP, showing this test have high diagnostic accuracy and predictive power for the occurrence of this disease in pregnant with RF.

Aspectos clínico-epidemiológicos das mulheres pós- abortamento em hospital de referência / Profile clinical-epidemiologist of women after-abortion in reference`s hospital

Caracterizar os aspectos clínico-epidemiológicos e principais fatores determinantes do abortamento em mulheres internadas em um hospital de referência no Estado do Pará. Método: estudo transversal analítico; foram entrevistadas 160 pacientes em idade fértil, internadas por abortamento no Hospital Fundação Santa Casa de Misericórdia do Pará, período de dezembro de 2007 a dezembro de 2008. Resultados: após análise dos dados observou-se que das 160 entrevistadas, 78,12% abortaram espontaneamente e 21,88% tiveram a intenção de interromper a gestação; a faixa etária mais freqüente foi de 20 a 29 anos (60%); constatou-se que o estado conjugal foi um importante fator determinante para o abortamento eletivo, pois 82,85% das mulheres que provocaram o término da gestação eram solteiras; o misoprostol foi método de escolha para cessar a gravidez em 82,9% dos casos; a instabilidade financeira foi o motivo mais apontado entre as pacientes que provocaram o abortamento (48,57%). Conclusão: houve redução no número de abortamentos provocados , prevalecendo os de causa espontânea. Não se descarta a possibilidade de subnotificações das ocorrências, pois a ilegalidade da interrupção eletiva da gestação leva mulheres a mentirem ou omitirem tal ato, com medo das conseqüências legais. Por isso, é importante ampliar estudos a respeito do tema, divulgando-os, na tentativa de combater os danos psicológicos e físicos às mulheres que provocam o abortamento, consequentemente, reduzindo o ônus ao sistema público de saúde.

To determine the profile physician-epidemiologist of the women after-abortion and the main influences factors of such act. Method: for this sample, they had been interviewed 160 patients in fertile age interned by abortion in an institution of reference in State of Pará, comtemplating the period of December of 2007 the December of 2008. Results: it was observed that the age with greater frequency of abortion, with was between 20 the 29 years (60%), the influence of the conjugal state with the type of abortion was evident, the induced were practiced for bachelors, they make use of misoprostol (82.9%), this method of choice for the interruption of the pregnancy, and this had as root cause the lack of financial condition (48,57). The studies abortions show, 78.12% had been spontaneous. Conclusion: this summary demonstrated the unfamiliarity on the treated subject, in the state of Pará, that suffers with this work demonstrated the unfamiliarity on boarded searched the subject treat/searched/boarded in the State to Pará, that it suffers with the great number of occurrence of spontaneous abortions. However, we evidence that the induced interruption of the pregnancy is a large Brazilian problem of public health and social justice, that exactly being illegal practical one and a crime foreseen in law, has its incidence in considerable degrees.