Orientadores: Raquel Silveira Bello Stucchi, Ilka de Fátima Santana Ferreira Boin / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T05:37:24Z (GMT). No. of bitstreams: 1 Limongi_Vivian_M.pdf: 4966241 bytes, checksum: 5286830ea48e718dfac3a565a7b7f54a (MD5) Previous issue date: 2014 / Resumo: Os candidatos à transplante de fígado podem apresentar desnutrição, fadiga, perda de massa e função muscular. A associação desses fatores induz à deficiência motora global e à inatividade física. O objetivo do estudo foi avaliar o perfil dos candidatos à transplante de fígado acompanhados no Gastrocentro - UNICAMP, bem como os efeitos de um programa de intervenção respiratória fisioterapêutica nesta população. Foram avaliados a PImáx e PEmáx por manovacuometria, atividade elétrica muscular do reto abdominal e diafragma por eletromiografia de superfície e anotados os valores de RMS quando solicitado uma respiração forçada a cada três segundos. A função pulmonar foi avaliada pela espirometria e a qualidade de vida pela aplicação do questionário SF-36. Participaram do estudo do perfil 62 pacientes, 74,2% do sexo masculino, idade 55,5±9,5 anos e MELD corrigido 18,6±5,1. A maioria com diagnóstico de cirrose por HVC (24,2%). Mais da metade (56,4%) eram ex-tabagistas, 72,6% ex-etilistas, 46,8% relataram dispneia, e a ascite esteve presente em 40,3% dos indivíduos. Houve diferença significante (p=0,017) entre a PImáx mensurada e PImáx predita para idade e gênero. Os pacientes apresentaram em média valores acima de 80% do predito para as variáveis obtidas por meio da espirometria e baixa pontuação em todos os domínios do questionário SF-36. Dos 62 pacientes, foram randomizados 37 pacientes para constituírem os grupos controle e intervenção, sendo que 23 participaram do grupo controle e 14 do grupo intervenção. As avaliações foram realizadas antes da intervenção, e após três meses desta. Os exercícios foram supervisionados à distância, mensalmente sempre pelo mesmo observador. A intervenção consistiu de um manual ilustrativo e explicativo a ser seguido em casa, com os exercícios de respiração diafragmática; exercício isométrico diafragmático, Threshold IMT®; elevação de membros superiores com bastão e fortalecimento dos abdominais. Todos os exercícios foram realizados em três séries, 15 repetições. Para treinamento com o Threshold IMT® foi utilizada uma carga de 23 a 40 cmH2O, ajustada para cada paciente de acordo com a sua tolerância. Durante os três meses, o indivíduo treinou com a mesma carga estabelecida na avaliação inicial. Houve aumento significativo (p=0,017) da PImáx no grupo controle e grupo intervenção após três meses; bem como nos domínios do SF-36, Estado Geral de Saúde (p=0,019) e Saúde Mental (p=0,004). O RMS do diafragma diminuiu no grupo intervenção (p=0,001) e houve aumento do escore de Capacidade Funcional (p=0,006) no tempo final, comparado ao grupo controle. Concluindo, o estudo do perfil dos pacientes em lista de espera para transplante de fígado revelou que eles apresentavam força muscular inspiratória diminuída em comparação ao predito para idade e gênero, função pulmonar preservada e a qualidade de vida prejudicada. A intervenção proposta foi capaz de melhorar a força muscular inspiratória dos pacientes, e consequentemente, reduzir a atividade elétrica do diafragma. Além disso, o grupo intervenção apresentou melhora na qualidade de vida, principalmente no escore Capacidade Funcional do SF-36 / Abstract: Candidates for liver transplantation may have malnutrition, fatigue, loss of muscle mass and function. The combination of these factors leads to global motor impairment and physical inactivity. The aim of the study was to evaluate the profile of candidates for liver transplantation followed at Gastrocentro - UNICAMP, and evaluate the effects of a program of respiratory physiotherapy intervention in this population. MIP and MEP were assessed by manometer, electrical muscle activity of the rectus abdominis and diaphragm was measured by surface electromyography, the RMS values were noted every three seconds, in this period the patient made forced breath. The pulmonary function was evaluated by spirometry and the SF-36 questionnaire was applied. The study of profile evaluated 62 patients, 74,2% males, age 55,5±9,5 and corrected MELD 18,6±5,1. Cirrhosis due to HCV was found in most patients (24,2%). More than half of the patients (56,4%) were former smokers, 72,6% were ex-alcoholics, 46,8% reported dyspnea, and ascites was present in 40,3% of patients. There was a significant difference (p=0,017) between the measured MIP and MIP predicted for age and gender. Patients had a mean values above 80% of predicted for the variables obtained by spirometry and low scores in all domains of the SF-36. Of the 62 patients, 37 patients were randomized to constitute the control and intervention groups, of which 23 participated in the control group and 14 in the intervention group. Evaluations were performed before the intervention, and three months after that. The exercises were supervised from a distance, monthly by the same observer. The evaluations were conducted before the intervention, and after three months of it. The intervention consisted of an explanatory and illustrative manual to be followed at home with diaphragmatic breathing exercises, diaphragmatic isometric exercise, Threshold IMT®, lifting upper with bat and strengthening the abdominals. All exercises were performed in three sets, 15 repetitions. For training with Threshold IMT®, a load 23-40 cmH2O adjusted for each patient according to their tolerance was used. During the three months, the subject trained with the same charge established in the initial evaluation. A significant increase of MIP (p=0,017) was found in bouth groups after three months; as well as in domains of SF-36, General Health (p=0,019) and Mental Health (p=0,004). The RMS of the diaphragm decreased in the intervention group (p=0,001) and the score of Functional Capacity increased (p=0,006) at the end of time, compared to the control group. In conclusion, the study of the profile of patients on the waiting list for liver transplantation revealed that they had decreased inspiratory muscle strength compared to the predicted for age and gender, lung function preserved and impaired quality of life. The proposed intervention was able to improve inspiratory muscle strength of patients, and hence reduce the electrical activity of the diaphragm. In addition, the intervention group showed improvement in quality of life, especially in the Functional Capacity, a SF-36 domain / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

Charles University, Faculty of Pharmacy in Hradec Kralové Department of Social and Clinical Pharmacy Author Anna Faltysová Supervisor PharmDr. Jitka Pokladníková, Ph.D. Consultant PharmDr. Julie Zubrová Title of Diploma Thesis Analysis of the risks associated with using dietary supplements by patients in pre-operative period Objectives: The thesis deals with the problem of the dietary supplement use by patients in the time before surgery. The aim of the thesis is to evaluate the prevalence of dietary suplement use by patients before surgery. Another aim is to point to potential danger which could endanger the patient while irrational using of the dietary supplement before the medical interventions (interactions of dietary supplement, side effects of dietary supplement). Methodology: The questionnaire research was conducted in order to obtain the data. It was counducted between 9th May 2017 till 30th June 2018 at 9 departments of the University Hospital in Hradec Králové. In total 332 patients in the time before surgery were asked and 257 completed questionnaires were analysed. Results: From the results of the study we can see the prevalence of the dietary supplement use by the patients in the time before surgery, which amounts to 42 %. It was stated that most of the patients does not inform their...