Trabalhos Acadêmicos
URI permanente desta comunidadehttps://repositorio.cmmg.edu.br/handle/123456789/5
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Item 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 FricheIntroduction 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.Item Correlação entre alcoolemia, álcool no ar expirado e exame clínico em um estudo clínico monitorado de ingestão de álcool(Faculdade Ciências Médicas de Minas Gerais, 2017-12-06) Freitas, Rodrigo Gomes de; Wainstein, Alberto Julius Alves; Wainstein, Ana Paula Drummond LageBackground: Policies that establish maximum blood alcohol concentrations (BACs) or breath alcohol concentration (BrACs) for drivers while driving can reduce traffic accidents by approximately 20%. In Brazil, the National Transit Council (CONTRAN) considers positive BAC and/or BrAC tests or signs of psychomotor capacity alterations as evaluated by a police authority to be an administrative infraction or even a crime. The observed clinical symptoms of alcohol intoxication based on a subject's appearance may not necessarily reflect the quantified BAC and/or BrAC. Methods: Brazilian health volunteers (n=15) drank ethanol (40% v/v) and, at scheduled times, the subjects underwent blood draws for BAC analysis, were tested for BrAC analysis, and underwent psychomotor alteration assessments performed by M (medical authority) and NM (non-medical authority). This study compared the clinical symptoms identified by M and a NM with BAC and BrAC measurements. Results: Concentration time profiles of the BACs and BrACs of the volunteer subjects were generated. The BAC values reached a peak at 60min and subsequently decreased with time. The average BrAC values decreased with time after ingestion. During the evaluations, M was able to identify a lack of static equilibrium until 240 min and a lack of dynamic equilibrium until 120 min. A lack of upper limb motor coordination was observed until 90 min, and a lack of coordination in the lower limbs was observed only during the first hour. Regarding the tests performed by NM, the signs related to the subjects' appearances were observed more frequently until 60 min. The other analyzed symptoms were not identified. Naturally, the signs reported by both M and NM disappeared with time. Conclusion: The evaluations of psychomotor changes performed by Brazilian M were superior to those performed by NM. However, independent of the examiner, at the alcohol concentrations reached in this study, the psychomotor alteration evaluations were ineffective compared with the BAC and BrAC results.Item Efeito agudo da hidroterapia sobre a pressão arterial e o augmentation index em grávidas hipertensas crônicas(Faculdade Ciências Médicas de Minas Gerais, 2017-12-19) Linhares, Giovana Macêdo; Malachias, Marcus Vinícius BolívarAcute effect of hydrotherapy on blood pressure and augmentation index in chronic hypertensive pregnant women Introduction and objectives: Chronic hypertension and elevation of augmentation index in pregnancy are associated with the risk of complications such as superimposed preeclampsia and low fetal growth. The impact of hydrotherapy had not yet be enassessed in this context.Objectives: To evaluate the acute effect of a session of aquatic physiotherapy (hydrotherapy), a modality of non-pharmacological treatment, on blood pressure and augmentation index in chronic hypertensive pregnant women.Methods: A cross-sectional controlled study evaluated the effect of a hydrotherapy session on the blood pressure and arterial stiffness of pregnant women. We used Mobil-O-Graph-NG equipment for arterial variables, before and after a hydrotherapy session, involving stretching, warming, strengthening and relaxation.Results: We evaluated 36 pregnant women, 12 hypertensives, 24 controls, 30.4 ± 4.8 years old, 29.2 ± 3,3 weeks of gestation. In both groups, we observed reduction in augmentation index adjusted for 75 bpm (hypertensives: 28.8 ± 7.3%, before, 22.4 ± 6.9%, after, p = 0.024 and controls: 29.1 ± 7 , P= 0.001), and heart rate reduction (hypertensives: 93.4 ± 11.8 bpm, before, 82.4 ± 10.0 bpm, after, p <0.001 and controls: 91.4 ± 13.4 bpm, before, 81.5 ± 12.6 bpm, then; p <0.001). Hydrotherapy promoted a borderline significant redution in systolic blood pressure in hypertensive patients (139.6 ± 12.1 mmHg, before, 130.1 ± 12.6 mmHg, later, p= 0.050). Conclusions: We demonstrated for the first time that a hydrotherapy session acutely reduces the arterial stiffness expressed by the augmentation index, as well as attenuation in the heart rate of hypertensive pregnant women, regardless of the reduction of the blood pressure. The intervention proved to be safe and could represent a potential accessory non-pharmacological strategy for the prevention of maternal-fetal complications associated with chronic hypertension during pregnancy.Item 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 FricheBackgrounds: 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.Item 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 AlvesIntroduction: 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.Item Criopreservação de oócitos para fertilidade futura: comparação da resposta ovariana entre pacientes oncológicas e não oncológicas(Faculdade Ciências Médicas de Minas Gerais, 2018-03-27) Moraes, Camila Cruz de; Marinho, Ricardo MelloBackground: the cryopreservation of human embryos in in vitro fertilization (IVF) cycles is a well-established, reliable and routinely performed technique in assisted reproduction laboratories. Oocyte cryopreservation gained importance because it became an option to preserve the fertility of women with cancer or other diseases whose treatment could compromise their ovarian reserve. Currently, the group that seeks the oocytes cryopreservation most is women who have a desire to be mothers, but who do not see the possibility of becoming pregnant at the moment, either for lack of partner or professional, economic or personal issues. The difference between these two groups is: patients who freeze their oocytes by postponing motherhood are healthy, while cancer patients are carriers of a potentially fatal, consumptive illness. It is questioned whether the cancer patients would have a smaller ovarian reserve, presenting a lower response during ovulation induction. Objective: evaluate if the occurrence of a diagnosis of cancer interferes, in some way, in ovarian function, prior to the treatment of the disease. Material and methods: retrospective study, through analysis of medical records and the electronic database of the laboratory with information about ovarian stimulation cycles for oocytes cryopreservation. Results: The mean age was 35.13 ± 3.72 years, and 51.6% of the pacients were between 36 and 40 years old. The majority of patients were single, 57.6% in both groups. 82.1% of the patients presented normal weight to the body mass index (BMI) in both groups. Most women had no pregnancies (85.5%), no births (95.1%), and no abortions (89.6%) prior to cryopreservation. Most patients, 85.9%, performed only one puncture. In most cycles, the Antagonist protocol was used for the non-oncologic and oncological groups (74.4% and 86.4%, respectively). The mean number of gonadotrophin (FSH and hMG) units used was 2,288.1 ± 1,159.4 for non-cancer patients and 2,355.9 ± 1,182 for cancer patients. For 28.3% of the women there were 13 days of induction until the day of the ovarian puncture. The mean number of oocytes obtained for non-cancer patients was 11.4 ± 8 and for cancer patients this number was 13.8 ± 9. The mean number of frozen mature oocytes was 9.7 ± 7 for the non oncological group and 11.2 ± 7.2 for the oncological group. The majority (63.1%) of the patients, frozen up to 10 oocytes per cycle. The most incident cancer was the breast cancer. There was no significant difference in ovarian response according to the type of cancer. Conclusion: The response to ovarian stimulation of oncological and non-oncological patients is similar, since the number of oocytes obtained and frozen from the two groups studied was similarItem 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 MacielBackground: 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.Item 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 AlvesIntroduction: 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 mortalityItem Estudo caso-controle para avaliar influência autonômica na bradicardia dos pacientes com a mutação R302Q no gene PRKAG2(Faculdade Ciências Médicas de Minas Gerais, 2019-06-28) Santos, Pedro Paulo Nascimento dos; Sternick, Eduardo BackBackground: It has been shown that bradycardia in the mutant murine model with ɣ2- AMPK mutation is caused by sinus node remodeling. We aim to assess the autonomic nervous system (ANS) phenotype in a cohort of carriers of R302Q PRKAG2 gene mutation and to assess its role in the sinus bradycardia occurring in PRKAG2 cardiomyopathy. Methods: This case-control cross-sectional study included twenty-seven individuals from five families, carriers of ɣ2 subunit PRKAG2 mutation and 27 relatives without the mutation, matched by sex and age as a control group, who underwent ANS evaluation by means of heart rate (HR) variability assessment using time and frequency domain parameters during 10 minutes supine resting and 24-hour Holter, resting and post phenylephrine baroreflex sensitivity, Valvalsa and respiratory maneuvers, Handgrip, head-up tilt table testing, basal and post orthostatism serum epinephrine, norepinephrine, and dopamine, serum NTproBNP, and pharmacologic dual autonomic blockade with atropine and propranolol (we classified in 3 types of response, 1 being normal, 2 with mildly abnormal intrinsic HR, 3 with severely abnormal intrinsic HR plus no response to atropine). Results: Control and PRKAG2 Groups had 55.6% females and similar age (36.3+14 vs 36.8+14.6 years, p=0.8). Holter HRV parameters were significantly higher in PRKAG2 group, particularly SDNN, SDRR and RMSSD and Total Power, as well as higher incidence of frequent atrial ectopy (7.4% vs 48.1%, p= 0.016). Systolic BP during Valsalva phase1 was higher among PRKAG2 subjects (124.80±13.72 vs 133.59±15.28, p=0.031). Results from baroreflex sensitivity, Valsalva and respiratory maneuvers, Handgrip, head-up tilt table testing did not differ among study Groups. Total peripheral resistance (TPRI) group was higher in PRKAG2 subjects at rest (3.406.77+1309.59 dyn.sec.cm-5 ; p< 0.0001) as well as after phenylephrine bolus (5717.19 + 2231.52 vs 3569.30 + 1292.32 dyn.sec.cm-5 ; p< .0001). PRKAG2 subjects had a slower HR at rest (52.2+8.2 vs 64.4+14.5 beats/ min; p= 0.0006), after atropine (92.8+19 vs 116.7+18.2 beats/ min; p< 0.0001), and intrinsic HR (67.6+21.4 vs 95.7+13.5 beats/ min; p<0.0001). After 1 year of follow-up 3 type-2 patients (20%) (PRKAG2 Group) had a major cardiac event (1 sudden death and 2 pacemakers). Conclusions: The autonomic nervous system plays no role in the bradycardia associated with PRKAG2 cardiomyopathy. There is evidence in favor of a heightened sympathetic drive in PRKAG2 subjects, which could have an impact in the risk of sudden death. Type 2 response to pharmacologic ANS blockade predicted major arrhythmic events in one year.Item Estudo transversal para avaliar o impacto da mutação R302Q na sub-unidade γ2 da proteína quinase ativada por AMP em vias metabólicas(Faculdade Ciências Médicas de Minas Gerais, 2018-02-26) Souza, André Chuster de; Sternick, Eduardo BackIntroduction: The R302Q mutation in the γ2 subunit of the PRKAG2 gene is associated with alterations in the metabolism of AMPK (AMP-activated protein kinase), enzyme responsible for the control of cellular energy homeostasis. The result of the PRKAG2 mutation is the loss of AMPK γ2 subunit function, characterizing a metabolic defect responsible for a glycogen metabolism disease. The phenotype resulting from this mutation includes ventricular hypertrophy, sinus bradycardia, conduction system abnormalities, atrial arrhythmias, ventricular pre-excitation syndrome, progressive heart failure and sudden cardiac death. Extra cardiac manifestations may occur in rare patients, mostly due to skeletal muscle glycogen storage. The objective of the present study is to examine the effect of the R302Q mutation of the PRKAG2 gene on metabolic pathways focusing on diabetes mellitus type 2, obesity and metabolic syndrome. Methods: This is an observational study with 26 heterozygous adults for the R302Q γ2 mutation and 44 individuals with a negative genotype for the given mutation. Clinical, anthropometric, biochemical were collected and previously validated questionnaires were applied. Results: Individuals with a positive genotype for the R302Q γ2 mutation had higher values of body mass index, waist-hip ratio and cutaneous skin-folds when compared to the control group. Carriers of the R302Q mutation had higher levels of gamma glutamyltransferase, bilirubin, fasting glucose and glycosylated hemoglobin. The HOMA model demonstrated lower levels of HOMA%B with similar levels of HOMA%S, consistent with a reduction in the activity of beta-pancreatic cells, with preserved insulin sensitivity. Conclusion: The R302Q γ2 mutation is associated with increased adiposity and reduced beta pancreatic cell activity, playing a key role in the genesis of the metabolic syndrome in this population.