Loud noise-exposure changes the firing frequency of subtypes of layer 5 pyramidal neurons and Martinotti cells in the mouse auditory cortex.

Introduction: Loud noise-exposure can generate noise-induced tinnitus in both humans and animals. Imaging and in vivo studies show that noise exposure affects the auditory cortex; however, cellular mechanisms of tinnitus generation are unclear. Methods: Here we compare membrane properties of layer 5 (L5) pyramidal cells (PCs) and Martinotti cells expressing the cholinergic receptor nicotinic alpha 2 subunit gene (Chrna2) of the primary auditory cortex (A1) from control and noise-exposed (4-18 kHz, 90 dB, 1.5 h, followed by 1.5 h silence) 5-8 week old mice. PCs were furthermore classified in type A or type B based on electrophysiological membrane properties, and a logistic regression model predicting that afterhyperpolarization (AHP) and afterdepolarization (ADP) are sufficient to predict cell type, and these features are preserved after noise trauma. Results: One week after a loud noise-exposure no passive membrane properties of type A or B PCs were altered but principal component analysis showed greater separation between type A PCs from control and noise-exposed mice. When comparing individual firing properties, noise exposure differentially affected type A and B PC firing frequency in response to depolarizing current steps. Specifically, type A PCs decreased initial firing frequency in response to +200 pA steps (p = 0.020) as well as decreased steady state firing frequency (p = 0.050) while type B PCs, on the contrary, significantly increased steady state firing frequency (p = 0.048) in response to a + 150 pA step 1 week after noise exposure. In addition, L5 Martinotti cells showed a more hyperpolarized resting membrane potential (p = 0.04), higher rheobase (p = 0.008) and an increased initial (p = 8.5 × 10-5) and steady state firing frequency (p = 6.3 × 10-5) in slices from noise-exposed mice compared to control. Discussion: These results show that loud noise can cause distinct effects on type A and B L5 PCs and inhibitory Martinotti cells of the primary auditory cortex 1 week following noise exposure. As the L5 comprises PCs that send feedback to other areas, loud noise exposure appears to alter levels of activity of the descending and contralateral auditory system.

Anxiety-like behavior induced by salicylate depends on age and can be prevented by a single dose of 5-MeO-DMT.

Salicylate intoxication is a cause of tinnitus and comorbidly associated with anxiety in humans. In a previous work, we showed that salicylate induces anxiety-like behavior and hippocampal type 2 theta oscillations (theta2) in mice. Here we investigate if the anxiogenic effect of salicylate is dependent on age and previous tinnitus experience. We also tested whether a single dose of DMT can prevent this effect. Using microwire electrode arrays, we recorded local field potential in young (4-5- month-old) and old (11-13-month-old) mice to study the electrophysiological effect of tinnitus in the ventral hippocampus (vHipp) and medial prefrontal cortex (mPFC) in an open field arena and elevated plus maze 1h after salicylate (300mg/kg) injection. We found that anxiety-like behavior and increase in theta2 oscillations (4-6 Hz), following salicylate pre-treatment, only occurs in young (normal hearing) mice. We also show that theta2 and slow gamma oscillations increase in the vHipp and mPFC in a complementary manner during anxiety tests in the presence of salicylate. Finally, we show that pre-treating mice with a single dose of the hallucinogenic 5-MeO-DMT prevents anxiety-like behavior and the increase in theta2 and slow gamma oscillations after salicylate injection in normal hearing young mice. This work further support the hypothesis that anxiety-like behavior after salicylate injection is triggered by tinnitus and require normal hearing. Moreover, our results show that hallucinogenic compounds can be effective in treating tinnitus-related anxiety.

Formação de lideranças idosas: uma estratégia para o fortalecimento do protagonismo e da participação social / Elderly leardeship formation: a strategy for strenghening protagonism and social participation

O crescente envelhecimento populacional é um fenômeno demográfico que traz consigo dilemas e desafios para os que envelhecem. Dentre os desafios, pontua-se que existe um distanciamento entre os direitos dos(as) idosos(as) já conquistados ao longo de uma trajetória de luta e o que de fato se materializa no cotidiano. Diante disso, o Curso de Formação de Lideranças Idosas: participação social e protagonismo surge como uma estratégia para estimular a autonomia e o protagonismo dos(as) idosos(as) na conquista por seus direitos. O presente trabalho consiste em um relato de experiência sobre o referido curso, analisando seus significados para o grupo de idosos(as) do Trabalho Social com Idosos ­ TSI ­, na Unidade Fortaleza do Sesc. O curso foi desenvolvido através de metodologias participativas, proporcionando a troca de saberes sobre temas relacionados ao protagonismo e à participação social, fortalecendo o conhecimento sobre políticas públicas para a pessoa idosa e o controle social. Os resultados expressam o interesse dos(as) idosos(as) em conhecer e acessar seus direitos, exercitando a participação social. Observou-se a necessidade de ampliar e fortalecer espaços de discussão que propiciem à pessoa idosa a compreensão da velhice como direito e a exigência de políticas públicas para essa população, envolvendo a sociedade e demais gerações na busca por um envelhecimento digno. Nesse sentido, a formação de sujeitos sociais e políticos fortalece o controle social na construção de uma sociedade democrática, participativa e justa para todas as idades.(AU)

The growth of the age of the population is a demographic phenomenon that brings with it dilemmas and challenges for the elderly. Among the challenges, it is pointed out that there is a gap between the rights that the elderly people already conquered along the trajec- tory of struggle and what actually materializes in daily life. In view of this, the Elderly Leadership Training Course: social participation and protagonism emerges as a strategy to stimulate the autonomy and protagonism of the elderly in exercising their rights. The meanings for the group of elderly people from Social Work with the Elderly ­ TSI at Fortaleza ­ Sesc Unit. The course was developed through participatory methodologies, providing the exchange of knowledge on topics related to protagonism and social participation, strengthening knowledge about public policies for the elderly and social control. The results express the interest of the elderly in knowing and accessing their rights, exercising social participation. There was a need to expand and strengthen spaces for discussion that provide elderly people with an understanding of rights that come with old age, and the requirement for public policies for this population, involving society and other generations in the search for a dignified aging. In this sense, the formation of social and political subjects strengthens social control in the construction of a democratic, participatory and fair society for all ages.(AU)

Chrna2-OLM interneurons display different membrane properties and h-current magnitude depending on dorsoventral location.

The hippocampus is an extended structure displaying heterogeneous anatomical cell layers along its dorsoventral axis. It is known that dorsal and ventral regions show different integrity when it comes to functionality, innervation, gene expression, and pyramidal cell properties. Still, whether hippocampal interneurons exhibit different properties along the dorsoventral axis is not known. Here, we report electrophysiological properties of dorsal and ventral oriens lacunosum moleculare (OLM) cells from coronal sections of the Chrna2-cre mouse line. We found dorsal OLM cells to exhibit a significantly more depolarized resting membrane potential compared to ventral OLM cells, while action potential properties were similar between the two groups. We found ventral OLM cells to show a higher initial firing frequency in response to depolarizing current injections but also to exhibit a higher spike-frequency adaptation than dorsal OLM cells. Additionally, dorsal OLM cells displayed large membrane sags in response to negative current injections correlating with our results showing that dorsal OLM cells have more hyperpolarization-activated current (Ih ) compared to ventral OLM cells. Immunohistochemical examination indicates the h-current to correspond to hyperpolarization-activated cyclic nucleotide-gated subunit 2 (HCN2) channels. Computational studies suggest that Ih in OLM cells is essential for theta oscillations in hippocampal circuits, and here we found dorsal OLM cells to present a higher membrane resonance frequency than ventral OLM cells. Thus, our results highlight regional differences in membrane properties between dorsal and ventral OLM cells allowing this interneuron to differently participate in the generation of hippocampal theta rhythms depending on spatial location along the dorsoventral axis of the hippocampus.

Development of an application to support in-service training of anesthesiologists on preoperative evaluation in a public hospital in Brazil.

RATIONALE, AIMS AND OBJECTIVES: This study investigated the process of construction, use, and field evaluation of a mobile application for teaching in the anesthesiology area. METHOD: The application was built by using the Co-Design Methodology, which consists of five phases (scoping, shared understanding, brainstorming, refinement and implementation). A one-week case study was carried out in a hospital involving 20 participants (medical students and residents). RESULTS: The results of the test indicated that the developed application presented a high level of usability. CONCLUSIONS: The students considered it to be a useful tool for training and systematizing the preoperative evaluation.

Velhos trabalhadores do Mercado São Sebastião: Reflexões sobre velhice e trabalho informal / Sao Sebastiao Market Old Workers: Reflections on Old Age and Informal Work / Viejos trabajadores del Mercado São Sebastião: Reflexiones sobre vejez y trabajo informal

O presente estudo teve como objetivo compreender os significados do trabalho e as condições de vida dos velhos trabalhadores do Mercado São Sebastião, localizado na cidade de Fortaleza, CE, Brasil. A coleta de dados foi realizada através de pesquisa bibliográfica e de campo, com observação, registro em diário de campo e aplicação de entrevista semiestruturada, tendo abordagem qualitativa e método de análise dialético hermenêutico. Os resultados apontaram que a importância do trabalho para os entrevistados está relacionada à manutenção do seu papel de provedor familiar, ao espaço de socialização proporcionado pelo labor e à garantia de uma renda suficiente para suprir as suas necessidades e as de sua família.

This study aimed to understand the meanings of work and living conditions of old workers in São Sebastião Market, located in the city Fortaleza, CE, Brazil. Data collection was conducted through literature and field research, with observation, registering in journal field and the application of semi-structured interview, with qualitative approach and hermeneutic dialectic method of analysis. The results showed that the importance of working for the respondents is related to maintaining their roles as family providers, the space for socialization provided by labor and ensured income that is enough to fulfill their needs and those of their relatives.

El presente estudio tuvo como objetivo comprender los significados del trabajo y las condiciones de vida de los viejos trabajadores del Mercado São Sebastião, ubicado en la ciudad de Fortaleza, CE, Brasil. La recolección de datos fue realizada a través de investigación bibliográfica y de campo, con observación, registro en diario de campo y aplicación de entrevista semiestructurada, teniendo abordaje cualitativo y método de análisis dialéctico hermenéutico. Los resultados apuntaron que la importancia del trabajo para los entrevistados está relacionada con el mantenimiento de su papel de proveedor familiar, el espacio de socialización proporcionado por la labor y la garantía de una renta suficiente para satisfacer sus necesidades y las de su familia.

Exercise Capacity Impairment Can Predict Postoperative Pulmonary Complications after Liver Transplantation.

BACKGROUND: Postoperative respiratory complications (PRCs) are common after liver transplantation (LT) and contribute significantly to the related morbidity and mortality. OBJECTIVE: The aim of this paper was to determine the incidence of PRCs after LT and the value of simple exercise capacity measures as independent predictors of PRCs. METHODS: We conducted a prospective cohort study of consecutive adults submitted to LT at a University Hospital in Fortaleza Brazil from March 2013 to March 2015. At baseline, exercise capacity was assessed with the 6-minute walk test (6MWT) and the 6-minute step test (6MST), lung function was tested by spirometry, and respiratory muscle strength was measured by maximal respiratory pressure. Additional relevant pre- and intraoperative data were collected through interview and chart review, and their association with the incidence of PRCs was evaluated. RESULTS: The study included 100 subjects, 44% of whom presented at least 1 of the PRCs. In the univariate analysis, poor 6MST and 6MWT results and a longer preoperative cold ischemia time were associated with PRCs. The logistic regression analysis showed that PRCs were less likely to occur when preoperative walking distances were longer: the odds ratio (95% CI) was reduced to 0.589 (0.357-0.971) for each 50 m walked (p = 0.03). Likewise, PRCs were more likely to occur in patients with longer preoperative cold ischemia times: the odds ratio (95% CI) increased to 1.008 (1.002-1.015) for each minute (p = 0.01). CONCLUSION: The incidence of PRCs is high in LT patients. A prolonged cold ischemia time and preoperative 6MWT results were independent predictors of PRCs in this patient population.

Assessment of fatigue using the Identity-Consequence Fatigue Scale in patients with lung cancer / Avaliação da fadiga utilizando a Escala de Identificação e Consequências da Fadiga em pacientes com câncer de pulmão

ABSTRACT Objective: To evaluate the properties of the Identity-Consequence Fatigue Scale (ICFS) in patients with lung cancer (LC), assessing the intensity of fatigue and associated factors. Methods: This was a cross-sectional study involving LC patients, treated at a teaching hospital in Brazil, who completed the ICFS. Patients with chronic heart disease (CHD) and healthy controls, matched for age and gender, also completed the scale. Initially, a Brazilian Portuguese-language version of the ICFS was administered to 50 LC patients by two independent interviewers; to test for reproducibility, it was readministered to those same patients. At baseline, the LC patients were submitted to spirometry and the six-minute walk test, as well as completing the Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), and Fatigue Severity Scale (FSS). Inflammatory status was assessed by blood C-reactive protein (CRP) levels. To validate the ICFS, we assessed the correlations of its scores with those variables. Results: The sample comprised 50 patients in each group (LC, CHD, and control). In the LC group, the intraclass correlation coefficients for intra-rater and inter-rater reliability regarding ICFS summary variables ranged from 0.94 to 0.76 and from 0.94 to 0.79, respectively. The ICFS presented excellent internal consistency, and Bland-Altman plots showed good test-retest reliability. The ICFS correlated significantly with FSS, HADS, and SF-36 scores, as well as with CRP levels. Mean ICFS scores in the LC group differed significantly from those in the CHD and control groups. Conclusions: The ICFS is a valid, reliable instrument for evaluating LC patients, in whom depression, quality of life, and CRP levels seem to be significantly associated with fatigue.

RESUMO Objetivo: Avaliar as propriedades da Escala de Identificação e Consequências da Fadiga (EICF) em pacientes com câncer de pulmão (CP), analisando a intensidade da fadiga e fatores associados. Métodos: Estudo transversal com pacientes com CP, atendidos em um hospital-escola no Brasil, que preencheram a EICF. Pacientes com doenças cardíacas crônicas (DCC) e controles saudáveis, pareados por idade e sexo, também preencheram a escala. Inicialmente, uma versão brasileira da escala foi aplicada a 50 pacientes com CP por dois entrevistadores independentes; para testar a reprodutibilidade, ela foi reaplicada aos mesmos pacientes. No momento basal, os pacientes com CP realizaram espirometria e teste de caminhada de seis minutos, bem como preencheram a Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e Fatigue Severity Scale (FSS). O estado inflamatório foi avaliado pelos níveis de proteína C reativa (PCR) no sangue. Para validar a EICF, avaliamos as correlações entre as pontuações na mesma e essas variáveis. Resultados: A amostra foi composta por 50 pacientes em cada grupo (CP, DCC e controle). No grupo CP, os coeficientes de correlação intraclasse para confiabilidade intra e interobservador para as variáveis resumidas da EICF variaram de 0,94 a 0,76 e de 0,94 a 0,79, respectivamente. A EICF apresentou excelente consistência interna, e as disposições gráficas de Bland-Altman demonstraram boa confiabilidade teste-reteste. A EICF apresentou correlações significativas com as pontuações na FSS, HADS e SF-36, bem como com os níveis de PCR. As médias das pontuações na EICF do grupo CP diferiram significativamente das dos grupos DCC e controle. Conclusões: A EICF é um instrumento válido e confiável para a avaliação de pacientes com CP, nos quais depressão, qualidade de vida e níveis de PCR parecem estar significativamente associados à fadiga.

Assessment of fatigue using the Identity-Consequence Fatigue Scale in patients with lung cancer.

OBJECTIVE:: To evaluate the properties of the Identity-Consequence Fatigue Scale (ICFS) in patients with lung cancer (LC), assessing the intensity of fatigue and associated factors. METHODS:: This was a cross-sectional study involving LC patients, treated at a teaching hospital in Brazil, who completed the ICFS. Patients with chronic heart disease (CHD) and healthy controls, matched for age and gender, also completed the scale. Initially, a Brazilian Portuguese-language version of the ICFS was administered to 50 LC patients by two independent interviewers; to test for reproducibility, it was readministered to those same patients. At baseline, the LC patients were submitted to spirometry and the six-minute walk test, as well as completing the Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), and Fatigue Severity Scale (FSS). Inflammatory status was assessed by blood C-reactive protein (CRP) levels. To validate the ICFS, we assessed the correlations of its scores with those variables. RESULTS:: The sample comprised 50 patients in each group (LC, CHD, and control). In the LC group, the intraclass correlation coefficients for intra-rater and inter-rater reliability regarding ICFS summary variables ranged from 0.94 to 0.76 and from 0.94 to 0.79, respectively. The ICFS presented excellent internal consistency, and Bland-Altman plots showed good test-retest reliability. The ICFS correlated significantly with FSS, HADS, and SF-36 scores, as well as with CRP levels. Mean ICFS scores in the LC group differed significantly from those in the CHD and control groups. CONCLUSIONS:: The ICFS is a valid, reliable instrument for evaluating LC patients, in whom depression, quality of life, and CRP levels seem to be significantly associated with fatigue. OBJETIVO:: Avaliar as propriedades da Escala de Identificação e Consequências da Fadiga (EICF) em pacientes com câncer de pulmão (CP), analisando a intensidade da fadiga e fatores associados. MÉTODOS:: Estudo transversal com pacientes com CP, atendidos em um hospital-escola no Brasil, que preencheram a EICF. Pacientes com doenças cardíacas crônicas (DCC) e controles saudáveis, pareados por idade e sexo, também preencheram a escala. Inicialmente, uma versão brasileira da escala foi aplicada a 50 pacientes com CP por dois entrevistadores independentes; para testar a reprodutibilidade, ela foi reaplicada aos mesmos pacientes. No momento basal, os pacientes com CP realizaram espirometria e teste de caminhada de seis minutos, bem como preencheram a Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e Fatigue Severity Scale (FSS). O estado inflamatório foi avaliado pelos níveis de proteína C reativa (PCR) no sangue. Para validar a EICF, avaliamos as correlações entre as pontuações na mesma e essas variáveis. RESULTADOS:: A amostra foi composta por 50 pacientes em cada grupo (CP, DCC e controle). No grupo CP, os coeficientes de correlação intraclasse para confiabilidade intra e interobservador para as variáveis resumidas da EICF variaram de 0,94 a 0,76 e de 0,94 a 0,79, respectivamente. A EICF apresentou excelente consistência interna, e as disposições gráficas de Bland-Altman demonstraram boa confiabilidade teste-reteste. A EICF apresentou correlações significativas com as pontuações na FSS, HADS e SF-36, bem como com os níveis de PCR. As médias das pontuações na EICF do grupo CP diferiram significativamente das dos grupos DCC e controle. CONCLUSÕES:: A EICF é um instrumento válido e confiável para a avaliação de pacientes com CP, nos quais depressão, qualidade de vida e níveis de PCR parecem estar significativamente associados à fadiga.

The impact of lung cancer resection surgery on fibrinogen and C-reactive protein and their relationship with patients outcomes: A prospective follow up study.

BACKGROUND: Major thoracic surgery is characterized by release of inflammatory markers.The objective of this study was to assess the preoperative and postoperative systemic inflammatory markers of patients undergoing lung cancer resection. METHODS: This is a prospective follow up study conducted with 48 patients submitted to lung cancer resection.All patients were assessed before and 1 month after surgery through measurement of fibrinogen and C-reative protein(CRP), pulmonary function tests, 6- minute Walk Test (6 MWT), maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax), anxiety and depression scale and karnofsky performance status scale. RESULTS: Both fibrinogen and CRP were higher 1 month after surgery, although only the change in CRP was statistically significant (p= 0.03). The following functional parameters: 6 MWT, PImax, PEmax, FEV1(%) and FVC(%) decreased after surgery with p ≤ 0.001 for all the parameters. Anxiety and depression improved and Karnofsky decrease after surgery (p= 0.03, p= 0.01 and p= 0.02; respectively). Change in CRP score following lung resection correlated significantly with changes in fibrinogen (r= 0.40; p= 0.003), change in Karnofsky scale (r= -0.50; p< 0.001) and a borderline significant trend with the 6 MWT (r= -0.28; p= 0.05). With the exception of video-assisted thoracoscopic surgery (VATS), who had a significantly lower fibrinogen level 1 month after surgery compared with thoracotomy (p= 0.01), no significant differences in fibrinogen or CRP were noted in other subgroups of patients considered at increased risk for higher levels of inflammation compared with lower risk counterparts. CONCLUSION: Lung cancer resection surgery was associated with increased level of CRP, 1 month after surgery, and correlated directly with change in fibrinogen and inversely with measurement of performance status. VATS provided lower level of fibrinogen after surgery.

Envelhecimento do homem: de qual velhice estamos falando? / Male ageing: which old age are we talking about?

O objetivo deste artigo é compreender as configurações acerca do envelhecimento masculino e como as relações de gênero influenciam na construção deste, a partir de um estudo descritivo e qualitativo. Os resultados encontrados apontam para o impacto da aposentadoria na velhice masculina, a ampliação da rede social desta a partir da participação em ações voltadas ao segmento e para a supremacia de famílias cuja responsabilidade pela manutenção econômica do lar é do velho.

This paper aims to understand the configurations regarding male ageing and how the gender relationships influence its construction, from a descriptive and qualitative study. The findings indicate the impact of retirement on male ageing, the extension of its social network from the participation in actions aimed at this segment and to the supremacy of families whose responsibility for economic support is borne by the elderly.

A percepção dos pacientes portadores de neoplasia pulmonar avançada diante dos cuidados paliativos da Fisioterapia / The Perception of the Patient Bearers of Advanced Lung Cancer before Physiotherapy Palliative Care / La Percepción de los Pacientes con Cáncer de Pulmón Avanzado ante los Cuidados Paliativos de la Fisioterapia

Introdução: O câncer de pulmão é uma doença altamente letal, geralmente detectado em estágios avançados.Corresponde ao terceiro tipo de tumor mais incidente no sexo masculino e no sexo feminino é o quinto tumormais frequente. O tratamento depende do histórico do paciente, sua idade, estado geral, estágio e tipo do tumor. Ofisioterapeuta detém métodos e recursos que são imensamente úteis nos cuidados paliativos, e sua atuação corrobora o tratamento multiprofissional. Objetivo: Descrever a percepção dos pacientes portadores de neoplasia pulmonar avançada diante dos cuidados paliativos da fisioterapia, bem como o estado de saúde em que o paciente se encontra e a principal queixa clínica relacionada à doença. Método: Trata-se de uma pesquisa qualitativa realizada com pessoasportadoras de neoplasia pulmonar avançada que se encontravam internadas no Hospital de Messejana Dr. Carlos Alberto Studart Gomes, em Fortaleza-Ceará, onde foi aplicado um questionário com cinco questões norteadoras em dez pacientes. Resultados: A partir da análise dos dados, emergiram três categorias distintas: a tristeza e sofrimentoocasionados pela doença; as limitações e incapacidades físicas no cotidiano; e a atuação da fisioterapia em relaçãoaos cuidados paliativos. Conclusão: A importância do papel da fisioterapia mostrou ser de grande valor, a partir daspercepções dos pacientes, sua atuação contribuiu de uma forma substancial no tratamento assistencial desses pacientescom câncer pulmonar tornando-se motivadora

A efetividade da escala de sonolência de Epworth como recurso auxiliar no diagnóstico da síndrome da apnéia obstrutiva do sono / La efectividad de la escala de somnolencia de Epworth como recurso auxiliar en el diagnóstico del síndrome de la apnea obstructiva del sueño / The effectiveness of the epworth sleepiness scale as an auxiliary resource in the diagnosis of obstructive sleep apnea syndrome

Objective: To analyze the effectiveness of the Epworth Sleepiness Scale (ESS) as an auxiliary resource in the diagnosis of the Obstructive Sleep Apnea Syndrome (OSAS). Methods: Observational study, with a retrospective phase and a prospective one, comprising 475 patients who sought the Sleep Study Center in Fortaleza (Centro de Estudo do Sono de Fortaleza - CESF). Data was collected from medical records, which comprises ESS, amidst some questionnaires prepared by CESF professionals and answered by the patients. The study compared the results raised by the ESS to the polysomnography data. Data analysis was performed on SPSS, using Pearson chi-square test, considering as statistically significant p-value < 0.05. Results: The male, the group aged 50 to 60, and those with body mass index> 30 kg/m2 were the most affected by OSAS, with 38.9%, 41% and 45.1%, respectively. A significant relationship was found between ESS score and OSAS (p = 0,001), showing that 25.9% (n = 123) of patients, who had values higher than 10 in the ESS, were diagnosed with OSAS. Conclusions: Data on this study shows that ESS fits as an auxiliary resource in the diagnosis of OSAS and it may be applied by any health professional while taking the clinical history. However, clinical signs are not sufficient to diagnose it, so that polysomnography is still required.

Objetivo: Analisar a efetividade da Escala de Sonolência de Epworth (ESE) como recurso auxiliar no diagnóstico da Síndrome da Apnéia Obstrutiva do Sono (SAOS). Métodos: Estudo observacional, sendo uma etapa retrospectiva e outra prospectiva com 475 pacientes que procuraram o Centro de Estudo do Sono de Fortaleza (CESF). Os dados foram coletados a partir de prontuários, que constam de questionários, incluindo a ESE, elaborados pelos profissionais do CESF e respondidos pelos pacientes. O estudo comparou os resultados obtidos na ESE com os dados da polissonografia. A análise dos dados foi realizada através do SPSS, utilizando o teste de Qui-quadrado de Pearson, considerando como estatisticamente significantes valores de p < 0,05. Resultados: O sexo masculino, na faixa etária de 50 a 60 anos e com índice de massa corpórea > 30 kg/m2 foram os mais acometidos pela SAOS com respectivamente 38,9%, 41% e 45,1%. Foi evidenciada uma relação significativa entre a pontuação da ESE e a SAOS (p = 0,001), mostrando que 25,9% (n = 123) dos pacientes, que obtiveram valores maiores que 10 na ESE, estavam com diagnóstico de SAOS. Conclusões: Os dados desta pesquisa mostram que a ESE serve como recurso auxiliar para o diagnóstico da SAOS, podendo ser aplicada por qualquer profissional de saúde durante as anamneses clínicas. Porém, a clínica do paciente não é suficiente para diagnosticá-la, sendo necessário o exame de polissonografia.

Objetivo: Analizar la efectividad de la Escala de Somnolencia de Epworth (ESE) como recurso auxiliar en el diagnóstico Del Síndrome de la Apnea Obstructiva del Sueño (SAOS). Métodos: Estudio observacional con una etapa retrospectiva y outra prospectiva con 475 pacientes que acudieron al Centro de Estudio del Sueño de Fortaleza (CESF). Los datos fueron recopilados a partir de las historias clínicas que se constituyen de cuestionarios incluyendo la ESE, creados por los profesionales del CESF y contestados por los pacientes. El estudio comparó los resultados obtenidos en la ESE con los datos de la polisomnografía. El análisis de los datos fue realizado a través del SPSS con el uso Del Chi-cuadrado de Pearson, considerando como estadísticamente significativos los valores de p < 0,05. Resultados: El sexo masculino en la franja de edad entre 50 y 60 años y con el índice de masa corporal > 30 kg/m2 fueron los más comprometidos por el SAOS con respectivamente 38,9%, 41% y 45,1%. Fue evidenciada relación significativa entre la puntuación de la ESSE y el SAOS (p = 0,001), señalando que el 25,9% (n = 123) de los pacientes que obtuvieron valores superiores a 10 en la ESSE presentaron el diagnóstico de SAOS. Conclusiones: Los datos de esta investigación señalan que la ESE sirve como recurso auxiliar en el diagnóstico de la SAOS pudiendo ser utilizada por cualquier profesional sanitario durante las anamnesis clínicas. Sin embargo, la clinica del paciente no es suficiente para diagnosticarla, siendo necesaria la prueba de la polisomnografía.

Efeitos do exercício físico no controle da hipertensão arterial em idosos: uma revisão sistemática / Effects of exercise on hypertension control in older adults: systematic review

O exercício físico é uma das principais terapêuticas utilizadas para o paciente hipertenso, pois reduz a pressão arterial (PA) e os fatores de risco cardiovasculares, diminuindo a morbimortalidade. OBJETIVO: Analisar os efeitos do exercício físico na PA de idosos hipertensos, com base nos resultados de pesquisas empíricas realizadas no período de 2000 a 2010. METODOLOGIA: Revisão sistemática de estudos experimentais, em inglês, português e espanhol, nas bases eletrônicas MEDLINE, PubMed, Lilacs, Cochrane e PEDro, publicados entre 2000 e 2010, utilizando os descritores hipertensão, atividade física, exercício físico, idoso, exercício aeróbio e treinamento de resistência. RESULTADOS: Foram encontrados 19 artigos e incluídos 12 artigos, sendo divididos em categorias temáticas: exercício aeróbico (6 artigos), exercício resistido (4), exercício aeróbico associado ao resistido (2). Entre os exercícios aeróbicos, três artigos evidenciaram redução na pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD). Três artigos afirmam que treinamento resistido reduz significativamente os valores de PAS em repouso e pressão arterial média (PAM), apenas um artigo não registrou uma redução significativa na PAD e frequência cardíaca (FC) de repouso. A utilização dos exercícios aeróbicos associados aos resistidos foram superiores aos demais, pois apontaram reduções significativas na PAS, PAD, PAM e FC de repouso, confirmando as recomendações da VI Diretriz Brasileira de Hipertensão Arterial, mas os estudos em idosos são escassos. CONCLUSÃO: Esta revisão confirma os benefícios oriundos da prática do exercício físico na redução da PA após o exercício em idosos hipertensos.

Physical exercise is one of the main techniques used for hypertensive patients because it reduces blood pressure (BP) and cardiovascular risk factors, reducing morbidity and mortality. OBJECTIVE: To analyze the effect of exercise on BP in elderly hypertensive patients, based on the findings of empirical research conducted from 2000 to 2010. METHODOLOGY: A systematic review of experimental studies in English, Portuguese and Spanish, in the electronic databases MEDLINE, PubMed, LILACS, Cochrane, and PEDro, published between 2000 and 2010 using the keywords hypertension, physical activity, exercise and the elderly, aerobic exercise, resistance training. RESULTS: We found 19 articles and selected 12, divided in thematic categories: aerobic exercise (6 articles) Resistance exercise (4), aerobic exercise associated with resistance (2). Among the aerobic exercise, three articles showed a reduction in SBP and DBP. Three articles argued that resistance training significantly reduces SBP and MBP at rest, and just one article reported a significant reduction in DBP and resting HR. The use of aerobic exercise associated with resistance was superior to others, as they showed significant reductions in SBP, DBP, MAP and HR at rest, confirming the recommendations of the Brazilian Guidelines on Hypertension, but studies in the elderly are scarce. CONCLUSION: This review confirms the benefits of exercise in reducing blood pressure after exercise in elderly hypertensive patients.

Indicações de revascularização miocárdica na doença coronariana crônica: em que ponto estamos? / Indications for revascularization in chronic coronary artery disease: where do we stand?

A doença arterial coronariana é uma das principais causas de morbidade e mortalidade no mundo. O tratamento clínico, associado ao estilo de vida, é sua base terapêutica. Somando-se a isso, para evitar a progressão da doença arterial coronariana, melhorar a qualidade de vida e reduzir a intensidade da angina, deve-se considerar a revascularização miocárdica. as indicações da cirurgia de revascularização miocpardica têm passado por mudanças, desde que a primeira intervenção cirurgica foi realizada em 1967. Apesar de diversos ensaios clínicos realizados, ainda hoje não há consenso sobre as indicações da abordagem cirúrgica, e seus reais benefícios em relação ao tratamento clínico otimizado...