Navegando por Assunto "Reumatologia"

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Análise da efetividade do fluxograma de encaminhamentos de pacientes ao ambulatório de reumatologia do Centro de Especialidades Médicas do Centro Universitário do Estado do Pará
(Centro Universitário do Estado do Pará, 2020) Travassos, Bárbara Laíse Guimarães; Azevedo, Thaiana Pedrosa de; Rodrigues, Fabíola Brasil Barbosa; Neves, Dilma Costa de Oliveira; http://lattes.cnpq.br/7230812534416350; http://lattes.cnpq.br/2425897539868497
Introduction. Pain is the main symptom of patients affected by rheumatological pathologies, and osteomyomaarticular pain is the most prevalent in the world. Although relatively simple, mistakes are common in referrals made by generalists and specialists, related to complaints and / or diagnostic hypotheses.Objectives: Evaluate the result of the implementation of the flowchart of referral of patients with joint complaints to the rheumatology service of CEMEC. Methodology. The present study was based on the preliminary study developed in 2017/2018, which was carried out in four stages, the fourth stage being the present study, whose research took place in three stages. In the first phase, the intervention was carried out, with a detailed explanation and explanation of the flowchart functioning for medical professionals of all CEMEC specialties and copies of the flowchart were attached on the premises of the establishment. The second phase consisted of a cross-sectional study, through the reapplication of a self-administered questionnaire, identical to that of the preliminary study, to the teaching and resident medical professionals working at CEMEC. The third phase consisted of a descriptive, qualitative, quantitative and comparative study and was based on a documentary analysis of referrals to CEMEC's rheumatology servisse, Results. Most referrals were classified as incorrect (cases with no real need for referral to a rheumatologist), even after the intervention. Among the correct referrals, more than half were classified as adequate (presence of appropriate technical terms in the reference guides), showing an improvement with regard to the number of correct and adequate referrals, compared to the preliminary study. The average waiting time to get an appointment at CEMEC Rheumatology in 2019 was 12 months, with a reduction of 6 months compared to the year 2017. The qualitative analysis of musculoskeletal complaints in the referral guides revealed that the osteomioarticular involvement with description, but without a diagnostic hypothesis was the criterion most frequently used by professionals to justify referrals. Among the specialties, nephrology was the one that referred the greatest number of patients to rheumatology. The highest percentage of correct referrals was observed in pneumology and infectious diseases. The professional profile of the interviewees was: young doctors; women; professionally experienced; and, most graduates from UFPA. The degree of complexity of musculoskeletal complaints was the reason most alleged by the participants to justify the referral. Regarding the degree of technical knowledge of the professionals, they present better clinical information about Gout disease (specific diagnosis and initial management). Conclusion. The increase in the number of correct referrals directly affects the quality of health care provided by the CEMEC Rheumatology service. The maintenance of the largest amount of incorrect and inadequate referrals points to the low adherence to the flowchart by the medical professionals working in the service. Thus, it is necessary to search for ways to encourage adherence to the tool, such as, for example, the periodic explanation of its operation not only to doctors, but also to CESUPA medical students, who are a fundamental part in the patient care.
Avaliação da qualidade de vida dos pacientes com lúpus eritematoso sistêmico juvenil atendidos no ambulatório de reumatologia pediátrica do Centro Universitário do Estado do Pará
(Centro Universitário do Estado do Pará, 2020) Nascimento, Igor Tadeu de Castro; Nascimento, Jéssyca Cristina Ramos do; Cavalcante, Erica Gomes do Nascimento
Introduction. Juvenile Systemic Lupus Erythematosus (JSLE) is a chronic condition characterized by loss of immunoregulatory control during the disease activity. The most prevalent JSLE clinical manifestations are on females, in the pediatric age. The high incidence of disease damage are related to lower quality of life, besides to the physical, psychosocial and school negative repercussions secondary to the health situation. Objectives. To evaluate the impact of JSLE on the quality of life in patients under follow-up at the pediatric rheumatology outpatient clinic of CESUPA. Methods. The survey was in three phases. The first phase had an exploratory documentary analysis, to identify patients diagnosed with JSLE according to the SLICC criteria. In the second phase, a cross-seccional study was conducted, using PedsQLTM 4 questionnaire for patients and parents and guardians, to evaluate the health-related quality of life. The last phase, the SLEDAI-2K and SLICC/ACR-DI indices were used to score disease activity and cumulative damages. Results. A good quality of life, according to PedsQLTM 4, are present in most patients of this study. The was no direct relationship between the SLICC/ACR-DI score evaluate in the last outpatient clinic follow-up and the improvement of the quality of life. The same thing happened when comparing with the SLEDAI-2K score; in the latter, among the patients with low disease activity, there were 1/3 with low HRQoL, while 2/3 presented high HRQoL. In relating HRQoL to time diagnosis, was observed a better quality of life in patients who had a shorter time since diagnosis. In isolated evaluation of quality of life, the social and physical domains had higher score than emotional domain. For parents and guardians, among children, the social and school aspects had the higher averages and the emotional aspect lower avarages. On the other hand, among adolescents, the social e physical domains had higher avarages. Both children and adolescents had higher SLEDAI-2K on the first appointment. The children compared to adolescents, had higher SLEDAI-2K on the first appointment and lower on the last appointment. The most frequent clinical manifestations on the first appointment were arthritis, alopecia and seizure, in SLEDAI-2K; and the laboratory manifestations was a decrease in the complement system and anti-dna, besides proteinuria. The majority of patients had no score on cumulatives damages - there were only 38,8%. Clinical and laboratory manifestations were varied on SLICC criteria for diagnosis on the first appointment. Demographically, there was female prevalence and brown skin color among patients; the majority diagnosis was in childhood. Conclusion. For patients, JSLE has a greater emotional impact. For parents and guardians, on the other hand, the emotional impact is greater only on children; and school impact is greater on adolescents. The damages had no impact on HRQoL and the disease activity decreased during course of the illness.
Prevalência de infecções em pacientes com doenças reumatológicas em tratamento com imunossupressores
(Centro Universitário do Estado do Pará, 2023-05-31) Alves, Gabriel Collares; Grandi, Natalia Crespo; Lima, Glauce Leão; http://lattes.cnpq.br/7526159894502830; Silva, Mariana do Socorro Quaresma; Yoshikawa, Gilberto Toshimitsu; http://lattes.cnpq.br/6926414747469197
Introduction: Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE) are chronic, systemic and autoimmune diseases that are very frequent in rheumatology outpatient clinics. Because of the involvement of the immune system by the disease itself and the state of immunosuppression that can be caused by the treatment of such diseases, it can have a great influence on the course of infectious diseases. Objective: Analyze the prevalence and outcome of infectious diseases in patients with rheumatic diseases using immunosuppressive treatments. Methods: It was performed an observational, cross-sectional, descriptive and analytical study. The study sample consisted of patients treated at the CEMEC rheumatology clinic on the days referring to patients with more severe manifestations of the diseases, during the period from September 2022 to January 2023. All tests were performed with the aid of the Bioestat software 5.5. Quantitative variables were described by minimum, maximum, mean, median and standard deviation and qualitative variables by frequency and percentage, with a significance level of 0.05 being defined. Results: The urinary tract infection (UTI) was the most recurrent infection in both analyzed pathologies, followed by lower airway infections. In patients with SLE, candidiasis had an epidemiological significance. The most frequent etiological agents were bacteria, fungus and viruses, respectively. There was no association between the use of immunobiologicals and the incidence of infectious episodes. There was a correlation between RA and osteoporosis. Conclusion: There was an important prevalence of rheumatological diseases and infectious conditions, mainly UTIs, and candidiasis was largely related to SLE. There was no relevant association between the most potent immunosuppressants and hospitalizations. In the study, the main difficulty was inconstancy in filling out information in the medical records, useful for understanding the clinical and pathological characteristics of patients, which could be applied to improve prevention and conduct in the face of infections. It is therefore understood the relevance of filling in the patient's vaccination status, as well as the DAS-28 classification for future studies comparing disease activity with the incidence of infection.