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1.
Int Arch Occup Environ Health ; 94(2): 275-284, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32936370

RESUMO

PURPOSE: Considering the relevance of muscle strength for sustaining good musculoskeletal health among workers who perform physically demanding work, the aim of this study was to evaluate the effectiveness of a therapeutic exercise program on muscle strength and low back symptoms among hospital nursing assistants. METHODS: One hundred and twenty-nine nursing assistants filled out a questionnaire on personal, occupational information and health status, which allowed the identification of workers able to exercise. Ninety participants were randomly allocated to an intervention and a reference group. The therapeutic exercise program (TEP) lasted 12 weeks and included warm-up, strengthening and stretching exercises. Muscle strength of trunk flexors and trunk extensors, hamstring flexibility, and low back symptoms were evaluated before and after the intervention period by two blinded assessors. The comparison between groups was carried out using Mann-Whitney and χ2 tests at a significance level of 0.05. RESULTS: The average participation in the exercise program was 17.5 sessions. Results showed increased trunk flexors muscle strength (p = 0.002; effect size: 0.77), improved pressure pain threshold for dorsal longissimus (p = 0.001; effect size > 0.8), and reduced low back symptoms (p = 0.002; OR = 6.25). No differences between groups were identified for back extensor muscle strength or flexibility. CONCLUSION: The exercise program applied is a feasible intervention which resulted clinically relevant results for nursing assistants' musculoskeletal health expressed through trunk flexors muscle strength improvement and low back symptoms control among nursing assistants. This RCT brings contribution to the Occupational Health field as the exercise program applied resulted in clinically relevant results for nursing assistants' musculoskeletal health. This study brings contribution especially for low-income and middle-income countries where low back pain and disability can be considered more severe as adequate resources to address the problem are scarce. Thus, we must highlight the importance of low-cost preventive strategies, like exercise programs carried out in hospital settings to avoid the progress of disability among active nursing personnel.


Assuntos
Terapia por Exercício , Hospitais Gerais , Dor Lombar/terapia , Assistentes de Enfermagem , Aptidão Física , Adulto , Feminino , Humanos , Dor Lombar/fisiopatologia , Dor Lombar/prevenção & controle , Masculino , Pessoa de Meia-Idade , Força Muscular , Músculo Esquelético/fisiologia , Método Simples-Cego , Avaliação de Sintomas , Local de Trabalho , Adulto Jovem
2.
Front Immunol ; 11: 608883, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33362796

RESUMO

Pulmonary arterial hypertension (PAH) is a disease of the lung blood vessels that results in right heart failure. PAH is thought to occur in about 5% to 10% of patients with hepatosplenic schistosomiasis, particularly due to S. mansoni. The lung blood vessel injury may result from a combination of embolization of eggs through portocaval shunts into the lungs causing localized Type 2 inflammatory response and vessel remodeling, triggering of autonomous pathology that becomes independent of the antigen, and high cardiac output as seen in portopulmonary hypertension. The condition is likely underdiagnosed as there is little systematic screening, and risk factors for developing PAH are not known. Screening is done by echocardiography, and formal diagnosis requires invasive right heart catheterization. Patients with Schistosoma-associated PAH show reduced functional capacity and can be treated with pulmonary vasodilators, which improves symptoms and may improve survival. There are animal models of this disease that might help in understanding disease pathogenesis and identify novel targets to screen and treatment. Pathogenic mechanisms include Type 2 immunity and activation and signaling in the TGF-ß pathway. There are still major uncertainties regarding Schistosoma-associated PAH development, course and treatment.


Assuntos
Hipertensão Arterial Pulmonar/patologia , Schistosoma mansoni/imunologia , Esquistossomose mansoni/patologia , Animais , Humanos , Pulmão/imunologia , Pulmão/patologia , Hipertensão Arterial Pulmonar/imunologia , Esquistossomose mansoni/imunologia , Fator de Crescimento Transformador beta/imunologia , Remodelação Vascular/imunologia , Remodelação Vascular/fisiologia
3.
J Surg Oncol ; 121(5): 863-872, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31902142

RESUMO

Despite the fact laparoscopic liver resections (LLR) for cholangiocarcinoma is still limited, this systematic review addressed surgical and oncological outcomes of LLR to treat both perihilar cholangiocarcinoma (pCCA) and intrahepatic cholangiocarcinoma (iCCA). Five comparative and 20 noncomparative studies were found. Regarding iCCA, LLR had lower blood loss and less need for Pringle maneuver. However, open liver resections (OLR) were performed more for major hepatectomies, with better lymphadenectomy rates and higher number of harvested lymph nodes. High heterogeneity and selection bias were suggested for iCCA studies.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/cirurgia , Hepatectomia/métodos , Laparoscopia , Perda Sanguínea Cirúrgica , Humanos , Excisão de Linfonodo
4.
Psicol. teor. prát ; 21(3): 501-516, sept.-Dec. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1040920

RESUMO

Primary care professionals are usually the first ones to detect symptomns of autism. We have developed and evaluated an educational model via a combined telehealth and face-to-face approach to handle autism spectrum disorders (ASD) and child mental health. The training comprised two modules involving distance-learning and face-to-face teaching environments. A total of 150 healthcare professionals - 75 doctors and 75 nurses - from five Brazilian cities were trained. Videos about ASD and child mental health were developed for the distance-learning module. The face-toface module was based on training regarding "Mental health communication skills for child and adolescent primary care." The professionals were evaluated before and after training utilizing a specific knowledge questionnaire and surveys on Knowledge, Attitude, and Practice (KAP). Knowledge acquisition, practice, and attitude improved significantly after training (p < 0.01). Our results indicated that the use of interactive tele-education to train professionals in primary care is feasible and effective.


Os primeiros sintomas de transtorno do espectro autista (TEA) são detectados por profissionais da atenção básica. O objetivo deste estudo foi desenvolver e avaliar um modelo de treinamento via telemedicina e workshop presencial sobre TEA e saúde mental infantil para médicos e enfermeiros da atenção básica. Participaram do treinamento 150 profissionais de cinco cidades brasileiras. No módulo a distância, foram desenvolvidos vídeos sobre TEA e os principais transtornos da infância, e no presencial foi baseado no treinamento "Técnicas de comunicação para lidar com saúde mental de crianças e adolescentes na atenção primaria". Os profissionais foram avaliados antes e depois da capacitação com questionários específicos de conhecimento e o Questionário de conhecimento, atitudes e prática (CAP). Os resultados apontaram a aquisição de conhecimento, atitudes e prática tanto pelos médicos quanto pelos enfermeiros. Os resultados deste estudo mostram que o treinamento de profissionais da atenção básica é factível e efetiva.


Los profesionales que detectan los primeros síntomas de trastorno del espectro autista son los profesionales de la atención básica. Desarrollamos y evaluamos un modelo de educación vía tele-salude y taller presencial sobre TEA y salud mental infantil para médicos y enfermeros de la atención básica. 150 profesionales de 5 ciudades brasileñas participaron en el entrenamiento. Para el módulo a distancia se desarrollaron vídeos sobre TEA y los principales trastornos de la infancia. El módulo presencial se basó en el entrenamiento "Técnicas de comunicación para lidiar con la salud mental de niños y adolescentes en la atención primaria". Los profesionales fueron evaluados antes y después de la capacitación con Cuestionario Específicos de Conocimiento y el Cuestionario de conocimiento, actitudes, práctica (CAP). Los resultados apuntaron que hubo adquisición de conocimiento, actitud y práctica tanto por los médicos y por los enfermeros. Los resultados muestran que el uso de tele-educación interactiva para la capacitación es factible y efectiva.


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade
6.
Rev. bras. psiquiatr ; 40(3): 296-305, July-Sept. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-959239

RESUMO

Objective: To develop, implement, and verify the impact of a training program for health care providers working with children with autism spectrum disorder (ASD) in psychosocial care centers for children and adolescents (Centro de Atenção Psicossocial à Infância e à Adolescência - CAPSi) in São Paulo, Brazil. Methods: This quasi-experimental study was conducted with 14 professionals from four CAPSi units. The training program consisted of six phases: 1) pre-intervention observation; 2) meeting with staff to assess the main needs of the training program; 3) developing materials for training and evaluation; 4) meetings to discuss program implementation; 5) a final meeting for case discussion and evaluation; and 6) distance supervision. Three measures were used to evaluate the training program: i) the Knowledge, Attitudes, and Practices (KAP) questionnaire; ii) videos containing questions designed to assess program comprehension; and iii) a satisfaction survey. Results: Thirteen videos were produced to as visual aids for use during the training program, and a further 26 videos were developed to evaluate it. The program was well evaluated by the participants. The video responses and KAP questionnaire scores suggest that staff knowledge and attitudes improved after training. Conclusion: The positive findings of this study suggest that the tested training program is feasible for use with multidisciplinary teams working in the CAPSi environment.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Avaliação de Programas e Projetos de Saúde , Pessoal de Saúde/educação , Serviços Comunitários de Saúde Mental , Transtorno do Espectro Autista/terapia , Satisfação Pessoal , Psicologia/educação , Brasil , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Educação Continuada , Transtorno do Espectro Autista/psicologia , Relações Interprofissionais , Programas Nacionais de Saúde
7.
Rev Assoc Med Bras (1992) ; 64(2): 119-126, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29641665

RESUMO

INTRODUCTION: The standard treatment for locally advanced rectal cancer (RC) consists of neoadjuvant chemoradiation followed by radical surgery. Regardless the extensive use of SUVmax in 18F-FDG PET tumor uptake as representation of tumor glycolytic consumption, there is a trend to apply metabolic volume instead. Thus, the aim of the present study was to evaluate a noninvasive method for tumor segmentation using the 18F-FDG PET imaging in order to predict response to neoadjuvant chemoradiation therapy in patients with rectal cancer. METHOD: The sample consisted of stage II and III rectal cancer patients undergoing 18F-FDG PET/CT examination before and eight weeks after neoadjuvant therapy. An individualized tumor segmentation methodology was applied to generate tumor volumes (SUV2SD) and compare with standard SUVmax and fixed threshold (SUV40%, SUV50% and SUV60%) pre- and post-therapy. Therapeutic response was assessed in the resected specimens using Dworak's protocol recommendations. Several variables were generated and compared with the histopathological results. RESULTS: Seventeen (17) patients were included and analyzed. Significant differences were observed between responders (Dworak 3 and 4) and non-responders for SUVmax-2 (p<0.01), SUV2SD-2 (p<0.05), SUV40%-2 (p<0.05), SUV50%-2 (p<0.05) and SUV60%-2 (p<0.05). ROC analyses showed significant areas under the curve (p<0.01) for the proposed methodology with sensitivity and specificity varying from 60% to 83% and 73% to 82%, respectively. CONCLUSION: The present study confirmed the predictive power of the variables using a noninvasive individualized methodology for tumor segmentation based on 18F-FDG PET/CT imaging for response evaluation in patients with rectal cancer after neoadjuvant chemoradiation therapy.


Assuntos
Adenocarcinoma/terapia , Quimiorradioterapia/métodos , Terapia Neoadjuvante/métodos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias Retais/terapia , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Adulto , Idoso , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/administração & dosagem , Neoplasias Retais/metabolismo , Neoplasias Retais/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Carga Tumoral
8.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 64(2): 119-126, Feb. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-896427

RESUMO

Summary Introduction: The standard treatment for locally advanced rectal cancer (RC) consists of neoadjuvant chemoradiation followed by radical surgery. Regardless the extensive use of SUVmax in 18F-FDG PET tumor uptake as representation of tumor glycolytic consumption, there is a trend to apply metabolic volume instead. Thus, the aim of the present study was to evaluate a noninvasive method for tumor segmentation using the 18F-FDG PET imaging in order to predict response to neoadjuvant chemoradiation therapy in patients with rectal cancer. Method: The sample consisted of stage II and III rectal cancer patients undergoing 18F-FDG PET/CT examination before and eight weeks after neoadjuvant therapy. An individualized tumor segmentation methodology was applied to generate tumor volumes (SUV2SD) and compare with standard SUVmax and fixed threshold (SUV40%, SUV50% and SUV60%) pre- and post-therapy. Therapeutic response was assessed in the resected specimens using Dworak's protocol recommendations. Several variables were generated and compared with the histopathological results. Results: Seventeen (17) patients were included and analyzed. Significant differences were observed between responders (Dworak 3 and 4) and non-responders for SUVmax-2 (p<0.01), SUV2SD-2 (p<0.05), SUV40%-2 (p<0.05), SUV50%-2 (p<0.05) and SUV60%-2 (p<0.05). ROC analyses showed significant areas under the curve (p<0.01) for the proposed methodology with sensitivity and specificity varying from 60% to 83% and 73% to 82%, respectively. Conclusion: The present study confirmed the predictive power of the variables using a noninvasive individualized methodology for tumor segmentation based on 18F-FDG PET/CT imaging for response evaluation in patients with rectal cancer after neoadjuvant chemoradiation therapy.


Resumo Introdução: O câncer retal (RC) é uma doença de importância global, e o tratamento padrão para o câncer retal localmente avançado compreende quimiorradiação neoadjuvante seguida de cirurgia radical. Independentemente do uso extensivo da captação tumoral mais intensa do 18F-FDG (conhecida como SUVmax) como representativo do consumo glicolítico do tumor nas imagens de PET, há uma tendência para aplicar volume metabólico. Dessa forma, o objetivo do presente estudo foi avaliar um método não invasivo de segmentação tumoral utilizando a 18F-FDG PET para predizer a resposta à quimiorradioterapia neoadjuvante em pacientes com câncer de reto. Método: A amostra consistiu em pacientes com câncer retal em estádios II e III submetidos ao exame de 18F-FDG PET/CT antes e oito semanas após a terapia neoadjuvante. Foi aplicada uma metodologia de segmentação tumoral individualizada para gerar volumes tumorais (SUV2SD). A resposta terapêutica foi avaliada nos espécimes ressecados utilizando as recomendações do protocolo de Dworak. Várias variáveis foram geradas e comparadas com os resultados histopatológicos. Resultados: Dezessete (17) pacientes foram incluídos e analisados. Foram observadas diferenças significativas entre os respondedores (Dworak 3 e 4) e não respondedores para SUVmax-2 (p<0,01), SUV2SD-2 (p<0,05), SUV40%-2 (p<0,05), SUV50%-2 (p<0,05) e SUV60%-2 (p< 0,05). As análises ROC mostraram áreas significativas sob a curva (p<0,01) para a metodologia proposta, com sensibilidade e especificidade variando de 60% a 83% e 73% a 82%, respectivamente. Conclusão: O presente estudo confirmou o poder preditivo das variáveis utilizando uma metodologia não invasiva individualizada para segmentação tumoral baseada em imagens 18F-FDG PET/CT para avaliação da resposta em pacientes com câncer retal após tratamento com quimiorradiação neoadjuvante.


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Neoplasias Retais/terapia , Adenocarcinoma/terapia , Terapia Neoadjuvante/métodos , Quimiorradioterapia/métodos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias Retais/metabolismo , Neoplasias Retais/patologia , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Compostos Radiofarmacêuticos/administração & dosagem , Fluordesoxiglucose F18/administração & dosagem , Carga Tumoral , Pessoa de Meia-Idade
9.
Braz J Psychiatry ; 40(3): 296-305, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29267601

RESUMO

OBJECTIVE: To develop, implement, and verify the impact of a training program for health care providers working with children with autism spectrum disorder (ASD) in psychosocial care centers for children and adolescents (Centro de Atenção Psicossocial à Infância e à Adolescência - CAPSi) in São Paulo, Brazil. METHODS: This quasi-experimental study was conducted with 14 professionals from four CAPSi units. The training program consisted of six phases: 1) pre-intervention observation; 2) meeting with staff to assess the main needs of the training program; 3) developing materials for training and evaluation; 4) meetings to discuss program implementation; 5) a final meeting for case discussion and evaluation; and 6) distance supervision. Three measures were used to evaluate the training program: i) the Knowledge, Attitudes, and Practices (KAP) questionnaire; ii) videos containing questions designed to assess program comprehension; and iii) a satisfaction survey. RESULTS: Thirteen videos were produced to as visual aids for use during the training program, and a further 26 videos were developed to evaluate it. The program was well evaluated by the participants. The video responses and KAP questionnaire scores suggest that staff knowledge and attitudes improved after training. CONCLUSION: The positive findings of this study suggest that the tested training program is feasible for use with multidisciplinary teams working in the CAPSi environment.


Assuntos
Transtorno do Espectro Autista/terapia , Serviços Comunitários de Saúde Mental , Pessoal de Saúde/educação , Avaliação de Programas e Projetos de Saúde , Adolescente , Transtorno do Espectro Autista/psicologia , Brasil , Criança , Pré-Escolar , Educação Continuada , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Relações Interprofissionais , Masculino , Programas Nacionais de Saúde , Satisfação Pessoal , Psicologia/educação , Inquéritos e Questionários
10.
Clin Nephrol ; 89 (2018)(1): 10-17, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29189197

RESUMO

INTRODUCTION: Factors associated with osteodystrophy in predialysis patients are poorly understood. In the present study, we attempted to evaluate the impact of body composition and hormonal regulatory factors on the bone microstructure in a group of men with chronic kidney disease (CKD) stages 3 and 4. MATERIALS AND METHODS: 46 men, aged 50 - 75 years, with previously unrecognized CKD were evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT), and dual-energy X-ray absorptiometry (DXA). HR-pQCT parameters were correlated with estimated glomerular filtration rate (eGFR), age, body mass index (BMI), muscle mass index (MMI), and biochemistry. RESULTS: As compared to patients in stage 3 CKD, those with stage 4 CKD showed lower serum 25-hydroxyvitamin D (25(OH)D) and bicarbonate levels, and higher serum fibroblast growth factor 23 (FGF-23) and parathyroid hormone (PTH) levels. They also exhibited lower total, trabecular, and cortical volumetric bone mineral density, lower trabecular bone volume/tissue volume, trabecular number, trabecular and cortical thickness, and increased heterogeneity of the trabecular network. In the whole cohort, cortical bone density and thickness were negatively associated with age, PTH, and FGF-23, and positively with BMI. Trabecular bone parameters were positively associated with MMI and 25(OH)D. After simultaneously adjusting for age and eGFR, BMI, and MMI remained significantly associated with bone microstructural variables. CONCLUSION: HR-pQCT showed significant differences in bone microstructure in stage 4 vs. stage 3 CKD patients. Increased BMI, probably due to increased muscle mass, may favorably affect bone architecture in predialysis CKD patients.
.


Assuntos
Composição Corporal/fisiologia , Osso e Ossos/diagnóstico por imagem , Fatores de Crescimento de Fibroblastos/sangue , Hormônio Paratireóideo/sangue , Insuficiência Renal Crônica , Tomografia Computadorizada por Raios X , Idoso , Densidade Óssea , Estudos de Coortes , Fator de Crescimento de Fibroblastos 23 , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/diagnóstico por imagem , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/fisiopatologia
11.
Photodiagnosis Photodyn Ther ; 14: 152-8, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27018246

RESUMO

BACKGROUND: Molecular investigation of breast tumors has permitted better understanding about interaction of genes and pathways involved in tumor progression. OBJECTIVE: The aim of this study was to evaluate the association between genes belonging to the pathway of apoptosis with tumor response to photodynamic therapy. STUDY DESIGN/MATERIALS AND METHODS: The mammary tumors were induced in twenty-four Spraguey-Dawley female rats by oral gavage of 7,12-dimethylbenz(a)anthracene (8mg/Kg body weight). Animals were divided into three groups: G1 (normal tissue), G2 (tumors without treatment), G3 (animals euthanized 48h after treatment). The photosensitizer used was a chlorin, 5,15-bis-(2-bromo-5-hydroxyphenyl) chlorin in the dose of 8mg/kg for each animal. Light source of diode laser at a wavelength of 660nm, fluence rate of 100mW/cm, and light dose of 100J/cm was delivery to lesions for treatment. A sample from each animal was investigated by quantitative real time PCR using Rat Apoptosis RT(2) Profiler™ PCR Array platform. RESULTS: Pro-apoptotic BAK1, CARD6, CASP8, CIDEA, CIDEB, DAPK1, TNF, TNFRSF10B, FASLG, LOC687813, and TP73 genes showed increased expression, and CD40 anti-apoptotic gene showed decreased expression in the group who underwent PDT (G3) in relation to G2. CONCLUSION: The results indicated that these genes are involved more directly with cellular apoptosis induced by PDT using the Chlorin photosensitizer.


Assuntos
Neoplasias da Mama , Fotoquimioterapia , Animais , Apoptose , Neoplasias da Mama/genética , Neoplasias da Mama/terapia , Modelos Animais de Doenças , Feminino , Expressão Gênica/efeitos dos fármacos , Expressão Gênica/efeitos da radiação , Porfirinas/uso terapêutico , Ratos , Reação em Cadeia da Polimerase em Tempo Real , Transdução de Sinais/efeitos da radiação
12.
Arq Bras Cir Dig ; 27(3): 182-3, 2014.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25184767

RESUMO

BACKGROUND: The upper esophageal sphincter is composed of striated muscle. The stress of intubation and the need to inhibit dry swallows during an esophageal manometry test may lead to variations in basal pressure of this sphincter. Upper esophageal sphincter is usually only studied at the final part of the test. Was observed during the performance of high resolution manometry that sphincter pressure may vary significantly over the course of the test. AIM: To evaluate the variation of the resting pressure of the upper esophageal sphincter during high resolution manometry. METHODS: Was evaluated the variation of the basal pressure of the upper esophageal sphincter during high resolution manometry. Were reviewed the high resolution manometry tests of 36 healthy volunteers (mean age 31 years, 55% females). The basal pressure of the upper esophageal sphincter was measured at the beginning and at the end of a standard test. RESULTS: The mean time of the test was eight minutes. The basal pressure of the upper esophageal sphincter was 100 mmHg at the beginning of the test and 70 mmHg at the end (p<0.001). At the beginning, one patient had hypotonic upper esophageal sphincter and 14 hypertonic. At the end of the test, one patient had hypotonic upper esophageal sphincter (same patient as the beginning) and seven hypertonic upper esophageal sphincter. CONCLUSION: A significant variation of the basal pressure of the upper esophageal sphincter was observed in the course of high resolution manometry. Probably, the value obtained at the end of the test may be more clinically relevant.


Assuntos
Esfíncter Esofágico Superior/fisiologia , Manometria , Adulto , Feminino , Humanos , Masculino , Pressão
13.
ABCD (São Paulo, Impr.) ; 27(3): 182-183, Jul-Sep/2014. graf
Artigo em Inglês | LILACS | ID: lil-720395

RESUMO

BACKGROUND: The upper esophageal sphincter is composed of striated muscle. The stress of intubation and the need to inhibit dry swallows during an esophageal manometry test may lead to variations in basal pressure of this sphincter. Upper esophageal sphincter is usually only studied at the final part of the test. Was observed during the performance of high resolution manometry that sphincter pressure may vary significantly over the course of the test. AIM: To evaluate the variation of the resting pressure of the upper esophageal sphincter during high resolution manometry. METHODS: Was evaluated the variation of the basal pressure of the upper esophageal sphincter during high resolution manometry. Were reviewed the high resolution manometry tests of 36 healthy volunteers (mean age 31 years, 55% females). The basal pressure of the upper esophageal sphincter was measured at the beginning and at the end of a standard test. RESULTS: The mean time of the test was eight minutes. The basal pressure of the upper esophageal sphincter was 100 mmHg at the beginning of the test and 70 mmHg at the end (p<0.001). At the beginning, one patient had hypotonic upper esophageal sphincter and 14 hypertonic. At the end of the test, one patient had hypotonic upper esophageal sphincter (same patient as the beginning) and seven hypertonic upper esophageal sphincter. CONCLUSION: A significant variation of the basal pressure of the upper esophageal sphincter was observed in the course of high resolution manometry. Probably, the value obtained at the end of the test may be more clinically relevant. .


RACIONAL: O esfíncter esofagiano superior é constituído de musculatura estriada. O estresse da intubação e a necessidade de coibir as deglutições secas durante a manometria esofágica podem alterar a pressão basal do esfíncter esofagiano superior que geralmente é estudado somente ao final da manometria convencional. Notou-se na manometria de alta resolução significante variação no decorrer do exame. OBJETIVO: Avaliar a variação da pressão basal do esfíncter esofagiano superior durante a manometria de alta resolução. MÉTODO: Foi avaliada a variação de pressão basal do esfíncter esofagiano superior durante manometria de alta resolução. Foram estudados 36 voluntários sadios (idade média de 31 anos, 55% de mulheres). A pressão basal foi aferida no início e ao término do exame. RESULTADOS: O tempo médio dos exames foi de oito minutos. A pressão basal do esfíncter esofagiano superior foi de 100 mmHg no início do exame e de 70 mmHg ao final, em média (p<0.001). No início do teste, um paciente tinha o esfíncter esofagiano superior hipotônico e 14 hipertônicos. No final, um paciente tinha o esfíncter esofagiano superior hipotônico (o mesmo do início) e sete hipertônicos. CONCLUSÃO: Há significante variação na pressão basal do esfíncter esofagiano superior no curso manometria de alta resolução. Provavelmente, o valor obtido ao final do exame possa ser mais clinicamente relevante. .


Assuntos
Adulto , Feminino , Humanos , Masculino , Esfíncter Esofágico Superior/fisiologia , Manometria , Pressão
14.
Braz. j. phys. ther. (Impr.) ; 18(4): 323-333, 08/2014. tab
Artigo em Inglês | LILACS | ID: lil-718135

RESUMO

Objective : This cross-sectional study aimed at analyzing: 1. the main musculoskeletal symptoms (MSS) presented by hospital nursing workers and; 2. personal, occupational, and health factors related to MSS among them. Method : Two questionnaires were filled in by 245 nurse technicians (NTs) and licensed practical nurses (LPNs) (response rate 95%) associated with direct patient care sectors from a hospital. These questionnaires were: the standardized version of the Nordic Musculoskeletal Questionnaire (NMQ) and one including questions on 15 demographic independent variables potentially related to outcomes from the NMQ. Univariate analyses and binary logistic regression analyses were performed to identify which variables would explain the occurrence of MSS in different body regions. Results: The low back (57%), shoulder (52%), and neck (48%) were identified as the most affected regions. The logistic regression analysis showed that low back symptoms in the last 12 months were significantly associated with LPN activities (OR=2.36; CI=1.24-4.5) and previous sick leave due to MSS (OR=5.97; CI=1.2-29.1). Smoking was significantly associated with symptoms in the low back (OR=2.77; CI=1.13-6.8) and thoracic spine (OR=2.37; CI=1.04-5.40). Physical exercise showed a protective effect on the cervical spine (OR=0.42; CI=0.23-0.77). Previous sick leave was significantly associated with pain in the knees (OR=4.24; CI=1.33-13.5) and in the upper limbs (OR=5.36; CI=1.07-26.7). Conclusions: The nursing workers who were evaluated presented a high prevalence of MSS. Previous history of sick leave was strongly associated with the presence of symptoms in various body regions. These results indicate the need for preventive programs in the hospital environment in order to control more severe MSS in nursing professionals. .


Assuntos
Adulto , Feminino , Humanos , Masculino , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Enfermagem , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Estudos Transversais , Técnicos de Enfermagem , Recursos Humanos de Enfermagem Hospitalar , Prevalência , Inquéritos e Questionários
15.
Braz J Phys Ther ; 18(4): 323-33, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25054385

RESUMO

OBJECTIVE: This cross-sectional study aimed at analyzing: 1. the main musculoskeletal symptoms (MSS) presented by hospital nursing workers and; 2. personal, occupational, and health factors related to MSS among them. METHOD: Two questionnaires were filled in by 245 nurse technicians (NTs) and licensed practical nurses (LPNs) (response rate 95%) associated with direct patient care sectors from a hospital. These questionnaires were: the standardized version of the Nordic Musculoskeletal Questionnaire (NMQ) and one including questions on 15 demographic independent variables potentially related to outcomes from the NMQ. Univariate analyses and binary logistic regression analyses were performed to identify which variables would explain the occurrence of MSS in different body regions. RESULTS: The low back (57%), shoulder (52%), and neck (48%) were identified as the most affected regions. The logistic regression analysis showed that low back symptoms in the last 12 months were significantly associated with LPN activities (OR=2.36; CI=1.24-4.5) and previous sick leave due to MSS (OR=5.97; CI=1.2-29.1). Smoking was significantly associated with symptoms in the low back (OR=2.77; CI=1.13-6.8) and thoracic spine (OR=2.37; CI=1.04-5.40). Physical exercise showed a protective effect on the cervical spine (OR=0.42; CI=0.23-0.77). Previous sick leave was significantly associated with pain in the knees (OR=4.24; CI=1.33-13.5) and in the upper limbs (OR=5.36; CI=1.07-26.7). CONCLUSIONS: The nursing workers who were evaluated presented a high prevalence of MSS. Previous history of sick leave was strongly associated with the presence of symptoms in various body regions. These results indicate the need for preventive programs in the hospital environment in order to control more severe MSS in nursing professionals.


Assuntos
Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Enfermagem , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Técnicos de Enfermagem , Masculino , Recursos Humanos de Enfermagem Hospitalar , Prevalência , Inquéritos e Questionários
16.
J Gastrointest Surg ; 18(5): 906-10, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24496746

RESUMO

The Roux-en-Y stasis syndrome is a troublesome postgastrectomy syndrome. Although the era of gastric resection for peptic ulcer disease has almost come to an end, the increasing incidence of proximal gastric cancer and the outbreak of bariatric operations make the study of the motility of the Roux-en-Y limb (RYL) after gastric resection or gastroplasty very relevant.This study aims to evaluate the motility of the RYL after total gastrectomy using high-resolution manometry (HRM). We performed an HRM on 8 patients after total gastrectomy for proximal gastric cancer and Roux-en-Y reconstruction, 74 ± 111 months after the operation. At the time of the study, all patients were asymptomatic without evidence of cancer recurrence.Peristaltic waves were noticed at the RYL in 3 (37%) of the patients. The mean wave amplitude of the peristaltic waves was 63 ± 29 (37-94) mmHg and 83 ± 35 (42-104) mmHg at 3 and 7 cm below the esophagojejunal junction, respectively. Simultaneous waves were noticed in 6 (75%) of the patients in 80 ± 32 % (30-100) of the swallows of these patients. No patient presented with absence of motor activity detectable at the HRM. Our results show that: (1) esophageal motility is normal after total gastrectomy with Roux-en-Y reconstruction; (2) motor activity is always detectable at the proximal RYL, but peristalsis is abnormal in most patients; and (3) absence of peristalsis does not translate into symptoms.


Assuntos
Anastomose em-Y de Roux/efeitos adversos , Deglutição/fisiologia , Esfíncter Esofágico Superior/fisiologia , Gastrectomia/efeitos adversos , Jejuno/fisiopatologia , Peristaltismo/fisiologia , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Manometria , Pessoa de Meia-Idade
17.
J Gastrointest Surg ; 18(2): 221-4; discussion 224-5, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24129827

RESUMO

BACKGROUND: Idiopathic achalasia (IA) and Chagas' disease esophagopathy (CDE) share several similarities. The comparison between IA and CDE is important to evaluate whether treatment options and their results can be accepted universally. High-resolution manometry (HRM) has proved a better diagnostic tool compared to conventional manometry. This study aims to evaluate HRM classifications for idiopathic achalasia in patients with CDE. METHODS: We studied 98 patients: 52 patients with CDE (52 % females, mean age, 57 ± 14 years) and 46 patients with IA (54 % females; mean age 48 ± 19 years). All patients underwent a HRM and barium esophagogram. RESULTS: The Chicago classification was distributed in IA as Chicago I, 35 %; Chicago II, 63 %; and Chicago III, 2 %, and in CDE as Chicago I, 52 %; Chicago II, 48 %; and Chicago III, 0 % (p = 0.1, 0.1, and 0.5, respectively). All patients had the classic Rochester type. CDE patients had more pronounced degrees of esophageal dilatation (p < 0.002). The degree of esophageal dilatation did not correlate with Chicago classification (p = 0.08). In nine (9 %) patients, the HRM pattern changed during the test from Chicago I to II. CONCLUSION: Our results show that (a) HRM classifications for IA can be applied in patients with CDE and (b) HRM classifications did not correlate with the degree of esophageal dilatation. HRM classifications may reflect esophageal repletion and pressurization instead of muscular contraction. The correlation between manometric findings and treatment outcomes for CDE needs to be answered in the near future.


Assuntos
Doença de Chagas/complicações , Acalasia Esofágica/classificação , Manometria/métodos , Adulto , Idoso , Dilatação Patológica/parasitologia , Acalasia Esofágica/parasitologia , Acalasia Esofágica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
World J Surg ; 38(4): 890-6, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24305918

RESUMO

INTRODUCTION: The threshold for pathologic proximal acid reflux is a controversial topic. Most values previously published are based on absolute numbers. We hypothesized that a relative value representing the quantitative relation between the amount of acid reflux that reaches proximal levels and the amount of distal reflux would be a more adequate parameter for defining pathologic proximal reflux. METHODS: We studied 20 healthy volunteers (median age 30 years, 70 % women) without gastroesophageal reflux disease (GERD); 50 patients (median age 51 years, 60 % women) with esophageal symptoms of GERD (heartburn, regurgitation); and 50 patients (median age 49 years, 60 % women) with extra-esophageal symptoms of GERD. All individuals underwent manometry and dual-probe pH monitoring. GERD was defined as a DeMeester score >14.7. The proximal/distal reflux ratio was calculated for all six parameters that constitute the DeMeester score. RESULTS: Absolute numbers for proximal reflux were not different for the three groups except for the number of episodes of reflux, which was higher for patients with GERD and esophageal symptoms than for patients with GERD and extra-esophageal symptoms (p = 0.007). The number of episodes of distal reflux reaching proximal levels was significantly higher in volunteers than in all patients with GERD and significantly higher in patients with GERD and esophageal symptoms than in those with extra-esophageal symptoms. CONCLUSIONS: Our results suggest that the proximal/distal reflux ratio is not a good normative value for defining proximal reflux.


Assuntos
Monitoramento do pH Esofágico , Refluxo Gastroesofágico/diagnóstico , Manometria , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Refluxo Gastroesofágico/fisiopatologia , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade
20.
J Gastrointest Surg ; 17(12): 2033-8, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24078388

RESUMO

INTRODUCTION: The motility of the pharynx, upper esophageal sphincter (UES), and proximal esophagus is still poorly understood. These structures have anatomical and functional peculiarities that hinder the accurate study of their motility with the technology traditionally available. High-resolution manometry (HRM) has characteristics that make it more suitable for the study of the upper digestive tract. This study aims to evaluate in healthy volunteers, using HRM and transnasal pharyngoscopy, (1) the correlation between anatomical landmarks and HRM plots and (2) the normal values for manometric parameters of the pharynx, UES, and proximal esophagus. METHODS: We studied 40 asymptomatic volunteers with HRM (50 % male; median age, 27 years). Fourteen of those also underwent transnasal pharyngoscopy. RESULTS AND DISCUSSION: Pharyngeal peak pressure, rise time, recovery time, and duration of contraction were 128 mmHg (range, 100­164 mmHg), 197 ms (range, 169­268 ms), 385 ms (range, 285­465 ms), and 604 ms (range, 544­626 ms) at the velum and 116 mmHg (range, 97­139 mmHg), 128 ms (range, 100­156 ms), 194 ms (range, 148­219 ms), and 336 ms (range, 267­386 ms) at the epiglottis, respectively. UES extension, basal pressure, residual pressure, and duration of relaxation were 3 cm (range, 2.6­3.6 cm), 76 mmHg (range, 58­109 mmHg), 4.4 mmHg (range, 1.2­6.9 mmHg), and 678 ms (range, 636­757 ms), respectively. In the proximal esophagus, wave amplitudes at 2, 4, and 6 cm below the UES were 72 mmHg (range, 53­97 mmHg), 56 mmHg (range, 42­76 mmHg), and 48 mmHg (range, 35­59 mmHg), respectively. CONCLUSIONS: In conclusion, normal values were established. These values may prove clinically useful and could contribute to future studies with dysphagic patients.


Assuntos
Deglutição/fisiologia , Esfíncter Esofágico Superior/fisiologia , Esôfago/fisiologia , Motilidade Gastrointestinal/fisiologia , Manometria/métodos , Faringe/fisiologia , Adulto , Feminino , Humanos , Masculino , Valores de Referência , Adulto Jovem
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