Effect of exercise on endothelial function in heart transplant recipients: systematic review and meta-analysis.

Endothelial dysfunction is associated with increased cardiovascular risk and death in heart transplant recipients (HTx). Although the measurement of peripheral endothelial function is considered a significant predictor of cardiovascular events in several populations, few studies have investigated this outcome after therapeutic strategies, including different exercise types, duration, and intensity. This systematic review and meta-analysis aimed to investigate the effects of continuous moderate exercise (CON) or high-intensity interval training (HIIT) to improve endothelial function (EF) in HTx. The search was conducted in Cochrane Central Registry of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Web of Science and Scopus/Elsevier, CINAHL/Ebsco, Physiotherapy Evidence Database (PEDro), LILACS/BIREME, and SciELO databases. Quality of the evidence was assessed using the Grading of Recommendations Assessment Development and Evaluation (GRADE). The search strategy retrieved 5192 titles. A total of four articles met the inclusion criteria and were included for the qualitative analysis. Meta-analysis showed that exercises improved EF ([mean difference-MD] 3.48 95% CI - 0.29 to 7.25, p = 0.007) when compared with the control. However, there was a poor quality of evidence to demonstrate that CON or HIIT is better than usual care to improve EF. Exercise training provides benefits to patients, but the poor quality of evidence does not allow us to state that exercise is related to endothelial function improvement in HTx.

Correlation between peripheral endothelial function, oxygen consumption and ventilatory efficiency in heart transplantation recipients.

BACKGROUND: Endothelial dysfunction and peak oxygen uptake (VO2peak) are also predictors of increased risk of cardiovascular events in heart transplantation (HTx) recipients. The preservation of endothelial function may contribute to exercise tolerance. OBJECTIVE: To investigate the correlation between peripheral endothelial function and exercise tolerance through VO2peak and ventilation to carbon dioxide production slope (VE / VCO2 slope) in HTx recipients. METHODS: A pilot cross-sectional study was conducted with adult individuals aged 18-65 years, HTx ≥ six months after surgery, who had a stable medical condition and no changes over the last three months of immunosuppressive treatment. The patients underwent an assessment of endothelial function through PAT (EndoPAT-2000®) and performed a cardiopulmonary exercise test (CPET). RESULTS: A total of 41% of the studied population presented endothelial dysfunction. The individuals were divided into two groups: the endothelial dysfunction (GED; n=9) group and the normal endothelial function (GNEF; n=13) group according to the logarithm of the reactive hyperemia index (LnRHI). There was a positive and moderate correlation between the LnRHI and VO2 peak (r=0.659, p=0.013) and a negative and moderate correlation between the LnRHI and VE/VCO2 slope (r= -0.686, p= 0.009) in the GNEF. However, no significant correlations were found in the GED. CONCLUSION: The results showed that the preservation of peripheral endothelial function is significantly correlated with an increase in exercise tolerance in individuals after HTx. These findings bring important considerations for cardiovascular risk prevention and emphasize that therapeutic strategies with physical training programs must be implemented early.

Effects of continuous aerobic training associated with resistance training on maximal and submaximal exercise tolerance, fatigue, and quality of life of patients post-COVID-19.

BACKGROUND AND PURPOSE: Dyspnea, fatigue, and reduced exercise tolerance are common in post-COVID-19 patients. In these patients, rehabilitation can improve functional capacity, reduce deconditioning after a prolonged stay in the intensive care unit, and facilitate the return to work. Thus, the present study verified the effects of cardiopulmonary rehabilitation consisting of continuous aerobic and resistance training of moderate-intensity on pulmonary function, respiratory muscle strength, maximum and submaximal tolerance to exercise, fatigue, and quality of life in post-COVID-19 patients. METHODS: Quasi-experimental study with a protocol of 12 sessions of an outpatient intervention. Adults over 18 years of age (N = 26) with a diagnosis of COVID-19 and hospital discharge at least 15 days before the first evaluation were included. Participants performed moderate-intensity continuous aerobic and resistance training twice a week. Maximal and submaximal exercise tolerance, lung function, respiratory muscle strength, fatigue and quality of life were evaluated before and after the intervention protocol. RESULTS: Cardiopulmonary rehabilitation improved maximal exercise tolerance, with 18.62% increase in peak oxygen consumption (VO2peak) and 29.05% in time to reach VO2 peak. VE/VCO2 slope reduced 5.21% after intervention. We also observed increased submaximal exercise tolerance (increase of 70.57 m in the 6-min walk test, p = 0.001), improved quality of life, and reduced perceived fatigue after intervention. DISCUSSION: Patients recovered from COVID-19 can develop persistent dysfunctions in almost all organ systems and present different signs and symptoms. The complexity and variability of the damage caused by this disease can make it difficult to target rehabilitation programs, making it necessary to establish specific protocols. In this work, cardiopulmonary rehabilitation improved lung function, respiratory muscle strength, maximal and submaximal exercise tolerance, fatigue and quality of life. Continuous aerobic and resistance training of moderate intensity proved to be effective in the recovery of post-COVID-19 patients.

Association between performance on the Glittre ADL-test and the functional capacity of patients with HF: A cross-sectional study.

Background: The Weber classification based on peak VO2 is a well-established method for categorizing patients with heart failure (HF) regarding severity. However, other submaximal tests such as the Glittre ADL-Test have been gaining prominence in practice due to a coherent and more comprehensive correlation with limitations for performing activities of daily living in patients with heart failure.Objective: To investigate the correlation between the time required to perform the Glittre ADL-Test and the peak VO2 in patients with HF.Methods: A cross-sectional study conducted with 40 adult individuals (21 to 65 years) diagnosed with HF of all etiologies, with LVEF<50% and NYHA II and III.Results: The average time for performing the Glittre ADL-Test was 284.9 seconds, and a significant difference was found between Weber classification classes A and C (p = .01). Significant correlations with peak VO2 were also found (r = -0.424 - p < .01). Thirty (30) patients performed a second test, and the ICC found in the reproducibility analysis was 0.75 (95% CI 0.14-0.91) and p < .01.Conclusion: The Glittre ADL-Test was able to reflect the functional performance of individuals with HF, suggesting that it represents an evaluation tool which can be safely used in clinical practice.

Influence of High-Intensity Interval Training Versus Continuous Training on Functional Capacity in Individuals With Heart Failure: A SYSTEMATIC REVIEW AND META-ANALYSIS.

INTRODUCTION: Cardiac rehabilitation programs reduce the risk of death and acute events related to the disease through the association of various modalities of exercise. When implemented in high-intensity interval training (HIIT) programs, it may allow for gradual adaptation of the skeletal muscles to greater exercise intensities. The present systematic review aimed to determine whether HIIT promoted a greater increase in exercise tolerance in comparison with continuous aerobic training in individuals with heart failure. METHODS: A systematic search for articles indexed in the PubMed/MEDLINE, LILACS, SciELO, PEDro, Scopus, and Web of Science databases was carried out. The descriptors used for the search followed the description of the MeSH/DeCS terms with no language or year of publication restrictions. When possible, a meta-analysis was performed and the quality of the evidence was evaluated using the GRADE scale. RESULTS: The broad search strategy resulted in 5258 titles, and a total of 7 articles were included in the qualitative synthesis. A low quality of evidence was observed demonstrating that interval training is superior to continuous aerobic training for improving peak oxygen uptake, which reflects an increase in functional capacity of these individuals and moderate quality of evidence regarding improved quality of life and left ventricular ejection fraction. CONCLUSION: High-intensity interval training and continuous training provide benefits for patients, however, the quality of evidence still does not allow us to indicate whether there is a superiority of HIIT over conventional continuous exercise training using the variables analyzed.

Accidental poisoning by castor bean (Ricinus communis) cake in horses / Intoxicação acidental por torta de mamona (Ricinus communis) em equinos

Ricinus communis is a shrub of the family Euphorbiaceae popularly known in Brazil as "mamona" or "carrapateira". It is an oleaginous plant whose seeds have been used mainly in biodiesel production. Plant seed oil can be extracted mechanically or using solvents, generating castor bean cake and castor bean meal as by-products, respectively. Accidental ingestion of these by-products can cause poisoning in animals and humans, characterized by digestive signs resulting from the presence of a toxalbumin called ricin. Seed toxicity varies among animal species; in horses, the lethal dose of seeds is 0.1 g/kg of body weight. The literature presents plenty of studies addressing poisoning by R. communis in different animal species and in humans; however, reports are scarce and little information is available on the pathological aspects of poisoning regarding equines. Therefore, the present study aimed to describe the epidemiological, clinical and pathological aspects observed in an outbreak of accidental poisoning with castor bean cake in horses. The equines were supplemented with palm kernel (Elaeis guianeesis) cake; however, in the purchase of a new batch, there was an error in the order, and castor bean cake was requested instead. Four horses that received castor bean cake presented clinical signs indicative of colic, which started about 21 hours after administration. Three of these horses died, with clinical evolution from 2 to 4.5 hours; the other animal was treated with intravenous fluid and antibiotic therapy and non-steroidal anti-inflammatory drugs and recovered after five days. In the necropsy of two of these horses, the main lesions were found in the small intestine, where mucosae with pronounced redness and covered with a thin layer of yellow fibrous material were observed. In the intestinal lumen, there was a large amount of bloody liquid. The stomach was full, and dark lumps similar to crushed castor bean seeds were observed in the contents. The adrenal glands of both horses presented congestion and hemorrhage in the cortex. In microscopy, the main lesion was an acute, diffuse and accentuated fibrin-necrotic enteropathy affecting the jejunum. The diagnosis of castor bean cake poisoning was based on the circumstantial evidence of by-product consumption supported by clinical and pathological aspects. The results indicate that castor bean cake commercially available as fertilizer is extremely toxic when ingested, and there is a need for appropriate detoxification or labeling informing of its toxicity.(AU)

Ricinus communis é um arbusto da família Euphorbiaceae conhecido popularmente como "mamona" ou "carrapateira". A planta é considerada oleaginosa e suas sementes têm sido utilizadas, principalmente, na produção de biodiesel. A extração do óleo pode ser mecânica ou com solventes, gerando, como subprodutos, a torta de mamona e a farinha de mamona, respectivamente. A ingestão acidental desses subprodutos pode causar intoxicação em animais e humanos, caracterizada por sinais digestivos devido a toxalbumina ricina. A toxidez das sementes varia entre as espécies animais, em equinos a dose letal de sementes é de 0,1g/kg de peso vivo. Há vasta literatura sobre a intoxicação por R. communis em diferentes espécies animais e humanos. Em relação aos equinos os relatos são escassos e com poucas informações sobre os aspectos patológicos da intoxicação. Assim, os objetivos do presente estudo foram descrever os aspectos epidemiológicos, clínicos e patológicos observados em um surto de intoxicação acidental por torta de mamona em equinos. Os equinos eram suplementados com torta de dendê (Elaeis guianeesis), no entanto, na compra de uma nova partida, houve um erro no pedido sendo solicitada torta de mamona. Os quatro equinos que receberam a torta de mamona apresentaram sinais clínicos indicativos de cólica, que iniciaram cerca de 21 horas após administração. Três destes morreram, com evolução clínica 2 a 4,5 horas, o outro animal foi tratado com fluidoterapia intravenosa, antibioticoterapia e anti-inflamatório não esteroidal, recuperando-se em 5 dias. Na necropsia de dois destes equinos, as principais lesões foram encontradas no intestino delgado, sendo observadas mucosas com avermelhamento acentuado e recobertas por fina camada de material amarelado fibrinoso. No lúmen intestinal, havia grande quantidade de líquido sanguinolento. O estômago estava repleto de grumos escuros semelhantes às sementes trituradas da mamona em meio ao conteúdo. As adrenais de ambos equinos apresentavam congestão e hemorragias corticais. Na microscopia, a principal lesão foi uma enteropatia fibrino-necrótica, aguda, difusa e acentuada, afetando com maior intensidade o jejuno. O diagnóstico de intoxicação por torta de mamona foi baseado na evidência circunstancial de consumo do subproduto, sendo corroborado pelos aspectos clínicos e patológicos. Os resultados indicam que a torta de mamona vendida para fertilização do solo é extremamente tóxica quando ingerida, havendo a necessidade de detoxicação ou rotulagem adequada informando sobre a sua toxicidade.(AU)