Adriana Sarmento de Oliveira

Fatores ambientais e risco de quedas em idosos: revisão sistemática

Falls in the elderly is the result of a complex interplay between intrinsic and extrinsic factors. Although it is difficult to separate these factors, studies indicate that environmental hazards are involved in approximately 40% of the falls. This study aimed to conduct a systematic review about the contribution of environmental hazards for falls in community-dwelling elderly. Studies published from January 2000 to May 2014 in the electronic databases MEDLINE, LILACS and SciELO were selected. Only free full-text articles written in English, Portuguese and Spanish were considered for this research. After title, abstract and full text analysis, ten articles were included in this review. In the studies analyzed, approximately half of the falls occurred during walk and involved tripping and slipping. The environmental risk factors are present in falls (20-58%), in which irregular surfaces, wet/slippery floors, objects/loose rugs and uneven floor/steps were the most prevalent hazards among the studies. There was tendency of increase in the occurrence of outdoor falls, which are often caused by extrinsic factors. More studies are needed to characterize and develop strategies to prevent outdoor falls among community-dwelling older adults.

Successful Endomyocardial Biopsy Guided by Transthoracic Two-Dimensional Echocardiography

INTRODUCTION Two-dimensional (2-D) echocardiography is an excellent alternative method to perform endomyocardial biopsies (EB) in special situations, mainly when the patient is in a critical state and cannot go to the catheterization laboratory or when there are contraindications to the use of fluoroscopy as in the pregnancy. OBJECTIVE This single-center experience analyzed the last 25 years use of an EB technique guided by echocardiography realized at the bedside on critical patients. METHODS From 1985 to 2010, we performed 76 EB guided by 2-D echocardiography on 59 patients, among whom 38 (64.4%) were critically ill with examinations at the bedside; among 10 (16.9%) subjects, the procedure was carried out simultaneously with fluoroscopy for safetys sake during the learning period. In addition, 8 (13.6%) were unavailable for fluoroscopy, and 3 (5.1%) required a hybrid method due to an intracardiac tumor. RESULTS The main adverse effects included local pain (n = 4, 5.6%); difficult out successful puncture due to previous biopsies (n = 4, 5.6%); local hematoma without major consequences (n = 3, 4.2%); failed but ultimately successful puncture on the first try due to previous biopsies or (n = 3, 4.2%); obesity and immediate postoperative period with impossibility to pass the bioptome into the right ventricle; however 2 days later the procedure was repeated successfully by echocardiography (n = 1, 1.4%). All myocardial specimens displayed suitable size. There were no undesirable extraction effects on the tricuspid valve tissue. In this series, there was no case of death, hemopericardium, or other major complication as a direct consequence of the biopsy. CONCLUSION 2-D echocardiography is a special feature to guide EB is mainly in critically ill patients because it can be performed at the bedside without additional risk or disadvantages of fluoroscopy. The hybrid method associating 2-D echocardiography and fluoroscopy allows the procedure in different situations such as intracardiac tumor cases.

Obesidade e testes de função pulmonar em crianças e adolescentes: uma revisão sistemática

ABSTRACT Objective : To perform a systematic review of observational studies that analyzed the relation between spirometric param -eters and the presence of obesity in children and adolescents. Data source : Data were selected without language re-striction, using the following databases: PubMed/Medline, Scopus, Lilacs, and SciELO, with no restriction as to initial date until December 2010. The descriptors were extracted from Medical Subject Headings: “respiratory function tests” and “childhood obesity”. Synthesis of data : 89 papers were initially found, but only five were selected. Observational studies reporting spirometric parameters and body mass index of the patients were included, and those that assessed pulmonary function by other methods and whose subjects were not exclusively children or enrolled patients with associated comorbidities were excluded. In order to assess the quality of these stud-ies, the scale for observational studies of the Agency for Healthcare Research and Quality was applied. All studies evaluated the forced vital capacity and the forced expiratory volume on the first second. Four papers also assessed the forced expiratory flow between 25 and 75%, forced expira -tory flow at 50%, expiratory peak flow, and the relation between forced expiratory volume on the first second and forced vital capacity

Obesity and pulmonary function tests in children and adolescents: a systematic review

ABSTRACT Objective : To perform a systematic review of observational studies that analyzed the relation between spirometric param -eters and the presence of obesity in children and adolescents. Data source : Data were selected without language re-striction, using the following databases: PubMed/Medline, Scopus, Lilacs, and SciELO, with no restriction as to initial date until December 2010. The descriptors were extracted from Medical Subject Headings: “respiratory function tests” and “childhood obesity”. Synthesis of data : 89 papers were initially found, but only five were selected. Observational studies reporting spirometric parameters and body mass index of the patients were included, and those that assessed pulmonary function by other methods and whose subjects were not exclusively children or enrolled patients with associated comorbidities were excluded. In order to assess the quality of these stud-ies, the scale for observational studies of the Agency for Healthcare Research and Quality was applied. All studies evaluated the forced vital capacity and the forced expiratory volume on the first second. Four papers also assessed the forced expiratory flow between 25 and 75%, forced expira -tory flow at 50%, expiratory peak flow, and the relation between forced expiratory volume on the first second and forced vital capacity

CAFEÍNA E EXERCÍCIO FÍSICO: UMA REVISÃO SISTEMÁTICA DOS ASPECTOS HEMODINÂMICOS

Objective: to systematically review the cardiovascular effects of caffeine on exercise in athletes, not athletes apparently healthy and cardiac patients. Material and methods: the search was conducted using the Medline, Lilacs and Scielo. Found 108 studies. Of these, only 10 were included in the hemodynamic aspects include exercise in humans. Results: hemodynamic variables were the most studied blood pressure (BP) (n = 9) and heart rate (HR) (n = 9). Few studies have examined blood pressure measured (n = 2), double-product (n = 1) and blood flow (n = 1). Moreover, were monitored during exercise, and only one, for a period of 10 minutes in the recovery period. Caffeine increased the BP in most studies. Likewise, increased the FC. However, two studies were found that the substance caused a significant decrease of this variable. Conclusion: caffeine in moderate concentrations of 5mg/kg body, causes cardiovascular changes both at rest and during and after exercise. However, the magnitude of these changes may vary according to population. DESCRIPTORS Blood pressure. Heart rate. Autonomic nervous system.

Obesidad y pruebas de función pulmonar en niños: una revisión sistemática

ABSTRACT Objective : To perform a systematic review of observational studies that analyzed the relation between spirometric param -eters and the presence of obesity in children and adolescents. Data source : Data were selected without language re-striction, using the following databases: PubMed/Medline, Scopus, Lilacs, and SciELO, with no restriction as to initial date until December 2010. The descriptors were extracted from Medical Subject Headings: “respiratory function tests” and “childhood obesity”. Synthesis of data : 89 papers were initially found, but only five were selected. Observational studies reporting spirometric parameters and body mass index of the patients were included, and those that assessed pulmonary function by other methods and whose subjects were not exclusively children or enrolled patients with associated comorbidities were excluded. In order to assess the quality of these stud-ies, the scale for observational studies of the Agency for Healthcare Research and Quality was applied. All studies evaluated the forced vital capacity and the forced expiratory volume on the first second. Four papers also assessed the forced expiratory flow between 25 and 75%, forced expira -tory flow at 50%, expiratory peak flow, and the relation between forced expiratory volume on the first second and forced vital capacity