Impacto da realidade virtual na funcionalidade e percepção de melhora de indivíduos com hemiparesia crônica: um estudo piloto / Impact of virtual reality-based therapy on functionality and perception of improvement in individuals with chronic hemiparesis: a pilot study

Objetivo: Avaliar os efeitos da realidade virtual sobre a funcionalidade da marcha e percepção de mudança de indivíduos com hemiparesia crônica. Métodos: Estudo clínico piloto do tipo experimental, longitudinal, prospectivo e de braço único. A amostra foi composta por indivíduos hemiparéticos submetidos ao treinamento funcional em ambiente de realidade virtual (RV). Na avaliação inicial (AV1) utilizou-se o Timed Up and Go (TUG) para análise da mobilidade e após 12 sessões de RV, na avaliação final (AV2), acrescentou-se a Escala de Mudança Percebida (EMP). Para verificar a normalidade dos dados utilizou-se o teste de Shapiro-Wilk, o teste T-Student ou de Wilcoxon para comparar os dados (p ≤ 0,05) e o Effect Size (ES) pela fórmula de Cohen (d) para o tamanho do efeito. Resultados: Dez indivíduos hemiparéticos (64,6 ± 9,53 anos) realizaram o TUG (AV1) em 14,59 ± 5,03 segundos e AV2 em 13,96 ± 4,64 segundos (p = 0,18) e o EF teve efeito insignificante (d = 0,14). O jogo Free Step apresentou diferença significativa entre a primeira e última sessão (p = 0,004) e na EMP os valores obtidos foram de 2,57 ± 0,3 de três pontos. Conclusão: A RV não promoveu melhora significante na mobilidade funcional, mas os indivíduos relataram mudanças positivas em alguns componentes da EMP. (AU)

Estudo sobre a mortalidade dos tipos de câncer mais comuns na infância em Goiânia / Mortality study of the most common types of cancer in childhood in Goiânia

Objetivo ­ Estudar a mortalidade dos tipos de câncer mais comuns em crianças residentes em Goiânia, analisar a tendência temporal das taxas de mortalidade, no período de 2000 a 2015, de acordo com o gênero e faixa etária. Métodos ­ Trata-se de um estudo ecológico de série temporal (2000 a 2015), observacional do tipo série histórica, de base populacional na cidade de Goiânia. Os dados de mortalidade foram extraídos do Sistema de Informações de Mortalidade (SIM). Os casos foram estratificados por faixas etárias, em três grupos: 0 a 4 anos; 5 a 9 anos e 10 a 14 anos. Nas análises de tendência utilizou-se o modelo regressão linear de Poisson. Resultados ­ Ocorreram 187 mortes por Leucemia, linfoma e câncer do sistema nervoso central no período de 2000 a 2015. As taxas de mortalidade foram de 12,59 óbitos por 1.000.000 de crianças para ambos os sexos, por ano. Destas, 117 (15,14 por 1.000.000) eram do sexo masculino e 70 (18,80 por 1.000.000) do sexo feminino. Nos meninos, por faixa etária, a maior frequência foi observada nas crianças de 5 a 9 anos (39,31%). Nas meninas, a maior frequência também ocorreu nas crianças de 5 a 9 anos, de 36%. Conclusão ­ O câncer mais letal foi a leucemia nos meninos. Verificou-se a priori que a mortalidade nos meninos é maior do que nas meninas. Na análise de tendência por gênero foi observado que houve aumento de mortalidade, para o sexo feminino de 2,5% e para o sexo masculino estabilização de 0,4% ao ano.

Objective ­ To study the mortality of the most common cancers in children in Goiânia, analyze the temporal trend of the mortality rates for the period from 2000 to 2015, according to the gender and age group. Methods ­ The study of ecological time series (2000 to 2015), observational, historic series type of population base in the city of Goiânia. The mortality data were extracted from the Mortality information system. The cases were stratified by age, into three groups: 0 to 4 years; 5 to 9 years and 10 to 14 years. Trend analyses using Poisson regression model. Results ­ There were 187 deaths from Leukemia, lymphoma and cancer of the central nervous system in the period of 2000 to 2015. Standardized mortality rates of 12.59 1 million deaths were of children for both sexes, by year. Of these, 117 (15.14 per 1 million) were male and 70 (18.80 per 1 million). In boys, 28.20% of children from 0 to 4 years died from 2000 to 2015 of pediatric cancer, 32.47% between 10 and 14 years and the increased frequency was observed in children from 5 to 9 years (39.31%). In boys, 28.20% of children from 0 to 4 years died from 2000 to 2015 of pediatric cancer, 32.47% between 10 and 14 years and the increased frequency was observed in children from 5 to 9 years (39.31%). In girls, as often occurred in children aged 5 to 9 years, 36%. Conclusion ­ The most deadly cancer was leukemia in boys. It was verified a priori that the mortality in children is greater than in girls. On trend analysis by gender it was observed that there was an increase of mortality, females of 2.5% for males and stabilization of 0.4% per year.

Perfil clínico e laboratorial de pacientes com e sem apneia obstrutiva do sono / Clinical and laboratory profile of patients with or without obstructive sleep apnea

OBJETIVO: Descrever o perfil de pacientes com e sem apneia obstrutiva do sono. MÉTODOS: Estudo transversal, descritivo, observacional, realizado em centro terciário de cardiologia, por meio da análise de 255 prontuários de pacientes consecutivos submetidos à polissonografia em um laboratório do sono do hospital. Os pacientes foram divididos de acordo com a presença de apneia obstrutiva do sono clinicamente significativa (índice de apneia e hipopneia ≥15 eventos/hora). Dentre as informações analisadas, estavam: características clínicas; dados antropométricos; antecedentes pessoais; medicamentos em uso; doença aterosclerótica; exames laboratoriais e polissonografia. RESULTADO: A prevalência da apneia obstrutiva do sono foi de 35,6%; deste porcentual, 90,1% apresentaram hipertensão arterial sistêmica; 70,3%, dislipidemias; 36,3%, tabagismo; e 35,2%, diabetes. Não houve diferença estatística com relação à maior parte dos parâmetros analisados, mas os pacientes com apneia obstrutiva do sono eram, em sua maioria, do sexo feminino, com idade mais avançada e maior índice de massa corporal, quando comparados aos indivíduos sem apneia obstrutiva do sono. CONCLUSÃO: Foi alta a prevalência de apneia obstrutiva do sono em indivíduos portadores de diversos fatores de risco cardiovasculares. Esta condição deve sempre ser pesquisada em indivíduos de maior risco cardiovascular.(AU)

OBJECTIVE: To describe the profile of patients with and without obstructive sleep apnea. METHODS: This is a cross-sectional, descriptive and observational study that was conducted in a tertiary cardiology center through the analysis of 255 records of consecutive patients who underwent polysomnography in a sleep laboratory of the hospital. Patients were divided according to the presence of clinically significant obstructive sleep apnea (apnea-hypopnea index ≥15 events/ hour). The analyses included: clinical features, anthropometric data, personal background, ongoing medication, atherosclerotic disease, laboratory tests and polysomnography. RESULTS: The prevalence of obstructive sleep apnea was 35.6%; of these, 90.1% had hypertension, 70.3% dyslipidemias, 36.3% were smokers, and 35.2% had diabetes. There was no statistical difference in most of the parameters analyzed; however, patients with obstructive sleep apnea were mostly female, older and with higher BMI when compared to individuals without obstructive sleep apnea. CONCLUSION: The prevalence of obstructive sleep apnea was high in individuals with various cardiovascular risk factors. Therefore, it is a condition that should always be investigated in patients with higher cardiovascular risk.(AU)

Performance of NoSAS score versus Berlin questionnaire for screening obstructive sleep apnoea in patients with resistant hypertension

ABSTRACT: Obstructive sleep apnoea (OSA) is the main secondary form associated with resistant hypertension (RH), but it is largely underdiagnosed and consequently undertreated in clinical practice. The Berlin questionnaire (BQ) is a useful tool among general population, but seems to not perform well among patients with RH. Recently, NoSAS score was validated in a large population, however, has not been tested in the cardiovascular scenario. Thus, we aimed to compare BQ versus the NoSAS score as screening tools for OSA in RH. In the present study, patients with confirmed diagnosis of RH were invited to perform polysomnography. OSA was diagnosed by an apnoea-hypopnoea index (AHI) ≥15 events/h. BQ and NoSAS were applied in a blinded way. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) of the two sleep questionnaires to detect OSA in RH. The frequency of OSA was 64%. The BQ presented a better sensitivity (91 vs. 72%) and higher values of NPV (67 vs. 54%) than NoSAS score. In contrast, the NoSAS score had higher specificity for excluding OSA (58 vs. 33%) and higher PPV (75 vs. 70%). Compared to the BQ, NoSAS score had a better AUC (0.55 vs. 0.64) but these values are in the fail to poor accuracy range. In conclusion, both BQ and NoSAS score had low accuracy for detecting OSA in RH. Considering the high frequency of OSA, objective sleep study may be considered in these patients.

Performance of NoSAS score versus Berlin questionnaire for screening obstructive sleep apnoea in patients with resistant hypertension.

Obstructive sleep apnoea (OSA) is the main secondary form associated with resistant hypertension (RH), but it is largely underdiagnosed and consequently undertreated in clinical practice. The Berlin questionnaire (BQ) is a useful tool among general population, but seems to not perform well among patients with RH. Recently, NoSAS score was validated in a large population, however, has not been tested in the cardiovascular scenario. Thus, we aimed to compare BQ versus the NoSAS score as screening tools for OSA in RH. In the present study, patients with confirmed diagnosis of RH were invited to perform polysomnography. OSA was diagnosed by an apnoea-hypopnoea index (AHI) ≥15 events/h. BQ and NoSAS were applied in a blinded way. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) of the two sleep questionnaires to detect OSA in RH. The frequency of OSA was 64%. The BQ presented a better sensitivity (91 vs. 72%) and higher values of NPV (67 vs. 54%) than NoSAS score. In contrast, the NoSAS score had higher specificity for excluding OSA (58 vs. 33%) and higher PPV (75 vs. 70%). Compared to the BQ, NoSAS score had a better AUC (0.55 vs. 0.64) but these values are in the fail to poor accuracy range. In conclusion, both BQ and NoSAS score had low accuracy for detecting OSA in RH. Considering the high frequency of OSA, objective sleep study may be considered in these patients.

Adiponectin concentration data improve the estimation of atherosclerotic risk in normal and in overweight subjects.

BACKGROUND: The combinations of adipokines and body mass parameters to estimate carotid atherosclerotic disease have not been completely delineated. OBJECTIVE: To test the combinations of well-established, easily accessible body mass indices and circulating biomarkers to identify increased carotid intima-media thickness (cIMT) in a primary prevention setting. DESIGN AND PATIENTS: In a cross-sectional analysis of 339 asymptomatic individuals with no history of cardiovascular events, inflammatory and insulin sensitivity biomarkers as well as adipokine levels were measured and combined with body mass parameters to evaluate the best marker for increased cIMT. RESULTS: As isolated parameters, body mass index (BMI) and adiponectin best identified abnormal cIMT (P = .04). Adiponectin levels were also linked to the relationship between BMI and cIMT (ß = 0.0371; P = .01). Twenty-nine individuals with increased cIMT were missed by BMI alone but detected by combining BMI and adiponectin measurements. When compared with BMI alone, the combination of adiponectin plus BMI improved the c-statistic (0.549-0.567) and the integrated discrimination improvement index (0.01725; P = .021). Segregation of individuals by the combined use of BMI + adiponectin is associated with significant differences in insulin sensitivity, glomerular filtration rate, systemic inflammatory activity, dyslipidaemia and cIMT. CONCLUSIONS: Combining plasma adiponectin measurements and BMI improves estimation of cIMT as compared to anthropometric parameters.

Adiponectin concentration data improve the estimation of atherosclerotic risk in normal and in overweight subjects

BACKGROUND: The combinations of adipokines and body mass parameters to estimate carotid atherosclerotic disease have not been completely delineated. OBJECTIVE: To test the combinations of well-established, easily accessible body mass indices and circulating biomarkers to identify increased carotid intima-media thickness (cIMT) in a primary prevention setting. DESIGN AND PATIENTS: In a cross-sectional analysis of 339 asymptomatic individuals with no history of cardiovascular events, inflammatory and insulin sensitivity biomarkers as well as adipokine levels were measured and combined with body mass parameters to evaluate the best marker for increased cIMT.RESULTS: As isolated parameters, body mass index (BMI) and adiponectin best identified abnormal cIMT (P = .04). Adiponectin levels were also linked to the relationship between BMI and cIMT (β = 0.0371; P = .01). Twenty-nine individuals with increased cIMT were missed by BMI alone but detected by combining BMI and adiponectin measurements. When compared with BMI alone, the combination of adiponectin plus BMI improved the c-statistic (0.549-0.567) and the integrated discrimination improvement index (0.01725; P = .021). Segregation of individuals by the combined use of BMI + adiponectin is associated with significant differences in insulin sensitivity, glomerular filtration rate, systemic inflammatory activity, dyslipidaemia and cIMT.

OSA and Prognosis After Acute Cardiogenic Pulmonary Edema: The OSA-CARE Study.

BACKGROUND: Acute cardiogenic pulmonary edema (ACPE) is a life-threatening condition. OSA may be a modifiable risk factor for ACPE recurrence. This study was designed to evaluate the impact of OSA on the incidence of cardiovascular events following ACPE recovery. METHODS: Consecutive patients with confirmed ACPE from 3 centers underwent a sleep study following clinical stabilization. OSA was defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. The mean follow-up was 1 year, and the primary outcome was ACPE recurrence. RESULTS: A total of 104 patients were included in the final analysis; 61% of the patients had OSA. A higher rate of ACPE recurrence (25 vs 6 episodes; P = .01) and a higher incidence of myocardial infarction (15 vs 0 episodes; P = .0004) were observed in patients with OSA than in those without OSA. All 17 deaths occurred in the OSA group (P = .0001). In a Cox proportional hazards regression analysis, OSA was independently associated with ACPE recurrence (hazard ratio [HR], 3.3 [95% CI, 1.2-8.8]; P = .01), incidence of myocardial infarction (HR, 2.3 [95% CI, 1.1-9.5]; P = .02), cardiovascular death (HR, 5.4 [95% CI, 1.4-48.4]; P = .004), and total death (HR, 6.5 [95% CI, 1.2-64.0]; P = .005). When the analysis was limited only to patients with OSA, levels of AHI and hypoxemic burden and rates of sleep-onset ACPE were significantly higher in those who presented with ACPE recurrence or who died than in those who did not experience these events. CONCLUSIONS: OSA is independently associated with higher rates of ACPE recurrence and both fatal and nonfatal cardiovascular events.

OSA and prognosis after acute cardiogenic pulmonary edema: the OSA-care study

BACKGROUND: Acute cardiogenic pulmonary edema (ACPE) is a life-threatening condition. OSA may be a modifiable risk factor for ACPE recurrence. This study was designed to evaluate the impact of OSA on the incidence of cardiovascular events following ACPE recovery. METHODS: Consecutive patients with confirmed ACPE from 3 centers underwent a sleep study following clinical stabilization. OSA was defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. The mean follow-up was 1 year, and the primary outcome was ACPE recurrence. RESULTS: A total of 104 patients were included in the final analysis; 61% of the patients had OSA. A higher rate of ACPE recurrence (25 vs 6 episodes; P = .01) and a higher incidence of myocardial infarction (15 vs 0 episodes; P = .0004) were observed in patients with OSA than in those without OSA. All 17 deaths occurred in the OSA group (P = .0001). In a Cox proportional hazards regression analysis, OSA was independently associated with ACPE recurrence (hazard ratio [HR], 3.3 [95% CI, 1.2-8.8]; P = .01), incidence of myocardial infarction (HR, 2.3 [95% CI, 1.1-9.5]; P = .02), cardiovascular death (HR, 5.4 [95% CI, 1.4-48.4]; P = .004), and total death (HR, 6.5 [95% CI, 1.2-64.0]; P = .005). When the analysis was limited only to patients with OSA, levels of AHI and hypoxemic burden and rates of sleep-onset ACPE were significantly higher in those who presented with ACPE recurrence or who died than in those who did not experience these events...

Sociodemographic and clinical factors affecting body image, sexual function and sexual satisfaction in women with breast cancer.

AIMS AND OBJECTIVES: To evaluate the effect of sociodemographic and clinical factors on body image, sexual function and sexual satisfaction in women following breast cancer treatment. BACKGROUND: Women with breast cancer may experience a wide range of symptoms associated with body image and sexuality that can severely affect their quality of life. Therefore, the health care professional's ability to understand the patient's complaints and her sexual history is highly relevant in specialised multidisciplinary care. DESIGN: A cross-sectional survey. METHODS: Seventy-seven participants were included. Body image, sexual function and sexual satisfaction were evaluated using the EORTC QLQ-BR23 questionnaire. Results were shown as means, standard deviations, frequencies and percentages. Cronbach's alpha was calculated. Spearman's correlation test, the chi-square test and multivariate logistic regression were used in the statistical analysis, conducted using the spss statistical software package, version 17.0. RESULTS: Low scores were found in the desire (34·63), frequency (32·03) and sexual satisfaction (45·91) domains, while body image scores were higher (63·57). No strong correlation was found between body image and any of the other domains. Patients without a steady partner experienced more sexual desire (p < 0·04) and more frequent sexual activity (p < 0·01). Sexual activity was also more frequent (p < 0·03) in women with a higher education level and in those using aromatase inhibitors. CONCLUSIONS: Sexual function and satisfaction were affected to a greater extent than body image. No association was found between body image and sexual performance. The effect of marital status and education level on sexual function merits particular attention. RELEVANCE TO CLINICAL PRACTICE: A well-trained multidisciplinary team should be available to evaluate women's need for support and to provide information on the disease, its treatment and its impact on their lives and on their sexuality.

[Female breast cancer mortality in Brazil according to color]. / Mortalidade por câncer de mama feminino no Brasil de acordo com a cor.

PURPOSE: To describe the mortality of female breast cancer in Brazil according to color, in the years 2000 and 2010. METHODS: A descriptive study in which demographic data were obtained from the Brazilian Institute of Geography and Statistics (IBGE). The breast cancer death information in Brazil was collected from the Ministry of Health through the Mortality Information System (SIM). The crude mortality rates for female breast cancer were calculated according to color and age group, up to 49 years and ≥50 years. The results obtained were distributed into five geographical regions of the country (North, Northeast, Midwest, South and Southeast). RESULTS: In Brazil, in women aged 50 or more, the highest crude mortality rates of breast cancer in 2000 were 62.6/100,000, 46.0/100,000 and 29.7/100,000 among yellow, white and black women, respectively. In women under 50 years in 2000, the crude mortality ranged from 2.0/100,000 among indigenous women to 6.8/100,000 among white women. After ten years, in women over 50 years, the crude mortality rate among yellow, white and black women was 21.5, 53.2 and 40.4 per 100,000, respectively. In the country's regions, the highest mortality rates of breast cancer were observed in white and black women from the South and Southeast. In the Northeast, mortality rates in black and brown women doubled in 2010. CONCLUSION: Breast cancer mortality rates show ethnic and geographical variations. However, it is not possible to exclude the possibility that large variations have occurred as a result of improvement in the quality of information on mortality in the country.

Mortalidade por câncer de mama feminino no Brasil de acordo com a cor / Female breast cancer mortality in Brazil according to color

Descrever a mortalidade por câncer de mama feminino no Brasil segundo a cor, nos anos de 2000 e 2010.

To describe the mortality of female breast cancer in Brazil according to color, in the years 2000 and 2010.

Mortalidade por câncer de mama em mulheres indígenas brasileira / Breast cancer mortality among Brazilian indigenous women

Objetivo: Avaliar a mortalidade por câncer de mama em mulheres indígenas do Brasil, nos anos de 2000 e de 2010. Métodos: Trata-se de um estudo retrospectivo, realizado por meio de coleta de número de óbitos por câncer de mama em mulheres indígenas brasileiras, nos anos de 2000 e de 2010. Os dados foram obtidos por meio do Instituto Brasileiro de Geografia e Estatística e do Sistema de Informações sobre Mortalidade. Foram calculadas as taxas de mortalidade bruta e a razão de risco (RR) entre a mortalidade observada entre mulheres de cor branca e indígenas, considerando um intervalo de confiança de 95% (IC95%). Para o teste do ?2 com correção de Yates, valores de p<0,05 foram considerados significativos. Resultados: No Brasil, a taxa bruta de mortalidade para mulheres indígenas foi de 4,72/100.000 em 2000, e de 2,23/100.000 em2010. Na distribuição por macrorregiões, observou-se que de 10 óbitos registrados em 2000, oito ocorreram na região Sudeste. Já em 2010, entre os cinco óbitos registrados, três ocorreram na região Norte. As mulheres indígenas brasileiras apresentaram menor risco de mortalidade em relação às mulheres de cor branca, tanto em 2000 (RR: 0,25; IC95% 0,138?0,47; p<0,001) quanto em 2010 (RR: 0,094; IC95% 0,03?0,22; p<0,001). Conclusão: A taxa de mortalidade por câncer de mama em mulheres indígenas no Brasil foi significantemente inferior ao observado em mulheres brancas, possivelmente em decorrência de variações étnicas, geográficas esocioculturais. Esses dados podem contribuir para o desenvolvimento de estratégias direcionadas ao controle da neoplasia mamária na população indígena brasileira.

Objective: To evaluate mortality from breast cancer in Indigenous women in Brazil, in 2000 and 2010. Methods: This was a retrospective study, by means of collecting the number of breast cancer deaths among Brazilian women in the years 2000 and 2010. Data were obtained from the Brazilian Instituteof Geography and Statistics and Mortality Information System. The crude mortality rates were calculated and the risk ratio (RR) of mortality observed among white women and indigenous women were calculated. It was used a confidence interval of 95% (CI95%). For the ?2 test with Yates correction, p<0.05 were considered significant. Results: The crude mortality rate for indigenous women was 4.72/100,000 in 2000 and 2.23/100,000 in 2010. In the distribution by geographical regions, it was observed that out of 10 deaths recorded in 2000, eight occurred in the Southeast Region. In 2010, among the five reported deaths, three occurred in the North Region. Brazilian indigenous women had lower risk of breast cancer mortality compared to white women, both in 2000 (RR: 0.25; 95%CI 0.138?0.47; p<0.001) and in 2010 (RR: 0.094, 95%CI 0.03?0.22; p<0.001). Conclusion: The mortality rate from breast cancer among indigenous women in Brazil was significantly lower than in white women, possibly due to ethnic,geographic and socio-cultural variations. This data can contribute to the development of strategies aimed at controlling the breast cancer in Brazil?s indigenous population.

Temporal trends in female breast cancer mortality in Brazil and correlations with social inequalities: ecological time-series study.

BACKGROUND: Breast cancer is the most common cause of death from cancer in women in less developed regions. Therefore, the objective of this study was to provide data on the temporal trends in female breast cancer mortality between 1990 and 2011 and to evaluate its association with the social inequalities present in Brazil. METHODS: Breast cancer mortality data and estimates for the resident population were obtained from the Brazilian National Health Service database for the 1990-2011 period. Age-standardized mortality rates were calculated (20-39, 40-49, 50-69 and ≥70 years) by direct standardization using the 1960 standard world population. Trends were modeled using joinpoint regression model and linear regression. The Social Exclusion Index and the Human Development Index were used to classify the 27 Brazilian states. Pearson's correlation was used to describe the association between the Social Exclusion Index and the Human DeveIopment and the variations in mortality rates in each state. RESULTS: Age-standardized mortality rates in Brazil were found to be stable (annual percent change [APC] = 0.3; 95% CI: -0.1 - 0.7) between 1994 and 2011. Considering the Brazilian states, significant decreases in mortality rates were found in Rio Grande do Sul, Rio de Janeiro and São Paulo. Increases in mortality rates were most notable in the states of Maranhão (APC = 11.2; 95 %CI: 5.8 - 16.9), Piauí (APC = 9.8; 95% CI: 7.6 - 12.1) and Paraíba (APC = 9.3; 95% CI: 6.0 - 12.8). There was a statistically significant correlation between Social Exclusion Index and a change in female breast cancer mortality rates in the Brazilian states between 1990 and 2011 and between Human Development Index and mortality between 2001 and 2011. CONCLUSIONS: Female breast cancer mortality rates are stable in Brazil. Reductions in these rates were found in the more developed states, possibly reflecting better healthcare.

Encefalopatia hipertensiva. Fisiopatologia e abordagem terapêutica / Hypertensive encephalopathy. Pathophysiology and therapeutic approach

A encefalopatia hipertensiva inclui-se dentre as emergências hipertensivas, ou seja, situação clínica caracterizada por elevação pressórica acentuada com lesão aguda progressiva em órgão-alvo, com maior risco de óbito, exigindo imediata redução da pressão arterial com agentes aplicados por via parenteral. Na emergência hipertensiva, ocorre elevação abrupta da pressão arterial ocasionando, em território cerebral, perda da autorregulação do fluxo sanguíneo e evidências de lesão vascular, com quadro clínico de encefalopatia hipertensiva, lesões hemorrágicas dos vasos da retina e papiledema. Na presença de elevação acentuada da pressão arterial é fundamental a identificação de lesões agudas de órgãos-alvo e o diagnóstico apropriado e precoce das emergências hipertensivas. Confirmado o diagnóstico de da encefalopatia hipertensiva e avaliadas outras condições clínicas associadas, o tratamento deve ser prontamente instituído, em unidade de terapia intensiva, preferencialmente com nitroprussiato de sódio endovenoso, mas tomando-se o cuidado para diminuição gradativa da pressão, e não necessariamente a sua normalização, com o objetivo de se evitar complicações isquêmicas.

Hypertensive encephalopathy is included among the hypertensive emergencies, that is, a clinical condition characterized by severe blood pressure elevation with acute progressive damage to the target organ, with higher risk of death, requiring immediate reduction of blood pressure with agents via parenteral application. In hypertensive emergency patients, an abrupt rise in blood pressure occurs, resulting in loss of autoregulation of blood flow and evidence of vascular injury, with clinical findings of hypertensive encephalopathy, hemorrhagic lesions of retinal vessels and papilledema in the cerebral area. In the presence of a marked elevation of blood pressure, it is essential to identify acute damages to target organs,and to diagnosis hypertensive emergencies appropriately andearly. Once the hypertensive encephalopathy diagnosis is confirmed and other associated clinical conditions are assesses, treatment should be promptly instituted in the intensive care unit, preferably with sodium nitroprusside, with special attention to keeping a gradual decrease in blood pressure, and not necessarily lowering it below the normal range, in order to prevent ischemic complications.