Ilma Aparecida Paschoal - Academia.edu (original) (raw)

Papers by Ilma Aparecida Paschoal

O "Shuttle Walking Test" (SWT), padronizado na literatura como um teste de esforco subm... more O "Shuttle Walking Test" (SWT), padronizado na literatura como um teste de esforco submaximo e utilizado em pacientes com DPOC (Doenca Pulmonar Obstrutiva Cronica), foi aplicado em individuos saudaveis para verificar se a dessaturacao, apos a realizacao deste teste, e um evento provavel. Foram selecionados individuos saudaveis, praticantes de atividade fisica pelo menos 2 vezes por semana em academia de ginastica. Os individuos que tivessem antecedentes de doencas pulmonares e/ou cardiacas ou qualquer outra condicao de saude que impossibilitassem a realizacao do teste foram excluidos do estudo. Os valores de fluxo expiratorio do primeiro segundo e do sexto segundo (VEF1 e VEF6) foram determinados antes da realizacao dos testes atraves de um medidor digital de pico de fluxo (Peck Flow). Outros parâmetros avaliados antes do SWT foram frequencia cardiaca basal e saturacao de oxigenio inicial. Logo apos o final do teste foram verificados os mesmos parâmetros do inicio do teste. A versao do SWT utilizada neste trabalho foi a modificada, com 12 niveis de intensidade. Oitenta e tres individuos (55 homens) foram selecionados (apenas um fumante). A idade media foi 35,05 ± 12,53. O indice de massa corporal (IMC) foi de 24,30 ± 3,47. A media de frequencia cardiaca de repouso foi de 75,12 ± 12,48. A media da saturacao periferica de O2 (SpO2) em repouso foi 97,96% ± 1,02%. A media do VEF1 foi de 3,75 ± 0,81 L; a media de VEF6 foi de 4,45 ± 0,87 L. A media VEF1/VEF6 foi de 0,83 ± 0,08 (sem restricao e / ou obstrucao). A media de distância percorrida foi 958,30 ± 146.32m. A media da frequencia cardiaca apos SWT foi 162,41 ± 18,24. A media da SpO2 final foi 96,27% ± 2,21%. Onze individuos apresentaram maiores valores de SpO2 final; 17 individuos tiveram quedas na SpO2 final, igual ou superior a 4 pontos. A comparacao entre os grupos, com e sem dessaturacao, nao mostraram diferencas em idade, sexo, VEF1, VEF6, VEF1/VEF6, saturacao inicial, distância caminhada, frequencia cardiaca e percentual da frequencia cardiaca maxima. O IMC foi maior naqueles que dessaturaram (p = 0,01) e SpO2 final foi menor (p <0,0001). Estes resultados permitem concluir que pessoas saudaveis podem dessaturar apos SWT e desta forma, a utilizacao do SWT para predicao de doencas respiratorias leves pode nao ser adequada. Dessaturacao e comum em individuos saudaveis apos o SWT, como na atividade fisica intensa, e pode ter efeitos deleterios. Abstr

Foram analisados 261 pacientes com carcinoma bronquico, atendidos entre janeiro de 1988 a dezembr... more Foram analisados 261 pacientes com carcinoma bronquico, atendidos entre janeiro de 1988 a dezembro de 1990, no ambulatorio de Onco-pneumologia do Hospital de Clinicas da Unicamp. A maioria dos pacientes era do sexo masculino (80%), . tabagista (95% dos homens e 63% das mulheres) e da regiao de Campinas. (52,5%). A faixa etaria entre 60-69 anos foi responsavel por 42% dos casos e foram raros os casos abaixo dos 40 anos. O carcinoma epidermoide, com 44,1% dos casos, seguido do adenocarcinoma, foi o mais frequente. No grupo dos fumantes o carcinoma epidermoide e o carcinoma de pequenas celulas foram os mais encontrados, principalmente, entre as mulheres. No grupo dos nao tabagistas o adenocarcinoma foi o mais com um sendo que neste grupo nao houve nenhum caso de carcinoma de pequenas celulas e de carcinoma epidermoide em homens. A maioria dos pacientes eram sintomaticos (96,2%). Com queixa de curta duracao e estadios anatomicos avancados. A tosse foi o sintoma mais relatado em todos os tipos histologicos. O carcinoma bronquico foi mais frequente no pulmao direito, nos lobos superiores e de localizacao central. Alteracao radiologica foi a principal causa de encaminhamento e o termo "massa", genericamente, o mais usado para descreve-lo. No estadiamento, metade dos casos foram considerados irressecayeis localmente, 36% apresentavam metastases a distância e 66% dos casos acometiam gânglios mediastinais. Na admissao predominaram metastases para figado, ossos e cerebro enquanto que durante o seguimento e no estadio tenl1inal estas predominaram para cerebro e ossos. Quarenta e nove (18%) pacientes foram submetidos a cirurgia nos seguintes estadios cirurgicos: 17(35%) estadio I; 7(14%) estadio II; 13(27%) estadio IIIa; 11(22%) estadio IIIb e 1(2%) estadio IV. Em 9(18%) ocorreram complicacoes, sendo que 2(4%) foram a obito. De 30 pacientes avaliados pos-cirurgia, 14(46,7%) apresentaram recidiva em menos de 2 anos. A recidiva no estadio I foi de 25%, no estadio 11 de 60% e no estadio IIIa de 67%. A recidiva local, metastases em ossos e cerebro foram os locais mais frequentes. Cento e um(39%) pacientes abandonaram o tratamento, 57 nos primeiros 2 meses. Apenas em 3% dos casos, a causa do obito nao estava relacionada ao carcinoma bronquico. A broncoscopia e a puncao percutânea quando disponiveis, deverao ser os metodos diagnosticos de escolha por serem seguros e com excelente positividade, alem do que, a broncoscopia permite fazer o estadiamento local. O baixo numero de pacientes assintomaticos, o elevado numero de pacientes em estadios avancados e a maior parte dos paciente com queixas em ate 6 meses, permitem concluir que: o carcinoma de pulmao apresenta sintomas tardios; os pacientes e medicos sub-valorizam as queixas; e o encaminhamento aconteceu mais em funcao do comprometimento do estado geral do paciente do que ao tempo de queixas.As enzimas hepaticas(AST, ALT, GGT) mostraram-se excelente metodo de deteccao de metastase hepatica. A predominância de lnetastase ossea e cerebral nos pacientes tratados pode estar relacionada a uma baixa eficacia do tratamento realizado para erradicar metastase nestes sitios. Com estas observacoes somadas aos dados da literatura conclui-se que, brevemente, havera uma epidemia de carcinoma bronquico e campanhas de esclarecimento devem ser feitas, visando principalmente os jovens. Finalmente, conclui-se que a formacao de um grupo multidisciplinar em oncopneumologia e fundamental, assim como a padronizacao de atendi1llento e a formacao de banco de dados para aquisicao de conhecimento, visando o beneficio do paciente e acumulo de material de pesquisa. Abstract

PURPOSE: to evaluate the effects of inspiratory muscle training (IMT) in adult sickle cell diseas... more PURPOSE: to evaluate the effects of inspiratory muscle training (IMT) in adult sickle cell disease (SCD) patients in relation to respiratory muscle strength (RMS) variables; lung function; exercise tolerance; blood lactation concentration; limitation imposed by dyspnea in activities of daily living and; impact of fatigue on quality of life. METHODS: a randomized, single-blind study, with true load (TG) and sham load group (SG) design of IMT. Initial assessment included spirometry, volumetric capnography (VCap), and measurement of RMS by maximal inspiratory and expiratory pressure (PImax and PEmax). The Medical Research Council (MRC) dyspnea scale and the modified fatigue impact scale (MFIS) were also applied, and blood lactate concentration (Lac) was measured before and after the 6-minute walk test (6MWT). After this initial assessment, the patient used the IMT device at home daily, returning every 6 weeks for RMS reassessment. Both groups used the same device and were unaware of which group they were in. After a total period of 18 weeks, the patients underwent the final evaluation as initially performed. RESULTS: 25 patients in total participated up to the end of the study (median age 42 years). There were no significant differences between TG and SG groups based on age, sex, body mass index, severity of genotype. At the end of the training, in both groups there was a significant increase in PEmax and PImax, improvement in Vcap and in exercise tolerance and reduction of dyspnea in performing daily life activities. The same improvement was observed in patients grouped according to disease severity (SS and Sβ 0 vs SC and Sβ +), without differences between groups. CONCLUSION: home-based inspiratory muscle training brings benefits to outpatients with SCD. Backgroud Sickle cell disease (SCD) is an autosomal recessive, clinically heterogeneous disorder affecting millions worldwide, and is characterized by hemolytic anemia, progressive vascular injury, vaseocclusive crises, end-organ injury and a reduced life expectancy (1,2). Pulmonary complications, including acute chest syndrome, pulmonary hypertension, venous thromboembolism, asthma/recurrent wheezing and sleep-disordered breathing are an important cause of morbidity and

Revista Portuguesa De Pneumologia, Jul 1, 2017

Objective: Quality of life (QOL), sexual satisfaction (SS) and physical performance have been ass... more Objective: Quality of life (QOL), sexual satisfaction (SS) and physical performance have been assessed in the management of numerous chronic diseases. Methods: In this study, the following tests and surveys were applied: (i) QOL questionnaire [Cystic Fibrosis Questionnaire (CFQ)]; (ii) SS questionnaire (SSQ) [female sexual quotient (FSQ) and male sexual quotient (MSQ)]; (iii) 6-minute walk test (6MWT). Spearman's correlation was used for comparison between the data; the Mann-Whitney test was applied to analyze the difference between genders. A total of 52 adult patients with CF were included in this study. Results: There was a positive correlation between CFQ domains and SSQ questions. The CFQ showed a positive correlation with peripheral oxygen saturation of hemoglobin (SpO 2) and the distance walked in the 6MWT, and a negative correlation with the Borg scale. The SSQ showed positive correlation with the distance walked and a negative correlation with the Borg scale. For some markers evaluated in the 6MWT, there was sometimes association with the evaluated domains and questions. Male patients showed better scores in the emotional CFQ domain, better performance in SSQ and physical performance. Conclusions: There was a correlation between CFQ, SSQ and 6MWT in CF. Finally; we believe that QOL surveys should assess the domain ''sexuality'' as well as physical performance tests.

Revista Brasileira de Geriatria e Gerontologia, 2023

Objetivo: Compreender os significados atribuídos pela pessoa idosa com Doença Pulmonar Obstrutiva... more Objetivo: Compreender os significados atribuídos pela pessoa idosa com Doença Pulmonar Obstrutiva Crônica (DPOC) em uso da Oxigenoterapia Domiciliar Prolongada (ODP) referente ao relacionamento amoroso e a prática sexual. Método: Estudo qualitativo, no qual foram realizadas sete entrevistas semidirigidas com pacientes com diagnóstico confirmado de DPOC e em uso de ODP, atendidos em serviço ambulatorial. A técnica de análise de conteúdo foi aplicada com o apoio do software WebQDA 2.0®. Os critérios COREQ foram usados para relatar o método e o resultado. Resultados: Duas categorias emergiram: 1-Desestabilização no relacionamento amoroso e na vida sexual do usuário de ODP: revelou que a terapia causa perturbação nos relacionamentos, mudança de parceiro depois que foi prescrita a ODP ou até a ideia de procurar uma pessoa extraconjugal. 2-Vivência e significados da DPOC e da oxigenoterapia durante a relação sexual: o sofrimento com as questões fisiológicas, o quanto o paciente sente falta de ar para ter relação sexual e o impacto disso no desempenho e na frequência, diminuindo esses momentos com o parceiro. Conclusão: A percepção da pessoa idosa com DPOC em uso da ODP indica que a oxigenoterapia impactou sobre a prática sexual e nos relacionamentos amorosos. Ter boa qualidade nos relacionamentos e na prática sexual é condição fundamental para promover a saúde.

05.02 - Monitoring airway disease

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

A obesidade provoca alteracoes importantes na funcao pulmonar, e alguns exames, como espirometria... more A obesidade provoca alteracoes importantes na funcao pulmonar, e alguns exames, como espirometria e capnografia volumetrica (VCap), podem ajudar a diagnosticar essas complicacoes. Objetivo foi descrever a influencia da perda de peso na melhora da funcao pulmonar. Foi avaliado um individuo com obesidade morbida grau III, que participou da abordagem de perda de peso multidisciplinar do HC da Unicamp e foi submetido a avaliacoes iniciais e finais de medidas antropometricas e da funcao pulmonar. Foi realizada espirometria, capnografia volumetrica e risco de desenvolvimento da Apneia do Sono pelo questionario de Berlim. Apos a perda de peso de 90kg, IMC de 28kg / m², observou-se melhora nos valores espirometricos no primeiro e segundo momentos nas variaveis de capacidade vital forcada (CVF), volume expiratorio final no primeiro segundo (FEV1), fluxo expiratorio final. Ja na capnografia volumetrica houve aumento do volume minuto alveolar [MValv (L)], volume minuto do espaco morto das ...

Journal of Cystic Fibrosis, 2016

Objectives: There is emerging evidence supporting the possibility of airborne routes for transmis... more Objectives: There is emerging evidence supporting the possibility of airborne routes for transmission for Pseudomonas aeruginosa and Burkholderia cepacia complex between people with CF. More recently M. abscessus has emerged as a potentially important pathogen in people with CF with evidence of accelerated lung function decline [2]. The aim of this study was to determine whether M. abscessus could survive within artificially demonstrated aerosols using a previously described laminar airflow model [1]. Methods: Five strains of M. abcessus isolated from patients with CF and a reference strain were studied. Aerosols were generated using a Collison 3-jet nebuliser, delivered into an airtight pipe of varying lengths and sampled using an Andersen 6-stage impactor as previously described [1]. Results: All the strains studied were able to produce viable aerosols of M. abscessus which survived 81 s and travelled a distance of 4 m. All the aerosols contained particles which were predominantly less than 2 mm in diameter. Conclusion: This study demonstrates that M. abscessus can survive within artificially generated aerosols in particles within the respirable range. Cross-infection of M. abscessus between people with CF could potentially occur via an airborne route. The survival of M. abscessus within the laminar airflow model was very similar to that of P. aeruginosa [1]. These results have important implications for the care of people with CF and reinforces the need for strict infection control practices to minimise the risk of cross-infection which pathogens such as M. abscessus.

Anales de Medicina Interna, 2006

Jornal De Pediatria, Dec 1, 2012

OBJECTIVE: To compare spirometry and volumetric capnography (VCap) to determine if the capnograph... more OBJECTIVE: To compare spirometry and volumetric capnography (VCap) to determine if the capnographic values add more information about early lung disease in cystic fibrosis (CF) patients. METHODS: This was a cross-sectional study involving CF patients: Group I (42 patients, 6-12 years of age); and Group II (22 patients, 13-20 years of age). The corresponding control groups were comprised of 30 and 50 healthy subjects, respectively. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and the FEV1/FVC ratio was determined by spirometry. Using VCap, we measured peripheral oxygen saturation (SpO2), respiratory rate (RR), inspiratory time (IT), expiratory time (ET), and the phase III slope normalized by expiratory volume (phase III slope/Ve). RESULTS: In comparison with control groups, all CF patients presented higher phase III slope/Ve values (p < 0.001) independent of the pulmonary disease stage. The phase III slope/Ve was significantly higher in the 24 patients who presented normal spirometry results (p = 0.018). The Group II patients showed lower FVC, FEV1, FEV1/FVC (p < 0.05), and also lower SpO2 values (p < 0.001) when compared with Group I patients. In comparison with Control Group II, the Group II patients presented higher RR (p < 0.001), and lower IT and ET values (p < 0.001). CONCLUSIONS: Compared to the controls, all studied CF patients showed an increase in phase III slope/Ve values. VCap identified the heterogeneity of the ventilation distribution in the peripheral airways of CF patients who presented normal spirometry.

Revista Brasileira De Reumatologia, May 1, 2014

Avaliação do comprometimento respiratório em pacientes com lúpus eritematoso sistêmico com o test... more Avaliação do comprometimento respiratório em pacientes com lúpus eritematoso sistêmico com o teste de caminhada de seis minutos

Journal of Cystic Fibrosis, Jun 1, 2014

Objectives: To identify evidence of possible patient to patient transmission of Non-Tuberculous M... more Objectives: To identify evidence of possible patient to patient transmission of Non-Tuberculous Mycobacterial (NTM) infection among paediatric CF patients in a large tertiary CF centre. Methods: All positive isolates of NTM in paediatric CF patients from 2010 onwards were identified using VNTR (variable number tandem repeat) typing, rpoB and hsp65 gene sequencing. The isolates have also been sent for whole genome sequencing. Three individuals isolated Mycobacterium abscessus with identical VNTR profiles. A limited network analysis of hospital contacts was then undertaken. Clinical and demographic data were collected from patient records. Results: 12 patients were identified (7 male, median age 11), giving a prevalence of 6%. Isolates included M. abscessus (8 isolates), M. bolletii (1), M. massiliense (2) and M. chelonae (1). 50% of patients in our service with poor lung function (FEV1 below 70% predicted) were NTM positive. Increased frequency of intravenous antibiotic courses (p = 0.03) was significantly associated with NTM infection, although whether this relationship is causal remains uncertain. Basic network analysis of the three cases with identical VNTR profiles identified an inpatient or outpatient contact with the index case with in the six week period prior to the first positive culture, raising the possibility of person to person transmission. Conclusion: Although we have identified a possible transmission event, the VNTR profiles of other isolates appear diverse suggestive of sporadic environmental acquisition. We have instituted infection control measures including complete segregation, separate in-patient unit and barrier nursing.

xxiii xxiv Six minute walk test evaluation of pulmonary involvement in scleroderma patients Pulmo... more xxiii xxiv Six minute walk test evaluation of pulmonary involvement in scleroderma patients Pulmonary involvement is the leading cause of systemic sclerosis (SSc) related deaths. A simple test to evaluate exercise capacity is the 6-minute walk test (6MWT), and the walk distance is increasingly used as a primary outcome in clinical trials. Hemoglobin desaturation during a 6MWT is predictive of mortality in patients with primary pulmonary hipertension. Objectives: To evaluate the walk distance and oxygen desaturation (Δsat) during the 6MWT in patients with SSc and to establish correlations between the 6MWT results and other clinical variables. Methods: This study analysed 110 SSc patients who underwent 6MWT. Δsat was defined as a decrease of 4 or more points in saturation between the resting point and the end of the test. Clinical and demographic data was collected. All the patients underwent radiological evaluations (X-rays and HRCT), had pulmonary function tests and echocardiograms performed, and the presence of autoantibodies determined. Results: The variables associated with a walk distance < 400 m (p<0.05) were age, dyspnea index, fibrosis on X-ray, PASP ≥ 30 mm Hg, desaturation; the variables associated with Δsat (p<0.05) were age, positive anti-Scl 70, dyspnea index, fibrosis on X-ray, FVC < 80%, PASP ≥ 30 mm Hg, ground-glass or reticular opacities on HRCT. In the multivariate logistic regression analysis, 3 variables were significant when tested with walk distance: age, race and dyspnea index; and 4 variables were significant when tested with Δsat: age, dyspnea index, positive anti-Scl-70 and FVC< 80%. (91) Conclusions: Desaturation during a 6MWT provides additional information regarding severity of disease in scleroderma patients with pulmonary manifestations.

Pulmonary circulation, Mar 1, 2021

Pulmonary arterial hypertension impairs exercise tolerance and daily physical activity. Aside fro... more Pulmonary arterial hypertension impairs exercise tolerance and daily physical activity. Aside from the hemodynamic limitations, physical, cognitive, and emotional factors may play a relevant and as yet unexplored role. We investigated whether there is an association between the physical activity level and psychological disorders, health‐related quality of life, and daily activities. We also searched for an association of the physical activity level with clinical factors and functional capacity. This was an analytical, cross‐sectional, observational study conducted in a Brazilian University Hospital. Twenty stable pulmonary arterial hypertension subjects wore an accelerometer for a week and completed an activity diary. They answered the quality of life questionnaire (SF‐36), as well as the Hospital Anxiety and Depression scale, and the Manchester Respiratory Activities of Daily Living questionnaire. Transthoracic echocardiography, the six‐minute walk test, the one‐minute sit‐to‐stand test, and spirometry were performed. For statistical analysis, we used Chi‐square tests or Fisher’s test as appropriate and the Mann–Whitney test to compare numerical values between two groups. The relationship between the parameters was assessed using the Spearman correlation test. The mean age was 44.3 years, 80% were women, 80% had idiopathic pulmonary arterial hypertension, and 20% had connective tissue disease. The mean daily step count was 4280 ± 2351, and the mean activity time was 41.6 ± 19.3 min. The distance covered (six‐minute walk test) was 451.5 m, and the number of movements (one‐minute sit‐to‐stand test) was 23.8. Thirty percent scored positive for anxiety, and 15% for depression (Hospital Anxiety and Depression scale). There was a significant correlation between accelerometer data and walking distance (six‐minute walk test), number of movements (one‐minute sit‐to‐stand test), level of daily physical activity (Manchester Respiratory Activities of Daily Living questionnaire), and depression symptoms. Our findings support the hypothesis that other aspects beyond physical and hemodynamic ones might impact the daily physical activity of patients with pulmonary arterial hypertension.

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Jornal Brasileiro De Pneumologia, Oct 1, 2006

Relata-se o caso de um paciente com dispnéia intensa ao se deitar, em que foram excluídas doenças... more Relata-se o caso de um paciente com dispnéia intensa ao se deitar, em que foram excluídas doenças pulmonares, neuromusculares ou cardíacas, cuja investigação revelou paresia diafragmática bilateral. Um sinal chave para o diagnóstico foi a evidência de respiração paradoxal com o doente em decúbito supino. Havia piora da oxigenação e da capacidade vital forçada com a mudança da posição ortostática para supina. A fluoroscopia ortostática foi normal. A pressão inspiratória máxima estava muito reduzida. A estimulação elétrica transcutânea do diafragma foi normal, e a eletroestimulação do nervo frênico mostrou ausência de resposta, permitindo o diagnóstico de paresia bilateral do diafragma.