“MORTALITY RISK FACTORS FOR A COHORT OF ELDERLY RESIDENTS IN SAO PAULO. BRAZIL.” Luis Roberto Ramos, Edwrdo Simdes, rind Clovis Peres. CEC, Escola Paulista de Medicina, S% Paulo, Brazil. Objectives: To determine 2-year mortality risk factors among urban elderly residents, m a country undergoing a fast demographic transition, like Brazil. Design: The study consisted of two household surveys that enabled a twoyear follow-up of an actively enrolled population of individuals aged 65 and over living in a middle class area of the city of %o Pa&. The interviews were conducted by trained interviewers using a previously validated multidimensional funcrional assessment questionnaire. Participants: A tcltal of 1,607 people matched the age criteria and were successfully interviewed in the first household survey. After two years 123 ha\re died, and 1,108 were interviewed. Intervention: Patients were randomized to receive non-diuretic antihypertrnsive drugs (control group n = 99) or a diuretic with or wirhout other antihypertensive drugs (study group n = 94) as per physician’s choice. Main Outcome Measure(s): We evaluated the hypothesis of a positive relatlonship between overall mortality and scores of functional and mental capacity, controlling for potential confounding effects of sociodemographic and health-related factors using logistic regression models. First order interactions were assessed for their association with mortality using a 2 log-likelihood chl-square rest comparing full and reduced models. We used hoth goodness of a fit test and graphical regression diagnostics to evaluate fitness and adequacy of the models. The analysis was done wirh SPSS 6.1 for Windows. Results: The following variables independently affected the risk of dying in rhe 2-year period: gender (male-RR = 2.5 [1.6-3.91); age (80+-RR = 3.1 [1.6-5.91); independence in daily living (severe impairment-RR = 5.0 [2.5-9.51); history nf at least one hospitalization in the previous year (RR = 3.2 [l&5.7]); hring hedridden at the time of the interview (RR = 22.3 [5.1-98.81); cogmtive starus (MMSE< 18-RR = 3.0 [1.6-5.51); self-evaluanon of health (worse rhan others-RR = 1.9 [1.2-3.01). Conclusion: Aparr from the striking risk associated with being bedridden, which acrually affected only a small number of individuals, the major risk facrors for dying (orher rhan age and gender as expected) were the loss of Independence of the activities of daily living, followed by history of hospitalization, impaired cognitive status, and self-evaluation. These results point to the need to include such varlahles in rhe routine medical assessment of elderly people. Geriatricians tend to do so, hut clinicians, in general, often do not.
“VALIDATION OF THE MODIFIED HODGKINSON’S QUESTIONNAIRE FOR THE DIAGNOSIS OF THE GENUINE FORM OF URINARY STRESS INCONTINENCE.” Aldo Franklin Ferreira Reis, Jose Carlos deJesus Conceicu, and Rim-do de Oliveiru e Silua. CEU, Universidad Federal do Rio de Janeiro, Brazil. Background: Patients wirh clinical diagnosis of urinary stress incontinence have high prevalence of concomirant neuromuscular dysfunction. It is said that the diagnosis of neuromuscular dysfunction should be made by urodynamic evaluarion. Our hypothesis is that Hodgkmson’s questionnaire can select patients with genuine stress incontinence for surgical treatment, suhstituting urodynamic evaluation with the advantage of saving costs. If the negative diagnosis of concomirant neuromuscular dysfunction is nor made patients will not benefit from surgery. Objective: To study the validiry of the modified (adapted to Brazilian conditions hy Conceicao) Hodgkmson’s questmnnaire for the negative diagnosis of neuromuscular dysfunction in patients wirh urinary stress incontinence hy comparing with urodynamic evaluation. Design: Diagnostic test study. Setting: Gynecologic urology outpatient clinic of Hospital Universitario Clementino Fraga Filho of the Federal Umversity of RIO de Janeiro. Participants: 595 patients with urinary stress incontinence submitted to hoth rhe questionnaire and urodynamic evaluatmn to select patients for surglcal treatment of the genuine form of urinary stress incontinence and for clmical treatment of dysfunctional problems combined or nor wirh stress inccmrinence. Main Outcome Measure(s): Questionnaire conclusion and urodynamic findings could he divided in genuine urinary stress incontinence and urmary strebs incontinence comhmed with neuromuscular dysfunction. Results: Neganve Predictive Value = 99% and Likehhood Ratio of ahsence of neuromuscular dysfunction = 0.036. Sensitivity = 99.2%, Specificiry = 22.4X, Positive Predictive Value = 25.6%. Conclusions: Hodgkinson’s questionnaire can identify the portion of patlents wirhout neuromuscular dysfunction who do nor need pre-surgical urodynamic evaluation. A substantial proportion of patients without neuromuscular dysfunction are misdiagnosed needing urodynamic evaluation. Modifications must he proposed to improve its Specificity and Positive Predictlve Value.
9s Ricardo “LATE DIAGNOSIS OF CHRONIC RENAL FAILURE.” Sesso and Angelica Belasco. CEU, Escola Paulista de Medicina, Sao Paulo, Brazil. Objective: An increasing numher of chronic renal failure patients are admitted to our institution at a very advanced stage of chronic renal failure. We investigated the influence of late diagnosis of chronic renal failure on patient mortality during maintenance dialysis. Design: Prospective cohort study with six months of follow-up. Setting: Hospital SZo Paula, Federal University; tertiary referral center m the city of SBo Pa&. Patients: Among 252 patients with end-stage renal disease who srarted maintenance dialysis between 1992-95, 205 had primary renal disease. Of these, 106 had a late diagnosis (LD) o f c h ronic renal failure (less rhan 1 month hefore starting dialysis), 78 had an early diagnosis (ED, more than 3 months of diagnosis) and were mcluded in this study. Main Outcome Measure(s): We compared clinical-laboratory features at first dialysis and cumulative mortality rates (Kaplan-Meier method) within six months of treatment for patients with LL) or ED. The influence of baseline factors on the risk of death was assessed usmg the Cox proportional hazards model. Results: Six-month patient survival rate was lower in rhe late rhan in the early diagnosis group (69% vs. 87%, log-rank test, p
“INTRAVENOUS ESMOLOL FOR ATTENUATION OF THE CARDIOVASCULAR RESPONSE TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION IN HYPERTENSIVE ANti ISCHEMIC HEART DISEASE PATIENTS.” Vijay R. Shrotey and H.J. Mankeshwur. CEU, Government Medical College, Nagpur, India. Objective: To assess cardiovascular response ro laryngoscopy and endotracheal intuhation in hypertensive and IHD patients with and without Esmolol. Design: Randomized controlled trial. Setting: Government Medical College and Hospital, Nagpur, India, a tertiary care hospital. Participants: 80 hypertensive patients having IHD receiving horh antihypertensive and antianginal treatment posted for elective surgery. Group IE = 40 , Group III’-40 patients. Intervention: Group IE-Esmolol 1.5 mg/Kg , group IIP - 1Oml Normal Saline IV just before induction. Main Outcome Measure(s): Heart rate, systolic, diastolic pressure, MAP, RPP. Results: Baseline (after premeditation) mean heart rate 91.4 (15.1) increased to 93.15 (7.56) mmHg at the time of maximum stimulatmn (1 minute after cuff inflation) (p = 0.43) in group IE, while it increased from 93.3 (10.2) to 131.90 (10.5) mmHg (p < 0.0001) in group III’. Baseline mean systolic pressure 141.25 (7.79) decreased to 140.25 (7.11) mmHg (p = 0.29) in group IE, while it increased from 141.5 (12) to 192.1 (21.3) mmHg in group IIP (p < 0.0001). Baseline mean diastolic pressure 87.75 (5.23) reached to 87.20 (5.04) mmHg in group IE (p = 0.91), while it increased from 86.95 (5.49) m 110.7 (7.11) mmHg in group IIP (p < 0.0001). The difference in mean heart rate, systolic pressure and diastolic pressure of two groups at the time of maximum stimulation was highly significant (p < 0.0001). Similarly MAP and RPP w h en compared wirh baseline did not change significantly in group IE hut changed significantly in group III’. At rhe time of maximum stimulation the difference between the Two groups was highly significant (p < 0.0001). Conclusion: It is concluded that Esmolol effectively attenuates rhe cardiovascular response ro laryngoscopy and endotracheal intuhation in hypertensive and IHD patients.