Medicina

URI Permanente desta comunidadehttps://repositorio.cesupa.br/handle/prefix/40

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Navegando Medicina por Orientador "Bastos, Fabíola de Arruda"

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    A influência dos níveis séricos de IGF-1 no perfil lipídico e glicêmico de acromegálicos em um Centro de Especialidades Médicas no Pará
    (Centro Universitário do Estado do Pará, 2021) Pereira, Caroline de Oliveira; Ferraz, Louise Paiva; Bastos, Fabíola de Arruda; Caldato, Milena Coelho Fernandes; http://lattes.cnpq.br/9477878606835309; http://lattes.cnpq.br/9386935778704228
    Introduction: Acromegaly is an insidious and rare disease, associated with a high mortality rate, which results from the pathological autonomous overproduction of growth hormone (GH) and the subsequent increase in insulin-like growth factor-1 (IGF-1) levels. Chronic hypersecretion of these hormones causes several metabolic changes, among which we can highlight lipolysis, atherosclerotic processes, hyperinsulinemia, gluconeogenesis and peripheral insulin resistance. These changes in lipid and glycemic metabolism are related to an increased risk of cardiovascular events in acromegalic patients, being today the second most common cause of mortality in these patients. As a result, it is necessary to assess whether the control of the disease also corresponds to a better metabolic control of these patients, resulting in a lower cardiovascular risk and a lower mortality rate. Objectives: To evaluate the influence of IGF-1 levels on the lipid and glycemic profile of acromegalic patients treated at the Cesupa Medical Specialties Center. Methodology: This is an epidemiological, cross-sectional and descriptive study, based on an exploratory analysis of the medical records of the Endocrinology Service of the Cesupa Medical Specialties Center (CEMEC) from August 2019 to June 2020. Results: When comparing acromegaly activity in the first and last consultation, it was found that there was an increase in disease control, from 22.2% to 71.1%. As for the glycemic profile, the glycemia of diabetic acromegalic patients was statistically higher than that of non-diabetics, both in the first assessment (Mean ± SD: 135.8 ± 59.4 vs 95.1 ± 15.2; P <0.001), and in the latter (Mean ± SD: 98.6 ± 13.2 vs 84.0 ± 11.1; P <0.001). When observing diabetic acromegalic patients, there was a significant decrease in the levels of IGF-1 (mean ± SD: 480.9 ± 250.5 vs 189.5 ± 91.5, P <0.001) and IGF-1 by LSN ( mean ± SD: 1.8 ± 1.0 vs 1.0 ± 0.6, P <0.001), when comparing the two assessments. It was possible to observe, comparing the laboratory parameters between the first and last evaluation, that in the uncontrolled acromegaly at the end (n = 13), there was a decrease in the total cholesterol levels (Mean ± SD: 179.3 ± 30.0 vs 155, 9 ± 28.8; P = 0.018) and, significant increase in HDL (Mean ± SD: 46.8 ± 14.3 vs 53.3 ± 7.9; P = 0.048). For patients with controlled acromegaly at the end (n = 32), there was a significant increase in the HDL level (Mean ± SD: 46.3 ± 26.0 vs 58.0 ± 24.2; P = 0.003) and a decrease in levels of IGF-1, GH, total cholesterol, LDL and TG. Conclusion: These results suggest that most of the acromegalics under study had control of the disease by reducing the levels of IGF-1, evidencing success in their therapeutic conduct. Concomitantly, the majority also obtained improvement in the levels of glucose, glycated hemoglobin, total cholesterol and HDL. This suggests that controlling disease activity is one of the most important interventions for reducing cardiovascular risk in these patients.
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    Avaliação da morfologia e função tireoidiana nos pacientes acromegálicos atendidos no Centro de Especialidades Médicas do CESUPA (CEMEC)
    (Centro Universitário do Estado do Pará, 2019) Ribeiro, Bruna Dias da Costa; Rodrigues, Silvana da Silva; Bastos, Fabíola de Arruda; Caldato, Milena Coelho Fernandes; http://lattes.cnpq.br/9477878606835309; http://lattes.cnpq.br/9386935778704228
    Introduction: Acromegaly is a chronic and multisystemic desease, has an insidious onset, and is debilitating. Results from hypersecretion of Growth Hormone and Insulin Growth Factor. The mortality rate is up to 3.5 times larger than the unaffected population due to mainly associated comorbidities and the late character of its diagnosis. Among the proved associations, it’s important to give attention to thyroid functional modifications and it’s morphology, due to evolution of these modifications until the appearance of thyroid neoplasms. Objective: Evaluate thyroid morphology and thyroid functional disorders in acromegalic patients attended at the “Centro de Especialidades Médicas (CEMEC) – CESUPA”, on the Pituitary and Adrenal abulatory. Methodology: Epidemiological, cross-sectional and retrospective study. Data were collected from the acromegalics patient’s medical records, enrolled at the Pituitary and Adrenal abulatory, at CEMEC until June 2019, with a total of 59 patients. Results: Most of the acromegalic patients treated at CEMEC presented pituitary macroadenoma (83.1%) in the initial evaluation. Among the altered laboratory results of TSH (first evaluation 17 and last evaluation 7), the majority presented values below normal in both the first (n = 15) and the last evaluation (n = 6). Thyroxine altered values were also analyzed (first evaluation n=10 and last evaluation n=8), and there was a higher occurrence of results below normality in the first evaluation (n = 7) and equality between values below and above normality in the final evaluation, however without statistically significant results (p = 0.9849). Evaluating the presence of thyroid nodules with gender and time of disease, there was no statistically significant difference (respectively p = 0.9426 and p = 0.4115), however, the relation was significant when related to age group, with a higher frequency between 70 and 79 years. years old (* p = 0.0435). Furthermore, it was evidenced that there was no statistically significant relation between the IGF-1 LSN values and the occurrence of thyroid nodules in the first and final evaluations (respectively p = 0.5834 and p = 0.9514). There was also no statistically significant relationship when analyzing mean GH values and nodule occurrence at the first and last assessment (p = 0.7197 and 0.6831).Conclusion: In the thyroid ultrasonography, most of the nodules found in the first and final evaluation had the following characteristics: localization in the right, single, hypoechoic sludge, with solid content and regular contours. The characteristics found weren’t suggestive of malignancy. Although acromegaly treatment control is unrelated to the occurrence of nodules, it is extremely important to follow up these possible modifications to improve the life expectancy of these patients and the early detection of potentially malignant lesions.
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    O impacto da pandemia da COVID-19 no perfil clínico dos pacientes diabéticos atendidos no Centro de Especialidades Médicas do Cesupa no ambulatório de hiperdia durante o período de 2019 a 2021
    (Centro Universitário do Estado do Pará, 2022) Covre, Paula Mendonça; Cavaléro, Talyssa Melo de Sousa; Bastos, Fabíola de Arruda; http://lattes.cnpq.br/9386935778704228
    Diabetes Mellitus type 2 is a chronic disease resulting from a state of hyperglycemia and peripheral insulin resistance, which gained notoriety during the COVID-19 pandemic because it is a comorbidity of risk for the development of this infection, as well as other chronic diseases. Consequently, the control of glycemic levels of diabetic patients faced obstacles embedded by the chaotic scenario that developed in the pandemic period, such as: social isolation, decreased supply of basic health services, difficulty in accessing consultations and elective procedures. Therefore, it is important to conduct a study that analyzes the change in the clinical profile of diabetic patients during the pandemic period. To leverage data that translates the change in the clinical profile of diabetic patients followed at the Hiperdia outpatient clinic of the Center for Medical Specialties of CESUPA (CEMEC) in the period of 2019 to 2021. This is a descriptive cross-sectional analytical study conducted by collecting data from medical records provided by the Center for Medical Specialties of CESUPA (CEMEC). Regarding the epidemiological profile, the majority are female (63.9%) aged 60 to 89 years (57.4%). Regarding the anthropometric variables analyzed, weight and BMI, no significant changes were found, both in BMI (p=0.124), or weight (p=0.244), between 2019 and 2020; between 2020 and 2021, there were also not many changes. In the present study, when comparing the number of drugs between 2019 and 2020, there was an increase (Mean ± SD:1.5 ± 0.7 vs 1.7 ± 0.8; P=0.050). Regarding the number of tablets, there was also an increase between 2019 and 2020 (Mean ± SD: 3.5 ± 1.7 vs 3.9 ± 1.7; P<0.001). Between 2020 and 2021, the number of medicines did not differ significantly (p=0.881) nor the number of tablets (p=0.814). It was possible to observe that the daily dose of metformin between 2019 and 2020 showed an increase (Mean ± SD: 1607.5 mg ± 686.5 mg vs 1761.3 mg ± 673.8 mg; P=0.019). Regarding laboratory tests, between 2019 and 2020 there was low difference between fasting blood glucose values (Mean ± SD: 134.4 ± 37.4 vs 144.2 ± 59.3; P=0.348), postprandial glycemia (Mean ± SD: 177.0 ± 76.7 vs 154.8 ± 40.3; P=0.384) and glycated hemoglobin (Mean ± SD: 7.0 ± 1.3 vs 6.9 ± 2.4; P=0.315). Before these results, it is possible to conclude that during the pandemic there was an adjustment in the therapeutic plan of the followed-up patients, with an increase in the number of medications and tablets. In addition, most patients improved glycemic levels by fasting glycemia, postprandial glycemia and glycated hemoglobin. Thus, it is ensured that this work is of great value, because it is found that despite the obstacles faced by patients during the pandemic, diabetes control was achieved.