Trabalhos Acadêmicos
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Resultados da Pesquisa
Item Estudo eletrofisiológico, histológico, histoquímico e ultraestrutural do miocárdio de pacientes com mutação do gene PRKAG2(Faculdade Ciências Médicas de Minas Gerais, 2022-03-30) Oliveira, Carla; Stenick, Eduardo BackBackground: PRKAG2gene mutation, which encodes the ɣ2 subunitof protein kinase activated by adenosine monophosphate (AMPK), is an autossomic dominant inherited disease with early adulthoodclinical onset, characterized by pre-excitation, atrial tachyarrhythmias, atrioventricular conduction abnormalities and cardiac hypertrophy. Half of the patients will need pacemaker implantation. One tenth will have sudden death, before the fourth decade.Early detection of the condition is advisable to ensure adequate care. Genetic sequencingis considered the gold standard diagnostic test, but it is not available in the Brazilian “Sistema Único de Saúde”. The diagnostic efficacy of biopsy in identifying PRKAG2 cardiomyopathy remains to be assessed.Objectives: To evaluate the magnetic resonance imaging with T1 mapping, extracellular volume, and late gadolinium enhancement of PRKAG2 cardiomyopathy and assess thehistologic, histochemical, and ultrastructural findings of myocardium fragments of patients with PRKAG2 gene mutations harvested by percutaneous endomyocardium biopsy. To compare the diagnostic efficiencyof endomyocardial biopsy with genetic sequencing as a gold standard. Methodology: The first study was an observational cross-sectional analysis of 30 patients with PRKAG2 cardiomyopathy. The second study was a cross-sectional with case-control study. We included18patientswith PRKAG2mutations(Arg302Gln and His401Gln). Acontrol group comprised of biopsies of 11 recipients of a heart transplant (within 10 days), and another control group with3 patients with hypertrophic sarcomeric cardiomyopathy.A single patient had a pathogenic variant -MYL3 Ala57Asp. Next Generation Sequencing was carried out in the probands with PRKAG2 cardiomyopathy and hypertrophic cardiomyopathy, while family members underwent cascade Sanger sequencing. Results: LV hypertrophy was found in 16 individuals (53.3%). Myocardial thickness increased in 25 individuals (83.3%), severe in 9 (30%) and extreme in 3. Hypertrophy patterns as septal, apical, and diffuse, without outflow tract obstruction. T1 mapping and ECV were normal in all. LGE was found in 16.6% (5/30), all with severe hypertrophy(5/9) of those, as compared with 0/21 patients with mild or no hypertrophy (p=0.009).The myocardium fragments inPRKAG2cardiomyopathy showed a significant increase in cardiomyocyte diameter, pronounced vacuolation, absence of fibrosis, except in two patients, who had focal low intensity interstitial fibrosis, absence of architectural disarray, and absence of inflammatory infiltrates as compared with normal controls (post heart transplant).Transmission electron microscopy showed large amounts of glycogen granules in the cytosol, particularly in perinuclear region. Polls of glycogen were also seen in interfibrillar space and in subsarcolemmal regions. The large amount of glycogen observed in patients with PRKAG2cardiomyopathy was not seen in any of the controls. A composite of pathology features like pronounced vacuolation, absence of inflammation, fibrosis, and architectural disarray, together with large amounts of glycogen granules in the cytosol as seen in transmission electron microscopy, was able to identify all cases of genotyped PRKAG2cardiomyopathy, even those patients without clinical hypertrophy in echocardiogram. Conclusion: CMR with T1 mapping techniques may help identify xi PRKAG2patients among individuals with unexplained hypertrophy. Endomyocardial biopsy was as efficient as genetic sequencing in identifying PRKAG2 cardiomyopathy.Item Rules protocol: como proceder em emergências durante cirurgia robótica(Faculdade Ciências Médicas de Minas Gerais, 2022-04-25) Almeida, Thiago Fabrício Pereira de; Campos, Marcelo Esteves Chaves; Santos, Fernando Augusto de VasconcellosIntroduction: As robotic surgery has expanded on it’s surgical application and it is also being noted a increase in surgical procedures complexity. In this context, the occurrence of emergency situations that require the conversion of the minimally invasive access route to open access routes is not uncommon. The urgent decoupling of the robotic platform is a complex and neglected process in robotic surgery training as it is nowadays Objective: To establish specific actions during a surgical procedure with the aid of the robotic platform in the face of emergency decoupling in a simulation environment. Method: Two surgery teams were submitted to a simulation environment in which there was a need for emergency decoupling of the robotic system. The intervention group (IG) underwent training with the RULES protocol and the control group (CG) could discuss among themselves without external intervention. Result: Decoupling time for the robotic platform from the IG was reduced by 66% and the CG by only 20%. Compared to the CG, in the second simulation, the IG acquired more critical actions necessary for decoupling and developed more non-technical skills after training with the RULES protocol. Conclusion: The RULES protocol proved to be effective, promoting an improvement in technical and non-technical skills of all surgical team menbers, resulting in more effective actions that resut in a coordinated and faster robotic undocking. It is also concluded that the surgeon and bed side surgeon are the key elements for the efficient robotic system undocking in emergency situations.Item 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 AlvesThe 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.Item 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 OliveiraIntroduction: 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.Item Impacto do exame clínico objetivo estruturado sobre a ansiedade e parâmetros cardiovasculares(Faculdade Ciências Médicas de Minas Gerais, 2022-12-13) Silva, Breno Augusto Ferreira; Lima, Isabela Maria Magalhães; Machado, Maria da Glória RodriguesIntroduction: Arterial stiffness (AS) is a set of alterations that refer to the material properties of the arterial wall that generate functional consequences for the artery. Mental stress can be the trigger for a cardiac or cerebrovascular event. One of these is test anxiety. A well-known mental stressor in academic settings is the Objective Structured Clinical Examination (OSCE), the gold standard in assessing clinical aptitude and practical skills. On the other hand, it is considered an important cause of anxiety in an academic environment. Objectives: To evaluate the association between changes in cardiovascular parameters and degrees of anxiety in OSCE participants. To assess vascular, hemodynamic parameters and AS indices in OSCE participants. To assess the degree of anxiety of OSCE participants and to analyze whether there is an association with the degree of mindfulness and with personality traits. Material and Methods: Eighty-one OSCE participants from the medical course in the second semester of 2021 were evaluated. Baseline data were collected 30 days before the OSCE (T1). The second collection (T2) took place on the day of the OSCE, with 25 minutes left for the participant to start his exam. Cardiovascular parameters were non invasively assessed using the Mobil-O-Graph® – the Pulse Wave Analysis Monitor. Anxiety was measured using the State Trace Anxiety Inventory (STAI), short version. Mindfulness was measured using the Mindful Attention Awareness Scale (MAAS). Personality traits were assessed using the Big Five Personality Factors Inventory (BIG 5). Results: Peripheral vascular pressures (systolic, diastolic, mean and pulse blood pressure) and central (systolic, diastolic and pulse pressure) and hemodynamic parameters (systolic volume, cardiac index and heart rate) were significantly higher in the T2 moment of OSCE completion. Similarly, the AS parameters: global peripheral and central AS indices (pPP/SVi and cPP/SVi), reflection coefficient, augmentation index (AIx@75), pulse wave velocity (PWV) and pressure amplification pulses increased significantly at T2. The degree of state anxiety and total anxiety increased significantly at T2. Trait anxiety and total anxiety were negatively associated with mindfulness. Conclusion: The present study showed, for the first time, the elevation of the AR indexes AIx@75, PWV, PPp/iVS and PPc/iVS of the participants, suggesting xiii that the OSCE significantly altered the main AS parameters. Such alterations were measured both in the parameters that are associated with hemodynamics, and those that are related to the AS indices and arterial compliance of the great arteries. The study also suggested that the OSCE caused an increase in the degree of anxiety in its participants. There was no association between anxiety and personality traits, suggesting that personality is not a predictor of anxiety for the OSCE. Associations found between mindfulness and anxiety suggest that OSCE participants who perceive themselves more physically and mentally have less anxiety. No association was found between changes in cardiovascular parameters and degrees of anxiety at T1 and T2.Item Impacto das transfusões sanguíneas precoces após o transplante renal na ocorrência de rejeições, função e sobrevida do enxerto(Faculdade Ciências Médicas de Minas Gerais, 2022-10-26) Silva, Bernardo Duarte Pessoa de Carvalho; Oliveira, Raquel Aparecida Salustriano Fabreti deIntroduction: Kidney transplant is considered the gold standard treatment for end stage kidney disease. However, despite the advances in this area, rejections are still the main causes of graft loss in the first year post-transplant. Blood transfusions in the postoperative period of a kidney transplant may induce antibody formation, responsible for the antibody-mediated rejection (ABMR) episodes, thus a better understanding of these events and whether there is a relationship with poorer graft survival is needed. Objectives: To analyze the relationship between blood transfusions in the first month post-transplantation and the occurrence of rejections as well as the impact on kidney function, global and graft survival in one year. Material and methods: A retrospective cohort study conducted with 445 patients who underwent living and deceased kidney transplants at University Hospital of the Faculty of Medical Sciences between 2008 and 2018. The participants were divided between those who received transfusion in the first month post-transplant (BTG) and those who did not receive hemotransfusions in the same period (NBTG). They had a one-year follow-up to assess the occurrence of rejections, function and graft survival. Results: Stratifying the 445 patients, the BTG group was composed of 125 and the NBTG of 320 patients. Regarding the main outcomes, BTG patients had a higher occurrence of ABMR in the first year (13.60%) compared to NBTG (4.38%) (p<0.001). Transfused patients developed de novo donor specific antibodies (DSA) in a higher proportion than non-transfused patients (p<0.001) in the first year post-transplantation. Transfused patients maintained higher creatinine levels in the first and third post-transplant month (p=0.012 and 0.038, respectively). The graft survival rate was worse, with more first year failures (11.2%) in the BTG group than in the NBTG group (2.5%) (p<0.001). The predictive risk factors for de novo DSA formation at one year after transplantation were the number of HLA mismatches (OR 1.95, p=0.031), not receive induction immunotherapy before KT (OR 1.81, p=0.043) and having received blood transfusion after KT (OR 1.53, p=0.039). Mortality was higher in the BTG group (7.20%) than in the NBTG group (2.81%) (p=0.035). Conclusion: Blood transfusions in the first month after transplantation are related to a higher occurrence of ABMR, as well as a worsening of renal function, reduced graft survival rate and higher mortality in the first year after transplantation.Item Validação do questionário Duke Activity Status Index (DASI) em indivíduos após acidente vascular cerebral por meio telefônico(Faculdade Ciências Médicas de Minas Gerais, 2022-12-13) Melo, Camila Dias Campos; Torriani-Pasi, Camila; Polese, Janaine CunhaIntroduction: Stroke survivors present several disorders that consequently reflect on mobility and social participation, which directly affect the functional capacity of this population. Therefore, the functional capacity is an important outcome to be assessed once it can portray the functional deficits of individuals. Its assessment can be indirectly acquired by questionnaires, such as the Duke Activity Status Index (DASI). This stands out for being an easy and quick tool, with low cost and able to predict oxygen consumption during activities. Facing the pandemic of COVID-19, health professionals had to adapt and deal with the social distance. In this new context, there was the need to validate instruments by telephone-based administration, as well as those that assess the functional capacity of individuals after stroke. Objective: Investigate the validity of administer the Duke Activity Status Index (DASI) questionnaire to chronic stroke survivors through telephone call. Methods: This is a methodological study, based on the COSMIN recommendations, in which participants with chronic stroke (>1 year), aged ≥ 20 years, and able to walk independently were included. After recruitment, participants were subjected to an initial assessment and subsequently completed the DASI questionnaire in person. After 5 to 7 days, the questionnaire was reapplied by telephone. Student's t-test with 95% confidence interval was used to compare the mean differences in the total scores of the face-to-face and telephone questionnaires to investigate concurrent validity. The intraclass correlation coefficient (ICC) and kappa coefficient were used to verify the agreement between administration in person and by telephone call. Results: Fifty participants were included (52% women), with a mean age of 56 ± 17 years. 66% of the sample had a clinical diagnosis of ischemic stroke. In the results of the total score of the DASI questionnaire administered in person and by telephone call, no statistically significant differences were observed (MD= -0.88; SD=4.14; 95%CI, -2.06 to 0.28; p=0.13) and very high agreement was found between the applications (ICC = 0.99; 95%CI, 0.94 to 0.98; p<0.05). As for the agreement of the individual items, the kappa coefficient ranged from 0.390-1.000, with the first item "take care of yourself" showing the best agreement (k=1.000) and the fourth item "climb a flight of stairs or a slope" showing the most inferior agreement (k=0.390). Conclusion: The DASI questionnaire is valid to assess functional capacity and can be administered through telephone in chronic stroke survivors. O questionário DASI apresentou-se válido para a avaliação da capacidadeItem Influência da ventilação mecânica, idade e ocorrência de incidentes em pacientes com doenças crônicas internados em uma unidade de terapia intensiva(Faculdade Ciências Médicas de Minas Gerais, 2022-12-16) Faiad, Ana Flávia Nunes; Pessoa, Bruno Porto; Leopoldino, Amanda Aparecida de OliveiraIntroduction: Patient safety is one of the main health concerns in Brazil and worldwide. The occurrence of incidents especially affects the most vulnerable populations, especially patients with chronic diseases, using mechanical ventilation and of advanced age, and may even result in death. Given this, analyzing the rate of occurrence of these incidents by respiratory physiotherapists can promote patient safety. Objective: To investigate the influence of incidents monitored by physiotherapists in patients with chronic diseases admitted to an Intensive Care Unit (ICU). Methods: Retrospective cross-sectional study that included analysis of medical records of patients with chronic diseases, admitted to an ICU from January 2019 to April 2021 in a hospital in a Brazilian metropolitan capital. The following variables were collected: sex, age, chronic diseases, severity classification, use of mechanical ventilation, mortality, occurrence of incidents and their characteristics, and length of stay. To determine mortality, the Cox model was used, using hazard ratio, with α=0.05. Results: 343 medical records were included (56.3% male, 73.2% aged 60 years or older and 51.3% suffered at least one incident). Increased age (HR 1.02, 95% CI 1.00; 1.04), the use of mechanical ventilation, which increased the risk of death by seven times (HR 7.34, CI 95) represented a greater risk of death. %3.21; 16.81) and the occurrence of an incident (HR 2.66, 95% CI 1.65; 4.28). Physical therapists were the professionals who reported the most incidents, and those with serious damage were more common during the night, and in this same shift, the lowest incidence of notifications of notifiable circumstances was observed. Conclusion: The findings presented in this study suggest that the occurrence of incidents in patients with chronic diseases admitted to an ICU increase the length of stay and mortality.Item 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 OliveiraIntroduction: 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.Item Incidência e fatores associados a infecção do sítio cirúrgico em pacientes submetidos a cirurgia do tornozelo e pé: uma coorte de 7 anos(Faculdade Ciências Médicas de Minas Gerais, 2022-07-01) Magalhães, João Murilo Brandão; Polese, Janaine Cunha; Leopoldino, Amanda Aparecida de OliveiraBackground: Surgical site infections (SSI) represent 31% of all hospital-acquired diseases, are the most common type of nosocomial infection, and have more severe orthopaedic complications. Surgical procedures of the ankle and foot, specifically, have an incidence of SSI ranging from 0.5% to 6.5%. Purpose: This study aimed to evaluate the incidence of superficial and deep SSI in foot and ankle surgery and the associated factors and to identify the most prevalent microorganisms. Methods: This study was a retrospective cohort including 2180 patients who underwent surgery of foot and ankle in a private hospital between 2014 and 2020. All elective and urgent procedures were included if they were considered clean. The outcome variable was SSI (superficial or deep) and the predictor variables were: sex, age, diabetes mellitus, systemic arterial hypertension (SAH), smoking, American Society of Anesthesiologists (ASA) score, and body mass index (BMI). Logistic regression models were used to determine associations between the study variables. Results: The incidence of SSI was 4% (83/2180), representing a incidence rate of 2.8% (57/2180) for superficial SSI and 1.2% (26/2180) for deep SSI. Two factors were identified as independently associated with SSI: smoking (OR 2.8, 95%CI 1.4-5.2) and ASA > 2 (OR 3.0, 95%CI 1.1-6.9). The group of patients with deep infections had higher proportions of smokers (p=0.002), SAH (p=0.018), emergency surgery (p=0.049), and ASA > 2 (p=0.011). The most prevalent organism detected by culture was Staphylococcus aureus in 61.5% of the cases, followed by Pseudomonas aeruginosa in 15.54%. Conclusions: The incidence of infection in this cohort was 4%; urgent surgical procedures, smoking, hypertension, and ASA classification > 2 were independently associated with the development of deep infections. The surgeon should be aware of these risk factors in order to manage the patient’s prophylactic antibiotic regimen.