Cognitive performance, fatigue, emotional, and physiological strains in simulated long-duration flight missions.

Pilots in long-duration flight missions in single-seat aircraft may be affected by fatigue. This study determined associations between cognitive performance, emotions and physiological activation and deactivation - measured by heart rate variability (HRV) - in a simulated 11-h flight mission in the 39 Gripen aircraft. Twelve participants volunteered for the study. Perceived fatigue was measured by the Samn-Perelli Fatigue Index (SPFI). Cognitive performance was measured by non-executive and executive tasks. Emotions were assessed by the Circumplex Affect Space instrument. HRV was considered in relation to the cognitive tasks in four time points - Hours 3, 5, 7, 9 - and their associations with emotional ratings. Results indicated a decrease in performance in the non-executive task after approximately 7 h. This result was correlated with self-reported measures of fatigue. HRV, assessed by indices of parasympathetic modulation, remained unchanged for both non-executive and executive tasks over time (p > .05 for all). Significant correlations were observed between emotions and HRV; with increased boredom, increased passiveness, decreased stimulation, and decreased activeness, HRV indicators increased (p < .05). This suggests that a low self-regulatory effort for maintaining performance in these conditions was prevalent and that pilots could adapt to some degree to the demands and fatigue of long-duration missions.

Efectos del Programa "Ejercicio Dirigido-Paseos Saludables en Entornos Curativos Exteriores" en ancianos hospitalizados por trastornos depresivos / Effects of the Program Directed Exercise-Healthy Walks in Healing Outdoor Environments in elderly hospitalized for depressive disorders

Objetivo: Analizar los efectos de un programa integrado de "Ejercicio Dirigido-Paseos Saludables en Entornos Curativos Exteriores" (ED + PSECE) en el bienestar físico y psicosocial de pacientes con trastorno depresivo, mayores de 65 años, ingresados en la Unidad de Agudos de Hospitalización Psiquiátrica. Método: Estudio piloto experimental con un grupo intervención (GI, n = 32 sujetos) y un grupo control (GC, n = 32 sujetos). Las mediciones pre y postintervención se realizan con el índice de Barthel, el test de Guralnik Short Physical Performance Battery (SPPB), la escala de Hamilton, el Get Up and Go Test y la taxonomía NOC. Sesultados: Se encuentran mejoras significativas del GI en funcionalidad según Barthel (0,036) y en posición corporal según NOC (0,025), así como disminución de síntomas depresivos según Hamilton (0,001). Conclusión: La actividad física contribuye a la reducción de síntomas negativos de los trastornos depresivos y a la mejora de la funcionalidad para el desempeño de actividades básicas de una vida autónoma, siendo fundamental el rol desempeñado por el profesional de enfermería para la adherencia al programa de los pacientes ancianos hospitalizados en una unidad de salud mental (AU)

Objective: To analyze the effects of an integrated "Healthy ExerciseWalks in Outdoor Healing Environments" on the physical and psychosocial well-being of patients with depressive disorders over 65 years of age admitted to acute unit of Psychiatric hospitalization. Method: Experimental pilot study with an intervention group (N IG=32 subjects) and a control group (N CG=32 subjects). Preand post-intervention measurements were made with the Barthel index test, Guralnik Short Physical Performance Battery (SPPB), Hamilton scale, a Get Up and Go Test and the Taxonomy NOC. Results: Significant progress of the IG is in functionality as Barthel test (0.036) and in corporal position as NOC (0.025), as well as decrease of depressive symptoms according to Hamilton (0.001). Conclusion: Physical activity contributes to the reduction of negative symptoms of depressive disorders and to the improvement of functionality for the performance of basic activities of an autonomous life, the role played by the professional nurse for adherence to the program of elderly patients hospitalized in a mental health unit (AU)

Fisioterapia e qualidade de vida na osteoartrose de joelho / Physical therapy and quality of life in knee osteoarthritis

Introdução: A osteoartrose (OA) é um distúrbio articular caracterizado patologicamente por perda localizada de cartilagem, remodelação de osso adjacente, formação de osteófitos e inflamação associada. Manifesta-se como um desarranjo molecular seguido de alterações anatômicas e fisiológicas, caracterizadas por degradação da cartilagem, remodelação óssea, formação de osteófitos, inflamação das articulações e perda da função articular normal. Objetivo: Realizar uma revisão da literatura, avaliando a influência da fisioterapia no tratamento dos indivíduos com OA de joelho, quanto ao seu impacto na qualidade de vida, identificando os diferentes tratamentos para OA de joelho. Métodos: Foi realizado uma revisão da literatura nas bases de dados Pubmed, Pedro, Scielo e Biblioteca Cochrane, com ensaios clínicos com data de publicação de 2014 a 2018 com as palavras-chave: osteoartrose de joelho, fisioterapia e qualidade de vida. Foram escolhidos estudos com participantes com diagnóstico de OA de joelho, com idade  50 anos, de ambos os gêneros, que relatassem informações sobre o tratamento e a qualidade de vida dos pacientes. Resultados: Foram encontrados 224 artigos e selecionados 12 artigos para análise. Conclusão: Os estudos demonstraram a eficiência do uso de exercícios e da educação na melhora dos sintomas decorrentes da osteoartrose, como dor, melhora da função física e qualidade de vida. (AU)

Introduction: Osteoarthrosis (OA) is a pathological disorder characterized by localized loss of cartilage, remodeling of adjacent bone, formation of osteophytes and associated inflammation. It manifests as molecular derangement followed by anatomical and physiological alterations, characterized by cartilage degradation, bone remodeling, formation of osteophytes, inflammation of the joints and loss of normal joint function. Objective: To review the literature evaluating the influence of physical therapy on the treatment of individuals with knee OA and its impact on quality of life, identifying the different treatments for knee OA. Methods: A literature review study was carried out in the Pubmed, Pedro, Scielo and Cochrane Library databases, with clinical trials with publication date from 2014 to 2018 with the keywords: osteoarthritis of knee, physical therapy and quality of life. Patients with a diagnosis of knee OA, 50 years, of both genders, who reported information on treatment and quality of life, were chosen. Results: We selected 12 articles on 224 for analysis. Conclusion: Studies demonstrated the efficacy of exercise and education in improving the symptoms of osteoarthritis, such as pain, improvement of physical function and quality of life. (AU)

Sweet´s syndrome and pancreatic neoplasm: an atypical association

El síndrome de Sweet es una dermatosis inflamatoria poco común, que se ha asociado a tumores malignos, principalmente de tipo hematológico. Presentamos un caso clínico de síndrome de Sweet asociado con una rara neoplasia pancreática, siendo uno de los pocos casos reportados en la literatura médica acerca de esta asociación.

Sweet's syndrome is an uncommon inflammatory dermatosis, which has been associated with malignant tumors, mainly of hematological type. We report a clinical case of Sweet syndrome associated with a rare pancreatic neoplasm, which is one of the few cases reported in the medical literature about this association.

Comparação da atividade eletromiográfica em músculos do powerhouse no roll up e roll back no solo e no Cadillac do método Pilates / Comparison of electromyographic activity of powerhouse muscles performing the roll up and roll back on the floor and on the Cadillac Pilates method

Introdução: A lombalgia é um problema de saúde pública que acomete grande parte da população em algum momento da vida. Exercícios físicos realizados pelo método Pilates são descritos na literatura como uma opção de tratamento. Entretanto, existem poucos estudos que elucidam movimentos adequados para este fim. Objetivo: Comparar a ativação elétrica dos músculos oblíquo externo, oblíquo interno e multífido durante exercícios abdominais no solo e no Cadillac, para identificar diferenças na atividade neuromuscular da musculatura flexora e extensora do tronco. Material e métodos: Onze mulheres realizaram oito repetições dos exercícios The Roll Up e Roll Back. Durante os movimentos, foi avaliada a extensão e flexão do quadril a partir da análise eletromiográfica de superfície. Resultados: A ativação eletromiográfica do músculo oblíquo externo foi estatisticamente significativo, nas duas fases do movimento, no exercício The Roll Up em comparação ao exercício Roll Back. Contudo, oblíquo interno e multífido não apresentaram diferenças quando comparados os exercícios. Conclusão: O exercício realizado no solo (The Roll Up) apresentou maior demanda da musculatura flexora e extensora. Esse achado representa um passo importante na compreensão de critérios objetivos para a elaboração de programas de reabilitação nas lombalgias e para o condicionamento físico utilizando o método Pilates.(AU)

Introduction: Low back pain is a public health problem and a large number of people suffer from it at some point in life. Physical exercises performed by the Pilates method are described in the literature as a treatment option. However, there are few studies that allow the development of appropriate actions for this purpose. Objective: Compare the electrical activation of external oblique, internal oblique and multifidus muscles during abdominal exercises on the floor and on the Cadillac, in order to identify the neuromuscular activity of the flexor and extensor musculature of the trunk. Methods: Eleven women performed eight repetitions of "The Roll Up" and "Roll Back" exercises. During the movements, the electromyographic surface analysis was used to measure the hip extension and flexion. Results: The electromyographic activation of the external oblique muscle was statistically significant, in the two stages of movement, The Roll Up exercise in comparison with the Roll Back exercise. However, internal oblique and multifidus did not show significant differences when exercises were compared. Conclusion: The exercise performed on the floor (The Roll Up) showed greater demand of the flexor and extensor muscles. This finding represents an important step in the understanding of objective criteria for the elaboration of rehabilitation programs in low back pain and for physical conditioning using the Pilates method. (AU)

Influencia de las características urbanísticas ambientales en el nivel de actividad física de la población de 18 a 65 años del área metropolitana de Pamplona / Influence of urbanistic characteristics in the level of physical activity in people aged 18 to 65 of the metropolitan area Pamplona, Spain

Fundamentos: Un entorno adecuado puede favorecer la práctica de la actividad física, siendo una opción fácil para la población. El objetivo fue determinar la influencia de la percepción de los factores urbanísticos ambientales en el nivel de actividad física de las personas adultas. Métodos: Estudio transversal basado en el International Physical Activity and the Environment Network. Las personas participantes fueron seleccionadas de forma aleatoria y estratificada de la población de las zonas básicas de salud del Área Metropolitana de Pamplona entre las que tenían edad de 18 a 65 años. Se utilizó un cuestionario autoadministrado que incluyó la versión completa de la escala Neighborhood Environment Walkability Scale para valorar la percepción de los factores urbanísticos ambientales y la versión larga del International Physical Activity Questionnaire para recoger datos de actividad física. Se calculó la chi2 y se realizó un análisis multivariable mediante regresión logística no condicional. Resultados: Participaron 905 sujetos (54,70% mujeres). Tener sendas de paseo próximas al domicilio o lugar de trabajo se relacionó con practicar actividad física moderada OR: 3,86 (IC 95% 1,70-8,74)] y actividad física total (suma de actividad física vigorosa, moderada y caminar) OR: 2,61 (IC 95% 1,24-5,45)]. La presencia en el barrio de lugares a los que podían ir caminando se asoció con dedicar más tiempo a caminar [OR: 1,26 (IC 95% 1,01-1,58)] y disponer cerca del domicilio o lugar de trabajo de espacios deportivos se asoció con practicar más actividad física vigorosa [OR: 1,46 (IC 95% 1,01 - 2,12). Conclusiones: Existe asociación directa entre la práctica de la actividad física y las características urbanísticas ambientales, como la existencia de sendas de paseo o instalaciones deportivas (AU)

Background: A suitable environment can encourage the practice of physical activity, being an easy option for the population, for this reason the main objective was to determine the influence of the urban environmental characteristics relate with the physical activity on adult people living on the Pamplona Area. Methods: Cross-sectional study based on the International Physical Activity and the Environment Network (IPEN Adult). Participants were selected in random and stratified from the basic areas of health attached to resident’s population in the Pamplona area, aged ranged between 18-65years old. A self-administered questionnaire was used, including a complete version of the Neighborhood Environment Walkability Scale scale, to evaluate the perception of the urban environmental factors. In addition, the extended version of International Physical Activity Questionnaire for the physical activity data collection was employed. Chi2 test was calculated and a multi variable analysis using non-conditional logistic regression. Results: The representative sample was composed of 905 subjects, [54,70% female]. The perception of having footpaths near to their place of resident or workplace was greater in the group that practice moderated physical activity OR: 3,86 [CI95% 1.70-8.74] and greater total physical activity (the summary of vigorous, moderated physical activity and walking) (OR: 2,61 [CI95% 1.24-5.45]). The people perception of having many places for walk in the neighborhood was associated with major habit of taking a walk (OR: 1,26 [IC95% 1.01-1.58]. Having sport spaces close to the workplace or place of resident was associated with major practice of vigorous physical s activity, OR: 1,46 [CI95% 1.01-2.12]. Conclusions: There is a direct association between the practice of physical activity and environmental urban characteristics, such as the existence of paths of walk or sports facilities (AU)

In situ carcinoma developed over oral lichen planus: a case report with analysis of BUB3, p16, p53, Ki67 and SOX4 expression

AbstractOral lichen planus (OLP) represents a common mucocutaneous disease. Various authors have suggested that OLP has malignant potential; however, the mechanisms involved in malignant transformation have not yet been elucidated. A 79-year-old man presented a white lesion for five months in the buccal mucosa diagnosed as OLP. After two months using 0.05% clobetasol ointment for treatment, the lesion became ulcerated. A new biopsy of the same lesion was performed, and histological analysis showed an in situ oral carcinoma (ISOC). An immunohistochemistry panel was performed, and p16 expression was negative in OLP, however, it showed weak cytoplasmic staining in ISOC. There was strong nuclear BUB3 staining in both OLP and ISOC areas. p53 showed less intense nuclear staining in both regions. Ki67 was negative in OLP area, but showed nuclear staining in the ISOC. SOX4 was negative in both studied areas. BUB3 expression, first reported in this case, and the p16 expression may suggest some influence of these genes on pathogenesis or malignant potential of OLP.

Relato de caso raro de extenso xantoma verruciforme no palato / A rare case of giant verruciform xanthoma in the palate

Verruciform xanthoma represents a rare disease of unknown etiology that typically affects the oral mucosa. In most cases, it is asymptomatic and characterized by a well demarcated elevation with irregular or papillary surface. The gums are the most affected oral site, and the lesion is usually less than 2 cm in diameter. The aim of this study is to report a rare case of an extensive verruciform xanthoma in the hard palate and gums of a 55-year-old male. Clinically, the well delimitated, reddish, elastic lesion measuring approximately 2.8 X 1.5 cm had a slightly granular surface. Histopathological analysis found proliferative epithelial activity with evident papillomatosis, parakeratosis, and large epithelial ridges. Xanthomatous cells with clear, vacuolated cytoplasm were detected in the lamina propria. The patient has been disease free for 18 months. According to an extensive research in the PubMed, MEDLINE, and Lilacs databases, this paper describes one of the most extensive cases of verruciform xanthoma reported in the literature.

O xantoma verruciforme ? uma les?o rara de etiologia n?o determinada, que acomete, principalmente, a mucosa oral. Na maioria das vezes ? assintom?tica, caracterizando-se por uma eleva??o bem-delimitada, de superf?cie rugosa ou papilar, e sua principal localiza??o na boca ? agengiva. Com rela??o ao tamanho, a maioria das les?es n?o ultrapassa 2 cm no seu maior di?metro. O objetivo do presente trabalho ? relatar um caso raro de extenso xantoma verruciforme em paciente do g?nero masculino, de 55 anos, apresentando les?o localizada no palato duroe na gengiva palatina. Clinicamente, a les?o possu?a bordas bem-destacadas, de superf?cie levemente granular e colora??o avermelhada, com consist?ncia el?stica, medindo aproximadamente 2,8 X 1,5cm. O exame histopatol?gico demonstrou a presen?a de prolifera??o do epit?liode revestimento, exibindo papilomatose, paraceratose e alongamento das cristas epiteliais. Na l?mina pr?pria, c?lulas xantomatosas com citoplasma claro e vacuolado puderam ser observadas. O paciente encontra-se livre de recidivas ap?s 18 meses de acompanhamento cl?nico. De acordo com extensa pesquisa em bases de dados (pubmed, medline, lilacs), o presente caso representa uma das maiores les?es do tipo xantoma verruciforme j? relatadas na literatura.

Cuidados invisibles: ¿son suficientemente reconocidos? / Invisible care: Is it adequately recognised?

Los cuidados invisibles son un elemento central y fundamental de la práctica de la Enfermería y son la base de su identidad profesional. La Enfermería ha sufrido un importante y positivo proceso de profesionalización en los últimos 150 años, sin embargo, los cuidados invisibles siguen siendo poco reconocidos, a pesar de su importancia en la recuperación y en la calidad de vida de los usuarios. En este trabajo se analizan brevemente las grandes transformaciones sociales actuales que obligan a replantearse la necesidad de visibilizar los cuidados invisibles, se plantean interrogantes clave para abordar esta discusión y se proponen una serie de acciones concretas para avanzar en este reconocimiento (AU)

Invisible care is a central and fundamental feature of nursing practice and the base of its professional identity. Nursing has undergone an important and positive process of professionalization in the last 150 years. Nonetheless, invisible nursing care is still under-recognised, despite its importance for the recovery and quality of life of users. In this article, we briefly analyse the major societal transformations, which demands us to rethink the need to make invisible care visible; and then we place key questions to tackle this issue and suggest concrete actions to advance in this recognition (AU)

Influência do trabalho intermitente máximo de curta duração sobre o desempenho aeróbio / The influence of the maximum intermittent training of short duration on the aerobic performance

O presente estudo teve como objetivo analisar o desempenho aeróbio de sujeitos submetidos a um programa de treinamento intermitente máximo de curta duração. Para tal catorze sujeitos realizaram uma bateria de testes e passaram por um programa de treinamento intermitente máximo de curta duração durante oito semanas. A bateria de testes consistiu de determinação do limiar ventilatório e do VO2pico com o auxílio do analisador de gases VO2000 realizado em um cicloergômetro mecânico. A fim de comparar o comportamento das variáveis foi utilizado o teste “t” de student para amostras pareadas, utilizando como nível de significância p≤0,05. Por meio da análise dos dados foi possível verificar que estímulos anaeróbios intensos também foram capazes de provocar modificações na condição aeróbia como pode ser observado na melhora do consumo de oxigênio de pico e na eficiência do músculo cardíaco, indicado pelo comportamento do duplo produto, dos sujeitos submetidos ao programa de treinamento.

The aim of this study was to analyze the aerobic performance of individuals who were submitted to a program of maximum intermittent training of short duration. For such investigation, fourteen subjects performed a set of tests, accomplishing a program of maximum intermittent training of short duration for eight weeks. Those tests consisted of the determination of the ventilatory threshold and the VO2max, using the gas analyzer VO2000. In order to compare the status of the variables, it was applied the student “t” test for paired samples, using p<0,05 as the significance level. By means of the data analysis, it was possible to verify that intense anaerobic stimulus could also provoke modifications in the aerobic condition, as it was observed in the improvement of the peak oxygen consumption and in the efficiency of the cardiac muscle, indicated by the behavior of the double product, of the individuals who were submitted to the training program.

El almuerzo de media mañana ¿es importante para una alimentación saludable? / Mid-morning snack: is it important for a healthy diet?

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Blood pressure and cardiorenal responses to antihypertensive therapy in obese women

OBJECTIVE: Blood pressure(BP) and target organ responses to antihypertensive drugs are not well established in hypertensive obese patients. This study is aimed at evaluating the effects of obesity and adiposity distribution patterns on these responses. METHODS: 49 hypertensive obese women were designated to different groups according to waist to hip ratio measurements - 37 with troncular and 12 with peripheral obesity. Patients were treated for 24-weeks on a stepwise regimen with cilazapril alone or a cilazapril/hydrochlorothiazide/amlodipine combination therapy to achieve a BP lower than 140/90mmHg. Ambulatory blood pressure monitoring (ABPM), echocardiography, and albuminuria were assessed before and after the intervention. RESULTS: After 24 weeks, weight loss was less than 2 percent in both groups. ABPM targets were achieved in 81.5 percent of patients upon a combination of 2(26.5 percent) or 3(55.1 percent) drugs. Similar reductions in daytime-SBP/DBP: -22.5/-14.1(troncular obesity) / -23.6/-14.9mmHg (peripheral obesity) were obtained. Decrease in nocturnal-SBP was greater in troncular obesity patients. Upon BP control, microalbuminuria was markedly decreased, while only slight decrease in left ventricular mass was observed for both groups. CONCLUSIONS: In the absence of weight loss, most patients required combined antihypertensive therapy to control their BP, regardless of their body fat distribution pattern. Optimal target BP and normal albuminuria were achieved in the group as a whole and in both obese patient groups, while benefits to cardiac structure were of a smaller magnitude.

As respostas pressórica e de órgãos-alvo mediante o tratamento anti-hipertensivo medicamentoso, não estão bem estabelecidas em pacientes obesos hipertensos. O presente estudo tem por objetivo avaliar as repercussões da obesidade e da distribuição de gordura corporal sobre estas respostas. MÉTODOS: Foram avaliadas 49 mulheres obesas hipertensas, separadas em subgrupos com distribuição troncular (n = 37) e periférica (n = 12) de gordura, de acordo com a distribuição cintura/quadril. As pacientes foram tratadas por 24 semanas com um regime anti-hipertensivo escalonado, iniciando-se com cilazapril e adicionando-se na seqüência, hidroclortiazida e amlodipina, com alvo pressórico inferior a 140 x 90 mmHg. Foram realizados MAPA, ecocardiograma e microalbuminuria antes e após o tratamento. RESULTADOS: Depois de 24 semanas observou-se perda de peso inferior a 2 por cento em ambos os subgrupos. O controle pressórico à MAPA pode ser observado em 81,5 por cento das pacientes mediante a combinação de duas (26,5 por cento) ou três (55,1 por cento) drogas. Foram obtidas reduções similares nas medidas de PAS/PAD diurnas: -22,5/-14,1(obesas tronculares)/-23,6/-14,9 mmHg (obesas periféricas), enquanto se observou nas obesas tronculares redução maior na PAS noturna. Mediante o controle pressórico, houve redução acentuada da microalbuminúria nos dois subgrupos. Por outro lado, observou-se em ambos, apenas discreta redução na massa ventricular. CONCLUSÕES: Na ausência de perda significativa de peso, e independentemente da distribuição de gordura corporal, a maioria das pacientes obesas necessitou terapia anti-hipertensiva combinada a fim de obter controle pressórico. Em ambos os subgrupos foram alcançados níveis adequados de pressão arterial e redução satisfatória da microalbuminúria, ao passo que os benefícios para a regressão estrutural cardíaca foram menores.

Tratamento da hipertensão na doença renal crônica / Hypertension treatment in chronic renal disease

A hipertensão é condição prevalente na doença renal crônica, e ambas são coadjuvantes numa relação de causa e efeito, e sinérgicas em relação ao risco cardiorrenal. O controle da hipertensão, embora aquém do desejado nessas populações, assim como a redução da proteinúria e da ativação sistema renina-angiotensina-aldosterona, mostram-se fundamentais quando se visa à proteção tanto cardiovascular como renal no paciente nefropata. O emprego da terapia anti-hipertensiva combinada, em geral com duas a três drogas, particularmente com os bloqueadores do sistema renina-angiotensina-aldosterona, tem sido preconizado para se obter metas pressóricas mais estreitas (pressão arterial < 130/80 mmHg), assim como redução da microalbuminúria e da proteinúria, e constitui a estratégia terapêutica no paciente renal diabético ou não. Soma-se a isso o controle de outros fatores tradicionais e aqueles relacionados à doença renal, como o diabetes, a dislipidemia, e os distúrbios do metabolismo cálcio-fósforo, que também são impactantes na doença cardiorrenal. A hipertensão é também prevalente e relevante nas populações de pacientes submetidos a transplante e a diálise, e seu controle provê proteção ao enxerto renal e diminuição de eventos cardiovasculares nessas populações. Os alvos terapêuticos, embora não totalmente estabelecidos, giram ao redor de 130-140/80-90 mmHg, devendo-se atentar às medidas pré/pós-diálise e à monitorização ambulatorial interdiálise. Por ora, a opção é de livre escolha dentre os anti-hipertensivos, embora haja preferência para o uso dos antagonistas de canais de cálcio nessas duas populações e uma indicação, não formal, para os bloqueadores do sistema renina-angiotensina-aldosterona nos pacientes sob diálise. Novos métodos dialíticos ainda têm sido preconizados no intuito de melhorar o componente hidrossalino no paciente dialítico.

Hypertension is a high prevalent condition in chronic renal disease and both are coadjuvants in a cause-effect relantionship, which is also synergic towards cardiorenal risk. Hypertension control, despite not ideal in this population, as so as microalbuminuria/ proteinuria reduction and blockade of the renin angiotensin system, are fundamental tools in terms of cardiovascular and renal protection. Combined antihypertensive therapy, in general with two or three drugs, particularly including a renin angiotensin system blocker, has been recommended in order to obtain a more strict blood pressure control and proteinuria regression in diabetic and non diabetic patients. Traditional and renal disease related cardiovascular risk factors, like as diabetes, dislipidemia, calcium-phosphate disturbances, must also be controlled together, since are contributors to cardiorenal disease. Hypertension is also highly prevalent in transplanted and dialysis patients, and its control provides allograft protection as so as cardiovascular events reduction in this populations. Although not yet established, advised therapeutic blood pressure goals are beyond 130-140/80-90 mmHg. Particular attention is recommended in the pre and post dialysis time, as so as in the interdialytic period. Until now, all first line antihypertensive drugs may be equally employed, although there is a general preference for calcium channel blockers in these populations and a not formal recommendation for the use of renin angiotensin system blockers in dialysis patients. Also, new dialytic methods have been employed in order to improve water and salt balance in dialytic patients.

Prognóstico da esclerose valvar aórtica na mortalidade cardíaca de pacientes atendidos no instituto de cardiologia do Rio Grande do Sul / Prognosis of aortic valve sclerosis in cardiovascular mortality of patients seen at the cardiology institute of Rio Grande do Sul

OBJETIVO: Avaliar o efeito prognóstico da esclerose valvular aórtica na mortalidade e morte de causa cardíaca de pacientes atendidos no Instituto de Cardiologia do Rio Grande do Sul nos anos de 1996 a 2000. MÉTODOS: Estudo de coorte histórico que utilizou informações contidas nos bancos de dados do laboratório de ecocardiografia do Hospital de Cardiologia e nos Registros de Obitos da Secretária da Saúde do Rio Grande do Sul. O período de avaliação foi de 1996 a 2000. Os desfechos foram morte e morte de causa cardíaca. RESULTADOS: Foram analisados 8.585 casos, dos quais 2.154 (25 por cento) eram portadores de esclerose valvular aórtica. O tempo de seguimento médio foi de 41±6 meses, e a ocorrência de morte e morte cardíaca foram respectivamente, de 299 (3,5 por cento) e 95 (1,1 por cento). O grupo de pacientes com esclerose valvular aórtica apresentou mais miocardiopatia segmentar, disfunção ventricular, aumento ventricular e hipertrofia ventricular, e não apresentou, entretanto, maior risco de morte ou morte de causa cardíaca quando feita análise de multivariança. CONCLUSÃO: A presença de esclerose valvular aórtica não aumentou o risco de morte e de morte de causa cardíaca na população estudada.

OBJECTIVE: To evaluate the prognostic effect of aortic valve sclerosis on all-cause and cardiovascular mortality of patients seen at the Cardiology Institute of the Brazilian state of Rio Grande do Sul from 1996 to 2000. METHODS: A historical cohort study using information from both the database of the Echocardiography Laboratory of the Cardiology Hospital and the Death Registry of Rio Grande do Sul Health Department. The evaluation was carried out from 1996 to 2000. Study endpoints were all-cause and cardiovascular mortality. RESULTS: A total of 8585 patients were analyzed, 2154 (25 percent) of whom had aortic valve sclerosis. Mean follow-up was 41±6 months, and all-cause and cardiovascular deaths were 299 (3.5 percent) and 95 (1.1 percent), respectively. The group of patients with aortic valve sclerosis had more segmental cardiomyopathy, ventricular dysfunction, ventricular enlargement, and ventricular hypertrophy; yet, they did not show higher risk for all-cause or cardiovascular mortality in the multivariate analysis. CONCLUSION: The presence of aortic valve sclerosis was not associated with increased risk for all-cause and cardiovascular mortality in the population studied.