Comparison of pregnancy characteristics and outcomes between HIV-infected and HIV-non-infected women in Brazil

The aim of this study is to evaluate the characteristics of pregnant women whether they are HIV infected or not and their prenatal care. It is a cross-sectional study. HIV-infected women were derived from a cohort study of all HIV-infected pregnant women followed from 1995 to 2005, at the Instituto de Puericultura e Pediatria Martagão Gesteira - Rio de Janeiro. HIV-non-infected women were derived from a random sample of all pregnant women who gave birth at Rio de Janeiro municipality between 1999 and 2001. All relevant sociodemographic, clinical, and pregnancy outcomes data were retrieved from both studies. To evaluate the prenatal care, we calculated the Kotelchuck Modified Index (KMI). The index is based on the months of initiation of prenatal care and the proportion of visits observed in each trimester, according to gestational age at birth. Comparisons were performed using Student t- and chi-square tests. Variables with p-value < 0.25 were included in an unconditional logistic regression model. There were 713 HIV-infected women and 2145 HIV-non-infected women. Variables independently associated with HIV status were: inadequate KMI (OR=4.08, 95% CI=3.17-5.24); lower educational level (OR=1.32, 95% CI=1.04-1.68); does not live with a partner (OR=3.54, 95% CI=2.66-4.64); lower family income (OR=4.71, 95% CI=3.62-6.14); tobacco use (OR=2.17, 95% CI=1.63-2.88); and hypertension (OR=1.47, 95% CI=1.01-2.17). Prematurity was not independently associated with HIV status. Although in Brazil, the HIV care is free of charge, pregnant women are still having difficulty to reach the specialized care. Better access to care must be offered to this population and studies of prematurity in the HIV-infected women must evaluate their prenatal care.

[Indications and results of lung resection in bronchiectasis]

The prevalence of bronchiectasis has decreased significantly over recent decades in developed countries. However, resection for bronchiectasis still plays an important role in thoracic surgery practice in some countries such as Portugal. Between 1994 and 2004, 51 patients (29 female and 22 male) with a mean age of 38.6 years (range, 4-65 years) underwent pulmonary resection for bronchiectasis. Mean duration of symptoms was 4.8 years. Surgery was indicated because of unsuccessful medical therapy in 25 patients (49.1%), hemoptysis in 12 (23.5%), lung mass in 9 (17.6%) and lung abscess in 5 (9.8%). The surgical treatment was as follows: pneumectomy in 7 patients, bilobectomy in 3, lobectomy in 36 segmentectomy in 5. There was no operative mortality. Complications occurred in 8 patients and the morbidity rate was 15.7%. Follow-up was complete in 45 (88.2%) patients with a mean of 3.4 years. Overall, 35 (77.7%) patients were asymptomatic after surgery symptoms were improved in 7 (15.6%). Unsuccessful medical therapy was still our main indication for surgery of bronchiectasis, despite aggressive antibiotic therapy. Surgical resection was performed with acceptable morbidity and morbility rates and markedly improved symptoms in the majority of patients.

[Two-years experience with the use of radial artery in coronary revascularization surgery]

INTRODUCTION

Among several other factors, in coronary surgery the results depend on the quality and durability of the grafts. Revascularization employing arterial conduits, namely the radial artery, has been playing a growing role, with the aim of replacing the autologous saphenous vein. The benefits and risks of this strategy is still a matter of controversy. The goal of the present study was the evaluation of the incidence of early complications related to the use of radial artery in the revascularization surgery of the myocardium.

METHODS

A series of consecutive patients who underwent coronary revascularization surgery in the CHVNGaia using radial artery, from January 2000 to December 2001, was retrospectively analyzed. Data were obtained through the revision of the clinical charts and hospital database. The major end-point assessed was the 30-day or intra hospital postoperative death; furthermore, acute myocardial infarction, stroke, renal failure, prolonged ventilation and reoperations for acute graft occlusion, bleeding and mediastistinitis were also evaluated.

RESULTS

During that period of time, 656 patients underwent coronary revascularization surgery, but the radial artery was used in only 230 (35%). Mean age was 60.2+/- 9.1 years and 42 (18.3%) were female. Two hundred and four patients (88.6%) were operated on under extracorporeal circulation. The average number of grafts was 2.6+/- 0.6 per patient. Mean duration of orotraqueal intubation was 2.4 +/- 6 hours. Thirty patients (14,3 %) developed atrial fibrillation and ten (4.3%) had postoperative bleeding. Perioperative myocardial infarction occurred in five cases (2.2%). Two patients (0.8%) underwent reoperation for mediastinitis and one patient (0.4%) was reoperated on for acute occlusion of the graft. The overall postoperative mortality was 1.3% (3 patients).

CONCLUSION

The use of radial artery in coronary revascularization did not caused morbidity and mortality, out of the usual context of coronary surgery. The results of our experience suggest that radial artery can be successfully used in myocardial revascularization surgery, enlarging the possibilities of utilization of arterial autografts.

Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass

BACKGROUND

With the evolution of anesthesia and surgical procedures, fast track extubation has gained an increased interest, mainly based on the possibility of reducing health costs seemingly without compromising patient care.

AIM

To compare two groups of patients submitted to a non-fast track extubation and a fast track extubation protocol after coronary artery bypass graft surgery with cardiopulmonary bypass, regarding their times of ventilation and intubation and their complication rates in the postoperative period.

METHODS

During the year of 1998, 323 sequential patients scheduled for isolated coronary artery bypass graft surgery with cardiopulmonary bypass were enrolled in the study. Fifty-nine patients were excluded due to preoperative use of emergent mechanical and/or inotropic hemodynamic support, low body mass index (< or =18-20 kg/m(2)), reoperations for acute surgical complications, off-pump coronary artery bypass graft surgery, severe respiratory disease, recent myocardial infarction (< or =7 days) and absence of relevant data. Previous myocardial infarction (> or =7 days), prophylactic intraaortic balloon pump and use of postoperative vasoactive drugs were not exclusion criteria. We compared 76 patients sequentially submitted to anesthesia by one of the authors with a fast track extubation protocol and 188 patients sequentially submitted to anesthesia by others in the same period and using a conventional anesthetic protocol.

RESULTS

Demographic data, previous medical and cardiac history, preoperative medication and operative data were all similar between the two groups. The mean ventilation and intubation times were significantly shorter in the fast track extubation group than in the non-fast track extubation patients (30 min vs. 7 h and 50 min vs. 8 h, respectively). Forty-two percent of patients in the fast track extubation group were extubated on arrival at the intensive care unit. Morbidity and mortality were similar in both groups.

CONCLUSIONS

The study shows that a very fast track extubation protocol may be safely implemented in patients submitted to coronary artery bypass graft surgery with cardiopulmonary bypass.

[Tetanus. A review of 54 cases]

Tetanus continues to be a frequent illness with a high rate of mortality which mainly affects the elderly. In view of this, 54 cases treated in the ICU between 1983 and 1991 were studied. The clinical support with mechanical ventilation and the use of new drugs, which allowed for a more satisfactory sedation and muscular relaxation, and which permitted the control of the autonomic overactivity, were the most determinant factors in the reduction of mortality verified in the late years of our practice.

Antihypertensive effects of tertatolol. A comparative study versus atenolol

The purpose of this study was to compare the antihypertensive efficacy and tolerance of tertatolol and atenolol. Sixty-one ambulatory patients with uncomplicated mild to moderate hypertension (diastolic blood pressure (DBP) between 95 and 120 mm Hg) received, following a randomized allocation, either 5 mg tertatolol (T) (n = 30) or 100 mg atenolol (A) (n = 31) in single daily dose. After a one-month single-blind placebo run-in period, the two drugs were administered double-blind over a 3 month period. Blood pressure (BP) and heart rate were measured before, and after the first and third months. Electrocardiographic and biological data were collected respectively before and at the third month. At each consultation, patients were asked to report any side effects. Atenolol and tertatolol were similar in controlling BP: the decrease in supine systolic blood pressure (SBP) reached 24.2 mm Hg (P less than .001) in group T and 21.7 mm Hg in group A (P less than .001), and the decrease in DBP reached 16.6 mm Hg in group T (P less than .001) and 16.8 mm Hg in group A (P less than .001). Supine heart rate (HR) fell by 15.5 beats/min and 14.8 beats/min in the T and A groups, respectively (P less than .001). At the end of the trial, blood pressure control (DBP less than or equal to 90 mm Hg) was obtained in 80% and 70% of the patients in the T and A groups, respectively. The clinical tolerance of both drugs was satisfactory with 8 slight and transient complaints in T group, and 14 complaints with one treatment-related withdrawal at the second month in A group. Electrocardiographic and biochemical variations were not significantly different in the two groups. We conclude that the antihypertensive efficacy of 5 mg tertatolol is comparable to that of 100 mg atenolol, with a similar clinical and biochemical tolerance.