First Evaluation of the Brazilian Advanced Life Support Training (TECA A)

Abstract Background Cardiac arrest (CA) is a common condition associated with high mortality. The Brazilian advanced life support training TECA A (Treinamento em Emergências Cardiovasculares Avançado — Advanced Cardiovascular Emergency Training) was created to train healthcare professionals in the management of CA. However, there are no studies evaluating the effectiveness of TECA A. Objective To assess the impact of TECA A on the management of CA using a simulated CA situation. Methods Fifty-six students underwent a simulated case of CA in a manikin. The students' performance in the management of CA was assessed for the time to first chest compression and defibrillation and for a global assessment score using a structured tool. These items were assessed and compared before and after the TECA A. Exclusion criteria were previous participation in CA trainings and absence from class. Categorical variables were compared using the McNemar test and quantitative variables using the Wilcoxon test. All tests were two-tailed, and statistical significance was set at p < 0.05. Results Compared with before TECA A, median global assessment scores were higher after TECA A (pre-training: 4.0 points [2.0-5.0] vs. 10 points [9.0-10.0]; p<0.001), the time to start chest compressions was shorter (pre-training: 25 seconds [15-34] vs. 19 seconds [16.2-23.0]; p=0.002) and so was the time to defibrillation (pre-training: 82.5 seconds [65.0-108.0] vs. 48 seconds [39.0-53.0]; p<0.001). Conclusions The TECA A promoted a higher adherence to cardiopulmonary resuscitation (CPR) guidelines and a reduction in the time elapsed from CA to first chest compression and defibrillation.

Comparison of Biological and Mechanical Prostheses for Heart Valve Surgery: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: The choice of a mechanical (MP) or biological prosthesis (BP) for patients with valvular heart disease undergoing replacement is still not a consensus. OBJECTIVE: We aimed to determine the clinical outcomes of MP or BP placement in those patients. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared biological prostheses and mechanical prostheses in patients with valvular heart diseases and assessed the outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of Science (from inception to November 2014) databases. Meta-analyses were performed using inverse variance with random effects models. The GRADE system was used to rate the quality of the evidence. A P-value lower than 0.05 was considered significant. RESULTS: A total of four RCTs were included in the meta-analyses (1,528 patients) with follow up ranging from 2 to 20 years. Three used old generation mechanical and biological prostheses, and one used contemporary prostheses. No significant difference in mortality was found between BP and MP patients (risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of bleeding was significantly lower in BP patients than MP patients (RR = 0.64; 95% CI 0.52-0.78); however, reoperations were significantly more frequent in BP patients (RR = 3.60; 95% CI 2.44-5.32). There were no statistically significant differences between BP and MP patients with respect to systemic arterial embolisms and infective endocarditis (RR = 0.93; 95% CI 0.66-1.31, RR = 1.21; CI95% 0.78-1.88, respectively). Results in the trials with modern and old prostheses were similar. CONCLUSIONS: The mortality rate and the risk of thromboembolic events and endocarditis were similar between BP and MP patients. The risk of bleeding was approximately one third lower for BP patients than for MP patients, while the risk of reoperations was more than three times higher for BP patients.

Comparison of Biological and Mechanical Prostheses for Heart Valve Surgery: A Systematic Review of Randomized Controlled Trials / Comparação de Próteses Biológicas e Mecânicas para Cirurgia de Válvula Cardíaca: Revisão Sistemática de Estudos Controlados Randomizados

Abstract Background: The choice of a mechanical (MP) or biological prosthesis (BP) for patients with valvular heart disease undergoing replacement is still not a consensus. Objective: We aimed to determine the clinical outcomes of MP or BP placement in those patients. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared biological prostheses and mechanical prostheses in patients with valvular heart diseases and assessed the outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of Science (from inception to November 2014) databases. Meta-analyses were performed using inverse variance with random effects models. The GRADE system was used to rate the quality of the evidence. A P-value lower than 0.05 was considered significant. Results: A total of four RCTs were included in the meta-analyses (1,528 patients) with follow up ranging from 2 to 20 years. Three used old generation mechanical and biological prostheses, and one used contemporary prostheses. No significant difference in mortality was found between BP and MP patients (risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of bleeding was significantly lower in BP patients than MP patients (RR = 0.64; 95% CI 0.52-0.78); however, reoperations were significantly more frequent in BP patients (RR = 3.60; 95% CI 2.44-5.32). There were no statistically significant differences between BP and MP patients with respect to systemic arterial embolisms and infective endocarditis (RR = 0.93; 95% CI 0.66-1.31, RR = 1.21; CI95% 0.78-1.88, respectively). Results in the trials with modern and old prostheses were similar. Conclusions: The mortality rate and the risk of thromboembolic events and endocarditis were similar between BP and MP patients. The risk of bleeding was approximately one third lower for BP patients than for MP patients, while the risk of reoperations was more than three times higher for BP patients.

Resumo Fundamento: A escolha de próteses mecânicas ou biológicas para pacientes com doença de válvula cardíaca ainda não é um consenso. Objetivo: Determinar os desfechos clínicos de próteses mecânicas e biológicas nesses pacientes. Métodos: Conduzimos uma revisão sistemática e metanálise e estudos controlados randomizados (RCTs) que compararam próteses mecânicas e biológicas em pacientes com doenças de válvulas cardíaca, e avaliamos seus resultados. A busca por RCTs foi feita nas bases de dados MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS e Web of Science (do início a novembro de 2014). As metanálises foram realizadas usando variação inversa com modelos de efeitos aleatórios. Usamos o sistema GRADE para avaliar a qualidade da evidência. Um valor menor que 0,05 foi considerado significativo. Resultados: Um total de quatro RCTs foi incluído na metanálise (1528 pacientes) com acompanhamento de 2 a 20 anos. Em três estudos, foram utilizadas próteses mecânicas e biológicas mais antigas, e em um estudo próteses contemporâneas. Não foi observada diferença de mortalidade entre os pacientes que receberam próteses mecânicas e biológicas (risco relativo, RR = 1,07; IC95% 0,99-1,15). O risco de sangramento foi significativamente mais baixo nos pacientes que receberam próteses biológicas que naqueles com próteses mecânicas (RR = 0,64; IC95% 0,52-0,78). Contudo, as reoparações foram mais frequentes em pacientes com próteses biológicas (RR = 3,60; IC95% 2,44-5,32). Não houve diferenças estatisticamente significativas entre pacientes com próteses biológicas e mecânicas em relação à embolia arterial sistêmica e endocardite infecciosa (RR = 0,93; IC95% 0,66-1,31; RR = 1,21; IC95% 0,78-1,88, respectivamente). Resultados entre os estudos com próteses modernas e antigas foram similares. Conclusões: A taxa de mortalidade e o risco de eventos tromboembólicos e endocardite foram similares entre os pacientes que receberam próteses biológicas e mecânicas. O risco de sangramentos foi aproximadamente um terço menor nos pacientes com próteses biológicas que mecânicas, ao passo que o risco de reoperação foi mais que três vezes maior nos pacientes com próteses biológicas.

Dissecção aguda de aorta manifestando-se com infarto agudo do miocárdio: relato de caso / Acute aortic dissection manifesting with acute myocardial infarction: case report

A dissecção aguda da aorta (DAA) é uma emergência cardiovascular que acarreta mortalidade alta, 50% a 68% em 48 horas e até 85% em um mês. Este caso refere-se a um homem com 65 anos, ex-tabagista, que teve precordialgia com queimação irradiada para membros superiores, associada a náuseas. O eletrocardiograma mostrou upradesnivelamento ST em parede inferolateral. Recebeu tratamento para infarto agudo do miocárdio com AAS, clopidogrel, enoxaparina e tenecteplase. O cateterismo cardíaco evidenciou DAA tipo A de Stanford e coronárias sem obstruções. O ecocardiograma transtorácico mostrou insuficiência aórtica moderada e dissecção estendendo-se da raiz da aorta até a porção descendente proximal. O paciente foi submetido à cirurgia de Bentall de Bono e enxerto safeno-coronário direito devido à obstrução durante a cirurgia, com boa evolução pós-operatória. A DAA continua a ser um desafio diagnóstico na sala de emergência. De acordo com International Registry of Acute Aortic Dissection, os achados clínicos nas dissecções tipo A incluem dor torácica súbita e intensa (86%), irradiação dorsal (47%), sopro de insuficiência aórtica (44%), assimetria de pressão arterial (50%) e pulsos (30%), alargamento de mediastino à radiografia de tórax (63%) e supradesnivelamento de ST (4%), majoritariamente por oclusão de óstio da coronária direita. O caso destaca-se pela evolução favorável a despeito do tratamento com potencial catastrófico inicialmente direcionado para doença coronariana aguda aterotrombótica

Acute Aortic Dissection (AAD) is a cardiovascular emergency that entails high mortality - 50-68% in 48 hours and up to 85% in one month. This case involves a 65-year-old male ex-smoker who had onset of precordial pain with a burning sensation, radiating into the upper limbs, in combination with nausea. Electrocardiogram showed inferolateral wall ST elevation. He received treatment for acute myocardial infarction with acetylsalicylic acid, clopidogrel, enoxaparin and tenecteplase. Cardiac catheterization revealed Stanford type A AAD and unobstructed coronary arteries. Transthoracic echocardiogram showed moderate aortic regurgitation and aortic dissection extending from the aortic root to its proximal descending portion. The patient underwent a Bentall-De Bono procedure and right coronary artery bypass grafting using the saphenous vein due to obstruction during surgery, with good postoperative progress. AAD remains a diagnostic challenge in the emergency room. According to the International Registry of Acute Aortic Dissection, clinical findings in type A dissections include: sudden severe chest pain (86%), dorsal irradiation (47%), aortic regurgitation murmur (44%), asymmetric blood pressure (50%) or pulse (30%), mediastinal widening on chest radiograph (63%) and ST-segment elevation (4%), mainly due to right coronary ostium occlusion. The case is distinctive because of favorable progress in spite of the potentially catastrophic treatment initially targeting acute coronary atherothrombotic disease

Sex effects on the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults: data from the SARCOS study

ABSTRACT Objective: The objective was to evaluate the association between sarcopenia (EWGSOP) and osteoporosis in older adults. Subjects and methods: This is a cross sectional analysis of a baseline evaluation of the SARCopenia and OSteoporosis in Older Adults with Cardiovascular Diseases Study (SARCOS). Three hundred and thirty-two subjects over 65 years of age were evaluated. Sarcopenia was determined by EWGSOP flowchart and Osteoporosis was established by WHO's criteria. Physical function, comorbidities and medications were evaluated. Results: Women were older (79.8 ± 7.2 years) than men (78.21 ± 6.7 years) (p = 0.042). Osteoporosis occurred in 24.8% of men, and in 42.7% of women (p < 0.001); sarcopenia occurred in 25.5% of men and in 17.7%, of women (p = 0.103). Osteoporosis was diagnosed in 68% of sarcopenic women, however only 20.7% (p = 0.009) of women with osteoporosis had sarcopenia; in older men, 44.7% of individuals with sarcopenia presented osteoporosis and 42.9% (p = 0.013) of men with osteoporosis showed sarcopenia. In an adjusted logistic regression analyses for sarcopenia, osteoporosis presented a statistically significant association with sarcopenia in men [OR: 2.930 (95% CI: 1.044-8.237; p = 0.041)] but not in women [OR: 2.081 (0.787-5.5; p = 0.142)]; in the adjusted logistic regression analyses for osteoporosis, a statistically significant association occurred in men [OR: 2.984 (95% CI: 1.144-7.809; p = 0.025)], but not in women [OR: 2.093 (0.962-3.714; p = 0.137)]. Conclusion: According to sex, there are significant differences in the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults. It is strong and significant in males; in females, despite showing a positive trend, it was not statistically significant.

Fragilidade é um preditor independente de morte precoce em idosos ambulatoriais com doenças cardiovasculares no Estudo SARCOS / Frailty is an independen t predictor of early death in elderly outpatients with cardiovascular disease in the SARCOS Study

Introdução: A fragilidade caracteriza-se pela perda da capacidade biológica e física de responder adequadamente ao estresse orgânico devido aos danos a diversos sistemas associados ao processo de envelhecimento. Entre os indivíduos com doenças cardiovasculares, a frequência da fragilidade é três vezes maior. Métodos: SARCOS é um estudo epidemiológico de coorte para avaliar a síndrome de vulnerabilidade com hospitalização e mortalidade em idosos ambulatoriais com doença cardiovascular (DCV). A fragilidade foi diagnosticada na presença de três ou mais dos seguintes critérios: perda de peso > 5%, velocidade de marcha reduzida, fraqueza muscular pela força de preensão, exaustão e perda de energia (levantar e sentar da cadeira cinco vezes). Resultados: Dos 169 pacientes avaliados, a fragilidade ocorreu em 19,5% (n=33). A média de idade foi de 78,3 ± 7,1 anos. A taxa mortalidade aos seis meses foi de 3% (n=5), sendo que 80% (n=4) eram frágeis e 20% (n=1) pré-frágeis (p=0,007). Na análise de regressão logística, a fragilidade mostrou ser um forte preditor de morte aos seis meses, com aumento de risco de 18 vezes quando comparado aos fortes (p=0,010), enquanto que entre as DCVs, a insuficiência cardíaca apresentou aumento de risco de quatro vezes (p=0,061). No modelo de interação entre a fragilidade e as DCVs, não houve diferença significativa da fragilidade em relação ao risco de morte. Conclusão: A fragilidade é um importante fator de risco de morte precoce em idosos ambulatoriais, independente e superior às doenças cardiovasculares crônicas mais frequentes que acometem essa população. A síndrome da fragilidade não apresenta sinergia com doenças cardiovasculares crônicas em relação ao risco de morte

Introduction: Frailty is characterized by the loss of the biological and physical capacity to respond adequately to organic stress as a result of damage to various systems associated with aging. The frequency of frailty is three times higher among individuals with cardiovascular disease. Methods: SARCOS is an epidemiological cohort study to evaluate vulnerability syndrome with hospitalization and mortality in elderly patients with cardiovascular disease (CVD). Frailty was diagnosed when three or more of the following criteria were present: Weight loss > 5%, slow walking speed, muscle weakness by the hand-grip test, exhaustion, and loss of energy (by the five times sit-to-stand test). Results: Of the 169 patients evaluated, frailty was present in 19.5%(n = 33). The mean age was 78.3 ± 7.1 years. The mortality rate at six months was 3% (n = 5), with 80% (n = 4) being frail and 20% (n = 1) pre-frail (p = 0.007). In the logistic regression analysis, frailty was shown to be a strong predictor of death at six months, with an 18-fold increase in risk when compared to strong individuals (p = 0.010), whereas among those with CVD, the heart failure presented a 4-fold increase in risk (p = 0.061). In the interaction model between frailty and CVD, there were no significant differences in frailty in relation to the risk of death. Conclusion: Frailty is an important risk factor for early death among outpatients, independent of, and higher than the most frequent chronic cardiovascular diseases that affect this population. Frailty syndrome was not correlated with chronic cardiovascular diseases, in relation to the risk of death

Sex effects on the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults: data from the SARCOS study.

OBJECTIVE: The objective was to evaluate the association between sarcopenia (EWGSOP) and osteoporosis in older adults. SUBJECTS AND METHODS: This is a cross sectional analysis of a baseline evaluation of the SARCopenia and OSteoporosis in Older Adults with Cardiovascular Diseases Study (SARCOS). Three hundred and thirty-two subjects over 65 years of age were evaluated. Sarcopenia was determined by EWGSOP flowchart and Osteoporosis was established by WHO's criteria. Physical function, comorbidities and medications were evaluated. RESULTS: Women were older (79.8 ± 7.2 years) than men (78.21 ± 6.7 years) (p = 0.042). Osteoporosis occurred in 24.8% of men, and in 42.7% of women (p < 0.001); sarcopenia occurred in 25.5% of men and in 17.7%, of women (p = 0.103). Osteoporosis was diagnosed in 68% of sarcopenic women, however only 20.7% (p = 0.009) of women with osteoporosis had sarcopenia; in older men, 44.7% of individuals with sarcopenia presented osteoporosis and 42.9% (p = 0.013) of men with osteoporosis showed sarcopenia. In an adjusted logistic regression analyses for sarcopenia, osteoporosis presented a statistically significant association with sarcopenia in men [OR: 2.930 (95% CI: 1.044-8.237; p = 0.041)] but not in women [OR: 2.081 (0.787-5.5; p = 0.142)]; in the adjusted logistic regression analyses for osteoporosis, a statistically significant association occurred in men [OR: 2.984 (95% CI: 1.144-7.809; p = 0.025)], but not in women [OR: 2.093 (0.962-3.714; p = 0.137)]. CONCLUSION: According to sex, there are significant differences in the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults. It is strong and significant in males; in females, despite showing a positive trend, it was not statistically significant.

P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy: Analysis from the SAMPA randomized trial.

BACKGROUND: A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed. METHODS: In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n=25) 180mg loading dose followed by 90mg bid, or a prasugrel (n=25) 60mg loading dose followed by 10mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y12 assay at 0, 2, 6, and 24h after randomization. RESULTS: Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1±6.9 and 13.3±6.3h, respectively (p=0.24). The values of PRU decreased significantly from baseline to 2h (all p<0.001) and from 2h to 6h (all p<0.001) in both groups. There was no difference in PRU values between 6h and 24h. The mean PRU values at 0, 2, 6, and 24h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study. CONCLUSIONS: In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y12 receptor inhibition within 24h, although maximal platelet inhibition after these potent agents was not achieved for 6h.

Prevalência de bloqueios atrioventriculares em pacientes da Atenção Básica de Saúde: análise por telemedicina / Prevalence of atrioventricular block in Primary Health Care patients: a telemedicine analysis

Bloqueios atrioventriculares constituem um grupo de alterações da condução do impulso elétrico cardíaco detectáveis pelo eletrocardiograma. Os recursos da telemedicina para laudos de eletrocardiograma à distância têm auxiliado de modo expressivo na identificação precoce de achados clinicamente significantes. Essespacientes, sobretudo os com bloqueios atrioventriculares de 2o e 3o graus, quando não prontamente identificados e/ou tratados, apresentam alta morbimortalidade. Dados sobre a prevalência de bloqueios atrioventriculares na população brasileira são escassos. O presente estudo avaliou a prevalência de bloqueios atrioventriculares em uma grande população atendida pelo Sistema Único de Saúde. Métodos: Estudo retrospectivo observacional em que foram acessados 269.578 eletrocardiogramas do banco de dados de um serviço de telemedicina comsede em um hospital terciário da cidade de São Paulo (SP) no período de setembro de 2010 a setembro de 2015.O serviço atende remotamente a 112 unidades públicas de saúde em quatro estados das regiões Sul, Sudeste eCentro-Oeste do País. Foram pesquisados os termos conforme árvore de diagnósticos estruturada com base nas diretrizes brasileiras. Os exames repetidos por excesso de artefatos e/ou com dados incompletos foram excluídos.Resultados: Foram validados 239.003 eletrocardiogramas, com prevalência de bloqueios atrioventriculares de 3,23%. A média de idade da população com bloqueios atrioventriculares foi de 65,15 + 17,03 anos, sendo 53,82% do sexo masculino. Dentre os bloqueios atrioventriculares, os classificados como de 1o grau e 2o grau do tipo Icorresponderam a 3,13% da população total. Conclusão: Em uma grande amostra populacional, notou-se altaprevalência de bloqueios atrioventriculares. Sexo masculino e idade avançada estão estatisticamente relacionados com maior prevalência de bloqueios atrioventriculares...

Atrioventricular blocks are a group of changes in the conduction of cardiac electrical impulse that can be detected by electrocardiogram. Telemedicine resources for remote electrocardiogram reports have helped significantly in the early identification of major clinically findings. These patients, especially thosewith second and third degree atrioventricular block, if not promptly identified and/or treated, have high morbidity and mortality. Prevalence data on atrioventricular block in the Brazilian population are scarce. This study assessed the prevalence of atrioventricular block in a large population served by the Public Health System. Methods:Retrospective observational study assessing 269,578 electrocardiograms of a telemedicine service database based in a tertiary hospital in São Paulo (SP) from September, 2010 to September, 2015. The service provides remote reports to 112 public health units in States in the South, Southeast and Mid-West of the country. The terms were assessed according to a structured diagnostic tree based on the Brazilian guidelines. Electrocardiograms repeated due to excessive artifacts and/or incomplete data were excluded. Results: 239,003 electrocardiograms were validated with a prevalence of 3.23% atrioventricular blocks. Mean age of patients with atrioventricular block was 65.15 + 17.03 years, and 53.82% were male. Among atrioventricular blocks, those classified as 1st degree and 2nd degree type I corresponded to 3.13% of the overall population. Conclusion: In a large population sample, a high prevalence of atrioventricular block was observed. Male gender and older age are statistically related to a higherprevalence of atrioventricular block...

Exercise-Induced Abnormal Increase of Systolic Pulmonary Artery Pressure in Adult Patients With Sickle Cell Anemia: An Exercise Stress Echocardiography Study.

BACKGROUND: Pulmonary hypertension (PH) at rest is a risk factor for death in patients with sickle cell anemia (SCA). Exercise echocardiography (EE) can detect latent PH. We sought to investigate the occurrence of exercise-induced abnormal response of systolic pulmonary artery pressure (SPAP) in adult patients with SCA and normal SPAP at rest, and to identify the independent predictors of this abnormal response. METHODS AND RESULTS: Forty-four adult patients with SCA and normal SPAP at rest (tricuspid regurgitant jet flow velocity [TRV] <2.5 m/sec) were studied and divided into 2 groups: exhibiting normal SPAP after treadmill EE (TRV ≤ 2.7 m/sec) (G1), and exhibiting abnormal exercise-induced increase of SPAP (TRV > 2.7 m/sec) (G2). TRV cutoff points at rest and during EE were based on data from healthy-matched control subjects. Abnormal response of SPAP with exercise occurred in 57% of the sample (G2), with mean TRV level of 3.39 ± 0.41 m/sec (range 2.8-4.5 m/sec), significantly higher than those of G1 (2.29 ± 0.25 m/sec, range 2.0-2.7 m/sec; P < 0.001). Multivariate analysis identified TRV value in resting conditions ≥2.25 m/sec (P < 0.05), left atrial volume index ≥41 mL/m2 (P < 0.05), and a E/e'-waves ratio ≥6.3 (P < 0.05) as independent predictors of exercise-induced increase of SPAP. CONCLUSION: We concluded that adult patients with SCA and normal SPAP at rest may exhibit abnormal exercise-induced increase in SPAP, which was independently related to resting TRV levels, and indices of diastolic impairment and left ventricular filling pressure.

Clinical use of the volume-time curve for endotracheal tube cuff management.

BACKGROUND: Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube (ETT) cuff management. However, the clinical impact of the volume-time curve application has not been documented. The purpose of this study was to compare the occurrence and intensity of a sore throat, cough, thoracic pain, and pulmonary function between these 2 techniques for ETT cuff management: volume-time curve technique versus minimal occlusive volume (MOV) technique after coronary artery bypass grafting. METHODS: A total of 450 subjects were randomized into 2 groups for cuff management after intubation: MOV group (n = 222) and volume-time curve group (n = 228). We measured cuff pressure before extubation. We performed spirometry 24 h before and after surgery. We graded sore throat and cough according to a 4-point scale at 1, 24, 72, and 120 h after extubation and assessed thoracic pain at 24 h after extubation and quantified the level of pain by a 10-point scale. RESULTS: The volume-time curve group presented significantly lower cuff pressure (30.9 ± 2.8 vs 37.7 ± 3.4 cm H2O), less incidence and intensity of sore throat (1 h, 23.7 vs 51.4%; and 24 h, 18.9 vs 40.5%, P < .001), cough (1 h, 19.3 vs 48.6%; and 24 h, 18.4 vs 42.3%, P < .001), thoracic pain (5.2 ± 1.8 vs 7.1 ± 1.7), better preservation of FVC (49.5 ± 9.9 vs 41.8 ± 12.9%, P = .005), and FEV1 (46.6 ± 1.8 vs 38.6 ± 1.4%, P = .005) compared with the MOV group. CONCLUSIONS: The subjects who received the volume-time curve technique for ETT cuff management presented a significantly lower incidence and severity of sore throat and cough, less thoracic pain, and minimally impaired pulmonary function than those subjects who received the MOV technique during the first 24 h after coronary artery bypass grafting.

Monitorização ambulatorial de pressão arterial em gestantes normotensas / Ambulatory blood pressure monitoring in normotensive pregnant women

As controvérsias sobre os padrões pressóricos durante a gravidez normal justificam a realização de estudos para melhor entender a questão. O objetivo deste estudo foi conhecer as variações normais da pressão arterial (PA), através da monitorização ambulatorial da pressão arterial (MAPA), em gestantes saudáveis numa capital da região norte do Brasil. Foram estudadas 89 gestantes normotensas, nulíparas ou multíparas, de 3 centros obstétricos da cidade de Belém (PA). As gestantes foram divididas em três grupos, segundo a idade gestacional: Grupo 1, composto por 25 grávidas, entre 6 e 13 semanas de gestação; Grupo 2, por 32 grávidas, entre 14 e 25 semanas; e Grupo 3, por 32 grávidas, entre 28 e 38 semanas de gestação. As 89 gestantes apresentavam idade entre 18 e 35 anos (mediana de 24 anos). Não houve diferenças significantes entre o número de nulíparas e multíparas (p = 0,5555). Quanto às variáveis da MAPA analisadas (média de 24 horas) houve diferenças estatisticamente significantes apenas em três delas: PA sistólica no Grupo 3 (aumento), PA diastólica no Grupo 2 (redução) e descenso noturno diastólico no Grupo 1 (aumento). Podemos concluir que em grávidas normotensas, os parâmetros da MAPA avaliados tiveram comportamento similar aos padrões de normalidade considerados para a população geral.

Controversies regarding blood pressure patterns during normal pregnancy justify studies for their better understanding. The objective of this study was to verify normal blood pressure (BP) variations by means of ambulatory blood pressure monitoring (ABPM) in healthy pregnant women in the capital of a northern Brazilian state. A total of 89 normotensive nulliparous or multiparous pregnant women from 3 obstetric centers in the city of Belém ­ State of Pará, were studied. The pregnant women were divided into three groups, according to their gestational age: Group 1, comprising 25 pregnant women between 6 and 13 weeks of gestation; Group 2, with 32 pregnant women between 14 and 25 weeks of gestation; and Group 3, with 32 pregnant women between 28 and 38 weeks of gestation. The ages of the 89 pregnant women ranged from 18 to 35 years (median of 24,0 years). There was no significant difference between the number of nulliparae and multiparae (p = 0.5555). As regards the ABPM variables analyzed (mean of 24 hours), statistically significant differences were observed in only three of them: systolic BP in Group 3 (increase); diastolic BP in Group 2 (decrease), and diastolic nocturnal dip in Group 1 (increase). In conclusion, in normotensive pregnant women the variation of the ABPM parameters analyzed was similar to the normal patterns observed in the general population.

Exercício físico não supervisionado melhora a qualidade de vida em mulheres com hipertensão arterial atendidas em um programa de saúde da família / No supervised physical exercise improve quality of life of women with systemic arterial hypertension followed in a health family program

A atividade física é um adjuvante no tratamento de pacientes com hipertensão arterial sistêmica, entretanto seu efeito na qualidade de vida destes pacientes é pouco conhecido. O presente estudo objetiva avaliar o efeito da atividade física não supervisionada na qualidade de vida de mulheres com hipertensão arterial, seguidas num programa de saúde da família. Participaram 67 mulheres; 35 no grupo exercício e 32 no grupo-controle. Foram avaliados a qualidade de vida pelo questionário SF-36 e o desempenho físico de todas participantes, antes e após o período de 16 semanas de treinamento físico, que foi exclusivo do grupo exercício. Foram usados testes t pareado, Wilcoxon, Mann-Whitney e quiquadrado; significante se p<0,05. A aderência ao programa foi de 82,8%. Houve melhora significante no teste graduado (escala de Borg de 15,4±1,9 para 14,6±1,1; p<0,05), estágio atingido de 5,5±0,8 para 6,2±1,0 (p<0,05), teste de flexibilidade de Wells de 22,5±8,7 para 25,1±8,2 (p<0,05), resistência muscular dos membros inferiores de 17,1±4,3 to 21,2±5,2 (p<0,05) e também na qualidade de vida do grupo exercício nos oito domínios estudados do SF-36; escores variaram de 25 a 61,7 antes e 60,6 a 85 após (p<0,05). Concluiu-se que o exercício físico não supervisionado pode melhorar a qualidade de vida de mulheres com hipertensão arterial atendidas num programa de saúde da família.

Sintomas depressivos em pacientes com síndrome coronariana aguda / Depressive symptoms in patients with acute coronary syndrome

Objective: To trace an epidemiological profile, to verify presence of depressive symptoms in patients with previous diagnosis of acute coronary syndrome and to identify factors that contribute to maintenance of depressive symptoms in the sample. Methods: A cross-section study carried out at the Cardiology Outpatients Clinics of Universidade Federal de São Paulo. An instrument prepared by the authors was used, which was based on similar studies with patient identification data, questions related to the psychological follow-up, relationship with family members and friends, in addition to use of the Beck Depression Inventory. Results: A total of 200 patients were interviewed, 127 (63.5%) were male. The mean age was 60.19 years with a standard deviation of 9.38, minimum age of 36 years and maximum of 81 years; 164 (82%) denied any follow-up with a psychologist or psychiatrist in the phase after acute coronary syndrome diagnosis and treatment. In the utilization of Beck Depression Inventory, 67 (33.5%) presented scores between 0 and 4, indicating mild depressive symptoms; 72 (36%) had scores between 5 and 9, indicating mild to moderate depressive symptoms, and 61 (30.5%) presented scores greater than 9, which point out moderate to severe depressive symptoms. Conclusion: The evaluation and multiprofessional follow-up can help patients cope with the illness in addition to providing greater compliance to drug therapy and beginning changes in life habits.

Objetivo: Traçar o perfil epidemiológico da amostra, verificar a presença de sintomas de depressão em pacientes com diagnóstico prévio de síndrome coronariana aguda e identificar os fatores contribuintes para a manutenção dos sintomas de depressão naamostra estudada. Métodos: Estudo transversal realizado no Ambulatório de Cardiologia da Universidade Federal de São Paulo. Foi aplicado um instrumento elaborado pelos autores, baseado em estudos semelhantes, com dados de identificação dos pacientes, questões relacionadas ao acompanhamento psicológico, relacionamento com familiares e amigos, além da aplicação do Inventário de Depressão de Beck. Resultados: A amostra constou de 200 pacientes, sendo 127 (63,5%) do sexo masculino. A média de idade foi de 60,19 anos com um desvio padrão de 9,38, com idade mínima de 36 e máxima de 81 anos; 164 (82%) negaram ter feito qualquer acompanhamento com psicólogo ou psiquiatra na fase após o diagnóstico e tratamento da síndrome coronariana aguda. Na aplicação do Inventário de Depressão de Beck, 67 (33,5%) apresentaram escores entre 0 e 4, indicando sintomas leves de depressão; 72 (36%) apresentaram escores entre 5 e 9, indicando sintomas leves a moderados; e 61 (30,5%) apresentaram escores maiores que 9, indicando sintomas moderados a graves. Conclusão: Avaliação e acompanhamento multiprofissional podem ajudar o paciente no enfrentamento da doença além de proporcionar maior adesão à terapia farmacológica e início das mudanças de hábitos de vida.