ABSTRACT
Fundamento: O processo de urbanização tem impacto na carga de doenças cardiovasculares. As populações indígenas podem sofrer uma transição epidemiológica devastadora. Objetivos: Descrever o protocolo de estudo do Projeto de Aterosclerose nas Populações Indígenas (PAI) para avaliar a análise ecocardiográfica e as doenças cardiovasculares (CV) subclínicas em populações indígenas de acordo com o grau de urbanização e mostrar resultados preliminares do estudo piloto. Métodos: O PAI é um estudo transversal, com voluntários com idade entre 30 e 70 anos, em grupos indígenas brasileiros expostos a estágios baixos e avançados de urbanização (Fulni-ô e Truká, respectivamente) e um grupo controle urbano, excluindo indivíduos com doenças CV conhecidas ou em hemodiálise. O estudo piloto começou no território de Fulni-ô em setembro de 2016. Os participantes foram submetidos a avaliação clínica e laboratorial, eletrocardiograma (ECG), ultrassonografia de carótidas e um protocolo ecocardiográfico abrangente, incluindo strain longitudinal global (SLG) avaliado por speckle tracking. Os resultados preliminares são descritos de acordo com o sexo em uma análise univariada. Resultados: O estudo piloto avaliou o protocolo descrito em 55 indivíduos do grupo indígena Fulni-ô (48,7 ± 12,0 anos, 80% mulheres). Foram encontrados fatores de risco tradicionais como hipertensão, diabetes e dislipidemia em 40%, 36% e 54%, respectivamente, sem diferenças estatísticas significativas entre os sexos. O uso de tabaco mostrou-se extremamente prevalente, referido em 91% dos participantes. Os parâmetros derivados da ecocardiografia estavam, em média, dentro da faixa normal. No entanto, a média do SLG foi de 17,3 ± 3,4% (p 0,73 por sexo). Conclusão: Descrevemos o protocolo do estudo PAI para avaliar doenças cardiovasculares subclínicas e fatores de risco em populações indígenas de acordo com o estágio de urbanização. Resultados preliminares sugerem alta prevalência desses na população indígena em menor grau de urbanização.
Background: The urbanization process impacts the burden of cardiovascular disease (CVD). Indigenous populations can undergo a devastating epidemiological transition. Objective: The present study aimed to describe the Project of Atherosclerosis among Indigenous Populations (PAI) study protocol for assessing echocardiographic images and subclinical CVD in indigenous populations according to the degree of urbanization and report its preliminary results. Methods: The PAI is a cross-sectional study that includes volunteers aged 3070 years among Brazilian indigenous groups exposed to low and advanced stages of urbanization (Fulni-ô and Truká, respectively) and an urban control group. Individuals with known CVD or who were on hemodialysis were excluded. The pilot study began in Fulni-ô territory in September 2016. The participants underwent clinical and laboratory
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Cardiovascular Diseases/epidemiology , Health of Indigenous Peoples , Atherosclerosis/diagnostic imaging , Urbanization , Echocardiography/methods , Echocardiography, Doppler/methods , Cross-Sectional Studies/methods , Risk Factors , Population Groups , Electrocardiography/methodsABSTRACT
PURPOSE: To test the predictive value of ophthalmic artery (OA) Doppler velocimetry in relation to the occurrence of hypertensive disorders of pregnancy (HDP). METHODS: We compared, by analysis of variance, the values of seven OA Doppler variables (peak systolic velocity, second systolic peak velocity [P2], mean velocity, end diastolic velocity, resistance index [RI], pulsatility index [PI], and peak ratio) of 31 women with preeclampsia and 33 women with gestational hypertension vs those of 227 women without HDP. The prognostic value of these variables in relation to the occurrence of HDP was evaluated by the area under the curve (AUC) receiver operating characteristic curve. RESULTS: All OA Doppler variables except RI and PI showed significant (P < .5) differences between groups. After adjustment for confounders, only P2 was an independent predictor of HDP (P < .001), with an AUC of 0.76. The best cut-off point for predicting HDP was P2 ≥ 21.4 cm/s, with sensitivity 69%, specificity 78%, positive likelihood ratio 3.1, negative likelihood ratio 0.4, positive predictive value 47%, and negative predictive value 90%. P2 improved the predictive ability of a model based on clinical variables, incrementing AUC from 0.77 to 0.84 in the final model containing clinical and Doppler variables. CONCLUSION: The elevation of OA P2 in the second trimester of pregnancy is an independent predictor of hypertensive disorders, and improves the discriminatory ability of clinical markers.
Subject(s)
Blood Flow Velocity/physiology , Hypertension, Pregnancy-Induced/diagnosis , Ophthalmic Artery/diagnostic imaging , Ultrasonography, Doppler/methods , Adult , Female , Humans , Hypertension, Pregnancy-Induced/physiopathology , Ophthalmic Artery/physiopathology , Predictive Value of Tests , Pregnancy , Pregnancy Trimester, Second , Prospective Studies , ROC Curve , Young AdultABSTRACT
BACKGROUND: This study aimed to identify predictors of early (7-day) mortality in patients with septic acute kidney injury (AKI) who required continuous renal replacement therapy (CRRT). METHODS: Prospective cohort of 186 septic AKI patients undergoing CRRT at a tertiary hospital, from October 2005 to November 2010. RESULTS: After multivariate adjustment, five variables were associated to early mortality: norepinephrine utilization, liver failure, medical condition, lactate level, and pre-dialysis creatinine level. These variables were combined in a score, which demonstrated good discrimination, with a C-statistic of 0.82 (95% CI = 0.76-0.88), and good calibration (χ 2 = 4.3; p = 0.83). SAPS 3, APACHE II and SOFA scores demonstrated poor performance in this population. CONCLUSIONS: The HEpatic failure, LactatE, NorepInephrine, medical Condition, and Creatinine (HELENICC) score outperformed tested generic models. Future studies should further validate this score in different cohorts.
