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A intensidade da dor e a incapacidade afetam a qualidade de vida relacionada à saúde da pessoa idosa com dor lombar? Análise multinível entre Brasil e Holanda: estudo cross sectional do consórcio BACE
(Faculdade Ciências Médicas de Minas Gerais, 2023-03-27) Grigorini, Adriana Estela de Oliveira; Pereira, Leani Souza Máximo; Leopoldino, Amanda Aparecida de Oliveira
Introduction: The prognosis of back pain (BP) in the elderly is less favorable than in adults and progress to adverse outcomes such as disability, falls, comorbidities, sleep disorders, psychosocial distress, and consequent worsening of health-related quality of life (HRQoL). Objective: To verify the association between the acute BP intensity, disability, and quality of life in elderly residents in Brazil and Netherlands. Methods: Data were collected from 602 Brazilian and 675 Dutch participants with a new episode of BP from the Back Complaints in Elders (BACE) consortium. For the present study, a cross section was used. Pain intensity and disability were assessed using the Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. HRQoL was assessed using the Short Form Health Survey (SF-36) quality of life questionnaire. Age, sex, and education were descriptive variables. Pain intensity (NPS score) and country were the independent variables and quality of life assessed by each SF domain - 36 was the dependent variable. Analysis of models at the individual level was performed to verify the association between pain and disability, also HRQoL in Netherlands and Brazil in the total sample. The multilevel model was used to verify whether the elderly person's country of residence influenced this relationship. Results: The evaluated sample consisted of 1270 participants who were divided into two groups: Brazilians (n = 602, 67.7 ± 7.0 years) and Dutch (n = 668, 66.4 ± 7.57 years). As for sociodemographic characteristics, 908 (71.5%) of all participants were female and 362 (28.5%) were male, with a mean age of 67 (± 7.33 years). Brazilian elderly had lower educational levels and worse scores for disability (RMDQ) and pain intensity (NPS) compared to Dutch elderly. In the total sample, linear regression analysis adjusted for sex and age showed a significant association between BP intensity scores and HRQoL, for all domains, observing that Dutch elderly people had a greater impact of pain on quality of life as assessed by the SF-36. There was no association between disability and HRQoL. In the multilevel analysis, there was an association between BP intensity and HRQoL in all domains and an association between the country of residence and HRQoL, influencing the effect of pain, in all domains, except for the physical functioning. Conclusion: Socioeconomic and cultural aspects of Brazil and Netherlands can impact the perception of the elderly about their quality of life in the presence of BP. Pain and disability in Brazilian and Dutch elderly ones are experienced differently in relation to their quality of life.
Achados ecocardiográficos em crianças de pacientes com diagnóstico de síndrome do PRKAG2
(Faculdade Ciências Médicas de Minas Gerais, 2023-08-25) Santos Neto, Dinamar Amador; Pena, José Luiz Barros
Background: PRKAG2 syndrome typically manifests in adolescence and early adulthood along with left ventricular hypertrophy, arrhythmias, and increased risk of sudden death. Echocardiographic marker findings before clinical manifestation in children of PRKAG2 parents can facilitate prevention strategies and therapeutic planning. Objective: Identify the existence of early echocardiographic findings in asymptomatic children of PRKAG2 parents. Methods: Cross-sectional observational study of seven children, aged between 9 months and 12 years, of PRKAG2 parents was compared to a control group matched by sex and age with no cardiovascular disease. All children underwent conventional and advanced echocardiographic techniques. Results: Conventional echocardiography showed higher values with statistical significance in the case group for left atrium, interventricular septum, left ventricular posterior wall, indexed ventricular mass, and relative wall thickness. Global longitudinal strain obtained from the two-dimensional examination showed no statistical significance between the groups. None of the parameters on the three dimensional echocardiogram showed statistical significance between the groups. Conclusion: Children diagnosed with PRKAG2 presented echocardiographic findings suggestive of a tendency to cardiac hypertrophy. Echocardiography can be a useful tool in the evaluation and follow-up of these patients before the onset of clinical manifestations.
Assistência fisioterapêutica 24 horas em doenças crônicas nos custos da Unidade de Terapia Intensiva nível III
(Faculdade Ciências Médicas de Minas Gerais, 2022-12-20) Ferreira, Flávia de Paula Castro; Mourão, Lídia Miranda Barreto; Leopoldino, Amanda Aparecida de Oliveira
Introduction: The total cost per patient in the intensive care unit (ICU) is closely related to the severity of the disease, number of comorbidities and length of stay. Thus, the study aims to investigate the influence of the insertion of 24-hour physical therapy care (PT-24 hours) compared with 14-hour coverage (PT-14 hours) in the ICU level III in patients with mechanically ventilated chronic diseases. Methods: This is a retrospective cross-sectional study, composed of a convenience sample of patients using invasive mechanical ventilation (IMV) admitted to the ICU, from May 2020 to May 2022, in a public hospital. The following data were compiled to characterize the sample: age, gender, chronic diseases, classification of severity by diagnostics related group methodology, expected and performed hospital stay, occurrence of infectious and non-infectious incident, hospital outcome (death/non-death), IMV time and costs per patient. The variables were tested for normality by the Anderson Darling test. The Kruskal-Wallis tests followed by Pos hoc Conover and Mann Whitney were used to compare the differences between the medians. The significance level of p<0.05 was adopted. The R software (R Core Team, 4.2.1) was used to perform the analyses. Results: The sample consisted of 469 patients, PT-14 hours 267 and PT-24 hours 202 patients, with arterial hypertension being the most prevalent comorbidity in both coverage of therapeutic care, 73% and 76.7%, respectively. The severity classification was similar in both groups. The insertion of pt-24 hours in the ICU compared to the coverage of the PT-14 hours, did not present statistical difference (p<0,005), but with a reduction in the total gross cost of 23%. Conclusion: The insertion of pt-24 hours in the ICU resulted in a lower percentage of the total gross amount spent on the hospitalization of critically ill patients when compared to patients who were only assisted by the PT-14 hours.
Avaliação epidemiológica, de características e desfechos clínicos e modalidades terapêuticas em pacientes câncer de mama e ovário portadoras de variantes genéticas
(Faculdade Ciências Médicas de Minas Gerais, 2023-10-04) Brandão, Flávio Silva; Garicochea, Bernardo; Rodrigues, Angélica Nogueira
INTRODUCTION: Knowledge about the germline mutational spectrum among Brazilians patients with hereditary breast (BC) and/or ovarian (OC) cancer (HBOC) caused by high- and moderate penetrance genes is limited, as well as their epidemiological characteristics, therapeutic/preventive strategies access and clinical outcomes. OBJECTIVES: To describe pathogenic (PV), likely pathogenic (LPV) variants and variants of uncertain significance (VUS) pattern of HBOC syndrome related genes, and clinical-epidemiological characteristics and outcomes in a cohort of affected patients. MATERIAL AND METHODS: This is a retrospective observational cohort. Professionals from four oncology clinics and one philanthropic hospital located in Minas Gerais, a state southeast of Brazil, were invited to include patients diagnosed with BC or OC, previously identified with a PV/LPV/VUS in BRCA1, BRCA2, CHEK2, ATM, PALB2, BARD1, RAD51C, RAD51D, PTEN, NF1, TP53, MSH6, CDH1, RECQL or FANCC genes. Patients were invited to participate in the study, and those who accepted should sign an informed consent form (ICF). Pathology reports, medical record data were analyzed, and available patients were interviewed for clinical and epidemiological data. RESULTS: A total of 144 patients were evaluated, of whom 85 signed the ICF form. 19 patients had not been diagnosed with breast or ovarian cancer and were excluded. A total of 66 patients were included in this analysis, 61 who consented and 5 patients who had died, scenario were ICF was waived by the IRB. Forty-three patients with BC and an PV/LPV underwent primary breast surgery and 22 of them (51.1%) were aware of the genetic test result at the time of the surgery and 15 (68.2%) of them underwent bilateral surgery. In the group who wasn’t aware of the genetic test result, only one (4.7%) underwent bilateral mastectomy, (p<0.001). The median time from diagnosis to genetic testing was 0.4 years in patients diagnoses before 2015 and it was 7.9 years when diagnosis was after this date (p<0,001). A total of 85 variants were found, 51 PV/LPV and 34 VUS. Four (6%) patients were diagnosed with OC and 62 (94%) with BC. 19 PV/LPV were found in BRCA1, 13 in BRCA2, 6 in TP53, 4 in ATM, 4 in PALB2. Other PV/LPV were found in CHEK2(2), RAD51C and PTEN. One of the patients with a LPV in TP53 had a PV in MUTYH. The most commonly found variant was c.2T>G (p.Met1Arg) of BRCA2, present in 4 unrelated patients with BC A comparison between the classifications found in the patients’ test reports and the ClinVar and VarSome in May/2023 was made. Only 49.4% of the variant classifications (42 of 85 variants reported) showed complete agreement between the reports, ClinVar and VarSome Thirty-eight patients of this cohort (57.5%) had access to genetic counseling, compared to only 3 out of 18 (16%) from the philanthropic hospital. CONCLUSION: To our knowledge, this is the second largest study identifying patients with PV/LPV/VUS in the state of Minas Gerais and one of the largest in Brazil. The study also shows a significant delay in the test result and limited access to genetic counseling, which possibly has influenced on the high rate or conservative surgery. There is a great need to expand hereditary cancer testing and counseling in Brazil. Understanding Brazilian´s unique social and structural barriers is needed to attain a significant impact.
Características epidemiológicas e clínicas de pacientes jovens com câncer de mama segundo o perfil mutacional
(Faculdade Ciências Médicas de Minas Gerais, 2024-06-13) Corrêa, Daniela Beggiato; Rodrigues, Angélica Nogueira
Introduction: Breast cancer is the most common cancer in women and an important cause of death. Advanced age is directly proportional to the risk of developing the disease, but young women are more likely to develop breast cancer with worse clinicopathological charac teristics and more aggressive subtypes. It is essential to get to know the epidemiological pro file of young breast cancer (YBC) patients to better organize strategies to improve its control. Data from Brazilian YBC patients are scarce, especially regarding its association with a germline mutations with pathogenic potential. Objective: To compare epidemiological and clinical outcome data from non-mutated YBC patients to mutated ones. Material and meth ods: It is a cross-sectional retrospective study that included the analysis of medical records from two institutions in Minas Gerais/Brazil, focusing on YBC patients diagnosed between January 2012 to December 2020. The following variables were collected: sociodemographic profile of patients, tumor and patient-related characteristics, presence or absence of genetic mutation and variants of uncertain significance, follow-up time, and death. Binary logistic regression models were built to assess the association between traits and the occurrence of the mutation. This study was approved by the ethics committee of Hospital Felício Rocho before data collection began (4.553.583 / 2021). Results: 377 patients were included, 99.5% of them were women, mean age was 36 years, 63.7% were married at diagnosis, 62.5% with a com plete college education, and 89% had a private health insurance. Most of the sample (54.6%) underwent mastectomy, and 35.6% had sentinel lymph node involvement. Genetic testing was performed in 137 patients, and 29.9% of them presented a pathogenic or likely pathogenic mutation, predominantly in the BRCA1 gene (36.6%). Patients with a positive family history of cancer were more likely to be mutated (OR 1.92, IC 95% 0.90-4.16). Mutated patients un derwent more frequent mastectomies (OR 2.74, IC 95% 1.24-6.45) and contralateral prophy lactic surgery (OR 7.39, IC 95% 3.22-17.72). 36.3% of the tumors were luminal B and 43% stage II. Stage IV was scored in 6.7% of cases, locoregional recurrences in 11.9%, distant metastasis in 20.4%, and 10.9% deaths. 96,7% dos pacientes não mutantes e 100% dos mutantes estavam vivos em um acompanhamento médio de três anos (p 0,36). Conclusion: In this cohort of YBC has an un-favorable prognosis, with greater luminal subtype B, inter mediate histological grade, tumors larger than 2 cm with anatomical stage II, and 20,4% of patients, more than a fifth of the sample, progressing with distant metastases. We observed high rates of genetic mutation in this population and an increase in genetic testing over the years; patients with a genetic mutation with pathogenic potential were submitted more radical surgical procedures.
Caracterização funcional de idosos comunitários durante a pandemia por Covid-19 em uma capital brasileira
(Faculdade Ciências Médicas de Minas Gerais, 2023-10-05) Vieira, Maria Carolina Santos; Barbosa, Maira Tonidandel; Leopoldino, Amanda Aparecida de Oliveira
Objective: to compare functional behavior in elderly people aged over and under 85 years, considering a sample of community-dwelling older adults in a Brazilian capital during the COVID-19 pandemic. Methods: a cross-sectional study was carried out with self-administered questionnaires available through digital means, consisting of questions to assess the risk of functional decline, frailty, perception of the impact of social isolation on health and participation of the family member or caregiver in the daily activities of the participants. Results: 373 elderly people with a mean age of 76.8 9,4 years participated in this study. Most of the sample reported that health problems do not limit the performance of activities (63.5%), that their health problems do not force them to stay at home (77.7%) and that they do not regularly depend on walking devices (88.6%). There was a significant difference in the risk of functional decline: 22.5% in individuals aged 60-84 years old and 40.1% in individuals aged 85 years or older needed more care and support from their family members or caregivers to carry out their daily tasks. Conclusions: aging itself does not imply functional dependence, but is an important risk factor for that. In the present study, the group of elderly aged 85 years and older had a higher risk of functional decline, need for support and care from family members, use of walking aids and activity limitations. The data suggest that this group must be considered a priority in interventions to mitigate the impacts of social isolation during pandemic periods and in similar epidemiological, clinical and psychosocial circumstances.
Comportamento alimentar, qualidade de vida e risco cardiovascular em crianças e adolescentes com obesidade e sobrepeso
(Faculdade Ciências Médicas de Minas Gerais, 2024-03-28) Santos, Fernanda Gabriela Colombo Drumond; Machado, Maria da Glória Rodrigues; Rezende, Bruno Almeida
INTRODUCTION: Eating habits are closely relate to the development of chronic diseases throughout life, such as obesity, diabetes, high blood pressure, dyslipidemia, among others. Adequate eating education and behavior contribute to good health and quality of life. Epidemiological studies show the increased occurrence of arterial hypertension during childhood and adolescence, probably due to the association of being overweight, obesity and lack of physical activity. OBJECTIVE: Evaluate the relationships between eating behaviors and their impact in body composition of children and teenagers, as well as possible association with quality of life (QoL) and early indicators of cardiovascular risk. METHODS: This is a transversal and observational that study which evaluated anthropometric, cardiovascular, QoL, and eating behavior parameters of 181 healthy children and teenagers, of both genders, and between the ages of 5 to 13, who are enrolled in the public education system in Belo Horizonte city, Minas Gerais, Brazil. They were fitted in three groups regarding body composition: Normal Weight, Overweight, and Obese. To determine these groups, the z-score for age-based body mass index (IMC/I) was used, and the children were classified according to the cutoff scores proposed by the World Health Organization (WHO). Anthropometry included weight, height, waist and hip circumferences, waist-hip ratio, and waist-height ratio. QoL was assessed using the Peds-QL 4.0 questionnaire, and eating behavior was assessed using the Children’s Eating Behaviour Questionnaire (CEBQ). Cardiovascular parameters were assessed using the Mobil-O-Graph® device, which measures the pulse wave velocity (PWV) and augmentation index (AIx@75) to estimate arterial stiffness (AS), which is considered an early marker of cardiovascular disease. RESULTS: In addition to the increase in anthropometric measurements (p < 0.001), the Obesity group exhibited behaviour related to food intake (p < 0.05). When analyzing QoL, a worsening in the social domain was also observed in the Obesity group (p < 0.05). However, PWV and AIx@75 did not differ between groups. CONCLUSION: Eating behaviour is related to the development of childhood obesity. However, early markers of cardiovascular risk related to AS did not change as a function of body composition in the children evaluated.
Desfechos clínicos em indivíduos sarcopênicos e não sarcopênicos pós Acidente Vascular Cerebral Crônico: um estudo transversal
(Faculdade Ciências Médicas de Minas Gerais, 2024-03-14) Oliveira, Ana Luíza Miranda de; Polese, Janaine Cunha; Leopoldino, Amanda Aparecida de Oliveira
Introduction: Sarcopenia is a condition characterized by low levels of muscular strength, quantity/quality and performance. When associated with cerebrovascular accident (CVA), sarcopenia can bring worse outcomes for both conditions, such as a reduction in the individuals’ functionality and an increase in their limitations and restrictions. Therefore, understanding the relationship between sarcopenia and clinical outcomes in post-stroke individuals is a way to better understand their prognosis and define appropriate treatment strategies. Objective: To compare clinical outcomes (level of physical activity, self-efficacy, frailty and mobility) in sarcopenic and non-sarcopenic individuals with chronic stroke. Methods: Cross-sectional study approved by the Research Ethics Committee of the Faculty of Medical Sciences of Minas Gerais. Chronic hemiparetic, non-aphasic, ambulatory individuals were included. Sarcopenia was screened using the SARC-CalF and diagnosed using the European Consensus on Definition and diagnosis of Sarcopenia. Individuals were considered to have some level of sarcopenia if diagnosed with probable, confirmed, or severe sarcopenia, or as non sarcopenic. The clinical outcomes investigated were: level of physical activity (Human Activity Profile), self-efficacy (Stroke Self-Efficacy Questionnaire - Brazil), frailty (Clinical Frailty Scale) and mobility (Timed Up and Go). Clinical measurements were evaluated according to the presence or absence of sarcopenia and in the paretic and non paretic hemibodies. Comparison between groups was made using Student’s T-test for independent samples (95%CI). Results: 62 individuals with a mean age of 62.6 years were included. Regarding the clinical outcomes evaluated, 43.5% of participants were considered moderately active; on average, they presented good self-efficacy (30.5±6.7); regarding the frailty level, individuals were, mostly, considered as vulnerable; and had reduced mobility (22.6 seconds ± 28.2 to complete the TUG test). There was a statistically significant difference in relation to the presence of sarcopenia on the paretic side in all measures: the level of physical activity (95% CI: 7.6 to 28.1, p = 0.001), self-efficacy (95% CI: 4.3 to 9.5, p = 0.000), frailty (95% CI: -2.0 to -0.6, p = 0.000) and mobility (95% CI: -25.5 to -3.0, p = 0.014). On the non-paretic side, there was a significant difference in relation to the presence of sarcopenia for the level of physical activity (95% CI: 1.4 to 20.2, p = 0.025), self-efficacy (95% CI: 1.2 to 8.1, p = 0.010) and frailty (95% CI: -1.8 to -0.5, p = 0.001), but not in relation to mobility (95% CI: -29.6 to 8.3, p = 0.260). Conclusion: Considering both the paretic and non-paretic sides, individuals with chronic stroke with some level of sarcopenia had lower levels of physical activity and self-efficacy and were more frail when compared to non-sarcopenic individuals. Regarding the mobility outcome and considering the paretic side, sarcopenic individuals had reduced levels when compared to those without sarcopenia. However, when considering the non-paretic side, the presence of sarcopenia did not mean worse mobility outcomes in post-stroke patients. Keywords: Stroke; Sarcopenia; Physical Activity; Self efficacy; Frailty; Mobility limitation.
Efeito imediato do exercício resistido pode alterar a morfologia da onda de pulso aórtica em indivíduos pós acidente vascular cerebral crônico?
(Faculdade Ciências Médicas de Minas Gerais, 2023-07-10) Dario, Daniella Moura; Machado, Maria da Glória Rodrigues; Polese, Janaine Cunha
Introduction: Stroke has a cardiovascular origin, and vascular alterations may be a risk factor for new stroke events. Resistance exercise is already recommended as therapy, with several associated positive outcomes. However, there is a lack of information about the variables related to aortic pulse wave morphology in individuals after stroke and the changes immediately after resistance exercise. Objectives: To evaluate the acute effect of single session of resistance exercise on arterial stiffness, hemodynamic and vascular variables in stroke subjects compared to healthy subjects, matched for age, sex and physical activity level. Materials and Methods: This is an experimental study, approved by the Institutional Ethics Committee (#3.555.916) and included individuals after chronic stroke. The arterial stiffness indexes: augmentation index (AIx@75, corrected for 75% of heart rate) and pulse wave velocity (PWV), hemodynamic variables: heart rate (HR), cardiac output (CO) and vascular variables: central systolic blood pressure (SBP), central diastolic blood pressure (DBP), central pulse pressure (PPc) and peripheral pulse pressure (PPp) were evaluated with brachial artery oscillometry, using the Mobil-O-Graph® equipment. The evaluations were performed before (rest period) and immediately after the resistance exercise protocol. To define the load of the resistance protocol, a test of 1 repetition maximum (RM) was performed on the extensor bench and the weight used was 75% of 1RM, with 10 repetitions. Results: Twenty-three chronic after stroke individuals with a mean of 35.4 (26.3) months of illness and 23 healthy individuals were included. The two groups had a mean age of 53 (18) years. The comparison of variables between pre and post exercise between the groups did not differ significantly in the after stroke and healthy groups, respectively. On arterial stiffness indices: mean difference between groups post and pre exercise (standard deviation): AIx@75(%): 2.31(8.12) and 5.04(7.98); VOP(m/s): 0.11(0.29) and 0.31(1.33); HR(bpm): 1.92(9.14) and 4.71(6.47); CO(l/min): 0.05(0.42) and -0.02(0.50); SBP(mmHg): 2.66(7.93) and - 0.39(7.03); DBP(mmHg): -0.31(6.35) and 10.71(43.59); PPc(mmHg): 2.98(5.59) and 10.71(43.59); PPp(mmHg): 2.45(7.28) and 2.75(6.02). Conclusions: Arterial stiffness, hemodynamic and cardiovascular variables were not changed immediately after the resistance training protocol in subjects after chronic stroke and in healthy subjects. The values remained the same as in the baseline state.
Estudo clínico para detecção de alterações vasculares através da retinografia digital, anteriormente ao diagnóstico de diabetes mellitus tipo 2
(Faculdade Ciências Médicas de Minas Gerais, 2023-07-13) Araújo, Levimar Rocha; Salomon, Tassila; Souza, Alessandra Hubner de
Introduction: Digital retinography (DR) consists of photographing the fundus of the eye that registers changes in the retina on ophthalmoscopy, allowing you to observe the effects of the treatments performed and compare them with the images evolved by digital angiography. This technique allows obtaining clear images of changes in the optic nerve, retina and macula, helping in the diagnosis, treatment and follow-up of patients who have diseases or changes in the posterior segment of the eye. Objective: To evaluate fundus microvascular lesions through HR in patients classified as having pre-diabetes and obesity. Evaluate the profile of the glycated hemoglobin (A1c) parameter and sociodemographic factors compared to the DR. Material and methods: Descriptive cross-sectional study with a population admission sample of 108 patients treated in a private endocrinology service, who have a diagnosis of pre-diabetes according to the criteria of the Brazilian Society of Diabetes (SBD) and who were authorized for digital retinography with authorized authorization. The retinographic evaluation was performed using the EYER Digital Retinograph (BAYER) with color and black and white pictures of the fundus of both eyes by a single technician, and being performed without pupillary dilation of the patients. DR analysis: The photos were sent for the issuance of a report by two ophthalmologists from a specialized and reference center in Belo Horizonte. All data were stored in an Excel spreadsheet and analyzed with the R program. Results: The results suggest that the presence of comorbidities, such as SAH, dyslipidemia and obesity, as well as inadequate glycemic control, represent factors associated with the risk of developing diabetic retinopathy in patients with pre-diabetes. Conclusion: These findings highlight the importance of preventive measures and adequate control of these conditions in pre-diabetic patients, in order to prevent or delay the progression of diabetic retinopathy and, consequently, reduce the risk of blindness and other ocular complications.
Eventos adversos do uso dos inibidores de SGLT2 em pacientes com insuficiência cardíaca com fração de ejeção reduzida e preservada: revisão sistemática e meta-análise
(Faculdade Ciências Médicas de Minas Gerais, 2023-12-14) Britto, Mariana Feldner de; Polese, Janaine Cunha; Souza, Alessandra Hubner de
ntroduction: Heart failure (HF) is a growing public health problem, with around 64 million people affected by the disease worldwide. In recent years, a new class of drugs has emerged for the treatment of this disease with the aim of preventing the development or worsening of HF, in addition to improving quality of life. Sodium-glucose cotransporter 2 (iSGLT2) inhibitors are a class of drugs that work by decreasing glucose reabsorption, helping patients with type 2 diabetes mellitus (T2DM), but also have other beneficial effects on the body such as kidneys and heart. Despite the positive effects, there are concerns and inconsistencies in the literature about the repercussion of the use of iSGLT2 in relation to its adverse events. Objective: The present systematic review and meta-analysis aims to evaluate the occurrence of adverse events (hypotension, volume depletion, and acute kidney injury) in patients with HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) using iSGLT2. Method: This is a review with systematic search and meta-analysis, registered in PROSPERO (CRD42022365684) and developed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in the following databases: PubMed, EBSCO and LILACS, with no restriction of language or publication date until 2023. The following descriptors were used (Mesh): sglt2 inhibitors, heart failure, reduced ejection fraction, preserved ejection fraction, hypotension, volume depletion, acute kidney injury ("sglt2" AND "heart failure"), ("acute kidney injury AND safety"), ("hypotension AND safety"), ("volume depletion AND safety"). The selection by titles was performed by two independent examiners using Rayyan software, and then the abstracts and full titles were evaluated. The articles were included considering the acronym PICOS: (1) (P) population (adult individuals diagnosed with HFpEF or HFpEF); (2) (I) type of intervention (use of iSGLT2); (3) (C) standard therapies; (4) (O) occurrence of hypotension, volume depletion, or acute kidney injury, and (5) (S) randomized controlled trials. Two evaluators independently analyzed the risk of bias using RoB 2. The meta-analysis was performed using RevMan 3.4.1 in order to verify the effects on XIII hypotension, volume depletion, and acute kidney injury. Results: A total of 9474 records were identified, of which ten articles were included in the systematic review and meta analysis. The outcomes of hypotension, volume depletion, and acute kidney injury were assessed in isolation. In the outcome of hypotension, a statistically significant increase in risk was observed through the meta-analysis of four studies, with no heterogeneity (RR: 1.15; 95% CI 1.01 – 1.30; P=0.03; I2= 0%). Regarding volume depletion, the meta analysis including five studies showed that there was no statistically significant difference and no heterogeneity (RR: 1.12; 95% CI 1.95 – 1.33; P=0.17; I2= 0%). For acute kidney injury, based on the meta-analysis carried out with seven studies, it was observed that it was not statistically significant, presenting low heterogeneity (RR: 0.85; 95% CI 0.69 – 1.06; P=0.14; I2 = 16%). Conclusion: The present systematic review and meta-analysis showed that iSGLT2 therapy leads to a higher risk of adverse events of hypotension. No increased risk of volume depletion and acute kidney injury was observed in association with iSGLT2. Despite the 15% reduction in relative risk (not significant) in the outcome of acute kidney injury, the results suggest a renal benefit. This analysis shows us that, despite a growing number of publications in recent years involving adverse events related to the use of iSGLT2, there is still divergence of results, leading to the need for future studies with the class.
Evolução clínica dos pacientes com doença renal crônica estágio 3b em fila de espera para consulta com nefrologia no Sistema Único de Saúde (SUS)
(Faculdade Ciências Médicas de Minas Gerais, 2023-07-04) Macedo, Juliana Gazzi; Almeida, Alessandra Maciel; Oliveira, Raquel Aparecida Salustriano Fabreti de
Background: Chronic kidney disease (CKD) is increasing in prevalence and importance as a global public health problem. The proper management of these patients from primary care to specialized atention, according to sugestions of guidelines is essential to slow up the progression of the disease. Objectives: To evaluate the care, request for tests and the evolution of the renal function of patients with CKD 3b referred by the general practitioner to the nephrologist in the Unified Health System (SUS), while on the waiting list for care, regarding compliance with clinical guidelines for the care of people with CKD. Methods: Retrospective cohort study that evaluated patients with CKD stage 3b (30 and 44 ml/min/1.73m² of glomerular filtration rate -GFR), queuing for care with nephrologist in the Brazilian Public Health System [SUS], from January 2018 to January 2020. Electronic records were evaluated [sociodemographic data, laboratory parameters, and comorbidities] for a period of 5 years, based on suggestions of kidney disease: Improving Global Outcome (KDIGO) 2012. The results were compared before the consultation with the nephrologist, called the pre group, and after the medical consultation with this specialist, called the post group. Results: A total of 211 patients with a mean age of 74±12 years were included. About a half were brown, overweight or obese. A total of 160 patients (75.8%) were hypertensive and 99 (46.9%) were diabetic, and 80% received a prescription for a renin-angiotensin-aldosterone system blocker. There was no worsening of renal function, and results for laboratory parameters were better than those expected based on the KDIGO guidelines. It’s importante to note that general practitioners and nephrologists did not ordered the tests as planned and the goals for the underlying disease were not achieved. Conclusion: According do the data evaluated,not all general practitioners follow the completely suggested guidelines, nor do they reach the clinical control goals for the underlying diseases, they do not request all the expected tests. It also was found from nephrological care. However, this fact does not seem to have an impact on the patients studied, on the evolution of the kidney disease, on the incidence of anemia, on the ionic disturbance or on albuminuria for stage 3b. Thus, these results suggest that this patient can be maintained under follow up with a general practitioner, but with improvement in permanent education policies, matrix support by a nephrologist and greater proximity to specialized care.
Fatores de risco associados ao óbito em pacientes que sofreram eventos adversos internados em uma unidade de terapia intensiva
(Faculdade Ciências Médicas de Minas Gerais, 2023-03-10) Faria, Luiza Mayer; Leopoldino, Amanda Aparecida de Oliveira; Polese, Janaine Cunha
Introduction: Patient safety is described as reducing the harm associated with health care to an acceptable minimum. Adverse events (AE) necessarily cause some harm to the patient and are related to health care. They are classified according to the degree of damage caused to the patient, namely: mild, moderate, severe and fatal. Notification is a used tool to identify and analyze any type of event, ensuring proper management of failures and errors in routines and activities. The occurrence of AE has a significant relationship with the increase in the length of stay and the mortality of patients in the ICU, implying major consequences and damage to health systems, requiring actions aimed at work processes and reduction of events. Objective: To identify risk factors associated with death in patients who suffered adverse events in an intensive care unit. Material and Methods: This is a retrospective cohort study with the collection and analysis of data from electronic medical records. Patients who had an adverse event during hospitalization in the ICU of a University Hospital in Minas Gerais, between 2019 and 2020 were included. The variables were collected: attendance; sex; age; patient's origin; date of ICU admission; CID on admission; use of mechanical ventilation; use of sedation; comorbidities; EA date; EA shift; type of EA; EA degree; date of EA notification; notification shift; notified by which specialty; length of stay after the AE; length of stay in the ICU; condition at discharge. To evaluate the association between characteristics and mortality, a Cox model was performed, with results presented as hazard ratio (HR) and respective confidence intervals (CI) of 95% raw and adjusted. Results: The total sample consisted of 335 patients, more than half of whom were male (61.2%) and 75.5% were 60 years of age or older. Regarding comorbidities, 74.6% had systemic arterial hypertension (SAH), 31.0% DM, 21.5% heart disease and 19.8% CKD. The mean number of comorbidities was 2.7 ± 1.6. The mortality rate was 34.0%. The female sex (HR 1.59, 95% CI 1.08; 2.34), increasing age (HR 1.02, 95% CI 1.01; 1.04), have hypertension (HR 1.89, 95% CI 1.20; 2.95), heart disease (HR 1.70, 95% CI 1.10; 2.62) and lung disease (HR 2.04, 95% CI 1.14; 3.67) represented a higher risk of mortality in the crude analysis. In the adjusted analysis represented by the multiple model controlled by the use of mechanical ventilation, female sex was associated with a higher risk of death (HR 1.55, 95% CI 1.05; 2.30), as well as increasing age (HR 1.019, 95% CI 1.003; 1.036) and arterial hypertension (HR 1.67, 95% CI 1.04; 2.67). Conclusion: The data found in this study identified that being female, increasing age, having hypertension, heart disease and lung disease represent a higher risk of mortality in the ICU in patients with AE
Fatores preditores de delirium e cognição em idoso com fratura de fêmur: pontos de corte para triagem cognitiva de 10 pontos (CS-10) e Mini-Cog que discriminam idosos com fratura de fêmur
(Faculdade Ciências Médicas de Minas Gerais, 2023-12-05) Gusmão, Vanessa Patrícia do Valle; Avelar, Núbia Carelli Pereira; Leopoldino, Amanda Aparecida de Oliveira
Summary: Delirium is a common complication in elderly people undergoing femoral fracture surgery. It is related to greater morbidity, mortality and functional and cognitive decline. Despite its relevance from a clinical, economic and social point of view, interventions to reduce its occurrence and severity remain neglected. Objectives: This study sought to establish cutoff points for the 10-point Cognitive Screening (CS-10) and Mini-Cog in elderly people after femoral fracture surgery and verify the association between cognitive decline and delirium, considering the points established cutoffs. Methods: 51 patients were evaluated in a prospective cohort study, with CS-10 and Mini-Cog tests performed before and after surgery. Delirium was assessed on admission and prospectively by the Confusion Assessment Method (CAM). Results: Analysis of the Receiver operator characteristic curve (ROC) determined cutoff points for CS-10 and Mini-Cog, which could discriminate delirium. Logistic regression reveals that elderly people with Cs-10 ≤5 points and Mini-Cog≤ 2 points were more likely to develop delirium, even after adjusting for sex, age and education. Conclusion: Patient with perioperative Cs-10 ≤5 and Cs-10 ≤5 was more likely to develop delirium. Stratification based on cognitive assessment can guide the implementation of cost effective prophylactic interventions in surgical patients with femoral fractures, aiming to improve clinical results and reduce costs in the healthcare system.
Impacto da pandemia da COVID-19 em pacientes oncológicos com câncer de pulmão e cabeça e pescoço assistidos em um hospital público no Brasil
(Faculdade Ciências Médicas de Minas Gerais, 2023-04-24) Veloso, Gilson Gabriel Viana; Rodrigues, Angélica Nogueira
Background: since the onset of the COVID-19 pandemic approximately 700,000 Brazilians have died. The Brazilian Society of Clinical Oncology recommended that no oncology treatment should be suspended due to the pandemic since the risks of tumor progression and obit could harm the quality of life and outcomes among cancer patients. However, it is necessary to update national data regarding the real impact of the COVID-19 pandemic on delaying diagnosis e treatment among patients with lung, head, and neck cancer in Brazil. Objective: to analyze the COVID-19 pandemic impact on cancer diagnosis and outcomes among lung, head, and neck cancer patients assisted in a tertiary cancer center in Southeastern Brazil as well as to analyze these patients’ pretreatment clinical features. Methods: this is a retrospective cohort of patients with lung and head and neck cancer assisted in a tertiary cancer center in southeastern Brazil between January/2019 and December/2021, aiming to compare each year patients’ clinical features as well as to verify the time gap between cancer diagnosis and first Oncology assessment. Additionally, we aimed to compare the clinical outcomes regarding objective rate response and patients’ survival. The population was compared between 2019 (year before the pandemic), 2020, and 2021 (two years after pandemic started); all analyses were based on a comparison between 2019 versus 2020, and 2019 versus 2021. This study was submitted and approved by the Coordination of the Oncology Center and by the Ethics Committee of Santa Casa de Misericórdia de Belo Horizonte by the number 39115720.9.0000.5138. Results: 652 patients were included in the current analysis, 332 with lung and 320 with head and neck cancer; it was observed a significant decrease in oncologic treatment recommendations and increase in palliative care recommendation during the pandemic in the lung cancer group, despite similar stages at diagnosis. During the COVID-19 pandemic, more pain symptoms were reported at the first Oncology assessment (p < 0.05 in all of them) for both lung cancer and head and neck cancer. Compared to 2019, head and neck cancer patients diagnosed in 2021 presented a worse initial performance status (p = 0.017). There were no significant differences in objective rate response among all compared groups. There was a statistically significant reduction in mortality for patients diagnosed with head and neck cancer in 2021 when compared to 2019 (p = 0.003). Conclusions: This research highlights high mortality rates for patients with lung and head and neck cancer in Brazil, even before the pandemic started, as consequence of advanced diseases at diagnosis and limited access to best treatment options at the publica health system. This is a reflection of how fragile the public healthcare system even before facing an acute public health crisis such as the COVID-19 pandemic. Yet, the total impact on public health may follow for many years.
Incidência e fatores associados a infecção do sítio cirúrgico em pacientes submetidos a cirurgia do tornozelo e pé: uma coorte de 7 anos
(Faculdade Ciências Médicas de Minas Gerais, 2022-07-01) Magalhães, João Murilo Brandão; Polese, Janaine Cunha; Leopoldino, Amanda Aparecida de Oliveira
Background: Surgical site infections (SSI) represent 31% of all hospital-acquired diseases, are the most common type of nosocomial infection, and have more severe orthopaedic complications. Surgical procedures of the ankle and foot, specifically, have an incidence of SSI ranging from 0.5% to 6.5%. Purpose: This study aimed to evaluate the incidence of superficial and deep SSI in foot and ankle surgery and the associated factors and to identify the most prevalent microorganisms. Methods: This study was a retrospective cohort including 2180 patients who underwent surgery of foot and ankle in a private hospital between 2014 and 2020. All elective and urgent procedures were included if they were considered clean. The outcome variable was SSI (superficial or deep) and the predictor variables were: sex, age, diabetes mellitus, systemic arterial hypertension (SAH), smoking, American Society of Anesthesiologists (ASA) score, and body mass index (BMI). Logistic regression models were used to determine associations between the study variables. Results: The incidence of SSI was 4% (83/2180), representing a incidence rate of 2.8% (57/2180) for superficial SSI and 1.2% (26/2180) for deep SSI. Two factors were identified as independently associated with SSI: smoking (OR 2.8, 95%CI 1.4-5.2) and ASA > 2 (OR 3.0, 95%CI 1.1-6.9). The group of patients with deep infections had higher proportions of smokers (p=0.002), SAH (p=0.018), emergency surgery (p=0.049), and ASA > 2 (p=0.011). The most prevalent organism detected by culture was Staphylococcus aureus in 61.5% of the cases, followed by Pseudomonas aeruginosa in 15.54%. Conclusions: The incidence of infection in this cohort was 4%; urgent surgical procedures, smoking, hypertension, and ASA classification > 2 were independently associated with the development of deep infections. The surgeon should be aware of these risk factors in order to manage the patient’s prophylactic antibiotic regimen.
Influência da ventilação mecânica, idade e ocorrência de incidentes em pacientes com doenças crônicas internados em uma unidade de terapia intensiva
(Faculdade Ciências Médicas de Minas Gerais, 2022-12-16) Faiad, Ana Flávia Nunes; Pessoa, Bruno Porto; Leopoldino, Amanda Aparecida de Oliveira
Introduction: Patient safety is one of the main health concerns in Brazil and worldwide. The occurrence of incidents especially affects the most vulnerable populations, especially patients with chronic diseases, using mechanical ventilation and of advanced age, and may even result in death. Given this, analyzing the rate of occurrence of these incidents by respiratory physiotherapists can promote patient safety. Objective: To investigate the influence of incidents monitored by physiotherapists in patients with chronic diseases admitted to an Intensive Care Unit (ICU). Methods: Retrospective cross-sectional study that included analysis of medical records of patients with chronic diseases, admitted to an ICU from January 2019 to April 2021 in a hospital in a Brazilian metropolitan capital. The following variables were collected: sex, age, chronic diseases, severity classification, use of mechanical ventilation, mortality, occurrence of incidents and their characteristics, and length of stay. To determine mortality, the Cox model was used, using hazard ratio, with α=0.05. Results: 343 medical records were included (56.3% male, 73.2% aged 60 years or older and 51.3% suffered at least one incident). Increased age (HR 1.02, 95% CI 1.00; 1.04), the use of mechanical ventilation, which increased the risk of death by seven times (HR 7.34, CI 95) represented a greater risk of death. %3.21; 16.81) and the occurrence of an incident (HR 2.66, 95% CI 1.65; 4.28). Physical therapists were the professionals who reported the most incidents, and those with serious damage were more common during the night, and in this same shift, the lowest incidence of notifications of notifiable circumstances was observed. Conclusion: The findings presented in this study suggest that the occurrence of incidents in patients with chronic diseases admitted to an ICU increase the length of stay and mortality.
Perfil epidemiológico, morfológico e funcional de recém-nascidos prematuros com persistência do canal arterial tratados com paracetamol: estudo observacional retrospectivo
(Faculdade Ciências Médicas de Minas Gerais, 2023-11-21) Ribas, Gabriela Aires; Pena, José Luiz Barros; Machado, Maria da Glória Rodrigues
Introduction: The persistence of the patent ductus arteriosus (PDA) is associated with increased morbidity and mortality in preterm newborns (PTNB). Objective: To identify the epidemiological, morphological, and functional parameters of the ductus arteriosusin newborns with PDA, treatment predictors. Method: This was a retrospective study conducted in the Neonatal Intensive Care Unit at a University Hospital from January 2015 to July 2020. The diagnosis of patent ductus arteriosus(PDA) was confirmed using echocardiographic parameters (Samsung ultrasound device HS40), including direct visualization of the ductus in two dimensional mode, using the parasternal short-axis view. Preterm newborns with a diagnosis of hemodynamically significant PDA (presence of diastolic flow in the descending aorta, left atrium enlargement, and increased Doppler flow velocity in the pulmonary valve) on echocardiography, who received paracetamol when treatment with ibuprofen failed or was contraindicated, were included in the study. Preterm newborns with hemodynamically insignificant PDA on echocardiography who received conservative treatment were considered as the control group. The dose of paracetamol used was 15 mg/kg/dose every 6 hours, orally, forseven days, and the cycle was repeated for a total of 14 days of treatment in case of treatment failure or reopening of the ductus arteriosus. The ROC curve was used to determine if the echocardiographic parameters, including ductus diameter, ductus diameter/weight, ductus diameter/left pulmonary branch, AE/Ao ratio, and diastolic velocity of the left pulmonary branch, were able to discriminate between patients who received conventional treatment and those who received paracetamol treatment. Results: Results: A total of 173 male and 179 female patients participated in the study. The mean birth weight in the paracetamol group was 1,090 g (970 - 1,685 g), which was significantly lower than the control group's 2,125 g (1,420 - 2,765 g). Closure of the ductus arteriosus after paracetamol treatment was 92%. In 59 preterm newborns (36%), the ductus closed after 7 days of treatment, and in 105 (64%) preterm newborns, extended treatment with two cycles of 7 days was required for remission of hemodynamic symptoms. Three preterm newborns (1,8%) were referred for surgical treatment. The following echocardiographic parameters were statistically significant in predicting the need for ductus arteriosus treatment: reverse diastolic flow in the descending aorta, non-restrictive x reverse transductal flow, AE/Ao ratio > 1.5, transmitral flow E/A ratio > 1, absence of reverse diastolic flow in the superior mesenteric arteries, and flow velocity in the left pulmonary branch. The absolute diameter of the ductus arteriosus in millimeters did not differ significantly between the control and paracetamol groups. However, the ratio between ductus diameter and weight was significantly higher in the paracetamol group. The area under the ROC curve was greater than 0.7752 for the following echocardiographic parameters: ductus diameter, ductus diameter/weight, ductus diameter/left pulmonary branch, AE/Ao ratio, and diastolic velocity of the left pulmonary branch. The highest sensitivity and specificity were observed for LA/Ao. Conclusion: In this study we identifed, for the first time, the optimal cut-off points for echocardiographic markers used to diagnose PDA, such as PDA diameter/weight, PDA diameter/left pulmonary branch, LA/Ao and diastolic velocity of the left pulmonary branch to differentiate paracetamol group compared to conventional treatment. Additionally, it was observed that the relationship between the internal diameter of the ductus arteriosus indexed to weight has a greater impact on determining the magnitude of blood flow than the absolute diameter of the ductus arteriosus in millimeters. The introduction of a screening, monitoring, and medication treatment protocol, when correctly indicated, significantly reduces the rate of surgical intervention.
Prevalência da obesidade e fatores associados em adultos brasileiros: revisão sistemática e meta-análise de estudos de representatividade nacional
(Faculdade Ciências Médicas de Minas Gerais, 2023-12-13) Garcia, Cecília Alcantara Braga; Souza, Alessandra Hubner de; Guimarães, Nathália Sernizon
Introduction: Obesity is a complex multifactorial disease that has a high impact on public health. This chronic condition is a significant risk factor for other morbidities and impaired quality of life. Objective: Estimate the prevalence of obesity among Brazilian adults. Material and methods: Systematic literature review carried out in accordance with the Cochrane Library manual and written using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. This study was previously registered on PROSPERO [#CRD42023390871]. The search was performed using the databases MEDLINE, Embase, Web of Science, Cochrane Library, Scopus, LILACS and the reference lists of the included studies. The primary outcomes were: (1) prevalence of obesity in Brazilian adults; (2) prevalence of obesity in Brazilian men; (3) prevalence of obesity in Brazilian women. Secondary outcomes were factors associated with obesity. Analyses were performed in the Rstudio software, version 4.1.0. Results: 5,634 references were identified, of which 19 studies and 21 national gray literature surveys, carried out from 1974 to 2021, were included in the meta-analysis. The pooled prevalence of obesity in Brazilian adults in the national territory was 20.0% (95%CI: 14.0-25.0%) while in the capitals it was equal to 17.0% (95%CI: 16.0-19. 0%). According to the regions of the country, obesity varied between 11.0% and 17.0%, with a lower and higher frequency in the Northeast and South regions. In the capitals, the prevalence of obesity varied between 14.0% and 17.0%, less frequently in the cities of Palmas and São Luis and more frequently in the city of Manaus. The prevalence of obesity remained higher among women in most periods, with a frequency of 18.0%, while in men it was 16.0%. In the subgroup analysis, considering the variables gender, geographic region of residence and urban or rural housing, there was no statistical difference. Conclusion: The prevalence of obesity in adults of both sexes living in Brazil and its states were high. There was no statistically significant difference in the subgroup analysis.
Prevalência e fatores associados com sarcopenia em idosos brasileiros: uma revisão sistemática e metanálise
(Faculdade Ciências Médicas de Minas Gerais, 2023-03-13) Cardoso Júnior, José Milton; Pereira, Leani Souza Máximo; Leopoldino, Amanda Aparecida de Oliveira
Introduction: Sarcopenia is a muscular disease that influences several homeostatic and functional mechanisms in the geriatric population. Despite being rooted in adverse muscular changes, it affects several organic systems. It can be divided into primary and secondary, the former originating in the aging of the individual and the latter due to associated comorbidities, where the prevalence in the elderly population is widely variable, as it ranges from 5% to 50% depending on sex, age, pathological conditions and mainly the diagnostic criteria. There is a pressing need for advances in the study of this pathology and to offer better diagnostic methods, prevention, and individualized health care. Physical activity and nutrition are the main ways studied to prevent, treat, and even reverse sarcopenia and to date, they offer better results in their approach. Objectives: To estimate the prevalence and cumulative incidence of sarcopenia in Brazilian elderly people living in the community and identify factors associated with this condition. Methods: Systematic review and meta-analysis. Searches were carried out in the LILACS, EMBASE, SciELO, AMED, CINAHL and MEDLINE/PubMed databases, with descriptors Brazil and sarcopenia, from 2005 to 2023. Observational studies were included, and assessments of risk of bias and quality of evidence were using the Joanna Briggs tool. All diagnostic recommendations were used to identify sarcopenia in studies according to publication date. The combined prevalence was estimated by the proportion of individuals with sarcopenia in the total sample of each included study. The pooled associated factors were calculated or obtained using odds ratios (OR) from the data reported in the included studies. The meta-analysis was performed using a random effects model. Results: A total of 53 studies were included grouping 17,555 participants. The overall prevalence of sarcopenia was 18% (95%CI=13.5–22.7%). The cumulative incidence of sarcopenia, considering a projection of the Brazilian elderly population in the period 2012-2023 (n=~26,723,827), was 0.13 (95%CI=0.13– 0.14) per 1,000 elderly people. The factors significantly associated with sarcopenia were: female sex (OR=0.67, 95%CI=0.45–0.99); advanced age 70–79 years: OR=1.50; 95%CI=1.13–1.99 and ≥80 years: OR=4.01; 95%CI=2.12–7.58); higher education level (OR=0.73, 95%CI=0.56–0.96); osteoporosis (OR=2.02, 95% CI=1.28– 3.18); depression (OR=1.17; 95CI%=1.07–1.27); falls (OR=1.30, 95%CI=1.13–1.51); and hospitalization (OR=2.24, 95%CI=1.35–3.71). Conclusion: The overall prevalence of sarcopenia was 18%. The factors that provide greater risks of developing the disease were advanced age, osteoporosis, depression, falls and hospitalization, while the factor that proved to be the lowest risk was higher education. These findings provide evidence for early identification of individuals at high risk for sarcopenia who may benefit from appropriate interventions to prevent, treat, and even reverse this condition and its complications.