PREVALENCE AND TIME OF DEVELOPMENT OF SYSTEMIC ARTERIAL HYPERTENSION IN PATIENTS AFTER LIVER TRANSPLANTATION.

BACKGROUND: The use of immunosuppressive drugs after liver transplantation (LT) is associated with the development of systemic arterial hypertension (SAH), in addition to other comorbidities of metabolic syndrome. OBJECTIVE: Therefore, the purpose of this study was to analyze the time after use immunosuppressive drugs the patient progresses to SAH, as well as to identify its prevalence and the factors that may be correlated to it. METHODS: A retrospective and longitudinal study was conducted, based on the analysis of medical records of 72 normotensive patients, attended in the transplant unit of a university hospital, between 2016 and 2019. RESULTS: It was observed, on average, 9±6.98 months after immunosuppressive use, the patients were diagnosed with hypertension, and the prevalence of transplanted patients who evolved to SAH in this study was 59.64% (41 patients). In addition, there was a correlation between serum dosage of tacrolimus and the development of SAH (P=0.0067), which shows that tacrolimus has a significant role in the development of SAH. Finally, it was noticed that the development of post-transplantation hypertension indicates a higher risk of the patient presenting the other parameters of metabolic syndrome, as well as a higher impairment in its renal function (P=0.0061). CONCLUSION: This study shows that the patients evolved to SAH in an average of 9±6.98 months after immunosuppressive drug use. We have also found high prevalence of systemic arterial hypertension (59.64%) in patients after liver transplantation, who used calcineurin inhibitors, especially when associated with the use of tacrolimus.

Prevalência e tempo de desenvolvimento da hipertensão arterial sistêmica em pacientes após transplante de fígado / Prevalence and time of development of systemic arterial hypertension in patients after liver transplantation

ABSTRACT BACKGROUND: The use of immunosuppressive drugs after liver transplantation (LT) is associated with the development of systemic arterial hypertension (SAH), in addition to other comorbidities of metabolic syndrome. OBJECTIVE: Therefore, the purpose of this study was to analyze the time after use immunosuppressive drugs the patient progresses to SAH, as well as to identify its prevalence and the factors that may be correlated to it. METHODS: A retrospective and longitudinal study was conducted, based on the analysis of medical records of 72 normotensive patients, attended in the transplant unit of a university hospital, between 2016 and 2019. RESULTS: It was observed, on average, 9±6.98 months after immunosuppressive use, the patients were diagnosed with hypertension, and the prevalence of transplanted patients who evolved to SAH in this study was 59.64% (41 patients). In addition, there was a correlation between serum dosage of tacrolimus and the development of SAH (P=0.0067), which shows that tacrolimus has a significant role in the development of SAH. Finally, it was noticed that the development of post-transplantation hypertension indicates a higher risk of the patient presenting the other parameters of metabolic syndrome, as well as a higher impairment in its renal function (P=0.0061). CONCLUSION: This study shows that the patients evolved to SAH in an average of 9±6.98 months after immunosuppressive drug use. We have also found high prevalence of systemic arterial hypertension (59.64%) in patients after liver transplantation, who used calcineurin inhibitors, especially when associated with the use of tacrolimus.

RESUMO CONTEXTO: O uso de imunossupressores pós-transplante de fígado (TF) está associado ao desenvolvimento de hipertensão arterial sistêmica (HAS), além de outras alterações da síndrome metabólica. OBJETIVO: Sendo assim, o objetivo deste estudo foi analisar a partir de quando tempo após o uso do imunossupressor o paciente evolui para HAS, assim como, identificar a sua prevalência e outros fatores que podem estar relacionados, como injuria renal. MÉTODOS: Realizou-se um estudo retrospectivo, longitudinal, baseado em análise de 72 prontuários de pacientes, atendidos na unidade de transplante de um hospital universitário, que não apresentavam hipertensão arterial prévia, entre período de 2016 a 2019. RESULTADOS: Observou-se que, em média, 9±6,98 meses após uso do imunossupressor, os pacientes foram diagnosticados com hipertensão arterial sistêmica, sendo que a prevalência de pacientes transplantados que evoluíram para HAS, neste estudo, foi de 59,64% (41 pacientes). Além disso, verificou-se uma correlação entre a dosagem sérica de tacrolimus e o desenvolvimento de HAS (P=0,0067), o que evidencia que o tacrolimus tem uma atuação significativa no desenvolvimento da hipertensão arterial sistêmica. Por fim, percebeu-se que o desenvolvimento de HAS pós-transplante indica um maior risco de paciente apresentar os outros parâmetros da síndrome metabólica, como também maior prejuízo na sua função renal (P=0,0061). CONCLUSÃO: Este estudo mostra que os pacientes evoluíram para HAS em média 9±6,98 meses após o início do uso do imunossupressor. Verificou-se também alta prevalência de hipertensão arterial sistêmica (59,64%) em pacientes pós-transplante de fígado, que usavam inibidores de calcineurina, principalmente, quando associado ao uso de tacrolimus.

The impact of chronic pain on functionality and quality of life of the elderly / O impacto da dor crônica na funcionalidade e qualidade de vida de idosos

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pain is one of the most common conditions found by health professionals in elderly and is associated with substantial impairment of reduced mobility, avoidance of activities, depression, sleep impairment and isolation. The objective of this study was to check the impact of chronic pain on the functionality and the quality of life of the elderly. METHODS: It is a descriptive, cross-sectional and exploratory study with 20 patients attending the Pain Clinic of Hospital de Base de São José do Rio Preto. Twenty patients under the age of 60 were evaluated by the same instruments for comparative data. The instruments used were a semi-structured interview containing questions about sensory aspects, emotional and functional impact, sleep, attitudes and beliefs, coping style, treatment, expectation and objectives, and resources. The World Health Organization Quality of Life Assessment for Older Adults questionnaire was used to evaluate the quality of life and, to evaluate the functional capacity of daily life, the OARS, multidimensional functional assessment questionnaire. The pain was assessed by the Brief Pain Inventory. RESULTS: A significant difference was observed between the domains of sensory abilities, autonomy and intimacy (p<0.05) in which the analyzed group presented worse values than the control, while the latter presented worse value in the domain of death and dying. In addition, there was a statistical difference between the groups in the instrumental activity of daily living and between the intensity of pain. CONCLUSION: The pain had a negative influence on the quality of life and impact on the functionality of the elderly studied in the Pain Clinic

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor crônica é uma das condições mais comuns encontradas pelos profissionais de saúde; e nos idosos está associada à substancial mobilidade reduzida, esquiva de atividades, depressão, comprometimento do sono e isolamento. O objetivo deste estudo foi verificar o impacto da dor crônica na funcionalidade e na qualidade de vida de idosos. MÉTODOS: Trata-se de um estudo descritivo, transversal, exploratório com amostra de 20 pacientes pertencentes à Clínica da Dor do Hospital de Base de São José do Rio Preto. Para os dados comparativos foram avaliados pelos mesmos instrumentos 20 pacientes com idade inferior a 60 anos. Os instrumentos utilizados foram: entrevista semiestruturada contendo questões sobre aspectos sensoriais, impacto emocional, impacto funcional, sono, atitudes e crenças, enfrentamento, tratamento, expectativa e objetivos e recursos. Para avaliar a qualidade de vida foi utilizado o questionário World Health Organization Quality of Life Assessment for Older Adults e, para avaliar a capacidade funcional da vida diária, a escala de atividades física e instrumental da vida diária "OARS". A dor, por sua vez, foi avaliada pelo Inventario Breve de Dor. RESULTADOS: Foi observada diferença significativa entre os domínios de habilidades sensoriais, autonomia e intimidade (p<0,05) em que o grupo analisado apresentou piores valores que o controle, enquanto este último grupo apresentou pior valor no domínio de morte e morrer. Além disso, houve diferença estatística entre os grupos na atividade instrumental da vida diária e entre a intensidade da dor. CONCLUSÃO: A dor acarretou influência negativa na qualidade de vida e afetou a funcionalidade dos idosos pesquisados na clínica da dor.