Impact of periodontal disease on late morbimortality (10 years) of pacientes with acute coronary syndrome / Impacto da doença periodontal na morbimortalidade tardia (10 anos) de pacientes com síndrome coronariana aguda

Background: It is known that predisposing factors for periodontal disease (PD) and cardiovascular diseases are similar, just as dissemination of oral flora pathogens can induce the development of cardiovascular diseases, which play a direct role on the morbimortality of patients. Objective: To assess the impact of periodontal disease in the presence of acute coronary syndrome on late morbimortality after long-term follow-up of patients (10 years). Methods: The historical prospective study of continuous assessment was based on the evaluation of 345 medical records of patients hospitalized for acute coronary syndrome, divided into 3 groups: edentulous, with periodontal disease and without periodontal disease. The patients studied were in the ICU, in 2006, with a clinical picture of acute coronary syndrome submitted to invasive stratification with coronary angiography on the basis of clinical indication and were reassessed over the next 10 years. The qualitative variables were compared using the Chi-square test. Long-term mortality was assessed using the Kaplan-Meier curves, quantified with the hazard ratio (HR) and a confidence interval of 95% and compared through Cox regression. P values of less than or equal to 0.05 were regarded as statistically significant. Results: Of the 345 patients, 233 had at least one coronary obstruction greater than or equal to 50%, being the main group for comparison according to the different status of periodontal disease (without periodontal disease, with periodontal disease and edentulous). In his cardiovascular condition, we found a difference in mortality among edentulous patients compared to those free of periodontal disease, with a p = 0.004 and a hazard ratio of 10.496 (95% CI: 4.988-22.089). A is ignificant difference was also noted between edentulous patients and patients with periodontal disease, with a p = 0.0017 and a hazard ratio of 2.512 (95% CI: 1.491-4.234). Conclusion: A significant increase in mortality was found according with the progression of periodontal disease, which justifies its classification as an important risk factor for the development of cardiovascular diseases, as well as the need for prevention and treatment of oral diseases

Caracterização dos idosos internados por doença respiratória aguda em um hospital escola terciário / Characterization of elderly inpatient with acute respiratory disease in a tertiary medical school hospital

Objetivo: Caracterizar o perfil sociodemográfico, clínico e de fatores de risco de idosos internados por Doença Respiratória Aguda (DRA) no Hospital de Base de São José do Rio Preto. Metodologia: Pesquisa quantitativa, descritiva e retrospectiva, com dados coletados através da análise de 94 prontuários médicos de idosos com idade igual ou superior a 60 anos, internados no período de agosto de 2012 a setembro de 2013 por DRA no Hospital de Base de São José do Rio Preto. Resultados: O estudo identificou que entre os 94 idosos internados por DRA, 56,4% eram homens (n=53), com 76 anos de idade ou mais (55,3%), brancos (88,3%), casados (54,2%), com baixa escolaridade (19,1% não alfabetizados e 53,3% com até 4 anos de estudo), portadores de pelo menos uma comorbidade (83%), e apresentavam pelo menos um fator de risco para DRA como tabagismo e/ou desnutrição. Dos classificados com dependência funcional, a maioria eram idosos acima dos 75 anos. Quanto à situação cognitiva, menos da metade dos idosos apresentava algum déficit relatado em prontuário, e entre estes a maioria era maior de 75 anos. Mais de 70% dos pacientes (n=68) receberam alta com melhora, sendo que mais da metade (n=38) tinham 75 anos de idade ou menos. Do total, 17 pacientes evoluíram a óbito, sendo que destes, 88,2% (n=15) tinham acima de 75 anos. Após a alta médica, um pequeno número de pacientes (n=11) foram contra-referenciados às suas Unidades Básicas de Saúde de origem. Conclusão: Os resultados do estudo apontam para a importância de se reforçar as redes de cuidados voltadas aos idosos comprometidos por DRA, especialmente aqueles com idade avançada, fatores de risco presentes, comorbidades associadas, dependência funcional e déficit cognitivo, devido à alta probabilidade de má evolução. A capacitação dos profissionais de saúde dos diferentes níveis de atenção à saúde e a criação de estratégias para educação da população são ações fundamentais para a consolidação destas redes de cuidados e, consequentemente, auxiliar na prevenção e no diagnóstico precoce, visando à redução das internações e a mortalidade por DRA

Objective: To characterize the sociodemographic and clinic profiles and risk factors of elderlies hospitalized by acute respiratory disease (ARD) in Hospital de Base de São José do Rio Preto. Metodology: A quantitative, descriptive and retrospective study, with data collected through the analysis of 94 medical records of elderly inpatient, 60 years or older, hospitalized from August 2012 to September 2013 due to ARD. Results: This study identified that among 94 elderly inpatient with acute respiratory disease, major were men (n = 53), 76 years old or more (n = 52), white (n = 83), and had at least one risk factor for ARDs, such as smoking and/or bad nutrition. Most of the elderly over 75 years were dependent on daily life activities. Less than a half had cognitive deficit reported in their medical records, and most of them were more than 75 years old. More than 70% of the patients were discharged with improvement (n = 68), and more than half were 75 years old or less (n = 38). Among the 94 patients, 17 have died, being 88.2% over 75 years old (n = 15). After discharge, a small number of patients were referred to their Primary Care Unit (n = 11). Conclusions: The results of this study appoint to the importance of increasing care networks for elderly people affected by ARD, especially the oldiest, with risk factors, associated comorbidities, functional dependence and cognitive deficit, due to the high probability of bad prognosis. Training professionals at different levels of health care and creation of strategies to instruct the population about ARD are fundamental actions, in order to consolidate these care networks and, consequently, support prevention and early diagnosis, targeting the reduction of hospitalizations and mortality due to ARD.