Impact of pharmaceutical care on the quality of life of patients with heart failure due to chronic Chagas disease: Randomized clinical trial.

AIMS: Chronic Chagas disease (ChD) has high morbimortality and loss in quality of life due to heart failure (HF). Pharmaceutical care (PC) optimizes clinical treatment and can improve quality of life in HF. We evaluated if PC improves quality of life of patients with ChD and HF. METHODS: Single-blinded, randomized, controlled trial that assigned adult patients with ChD and HF (81 patients; 61 ± 11 years; 48% male) to PC (n = 40) or standard care (n = 41). Quality of life according to SF-36 and Minnesota living with HF questionnaires, incidence of drug-related problems (DRPs), and adherence to medical treatment were determined at baseline and at every 3 months for 1 year. Intention-to-treat analyses were performed by mixed linear model to verify the treatment effect on the changes of these variables throughout the intervention period. RESULTS: Relative changes from baseline to 1 year of follow-up of the domains physical functioning (+16.6 vs -8.5; P < .001), role-physical (+34.0 vs +5.2; P = .01), general health (+19.4 vs -6.1; P < .001), vitality (+11.5 vs. -5.8; P = .003), social functioning (+7.5 vs -13.3; P = .002), and mental health (+9.0 vs -3.7; P = .006) of the SF-36 questionnaire and the Minnesota living with HF questionnaire score (-12.7 vs +4.8; P < .001) were superior in the PC group than in the standard care group. Adherence to medical treatment increased as early as after 3 months of follow-up and DRPs incidence decreased after 6 months of follow-up only in the PC group. CONCLUSIONS: Patients with ChD and HF who received PC presented improved quality of life, decrease in DRP frequency, and increase in medication adherence.

Relação entre Comportamento Glicêmico eLactacidêmico no Exercício Resistido / Relationship Between Glycemic and Lactacidemic Behavior in the Resistance Exercise

Investigar a relação entre o comportamentoglicêmico e a produção de lactato no exercício demusculação. Material e Métodos: Cinco homens (18 e 25anos), realizaram dois treinamentos com três séries de 10exercícios para membros inferiores, com intensidade elevada(SI), utilizando-se 08 a 12 repetições máximas; e moderada(SM), com cargas equivalentes a 50% da utilizada em SI.Coletas sanguíneas foram tomadas antes e ao final de cadadois exercícios. As concentrações séricas de lactato eglicemia foram feitas em analisadores portáteis. Os dadosforam tratados pelo teste de Wilcoxon e pela correlação deSpearman (p< 0,05). Resultados: Em SI, a glicemia mostrousesempre mais elevada (98, 93.4, 100, 103 e 104 mg/dl) queem SM (95.6, 90.6, 93.8, 90.2 e 92.4 mg/dl), com p<0,05 nosdois últimos exercícios. Os maiores valores glicêmicos foramacompanhados de concentrações séricas de lactato maiselevadas em SI (7.08, 8.40, 9.12, 7.66, 8.82 mM), comparadocom SM (6.12, 7.54, 6.06, 5.22 e 6.70 mM), com p<0,05 nastrês últimas medidas. Observou-se correlação entre lactatoe glicemia em SI (r2= 0,839) e SM (R2= 0,873), indicandorelação de causa e efeito entre lactacidemia e glicemia.Conclusão: A maior produção de lactato em exercícios dealta intensidade pode ser entendido como um dos fatoresenvolvidos nos maiores valores glicêmicos encontradosnestes exercícios...

To Investigate the relationship between behaviorglycemic and lactate production in the resistance training.Material and methods: Five males (age 18 to 25), performedtwo sessions with three series of 10 exercises for the lowerlimbs, with intensity high (SI), using 08 to 12 maximalrepetitions; and moderate (SM), with loads equivalent to 50%of SI. Blood samples were taken before and at the end ofevery two exercises. The serum concentrations of lactateand glucose were made in portable analyzers. The Datawere treated by the Wilcoxon test and by Spearman’scorrelation (p<0.05). Results: In SI, glycemia was alwayshigher (98, 93.4, 100, 103 and 104 mg/dl) that SM (95.6, 90.6,93.8, 90.2 and 92.4 mg/dl), with p<0.05 in the last twoexercises. The highest glycemic values were accompaniedby serum higher concentrations of lactate in SI (7.08, 8.40,9.12, 7.66, 8.82 mM), compared with SM (6.12, 7.54, 6.06,5.22 and 6.70 mM), with p<0.05 in the last three measures. Itwas observed correlation between lactate and glycemia inboth SI (r2= 0.839) and SM (r2= 0.873), indicating a cause -effect relationship between lactacidemia and glycemia.Conclusion: The greater lactate production in exercises ofthe high intensity may be understood as one of the factorsinvolved in the largest glycemic values encountered in theseexercises...

Obstruction of the left ventricular outflow tract after mitral valvuloplasty with implantation of Gregori's ring.

Mitral valvuloplasty is efficient for repairing mitral valve disease with few complications. In some cases, obstruction of the left ventricular outflow tract may occur due to systolic anterior motion of the mitral valve. We report the case of a patient with this complication and a pressure gradient between the left ventricle and the aorta of 130 mm Hg after mitral valvuloplasty with implantation of a Gregori's ring. The management was clinical with suspension of the vasoactive drugs and introduction of a beta-blocker. Two years after the surgery, the patient is asymptomatic and has a normal life.

Obstruçäo da via de saída do ventrículo esquerdo após plastia valvar mitral com implante do anel de Gregori / Obstruction of the left ventricular outflow tract after mitral valvuloplasty with implantation of Gregori's ring

Mitral valvuloplasty is efficient for repairing mitral valve disease with few complications. In some cases, obstruction of the left ventricular outflow tract may occur due to systolic anterior motion of the mitral valve. We report the case of a patient with this complication and a pressure gradient between the left ventricle and the aorta of 130 mm Hg after mitral valvuloplasty with implantation of a Gregori's ring. The management was clinical with suspension of the vasoactive drugs and introduction of a beta-blocker. Two years after the surgery, the patient is asymptomatic and has a normal life