RESUMO
BACKGROUND: Considering the difficulty in obtaining weight and height measurements of patients at hospital admission, the Malnutrition Universal Screening Tool (MUST) proposes the use of mid-upper arm circumference (MUAC) instead of body mass index (BMI) as an alternative for screening of malnutrition risk. The present study aimed to evaluate the performance of MUST with MUAC in place of BMI to identify nutritional risk and predict prolonged hospitalisation and mortality in hospitalised patients. METHODS: The prospective cohort study involved ambulant patients aged ≥18 years who were admitted to the emergency department of a public hospital. A questionnaire concerning clinical and socio-demographic data was applied and anthropometric measurements were performed (weight, height, BMI and MUAC). Nutritional risk screening was performed using the original MUST (BMI) and MUST-MUAC tools. The outcomes were length of hospital stay and death. RESULTS: Seven hundred and fifty-two patients were included and followed-up for 13.5 (interquartile range 3.00-19.00) days. The frequency of patients at nutritional risk was higher according to MUST-MUAC (48.9%) compared to the original MUST (37.1%). MUST-MUAC showed concurrent validity, demonstrating good agreement with the original MUST (k = 0.690), high sensitivity (95.3%) and accuracy (area under the curve = 0.868; 95% confidence interval = 0.841-0.895) with respect to identifying nutritional risk. The presence of nutritional risk detected by the MUST-MUAC increased the chance of prolonged hospital stay by 1.9 (95% CI. 1.4-2.7)-fold and mortality by 3.2 (95% CI. 1.1-9.4)-fold. CONCLUSIONS: MUST-MUAC showed satisfactory concurrent and predictive validity. Considering that MUAC measurement is easier to perform than BMI, the MUST-MUAC should be used for screening of nutritional risk in hospitalised patients.
Assuntos
Antropometria/métodos , Braço/anatomia & histologia , Índice de Massa Corporal , Programas de Rastreamento/métodos , Adulto , Idoso , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Tempo de Internação , Masculino , Desnutrição/diagnóstico , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Prospectivos , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To evaluate the agreement between two nutritional screening tools (Malnutrition Universal Screening Tool [MUST] and Nutritional Risk Screening-2002 [NRS-2002]) and Subjective Global Assessment (SGA) to identify nutritional risk in patients admitted to public emergency rooms. STUDY DESIGN: Cross-sectional study. METHODS: Patients aged ≥18 years who were admitted to an emergency room of a tertiary public hospital were evaluated. A nutritional risk assessment was performed in the first 48 h following hospital admission, through MUST, NRS-2002, and SGA. The Cohen's kappa coefficient was calculated. RESULTS: The study included 577 patients, with an average age of 53.9 ± 15.8 years; 56% of whom were women. Prevalence of nutritional risk was 35.3% and 28.5% according to MUST and NRS-2002, respectively, and malnutrition prevalence was equal to 32.9% according to SGA. The Cohen's kappa coefficient between SGA and MUST was 0.67 and between SGA and NRS-2002 was 0.62. CONCLUSION: MUST and NRS-2002 showed good agreement with SGA in identification of nutritional risk, suggesting that both tools have similar applicability for nutritional screening in adults or older patients admitted to public emergency rooms.
Assuntos
Serviço Hospitalar de Emergência , Hospitais Públicos , Desnutrição/diagnóstico , Programas de Rastreamento/instrumentação , Avaliação Nutricional , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Hospitalização , Humanos , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Centros de Atenção Terciária , Adulto JovemRESUMO
PURPOSE: To evaluate the value of recurrent anginal symptoms combined with seriation of conventional EKG in detecting coronary restenosis (renarrowing > or = 50% at the site dilated) after PTCA. Two hundred and seventy patients (204 men, mean age 53.1 +/- 9.4 years) with angina who submitted to successful PTCA of single-vessel coronary disease were followed and restudied angiographically 5.2 +/- 1.6 months after the procedure. At any moment from PTCA to follow-up: 1) typical angina pectoris was classified as either absent or present; 2) a 12-lead EKG was classified as improved, unchanged or worsened in comparison with the EKG either before or early after PTCA on the basis of ST-T alterations; 3) all patients underwent coronariography and were then classified as either having or lacking restenosis. The sensitivity and predictive positive value of recurrent angina, worsened EKG, or both, in detecting restenosis were respectively: 74.6% and 68.6%, 44.3% and 85.3%, and 55.9 and 91.7%. The specificity and predictive negative value of no recurrence of angina, improved EKG, or both, in detecting the absence of restenosis were respectively: 85.8% and 89.1%; 69.6% and 91.0%; and 75.6% and 93.9%. CONCLUSION: In single-vessel coronary disease, the detection of coronary restenosis after PTCA based on behavior of the symptoms plus rest EKG seriation shows acceptable degrees of sensitivity, specificity and mainly of predictive values when comparison with respective historical values of the ergometric test is considered.
Assuntos
Angina Pectoris/fisiopatologia , Angioplastia Coronária com Balão , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/diagnóstico , Eletrocardiografia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Descanso , Sensibilidade e EspecificidadeRESUMO
Based on a literature overview and on his personal experience with the method, the author analyzes the different phases in the evolution of coronary angioplasty, its indications and limitations in the contemporary setting, as well as the impact of new devices. He emphasizes: the value of the balloon as a basic instrument, followed by the stent; the various attitudes related to the technique; prevention and management of complications during and after the procedure; development, prediction and management of coronary restenosis.
Assuntos
Angioplastia com Balão/tendências , Angioplastia Coronária com Balão , Contraindicações , HumanosRESUMO
OBJECTIVE: To test the hypothesis that left ventricular hypertrophy (LVH) reduces the electrocardiographic and functional effects of right coronary artery occlusion. METHODS: We analysed 215 patients (166 males and 49 women, age of 58.9 +/- 10.6 years), with occlusion of the right coronary artery without other associated lesions. There was no significant difference (p > 0.05) in age and gender distribution between the 78 patients with LVH (left ventricular mass > 100 g/m2) (Group A) when compared with the 137 patients without LVH (left ventricular mass < 100 g/m2) (Group B). RESULTS: The electrocardiographic finding of transmural necrosis was more often found in group B patients than in group A patients (56.9% and 30.8%, respectively; p < 0.05). The left ventricular function parameters of group A were better than those of group B: the ratio end-diastolic pressure/systolic pressure (EDP/SP) (A: 0.108 +/- 0.036; B: 0.121 +/- 0.050; p < 0.05); the end-diastolic volume index (A: 75.9 +/- 31.3 ml/m2; B: 88.0 +/- 31.0 ml/m2; p < 0.01); the end-systolic volume index (A: 16.0 +/- 10.0 ml/m2; B: 27.0 +/- 20.0 ml/m2; p < 0.001); the ejection fraction (A 78.6 +/- 10.8%; B 67.7 +/- 17.9%; p < 0.001); the anteroinferior shortening (A: 43.9 +/- 10.3%; B: 35.1 +/- 12.8%; p < 0.001). A higher degree of coronary tortuosity was observed in group A than in group B (78.2% and 24.1%; p < 0.001) and also a more frequent absent or minimal diaphragmatic hypokinetic area (A: 80.8%; B: 54.0%; p < 0.05). CONCLUSION: LVH reduces the effects of myocardial sequela and protects LV function when right coronary occlusion develops.
Assuntos
Doença das Coronárias/fisiopatologia , Hipertrofia Ventricular Esquerda , Estudos de Coortes , Doença das Coronárias/complicações , Eletrocardiografia , Feminino , Hemodinâmica , Humanos , Hipertrofia Ventricular Esquerda/complicações , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosRESUMO
PURPOSE: Children's blood changes during angiocardiography may not be only due to the contrast media (CM). METHODS: We studied the presence and severity of changes in those parameters in 35 pediatric patients undergoing angiocardiography with ioxaglate aiming to identify independent variable responsible for those changes. Blood samples were taken at the beginning of the procedure (SI), at the end (S2) and two hours later (S3). RESULTS: Hematocrit: S1 = 47.3 +/- 6.9%; S2 = 40.7 +/- 7.4% (p < 0.001), (related to the CM volume r=0.37, (p < 0.05). Hemoglobin: S1 = 15 +/- 2.1g%; S2 = 13.2 +/- 2.4g% (p < 0.001), and S3 = 12.7 +/- 2.5g% (NS). White blood cell count: S1 = 7940 +/- 3040 leukocytes/mm3; S2 = 6950 +/- 2700/mm3 (NS); S3 = 10830 +/- 4690 leukocytes/mm3 (p < 0.001). Procedure duration (r = 0.83, p < 0.05) and 5% glucose fluid given between S2 and S3 (r = 0.49, p < 0.05) were isolated. Sodium: S1 = 134.5 +/- 0.4mEq/L, S2 = 130.7 +/- 0.4mEq/L (p < 0.001) (due to 5% glucose fluid injected, r = 0.61, p < 0.01). Potassium: S1 = 4.22 +/- 0.45mEq/L, S2 = 300.6 +/- 13.3mOsm/kg (p < 0.001). Calcium: S1 = 9.13 +/- 1.03mg%; S2 = 8.4 +/- 0.91 mg/dL. (related to the CM, r = 0.43, p < 0.01.) Osmolality: S1= 293.3 +/- 12.5mOsm/kg; S2 = 3.83 +/- 0.4mEq/L (p<0.001). Viscosity: S1 = 3.36 +/- 0.81; S2 = 3.09 +/- 0.74 (p < 0.01); S3 = 3.87 +/- 0.89, p < 0.001. There was an indirect linear regression with the CM. CONCLUSION: There were profound differences among the dependent variables observed but the ioxaglate was partially related to changes in hematocrit/hemoglobin, total calcium and viscosity. We failed to demonstrate significant regression coefficient between CM and changes in leukocytes, sodium, potassium, and osmolality.
Assuntos
Angiocardiografia , Viscosidade Sanguínea , Cálcio/sangue , Meios de Contraste/efeitos adversos , Ácido Ioxáglico/efeitos adversos , Potássio/sangue , Sódio/sangue , Contagem de Células Sanguíneas , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/sangue , Humanos , Lactente , Recém-Nascido , Masculino , Concentração Osmolar , Estudos ProspectivosRESUMO
OBJECTIVE: Evaluate early and late evolution of patients submitted to primary coronary angioplasty for acute myocardial infarction. METHODS: A prospective study of 135 patients with acute myocardial infarction submitted to primary transcutaneous coronary angioplasty (PTCA). Success was defined as TIMI 3 flow and residual lesion <50%. We performed statistical analyses by univariated, multivariated methods and survival analyze by Kaplan-Meier. RESULTS: PTCA success rate was 78% and early mortality 18,5%. Killip classes III and IV was associated to higher mortality, odds ratio 22.9 (95% CI: 5,7 to 91,8) and inversely related to age <75 years (OR = 0,93; 95% CI: 0.88 to 0.98). If we had chosen success flow as TIMI 2 and had excluded patients in Killip III/IV classes, success rate would be 86% and mortality 8%. The survival probability at the end or study, follow-up time 142 +/- 114 days, was 80% and event free survival 35%. Greater survival was associated to stenting (OR = 0.09; 0.01 to 0.75) and univessel disease (OR = 0.21; 0.07 to 0.61). CONCLUSION: The success rate was lower and mortality was higher than randomized trials, however similar to that of non randomized studies. This demonstrated the efficacy of primary PTCA in our local conditions.
Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio/terapia , Idoso , Estudos de Coortes , Intervalos de Confiança , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
Anomalous origin of the left main coronary artery from the right anterior aortic sinus is a rare condition (0.02 to 0.07%) and its clinical significance is sometimes controversial. The authors present the case of a 44-year-old female with this anomaly and septal course with clinical, electrocardiographic, scintigraphic and cineangiographic evidences of myocardial infarction without coronary lesions. Literature is reviewed regarding diagnosis, clinical significance, pathophysiology and management. It is probably the first evidence of the potential danger of this anomaly with septal course.
Assuntos
Anomalias dos Vasos Coronários/complicações , Infarto do Miocárdio/etiologia , Adulto , Anomalias dos Vasos Coronários/diagnóstico , Feminino , HumanosRESUMO
PURPOSE: To verify the minimal proximal and distal residual diameters by quantitative digital angiography and intravascular ultrasound, after the implantation of the intracoronary prosthesis. METHODS: We studied twenty patients with coronary atherosclerosis, ages ranging from 40 to 77 (56.7 +/- 10) years, 13 (65%) were male. Patients with eccentric obstructive atherosclerotic lesions of 70% or more in the proximal third of the anterior descendent, circumflex, or right coronary arteries received a stent implant as treatment for the obstruction. RESULTS: The mean proximal minimal residual diameters assessed by digital angiography were 3.32 +/- 0.33 mm and by ultrasound 3.08 +/- 0.31 mm (p < 0.05); the distal diameters by angiography were 3.33 +/- 0.37 mm and by ultrasound 3.05 +/- 0.39 mm (p < 0.05). Therefore, the measurements by ultrasound were always smaller. There is a significant linear correlation between measurements by angiography and ultrasound for both proximal (r = 0.92; p < 0.0001) and distal diameters (r = 0.91; p < 0.0001). The determination coefficient was 84% for proximal diameters and 87% for distal diameters. Therefore, the proximal diameters variate 16% and distal diameters 13% between both methods, due to the peculiarities of each method. CONCLUSION: Both methods correlate adequately, concerning to the measurements; the methods are interdependent, determining with the same accuracy intracoronary diameters in most cases studied; ultrasound is a safe and feasible technical resource for the evaluation of intravascular structures; the intravascular ultrasound system can contribute for the direct analysis inside the vascular structure, immediately after intracoronary stent implanting.
Assuntos
Doença da Artéria Coronariana/cirurgia , Stents , Adulto , Idoso , Angiografia Digital , Cateterismo Cardíaco , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , UltrassonografiaRESUMO
A 60-year-old female with unstable angina was submitted to coronary arteriography. A 90% obstruction of the left main coronary artery ostium was detected, and the patient developed ventricular fibrillation. Circulatory support was instituted with cardiopulmonary bypass. Percutaneous transluminal coronary angioplasty was then successfully carried on. Ventricular fibrillation could be controlled and the patient was submitted to coronary artery bypass graft surgery 14 days later.
Assuntos
Angioplastia com Balão/métodos , Ponte Cardiopulmonar/métodos , Doença da Artéria Coronariana/terapia , Angina Instável/diagnóstico , Angina Instável/etiologia , Angina Instável/terapia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Eletrocardiografia , Teste de Esforço , Feminino , Humanos , Hipertensão/complicações , Pessoa de Meia-Idade , Radiografia , RecidivaRESUMO
PURPOSE: To show the initial experience of Institute of Cardiology of Rio Grande do Sul in the treatment of congenital valvular aortic stenosis with percutaneous balloon aortic valvuloplasty. METHODS: Twenty four patients were submitted to the procedure, 14 males and 10 females. The mean age 7 years (4 days-17 years). Four patients were aged below 30 days and three patients had previous surgical valvuloplasty. The percutaneous balloon aortic valvuloplasty were made the retrograde approach in all patients. RESULTS: The peak systolic pressure gradient was reduced from 65.96 +/- 22.68 to 27.08 +/- 18.74 mmHg. The procedure resulted in aortic regurgitation in seven patients and worsened aortic regurgitation in two patients. One patient had cardiac arrest that was reverted by cardiopulmonary resuscitation, this patient had hospital discharge without sequel. Five patients had acute femoral artery thrombosis, and hemorrhage in the site of puncture happened in one patient. CONCLUSION: The percutaneous balloon aortic valvuloplasty results in effective reduction of the peak systolic pressure gradient, it is a save and effective therapy in patients with congenital valvular aortic stenosis. Further evaluation of the long term results are necessary for definitive conclusions.
Assuntos
Estenose da Valva Aórtica/terapia , Cateterismo , Adolescente , Estenose da Valva Aórtica/congênito , Cateterismo/efeitos adversos , Cateterismo/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
PURPOSE: To present the Cardiology Institute of Rio Grande do Sul experience with percutaneous coronary angioplasty (PTCA), after thrombolytic therapy in acute myocardial infarction (AMI). METHODS: Fifty-three patients with transmural AMI in whom early successful intravenous streptokinase recanalization was followed by PTCA. The mean age was 50 years, male patients were more frequent, the predominant area of infarct was anterior wall and more frequently the "culprit" coronary was the left anterior descendent. The main indication of PTCA was uniarterial lesion with less than 20 mm of length. RESULTS: The success comes out in 44 patients (81.5%). Ten patients (18.5%) were considered unsuccessful and were referred to emergency bypass graft surgery. The in-hospital AMI rate after PTCA was 5.5%. In the follow-up the reestenoses rate was 11% and reocclusion was 3.7%. New PTCA was necessary in 3 patients (5.5%) and in one, by-pass graft (1.8%). CONCLUSIONS: PTCA is an important and secure modality of complementary therapy after thrombolytic therapy with low morbidity and mortality.