Made available in DSpace on 2014-10-09T12:53:24Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:58:37Z (GMT). No. of bitstreams: 1 11920.pdf: 5864547 bytes, checksum: 5ef2e00923af82aba8772a4858fa873e (MD5) / Dissertacao (Mestrado) / IPEN/D / Instituto de Pesquisas Energéticas e Nucleares - IPEN-CNEN/SP

A pesquisa, desenvolvida entre universitários da cidade de Lubango - Angola, teve o objetivo de identificar a prevalência da hipertensão arterial sistêmica (HAS) e os fatores de risco associados naquela população. Adotou-se como referencial teórico o Modelo de “Campo de Saúde” de Lalonde, composto pelos elementos de biologia humana, meio ambiente, estilo de vida e organização dos serviços de saúde. A população estudada foi composta de 667 universitários, entre 18 e 55 anos de idade, média 29 anos e desvio padrão de 8. Obtiveram-se os dados por meio de entrevista individual, realizada na própria escola onde estudavam. Ao término de cada entrevista, procedeu-se à aferição do peso, altura, valores da pressão arterial (PA), circunferência abdominal e do quadril. Para avaliação do peso, utilizou-se balança portátil; para mensuração da estatura utilizou-se fita métrica inelástica, afixada em parede plana a 50 centímetros do chão. Aferiu-se a PA usando o método auscultatório, com esfigmomanometros do tipo aneróides testados e devidamente calibrados e manguitos de bolsa de borracha compatíveis com a circunferência braquial do indivíduo. Os dados relativos à biologia humana indicaram que 17,1% dos indivíduos apresentavam sobrepeso; 3,2%, obesidade. Identificou-se uma prevalência de HAS de 23,5%. Ao se analisarem os antecedentes familiares, 40,3% relataram que tinham pelo menos um dos pais hipertenso e 22,0% possuíam, no mínimo, um parente do 1º grau com a doença. Quanto ao meio ambiente; 36,1% tinham dedicação exclusiva aos estudos; 55,5% trabalhavam no setor público; 28,9% não possuíam renda individual; 51,3% tinham renda individual de até 250 dólares. Quanto à renda familiar, 27,0% não souberam informar; 33,1% indicaram renda de até 250 dólares; 51,9% indicaram que somente uma pessoa da família contribuía com a renda familiar. Em relação ao estilo de vida, 86,2% realizavam atividade física, 61,2% a praticavam três ou mais vezes por semana; 60,6% indicaram preferência à ingestão de alimentos salgados; 4,0% eram fumantes; 47,6% dos fumantes começaram com o hábito próximo aos 19 anos; 8,4% dos não-fumantes compartilhavam locais fechados com fumantes no dia-dia; 40,6% faziam uso de bebida alcoólica; 59,8% consideravam-se estressados; 15,3% das mulheres usavam contraceptivo hormonal. Quanto ao atendimento à saúde, 82,8% já haviam aferido a PA em alguma ocasião e 65,4% deles não se lembravam do valor encontrado; 12,7% não tinham conhecimento prévio da causa da HAS; 92,1% utilizavam algum tipo de serviço de saúde; 73,6% buscavam serviços de saúde somente em casos de necessidade, para tratamento médico. Conclui-se que estes dados revelam uma elevada prevalência de HAS, considerando que a maioria dos participantes eram jovens; falta de maiores informações sobre a HAS e presença de hábitos autocriados que se constituem em fatores de risco para as doenças hipertensiva e cardiovasculares em geral, que podem ser modificados mediante implementação de programas educativos com ações voltadas à promoção da saúde, visando ao controle dessas doenças. / This research, developed among college students Lugango city - Angola, aimed at identifying the prevalence of systemic arterial hypertension (SAH) and associated risk factors in this population. The theoretical reference adopted was the Lalonde model for “Population health”, with elements from human biology, environment, life style and management of health services. The population studied was composed of 667 college students from 18 to 55 years old, mean 29 and standard deviation of 8. The data was obtained by means of individual interviews, performed in the college where they studied. At the end of each interview, the body weight, height, waist perimeter, arterial pressure (AP) values, abdominal and hip circumference were assessed. The body weight assessment was evaluated utilizing a portable balance; the height assessment with a non-elastic tape measure, fixed in a flat wall 50 centimeters from the floor. The arterial pressure was assessed by the auscultatory method, with aneroid sphygmomanometers tested and properly calibrated and rubber bladder compatible to the arm circumference of each individual. Data related to human biology indicated that 17.1% of the interviewed were over weight; 3.2% were obese. The prevalence of SAH was of 23.5%. When the familiar antecedents were analyzed, 40.3% declared that at least one of their parents presented hypertension and 22.0% had, at least, one first grade parent with the disease. With respect to environment; 36.1% had exclusive dedication to studies; 55.5% worked on the public service, 28.9% did not received individual income; 51.3% received an individual income of up to 250 dollars. With regard to familiar income, 27.0% did not know to inform; 33.1% indicated an income of up to 250 dollars; 51.9% related that only one person of the family contributed to the familiar income. With regard to life style, 86.2% used to practice some physical activity, 61.2% practice it three or more times a week; 60.6% indicated salty food preference; 4.0% were smokers; 47.6% of the smokers started with the addiction when they were around 19 years old; 8.4% of nonsmokers used to share closed places with smokers day by day; 40.6% use to drink alcoholic drinks; 59.8% considered themselves as stressed; 15.3% of the women utilized hormonal contraceptives. With regard to the management of health services, 82.8% had already assessed their AP in some occasion and 65.4% of them did not remember the obtained value; 12.7% did not have previous knowledge of the possible causes for SAH; 92.1% utilized some type of health service; 73.6% used to look for health services just in extremely need, in order to obtain medical care. The data show a high prevalence of SAH, considering that most of the subjects were young; a lack of information about arterial hypertension and the presence of auto-created habits that are considered as risk factors to hypertensive and cardiovascular diseases that can be modified by means of implementation of educative programs with actions directed to health promotion, in order to control these diseases.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O presente estudo abordou os fatores de risco cardiovascular na populaÃÃo especÃfica de crianÃas e adolescentes, no ambiente escolar, investigando a prevalÃncia destes fatores de risco. O enfermeiro, pode atuar neste ambiente e contribuir para o desenvolvimento de hÃbitos promotores da saÃde cardiovascular, representando a possibilidade de prevenÃÃo mais efetiva da ocorrÃncia de eventos cardiovasculares. Estudo do tipo transversal, com cenÃrio composto pelas escolas da rede pÃblica de Fortaleza, populaÃÃo: crianÃa e adolescentes com idades entre 7 e 14 anos. Amostra nÃo-probabilÃstica, aleatÃria, com um total de 204 estudantes. Notou-se que o grupo apresentou predominÃncia masculina; 70,6% foram classificados como eutrÃficos; 11,3% estavam com sobrepeso. Quanto à porcentagem de gordura corporal, as faixas normal e sobrepeso foram as mais identificadas. Quanto à classificaÃÃo segundo os valores de pressÃo arterial, o grupo foi predominantemente normotenso. A maioria (74,5%) dos estudantes realizava atividade fÃsica. A mediana de escolaridade foi de 05 anos de estudo. Os estudantes tinham mediana de 12 anos de idade. Os estudantes do sexo feminino apresentaram maior frequÃncia de valores alterados de pressÃo arterial, de gordura corporal, colesterol total, LDL, HDL, triglicerÃdeos, realizavam com menos frequÃncia atividade fÃsica adequada. Os estudantes do sexo masculino alimentavam-se com mais frequÃncia à TV (35%). Dos 204 estudantes avaliados, 51 (24%) apresentavam alteraÃÃo da pressÃo arterial, destes, 32 (5,7%) tinham familiar diagnosticado com hipertensÃo, sendo 20 (9,8%) de segundo grau e 14 (6,9%) de primeiro grau. Acredita-se que estudar fatores de risco possibilita ao enfermeiro traÃar planos de aÃÃo e estratÃgias comunitÃrias dentro da EstratÃgia SaÃde da FamÃlia como no Programa SaÃde da Escola. O impacto destas intervenÃÃes seriam visualizados à longo prazo, quando a populaÃÃo apresentasse reduÃÃo de casos novos ou retardo na apresentaÃÃo de sequelas e complicaÃÃes associadas. / The present study addressed the cardiovascular risk factors in specific populations of children and adolescents in the school environment, investigating the prevalence of these risk factors. The nurse can work in this environment and contribute to the development of habits of cardiovascular health promoters, representing the possibility of more effective prevention of cardiovascular events. Cross-sectional study, with scenery composed of the public schools in Fortaleza, population: children and adolescents aged 7 to 14 years. Non-probability sample, random, with a total of 204 students. It was noted that the group presented predominantly male, 70.6 % were classified as normal, 11.3 % were overweight. As for the percentage of body fat, normal and overweight ranges were the most identified. Regarding the classification according to the values of blood pressure, the group was predominantly normotensive. The majority (74.5 %) of students performed physical activity. The median education level was 05 years of study. The students had a median age of 12 The female students had a higher frequency of abnormal values of blood pressure, body fat, total cholesterol, LDL, HDL, triglycerides, performed less frequently adequate physical activity. The male students fed up with the TV more often (35 %). Of the 204 students assessed, 51 (24 %) had blood pressure change, of these, 32 (5.7 %) had a family diagnosed with hypertension, 20 (9.8%) of high school and 14 (6.9%) first degree. It is believed that studying risk factors allows nurses to draw up action plans and strategies within the Community Health Strategy as a Family Health Program in the School. The impact of these interventions would be viewed in the long term, when the population of new cases present reduction or delay in the presentation of sequelae and complications.

Made available in DSpace on 2014-10-09T12:28:21Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:56:30Z (GMT). No. of bitstreams: 0 / A Doença de Chagas (DC) foi descrita por Carlos Chagas em 1909. É causada por um parasita T. cruzi, transmitido por triatomíneos, por transfusão de sangue, vertical e por via oral. A DC tem duas fases: aguda e crônica. A evolução para a forma cardíaca ocorre em cerca de 30% dos casos crônicos e é a maior responsável pela mortalidade na doença de Chagas crônica. O objetivo deste trabalho foi estudar a cardiopatia chagásica em pacientes do Tocantins, comparando com outras cardiopatias e pacientes assintomáticos do ponto de vista de exames complementares não invasivos usando energias radiantes, como ecocardiografia e RX e o ECG. Houve uma prevalência de 9,5% de pacientes chagásicos atendidos no ambulatório de cardiologia em Araguaína Tocantins, sendo que 7.3% na forma crônica e 2,21% na forma indeterminada .Dos pacientes crônicos, incluídos no estudo 50% tinham megaesôfago e 4 megacolon (20%). A maioria dos pacientes não apresentou história familiar positiva para DC, nem era tabagista ou etilista. As principais alterações eletrocardiográficas encontradas referem-se à condução. A avaliação do ICT, do chagásico crônico mostrou se aumentada em 40% dos pacientes, 40% apresentam alterações esofágicas e 20% dos pacientes s apresentavam megacolon . O ecocardiograma mostrou-se alterado em 42%). 27% dos pacientes apresentaram FE abaixo de 55% alterada. Alterações da contratilidade segmentar e Assincronia septal foram encontradas em 80% dos chagásicos crônicos. Em 80% dos pacientes foi verificada disfunção diastólica. As alterações valvares ocorreram em 75%. As alterações eletrocardiográficas,ocorreram em 80% dos pacientes com CCC, , enquanto nas outras cardiopatias tinham alterações no ECG. Observou-se que no grupo dos chagásico a diminuição da fração de ejeção esta correlacionada a maior incidência de arritmias alem da disfunção diastólica e relacionada com aumento do atrio esquerdo, ICT tem correlação com a FE e tamanho de VE e AE. Os ECG alterados também guardam relação com as disfunções. / Dissertacao (Mestrado) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Made available in DSpace on 2014-10-09T12:53:24Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:58:37Z (GMT). No. of bitstreams: 1 11920.pdf: 5864547 bytes, checksum: 5ef2e00923af82aba8772a4858fa873e (MD5) / Dissertacao (Mestrado) / IPEN/D / Instituto de Pesquisas Energéticas e Nucleares - IPEN-CNEN/SP

Orientadores: Heitor Moreno Junior, Maricene Sabha / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T18:07:53Z (GMT). No. of bitstreams: 1 Favero_FabriciodeFaveri_M.pdf: 1407421 bytes, checksum: 06435063a3f8e02cab7d2728ccdd05e0 (MD5) Previous issue date: 2009 / Resumo: Introdução: Em pacientes hipertensos, há uma relação entre morbidade e mortalidade e dano arterial, afetando um ou vários órgãos como: coração, cérebro, rins e outros. Portanto, lesões arteriais requerem uma avaliação precoce dos fatores de risco cardiovascular, uma vez que são os maiores contribuintes para doenças cardiovasculares. Entre os métodos simples e não invasivos de avaliação da rigidez arterial, a Velocidade de Onda de Pulso (VOP) é amplamente utilizada como um índice de rigidez arterial e elasticidade, sendo preciso, simples, reproduzível e habitualmente aplicado em estudos clínicos. Objetivos: Detectar alterações na velocidade de onda de pulso (VOP) em pacientes com hipertensão arterial resistente e hipertensos controlados quando comparados a indivíduos não hipertensos, durante dois períodos. Materiais e Métodos: este estudo avaliou 129 pacientes: 42 com hipertensão arterial resistente (HAR), 46 com hipertensão arterial controlada (HAC) e 41 indivíduos sem doença hipertensiva, representando o grupo controle (CT). O estudo foi realizado em duas fases - inicialmente com terapia medicamentosa otimizada (fase 0) e, após 6 meses, os pacientes foram reavaliados com o tratamento habitual associado à espironolactona na dose de 25 mg/dia (fase 1). Resultados: Na fase 0, a VOP do grupo CT (7,8±1,06 m/s) foi inferior a do grupo HAC (8,6±1,26 m/s), que mostrou-se inferior a do grupo HAR (9,3±1,5 m/s). Na fase 1, os resultados seguiram o mesmo padrão: grupo CT = 7,8±1,12 m/s, grupo HAC = 8,42±1,19 m/s e grupo HAR = 9,4±1,45 m/s. Conclusões: As alterações da VOP encontradas nos grupos HAR e HAC sugerem um aumento na rigidez arterial desses grupos. Os resultados indicam que valores mais altos de VOP estão associados a níveis de hipertensão moderado a severo. A associação da espironolactona não alterou os valores da VOP, aparentemente, não interferindo no remodelamento vascular. No que se refere à VOP, são necessários estudos adicionais com "n" maior de pacientes, por um período mais prolongado. / Abstract: Introduction: In hypertensive patients, there is a relationship between morbidity and mortality and arterial damage, affecting one or several organs like: heart, brain, kidney and others. Therefore, large arterial injuries require early evaluation of cardiovascular risk factors, once they are major contributors to cardiovascular diseases. Among the simple and non-invasive methods of arterial assessment, the Pulse Wave Velocity (PWV) measurement is widely utilized as an index of arterial stiffness and elasticity, for being accurate, simple, reproducible and usually applied in clinical trials. Objectives: To detect PWV alterations in arterial resistant and controlled hypertensive patients when compared to subjects with no hypertensive disease, during two periods. Materials and Methods : This study assessed 129 subjects: 42 Resistant Hypertensive (RH) patients, 46 Controlled Hypertensive (CH) patients and 41 subjects with no hypertensive disease, representing the Control group (CT). The study was performed in two phases - it began at an initial therapeutic optimization time (phase 0) and, after 6 months, patients were reassessed with their usual treatment associated to a spironolactone dose of 25 mg/day (phase 1). Results: In phase 0, PWV value of the CT group (7,8±1,06 m/s) was lower than the CH group (8,6±1,26m/s), which was lower than the RH group (9,3±1,5 m/s). In phase 1, results followed the same pattern: CT group = 7,8±1,12 m/s, CH group = 8,42±1,19 m/s and RH group = 9,4±1,45 m/s. Conclusions: PWV alterations found in groups RH and CH suggest an increase in arterial stiffness in these groups. Results indicate that higher PWV values are associated to moderate-to-severe levels of hypertension. The association of spironolactone did not alter PWV values, apparently, not interfering in vascular remodeling. Regarding PWV, additional studies are necessary with an increased number of patients, for a longer period. / Mestrado / Mestre em Farmacologia

Atrial fibrillation is the most common type of serious dysrhythmia, with increasing prevalence in older age groups. Thromboembolism is a serious complication seen with atrial fibrillation and can range from ischemic stroke, mesenteric ischemia to acute limb ischemia. The annual incidence of acute limb ischemia secondary to atrial fibrillation is 0.14%[1]. Here we report a case of critical limb ischemia with brachial artery occlusion due to an embolus in a patient with new onset atrial fibrillation. A 90 year-old female patient presented to the hospital with complaints of shortness of breath on exertion, orthopnea and palpitations of one week duration. She denied any chest pain, dizziness, or syncope. Past medical history was significant for longstanding hypertension well controlled with amlodipine and a provoked deep vein thrombosis of the leg 40 years prior to presentation complicated by heparin-induced thrombocytopenia. On examination, she had an irregularly irregular rhythm and an HR in 120s, no murmurs or gallops were appreciated. 12 lead EKG was suggestive of atrial fibrillation with rapid ventricular response. She was started on metoprolol tartrate for rate control and Apixaban for anticoagulation. TSH was normal and serial troponins returned negative. A Transthoracic echocardiogram was obtained and showed an ejection fraction of 55-60%, mildly dilated left atrium, mild MR, there was no evidence of a thrombus or patent foramen ovale. Three hours after the first dose of Apixaban, and right prior to discharge, the patient started complainig of sudden onset sharp pain and paresthesia of the left upper extremity below the elbow. On Inspection, the left upper extremity was pale and cold to touch. Radial and ulnar pulses were absent, confirmed by doppler ultrasound. A stat computed tomography angiography of the left upper extremity showed complete occlusion of the brachial artery at the level of the elbow joint. She was started on Argatroban drip en route for emergent brachial embolectomy after Vascular Surgery consultation. Blood circulation to the arm was fully restored. Apixaban was resumed post-operatively and with clinical improvement, the patient was safely discharged home. Atrial fibrillation, irrespective of the type (persistent, paroxysmal, permanent or silent) leads to increased risk of thromboembolism owing to atrial clot formation[2]. However, the timing of initiation of antithrombotic therapy has been widely discussed and needs to be individualized based on the presence of risk factors for thromboembolism and bleeding. Acute limb ischemia may be defined as sudden loss of blood flow to the limb. The cause being either thrombotic (60%) or embolic (30%). It has been noted that 80% of peripheral emboli originate in the heart secondary to atrial fibrillation[3]. A timely diagnosis and treatment is of utmost importance to decrease morbidity and mortality and to salvage the limb’s functionality. References 1.Thromboembolism in atrial fibrillation Menke J1, Lüthje L, Kastrup A, Larsen J. 2.Writing Committee Members, January CT, Wann LS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199-e267. doi:10.1161/CIR.0000000000000041. 3.Callum K, Bradbury A. Acute limb ischaemia. BMJ : British Medical Journal. 2000;320(7237):764-767.

Background: Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality in HIV-infected adults. Research in noninfected populations suggests that knowledge of CVD risk factors significantly influences perception of risk. Understanding the level of risk factor knowledge and risk perception can inform the development of innovative interventions to reduce risk. The purpose of this study was to describe cardiovascular risk factor knowledge and risk perception in a cohort of HIV-infected adults. Specific aims included (a) describing the estimated risk of CVD, the perceived risk of CVD, and the level of CVD risk factor knowledge; (b) describing the relationship between estimated and perceived risk, and (c) examining the influence of risk factor knowledge on perceived risk of CVD. The Health Belief Model was the theoretical framework that guided the study. Methods: A prospective observational cohort; cross-sectional design. A convenience sample of 130 HIV-infected adults was recruited from two hospital-based HIV clinics. Each participant had one study visit in which all data were collected by direct interview. Results: Results: Mean age of enrollees was 48 years (SD 8.4); 62% were male; 41.5% White, 32% Black, 23% Hispanic; 56% current smokers; mean years since HIV diagnosis were 14.7; mean BMI 27 (SD 5.5); 48.5% had prehypertension. Higher scores on the Heart Disease Fact Questionnaire indicate a higher degree of knowledge. In this sample, the Mean was 19, (S.D. 3.5; range 6–25), indicating a fair degree of knowledge. Estimated and perceived risk were significantly, though weakly, correlated r (126) = .24, p = .01. Controlling for age, risk factor knowledge was not predictive of perceived risk (F[1,117] = 0.13, p > .05). Conclusions: HIV-infected adults are at increased risk for cardiovascular disease. Traditional CVD risk factors such as smoking, prehypertension, and being overweight are highly prevalent. Despite having a fair level of risk factor knowledge, knowledge did not influence perception of risk for CVD. Research to improve risk perception and to develop innovative interventions that reduce CVD risk is needed for this population.

The triglyceride/high-density cholesterol-lipoprotein (TG/HDL-c) is a biomarker of cardiovascular events and mortality. In hemodialysis patients, the evidence is controversial. A systematic review was carried out in the Medline, Scopus, Embase, Web of Science, and Pubmed databases to identify the relevant cohort studies on cardiovascular events and mortality in hemodialysis patients the role of TG/HDL-c as a risk factor. Four cohort-type studies were evaluated, with a total of 52,579 hemodialysis patients. Three studies conducted in Asian populations and one study in the United States had the highest percentage of the sample (50,673 patients). The elevated TG/HDL-c ratio is associated with better survival, and there is a consistent gradual inverse association between TG/HDL-c and mortality in all analysis subgroups. In the decile categorization of the exposure variable, a 21% decrease in the risk of cardiovascular mortality and a 15% decrease in all-cause mortality in the highest decile compared to the reference group (D10 aHR = 0.79; 95% CI: 0.69–0.91 and D10 aHR = 0.85; 95%CI: 0.78–0.92). Our results show that the TG/HDL-c ratio is a protective factor for cardiovascular outcomes and mortality in the American population and a risk factor for them in the population from Asia. / Revisión por pares

Cardiovascular disease (CVD) is the leading cause of death worldwide. Pre-menopausal women have a lower incidence and severity of CVD compared to age-matched men. However, at the onset of menopause, CVD increases. A central feature in patients with CVD is excessive chronic sympathetic stimulation (CSS) of β-adrenergic receptors (β-AR’s). Clinical and animal studies show estrogen deficiency and age exacerbate cardiac β-AR signaling and contractile function. This led to the hypothesis that prolonged estrogen deficiency followed by CSS worsens left ventricular cardiac function and hypertrophy in the aged female heart. Female mice underwent bilateral ovariectomy or SHAM surgery at 2.5 months of age. At 12 months post-ovariectomy, mice were infused with Isoproterenol (400μg/kg/h) via mini-osmotic pumps for three days to induce CSS. This observation demonstrates prolonged estrogen deficiency worsens cardiac function and structure in aged female hearts. Thereby emphasizing the importance of clinical intervention and prevention for CVD in menopausal women.