Left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction: the evidence so far and prospects for phenotyping strategy.

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) represents a significant proportion of heart failure cases. Accurate diagnosis is challenging due to the heterogeneous nature of the disease and limitations in traditional echocardiographic parameters. MAIN BODY: This review appraises the application of Global Longitudinal Strain (GLS) and Left Atrial Strain (LAS) as echocardiographic biomarkers in the diagnosis and phenotyping of HFpEF. Strain imaging, particularly Speckle Tracking Echocardiography, offers a superior assessment of myocardial deformation, providing a more detailed insight into left heart function than traditional metrics. Normal ranges for GLS and LAS are considered, acknowledging the impact of demographic and technical factors on these values. Clinical studies have demonstrated the prognostic value of GLS and LAS in HFpEF, especially in predicting cardiovascular outcomes and distinguishing HFpEF from other causes of dyspnea. Nevertheless, the variability of strain measurements and the potential for false-negative results underline the need for careful clinical interpretation. The HFA-PEFF scoring system's integration of these biomarkers, although systematic, reveals gaps in addressing the full spectrum of HFpEF pathology. The combined use of GLS and LAS has been suggested to define HFpEF phenogroups, which could lead to more personalized treatment plans. CONCLUSION: GLS and LAS have emerged as pivotal tools in the non-invasive diagnosis and stratification of HFpEF, offering a promise for tailored therapeutic strategies. Despite their potential, a structured approach to incorporating these biomarkers into standard diagnostic workflows is essential. Future clinical guidelines should include clear directives for the combined utilization of GLS and LAS, accentuating their role in the multidimensional assessment of HFpEF.

Soil degradation index developed by multitemporal remote sensing images, climate variables, terrain and soil atributes.

Studies on soil degradation are essential for environmental preservation. Since almost 30% of the global soils are degraded, it is important to study and map them for improving their management and use. We aimed to obtain a Soil Degradation Index (SDI) based on multi-temporal satellite images associated with climate variables, land use, terrain and soil attributes. The study was conducted in a 2598 km2 area in São Paulo State, Brazil, where 1562 soil samples (0-20 cm) were collected and analyzed by conventional methods. Spatial predictions of soil attributes such as clay, cation exchange capacity (CEC) and soil organic matter (OM) were performed using machine learning algorithms. A collection of 35-year Landsat images was used to obtain a multi-temporal bare soil image, whose spectral bands were used as soil attributes predictors. The maps of clay, CEC, climate variables, terrain attributes and land use were overlaid and the K-means clustering algorithm was applied to obtain five groups, which represented levels of soil degradation (classes from 1 to 5 representing very low to very high soil degradation). The SDI was validated using the predicted map of OM. The highest degradation level obtained in 15% of the area had the lowest OM content. Levels 1 and 4 of SDI were the most representative covering 24% and 23% of the area, respectively. Therefore, satellite images combined with environmental information significantly contributed to the SDI development, which supports decision-making on land use planning and management.

Functionalized ferrocenes: The role of the para substituent on the phenoxy pendant group.

Six ferrocenecarboxylates with phenyl, 4-(1H-pyrrol-1-yl)phenyl, 4-fluorophenyl, 4-chlorophenyl, 4-bromophenyl, 4-iodophenyl as pendant groups were synthesized and fully characterized by spectroscopic, electrochemical and X-ray diffraction methods. The anti-proliferative activity of these complexes were investigated in hormone dependent MCF-7 breast cancer and MCF-10A normal breast cell lines, to determine the role of the para substituent on the phenoxy pendant group. The 4-fluorophenyl ferrocenecarboxylate is inactive in both cell lines while 4-(1H-pyrrol-1-yl)phenyl ferrocenecarboxylate is highly cytotoxic in both cell lines. 4-chlorophenyl and 4-bromophenyl ferrocenecarboxylates have moderate to good anti-proliferative activity in MCF-7 and low anti-proliferative activity on normal breast cell line, MCF-10A whereas the 4-iodophenyl analog is highly toxic on normal breast cell line. The phenyl ferrocenecarboxylate has proliferative effects on MCF-7 and is inactive in MCF-10A. Docking studies between the complexes and the alpha-estrogen receptor (ERα) were performed to search for key interactions which may explain the anti-proliferative activity of 4-bromophenyl ferrocenecarboxylate. Docking studies suggest the anti-proliferative activity of these ferrocenecarboxylates is attributed to the cytotoxic effects of the ferrocene group and not to anti-estrogenic effects.

Effects of the Use of Beta-Blockers on Chronic Obstructive Pulmonary Disease Associated with Cardiovascular Comorbities: Systematic Review and Meta-analysis.

Cardiovascular comorbidity is common in individuals with chronic obstructive pulmonary disease (COPD). This factor interferes with pharmacological treatment. The use of ß-blockers has been proposed for their known cardioprotective effects. However, due to their adverse reactions, and the risk of causing bronchospasm, there is reluctance to use them. To summarize existing evidence on the effects of ß-blocker use in COPD associated with cardiovascular comorbidities in relation to disease severity, exacerbation, and mortality outcomes. EMBASE, Medline, Lilacs, Cochrane Library, and Science Direct databases were used. Observational studies that evaluated the effects of ß-blockers on individuals with COPD and cardiovascular comorbidities, and related disease severity, exacerbations, or mortality outcomes were included. Studies that did not present important information about the sample and pharmacological treatment were excluded. Twenty studies were included. Relevance to patient care and clinical practice: The use of ß-blockers in individuals with COPD and cardiovascular disease caused positive effects on mortality and exacerbations outcomes, compared with the results of individuals who did not use them. The severity of the disease caused a slight change in forced expiratory volume in 1 second. The odds ratio for mortality was 0.50 (95% confidence interval [CI], 0.39 to 0.63; p<0.00001), and for exacerbations, 0.76 (95% CI, 0.62 to 0.92; p=0.005), being favorable to the group that used ß-blockers. Further studies are needed to study the effect of using a specific ß-blocker in COPD associated with a specific cardiovascular comorbidity.

Left atrial strain as a predictor of left ventricular filling pressures in coronary artery disease with preserved ejection fraction: a comprehensive study with left ventricular end-diastolic and pre-atrial contraction pressures.

Assessing left ventricular (LV) filling pressure (LVFP) is challenging in patients with coronary artery disease (CAD) and preserved LV ejection fraction (LVEF). We aimed to correlate left atrial strain (LAS) with two invasive complementary parameters of LVFP and compared its accuracy to other echocardiographic data to predict high LVFP. This cross-sectional, single-center study enrolled 81 outpatients with LVEF > 50% and significant CAD from a database. Near-simultaneous echocardiography and invasive measurements of both LV end-diastolic pressure (LVEDP) and LV pre-atrial contraction (pre-A) pressure were performed in each patient, based on the definition of LVEDP > 16 mmHg and LV pre-A > 12 mmHg as high LVFP. A moderate to strong correlation was observed between LAS reservoir (LASr), contractile strain, and LVEDP (r: 0.67 and 0.62, respectively; p < 0.001); the same was true for LV pre-A (r: 0.65 and 0.63, respectively; p < 0.001). LASr displayed good diagnostic performance to identify elevated LVFP, which was higher when compared to traditional parameters. Median value of LASr was higher for an isolated increase of LVEDP than for simultaneously high LV pre-A. The cutoff found to predict high LVFP was lower for LV pre-A than that one for LVEDP. In the current study, LASr did not provide an additional contribution to the 2016 diastolic function algorithm. LAS is a valuable tool for predicting LVFP in patients with CAD and preserved LVEF. The choice of LVEDP or LV pre-A as the representative marker of LVFP leads to different cutoffs to predict high pressures. The best strategy for adding this tool to a multiparametric algorithm requires further investigation.

Prevalence and Impact of Comorbidities in Individuals with Chronic Obstructive Pulmonary Disease: A Systematic Review.

This study aimed to describe the prevalence of comorbidities associated with chronic obstructive pulmonary disease (COPD) and their relation with relevant outcomes. A systematic review based on the PRISMA methodology was performed from January 2020 until July 2021. The MEDLINE, Lilacs, and Scielo databases were searched to identify studies related to COPD and its comorbidities. Observational studies on the prevalence of comorbidities in COPD patients and costs with health estimates, reduced quality of life, and mortality were included. Studies that were restricted to one or more COPD pain assessments and only specific comorbidities such as osteoporosis, bronchitis, and asthma were excluded. The initial search identified 1,409 studies and after applying the inclusion and exclusion criteria, 20 studies were finally selected for analysis (comprising data from 447,459 COPD subjects). The most frequent COPD comorbidities were: hypertension (range, 17%-64.7%), coronary artery disease (19.9%-47.8%), diabetes (10.2%-45%), osteoarthritis (18%-43.8%), psychiatric conditions (12.1%-33%), and asthma (14.7%-32.5%). Several comorbidities had an impact on the frequency and severity of COPD exacerbations, quality of life, and mortality risk, in particular malignancies, coronary artery disease, chronic heart failure, and cardiac arrhythmias. Comorbidities, especially cardiovascular diseases and diabetes, are frequent in COPD patients, and some of them are associated with higher mortality.

Bare Earth's Surface Spectra as a Proxy for Soil Resource Monitoring.

The Earth's surface dynamics provide essential information for guiding environmental and agricultural policies. Uncovered and unprotected surfaces experience several undesirable effects, which can affect soil ecosystem functions. We developed a technique to identify global bare surface areas and their dynamics based on multitemporal remote sensing images to aid the spatiotemporal evaluation of anthropic and natural phenomena. The bare Earth's surface and its changes were recognized by Landsat image processing over a time range of 30 years using the Google Earth Engine platform. Two additional products were obtained with a similar technique: a) Earth's bare surface frequency, which represents where and how many times a single pixel was detected as bare surface, based on Landsat series, and b) Earth's bare soil tendency, which represents the tendency of bare surface to increase or decrease. This technique enabled the retrieval of bare surfaces on 32% of Earth's total land area and on 95% of land when considering only agricultural areas. From a multitemporal perspective, the technique found a 2.8% increase in bare surfaces during the period on a global scale. However, the rate of soil exposure decreased by ~4.8% in the same period. The increase in bare surfaces shows that agricultural areas are increasing worldwide. The decreasing rate of soil exposure indicates that, unlike popular opinion, more soils have been covered due to the adoption of conservation agriculture practices, which may reduce soil degradation.

Effects of physical exercise at the workplace for treatment of low back pain: a systematic review with meta-analysis.

BACKGROUND: The prevalence of low back pain is high among the economically active population. Low back pain reduces productivity and causes absenteeism, impaired quality of life and leaves of absence. Several measures were suggested to reduce the occurrence of this occupational condition, among which physical exercise at the workplace stands out. AIM: To analyze studies which assessed physical exercise at the workplace for treatment of low back pain. METHODS: The present study consisted of a systematic review with meta-analysis. An electronic search was conducted on database MEDLINE using keywords "workplace," "low back pain" and "exercise," synonyms and headings located on Health Sciences Descriptors and Medical Subject Headings. We considered all the studies that included physical exercise at the workplace and defined low back pain as outcome. RESULTS: We located 499 potential studies and finally included 15 for review. The duration of treatment varied from 3 weeks to 18 months, and the main interventions were strength and stretching exercises and muscle relaxation. CONCLUSIONS: The meta-analysis showed that physical exercise at the workplace did not reduce the occurrence of low back pain (difference of means=0.62, 95%CI -0.8-2.04, p<0.4). The present systematic review was registered in database PROSPERO, registration number CRD42017071563.

CONTEXTO: A dor lombar apresenta alta prevalência na população economicamente ativa, promovendo a diminuição da capacidade produtiva, absenteísmo, prejuízos à qualidade de vida e afastamento previdenciário. Medidas diversas têm sido adotadas no intuito de diminuir esse infortúnio laboral, destacando-se a prática de exercício físico no ambiente de trabalho. OBJETIVO: O objetivo desta revisão foi identificar estudos que utilizaram o exercício físico realizado no ambiente laboral para tratamento da dor lombar. MÉTODOS: Trata-se de uma revisão sistemática com metanálise. Foi realizada busca eletrônica na base de dados MEDLINE utilizando os descritores "workplace"; "low back pain" e "exercise" e os respectivos sinônimos e palavras-chaves identificados nos Descritores em Ciências da Saúde e no Medical Subject Headings. RESULTADOS: Foram considerados todos os estudos que adotaram exercício físico no ambiente de trabalho e possuíam desfechos relacionados à dor lombar. Foram encontrados 499 estudos em potencial, resultando na inclusão final de 15 artigos. O tempo de tratamento variou de 3 semanas a 18 meses, e as principais intervenções foram exercícios de força, alongamentos e relaxamento muscular. CONCLUSÃO: A metanálise demonstrou que não há efeito do exercício físico no ambiente de trabalho na redução da percepção da dor lombar (diferença entre médias=0.62, CI95%, -0.8,2.04; p<0.4). Esta revisão sistemática foi registrada no PROSPERO, sob protocolo CRD42017071563.

Applicability of Longitudinal Strain of Left Ventricle in Unstable Angina.

BACKGROUND: Unstable angina (UA) is a common cause of hospital admission; risk stratification helps determine strategies for treatment. OBJECTIVE: To determine the applicability of two-dimensional longitudinal strain (SL2D) for the identification of myocardial ischemia in patients with UA. METHODS: Cross-sectional, descriptive, observational study lasting 60 days. The sample consisted of 78 patients, of which fifteen (19.2%) were eligible for longitudinal strain analysis. The value of p < 0.05 was considered significant. RESULTS: The group of ineligible patients presented: a lower proportion of women, a higher prevalence of diabetes mellitus (DM), use of ASA, statins and beta-blockers and larger cavity diameters. The main causes of non-applicability were: presence of previous infarction (56.4%), previous CTA (22.1%), previous MRI (11.5%) or both (16.7%) and the presence of specific electrocardiographic abnormalities (12.8%). SL2D assessment revealed a lower global strain value in those with stenosis greater than 70% in some epicardial coronary arteries (17.1 [3.1] versus 20.2 [6.7], with p = 0.014). Segmental strain assessment showed an association between severe CX and RD lesions with longitudinal strain reduction of lateral and inferior walls basal segments; (14 [5] versus 21 [10], with p = 0.04) and (12.5 [6] versus 19 [8], respectively). CONCLUSION: There was very low SL2D applicability to assess ischemia in the studied population. However, the global strain showed a correlation with the presence of significant coronary lesion, which could be included in the UA diagnostic arsenal in the future.

Spatial and seasonal variation of benthic fish assemblages in whitewater rivers of Central Amazon / Variação espacial e sazonal de assembleias de peixes bentônicos em rios de água branca da Amazônia Central

Abstract Despite the high number of fish species described for the Amazon region, the ichthyofauna that inhabits the depths of the main channels of large tropical rivers is one of the least known. In order to know the diversity patterns of these fish in whitewater rivers of the Central Amazon, we used data from the main channel benthic fish assemblage of the Japurá, Purus and Madeira rivers and tested the hypothesis that there are marked spatial and seasonal differences in the composition of the fish community among them. For this, we used a multivariate dispersion test, total β diversity and its decomposition into local (LCBD) and species contribution to β diversity (SCBD). Additionally, we tested for relationships between LCBD values and richness, total abundance, and environmental variables. We categorized species with higher SCBD values into resident or migratory to investigate the potential importance of floodplains to benthic fish assemblage of the main channel of whitewater rivers. Our results corroborate the proposed hypothesis, showing that there are seasonal and inter-river differences in benthic ichthyofauna, being more evident for the Purus River. LCBD showed strong negative relationships with species richness and total abundance, particularly in the Japurá and Madeira rivers in rising season, indicating that rivers and season with high uniqueness in their composition also had low richness and abundance. LCBD was negatively correlated with conductivity and pH, which increased with declining these environmental variables, as observed mainly in Japurá River in both seasons. Approximately one third of the species had higher than average SCBD values and were considered major contributors to β diversity, as well as classified as migratory. This demonstrates the importance of conducting studies that use spatial and seasonal variables, in addition to including the background fish fauna in conservation studies, expanding the protected area and taking into account the different patterns of diversity between rivers. Furthermore, these differences in assemblage composition might be explained by the asymmetrical spatial use of habitats during different seasons, strongly suggesting the importance of the flood-pulse cycle for maintaining diversity in this environment.

Resumo Apesar do elevado número de espécies de peixes descritas para a região amazônica, a ictiofauna que habita as profundezas dos principais canais de grandes rios tropicais é uma das menos conhecidas. Para conhecer os padrões de diversidade desses peixes nos rios de águas brancas da Amazônia Central, utilizamos dados da assembleia de peixes bentônicos do canal principal dos rios Japurá, Purus e Madeira e testamos a hipótese de que existem marcadas diferenças espaciais e sazonais na composição da comunidade de peixes. Para isso, nós usamos um teste de dispersão multivariada, diversidade β total e sua decomposição em local (LCBD) e contribuição de espécies para diversidade β (SCBD). Além disso, testamos as relações entre os valores de LCBD e riqueza, abundância total e variáveis ambientais. Nós categorizamos as espécies com valores mais altos de SCBD em residentes ou migratórias para investigar a importância potencial das planícies de inundação para a assembleia de peixes bentônicos do canal principal dos rios de águas brancas. Nossos resultados corroboram a hipótese proposta, mostrando que existem diferenças sazonais e entre rios na ictiofauna bentônica, sendo mais evidente para o rio Purus. O LCBD apresentou fortes relações negativas com a riqueza de espécies e abundância total, principalmente nos rios Japurá e Madeira no período de enchente, indicando que rios e períodos com alta singularidade em sua composição também apresentaram baixa riqueza e abundância. O LCBD correlacionou-se negativamente com a condutividade e o pH, aumentando com o declínio dessas variáveis ambientais, como observado principalmente no Rio Japurá em ambos os períodos. Aproximadamente um terço das espécies apresentou valores de SCBD acima da média e foram considerados os principais contribuintes para a diversidade β, além de terem sido classificadas como migratórios. Isso demonstra a importância da realização de estudos que utilizem variáveis espaciais e sazonais, além de incluir a ictiofauna de fundo nos estudos de conservação, ampliando a área protegida e levando em consideração os diferentes padrões de diversidade entre os rios. Além disso, essas diferenças na composição da assembleia podem ser explicadas pelo uso espacial assimétrico dos habitats durante as diferentes estações do ano, sugerindo fortemente a importância do ciclo do pulso de inundação para a manutenção da diversidade neste ambiente.

Reprodutibilidade intraobservador do teste Timed Up and Go para pacientes com DPOC / Intrarater reliability of Timed Up and Go Test to patients with COPD

| INTRODUÇÃO: O Timed UP and Go Test (TUG) é um importante teste utilizado para a avaliação de desfechos funcionais na DPOC, como mobilidade, equilíbrio dinâmico e risco de queda. No cenário clínico prático, a aplicação repetida do TUG é realizada muitas vezes pelo mesmo observador, no objetivo de avaliar diversas intervenções aplicadas na DPOC. OBJETIVO: Avaliar o grau de reprodutibilidade intraobservador do TUG em indivíduos com DPOC. METODOLOGIA: Estudo descritivo, de corte transversal, realizado com indivíduos com DPOC, atendidos ambulatorialmente na cidade de Salvador-Bahia. Foram verificadas características sociodemográficas e clínicas como a espirometria (VEF1/CVF), e tempo de realização de duas práticas no mesmo dia do teste TUG. A reprodutibilidade do TUG foi avaliada pelo Coeficiente de Correlação Intraclasse (CCI), CAAE número 38143214.0.0000.0057. RESULTADOS: Trinta e um pacientes voluntários foram avaliados; destes, 24 (77,4%) homens, média da idade de 68,6 ± 9,8 anos, com relação VEF1/CVF pós-broncodilatador de 59,0 ± 10,8 %. Na análise da reprodutibilidade intraobservador do TUG pelo CCI, obteve-se α = 0,897 (CI 95%: 0,786; 0,950; p < 0,0001). CONCLUSÃO: O teste TUG possui excelente reprodutibilidade intraobservador e uma pequena variabilidade quando aplicados duas vezes em pacientes com DPOC, sendo a aplicação para avaliação da mobilidade, na prática do cuidado em saúde considerada factível.

INTRODUCTION: The Timed UP and Go Test (TUG) is an important test used to assess functional outcomes in COPD, such as mobility, dynamic balance, and risk of falling. In clinical practice, the repeated application of the TUG is performed several times by the same observer to evaluate different interventions applied in COPD. OBJECTIVE: To assess the degree of intraobserver reproducibility of TUG in individuals with COPD. METHODOLOGY: Descriptive, cross-sectional study carried out with individuals with COPD treated in an outpatient clinic in the city of SalvadorBahia. Sociodemographic and clinical characteristics such as spirometry (FEV1/FVC) were verified, as well as two practices of the TUG Test on the same day. The reproducibility of TUG was evaluated fur Intraclass Correlation Coefficient (ICC). CAAE number 38143214.0.0000.0057. RESULTS: Thirty-one volunteer patients were evaluated, of which 24 (77.4%) men, mean age 68.6 ± 9.8 years, with post-bronchodilator FEV1//FVC ratio 59.0 ± 10.8%. In the analysis of intraobserver reproducibility of the TUG by the ICC, α = 0.897 (CI 95%: 0.786; 0.950; p < 0.0001) was obtained. CONCLUSION: The TUG test has excellent intraobserver reproducibility and a small variability when applied twice in patients with COPD, being the application for mobility assessment, in care practice, considered viable.

Clinical characteristics and mid-term follow-up of elderly patients with severe aortic stenosis not eligible for TAVI

BACKGROUND: The treatment for symptomatic severe aortic stenosis (AS) is the correction of valve stenosis by surgical valve replacement and more recently by transcatheter aortic valve implant (TAVI). However, in some high risk surgical patients, TAVI is not possible for technical or clinical reasons or due to the unavailability of the endoprosthesis. OBJECTIVE: The aim of this study was to evaluate a mid-term follow-up of symptomatic severe AS patients who are not eligible for TAVI trials, as well as to identify the clinical features of these patients. METHODS: This was an observational, retrospective study conducted with 475 symptomatic severe AS patients, evaluated by the Heart Team between 2000 and 2017. Inclusion criterias were: patients considered not to be eligible for TAVI. The Shapiro-Wilk test was applied to evaluate normality. Non-paired t and Mann-Whitney tests were applied for continuous variables, while the chi-squared and Fischer exact tests were applied for categorical variables, with a level of significance of p<0,05. RESULTS: The heart team evaluated 475 patients: 25 (5.26%) died before any intervention could be proposed; 326 (68.3%) were submitted to TAVI, so the study population consisted of 124 patients not eligible for TAVI. Of these, 31 (25%) underwent surgery and 93 (75%) remained in clinical treatment. In a mean 56 months- follow-up the mortality in clinical group was 46.2%. In the surgical group the mortality was 23.9% (in-hospital 12.9% and late mortality 11% in a mean 47.4 months follow-up). The patients that died presented a significantly lower left ventricle ejection fraction (LVEF), a smaller valve area, and a larger end-systolic diameter of the LV. CONCLUSION: The mortality of the clinical group's patients was significantly higher than the surgical mortality (46.2% vs. 12.9%; p=0.021). The patients of the clinical group were older, weighed less, and had a higher incidence of renal failure and a higher STS score.

Terapia de antiagregação plaquetária: prevenção primária e secundária / Platelet antiaggregation therapy: primary and secondary prevention, peculiarities in anticoagulation of the patient with DM

O diabetes mellitus (DM) é um importante e crescente problema de saúde, sendo que a doença aterosclerótica é uma importante comorbidade. Além do uso de fármacos, a prevenção da aterosclerose envolve mudança do estilo de vida como exercícios, nutrição, controle do peso e interrupção do tabagismo. O uso da aspirina possui papel bem estabelecido na prevenção secundária da doença cardiovascular (DCV) em pacientes com DM2, porém, o seu uso na prevenção primária permanece controverso e ainda com estudos em andamento. O objetivo desse estudo consistia em realizar uma revisão na literatura sobre as principais indicações para o uso da terapia de antiagregação plaquetária nos pacientes diabéticos. Já na prevenção secundária, o uso da aspirina é um consenso e a dupla terapia é indicada após síndromes coronárias agudas. As diretrizes não trazem informações específicas aos pacientes diabéticos, assim como, suas indicações clássicas na anticoagulação.

Efeitos do exercício físico no ambiente de trabalho no tratamento da dor lombar: uma revisão sistemática com metanálise / Effects of physical exercise at the workplace for treatment of low back pain: a systematic review with meta-analysis

Contexto: A dor lombar apresenta alta prevalência na população economicamente ativa, promovendo a diminuição da capacidade produtiva, absenteísmo, prejuízos à qualidade de vida e afastamento previdenciário. Medidas diversas têm sido adotadas no intuito de diminuir esse infortúnio laboral, destacando-se a prática de exercício físico no ambiente de trabalho. Objetivo: O objetivo desta revisão foi identificar estudos que utilizaram o exercício físico realizado no ambiente laboral para tratamento da dor lombar. Métodos: Trata-se de uma revisão sistemática com metanálise. Foi realizada busca eletrônica na base de dados MEDLINE utilizando os descritores "workplace"; "low back pain" e "exercise" e os respectivos sinônimos e palavras-chaves identificados nos Descritores em Ciências da Saúde e no Medical Subject Headings. Resultados: Foram considerados todos os estudos que adotaram exercício físico no ambiente de trabalho e possuíam desfechos relacionados à dor lombar. Foram encontrados 499 estudos em potencial, resultando na inclusão final de 15 artigos. O tempo de tratamento variou de 3 semanas a 18 meses, e as principais intervenções foram exercícios de força, alongamentos e relaxamento muscular. Conclusão: A metanálise demonstrou que não há efeito do exercício físico no ambiente de trabalho na redução da percepção da dor lombar (diferença entre médias=0.62, CI95%, -0.8,2.04; p<0.4). Esta revisão sistemática foi registrada no PROSPERO, sob protocolo CRD42017071563

Background: The prevalence of low back pain is high among the economically active population. Low back pain reduces productivity and causes absenteeism, impaired quality of life and leaves of absence. Several measures were suggested to reduce the occurrence of this occupational condition, among which physical exercise at the workplace stands out. Aim: To analyze studies which assessed physical exercise at the workplace for treatment of low back pain. Methods: The present study consisted of a systematic review with meta-analysis. An electronic search was conducted on database MEDLINE using keywords "workplace," "low back pain" and "exercise," synonyms and headings located on Health Sciences Descriptors and Medical Subject Headings. We considered all the studies that included physical exercise at the workplace and defined low back pain as outcome. Results: We located 499 potential studies and finally included 15 for review. The duration of treatment varied from 3 weeks to 18 months, and the main interventions were strength and stretching exercises and muscle relaxation. Conclusions: The meta-analysis showed that physical exercise at the workplace did not reduce the occurrence of low back pain (difference of means=0.62, 95%CI -0.8­2.04, p<0.4). The present systematic review was registered in database PROSPERO, registration number CRD42017071563.

Applicability of Longitudinal Strain of Left Ventricle in Unstable Angina / Aplicabilidade do Strain Longitudinal do Ventrículo Esquerdo na Angina Instável

Abstract Background: Unstable angina (UA) is a common cause of hospital admission; risk stratification helps determine strategies for treatment. Objective: To determine the applicability of two-dimensional longitudinal strain (SL2D) for the identification of myocardial ischemia in patients with UA. Methods: Cross-sectional, descriptive, observational study lasting 60 days. The sample consisted of 78 patients, of which fifteen (19.2%) were eligible for longitudinal strain analysis. The value of p < 0.05 was considered significant. Results: The group of ineligible patients presented: a lower proportion of women, a higher prevalence of diabetes mellitus (DM), use of ASA, statins and beta-blockers and larger cavity diameters. The main causes of non-applicability were: presence of previous infarction (56.4%), previous CTA (22.1%), previous MRI (11.5%) or both (16.7%) and the presence of specific electrocardiographic abnormalities (12.8%). SL2D assessment revealed a lower global strain value in those with stenosis greater than 70% in some epicardial coronary arteries (17.1 [3.1] versus 20.2 [6.7], with p = 0.014). Segmental strain assessment showed an association between severe CX and RD lesions with longitudinal strain reduction of lateral and inferior walls basal segments; (14 [5] versus 21 [10], with p = 0.04) and (12.5 [6] versus 19 [8], respectively). Conclusion: There was very low SL2D applicability to assess ischemia in the studied population. However, the global strain showed a correlation with the presence of significant coronary lesion, which could be included in the UA diagnostic arsenal in the future.

Resumo Fundamento: A angina instável (AI) é uma causa comum de internação hospitalar, a estratificação de risco ajuda a determinar estratégias para o tratamento. Objetivo: Determinar a aplicabilidade do strain longitudinal bidimensional (SL2D) para identificação de isquemia miocárdica, em pacientes com AI. Métodos: Estudo observacional transversal, descritivo, com duração de 60 dias. A amostra foi composta por 78 pacientes, sendo quinze (19,2%) elegíveis para análise do strain longitudinal. O valor de p < 0.05 foi considerado significativo. Resultados: O grupo dos não elegíveis apresentou: menor proporção de mulheres, maior prevalência de diabetes mellitus (DM), do uso de AAS, estatinas e betabloqueadores e maiores diâmetros cavitários. As principais causas da não aplicabilidade foram: presença de infarto prévio (56,4%), ATC prévia (22,1%), RM prévia (11,5%) ou ambos (16,7%) e presença de alterações eletrocardiográficas específicas (12,8%). A avaliação do SL2D revelou um valor de strain global inferior naqueles com estenose maior que 70% em alguma coronária epicárdica (17,1 [3,1] versus 20,2 [6,7], com p = 0,014). A avaliação do strain segmentar demonstrou associação entre lesão grave nas coronárias CX e CD com redução do strain longitudinal dos segmentos basais das paredes lateral e inferior; (14 [5] versus 21 [10], com p = 0,04) e (12,5 [6] versus 19 [8], com p = 0,026), respectivamente. Conclusão: Houve aplicabilidade muito baixa do SL2D para avaliar isquemia na população estudada. Entretanto, o strain global apresentou correlação com presença de lesão coronária significativa, podendo, futuramente, ser incluído no arsenal diagnóstico da AI.

A biografia escrita por Reila Gracie e as fontes jornalísticas: revisando a história hegemônica / A biography written by Reila Gracie and journalistic sources: reviewing a hegemonic history / La biografía escrita por Reila Gracie y las fuentes periodísticas: revisión de la historia hegemónica

O objetivo da presente pesquisa consiste em relacionar a narrativa desenvolvida na biografia Carlos Gracie: o criador de uma dinastia, de 2008, e a perspectiva veiculada por alguns periódicos cariocas do início do século XX, no que se refere ao estabelecimento e disseminação do jiu-jítsu e dos combates intermodalidades no Brasil, em especial na cidade do Rio de Janeiro. Para tanto, utilizaram-se os preceitos metodológicos acerca das particularidades das fontes biográficas e jornalísticas. A partir da análise das referidas fontes, pode-se pensar a hipótese de que Reila Gracie tenha lançado mão de uma tradição inventada, por meio da biografia e aproveitando-se da dimensão ficcional peculiar a tal gênero, com sentido de atribuir aos integrantes da família Gracie o pioneirismo do jiu-jítsu e dos combates intermodalidades no Brasil

This research discusses the narratives developed in the 2008 biography Carlos Gracie: o criador de uma dinastia and the perspective spread by some Rio de Janeiro based newspapers during the early 20th century on the establishment of jiu jitsu and interfight competitions in Brazil. Therefore, we used methodological frameworks about the particularities of biographical and journalistic sources. From the analysis of those sources, it is possible to think about the hypothesis that Reila Gracie used an invented tradition, through biography and its peculiar fictional dimension, thus establishing the Gracie family as a pioneer in jiu-jitsu and inter-fight competitions in Brazil

El objetivo de esta investigación es relacionar la narrativa desarrollada en la biografía Carlos Gracie: o criador de uma dinastia, de 2008, con la perspectiva transmitida por algunos periódicos de Rio de Janeiro a inicios del siglo XX, en lo que se refiere al establecimiento y diseminación del jiu-jitsu y de los combates entre modalidades en Brasil, especialmente en la ciudad de Río de Janeiro. Para ello, hemos utilizado los preceptos metodológicos sobre las particularidades de las fuentes biográficas y periodísticas. A partir del análisis de estas fuentes, es posible pensar la hipótesis de que Reila Gracie haya hecho uso de una tradición inventada, a través de la biografía, aprovechándose de la dimensión ficcional propia de este género, en el sentido de atribuir a los integrantes de la familia Gracie el pionerismo en el jiu-jitsu y los combates entre modalidades en Brasil

Tecnologias aplicadas à promoção da saúde do trabalhador: uma revisão sistemática / Technologies applied to occupational health promotion: a systematic review

Contexto: Os programas de promoção da saúde do trabalhador via web são cada vez mais oferecidos pelas empresas com o objetivo de promover estilos de vida saudáveis, prevenir ou gerenciar doenças, contribuir para a saúde ocupacional e melhorar o clima organizacional. Objetivos: Sistematizar o conhecimento acerca da utilização de programas via web, sites, aplicativos online e e-mails como tecnologias aplicadas à promoção da saúde do trabalhador. Métodos: Foi feita uma revisão sistemática de ensaios clínicos sobre a temática na base de dados Medline. Resultados: A pesquisa resultou em 3.071 títulos únicos de artigos. Destes, 139 foram selecionados com rastreio de títulos. Dos 139 escolhidos, 47 foram selecionados pela leitura dos resumos que pareceram atender aos critérios de seleção. No entanto, após a leitura integral dos artigos, verificou-se que 31 deles não cumpriam todos os critérios de inclusão, resultando na seleção final de 16 artigos. Conclusões: De acordo com os achados desta revisão, programas baseados na web podem ser um meio promissor de acesso à informação para a promoção da saúde dos trabalhadores.

Background: Health promotion programs for workers via the web are increasingly offered by companies to promote healthy lifestyles, prevent or manage diseases, contribute to occupational health and improve the organizational climate. Aims: To systematize the knowledge on the use of web-based programs, websites, online applications and e-mails as technologies for occupational health promotion. Methods: A systematic review of clinical trials was conducted on the subject of interest in database MedLine. Results: The search resulted in 3,071 articles. From these, 139 studies were selected after screening of titles; the number was reduced to 47 after analysis of abstracts indicated they seemed to meet the inclusion criteria. However, reading of the full-text showed that 31 articles did not meet the inclusion criteria, therefore, the final sample consisted of 16 articles. Conclusions: According to the findings of the present review web-based programs might be a promising means of access to information for the promotion of occupational health.

Causas de abandono do tratamento entre portadores de tuberculose / Reasons for treatment abandonment among tuberculosis patients

OBJETIVO: Identificar e analisar as causas de abandono do tratamento da tuberculose entre pacientes em retratamento, por abandono anterior. MÉTODOS: Estudo descritivo, transversal, constituído por análise qualitativa, realizado por meio de análise de prontuários, entrevistas e aplicação de questionários a pacientes que reingressaram no tratamento de tuberculose após abandono, no período de abril de 2013 a abril de 2014, no município de Belém (PA). RESULTADOS: Os fatores mais citados pelos pacientes como motivadores do abandono do tratamento de tuberculose foram: melhora dos sintomas após o início do uso dos medicamentos (seis respostas), uso de drogas ilícitas (cinco respostas), falta de conhecimento da tuberculose e de seu tratamento (três respostas), uso de bebidas alcoólicas (três respostas), falta de dinheiro para ir ao posto (3 respostas), problemas familiares e falta de apoio familiar (três respostas). Essas causas foram apontadas como os principais motivadores do não seguimento do tratamento, o que correspondeu a 63,9% de todas as respostas. CONCLUSÃO: Diversos fatores ocasionaram o abandono do tratamento da tuberculose. São necessárias mais ações que aumentem a compreensão e conhecimento da doença pelo paciente.(AU)

OBJECTIVE: To identify and analyze the causes of treatment abandonment among tuberculosis patients in retreatment due to previous abandonment. METHODS: A descriptive, cross-sectional study consisting of qualitative analysis, carried out through an analysis of medical records, interviews and questionnaires applied to patients who rejoined treatment of tuberculosis after abandonment, from April 2013 to April 2014, in the city of Belem, state of Para. RESULTS: The factors that are most cited by patients as causes of abandonment of TB treatment were: improvement of symptoms after the start of drug use (six answers), illicit drug use (five answers), lack of knowledge about tuberculosis and its treatment (three answers), the use of alcohol (three answers), lack of money to go to the hospital (three answers), family problems and lack of Family support (three answers). These causes are cited as the main reasons for not following the treatment, which corresponded to 63.9% of all responses. CONCLUSION: There are several factors that cause abandonment of tuberculosis treatment. More actions to increase patient understanding and knowledge of the disease are needed.(AU)

Fatores preditores para boa resposta à terapia de ressincronização cardíaca: critérios práticos para o clínico / Predicting factors of good response to cardiac resynchronization therapy: practical criteria for the clinician

A terapia de ressincronização cardíaca é uma alternativa eficaz em pacientes com insuficiência cardíaca e dessincronia, podendo reduzir significativamente a morbimortalidade. Apesar de haver indicações bem estabelecidas, cerca de um terço dos pacientes não responde à terapia; assim, a busca por critérios que possam avaliar de forma acurada a real chance de resposta à terapia de ressincronização cardíaca faz-se imprescindível. A seleção correta dos pacientes, a utilização de técnicas para otimizar o posicionamento do cabo-eletrodo de ventrículo esquerdo, a programação cuidadosa, o acompanhamento após o implante e a procura rotineira de fatores associados à ausência de resposta podem reduzir o número de não respondedores

Cardiac resynchronization therapy is an effective alternative for patients with heart failure and dyssynchrony that may significantly reduce morbidity and mortality. Although indications are well established, about 1/3 of the patients do not respond to therapy. Thus, it is critical to search for criteria that may accurately assess the actual probability of response to cardiac resynchronization therapy. Proper patient selection, the use of techniques to optimize left ventricular lead positioning, careful setting, post-implantation follow-up and routine search for factors associated with the lack of response, may reduce the number of non-responders

A crônica esportiva de José Lins do Rego: política, paixão e relações de força / José Lins do Rego´s sports chronicles: politics, passion and power relationships

Resumo Além do envolvimento com o futebol, outra característica típica da crônica de José Lins do Rego foi o diálogo (ou debates) com o círculo intelectual no qual estava inserido. As influências de Gilberto Freyre e Mário Filho foram as mais sensíveis, mas não foram poucos os seus interlocutores. Desta forma, perspectiva-se compreender o posicionamento de José Lins do Rego em suas crônicas esportivas, sem perder de vista esta interdependência estabelecida pela intelectualidade brasileira. Em caráter conclusivo, constatou-se que as crônicas de José Lins, permeadas pela racionalidade e pela paixão, exerceram funções múltiplas em se tratando do convívio com a intelectualidade brasileira.(AU)

Abstract Two major aspects of Jose Lins do Rego´s chronicles were the reference to soccer and the establishment of a dialogue (or discussion) with his intellectual circle. The influence of Gilberto Freyre and Mário Filho were the most prominent ones, but Rego had many other dialogic counterparts. Thus, this paper aims to understand José Lins do Rego´s stand in his sports chronicles at the same time it sheds light on the exchange of ideas within the Brazilian intelligentsia. Ultimately, we conclude that José Lins´ chronicles, full of rationality and passion, have played multiple roles when related to the Brazilian intellectual production.