Perfil e capacidade funcional em sujeitos com Doença de Huntington / Profile and functional capacity in Huntington's disease subjects

Objetivo: traçar o perfil e a capacidade funcional de sujeitos com Doença de Huntington (DH) atendidos em um ambulatório de fisioterapia do Distrito Federal. Método: trata-se de um estudo transversal em que foram aplicados um questionário para coletar informações gerais para traçar o perfil, além do índice de Barthel, escala Lawton para medir grau de independência para as atividades de vida diária, força de preensão palmar por meio do dinamômetro JAMAR®, equilíbrio por meio da escala de equilíbrio de Berg, declínio cognitivo por meio da Montreal Cognitive Assessment (MoCA), e risco de disfagia utilizando a Eating assessment tool (EAT-10). Resultados: foram avaliados sete sujeitos, 58% homens e 42% mulheres com média de idade de 45,8±10,5 anos e tempo médio de diagnóstico de 7,5±4,2 anos. Todos apresentam redução da força de preensão palmar (21,1±7,3 Kg/F) e declínio cognitivo (13,1±4,2 pontos) no MoCA. Sobre o risco de cair, este se fez presente em todos os participantes com o risco de disfagia. Conclusão: os indivíduos com Doença de Huntington apresentaram déficit cognitivo, diminuição da força de preensão palmar e alterações de marcha; porém, ainda mantêm independência para as atividades básicas de vida diária , além de risco para a disfagia.

Objective: to outline the profile and functional capacity of subjects with Huntington's disease (HD) attended at a physiotherapy clinic in the Federal District. Methods: This is a cross-sectional study in which a questionnaire was used to collect general information to profile, besides Barthel index, Lawton scale to measure the degree of independence for the activities of daily life, palmar grip strength using the JAMAR® dynamometer, balance by means of Berg balance scale, cognitive decline by means of the Montreal Cognitive Assessment (MoCA), and risk of dysphagia using the Eating assessment tool (EAT-10). Results: Seven subjects were evaluated, 58% male and 42% female with mean age of 45.8 ± 10.5 years and mean diagnosis time of 7.5 ± 4.2 years. All presented reduced palmar grip strength (21.1 ± 7.3 Kg / F) and cognitive decline (13.1 ± 4.2 points) in MoCA. About the risk of falling this was present in all partcipants as well as the risk of dysphagia. Conclusion: The individuals with Huntington's disease presented cognitive deficit, decreased palmar grip strength and gait alterations, however still maintains independence for the basic activities of daily life, besides risk for dysphagia.

High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

OBJECTIVE: The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery. METHODS: We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h. RESULTS: Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation. CONCLUSIONS: A high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period.