Factors associated with surgical site infection in myocardial revascularization: a retrospective longitudinal study.

OBJECTIVES: to analyze the influence of sociodemographic and clinical variables, as well as the surgical checklist adherence score, on the occurrence of surgical site infection among patients undergoing myocardial revascularization. METHODS: an observational, longitudinal, retrospective study was conducted at a university hospital, involving 266 medical records of patients who underwent myocardial revascularization surgery. Instruments containing sociodemographic, clinical, and infection-related variables were used, along with the Perioperative Surgical Safety Checklist. Descriptive, bivariate, and logistic regression analyses were employed. RESULTS: surgical site infection occurred in 89 (33.5%) patients. There was a statistically significant association between body temperature outside the range of 36 degrees Celsius to 36.5 degrees Celsius (p=0.01), the presence of invasive devices (p=0.05), surgical procedures with the anticipation of critical events (p<0.001), and the occurrence of infection. CONCLUSIONS: body temperature, the presence of invasive devices, and surgical procedures with the anticipation of critical events were significant factors contributing to an increased risk of infection.

PREVALÊNCIA E FATORES DE RISCOS ASSOCIADOS À HIPERTENSÃO ARTERIAL EM IDOSOS HOSPITALIZADOS / PREVALENCE AND RISK FACTORS ASSOCIATED WITH HYPERTENSION IN HOSPITALIZED ELDERLY

Introdução: A hipertensão é o principal fator contribuidor para todas as causas de morte e invalidez. Alterações fisiopatológicas em razão do envelhecimento justificam alta incidência da hipertensão no idoso. Objetivo: Verificar a prevalência e fatores associados a hipertensão em idosos hospitalizados. Método: Estudo transversal, quantitativo, realizado com 233 idosos em hospital de ensino brasileiro de grande porte. Dados sociodemográficos/clínicos e hábitos de vida foram coletados. Análise bivariada e regressão logística foram realizadas, sendo considerado significativo p<0,05. Resultados: A média de idade foi 70,9±8,1anos, com prevalência do sexo masculino (63,1%), brancos (62,2%) e hipertensos (67%). Idade ≥80anos (OR:3,965, IC 95%:1,430- 10,995) e diabetes (OR:4,196, IC 95%:1,968-8,946) foram significativos para ocorrência de hipertensão. Conclusão: Indivíduos muito idosos e diabetes foram fatores significativos para hipertensão em idosos hospitalizados.

Introduction: Hypertension is the main contributing factor to all causes of death and disability. Pathophysiological changes due to aging justify a high incidence of hypertension in the elderly. Objective: To verify the prevalence and factors associated with hypertension in hospitalized elderly. Method: Cross-sectional, quantitative study conducted with 233 elderly people in a large Brazilian teaching hospital. Sociodemographic/clinical data and lifestyle habits were collected. Bivariate analysis and logistic regression were performed, and p<0.05 was considered significant. Results: The mean age was 70.9±8.1 years, with prevalence of males (63.1%), whites (62.2%) and hypertensive (67%). Age ≥80 years (OR:3.965, 95% CI:1.430-10.995) and diabetes (OR:4.196, 95% CI:1.968-8.946) were significant for the occurrence of hypertension. Conclusion: Very elderly individuals and diabetes were significant factors for hypertension in hospitalized elderly.

Risk Factors for In-Hospital Mortality from Cardiac Causes After Acute Myocardial Infarction

Abstract Background: Risk stratification on admission of patients with acute ST-elevation myocardial infarction (STEMI) is considered a clear strategy for effective treatment, early intervention, and survival. Objective: The purpose of this study was to determine the risk factors for in-hospital mortality from cardiac causes after STEMI. Methods: Observational, retrospective, longitudinal study, with a quantitative approach, based on data from the medical records of individuals diagnosed with STEMI treated at the Emergency Room of a large hospital in the state of Minas Gerais, Brazil, from January 2011 to July 2016. The outcome of interest was 30-day in-hospital mortality from after STEMI. For statistical analysis, the Pearson's chi-square test, Spearman's correlation and multivariable Cox-regression analysis were used, with a significance level of α = 0.05. Results: Of the 459 patients, 55 (12%) died from cardiac causes within 30 days after STEMI. Mean admission SBP of these patients was 109.08mmHg. The incidence of death was higher in women (23.7%), patients with systemic arterial hypertension (SAH) (13.8%) and elderly patients (16.5%). The elderly — heart rate (HR) = 3.54 — and women — HR = 2.55 — had a statistically significant higher risk of progressing to death when compared to younger adults and men. The highest admission SBP had a protective effect (HR = 0.97), reducing the chance of death by 3%. Conclusion: SBP on admission, female gender and advanced age were significant risk factors for death within 30 days after STEMI.

Factors Associated With Elevated Blood Pressure in Nursing Workers

Abstract Introduction Nurses from the night shift are exposed to sleep deprivation, which is associated with circadian rhythm alteration, lifestyle changes, psychosocial stress, and, consequently, increased risk of blood pressure (BP) deregulation and hypertension. Objective To analyze risk factors associated with elevated BP levels in nursing workers. Methods A transversal, quantitative study was conducted with 172 nursing professionals of a large hospital in the state of Minas Gerais, Brazil. The following data were collected: anthropometric and BP measurements, sociodemographic characteristics, clinical variables, and lifestyle habits. Results were evaluated by bivariate analysis and logistic regression. The level of significance adopted in the statistical analysis was 5%. Results Participants' average age was 42.7 ± 9.6 years old; 86.6% (n = 149) were female, and 20.3% (n = 35) had previous diagnosis of hypertension. Overweight and obesity (odds ratio [OR]: 2.187, 95% confidence interval [CI]: 1.060 - 4.509) and night shift (OR: 2.100, CI 95%: 1.061 - 4.158) were statistically significant (p < 0.05) for increased risk of elevated BP level. Conclusion Excessive weight and night shift were significant factors for increased BP in nursing workers.

Factors associated with surgical site infection in myocardial revascularization: a retrospective longitudinal study / Factores asociados a la infección del sitio quirúrgico en la revascularización miocárdica: estudio longitudinal retrospectivo / Fatores associados à infecção de sítio cirúrgico em revascularização miocárdica: estudo longitudinal retrospectivo

ABSTRACT Objectives: to analyze the influence of sociodemographic and clinical variables, as well as the surgical checklist adherence score, on the occurrence of surgical site infection among patients undergoing myocardial revascularization. Methods: an observational, longitudinal, retrospective study was conducted at a university hospital, involving 266 medical records of patients who underwent myocardial revascularization surgery. Instruments containing sociodemographic, clinical, and infection-related variables were used, along with the Perioperative Surgical Safety Checklist. Descriptive, bivariate, and logistic regression analyses were employed. Results: surgical site infection occurred in 89 (33.5%) patients. There was a statistically significant association between body temperature outside the range of 36 degrees Celsius to 36.5 degrees Celsius (p=0.01), the presence of invasive devices (p=0.05), surgical procedures with the anticipation of critical events (p<0.001), and the occurrence of infection. Conclusions: body temperature, the presence of invasive devices, and surgical procedures with the anticipation of critical events were significant factors contributing to an increased risk of infection.

RESUMEN Objetivos: analizar la influencia de variables sociodemográficas y clínicas, así como del puntaje de adherencia a la lista de verificación quirúrgica en aparición de infección del sitio quirúrgico en pacientes sometidos a revascularización miocárdica. Métodos: estudio observacional, longitudinal y retrospectivo realizado en un hospital universitario con 266 expedientes de pacientes sometidos a cirugía de revascularización miocárdica. Se utilizaron instrumentos que contenían variables sociodemográficas, clínicas y relacionadas con la incidencia de infecciones del sitio quirúrgico, así como la Lista de Verificación de Seguridad Quirúrgica Perioperatoria. Se realizaron análisis descriptivos, bivariados y de regresión logística. Resultados: la infección del sitio quirúrgico se produjo en 89 (33,5%) pacientes. Hubo una asociación estadísticamente significativa entre la temperatura fuera del rango de 36°C a 36,5°C(p=0,01), la presencia de dispositivos invasivos(p=0,05) y los procedimientos quirúrgicos con previsión de eventos críticos(p<0,001) y la aparición de infección. Conclusiones: la temperatura corporal, presencia de dispositivos invasivos y los procedimientos quirúrgicos con previsión de eventos críticos fueron factores significativos para aumentar el riesgo de infección.

RESUMO Objetivos: analisar a influência de variáveis sociodemográficas e clínicas e do escore de adesão ao checklist cirúrgico sobre a ocorrência de infecção de sítio cirúrgico entre pacientes submetidos à revascularização miocárdica. Métodos: estudo observacional, longitudinal, retrospectivo, realizado em hospital universitário, com 266 prontuários de pacientes submetidos à cirurgia de revascularização miocárdica. Utilizaram-se instrumentos contendo variáveis sociodemográficas, clínicas e relacionadas à incidência de infecções de sítio cirúrgico; e a Lista de Verificação de Segurança Cirúrgica Perioperatória. Empregaram-se análises descritivas, bivariadas e regressão logística. Resultados: a infecção de sítio cirúrgico ocorreu em 89 (33,5%) pacientes. Houve associação estatisticamente significativa entre temperatura fora da faixa entre 36°C e 36,5°C (p=0,01), presença de dispositivos invasivos (p=0,05) e procedimentos cirúrgicos com previsão de eventos críticos (p<0,001) e ocorrência de infecção. Conclusões: temperatura corporal, presença de dispositivos invasivos e procedimentos cirúrgicos com previsão de eventos críticos foram fatores significativos para o aumento do risco de infecção.

Cardiovascular and metabolic changes in Brazilian truck drivers.

OBJECTIVE: To identify the relationship between the Ankle Brachial Index (ABI) and the presence of cardio-metabolic diseases, alcohol, and tobacco abuse among truck drivers. METHODS: This is a cross-sectional study with a quantitative approach carried out with 235 truck drivers. Demographic, professional, clinical, alcohol, and tobacco abuse data were collected through interviews. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) instrument was used for this study. An odds ratio (OR) and 95% confidence interval (95% CI) adjusted for logistic regression were used for the association between variables. The Spearman's test was used to correlate quantitative variables. The significance level used was α = 0.05. RESULTS: The sample consisted of 235 truck drivers, all males, with an average age of 42.4 years, married (69.8%), self-reported white skin color (43.4%). ABI values equal to or less than 0.89 were identified in 38.7% of truck drivers. Tobacco abuse appeared in 18.5% of participants, and alcohol abuse was present in 8.9% of truck drivers according to the ASSIST rating. The most commonly found self-reported cardiometabolic diseases were obesity (29%), systemic arterial hypertension (SAH) (21.7%), and diabetes mellitus (DM) (10.6%). Those with altered ABI had 5.65 times the odds to have self-reported diabetes mellitus (95% CI 2.20-14.52; p = 0.0003), 2.86 times the odds to present alcohol abuse (95% CI 1.03-7.97; p = 0.0400), 3.03 times the odds to have edema (95% CI 1.25-7.36; p = 0.0144) and 5.10 times the odds to have varicose veins in the lower limbs (95% CI 2.22-11.73; p = 0.0001) compared to those with normal ABI values. CONCLUSION: Truck drivers have changes in the ABI which are associated with long working hours, alcohol abuse and the presence of diabetes mellitus.

Sleep quality and body composition in a nursing team

Recent studies have shown that nursing professionals have affected sleep quality, yet no relation between sleep quality and body composition has been established. The present study investigated the relation between body composition and sleep quality in nursing professionals. It was a transversal, quantitative, descriptive, and analytical study. Nursing workers from HC-UFU were randomly selected to participate in this study. Interviews were done with validated questionnaire to evaluate sleep quality of the professionals, and a bioimpedance exam was done with a tetrapolar device. Two hundred forty-three professionals of the nursing team participated in the survey, mostly females (n=205; 84.4%), nursing technicians (53.1%). Average abdominal circumference was 91.97±13.83 cm, body fat was 31.668.24% or 24.0711.50 kg. The body mass index (BMI) was 27.094.63. Most participants evaluated sleep quality as bad (n=99; 40.7%) and "Sleep Latency" between 31 and 60 minutes (n=74; 30.5%) in the dominion "Subjective Sleep Quality". Correlations were observed between: percentage of body water X Sleep Duration Dominion (r=-0.135; p<0.05); water resistance in the body X Dominion Sleep Efficacy (r=0.149; p<0.05); percentage of body fat X "Disfunction During the Day" (r=0.233; p<0.01); fat mass (kg) and fat percentages X "Sleep disturbance"(r=0.148; r=0.177; r=0.182; p<0.01) respectively; BMI X "Sleep Disturbance", (r=0.146; p<0.05) as well as percentage of lean mass and body water X "Sleep Disturbance" (r=-0.244; r=0.247; p<0.01). This is the first study comparing sleep quality with body composition data in a nursing team. It became clear that more studies should be done to obtain greater knowledge about the health profile of nursing teams and, therefore, establish better plans and solutions for the group studied.

Avaliação da segurança do paciente na perspectiva dos profissionais de saúde

Objetivo: Avaliar a cultura de segurança do paciente na perspectiva dos profissionais de saúde das unidades assistenciais de áreas críticas em um hospital universitário. Material e Método: Estudo observacional, seccional, de abordagem quantitativa, realizado com 207 profissionais de saúde, médicos, enfermeiros e técnicos em enfermagem de um hospital no estado de Minas Gerais, Brasil, no período de janeiro a novembro de 2020. Os participantes foram obtidos por meio de amostra não probabilística e responderam ao questionário Hospital Survey on Patient Safety Culture, instrumento já validado para a realidade brasileira. Empregaram-se análises estatística descritiva e de regressão linear múltipla; o nível de significância considerado foi α =0,05. Resultados: A dimensão melhor avaliada foi "Aprendizado Organizacional - melhoria contínua" (64,4%). Nenhuma dimensão foi considerada área forte por não receber pontuação ≥ 75%. Oito dimensões foram consideradas áreas frágeis (≤ 50%), sendo a dimensão "Respostas não punitivas aos erros" a pior avaliada (20,3%). A nota de segurança do paciente conferida pelo profissional em sua área de trabalho no hospital (β = 0,502; p< 0,001) e o tempo de trabalho no hospital (β = 0,135; p= 0,032) foram estatisticamente significativos quando associadas ao escore geral. Conclusão: O estudo permitiu identificar fragilidades dentro da instituição, sendo a resposta não punitiva aos erros a mais preocupante. Os líderes devem propor intervenções que propiciem um ambiente livre de culpa, para que os profissionais relatem os eventos adversos. Considerar a segurança do paciente como uma prioridade da gestão pode proporcionar melhor qualidade aos serviços oferecidos pela organização.

Objective: To assess patient safety culture from the perspective of health care professionals working in critical care units at a university hospital. Material and Method: Observational, sectional study, with a quantitative approach, conducted with 207 health professionals, doctors, nurses and nursing technicians from a hospital in the state of Minas Gerais, Brazil, from January to November 2020. The participants were obtained through a non-probabilistic sample and answered the Hospital Survey on Patient Safety Culture questionnaire, an instrument already validated for the Brazilian context. Descriptive statistical and multiple linear regression analyses were used; the significance level was α =0.05. Results: The best assessed dimension was "Organizational learning - continuous improvement" (64.4%). No dimension was considered particularly strong as it did not receive a score ≥ 75%. Eight dimensions were considered weak areas (≤ 50%), with the dimension "Non-punitive response to error" being the worst assessed (20.3%). The patient safety score given by the professional in their hospital working area (β=0.502, p<0.001) and the length of time working in the hospital (β=0.135, p=0.032) were statistically significant when associated with the overall score. Conclusions: This study makes it possible to identify weaknesses within the institution, with the non-punitive response to errors being the most concerning. Leaders should propose interventions that provide a blame-free environment for professionals to report adverse events. Considering patient safety as a management priority can provide better quality to the services offered by the organization.

Objetivo: Evaluar la cultura de seguridad del paciente desde la perspectiva de los profesionales de la salud que laboran en las unidades de cuidados críticos de un hospital universitario. Material y Método: Estudio observacional, seccional, con abordaje cuantitativo, realizado con 207 profesionales de la salud, médicos, enfermeros y técnicos de enfermería de un hospital en el estado de Minas Gerais, Brasil, de enero a noviembre de 2020. Los participantes fueron obtenidos a través de una muestra no probabilística y respondieron al cuestionario Hospital Survey on Patient Safety Culture, un instrumento ya validado para la realidad brasileña. Se utilizaron análisis estadísticos descriptivos y de regresión lineal múltiple; el nivel de significancia considerado fue de α =0,05. Resultados: La dimensión mejor evaluada fue "Aprendizaje organizacional - mejora continua" (64,4%). Ninguna dimensión se consideró un área fuerte por no recibir una puntuación ≥ 75%. Se consideraron áreas frágiles ocho dimensiones (≤ 50%), siendo la dimensión "Respuesta no punitiva al error" la peor evaluada (20,3%). El puntaje de seguridad del paciente otorgado por el profesional en su área laboral del hospital (β= 0,502, p <0,001) y el tiempo de trabajo laboral en el hospital (β= 0,135, p = 0,032) fueron estadísticamente significativos cuando se asociaron con la puntuación general. Conclusión: El estudio permitió identificar debilidades dentro de la institución, siendo la respuesta no punitiva a los errores la más preocupante. Los líderes deben proponer intervenciones que proporcionen un entorno libre de culpa para que los profesionales informen los eventos adversos. Considerar la seguridad del paciente como una prioridad de gestión puede aportar una mejor calidad a los servicios que ofrece la organización.

Fatores de risco associados ao déficit neurológico em pessoas vítimas de acidente vascular cerebral isquêmico / Risk factors associated with neurological déficit in ischemic stroke victims / Factores de riesgo asociados al déficit neurológico en víctimas de ictus isquémico

Objetivo: Identificar os fatores de risco associados ao déficit neurológico em pessoas vítimas de acidente vascular cerebral isquêmico. Métodos: Trata-se de um estudo retrospectivo descritivo quantitativo realizado em um hospital no interior de Minas Gerais Brasil. Os dados foram coletados em 52 prontuários, através de um instrumento contendo variáveis sociodemográficas, clínicas e janelas de tempo de tratamento. Para avaliação do déficit neurológico utilizou-se National Institutes of Health Stroke Scale. Os testes de Shapiro-Wilk, Quiquadrado de Pearson, T Student e McNemar foram utilizados para a análise estatística. O nível de significância foi de 0,05. Resultados: Na admissão hospitalar houve prevalência do déficit neurológico moderado, e na alta hospitalar, o déficit neurológico leve. O valor do déficit neurológico na admissão hospitalar e alta hospitalar foram, respectivamente 13,10 (±7,2) e 7,58 (±8,3), p = (0,000). O período de internação foi de 7,78 dias para os indivíduos com déficit neurológico leve/moderado e 11,67 dias para déficit neurológico grave (p=0,044). O tempo de janela porta agulha foi 38 minutos nos pacientes com déficit neurológico leve/moderado e 55,3 minutos para o déficit neurológico grave (p=0,025). Conclusão: Destaca-se a influência da condição neurológica no tempo de internação e a importância do atendimento ágil por parte da equipe. (AU)

Objective: To identify the risk factors associated with neurological deficit in people who victims of ischemic stroke. Methods: This is a retrospective quantitative descriptive study carried out in a hospital in the interior of Minas Gerais Brazil. Data were collected from 52 medical records, using an instrument containing sociodemographic and clinical variables and treatment time windows. To assess neurological deficit, the National Institutes of Health Stroke Scale was used. The Shapiro-Wilk, Pearson Chi- square, T Student and McNemar testes were used for statistical analysis. The significance level was 0,05. Results: At hospital admission there was a prevalence of moderate neurological deficit, and at hospital discharge, mild neurological deficit. Neurological deficit values at hospital admission and discharge werw respectively 13,10 (±7,2) and 7,58 (±8,3), p = (0,000). The hospital stay was 7,78 days for individuals with mild/moderate neurological deficit and 11,67 days for severe neurological deficit (p=0,044). The needle door window time was 38 minutes for patients with mild/moderate neurological deficit and 55,3 minutes for severe neurological deficit (p=0,025). Conclusion: The influence of the neurological condition on the length of stay and the importance of prompt care by the team are highlighted. (AU)

Objetivo: Identificar los factores de riesgo asociados al déficit neurológico en personas víctimas de ictus isquémico. Métodos: Se trata de un estudio cuantitativo descriptivo retrospectivo realizado en un hospital del interior de Minas Gerais Brasil. Se recolectaron datos de 52 historias clínicas, utilizando un instrumento que contiene variables sociodemográficas y clínicas y ventanas de tiempo de tratamiento. Para evaluar el déficit neurológico, se utilizó la National Institutes of Health Stroke Scale. Para el análisis estadístico se utilizaron las pruebas de Shapiro-Wilk, Chi-cuadrado de Pearson, T de Student y McNemar. El nivel de significancia fue 0.05. Resultados: al ingreso hospitalario prevaleció déficit neurológico moderado y al alta hospitalaria déficit neurológico leve. Los valores de déficit neurológico al ingreso y al alta hospitalaria fueron respectivamente 13,10 (± 7,2) y 7,58 (± 8,3), p = (0,000). La estancia hospitalaria fue de 7,78 días para individuos con déficit neurológico leve / moderado y de 11,67 días para déficit neurológico severo (p = 0,044). El tiempo de ventana de la puerta de la aguja fue de 38 minutos para pacientes con déficit neurológico leve / moderado y de 55,3 minutos para déficit neurológico severo (p = 0,025). Conclusión: Se destaca la influencia de la afección neurológica en la duración de la estadía y la importancia de una atención inmediata por parte del equipo. (AU)

Rastreamento da pressão arterial elevada e fatores de riscos associados em comunidade universitária / Tracking of high blood pressure and associated risk factors in the university community / Seguimiento de la hipertensión arterial y los factores de riesgo asociados en una comunidad universitaria

Objetivo: Rastrear, em uma comunidade adulta/jovem universitária, valores de pressão arterial e sua associação com fatores de risco cardiovascular. Método: Estudo transversal, realizado com 270 estudantes e 28 professores/técnicos administrativos em uma universidade pública do interior de Minas Gerais-Brasil. Medidas antropométricas e da pressão arterial foram realizadas, além de dados sociodemográficos/clínicos e hábitos de vida coletados. Análises bivariadas foram realizadas. Resultados: A média da idade dos estudantes e professores/técnicos administrativos foram, respectivamente, 23±5anos e 43±7anos, com prevalência do sexo feminino (75%). Setenta porcento dos participantes foram classificados como normotensos e 30% como pressão arterial elevada, sendo 93% pré-hipertensos e 7% hipertensos. A média da pressão arterial sistólica/diastólica e índice de massa corpórea foram maiores nos participantes com pressão arterial elevada (p<0,05). Os fatores de risco cardiovascular não apresentaram associação com a pressão arterial elevada (p>0,05). Conclusão: Alta taxa de pré-hipertensão foi observada na comunidade universitária. (AU).

Objective: Tracking, in a university young/adult community, blood pressure values and their association with cardiovascular risk factors. Method: Cross-sectional study, conducted with 270 students and 28 professors/administrative technicians at a public university in the interior of Minas Gerais-Brazil. Anthropometric and blood pressure measurements were performed, in addition to socio-demographic/clinical data and life habits collected. Bivariate analyses were performed. Results: The average age of students and teachers/technicians were, respectively, 23±5 years and 43±7 years, with prevalence of female (75%). Seventy percent of participants were classified as normotensive and 30% as elevated blood pressure, 93% being pre-hypertensive and 7% hypertensive. The mean systolic/diastolic blood pressure and body mass index were higher in participants who were identified as having elevated blood pressure (p<0.05). Cardiovascular risk factors were not associated with elevated blood pressure levels (p>0.05). Conclusion: A high rate of pre-hypertension was observed in the university community. (AU).

Objetivo: estudiar, en una comunidad universitaria de adultos/jóvenes, los valores de presión arterial y su asociación con factores de riesgo cardiovascular. Método: estudio transversal, realizado con 270 estudiantes y 28 profesores/técnicos administrativos de una universidad pública del interior de Minas Gerais-Brasil. Se hicieron mediciones antropométricas y de presión arterial, además se recolectaron datos sociodemográficos/clínicos y hábitos de vida. Se realizaron análisis bivariados. Resultados: la edad promedio de los estudiantes y profesores/técnicos administrativos fue, respectivamente, 23 ± 5 años y 43 ± 7 años, predominó el sexo femenino (75%). El setenta por ciento de los participantes fue clasificado como normotenso y el 30% como con presión arterial alta, de los cuales el 93% eran prehipertensos y el 7% hipertensos. La presión arterial sistólica/diastólica media y el índice de masa corporal fueron más altos en los participantes con presión arterial alta (p <0,05). Los factores de riesgo cardiovascular no se asociaron con niveles elevados de presión arterial (p> 0,05). Conclusión: se observó una alta tasa de prehipertensión en la comunidad universitaria. (AU).

Características laborais associadas à pressão arterial elevada entre caminhoneiros / Labor characteristics associated with high blood pressure among truck drivers / Características laborales asociadas a la hipertensión arterial entre los camioneros

Objetivo: Avaliar a prevalência de pressão arterial elevada entre caminhoneiros e sua associação a características laborais. Métodos: coleta de dados realizada por meio de instrumento semi estruturado, com questões sobre variáveis sociodemográficas, hábitos de vida, laborais, e clínicos. Não foram incluídos caminhoneiros com história clínica de hipertensão arterial. Resultados: 184 caminhoneiros com idade média (±DP) de 41,3 (±10,2) anos; a maioria percorria ao menos 3.000 km por semana (58,7%) e dirigia por mais de 10 horas diariamente (63,0 %). PA elevada foi verificada em 73 (39,6%) participantes. Mediante a análise da Odds ratio ajustado, verificou-se que entre os caminhoneiros que rodavam 3000km ou mais por semana (n=76, 41,3%) a chance de PA elevada era 2,3 vezes maior comparado ao grupo que rodava menos de 3000Km por semana (p<0,05). Conclusão: A maior distância percorrida pelos caminhoneiros aumentou cerca de duas vezes a chance desse profissional ter sua PA elevada (AU).

Objective: To evaluate the prevalence of high blood pressure among truck drivers and its association with job characteristics. Methods: data collection performed using a semi-structured instrument, developed by the researchers, with questions about sociodemographic variables, life habits, work, and clinical. Blood pressure (BP) was measured, in addition to the measurement of body weight and height. Truck drivers with a medical history of high blood pressure were not included. Results: 184 truck drivers with a mean age (± SD) of 41.3 (± 10.2) years were included; the majority covered at least 3,000 km per week (58.7%) and drove for more than 10 hours daily (63.0%). Elevated BP was verified in 73 (39.6%) participants. Through the analysis of the adjusted Odds ratio, it was found that among truck drivers who traveled 3000km or more per week (n = 76, 41.3%) the chance of high BP was 2.3 times greater compared to the group who rode less than 3000 km per week (p <0.05). Conclusion: The greater distance traveled by truck drivers increased about twice the chance of this professional having his BP increased (AU).

Objetivo: Evaluar la prevalencia de hipertensión arterial en los camioneros y su asociación con las características laborales. Métodos: recolección de datos realizada mediante un instrumento semiestructurado, desarrollado por los investigadores, con preguntas sobre variables sociodemográficas, hábitos de vida, laborales y clínicos. Se midieron la presión arterial (PA), el peso corporal y la altura. No fueron incluidos los camioneros con antecedentes médicos de hipertensión arterial. Resultados: se incluyeron 184 camioneros con una edad media (± DE) de 41,3 (± 10,2) años; la mayoría recorría al menos 3.000 km por semana (58,7%) y conducía más de 10 horas diarias (63,0%). Se detectó PA elevada en 73 (39,6%) participantes. Mediante el análisis de la razón de probabilidades ajustada, se observó que los camioneros que viajaban más de 3000 km por semana (n = 76, 41,3%) tenían 2,3 veces más probabilidades de desarrollar PA elevada que los que viajaban menos de 3000 km por semana (p <0,05). Conclusión: Un aumento en la distancia que recorren los camioneros aumentó aproximadamente el doble las posibilidades de que la PA de los mismos subiera (AU).

Diagnóstico de Enfermagem em pacientes com infarto do miocárdio: estudo longitudinal / Nursing diagnoses in patients whit myocardial infarction: follow up study / Diagnósticos de Eanfermería em pacientes com infarto de miocardio: estudio longitudinal

Objetivo: Identificar o diagnóstico de enfermagem prioritário no paciente pós-infarto do miocárdio com supradesnivelamento do segmento ST. Métodos: Estudo observacional, longitudinal, prospectivo, realizado com 54 pacientes de ambos os sexos, admitidos na fase aguda do infarto durante os primeiros cinco dias pós-infarto (D1 a D5), em um hospital de ensino. Amostragem foi não probabilística. Para a coleta de dados, utilizou-se um instrumento estruturado a partir do modelo teórico conceitual das Necessidades Humanas Básicas. Empregaram-se análises descritivas e bivariadas. Resultados: O diagnóstico de enfermagem de maior incidência no D1 pós-infarto foi Debito cardíaco diminuído, seguido por padrão respiratório ineficaz e dor aguda. O diagnóstico de enfermagem Débito Cardíaco Diminuído foi associado aos indivíduos não brancos (p<0,05). Conclusão: Observou-se a prevalência do diagnóstico de enfermagem prioritário de débito cardíaco diminuído nos cinco primeiros dias pós-infarto. (AU)

Objective: Identify the priority nursing diagnosis in the post-myocardial infarction patient with ST segment elevation. Methods: Observational, longitudinal, prospective study conducted with 54 patients of both sexes, admitted in the acute phase of infarction during the first five days post-infarction (D1 to D5), in a teaching hospital. Sampling was non-probabilistic. To collect data, we used a structured instrument from the conceptual theoretical model of Human Basic Needs. We used descriptive and bivariate analysis. Results: The nursing diagnosis with the highest incidence in post-infarction D1 was a decrease in cardiac output, followed by an ineffective breathing pattern and acute pain. The nursing diagnosis Decreased Cardiac Output was associated with non-white individuals (p <0.05). Conclusion: The prevalence of the priority nursing diagnosis of decreased cardiac output was observed in the first five days after infarction. (AU)

Objetivo: Identificar el diagnóstico de enfermería prioritario en el paciente con infarto de miocardio con elevación del segmento ST. Métodos: Estudio observacional, longitudinal, prospectivo, realizado con 54 pacientes de ambos sexos, ingresados en la fase aguda del infarto durante los primeros cinco días posteriores al infarto (D1 a D5), en un hospital universitario. El muestreo no fue probabilístico. Para la recolección de datos, se utilizó un instrumento estructurado a partir del modelo teórico conceptual de las necesidades humanas básicas. Se utilizaron análisis descriptivos y bivariados. Resultados: El diagnóstico de enfermería con la mayor incidencia en el post-infarto D1 fue disminución del gasto cardíaco, seguido de un patrón de respiración ineficaz y dolor agudo. El diagnóstico de enfermería Disminución del gasto cardíaco se asoció con individuos no blancos (p <0.05). Conclusión: La prevalencia del diagnóstico de enfermería prioritario de disminución del gasto cardíaco se observó en los primeros cinco días después del infarto. (AU)

Associations between surgical wound infectious and clinical profile in patients undergoing cardiac surgery.

BACKGROUND: Infections are surgical severe adverse events that pose risks to patient safety in health services, in addition to increasing costs and morbidity and mortality. AIM: This study aims to describe the infectious profile of patients undergoing cardiac surgery and associate comorbidities and lifestyle habits with surgical wound infection. DESIGN: Observational and retrospective study. METHODS: The study included 453 patients undergoing cardiac surgery in a public teaching hospital from January 2014 to January 2019. Data were collected from the clinical records through an instrument composed of variables clinical characteristics, comorbidities, life habits, infection rates, infectious agents, clinical management and surgical wound features. Simple frequency, measures of central tendency and variability, Chi-Square test and logistic regression were used for data analysis. RESULTS: There was a predominance of hypertensive patients (367; 81%), smokers (107; 23.6%), alcoholics (76; 16.8%). Surgical wound infection affected 86 (19%) patients. Besides, most patients were under antibiotic therapy (310; 68.4%). Klebsiella pneumoniae; Staphylococcus epidermides and Staphylococcus aureus were the most frequent pathogens. Diabetes Mellitus, nephropathy and age were statistically significant (P<0.05) for higher risk of surgical wound infection. CONCLUSION: Chronic diseases and lifestyle habits were related to postoperative infection. More research is needed, focusing on risk factors for the development of surgical wound infection.

Impacto da cirurgia de revascularização miocárdica na qualidade de vida / Impact of myocardial revascularization surgery on quality of life

Objetivo: avaliar o impacto da Cirurgia de Revascularização do Miocárdio na qualidade de vida relacionada à saúde. Método: trata-se de um estudo quantitativo, observacional, longitudinal, prospectivo, com 51 participantes submetidos à CRVM, por meio da aplicação dos questionários para avaliar a qualidade de vida relacionada à saúde EuroQol-3L (EQ5D-3L) e MacNew QLMI. Organizaram-se os dados em planilha Excel®, validando-os por dupla digitação e exportando-os para o SPSS, versão 17.0. Resultados: incluíram-se 51 participantes, sendo 74,5% do sexo masculino, 54,9% compostos por idosos ≥ 60 anos, 62,7% com cor da pele autorreferida branca, 76,4% tiveram infarto agudo do miocárdio, 72,5% apresentavam Hipertensão Arterial Sistêmica, 82,4% eram sedentários, 54,9%, ex-tabagistas e 45,1%, etilistas. Evidenciou-se, nas dimensões do EQ-5D-3L, melhora da qualidade de vida quanto ao domínio ansiedade/depressão (p = 0,000) e a Escala Visual Analógica identificou melhora do estado de saúde (p = 0,005). Demonstrou-se, no questionário MacNew QLMI, melhora da qualidade de vida nos domínios: emocional (p = 0,000); físico (p = 0,000) e social (p = 0,000). Conclusão: evidenciou-se melhora da QVRS analisada pelos questionários genérico e específico após transcorrer seis meses do pós-operatório de CRVM.(AU)

Objective: to assess the impact of Myocardial Revascularization Surgery on health-related quality of life. Method: this is a quantitative, observational, longitudinal, prospective study, with 51 participants submitted to MRVS, through the application of questionnaires to assess health-related quality of life EuroQol-3L (EQ-5D-3L) and MacNew QLMI. Data was organized in an Excel® spreadsheet, validating them by double typing and exporting them to SPSS, version 17.0. Results: 51 participants were included, of which 74.5% were male, 54.9% were elderly ≥ 60 years old, 62.7% had selfreported skin color, 76.4% had acute myocardial infarction, 72 , 5% had Systemic Arterial Hypertension, 82.4% were sedentary, 54.9%, ex-smokers and 45.1%, alcoholics. In the dimensions of the EQ-5D-3L, there was an improvement in the quality of life regarding the anxiety / depression domain (p = 0.000) and the Visual Analogue Scale identified an improvement in health status (p = 0.005). The MacNew QLMI questionnaire demonstrated an improvement in the quality of life in the following domains: emotional (p = 0.000); physical (p = 0.000) and social (p = 0.000). Conclusion: there was an improvement in the HRQoL analyzed by the generic and specific questionnaires after six months after the MRVS operation.(AU)

Objetivo: evaluar el impacto de la cirugía de revascularización de miocardio en la calidad de vida relacionada con la salud. Método: este es un estudio cuantitativo, observacional, longitudinal, prospectivo, con 51 participantes sometidos a CRVM, mediante la aplicación de cuestionarios para evaluar la calidad de vida relacionada con la salud, EuroQol-3L (EQ-5D-3L) y MacNew QLMI. Los datos se organizaron en una hoja de cálculo Excel®, validada por doble tipeo y exportada a SPSS, versión 17.0. Resultados: se incluyeron 51 participantes, hombres (74.5%), ancianos ≥ 60 años (54.9%), color de piel autoinformado blanco (62.7%), infarto agudo de miocardio (76.4%), hipertensión arterial sistémica (72,5%), inactividad física (82,4%), tabaquismo (54,9%) y alcoholismo (45,1%). Las dimensiones del EQ-5D-3L mostraron una mejora en la calidad de vida con respecto al dominio de ansiedad / depresión (p = 0,000) y la Escala Analógica Visual identificó una mejora en el estado de salud (p = 0,005). El cuestionario MacNew QLMI demostró una mejora en la calidad de vida en los dominios: emocional (p = 0,000); física (p = 0.000) y social (p = 0.000). Conclusión: hubo una mejora en la CVRS analizada por los cuestionarios genéricos y específicos, seis meses después del postoperatorio de CABG.(AU)

Papel das estatinas na modulação da função endotelial vasomotora na hipertensão e doença coronariana / The role of statins in the modulation of endothelium vasomotor function in hypertension and coronary artery disease

o benefício em longo prazo do tratamento com estatinas naprevenção de eventos coronarianos primários e secundários éindiscutível. Embora uma parte deste benefício esteja ligadaao efeito sobre a redução da circulação de lipoproteínasaterogênicas, outros mecanismos, como a modulação datrombogênese, a redução da inflamação e melhora da funçãoendotelial, têm sido investigados. O efeito da estatina sobrea função endotelial está ligado à sua inibição da produçãode superóxido e sua regulação positiva da síntese do óxidonítrico (NOS) no endotélio. Na prática clínica, o benefíciona função do endotélio depois do tratamento com estatinatem sido observado em uma ampla variedade de condiçõesque incluem a hipertensão arterial sistêmica, doença arterialcrônica e síndrome coronariana aguda. Esta breve revisãoincidirá sobre as principais conclusões relacionadas à terapiacom estatina sobre o tônus arterial sistêmico e doença arterialcoronariana aguda e crônica...

The long-term benefit of statin treatment on the prevention of primary and secondary coronary events is undisputed. Although a proportion of this effect has been linked to its reduction of circulating atherogenic lipoproteins, other mechanisms have been studied such as modulation of thrombogenesis, reduction of inflammation, and improvement of endothelia! function. Its favorable effect on endothelial function is tied to its inhibition of superoxide production and its positive regulation of nitric oxide synthase (NOS) in the endothelium. In the clinica! setting, the gain in endothelia! function after statin treatment has been observed in a wide range of conditions that include systernic hypertension, chronic arterial disease, and acute coronary syndrome. This brief review will focus on the main findings related to statin therapy on the systernic arterial tone and both acute and chronic coronary artery disease...

Circadian autonomic disturbance in resistant hypertension with and without white coat phenomenon / Distúrbios autonômicos do ritmo circadiano na hipertensão resistente com e sem o fenômeno do avental branco

JUSTIFICATIVA E OBJETIVOS: A definição de hipertensão arterial resistente inclui pacientes cuja pressão arterial permanece acima da meta apesar do uso de 3 classes de anti-hipertensivos bem como aqueles que usam 4 ou mais classes e possuem pressão controlada. A monitorização ambulatorial da pressão arterial é um método indispensável para o diagnóstico da hipertensão arterial resistente, excluindo a pseudorresistência, e classificar o hipertenso resistente em 2 grupos: hipertensão arterial resistente sem e com a presença do fenômeno do avental-branco. O objetivo deste estudo foi avaliar o perfil circadiano autonômico da hipertensão arterial resistente com e sem resposta ao fenômeno do avental-branco. MÉTODOS: Quarenta e quatro pacientes com hipertensão arterial resistente foram divididos em dois grupos: hipertensão arterial resistente com presença do fenômeno do avental-branco (n=25) e hipertensão arterial resistente sem presença do fenômeno do avental-branco (n=19). Todos os pacientes foram submetidos à medida da pressão arterial de escritório, monitorização ambulatorial da pressão arterial e eletrocardiografia ambulatorial para análise da variabilidade da frequência cardíaca. RESULTADOS: Não foram observadas diferenças entre a hipertensão arterial resistente com e sem a presença do fenômeno do avental-branco em relação à idade, índice de massa corporal ou de gênero. No grupo de hipertensão arterial resistente com a presença do fenômeno do avental-branco observou-se maior desequilíbrio autonômico avaliado por parâmetros da variabilidade da frequência cardíaca no domínio da frequência em comparação aos pacientes sem o fenômeno do avental-branco. Além disso, os parâmetros da variabilidade da frequência cardíaca noturnos no grupo da hipertensão arterial resistente com a presença do fenômeno do avental-branco correlacionaram-se positivamente com a hipertensão arterial resistente e pressão de pulso de consultório (r=0,57, p<0,05 er=0,55, p<0,05, respectivamente)...

BACKGROUND AND OBJECTIVES: The current definition of resistant hypertension includes both patients whose blood pressure is uncontrolled on three or more medications and those whose blood pressure is controlled when using four or more antihypertensive medications. Ambulatory blood pressure monitoring is an indispensable method to diagnose resistant hypertension and classify it into 2 groups: resistant hypertension without white-coat response and resistant hypertension with white-coat response. The aim of this study was to evaluate the circadian autonomic profile of resistant hypertension with and without white-coat phenomenon. METHODS: Forty four resistant hypertension patients were divided into two groups: resistant hypertension with white-coat phenomenon (n=25) and resistant hypertension without white-coat (n=19) phenomenon. All patients underwent office blood pressure measurement, ambulatory blood pressure monitoring, and 24-hour Holter monitoring. RESULTS: No differences were observed between the resistant hypertension with white-coat phenomenon and resistant hypertension without white-coat phenomenon groups regarding age, body mass index or gender. The group of resistant hypertension with white-coat phenomenon had greater autonomic imbalance evaluated by heart rate variability parameters in frequency domain compared to resistant hypertension patients without white-coat phenomenon. Moreover, nighttime frequency domain parameters of resistant hypertension group with white-coat phenomenon correlated positively with office resistant hypertension and office pulse pressure (r=0.57, p<0.05 and r=0.55, p<0.05, respectively). CONCLUSION: The presence of the white-coat response in resistant hypertension patients implies worse autonomic imbalance...

The white coat effect is not associated with additional increase of target organ damage in true resistant hypertension

Background and objective: White coat effect (WCE) (i.e., the difference between office blood pressure [OBP] and awake ambulatory blood pressure monitoring [ABPM]) may be present in hypertensive individuals. The relationship between occurrence of WCE and target organ damage (TOD) has not yet been assessed in true resistant hypertension (RHTN). Patients and methods: RHTN patients were divided into two groups: RHTN with WCE (WCE, n=66) and RHTN without WCE (non-WCE, n=61). All patients were submitted to OBP measurement, ABPM, echocardiography and renal function evaluation in three visits. Results: No differences were observed between the WCE and non-WCE groups regarding age, body mass index or gender. OBP were 169.8±15.8/95.1±14.0 (WCE) and 161.9±9.0/90.1±10.4mmHg (non-WCE), ABPM=143.0±12.8/86.1±9.9 (WCE) and 146.1±13.6/85.1±14.9mmHg (non-WCE). No statistical differences were observed between WCE and non-WCE subgroups with respect to left ventricular mass index (LVMI) (WCE=131±4.7; non-WCE=125±2.9g/m2), creatinine clearance (WCE=78±4.7; non-WCE=80±3.6ml/min/m2) and microalbuminuria (MA) (WCE=44±8.4; non-WCE=49±6.8mg/g Cr). Conclusions: This finding may suggest that WCE is not associated with additional increase of TOD in true RHTN subjects (AU)

Fundamento y objetivo: El efecto de bata blanca (EBB), es considerado cuando la diferencia entre la PAS/PAD medida en consulta médica y aquella obtenida por monitorización ambulatoria de la presión arterial (MAPA) y puede estar presente durante la consulta médica en pacientes con hipertensión arterial resistente (HTA-R). La relación entre la presencia del efecto bata blanca y daños en órganos diana aún no ha sido evaluada en individuos con HTA-R verdadera. Pacientes y método: En este estudio, sesenta y seis pacientes con HTA-R verdadera presentaron EBB y otros 61 no lo hicieron. A todos los sujetos se les practicó una monitorización ambulatoria de la presión arterial durante 24 horas (MAPA). La afectación de órganos diana se determinó mediante la realización de ecocardiograma y evaluación de la función renal. Resultados: Los valores de PAS y PAD en consulta médica fueron: 169,8±15,8/95,1±14,0 (pacientes con EBB) y 161,9±9,0/90,1±10,4mmHg (pacientes sin EBB), respectivamente y mediante MAPA los valores promedios de PAS y PAD de 24 horas fueron: 143,0±12,8/86,1±9,9 (pacientes con EBB) y 146,1±13,6/85,1±14,9 mmHg (pacientes sin EBB), respectivamente. No se observaron diferencias significativas entre los pacientes con o sin EBB con respecto al índice de masa ventricular izquierda (con EBB=131±4,7; sin EBB=125±2,9g/m2), aclaramiento de creatinina (con EBB=78±4,7; sin EBB=80±3,6ml/min/m2) y microalbuminuria (con EBB=44±8,4; sin EBB=49±6,8mg/g Cr). Conclusiones: Este hallazgo sugiere que el EBB no se asocia a incremento adicional de daños en órganos diana en pacientes con HTA-R verdadera (AU)

The white coat effect is not associated with additional increase of target organ damage in true resistant hypertension.

BACKGROUND AND OBJECTIVE: White coat effect (WCE) (i.e., the difference between office blood pressure [OBP] and awake ambulatory blood pressure monitoring [ABPM]) may be present in hypertensive individuals. The relationship between occurrence of WCE and target organ damage (TOD) has not yet been assessed in true resistant hypertension (RHTN). PATIENTS AND METHODS: RHTN patients were divided into two groups: RHTN with WCE (WCE, n=66) and RHTN without WCE (non-WCE, n=61). All patients were submitted to OBP measurement, ABPM, echocardiography and renal function evaluation in three visits. RESULTS: No differences were observed between the WCE and non-WCE groups regarding age, body mass index or gender. OBP were 169.8±15.8/95.1±14.0 (WCE) and 161.9±9.0/90.1±10.4mmHg (non-WCE), ABPM=143.0±12.8/86.1±9.9 (WCE) and 146.1±13.6/85.1±14.9mmHg (non-WCE). No statistical differences were observed between WCE and non-WCE subgroups with respect to left ventricular mass index (LVMI) (WCE=131±4.7; non-WCE=125±2.9g/m(2)), creatinine clearance (WCE=78±4.7; non-WCE=80±3.6ml/min/m(2)) and microalbuminuria (MA) (WCE=44±8.4; non-WCE=49±6.8mg/g Cr). CONCLUSIONS: This finding may suggest that WCE is not associated with additional increase of TOD in true RHTN subjects.

Infliximab reduces cardiac output in rheumatoid arthritis patients without heart failure.

OBJECTIVE: Human anti-tumor necrosis factor (TNF-α) monoclonal antibody (infliximab) is used to treat autoimmune diseases such as rheumatoid arthritis (RA). Although the risk of worsening heart failure has been described in patients under chronic treatment, the acute cardiovascular effects of this drug are unknown in RA patients without heart failure. METHODS: 14 RA patients with normal echocardiography and no history of heart failure were evaluated during the 2-hour infliximab (3-5 mg/kg) infusion period, using a noninvasive hemodynamic beat-to-beat system (Portapres). Stroke volume (SV); systolic, diastolic and mean blood pressures (SBP, DBP and MBP, respectively); cardiac output (CO); heart rate (HR); and total peripheral vascular resistance (PVR) were recorded. All patients also received saline infusion instead of infliximab as a control. Significant differences in hemodynamic parameters were determined using Tuckey's test. All values were expressed as mean ± standard deviation (SD). RESULTS: Fourteen RA patients (6M/8F) with mean age of 47.2 ± 8.8 years were evaluated. A significant decrease was found in cardiac output and stroke volume (7.04 ± 2.3 to 6.12 ± 2.1 l/min and 91 ± 29.0 to 83 ± 28.8 mL/beat, respectively) after infliximab infusion. Although not statistically significant, a progressive increase was detected in SBP, DBP and total PVR during infusion. Saline infusion did not cause significant hemodynamic changes in the same group of RA patients. No adverse effects were observed during the infusion period. CONCLUSION: Acute infliximab administration decreased cardiac output due to low stroke volume in RA patients without heart disease. The results also demonstrated that, in spite of its negative inotropic effect, infliximab enhanced BP, probably by increasing PVR.

Infliximab reduces cardiac output in rheumatoid arthritis patients without heart failure / Infliximabe reduz débito cardíaco em pacientes com artrite reumatoide sem insuficiência cardíaca

OBJECTIVE: Human anti-tumor necrosis factor (TNF-α) monoclonal antibody (infliximab) is used to treat autoimmune diseases such as rheumatoid arthritis (RA). Although the risk of worsening heart failure has been described in patients under chronic treatment, the acute cardiovascular effects of this drug are unknown in RA patients without heart failure. METHODS: 14 RA patients with normal echocardiography and no history of heart failure were evaluated during the 2-hour infliximab (3-5 mg/kg) infusion period, using a noninvasive hemodynamic beat-to-beat system (Portapres). Stroke volume (SV); systolic, diastolic and mean blood pressures (SBP, DBP and MBP, respectively); cardiac output (CO); heart rate (HR); and total peripheral vascular resistance (PVR) were recorded. All patients also received saline infusion instead of infliximab as a control. Significant differences in hemodynamic parameters were determined using Tuckey's test. All values were expressed as mean ± standard deviation (SD). RESULTS: Fourteen RA patients (6M/8F) with mean age of 47.2 ± 8.8 years were evaluated. A significant decrease was found in cardiac output and stroke volume (7.04 ± 2.3 to 6.12 ± 2.1 l/min and 91 ± 29.0 to 83 ± 28.8 mL/beat, respectively) after infliximab infusion. Although not statistically significant, a progressive increase was detected in SBP, DBP and total PVR during infusion. Saline infusion did not cause significant hemodynamic changes in the same group of RA patients. No adverse effects were observed during the infusion period. CONCLUSION: Acute infliximab administration decreased cardiac output due to low stroke volume in RA patients without heart disease. The results also demonstrated that, in spite of its negative inotropic effect, infliximab enhanced BP, probably by increasing PVR.

OBJETIVO: O inibidor de fator de necrose tumoral (TNF-α) infliximabe é usado no tratamento de doenças autoimunes como a artrite reumatoide (AR). Embora o risco de piora de insuficiência cardíaca em pacientes submetidos a tratamento crônico tenha sido descrito, os efeitos cardiovasculares agudos da infusão desta droga em pacientes com AR sem insuficiência cardíaca são desconhecidos. MÉTODOS: Pacientes com AR e ecocardiogramas normais e sem antecedentes de insuficiência cardíaca foram avaliados durante o período de infusão de infliximabe (3-5mg/kg), de 2 horas, utilizando um sistema de monitoramento hemodinâmico não invasivo batimento-a-batimento (Portapres). As variáveis avaliadas foram: volume sistólico (VS), pressão arterial sistólica, diastólica e média (PAS, PAD e PAM, respectivamente), débito cardíaco (DC), frequência cardíaca (FC) e resistência vascular periférica total (RVPT). Todos os voluntários também receberam infusão de soro fisiológico (SF) como estudo controle. Estatísticas foram avaliadas usando o teste de Tuckey. Os valores estão expressos em média ± desvio-padrão. RESULTADOS: Catorze pacientes (6M/8F), com idade média de 47,2 ± 8,8 anos, foram avaliados. Reduções significativas no débito cardíaco e volume sistólico foram encontradas após a infusão do infliximabe (7,04 ± 2,3 a 6,12 ± 2,1 L/min e 91 ± 29,0 a 83 ± 28,8 mL/batimento, respectivamente). Embora não estatisticamente significante, detectaram-se aumentos progressivos na PAS, PAD e RVPT durante a infusão. A infusão controle de SF não causou mudanças hemodinâmicas significativas nos pacientes estudados. Não foram observados efeitos adversos no período de infusão. CONCLUSÃO: A administração de infliximabe reduz agudamente o débito cardíaco devido a redução no volume sistólico em pacientes com AR sem insuficiência cardíaca. Nossos resultados mostram que, apesar do efeito inotrópico negativo, o infliximabe elevou a pressão arterial, provavelmente devido ao aumento na RVPT.