Navegando por Assunto "Conduta do tratamento medicamentoso"
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Item Avaliação da conduta terapêutica para pacientes com insuficiência cardíaca com fração de ejeção reduzida do Centro de Especialidades Médicas do CESUPA(Centro Universitário do Estado do Pará, 2022-11-10) Barros, Juliano Sousa; Lopes, Vitor Maués; Pereira, Paulo Henrique Nunes; http://lattes.cnpq.br/5351191172079560; Machado, Louise Pinheiro Moutinho; http://lattes.cnpq.br/9482657241416195; Couto, Tauin Raoni de; http://lattes.cnpq.br/2151046047496564Heart failure (HF) is a worldwide problem associated with high mortality and low quality of life. It is not a single pathological diagnosis, but a clinical syndrome characterized by clinical signs that are a result of impaired ventricular filling, the ability of the ventricles to eject blood, or both. HF can be classified into 3 distinct phenotypes, according to left ventricular ejection fraction (LVEF), into HF with preserved ejection fraction (HFpEF), mildly reduced ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF). With regard to HFpEF, drugs that can modify the natural history of the disease in patients with this phenotype have not yet been identified, in contrast to the treatment of HFrEF, which has a wide range of drug therapies capable of reducing morbidity and mortality when using targeted optimized doses by guidelines. To analyze whether the therapeutic approach for patients with HF with reduced ejection fraction (HFrEF) at CEMEC (Cesupa Medical Specialty Center) is in accordance with the guidelines recommended by the main Brazilian and global guidelines on HF. This is an observational, retrospective and quantitative study, through the analysis of medical records of patients with HFrEF between the years 2018 and 2021, registered at CEMEC, identifying whether the therapeutic approach is in accordance with the guidelines brazilian and worldwide on HF. 54 patients were included in the study, attended by the Center for Medical Specialties of CESUPA between 2018 and 2021. Among the patients analyzed, more than half (53.7%) were male and most (74, 1%) was elderly, aged between 60 and 98 years. During the study, it was decided to analyze medical records of patients with HFmrEF for a complementary analysis. In this study, most patients (61.1%) had a reduced ejection fraction and 38.9% had a slightly reduced ejection fraction. In the individual analysis of drug classes, 21 individuals were using ACE inhibitors, most of them were using Enalapril, and 12 (57%) were on optimized doses. With regard to ARBs, 26 patients were using, mostly Losartan, and 15 (59%) had optimized doses. The BB class, whose most used representative is Carvedilol, had a total of only 1 patient out of 52 (1.9%) at full dose. As for the MRA class, represented in Brazil by Spironolactone, it was found that 38 patients used it and 35 (92%) were at the minimum recommended dose. Furthermore, only 1 patient was using Sacubitril-Valsartan (ARNI) and 6 were using SGLT2 Inhibitors, and all were on full dose. Therefore, all CEMEC patients with HFrEF and HFmrEF use at least one of the drugs that modify the prognosis of the disease, in addition to the majority being within the recommended target dose. Drugs that interfere with the renin-angiotensin-aldosterone system showed a high prevalence of patients on full-dose medication. Regarding MRA, almost all patients already use the target dose of the drug. Regarding BB, it is observed that, in general, patients need to be better informed about the need to use these medications, in order to reach the target dose.Item Avaliação do manejo preventivo de pacientes com enxaqueca no ambulatório de neurologia do Centro de Especialidades do CESUPA no período de 2014-2018: um estudo retrospectivo(Centro Universitário do Estado do Pará, 2019) Costa Neto, Antônio da Luz; Gomes, Fernando Bispo; Sefer, Celina Cláudia Israel; http://lattes.cnpq.br/0218316102057635Introduction: Migraine is one of the most prevalent causes of pain in Brazil and globally, being incapacitating when severe. They are primary headaches and are classified for their etiology in migraine with aura and without aura. Treatment is performed according to the specificity of migraine. Thus, it is imperative that there be a knowledge of the medical conduct on this subject, so that it cannot only diagnose and treat, but also adequately guide patients with migraine in outpatient services. Objective: To evaluate the preventive management of patients with migraine at the CEMEC-CESUPA Outpatient Neurology in the period 2014-2018. Methodology: Retrospective study of 961 patient charts from the CEMEC-CESUPA Neurology Outpatient Clinic. 52 charts followed the exclusion and inclusion criteria established for this research. The sample characterization information was compiled in databases prepared in Microsoft Office Excel® 2016 software; adopting a significance level α < 0.05. Results: There was a predominance of females (88.46%), with a prevalence of patients with migraine without aura (55.8%) compared to aura (44.2%). The most evident age at onset of migraine was between 19 and 30 years (39.1%). Among the patients analyzed, 88.5% reported severe pain and only 5.8% moderate pain, and there were no subjects who reported poor pain or absence of pain. Migraine attacks usually occur in 50% of cases 3 to 14 times a month, followed by 15 to 30 times monthly (44.7%); its average duration is 4 to 72 hours in 64.1% of patients. The prodrome with the highest prevalence in the research were the scotomas (78.9%). Its most frequent triggering factors were stress (60.5%), food (32.6%) and sleep (32.6%); among the foods, coffee and chocolate (35.7% and 28.6%, respectively) were the most prevalent. In the morbid antecedents, systemic arterial hypertension and psychiatric diseases were the most mentioned in this study (41.9% and 38.7%, respectively). Among the most frequently mentioned life habits during non-pharmacological treatment, the therapeutic activity prevailed (55%). Of the patients evaluated, 40% of evasion was observed after the first return visit. There was little filling of the headache diary (34%). The prevalence of the main drugs used in prophylactic therapy were tricyclic derivatives (77%), topiramato (23%), flunarizine (9.5%) and propranolol (11.5%). It was noted that 66.6% of the patients were using abusive analgesics before treatment. Conclusion: The main benefits of this study for the CEMEC-CESUPA outpatient clinic of Neurology are the contribution of the scientific analysis to the elaboration of adherence strategies for the patients treated in this clinic and the elaboration of a proposal for a headache diary.