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Longo Covid-19: avaliação e comparação da qualidade de vida, sarcopenia e proteinúria em pacientes que tiveram apresentação clínica leve e moderada

Thu, 14 Dec 2023 00:00:00 GMT

Título: Longo Covid-19: avaliação e comparação da qualidade de vida, sarcopenia e proteinúria em pacientes que tiveram apresentação clínica leve e moderada Autor: Montenegro, Sayane Marlla Silva Leite Primeiro orientador: Dalboni, Maria Aparecida Abstract: The pandemic caused by the coronavirus (SARS-CoV-2) called COVID-19, was responsible for high hospitalization and mortality rates. Patients recovered from COVID-19 (long COVID-19), especially those who were admitted to the ICU, report tiredness, dyspnea, muscle pain; which are associated with worse quality of life. However, there are few reports evaluating long COVID-19 in its sequelae regarding quality of life, sarcopenia and proteinuria in individuals with mild and moderate clinical presentation. Objective: To evaluate and compare quality of life, sarcopenia and proteinuria in patients with long COVID-19 according to mild and moderate clinical presentation. Methods: Quantitative and longitudinal study. We evaluated 253 individuals with mild (n=119) and moderate (n=134) clinical presentation for COVID-19 (positive RT-PCR) after 6 (T6) and 12 (T12) months from the date of acute infection. Quality of life was assessed using the Short Form 36 (SF – 36) questionnaire, pain using the visual analogue scale (VAS), risk of sarcopenia using the Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC-F), functionality using the Dominant Palm Grip Strength (HGS), Sit – Up (sit and stand), and with the aid of the Duke Activity Status Index Questionnaire (DASI) and proteinuria using a urinalysis strip. Results: The average age was 44±10 and 43±12 years; female 68% and 59% for the mild and moderate groups, respectively. 75% or more of patients were vaccinated with at least 2 doses before acquiring COVID-19 infection. Individuals with a moderate clinical presentation in relation to mild cases were: hypertensive (23% and 6%, p < 0.001) and with diabetes mellitus (9% and 2%; p = 0.01) at the time of COVID-19 infection. The moderate group showed a statistically significant difference at T6: lower functional capacity (SF36: 46±20 vs. 61±24); more pain (SF36: 45±29 vs. 67±32 and VAS: 55% vs. 32%); greater dysfunctionality for daily activities (DASI: 40±11 vs. 45±10); lower number of repetitions for lower limb muscle strength (Sit-up: 9±2 vs. 11±2); higher sarcopenia score (SARC-F: 6±4 vs. 4±3) and higher proteinuria ≥1”+”: 59% vs. 42%) compared to the mild group. After 12 months, the moderate group remained with greater pain (SF36+VAS) and more dysfunctionality in daily activities (DASI) compared to the mild group. Comparing T12 to T6, we observed that the mild group had worse functional capacity; more pain (SF36+VAS); lower FPP and higher proteinuria ≥1”+”: 63% vs. 42%). The moderate group had lower HGS; greater 10 number of repetitions for the Sit-up at T12 compared to T6. We observed that individuals who had a higher SARC-F score showed a negative correlation with upper limb strength (Handgrip/FPP); lower limbs (Sit-up); functional capacity (SF36); dysfunction for daily activities (DASI). Conclusion: our results show that individuals who had mild and moderate presentation at the time of COVID-19 infection had long-term COVID-19 sequelae. However, the moderate group had greater pain sequelae at T6 and T12 and a greater risk of sarcopenia after 6 months, reduced muscle strength, which may contribute to a worse quality of life for these individuals. Furthermore, the presence of proteinuria for both groups is a warning to evaluate renal function; through other biomarkers to determine whether this proteinuria is transient or whether the infection caused by SARS-CoV-2 may be a risk factor for loss of kidney function and progression of kidney disease. Therefore, it is necessary to develop strategies for physical rehabilitation and follow-up assessment of renal filtration function in this population. Instituição: Universidade Nove de Julho Tipo do documento: Tese

Efeitos do treinamento em ergômetro de braço na pressão arterial ambulatorial em pacientes com doença arterial periférica

Tue, 13 Jun 2023 00:00:00 GMT

Título: Efeitos do treinamento em ergômetro de braço na pressão arterial ambulatorial em pacientes com doença arterial periférica Autor: Costa, Renan Massena Primeiro orientador: Correia, Marilia de Almeida Abstract: Patients with peripheral artery disease (PAD) are at high risk of fatal and non-fatal cardiovascular events. Strategies that help reduce cardiovascular risk in these patients are necessary to improve the health and quality of life of these patients. Studies with arm crank (AC) training have shown benefits in the functional capacity of patients with PAD, bypassing the main barrier to exercising in these patients, pain. However, the effect of this type of training on indicators of cardiovascular function, such as ambulatory blood pressure, is not yet established. Therefore, the aim of the present study was to analyze the effects of AC training on ambulatory blood pressure in patients with PAD and to compare it with the current exercise recommendation, walking training (WT). In this randomized controlled clinical trial, patients were randomly allocated into three experimental groups: AC training, WT and control group (CG). The AC and WT groups performed two weekly sessions with an intensity equivalent to 13-15 on the Borg subjective perception of exertion scale. Patients in the CG attended twice a week just to carry out various activities and socializing in a group, with no exercise involved. In addition, all groups were encouraged to increase their level of physical activity, which is usually the guideline in clinical management. Prior to the start and after 12 weeks of intervention, the following indicators of ambulatory blood pressure systolic (SBP), mean (MAP) and diastolic (DBP) were obtained: 24-hour mean, waking period, sleeping period, morning rise, nocturnal pressure load and mean real variability. For the analysis, the generalized estimation equations were used, having as factors the groups (AC, WT and CG) and the times (pre and post-intervention) and P <0.05 as significance. All groups started from the same ambulatory blood pressure values. After 12 weeks, it was possible to observe an interaction effect on the 24-hour DBP with a post hoc effect only on the AC [pre 78 (10) vs. powder 72 (5) mmHg, p=0.005]; in the MAP of wakefulness in [AC: pre 94 (11) vs. post 96 (11), p=0.044] and [WT: pre 94 (11) vs. post 96 (11) mmHg, p=0.044]; in wakefulness DBP of the AC group [pre 81 (11) vs. powder 76 (14) mmHg, p=0.001]; in the 24-hour DBP pressure load [AC: pre 45 (42) vs. powder 24 (35) %, p=0.016]; in the real mean variability of DBP [AC: pre 9 (3) vs. powder 8 (2); and WT pre 7 (3) vs. after 8 (3), CG: pre 7 (4) vs. after 7 (3), p=0.018. In the other variables, it was not possible to observe significant effects. In conclusion, the preliminary results of this clinical trial demonstrate that 12 weeks of AC training possibly reduces 24h DBP and waking DBP and MAP, DBP values in real mean variability and 24h pressure load in patients with PAD and symptoms of intermittent claudication. Instituição: Universidade Nove de Julho Tipo do documento: Dissertação

Estudo dos hormônios tireoidianos em uma unidade de terapia intensiva obstétrica

Fri, 15 Dec 2023 00:00:00 GMT

Título: Estudo dos hormônios tireoidianos em uma unidade de terapia intensiva obstétrica Autor: Motta, Míriam Duarte de Arruda Primeiro orientador: Camacho, Cleber Pinto Abstract: Physiological changes in thyroid function during pregnancy are important for maintaining homeostasis. It is estimated that hypothyroidism occurs in 4% of pregnancies (0.5% true hypothyroidism and 3.5% subclinical hypothyroidism) and hyperthyroidism occurs in 2.4% of pregnancies (0.6% true hyperthyroidism and 1 .8% subclinical hyperthyroidism). Because thyroid hormones have many effects on cardiovascular and renal physiology, thyroid dysfunction can have a significant impact on critically ill patients in the Intensive Care Unit (ICU). Our objective is to evaluate the degree of association between hormonal concentrations and clinical repercussions (age, weight, BMI, gestational age, complications and death) in critically ill pregnant women, according to the severity criteria of the APACHE II Prognostic and Mortality Score and compare the different reference methods of values of thyroid hormones (THs) in the diagnosis of thyroid dysfunctions, such as hypothyroidism, hyperthyroidism and sick euthyroid syndrome in pregnant women admitted to the ICU. Materials and methods: 1425 pregnant women admitted to the ICU, from January 2018 to December 2022, were evaluated and 160 pregnant women with thyroid hormones measured at admission were included. The study is retrospective, therefore, we used data from medical records of women with clinical diseases during the period of admission to the ICU, such as sepsis, diabetes mellitus, cardiovascular disorders, bleeding disorders, hydroeletrolytic disorders, obstetric infection, SARS CoV-2 infection, respiratory disorders, pregnant women with eclampsia and severe pre-eclampsia (PE). The women were divided into groups according to TSH and free T4 values, according to the values of the established laboratory test, and evaluated using the Hoffman mathematical method compared with the prognostic scores used in ICUs and their complications. Based on the results obtained, all the complications were significant in Q-square test. The hemodynamic instability, respiratory failure, uterine hemorrhage, fetal death and psychological disorders were significant in many Analysis. The conclusion was na evidente association between thyroid hormones and BMI, gestational age through Ultrasound and some complications observed in the obstetric ICU, as respiratory failure, hemodynamic instability uterine hemorrhage and fetal death, ix suggest that hormonal dosage can be used as a predictor of complications in obstetric therapy. Instituição: Universidade Nove de Julho Tipo do documento: Tese

Composição da lipoproteína de densidade alta (HDL) e sua capacidade em remover colesterol celular estão associadas ao risco reduzido de desenvolvimento de artrite reumatoide

Wed, 27 Nov 2024 00:00:00 GMT

Título: Composição da lipoproteína de densidade alta (HDL) e sua capacidade em remover colesterol celular estão associadas ao risco reduzido de desenvolvimento de artrite reumatoide Autor: Giacaglia, Marcia Benacchio Primeiro orientador: Passarelli, Marisa Abstract: In rheumatoid arthritis (RA), the risk of cardiovascular death is 50% higher compared to the general population. This increased risk is partly due to the systemic inflammation characteristic of RA and changes in the lipoprotein profiles. This study investigated plasma lipid levels, lipid ratios, and the composition and functionality of high-density lipoprotein (HDL) in control individuals and RA subjects based on the disease’s inflammatory score (DAS28). HDL was isolated from fasting plasma by ultracentrifugation from individuals with RA (n=56) and control individuals (n=50) matched by age, sex and body mass index (BMI). Of the 56 participants with RA, 13 (23%) were in remission/low disease activity and 43 (77%) had active disease. Plasma lipids (total cholesterol, TC; triglycerides, TG) and HDL composition (TC; TG; phospholipids, PL) were determined using enzymatic methods; apolipoprotein B (apoB) and apolipoprotein A-1 (apoA-1), by immunoturbidimetry. Macrophages differentiated from cells obtained from the bone marrow of mice were loaded with cholesterol and then exposed to HDL from individuals in the RA and control groups for 24 h. After washing, the cells were incubated with lipopolysaccharides (LPS), as an inflammatory insult, for 24 h. The concentration of interleukin-6 (IL-6) and tumor necrosis factor (TNF) was determined in the culture medium by ELISA. Cellular cholesterol removal by HDL was determined in macrophages previously overloaded with cholesterol and 14C-cholesterol. Comparisons were made using the Mann–Whitney test, and binary logistic regression was used to identify the predictors of active RA. A p-value < 0.05 was considered significant. Plasma concentrations of low-density lipoprotein (LDLc), apoB and TG, and TG/HDLc were similar between the RA and CTR groups. Higher plasma concentrations of TC and HDLc, TC/apoB, and higher content of PL and apoA-1 in HDL were observed in total RA group. Subjects with active disease exhibited higher levels of TG and the TG/HDLc ratio; and lower levels of HDLc, the TC/apoB ratio, and TC and apoA-1 content in HDL particles compared to those with remission/low-activity RA. Increased levels of HDLc [odds ratio (OR) 0.931, 95% CI = 0.882–0.984], TC/apoB (OR 0.314, 95% CI = 0.126–0.78), and HDL particle content in TC (OR 0.912, 95% CI = 0.853–0.976), PL (OR 0.973, 95% CI = 0.947–1.000), and apoA-1 (OR 0.932, 95% CI = 0.882–0.985) were associated with a decreased risk of active disease, but BMI (OR 1.169, 95% CI = 1.004–1.360) and TG (OR 1.031, 95% CI = 1.005–1.057) were positively associated with active disease. There was no difference in IL-6 and TNF concentrations between the groups. A reduction in HDL-mediated cholesterol efflux increased the OR for active RA by 26.2%. The plasma levels of HDLc, along with the composition and functionality of HDL, influence the inflammatory score in RA and may affect the development of cardiovascular disease. Instituição: Universidade Nove de Julho Tipo do documento: Tese