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5.
Arq. bras. cardiol ; 113(6): 1062-1069, Dec. 2019. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1055061

RESUMO

Abstract Background: The improvement in surgical techniques has contributed to an increasing number of childbearing women with complex congenital heart disease (CCC). However, adequate counseling about pregnancy in this situation is uncertain, due to a wide variety of residual cardiac lesions. Objectives: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. Methods: During 10 years we followed 435 consecutive pregnancies in patients (pts) with congenital heart disease. Among of them, we selected 42 pregnancies in 40 (mean age of 25.5 ± 4.5 years) pts with CCC, who had been advised against pregnancy. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries, pulmonary atresia, tricuspid atresia, single ventricle, double-outlet ventricle and truncus arteriosus. The surgical procedures performed before gestation were: Fontan, Jatene, Rastelli, Senning, Mustard and other surgical techniques, including Blalock, Taussing, and Glenn. Eight (20,0%) pts did not have previous surgery. Nineteen 19 (47.5%) pts had hypoxemia. The clinical follow-up protocol included oxygen saturation recording, hemoglobin and hematocrit values; medication adjustment to pregnancy, anticoagulation use, when necessary, and hospitalization from 28 weeks, in severe cases. The statistical significance level considered was p < 0.05. Results: Only seventeen (40.5%) pregnancies had maternal and fetal uneventful courses. There were 13 (30.9%) maternal complications, two (4.7%) maternal deaths due to hemorrhage pos-partum and severe pre-eclampsia, both of them in women with hypoxemia. There were 7 (16.6%) stillbirths and 17 (40.5%) premature babies. Congenital heart disease was identified in two (4.1%) infants. Maternal and fetal complications were higher (p < 0.05) in women with hypoxemia. Conclusions: Pregnancy in women with CCC was associated to high maternal and offspring risks. Hypoxemia was a predictive variable of poor maternal and fetal outcomes. Women with CCC should be advised against pregnancy, even when treated in specialized care centers.


Resumo Fundamento: A contínua habilidade na conduta das cardiopatias congênitas complexas (CCC) tem permitido o alcance da idade fértil. Contudo, a heterogeneidade das lesões cardíacas na idade adulta limita a estimativa do prognóstico da gravidez. Objetivo: Estudar a evolução materno-fetal das gestantes portadoras de CCC e analisar as variáveis presumíveis de prognóstico. Método: No período de 10 anos, 435 gestantes portadoras de cardiopatias congênitas foram consecutivamente incluídas no Registro do Instituto do Coração (Registro-InCor). Dentre elas, foram selecionadas 42 gestações em 40 mulheres com CCC (24,5 ± 3,4 anos) que haviam sido desaconselhadas a engravidar. As cardiopatias de base distribuíram-se em: transposição das grandes artérias, atresia pulmonar, atresia tricúspide, ventrículo único, dupla via de saída de ventrículo direito, dupla via de entrada de ventrículo esquerdo e outras lesões estruturais. As cirurgias realizadas foram Rastelli, Fontan, Jatene, Senning, Mustard e outros procedimentos combinados, como tunelização, Blalock Taussing e Glenn. Oito pacientes (20%) não haviam sido operadas, e 19 (47,5%) apresentavam hipoxemia. O protocolo de atendimento incluiu: registro da saturação de oxigênio, hemoglobina sérica, hematócrito, ajuste das medicações, anticoagulação individualizada e hospitalização a partir de 28 semanas de gestação, em face da gravidade do quadro clínico e obstétrico. Na análise estatística, o nível de significância adotado foi de 0,05. Resultado: Somente 17 gestações (40,5%) não tiveram complicações maternas nem fetais. Houve 13 problemas maternos (30,9%) e 2 mortes (4,7%) causadas por hemorragia pós-parto e pré-eclâmpsia grave, ambas em pacientes que apresentavam hipoxemia. Houve 7 perdas fetais (16,6%), 17 bebês prematuros (40,5%) e 2 recém-nascidos (4,7%) com cardiopatia congênita. As complicações materno-fetais foram significativamente maiores em pacientes que apresentavam hipoxemia (p < 0,05). Conclusão: O alcance da idade reprodutiva em pacientes com CCC é crescente; contudo, a má evolução materno-fetal desaconselha a gravidez, particularmente nas pacientes que apresentam hipoxemia.

7.
Arq Bras Cardiol ; 113(6): 1062-1069, 2019 12.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31596322

RESUMO

BACKGROUND: The improvement in surgical techniques has contributed to an increasing number of childbearing women with complex congenital heart disease (CCC). However, adequate counseling about pregnancy in this situation is uncertain, due to a wide variety of residual cardiac lesions. OBJECTIVES: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. METHODS: During 10 years we followed 435 consecutive pregnancies in patients (pts) with congenital heart disease. Among of them, we selected 42 pregnancies in 40 (mean age of 25.5 ± 4.5 years) pts with CCC, who had been advised against pregnancy. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries, pulmonary atresia, tricuspid atresia, single ventricle, double-outlet ventricle and truncus arteriosus. The surgical procedures performed before gestation were: Fontan, Jatene, Rastelli, Senning, Mustard and other surgical techniques, including Blalock, Taussing, and Glenn. Eight (20,0%) pts did not have previous surgery. Nineteen 19 (47.5%) pts had hypoxemia. The clinical follow-up protocol included oxygen saturation recording, hemoglobin and hematocrit values; medication adjustment to pregnancy, anticoagulation use, when necessary, and hospitalization from 28 weeks, in severe cases. The statistical significance level considered was p < 0.05. RESULTS: Only seventeen (40.5%) pregnancies had maternal and fetal uneventful courses. There were 13 (30.9%) maternal complications, two (4.7%) maternal deaths due to hemorrhage pos-partum and severe pre-eclampsia, both of them in women with hypoxemia. There were 7 (16.6%) stillbirths and 17 (40.5%) premature babies. Congenital heart disease was identified in two (4.1%) infants. Maternal and fetal complications were higher (p < 0.05) in women with hypoxemia. CONCLUSIONS: Pregnancy in women with CCC was associated to high maternal and offspring risks. Hypoxemia was a predictive variable of poor maternal and fetal outcomes. Women with CCC should be advised against pregnancy, even when treated in specialized care centers.

11.
Rev Lat Am Enfermagem ; 27: e3138, 2019 Apr 29.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31038632

RESUMO

OBJECTIVE: to analyze the factors associated with gait speed in elderly subjects undergoing physical and mental fitness tests to obtain a driver's license. METHOD: a cross-sectional quantitative study conducted in transit agencies. The probabilistic sample included 421 elderly (≥ 60 years old). The study was developed through application of questionnaires and tests that assess the frailty phenotype. For evaluating gait speed, the time spent by each participant to walk a 4.6 meter distance at normal pace on a flat surface was timed. Data were analyzed by using multiple linear regression and the stepwise method. The R statistical program version 3.4.0 was adopted. RESULTS: there was a significant association between gait speed and paid work (<0.0000), body mass index (<0.0000), Mini-Mental State Examination (=0.0366), physical frailty (pre-frail =0.0063 and non-frail <0.0000), age (<0.0000), sex (=0.0255), and manual grip strength (<0.0000). CONCLUSION: elderly drivers who do not work, women of advanced age, high body mass index, low score in the Mini-Mental State Examination, low hand grip strength, and frail tend to decrease gait speed and should be a priority of interventions.


Assuntos
Exame para Habilitação de Motoristas , Idoso Fragilizado , Avaliação Geriátrica , Velocidade de Caminhada/fisiologia , Idoso , Idoso de 80 Anos ou mais , Exame para Habilitação de Motoristas/psicologia , Estudos Transversais , Feminino , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade
15.
REME rev. min. enferm ; 23: e-1176, jan.2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1005456

RESUMO

Objetivo: trata-se de estudo transversal cujo objetivo foi analisar a associação entre a condição de fragilidade física e as características clínicas dos idosos submetidos aos exames de aptidão física e mental para conduzir veículos automotores. Método: o estudo foi realizado em 11 clínicas de trânsito no período de agosto de 2015 a março de 2017. A amostra foi constituída por 347 idosos (≥ 60 anos). Destes, 1,5% foi considerado frágil, 46,8% pré-frágeis e 51,7% não frágeis. Quanto às características clínicas 67,4% possuem alguma doença, 66,6% utilizam medicamento(s), 4,9% usam cinco ou mais medicamentos, 21,6% ingerem bebidas alcoólicas, 9,8% fazem uso de tabaco, 9,2% sofreram queda(s) e 9,8% foram hospitalizados. Resultados: não houve associação significativa entre as características clínicas e a condição de fragilidade física dos idosos. A condição de pré-fragilidade apresentou alto percentual, o que reforça a necessidade do rastreamento da fragilidade física em idosos nas clínicas de trânsito. Conclusão: o estudo é inédito na área da Enfermagem e os resultados fornecem subsídios para outros estudos que objetivam um trânsito mais seguro.(AU)


Objective: this is a cross-sectional study whose objective was to analyze the association between the condition of physical frailty and clinical characteristics of elderly people undergoing physical and mental fitness examination for driving licensing of motor vehicles. Method: the study was carried out in 11 clinics specialized in traffic, from August 2015 to March 2017. The sample consisted of 347 elderly (≥ 60 years old). Of these, 1.5% elderly were considered frail, 46.8% pre-frail, and 51.7% non-frail. Regarding clinical characteristics, 67.4% had a disease, 66.6% used medication(s), 4.9% made use of five or more medicines, 21.6% drank alcohol, 9.8% used tobacco, 9.2% had suffered falls, and 9.8% had been hospitalized. Results: there was no significant association between the clinical characteristics and the condition of physical frailty in the elderly. Pre-frailty presented a high percentage, which reinforces the need to track physical frailty in elderly people in clinics specialized in traffic. Conclusion: the study is unprecedented in the area of Nursing and the results provide subsidies for further studies aimed at a safer traffic.(AU)


Objetivo: estudio transversal con el objetivo de analizar la asociación entre la condición de fragilidad física y las características clínicas de las personas mayores obligadas a realizar las pruebas de aptitud física y mental para conducir vehículos automotores. Método: el estudio fue realizado en 11 clínicas de tránsito entre agosto de 2015 y marzo de 2017. Resultados y discusión: la muestra estaba compuesta de 347 adultos mayores (≥ 60 anos). El 1,5% era considerado frágil, 46,8% pre-frágil y un 51,7% no frágil. Sobre...(AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Exame para Habilitação de Motoristas , Condução de Veículo , Características da População , Idoso Fragilizado , Saúde do Idoso
17.
Rev. latinoam. enferm. (Online) ; 27: e3138, 2019. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1004253

RESUMO

Objetivo analisar os fatores associados à velocidade da marcha em idosos submetidos aos exames de aptidão física e mental para habilitação veicular. Método estudo quantitativo de corte transversal realizado nas clínicas de trânsito, no qual fizeram parte da amostra do tipo probabilística 421 idosos (≥ 60 anos). O estudo foi desenvolvido mediante aplicações de questionários e testes que constituem o fenótipo da fragilidade. Para avaliar a velocidade da marcha, cronometrou-se o tempo gasto pelo participante para percorrer uma distância de 4,6 metros, de maneira habitual e em superfície plana. Os dados foram analisados utilizando a regressão linear múltipla por meio do método stepwise. Adotou-se o programa estatístico R versão 3.4.0. Resultados houve associação significativa entre velocidade da marcha e trabalho remunerado (<0,0000), índice de massa corporal (<0,0000), escore do Mini-Exame de Estado Mental (=0,0366), fragilidade física (pré-frágeis =0,0063 e não frágeis <0,0000), idade (<0,0000), sexo (=0,0255) e força de preensão manual (<0,0000). Conclusão idosos motoristas que não trabalham, mulheres, com idade avançada, elevado índice de massa corporal, baixo escore no Mini-Exame de Estado Mental, baixa força de preensão manual e frágeis possuem tendência de diminuição da velocidade da marcha e devem ser prioridade das intervenções.


Objective to analyze the factors associated with gait speed in elderly subjects undergoing physical and mental fitness tests to obtain a driver's license. Method a cross-sectional quantitative study conducted in transit agencies. The probabilistic sample included 421 elderly (≥ 60 years old). The study was developed through application of questionnaires and tests that assess the frailty phenotype. For evaluating gait speed, the time spent by each participant to walk a 4.6 meter distance at normal pace on a flat surface was timed. Data were analyzed by using multiple linear regression and the stepwise method. The R statistical program version 3.4.0 was adopted. Results there was a significant association between gait speed and paid work (<0.0000), body mass index (<0.0000), Mini-Mental State Examination (=0.0366), physical frailty (pre-frail =0.0063 and non-frail <0.0000), age (<0.0000), sex (=0.0255), and manual grip strength (<0.0000). Conclusion elderly drivers who do not work, women of advanced age, high body mass index, low score in the Mini-Mental State Examination, low hand grip strength, and frail tend to decrease gait speed and should be a priority of interventions.


Objetivo analizar los factores asociados a la velocidad de la marcha en adultos mayores sometidos a los exámenes de aptitud física y mental para habilitación vehicular. Método estudio cuantitativo de corte transversal realizado en las clínicas de tránsito, en el cual hicieron parte de la muestra del tipo probabilística 421 adultos mayores (≥ 60 años). El estudio fue desarrollado mediante aplicaciones de cuestionarios y pruebas que constituyen el fenotipo de fragilidad. Para evaluar la velocidad de la marcha fue cronometrado el tiempo gasto por el participante para andar una distancia de 4,6 metros, de manera habitual y en una superficie plana. Los datos fueron analizados utilizándose la regresión linear múltiple por medio del método stepwise. Fue adoptado el programa estadístico R versión 3.4.0. Resultados hubo una asociación significativa entre velocidad de la marcha y trabajo remunerado (<0,0000), índice de masa corporal (<0,0000), puntaje del Mini-Examen de Estado Mental (=0,0366), fragilidad física (pre-frágiles =0,0063 y no frágiles <0,0000), edad (<0,0000), sexo (=0,0255) y fuerza de prensión manual (<0,0000). Conclusión adultos mayores conductores que no trabajan, mujeres, con edad avanzada, elevado índice de masa corporal, bajo puntaje en el Mini-Examen de Estado Mental, baja fuerza de prensión manual y frágil poseen tendencia de disminución de la velocidad de la marcha y deben ser prioridad de las intervenciones.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Exame para Habilitação de Motoristas/psicologia , Força da Mão/fisiologia , Velocidade de Caminhada/fisiologia , Avaliação Geriátrica , Estudos Transversais , Idoso Fragilizado
18.
Rev Esc Enferm USP ; 52: e03392, 2018 Dec 13.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30570081

RESUMO

OBJECTIVE: To identify the outcomes of studies on gait speed and its use as a marker of physical frailty in community elderly. METHOD: Systematic review of the literature performed in the following databases: LILACS, SciELO, MEDLINE/PubMed, ScienceDirect, Scopus and ProQuest. The studies were evaluated by STROBE statement, and the PRISMA recommendations were adopted. RESULTS: There were 6,303 studies, and 49 of them met the inclusion criteria. Of the total number of studies, 91.8% described the way of measuring gait speed. Of these, 28.6% used the distance of 4.6 meters, and 34.7% adopted values below 20% as cutoff points for reduced gait speed, procedures in accordance with the frailty phenotype. Regarding the outcomes, in 30.6% of studies, there was an association between gait speed and variables of disability, frailty, sedentary lifestyle, falls, muscular weakness, diseases, body fat, cognitive impairment, mortality, stress, lower life satisfaction, lower quality of life, napping duration, and poor performance in quantitative parameters of gait in community elderly. CONCLUSION: The results reinforce the association between gait speed, physical frailty and health indicator variables in community elderly.


Assuntos
Fragilidade/diagnóstico , Marcha/fisiologia , Velocidade de Caminhada/fisiologia , Idoso , Avaliação da Deficiência , Idoso Fragilizado , Avaliação Geriátrica/métodos , Humanos , Qualidade de Vida
20.
AJR Am J Roentgenol ; 211(6): 1212-1220, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30247977

RESUMO

OBJECTIVE: Currently, there is no consensus in the literature regarding the screening of hepatic nodules in patients who have undergone the Fontan procedure. The objectives of this study are to evaluate in this population the frequency of hepatic nodules at ultrasound (US), CT, and MRI; to measure liver stiffness using acoustic radiation force impulse (ARFI) elastography; and to investigate predictive factors for hepatic nodules. SUBJECTS AND METHODS: In this cross-sectional study, 49 patients who underwent the Fontan procedure were prospectively recruited from August 2014 through June 2016. These patients underwent clinical evaluation for hepatic disorders, ARFI elastography, US, CT, and MRI. RESULTS: Most of the patients had no symptoms, and hepatic nodules were detected in three of 49 (6.1%) patients at US, 14 of 44 (31.8%) patients at CT, and 19 of 48 (39.6%) patients at MRI. Liver stiffness at ARFI elastography was significantly higher in patients with hepatic nodules than in patients without such nodules (2.64 ± 0.81 m/s vs 1.94 ± 0.49 m/s; p = 0.002) and was a significant predictor of hepatic nodule (AUC, 0.767; p = 0.002). No clinical or laboratory data had any significant correlation with the existence of hepatic nodules, including time since Fontan procedure. CONCLUSION: In our study, more than one-third of patients had hepatic nodules at CT or MRI, but US did not detect most hepatic nodules. Liver stiffness at ARFI elastography was significantly higher in patients with hepatic nodules, and it may help guiding which patient should be further imaged with CT or MRI.


Assuntos
Técnica de Fontan , Cardiopatias Congênitas/cirurgia , Hepatopatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Ultrassonografia , Adulto , Estudos Transversais , Técnicas de Imagem por Elasticidade , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Hepatopatias/complicações , Masculino , Imagem Multimodal , Valor Preditivo dos Testes , Adulto Jovem
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