Exploring the complexity: the interplay between the angiotensin-converting enzyme insertion/deletion polymorphism and the sympathetic response to hemodialysis.

Patients on hemodialysis (HD) are at increased risk for arrhythmias and sudden cardiac death. Autonomic nervous system (ANS) dysfunction seems to participate in the arrhythmogenic process. Genetic factors have an impact on ANS modulation, but the specific role of the insertion/deletion (I/D) polymorphism in the gene for angiotensin-converting enzyme (ACE) has not been investigated. Since the D allele increases gene expression, it is a candidate polymorphism to interact with the ANS. The aim of the present study was to compare the behavior of heart rate variability (HRV) during HD, as a surrogate for ANS response to stressors, between the ACE genotypes. In a sample of patients with chronic kidney disease I/D ACE genotypes were assessed with PCR and HRV was measured before, in the second hour, and after a HD session. HRV parameters in the time and frequency domains were analyzed by repeated-measures mixed models according to the time of measurement and ACE polymorphism. HRV parameters in the frequency domain presented significantly different variations during the HD session between patients with or without the D allele. Only patients with the II genotype presented an increase in low-frequency normalized units and in the low frequency-to-high frequency ratio throughout HD. Patients with the II genotype seemed to have a more physiological response to the volemic and electrolytic changes that occur during HD, with greater sympathetic activation than patients with ID and DD genotypes. NEW & NOTEWORTHY Adding to the effort to understand the complexity of cardiovascular system regulation, we have found that the autonomic nervous system response to the acute volume removal during hemodialysis may be different between angiotensin-converting enzyme insertion/deletion polymorphisms. To our knowledge, this is the first time that this specific interaction was analyzed during a volume removal intervention.

O profissional Fisioterapeuta, a pandemia e os ecos futuros / The professional physical therapist, the pandemic and future echoes / El fisioterapeuta, la pandemia y los ecos del futuro

Este artigo é resultado do "I Encontro da Fisioterapia da UFPel", que ocorreu junto ao tradicional Simpósio Nacional de Educação Física da Universidade Federal de Pelotas, e tem o objetivo de apresentar experiências vividas por profissionais fisioterapeutas sobre o momento pandêmico, o cenário apresentado, as dificuldades enfrentadas e os aprendizados. Foi relatada a experiência de profissionais que atuaram durante a pandemia nas áreas de terapia intensiva, unidade de tratamento intensivo neonatal e na clínica, após a alta hospitalar. Identificamos que as experiências vivenciadas na atuação do profissional fisioterapeuta foi marcada pela adaptação ao novo cenário e pelo enfrentamento de diferentes situações com protagonismo, o que possibilitou mostrar o quanto esses profissionais estão prontos para agir, junto aos demais membros da equipe de saúde, nas diversas situações em saúde que podem se apresentar.

This article is the result of the "I Meeting of Physiotherapy at UFPel", which took place together with the traditional National Symposium of Physical Education at the Federal University of Pelotas, and aims to present experiences lived by professional physiotherapists about the pandemic moment, the scenario presented, the difficulties faced and the lessons learned. The experience of professionals who worked during the pandemic in the areas of intensive care, neonatal intensive care unit and in the clinic, after hospital discharge, was reported. We identified that the experiences lived in the work of the physiotherapist professional were marked by the adaptation to the new scenario and by the confrontation of different situations with protagonism, which made it possible to show how these professionals are ready to act, together with the other members of the health team, in the various health situations that may arise.

Este artículo es el resultado del "I Encuentro de Fisioterapia de la UFPel", que se realizó en conjunto con el tradicional Simposio Nacional de Educación Física en la Universidad Federal de Pelotas, y tiene como objetivo presentar experiencias vividas por fisioterapeutas profesionales sobre el momento de la pandemia, el escenario presentado, las dificultades enfrentadas y las lecciones aprendidas. Se relató la experiencia de los profesionales que actuaron durante la pandemia en las áreas de cuidados intensivos, unidad de cuidados intensivos neonatales y en la clínica, después del alta hospitalaria. Identificamos que las experiencias vividas en el trabajo del profesional fisioterapeuta estuvieron marcadas por la adaptación al nuevo escenario y el enfrentamiento de diferentes situaciones con protagonismo, lo que permitió evidenciar cómo estos profesionales están preparados para actuar, junto a los demás integrantes del equipo de salud, en las diferentes situaciones de salud que se presenten.