Marcelo Palmeira Rodrigues

Fatores associados a quedas em mulheres idosas residentes na comunidade

OBJECTIVE To determine the factors related to falls of a group of independent and autonomous elderly women. METHODS This was a descriptive study of 83 elderly women enrolled on the Elderly Health Promotion Project at the Universidade Católica de Brasília. They replied to questionnaires on their age, sociodemographic factors, dizziness, use of continuous medication, self-perception of health and vision and underwent the Yesavage Geriatric Depression Scale, Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. RESULTS No statistical relationship was identified between age, social demographic factors, dizziness, or negative self-perception of health and vision and fall phenomena. However there was a significant statistical relationship with the Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. CONCLUSION Elderly womens ability to balance was the major factor related to fall events. Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment were considered effective for predicting risk of falling, indicating that they could be used for assessment and identification of improved balance after trainingOBJECTIVE: Verify the factors related to falls of a group of independent and autonomous elderly women. METHODS: A descriptive study was conducted with 83 elderly women that participate in the Elderly Health Promotion Project of the Universidade Catolica de Brasilia. They replied to questions related to their age, social demographic factors, dizziness, use of continuous medication, self-perception of health and vision and were submitted to the Yesavage Geriatric Depression Scale, Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. RESULTS: No statistical relation was identified between age, social demographic factors, dizziness, and negative self-perception of health and vision with fall phenomena. Although there is a significant statistical relation to the Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. CONCLUSION: Body balance condition of the elderly women was the major factor related to fall occurrences. Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment were considered efficient to predict the risk of falling, indicating that they may be used for the assessment and identification of an improved body balance after training.

Evaluation of peak inspiratory pressure, tidal volume and respiratory rate during ventilation of premature lambs using a self-inflating bag

OBJECTIVE To evaluate the peak inspiratory pressure, tidal volume and respiratory rate achieved during manual ventilation of premature lambs, using a self-inflating bag. METHODS In this descriptive, experimental study, five pairs of physicians, selected at random among 35 neonatologists working at a neonatal intensive care unit and with experience in the resuscitation of newborn infants, ventilated five intubated premature lambs using a self-inflating bag. Pressure and flow monitor signals were passed through a transducer and digitized for recording and analysis. Tidal volume and pressure curves were obtained from the integral of flow rate, at peak, during the last 50 seconds of every fifth minute, and analyzed. RESULTS Median pressure was 39.8 (IQ(25-75%) 30.2-47.2) cmH(2)O; being below 20 in 1.1% of cases and above 40 in 49.1%. Seven out of 10 physicians produced more than six pressure peaks of over 40 cmH(2)O. Median tidal volume/kg was 17.8 (IQ(25-75%) 14.1-22.4) mL, being below 5 mL in 0.1% of cases and greater than or equal to 20 mL in 37.7%. All of the physicians propelled five or more ventilation cycles with tidal volume/kg of 20 mL or more. Respiratory rate was between 30 and 60 cycles/minute in 65.9% of cases, being below 30 in 6.8% of cases and over 60 in 27.3% of cases. CONCLUSIONS There was major variation in peak inspiratory pressure and tidal volume/kg values, which were in many cases elevated, attaining levels that habitually cause biotrauma, while respiratory rates were adequate in the majority of cases.

Avaliação do pico de pressão e da freqüência respiratória durante o uso de balão auto-inflável em um modelo de pulmão neonatal

OBJETIVO: Avaliar o pico de pressao inspiratoria e a frequencia ventilatoria obtidos por medicos quando da utilizacao de balao auto-inflavel neonatal em modelo de pulmao. METODOS: Quinze medicos ventilaram simuladores de pulmao de recem-nascidos a termo e pre-termo, sendo os desfechos captados atraves de um monitor de ventilacao. RESULTADOS: As medianas dos picos de pressao foram 23 (intervalo interquartil, 15-47) e 26 (intervalo interquartil, 14-51) cmH2O, sendo menor que 20 em 41,2 e 35,8% das vezes; maior que 40 em 29,7 e 33,6% das vezes e entre 27 e 33 cmH2O em 8,2 e 6,5% das vezes, para o pulmao de termo e de pre-termo, respectivamente. As medianas das frequencias ventilatorias foram de 45 (intervalo interquartil, 36-57) e 48 (intervalo interquartil, 39-55,5) ciclos por minuto, sendo menor que 30 em 9,3 e 6,7% das vezes e maior que 60 em 12 e 13,3% das vezes, respectivamente, para o pulmao de termo e de pre-termo. As diferencas nas medianas nao foram estatisticamente significantes. CONCLUSAO: A ventilacao utilizando o balao auto-inflavel promoveu adequacao para a frequencia ventilatoria em aproximadamente 80% das vezes, e os medicos nao conseguiram promover ventilacao com minima variabilidade na pressao, alcancando niveis diferentes daqueles definidos no curso de reanimacao neonatal em 70% das vezes. Essa situacao independeu da ventilacao do pulmao-teste analogo ao sistema respiratorio de recem-nascidos a termo ou pre-termo.

Evaluation of peak inspiratory pressure and respiratory rate during ventilation of an infant lung model with a self-inflating bag

OBJECTIVE To evaluate the peak inspiratory pressure and ventilation rate achieved by physicians when using a neonatal self-inflating bag on a lung model. METHODS Fifteen physicians ventilated full term and preterm infant lung simulators while the outcomes were captured by a ventilation monitor. RESULTS Median peak pressures in cmH(2)O for full term and preterm lungs were 23 (interquartile range: 15-47) and 26 (interquartile range: 14-51), being less than 20 in 41.2 and 35.8% of the pressure curves analyzed, more than 40 in 29.7 and 33.6%, and between 27 and 33 cmH(2)O in 8.2 and 6.5% of the curves, respectively. Median ventilation rates were 45 (interquartile range: 36-57) and 48 (interquartile range: 39-55.5) cycles per minute, being more than 30 in 9.3 and 6.7% of pressure curves and more than 60 in 12 and 13.3% of pressure curves, for the full term and preterm lungs, respectively. The differences between these medians were not statistically significant. CONCLUSIONS Ventilation rates achieved with the self-inflating bag were adequate in approximately 80% of pressure curves analyzed, but the physicians were unable to provide ventilation with minimal pressure variation, producing pressures that diverged from those defined by the neonatal resuscitation training course in 70% of the curves. This was irrespective of whether they were ventilating the lung model analogous to preterm or full term infant lungs.

Prevalência de Mycobacterium tuberculosis resistente em pacientes sob tratamento parcialmente intermitente ou sob tratamento diário

OBJECTIVE To compare the prevalence rates of drug-resistant Mycobacterium tuberculosis in patients under intermittent treatment with those observed in patients under daily treatment. METHODS We used World Health Organization data regarding 5,138 patients with active pulmonary TB in Brazil, separated into two groups: patients in the Federal District of Brasília, treated with a one-month daily regimen followed by an intermittent thrice-weekly regimen; and patients in other parts of Brazil, treated with a daily regimen only. The resistance pattern was categorized as primary or acquired, based on the history of previous treatment. Multidrug resistance was defined as resistance to at least isoniazid and rifampin, whereas monoresistance was defined as resistance to only one drug. RESULTS The prevalence of primary resistance in the Federal District of Brasília and in the other parts of Brazil, respectively, was as follows: overall, 9.2% and 9.3% (p = 0.94); monoresistance, 6.6% and 6.9% (p = 0.89); and multidrug resistance, 1.0% and 1.2% (p = 0.85). The prevalence of acquired resistance in the Federal District of Brasília and in the other parts of Brazil, respectively, was as follows: overall, 15.8% and 26.8% (p = 0.39); monoresistance, 5.3% and 13.7% (p = 0.33); and multidrug resistance, 0.0% and 10.2% (p = 0.16). CONCLUSIONS No significant differences were found between patients treated with an intermittent regimen and those treated with a daily regimen in term of resistance rates.

Factors related to falls of elderly women residents in a community

OBJECTIVE To determine the factors related to falls of a group of independent and autonomous elderly women. METHODS This was a descriptive study of 83 elderly women enrolled on the Elderly Health Promotion Project at the Universidade Católica de Brasília. They replied to questionnaires on their age, sociodemographic factors, dizziness, use of continuous medication, self-perception of health and vision and underwent the Yesavage Geriatric Depression Scale, Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. RESULTS No statistical relationship was identified between age, social demographic factors, dizziness, or negative self-perception of health and vision and fall phenomena. However there was a significant statistical relationship with the Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. CONCLUSION Elderly womens ability to balance was the major factor related to fall events. Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment were considered effective for predicting risk of falling, indicating that they could be used for assessment and identification of improved balance after trainingOBJECTIVE: Verify the factors related to falls of a group of independent and autonomous elderly women. METHODS: A descriptive study was conducted with 83 elderly women that participate in the Elderly Health Promotion Project of the Universidade Catolica de Brasilia. They replied to questions related to their age, social demographic factors, dizziness, use of continuous medication, self-perception of health and vision and were submitted to the Yesavage Geriatric Depression Scale, Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. RESULTS: No statistical relation was identified between age, social demographic factors, dizziness, and negative self-perception of health and vision with fall phenomena. Although there is a significant statistical relation to the Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. CONCLUSION: Body balance condition of the elderly women was the major factor related to fall occurrences. Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment were considered efficient to predict the risk of falling, indicating that they may be used for the assessment and identification of an improved body balance after training.

Factors related to falls among elderly women resident in a community.

OBJECTIVE To determine the factors related to falls of a group of independent and autonomous elderly women. METHODS This was a descriptive study of 83 elderly women enrolled on the Elderly Health Promotion Project at the Universidade Católica de Brasília. They replied to questionnaires on their age, sociodemographic factors, dizziness, use of continuous medication, self-perception of health and vision and underwent the Yesavage Geriatric Depression Scale, Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. RESULTS No statistical relationship was identified between age, social demographic factors, dizziness, or negative self-perception of health and vision and fall phenomena. However there was a significant statistical relationship with the Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. CONCLUSION Elderly womens ability to balance was the major factor related to fall events. Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment were considered effective for predicting risk of falling, indicating that they could be used for assessment and identification of improved balance after trainingOBJECTIVE: Verify the factors related to falls of a group of independent and autonomous elderly women. METHODS: A descriptive study was conducted with 83 elderly women that participate in the Elderly Health Promotion Project of the Universidade Catolica de Brasilia. They replied to questions related to their age, social demographic factors, dizziness, use of continuous medication, self-perception of health and vision and were submitted to the Yesavage Geriatric Depression Scale, Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. RESULTS: No statistical relation was identified between age, social demographic factors, dizziness, and negative self-perception of health and vision with fall phenomena. Although there is a significant statistical relation to the Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment. CONCLUSION: Body balance condition of the elderly women was the major factor related to fall occurrences. Functional Reach Test and Tinetti Performance-Oriented Mobility Assessment were considered efficient to predict the risk of falling, indicating that they may be used for the assessment and identification of an improved body balance after training.

Using clinical data to predict sleep hypoxemia in patients with acromegaly

Hypoxemia secondary to sleep apnea is commonly seen in patients with acromegaly, and this alteration apparently leads to considerable morbidity and mortality among such patients. With the objective of identifying hypoxemia based on clinical data, we conducted a cross-sectional study of 34 patients with acromegaly, all of whom were submitted to nocturnal oximetry and evaluation of snoring, as well as to the determination of body mass index (BMI) and neck circumference. In addition, daytime sleepiness was evaluated using the Epworth sleepiness scale (ESS). In this study, sleep hypoxemia was defined as five or more episodes of desaturation per hour. The sensitivity and specificity of the various parameters in predicting such hypoxemia were, respectively, as follows: snoring (92.9% and 35%); BMI>28.5 kg/m2 (71.4% and 60%); neck circumference>44 cm (28.6% and 95%); ESS score>10 (42.9% and 70%). For patients with a neck circumference of more than 44 cm, the probability of sleep hypoxemia was found to increase from 41% (pre-test) to 80% (post-test). For patients with a neck circumference of less than 44 cm, positivity for two or three of the other parameters (snoring, ESS score>10 and BMI>28.5 kg/m2) increased the post-test probability to 62%, whereas positivity for only one (or none) reduced post-test probability to 8%. We can conclude that the clinical parameters evaluated allowed us to predict, with considerable accuracy, whether or not sleep hypoxemia would occur in patients with acromegaly.

Craniofacial abnormalities, obesity, and hormonal alterations have similar effects in magnitude on the development of nocturnal hypoxemia in patients with acromegaly.

Backgrounds: In patients with acromegaly, sleep apnea-related hypoxemia results in considerable morbidity and mortality. Aims: To evaluate the relative weight of pathogenic factors in predicting such hypoxemia. Methods: In this cross-sectional study, 34 acromegaly patients were submitted to clinical evaluation, nocturnal oximetry, and nasolaryngeal airway tomography. GH, IGF-I, and its upper limit normal value were measured. Nocturnal hypoxemia was defined as >5 episodes of desaturation/h of sleep. Craniofacial abnormalities were expressed using a linear parameter index (LPI). Nocturnal hypoxemia was predicted using logistic regression, including the variables markers of craniofacial abnormality, hormonal alteration, and obesity. Coefficients were standardized in order to determine their effect magnitudes relative to the outcome. The best model included the variables gender, age, LPI, body mass index (BMI), and IGFI upper limit normal value. Main results: In the absence of the age and gender variables, the odds ratio for the LPI (1.60) was slightly higher than those found for BMI (1.49) and upper limit normal value (1.40). When the data were adjusted for age, the hormone upper limit normal value presented little alteration (1.49), although the decrease in the LPI was considerable (1.21), as was the increase in the BMI (2.18). The relative weight of the LPI was age-dependent. The gender variable did not alter the relevance of the others. Conclusions: The effects that craniofacial aspect, obesity, and hormonal alterations have on nocturnal hypoxemia are of similar magnitude.

Prevalence of lung structure abnormalities in patients with acromegaly and their relationship with gas exchange: cross-sectional analytical study with a control group

CONTEXT AND OBJECTIVE Different functional respiratory alterations have been described in acromegaly, but their relationship with pulmonary tissue abnormalities is unknown. The objective of this study was to observe possible changes in lung structure and explain their relationship with gas exchange abnormalities. DESIGN AND SETTING Cross-sectional analytical study with a control group, conducted at a university hospital. METHODS The study included 36 patients with acromegaly and 24 controls who were all assessed through high-resolution computed tomography of the thorax (CT). Arterial blood gas, effort oximetry and serum growth hormone (GH) and insulin-like growth factor I (IGF-1) were also assessed in the patients with acromegaly. RESULTS The abnormalities found in the CT scan were not statistically different between the acromegaly and control groups: mild cylindrical bronchiectasis (P = 0.59), linear opacity (P = 0.29), nodular opacity (P = 0.28), increased attenuation (frosted glass; P = 0.48) and decreased attenuation (emphysema; P = 0.32). Radiographic abnormalities were not associated with serum GH and IGF-1. Hypoxemia was present in seven patients; however, in six of them, the hypoxemia could be explained by underlying clinical conditions other than acromegaly: chronic obstructive pulmonary disease in two, obesity in two, bronchial infection in one and asthma in one. CONCLUSION No changes in lung structure were detected through thorax tomography in comparison with the control subjects. The functional respiratory alterations found were largely explained by alternative diagnoses or had subclinical manifestations, without any plausible relationship with lung structural factors.