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1.
Int J Sports Med ; 40(4): 283-291, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30791079

RESUMO

Blood pressure (BP) and hemodynamic response to heated water-based (HEx) vs. land-based exercise (LEx) were assessed in 15 (6 men) older hypertensives (age 66.4±4.9 yr) under pharmacological treatment. Participants were randomly assigned to perform 30 min of moderate-intensity HEx (walking inside the pool), LEx (walking on a treadmill) and non-exercise control (CON) intervention. Resting BP, arterial stiffness, endothelial reactivity and heart rate variability (HRV) were measured before, immediately after, and 45 min after interventions. 24-h ambulatory BP monitoring was performed after interventions. Resting systolic (but not diastolic) BP reduced 9.9±3.1 mmHg (P<0.01) 45 min after HEx only. 24-h systolic and diastolic, daytime diastolic and nightime systolic BP were lower (P<0.05) after HEx than both LEx and CON. Daytime systolic BP was also lower (P<0.05) after HEx than CON. Nighttime diastolic was not different between interventions. HEx-induced ambulatory BP reduction ranged 4.5±1.3 mmHg (24-h diastolic BP) to 9.5±3.0 mmHg (nighttime systolic BP), and persisted for 18/11 h in systolic/diastolic BP, when compared with CON. No significant changes in arterial stiffness, endothelial reactivity and HRV were found during any intervention. These results suggest that HEx may have important implications for managing BP in older hypertensive under pharmacological treatment.


Assuntos
Terapia por Exercício/métodos , Hidroterapia/métodos , Hipertensão/terapia , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Endotélio Vascular/fisiologia , Feminino , Frequência Cardíaca , Temperatura Alta , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Rigidez Vascular
2.
Can J Cardiol ; 34(12): 1641-1647, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527153

RESUMO

BACKGROUND: Heated water-based exercise (HEx) promotes a marked reduction of blood pressure (BP), but it is not entirely clear whether its effects on BP persist after cessation of HEx. METHODS: We analyzed the effects of cessation of HEx on 24-hour ambulatory BP monitoring (ABPM) in patients with resistant hypertension (RH). Thirty-two patients (aged 53 ± 6 years) with RH (4 to 6 antihypertensive drugs) were randomly assigned to HEx (n = 16) or control (n = 16) groups. Antihypertensive therapy remained unchanged during the protocol. The HEx group participated in 36 sessions (60 minutes) in a heated pool (32oC [89.6°F]) for 12 weeks (training), followed by 12 weeks of cessation of training. The control group was evaluated during the same period and instructed to maintain their habitual activities. RESULTS: HEx and control groups had similar BP levels at baseline. HEx training reduced the 24-hour systolic (-19.5 ± 4.6 vs 3.0 ± 0.7 mm Hg, P = 0.001) and diastolic BP (-11.1 ± 2.4 vs 2.06 ± 0.9 mm Hg, P = 0.001) at week 12, compared with the control group. After 12 weeks of training cessation (week 24), 24-hour BP remained significantly lower in the HEx group than in the control group (-9.6 ± 3.8 vs 6.3 ± 3.5 mm Hg, P = 0.01 and -7.5±2.2 vs 2.2 ± 1.0 mm Hg, P = 0.009, for systolic and diastolic BP, respectively), although these differences were attenuated. CONCLUSIONS: BP remained lower after cessation of 12-week training among patients with RH who underwent HEx compared with the controls. The carryover effects of HEx on BP may help to overcome the challenging problem of exercise compliance in long-term follow-up.


Assuntos
Terapia por Exercício , Temperatura Alta/uso terapêutico , Hipertensão/terapia , Água , Anti-Hipertensivos/uso terapêutico , Resistência a Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio
4.
Artigo em Inglês | MEDLINE | ID: mdl-30230920

RESUMO

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

5.
Front Plant Sci ; 9: 614, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29868070

RESUMO

Nickel (Ni)-a component of urease and hydrogenase-was the latest nutrient to be recognized as an essential element for plants. However, to date there are no records of Ni deficiency for annual species cultivated under field conditions, possibly because of the non-appearance of obvious and distinctive symptoms, i.e., a hidden (or latent) deficiency. Soybean, a crop cultivated on soils poor in extractable Ni, has a high dependence on biological nitrogen fixation (BNF), in which Ni plays a key role. Thus, we hypothesized that Ni fertilization in soybean genotypes results in a better nitrogen physiological function and in higher grain production due to the hidden deficiency of this micronutrient. To verify this hypothesis, two simultaneous experiments were carried out, under greenhouse and field conditions, with Ni supply of 0.0 or 0.5 mg of Ni kg-1 of soil. For this, we used 15 soybean genotypes and two soybean isogenic lines (urease positive, Eu3; urease activity-null, eu3-a, formerly eu3-e1). Plants were evaluated for yield, Ni and N concentration, photosynthesis, and N metabolism. Nickel fertilization resulted in greater grain yield in some genotypes, indicating the hidden deficiency of Ni in both conditions. Yield gains of up to 2.9 g per plant in greenhouse and up to 1,502 kg ha-1 in field conditions were associated with a promoted N metabolism, namely, leaf N concentration, ammonia, ureides, urea, and urease activity, which separated the genotypes into groups of Ni responsiveness. Nickel supply also positively affected photosynthesis in the genotypes, never causing detrimental effects, except for the eu3-a mutant, which due to the absence of ureolytic activity accumulated excess urea in leaves and had reduced yield. In summary, the effect of Ni on the plants was positive and the extent of this effect was controlled by genotype-environment interaction. The application of 0.5 mg kg-1 of Ni resulted in safe levels of this element in grains for human health consumption. Including Ni applications in fertilization programs may provide significant yield benefits in soybean production on low Ni soil. This might also be the case for other annual crops, especially legumes.

6.
J Am Coll Cardiol ; 71(20): 2281-2290, 2018 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-29540327

RESUMO

BACKGROUND: Anthracycline (ANT) chemotherapy is associated with cardiotoxicity. Prevention with ß-blockers remains controversial. OBJECTIVES: This prospective, randomized, double-blind, placebo-controlled study sought to evaluate the role of carvedilol in preventing ANT cardiotoxicity. METHODS: The authors randomized 200 patients with HER2-negative breast cancer tumor status and normal left ventricular ejection fraction (LVEF) referred for ANT (240 mg/m2) to receive carvedilol or placebo until chemotherapy completion. The primary endpoint was prevention of a ≥10% reduction in LVEF at 6 months. Secondary outcomes were effects of carvedilol on troponin I, B-type natriuretic peptide, and diastolic dysfunction. RESULTS: Primary endpoint occurred in 14 patients (14.5%) in the carvedilol group and 13 patients (13.5%) in the placebo group (p = 1.0). No differences in changes of LVEF or B-type natriuretic peptide were noted between groups. A significant difference existed between groups in troponin I levels over time, with lower levels in the carvedilol group (p = 0.003). Additionally, a lower incidence of diastolic dysfunction was noted in the carvedilol group (p = 0.039). A nonsignificant trend toward a less-pronounced increase in LV end-diastolic diameter during the follow-up was noted in the carvedilol group (44.1 ± 3.64 mm to 45.2 ± 3.2 mm vs. 44.9 ± 3.6 mm to 46.4 ± 4.0 mm; p = 0.057). CONCLUSIONS: In this largest clinical trial of ß-blockers for prevention of cardiotoxicity under contemporary ANT dosage, the authors noted a 13.5% to 14.5% incidence of cardiotoxicity. In this scenario, carvedilol had no impact on the incidence of early onset of LVEF reduction. However, the use of carvedilol resulted in a significant reduction in troponin levels and diastolic dysfunction. (Carvedilol Effect in Preventing Chemotherapy-Induced Cardiotoxicity [CECCY]; NCT01724450).

7.
Arq Bras Cardiol ; 110(2): 188-194, 2018 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29466487

RESUMO

Heart transplantation (HTx) is considered an efficient and gold-standard procedure for patients with end-stage heart failure. After surgery, patients have lower aerobic power (VO2max) and compensatory hemodynamic responses. The aim of the present study was to assess through a systematic review with meta-analysis whether high-intensity interval training (HIIT) can provide benefits for those parameters. This is a systematic review with meta-analysis, which searched the databases and data portals PubMed, Web of Science, Scopus, Science Direct and Wiley until December 2016 (pairs). The following terms and descriptors were used: "heart recipient" OR "heart transplant recipient" OR "heart transplant" OR "cardiac transplant" OR "heart graft". Descriptors via DeCS and Mesh were: "heart transplantation'' OR "cardiac transplantation". The words used in combination (AND) were: "exercise training" OR "interval training" OR "high intensity interval training" OR "high intensity training" OR "anaerobic training" OR "intermittent training" OR "sprint training". The initial search identified 1064 studies. Then, only those studies assessing the influence of HIIT on the post-HTx period were added, resulting in three studies analyzed. The significance level adopted was 0.05. Heart transplant recipients showed significant improvement in VO2peak, heart rate and peak blood pressure in 8 to 12 weeks of intervention.


Assuntos
Transplante de Coração/reabilitação , Treinamento Intervalado de Alta Intensidade/normas , Transplantados , Feminino , Humanos , Masculino , Consumo de Oxigênio/fisiologia
8.
Arq. bras. cardiol ; 110(2): 188-194, Feb. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-888012

RESUMO

Abstract Heart transplantation (HTx) is considered an efficient and gold-standard procedure for patients with end-stage heart failure. After surgery, patients have lower aerobic power (VO2max) and compensatory hemodynamic responses. The aim of the present study was to assess through a systematic review with meta-analysis whether high-intensity interval training (HIIT) can provide benefits for those parameters. This is a systematic review with meta-analysis, which searched the databases and data portals PubMed, Web of Science, Scopus, Science Direct and Wiley until December 2016 (pairs). The following terms and descriptors were used: "heart recipient" OR "heart transplant recipient" OR "heart transplant" OR "cardiac transplant" OR "heart graft". Descriptors via DeCS and Mesh were: "heart transplantation'' OR "cardiac transplantation". The words used in combination (AND) were: "exercise training" OR "interval training" OR "high intensity interval training" OR "high intensity training" OR "anaerobic training" OR "intermittent training" OR "sprint training". The initial search identified 1064 studies. Then, only those studies assessing the influence of HIIT on the post-HTx period were added, resulting in three studies analyzed. The significance level adopted was 0.05. Heart transplant recipients showed significant improvement in VO2peak, heart rate and peak blood pressure in 8 to 12 weeks of intervention.


Resumo O transplante de coração é considerado procedimento eficiente e padrão ouro para pacientes com quadro de insuficiência cardíaca terminal. Verifica-se que após o procedimento cirúrgico os pacientes apresentam menor valor de potência aeróbia (VO2máx) e respostas hemodinâmicas descompensadas. O objetivo do presente estudo foi de verificar por meio de uma revisão sistemática com meta-análise se o treinamento intervalado de alta intensidade é capaz de proporcionar benefícios a tais capacidades. Trata-se de uma revisão sistemática com meta-análise, que realizou buscas em pares nas bases e portais de dados PubMed, Web of Science, Scopus, Science Direct e Wiley até dezembro de 2016. Para busca dos artigos utilizaram-se os termos e descritores: "heart recipient" OR "heart transplant recipient" OR "heart transplant" OR "cardiac transplant" OR "heart graft". Os descritores pelo DeCS e Mesh foram: "heart transplantation'' OR "cardiac transplantation". As palavras utilizadas em combinação (AND) foram "exercise training" OR "interval training" OR "high intensity interval training" OR "high intensity training" OR "anaerobic training" OR "intermittent training" OR "sprint training". A busca inicial identificou 1064 estudos. Em seguida, apenas os estudos que analisaram a influência do treinamento intervalado de alta intensidade no período pós transplante foram adicionados, sendo, assim, três estudos analisados. O nível adotado nas análises estatísticas para determinar significância foi de 0,05. Verificou-se que, entre 8 e 12 semanas de intervenção, os pacientes transplantados de coração apresentaram melhoras significativas em VO2pico, frequência cardíaca e pressão arterial pico.

9.
ESC Heart Fail ; 5(3): 249-256, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29266804

RESUMO

AIMS: The SHIFT trial showed that ivabradine reduced heart rate (HR) and the risk of cardiovascular outcomes. Concerns remain over the efficacy and safety of ivabradine on heart failure (HF) due to Chagas disease (ChD). We therefore conducted a post hoc analysis of the SHIFT trial to investigate the effect of ivabradine in these patients. METHODS AND RESULTS: SHIFT was a randomized, double-blind, placebo-controlled trial in symptomatic systolic stable HF, HR ≥ 70 b.p.m., and in sinus rhythm. The ChD HF subgroup included 38 patients, 20 on ivabradine, and 18 on placebo. The ChD HF subgroup showed high prevalence of bundle branch right block and, compared with the overall SHIFT population, lower systolic blood pressure; higher use of diuretics, cardiac glycosides, and antialdosterone agents; and lower use of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker or target daily dose of beta-blocker. ChD HF presented a poor prognosis (all-cause mortality at 2 years was ~60%). The mean twice-daily dose of ivabradine was 6.26 ± 1.15 mg and placebo 6.43 ± 1.55 mg. Ivabradine reduced HR from 77.9 ± 3.8 to 62.3 ± 10.1 b.p.m. (P = 0.005) and improved functional class (P = 0.02). A trend towards reduction in all-cause death was observed in ivabradine arm vs. placebo (P = 0.07). Ivabradine was not associated with serious bradycardia, atrioventricular block, hypotension, or syncope. CONCLUSIONS: ChD HF is an advanced form of HF with poor prognosis. Ivabradine was effective in reducing HR in these patients and improving functional class. Although our results are based on a very limited sample and should be interpreted with caution, they suggest that ivabradine may have a favourable benefit-risk profile in ChD HF patients.

10.
Rev. bras. cir. plást ; 32(4): 472-479, out.-dez. 2017. ilus
Artigo em Inglês, Português | LILACS-Express | ID: biblio-878707

RESUMO

Introdução: Várias técnicas de rejuvenescimento facial buscam encontrar resultados satisfatórios com mínimas complicações. Com a introdução da lipoaspiração, a cirurgia da face teve um grande benefício na região cervical. O objetivo deste estudo é demonstrar a técnica de tunelização associada a lipoaspiração prévia e descolamento reduzido da face e plicatura do SMAS/ platisma para tratamento do envelhecimento facial. Métodos: Foram analisados retrospectivamente os resultados obtidos com 129 pacientes operados entre 2005 e 2015, com a tática cirúrgica proposta, aqui demonstrada. Resultados: Os pacientes apresentaram boa satisfação com a tática cirúrgica utilizada, baixo índice de complicações e retorno rápido ao trabalho. Conclusões: A ritidoplastia com tunelização associada a lipoaspiração e descolamento seletivo é efetiva, com boa mobilidade e segurança do retalho cutâneo suprajacente, reprodutível, sendo uma opção no tratamento do envelhecimento facial.


Introduction: Multiple facial rejuvenation techniques have been used to obtain satisfactory results with minimal complications. With the introduction of liposuction for facial surgery, treatment of the cervical region has improved. This study aimed to describe a technique using preceding liposuction combined with reduced detachment and plication of the superficial muscular aponeurotic system/platysma for treatment of facial aging. Methods: We retrospectively analyzed the results in 129 patients who underwent surgery between 2005 and 2015. Results: The patients reported satisfaction with the surgical technique, a low complication rate, and early return to work. Conclusions: Rhytidectomy with tunneling combined with liposuction and selective detachment is effective, with good mobility of the overlying skin flap; the technique is safe and reproducible, and is an option for the treatment of facial aging.

12.
Eur J Prev Cardiol ; 24(8): 808-817, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28134562

RESUMO

Background In patients with heart failure, inflammation has been associated with worse functional capacity, but it is uncertain whether it could affect their response to exercise training. We evaluated whether inflammatory biomarkers are related to differential effect of exercise on the peak oxygen uptake (V˙O2) among patients with heart failure. Design Open, parallel group, randomized controlled trial. Methods Patients with heart failure and ejection fraction ≤0.4 were randomized into exercise training or control for 12 weeks. Patients were classified according to: 1) inflammatory biomarkers blood levels, defined as 'low' if both interleukin-6 and tumor necrosis factor-alpha blood levels were below median, and 'high' otherwise; and 2) galectin-3 blood levels, which also reflect pro-fibrotic processes. Results Forty-four participants (50 ± 7 years old, 55% men, 25% ischemic) were allocated to exercise training ( n = 28) or control ( n = 16). Exercise significantly improved peak V˙O2 among participants with 'low' inflammatory biomarkers (3.5 ± 0.9 vs. -0.7 ± 1.1 ml/kg per min, p = 0.006), as compared with control, but not among those with 'high' inflammatory biomarkers (0.4 ± 0.6 vs. -0.2 ± 0.7 ml/kg per min, p = 0.54, p for interaction = 0.009). Similarly, exercise improved peak V˙O2 among participants with below median (2.4 ± 0.8 vs. -0.3 ± 0.9 ml/kg per min, p = 0.032), but not among those with above median galectin-3 blood levels (0.3 ± 0.7 vs. -0.7 ± 1.0 ml/kg per min, p = 0.41, p for interaction = 0.053). Conclusion In patients with heart failure, levels of biomarkers that reflect pro-inflammatory and pro-fibrotic processes were associated with differential effect of exercise on functional capacity. Further studies should evaluate whether exercise training can improve clinical outcomes in patients with heart failure and low levels of these biomarkers.


Assuntos
Terapia por Exercício , Tolerância ao Exercício , Insuficiência Cardíaca/terapia , Mediadores da Inflamação/sangue , Interleucina-6/sangue , Fator de Necrose Tumoral alfa/sangue , Adulto , Biomarcadores/sangue , Brasil , Teste de Esforço , Feminino , Fibrose , Galectina 3/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
13.
Circ J ; 81(3): 339-345, 2017 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-28049937

RESUMO

BACKGROUND: The neurohumoral and endothelial responses to the blood pressure (BP) lowering effects of heated water-based exercise (HEx) in resistant hypertension (HT) patients remain undefined.Methods and Results:We investigated these in 44 true resistant HT patients (age 53.3±0.9 years, mean±SEM). They were randomized and allocated to 2 groups, 28 to a HEx training protocol, which consisted of callisthenic exercises and walking in a heated pool for 1 h, three times weekly for 12 weeks and 16 patients to a control group maintaining their habitual activities. Measurements made before and after 12 weeks of HEx included clinic and 24-h BP, plasma levels of nitric oxide, endothelin-1, aldosterone, renin, norepinephrine and epinephrine, as well as peak V̇O2, and endothelial function (reactive hyperemia). After 12 weeks of HEx patients showed a significant decrease in clinic and 24-h systolic and diastolic BPs. Concomitantly, nitric oxide increased significantly (from 25±8 to 75±24 µmol/L, P<0.01), while endothelin-1 (from 41±5 to 26±3 pg/mL), renin (from 35±4 to 3.4±1 ng/mL/h), and norepinephrine (from 720±54 to 306±35 pg/mL) decreased significantly (P<0.01). Plasma aldosterone also tended to decrease, although not significantly (from 101±9 to 76±4 pg/mL, P=NS). Peak V̇O2increased significantly after HEx (P<0.01), while endothelial function was unchanged. No significant change was detected in the control group. CONCLUSIONS: The BP-lowering effects of HEx in resistant HT patients were accompanied by a significant reduction in the marked neurohumoral activation characterizing this clinical condition.


Assuntos
Banhos , Endotélio Vascular , Terapia por Exercício , Hipertensão , Adulto , Idoso , Aldosterona/sangue , Endotelina-1/sangue , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiopatologia , Epinefrina/sangue , Feminino , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/sangue , Norepinefrina/sangue , Renina/sangue
14.
Oncotarget ; 8(4): 6994-7002, 2017 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-28052002

RESUMO

Cardiotoxicity is associated with the chronic use of doxorubicin leading to cardiomyopathy and heart failure. Identification of cardiotoxicity-specific miRNA biomarkers could provide clinicians with a valuable prognostic tool. The aim of the study was to evaluate circulating levels of miRNAs in breast cancer patients receiving doxorubicin treatment and to correlate with cardiac function. This is an ancillary study from "Carvedilol Effect on Chemotherapy-induced Cardiotoxicity" (CECCY trial), which included 56 female patients (49.9±3.3 years of age) from the placebo arm. Enrolled patients were treated with doxorubicin followed by taxanes. cTnI, LVEF, and miRNAs were measured periodically. Circulating levels of miR-1, -133b, -146a, and -423-5p increased during the treatment whereas miR-208a and -208b were undetectable. cTnI increased from 6.6±0.3 to 46.7±5.5 pg/mL (p<0.001), while overall LVEF tended to decrease from 65.3±0.5 to 63.8±0.9 (p=0.053) over 12 months. Ten patients (17.9%) developed cardiotoxicity showing a decrease in LVEF from 67.2±1.0 to 58.8±2.7 (p=0.005). miR-1 was associated with changes in LVEF (r=-0.531, p<0.001). In a ROC curve analysis miR-1 showed an AUC greater than cTnI to discriminate between patients who did and did not develop cardiotoxicity (AUC = 0.851 and 0.544, p= 0.0016). Our data suggest that circulating miR-1 might be a potential new biomarker of doxorubicin-induced cardiotoxicity in breast cancer patients.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Cardiotoxicidade/genética , Doxorrubicina/efeitos adversos , MicroRNAs/sangue , Biomarcadores , Neoplasias da Mama/sangue , Neoplasias da Mama/genética , Carbazóis , Cardiotoxicidade/sangue , Cardiotoxicidade/fisiopatologia , Carvedilol , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Propanolaminas , Curva ROC , Volume Sistólico/efeitos dos fármacos , Troponina C/metabolismo , Função Ventricular Esquerda/efeitos dos fármacos
15.
Ann Med ; 49(2): 165-175, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27763780

RESUMO

INTRODUCTION: Ambient air pollution is associated with adverse cardiovascular events. This meta-analysis aimed to investigate the short-term association between air pollution and cardiovascular effects on healthy volunteers. METHODS: We searched databases to identify randomized trials with controlled human exposures to either of two models for studying ambient particulate matter: diesel-exhaust or concentrated ambient particles. Estimates of size effect were performed using standardized mean difference (SMD). Heterogeneity was assessed with I2 statistics. Outcomes were vascular function estimated by forearm blood flow (FBF), blood pressure, heart rate, and blood analysis. RESULTS: Database searches yielded 17 articles (n = 342) with sufficient information for meta-analyses. High levels of heterogeneity for the some outcomes were analyzed using random-effects model. The pooled effect estimate showed that short-term exposure to air pollution impaired FBF response from 2.7 to 2.5 mL/100 mL tissue/min (SMD 0.404; p = .006). There was an increase in 5000 platelet/mm3 following pollution exposure (SMD 0.390; p = .050) but no significant differences for other outcomes. CONCLUSION: Controlled human exposures to air pollution are associated with the surrogates of vascular dysfunction and increase in platelet count, which might be related to adverse cardiovascular events. Given the worldwide prevalence of exposure to air pollution, these findings are relevant for public health. KEY MESSAGES Controlled exposure to air pollution impairs vasomotor response, which is a surrogate for adverse cardiovascular events. This is the first meta-analysis from randomized clinical trials showing short-term association between air pollution and cardiovascular effects on healthy volunteers. Given the worldwide prevalence of exposure to air pollution, this finding is important for public health.


Assuntos
Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/etiologia , Material Particulado/envenenamento , Emissões de Veículos/envenenamento , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
16.
Rev. Bras. Psicoter. (Online) ; 19(1): 32-42, 2017.
Artigo em Inglês | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-849208

RESUMO

OBJETIVO: A formação médica é geradora de ansiedade, tornando os estudantes de medicina vulneráveis a transtornos psiquiátricos, em particular os transtornos de ansiedade. Para lidar com a ansiedade o estudante de medicina lança mão de vários mecanismos de defesa. Objetivou-se avaliar a associação entre a presença de sintomas de ansiedade e o estilo defensivo em alunos de uma escola médica pública federal. MÉTODO: Trata-se de um estudo observacional transversal, de uma amostra de estudantes de medicina, do primeiro e sexto ano, devidamente matriculados e frequentando regularmente as aulas. No presente estudo utilizou-se um questionário sócio-demográfico, o Inventário Beck de Ansiedade e o questionário de estilo defensivo (DSQ-40). RESULTADOS: Responderam aos questionários 232 alunos, 110 do primeiro ano e 122 do sexto, representando 67,4% do total de alunos matriculados. Em relação aos mecanismos de defesa na amostra, as analises multivariadas mostraram que mecanismos de defesa neuróticos e imaturos estavam associados à presença de ansiedade (p < 0,001). CONCLUSÃO: Os dados encontrados no estudo apontam que alunos do curso médico que apresentaram sintomas de ansiedade utilizaram significativamente mais mecanismos de defesa neurótiocos e imaturos do que os que não tinham esses sintomas. Planos de prevenção, atenção e estratégias de apoio psicológico deveriam ser desenvolvidos para esse grupo, pois os mecanismos de defesa não parecem ser adaptativos em estudantes de medicina enfrentando ansiedade.(AU)


OBJECTIVE: Medical training is a generator of anxiety, making medical students vulnerable to psychiatric disorders. To deal with anxiety, medical students make use of several defense mechanisms. The aim was to assess the association between the presence of symptoms of anxiety and the defense style in students of a federal public medical school. METHOD: This is a cross-section observational study, of a sample of medical students, of the first and sixth years, duly enrolled and regularly attending classes. For the present study a socio-demographic questionnaire, the Beck Anxiety Inventory and the Defense Style Questionnaire (DSQ-40) were used. RESULTS: The questionnaires were answered by 232 students, 110 from the first year and 122 of the sixth year, representing 67.4% of the total amount of students. In relation to the defense mechanisms in the sample, the multivariate analysis showed that neurotic and immature defense mechanisms were associated with the presence of anxiety (p<0.001). CONCLUSION: The data found in this study indicate that medical students who showed symptoms of anxiety, used more neurotic or immature defense mechanisms than students who did not present these symptoms. Prevention and attention plans, as well as psychological support strategies should be developed for this group, because defense mechanisms do not appear to be adaptive in medical students experiencing anxiety.(AU)


Assuntos
Ansiedade , Mecanismos de Defesa , Estudantes de Medicina
17.
JACC Heart Fail ; 4(6): 517-8, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27256758
18.
Arq. bras. cardiol ; 106(6): 502-509, tab, graf
Artigo em Inglês | LILACS-Express | ID: lil-787319

RESUMO

Abstract Background: Idiopathic dilated cardiomyopathy (IDCM), most common cardiac cause of pediatric deaths, mortality descriptor: a low left ventricular ejection fraction (LVEF) and low functional capacity (FC). FC is never self reported by children. Objective: The aims of this study were (i) To evaluate whether functional classifications according to the children, parents and medical staff were associated. (iv) To evaluate whether there was correlation between VO2 max and Weber's classification. Method: Prepubertal children with IDCM and HF (by previous IDCM and preserved LVEF) were selected, evaluated and compared. All children were assessed by testing, CPET and functional class classification. Results: Chi-square test showed association between a CFm and CFp (1, n = 31) = 20.6; p = 0.002. There was no significant association between CFp and CFc (1, n = 31) = 6.7; p = 0.4. CFm and CFc were not associated as well (1, n = 31) = 1.7; p = 0.8. Weber's classification was associated to CFm (1, n = 19) = 11.8; p = 0.003, to CFp (1, n = 19) = 20.4; p = 0.0001and CFc (1, n = 19) = 6.4; p = 0.04). Conclusion: Drawing were helpful for children's self NYHA classification, which were associated to Weber's stratification.


Resumo Fundamento: A cardiomiopatia dilatada idiopática (CMDid) possui poucos preditores de mortalidade descritos: a baixa fração de ejeção de ventrículo esquerdo (FEVE) e a baixa capacidade funcional, sendo esta subjetiva. Objetivo: Os objetivos desse estudo foram (i) Avaliar se as classes funcionais propostas pela NYHA, modificada para crianças, estiveram associadas entre a percepção médica (CFm), dos pais ou representantes (CFp) e das próprias crianças avaliadas (CFc). (ii) Avaliar se houve correlação entre VO2 max e a classificação proposta por Weber. Método: Crianças com CMDid e com IC por CMDid prévia com FEVE preservada, na fase pré-puberdade foram selecionadas submetidas a avaliações de ergoespirometria e classificação da classe funcional. As crianças utilizaram uma representação gráfica para se intitular quanto à classe funcional. Resultado: O teste Chi-quadrado mostrou que houve associação ente a CFm e CFp (1, n = 31) = 20,6; p = 0,002. Não houve associação significativa entre CFp e CFc (1, n = 31) = 6,7; p = 0,4. As CF segundo médico e CFc não foram, tampouco, associadas (1, n = 31) = 1,7; p = 0,8. A classificação de Weber foi significativamente associada às três classes funcionais (classificação de Weber e CFm (1, n = 19) = 11,8; p = 0,003; classificação de Weber e CFp (1, n = 19) = 20,4; p = 0,0001; classificação de Weber e CFc (1, n = 19) = 6.4; p = 0.04.). Conclusão: A representação gráfica serviu para que as crianças pudessem se classificar segundo a NYHA, que se demonstrou associada com a estratificação de Weber.

19.
Arq Bras Cardiol ; 106(6): 502-9, 2016 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-27168472

RESUMO

BACKGROUND: Idiopathic dilated cardiomyopathy (IDCM), most common cardiac cause of pediatric deaths, mortality descriptor: a low left ventricular ejection fraction (LVEF) and low functional capacity (FC). FC is never self reported by children. OBJECTIVE: The aims of this study were (i) To evaluate whether functional classifications according to the children, parents and medical staff were associated. (iv) To evaluate whether there was correlation between VO2 max and Weber's classification. METHOD: Prepubertal children with IDCM and HF (by previous IDCM and preserved LVEF) were selected, evaluated and compared. All children were assessed by testing, CPET and functional class classification. RESULTS: Chi-square test showed association between a CFm and CFp (1, n = 31) = 20.6; p = 0.002. There was no significant association between CFp and CFc (1, n = 31) = 6.7; p = 0.4. CFm and CFc were not associated as well (1, n = 31) = 1.7; p = 0.8. Weber's classification was associated to CFm (1, n = 19) = 11.8; p = 0.003, to CFp (1, n = 19) = 20.4; p = 0.0001and CFc (1, n = 19) = 6.4; p = 0.04). CONCLUSION: Drawing were helpful for children's self NYHA classification, which were associated to Weber's stratification.


Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Consumo de Oxigênio/fisiologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Cardiomiopatia Dilatada/classificação , Criança , Pré-Escolar , Estudos Transversais , Teste de Esforço , Feminino , Humanos , Masculino , Ventilação Voluntária Máxima/fisiologia , Esforço Físico/fisiologia , Projetos Piloto , Estudos Prospectivos , Distribuição Aleatória
20.
Int J Cardiol ; 215: 92-7, 2016 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-27107547

RESUMO

BACKGROUND: Air pollution exposure could mitigate the health benefits of exercise in patients with heart failure (HF). We tested the effects of a respiratory filter on HF patients exposed to air pollution during exercise. METHODS AND RESULTS: Ancillary analysis of the FILTER-HF trial, focused on the exercise outcomes. In a randomized, double-blind, 3-way crossover design, 26 HF patients and 15 control volunteers were exposed to clean air, unfiltered dilute diesel engine exhaust (DE), or filtered DE for 6min during a submaximal cardiopulmonary testing in a controlled-exposure facility. Prospectively collected data included six-minute walking test [6mwt], VO2, VE/VCO2 Slope, O2Pulse, pulmonary ventilation [VE], tidal volume, VD/Vt, oxyhemoglobin saturation and CO2-rebreathing. Compared to clean air, DE adversely affected VO2 (11.0±3.9 vs. 8.4±2.8ml/kg/min; p<0.001); 6mwt (243.3±13.0 vs. 220.8±13.7m; p=0.030); and O2Pulse (8.9±1.0 vs. 7.8±0.7ml/beat; p<0.001) in HF patients. Compared to DE, filtration reduced the particulate concentration from 325±31 to 25±6µg/m(3), and was associated with an increase in VO2 (10.4±3.8ml/kg/min; p<0.001 vs. DE) and O2Pulse (9.7±1.1ml/beat; p<0.001 vs. DE) in patients with HF. Filtration was associated with higher VE and CO2-rebreathing in both groups. VE/VCO2 Slope was higher among patients with HF. CONCLUSION: DE adversely affects exercise capacity in patients with HF. A simple respiratory filter can reduce the adverse effects of pollution on VO2 and O2Pulse. Given the worldwide prevalence of exposure to traffic-related air pollution, these findings are relevant for public health especially in this highly susceptible population. The filter intervention holds great promise that needs to be tested in future studies.


Assuntos
Poluição do Ar/efeitos adversos , Teste de Esforço/métodos , Insuficiência Cardíaca/fisiopatologia , Exposição por Inalação , Dispositivos de Proteção Respiratória , Emissões de Veículos , Adulto , Estudos Cross-Over , Método Duplo-Cego , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Exposição por Inalação/efeitos adversos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Ventilação Pulmonar/fisiologia
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