Ingrid Correia Nogueira

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.

The impact of lung cancer resection surgery on fibrinogen and C-reactive protein and their relationship with patients outcomes: A prospective follow up study

BACKGROUND Major thoracic surgery is characterized by release of inflammatory markers.The objective of this study was to assess the preoperative and postoperative systemic inflammatory markers of patients undergoing lung cancer resection. METHODS This is a prospective follow up study conducted with 48 patients submitted to lung cancer resection.All patients were assessed before and 1 month after surgery through measurement of fibrinogen and C-reative protein(CRP), pulmonary function tests, 6- minute Walk Test (6 MWT), maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax), anxiety and depression scale and karnofsky performance status scale. RESULTS Both fibrinogen and CRP were higher 1 month after surgery, although only the change in CRP was statistically significant (p= 0.03). The following functional parameters: 6 MWT, PImax, PEmax, FEV1(%) and FVC(%) decreased after surgery with p ≤ 0.001 for all the parameters. Anxiety and depression improved and Karnofsky decrease after surgery (p= 0.03, p= 0.01 and p= 0.02; respectively). Change in CRP score following lung resection correlated significantly with changes in fibrinogen (r= 0.40; p= 0.003), change in Karnofsky scale (r= -0.50; p< 0.001) and a borderline significant trend with the 6 MWT (r= -0.28; p= 0.05). With the exception of video-assisted thoracoscopic surgery (VATS), who had a significantly lower fibrinogen level 1 month after surgery compared with thoracotomy (p= 0.01), no significant differences in fibrinogen or CRP were noted in other subgroups of patients considered at increased risk for higher levels of inflammation compared with lower risk counterparts. CONCLUSION Lung cancer resection surgery was associated with increased level of CRP, 1 month after surgery, and correlated directly with change in fibrinogen and inversely with measurement of performance status. VATS provided lower level of fibrinogen after surgery.

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.

Assessment of fatigue using the Identity-Consequence Fatigue Scale in patients with lung cancer

Objetivo: Avaliar as propriedades da Escala de Identificacao e Consequencias da Fadiga (EICF) em pacientes com câncer de pulmao (CP), analisando a intensidade da fadiga e fatores associados. Metodos: Estudo transversal com pacientes com CP, atendidos em um hospital-escola no Brasil, que preencheram a EICF. Pacientes com doencas cardiacas cronicas (DCC) e controles saudaveis, pareados por idade e sexo, tambem preencheram a escala. Inicialmente, uma versao brasileira da escala foi aplicada a 50 pacientes com CP por dois entrevistadores independentes; para testar a reprodutibilidade, ela foi reaplicada aos mesmos pacientes. No momento basal, os pacientes com CP realizaram espirometria e teste de caminhada de seis minutos, bem como preencheram a Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e Fatigue Severity Scale (FSS). O estado inflamatorio foi avaliado pelos niveis de proteina C reativa (PCR) no sangue. Para validar a EICF, avaliamos as correlacoes entre as pontuacoes na mesma e essas variaveis. Resultados: A amostra foi composta por 50 pacientes em cada grupo (CP, DCC e controle). No grupo CP, os coeficientes de correlacao intraclasse para confiabilidade intra e interobservador para as variaveis resumidas da EICF variaram de 0,94 a 0,76 e de 0,94 a 0,79, respectivamente. A EICF apresentou excelente consistencia interna, e as disposicoes graficas de Bland-Altman demonstraram boa confiabilidade teste-reteste. A EICF apresentou correlacoes significativas com as pontuacoes na FSS, HADS e SF-36, bem como com os niveis de PCR. As medias das pontuacoes na EICF do grupo CP diferiram significativamente das dos grupos DCC e controle. Conclusoes: A EICF e um instrumento valido e confiavel para a avaliacao de pacientes com CP, nos quais depressao, qualidade de vida e niveis de PCR parecem estar significativamente associados a fadiga.

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.