GISELE CHAGAS DE MEDEIROS

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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  • article 3 Citação(ões) na Scopus
    Clinical Manifestation of Nebulin-Associated Nemaline Myopathy
    (2023) MORENO, Cristiane Araujo Martins; ARTILHEIRO, Mariana Cunha; FONSECA, Alulin Tacio Quadros Santos Monteiro; CAMELO, Clara Gontijo; MEDEIROS, Gisele Chagas de; SASSI, Fernanda Chiarion; ANDRADE, Claudia Regina Furquim de; DONKERVOORT, Sandra; SILVA, Andre Macedo Serafim; DALFIOR-JUNIOR, Luiz; ABATH-NETO, Osorio Lopes; REED, Umbertina Conti; BOENNEMANN, Carsten; ZANOTELI, Edmar
    Background and ObjectivesNemaline myopathy (NM) is a genetically heterogeneous inherited myopathy related with at least 12 genes, whereas pathogenic variants in NEB gene are the most common genetic cause. The clinical spectrum of NM caused by NEB pathogenic variants (NM-NEB) is very broad, ranging from mild to severe presentations manifesting with generalized weakness, as well as respiratory and bulbar involvement. There is currently not enough data regarding the progression of the disease. In this study, we present a genotypic and phenotypic spectrum of 33 patients with NM caused by NEB variants (NM-NEB) classified according to age groups and the use of ventilatory support. We focused on interventional support, genotype-phenotype correlation, and association between respiratory, bulbar, and motor systems in groups of patients stratified by age and by the use of ventilatory support (VS). MethodsClinical and genetic data from patients with NM-NEB followed up in one specialized center were collected through regular consultations. Patients were evaluated regarding motor, bulbar, and respiratory functions. ResultsThirty-three patients with NM-NEB were evaluated consisting of 15 females and 18 males with an average age of 18 (+/- 12) years and a median of 17 (+/- 11) years. 32% of patients with NM-NEB used a G tube, 35% were not able to walk without support, and 55% needed VS. Scoliosis and dysphagia were more common among patients who used VS. Described for the first time, half of the patients presented tongue atrophy in a triple furrow pattern, and the presence of the atrophy was associated with dysphagia. Comparing the patients grouped by age, we found that, proportionally, older patients had more scoliosis and respiratory dysfunction than younger groups, suggesting the progression of the disease in these domains. In addition to that, we showed that VS use was associated with scoliosis and dysphagia. DiscussionNM-NEB is a very debilitating disease. There is an association between scoliosis and respiratory dysfunction while patients using VS have more often scoliosis than the no-VS group. Triple furrow tongue atrophy is a novel and frequent finding, which is directly associated with dysphagia. Grouping patients by age suggested disease stability in motor and swallow function, but a progression in respiratory dysfunction and skeletal deformities. All observations are relevant in the management care of patients with NM.
  • article 7 Citação(ões) na Scopus
    Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration
    (2016) MEDEIROS, Gisele Chagas de; SASSI, Fernanda Chiarion; ZAMBOM, Lucas Santos; ANDRADE, Claudia Regina Furquim de
  • bookPart
    Atuação fonoaudiológica em disfagia em cuidados paliativos
    (2022) MEDEIROS, Gisele Chagas de; FERRUCCI, Juliana Lopes; JACINTO-SCUDEIRO, Laís Alves; BANDEIRA, Thayna Passarini; SIMõES, Higor; ANDRADE, Claudia Regina Furquim de
  • article 3 Citação(ões) na Scopus
    Decannulation: a retrospective cohort study of clinical and swallowing indicators of success
    (2022) ESCUDERO, Carina; SASSI, Fernanda Chiarion; MEDEIROS, Gisele Chagas de; LIMA, Maira Santilli de; CARDOSO, Paulo Francisco Guerreiro; ANDRADE, Claudia Regina Furquim de
    Objective: To investigate the clinical and swallowing indicators related to a successful decannulation process during the hospital stay. Methods: A retrospective cohort clinical study. The study sample comprised a heterogeneous patient population who had submitted to a tracheostomy procedure in a tertiary hospital. Patients were divided into two groups (decannulated vs. non-decannulated) and compared not only in terms of demographic and clinical data but also the results of a swallowing assessment and intervention outcome. Results: Sixty-four patients were included in the present study: 25 (39%) who had been successfully decannulated, and 39 (61%) who could not be decannulated. Between-group comparisons indicated that both groups presented similar clinical and demographic characteristics. The groups also presented similar swallowing assessment results prior to intervention. However, significant differences were observed regarding the time to begin swallowing rehabilitation. The decannulated group was assessed nine days earlier than the non-decannulated group. Other significant differences included the removal of the alternate feeding method (72.0% of decannulated patients vs. 5.1% of non-decannulated patients) and the reintroduction of oral feeding (96.0% of decannulated patients vs. 41.0% of non-decannulated patients) and functional swallowing level at patient disclosure. The non-decannulated patient group presented higher death rates at disclosure. Conclusion: The results of the present study indicated that the following parameters were associated with a successful decannulation process: early swallowing assessment, swallowing rehabilitation, and improvement in the swallowing functional level during the hospital stay. The maintenance of low swallowing functional levels was found to be negatively associated with successful decannulation.
  • article 7 Citação(ões) na Scopus
    Clinical swallowing prognostic indicators in patients with acute ischemic stroke
    (2019) LEITE, Karoline Kussik de Almeida; SASSI, Fernando Chiarion; MEDEIROS, Gisele Chagas de; COMERLATTI, Luiz Roberto; ANDRADE, Claudia Regina Furquim de
    A swallowing disorder is present in more than 50% of patients with acute stroke. Objective: To identify clinical prognostic indicators of the swallowing function in a population with acute ischemic stroke and to determine prioritization indicators for swallowing rehabilitation. Methods: Participants were adults admitted to the emergency room who were diagnosed with acute ischemic stroke. Data gathering involved a swallowing assessment to determine the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) and the verification of demographic and clinical variables. Results: The study sample included 295 patients. For analysis purposes, patients were grouped as follows: ASHA NOMS levels 1 and 2 - ASHA1 (n = 51); levels 3, 4 and 5 - ASHA2 (n = 96); levels 6 and 7 - ASHA3 (n = 148). Statistical analyses indicated that patients who presented a poorer swallowing function (ASHA1) were older (age >= 70 years); had anterior circulation infarct: had lower scores on the Glasgow Coma Scale (GCS <= 14 points); took longer to initiate swallowing rehabilitation: had longer hospital stays; made more use of alternative feeding methods: needed more sessions of swallowing rehabilitation to remove alternate feeding methods: took longer to return to oral feeding and had poorer outcomes (fewer individuals discharged from swallowing rehabilitation sessions and increased mortality). Conclusion: Patients with acute ischemic stroke, admitted to the emergency room, aged >= 70 years. score on the GCS <= 14, anterior circulation infarct and dementia should be prioritized for swallowing assessment and rehabilitation.
  • article 4 Citação(ões) na Scopus
    Diagnostic precision for bronchopulmonary aspiration in a heterogeneous population
    (2020) LIMA, Maira Santilli de; SASSI, Fernanda Chiarion; MEDEIROS, Gisele Chagas de; JAYANTHI, Shri Krishna; ANDRADE, Claudia Regina Furquim de
    Purpose: The purpose of the present study was to assess the validity of a simple instrument for screening dysphagia used in a large public hospital in Brazil with heterogeneous adult population. Method: The Dysphagia Risk Evaluation Protocol (DREP) - screening version contains four items (altered cervical auscultation, altered vocal quality, coughing and choking before / during / after swallowing) that were previously indicated as independent risk factors associated to the presence of dysphagia in the swallowing test with water. Trained speech therapists administered and scored DREP - screening version to consecutive patients referred by hospital's medical team to perform Video Fluoroscopic for Swallowing Study (VFSS). Results: 211 patients received the swallowing screen (DREP): 99 failed and 112 passed. One in every five patients was randomized to receive a VFSS. The DREP screening version demonstrated excellent validity with sensitivity at 92.9%, specificity at 75.0%, negative predictive values at 95.5% and an accuracy of 80.9%. Conclusion: The DREP - screening version is a simple and accurate tool to identify the risk for penetration and / or aspiration in patients who are not tube-fed, who have a good level of alertness, have no history of recurrent pneumonia, are not on pneumonia, and that do not use a tracheostomy cannula.
  • article 16 Citação(ões) na Scopus
    Avaliação e classificação da disfagia pós-extubação em pacientes críticos.
    (2018) SASSI, Fernanda Chiarion; MEDEIROS, Gisele Chagas de; ZAMBON, Lucas Santos; ZILBERSTEIN, Bruno; ANDRADE, Claudia Regina Furquim de
    ABSTRACT Objective: to identify factors associated with dysphagia in patients undergoing prolonged orotracheal intubation (pOTI) and the post-extubation consequences. Methods: 150 patients undergoing pOTI participated in the study, evaluated according to the deglutition functional level (American Speech Language - Hearing Association National Outcome Measurement System - ASHA NOMS), severity determination (The Simplified Acute Physiology Score - SOFA) and submitted to collection of variables age, mortality, days of orotracheal intubation, number of sessions to introduce oral diet, and days to hospital discharge. We grouped patients according to ASHA classification: 1 (levels 1 and 2), 2 (levels 3, 4 and 5) and 3 (levels 6 and 7). Results: the variables associated with impaired deglutition functionality were age (p<0.001), mortality (p<0.003), OTI days (p=0.001), number of sessions to introduce oral diet (p<0.001) and days to hospital discharge (p=0.018). Multiple comparisons indicated significant difference between ASHA1 and ASHA2 groups in relation to ASHA3 group. ASHA1 and ASHA2 groups had a lower SOFA score when compared with the ASHA3 group (p=0.004). Only 20% of ASHA1 patients and 32% of ASHA2 patients presented safe deglutition levels before discharge. Conclusion: factors associated with dysphagia in patients submitted to pOTI were age over 55 years and orotracheal intubation time (greater in the cases with worse deglutition functionality). The post-extubation consequences were increased mortality and length of hospital stay in the presence of dysphagia.
  • article 0 Citação(ões) na Scopus
    Characterization of feeding skills and clinical markers of preterm newborns with gastroschisis in a neonatal therapy unit
    (2023) SASSI, Fernanda Chiarion; RITTO, Ana Paula; SASSI, Daniela Chiarion; ANSUINO, Ana Carla; MEDEIROS, Gisele Chagas de; JUSTE, Fabiola; BEFI-LOPES, Debora Maria; ANDRADE, Claudia Regina Furquim de
    Objective: To describe the clinical and feeding findings of premature infants with gastroschisis (GTQ) in a neonatal intensive care unit and compare them to preterm infants (NBs) without congenital anomalies. Methods: A retrospective case-control study was conducted with 50 premature NBs (25 with GTQ and 25 without comorbidities - control group). The NBs were compared regarding demographic and clinical data: risk of mortality and speechlanguage assessment (nonnutritive and nutritive sucking). Subsequently, a multiple logistic regression model was applied to determine the variables associated with the negative speech therapy outcome (speech therapy discharge after more than 7 days considering the first speech therapy evaluation). Results: The results of the first analysis indicated that there was a difference between the GTQ and the CG for the following variables: total time in days of hospitalization; use of mechanical ventilation (invasive x noninvasive); days of life on the date of the first speechlanguage assessment; use of alternative feeding route; and the GTQ group had worse results. The results of the multiple logistic regression indicated that the diagnosis of GTQ, the use of invasive mechanical ventilation, and the absence of adequate intraoral pressure during the first speech-language evaluation were risk factors for a negative speech-language outcome. Conclusion: The feeding skills of preterm infants with QTG are related to the severity of the condition (gastrointestinal tract complications), requiring longer hospitalization, use of invasive mechanical ventilation, prolonged use of alternative feeding route and requiring more speech therapy to start oral feeding.
  • article 25 Citação(ões) na Scopus
    Preliminary results of a clinical study to evaluate the performance and safety of swallowing in critical patients with COVID-19
    (2020) LIMA, Maira Santilli de; SASSI, Fernanda Chiarion; MEDEIROS, Gisele C.; RITTO, Ana Paula; ANDRADE, Claudia Regina Furquim de
  • article 20 Citação(ões) na Scopus
    Oral transit time: a critical review of the literature
    (2015) SOARES, Thais Jacóe; MORAES, Danielle Pedroni; MEDEIROS, Gisele Chagas de; SASSI, Fernanda Chiarion; ZILBERSTEIN, Bruno; ANDRADE, Claudia Regina Furquim de
    INTRODUCTION: Oral transit time is one of the parameters observed during the clinical assessment of the swallowing function. The importance of this parameter is due to its impact on the total duration of a meal, whose consequence can be an unfavorable nutritional prognostic. OBJECTIVE: To document scientific papers that measure oral transit time in healthy subjects. METHOD: The review followed the steps proposed by the Cochrane Handbook. The search was done via the PubMed database through the use of descriptors related to the oral phase of swallowing, as well as to types of food consistency. RESULTS: The articles on the theme had different definitions for oral transit time, as well as heterogeneity of tested volumes, age and gender of the participants. The times found varied from 0.35 s to 1.54 s for liquids, from 0.39 s to 1.05 s for pasty foods and from 1 s to 12.8 s for solid foods. Also, regardless of volume or consistency, oral transit time in elderly people is significantly longer than in adults. CONCLUSION: There's no consensus in the literature about oral transit time in healthy subjects. However, this parameter should be valued during the assessment of the swallowing function due to its negative impact on the dynamics of swallowing, which can cause high energy expenditure during feeding.