Eduardo Eriko Tenório de França

Tabagismo como fator de risco para a doença renal crônica: revisão sistemática

INTRODUCTION Chronic kidney disease (CKD) and smoking are public health problems. OBJECTIVE To assess smoking as a risk factor for progression of CKD. METHODS We conducted a systematic review in Medline, LILACS, SciELO, Google Scholar, Embase and Trials.gov with articles published until February/2013. Were included: cohort, clinical trials and case-control. Performed in humans, aged ≥ 18 years with smoking as a risk factor for progression of CKD. We excluded studies that reported no smoking and CKD in the title or had proposed to reduce smoking. RESULTS Among 94 citations, 12 articles were selected. Of these, six were multicenter conducted in developed countries, four were randomized. Males predominated 51-76%. There was associated with smoking progression in 11 studies. It was found that the consumption ≥ 15 packs/ year increases the risk of progression of CKD. CONCLUSION Smoking is a risk factor for progression of CKD.

Effects of electrical muscle stimulation early in the quadriceps and tibialis anterior muscle of critically ill patients

Abstract Background: Electrical muscle stimulation (EMS) is applied to critically ill patients in order to improve their muscle strength, thereby preventing hypotrophy and promoting functional recovery. Objective: To assess the effects of early EMS on the range of movement of the ankle joint, and on thigh and leg circumference in critically ill patients. Methods: This is a prospective randomized clinical trial comprising 11 patients undergoing mechanical ventilation. Before and after EMS the thigh and leg circumference in both lower limbs and the goniometry of the tibiotarsal joint were measured. The angle of 90° on the goniometer was taken as the standard neutral position (NP), with the arm fixed on the lateral malleolus of the ankle joint. Other measurements, namely dorsiflexion and plantar flexion, referred to as mobile arm, were taken from the NP. These recordings were obtained following an active contraction of the patients’ muscles. Results: Compared with the electrostimulated limb, a difference in dorsiflexion of the control limb was observed (96.2 ± 24.9 versus 119.9 ± 14.1°; p = 0.01). A girth of 10 cm of the leg was found in limb reduction when compared to the electrostimulated one (24.7 ± 3.1 versus 26.4 ± 4.0 cm; p = 0.03). Conclusions: EMS used at low current intensity and for a short duration failed to prevent muscle atrophy in critically ill patients. However, we did find a significant improvement in active dorsiflexion of the ankle joint suggesting that it could help to prevent against stance plantar flexion in these patients.

Quality of life and physical activity in intensive care professionals from middle São Francisco

OBJECTIVE The objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU. METHOD This was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity--short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire. RESULTS It was classified active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p = 0.046). CONCLUSION Physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity.

Acute Effect of Neuromuscular Electrical Stimulation on Oxidative Stress and Hematological Parameters in Critical Patients

Aims: To analyze oxidative cellular stress and monitor the evolution of hematological parameters before and after of neuromuscular electrical stimulation (NMES) in critically ill patients. Methods: A controlled and randomized clinical trial, composed of a sample of 19 patients, admitted to the Agamenon Magalhaes Hospital intensive care unit. The patients were divided into two groups: NMES group (n=9), patients that underwent only one NMES in the quadriceps muscle for 20 min, and the other, control group (n=10) that did undergo any therapeutic intervention. Results: In relation to the demographic and clinical variables, the groups were homogeneous at the beginning of the study. For the nitric oxide (NO) analysis, we perceived a reduction, when comparing the before and after analyses, in NO in the stimulated cell (p=0.0188) and non-stimulated cell (p=0.0258) in the NMES group. Also in relation to NO, when comparing the two groups, we observed a significant reduction in the NMES group compared to the control one. For the hematological parameters we did not observe any difference when comparing before and after in the two groups studied. Conclusion: We can conclude that the use of NMES causes a reduction in cellular NO levels, showing the beneficial effects in reducing oxidative stress. With relation to complete blood count, we observed that its application was not able to causes any alterations.

Oxidative stress and immune system analysis after cycle ergometer use in critical patients

OBJECTIVE: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

Qualidade de vida e atividade física em profi ssionais de terapia intensiva do sub médio São Francisco

OBJECTIVE The objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU. METHOD This was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity--short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire. RESULTS It was classified active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p = 0.046). CONCLUSION Physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity.

Colangiopancreatografía retrógrada endoscópica en pacientes con asa en Y-de-Roux

Endoscopic retrograde cholangiopancreatography in Roux-en-Y patients The reconstruction of the digestive tract with a Roux-en-Y anastomosis has been performed more fre- quently in the last years mainly due to the overgrowth in the surgical treatment of obesity by gastric bypass in Roux-en-Y. The obesity pandemic is also associated with an increase in both the preoperative and postoperati- ve diagnosis of gallstones in this population. Bearing in mind the greater complexity of endoscopic retrograde cholangiopancreatography in these circumstances, the authors have reviewed the various endoscopic appro- aches available, evaluating 249 articles published between 1990 and 2010 obtained from Medline, Cochrane and Scielo, excluding case reports and articles outside the specifi c scope of this study. Endoscopic techniques with high success rates include the use of enteroscope, colonoscope, enteral and transgastric access combined with surgery. Even with the technological progress already made, further development of the instruments used will be necessary if greater comfort and safety is to be achieved with this procedure.