Clarissa Bentes de Araujo Magalhães

Portuguese-language version of the COPD Assessment Test: validation for use in Brazil.

OBJECTIVE: To validate a Portuguese-language version of the COPD assessment test (CAT) for use in Brazil and to assess the reproducibility of this version. METHODS: This was multicenter study involving patients with stable COPD at two teaching hospitals in the city of Fortaleza, Brazil. Two independent observers (twice in one day) administered the Portuguese-language version of the CAT to 50 patients with COPD. One of those observers again administered the scale to the same patients one week later. At baseline, the patients were submitted to pulmonary function testing and the six-minute walk test (6MWT), as well as completing the previously validated Portuguese-language versions of the Saint Georges Respiratory Questionnaire (SGRQ), modified Medical Research Council (MMRC) dyspnea scale, and hospital anxiety and depression scale (HADS). RESULTS: Inter-rater and intra-rater reliability was excellent (intraclass correlation coefficient [ICC] = 0.96; 95% CI: 0.93-0.97; p < 0.001; and ICC = 0.98; 95% CI: 0.96-0.98; p < 0.001, respectively). Bland Altman plots showed good test-retest reliability. The CAT total score correlated significantly with spirometry results, 6MWT distance, SGRQ scores, MMRC dyspnea scale scores, and HADS-depression scores. CONCLUSIONS: The Portuguese-language version of the CAT is a valid, reproducible, and reliable instrument for evaluating patients with COPD in Brazil.

Efeitos do exercício físico no controle da hipertensão arterial em idosos: uma revisão sistemática

O exercicio fisico e uma das principais terapeuticas utilizadas para o paciente hipertenso, pois reduz a pressao arterial (PA) e os fatores de risco cardiovasculares, diminuindo a morbimortalidade. OBJETIVO: Analisar os efeitos do exercicio fisico na PA de idosos hipertensos, com base nos resultados de pesquisas empiricas realizadas no periodo de 2000 a 2010. METODOLOGIA: Revisao sistematica de estudos experimentais, em ingles, portugues e espanhol, nas bases eletronicas MEDLINE, PubMed, Lilacs, Cochrane e PEDro, publicados entre 2000 e 2010, utilizando os descritores hipertensao, atividade fisica, exercicio fisico, idoso, exercicio aerobio e treinamento de resistencia. RESULTADOS: Foram encontrados 19 artigos e incluidos 12 artigos, sendo divididos em categorias tematicas: exercicio aerobico (6 artigos), exercicio resistido (4), exercicio aerobico associado ao resistido (2). Entre os exercicios aerobicos, tres artigos evidenciaram reducao na pressao arterial sistolica (PAS) e pressao arterial diastolica (PAD). Tres artigos afirmam que treinamento resistido reduz significativamente os valores de PAS em repouso e pressao arterial media (PAM), apenas um artigo nao registrou uma reducao significativa na PAD e frequencia cardiaca (FC) de repouso. A utilizacao dos exercicios aerobicos associados aos resistidos foram superiores aos demais, pois apontaram reducoes significativas na PAS, PAD, PAM e FC de repouso, confirmando as recomendacoes da VI Diretriz Brasileira de Hipertensao Arterial, mas os estudos em idosos sao escassos. CONCLUSAO: Esta revisao confirma os beneficios oriundos da pratica do exercicio fisico na reducao da PA apos o exercicio em idosos hipertensos.

Exercise Capacity Impairment Can Predict Postoperative Pulmonary Complications after Liver Transplantation

Background: Postoperative respiratory complications (PRCs) are common after liver transplantation (LT) and contribute significantly to the related morbidity and mortality. Objective: The aim of this paper was to determine the incidence of PRCs after LT and the value of simple exercise capacity measures as independent predictors of PRCs. Methods: We conducted a prospective cohort study of consecutive adults submitted to LT at a University Hospital in Fortaleza Brazil from March 2013 to March 2015. At baseline, exercise capacity was assessed with the 6-minute walk test (6MWT) and the 6-minute step test (6MST), lung function was tested by spirometry, and respiratory muscle strength was measured by maximal respiratory pressure. Additional relevant pre- and intraoperative data were collected through interview and chart review, and their association with the incidence of PRCs was evaluated. Results: The study included 100 subjects, 44% of whom presented at least 1 of the PRCs. In the univariate analysis, poor 6MST and 6MWT results and a longer preoperative cold ischemia time were associated with PRCs. The logistic regression analysis showed that PRCs were less likely to occur when preoperative walking distances were longer: the odds ratio (95% CI) was reduced to 0.589 (0.357-0.971) for each 50 m walked (p = 0.03). Likewise, PRCs were more likely to occur in patients with longer preoperative cold ischemia times: the odds ratio (95% CI) increased to 1.008 (1.002-1.015) for each minute (p = 0.01). Conclusion: The incidence of PRCs is high in LT patients. A prolonged cold ischemia time and preoperative 6MWT results were independent predictors of PRCs in this patient population.

Estratégia dE Educação continuada na árEa dE rEabilitação cardíaca

O programa de reabilitacao cardiovascular consiste nas atividades multiprofissionais necessarias para garantir aos cardiopatas melhores condicoes biopsicossociais. O presente estudo trata-se de um relato de experiencia da pratica assistencial desenvolvido entre marco a maio de 2011, com 12 profissionais em um hospital escola de nivel terciario na cidade de Fortaleza-Ce e que descreve a estrategia utilizada para realizacao de acoes de educacao continuada. Foram realizadas 6 atividades para delinear protocolos de atendimento e revisao dos temas especificos. Baseou-se nas experiencias do cotidiano das equipes. Alguns temas foram organizados por categoria profissional e outros em conjuntas. Implantar processos de Educacao Permanente e fundamental para qualificacao do servico.

A efetividade da escala de sonolência de Epworth como recurso auxiliar no diagnóstico da síndrome da apnéia obstrutiva do sono

Objective: To analyze the effectiveness of the Epworth Sleepiness Scale (ESS) as an auxiliary resource in the diagnosis of the Obstructive Sleep Apnea Syndrome (OSAS). Methods: Observational study, with a retrospective phase and a prospective one, comprising 475 patients who sought the Sleep Study Center in Fortaleza (Centro de Estudo do Sono de Fortaleza - CESF). Data was collected from medical records, which comprises ESS, amidst some questionnaires prepared by CESF professionals and answered by the patients. The study compared the results raised by the ESS to the polysomnography data. Data analysis was performed on SPSS, using Pearson chi-square test, considering as statistically significant p-value 30 kg/m2 were the most affected by OSAS, with 38.9%, 41% and 45.1%, respectively. A significant relationship was found between ESS score and OSAS (p = 0,001), showing that 25.9% (n = 123) of patients, who had values higher than 10 in the ESS, were diagnosed with OSAS. Conclusions: Data on this study shows that ESS fits as an auxiliary resource in the diagnosis of OSAS and it may be applied by any health professional while taking the clinical history. However, clinical signs are not sufficient to diagnose it, so that polysomnography is still required.