Trabalhos Acadêmicos

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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.
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.
Análise eletromiográfica e propriedades clinimétricas do teste muscular manual da cinesiologia aplicada
(Faculdade Ciências Médicas de Minas Gerais, 2020-03-13) Oliveira, Décio Gomes de; Kirkwood, Renata Noce
Background: The Applied Kinesiology’s manual muscle test (AK-MMT) is a clinical assessment tool that can be used to identify motor control changes in neurologically healthy subjects. The AK-MMT classifies muscles as ‘facilitated’ or ‘inhibited’ and the hypothesis that explains this difference is that inhibited muscles present a latency delay. Objective: Investigate the hypothesis of the latency delay in inhibited muscles and test the clinimetric properties of the AK-MMT. Methods: A cross-sectional and methodological study was conducted in 38 participants with a mean age of 41.1 years (SD 14.8). Electromyography integrated with an electrical goniometer and a hand-held dynamometer were used to measure latency, angular displacement and muscle force of the gluteus medius muscles, respectively. Inter- and intra rater reliability of two examiners with different levels of experience were obtained using Intraclass Correlation Coefficient (ICC). Muscle force, latency and joint angular displacement were compared between groups (facilitated vs. inhibited) using Mann-Whitney U test. Latency and angular displacement were also compared within groups by paring the participants that presented facilitated gluteus medius in one side and inhibited in the opposite one using the Wilcoxon paired test. For the concurrent validity of the AK-MMT in classifying an inhibited muscle as weak was conducted the receiver operating characteristic curve (ROC curve), by using as the test variable the strength test obtained with the dynamometer. Results: Intra- and inter-examiner reliability was excellent, with ICC’s > 0.9. When the whole sample was considered there was no significant difference in latency, but the Wilcoxon paired test showed a significantly difference delay in latency time of the inhibited muscles (mean 0.10 s vs. 0.18 s, p=0.007) compared to the facilitated gluteus medius. Force and peak force of the inhibited gluteus medius were significantly decreased compared to the facilitated ones. Joint angular displacement was significantly greater in the inhibited group. ROC curve showed an area under the curve of 0.743, demonstrating that the classification of the most experienced examiner discriminated the force between groups (p=0.001), which means that the test has concurrent validity. Conclusion: The results have demonstrated that AK-MMT has good clinimetric properties and support the hypothesis that the AK-MMT is sensitive to differences in strength and latency. This means that physical therapists have now a tool to identify neuromuscular dysfunctions that is reliable, valid and easy to be applied in clinical environment. In addition to providing information about the strength and quality of muscle contraction, the use of TMM AK can facilitate the development of therapeutic strategies aimed at correcting motor control dysfunctions, commonly overlooked in the treatment of acute pain and degenerative musculoskeletal disorders.
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.
Associação da força muscular e corrida de alta velocidade com a lesão muscular de isquiossurais em atletas de futebol profissional
(Faculdade Ciências Médicas de Minas Gerais, 2020-12-18) Oliveira Júnior, Otaviano de; Bittencourt, Natalia Franco Netto; Leopoldino, Amanda Aparecida Oliveira
Background: Hamstring muscle injury (HMI) is the most incident injury in soccer and many risk factors are studied in the literature, the most recognized being the previous muscle injury and the increased age of the athlete. The multifactorial nature of the variables involved and their interrelations at different times of the season is a matter of controversy. Objective: Conduct three studies in elite male professional soccer players from a Brazilian club, the main one being to verify if there is a difference in muscle strength, age, history of previous HMI, ankle sprain, knee anterior cruciate ligament (ACL) injury, performance position in the field, amplitude of ankle dorsiflexion and distance covered at high speed, that is, ≥ 19.8 km/h (high-speed running, HIR) among athletes who had HMI and athletes without muscle injury during one season. The second would be to test the reliability between two instruments with different load analysis mechanisms, either by GPS or by video analysis, relating results of total distance covered and HIR during official matches. Finally, establish the profile of muscle injuries; investigate the severity, the muscle group, the position that the athlete plays and the time of absence in the seasons from 2011 to 2019. Methods: The first study is observational and retrospective with 34 athletes, excluding goalkeepers, for 12 consecutive months. The second is a methodological study with data from 35 male professional soccer athletes (102 individual analyzes) collected in official matches. The third study was observational, including 89 athletes with participation in official matches and training for nine seasons. Results: It was found nine HMI (13.2%), with a positive correlation between athletes with previous HMI (p = 0.011); in the group of lower limbs with higher levels of flexor fatigue in the isokinetic (p = 0.027) and lower values of ankle dorsiflexion (p = 0.017). There was no difference in the performance of the average HIR used as a reference for the demand of athletes with and without injury, as well as for the other variables of strength, age, field position, previous ACL injury and ankle sprain. In the second study, there was good agreement in the comparison of the two systems designed to analyze the demands of total distance covered in professional soccer. In the third study, occurred most muscle injuries in four groups: HMI (36.7%), adductors (22%), calf (21%) and quadriceps (17.3%), with greater incidence of quadriceps injuries in training, a tendency to decrease the incidence of adductor injuries and an increase in HMI during the seasons from 2011 to 2019. xiii Conclusion: The study demonstrates results applied to the practical reality of professional soccer in an elite club in Brazil and a path for future studies that can analyze the interrelationship between the variables of capacity and demand in soccer, as well as helping clubs in the preventive planning of these injuries.
Avaliação da capacidade civil de indivíduos com demência: perfil de curatelados e concordância entre perícia médica e sentença judicial no Tribunal de Justiça de Minas Gerais
(Faculdade Ciências Médicas de Minas Gerais, 2022-03-15) Silva, Juliana Barbosa e; Ricardo, Laíss Bertola de Moura; Leopoldino, Amanda Aparecida de Oliveira
Introduction: The increase in the number of elderly people and their lifespan brings as a consequence the growth of diseases typical of this age group, such as dementia. This scenario may trigger a greater demand for guardianship requests from families of older people who have difficulties managing their own lives. The Brazilian Law for the Inclusion of Persons with Disabilities (LBIPD changed the disability regime. If the protection measures offered by the judiciary are insufficient, the desired protection may not occur or even put the person with dementia at risk, considering the course of the disease. Objectives: To verify the clinical, legal and social consequences brought about by the beginning of the LBIPD (Law nº 13.146/15) identified in the processes of guardianship of people with dementia. Identify the sociodemographic, clinical and legal profile of the person with dementia curated by the TJMG, between the period from January 1, 2016 to January 31, 2020. Investigate the level of agreement between the clinical diagnoses described in the expert report and in the court decision. Material and Methods: Retrospective cohort, composed of 165 lawsuits of individuals with dementia curated by the TJMG. The variables were described as measures of central tendency and variability. The Kappa coefficient was used to assess the agreement between the definition of clinical conditions and the conclusions about the limits of disability described in expert reports and court rulings. Results: A predominance of female elderly was identified, except for those under 60 years of age. The almost perfect agreement (Kappa coefficient 0.918, p<0.001) found between the clinical conditions indicated in the expert report and in the judicial sentence suggests that magistrates rely on expert reports to base their decisions. A poor degree of agreement (Kappa 0.05, p=0.083 after 2016) was found between the conclusions about the limits of incapacity described in the expert report and in the court decision. It is possible that the changes that took place in 2016 did not impact the experts' assessment and conclusion. Conclusion: Understanding expected outcomes for people with dementia, such as the occurrence of curatorship processes, is crucial for the instruction of public health policies, family members and judicial professionals. The identification of the profile of the curators and the agreement between clinical and legal aspects was a first step that made it possible to identify the need for greater alignment between clinical evidence on dementia and its impacts on judicial decisions. More detailed expert reports that address the assessment of civil capacity in the biopsychosocial context may produce a lower degree of discrepancy between experts. Clearer descriptions about the aspects related to the course of the neurodegenerative disease, the ―likely‖ possibilities and needs related to the subject's decision-making capacity, may favor the magistrates' understanding of dementia, contributing to the improvement of the jurisdictional provision.
Avaliação da cirurgia citorredutora associada à quimioterapia intraperitoneal em centros oncológicos de Belo Horizonte
(Faculdade Ciências Médicas de Minas Gerais, 2019-07-05) Marcos, Priscilla Rossi Baleeiro; Wainstein, Ana Paula Drummond Lage; Wainstein, Alberto Julius Alves
Introduction: Intraperitoneal chemotherapy (IPC) is a highly complex process of drug delivering with curative intent to carefully selected patients with advanced peritoneal carcinomatosis (PC). Objective: This study aimed to evaluate the use of IPC, in a real-life setting, and assess the patient’s profile and outcomes. Method: A retrospective descriptive study was performed through the analysis of medical charts of patients hyperthermic intraperitoneal chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy. Eligible patients presented ECOG performance status scores of 0 or 1 and peritoneal metastasis. Results: Twenty-six patients, with 72% of females, and the mean age of 55.19±11.21 were included. Ovarian cancer (50%), pseudomyxoma peritonei (34.6%), and colorectal cancer (15.3%) were the most common primary tumors. The individuals in the HIPEC group presented better ECOG score compared to the EPIC group (76.2% vs. 20%). In 92.3% of the cases, IPC was indicated as rescue therapy for relapsed tumors; in 57.6% of the cases, it was delivered after a second recurrence. Patients with pseudomyxoma peritonei (7.6%) received HIPEC as primary therapy after cytoreductive surgery. Only subjects with ovarian cancer receiver EPIC (19.2% of the included patients), all after a second recurrenThere was no difference in time to progression, considering HIPEC or EPIC treatments. Conclusion: Although complex, peritonectomy combined with IPC can be performed in referral centers with acceptable levels of morbidity and mortality
Avaliação da qualidade de vida e analgesia de pacientes com tumores sólidos e em uso de opióides
(Faculdade Ciências Médicas de Minas Gerais, 2019-05-17) Pos, Alexandre Mio; Wainstein, Alberto Julius Alves; Wainstein, Ana Paula Drummond Lage
Introduction: Use of opioid analgesics remains being the main therapy for pain control in cancer patients. However, ample evidence persists showing that treatment is still inadequate. Data on this dilemma and its impact on patients' lives are still scarce in our population. Objective: To evaluate the impact of opioid use on analgesia and qual ity of life of patients with solid tumors. Material and Methods: This cross-sectional, analytical study was carried out between January and December 2017 in a Tertiary Referral Unit for Cancer Treatment. The pain, depression and quality of life were eval uated through validated instruments that included the Pain Management Index (PMI), European Organization for Research and Treatment of Cancer-Core 30 (EORTEC QLQ.C30), Beck Depression Inventory (BDI), Karnofsky Performance Status (KPS), Douleur Neuropathique 4 (DN4), Brief Pain Inventory-Short Form (BPI-SF). Results: 100 patients with advanced solid tumors and making use of opioids were studied. 82% of them reported daily pain being 58% with intense pain. 57% were making use of morphine with a mean dose of 49 Morphine Milligram Equivalent (MME) and PMI was negative in 34% of sample. Neuropathic pain (NP) was found in 72% and BDI was greater than 12 in 90% of patients. The pain was related to all BPI variables, mood, general activity, work and pleasure of living. Conclusion: Despite the substantial neg ative impact of pain on QOL, no international consistency was found among the clinical factors studied with QOL itself. This gap can be interpreted due to persistence of high levels of subtreatment, depression and neuropathic pain, associated with the use of low doses of opiates and adjuvant drugs in the sample
Avaliação do fluxo e satisfação de 233 pacientes com cateteres totalmente implantáveis em tratamento quimioterápico
(Faculdade Ciências Médicas de Minas Gerais, 2022-06-15) Cesar, Rodrigo Melo Moreira; Wainstein, Ana Paula Drummond Lage; Wainstein, Alberto Julius Alves
The fully implantable chemotherapy catheter has benefited cancer patients for many years. It is used in situations where there is a need for prolonged or permanent access to the vascular system. It has advantages such as reducing the risk of chemotherapy overflow in the subcutaneous tissue, and the possibility of doing chemotherapy at home and mainly to avoid multiple venous punctions and missing chemotherapy sections because lack of venous access. The implantation and use of catheters are, however, not immune to complications. This study aims to evaluate the use of venous access in cancer patients, related to the catheter flow and the general satisfaction of patients. The sample is composed of 233 patients diagnosed with cancer who underwent chemotherapy treatment through venous access through port-a-cath in the period between January 2015 and December 2019. 97% of the patients consulted were undergoing palliative chemotherapy, and 99.1% patients reported good satisfaction with the implantation process and treatment method. Regarding catheter flow according to venous return and drip during drug infusion, 98.7% individuals presented good flow. The results obtained by the research method used show that catheter flow was satisfactory in all implant sites observed and highlight the advantages of using a fully implanted catheter in view of the reduction of emotional factors that cause stress in cancer patients receiving chemotherapy, as well as the reduction of trauma and discomfort experienced by patients during the infusion of peripheral chemotherapy.
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.
Avaliação longitudinal do eletrocardiograma do atleta jovem
(Faculdade Ciências Médicas de Minas Gerais, 2019-12-18) Aleixo, Haroldo Christo; Sternick, Eduardo Back
Background: Competitive sports practice is associated with an increase in the risk of sudden cardiac death in athletes with a silent preexistent non diagnosed cardiovascular condition. Aiming to tackle this real threat, a number of preparticipation cardiovascular protocols have been implemented with varying results. One of the suggested strategies uses the resting electrocardiogram as a screening tool. However, the definition of abnormal findings in the young athlete is still debated, and there is lack of consensus in the literature. Objectives: report electrocardiographic patterns of Brazilian soccer players; evaluate current accepted normal electrocardiographic patterns in the young athlete and to assess its longitudinal variability overtime, from adolescence to early adulthood; Methods: Between 2009 and 2019, 487 male athletes (14,1± 2,0 years-old) participated and their 1503 electrocardiograms were analyzed according to the International Recommendations Criteria (2017). The athletes that competed for a minimum of two consecutive seasons were included in the study. All athletes were evaluated at admission and also before the onset of every new season of competition. Medical evaluation consisted of an individual medical assessment and resting electrocardiogram. In the present study we reviewed all electrocardiograms and clinical charts of these athletes. Results: T-wave inversion was found in 65 (13,3%) athletes, 14,7% (5/34) pretos, 14,4% (44/306) pardos, and 10,9% (16/147) brancos. TWI proportion in electrocardiograms was significantly higher in pretos (p=0,003). Age was inversely correlated to TWI in V1-V3 (p=0,01) and directly correlated when occurring in inferior leads (p<0,001). Twenty two athletes (4,5%) had and abnormal electrocardiogram, and 10 of them (2,1%) had two or more borderline findings. From the evolutionary point of view, the non-deep T-wave inversions (<2,0mm) in inferior leads completely disappeared in 7 of 7 athletes, while it was also observed in 3 of 10 athletes with T-wave inversion in the lateral leads. On the second study, after an interval of 4 years between medical evaluations, unprecedented marked inferolateral repolarization alterations were observed in a former asymptomatic athlete, with no history of heart disease. Conclusions: Both studies reveal the dynamic electrocardiographic patterns likely to occur during adolescence thru early adulthood and suggest that electrocardiogram must be periodically repeated in athletes during this phase.
Câncer em pacientes transplantados renais: evolução clínica e sobrevida do enxerto e do receptor
(Faculdade Ciências Médicas de Minas Gerais, 2020-10-19) Pinto Filho, Valter Alves; Nascimento, Evaldo; Oliveira, Raquel Aparecida Salustriano Fabreti de
Introduction. The end-stage renal disease (ESRD) has become an important public health problem in the world and kidney transplantation is considered the best treatment for ESRD in comparison with dialysis. In order to avoid graft rejection, the transplanted patient underwent continuous treatment with immunosuppressive drugs, whose side effects are associated with the development of different types of cancer (CA) with an important risk factor for mortality. The risk for malignant diseases can increase by two to 20 times in transplant patients. Despite this, cancer screening in the transplant population is inadequate and lacks specific guidelines. Objective. The aim of this study was to analyze the occurrence of cancer in kidney transplant patients, risk factors, clinical evolution and graft and patient survival. Material and methods. This case-control study included 100 patients who received a kidney transplant in the period of 2008 to 2018 at the Transplant Unit of the University Hospital Medical Sciences. Of these, 25 patients who developed CA were assigned to the case group and 75 patients without CA after transplantation were assigned to the control group. All patients were interviewed to survey risk factors such as smoking habit, family history among others before transplant and also screened for malignancies by laboratory and imaging exams. The immunosuppressive therapy was performed with induction immunotherapy in sensitized patients; maintenance triple immunosuppressive therapy using calcineurin inhibitor, methylprednisolone, and sodium mycophenolate. After transplantation, clinical suspicion associated with a positive history of malignancies motivated the initial screening for CA. If CA diagnosis was confirmed, the patient was underwent appropriate treatment. The logistic regression models to obtain the odds ratios and Kaplan-Meier method for survival curves were used in the analyzes. Results. An association of the risk factors as causes of ESRD, time in dialysis, smoking habit, family history of CA, rejection episodes, induction immunotherapy, and maintenance triple immunosuppression with CA development was not observed. Non-melanoma skin cancer was the most common, accounting for 60% of the cases, which was followed by stomach and prostate CA and lymphoproliferative diseases (4% each). The most frequent age range with CA diagnosis was 50–59 years and the highest number of diagnoses was noted from the fifth to seventh year after transplant (43.83%). Graft and patient survival was similar between the groups. Fifty per cent of the patients that died in the case group was due to CA. Conclusion. Association between CA development and the risk factors family history and smoking habit was not observed, and no differences in allograft and patient survival were found between the groups. However, CA can occur early after transplantation, significantly affecting the patient's quality of life. Due to the continuous use of immunosuppression in transplant patients and the high risk of CA, we suggest screening for oncological diseases.
Capacidade Funcional e Rigidez Arterial em Indivíduos Pós Acidente Vascular Encefálico Crônico
(Faculdade Ciências Médicas de Minas Gerais, 2021-07-14) Procópio, Cléucia Coelho Lage; Machado, Maria da Glória Rodrigues; Polese, Janaine Cunha
Introduction: Stroke is a cardiovascular health condition with neurological impairment, characterized by motor impairment, resulting from vascular changes. Individuals after chronic stroke often present motor disabilities resulting from brain injury, which can lead to changes in the functional capacity of these individuals. Concomitantly, vascular changes lead to increase in arterial stiffness in individuals after chronic stroke when compared to healthy individuals. Structural and functional changes in arteries related to arterial stiffness, establish pathophysiological mechanisms that hinder the propagation of pulse waves, in which they contribute to brain damage. Objective: To investigate the association between the functional capacity and arterial stiffness between individuals after chronic stroke, in addition to comparing arterial stiffness stratified in worse and better functional capacity. Methods: This is a cross- sectional study, composed of individuals diagnosed with chronic stroke, both sexes, over 18 years age. Functional capacity was assessed using the Duke Activity Status Index (DASI) questionnaire. The individuals were stratified into worse functional capacity (˂31,95 points) and better functional capacity (≥ 31,95 points). Arterial stiffness was assessed by means of arterial stiffness indices, using the Augmentation Index corrected by the heart rate 75 beats per minute (Alx@75). Arterial stiffness was assessed in the paretic arm, non-invasively, using the Mobil-O-Graph® equipment. Pearson’s correlation was used to verify the association between functional capacity and arterial stiffness and the T test (CI95%) was used to compared Alx@75 between individuals with worse and better functional capacity. All variables were analyzed using the SPSS version 17.0 statistical package, with a significance level of 5%. Results: The sample consisted of twenty-eight individuals with chronic stroke, mean age of 57.7 ±17.0 years, 61% of the sample consisting of men. Individuals had a mean of 51.1 ±54.1 months since stroke and 84% of the sample had ischemic stroke. The average of the DASI score was 29±19 METS and the mean Alx@75 was 23.8 ±11.4%. There was a significant, negative and reasonably magnitude correlation (r: -0.53; p: 0.01) between functional capacity and arterial stiffness. Eighteen individuals were categorized with worse functional capacity. There was a statistically significant difference between groups (mean difference 10.04 [CI95% 2.44 to 17.64]). Conclusion: The present study demonstrated association between functional capacity and arterial stiffness in individuals with chronic stroke. Individuals with better functional capacity have lower arterial stiffness indices.
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.
Como os pacientes com melanoma morrem: estudo transversal sobre a percepção entre os cuidadores sobre os últimos 30 dias do final da vida
(Faculdade Ciências Médicas de Minas Gerais, 2017-09-25) Parreiras, Fernanda Cardoso; Wainstein, Ana Paula Drummond Lage; Wainstein, Alberto Julius Alves
Introduction: Melanoma is the skin cancer with the worst prognosis and is responsible for most of the skin cancer-related deaths. Even with the innovations of target immunotherapies and therapies, most patients with metastatic melanoma still evolve to death. So knowing the conditions in which advanced melanoma patients live at their end of life is important in helping doctors determine better control of symptoms and improve the quality of death of these patients. Objective: To evaluate the symptoms in the period before death and to identify the place where it occurred, the caregiver's opinion about the ideal environment for death and end-of-life care. METHOD: This was a retrospective cross-sectional study that used secondary data (review of medical records of 818 patients with melanoma) and interviews with caregivers between 2015 and 2016. Among 66 confirmed deaths, 32 patients were effectively included in the study, and the signs and symptoms were evaluated. most prevalent symptoms 1 month, 1 week and on the day of death. Results: Pain (40.63%) was the most disturbing symptom for patients. Digestive symptoms such as nausea, vomiting and weight loss were very prevalent and cumulative from the 30th day of death. Complaints of limitation for ambulation, personal hygiene and depression also showed high prevalence from 30 days before death. In the week prior to death these symptoms were more prevalent showing inadequate control, however, on the day of death there was no significant change. The majority of patients died in the hospital (84.38%) and, according to caregivers, this is the best place to provide better conditions and control of symptoms. Conclusion: Controlling the most prevalent symptoms improves the quality of death of patients. It highlights the importance of accessing their conditions and preferences, especially the place where they wish to die, and thus, plan a treatment according to their needs.
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.