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Impacto do estado nutricional pré-transplante nos desfechos clínicos, sobrevida do enxerto e risco de morte em pacientes transplantados renais
(Faculdade Ciências Médicas de Minas Gerais, 2020-04-09) Santos, Marina Ribeiro de Oliveira; Nascimento, Evaldo; Oliveira, Raquel Aparecida Salustriano Fabreti de
Introduction: Chronic kidney disease is currently considered a health problem worldwide and protein-energy malnutrition in these patients is frequent and an important predictor of morbidity and mortality. Kidney transplantation can improve patient's quality of life and survival, but complications after the procedure are still significant and may be associated with the recipient's nutritional status. Little consideration is given to nutrition in the preparation phase and in kidney transplant surgery and, therefore, the prevalence of malnourished patients before and after transplantation and the influence of the nutritional status on results after the procedure are still underestimated. Objectives: To assess the impact of the nutritional status in recipients before kidney transplantation on renal function, clinical outcomes, graft survival and risk of death. Material and Methods: In this retrospective cohort study including 451 transplanted patients between 2008 and 2018, at University Hospital of The Faculty of Medical Sciences, an easy to use nutritional screening tool was developed for patients in preparation for kidney transplantation, based on anthropometric, laboratory and clinical data. For this, a risk score was elaborated with these data. The sum of all components of the score varies from 0 to 12 points. The patients were stratified into three groups, according to the final score: G1 (0 to 2 points) = low risk; G2 (2-4 points) = moderate risk and G3 (> 5 points) = high risk of malnutrition. Results: Stratifying the 451 patients based on the pre-transplant risk score, G1 was composed of 90, G2 of 292 and G3 of 69 patients. G1 patients maintained the lowest creatinine levels at the time of hospital discharge after transplantation, when compared to the other two groups (p = 0.012). Transplant recipients from G3 had a higher proportion of graft losses, with the mean graft survival time in months being 100.56 + 46.49 in G1, 94.64 + 54.34 in G2 and 77.76 +49.01 in G3 (p = 0.044). The Kaplan-Meier survival curve showed better survival for patients in G1, when compared to the other groups (p = 0.046). G3 patients had almost three times greater risk of graft loss (Hazard Ratio [HR] 2.94; 95% CI; 1.084-7.996). Sensitized patients and patients with delayed graft function had almost twice the risk (HR 1,904, 95% CI 1,168-3,105; HR 1,921, 95% CI 1,238-2,980) and patients with cellular rejection or humoral rejection had a 2.18 times greater risk (HR 2,180, 95% CI 1,251-3,798) of graft loss. Conclusion: Kidney transplant patients with a higher risk of malnutrition according to the pre transplant score were associated with worse outcomes and graft survival. The nutritional screening tool is easy to be used in clinical practice to evaluate the patient in preparation for kidney transplant.
Alta associação entre síndrome do intestino irritável e transtornos psiquiátricos em Belo Horizonte-MG
(Faculdade Ciências Médicas de Minas Gerais, 2017-10-06) Oliveira Sobrinho, Ismael Gomes de; Almeida, Alessandra Maciel; Passos, Maria do Carmo Friche
Introduction Irritable Bowel Syndrome (IBS) is a functional intestinal disorder that affects about 11% of the world population and is really associated to psychological stress and psychiatric comorbidities. According to the medical literature the prevalence of IBS in psychiatric patients is significantly higher than in the general population, and the epidemiological data are analyzed together, once they bring significant impacts on quality of life and high direct and indirect costs. There are few studies that evaluate the prevalence of IBS in psychiatric patients, and there is no study in the Brazilian population. Objective: To investigate the prevalence of IBS in patients diagnosed with depression, generalized anxiety disorder and panic disorder in a psychiatry service. Materials and Methods: One hundred and eighty-seven patients, aged between 18 and 65 years of age, treated in a psychiatry clinical of Belo Horizonte/Brazil, agreed documentally to participate in the study. They first responded to a structured questionnaire containing demographic and health data and subsequently underwent a standardized questionnaire (MINI) to obtain their respective psychiatric diagnoses. After exclusion criteria, 113 of these patients were subjected to a specific questionnaire for diagnosis of IBS according to diagnostic criteria of Rome III. Results: Of the 113 patients, 70 (61.9%) were female and 43 (38.1%) male, 70 (61.9%) were 31 years of age or older. The married or in a stable union patients made up a total of 61 patients (54%), the same number found for patients who attended higher education (54%). Among the patients, 92 (81.4%) lived in the capital and 82(72.6%) reported having non-white complexion. The prevalence IBS according to the diagnostic criteria of Rome III was 40.7%, and the subtype diarrhea was the most common (20.4%), followed by the mixed subtype (12.4%) and finally the constipation subtype (8%). The prevalence in patients diagnosed with depression was 29.6%, with generalized anxiety disorder in 60%, and in those with panic disorder, 58.3%. Conclusion: The results of this Brazilian populational study are in agreement with previous studies performed in various regions of the world, that using similar parameters of evaluation show a higher prevalence of IBS in psychiatric patients than in the general population. The prevalence of IBS according to the Rome III criteria was 40.7% in this population with psychiatric diseases.
Correlação entre alcoolemia, álcool no ar expirado e exame clínico em um estudo clínico monitorado de ingestão de álcool
(Faculdade Ciências Médicas de Minas Gerais, 2017-12-06) Freitas, Rodrigo Gomes de; Wainstein, Alberto Julius Alves; Wainstein, Ana Paula Drummond Lage
Background: Policies that establish maximum blood alcohol concentrations (BACs) or breath alcohol concentration (BrACs) for drivers while driving can reduce traffic accidents by approximately 20%. In Brazil, the National Transit Council (CONTRAN) considers positive BAC and/or BrAC tests or signs of psychomotor capacity alterations as evaluated by a police authority to be an administrative infraction or even a crime. The observed clinical symptoms of alcohol intoxication based on a subject's appearance may not necessarily reflect the quantified BAC and/or BrAC. Methods: Brazilian health volunteers (n=15) drank ethanol (40% v/v) and, at scheduled times, the subjects underwent blood draws for BAC analysis, were tested for BrAC analysis, and underwent psychomotor alteration assessments performed by M (medical authority) and NM (non-medical authority). This study compared the clinical symptoms identified by M and a NM with BAC and BrAC measurements. Results: Concentration time profiles of the BACs and BrACs of the volunteer subjects were generated. The BAC values reached a peak at 60min and subsequently decreased with time. The average BrAC values decreased with time after ingestion. During the evaluations, M was able to identify a lack of static equilibrium until 240 min and a lack of dynamic equilibrium until 120 min. A lack of upper limb motor coordination was observed until 90 min, and a lack of coordination in the lower limbs was observed only during the first hour. Regarding the tests performed by NM, the signs related to the subjects' appearances were observed more frequently until 60 min. The other analyzed symptoms were not identified. Naturally, the signs reported by both M and NM disappeared with time. Conclusion: The evaluations of psychomotor changes performed by Brazilian M were superior to those performed by NM. However, independent of the examiner, at the alcohol concentrations reached in this study, the psychomotor alteration evaluations were ineffective compared with the BAC and BrAC results.
Efeito agudo da hidroterapia sobre a pressão arterial e o augmentation index em grávidas hipertensas crônicas
(Faculdade Ciências Médicas de Minas Gerais, 2017-12-19) Linhares, Giovana Macêdo; Malachias, Marcus Vinícius Bolívar
Acute effect of hydrotherapy on blood pressure and augmentation index in chronic hypertensive pregnant women Introduction and objectives: Chronic hypertension and elevation of augmentation index in pregnancy are associated with the risk of complications such as superimposed preeclampsia and low fetal growth. The impact of hydrotherapy had not yet be enassessed in this context.Objectives: To evaluate the acute effect of a session of aquatic physiotherapy (hydrotherapy), a modality of non-pharmacological treatment, on blood pressure and augmentation index in chronic hypertensive pregnant women.Methods: A cross-sectional controlled study evaluated the effect of a hydrotherapy session on the blood pressure and arterial stiffness of pregnant women. We used Mobil-O-Graph-NG equipment for arterial variables, before and after a hydrotherapy session, involving stretching, warming, strengthening and relaxation.Results: We evaluated 36 pregnant women, 12 hypertensives, 24 controls, 30.4 ± 4.8 years old, 29.2 ± 3,3 weeks of gestation. In both groups, we observed reduction in augmentation index adjusted for 75 bpm (hypertensives: 28.8 ± 7.3%, before, 22.4 ± 6.9%, after, p = 0.024 and controls: 29.1 ± 7 , P= 0.001), and heart rate reduction (hypertensives: 93.4 ± 11.8 bpm, before, 82.4 ± 10.0 bpm, after, p <0.001 and controls: 91.4 ± 13.4 bpm, before, 81.5 ± 12.6 bpm, then; p <0.001). Hydrotherapy promoted a borderline significant redution in systolic blood pressure in hypertensive patients (139.6 ± 12.1 mmHg, before, 130.1 ± 12.6 mmHg, later, p= 0.050). Conclusions: We demonstrated for the first time that a hydrotherapy session acutely reduces the arterial stiffness expressed by the augmentation index, as well as attenuation in the heart rate of hypertensive pregnant women, regardless of the reduction of the blood pressure. The intervention proved to be safe and could represent a potential accessory non-pharmacological strategy for the prevention of maternal-fetal complications associated with chronic hypertension during pregnancy.
Achados fonoaudiológicos na avaliação do sistema estomatognático em pacientes com doença do refluxo gastroesofágico
(Faculdade Ciências Médicas de Minas Gerais, 2017-04-26) Silva, Ana Paula Ferreira Opaso Alvarez Antonucci e; Almeida, Alessandra Maciel; Passos, Maria do Carmo Friche
Backgrounds: There is some evidence that a portion of patients with Gastroesophageal Reflux Disease present alterations in the stomatognathic system that justify the mainly atypical symptomatology. Objectives: To evaluate the stomatognathic system in adult patients with GERD and verify the association of disorders of the stomatognathic system and esophageal and extraesophageal symptoms. Methods: A total of 40 patients, aged over 18 years with a confirmed diagnosis of GERD by the gastroenterologist, were selected. All patients answered a questionnaire prepared by the researchers and underwent an evaluation of the stomatognathic system performed by the speech pathologist. The findings of the speech-language pathologist evaluation were correlated with those obtained in the self-evaluation of the patient. Results: The sample was predominantly female (60%), mean age of 48.2 years. Most of the patients performed physical activities (62.5%), 37.5% gained weight in the last six months. More than half of the patients (55%) have comorbidities, and hypertension is the most prevalent. In the evaluation of the stomatognathic system, 40% had decreased tone and mobility of the orofacial musculature. It was found that 57.5% of the patients presented adequate chewing according to the audiologist's evaluation and in the self-assessment, 65.1% of the diagnoses were concordant. Of these, 72.5% stated that they did not present noises / cracks in the temporomandibular joint during mastication, however in the expert's evaluation this number was 65.5%. Of the 11 patients who reported noises / snags in the temporomandibular joint during chewing, only 4 (36.4%) presented concordant results with the audiologist's evaluation. Also, 52.5% of the patients had a preference for crushing food, 20% of which used prostheses and 30% had dental flaws. Conclusion: The majority of patients diagnosed with gastroesophageal reflux disease present orofacial muscular hypotonia, which can lead to ineffective chewing, causing a disorder in the digestive process and may induce or aggravate the symptoms of gastroesophageal reflux disease.