ABSTRACT
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, and its incidence has grown within several years, quickly becoming the third leading cause of mortality. The disease is characterized by alveolar destruction, air-trapping, and chronic inflammation due to persistent exposure to a large spectrum of harmful particles. The diagnosis of COPD is made by demonstration of persistent and not fully reversible airflow limitation, and different phenotypes may be recognized based on pathophysiological, clinical, and radiological features. However, COPD is a systemic disease with effects involving several organs. For example, mechanical and functional alterations secondary to COPD involve heart function. Indeed, cardiovascular diseases are highly prevalent in patients affected by COPD and represent the primary cause of mortality in such patients. An electrocardiogram is a simple and cheap test that gives much information about the heart status of COPD patients. Consequently, variations from "normality" can be appreciated in these patients, with the most frequent abnormalities being P-wave, QRS axis, and ventricular repolarization abnormalities, in addition to conduction alterations and a vast number of arrhythmias. As a result, ECG should be routinely performed as a valuable tool to recognize alterations due to COPD (i.e., mechanical and functional) and possible associated heart diseases. This review aims to describe the typical ECG features in most COPD patients and to provide a systematic summary that can be used in clinical practice.
ABSTRACT
Chronic obstructive pulmonary disease (COPD) is a significant preventable and treatable clinical disorder defined by a persistent, typically progressive airflow obstruction. This disease has a significant negative impact on mortality and morbidity worldwide. However, the complex interaction between the heart and lungs is usually underestimated, necessitating more attention to improve clinical outcomes and prognosis. Indeed, COPD significantly impacts ventricular function, right and left chamber architecture, tricuspid valve functionality, and pulmonary blood vessels. Accordingly, more emphasis should be paid to their diagnosis since cardiac alterations may occur very early before COPD progresses and generate pulmonary hypertension (PH). Echocardiography enables a quick, noninvasive, portable, and accurate assessment of such changes. Indeed, recent advancements in imaging technology have improved the characterization of the heart chambers and made it possible to investigate the association between a few cardiac function indexes and clinical and functional aspects of COPD. This review aims to describe the intricate relation between COPD and heart changes and provide basic and advanced echocardiographic methods to detect early right ventricular and left ventricular morphologic alterations and early systolic and diastolic dysfunction. In addition, it is crucial to comprehend the clinical and prognostic significance of functional tricuspid regurgitation in COPD and PH and the currently available transcatheter therapeutic approaches for its treatment. Moreover, it is also essential to assess noninvasively PH and pulmonary resistance in patients with COPD by applying new echocardiographic parameters. In conclusion, echocardiography should be used more frequently in assessing patients with COPD because it may aid in discovering previously unrecognized heart abnormalities and selecting the most appropriate treatment to improve the patient's symptoms, quality of life, and survival.
Subject(s)
Hypertension, Pulmonary , Pulmonary Disease, Chronic Obstructive , Humans , Quality of Life , Echocardiography/methods , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnostic imaging , Heart , Lung , Hypertension, Pulmonary/diagnostic imaging , Hypertension, Pulmonary/etiologyABSTRACT
Resumo Empatia pressupõe a capacidade e sobretudo a vontade de compreender o outro e se colocar em seu lugar. Considerando isso, espera-se que profissionais envolvidos em cuidados de saúde sejam mais empáticos e capazes de ler o mundo ao seu redor com olhar humanizado, crítico e reflexivo. Objetivou-se investigar, mediante revisão integrativa, o que tem sido discutido a respeito do ensino da empatia nos cursos de graduação da área da saúde nos últimos cinco anos. Foram selecionados 27 artigos das bases de dados MEDLINE e LILACS, por meio dos quais se identificou que a maioria dos estudos disponíveis foram realizados nas áreas de medicina e enfermagem. Além disso, constatou-se que, apesar de o tema empatia remeter à subjetividade, a metodologia quantitativa com aplicação de escalas padronizadas foi a mais utilizada para mensurar níveis de empatia e que, por fim, o ensino da empatia ocorreu por meio de metodologias ativas.
Abstract Empathy presupposes the ability and, most importantly, the willingness to understand others and put oneself in their place. Hence, health personnel are expected to be more empathetic and able to read the world around them with a humanized, critical, and reflexive look. This integrative review examines the studies on teaching empathy in undergraduate health programs published in the last five years. A total of 27 studies were selected from the MEDLINE and LILACS databases, most of which were published in the fields of medicine and nursing. Although a subjective element, most studies measured empathy using standardized scales (quantitative approach). Finally, empathy was taught using active methodologies.
Resumen La empatía es una capacidad, sobre todo una voluntad, de comprender al otro y de ponerse en su piel. Así se espera que los profesionales involucrados en el cuidado de la salud sean más empáticos y tengan una mirada humanizada, crítica y reflexiva sobre el mundo. Esta es una revisión integradora para identificar cómo se enseña la empatía en las carreras de graduación en el área de la salud en los últimos cinco años. Se seleccionaron 27 artículos de las bases de datos MEDLINE y LILACS, y se identificó que la mayoría de los estudios disponibles fueron de las áreas de Medicina y Enfermería. Se constató también que, aunque el tema de la empatía se refiera a la subjetividad, el método cuantitativo con la aplicación de escalas estandarizadas fue el más utilizado para medir los niveles de empatía y que la enseñanza de la empatía ocurrió por metodologías activas.
Subject(s)
Students , Health Education , Education, Medical , EmpathyABSTRACT
OBJECTIVES: The diagnosis of primary Sjogren's syndrome (pSS) continues to be difficult and several patients keep symptomatic for years with different diagnoses before confirmation of pSS. Since the IL-23-IL-17 axis is involved in the etiopathogenesis of pSS we evaluated by immunohistochemistry and morphometric methods the presence of IL-17 as well as IL-23 within minor salivary glands (MSG) obtained from patients with uncertain diagnosis of pSS. MATERIALS AND METHODS: 42 patients, with symptoms attributable to pSS, and 8 patients used as a control, were enrolled for the study. Autoantibody detection, histological analysis for the presence of Germinal Centers (GC+), immunohistochemistry to detect IL-23 and IL-17 were performed. RESULTS: The detection of GC + anti-SSA and anti-SSB antibody in parallel with the detection of IL-17 and IL-23, displays only a diagnostic reinforcement value. Instead, the detection of a positive reaction for both IL-17 and IL-23 without GC + or autoantibody within minor salivary glands, as detected in 36 % of patients with uncertain diagnosis, may be hold as a sensitive and specific marker to identify those patients who are likely to evolve into pSS. CONCLUSION: we suggest to use the IL-17/ IL-23 immunohistochemical detection to improve the identification of patients with a possible diagnosis in all cases which do not fully meet the American-European criteria for pSS, in particular when the GC + are not present at histopathological analysis and anti-SSA and anti-SSB antibody are undetectable in the serum.
