Promoção da adesão ao regime terapêutico da pessoa com doença mental grave

Com o presente Relatório de Estágio pretendo dar a conhecer a experiência e o trabalho desenvolvido durante o percurso de estágio de Enfermagem de Saúde Mental e Psiquiátrica. Assente nos modelos teóricos de enfermagem de Hildegard Peplau e Betty Neuman, tendo como finalidade a “Promoção da adesão ao regime terapêutica da pessoa com doença mental grave”, definiu-se como objetivos gerais: Promover a adesão ao regime terapêutico da pessoa com doença mental grave e Adquirir competências do enfermeiro especialista em enfermagem de saúde mental e psiquiátrica. Em contexto de internamento e em hospital de dia, através da realização de intervenções especializadas de enfermagem, nomeadamente de âmbito psicoterapêutico e psicoeducacional. As intervenções foram centradas na Pessoa com abordagem do domínio relacional baseada na empatia, respeito e autenticidade, considerando as características, competências, necessidades e recursos do utente e do grupo. A avaliação da eficácia das intervenções foi realizada através da observação de comportamento e atividades realizadas após a sessão

Prognostic Value of VEGF in Patients Submitted to Percutaneous Coronary Intervention

The authors gratefully acknowledge the assistance of the staff of Servico de Cardiologia, Hospital de Santa Marta, and Ms. Rute Pinheiro for the help with laboratory work. The study was financially supported by Fundacao para a Ciencia e Tecnologia, PIC/IC/82734/2007 Contract and SFRM/BPD/6308/2009 Grant, and by Liga dos Amigos do Hospital de Santa Marta.We examined the longitudinal changes of VEGF levels after percutaneous coronary intervention for predicting major adverse cardiac events (MACE) in coronary artery disease (CAD) patients. VEGF was measured in 94 CAD patients' serum before revascularization, 1-month and 1-year after. Independently of clinical presentation, patients had lower VEGF concentration than a cohort of healthy subjects (median, IQ: 15.9, 9.0-264 pg/mL versus 419, 212-758 pg/mL; P < 0.001) at baseline. VEGF increased to 1-month (median, IQ: 276, 167-498 pg/mL; P < 0.001) and remained steady to 1-year (median, IQ: 320, 173-497 pg/mL; P < 0.001) approaching control levels. Drug eluting stent apposition and previous medication intake produced a less steep VEGF evolution after intervention (P < 0.05). Baseline VEGF concentration <40.8 pg/mL conveyed increased risk for MACE in a 5-year follow-up. Results reflect a positive role of VEGF in recovery and support its importance in CAD prognosis.publishersversionpublishe

T lymphocytes alterations are associated with oxidized LDL, troponin T, white blood cells and C-reactive protein during acute myocardial infarction

BACKGROUND: Auto-immune responses are associated with oxidized LDL (ox-LDL) release, a key factor in plaque destabilization. Data on the relationship between ox-LDL and T lymphocytes in human populations remains scarce. T cells also react with other molecules from the lesion and/or damage the myocardium. OBJECTIVE: The objective of the present study was to examine the relationship between circulating T lymphocytes, ox-LDL, markers of myocardial necrosis (cTnT), myocardial dysfunction (N-terminal pro-brain natriuretic peptide – NT-proBNP) and inflammation (C-reactive protein – CRP) in the setting of acute myocardial infarction. METHODS: A longitudinal study of 55 patients with ST-elevation myocardial infarction (STEMI) were evaluated at three time points: admission, 2 and 40 days following admission, together with 30 patients with stable angina (SA) and 56 subjects without coronary artery disease serving as controls (CTR). RESULTS: STEMI patients had maximal ox-LDL values and minimal levels of CD3+ T lymphocytes at admission, which was normalized during the recovery period. The increasing trend of CD3+ T cells was positively associated with an ox-LDL decline over time. CRP and cTnT longitudinal variations were negatively associated with the CD3+ T-cell increasing trend. These associations were not found in SA patients or controls. CONCLUSIONS: The associations found between CD3+ T lymphocytes, ox-LDL and cTnT suggest a specificity of the immune response in AMI towards arterial and myocardial inflammation and remodelling.This work was supported by the Fundação para a Ciência e Tecnologia (SFRM/BPD/6308/2009 and PIC/IC/82734/2007); and by Liga dos Amigos do Hospital de Santa Marta.publishe

Stratification of ST-elevation myocardial infarction patients based on soluble CD40L longitudinal changes

© 2016 Elsevier Inc. All rights reserved.Involvement of soluble CD40 ligand (sCD40L) in thrombosis and inflammation on the context of coronary artery disease is currently being revised. In that perspective, we had studied the association of sCD40L with markers of platelet activation and markers of endothelial and vascular function. On that cohort, a stratification of patients with acute myocardial infarction (AMI) 1 month after percutaneous coronary intervention (PCI) was observed based on concentrations of sCD40L. The study intended to identify the groups of AMI patients with different profiles of sCD40L concentrations and verify how medication, clinical evolution, biochemical data, and markers of regulation of endothelial function at genetic (endothelial nitric oxide synthase polymorphisms) and post-transcriptional levels (circulating microRNAs) affect sCD40L serum levels. Lower quartiles of sCD40L (,2.3 ng/mL) were associated with higher concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), high frequency of G894T polymorphism, and altered expression of a set of microRNAs assumed to be involved in the regulation of endothelial and cardiac function and myocardium hypertrophy, relative to patients in sCD40L upper quartiles. A characteristic sCD40L variation pattern in STEMI patients was identified. Low levels of sCD40L 1 month after PCI distinguish STEMI patients with worse prognosis, a compromised cardiac healing, and a persistent endothelial dysfunction, as given by the association between sCD40L, NT-proBNP, G894T polymorphism, and specific profile of miRNA expression. These results suggest sCD40L could have a prognostic value in STEMI patients.The work was financially supported by Fundação para a Ciência e Tecnologia (SFRM/BPD/6308/2009 and UID/BIO/04565/2013) and Liga dos Amigos do Hospital de Santa Marta.info:eu-repo/semantics/publishedVersio

Prognóstico do duke-escore versus cintilografia em pacientes com fatores de risco para doença arterial coronariana: seguimento de um ano Prognosis of duke treadmill score versus scintilography in patients at risk for coronary artery disease: one year follow-up

OBJETIVO: Determinar a sensibilidade, a especificidade e o risco de eventos cardiovasculares em pacientes com Duke-escore (DE) baixo, intermediário e alto risco, em comparação com a presença (ou não) de defeitos de perfusão à cintilografia do miocárdio. MÉTODOS: Estudo prospectivo, consecutivo, com 173 pacientes com 2 ou mais fatores de risco para doença arterial coronariana (DAC), que foram submetidos à cintilografia de perfusão do miocárdio com tetrofosmin marcado com tecnécio-Tc 99m (CPM) e ao teste ergométrico (aplicando-se o DE), de um bairro de Curitiba, entre janeiro de 2003 a fevereiro de 2004. Os pacientes tiveram seguimento de 13±1 meses e 162 completaram o acompanhamento. Foi avaliada a presença de morte, angina, infarto agudo do miocárdio, angioplastia coronariana e revascularização do miocárdio. RESULTADOS: A média do DE dos pacientes que apresentaram eventos (18) foi de -0,27 (95% IC= -3,97 a +3,91) e daqueles livres de eventos (144) foi de +4,92 (95% IC= +4,03 a +5,81), com p<0,00069. A sensibilidade do DE foi de 72,22% e da CPM foi de 77,78%, sem diferença estatística, com p=0,21. A especificidade do DE foi de 54,17% e a da CPM foi de 88,19%, com p<0,0001. A curva de Kaplan-Meier demonstrou que 94% dos pacientes com DE baixo risco permaneceram livres de eventos em 01 ano. Em contraste, todos os de alto risco apresentaram eventos no mesmo período. Os que apresentaram DE de intermediário risco apresentaram 15% de eventos em 01 ano. CONCLUSÃO: O DE foi tão sensível quanto CPM em determinar o risco para DAC em um ano. Os pacientes com DE <-0,27 tiveram maior risco de eventos cardíacos.<br>OBJECTIVE: The purpose was to determine the sensitivity, the specificity and a year-long risk of subsequent cardiovascular events in patients with low, intermediate and high risk prognostic Duke treadmill score (DTS) in comparison with the presence (or not) of the myocardial perfusion defects on radionuclide images. METHODS: A prospective study, with 173 consecutive patients with 02 or more risk factors to coronary artery disease (CAD), who underwent to exercise single photon - emission computed tomographic myocardial perfusion images using technetium-99m tetrophosmin (SPECT) and treadmill test (with DTS), from one neighbourhood of Curitiba city, between January 2003 and February 2004, were followed up for cardiac-cause mortality and major cardiac events. Follow-up was performed in 13± 1 months and in 162 patients was complete. RESULTS: The DTS mean those patients with cardiac event (18) over a year was -0.27 (95% CI= -3.97 to +3.91) and those free cardiac event patients (144) was +4.92 (95% CI= +4.03 to +5.81), with p<0.00069. The DTS sensitivity was 72.22% and the SPECT sensitivity was 77.78%, with no significant difference p=0.21. The DTS specificity was 54.17% and the SPECT specificity was 88.19%, with p<0.0001. The cumulative proportion free-events (Kaplan-Meier) curves demonstrated that 94% those patients with low-risk DTS remained free-cardiac events. In contrast, all high-risk DTS had adverse cardiac events. Those patients with intermediate-risk DTS had 15% of cardiac event over a year. CONCLUSIONS: The DTS was as sensitivity as SPECT in determine a year risk for CAD. Those patients with DTS <-0.27 had high-risk cardiac event