Factors associated with oropharyngeal dysphagia in individuals with cardiovascular disease and COVID-19.

PURPOSE: Oropharyngeal dysphagia (OD) is one of the possible outcomes in patients hospitalized with COVID-19 and also in the population hospitalized for the treatment of cardiovascular disease. Thus, knowing the predictive risk factors for OD may help with referral and early intervention. This study aimed to verify the association of different factors with OD in hospitalized individuals with cardiovascular disease and COVID-19. METHODS: Cross-sectional clinical study approved by the Research Ethics Committee (4,521,771). Clinical evaluation of swallowing was carried out in 72 adult patients with cardiovascular disease and COVID-19 hospitalized from April to September 2020. Individuals under 18 years of age and without previous cardiovascular disease were excluded. The presence of general clinical and/or neurological complications, pronation, stay in the intensive care unit (ICU), orotracheal intubation (OTI), tracheostomy tube, oxygen support and age were considered as predictive risk factors for oropharyngeal dysphagia. Fisher's exact test, Mann Whitney test and logistic regression model were used for analysis. RESULTS: General clinical complications (p=0.001), pronation (p=0.003), ICU stay (p=0.043), in addition to the need for oxygen supplementation (p=0.023) and age (p= 0 .037) were statistically significant factors associated. The pronation (0.013) and age (0.038) were independently associated with dysphagia. OTI (p=0.208), tracheostomy (p=0.707) and the presence of previous cerebrovascular accidents (p=0.493) were not statistically significant. CONCLUSION: In this study, age and prone position were factors independently associated with oropharyngeal dysphagia, complications such as the need for oxygen supplementation, in addition to the need for ICU admission, were also associated factors in the population.

The effect of the a regional cardioprotective nutritional program on inflammatory biomarkers and metabolic risk factors in secondary prevention for cardiovascular disease, a randomised trial.

BACKGROUND & AIMS: To evaluate the effect of the Brazilian Cardioprotective Diet Program (BALANCE Program) on inflammatory biomarkers, involved in the pathophysiology of the atherosclerosis, on inflammatory biomarkers, cardiovascular risk factors, and on plasma fatty acids in cardiovascular disease secondary prevention patients. METHODS: In this substudy of the BALANCE Program randomized clinical trial, a total of 369 patients aged 45 years or older, who have experienced cardiovascular disease in the previous 10 years, were included. These patients were randomized into two groups and followed up for six months: BALANCE Program group and control group (conventional nutrition advice). In the initial and six-month final visits, anthropometry (body weight, height and waist circumference), food intake evaluation by 24-h dietary recall, plasma inflammatory biomarkers (IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-α, adiponectin, and C-reactive protein levels), blood pressure, glycemia, insulinemia, lipid profile, and plasma fatty acids levels were evaluated. RESULTS: The BALANCE Program group showed increased plasma alpha-linolenic acid levels (P = 0.008), reduction in waist circumference (P = 0.049) and BMI (P = 0.032). No difference was observed among plasma inflammatory biomarkers and clinical data. CONCLUSION: After six months of follow-up, BALANCE Program led to a significant reduction on BMI and waist circumference in individuals in secondary prevention for cardiovascular disease. Although plasmatic alpha-linolenic acid has increased, there was no impact on plasma inflammatory biomarkers. CLINICAL TRIAL REGISTRATION: NCT01620398.

Risk factors for oropharyngeal dysphagia in cardiovascular diseases.

Some conditions consolidated as risk factors for oropharyngeal dysphagia have already been identified in other diseases, such as neurological. Studies on cardiovascular diseases concentrate in individuals in the postoperative period; thus, it is unknown if these same factors occur in individuals hospitalized for clinical or surgical treatment of these diseases. Objective to correlate predictive risk factors for oropharyngeal dysphagia in individuals with cardiovascular disease admitted at a reference cardiology hospital. Methodology This is a retrospective clinical study. Medical records of 175 individuals hospitalized for clinical and/or surgical treatment at a reference cardiology hospital from January to June 2017, attendants of the Speech-Language Pathology and Nutrition team, were analyzed. Of these, 100 records were included in the study: 41 females and 59 males (mean age 67.56 years). Deaths and individuals from 0 to 18 years were excluded. Stroke, malnutrition, age and prolonged orotracheal intubation were considered predictive risk factors for oropharyngeal dysphagia. Mann-Whitney test and Fisher's test were used for statistical analysis. Results Stroke (OR=2.93 p=0.02), malnutrition (OR=2.89 p=0.02) and prolonged orotracheal intubation (OR=3.94 p=0.02) were statistically significant predictors for oropharyngeal dysphagia within this population. Age below 80 years was not significant (p=0.06), but within octogenarians, significance was found (p=0.033). Conclusion Stroke, malnutrition, prolonged orotracheal intubation and age > 80 years are predictive risk factors for oropharyngeal dysphagia in adult population with cardiovascular diseases.

Unsaturated Fatty Acids Improve Atherosclerosis Markers in Obese and Overweight Non-diabetic Elderly Patients.

BACKGROUND: Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. METHOD: Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged. RESULTS: The flaxseed oil group had improved ultra-sensitive C-reactive protein levels (p = 0.074) and reduced carotid intima-media thickness (CIMT) (p = 0.028); the olive oil group exhibited an improved apolipoprotein (Apo)B/ApoA ratio (p = 0.021), reduced CIMT (p = 0.028), and improved flow-mediated vasodilation (FMV) (p = 0.054); and similarly, the sunflower oil group showed an improved ApoB/ApoA ratio (p = 0.024), reduced CIMT (p = 0.048), and improved FMV (p = 0.001). CONCLUSION: Unsaturated fatty acid supplementation using the three vegetable oils attenuated pro-inflammatory properties and improved prothrombotic conditions. Therefore, introducing or replacing saturated and trans fat with unsaturated fatty acids is beneficial for cardiovascular risk reduction in obese or overweight non-diabetic elderly people. Further studies are needed to determine which unsaturated fat best prevents cardiovascular disease in elderly patients.

Diabetes and cardiovascular events in high-risk patients: Insights from a multicenter registry in a middle-income country.

AIMS: The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country. METHODS: REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk. Patients were followed for 12months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke). RESULTS: A total of 5006 subjects was included and analyzed in four groups: No diabetes and no previous cardiovascular event, n=430; diabetes and no previous cardiovascular event, n=1138; no diabetes and previous cardiovascular event, n=1747; and diabetes and previous cardiovascular event, n=1691. Major clinical events in one-year follow-up occurred in 332 patients. A previous cardiovascular event was associated with a higher risk of having another event in the follow-up (HR 2.31 95% CI 1.74-3.05, p<0.001), as did the presence of diabetes (HR 1.28 95% CI 1.10-1.73, p=0.005). In patients with diabetes,failure to reach HbA1c targetswas related topoorer event-free survival compared to patients with good metabolic control (HR 1.70 95% CI 1.01-2.84, p=0.044). CONCLUSIONS: In Brazil, diabetes confers high risk for major clinical events, but this condition is not equivalent to having a previous cardiovascular event. Moreover, not so strict targets for HbA1c in patients with diabetes and previous cardiovascular events might be considered.

Risk factors for oropharyngeal dysphagia in cardiovascular diseases

ABSTRACT: Some conditions consolidated as risk factors for oropharyngeal dysphagia have already been identified in other diseases, such as neurological. Studies on cardiovascular diseases concentrate in individuals in the postoperative period; thus, it is unknown if these same factors occur in individuals hospitalized for clinical or surgical treatment of these diseases. OBJECTIVE: to correlate predictive risk factors for oropharyngeal dysphagia in individuals with cardiovascular disease admitted at a reference cardiology hospital. METHODOLOGY: This is a retrospective clinical study. Medical records of 175 individuals hospitalized for clinical and/or surgical treatment at a reference cardiology hospital from January to June 2017, attendants of the Speech-Language Pathology and Nutrition team, were analyzed. Of these, 100 records were included in the study: 41 females and 59 males (mean age 67.56 years). Deaths and individuals from 0 to 18 years were excluded. Stroke, malnutrition, age and prolonged orotracheal intubation were considered predictive risk factors for oropharyngeal dysphagia. Mann-Whitney test and Fisher's test were used for statistical analysis. RESULTS: Stroke (OR=2.93 p=0.02), malnutrition (OR=2.89 p=0.02) and prolonged orotracheal intubation (OR=3.94 p=0.02) were statistically significant predictors for oropharyngeal dysphagia within this population. Age below 80 years was not significant (p=0.06), but within octogenarians, significance was found (p=0.033). CONCLUSION: Stroke, malnutrition, prolonged orotracheal intubation and age > 80 years are predictive risk factors for oropharyngeal dysphagia in adult population with cardiovascular diseases.

Análise do consumo alimentar e do estado nutricional de indivíduos submetidos à cirurgia cardíaca eletiva em hospital público de referência em Cardiologia / Analysis of dietary intake and nutritional status of subjects submitted to elective cardiac surgery at a public reference hospital in Cardiology

INTRODUÇÃO: As doenças cardiovasculares representam a principal causa de morte no mundo. Seus fatores de risco são divididos em modificáveis e não-modificáveis. Diversos estudos clínicos vêm demonstrando a influência positiva da dieta na prevenção primária e secundária de eventos cardiovasculares. Dada a importância já documentada de uma dieta equilibrada, assim como do estado nutricional adequado na manutenção da saúde cardiovascular, este estudo objetivou avaliar a adequação da dieta habitual e do estado nutricional de pacientes submetidos a cirurgia cardíaca eletiva em hospital especializado em Cardiologia. MÉTODO: Estudo de caráter descritivo e transversal, com amostra de conveniência, composta por 38 indivíduos adultos, de ambos os sexos, encaminhados para cirurgia eletiva de revascularização do miocárdio, troca de válvula ou cirurgia combinada (revascularização do miocárdio e troca de válvula). A coleta de dados ocorreu no ambulatório de Nutrição do Instituto Dante Pazzanese de Cardiologia, anteriormente à cirurgia cardíaca, sendo realizada coleta de dados demográficos, tipo de cirurgia, antecedentes clínicos, consumo alimentar e avaliação nutricional. RESULTADOS: Na amostra avaliada, 68,42% dos pacientes estavam em sobrepeso e obesidade, segundo o índice de massa corporal. O percentual de gordura corporal apresentou valores acima da normalidade em 96,87% dos pacientes, com circunferência abdominal de risco elevado e muito elevado em 75,68%. Na avaliação habitual da dieta, a adequação no consumo de macronutrientes foi de 47,37%, 2,6% e 44,74% para carboidratos, proteínas e lipídeos respectivamente. Quanto aos ácidos graxos saturados, 36,84% dos pacientes apresentaram consumo superior ao recomendado. Foi observado baixo consumo de frutas, verduras e legumes por 89,48% dos pacientes e, consequentemente, de fibras dietéticas por 97,37%. CONCLUSÃO: Conclui-se que a amostra, composta por pacientes com excesso de peso, percentual de gordura elevado, alto risco cardiovascular e submetidos à cirurgia cardíaca eletiva, apresentou um padrão alimentar com baixo consumo de frutas, verduras, legumes e fibras dietéticas, necessitando de acompanhamento nutricional individualizado. (AU)

Evidence-based therapy prescription in high-cardiovascular risk patients: the REACT study.

BACKGROUND: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient. OBJECTIVE: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies. METHODS: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed. RESULTS: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease. CONCLUSION: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.

Is intake of vitamin D and calcium important for cardiovascular health in elderly obese patients?

There is compelling evidence that bariatric weight loss reduces cardiovascular complications; however, these still tend to be the most common cause of late death after surgical intervention. In a prospective cohort study, correlations of dietary nutrients with indexes of vascular health were sought, with emphasis on vitamin D and calcium. Clinically stable obese outpatient subjects (>60 years old, N = 44) were interviewed about dietary macro and micronutrients. Nutritional assessment targeted anthropometric and bioimpedance analysis (BIA), hematologic counts, lipid profile, glucose homeostasis, and inflammatory markers. Carotid intima-media thickness (IMT) and brachial flow-mediated dilation (FMD), along with related vascular measurements, were documented, and results were correlated by uni- and multivariate analysis, corrected for known risk factors. IMT, FMD, and also brachial basal flow were positively influenced by vitamin D (P < 0.001). Calcium appeared beneficial for brachial basal flow only (P = 0.010). No association with IMT occurred, and a negative result for FMD was elicited. Also, vitamins A and B12 were advantageous for FMD, whereas iron was deleterious for IMT. Intake of many micronutrients including calcium and vitamin D did not meet recommendations. Vitamin D displayed a beneficial profile regarding vascular health, and more attention to this nutrient should be given, especially concerning obese patients with cardiometabolic risk. Calcium exhibited less straightforward results but deserves focus as well, along with antioxidant vitamin A as well as the B-complex which were mostly deficient in this experience.

Diabetes and cardiovascular events in high-risk patients: Insights from a multicenter registry in a middle-income country

AIMS:The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country.METHODS:REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk. Patients were followed for 12months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke).

Revisão integrativa: atuação fonoaudiológica com recém-nascidos portadores de cardiopatia em unidade de terapia intensiva neonatal / An integrative review: speech therapy with newborns with heart disease in neonatal intensive care unit

RESUMO O objetivo deste estudo foi identificar e analisar, por meio de levantamento bibliográfico, a atuação fonoaudiológica em Unidades de Terapia Intensiva Neonatal (UTINs) em casos de cardiopatia congênita. Como fonte de dados foram utilizadas as seguintes plataformas: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval Sistem on-line (MEDLINE), Scielo e o serviço de pesquisa da National Library of Medicine nas bases de dados Pubmed, sistema de procura do Google Acadêmico (HTTP//scholar.google.com.br). Foram pesquisados trinta e dois trabalhos, sendo a atuação fonoaudiológica em UTINs descrita em vinte e oito deles, os quais apresentam como procedimentos avaliação e estimulação do sistema sensório-motor-oral, com uso de técnicas de sucção não-nutritiva e nutritiva, além de triagem auditiva. Porém, as características dos neonatos com cardiopatia congênita e a inserção do fonoaudiólogo em UTIN cardíaca não são citadas, pouco se caracterizando os objetivos e a prática desse profissional. Apenas uma publicação obedeceu aos critérios de inclusão do presente estudo. Trata-se de um trabalho que descreve a transição da alimentação enteral direta para o seio materno em recém-nascidos pré-termo cardiopatas, com idade corrigida, em um centro de terapia intensiva neonatal. Foi possível constatar então a escassez de trabalhos publicados sobre intervenção fonoaudiológica com RN cardiopatas, o que indica a necessidade de novos estudos sobre o tema, já que a atenção a esses pacientes deve ser diferenciada, visto que apresentam particularidades que podem comprometer o desempenho na alimentação.

ABSTRACT The purpose of this study is to identify and analyze, through bibliographical survey, the use of speech therapy care in Neonatal Intensive Care Unit (NICU) in cases of newborns with congenital heart disease. The source data is from Latin American and Caribbean Health Sciences (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), SciELO and the search engine of the National Library of Medicine in the databases PubMed, also the Google Scholar search system (http // scholar.google.com.br). Thirty two works were studied and the use of speech therapy in NICU´s was described in twenty eight of them which presented as procedures the assessment and stimulation of the sensory-motor-oral system, using nonnutritive and nutritive sucking and hearing screening techniques. However, the characteristics of newborns with congenital heart disease and the insertion of the speech therapist into cardiac neonatal ICU are not mentioned, not even the description of the objectives and practice of such professional. The care of patients with congenital heart disease should be differentiated as it has particular features that can undermine the performance concerning feeding. Only one publication followed the inclusion criteria of the present survey. It describes the transition of the direct gastric feeding to breast feeding in preterm newborns with heart disease, with age corrected, in a newborn intensive care unit. It was possible to verify the lack of works published on speech therapy intervention with newborns with heart disease, which indicates the need of new studies on the theme, as the care of such patients should be differentiated once they present particularities that could undermine the performance of feeding.

The effect of the a regional cardioprotective nutritional program on inflammatory biomarkers and metabolic risk factors in secondary prevention for cardiovascular disease, a randomised trial

BACKGROUND & AIMS: To evaluate the effect of the Brazilian Cardioprotective Diet Program (BALANCE Program) on inflammatory biomarkers, involved in the pathophysiology of the atherosclerosis, on inflammatory biomarkers, cardiovascular risk factors, and on plasma fatty acids in cardiovascular disease secondary prevention patients. METHODS: In this substudy of the BALANCE Program randomized clinical trial, a total of 369 patients aged 45 years or older, who have experienced cardiovascular disease in the previous 10 years, were included. These patients were randomized into two groups and followed up for six months: BALANCE Program group and control group (conventional nutrition advice). In the initial and six-month final visits, anthropometry (body weight, height and waist circumference), food intake evaluation by 24-h dietary recall, plasma inflammatory biomarkers (IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-a, adiponectin, and C-reactive protein levels), blood pressure, glycemia, insulinemia, lipid profile, and plasma fatty acids levels were evaluated. RESULTS: The BALANCE Program group showed increased plasma alpha-linolenic acid levels (P » 0.008), reduction in waist circumference (P » 0.049) and BMI (P » 0.032). No difference was observed among plasma inflammatory biomarkers and clinical data. CONCLUSION: After six months of follow-up, BALANCE Program led to a significant reduction on BMI and waist circumference in individuals in secondary prevention for cardiovascular disease. Although plasmatic alpha-linolenic acid has increased, there was no impact on plasma inflammatory biomarkers. Clinical trial registration: NCT01620398.

Impacto da intubação orotraqueal na deglutição do indivíduo pós-acidente vascular encefálico após cirurgia cardíaca / Impact of orotracheal intubation on a post stroke individual's swallowing after cardiac surgery

OBJETIVO: associar o grau de disfagia orofaríngea e o tempo de intubação orotraqueal no indivíduo pós-acidente vascular encefálico após cirurgia cardíaca. MÉTODOS: estudo clínico transversal descritivo, retrospectivo, realizado por meio da coleta de dados de protocolos e registros de prontuário, durante seis meses, em Hospital Público de Referência em Cardiologia. Foram analisados 25 protocolos e prontuários de indivíduos submetidos à cirurgia cardíaca, que evoluíram com acidente vascular encefálico e foram assistidos pela equipe de Fonoaudiologia. Os indivíduos foram divididos em dois grupos. O Grupo I (GI) constou de 10 indivíduos com intubação orotraqueal menor que 24 horas e o Grupo II (GII) de 15 indivíduos com intubação orotraqueal maior que 24 horas. Realizada avaliação clínica da deglutição e analisada a associação entre a classificação clínica do grau de comprometimento para disfagia e o tempo de intubação orotraqueal. RESULTADOS: verificou-se que no GI 40% apresentaram disfagia leve, 30% moderada e 20% grave. No GII 13,3% apresentaram disfagia leve, 33,3% moderada e 53,33% grave. Verificou-se associação linear significante entre o grau de disfagia e o tempo de IOT (p= 0,031), indicando que o número de indivíduos com disfagia moderada e grave foi maior no grupo com mais tempo de intubaçao. CONCLUSÕES: constatou-se que o tempo de intubação orotraqueal maior que 24 horas aumentou o grau da disfagia orofaríngea nesta população. .

PURPOSE: to associate the degree of oropharyngeal dysphagia and orotracheal intubation time in post stroke individuals after cardiac surgery. METHODS: a cross-sectional retrospective descriptive clinical study carried out by means of protocols data collection and chart records during six months in a public hospital of reference in cardiology. We analyzed 25 protocols and medical records of individuals undergoing cardiac surgery who evolved with stroke and were assisted by a team of speech and language pathology. The subjects were divided into two groups. Group I (GI) consisted of 10 individuals with orotracheal intubation less than 24 hours and Group II (GII) of 15 individuals with orotracheal intubation more than 24 hours. After performing swallowing clinical evaluation and analyzing the association between the clinical classification of degree of commitment for dysphagia and orotracheal intubation time. RESULTS: it was found that 40% of the individuals in GI presented mild dysphagia, 30% moderate and 20% severe. In GII, 13.3 % presented mild dysphagia, 33.3% moderate and 53.33% severe. There was a significant linear association between the degree of dysphagia and the duration of intubation (p = 0.031), indicating that the number of individuals with moderate and severe dysphagia was higher in the group with a longer intubation. CONCLUSIONS: we could observe that time of orotracheal intubation more than 24 hours increases the degree of oropharyngeal dysphagia in this population. .

Prevalência de disfagia orofaríngea no acidente vascular cerebral após cirurgia cardíaca / Prevalence of oropharyngeal dysphagia in stroke after cardiac surgery

Resumo:OBJETIVO:determinar a prevalência de disfagia orofaríngea em indivíduos submetidos à cirurgia cardíaca e que evoluíram com Acidente Vascular Cerebral em Hospital Público de Referência.MÉTODOS:estudo clínico descritivo, retrospectivo, realizado por meio da coleta de dados de protocolos de avaliação clínica da deglutição orofaríngea, no período de novembro de 2010 á novembro de 2011. Foram incluídos os 25 protocolos de avaliação clínica para disfagia orofaríngea de indivíduos que fizeram cirurgia cardíaca e evoluíram com Acidente Vascular Cerebral no pós-operatório, durante o período estudado, e que foram assistidos pela equipe de Fonoaudiologia. A avaliação clinica da deglutição foi baseada em instrumento clinico e a deglutição classificada como normal, disfagia leve, moderada e grave.RESULTADOS:dos 25 (100%) indivíduos, 24 (96%) apresentaram algum grau de disfagia orofaríngea na avaliação clínica. (95% [IC]: 79,6- 99,9). Constatou-se que 41,66% apresentaram disfagia grave, 33,66% disfagia moderada e 25% disfagia leve.CONCLUSÃO:é alta a prevalência de disfagia orofaríngea em indivíduos com Acidente Vascular Cerebral após cirurgia cardíaca.

Abstract:PURPOSE:to determine the prevalence of oropharyngeal dysphagia in patients undergoing cardiac surgery and who developed stroke in a public referral hospital.METHODS:a retrospective descriptive clinical cross-sectional study conducted by collecting data on clinical assessment protocols of oropharyngeal swallowing in the period November 2010 to November 2011, including the protocols of 25 individuals for clinical evaluation of oropharyngeal dysphagia with post-operative stroke during the study period who were assisted by the Speech-Language Pathology team. Clinical swallowing assessment was based on clinical tools and swallowing classified as normal, mild, moderate and severe dysphagia.RESULTS:of the twenty-five (100%) patients, 24 (96%) presented dysphagia in clinical evaluation and 1 (4%) did not (95% [IC]: 79.6- 99.9). It was found that 41.66% had severe dysphagia, 33.66% moderate and 25% mild dysphagia.CONCLUSION:there was a high prevalence of oropharyngeal dysphagia in patients with stroke after cardiac surgery.

Long-term use of a diabetes-specific oral nutritional supplement results in a low-postprandial glucose response in diabetes patients.

BACKGROUND: To determine the effect of 12 weeks supplementation with a high-MUFA, high-fibre diabetes-specific oral nutritional supplement (ONS) on postprandial glucose response in type 2 diabetic patients at risk for malnutrition. METHODS: Forty patients participated in this randomised, controlled, double-blind, parallel-group study. Subjects consumed 2 x 200 ml of diabetes-specific ONS (Diasip) or standard ONS per day in addition to their normal diet. At baseline, after 6 and 12 weeks postprandial glucose responses and secondary parameters were assessed. RESULTS: Postprandial glucose responses (incremental area under curve) (p<0.01) and delta postprandial peak glucose concentration (p<0.01) were significantly lower in the diabetes-specific ONS group compared with the standard ONS group at all visits. In time, iAUC glucose (p=0.074, t=0 week vs. t=12 weeks) and delta postprandial peak plasma glucose concentration (p<0.05, t=0 week vs. t=12 weeks) were decreased within the diabetes-specific ONS group, but not in the standard ONS group. No significant differences in fasting glucose, insulin, HbA1c, lipid profile, hs-CRP, oxidized LDL and malondialdehyde, laboratory safety parameters and nutritional status parameters were found between both groups at either of the visits. CONCLUSIONS: These data demonstrate that diabetic patients at risk for malnutrition benefit from use of this diabetes-specific ONS to improve postprandial blood glucose control.

Risco da ingesta exagerada de sódio na utilização de espessante para disfagia / Risk of excessive sodium intake in the use of a thickener for dysphagia

A disfagia orofaríngea é um distúrbio de deglutição decorrente de causas neurológicas e/ou estruturais que pode ocasionar alteração da interação social, prazer alimentar do indivíduo, desnutrição, desidratação, quadros infecciosos pulmonares e outros de alta morbidade...

Prescrição de terapias baseadas em evidências para pacientes de alto risco cardiovascular: estudo REACT / Evidence-based therapy prescription in high-cardiovascular risk patients: the REACT study

FUNDAMENTO: Dados de atendimento ambulatorial ao paciente de alto risco cardiovascular no Brasil são insuficientes. OBJETIVO: Descrever o perfil e documentar a prática clínica do atendimento ambulatorial de pacientes de alto risco cardiovascular no Brasil, no que diz respeito à prescrição de terapias baseadas em evidências. MÉTODOS: Registro prospectivo que documentou a prática clínica ambulatorial de indivíduos de alto risco cardiovascular, que foi definido como a presença de um dos seguintes fatores: doença arterial coronariana, cerebrovascular e vascular periférica; diabetes; ou aqueles com pelo menos três dos seguintes fatores: hipertensão arterial, tabagismo, dislipidemia, maiores 70 anos, histórico familiar de doença arterial coronariana, nefropatia crônica ou doença carotídea assintomática. Foram avaliadas características basais e a taxa de prescrição das intervenções medicamentosas e não medicamentosas. RESULTADOS: Foram incluídos 2.364 pacientes consecutivos, sendo 52,2% do gênero masculino, idade média de 66,0 anos (± 10,1). Dentre os pacientes incluídos, 78,3% utilizavam antiplaquetários, 77,0% estatinas e, dos pacientes com história de infarto do miocárdio, 58,0% receberam betabloqueadores. O uso concomitante destas três classes foi de 34%. Não atingiram as metas preconizadas pelas diretrizes 50,9% dos hipertensos, 67% dos diabéticos e 25,7% dos dislipidêmicos. Os principais preditores de prescrição de terapias com benefício comprovado foram centro com cardiologista e histórico de doença arterial coronariana. CONCLUSÃO: Este registro nacional e representativo identificou hiatos importantes na incorporação de terapias com benefício comprovado, oferecendo um panorama real dos pacientes de alto risco cardiovascular.

BACKGROUND: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient. OBJECTIVE: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies. METHODS: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed. RESULTS: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease. CONCLUSION: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.