Levels of circulating anti-muscarinic and anti-adrenergic antibodies and their effect on cardiac arrhythmias and dysautonomia in murine models of Chagas disease.

SUMMARY Antibodies (Ab) recognizing G-protein coupled receptors, such as ß 1 and ß 2 adrenergic (anti-ß 1-AR and anti-ß 2-AR, respectively) and muscarinic cholinergic receptors (anti-M2-CR) may contribute to cardiac damage, however their role in chronic chagasic cardiomyopathy is still controversial. We describe that Trypanosoma cruzi-infected C3H/He mice show increased P and QRS wave duration, and PR and QTc intervals, while the most significant ECG alterations in C57BL/6 are prolonged P wave and PR interval. Echocardiogram analyses show right ventricle dilation in infected animals of both mouse lineages. Analyses of heart rate variability (HRV) in chronically infected C3H/He mice show no alteration of the evaluated parameters, while C57BL/6 infected mice display significantly lower values of HRV components, suggesting autonomic dysfunction. The time-course analysis of anti-ß 1-AR, anti-ß 2-AR and anti-M2-CR Ab titres in C3H/He infected mice indicate that anti-ß 1-AR Ab are detected only in the chronic phase, while anti-ß 2-AR and anti-M2-CR are observed in the acute phase, diminish at 60 dpi and increase again in the chronic phase. Chronically infected C57BL/6 mice presented a significant increase in only anti-M2-CR Ab titres. Furthermore, anti-ß 1-AR, anti-ß 2-AR and anti-M2-CR, exhibit significantly higher prevalence in chronically T. cruzi-infected C3H/He mice when compared with C57BL/6. These observations suggest that T. cruzi infection leads to host-specific cardiac electric alterations.

Effects of chronic exercise on severity, quality of life and functionality in an elderly Parkinson's disease patient: case report.

Exercise produces potential influences on physical and mental capacity in patients with neuropsychiatric disorders, and can be made a viable form of therapy to treat Parkinson's disease (PD). We report the chronic effects of a regular physical exercise protocol on cognitive and motor functions, functional capacity, and symptoms in an elderly PD patient without dementia. The patient participated of a program composed of proprioceptive, aerobic and flexibility exercises, during 1 hour, three days a week, for nine months. Patient used 600 mg of L-DOPA daily, and 1 hour prior to each exercise session. Assessment was conducted in three stages, 0-3, 3-6 and 6 to 9 months, using percentual variation to the scales Hoehn and Yahr, Mini-Mental State Examination (MMSE), Parkinson Activity Scale (PAS), Beck Depression Inventory (BDI), and Unified Parkinson's Disease Rating Scale (UPDRS-III). Reassessment showed clear changes in clinical parameters for Hoehn and Yahr (4 to 2.5), MMSE (14 to 22), PAS (13 to 29), BDI (9 to 7) and UPDRS-III (39 to 27) at the end of 9 months. According to our data, exercise seems to be effective in promoting the functional capacity and the maintenance of cognitive and motor functions of PD patients. Regular exercise protocols can be implemented as an adjunctive treatment for reducing the severity of PD.

Normalizing handgrip strength in older adults: An allometric approach.

PURPOSE: Handgrip strength is an important variable to assess as part of any health intervention among older adults. Although the use of allometric normalization is the appropriate approach for removing the body size effect in handgrip performance, the best body size variable for this normalization is still unclear. Therefore, the aim of the present study was to compare the use of three body size variables (body mass, fat-free mass and body height) in allometric normalization for Handgrip strength among older adults. METHODS: Data from individuals admitted to the Elderly Care Center of the Open University of the Third Age were used, the sample consisting of 263 individuals (140 women), aged between 60-87. RESULTS: The results provided allometric exponents for normalization of HGS in each body size variable (body mass: 0.31; fat-free mass: 0.11; body height: 0.46). The correlations between normalized HGS and body size variables were significant (p<0.05) when HGS were normalized by body mass or fat-free mass. On the contrary, no significant correlations were found when HGS were normalized by body height. CONCLUSIONS: Body height seems to be the best body size variable for performing allometric normalization of HGS among older adults.

Nandrolone decanoate impairs exercise-induced cardioprotection: role of antioxidant enzymes.

The beneficial effects of exercise in reducing the incidence of cardiovascular diseases are well known and the abuse of anabolic androgenic steroids (AAS) has been associated to cardiovascular disorders. Previous studies showed that heart protection to ischemic events would be mediated by increasing the antioxidant enzyme activities. Here, we investigated the impact of exercise and high doses of the AAS nandrolone decanoate (DECA), 10 mgkg(-1) body weight during 8 weeks, in cardiac tolerance to ischemic events as well as on the activity of antioxidant enzymes in rats. After a global ischemic event, hearts of control trained (CT) group recovered about 70% of left ventricular developed pressure, whereas DECA trained (DT), control sedentary (CS) and DECA sedentary (DS) animals recovered only about 20%. Similarly, heart infarct size was significantly lower in the CT group compared to animals of the three other groups. The activities of the antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (GR) were significantly higher in CT animals than in the other three groups, whereas catalase activity was not affected in any group. Together, these results indicate that chronic treatment with DECA cause an impairment of exercise induction of antioxidant enzyme activities, leading to a reduced cardioprotection upon ischemic events.

Effects of Different Types of Physical Exercise on the Perceived Quality of Life in Active Elderly.

UNLABELLED: There is a lack of knowledge about the influence of individual physical activities on the quality of life (QoL) of older adults, especially in strength training and swimming, two popular activities. OBJECTIVES: To assess and compare the perceived QoL levels among sedentary, swimming and strength training groups in elderly individuals. METHODS: Twenty one subjects were evaluated: 9 sedentary, 10 swimming and 12 strength training. Physical activity levels were assessed by the International Physical Activity Questionnaire short version, and the physical, psychological, social and environmental domains, as well the general QoL of each group, were assessed through the World Health Organization questionnaire short version. In addition, the contribution of each domain in general QoL was also verified. RESULTS: The sedentary group presented a statistically lower score in each variable examined (p<0.05). The physical domain was higher only in the strength training group and the psychological and social domains were higher only in the swimming group. In relation to the influence on general QoL, the physical domain (i.e., sedentary); the physical and psychological domains (i.e., swimming) and the social and environmental domains (i.e., strength training) were statistically significant. CONCLUSION: The results suggest that the QoL levels were always lower in the sedentary group. However, the determination of the domain depended on the physical activity level of each subject. Further, the domains with better scores were not necessarily the ones that showed a higher association with the general QoL in each group.

Frequency of Cardiovascular Involvement in Familial Amyloidotic Polyneuropathy in Brazilian Patients.

BACKGROUND: Familial amyloidotic polyneuropathy (FAP) is a rare disease diagnosed in Brazil and worldwide. The frequency of cardiovascular involvement in Brazilian FAP patients is unknown. OBJECTIVE: Detect the frequency of cardiovascular involvement and correlate the cardiovascular findings with the modified polyneuropathy disability (PND) score. METHODS: In a national reference center, 51 patients were evaluated with clinical examination, electrocardiography (ECG), echocardiography (ECHO), and 24-hour Holter. Patients were classified according to the modified PND score and divided into groups: PND 0, PND I, PND II, and PND > II (which included PND IIIa, IIIb, and IV). We chose the classification tree as the statistical method to analyze the association between findings in cardiac tests with the neurological classification (PND). RESULTS: ECG abnormalities were present in almost 2/3 of the FAP patients, whereas ECHO abnormalities occurred in around 1/3 of them. All patients with abnormal ECHO also had abnormal ECG, but the opposite did not apply. The classification tree identified ECG and ECHO as relevant variables (p < 0.001 and p = 0.08, respectively). The probability of a patient to be allocated to the PND 0 group when having a normal ECG was over 80%. When both ECG and ECHO were abnormal, this probability was null. CONCLUSIONS: Brazilian patients with FAP have frequent ECG abnormalities. ECG is an appropriate test to discriminate asymptomatic carriers of the mutation from those who develop the disease, whereas ECHO contributes to this discrimination.

Frequency of Cardiovascular Involvement in Familial Amyloidotic Polyneuropathy in Brazilian Patients / Frequência de Envolvimento Cardiovascular na Polineuropatia Amiloidótica Familiar em Pacientes Brasileiros

Background:Familial amyloidotic polyneuropathy (FAP) is a rare disease diagnosed in Brazil and worldwide. The frequency of cardiovascular involvement in Brazilian FAP patients is unknown.Objective:Detect the frequency of cardiovascular involvement and correlate the cardiovascular findings with the modified polyneuropathy disability (PND) score.Methods:In a national reference center, 51 patients were evaluated with clinical examination, electrocardiography (ECG), echocardiography (ECHO), and 24-hour Holter. Patients were classified according to the modified PND score and divided into groups: PND 0, PND I, PND II, and PND > II (which included PND IIIa, IIIb, and IV). We chose the classification tree as the statistical method to analyze the association between findings in cardiac tests with the neurological classification (PND).Results:ECG abnormalities were present in almost 2/3 of the FAP patients, whereas ECHO abnormalities occurred in around 1/3 of them. All patients with abnormal ECHO also had abnormal ECG, but the opposite did not apply. The classification tree identified ECG and ECHO as relevant variables (p < 0.001 and p = 0.08, respectively). The probability of a patient to be allocated to the PND 0 group when having a normal ECG was over 80%. When both ECG and ECHO were abnormal, this probability was null.Conclusions:Brazilian patients with FAP have frequent ECG abnormalities. ECG is an appropriate test to discriminate asymptomatic carriers of the mutation from those who develop the disease, whereas ECHO contributes to this discrimination.

Fundamento:A polineuropatia amiloidótica familiar (PAF) é uma doença rara diagnosticada no Brasil e no mundo. A frequência de envolvimento cardiovascular em pacientes brasileiros com PAF é desconhecida.Objetivos:Detectar a frequência de envolvimento cardiovascular e correlacionar os achados cardiovasculares com o escore PND (Polyneuropathy Disability Score) modificado.Métodos:Em um centro de referência nacional, 51 pacientes foram avaliados com exame clínico, eletrocardiograma (ECG), ecocardiograma (ECO) e Holter de 24 horas. Os pacientes foram classificados de acordo com o escore PND modificado e divididos em grupos: PND 0, PND I, PND II e PND > II (que incluiu o PND IIIa, IIIb e IV). Nós escolhemos a árvore de classificação como o método estatístico para analisar a associação entre achados nos exames cardiovasculares e a classificação neurológica (PND).Resultados:Anormalidades no ECG estiveram presentes em quase 2/3 dos pacientes com PAF, enquanto que anormalidades no ECO ocorreram em cerca de 1/3 deles. Todos os pacientes com ECO anormal também apresentaram ECG anormal, mas o oposto não ocorreu. A árvore de classificação identificou o ECG e o ECO como variáveis relevantes (p < 0,001 e p = 0,08, respectivamente). A probabilidade de um paciente estar no grupo PND 0 quando apresentava um ECG normal foi superior a 80%. Quando ambos o ECG e o ECO eram anormais, essa probabilidade era nula.Conclusões:Pacientes brasileiros com PAF apresentam anormalidades frequentes ao ECG. O ECG é um bom exame para discriminar portadores assintomáticos da mutação daqueles que desenvolveram a doença, enquanto que o ECO contribui para esta discriminação.

Could a high-fat diet rich in unsaturated fatty acids impair the cardiovascular system?

BACKGROUND: Dyslipidemia results from consumption of a diet rich in saturated fatty acids and is usually associated with cardiovascular disease. A diet rich in unsaturated fatty acids is usually associated with improved cardiovascular condition. OBJECTIVE: To investigate whether a high-fat diet rich in unsaturated fatty acids (U-HFD) - in which fatty acid represents approximately 45% of the total calories - impairs the cardiovascular system. METHODS: Male, 30-day-old Wistar rats were fed a standard (control) diet or a U-HFD containing 83% unsaturated fatty acid for 19 weeks. The in vivo electrocardiogram, the spectral analysis of heart rate variability, and the vascular reactivity responses to phenylephrine, acetylcholine, noradrenaline and prazosin in aortic ring preparations were analyzed to assess the cardiovascular parameters. RESULTS: After 19 weeks, the U-HFD rats had increased total body fat, baseline glucose levels and feed efficiency compared with control rats. However, the final body weight, systolic blood pressure, area under the curve for glucose, calorie intake and heart weight/final body weight ratio were similar between the groups. In addition, both groups demonstrated no alteration in the electrocardiogram or cardiac sympathetic parameters. There was no difference in the responses to acetylcholine or the maximal contractile response of the thoracic aorta to phenylephrine between groups, but the concentration necessary to produce 50% of maximal response showed a decrease in the sensitivity to phenylephrine in U-HFD rats. The cumulative concentration- effect curve for noradrenaline in the presence of prazosin was shifted similarly in both groups. CONCLUSIONS: The present work shows that U-HFD did not impair the cardiovascular parameters analyzed.

Aspectos dosimétricos da irradiaçäo de meio corpo / Dosimetric aspects of half body irradiation

O uso da irradiaçäo de meio corpo (IMC) no tratamento das metástases ósseas disseminadas e como tratamento adjuvante de certas patologias malignas tem sido empregado cada vez mais freqüentemente. A eficácia desse método terapêutico já foi perfeitamente demonstrada por vários autores. Como o método consiste no emprego de campos grandes de irradiaçäo e distância fonte superfície superior a 110 cm, é fundamental que os parâmetros dosimétricos, para cada aparelho utilizado, sejam especialmente avaliados. No Eldorado 78, utilizado no Instituto Nacional de Câncer, a homogeneidade do feixe de radiaçäo foi medida ao longo dos eixos céfalo-caudal e transversal bem como ao longo da diagonal. A planura do feixe foi considerada adequada em todas essas medidas, näo havendo necessidade de construçäo de filtros homogeneizadores. A IMC pode ser utilizada como método paliativo de tratamento num grande número de pacientes. A sua dosimetria é simples e facilmente realizável na maioria dos centros de radioterapia

Irradiaçäo de corpo inteiro usando-se uma unidade de telecobaltoterapia com seus colimadores removidos / Total body irradiation using a cobalt unit with its collimators removed

A técnica de radiaçäo de corpo inteiro requer campos suficientemente grandes a fim de englobar todo o paciente. Existem vários métodos que podem ser utilizados para a obtençäo dos campos requeridos por essa técnica de tratamento, entre os quais a construçäo de uma unidade exclusiva, o deslocamento do paciente ao longo de uma unidade fixa ou a modificaçäo de uma unidade construída para o tratamento convencional. No Instituto Nacional de Câncer o problema foi resolvido por meio de remoçäo dos colimadores de uma unidade construída para o tratamento convencional que possibilita a obtençäo de um campo circular de 2,25 , de diâmetro a 147 cm da fonte. O processo de remoçäo e reposiçäo dos colimadores é extremamente rápido e näo interfere no funcionamento normal do aparelho. A homogeneidade do campo de um filtro achatador, de simples construçäo e fácil colocaçäo. Os parâmetros dosimétricos e relevantes foram mantidos nas condiçöes geométricas de tratamento

Estudo da dose superfície e regiäo de bluild-up de um feixe de fótons de 18 MV / Surface dose and build-up region from a 18 MV photon beam

Foi realizado um estudo do comportamento da dose superfície e da regiäo de build-up em funçäo de diversos parâmetros de intersse clínico para o feixe de fótons de 18 MV do acelerador linear Saturne (Therac 20). As curvas de dose em profundidade foram obtidas, com uma câmara de ionizaçäo de placas paralelas de 0,03 cm3, para ambas as polaridades, em um fantoma de acrílico, no eixo central do feixe, além de pontos fora do eixo correspondentes a regiöes anatômicas de interesse quando da irradiaçäo de campos irregulares. Foi estudada a variaçäo da dose superfície em funçäo do tamanho de campo, da distância fonte superfície e da presença da bandeja e da placa de mylar do tampo eda mesa quando da irradiaçäo póstero-anterior. Foram também feitas medidas no eixo central variando-se o ângulo de incidência do feixe

Radiocirurgia estereotáxica com acelerador linear para tratamento da malformação arteriovenosa cerebral / Stereotactic radiosurgery for cerebral arteriovenous malformations using a standard linear accelerator

Este trabalho apresenta os resultados de tratamento comradiocirurgia estereotáxica (RCE) em 12 pacientes portadoresde malformação arteriovenosa cerebral (MAV), com o uso deacelerador linear (LINAC) de 6 Mev de energia e os principaisefeitos colaterais agudos do tratamento. A taxa de respostacompleta foi de 83%, com efeitos colaterais agudos em 50% enenhum efeito colateral tardio, mostrando-se como alternativa,segura e eficaz, para o tratamento desta afecção.