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SUMMARY OBJECTIVE: Use Lead-DBS software to analyze stereotactical surgical outcome of an operated population and demonstrate that small target deviations do not compromise the stimulation of desired structures, even with small amperages. METHODS: Image exams of patients submitted to deep brain stimulation for movement disorders treatment were processed in Lead-DBS software. Electrode stereotactic coordinates were subtracted from the planned target and those deviations, compared among different anatomical targets and sides operated firstly and secondly. We also quantified the frequency of relation between the activated tissue volume and the planned target through computer simulations. RESULTS: None of the 16 electrodes were exactly implanted at the planned coordinates. A stimulation of 3 mA reached 62.5% of the times the planned coordinates, rising to 68.75% with a 3,5 mA. No statistical significance was demonstrated in any comparison of laterality and anatomical sites. CONCLUSIONS: The simulation of small amperage fields could reach the intended target even when electrode placement is suboptimal. Furthermore, such a goal can be achieved without overlapping the volume of activated tissue with undesired structures. Software Lead-DBS proved to be a valuable complementary asset for surgical stereotactical result assessment.

Objetivos. Analisar os efeitos da educação em saúde em pacientes com Diabetes Mellitus atendidos no Hospital Geral de Nova Iguaçu-RJ, visando ampliar o conhecimento sobre o cuidado integral e interdisciplinar a respeito da doença. Método. Foi elaborado questionário com perguntas contemplando conhecimento sobre a doença, fatores de risco, formas de controle e tratamento e percepção de risco. Sua aplicação foi realizada em 77 pacientes, em três momentos distinto, pré e pós a realização das palestras e via contato telefônico três meses após a realização das mesmas. Foi utilizado o Teste de McNemar para identificar a retenção do conhecimento pelos pacientes à curto e médico prazo. Resultados. Houve mudança significante em 100% das respostas dos participantes, imediatamente após as oficinas educativas, demonstrando ampliação no conhecimento sobre a doença. Três meses após a intervenção educativa não houve mudança significativamente estatística, demonstrando que a retenção do aprendizado foi eficaz a ponto de perdurar nesse intervalo de tempo. Conclusões. Neste estudo, o intervalo de tempo entre a aplicação do questionário e a realização do recurso educacional não promoveu perda de aprendizado pelos participantes.

Introdução: O polegar é o dedo de maior importância funcional da mão, por isso a justificativa de reimplantação e reabilitação do mesmo. Objetivo: Realizar uma análise retrospectiva dos resultados, via revisão de prontuários de pacientes submetidos í reimplante de polegar, realizados pelo Serviço SOS-Reimplante do Hospital Estadual Adão Pereira Nunes. Metodologia: Trata-se de um estudo retrospectivo com amostra de conveniência, abrangendo o perí­odo entre janeiro de 2010 a dezembro de 2015, realizado através de prontuários de pacientes submetidos a processo de reimplante de polegar, atendidos no Serviço de Terapia Ocupacional/TO-Mão no Hospital estadual Adão Pereira Nunes, em Duque de Caxias, Rio de Janeiro. Foram coletadas informações sociodemográficas, além de força muscular, sensibilidade e tempo de reabilitação. Resultados: Foram revisados 63 prontuários de pacientes submetidos a procedimento de reimplante de polegar, na faixa etária de 18 a 65 anos. Quanto ao local do acidente, 76,1% dos casos foi decorrente de acidente de trabalho e 23,2% acidentes domésticos. Ao observamos í lateralidade da lesão, 92% dos pacientes eram destros, enquanto o polegar com maior número de lesões foi o esquerdo, com um total de 82,5% pacientes. Quanto ao ní­vel da lesão, 25,3% pacientes sofreram lesão na falange proximal, 20,8% pacientes sofreram lesão na região da interfalangeana, e 53,9% dos pacientes apresentaram lesão na falange distal. Dentre os reencaminhados para nova avaliação, 28,5% pacientes, foram submetidos a outros procedimentos cirúrgicos. Houve ganho de força em global em 88,2% dos pacientes em de sensibilidade. Conclusão: A maioria dos pacientes que sofreram reimplante do polegar conseguiram obter ganho de força muscular e sensibilidade, conseguirem retornar as suas atividades laborais, com um tempo de reabilitação que variou de 4 a 14 meses.Palavras-chave: terapia da mão, reabilitação, reimplante.

Introdução: A COVID-19 é uma infecção causada pelo ví­rus SARS-CoV-2, que se originou na cidade de Wuhan (China) e se propagou rapidamente para outros paí­ses e continentes até que a Organização Mundial da Saúde (OMS) declarasse situação de pandemia. Dentre as condições graves decorrentes da patologia, observou-se que determinados pacientes apresentaram sintomatologias neurológicas sistêmicas, como acidente vascular encefálico (AVE). Objetivo: O objetivo do presente trabalho é propor uma discussão acerca dos conhecimentos atuais sobre a fisiopatologia do AVE em adultos jovens com COVID-19. Métodos: Fora realizada uma busca nas principais bases de dados: LILACS, BIREME, PuBMED nos idiomas português e inglês, de artigos compreendidos no ano vigente. A escolha ocorrera de forma aleatória, obviamente, seguindo uma linha de raciocí­nio dos autores envolvidos. As palavras-chave pesquisadas foram: COVID-19, Acidente Vascular Encefálico, Fisiopatologia, Coagulopatia. Discussão: Conjectura-se inúmeras possiblidades que explicariam a ligação do ví­rus í doença cerebrovascular. É considerado que o SARS-CoV-2 instiga um processo inflamatório na parede arterial e isso seja responsável pelo AVE. Embora a correlação entre essas duas condições clí­nicas seja notória, ainda não existem estudos que determinem claramente o mecanismo fisiopatológico implicado no processo. Conclusão: Manifestações neurológicas na COVID-19 são relatadas, incluindo o acidente vascular encefálico. O estado de hipercoagulabilidade gerado pela tempestade de citocinas parece estar relacionado ao mecanismo fisiopatológico desta condição. Ainda assim, não existem evidências claras quanto a isso e estudos são necessários a fim de elucidar sua fisiopatogenia.Palavras-chave: infecção por coronaví­rus, acidente vascular encefálico, fisiopatologia, coagulopatia.

As pandemias são epidemias de larga escala que se espalham pelo mundo. Nas últimas semanas, a população e os governos de todo o mundo têm dedicado esforços para frear o rápido avanço da pandemia de Covid-19, que infectou pessoas em 169 países. Além de mortes, problemas econômicos e o colapso dos sistemas de saúde dos países afetados, o espalhamento da pandemia provocou pânico generalizado. No entanto, notavelmente pouca atenção tem sido dedicada aos fatores psicológicos que influenciam a propagação da infecção pandêmica e o sofrimento emocional associado e a ruptura social e as perdas associadas aos fatores de vulnerabilidade psicológica que contribuem para a disseminação de doenças e angústias. O presente artigo objetivou analisar e refletir sobre o medo, a ansiedade e a falta do rito da finalização da vida, afetando psicologicamente quem perde seus entes queridos sem o direito a despedida, perpetuando o luto. Muitos não estão sendo aceitos socialmente, desencadeando sofrimentos secundários e colaterais, os denominados lutos marginais e necessitam de urgentes ações de políticas públicas de apoio psicológicos pois, notadamente pouca atenção tem sido dedicada a este sofrimento.

Introduction: The disease SARS-CoV-2, named COVID-19, was officially declared a pandemic by the World Health Organization on March 11th, 2020. SARS-CoV-2 contains a single-stranded, positive-sense RNA genome surrounded by an extracellular membrane containing a series of spike glycoproteins resembling a crown. Neuropsychiatric manifestations are common during viral pandemics but are not effectively addressed. Case Report: We report the case of a man, 42 years old, who after the infection by SARS-COV2, presented dysnomy, cognitive easing and errors in motor processing. Results and Discussion: Studies have shown the neuroinvasive capability of SARS-COV2, resulting in neurological complications. Common neurological symptoms are headache, dizziness, anosmia, dysgeusia, mental confusion, and muscle weakening, progressing toward severe complications like cerebrovascular disease, seizures, muscle pain, and Guillain-Barre syndrome. The patient in the present case, about seven days after the initial infection, began to have difficulties in naming basic objects and "cognitive" slowness in the performance of basic and instrumental activities of daily life, especially those that required mutual tasks and that required concentration. Patients may be at higher risk of developing cognitive decline after overcoming the primary COVID-19 infection. Neuroinvasive capacities and neuroinflammatory events that may lead to the same short- and long-term neuropathologies that SARS-CoV had shown in human and animal models. The presence of dementia, minimal cognitive impairment and problems with motor planning and execution has been described. Conclusion: A structured prospective evaluation should analyze the likelihood, time course, and severity of cognitive impairment following the COVID-19 pandemic.

Introduction: The outbreak of COVID-19 among humans in Brazil and its spread around the world is strongly impacting mental health. Health problems such as anxiety, depression, insomnia and fear were the most related to. High levels of stress during the day can impair quality and time of sleep. Method: The purpose of this article was to update, through a bibliographic search, the effects of the pandemic on sleep disorders, with insomnia being the most related. A systematic search had been carried out in the main databases: Lilacs, Bireme and PubMed. The languages used in the search were Portuguese and English, from articles published this year. Using the following keywords: Sleep quality, COVID-19, Insomnia, Cognitive behavioral therapy. Discussion: The concern about financial and political uncertainties, feelings of impotence and fear of self-contamination and of family members are factors that corroborate with the worsening of the sleep quality of the population and health professionals’ working on the front lines of the fight against the pandemic, leading to increased cases of insomnia. Behavioral Cognitive Therapy, hypnotherapy and social interaction mediated by Web conferencing tools are the best ways to treat these symptoms at the moment. Even so, the brazilian literature on the subject is extremely scarce, making it an extremely relevant subject for future research.

O processo acelerado de envelhecimento da população brasileira impõe desafios urgentes e prioritários na área da saúde. Segundo dados recentes do IBGE o número de idosos no paí­s aumentou mais de 50% na última década. Hoje, 11% da população são maiores de 60 anos. A projeção para 2050 é de que a expectativa média de vida alcance os 82 anos, caso o comportamento sócio demográfico continue nesse ritmo, o percentual de idosos no Brasil vai ultrapassar os 22% [1,2]...

Background Patient limitations guide selection of heart failure therapies, for which indications often specify New York Heart Association Class. Objectives To determine the extent of patient‐reported limitations during daily activities and compare to New York Heart Association class assigned by providers during the same visit, and to left ventricular ejection fraction (LVEF) group. Methods and Results While waiting for their appointment, 948 patients on return visits to an ambulatory HF clinic completed a written questionnaire assessing specific activity limitations, which were compared to physician‐assigned NYHA class during the same visit. Patient‐reported limitation to perform daily activity ranged from 25% for bathing to 61% for yardwork or housework and 71% for jogging or hurrying. Most patients who did not report limitations to perform daily life activities were correctly classified as NYHA I by the physicians (76%), but 12% of the 376 patients classified as NYHA I reported limitations to showering or bathing and 73% reported limitations while doing yardwork or house work. Limitation to walking was reported by 172 patients (50%) classified as class II. Limitations to walking one block were most common in patients with LVEF ≥40% compared to patients with LVEF

Resumo Fundamento O exame físico permite a avaliação prognóstica de pacientes com insuficiência cardíaca (IC) descompensada, porém não é suficientemente confiável e depende da experiência clínica do profissional. Considerando as respostas hemodinâmicas a situações do tipo “luta ou fuga” tais como a admissão no serviço de emergência, foi proposto o índice hemodinâmico agudo (IHA), calculado a partir da frequência cardíaca e pressão de pulso. Objetivo avaliar a capacidade prognóstica intra-hospitalar do IHA na IC descompensada. Métodos estudo prospectivo, multicêntrico e observacional baseado no registro BREATHE, incluindo dados de hospitais públicos e privados no Brasil. Foram utilizadas análises ROC (Receiver Operating Characteristic), de estatística c e de regressão multivariada, assim como o critério de informação de Akaike, para testar a capacidade prognóstica do IHA. O valor-p < 0,05 foi considerado estatisticamente significativo. Resultados Foram analisados dados de 463 pacientes com IC com fração de ejeção reduzida a partir do registro BREATHE. A mortalidade intra-hospitalar foi de 9%. A mediana do IHA foi considerada o valor de corte (4 mmHg⋅bpm). Um baixo IHA (≤ 4 mmHg⋅bpm) foi encontrado em 80% dos pacientes falecidos. O risco de mortalidade intra-hospitalar em pacientes com baixo IHA foi 2,5 vezes maior que aquele para pacientes com IHA > 4 mmHg⋅bpm. O IHA foi capaz de predizer independentemente a mortalidade intra-hospitalar na IC aguda descompensada [sensibilidade: 0,786; especificidade: 0,429; AUC (área sob a curva): 0,607 (0,540-0,674), p = 0,010] mesmo depois dos ajustes para comorbidades e uso de medicamentos [razão de chances (RC): 0,061 (0,007-0,114), p = 0,025]. Conclusões O IHA é capaz de predizer independentemente a mortalidade intra-hospitalar na IC aguda descompensada. Esse índice simples e realizado à beira do leito pode se mostrar útil em serviços de emergência. (Arq Bras Cardiol. 2021; 116(1):77-86) Abstract Background The physical examination enables prognostic evaluation of patients with decompensated heart failure (HF), but lacks reliability and relies on the professional’s clinical experience. Considering hemodynamic responses to “fight or flight” situations, such as the moment of admission to the emergency room, we proposed the calculation of the acute hemodynamic index (AHI) from values of heart rate and pulse pressure. Objective To evaluate the in-hospital prognostic ability of AHI in decompensated HF. Methods A prospective, multicenter, registry-based observational study including data from the BREATHE registry, with information from public and private hospitals in Brazil. The prognostic ability of the AHI was tested by receiver-operating characteristic (ROC) analyses, C-statistics, Akaike’s information criteria, and multivariate regression analyses. p-values < 0.05 were considered statistically significant. Results We analyzed data from 463 patients with heart failure with low ejection fraction. In-hospital mortality was 9%. The median AHI value was used as cut-off (4 mmHg⋅bpm). A low AHI (≤ 4 mmHg⋅bpm) was found in 80% of deceased patients. The risk of in-hospital mortality in patients with low AHI was 2.5 times that in patients with AHI > 4 mmHg⋅bpm. AHI independently predicted in-hospital mortality in acute decompensated HF (sensitivity: 0.786; specificity: 0.429; AUC: 0.607 [0.540–0.674]; p = 0.010) even after adjusting for comorbidities and medication use [OR: 0.061 (0.007–0.114); p = 0.025). Conclusions The AHI independently predicts in-hospital mortality in acute decompensated HF. This simple bed-side index could be useful in an emergency setting. (Arq Bras Cardiol. 2021; 116(1):77-86)

Em dezembro de 2019, um surto de pneumonia de etiologia desconhecida foi relatado em Wuhan, proví­ncia de Hubei, China. A maioria desses casos estava epidemiologicamente relacionada ao mercado atacadista de frutos do mar de Huanan [1]. A inoculação do lí­quido obtido por lavagem broncoalveolar de pacientes com essa pneumonia levou ao isolamento de um novo coronaví­rus, inicialmente chamado 2019-nCov, e posteriormente denominado sí­ndrome respiratória aguda grave pelo coronaví­rus 2 (SARS-CoV-2) [2].Devido ao aumento do número de casos de COVID-19 em todo o mundo, foi decretado pela Organização Mundial da Saúde, um estado de pandemia. O COVID-19 é uma doença que pode causar uma importante lesão pulmonar, exigindo hospitalização para uso de oxigênio e, no último caso, internação em unidade de terapia intensiva com uso de ventilação mecânica invasiva [2,3].Pacientes que sobrevivem ao evento agudo causado pelo COVID-19 costumam sofrer os efeitos deletérios de uma internação prolongada, como: alterações cognitivas, depressão, ansiedade, alterações de mobilidade, além de alterações cardiovasculares e pulmonares.Como essa condição é real em todo o mundo, qual será nosso próximo desafio? Este é um segundo momento da pandemia e que merece ser tratado com a mesma atenção pelas autoridades e que levou a Organização Pan-Americana da Saúde a publicar um documento intitulado Rehabilitation considerations during the COVID-19 outbreak [4].Este documento deixa claro o papel da reabilitação no acompanhamento a longo prazo de pacientes com COVID-19.Muitos foram os relatos descrevendo o processo de reabilitação em pacientes sobreviventes ao COVID-19, em atendimento ambulatorial. Yang e Yang [5] publicaram um artigo de revisão mencionando os benefí­cios da reabilitação pulmonar para pacientes afetados pelo COVID-19. Sheehy [6] também expressou sua opinião sobre a importância da reabilitação em sobreviventes do COVID-19, no entanto, vale ressaltar que esses dois autores (assim como outros que não foram mencionados aqui) ainda estavam no campo de hipóteses e elucubrando alternativas.De todos os artigos publicados presente até o momento sobre essa temática, um que merece destaque é elegante trabalho realizado por Liu et al. [7] pelo fato de ser pioneiro em alguns apontamentos. Os autores descreveram os efeitos de um programa de reabilitação com duração de seis semanas em pacientes sobreviventes ao COVID-19 e observaram melhoras significativas na função pulmonar, por meio da espirometria, melhora da capacidade funcional mensurada através do teste de caminhada de seis minutos, além de melhoria na qualidade de vida através do questionário SF-36, atividades da vida diária através da Medida de Independência Funcional (MIF).Cabe ressaltar que, em relação í reabilitação de pacientes sobreviventes do COVID-19, as informações começam a ser organizadas para facilitar o desempenho dos profissionais de saúde. Com base nessa premissa, o de Stanford Hall para a reabilitação pós-COVID-19 [8] realizado por pesquisadores do Reino Unido reúne até agora as melhores evidências para a condução da reabilitação nesse novo cenário que se apresenta a todo o mundo. O documento abrange recomendações para: reabilitação pulmonar, cardiovascular, neuromusculoesquelética e neurológica, sem deixar de lado as recomendações médicas e psicológicas, diretamente relacionadas í reabilitação.A reabilitação sempre foi descrita como um processo multidisciplinar e, em pacientes sobreviventes ao COVID-19, devido ao fato de ser uma condição clí­nica e funcional de recente descoberta, será extremamente importante para os profissionais trocarem o máximo de informações possí­veis, para que os indiví­duos retomem as suas atividades diárias, o mais próximo possí­vel do que eram anteriormente.O documento Rehabilitation considerations during the COVID-19 outbreak [4] é enfático ao afirmar que os esforços do governo para oferecer reabilitação aos pacientes que sobrevivem ao COVID-19 devem ser os mesmos realizados quanto a oferta de leitos hospitalares.Além dos centros de reabilitação, dos programas ambulatoriais, dos atendimentos domiciliares, a pandemia nos mostrou uma potencialidade pertinente ao momento atual, a telessaúde, incluindo telemedicina e tele-reabilitação.

Background Minute ventilation-carbon dioxide production relationship (VE/VCO2 slope), as assessed by cardiopulmonary exercise testing (CPET), strongly predicts outcomes in heart failure (HF). High VE/VCO2 slope can indicate ventilatory inefficiency. A single VE/VCO2 slope threshold defining abnormal of ≥ 34 to 36 is used clinically across HF categories; however, this threshold has been validated largely in patients with reduced left ventricular ejection fraction (LVEF). Objectives To examine the associations between VE/VCO2 slope categories and a composite outcome of all-cause mortality and HF hospitalization across the spectrum of HF patients defined by LVEF. Methods Single-center retrospective cohort study of 1347 patients with heart failure (60.5% male, age 58.0±14.6 years, LVEF 42 ± 17%) clinically referred for CPET between 2010 and 2016. LVEF was obtained from echocardiogram (n=1309) or cardiac MRI (n=38). All-cause mortality was determined using Partners Research Patient Data Registry, which is linked to National Death Index. HF hospitalization data were adjudicated by review of electronic medical record. Patients with HF were categorized based on LVEF into heart failure with reduced (HFrEF, LVEF Results At two-year follow-up post CPET, there were 197 composite events (64 deaths and 133 HF hospitalizations). Across the entire cohort, increases in VC category were associated with increasing risk of two-year composite outcome in unadjusted and adjusted models. Compared to patients in VC-I, patients in VC-II were at increased risk of having two-year composite outcome in both HFrEF and HFpEF cohorts. Patients in VC III and IV had incremental increases in the likelihood of two-year composite outcome across all three HF cohorts (Table). Conclusions Higher VE/VCO2 slope categories are associated with increased risk of the two-year composite outcome of all-cause mortality and HF hospitalization across the spectrum of HF defined by LVEF. A VE/VCO2 slope between 29 and 36, often considered borderline in clinical practice, is associated with increased risk of this composite outcome in patients with HFrEF and HFpEF. Identifying a wider VE/VCO2 slope associated with increased risk in HF may have important implications on risk stratification clinically.

Summary We present a clinical case of liver failure induced by heat stroke.

The objective of this study is to evaluate the cardiorespiratory variables of Taekwondo athletes while performing incremental exercise test on an ergometer using a ramp protocol and to propose a specific protocol for assessing these physiological variables during Taekwondo practice. Fourteen athletes participated in 2 incremental exercise tests: a treadmill exercise test (TREADtest) and a Taekwondo-specific exercise test (TKDtest). The TKDtest consists in 1-minute stages of kicks with an incremental load between then. The subjects perform kicks each time a sound signal was heard. Heart rate (HR), oxygen uptake (V[Combining Dot Above]O2), and their reserve correspondents (V[Combining Dot Above]O2R and reserve heart rate [HRR]) were divided into quartiles to verify their kinetics along the tests. Significant difference between 2 tests was found only for V[Combining Dot Above]O2R (p = 0.03). Regarding the quartiles, significant differences were found for HR in the first (p = 0.030) and second (p = 0.003). Analyzing the regression curves, significant differences were found for HR for intercept (p = 0.01) and slope (p = 0.05) and HRR for slope (p = 0.02). Analysis showed that significant reliability, with intraclass correlation coefficient (ICC), was found for the V[Combining Dot Above]O2peak (ICC = 0.855, p = 0.003), V[Combining Dot Above]O2 in ventilatory thresholds 1 (ICC = 0.709, p = 0.03) and 2 (ICC = 0.848, p = 0.003). Bland-Altman analyses reported a mean difference ± the 95% limits of agreement of 2.2 ± 8.4 ml·kg·min to V[Combining Dot Above]O2peak. The TKDtest is reliable for measurement of cardiorespiratory variables, and the behavior of these variables differs mainly from TREADtest, probably because of the motor task performed.

Introduction Parasympathetic dysfunction may play a role in the genesis of arrhythmias in Chagas disease. Aim This study evaluates the acute effects of pyridostigmine (PYR), a reversible cholinesterase inhibitor, on the occurrence of arrhythmias in patients with Chagas cardiac disease. Method Following a double-blind, randomized, placebo-controlled, cross-over protocol, 17 patients (age 50±2 years) with Chagas cardiac disease type B underwent 24-hour Holter recordings after oral administration of either pyridostigmine bromide (45 mg, 3 times/day) or placebo (PLA). Results Pyridostigmine reduced the 24-h incidence [median (25%-75%)] of premature ventricular beats - PLA: 2998 (1920-4870), PYR: 2359 (940-3253), P=0.044; ventricular couplets - PLA: 84 (15-159), PYR: 33 (6-94), P=0.046. Although the total number of non-sustained ventricular tachycardia in the entire group was not different (P=0.19) between PLA [1 (0-8)] and PYR [0 (0-4)], there were fewer episodes under PYR in 72% of the patients presenting this type of arrhythmia (p= 0.033). Conclusion Acute administration of pyridostigmine reduced the incidence of non-sustained ventricular arrhythmias in patients with Chagas cardiac disease. Further studies that address the use of pyridostigmine by patients with Chagas cardiac disease under a more prolonged follow-up are warranted. This article is protected by copyright. All rights reserved.

The purpose of this study was to determine the effect of respiratory muscle fatigue on intercostal and forearm muscle perfusion and oxygenation in patients with heart failure. Five clinically stable heart failure patients with respiratory muscle weakness (age, 66 ± 12 years; left ventricle ejection fraction, 34 ± 3%) and nine matched healthy controls underwent a respiratory muscle fatigue protocol, breathing against a fixed resistance at 60% of their maximal inspiratory pressure for as long as they could sustain the predetermined inspiratory pressure. Intercostal and forearm muscle blood volume and oxygenation were continuously monitored by near-infrared spectroscopy with transducers placed on the seventh left intercostal space and the left forearm. Data were compared by two-way ANOVA and Bonferroni correction. Respiratory fatigue occurred at 5.1 ± 1.3 min in heart failure patients and at 9.3 ± 1.4 min in controls (P0.05), but perceived effort, changes in heart rate, and in systolic blood pressure were similar between groups (P0.05). Respiratory fatigue in heart failure reduced intercostal and forearm muscle blood volume (P0.05) along with decreased tissue oxygenation both in intercostal (heart failure, -2.6 ± 1.6%; controls, +1.6 ± 0.5%; P0.05) and in forearm muscles (heart failure, -4.5 ± 0.5%; controls, +0.5 ± 0.8%; P0.05). These results suggest that respiratory fatigue in patients with heart failure causes an oxygen demand/delivery mismatch in respiratory muscles, probably leading to a reflex reduction in peripheral limb muscle perfusion, featuring a respiratory metaboreflex.

Coronary aneurysms (CAs) are found in

The present work quantifies, through principal components analysis (PCA) the relationships among the variability of breath-by-breath ventilatory parameters [minute-ventilation (VE), tidal volume (Vt), and respiratory rate (FR)] during a maximal progressive exercise test. The results show that the first and second eigenvalues of the covariant matrix contains almost 90% of the variables' variance possible to see through the PCA, which means that the problem can be reduced by a two-dimensional analysis. The results show a close similarity between the global variability in two groups test, athletes and sedentary (control). For the athletes group, the parameter Vt is responsible for the high VE variability values while in the sedentary group the FR is more relevant for VE variability. The result improves the knowledge about respiratory variability during exercise, showing that Vt's and FR's variabilities contribute in different ways to global ventilation variability during a maximal cardiopulmonary exercise test in athletes and sedentary men.

Although controlled heart rate (HR) and increased pulse pressure (PP) are related to better outcomes in stable heart failure (HF), the prognostic impact of hemodynamic response to acute stress is unknown. We hypothesized that higher HR and PP during HF decompensation would be related to better in

The goals of permanent pacing go beyond syncope prevention, including reduction of cardiovascular morbidity. In patients with pacemakers, exercise testing (ET) may be required to evaluate the quality of atrial sensing and pacing rate responsiveness to exercise. We present a case where ET was used to

Background Parasympathetic dysfunction is an independent risk factor for mortality in heart failure for which there is no specific pharmacologic treatment. This article aims to determine the effect of pyridostigmine, an anticholinesterase agent, on the integrated physiologic responses to dynamic exercise in heart failure. Methods and Results Patients with chronic heart failure (n = 23; 9 female; age=48 ± 12 years) were submitted to 3 maximal cardiopulmonary exercise tests on treadmill in different days. The first test was used for adaptation and to determine exercise tolerance. The other tests were performed after oral administration of pyridostigmine (45 mg, 3 times/day, for 24 hours) or placebo, in random order. All patients were taking their usual medication. Pyridostigmine reduced cholinesterase activity by 30%, inhibited the chronotropic response throughout exercise, up to 60% of maximal effort (pyridostigmine = 108 ± 3 beats/min vs. placebo=113 ± 3 beats/min; P = .040), and improved heart rate reserve (pyridostigmine = 73 ± 5 beats/min vs. placebo=69 ± 5 beats/min; P = 0.035) and heart rate recovery in the first minute after exercise (pyridostigmine = 25 ± 2 beats/min vs. placebo=22 ± 2 beats/min; P = .005), whereas peak heart rate was similar to placebo. Oxygen pulse, an indirect indicator of stroke volume, was higher under pyridostigmine during submaximal exercise. Conclusions Pyridostigmine was well tolerated by heart failure patients, leading to improved hemodynamic profile during dynamic exercise.

Introduction: Syncope is a common problem and can lead to serious consequences in the elderly. Tilt test is useful to investigate recurrent syncope, but few studies have investigated the hemodynamic responses of this population to tilt test. Objective: To describe the tilt test responses of elderly patients with recurrent syncope of unknown origin and to determine the occurrence of altered cardiovascular autonomic function in a subset of those with the diagnosis of dysautonomic pattern to the tilt test. Methods: Elderly patients (n=165; >60 years old) who sought medical assistance because of recurrent syncope during 18months were initially enrolled and submitted to a two-stage, nitroglycerin-potentiated tilt test. A subset of patients who presented with dysautonomic response to tilt test performed clinical autonomic tests. Results: The most frequent cause of syncope during tilt test was the dysautonomic pattern (43%), followed by mixed type neurocardiogenic syncope (35%). Most patients who remained asymptomatic during tilt test showed clear abnormal hemodynamic response during the exam. Conclusion: Autonomic dysfunction, which can be found during tilt test, is probably an important cause of syncope in the elderly, regardless of the occurrence of symptoms during the tilt test. D 2006 Elsevier B.V. All rights reserved.

Apresentam-se, neste estudo, os números relativos ao controle de doping em nosso país, em competição e fora de competição do ano de 2003, e consideram-se as ações preventivas desenvolvidas. Todos os controles foram feitos de acordo com as técnicas e procedimentos orientados pela Agência Mundial Antidoping (AMA), sendo então realizada uma estatística descritiva dos mesmos. Os resultados mostram 3.797 exames realizados, sendo 3.266 controles em competição e 531 fora de competição, com caráter de surpresa. A maior parte dos controles em competição (92,1%) e fora dela (92,4%) foi realizada pelo LAB DOP, da Universidade Federal do Rio de Janeiro (UFRJ). O futebol profissional foi responsável por grande parte dos controles em competição, 2.975 (91,1%), apresentando oito positivos e um percentual baixo de 0,27%, quando comparado com dados da literatura internacional. A grande maioria dos controles fora de competição foi realizada pelo Comitê Olímpico Brasileiro (COB), durante a preparação de nossos atletas para os XIV Jogos Pan-Americanos, na República Dominicana (92,4%). Foram encontrados 19 exames positivos nos controles em competição e seis positivos fora de competição, dentre os quais dois atletas de eqüestre que se negaram a ceder uma amostra biológica. O percentual encontrado em competição (0,5%) é menor do que o descrito internacionalmente, que é de 1,80, com exceção da luta de braço (30%), do tênis de mesa paraolímpico (10%), do atletismo (6,1%) e do ciclismo (4,6%). Nos exames fora de competição, foi observada uma incidência maior do que a descrita internacionalmente no fisiculturismo (33,33%), em eqüestre (22,2%), no boxe (7,6%). Na natação (2,5%) e no atletismo (1,8%), estão um pouco elevados e a média encontrada (1,1%) pode ser descrita como estando ainda na média internacional (0,9%). Os trabalhos de prevenção do COB, da Confederação Brasileira de Futebol (CBF) e do LAB DOP da UFRJ são referidos no presente artigo, juntamente com a nova legislação antidoping proposta pelo Ministério do Esporte. El presente estudio presenta los números relativos al control de dopaje en nuestro país, en competencia y fuera de competencia en el año 2003, considerando además las acciones preventivas desarrolladas. Todos los controles fueron realizados de acuerdo con las técnicas y los procedimientos orientados por la Agencia Mundial Antidopaje (AMA) siendo la misma una estadística descriptiva de los mismos. Los resultados mostraron 3.797 exámenes siendo 3.266 en competencia y 531 fuera de competencia con carácter sorpresivo. La mayor parte de los controles en competencia (92,1%) y fuera de la competencia (92,4%) fueron realizados por el LAB DOP, de la Universidad Federal de Rio de Janeiro (UFRJ). El fútbol profesional fue responsable por gran parte de los controles en competencia 2.975 (91,1%), presentando ocho positivos en un porcentaje bajo de 0,27%, comparado con los datos de la literatura internacional. La gran mayoría de los casos de controles fuera de competencia fueron realizados por el Comité Olímpico Brasileño (COB), durante la preparación de nuestros atletas para los XIV Juegos Pan-Americanos, en la República Dominicana (92,4%). Fueron encontrados 19 casos positivos en los controles en competencia y seis en los controles fuera de competencia. Dentro de los cuales dos de los atletas de ecuestre se negaron a brindar la muestra biológica. El porcentaje encontrado en competencia (0,5%) es menor que el que se describe internacionalmente que es de 1,8%, con excepción de la lucha (30%), del tenis de mesa paralimpico (10%), del atletismo (6,1%) y del ciclismo (4,6%). En los exámenes fuera de competencia se ha observado una incidencia mayor que la descripta internacionalmente en el fisicoculturismo (33,33%), en ecuestre (22,2%), en boxeo (7,6%). En natación (2,5%) y en atletismo (1,8%), están un poco elevados de la media encontrada (1,1%) lo que lo podría definir como estando en la media internacional (0,9%). Los trabajos de prevención del COB, de la Brasileña de Fútbol (CBF) y del LAB DOP de la UFRJ están referidos en el presente artículo juntamente con la nueva legislación antidopaje propuesta por el Ministerio del Deporte. This study presents the statistics of doping control, in- and out-of-competition in Brazil during the year 2003 and also shows the preventive actions developed. We have asked four laboratories and their coordinators to inform us about the controls on Brazilian athletes performed during the year 2003. All controls were performed under the World Anti-doping Agency's (WADA) rules and regulations. Our results show that 3,797 controls were performed in this year, being 3,266 in-competition and 531 out-of-competition controls. Most of the in-competition (92.16%) and out-of-competition tests (92.47%) were performed by LAB DOP, the doping control laboratory of the Chemical Institute of the Rio de Janeiro Federal University (UFRJ), one of the South American accredited laboratories. Professional soccer was the sport where most of the in-competition controls were performed (2.975 = 91.1%), with eight positive findings and a very low percent of positives (0.27%) when compared to the international literature. Most of the out-of-competition tests were performed by the Brazilian Olympic Committee (COB), during the preparation of our athletes for participating in the XIV Pan-American Games, at the Dominican Republic (92.47%). The positive result found was 19 positive in in-competition test and six in out-of-competition test. Two equestrian athletes refused to be tested. The percentage of positive in-competition (0.58%) is lower than the international percentages described, that ranges from 1 to 2%, with the exceptions of arm-fighting (30%), Paralympics table-tennis (10%), track and field (6.15%) and cycling (4.69%). The out-of-competition tests were found to have a greater incidence of positive results in bodybuilding (33.33%), equestrian (22.22%) and boxing (7.69%). The results of swimming (2.56%), track and field (1.89%) were in agreement with international data. The preventive actions of COB, the Brazilian Soccer Confederation and LAB DOP were shown in this article, altogether with the new anti-doping law from the Brazilian Sports Ministry.

Epilepsy is one of the most frequent causes of neurological disorders in young adults. We report the case of a patient who lived with the diagnosis of refractory epilepsy for twelve years, when actually the cause of the symptoms could be found with the performance of a tilt table test. Cardiologists should be aware of the possible diagnosis of neurocardiogenic syncope in patients previously diagnosed with epilepsy, especially in those with difficult therapeutic control.

Despite mortality from heart disease has been decreasing, the decline in death in women remains lower than in men. Hypertension (HT) is a major risk factor for cardiovascular disease. Therefore, approaches to prevent or delay the onset of HT would be valuable in women. Given this background, we investigated the effect of diet and exercise training on blood pressure (BP) and autonomic modulation in women with prehypertension (PHT). Ten women with PHT (39 ± 6 years, mean ± standard deviation) and ten with normotension (NT) (35 ± 11 years) underwent diet and exercise training for 12 weeks. Autonomic modulation was assessed through heart rate (HR) and systolic BP (SBP) variability, using time and frequency domain analyses. At preintervention, women with PHT had higher SBP (PHT: 128 ± 7 vs. NT: 111 ± 6 mmHg, p0.05) and lower HR variability [standard deviation of normal-to-normal beats (SDNN), PHT: 41 ± 18 vs. NT: 60 ± 19 ms, p0.05]. At post-intervention, peak oxygen consumption and muscular strength increased (p0.05), while body mass index decreased in both groups (p0.05). However, SBP decreased (118 ± 8 mmHg, p0.05 vs. preintervention) and total HR variability tended to increase (total power: 1,397 ± 570 vs. 2,137 ± 1,110 ms(2), p = 0.08) only in the group with PHT; consequently, HR variability became similar between groups at post-intervention (p0.05). Moreover, reduction in SBP was associated with augmentation in SDNN (r = -0.46, p0.05) and reduction in low-frequency power [LF (n.u.); r = 0.46, p0.05]. In conclusion, diet and exercise training reduced SBP in women with PHT, and this was associated with augmentation in parasympathetic and probably reduction in sympathetic cardiac modulation.