Search

Medicinal Biomagnetism (MB) is a therapy for the prevention, diagnosis, and treatment of diseases using static magnetic fields. It is based on physical-chemical and physiopathological principles. To understand the technique, it is necessary to present the concepts of magnetism, potential of hydrogen, magnetic resonance, entropy, symbiosis, homeostasis, and the rheology of fluids. Understanding the fundamentals of MB is the first step towards the construction of a scientific language, as well as for the understanding and clinical interpretation of its results. This study is a narrative review of the literature that aims to present the fundamentals of MB within the principles of physics, chemistry, biology, physiology, and biochemistry to serve as a basis for technique application and for new scientific research projects in the area. Most of the studies that have applied the technique could not be considered for analysis due to a lack of the necessary methodological rigor, while others were derived from end-of-course papers and are not yet published. Regarding the investigated fundamentals, a vast body of literature was found, and its relationship with MB can be explored. It is concluded that there is coherence between the theoretical bases already substantiated in science and the principles of MB.

Medicinal Biomagnetism (BM) has os its founder Dr. Isaac Goiz Durán, and as a proposal, to be an integrative and complementary therapeutic measure in health, in a comprehensive and universal way. However, as it is generally disseminated through free courses, it is subject to interpretation and application bias in the identification of tracking points and Biomagnetic Pairs (PBMs). Clinical Protocols and Therapeutic Guidelines establish criteria for health management in any clinical specialty. The objective of this study is to present a proposal for the standardization of a physical examination (screening) and semiology protocol for BM, in a structured and systematized way, aiming to provide a standard language for Biomagnetists and an adequate guideline for investigations and scientific evidence. A narrative review was used to support this proposal. The protocol proposed in this study originates from the works developed by its founder, and is presented in a segmented way, in four columns, for better visualization. The columns show the divisions with the classification of PBMs, the tracking points and their anatomical location, the impaction or resonance points and their anatomical location, and finally, a column with the symptomatology and symptomatological specification of the PBMs. What is observed in this review is the organized arrangement of the screening points and other important information for an adequate application and investigation of the technique. Thus, the present study is relevant in presenting a proposal for a structured and systematized protocol, for a better understanding of professionals who work in the application of the technique, patients and the scientific community. This opens up perspectives that this protocol can serve as a research base and the BM reaches the desired robust scientific evidence, and that it is recognized and included as an integrative and complementary practice in structured public and private health services.

Resumo Fundamento: A doença de Chagas leva à redução da capacidade funcional. Entretanto, o estágio em que o comprometimento funcional é detectável permanece obscuro. Objetivos: O presente estudo teve como objetivo comparar a capacidade funcional de pacientes em diferentes estágios da doença de Chagas e de indivíduos saudáveis e verificar os determinantes do consumo de oxigênio de pico (VO2pico). Métodos: Em um estudo transversal, foram selecionados 160 indivíduos, 35 saudáveis e 125 com doença de Chagas. No grupo chagásico, 61 (49%) estavam na forma indeterminada da doença, 45 (36%) com cardiomiopatia chagásica (CC) e função cardíaca preservada e 19 (15%) com disfunção cardíaca e CC dilatada. Os dados foram analisados por meio de análise de regressão univariada e multivariada. A significância estatística foi fixada em 5%. Resultados: Pacientes na forma indeterminada da doença apresentaram capacidade funcional semelhante a indivíduos saudáveis (p> 0,05). Pacientes com ChC e função cardíaca preservada apresentaram VO2pico menor que os pacientes na forma indeterminada (p 0.05). Patients with ChC and preserved cardiac function had lower VO2peak than patients in the indeterminate form (p

Systolic dysfunction is a well-established marker of mortality in patients with Chagas cardiomyopathy (CC). However, its diagnosis is expensive and useful tools for screening these patients are required. The evaluation of the health-related quality of life (HRQoL) detects the patient's perception of the disease's impact. However, its accuracy in identifying patients with CC and systolic dysfunction is unknown. The study aimed to verify the sensitivity, specificity and predictive values of the physical and mental components related to HRQoL in identifying patients with CC and systolic dysfunction.75 patients with CC, aged 49 (95% confidence interval: 47-51) years, were evaluated by echocardiography and Short-Form of Health Survey (SF-36) questionnaire. Systolic dysfunction was defined by left ventricular ejection fraction52% for men and54% for women and left ventricular diastolic diameter55 mm.Most patients (73%) had systolic dysfunction, with lower HRQoL values in the physical functioning, physical role functioning and general health perceptions domains and in the physical component summary. The accuracy of identifying patients with systolic dysfunction by the scores of physical components was 73% and 62% of mental components. The optimal cut-off point was 46 for physical and 54 for mental components, with respective positive predictive values of 91% and 80%.The evaluation of the HRQoL by the SF-36, a low-cost instrument, can be useful in identifying patients with systolic dysfunction, assisting in the screening and risk stratification of patients.

Chagas heart disease (CHD) leads to a progressive functional impairment. Field tests, as the 6-min walk test (6MWT) and the incremental shuttle walk test (ISWT), may be inexpensive approaches in the evaluation of functional capacity of these patients. The present study was addressed to compare the 6MWT and the ISWT measures, and to determine the accuracy of these tests in the identification of functional impairment in patients with CHD. Thirty-five patients with CHD (47.1±8.2 years, NYHA I-III) were evaluated by echocardiography, cardiopulmonary exercise test (CPET), 6MWT, and ISWT. Correlations between the CPET (peak oxygen uptake [peak VO2] and the ratio between ventilation and the carbon dioxide production [VE/VCO2 slope]) and the field tests (walking distances) were also performed. The receiver operating characteristic (ROC) curve was selected to identify the best distances related to identify those patients with functional impairment. There was no difference between distances walked during the 6MWT and ISWT (P=0.694). The Bland-Altman analysis showed good agreement between the field tests. Both 6MWT and ISWT correlated with peak VO2 (r=0.577, P

Background Serum brain-derived neurotrophic factor (BDNF) levels have been shown to be lower in patients with Chagas cardiomyopathy (ChC) than in patients with non-dilated chagasic cardiomyopathy. However, its prognostic value was not established in patients with ChC. Methods Forty-nine patients with ChC (50 ± 7 years, New York Heart Association "NYHA" I-III); were evaluated by echocardiography, exercise testing, and blood analysis. Serum BDNF levels were determined using enzyme-linked immunosorbent assay sandwich. Patients were followed-up, and cardiac death was considered the end-point. The survival analyses were performed using Kaplan-Meier and Cox regression. Results After 39 ± 14 months of follow-up, 12 patients (25%) died. The concentration of 2.5 ng/mL was the optimal cut-off value to predict survival with significant difference between the groups with low (≤ 2.5 ng/mL) and high (> 2.5 ng/mL) BDNF levels (p = 0.006). Lower serum BDNF levels (hazards ratio (HR) 1.1, 95% confidence interval (CI) 1.1-1.4; p = 0.001), peak oxygen uptake (HR 1.2, 95% CI 1.0-1.3; p = 0.009), and left ventricular ejection fraction (HR 0.8, 95% CI 0.7-0.9; p = 0.001) were the independent predictors of survival. The combination of low serum BDNF levels and reduced left ventricular ejection fraction were highly predictive of death (HR 5.6, 95% CI: 1.2-9.7; p = 0.026). Conclusion In patients with ChC, reduced serum BDNF levels, especially if associated with systolic function, may provide useful prognostic information.

Chagas disease (ChD), a neglected tropical disease caused by infection with the parasite Trypanosoma cruzi (T. cruzi), remains a serious public health issue in Latin America and is an emerging disease in several non-endemic countries, where knowledge of the condition and experience with its clinical management are limited. Regionally, the disease is the major cause of disability secondary to tropical diseases in young adults. Health-related quality of life (HRQoL) impairment is common in patients with ChD, especially in those with Chagas dilated cardiomyopathy, the most severe manifestation of the disease, which frequently leads to heart failure. The aim of this review was to conduct a literature search for studies that have evaluated the determining factors of HRQoL in ChD patients. We included cross-sectional, case-control, cohort, and experimental studies, as well as clinical trials that evaluated the HRQoL in ChD patients aged 18 to 60 years and are presenting an explicit description of statistical analysis. Using a combination of keywords based on Descriptors in Health Sciences (DeCS) and Medical Subject Headings (MeSH) for searches in PubMed and the Scientific Electronic Library Online (SciELO), 148 studies were found. After exclusions, 12 studies were selected for analysis. Three main findings were extracted from these studies: 1) cardiac involvement is associated with a worse HRQoL in ChD patients; 2) HRQoL is associated with the patients' functional capacity; and 3) simple and inexpensive therapeutic measures are effective for improving HRQoL in ChD patients. Hence, ChD patients' functional capacity, the effectiveness of non-surgical conservative treatment, and cardiac involvement are important determining factors for the HRQoL in ChD patients.

Introduction: Chagas disease remains a public health problem in Latin America and currently in non-endemic countries. The cardiac form is the most severe and exercise training has been shown to be effective in the treatment of these patients. However, a review of the clinical findings of pre-training assessment is necessary to guide the exercise prescription. Objective: to describe the cycle of the disease and the physiotherapeutic evaluation and of patients with Chagas disease, focusing on the patient with cardiopathy.Methods: a literature search in MEDLINE/Pubmed, Scientific Electronic Library Online, Cumulative Index of Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature and Web of Science databases performed between November 2017 and January 2018.Results: In the anamnesis, drug therapy and functional class of the New York Heart Association should be investigated. In the maximum exercise testing, the presence of ventricular arrhythmias, the peak of oxygen uptake and the slope of increase of ventilation relative to carbondioxide production may assist in the functional evaluation, risk stratification and prognosis establishment. Field tests, such as the Six-Minute Walk Test and Incremental Shuttle Walk Test, are inexpensive and effective in functional assessment. Respiratory evaluation has received special attention in recent years by the prevalence of inspiratory muscle weakness. Finally, quality of life is a crucial point in the evaluation of the chagasic patient, mainly due to the stigmatizing nature of the disease.Conclusion: The peculiarities of Chagas heart disease should be taken into account in the functional evaluation of the patient and plays a key role in the exercise prescription before physical training.

Background Cardiac rehabilitation (CR) is a recommended model of care for cardiovascular diseases; however, is not widely available and is underutilized, especially in low- and middle-income countries. Objectives To identify the CR programs available in one Brazilian state (Minas Gerais; MG) and describe their characteristics by funding type. Methods In this multi-center descriptive study, CR programs were identified in four MG regions and 41 CR coordinators were sent a survey to report the characteristics of their programs, including CR components described in guidelines and barriers to patients’ participation. Descriptive and comparative analysis between public and private programs were carried out. Results Forty-one CR programs were identified, only 21.9% public. Nineteen completed the survey. The majority of CR programs offered initial assessment and physical training. Components of comprehensive CR programs that were rarely offered included treatment of tobacco dependence, psychological support and lipid control. Physical therapists were present in all CR programs. The six-minute walk test was used in most programs to assess functional capacity. Programs were located intra-hospital only in public hospitals. Phase 2 (initial outpatient) and phase 4 (maintenance) were offered significantly more in private programs when compared to public ones. The main barrier for CR participation was the lack of referral. Conclusions The availability of CR programs in MG state is low, especially public programs. Most programs do not offer all core components of CR.

35%) [2] must be considered. The power of these findings are limited by thesmall numberof patientswithmoderate airways reversibility (n=4). However,we take some reassurance from the goodproportionof patients diagnosed with asthma recruited to the study. Despite the limitation, we believe our study provides important hypothesis-generating data that contributes to a paucity of relevant literature in this area. A larger long-term study is required to provide definitive data regarding the effect of nebivolol on CHF patients withmoderate reversibility airways disease.

a Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clinicas of the Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil b Healthy and Biological Sciences Faculty, Physical Therapy School, Federal University of the Jequitinhonha and Mucuri Valleys (UFVJM), Diamantina, Brazil c Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil

Aims The effects of exercise training in chronic heart failure are well established, however, they have not been evaluated in Chagas cardiomyopathy (ChC). We sought to determine the effects of exercise training on functional capacity, health-related quality of life (HQoL), and brain natriuretic peptide (BNP) levels in patients with ChC. Methods and results This randomized, controlled, single-blind trial included 40 patients with ChC (age 49.5 ± 7.8 years, 57.5% male) who did not practice regular exercise. All patients were assessed, at baseline and at the end of the study, by exercise test (VO2 and exercise time), six-minute walk test (6MWT), Goldman Specific Activity Scale (SAS), HQoL, and BNP levels. Patients were randomized to inactive control group (ICG = 19) or exercise training group (ETG = 21). Exercise training group patients underwent 12 weeks of exercise training: walking for up to 30 min (intensity 50–70% HR reserve + HR at rest) and warm-up and cooling-down exercising, three times a week. The data were analysed for delta values (Δ= end − baseline). After intervention, compared with the ICG, the ETG had significant increases in functional parameters including, ΔVO2 (6.5 vs. 2.8 mL/kg/min, P = 0.001), Δ exercise time (2.9 vs.1.1 min, P < 0.001), Δ6MWT distance (83.5 vs. 2.0 m, P = 0.001) improved ΔSAS (8 vs. 1 patient, P = 0.008), and HQoL: Δ domains vitality (7.5 vs. 0 points, P = 0.013), Δ emotional aspects (16.7 vs. 0 points, P = 0.012), and Δ mental health (16.1 vs. 0 points, P = 0.031). There was no difference in BNP levels. Conclusion In patients with ChC, exercise training was associated with a major improvement in functional capacity and HQoL without any adverse effects.

Aims Right ventricular (RV) dysfunction is an important factor on effort tolerance in cardiopulmonary diseases. Nevertheless, the role of RV function in predicting exercise capacity in patients with Chagas disease has not been reported. This study aims to evaluate whether RV function assessed by tissue Doppler can predict functional capacity in patients with Chagas heart disease. Methods and results We evaluated 65 patients (48.6 ± 9.1 years, 60% men) with Chagas heart disease. Standard and tissue Doppler echocardiography were performed before maximal exercise testing. Tissue Doppler imaging (TDI) was used to measure RV peak annular systolic and diastolic velocities. Exercise testing was performed using a standard Bruce protocol. Linear regression analysis was used to determine multivariate peak oxygen consumption (VO2) predictors. All patients were in NYHA functional class I or II. Mean peak VO2 was 32.4 ± 10.2 mL/kg/min and mean LV ejection fraction was 43 ± 11%. There was correlation between TDI RV peak systolic velocity and LV ejection fraction ( r = 0.5; P < 0.001). In a multivariate analysis, after adjustment for age and gender, RV function emerged as an independent predictor of functional capacity, as demonstrated in the model: peak VO2 ( r = 0.71) was: 42.22−(9.77 × female gender)−(0.29 × age) + (1.54 × RV systolic velocity). Conclusion In this cross-sectional study, RV function was an important, independent determinant of exercise capacity in patients with Chagas heart disease. TDI RV systolic annular velocity was most closely associated with peak VO2, regardless of the influence of age, gender, and other echocardiographic parameters.

To assess the effects of an 11-week Pilates exercise program on the functional capacity of young sedentary women.Ten subjects underwent the shuttle walking test. A portable metabolic system was used during the shuttle walking test to measure the maximum heart rate and VOThe findings showed increased walking distance, maximum heart rate and heart rate recovery after completing the protocol. The peak of VOThe current results suggest that Pilates exercises significantly improve walking functional capacity.

Introdução O tabagismo é uma das principais causas de morbimortalidade em todo o mundo. Indivíduos fumantes têm risco aumentado de desenvolver disfunção autonômica, a qual pode ser avaliada tanto pela variabilidade da frequência cardíaca (VFC) como pela frequência cardíaca de recuperação (FCRec). A maioria dos estudos envolvendo esta análise é realizada em adultos de idade avançada e na condição de repouso. Objetivos Comparar a atividade autonômica cardíaca em repouso e esforço, em homens jovens, fumantes e não fumantes. Métodos Trinta e dois jovens voluntários, (idade 22,0 ± 2,8 anos) foram distribuídos em dois grupos: o grupo fumante (GF; n=15) e o não fumante (GNF; n=17). Realizou-se o teste de Cooper, com análise da VFC pelo cardiofrequencímetro Polar(r)s810i, em repouso e durante o esforço e FCRec. Resultados No GF, 73% foram classificados com nível de dependência nicotínica "muito baixa" segundo questionário de Fargeström. A classificação de ativos e muito ativos pelo questionário IPAQ correspondeu a mais de 50% da amostra em ambos os grupos. Não se observou diferenças significativas entre os grupos na VFC, tanto no repouso quanto no esforço. Entretanto, em cada grupo, notou-se diferença na maioria dos índices de VFC do repouso para o esforço. No teste de Cooper não foram observadas diferenças significativas na FCmédia, FCpico e de FCRec entre os grupos, mas notou-se uma melhor capacidade funcional no GNF pela distância caminhada (2050,2 ± 300,0 vs. 1780,3 ± 390,4 m, p=0,036). Conclusão O GF apresentou menor capacidade funcional e ativação parassimpática durante o esforço, além de menores índices de VFC durante repouso, o que pode sugerir um comprometimento precoce na modulação autonômica cardíaca. Introduction Smoking is one of the major causes of morbidity and mortality worldwide. Smokers have an increased risk of developing autonomic dysfunction, which can be evaluated by both heart rate variability (HRV) and heart rate recovery (HRRec). Most studies involving this analysis is performed on adults of advanced age and in condition of rest. Objectives To compare the cardiac autonomic activity, at rest and during exercise in young men, smokers and non-smokers. Methods Thirty-two young volunteers (aged 22.0 ± 2.8 years) were divided into two groups: the smoking group (SG, n = 15) and non-smokers (NSG, n = 17). We carried out the Cooper test and HRV analysis by heart rate monitor Polar(r)s810i, at rest and during exercise and HRRec. Results In SG, 73% were classified as having a "very low" level of nicotine dependence according to the Fargeström's questionnaire. Classification of active and very active by the IPAQ questionnaire accounted for over 50% of sample in both groups. There were no significant differences between groups in HRV, both at rest and during exercise. However, in each group, difference has been noted in most HRV indexes from rest to exercise. During Cooper test there were no significant differences in mean HR, HRpeak and HRRec between groups, but a better functional capacity was noted in NSG in the distance walked (2050.2 ± 300.0 vs. 1780.3 ± 390.4m, p = 0.036). Conclusion The SG showed lower functional capacity and parasympathetic activation during exercise, besides lower HRV indexes during rest, suggesting an early impairment in cardiac autonomic modulation. Introducción El consumo de cigarrillos es una de las más importantes causas de morbilidad y mortalidad en todo el mundo. Los individuos fumadores tienen mayor riesgo de desarrollar disfunción autonómica, que puede ser evaluada tanto por la variabilidad del ritmo cardíaco (VRC) como por la frecuencia cardiaca de recuperación (FCrec). La mayoría de los estudios con estos análisis se lleva a cabo en las personas más viejas y en situación de reposo. Objetivos Comparar la actividad autonómica cardiaca, en momento de reposo y durante ejercicios, en hombres jóvenes, fumadores y no fumadores. Métodos Treinta y dos voluntarios jóvenes (edad 22,0 ± 2,8 años) fueron divididos en dos grupos: grupo de fumadores (GF; n = 15) y no fumadores (GNF; n = 17). Se realizó la prueba de Cooper con el análisis de la VRC por pulsómetro Polar(r)s810i, durante reposo y ejercicio y FCrec. Resultados En el GF, el 73% fueron clasificados con niveles de dependencia por la nicotina "muy bajo", según cuestionario Fargeström. La clasificación de activos y muy activos, mediante cuestionario IPAQ, correspondió a más de 50% de la amuestra en ambos los grupos. No hubo diferencia significativa entre los grupos en la VRC, tanto en reposo cuanto en ejercicio. Sin embargo, en cada grupo, observamos una diferencia en la mayoría de los índices de VRC del reposo para el ejercicio. En la prueba de Cooper no se observó diferencias significativas en las FC media, FCpico y FCrec, pero se verificó una mejor capacidad funcional en el GNF por la distancia caminada (2050.2 ± 300.0 vs. 1780,3 ± 390,4 m, p = 0,036). Conclusión El GF mostró una capacidad funcional y una activación parasimpática más baja durante el ejercicio, así como tasas más bajas de VRC en reposo, lo que puede sugerir un deterioro temprano en la modulación autonómica cardíaca.

INTRODUCTION : Exercise-induced ventricular arrhythmia (EIVA) and autonomic imbalance are considered as early markers of heart disease in Chagas disease (ChD) patients. The objective of the present study was to verify the differences in the occurrence of EIVA and autonomic maneuver indexes between healthy individuals and ChD patients with no apparent cardiac involvement. METHODS : A total of 75 ChD patients with no apparent cardiac involvement, aged 44.7 (8.5) years, and 38 healthy individuals, aged 44.0 (9.2) years, were evaluated using echocardiography, symptom-limited treadmill exercise testing and autonomic function tests. RESULTS : The occurrence of EIVA was higher in the chagasic group (48%) than in the control group (23.7%) during both the effort and the recovery phases. Frequent ventricular contractions occurred only in the patient group. Additionally, the respiratory sinus arrhythmia index was significantly lower in the chagasic individuals compared with the control group. CONCLUSIONS : ChD patients with no apparent cardiac involvement had a higher frequency of EIVA as well as more vagal dysfunction by respiratory sinus arrhythmia. These results suggest that even when asymptomatic, ChD patients possess important arrhythmogenic substrates and subclinical disease.

Introduction Inspiratory muscle function may be affected in patients with End-Stage Renal Disease (ESRD), further worsening the functional loss in these individuals. However, the impact of inspiratory muscle weakness (IMW) on the functional capacity (FC) of hemodialysis patients remains unknown. Thus, the present study aimed to evaluate the impact of IMW on FC in ESRD patients undergoing hemodialysis. Materials and methods ESRD patients on hemodialysis treatment for more than six months were evaluated for inspiratory muscle strength and FC. Inspiratory muscle strength was evaluated based on maximal inspiratory pressure (MIP). IMW was defined as MIP values less than 70% of the predicted value. FC was evaluated using the Incremental Shuttle Walk test (ISWT). Patients whose predicted peak oxygen uptake (VO2peak) over the distance walked during the ISWT was less than 16mL/kg/min were considered to have FC impairment. Associations between variables were assessed by linear and logistic regression, with adjustment for age, sex, body mass index (BMI), presence of diabetes and hemoglobin level. Receiver-operating characteristic (ROC) analysis was used to determine different cutoff values of the MIP for normal inspiratory muscle strength and FC. Results Sixty-five ERSD patients (67.7% male), aged 48.2 (44.5–51.9) years were evaluated. MIP was an independent predictor of the distance walked during the ISWT (R2 = 0.44). IMW was an independent predictor of VO2peak < 16mL/kg/min. (OR = 5.7; p = 0.048) in adjusted logistic regression models. ROC curves showed that the MIP cutoff value of 82cmH2O had a sensitivity of 73.5% and specificity of 93.7% in predicting normal inspiratory strength and a sensitivity and specificity of 76.3% and 70.4%, respectively, in predicting VO2peak ≥ 16mL/kg/min. Conclusions IMW is associated with reduced FC in hemodialysis patients. Evaluation of the MIP may be important to functional monitoring in clinical practice and can help in the stratification of patients eligible to perform exercise testing.

Chagas' disease (ChD), caused by the protozoaTrypanosoma cruzi(T. cruzi), was discovered and described by the Brazilian physician Carlos Chagas in 1909. After a century of original description, trypanosomiasis still brings much misery to humanity and is classified as a neglected tropical disease prevalent in underdeveloped countries, particularly in South America. It is an increasing worldwide problem due to the number of cases in endemic areas and the migration of infected subjects to more developed regions, mainly North America and Europe. Despite its importance, chronic chagas cardiomyopathy (CCC) pathophysiology is yet poorly understood, and independently of its social, clinical, and epidemiological importance, the therapeutic approach of CCC is still transposed from the knowledge acquired from other cardiomyopathies. Therefore, the objective of this review is to describe the treatment of Chagas cardiomyopathy with emphasis on its peculiarities.

Background Chagas disease patients with right bundle-branch block (RBBB) have diverse clinical presentation and prognosis, depending on left ventricular (LV) function. Autonomic disorder can be an early marker of heart involvement. The heart rate recovery (HRR) after exercise may identify autonomic dysfunction, with impact on therapeutic strategies. This study was designed to assess the HRR after symptom-limited exercise testing in asymptomatic Chagas disease patients with RBBB without ventricular dysfunction compared to patients with indeterminate form of Chagas disease and healthy controls. Methods One hundred and forty-nine subjects divided into 3 groups were included. A control group was comprised of healthy individuals; group 1 included patients in the indeterminate form of Chagas disease; and group 2 included patients with complete RBBB with or without left anterior hemiblock, and normal ventricular systolic function. A symptom-limited exercise test was performed and heart rate (HR) response to exercise was assessed. HRR was defined as the difference between HR at peak exercise and 1 min following test termination. Results There were no differences in heart-rate profile during exercise between healthy individuals and patients in indeterminate form, whereas patients with RBBB had more prevalence of chronotropic incompetence, lower exercise capacity and lower HRR compared with patients in indeterminate form and controls. A delayed decrease in the HR after exercise was found in 17 patients (15%), 9% in indeterminate form and 24% with RBBB, associated with older age, worse functional capacity, impaired chronotropic response, and ventricular arrhythmias during both exercise and recovery. By multivariable analysis, the independent predictors of a delayed decrease in the HRR were age (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.03 to 1.21; p = 0.010) and presence of RBBB (OR 3.97; 95% CI 1.05 to 15.01; p = 0.042). Conclusions A small proportion (15%) of asymptomatic Chagas patients had attenuated HRR after exercise, being more prevalent in patients with RBBB compared with patients in indeterminate form and controls.

OBJETIVO: Avaliar o efeito do treinamento com exercício aeróbio na capacidade funcional (CF) e no controle da pressão arterial (PA), em mulheres na pós-menopausa, hipertensas estágio I, controladas ou não com tratamento medicamentoso, em uma Unidade Básica de Saúde (UBS). METODOLOGIA: Antes e após 12 semanas de treinamento com exercício aeróbio em uma UBS, dez mulheres hipertensas na pós-menopausa, idade de 56,9 ± 6 anos, sedentárias, não usuárias de terapia de reposição hormonal, foram submetidas à avaliação do índice de massa corporal (IMC); da circunferência da cintura (CC); da CF pelo teste ergométrico (maior consumo de oxigênio/ VO2 e tempo de teste) e teste de caminhada em seis minutos (distância caminhada); e das medidas casuais repetidas da PA. Reavaliações foram efetuadas a cada 30 dias. Os dados são expressos em média e desvio-padrão. Foram aplicados os testes de Kolmogorov-Smirnov, t de Student pareado, Wilcoxon e ANOVA para medidas repetidas, considerando significativo p < 0,05. RESULTADOS: Não houve diferença significativa no IMC (p = 0,40) e CC (p = 0,74) após a intervenção. Entretanto, após 30 dias observou-se redução da PA sistólica (de 142,70 ± 6,25 para 130,76 ± 5,80 mmHg, p < 0,001) e diastólica (de 87,03 ± 4,48 para 81,90 ± 4,30 mmHg, p = 0,002) e melhora da CF pelo VO2 (de 24,90 ± 6,38 para 27,82 ± 6,14 mL/kg/min, p = 0,028), tempo de teste (de 6,89 ± 1,78 para 7,7 ± 1,8 min, p = 0,022) e distância caminhada (de 511,07 ± 41,99 para 556,1 ± 43,19 m, p = 0,009). CONCLUSÃO: O programa de treinamento com exercício aeróbio em uma UBS mostrou-se efetivo e viável, contribuindo para a redução da PA e melhora da capacidade funcional em mulheres hipertensas na pós-menopausa. OBJECTIVE: To evaluate the effect of the aerobic exercise training on functional capacity (FC) and blood pressure (BP) control in hypertensive stage I or controlled hypertension postmenopausal women in a primary care unit (PCU). METHODS: Before and after 12 weeks of aerobic exercise training in a PCU, 10 hypertensive postmenopausal women age 56.9 ± 5.98, sedentary, non-users of hormone replacement therapy were submitted to: the evaluation of the body mass index (BMI); the waist circumference (WC); the FC by ergometric test (oxygen uptake/VO2, duration of the test) and six minute walk test (walked distance); and repeated casual measures of BP. Revaluations were made for each 30 days. Data were presented in mean and standard deviation and analyzed by Kolmogorov-Smirnov test, paired Student's t-test, Wilcoxon and a repeated-measures ANOVA considering p < 0.05. RESULTS: No significant difference was found in BMI (p = 0.40) and WC (p = 0.74) after training. However, after 30 days, a reduction had already been observed in systolic BP (from 142.70 ± 6.25 to 130.76 ± 5.80 mmHg, p < .001) and diastolic (from 87.03 ± 4.48 to 81.90 ± 4.30 mmHg, p = .002) and also a significant improvement of functional capacity by VO2 (from 24.90 ± 6.38 to 27.82 ± 6.14 mL/kg/min, p = .028), duration of the test (from 6.89 ± 1.78 to 7.70 ± 1.80 min, p = .022) and distance walked (from 511.07 ± 41.99 to 556.1 ± 43.19 m, p = .009). CONCLUSION: The aerobic exercise training program in a primary care unit was effective and viable as a strategy to reduce the BP and to improve the functional capacity in hypertensive postmenopausal women.

Reduced peak oxygen uptake (VO2peak) is a common clinical finding in progressive Chagas disease. However, the disease stage in which functional impairment is detectable remains uncertain. The present study compared functional capacity between healthy controls and patients with different clinical forms of Chagas disease. A systematic review and meta-analysis (PROSPERO database CRD42017058353) was conducted following a search of the MEDLINE, Web of Science, CINAHL, and LILACS databases from September to December 2017 for articles published in English, Spanish, or Portuguese, with no date restrictions. We included studies that compared the VO2peak between healthy and Chagas disease patients, stratified according to 3 clinical forms [no apparent cardiac disease, non-dilated Chagas heart disease (CHD), and dilated CHD]. Seven cross-sectional studies were included. Chagas disease patients without apparent cardiac disease (n=208) had VO2peak values [mean difference, -1.55ml/kg/min; 95% confidence interval (CI), -4.98ml/kg/min to 1.88ml/kg/min] similar to those of healthy controls (n=105; p=0.38, I2=52%). In non-dilated CHD (n=159), VO2peak was 8.71ml/kg/min lower (95% CI, -13.99 to -3.42ml/kg/min) than in healthy controls (n=59; p=0.001, I2=75%). VO2peak was also significantly lower (mean difference, -9.30ml/kg/min; 95% CI, -11.34 to -7.25ml/kg/min) in dilated CHD patients (n=131) than in healthy controls (n=53; p

Introdução: Apesar do atual controle da sua transmissão, a doença de Chagas (DC) permanece sendo um grave problema de saúde pública, com elevada taxa de morbimortalidade. A miocardiopatia é a complicação mais temível na DC, por ser uma das principais etiologias de insuficiência cardíaca com prognóstico sombrio. A identificação dos pacientes com miocardiopatia dilatada de alto risco para eventos adversos é fundamental para se estabelecer estratégias terapêuticas diferenciadas com possível impacto no prognóstico. Nesse contexto, a eficiência ventilatória, expressa pela razão entre a ventilação e a produção de gás carbônico, está alterada em pacientes com insuficiência cardíaca (IC). Vários estudos relacionaram a eficiência ventilatória à ocorrência de eventos adversos, com valor prognóstico superior à capacidade funcional. A eficiência ventilatória pode ser avaliada através da inclinação da relação Δ VE/Δ VCO2 ou pela razão do VE/VCO2 medida no limiar estimado de lactato (VE/VCO2LL). Estudos anteriores demonstraram que a inclinação da relação ΔVE/ ΔVCO2 está fortemente associada a eventos adversos, mas o valor prognóstico da razão VE/VCO2 LL ainda não se encontra definido nos pacientes com IC. Dessa forma, o presente estudo foi desenhado para se verificar os determinantes do VE/ VCO2LL e avaliar o impacto prognóstico dessa variável nos pacientes com IC secundária às miocardiopatias dilatadas de etiologia chagásica e idiopática. Materiais e Métodos: Pacientes com miocardiopatia dilatada de etiologia chagásica e idiopática foram submetidos ao exame clinico, avaliação ecocardiográfica e ao teste cardiopulmonar de exercício (TCPE), sintoma limitado. Vários parâmetros do TCPE foram medidos, incluindo VO2 de pico, inclinação da relação ΔVE/ ΔVCO2 e o VE/VCO2LL. O desfecho avaliado durante o seguimento foi combinado, definido por morte, internação por IC, acidente vascular cerebral isquêmico ou necessidade de transplante cardíaco. Resultados: Foram incluídos 79 pacientes com miocardiopatia dilatada, 52 (66%) secundária à DC, e 27 (34%) idiopática, com idade de 51±14 anos. Cinquenta e nove pacientes estavam em classe funcional da NYHA de II e III. A maioria estava em uso de betabloqueadores (87,3%) e 84,8% em uso de IECA e/ou BRA. A fração de ejeção do ventrículo esquerdo foi de 38 % ± 10% e a função ventricular direita avaliada pela fração de mudança de área foi de 49 % ± 15%. Todos os pacientes realizaram o TCPE, sem complicações, com tempo de esforço de 522± 38minutos. A inclinação da relação ΔVE/ΔVCO2 foi de 34,8 ± 7,2 e do VE/ VCO2 LL foi de 30,9± 4,6. Subsequentemente, foram avaliados os fatores associados ao VE/VCO2 LL. Os fatores associados ao VE/VCO2 LL foram a classe funcional da NYHA (p=0,007), volume atrial esquerdo (p

O comprometimento funcional cardíaco pode ocorrer em graus variados na cardiopatia chagásica (CCh). Para avaliação da capacidade funcional (CF) desses pacientes, métodos simples e de baixo custo operacional como o Teste de Caminhada de Seis Minutos (TC6) são preconizados uma vez que o Teste de Esforço Cardiopulmonar (TECP), padrão-ouro nesta avaliação, é oneroso e de difícil realização em regiões com poucos recursos financeiros e tecnológicos. Estudos prévios relataram que a concentração do fator neurotrófico derivado do cérebro (BDNF) encontra-se aumentada na CCh. Esse aumento parece ter associação postiva à CF e a concentração no BDNF pode se alterar em resposta ao exercício físico nesse grupo. Diante disso, os objetivos desta tese foram, em quatro estudos distintos, verificar na cardiopatia chagásica: 1) a possível correlação entre a distância caminhada no TC6 com o VO2pico e inclinação do equivalente ventilatório para o dióxido de carbono (VE/VCO2 slope) e demonstrar a acurácia da distância caminhada na identificação de pacientes com comprometimento funcional; 2) o melhor modelo de regressão para predizer o VO2pico pelo TC6 e variáveis clínicas de fácil mensuração; 3) a resposta aguda dos níveis do BDNF sérico após exercício e 4) os preditores funcionais e ecocardiográficos e o valor prognóstico do BDNF sérico. Em três estudos transversais, os pacientes com CCh (n=30, n=41, n=81) foram submetidos a exame ecocardiográfico, teste de esforço máximo, TC6 e dosagem do BDNF sérico, antes e após uma sessão de exercício aeróbio. Em estudo longitudinal, os pacientes (n=75) foram acompanhados durante o seguimento por 48 meses e classificados de acordo com a presença de eventos cardiovasculares adversos. Encontrou-se correlação significativa entre a distância caminhada no TC6 e o VO2pico (r=0,586; p

Introdução: os biomarcadores são comumente empregados no infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST) e podem ser úteis na avaliação prognóstica. Este trabalho avaliou a associação entre níveis plasmáticos dos biomarcadores interleucina 33 (IL-33), ST2, adiponectina (ApN), fator neurotrófico derivado do cérebro (BDNF) e peptídeo natriurético cerebral (BNP) e a mortalidade em 30 dias em pacientes com IAMCSST e a associação entre os níveis plasmáticos desses biomarcadores entre si e com o escore de risco GRACE, níveis de troponina I e a fração de ejeção do ventrículo esquerdo (FEVE). Métodos: trata-se de um estudo de coorte no qual foram incluídos 131 pacientes internados consecutivamente que preencheram os critérios diagnósticos de IAMCSST. Todos foram submetidos à abordagem diagnóstica padronizada, conforme protocolo clínico, incluindo ECG seriados, ecocardiograma, dosagem de troponina I e, quando pertinente, cineangiocoronariografia. As amostras sanguíneas para dosagem dos biomarcadores foram obtidas nas primeiras 24 horas após a internação na unidade coronariana e o status vital foi avaliado com 30 dias do evento. Resultados: dos 131 pacientes, oito foram excluídos da análise e 123 foram distribuídos em dois grupos: não sobreviventes - n=11 (8,9%) - e sobreviventes - n=112 (91,1%). A idade média foi de 60 ± 12 anos, com predomínio do sexo masculino (n=88, 72%); 73 pacientes (59%) foram submetidos à terapia de reperfusão durante a fase aguda (41 por trombólise, 26 por angioplastia primária e seis por angioplastia de resgate). A mediana do tempo de reperfusão (entre o início da dor e o início do fibrinolítico ou a primeira insuflação do balão na ICPP) foi de 292 minutos. Entre os biomarcadores mensurados nas primeiras 24 horas de internação, apenas os níveis de IL-33 foram significativamente mais elevados nos pacientes que evoluíram para óbito, em relação aos sobreviventes (82,6 [59,7-392,7] VS 23,1 [2,5-95,9], p=0,003). Quanto à associação entre biomarcadores, a IL-33 e o ST2 correlacionaram-se (rs=0,256, p=0,005) e o ST2 correlacionou-se com o pico de troponina (rs=0,430, p

A doença de Chagas (DC) é uma doença infecciosa causada peloprotozoário Trypanosoma cruzi, impondo limitações físicas, funcionais elaborais nas suas diferentes formas de acometimento. O objetivo do estudo foi avaliar aspectos funcionais e de qualidade de vida em dois grupos de indivíduos com sorologia positiva para doença de Chagas: 1) sem cardiopatia aparente; 2) cardiopatia chagásica crônica. O presente estudo apresentou relevantes achados baseado nos modernos conceitos de função, disfunção, limitação à atividade e restrição à participação, propostos pela CIF. No que tange a capacidade funcional, avaliada pelo TC6, não foram observadas diferenças estatisticamente significativas entre os dois grupos. Por outro lado, os pacientes do grupo sem cardiopatia aparente alcançaram maiores escores de desempenho funcional e qualidade de vida, indicando menor limitação funcional e melhores níveis de atividade no dia-a-dia por esse grupo de pacientes. Finalmente observou-se que os fatores relacionados ao desempenho funcional e qualidade de vida são distintos nos dois grupos avaliados. Chagas disease (CD) is an infection caused by protozoan Trypanosoma cruzi that imposes physical, functional and occupational limitations in its various forms of involvement. The aim of this study was to evaluate functional aspects and quality of life in two groups of subjects serologically positive for CD: 1) with no apparent cardiac involvement (n=21) and 2) chronic Chagas cardiomyopathy (n=35). All participants underwent initial clinical evaluation, echocardiography and assessment of quality of life, physical activity level, functional capacity and performance. Functional capacity, assessed by the six-minute walk test(6MWT), showed no significant differences between the groups. However, patients with no apparent cardiac involvement reached higher functional performance and quality of life scores, indicating smaller functional impairment and higher levels of daily activities. It was also observed that the factors related to functional performance and quality of life were distinct between the two groups.

A doença de Chagas ainda representa um grande problema de saúde pública, que atinge milhões de brasileiros. A maioria dos indivíduos chagásicos encontra-se na forma indeterminada da doença e cerca de 30% apresentam manifestações da forma cardíaca, que representa a expressão mais importante da doença, devido sua elevada morbimortalidade. O diagnóstico da doença pode ocasionar significativas mudanças na vida de seus portadores devido a adversidades múltiplas que tornam a doença estigmatizante e que, caso não sejam elaboradas, podem acarretar consequências negativas, comprometendo a qualidade de vida relacionada à saúde (QVRS). O objetivo desta pesquisa foi o de estudar o perfil da qualidade de vida em dois grupos de pacientes com doença de Chagas; um, constituído por 46 pacientes apresentando bloqueio completo de ramo direito (BCRD) e, outro, constituído por 65 pacientes sem cardiopatia aparente, e pesquisar os fatores associados aos escores, por meio do Short-Form 36. Foram realizadas análises uni e multivariada em modelo de regressão ordinal. Os pacientes com BCRD apresentaram menores escores nos domínios da qualidade de vida quando comparados a pacientes sem cardiopatia aparente. A análise multivariada demonstrou que a presença do BCRD, o sexo feminino e a ausência de apoio familiar foram fatores independentes de menores escores da QVRS. Chagas disease is still a major public health problem that affects millions of Brazilians. Most individuals with Chagas disease is in the indeterminate form of the disease and about 30% have manifestations of the cardiac form, which is the most important clinical expression of the disease, due to its high morbidity and mortality. Diagnosis of the disease can cause significant changes the patients' lives due to multiple adversities that make it a stigmatizing disease and if they are not prepared, it can have negative consequences, compromising the health-related quality of life (HRQOL). The objective of this research was to study the profile of life's quality in two groups of patients with Chagas' disease, one composed of 46 patients with right bundle branch block (RBBB) and the other consisting of 65 patients without apparent cardiopathy and to investigate factors associated with scores through the Short-Form 36. Univariate and multivariate analysis by ordinal logistic regression was performed. Patients with RBBB had lower scores in the areas of quality of life when compared to patients without apparent heart disease. Multivariate analysis demonstrated that the presence of RBBB, females and lack of family support were independent predictors of lower scores of HRQOL.