Showing papers by "Daniel Virella published in 2013"

The adjusted effect of maternal body mass index, energy and macronutrient intakes during pregnancy, and gestational weight gain on body composition of full-term neonates.

Abstract: Objective To evaluate the effect of prepregnancy body mass index (BMI), energy and macronutrient intakes during pregnancy, and gestational weight gain (GWG) on the body composition of full-term appropriate-for-gestational age neonates. Study Design This is a cross-sectional study of a systematically recruited convenience sample of mother–infant pairs. Food intake during pregnancy was assessed by food frequency questionnaire and its nutritional value by the Food Processor Plus (ESHA Research Inc, Salem, OR). Neonatal body composition was assessed both by anthropometry and air displacement plethysmography. Explanatory models for neonatal body composition were tested by multiple linear regression analysis. Results A total of 100 mother–infant pairs were included. Prepregnancy overweight waspositivelyassociatedwithoffspringweight,weight/length,BMI,andfat-freemassin the whole sample; in males, it was also positively associated with midarm circumference, ponderal index, and fat mass. Higher energy intake from carbohydrate was positively associated with midarm circumference and weight/length in the whole sample. Higher GWG was positively associated with weight, length, and midarm circumference in females. Conclusion Positive adjusted associations were found between both prepregnancy BMI and energy intake from carbohydrate and offspring body size in the whole sample. Positive adjusted associations were also found between prepregnancy overweight and adiposity in males, and between GWG and body size in females.

The role of sensory modulation deficits and behavioral symptoms in a diagnosis for early childhood.

Abstract: To contribute to the validation of the sensory and behavioral criteria for Regulation Disorders of Sensory Processing (RDSP) (DC:0-3R, 2005), this study examined a sample of toddlers in a clinical setting to analyze: (1) the severity of sensory modulation deficits and the behavioral symptoms of RDSP; (2) the associations between sensory and behavioral symptoms; and (3) the specific role of sensory modulation deficits in an RDSP diagnosis. Based on clinical observations, 78 toddlers were classified into two groups: toddlers with RDSP (N = 18) and those with “other diagnoses in Axis I/II of the DC:0-3R” (OD3R; N = 60). The parents completed the Infant Toddler Sensory Profile and the Achenbach Checklist. The results revealed that the RDSP group had more severe sensory modulation deficits and specific behavioral symptoms; stronger, although not significant, associations between most sensory and behavioral symptoms; and a significant sensory modulation deficit effect. These findings support the validity of RDSP.

Prognostic value of left atrial volume in patients with dilated cardiomyopathy.

Abstract: Background Increased left atrial (LA) size is a prognostic marker of mortality in the general population. LA size varies considerably in patients with dilated cardiomyopathy (DCM), but its clinical significance has not been widely studied. Objective To evaluate the long-term prognostic value of LA volume (LAV) in patients with DCM. Methods We prospectively studied patients admitted between January and December 2004 with a diagnosis of DCM, in sinus rhythm. Complete echocardiographic study at rest and after pharmacological stress was performed in all patients. The composite endpoint of mechanical ventricular assistance (MVA), heart transplantation or death during follow-up was assessed by univariate and multivariate analysis using a Cox regression model. Results The study population consisted of 35 patients (68.6% male, mean age 52.0) with DCM, 82.9% of non-ischemic etiology. Ejection fraction (EF) at rest was 31.1±9.4%. During follow-up, eight patients died, one was placed on MVA and one underwent transplantation. Univariate Cox analysis showed various potential echocardiographic markers of prognosis in our population, including LA size in M-mode (HR 1.12, CI: 0.99–1.26, p=0.067), LAV (HR 1.03, CI: 1.00–1.07, p=0.046), LAV adjusted for body surface area (HR 1.03, CI: 0.99–1.26, p=0.049), E/A ratio (HR 0.99; CI: 0.99–1.81; p=0.060); E/A >2 (HR 7.00, CI: 1.48–32.43, p=0.014) and mitral E/E’ ratio (HR 1.04, CI: 1.00–1.09, p=0.074). The only variable that remained in the multivariate model was LAV, with a cut-off value of 63 ml (HR 7.7, CI: 0.97–60.61, p=0.05). Conclusions LAV was the only echocardiographic determinant of MVA, heart transplantation or death in our population with DCM. The echocardiographic parameters commonly used for risk stratification such as EF, left ventricular end-diastolic diameter and contractile reserve did not show prognostic significance in our study.

Restraints to anticoagulation prescription in atrial fibrillation and attitude towards the new oral anticoagulants

Abstract: Introducao e Objetivos: Avaliar a taxa de prescricao de anticoagulantes orais na fibrilhacao auricular, os fatores associados a nao prescricao, os motivos referidos pelos clinicos para nao prescricao de anticoagulantes incluindo os de nova geracao e realizar estudo evolutivo a medio prazo Material e Metodos: Estudo prospetivo sobre casos consecutivos de doentes com fibrilhacao auricular com alta hospitalar Registaram- se os scores CHA2DS2VASc e HASBLED, comorbilidades associadas e a medicacao previa e a data de alta Na alta hospitalar, o medico assistente indicou em questionario o motivo de nao prescricao de anticoagulantes orais e dos novos anticoagulantes orais Exclusao: contra-indicacao absoluta para anticoagulacao, CHA2DS2VASc ≤ 1 e doenca valvular Os doentes foram reavaliados um ano apos o recrutamento do primeiro doente Resultados: Identificaram-se 103 candidatos a anticoagulacao oral (79,6 ± 8,0 anos; CHA2DS2VASc 5,8 ± 1,4; HASBLED 2,6 ± 1,0; HASBLED ≥ 3 em 55,3%); os anticoagulantes foram prescritos em 34,0% Fatores associados a nao prescricao por ordem decrescente de relevância: uso previo de antiagregantes, doente acamado e/ou demente, ausencia de insuficiencia cardiaca e numero de fatores de risco hemorragico Razoes invocadas para nao prescricao por ordem decrescente de frequencia: risco hemorragico elevado, pequeno beneficio, incapacidade de seguir o esquema terapeutico e dificuldade na monitorizacao da razao normalizada internacional (INR) Os novos anticoagulantes nao foram prescritos e as razoes invocadas foram, por ordem decrescente de frequencia: informacao insuficiente sobre estes farmacos, risco hemorragico elevado, custo elevado e pequeno beneficio Aos 8,2 ± 2,5 meses de estudo evolutivo 33,3% dos doentes encontravam-se sob anticoagulacao sem que os novos anticoagulantes tivessem sido prescritos Conclusoes: Nesta amostra, a taxa de prescricao de anticoagulacao oral foi baixa e o fator mais associado a nao prescricao foi o uso previo de antiagregantes O impedimento a prescricao mais referido foi o risco hemorragico, seguido do pequeno beneficio reconhecido Os principais impedimentos referidos a prescricao dos novos anticoagulantes foram a informacao insuficiente e o alto risco hemorragico A medio prazo, a proporcao de doentes sob anticoagulacao mantinha-se baixa e os novos anticoagulantes nao tinham sido prescritos

O volume da aurícula esquerda como marcador ecocardiográfico de prognóstico em doentes com miocardiopatia dilatada

Abstract: Resumo Introducao O aumento da auricula esquerda (AE) e um marcador de mortalidade na populacao geral. Os doentes com miocardiopatia dilatada (MCD) tem um amplo espetro de tamanhos de AE, mas a importância clinica desta observacao tem sido pouco estudada. Objectivo Avaliar a importância prognostica a longo prazo do volume da AE (VAE) em doentes com MCD. Metodos Estudo prospetivo de doentes admitidos durante o ano de 2004 com o diagnostico de MCD, em ritmo sinusal. Foi realizado estudo ecocardiografico completo em repouso e apos stress farmacologico. O endpoint composto considerou a assistencia ventricular mecânica (AVM), a transplantacao cardiaca ou a morte. Resultados Foram incluidos 35 doentes (68,6% sexo masculino, idade media 52,0), 82,9% etiologia nao isquemica. Fracao ejecao em repouso 31,1 ± 9,4%. Durante o seguimento, oito doentes morreram, um foi colocado em AVM e um foi transplantado. A analise de Cox univariavel revelou potenciais marcadores ecocardiograficos de prognostico na amostra tais como a dimensao da AE em modo M (HR-1,12; IC: 0,99-1,26; p = 0,067); VAE (HR-1,02; IC: 1,00-1,04; p = 0,046); VAE ajustado a superficie corporal (HR-1,03; IC: 1,00-1,07; p = 0,049); E/A (HR-0,99; IC: 0,99-1,81; p = 0,060); E/A > 2 (HR-7,00; IC:1,48-32,43; p = 0,014) e E/E’ mitral (HR-1,04; IC: 1,00-1,09; p = 0,074). Na analise multivariavel a unica variavel que permaneceu no modelo foi o VAE com o ponto de corte de 63 ml (HR-7,7, IC: 0,97-60,61, p = 0,05). Conclusao Nesta amostra, o VAE foi o unico parâmetro ecocardiografico determinante de AVM, transplantacao cardiaca ou morte. Os parâmetros ecocardiograficos habitualmente utilizados para estratificacao de risco, tais como a fracao ejecao do ventriculo esquerdo, a dimensao do ventriculo esquerdo e a reserva contratil nao tiveram valor prognostico na nossa amostra.