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1.
Rev Soc Bras Med Trop ; 54: e07892020, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33533821

RESUMO

Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.


Assuntos
Insuficiência Cardíaca , Miocardite , Hospitalização , Humanos
2.
Rev Soc Bras Med Trop ; 53: e20200123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33174953

RESUMO

INTRODUCTION: Chagas cardiomyopathy (ChC) is highly stigmatized, and the presence of depressive symptoms may be a common feature. However, its determinants remain unclear. Therefore, the present study aimed to verify the prevalence of depression and the clinical, echocardiographic, functional, and quality of life factors associated with depressive symptoms in patients with ChC and predominantly preserved cardiac function. METHODS: Thirty-five patients with ChC (aged 40 to 60 years, 66% men, NYHA I-III) were evaluated by echocardiography, cardiopulmonary exercise testing, 6-minute walk test (6MWT), and Mini-Mental State Examination. Physical activity level was assessed using the Human Activity Profile (HAP) and health-related quality of life was assessed using the Short-Form Health Survey (SF-36). Depressive symptoms were evaluated using the Beck Depression Inventory. A cutoff point greater than 9 was indicative of depression. RESULTS: Depression was detected in 13 patients (37%). In the univariate analysis, female sex, NYHA functional class, body mass index, HAP score, mental summary of SF-36, peak oxygen uptake, and 6MWT distance were associated with depressive symptoms. The final model showed that only the HAP score (B = -0.533; 95% confidence interval [CI]: -0.804 to -0.262) and SF-36 mental summary (B = -0.269; 95% CI: -0.386 to -0.153) remained as independent predictors of depressive symptoms in patients with ChC. CONCLUSIONS: Depression was prevalent in patients with ChC and predominantly preserved cardiac function. Physical activity and mental health were independent risk factors for depressive symptoms.

3.
Disabil Rehabil ; : 1-8, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32870711

RESUMO

PURPOSE: To investigate the validity and within-day reliability of the Glittre activities of daily living test (Glittre ADL-test) in patients on hemodialysis. METHODS: Ninety-one patients on hemodialysis were evaluated using Glittre ADL-test, functional tests, health-related quality of life, human activity profile, and social participation. Convergent validity was analyzed by the correlation analysis. The Glittre ADL-test results were compared among different levels of the functional tests, human activity profile, and participation (known-groups validity). Within-day reliability was examined by Intra-class Correlation Coefficient (ICC). RESULTS: There was a significant moderate to strong correlation between Glittre ADL-test and functional tests (r = 0.62 to 0.66 and -0.70 to -0.44). A significant weak correlation was found between Glittre ADL-test, health-related quality of life (r = 0.28 to 0.32), and human activity profile (r=-0.33). There was no significant correlation with participation. Except for participation level, the Glittre ADL-test results were able to identify individuals with low performance in all evaluated tests and were able to differentiate among inactive and active individuals by human activity profile (p < 0.05). Within-day reliability was evaluated in 42 patients. The ICC was 0.97. CONCLUSION: The Glittre ADL-test is a reliable test associated with functional parameters and physical aspects related to health-related quality of life, with potential value in the functional evaluation of patients on hemodialysis. Implications for rehabilitation Functional impairment is a common clinical finding and is an important predictor of poor prognosis in patients on hemodialysis. The Glittre ADL-test has excellent within-day reliability and is a valid instrument for functional assessment in patients on hemodialysis. Activity limitations of patients on hemodialysis can be assessed by Glittre ADL-test.

4.
Disabil Rehabil ; : 1-8, 2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32779544

RESUMO

PURPOSE: This study aimed to evaluate acute and subacute hemodynamic responses and perception of effort in individuals with CCC submitted to different IMT protocols. MATERIALS AND METHODS: This was a randomized cross-over trial conducted on CCC subjects with systolic left ventricular dysfunction (<45% left ventricular ejection fraction) without or with heart failure (stages B2 and C, respectively). Twenty-one participants performed two IMT protocols, one targeting 60% maximal inspiratory pressure with 3 × 10 repetitions (MIP60) and the other targeting 30% maximal inspiratory pressure (MIP30) with 3 × 20 repetitions with a 2 min recovery between sets for both. MIP60 and MIP30 were performed on the same day with a 2 h washout period. Measurements were taken at baseline, during and 60 min after IMT. RESULTS: No differences in hemodynamic variables were observed across protocols. The perception of effort increased in both protocols, with higher scores for the MIP30 protocol (ß = +1.6, p = 0.01; ß = +1.1, p = 0.02; ß = +0.9, p = 0.08 for the 1st, 2nd and 3rd sets, respectively). CONCLUSIONS: There were no differences in hemodynamic responses comparing MIP60 and MIP30 protocols in subjects with CCC. Despite the higher perception of effort during endurance protocol, both protocols can be considered a safe therapeutic strategy. IMPLICATIONS FOR REHABILITATION Despite inspiratory muscle training may result in functional capacity improvements, no previous study evaluated the hemodynamic acute and subacute responses to inspiratory muscle training in chronic Chagas cardiomyopathy. The two inspiratory muscle training protocols (30% and 60% of maximal inspiratory pressure) did not cause significant hemodynamic repercussions in subjects with chronic Chagas cardiomyopathy. Inspiratory muscle training seems to be an effective strategy to improve functional capacity and can be implemented in the rehabilitation programs for patients with Chagas cardiomyopathy. Since no significant adverse responses were observed in any of the hemodynamic parameters during the inspiratory muscle training sessions, these two protocols of inspiratory muscle training (30% and 60% of maximal inspiratory pressure) seems to be safe in subjects with Chagas cardiomyopathy.

5.
Rev Soc Bras Med Trop ; 53: e20200100, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32638887

RESUMO

Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.


Assuntos
Cardiomiopatia Chagásica/fisiopatologia , Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Insuficiência Cardíaca/fisiopatologia , Função Ventricular Esquerda/fisiologia , Função Ventricular Direita/fisiologia , Ecocardiografia , Humanos , Prognóstico
6.
Int J Cardiol ; 316: 101-103, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32320786

RESUMO

BACKGROUND: The soluble receptors tumor necrosis factor-alpha (sTNFRs) can lead to an increase in the expression of tumor necrosis factor, increasing its detrimental to systemic inflammatory activation in Chagas cardiomyopathy (ChC). However, the correlation between sTNFRs levels, echocardiographic, and functional levels in patients with ChC remains unknown. This study aimed to verify the correlation between the plasma sTNFRs levels, echocardiographic, and NYHA functional levels in patients with ChC. METHODS: Sixty-four patients with ChD (54 ± 2 years, 44% males, NYHA I-II) were evaluated by anamnesis protocol, echocardiography, and plasma sTNFR1 and sTNFR2 measurement. Linear regression analysis and Student's t-test were used as appropriate. RESULTS: Higher plasma sTNFR1 and sTNFR2 levels were associate with worse systolic function (R2 = 0.10; p = 0.008 and R2 = 0.44; p < 0.001) and cardiac dilation (R2 = 0.13; p = 0.002 and R2 = 0.43; p < 0.001). Patients with systolic dysfunction and cardiac dilatation had higher sTNFRs levels (p < 0.001). There were no significant differences among NYHA functional classes for both sTNFRs. CONCLUSION: Plasma sTNFR1 and sTNFR2 levels are associated with greater cardiac dilation and poor systolic function in ChC patients.

7.
Nucl Med Commun ; 41(6): 510-516, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32282632

RESUMO

OBJECTIVES: This study was designed to investigate digestive and heart associations, using esophageal transit scintigraphy in three different groups: patients exclusively with the dilated cardiac form of Chagas disease (DCCh), an indeterminate form of Chagas disease, and healthy controls. As a hypothesis, we assumed that autonomic chagasic denervation is a global process. MATERIALS AND METHODS: Twenty healthy controls and 75 outpatients with Chagas disease, divided into indeterminate form (n = 33) and (DCCh, n = 42), underwent esophageal scitigraphy. The esophageal transit time (ETT) and percentage of esophageal emptying (%EE) were analyzed by group and correlated with left ventricular ejection fraction (LVEF). RESULTS: ETT alterations were found in 57% of indeterminate form and 80% of DCCh. The observed values of ETT and %EE in Chagas disease groups were significantly different from the controls (P-value <0.001). The lowest median ETT was observed for the controls (median = 8.0), followed by indeterminate form (median = 16.5) and DCCh (median = 60.0). Regarding %EE, a higher median value was observed for the controls (median = 92.3), followed by indeterminate form (median = 86.7) and DCCh (median = 56.9). In the DCCh group, ETT and %EE were significantly correlated with LVEF values (r = 0.398; P = 0.015) and (r = 0.475; P = 0.003), respectively. CONCLUSION: An association between left ventricular systolic dysfunction and functional esophageal alterations was observed which was interpreted as indirect evidence of concomitance of gastrointestinal and cardiac disorders. We also found that the greater the impairment of the esophagus's autonomic function, the worse the cardiac dysfunction.

8.
J Am Soc Echocardiogr ; 33(5): 550-558, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32127221

RESUMO

BACKGROUND: Pulmonary hypertension in response to exercise is a marker of the hemodynamic severity of mitral stenosis (MS). However, the factors related to elevated pulmonary pressure with exercise are not well defined. The aim of this study was to assess the parameters associated with the pulmonary pressure response to exercise in patients with pure rheumatic MS. An additional aim was to determine the impact of exercise-induced pulmonary hypertension on clinical outcome. METHODS: One hundred thirty patients with MS (94% women; mean age, 45 ± 11 years) underwent exercise echocardiography. A range of echocardiographic parameters were obtained at rest and at peak exercise. Symptom-limited graded ramp bicycle exercise was performed in the supine position. The primary end point was mitral valve intervention, either percutaneous or surgical. RESULTS: In the overall population, systolic pulmonary artery pressure (SPAP) increased from 38.3 ± 13.4 mm Hg at rest to 65.8 ± 20.7 mm Hg during exercise. Increases in mean mitral gradient, right ventricular function, left atrial volume, and net atrioventricular compliance were independently associated with SPAP at peak exercise, after adjusting for changes in heart rate. During the follow-up period (median, 17 months; range, 1-45 months), 46 adverse clinical events were observed. By multivariate Cox proportional-hazards analysis adjusted for age and sex, SPAP achieved at peak exercise was an important predictor of adverse outcome (adjusted hazard ratio, 1.025; 95% CI, 1.010-1.040; P = .001). New York Heart Association functional class (adjusted hazard ratio, 2.459; 95% CI, 1.509-4.006; P < .001) and the interaction between valve area and net atrioventricular compliance (P = .001) were also significant predictors of adverse events. Time-dependent areas under the receiver operating characteristic curve for the model with SPAP during exercise were better than for the model with SPAP at rest, with a significant improvement from 3 years onward. CONCLUSIONS: In patients with MS, the pulmonary artery pressure response to exercise is determined by a combination of factors, including transmitral mean gradient at exercise, net atrioventricular compliance, left atrial volume, and right ventricular function. Pulmonary artery pressure at peak exercise is a predictor of clinical outcomes and adds incremental prognostic value beyond that provided by standard resting measurements, including valve area.

9.
Fisioter. Pesqui. (Online) ; 27(1): 78-84, jan.-mar. 2020. tab
Artigo em Português | LILACS | ID: biblio-1090417

RESUMO

RESUMO O objetivo deste estudo foi traduzir e adaptar a escala de utilidade clínica de Tyson e Connell para o português brasileiro, além de avaliar sua confiabilidade interexaminador e intraexaminador. O processo de tradução e adaptação transcultural foi desenvolvido em cinco estágios: tradução; síntese das traduções; retrotradução; avaliação pelo comitê de especialistas; e teste da versão pré-final. Para avaliação da confiabilidade intra e interexaminador da escala, 20 instrumentos de avaliação foram analisados de forma independente por dois examinadores (confiabilidade interexaminador). Além disso, um dos examinadores fez todas as avaliações, em dois momentos distintos, com um intervalo de 30 dias entre uma e outra (confiabilidade intraexaminador). A tradução e a adaptação transcultural foram realizadas de forma sistemática, seguindo os critérios propostos, de modo que houve apenas pequenas alterações em dois itens para tornar a escala mais útil a todos os instrumentos disponíveis na literatura. Em relação à confiabilidade interexaminador da escala de utilidade clínica de Tyson e Connell-Brasil, o valor encontrado foi CCI=0,85 (IC 95%, 0,79-0,87), enquanto para a confiabilidade intraexaminador o resultado foi CCI=0,89 (IC 95%, 0,85-0,93). Os resultados deste processo indicaram adequado grau de equivalência semântica, conceitual e cultural. Além disso, as medidas de confiabilidade intra e interexaminadores foram consideradas adequadas. Esses achados demonstraram que a escala é adequada para avaliar a utilidade clínica de instrumentos de avaliação comumente utilizados em pacientes. Dessa forma, deve ser incorporada na prática clínica e em pesquisas para a escolha do melhor instrumento.


RESUMEN O objetivo deste estudo foi traduzir e adaptar a escala de utilidade clínica de Tyson e Connell para o português brasileiro, além de avaliar sua confiabilidade interexaminador e intraexaminador. O processo de tradução e adaptação transcultural foi desenvolvido em cinco estágios: tradução; síntese das traduções; retrotradução; avaliação pelo comitê de especialistas; e teste da versão pré-final. Para avaliação da confiabilidade intra e interexaminador da escala, 20 instrumentos de avaliação foram analisados de forma independente por dois examinadores (confiabilidade interexaminador). Além disso, um dos examinadores fez todas as avaliações, em dois momentos distintos, com um intervalo de 30 dias entre uma e outra (confiabilidade intraexaminador). A tradução e a adaptação transcultural foram realizadas de forma sistemática, seguindo os critérios propostos, de modo que houve apenas pequenas alterações em dois itens para tornar a escala mais útil a todos os instrumentos disponíveis na literatura. Em relação à confiabilidade interexaminador da escala de utilidade clínica de Tyson e Connell-Brasil, o valor encontrado foi CCI=0,85 (IC 95%, 0,79-0,87), enquanto para a confiabilidade intraexaminador o resultado foi CCI=0,89 (IC 95%, 0,85-0,93). Os resultados deste processo indicaram adequado grau de equivalência semântica, conceitual e cultural. Além disso, as medidas de confiabilidade intra e interexaminadores foram consideradas adequadas. Esses achados demonstraram que a escala é adequada para avaliar a utilidade clínica de instrumentos de avaliação comumente utilizados em pacientes. Dessa forma, deve ser incorporada na prática clínica e em pesquisas para a escolha do melhor instrumento.


ABSTRACT This study aimed to translate and adapt the Clinical Utility Scale of Tyson and Connell into Brazilian Portuguese, in addition to evaluating intra- and inter-rater reliability. The process of cross-cultural translation and adaptation was developed in five stages: translation, synthesis of translations, retro translation, evaluation by the committee of experts and testing of the pre-final version. To evaluate the intra- and inter-rater reliability of the Clinical Utility Scale of Tyson and Connell, 20 assessment instruments were independently assessed by two examiners (inter-rater reliability). In addition, one of the examiners performed all assessments at two different times with a 30-day interval (intra-rater reliability). The translation and cross-cultural adaptation were performed in a systematic way, following the proposed criteria, and only minor changes in two items were necessary to make the scale more useful to all instruments currently available in the literature. Regarding the inter-rater reliability of the Clinical Utility Scale of Tyson and Connell, the value found was ICC=0.85 (IC 95%, 0,79-0,87), while for intra-rater reliability the result was ICC=0,89 (IC 95%, 0,85-0,93). The results of this process indicated an adequate degree of semantic, conceptual and cultural equivalence. In addition, intra- and inter-rater reliability measures were considered adequate. These findings have shown the scale is adequate to assess the clinical utility of evaluation instruments usually applied to patients. Therefore, it must be incorporated into clinical practice and research when choosing the best evaluation instrument to be used.


Assuntos
Tradução , Pesos e Medidas/instrumentação , Análise Custo-Benefício/métodos , Avaliação da Deficiência , Exame Físico/instrumentação , Reprodutibilidade dos Testes , Gerenciamento Clínico , Transtornos das Habilidades Motoras/diagnóstico , Limitação da Mobilidade
10.
Rev. Soc. Bras. Med. Trop ; 53: e20200100, 2020. tab, graf
Artigo em Inglês | LILACS-Express | LILACS, Coleciona SUS, Sec. Est. Saúde SP | ID: biblio-1136806

RESUMO

Abstract Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.

11.
Rev. Soc. Bras. Med. Trop ; 53: e20200123, 2020. tab
Artigo em Inglês | LILACS-Express | LILACS, Coleciona SUS, Sec. Est. Saúde SP | ID: biblio-1136824

RESUMO

Abstract INTRODUCTION: Chagas cardiomyopathy (ChC) is highly stigmatized, and the presence of depressive symptoms may be a common feature. However, its determinants remain unclear. Therefore, the present study aimed to verify the prevalence of depression and the clinical, echocardiographic, functional, and quality of life factors associated with depressive symptoms in patients with ChC and predominantly preserved cardiac function. METHODS: Thirty-five patients with ChC (aged 40 to 60 years, 66% men, NYHA I-III) were evaluated by echocardiography, cardiopulmonary exercise testing, 6-minute walk test (6MWT), and Mini-Mental State Examination. Physical activity level was assessed using the Human Activity Profile (HAP) and health-related quality of life was assessed using the Short-Form Health Survey (SF-36). Depressive symptoms were evaluated using the Beck Depression Inventory. A cutoff point greater than 9 was indicative of depression. RESULTS: Depression was detected in 13 patients (37%). In the univariate analysis, female sex, NYHA functional class, body mass index, HAP score, mental summary of SF-36, peak oxygen uptake, and 6MWT distance were associated with depressive symptoms. The final model showed that only the HAP score (B = -0.533; 95% confidence interval [CI]: -0.804 to -0.262) and SF-36 mental summary (B = -0.269; 95% CI: -0.386 to -0.153) remained as independent predictors of depressive symptoms in patients with ChC. CONCLUSIONS: Depression was prevalent in patients with ChC and predominantly preserved cardiac function. Physical activity and mental health were independent risk factors for depressive symptoms.

12.
Qual Life Res ; 28(1): 67-72, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30167935

RESUMO

PURPOSE: To verify the prognostic value of health-related quality of life (HRQoL) and the differences in HRQoL and clinical variables between groups of Chagas heart disease (CHD) patients with and without cardiovascular adverse events. METHODS: Seventy-five CHD patients were evaluated by echocardiography, maximal exercise testing, and Short-form of Health Survey (SF-36) Questionnaire. Patients were followed during 6 years. In the statistical analysis, uni- and multivariate Cox regression were performed to verify the accuracy of the HRQoL in predicting cardiovascular events. RESULTS: After the follow-up period (41 ± 12 months), 20 patients (27%) had adverse events. Those with poor outcome had lower left ventricular ejection fraction (LVEF) (p = 0.002), higher left ventricular end-diastolic diameter (LVDd) (p = 0.019), and worse scores in general health perceptions (p = 0.047), social role functioning (p = 0.026), and mental component summary (p = 0.043) of SF-36. Patients with lower LVEF (p = 0.003), higher LVDd (p = 0.022), worse HRQoL in the general heath perceptions domain (p = 0.022), and mental component summary (p = 0.031) were associated with worse prognosis. In the multivariate Cox regression, LVEF (HR 0.94, 95% CI from 0.90 to 0.98, p = 0.007) and mental component summary (HR 0.98, 95% CI from 0.94 to 1.00, p = 0.047) remained as independent predictors of adverse events in CHD patients. CONCLUSION: The assessment of HRQoL, especially the mental component, should be taken into account to provide an accurate prognosis in addition to other well-established predictors of poor outcomes in CHD patients.


Assuntos
Cardiomiopatia Chagásica/psicologia , Cardiopatias/psicologia , Qualidade de Vida/psicologia , Cardiomiopatia Chagásica/patologia , Feminino , Inquéritos Epidemiológicos , Cardiopatias/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
13.
J Exerc Rehabil ; 14(5): 844-850, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30443532

RESUMO

Chagas heart disease (CHD) leads to a progressive functional impairment. Field tests, as the 6-min walk test (6MWT) and the incremental shuttle walk test (ISWT), may be inexpensive approaches in the evaluation of functional capacity of these patients. The present study was addressed to compare the 6MWT and the ISWT measures, and to determine the accuracy of these tests in the identification of functional impairment in patients with CHD. Thirty-five patients with CHD (47.1±8.2 years, NYHA I-III) were evaluated by echocardiography, cardiopulmonary exercise test (CPET), 6MWT, and ISWT. Correlations between the CPET (peak oxygen uptake [peak VO2] and the ratio between ventilation and the carbon dioxide production [VE/VCO2 slope]) and the field tests (walking distances) were also performed. The receiver operating characteristic (ROC) curve was selected to identify the best distances related to identify those patients with functional impairment. There was no difference between distances walked during the 6MWT and ISWT (P=0.694). The Bland-Altman analysis showed good agreement between the field tests. Both 6MWT and ISWT correlated with peak VO2 (r=0.577, P<0.001 and r=0.587, P<0.001, respectively) and ISWT correlated with VE/VCO2 slope (r=-0.339, P=0.003). The cutoff distances of 6MWT and ISWT to identify patients with peak VO2 less than 20 mL/kg/min were 520 m and 400 m, respectively, with no difference between the areas under ROC curves (P=0.276). Both the 6MWT and the ISWT demonstrated accuracy in identify functional impairment in patients with CHD, being useful tools for the risk stratification of these patients.

14.
Rev Soc Bras Med Trop ; 51(4): 421-426, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30133623

RESUMO

Reduced peak oxygen uptake (VO2peak) is a common clinical finding in progressive Chagas disease. However, the disease stage in which functional impairment is detectable remains uncertain. The present study compared functional capacity between healthy controls and patients with different clinical forms of Chagas disease. A systematic review and meta-analysis (PROSPERO database CRD42017058353) was conducted following a search of the MEDLINE, Web of Science, CINAHL, and LILACS databases from September to December 2017 for articles published in English, Spanish, or Portuguese, with no date restrictions. We included studies that compared the VO2peak between healthy and Chagas disease patients, stratified according to 3 clinical forms [no apparent cardiac disease, non-dilated Chagas heart disease (CHD), and dilated CHD]. Seven cross-sectional studies were included. Chagas disease patients without apparent cardiac disease (n=208) had VO2peak values [mean difference, -1.55ml/kg/min; 95% confidence interval (CI), -4.98ml/kg/min to 1.88ml/kg/min] similar to those of healthy controls (n=105; p=0.38, I2=52%). In non-dilated CHD (n=159), VO2peak was 8.71ml/kg/min lower (95% CI, -13.99 to -3.42ml/kg/min) than in healthy controls (n=59; p=0.001, I2=75%). VO2peak was also significantly lower (mean difference, -9.30ml/kg/min; 95% CI, -11.34 to -7.25ml/kg/min) in dilated CHD patients (n=131) than in healthy controls (n=53; p<0.001, I2=0%). Exercise capacity in Chagas disease patients without apparent cardiac disease is similar to that in healthy controls. Functional impairment in Chagas disease is detectable in the early stages of cardiac involvement, even in the absence of systolic dysfunction and signs of heart failure.


Assuntos
Doença de Chagas/fisiopatologia , Volume Expiratório Forçado/fisiologia , Ventilação Voluntária Máxima/fisiologia , Consumo de Oxigênio/fisiologia , Estudos de Casos e Controles , Humanos
15.
Rev. Soc. Bras. Med. Trop ; 51(4): 421-426, July-Aug. 2018. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-957435

RESUMO

Abstract Reduced peak oxygen uptake (VO2peak) is a common clinical finding in progressive Chagas disease. However, the disease stage in which functional impairment is detectable remains uncertain. The present study compared functional capacity between healthy controls and patients with different clinical forms of Chagas disease. A systematic review and meta-analysis (PROSPERO database CRD42017058353) was conducted following a search of the MEDLINE, Web of Science, CINAHL, and LILACS databases from September to December 2017 for articles published in English, Spanish, or Portuguese, with no date restrictions. We included studies that compared the VO2peak between healthy and Chagas disease patients, stratified according to 3 clinical forms [no apparent cardiac disease, non-dilated Chagas heart disease (CHD), and dilated CHD]. Seven cross-sectional studies were included. Chagas disease patients without apparent cardiac disease (n=208) had VO2peak values [mean difference, -1.55ml/kg/min; 95% confidence interval (CI), -4.98ml/kg/min to 1.88ml/kg/min] similar to those of healthy controls (n=105; p=0.38, I2=52%). In non-dilated CHD (n=159), VO2peak was 8.71ml/kg/min lower (95% CI, -13.99 to -3.42ml/kg/min) than in healthy controls (n=59; p=0.001, I2=75%). VO2peak was also significantly lower (mean difference, -9.30ml/kg/min; 95% CI, -11.34 to -7.25ml/kg/min) in dilated CHD patients (n=131) than in healthy controls (n=53; p<0.001, I2=0%). Exercise capacity in Chagas disease patients without apparent cardiac disease is similar to that in healthy controls. Functional impairment in Chagas disease is detectable in the early stages of cardiac involvement, even in the absence of systolic dysfunction and signs of heart failure.

16.
PLoS One ; 13(7): e0200727, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30048473

RESUMO

OBJECTIVE: Evaluate and compare the isolated and combined effects of Inspiratory Muscle Training (IMT) and Aerobic Training (AT) on respiratory and functional parameters, inflamatory biomarkers, redox status and health-related quality of life (HRQoL) in hemodialysis patients. METHODS: A randomised controlled trial with factorial allocation and intention-to-treat analysis was performed in hemodialysis patients. Volunteers were randomly assigned to performe 8-weeks of IMT at 50% of maximal inspiratory pressure (MIP), low intensity AT or combined training (CT). Before the interventions, all the volunteers went 8-weeks through a control period (without training). Measures are taken at baseline, 8-week (after control period) and 16-week (after the interventions). Primary outcomes were functional capacity (incremental shuttle walk test), MIP and lower limbs strength (Sit-to-Stand test of 30 seconds). Plasma levels of interleukin-6 (IL-6), soluble tumor necrosis factor receptor 1 (sTNFR1) and 2 (sTNFR2), adiponectin, resistin and leptin, redox status parameters and HRQoL (KDQOL-SF questionnaire) were the scondary outcomes. Data analyses were performed by two-way repeated measurements ANOVA. RESULTS: 37 hemodialysis patients aged 48.2 years old (IC95% 43.2-54.7) were randomized. Increase of MIP, functional capacity, lower limbs strength and resistin levels, and reduction of sTNFR2 levels in 16-week, compared to baseline and 8-week, were observed in all the groups (p<0.001). IMT improved functional capacity, MIP and lower limbs strength in 96.7m (IC95% 5.6-189.9), 34.5cmH2O (IC95% 22.4-46.7) and 2.2repetitions (IC95% 1.1-3.2) respectively. Increase in resistin leves and reduction in sTNFR2 leves after IMT was 0.8ng/dL (IC95% 0.5-1.1) and 0.8ng/dL (IC95% 0.3-1.3), respectively, without between-group differences. Compared to baseline and 8-week, adiponectin levels (p<0.001) and fatigue domain of the HRQoL (p<0.05) increased in 16-week only in CT. CONCLUSION: IMT, AT and CT improved functional parameters and modulated inflammatory biomarkers, in addition, IMT provoked a similar response to low intensity AT in hemodialysis patients. TRIAL REGISTRATION: Registro Brasileiro de Ensaios clínicos RBR-4hv9rs.


Assuntos
Exercícios Respiratórios/métodos , Fadiga/reabilitação , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Músculos Respiratórios/fisiopatologia , Adulto , Biomarcadores/análise , Fadiga/sangue , Fadiga/etiologia , Fadiga/fisiopatologia , Feminino , Humanos , Inflamação/sangue , Inflamação/etiologia , Falência Renal Crônica/complicações , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Força Muscular , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
17.
Cad. saúde colet., (Rio J.) ; 26(2): 222-232, abr.-jun. 2018. tab, graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-952511

RESUMO

Resumo Introdução A Doença de Alzheimer (DA) é caracterizada por perda das funções cognitivas de forma progressiva, como falhas na memória, aprendizagem e linguagem, que tendem a se agravar com o avanço da doença. As ações multidisciplinares no paciente com DA têm como objetivo interferir positivamente no processo saúde-doença, por meio de uma abordagem integral aos indivíduos e familiares, intervindo com ações voltadas à realidade na qual estão inseridos. Objetivo Realizar uma revisão sistemática sobre os efeitos da reabilitação multidisciplinar em pacientes com Doença de Alzheimer (DA). Método Foram realizadas buscas nas bases MEDLINE, LILACS, PEDro, CINAHL e Web of Science , sem restrição de data ou de idioma de publicação. Os artigos foram avaliados pelo título, pelo resumo e, posteriormente, pelo texto completo, por dois autores independentes. A qualidade metodológica dos estudos experimentais selecionados foi avaliada de acordo com a escala PEDro. Resultados Foram incluídos cinco estudos, de qualidade metodológica moderada (5,4 na escala PEDro), que evidenciaram que um programa multidisciplinar pode ser eficaz no tratamento de pacientes com DA, com melhoras significativas, principalmente, em sintomas neuropsiquiátricos, depressão e qualidade de vida. Para as demais medidas de desfecho investigadas, devido à presença de poucos estudos que encontraram efeitos positivos (nível de estresse, ansiedade, independência, atividades) ou de resultados conflitantes (cognição), não é possível determinar a eficácia dessa intervenção. Conclusão Esta revisão sistemática evidenciou que um programa multidisciplinar pode ser eficaz no tratamento de pacientes com DA, com melhoras significativas, principalmente, em sintomas neuropsiquiátricos, depressão e qualidade de vida. No entanto, os resultados para cognição, nível de ansiedade, estresse, independência e realização de atividades não foram significativos ou foram conflitantes.


Abstract Background Alzheimer's Disease (AD) is characterized by a progressive loss of cognitive functions, such as memory, learning and language deficits, which tend to be aggravated by the progression of the disease. Multidisciplinary actions in the patient with AD aim to positively interfere in the health-disease process, through an integral approach to individuals and families, intervening with actions focused on the reality in which they are inserted. Objective Conduct a systematic review of the literature investigating the effects of multidisciplinary rehabilitation programs on patients with Alzheimer's disease (AD). Method A searches was conducted in the Medline, LILACS, Scielo, PEDro, and CINAHL databases with no restriction regarding language and year of publication. The articles were evaluated by title, abstract, and full text and, finally selected according to eligibility by two independent authors. The methodological quality of the experimental studies was evaluated using the PEDro scale. Results Five studies of moderate methodological quality were included in the present systematic review. Results showed that multidisciplinary programs may be effective in the treatment of AD patients, with significant improvements mainly in neuropsychiatric symptoms, depression, and quality of life. For the other outcome measures investigated, because few studies with positive effects (stress level, anxiety, autonomy, and activity) or conflicting results (cognition) were found, it was not possible to determine the effectiveness of this intervention. Conclusion This systematic review has shown that multidisciplinary programs can be effective in the treatment of patients with AD, with significant improvements mainly in neuropsychiatric symptoms, depression, and quality of life; however, results regarding cognition, levels of anxiety and stress, autonomy, and performance of activities were neither significant nor conflicting.

18.
PLoS One ; 12(3): e0173159, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28278163

RESUMO

INTRODUCTION: Inspiratory muscle function may be affected in patients with End-Stage Renal Disease (ESRD), further worsening the functional loss in these individuals. However, the impact of inspiratory muscle weakness (IMW) on the functional capacity (FC) of hemodialysis patients remains unknown. Thus, the present study aimed to evaluate the impact of IMW on FC in ESRD patients undergoing hemodialysis. MATERIALS AND METHODS: ESRD patients on hemodialysis treatment for more than six months were evaluated for inspiratory muscle strength and FC. Inspiratory muscle strength was evaluated based on maximal inspiratory pressure (MIP). IMW was defined as MIP values less than 70% of the predicted value. FC was evaluated using the Incremental Shuttle Walk test (ISWT). Patients whose predicted peak oxygen uptake (VO2peak) over the distance walked during the ISWT was less than 16mL/kg/min were considered to have FC impairment. Associations between variables were assessed by linear and logistic regression, with adjustment for age, sex, body mass index (BMI), presence of diabetes and hemoglobin level. Receiver-operating characteristic (ROC) analysis was used to determine different cutoff values of the MIP for normal inspiratory muscle strength and FC. RESULTS: Sixty-five ERSD patients (67.7% male), aged 48.2 (44.5-51.9) years were evaluated. MIP was an independent predictor of the distance walked during the ISWT (R2 = 0.44). IMW was an independent predictor of VO2peak < 16mL/kg/min. (OR = 5.7; p = 0.048) in adjusted logistic regression models. ROC curves showed that the MIP cutoff value of 82cmH2O had a sensitivity of 73.5% and specificity of 93.7% in predicting normal inspiratory strength and a sensitivity and specificity of 76.3% and 70.4%, respectively, in predicting VO2peak ≥ 16mL/kg/min. CONCLUSIONS: IMW is associated with reduced FC in hemodialysis patients. Evaluation of the MIP may be important to functional monitoring in clinical practice and can help in the stratification of patients eligible to perform exercise testing.


Assuntos
Tolerância ao Exercício , Falência Renal Crônica/fisiopatologia , Debilidade Muscular/fisiopatologia , Diálise Renal/efeitos adversos , Músculos Respiratórios/fisiopatologia , Estudos Transversais , Feminino , Humanos , Capacidade Inspiratória , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Força Muscular , Debilidade Muscular/etiologia , Consumo de Oxigênio
20.
Clin Auton Res ; 26(3): 181-8, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26979171

RESUMO

PURPOSE: The autonomic maneuvers are simple methods to evaluate autonomic balance, but the association between autonomic maneuvers and heart rate variability (HRV) in hemodialysis patients remains unknown. This study aimed to evaluate the correlation between HRV and respiratory sinus arrhythmia (RSA) and Valsalva maneuver (VM) indexes in hemodialysis patients and to compare two methods for RSA indexes acquisitions. METHODS: Forty-eight volunteers on hemodialysis (66.7 % men) were evaluated by VM, RSA, and 24 h Holter monitoring. At the VM, the Valsalva index (VI) was the variable considered. In the RSA, the ratio and difference between the RR intervals of inspiratory and expiratory phase (E:I and E-I, respectively) were considered by traditional form (average of respiratory cycles) and independent respiratory cycles (E:Iindep and E-Iindep). The HRV indexes evaluated were standard deviation of all normal RR intervals (SDNN), standard deviation of sequential 5-min RR interval means (SDANN), root mean square of the successive differences (rMSSD) and percentage of adjacent RR intervals with difference of duration greater than 50 ms (pNN50). RESULTS: The SDNN, SDANN showed significant correlation with all classic indexes of RSA (E:I: r = 0.62, 0.55, respectively, E-I: r = 0.64, 0.57, respectively), E:Iindep (r = 0.59, 0.54, respectively), E-Iindep (r = 0.47, 0.43, respectively) and VI (r = 0.42, 0.34, respectively). Significant correlation of rMSSD with E:I (r = 0.37), E-I (r = 0.41) and E:Iindep (r = 0.34) was also observed. There was no association of any variable with pNN50. Have been show high values for all variables of independent cycles method (p < 0.05). CONCLUSION: The autonomic maneuvers, especially RSA, are useful methods to evaluate cardiac autonomic function in hemodialysis patients. The acquisition of the RSA index by independent cycles should not be used in this population.


Assuntos
Frequência Cardíaca/fisiologia , Diálise Renal , Adulto , Variação Biológica Individual , Feminino , Testes de Função Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/estatística & dados numéricos , Arritmia Sinusal Respiratória/fisiologia
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