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- ItemAcesso aberto (Open Access)Aplicativo com escores múltiplos para Síndrome Coronariana Aguda (Cardio SCA Score app)(Universidade Federal de São Paulo (UNIFESP), 2021) Albuquerque, Mauro Guimaraes [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São PauloIntrodução: As síndromes coronarianas agudas estão entre as principais causas de óbito no mundo. Nesse contexto, surgiram modelos de predição de risco para a tomada de decisão quanto à terapêutica, transferências,realização de exames, internação e gestão de recursos hospitalares. Objetivo: Desenvolver um aplicativo de múltiplos escores de síndrome coronarianas agudas. Método: O estudo seguiu a metodologia Design Thinking, com as fases: Descobrir – Foram realizadas busca na literatura médica no MEDLINE, Cochrane, LILLACS e SCieLO; busca de anterioridade no World Intelectual Property Organization, United States Patent and Trademark Office, Instituto Nacional de propriedade Intelectual e busca por apps no App Store e Play Store. Também foram aplicados questionários a 25 médicos que atendiam síndromes coronarianas agudas. Definir – Foram definidas as características necessárias ao aplicativo em uma sessão de brainstorming e foi selecionada a equipe de informática. Desenvolver – Foi criado e testado um protótipo com especialista em informática. Entregar – Foi produzido o aplicativo. Resultado: O protótipo criado teve sua usabilidade comprovada pelo System Usability Scale – SUS (escore 81.8) e foi aperfeiçoado com os dados obtidos na fase descobrir e fontes das mais atualizadas diretrizes da Sociedade Brasileira de Cardiologia, European Society of Cardiology e American Heart Association/American Colegy of Cardiology, resultando num app com oito tópicos: conceitos, classificação de IAM, dor torácica, ECG, fármacos, escores, terapêuticas e referências. Conclusão: Foi desenvolvido o Cardio SCA Score App – Aplicativo com escores múltiplos para síndrome coronariana aguda.
- ItemSomente MetadadadosAssociação De Múltiplas Variantes Genéticas Com A Extensão E Gravidade Da Doença Coronária(Universidade Federal de São Paulo (UNIFESP), 2017-02-24) Fischer, Simone Cristina Pinto Matheus [UNIFESP]; Izar, Maria Cristina De Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: Cardiovascular diseases, mainly ischemic heart disease and stroke, respond for the majority of deaths worldwide. Sedentary lifestyle and industrialized foods have determined na increase in metabolic diseases and cardiovascular risk. The concept of metabolic syndrome (MS) has emerged, and patients after an acute coronary syndrome (ACS) are associated with greater anatomic obstruction in the coronary tree. Despite the strong environmental influence, MS can be influenced in each componente by genetic variants. Polymorphisms related to lipid metabolism, lipid peroxidation, increase in blood pressure levels, and vascular reactivity can interact with environment to determine greater severity of coronary atherosclerosis in individuals with MS, acting sinergistically, even though the individual contribution of each genetic variant is small. Thus. The aim of this study was to examine the contribution of genetic polymorphisms on the extension and severity of coronary disease in subjects with MS and recente ACS. METHODS: One-hundred and sixteen patients of both genders, with three ormore criteria for MS (NCEP III) were prospectively evaluated, in the hospitalization period after na ACS. In this cross sectional study we performed clinical evaluation, laboratory parameters, assessment of inflammation and hemostasia markers, TBARS (thiobarbituric acid reactive substances), adiponectin, endotelial function (FMD). The extension and severity of coronary disease was assessed by measuring the Gensini score. Polymorphisms of the genes encoding paraoxonase-1 (PON-1), methylenotetrahydrofolato reductase (MTHFR), endothelial nitirc oxide sintase (ENOS), angiotensin-converting enzyme (ECA), angiotensin II type 1 receptor (AT1R), apolipoprotein C3 (APOC3), lipoprotein lipase (LPL) were analysed using PCR-RFLP, with data presented according to genotype distribution. Statistical analyses used Chisquare, or Fisher’s exact test, for categorical variables and to test for deviation of the Hardy-Weinberg equilibrium. Numerical variables were compared by Student’s t testo r Mann-Whitney test, when appropriate. Pearson’s correlation test was also used. Significance was set at a P-value < 0.05. RESULTS: One-hundred and sixteen patients with MS in the hospital phase after na ACS, aging 56 + 9 years, 68% males, were evaluated. Polymorphisms of PON-1, MTHFR and ENOS were not in Hardy-Weinberg equilibrium. Many genotypes were associated with clinical variables, such as heart rate, diastolic blood pressure, or laboratory parameters like C-reactive protein, glycated hemoglobin, adiponectin, coagulation and fibrinolysis, in addition to associations with hormones or hepatic and muscle enzymes. Only the DD genotype of the D9N polymorphism of LPL was associated with greater severity and extension of coronary lesions. Genetic score was greater in patients with Gensini score < P50 (13.7 + 1.5 vs. 13.0 + 1.6, P=0.066). There was a weak inverse correlation between genetic score and Gensini score (R=-0.194, P=0.078). CONCLUSION: The polymorphisms studied had small contribution to the extension and severity of coronary disease. Only the D9N polymorphism of LPL has contributed to the severity of coronary disease in patients with MS after na ACS. Combined analyses of these polymorphismspresented weak association with severity of coronary disease, being the disease more severe with lower genetic score.
- ItemAcesso aberto (Open Access)Association of cardiovascular risk factors with thedifferent presentations of acute coronary syndrome(Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2014-08-01) Brunori, Evelise Helena Fadini Reis; Lopes, Camila Takáo [UNIFESP]; Cavalcante, Agueda Maria Ruiz Zimmer; Santos, Vinicius Batista; Lopes, Juliana de Lima [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: to identify the relationship between different presentations of acute coronary syndrome and cardiovascular risk factors among hospitalized individuals. METHOD: cross-sectional study performed in a teaching hospital in São Paulo, in the State of São Paulo (SP). Socio-demographic, clinical and anthropometric data of 150 individuals hospitalized due to acute coronary syndrome were collected through interviews and review of clinical charts. Association between these data and the presentation of the syndrome were investigated. RESULTS: there was a predominance of ST segment elevation acute myocardial infarction. There was significant association of systemic hypertension with unstable angina and high values of low density lipoprotein with infarction, without influence from socio-demographic characteristics. CONCLUSION: arterial hypertension and high levels of low-density lipoprotein were associated with different presentations of coronary syndrome. The results can provide support for health professionals for secondary prevention programs aimed at behavioural changing.
- ItemSomente MetadadadosEficácia Da Redução No Tempo De Imobilização No Leito Em Pacientes Com Síndrome Coronariana Aguda Após Angioplastia Coronariana:Ensaio Clínico Randomizado(Universidade Federal de São Paulo (UNIFESP), 2018-02-22) Santos, Vinicius Batista [UNIFESP]; Barros, Alba Lucia Bottura Leite De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Percutaneous Coronary Intervention (Pci) Is The Treatment Performed In Patients With Coronary Artery Disease, Especially In Patients With Acute Coronary Syndrome (Acs). The Nursing Care In These Patients After Performing This Treatment Is The Maintenance Of The Supine Position For An Average Period Of Four Hours After Removal Of Femoral Artery Sheath. This Care Has The Purpose Of Preventing Vascular Complications, But This Immobility Time May Cause Discomfort (Back Pain, Low Back Pain, Paresthesia And Difficulty In Urination) And Greater Need For Analgesic Drugs, But There Is No Consensus Concerning The Ideal Time Of Immobility In Acs Patients Who Underwent Pci By The Femoral Artery. Objective: To Evaluate The Efficacy Of Reduction In The Immobility Time In Bed From Four To Two Hours After Sheath Removal Of The Femoral Artery In Patients With Acs Undergoing Pci. Method: This Was A Randomized Clinical Trial, Including Patients With Acs Who Underwent Pci Through Femoral Artery, Being Randomized By
- ItemSomente MetadadadosQualidade do sono e sonolência diurna de pacientes atendidos em unidades de terapia intensiva(Universidade Federal de São Paulo (UNIFESP), 2021) Higa, Karina Thalita Da Silva [UNIFESP]; Avelar, Ariane Ferreira Machado [UNIFESP]; Universidade Federal de São PauloIntroduction: Since the beginning of nursing, Florence Nightingale has emphasized the need for care that promotes the light-dark cycle for the recovery of sick patients. In intensive care environments, the absence of this cycle is common due to care and administrative demands. Objectives: To identify the available scientific evidence on the effect of implementing the light-dark cycle on sleep quality and daytime sleepiness of patients seen in intensive care units, and to evaluate the perception of sleep quality and daytime sleepiness of patients admitted for acute myocardial infarction in a intensive care unit and identify the illuminance levels of the unit. Methods: a study developed in two stages: A systematic review with meta-analysis and a descriptive study. The review followed the Cochrane recommendations, including experimental and quasi-experimental studies on the effect of implementing the light-dark cycle on sleep quality in patients admitted to intensive care. The searches were carried out at the Cochrane Library, Embase, Virtual Health Library Portal, Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Scopus, in addition to searching the gray literature. The data were extracted by two independent reviewers with the Covidence software, assessed the risk of bias with Cochrane tools, and certainty of the evidence for the outcomes subjective and objective quality of sleep and daytime sleepiness by GRADE. The meta-analysis was performed using the Revman software and direct comparisons between two interventions using the random-effects model with heterogeneity assessed by the Chi-square with a 95% confidence interval. The descriptive study was carried out with patients admitted for acute myocardial infarction in a cardiac intensive care unit of a university hospital in São Paulo, evaluating the perception of sleep quality and daytime sleepiness with a Sleep Assessment Questionnaire in Cardiac Intensive Care, Morningness - Eveningness Questionnaire, Epworth Sleepiness Scale and Stanford Sleepiness Scale. Results: 13 articles were included in the systematic review and seven in the meta-analysis that addressed light reduction measures and the use of eye masks with or without other devices. The reduction in luminosity associated with the control of environmental noise versus the usual routine obtained statistical significance in the improvement of scores of subjective sleep quality (mean difference of 11.89 points; 95% CI 8.03 to 15.76) and in the reduction of daytime sleepiness (standardized mean difference -0.63 standard deviations; 95% CI -0.98 to -0.28). The use of eye masks and lighting control improved the subjective quality of sleep (p <0.01). In the descriptive study, the sample consisted of eight patients, with an average score on the Epworth sleepiness scale of 6.88 ± 3.4 points; 87.5% of the patients reported having their sleep interrupted mainly by the health team (85.7%). Most (62.5%) were classified as having good sleep and 37.5% as being regular, with 25% of patients indicating that lighting interferes with sleep. Conclusions: Environmental factors interfere with the quality of sleep and excessive sleepiness of patients admitted to intensive care units and the institution of measures such as reduced light and noise at night significantly improve these outcomes.