Trabalhos Acadêmicos

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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.
Acidose metabólica e o estado nutricional nos pacientes em hemodiálise
(Faculdade Ciências Médicas de Minas Gerais, 2018-04-06) Machado, Renata Silva; Passos, Maria do Carmo Friche; Almeida, Alessandra Maciel
Background: The prevalence of malnutrition in hemodialysis patients is high, being a marker of poor prognosis in chronic kidney disease. Metabolic acidosis is frequent in a dialysis patient, and has been associated with mortality. Objectives: To evaluate metabolic acidosis and nutritional status of hemodialysis patients. Methods: Cross sectional study in patients on hemodialysis in a single center. Information was collected in medical records and evaluation of the presence of metabolic acidosis and nutritional status as measured by anthropometric and biochemical indicators. Results: The sample consisted of 63 patients, male (54%) and 45 to 64 years old (58.7%). The mean dialysis time was 5.49 ± 4.39 years. The mean value of body mass index was 24.95 ± 6.81 kg / m2 and albumin was 3.93 ± 0.31 g / dL. The prevalence of metabolic acidosis was 77.8%. There was a negative linear correlation between bicarbonate and creatinine (p = 0.006) without correlation with anthropometric and albumin indicators. Patients malnourished according to Body Mass Index gained more interdialytic weight (p = 0.006). They were classified as malnourished by body mass index (55.55%), arm circumference index (14.29%) and 49.20% of patients by albumin (<4.0 g / dL). Creatinine levels were higher in patients aged 45 to 64 years (p = 0.032) and in males. No differences were observed by time in hemodialysis in relation to age, interdialytic weight gain, laboratory and anthropometric measures. Conclusion: The prevalence of metabolic acidosis was high, and there was no correlation with nutritional status. Bicarbonate <22mEq / L correlated with higher creatinine values unrelated to nutritional status. Nutritional assessment by body mass index was in agreement with the Brazilian literature, and albumin indicated elevated malnutrition. The dialysis time did not affect the nutritional evaluation parameters.
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.
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.
Função sexual e alterações metabólicas e hormonais em mulheres usuárias de anticoncepcionais hormonais e não hormonais de longa permanência
(Faculdade Ciências Médicas de Minas Gerais, 2020-07-15) Moreira, Igor Fernando de Aquino; Almeida, Alessandra Maciel; Rezende, Bruno Almeida
Background: Female sexual dysfunction is a common condition that negatively impacts the emotional health and quality of life of the affected individuals. Long-acting reversible contraceptives (LARCs) are becoming increasingly popular due to their effectiveness and convenience. LARCs can be hormonal (etonogestrel releasing implant—ENG and Levonorgestrel intrauterine system—LNG) or non-hormonal (copper intrauterine device— CuIUD and copper silver intrauterine device—SIUD). There are very few studies that assess the influence on LARCS on sexual function are lacking.This study aimed to assess changes in sexual function as well as metabolic and hormonal parameters in women after implantation with LARCs. Methods: In this prospective cohort study, we assessed 80 women who visited the Military Police Hospital in Brazil for LARCs placement. The study participants were divided into 4 groups according to the type of LARC received: ENG n=17; LNG n=21, CuIUD n=18 and SIUD n=23. The four groups were evaluated twice (prior to LARC placement and approximately 3 months later) for sexual function, using the Female Sexual Function Index (FSFI) and Female Sexual Quotient (QS-F) questionnaires. Metabolic and hormonal parameters were also assessed using blood tests. p<0.05 was considered to indicate statistical significance. Results: We observed an improvement in sexual function with CuIUD placement according to QS-F (p<0.017) and SIUD (FSFI: p=0.06 and QS-F: p<0.001). However, ENG worsened sexual function according to FSFI and QS-F (p<0.001 and p=0.003), across all domains. A decrease in sex hormone-binding globulin (SHBG) was observed for all groups (LNG: p=0.019; ENG: p=0.024; CuIUD: p=0.010; SIUD: p=0.022) and an increase in total testosterone levels (p=0.007 and p = 0.003) and prolactin (p=0.049 and p=0.001) with CuIUD and SIUD placement. Hemoglobin levels increased with LIS (p<0.001) and ENG (p=0.025) and decreased with CuIUD placement (p<0.001). Conclusion: The use of non-hormonal LARCS improved sexual function, especially in the desire domain. Etonogestrel implants, had a negative influence on sexual function, probably by blocking ovarian function, and thus reducing the production of androgens and estrogens. SIUD placement was superior as it improved sexual function, interfered less with hormonal levels, and did not decrease hemoglobin levels.
Simulação de alta e baixa fidelidade para o ensino de suporte avançado de vida cardiovascular: satisfação e autoconfiança
(Faculdade Ciências Médicas de Minas Gerais, 2021-03-29) Chaves, Marcos Lázaro Avelar; Scalabrini Neto, Augusto; Almeida, Alessandra Maciel
Introduction: The importance of simulation in increasing students’ satisfaction and self-confidence has been demonstrated, emphasizing the value of the assessment in learning as factor to encourage motivation. Methods: This is an experimental study conducted at the Faculty of Medical Sciences of Minas Gerais (FCM-MG), Brazil, from July 2018 to July 2019. The 51 participants were randomly assigned to 9 groups of 5-6 medical students: (High -Fidelity – HF) (5 teams) and (Low- Fidelity – LF) (4 teams) using a randomized sequence with permuted blocks. The groups underwent initial training, practical evaluation, and assessment of satisfaction/self-confidence. The practical evaluation was carried out with a checklist elaborated and validated by the researchers for assessment of performing the necessary skills in the scenario, and only the team-related items were considered for this study. After debriefing or feedback, students were asked to respond to the Student Satisfaction and Self Confidence in Learning Scale (SSSCL) validated in Portuguese. Results: The satisfaction and self-confidence levels were similar between the HF and LF groups. Considering the team-related items in HF, a positive correlation was observed between team´s communication and student satisfaction/self-confidence. Also, for HF, a positive correlation was found among the dimensions of the Satisfaction and Self-Confidence in SSSCL. Conclusion: No differences were observed in satisfaction and self-confidence levels comparing HF with LF scenarios. However, in the HF scenario, the greater the self-confidence, the greater the satisfaction is, and the greater the team’s communication, the greater the student satisfaction/self confidence is.
Simulação de alta fidelidade comparada à de baixa fidelidade no suporte avançado de vida cardiovascular
(Faculdade Ciências Médicas de Minas Gerais, 2020-05-08) Alcântara, Rafael Barbosa; Scalabrini Neto, Augusto; Almeida, Alessandra Maciel
Introduction: Teaching skills and knowledge using simulation is a useful and important tool for training students in the healthcare students. This teaching model is a constant challenge for institutions and professionals. In a productive and safe environment, there is the possibility of training and assessing students regarding their knowledge, skills and behavioral aspects. In order to achieve that, it uses reliable tools such as checklists to follow a standardized teaching and assessment script. The American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) training program relies on simulation for teaching the trainees. Conflicting results are observed in the literature regarding the real benefit of using high fidelity simulation in ACLS courses or in ACLS scenarios. In view of the various forms of teaching using simulation, it becomes necessary to identify the most effective method for training the ACLS. Objectives: (1) To develop a checklist that represents the scenario elaborated by the researchers for the care of cardiorespiratory arrest (PCR) using a Likert scale, (2) To compare the effectiveness of high and low fidelity simulation methods in the training of ACLS using the checklist created. Materials and methods: A checklist was developed using items from a previous one and adding more items created by experts. Final adjustments were made based on the training video, before the approval of the final version. Once the checklist was ready to use, an experimental study was conducted with 55 medical students from the Medical Sciences Faculty of Minas Gerais (FCM-MG) of the 3rd and 4th years. All students completed all phases of the study. Thirty seven were female (67.3%) and the average age was 21.7 ± 1.46 years. The training followed the following steps: (1) Theoretical and practical training of students randomly distributed in groups: experimental (n = 30), which carried out training in high-fidelity simulation and control group (n = 25), of low fidelity. (2) Subsequently, the teams were subjected to a practical assessment of the team's performance using the checklist. Results: Thirty (81.1%) out of 37 checklist items assessed by the experts were scored the highest grade by all of them in a scale from 1 to 4, other six items (16.2%d) were scored 3 by at least one evaluator, and only one (2.7%) was scored 1. Highest grade was scored for 91.9% of the items, exceeding the 85% goal. All students completed the study. Thirty-seven were female and the average age was 21.7 ± 1.46 years. The high fidelity group was compose mainly by females (90.9%) and received more training in emergency and acute care (60.6%, p = 0.002). Practical performance scores were similar for both groups (p = 0.14). Conclusion: The designed checklist based on the 2015 guidelines of the AHA proved to be reliable, with high agreement between the experts. By assessing different types of simulation, this study suggested that there was no advantage in the use of high-fidelity teaching methods.