Impact of an active lifestyle on cardiovascular autonomic modulation and oxidative stress in males with overweight and parental history of hypertension.

Family history of hypertension is associated with early autonomic dysfunction and increased oxidative stress. These alterations have been found to be reinforced by the overweight factor. Conversely, an active lifestyle is effective in improving the mechanisms regulating blood pressure control. Hence, we ought to investigate the effects of an active lifestyle on the hemodynamic, autonomic and oxidative stress parameters in individuals carrying both family history of hypertension and overweight risk factors. Fifty-six normotensive males were divided into four groups: eutrophic offspring of normotensive parents (EN, n = 12), eutrophic and inactive with hypertensive parents (EH, n = 14), overweight and inactive with hypertensive parents (OH, n = 13), and overweight and physically active with hypertensive parents (OAH, n = 17). Cardiovascular autonomic modulation was assessed by heart rate (HRV) and blood pressure (BPV) variability indexes. Oxidative stress included pro/antioxidant markers and nitrite concentration. Inactive offspring of hypertensive parents (EH and OH) showed higher LFSBP (vs EN), an indicator of sympathetic outflow to the vasculature and reduced anti-oxidant activity (vs EN), while higher pro-oxidant markers were found exclusively in OH (vs EN and EH). Conversely, the OAH group showed bradycardia, higher vagally-mediated HFabs index (vs OH and EN), lower sympathovagal balance (vs OH) and preserved LFSBP. Yet, the OAH showed preserved pro/antioxidant markers and nitrite levels. Our findings indicates that overweight offspring of hypertensive parents with an active lifestyle have improved hemodynamic, cardiac autonomic modulation and oxidative stress parameters compared to their inactive peers.

Cardiovascular, Respiratory, and Functional Effects of Home-Based Exercise Training after COVID-19 Hospitalization.

INTRODUCTION: The present randomized, single-center, and single-blinded clinical trial tested the hypothesis that tele-supervised home-based exercise training (exercise) is an effective strategy for improving cardiovascular, respiratory, and functional capacity parameters in individuals who were hospitalized due to coronavirus disease 2019 (COVID-19). METHODS: Thirty-two individuals (52 ± 10 yr; 17 were female) randomly assigned to exercise ( n = 12) or control groups ( n = 20) had their anthropometric (weight, body mass index), hemodynamic (brachial and central blood pressure), vascular (arterial stiffness), ventilatory (pulmonary function and respiratory muscle strength), and functional parameters (handgrip strength, five-time sit to stand, timed up and go test, and 6-min walking test) assessed at baseline (30-45 d of hospital discharged) and after 12 wk of follow-up. RESULTS: Both groups similarly increased ( P < 0.001) forced vital capacity (absolute and percent of predicted), forced expiratory volume in the first second (absolute and percent of predicted), and handgrip strength during follow-up. However, only the exercise group reduced carotid-femoral pulse wave velocity (-2.0 ± 0.6 m·s -1 , P = 0.048) and increased ( P < 0.05) resting oxygen saturation (1.9% ± 0.6%), mean inspiratory pressure (24.7 ± 7.1 cm H 2 O), mean expiratory pressure (20.3 ± 5.8 cm H 2 O), and percent of predicted mean expiratory pressure (14% ± 22%) during follow-up. No significant changes were found in any other variable during follow-up. CONCLUSIONS: Present findings suggest that tele-supervised home-based exercise training can be a potential adjunct therapeutic to rehabilitate individuals who were hospitalized due to COVID-19.

Can Previous Levels of Physical Activity Affect Risk Factors for Cardiorespiratory Diseases and Functional Capacity after COVID-19 Hospitalization? A Prospective Cohort Study.

Purpose: To evaluate the influence of previous levels of physical activity on hemodynamic, vascular, ventilatory, and functional outcomes after coronavirus disease 2019 (COVID-19) hospitalization. Methods: Sixty-three individuals with COVID-19 had their clinical status and previous levels (12 month) of physical activity (Baecke Questionnaire of Habitual Physical Activity) assessed at hospital admission. Individuals were then allocated to lower levels of physical activity (ACTLOWER; N = 22), intermediate levels of physical activity (ACTINTERMEDIATE; N = 22), or higher levels of physical activity (ACTHIGHER; N = 19) groups, according to tertiles of physical activity. Resting hemodynamic (heart rate and brachial/central blood pressures) and vascular (carotid-femoral pulse wave velocity, augmentation index, and brachial artery flow-mediated dilation) variables, pulmonary function (spirometry), respiratory muscle strength (maximal respiratory pressures), and functional capacity (handgrip strength, five-time sit-to-stand, timed-up and go, and six-minute walking tests) were measured at 30 to 45 days after hospital discharge. Results: ACTLOWER showed lower levels (P < 0.05) of forced vital capacity, forced expiratory volume in the first second, maximal voluntary ventilation, and maximal expiratory pressure than ACTHIGHER. ACTLOWER also had lower (P = 0.023) walking distance (~21%,) and lower percentage of predicted walking distance (~20%) at six-minute walking test during follow-up than ACTINTERMEDIATE. However, hemodynamic and vascular variables, handgrip strength, five-time sit-to-stand, and timed-up and go were not different among groups. Conclusion: ACTLOWER showed impaired ventilatory parameters and walking performance when compared with ACTHIGHER and ACTINTERMEDIATE, respectively. These results suggest that previous levels of physical activity may impact ventilatory and exercise capacity outcomes 30 to 45 days after COVID-19 hospitalization discharge.

Determinants of endothelial dysfunction in noncritically ill hospitalized COVID-19 patients: A cross-sectional study.

OBJECTIVE: The aim of this study was to identify determinants of endothelial dysfunction in patients hospitalized with acute COVID-19. METHODS: A total of 109 hospitalized COVID-19 patients in noncritical status were cross-sectionally studied. Clinical data (age, sex, comorbidities, and medications) and BMI were assessed. Laboratory tests included serum hemoglobin, leukocytes, lymphocytes, platelets, C-reactive protein, ferritin, D-dimer, and creatinine. Physical status was evaluated using a handgrip dynamometer. Endothelial function was assessed noninvasively using the flow-mediated dilation (FMD) method. RESULTS: The sample average age was 51 years, 51% of patients were male, and the most frequent comorbidity was obesity (62%). Univariate analysis showed association of lower FMD with higher BMI, hypertension, use of oral antihypertensive, higher blood levels of creatinine, and larger baseline artery diameter. After adjusting for confounders, the multivariate analysis showed BMI (95% CI: -0.26 to -0.11; p < 0.001) as the major factor associated with FMD. Other factors associated with FMD were baseline artery diameter (95% CI: -1.77 to -0.29; p = 0.007) and blood levels of creatinine (95% CI: -1.99 to -0.16; p = 0.022). CONCLUSIONS: Increased BMI was the major factor associated with endothelial dysfunction in noncritically hospitalized COVID-19 patients. This may explain one of the pathways in which obesity may increase the risk for severe COVID-19.

The Urgent Need for Recommending Physical Activity for the Management of Diabetes During and Beyond COVID-19 Outbreak.

Diabetes is the second most prevalent non-communicable chronic diseases (NCDs) in patients with coronavirus disease 2019 (COVID-19) and is highly associated with increased incidence of disease severity and mortality. Individuals with diabetes and poor glycemic control have an even worse prognosis. Despite of the need/effectiveness of social distancing measures (i.e.: home confinement, quarantine and/or lockdown) during COVID-19 outbreak, preliminary findings showed an increase in negative behaviors during COVID-19 home confinement (i.e.: ~33.5% reduction in physical activity, ~28.6% (~3.10h) increase in sedentary behavior (i.e.: daily sitting, reclining and lying down time), and more unhealthy food consumption and meal pattern), which may have important clinical implications. For example, we estimated that this reduction in physical activity can increase the cases of type 2 diabetes (from ~7.2% to ~9.6%; ~11.1 million cases per year) and all-cause mortality (from ~9.4% to ~12.5%; ~1.7 million deaths per year) worldwide. Few weeks of reduction in physical activity levels result in deleterious effects on several cardiometabolic (i.e.: glycemic control, body composition, inflammatory cytokines, blood pressure, vascular function…) and functional parameters (i.e.: cardiorespiratory/muscle fitness, balance, agility…). In contrast, physical activity and exercise are important tools for preventing and treating diabetes and others NCDs. Home-based exercise programs are useful, safe and effective for the management of diabetes, and could be widely used during COVID-19 outbreak. In this context, there is an urgent need for recommending physical activity/exercise, during and beyond COVID-19 outbreak, for improving the management of diabetes, as well as to prevent the increase in global burden of COVID-19, diabetes and others NCDs.

Impact of Overweight in Mens with Family History of Hypertension: Early Heart Rate Variability and Oxidative Stress Disarrangements.

AIM: To evaluate cardiovascular, autonomic, and oxidative stress markers in eutrophic and overweight offspring of hypertensive parents comparing them to eutrophic and overweight offspring of normotensive parents. METHODS: We conducted a cross-sectional study. We selected 71 male and sedentary subjects, divided into 4 groups: eutrophic group with a negative family history of hypertension (EH-, n = 18) or positive family history of hypertension (EH+, n = 17), overweight group with a negative family history of hypertension (OH-, n = 19) or a positive family history of hypertension (OH+, n = 17), and aged between 18 and 35 years. RESULTS: Blood glucose was higher in the OH+ group when compared to other groups. Diastolic blood pressure was increased in OH- and OH+ groups when compared to eutrophic groups. Regarding the HRV, the LF abs was higher in OH- and OH+ groups when compared to the EH- group. LF/HF values were higher in EH+ and OH+ groups when compared to the EH- and OH- groups. As to oxidative stress and the metabolism of nitric oxide, we observed an increase in hydrogen peroxide and nitrite levels in the OH+ group, and in the NADPH oxidase in OH- and OH+ groups when compared to the other groups. CONCLUSION: Our findings demonstrate that the overweight group with a family history of hypertension presented all the dysfunctions observed in isolation from these risk factors. We observed an exacerbation of cardiac sympathetic modulation and early prooxidants increase, which may be associated with target organ damage and cardiovascular risk in this population.

Effects of photobiomodulation on interleukin-10 and nitrites in individuals with relapsing-remitting multiple sclerosis - Randomized clinical trial.

OBJECTIVE: Investigate the effects of photobiomodulation (PBM) on the expression of IL-10 and nitrites in individuals with Relapsing-Remitting multiple sclerosis (MS), as these biomarkers play a fundamental role in the physiopathology of the disease. The modulation of IL-10 and nitrites through treatment with PBM may be a novel treatment modality for MS. METHODS: A randomized, uncontrolled, clinical trial was conducted involving 14 individuals with a diagnosis of Relapsing-Remitting MS and a score of up to 6.0 on the Expanded Disability Status Scale (EDSS). THE PARTICIPANTS WERE RANDOMIZED TO TWO GROUPS: Group 1 -PBM in the sublingual region; Group 2 -PBM over the radial artery. Irradiation was administered with a wavelength of 808 nm and output power of 100 mW for 360 seconds twice a week, totaling 24 sessions. Peripheral blood was analyzed for the determination of serum levels of IL-10 and nitrites. RESULTS: After treatment with PBM, the expression of IL-10 increased in both the sublingual group (pre-treatment: 2.8 ± 1.4 pg/ml; post-treatment: 8.3 ± 2.4 pg/ml) and the radial artery group (pre-treatment: 2.7 pg/ml ± 1.4; post-treatment: 11.7 ± 3.8 pg/ml). In contrast, nitrite levels were not modulated in the sublingual group (pre-treatment: 65 ± 50 nmol/mg protein; post-treatment: 51 ± 42 nmol/mg protein) or the radial artery group (pre-treatment: 51 ± 16 nmol/mg protein; post-treatment: 42 ± 7 nmol/mg protein). CONCLUSION: Treatment with PBM positively modulated the expression of IL-10 but had no effect on nitrite levels. Further studies should be conducted with a larger sample and a control group, as PBM may be a promising complementary treatment for the management of MS. This trial is registered at ClinicalTrials.gov. Identifier: NCT03360487.

Sedentary lifestyle in adolescents is associated with impairment in autonomic cardiovascular modulation / Sedentarismo em adolescentes é associado ao comprometimento da modulação cardiovascular autonômica / Sedentarismo en adolescentes es asociado al compromiso de la modulación cardiovascular autonómica

ABSTRACT Introduction Regular physical exercise, or a more active lifestyle, are important to prevent cardiovascular diseases, reducing not only cardiovascular mortality but also promoting a reduction in the risk factors related to these diseases. Objective To assess the association between physical inactivity and heart rate variability (HRV) in adolescents. Methods This was a cross-sectional study of the Diagnostic Type with Level of Evidence II according to the Oxford table. One hundred and twenty-nine adolescents were evaluated, aged 15 and 17 years old, divided into four groups: male teenagers who were insufficiently active (IAM n = 28) or physically active (FAM n = 29), and female teenagers who were insufficiently active (IAF n = 42) or physically active (FAF n = 30). The level of physical activity was assessed by the IPAQ. The HRV was evaluated in the time and frequency domains. Results Reduced pulse interval variance was observed in the insufficiently active male or female groups (5089 ± 378 ms2 and 4335 ± 276 ms2 respectively) compared to the physically active groups (9106 ± 606 ms2 and 6182 ± 366 ms2 respectively). Moreover, the insufficiently active groups presented higher cardiac sympathetic/vagal balance values (0.81 ± 0.05 and 0.80 ± 0.05 respectively) compared to the physically active groups (0.63 ± 0.05 and 0.55 ± 0.05 respectively). Conclusion A physically active lifestyle was associated with better cardiovascular autonomic modulation in adolescents. Level of Evidence II; Diagnostic Studies - Investigating a Diagnostic Test.

RESUMO Introdução A prática regular de exercícios físicos ou o estilo de vida mais ativo são importantes na prevenção de doenças cardiovasculares, reduzindo não somente a mortalidade cardiovascular, mas também favorecendo a redução dos fatores de risco relacionados com essas doenças. Objetivo Avaliar a associação entre inatividade física e variabilidade da frequência cardíaca (VFC) em adolescentes. Métodos Este foi um estudo transversal do tipo Diagnóstico com Nível de Evidência II segundo a tabela de Oxford. Foram avaliados 129 adolescentes com idades entre 15 e 17 anos, divididos em quatro grupos: adolescentes insuficientemente ativos (IAM, n = 28) ou fisicamente ativos (FAM, n = 29) do sexo masculino e adolescentes, insuficientemente ativos (IAF, n = 42) ou fisicamente ativos do sexo feminino (FAF, n = 30). O nível de atividade física foi avaliado por meio do IPAQ. A VFC foi avaliada no domínio do tempo e da frequência. Resultados Nos adolescentes do sexo masculino e feminino, foram observados valores menores na variância do intervalo de pulso nos grupos insuficientemente ativos (5.089 ± 378 ms2 e 4.335 ± 276 ms2, respectivamente) quando comparados com os grupos fisicamente ativos (9.106 ± 606 ms2 e 6.182 ± 366 ms2, respectivamente). Além disso, os grupos insuficientemente ativos apresentaram maiores valores de balanço simpato-vagal cardíaco (0,81 ± 0,05 e 0,80 ± 0,05, respectivamente) comparados aos dos grupos fisicamente ativos (0,63 ± 0,05 e 0,55 ± 0,05, respectivamente). Conclusão A vida fisicamente ativa foi associada à melhor modulação cardiovascular autonômica em adolescentes. Nível de Evidência II; Estudos diagnósticos - Investigação de um exame para diagnóstico.

RESUMEN Introducción La práctica regular de ejercicios físicos o el estilo de vida más activo son importantes en la prevención de enfermedades cardiovasculares, reduciendo no sólo la mortalidad cardiovascular, sino también favoreciendo la reducción de los factores de riesgo relacionados con esas enfermedades. Objetivo Evaluar la asociación entre inactividad física y variabilidad de la frecuencia cardíaca (VFC) en adolescentes. Métodos Este fue un estudio transversal del tipo Diagnóstico con Nivel de Evidencia II según la tabla de Oxford. Se evaluaron 129 adolescentes con edades entre 15 y 17 años, divididos en cuatro grupos: adolescentes insuficientemente activos (IAM, n=28) o físicamente activos (FAM, n=29) del sexo masculino y adolescentes insuficientemente activos (IAF, n=42) o físicamente activos del sexo femenino (FAF, n=30). El nivel de actividad física fue evaluado a través del IPAQ. La VFC fue evaluada en el dominio del tiempo y de la frecuencia. Resultados Los adolescentes del sexo masculino y femenino insuficientemente activos presentaron valores menores en la varianza del intervalo de pulso (5.089 ± 378; y 4.335 ± 276 ms2, respectivamente) cuando se compararon con los grupos físicamente activos (9.106 ± 606 y 6.182 ± 366 ms2, respectivamente). Además, los grupos insuficientemente activos presentaron mayores valores del balance simpático-vagal cardíaco (0,81 ± 0,05 y 0,80 ± 0,05, respectivamente) comparados a los grupos físicamente activos (0,63 ± 0,05 y 0,55 ± 0,05, respectivamente). Conclusión La vida físicamente activa fue asociada a la mejor modulación cardiovascular autonómica en adolescentes. Nivel de Evidencia II; Estudios de diagnósticos - Investigación de un examen para diagnóstico.

Effects of Transcranial Direct Current Stimulation (tDCS) and Exercises Treadmill on Autonomic Modulation of Hemiparetic Patients Due To Stroke-Clinic Test, Controlled, Randomized, Double-Blind.

Background: After a Stroke, there is an autonomic nervous system (ANS) changes. Transcranial Direct Current Stimulation (tDCS) can promote the reorganization of the affected circuits. Objective: To evaluate the effects of tDCS applied before a session of physical activity on the treadmill, in the modulation of the autonomic nervous system of post-stroke patients. Methodology: Cross-over study, were randomized 12 adult hemiparetic subjects in 2 groups, Group 1 (active tDCS before exercise on the treadmill) and Group 2 (sham tDCS before exercise on the treadmill). Stimulation times were 20 min; treadmill time was 20 min. The heart rate variability (HRV) and Variability of Systolic Blood Pressure (VSBP) were evaluated for 15 min, in 3 periods (pre and post tDCS and during exercise recovery on the treadmill). Results: There was no difference in the VSBP and the HRV between the groups, compared with the baseline data; however, in the intragroup analysis, the parasympathetic modulation after active tDCS increased by 18% over baseline by the RMSSD with IC 95% (-7.85 to -0.34). In group 1, the post-tDCS active and post-exercise periods presented a value of variance above baseline, indicating a better prognosis. In group 2, there was a significant reduction of 38% of Variance values (p = 0.003) after tDCS sham. Conclusion: tDCS does not generate immediate effects on HRV and VSBP, except for intragroup comparison, which has greater participation in parasympathetic modulation in the group receiving active tDCS.

Prescribing high-intensity interval exercise by RPE in individuals with type 2 diabetes: metabolic and hemodynamic responses.

We tested the hypothesis that rating of perceived exertion (RPE) is a tool as efficient as the heart rate (HR) response to the cardiopulmonary exercise test (CPX) for prescribing and self-regulating high-intensity interval exercise (HIIE), and that metabolic and hemodynamic response to HIIE is superior than to continuous moderate-intensity exercise (MICE) in individuals with type 2 diabetes mellitus (T2DM). Eleven participants (age = 52.3 ± 3 years) underwent HIIE prescribed and self-regulated by RPE (HIIERPE; 25 min), HIIE prescribed and regulated by an individual's HR response to CPX (HIIEHR; 25 min), MICE prescribed and self-regulated by RPE (30 min) and control (30 min of seated resting) intervention in random order. HR, blood pressure (BP), capillary glucose, endothelial reactivity, and carotid-femoral pulse wave velocity were assessed before, immediately after, and 45 min after each intervention. Exercise HR, speed, and distance were measured during exercise sessions. Twenty-four-hour ambulatory BP was measured after each intervention. Exercise HR, speed, and distance were similar between HIIERPE and HIIEHR. BP response was not different among HIIERPE, HIIEHR, and MICE. Capillary glycaemia reduction was greater (P < 0.05) after HIIERPE (48.6 ± 9.6 mg/dL) and HIIEHR (47.2 ± 9.5 mg/dL) than MICE (29.5 ± 11.5 mg/dL). Reduction (P < 0.05) in 24-h (6.7 ± 2.2 mm Hg) and tendency toward reduction (P = 0.06) in daytime systolic (7.0 ± 2.5 mm Hg) ambulatory BP were found only after HIIERPE. These results suggest that HIIE is superior to MICE for reducing glycaemia and ambulatory BP, and that the 6-20 RPE scale is a useful tool for prescribing and self-regulating HIIE in individuals with T2DM.

The impact of sedentarism on heart rate variability (HRV) at rest and in response to mental stress in young women.

Sedentarism is one of the main risk factors for the onset of cardiometabolic diseases. Some biomarkers, such as heart rate variability (HRV), have been largely studied and found to be involved in the genesis of the dysfunctions associated with sedentary behavior. However, comparatively few studies have focused on the female sex. The objective of this study was to analyze the hemodynamic, autonomic and quality of life parameters at rest and in response to mental stress of sedentary and physically active young women. A total of 96 women, 18-30 years of age, were divided into sedentary (SW = 48) and active (AW = 48) groups. Anthropometric, hemodynamic and quality of life parameters were evaluated and the R-R interval was recorded to quantify the cardiac autonomic modulation at rest and in response to the Stroop Color Test. The groups were similar in age, weight, height, body mass index, fat percentage, systolic and diastolic blood pressure values and glycemia. The physical health domain of quality of life was compromised in the SW group. The SW group presented higher heart rate, lower variance of RR interval and RMSSD and higher cardiac sympathovagal balance (LF/HF) both at rest and in response to the mental stress test. We concluded that sedentary lifestyle in women induces impairment in autonomic cardiac modulation at rest and in response to physiological stress, compromising the quality of life, even before altering any cardiovascular or metabolic clinical parameters, reinforcing the potential role of HRV as early marker of cardiovascular risk in this population.

Effect of photobiomodulation treatment in the sublingual, radial artery region, and along the spinal column in individuals with multiple sclerosis: Protocol for a randomized, controlled, double-blind, clinical trial.

BACKGROUND: Multiple sclerosis (MS) is an autoimmune disease, for which the forms of treatment are medication and rehabilitation. However, in vitro and in vivo studies have demonstrated that photobiomodulation can be an effective treatment modality for inflammatory diseases, including MS. Photobiomodulation has a broad range of benefits, such as the avoidance of cell and tissue death, the stimulation of healing and injury repair, reductions in pain, edema and inflammation, cell proliferation, and even apoptosis. The outcomes of photobiomodulation include the regeneration of cells, the stimulation of the growth of Schwann cells, a reduction in spasticity, functional improvements, a reduction in nitric oxide levels, and the upregulation of the cytokine IL10, demonstrating that this therapeutic modality can offer neuroprotection. METHODS: A randomized, controlled, double-blind, clinical trial is proposed. The patients will be divided into 6 groups. Groups 1 and 2 will receive sham and active photobiomodulation in the sublingual region, respectively. Groups 3 and 4 will receive sham and active photobiomodulation along the spinal cord, respectively. Group 5 will receive placebo treatment with photobiomodulation on the skin in the region of the radial artery with a specific bracelet. Group 6 will be treated with photobiomodulation on the skin in the region of the radial artery. DISCUSSION: Treatment for MS is directed at the immune response and slowing the progression of the disease. This is one of the first clinical trials involving photobiomodulation in the sublingual region and along the spinal cord, which could help establish a promising new form of nonpharmacological treatment for autoimmune diseases. This is one of the first clinical trials with sublingual photobiomodulation and along the spinal cord that could help establish a new form of promising treatment of the disease associated with pharmacological treatment.

Clinical outcomes related to the incidence of ventilator-associated pneumonia in adults - a cohort study / Desfechos clínicos ligados à incidência de pneumonia associada à ventilação mecânica no adulto - estudo de coorte

Abstract Introduction: Ventilator-Associated Pneumonia (VAP) is a common complication found in the Intensive Care Unit (ICU) and is associated with increased mortality, length of hospital stay and mechanical ventilation (MV) time. Objective: To determine the incidence of VAP and its impact on the clinical course of the subject undergoing invasive MV in the ICU. Methods: This is a cohort study of hospitalized subjects in the general adult ICU of the State Hospital of Bauru / SP. The clinical information for the period of 19 months were collected. Stratification for the groups was based on the presence or absence of VAP, free_VAP and VAP, respectively. The Hotelling T² with 95% confidence, chi-square and the Mann-Whitney tests were executed using the "R" software and the results showed as mean ± standard deviation and absolute and relative distribution (p < 0.05). Results: The sample was of 322 subjects; the VAP group consisted of 73 (22.67%), 54.79% male, age: 62.31±16.96 years and the APACHE II: 29.98 ± 8.64. The VAP group had longer time of the MV and of the ICU compared to free VAP group; even in this group, the highest incidence of death in the ICU occurred between the 16th and 20th day of hospitalization. The free VAP group was older and 50% of the patients discharged from hospital. Conclusion: VAP and their interfaces still impact on the clinical evolution of the subjects mainly on the time factor of MV and ICU stay. The highest incidence of death in the ICU occurs in the first weeks.

Resumo Introdução: A Pneumonia Associada à Ventilação Mecânica (PAV) é uma complicação comumente encontrada na Unidade de Terapia Intensiva (UTI) e está associada à maior mortalidade, tempo de internação e ventilação mecânica (VM). Objetivo: Verificar a incidência da PAV e seu impacto sobre a evolução clínica dos sujeitos submetidos à ventilação mecânica invasiva na UTI. Métodos: Trata-se de um estudo de coorte com sujeitos internados na UTI geral adulto do Hospital Estadual de Bauru/SP. Foram coletadas as informações clínicas referentes ao período de 19 meses. A estratificação para os grupos foi realizada com base na ocorrência ou não da PAV, sem_PAV e PAV, respectivamente. Foi aplicado o teste T2 de Hotelling com 95% de confiança e Qui-Quadrado utilizando o Software "R" e os resultados apresentados em média ± desvio padrão e distribuição absoluta e relativa (p < 0,05). Resultados: A casuística foi de 322 sujeitos; o grupo PAV constou de 73 (22,67%), sendo 54,79% do sexo masculino, idade: 62,31 ± 16,96 anos e APACHE II: 29,98 ± 8,64. O grupo NAV teve maior tempo de VM e na UTI se comparado ao grupo sem_NAV; ainda neste grupo, a maior incidência de óbito na UTI ocorreu entre o 16° ao 20° dia de internação. O grupo sem_PAV era mais velho e 50% deste tiveram alta hospitalar. Conclusão: A PAV e suas interfaces ainda causam impacto sobre a evolução clínica dos sujeitos principalmente quanto ao fator tempo de ventilação mecânica e de internação na UTI. A maior incidência de óbito na UTI ocorre nas primeiras semanas.

The cost of excessive postoperative use of antimicrobials: the context of a public hospital.

OBJECTIVE: To evaluate the improper use of antimicrobials during the postoperative period and its economic impact. METHODS: We conducted a prospective cohort study by collecting data from medical records of 237 patients operated on between 01/11/08 and 31/12/08. RESULTS: from the 237 patients with the information collected, 217 (91.56%) received antimicrobials. During the postoperative period, 125 (57.7%) patients received more than two antimicrobials. On average, 1.7 ± 0.6 antimicrobials were prescribed to patients, the most commonly prescribed antibiotic being cephalothin, in 41.5% (154) of cases. The direct cost of antimicrobial therapy accounted for 63.78% of all drug therapy, this large percentage being attributed in part to the extended antimicrobial prophylaxis. In the case of clean operations, where there was a mean duration of 5.2 days of antibiotics, antimicrobials represented 44.3% of the total therapy cost. CONCLUSION: The data illustrate the impact of overuse of antimicrobials, with questionable indications, creating situations that compromise patient safety and increasing costs in the assessed hospital.

The cost of excessive postoperative use of antimicrobials: the context of a public hospital / Consequências do uso excessivo de antimicrobianos no pós-operatório: o contexto de um hospital público

OBJECTIVE: To evaluate the improper use of antimicrobials during the postoperative period and its economic impact. METHODS: We conducted a prospective cohort study by collecting data from medical records of 237 patients operated on between 01/11/08 and 31/12/08. RESULTS: from the 237 patients with the information collected, 217 (91.56%) received antimicrobials. During the postoperative period, 125 (57.7%) patients received more than two antimicrobials. On average, 1.7 ± 0.6 antimicrobials were prescribed to patients, the most commonly prescribed antibiotic being cephalothin, in 41.5% (154) of cases. The direct cost of antimicrobial therapy accounted for 63.78% of all drug therapy, this large percentage being attributed in part to the extended antimicrobial prophylaxis. In the case of clean operations, where there was a mean duration of 5.2 days of antibiotics, antimicrobials represented 44.3% of the total therapy cost. CONCLUSION: The data illustrate the impact of overuse of antimicrobials, with questionable indications, creating situations that compromise patient safety and increasing costs in the assessed hospital. .

OBJETIVO: avaliar o emprego de antimicrobianos relacionado ao seu uso inadequado e impacto econômico durante o período pós-operatório. MÉTODOS: foi desenvolvido um estudo de coorte prospectivo por meio da coleta de dados de 237 prontuários de pacientes operados entre 01/11/08 e 31/12/08. RESULTADOS: dos 237 pacientes com informações coletadas no estudo 217 (91,56%) fizeram uso de antimicrobianos. Durante o pós-operatório, 125 (57,7%) pacientes utilizaram mais de dois antimicrobianos. Foi prescrito, em média, 1,7 ± 0,6 antimicrobianos por paciente, sendo o antimicrobiano mais prescrito a cefalotina, em 41,5% (154) dos casos. O custo direto da terapia antimicrobiana representou 63,78% de toda a terapia farmacológica, sendo esta grande porcentagem atribuída em parte ao prolongamento da profilaxia antimicrobiana. No caso das operações limpas, onde houve um tempo médio de uso de antimicrobianos de 5,2 dias, os gastos com antimicrobianos representaram 44,3% do custo total da terapia. . CONCLUSÃO: os dados exemplificam o impacto do uso excessivo de antimicrobianos, com indicações questionáveis e criando situações que comprometem a segurança dos pacientes e aumento os custos no hospital avaliado. .

Brazilian Portuguese translation and cross-cultural adaptation of the "Caregiver Priorities and Child Health Index of Life with Disabilities" (CPCHILD) questionnaire.

BACKGROUND: Consideration of the quality of life in relation to individual health status is crucial for planning and maintaining a system of patient-centered care. Until recently, there have been no suitable instruments to assess health-related quality of life (HRQoL,) of children and adolescents with severe, non-ambulant cerebral palsy (GMFCS functional levels IV and V). The "Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire" (CPCHILD) was developed in English specifically for this population, and has been validated in Canada. The aim of this study was to translate and adapt the CPCHILD Questionnaire into Brazilian Portuguese, thus permitting researchers in Brazil to access this important tool for measuring HRQoL in this population, as well as the possibility of making comparisons with other studies that use the same questionnaire in other languages. METHOD: The cross-cultural adaptation included two forward translations by independent translators, their synthesis, two back-translations by independent translators, an assessment of the versions by an expert committee and the development of a pre-final version, which was tested on 30 caregivers of children (5 -18) with severe cerebral palsy (GMFCS IV & V). RESULTS: Despite the relative equivalence between the two translations, some items required adaptations for the synthesized version. Certain modifications were necessary in the pre-final version to achieve idiomatic equivalence. The modifications were required to account for the socioeconomic and cultural levels of the target population. CONCLUSION: The translation and cross-cultural adaptation of the CPCHILD questionnaire provides a Brazilian Portuguese equivalent to measure the HRQoL of children with severe developmental disabilities, with the potential to measure the benefits of various procedures that are indicated for these patients. This adaptation exhibited a satisfactory level of semantic equivalence between the Portuguese target and the original English source versions. The validity of the Brazilian version of the instrument must be established in the future by assessing its psychometric properties on Brazilian epidemiological samples.

Comprometimento sensório-motor dos membros inferiores em diabéticos do tipo 2 / Sensitive-motor alteration of the lower limbs in diabetics type 2

INTRODUÇÃO: A alta incidência do Diabetes mellitus (DM) na população torna essa patologia alvo de muitas pesquisas. Uma das complicações do DM é a neuropatia periférica crônica caracterizada por atrofia e degeneração axonal e/ou alteração da célula de Schwann. A fisioterapia atua na estimulação da regeneração da fibra nervosa, o que reduz o risco de desenvolvimento do pé diabético. OBJETIVO: Identificar o comprometimento da sensibilidade nos membros inferiores (MMII) de diabéticos e verificar fatores que contribuíram para o desenvolvimento do pé diabético, como glicemia, hemoglobina glicada (HbA1c), tempo de diagnóstico, pressão arterial e antropometria. MATERIAIS E MÉTODOS: Os diabéticos foram avaliados na Associação dos Diabéticos de Bauru, participaram de entrevista e foram submetidos a antropometria, triagem pressórica e teste neurossensorial no Sistema Pontuação Clínica Toronto (SPCT). RESULTADOS: Os 68 pacientes (61,76% mulheres e 38,23% homens) tinham 62,93 ± 9,64 anos, apresentaram pressão sistólica de 132,54 ± 17,95 mmHg e diastólica 80,39 ± 11,35 mmHg, índice de massa corpórea 30,34 ± 5,80 kg/m², glicemia 149,20 ± 60,37mg/dL, HbA1c 7,72 ± 1,4%; tempo de diagnóstico de um a 34 anos. Dentre eles, 80,88% apresentavam sobrepeso; 72,06%, hipertensão arterial; 42,64%, dislipidemia; 14,7%, problemas renais; e 17,64%, vasculares. Pelo SPCT, 97,05% apresentavam neuropatia, 95,59% com simetria. Na avaliação, 57,35% apresentavam alteração sensitiva protetora; 60,29%, sensibilidade térmica; 26,47%, tátil; 17,64%, vibratória; 7,35%, dolorosa; e 1,47%, alteração cinestésica. Nos pés, 72,05% apresentavam pele ressecada; 64,70%, fissuras; 54,41%, calosidade; e 44,11%, micose; 50% referiram dor; 39,7%, dormência; 41,17%, parestesia; 27,94%, ataxia. Reflexos estavam ausentes ou diminuídos em 14,71% dos indivíduos; desses, 38,23% no Aquileu. Observou-se correlação positiva entre o SPCT com a glicemia e a circunferência abdominal e a hemoglobina glicada com a glicemia. CONCLUSÃO: Houve grande incidência de neuropatia simétrica; alteração de sensibilidade com presença de sinais clínicos, sintomas, arreflexia e hiporeflexia; e incidência de obesidade e hipertensão associadas. Faz-se necessário o acompanhamento da fisioterapia na avaliação da sensibilidade para prevenir, reduzir sintomas e melhorar a circulação sanguínea em MMII.

INTRODUCTION: The high incidence of diabetes mellitus (DM) in the population becomes this pathology subject of much research. One complication of diabetes is peripheral neuropathy characterized by chronic atrophy and axonal degeneration and/or alteration of the Schwann cell. The physiotherapy works in the stimulation of regeneration of the nerve fiber, which reduces the risk of developing diabetic foot. OBJECTIVE: To identify the sensitivity disorders in the lower limbs (LL) in diabetics patients and verify factors that contribute to the development the diabetic foot as glicemic level, glycosylated hemoglobin (GH), time of the diagnostic, blood pressure, anthropometry and life habits. MATERIALS AND METHODS: The diabetics patients were valued in Bauru Diabect Association and submitted the interview, anthropometry, blood pressure, by the Toronto Clinical Scoring System avaliation (TCSS - sensorial test, reflexes e symptoms). RESULTS: The 68 enrolled patients, 61.76% female and 38.23% male, with 62.93 ± 9.64 years-old, showed systolic blood pressure of 132.54 ± 17.95 mmHg and diastolic blood pressure of 80.39 ± 11,35 mmHg; body mass index, 30,34 ± 5,80 kg/m2; glicemic level, 149,20 ± 60,37mg/dL; GH, 7,72 ± 1,4%; time of the diagnostic, one to 34 years; 80,88% had overweight, 72,06%, hypertension; 42,64%, dyslipidemia; 14,7%, kidney; and 17,64%, vascular disorders. According to TCSS, 97.05% showed neuropathy, 95.59% were symmetrical. Regarding the sensitivity altered, 57.35% showed in protect; 60.29%, thermal; 26.47%, tactile; 17.64%, vibratory; 7.35%, painful; and 1.47%, kinectic-postural. In the feet, 72.05% had dry foot skin; 64.70%, fissures; 54.41%, callosity; 44.11%, mycosis; 50% reported pain; 39,7%, numbness; 41,17%, tingling; 27,94%, sensory ataxia. The reflexes were abolished or decreased in 14.71%; 38.23% are localized in Achilles tendon. There was positive correlation between the TCSS with abdominal circumference and blood glucose and glycated hemoglobin with glucose. CONCLUSION: There was great incidence of the symmetrical neuropathy; sensibility alteration with clinical manifestations, symptons, areflexia and hyporeflexia; obesity and hypertension incidences were associated. It is very necessary the physiotherapy accompaniment on the sensitivity valuation to prevent, reduce the symptons and improve the blood circulation in LL.