Estrategia de orientación físico-terapéutica, para personas con cardiopatía isquémica crónica fase III

Los ejercicios físico-terapéuticos son significativos para la rehabilitación de personas con cardiopatía isquémica crónica fase III; de ahí, la importancia de la investigación que se presenta dada la necesidad de concientizar el ejercicio físico como una práctica regular para conservar una salud favorable. La investigación tuvo como objetivo aplicar una estrategia de orientación físico-terapéutica para personas con cardiopatía isquémica crónica fase III, sustentada en un modelo de igual naturaleza, basado en una perspectiva profiláctica, preventiva y salubrista. Se utilizaron los métodos teóricos de análisis-síntesis, inducción-deducción y sistémico-estructural-funcional. Se emplearon métodos empíricos como la observación a clases, el análisis documental, la entrevista, la encuesta, la técnica de los diez deseos, el grupo de discusión y la triangulación para contrastar e interpretar la información. El diagnóstico reveló la limitada preparación de los profesores y el desinterés hacia las actividades por algunos cardiópatas; se utilizó el criterio de especialistas para evaluar los resultados y el estadístico-matemático para el análisis porcentual y procesamiento de tablas y gráficos. Fueron elaborados un modelo y una estrategia de orientación físico-terapéutica para personas con cardiopatía isquémica crónica fase III. Se concluyó que las acciones diseñadas en la estrategia facilitaron la preparación de estos pacientes, con vistas a su reincorporación social y laboral.

Os exercícios fisioterapêuticos são significativos para a reabilitação de pessoas com cardiopatia isquêmica crônica fase III; daí a importância da pesquisa apresentada dada a necessidade de conscientização sobre o exercício físico como prática regular para manter uma saúde favorável. O objetivo da investigação foi aplicar uma estratégia de orientação fisioterapêutica a pessoas com doença cardíaca isquémica crónica fase III, apoiada num modelo da mesma natureza, assente numa perspetiva profilática, preventiva e de saúde. Foram utilizados os métodos teóricos de análise-síntese, indução-dedução e sistêmico-estrutural-funcional. Métodos empíricos como observação de aulas, análise documental, entrevistas, pesquisas, técnica dos dez desejos, grupos de discussão e triangulação foram utilizados para contrastar e interpretar as informações. O diagnóstico revelou o preparo limitado dos professores e o desinteresse pelas atividades por parte de alguns cardiopatas; Foram utilizados critérios de especialistas para avaliação dos resultados e critérios estatístico-matemáticos para análise percentual e processamento de tabelas e gráficos. Foram desenvolvidos um modelo e uma estratégia de orientação físico-terapêutica para pessoas com cardiopatia isquêmica crônica fase III. Concluiu-se que as ações desenhadas na estratégia facilitaram o preparo desses pacientes, visando sua reinserção social e laboral.

Physical-therapeutic exercises are significant for the rehabilitation of people with phase III chronic ischemic heart disease; hence, the importance of the research presented given the need to raise awareness of physical exercise as a regular practice to maintain favorable health. The objective of the research was to apply a physical-therapeutic orientation strategy for people with phase III chronic ischemic heart disease, supported by a model of the same nature, based on a prophylactic, preventive and health perspective. The theoretical methods of analysis-synthesis, induction-deduction and systemic-structural-functional were used. Empirical methods such as class observation, documentary analysis, interviews, surveys, the ten wishes technique, discussion groups and triangulation were used to contrast and interpret the information. The diagnosis revealed the limited preparation of the teachers and the lack of interest in the activities by some heart patients; the criteria of specialists were used to evaluate the results and the statistical-mathematical criteria for the percentage analysis and processing of tables and graphs. A model and a physical-therapeutic orientation strategy for people with phase III chronic ischemic heart disease were developed. It was concluded that the actions designed in the strategy facilitated the preparation of these patients, with a view to their social and work reintegration.

Factores de riesgos de mortalidad por enfermedades cardiovasculares en adultos mayores / Mortality Risk Factors from Cardiovascular Diseases in Older Adults

Introducción: Las enfermedades cardiovasculares ateroescleróticas están en el nivel máximo de las enfermedades que afectan tanto a mujeres como a hombres adultos mayores en todo el mundo. Objetivo: Evaluar las posibles diferencias de sexo y tipo de enfermedad aterosclerótica, en pacientes mayores de 60 años, fallecidos por enfermedad cardiovascular. Métodos: Se realizó un estudio descriptivo de corte transversal en 237 adultos mayores, fallecidos por enfermedad cardiovascular, perteneciente a tres áreas de salud del municipio Santiago de Cuba, en el período de enero a diciembre de 2021 Se analizaron variables socio-demográficas y clínicas. La información fue procesada y analizada mediante estadística descriptiva. Se sistematizó la información con el paquete estadístico versión 22 y Excel. Resultados: Existieron diferencias significativas en los factores de riesgos de tabaquismo y alcoholismo con una mayor frecuencia en la población masculina, la obesidad, el sedentarismo y la diabetes mellitus fue más relevante en las mujeres, con similar comportamiento en el infarto agudo de miocardio y la enfermedad cerebrovascular. Conclusiones: La mortalidad generada por las enfermedades cardiovasculares, en la población de adultos mayores, es similar para ambos sexos la presencia de factores de riesgo evidenciaron la misma frecuencia para la mortalidad por enfermedad del corazón y cerebrovascular(AU)

Introduction: Atherosclerotic cardiovascular diseases are at the highest level of diseases that affect both older women and men worldwide. Objective: To evaluate the possible differences of sex and type of atherosclerotic disease in patients over 60 years of age who died of cardiovascular disease. Methods: A descriptive cross-sectional study was carried out in 237 older adults who died from cardiovascular disease, belonging to three health areas of Santiago de Cuba municipality, from January to December 2021. Sociodemographic and clinical variables were analyzed. The information was processed and analyzed using descriptive statistics. The information was systematized with the statistical package version 22 and Excel. Results: There were significant differences in the risk factors of smoking and alcoholism with a higher frequency in the male population, obesity, sedentary lifestyle. Diabetes mellitus was more relevant in females, with similar behavior for acute myocardial infarction and cerebrovascular disease. Conclusions: The mortality generated by cardiovascular diseases, in the population of older adults, is similar in both sexes. The presence of risk factors showed the same frequency for mortality from heart disease and cerebrovascular disease(AU)

Cardiovascular Risk Factors in Premature Ovarian Insufficiency using Hormonal Therapy / Fatores de risco cardiovascular na insuficiência ovariana prematura em uso de terapia hormonal

Abstract Objective Premature ovarian insufficiency (POI) is characterized by early hypoestrogenism. An increased risk of cardiovascular (CV) disease is a long-term consequence of POI. A challenge of hormone therapy (HT) is to reduce the CV risk. Methods Cross-sectional study with lipid profile analysis (total cholesterol, LDL-C, HDL-C, VLDL-C and triglycerides), blood glucose levels and arterial blood pressure of women with POI using HT, compared with age and BMI-matched women with normal ovarian function (controls). Results The mean age and BMI of 102 POI patients using HT and 102 controls were 37.2 ± 6.0 and 37.3 ± 5.9 years, respectively; 27.0 ± 5.2 and 27.1 ± 5.4 kg/m2. There wasn't difference between groups in arterial systolic and diastolic blood pressure, blood glucose levels, total cholesterol, LDL-C, VLDL-C and triglycerides. HDL-C levels were significantly higher in the POI group (56.3 ± 14.6 and 52 ± 13.9mg/dL; p = 0.03). Arterial hypertension was the most prevalent chronic disease (12% in the POI group, 19% in the control group, p = ns), followed by dyslipidemia (6 and 5%, in POI and control women). Conclusion Women with POI using HT have blood pressure levels, lipid and glycemic profile and prevalence of hypertension and dyslipidemia similar to women of the same age and BMI with preserved gonadal function, in addition to better HDL levels.

Resumo Objetivo A insuficiência ovariana prematura (IOP) é caracterizada pelo hipoestrogenismo precoce. Risco aumentado de doença cardiovascular (CV) é uma consequência a longo prazo da IOP e um desafio da terapia hormonal (TH) é reduzir o risco CV. Métodos Estudo transversal com análise do perfil lipídico (colesterol total, LDL-C, HDL-C, VLDL-C e triglicerídeos), glicemia e pressão arterial de mulheres com IOP em uso de TH, em comparação a mulheres com função ovariana normal (controles) pareadas por idade e IMC. Resultados A média de idade e IMC de 102 pacientes com IOP em uso de TH e 102 controles foi de 37,2 ± 6,0 e 37,3 ± 5,9 anos, respectivamente; 27,0 ± 5,2 e 27,1 ± 5,4 kg/m2. Não houve diferença entre os grupos na pressão arterial sistólica e diastólica, glicemia, colesterol total, LDL-C, VLDL-C e triglicerídeos. Os níveis de HDL-C foram significativamente maiores no grupo IOP (56,3 ± 14,6 e 52 ± 13,9mg/dL; p = 0,03). A hipertensão arterial foi a doença crônica mais prevalente (12% no grupo POI, 19% no grupo controle, p = ns), seguida da dislipidemia (6 e 5%, no grupo POI e controle). Conclusão Mulheres com IOP em uso de TH apresentam níveis pressóricos, perfil lipídico e glicêmico e prevalência de hipertensão e dislipidemia semelhantes às mulheres da mesma idade e IMC com função gonadal preservada, além de melhores níveis de HDL.

Bloqueo del eje renina angiontensina aldosterona (RAAS) en la enfermedad renal diabética. Más allá del control de la hipertensión arterial / Renin angiotensin aldosterone system (RAAS) and its suppression in diabetic kidney disease. Control of arterial hypertension and beyond

La enfermedad renal diabética (ERD) es una comorbilidad con alta prevalencia a nivel mundial, siendo una de las complicaciones más frecuentes de la diabetes mellitus (DM). La ERD se relaciona con complicaciones cardiovasculares y progresión de la enfermedad renal crónica (ERC), por ello la identificación de factores modificables, como el control de la presión arterial, es uno de los pilares más importantes en el manejo integral. En esta revisión hacemos un recorrido sobre el papel de la hipertensión y el bloqueo del eje renina angiotensina aldosterona (RAAS) en el curso de la ERD y las estrategias terapéuticas orientadas a la reducción de la presión arterial (PA), el bloqueo RAAS y el impacto en resultados renales y cardiovasculares. El objetivo de este artículo es hacer una revisión de las intervenciones más importantes que actúan bloqueando el eje renina angiotensina aldosterona (RAAS) y determinar si estas medidas en los pacientes con ERD, solo tienen impacto en el control de la presión arterial o si también son estrategias de nefro y cardio-protección. Conclusión: La ERD es una de las complicaciones más frecuentes de la diabetes mellitus (DM). El control de la PA sigue siendo un pilar fundamental para lograr estos objetivos. Los bloqueadores del RAAS (iECAS y BRAs) son los antihipertensivos de elección con efecto terapéutico por el bloqueo RAAS y esto les permite tener además del control de la PA, efectos nefroprotectores y cardioprotectores importantes en pacientes con ERD, sobre todo cuando hay la presencia de albuminuria. Evaluamos que además de los inhibidores de la enzima convertidora de angiotensina (iECAs) y los bloqueadores del receptor de angiotensina (BRAs), vienen tomando importancia los antagonistas selectivos del receptor mineralocorticoide (ARM) como Finerenona.

Diabetic kidney disease (DKD) is a comorbidity with a high worldwide prevalence, and one of the most frequent complications of diabetes mellitus (DM). CKD is related to cardiovascular complications and the progression of chronic kidney disease (CKD), therefore the identification of modifiable factors, such as blood pressure control, is one of the most important pillars in comprehensive management. In this review, we will analyze the role of hypertension and the renin-angiotensin-aldosterone system (RAAS) and its suppression in the course of CKD, and therapeutic strategies aimed at reducing blood pressure (BP), RAAS blockade, and the impact on renal and cardiovascular outcomes. The objective of this article is to review the most important interventions that act by blocking the renin-angiotensin-aldosterone system (RAAS) and to determine if these measures in patients with CKD only have an impact on blood pressure control or if they are also nephron and cardio-protective strategies. Conclusion: DKD is one of the most frequent complications of diabetes mellitus (DM). BP control continues to be a fundamental pillar to achieve these objectives. RAAS blockers (iECAS and ARBs) are the first-line antihypertensive with a therapeutic effect due to RAAS blockade and this allows them to have, in addition to BP control, important nephroprotective and cardioprotective effects in patients with CKD, especially when there is albuminuria. We evaluated that in addition to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), selective mineralocorticoid receptor antagonists (MRA) such as Finerenone are gaining importance.

Prevalência de saúde cardiovascular ideal na população adulta brasileira - Pesquisa Nacional de Saúde 2019 / Prevalencia de salud cardiovascular ideal en la población adulta brasileña - Encuesta Nacional de Salud 2019 / Prevalence of ideal cardiovascular health in the Brazilian adult population - National Health Survey 2019

Objective: to analyze the prevalence of ideal cardiovascular health (CVH) in the Brazilian adult population based on the 2019 National Health Survey. Methods: this was a population-based cross-sectional study (n = 77,494); prevalence and respective 95% confidence intervals (95%CI) of ideal CVH (seven metrics achieved simultaneously) and by individual metrics (four behavioral and three biological metrics), as defined by the American Heart Association, were estimated. Results: only 0.5% (95%CI 0.4;0.6) of the study population presented ideal CVH, with higher prevalence among those with higher level of education (1.3%; 95%CI 0.9;1.6) and residents in urban areas (0.6%; 95%CI 0.5;0.7); the prevalence of behavioral and biological metrics was 0.7% (95%CI 0.6;0.8) and 63.3% (95%CI 62.7;63.9) respectively. Conclusion: the prevalence of ideal CVH was very low, highlighting the need for public policies aimed at promotion, surveillance and CVH care in the Brazilian adult population.

Objetivo: analizar la prevalencia de salud cardiovascular (SCV) ideal en la población adulta brasileña con base en la Encuesta Nacional de Salud de 2019. Métodos: estudio transversal de base poblacional (n = 77.495). Según lo propuesto por la Asociación Americana del Corazón, la prevalencia y los intervalos de confianza del 95% (IC95%) del SCV ideal se estimaron globalmente (siete metas alcanzadas simultáneamente) y por metas individuales (cuatro metas de comportamiento y tres metas). Se calculó la prevalencia de las metas por variables sociodemográficas. Resultados: sólo el 0,5% (IC95% 0,4;0,6) de la población presentó SCV ideal, siendo más frecuente en aquellos con educación superior (1,3%; IC95% 0,9;1,6) y entre los residentes de áreas urbanas (0,6%; IC95%0,5;0,7). La prevalencia de las metas de comportamiento y biológicas fue de 0,7% (IC95% 0,6;0,8) y 63,3% (IC95% 62,7;63,9), respectivamente. Conclusión: la prevalencia de SCV ideal en adultos brasileños es muy baja, destacando la necesidad de políticas públicas para la promoción, vigilancia y atención a la SCV en la población adulta brasileña.

Objetivo: analisar a prevalência de saúde cardiovascular (SCV) ideal na população adulta brasileira. Métodos: estudo transversal com base na Pesquisa Nacional de Saúde de 2019 (n = 77.494); foram estimadas as prevalências e respectivos intervalos de confiança de 95% (IC95%) de SCV ideal (sete metas alcançadas simultaneamente) e por metas individuais (quatro metas comportamentais; três biológicas), conforme propõe a Associação Americana do Coração. Resultados: apenas 0,5% (IC95% 0,4;0,6) da população estudada apresentou SCV ideal, observando-se maior prevalência entre aqueles com maior escolaridade (1,3%; IC95% 0,9;1,6) e os residentes em áreas urbanas (0,6%; IC95% 0,5;0,7); as prevalências das metas comportamentais e biológicas foram de 0,7% (IC95% 0,6;0,8) e 63,3% (IC95% 62,7;63,9) respectivamente. Conclusão: a prevalência de SCV ideal foi muito baixa, evidenciando a necessidade de políticas públicas para promoção, vigilância e atenção à SCV na população adulta brasileira.

The epidemiological burden of reducing salt intake in Paraguay: A modeling study / A carga epidemiológica da redução do sal no Paraguai: um estudo de modelagem

ABSTRACT Objective This study aims to estimate the epidemiological burden of excessive salt intake reduction and achieve the World Health Organization salt reduction target for 2025 in Paraguay, in 2019. Methods We used the Preventable Risk Integrated Model, a comparative risk assessment macro-simulation model, to estimate the averted deaths, disease incidence, and disability-adjusted life years from cardiovascular disease attributable to salt intake in the population of Paraguay for different salt reduction policy scenarios. Results As a result, in Paraguay, excessive salt intake (over 5 g/day) is responsible for approximately 2,656 cardiovascular disease deaths (95% Uncertainty Interval: 1,250-3,765), 4,816 cardiovascular disease cases (95% UI: 2,251-6,947), and 60,529 disability-adjusted life years (95% UI: 27,828-86,258) per year. By reducing salt consumption by 30%, as recommended by the World Health Organization until 2025, approximately 1,188 deaths (95% UI: 520 to 1,820), 2,100 incident cases (95% UI: 923-3,234), and 27,272 disability-adjusted life years (95% UI: 11,999-41,675) from cardiovascular disease could be averted every year. Conclusion In conclusion, the burden of cardiovascular disease attributable to excessive salt intake is significant and salt reduction policies must become a priority in Paraguay.

RESUMO Objetivo Este estudo visa estimar a carga epidemiológica do consumo excessivo de sal e o alcance da meta da Organização Mundial de Saúde para 2025 no Paraguai, em 2019. Métodos Foi usado um modelo de avaliação comparativa de risco (Preventable Risk Integrated Model) para análise comparativa de risco para estimar mortes, casos incidentes e anos de vida ajustados por incapacidade (DALYs) por doenças cardiovasculares atribuíveis ao consumo excessivo de sal na população paraguaia em diferentes cenários. Resultados No Paraguai, o consumo excessivo de sal é responsável por aproximadamente 2.656 mortes (Intervalo de Incerteza 95%: 1.250-3.765), 4.816 casos incidentes (95% II: 2.251-6.947) e 60.529 DALYs (95% II: 27.828-86.258) por doenças cardiovasculares por ano. Com uma redução de 30% no consumo de sal, como recomendado pela Organização Mundial de Saúde até 2025, aproximadamente 1.188 mortes (95% II: 520-1.820), 2.100 casos incidentes (95% II: 923-3.234) e 27.272 DALYs (95% II: 11.999-41.675) por doenças cardiovasculares poderiam ser prevenidos ou adiados por ano. Conclusão Concluiu-se que a carga de doenças cardiovasculares atribuível ao consumo excessivo de sal no Paraguai é significante e políticas de redução deveriam ser priorizadas no país.

Enfermedades cardiovasculares: ¿qué perciben las mujeres de Uruguay? / Cardiovascular diseases: what do women in Uruguay perceive? / Doenças cardiovasculares: ¿o que percebem as mulheres no Uruguai?

Antecedentes: aunque la enfermedad cardiovascular (ECV) es la principal causa de muerte de las mujeres en Uruguay, ellas no lo perciben. Objetivos: el propósito de este estudio fue evaluar la percepción, el conocimiento y las conductas de prevención de las ECV entre mujeres por grupos de edad, nivel socioeconómico (NSE) y región, así como su conocimiento sobre factores de riesgo, síntomas y comportamientos cardiosaludables. Métodos: en 2020 se encuestaron vía web 700 mujeres de entre 20 y 70 años, residentes en Uruguay (Montevideo: 301, interior del país: 399). Se pautó publicidad en redes sociales para convocar a la población objetivo a participar. Las integrantes de la muestra, que completaron una encuesta autoadministrada, presentaban distribución similar a la población general en cuanto al NSE y la edad. Resultados: las mujeres encuestadas percibieron a la ECV como principal problema de salud (PS) en el 10% y como primera CM en el 18%. Las montevideanas, comparadas con las del interior, tuvieron mayores niveles de percepción (PS: 13% vs. 7%-CM: 20% vs. 17%); así como las de NSE alto vs. las de medio-bajo (PS: 17% vs. 8%-CM: 29% vs. 14%). La percepción y el conocimiento sobre ECV son bajos, las jóvenes son las menos informadas (escasos/muy escasos: 62%). Los médicos advierten poco sobre síntomas (23%) y estrategias de prevención (48%). Conclusión: la percepción de las mujeres encuestadas sobre la ECV es baja, existiendo brechas por edad, NSE y región. En la consulta, los médicos informan poco sobre el tema. Es necesario un esfuerzo continuo para mejorar la percepción de las mujeres sobre la ECV en su propio género, intentando llegar principalmente a las poblaciones de mayor riesgo.

Background: although cardiovascular disease (CVD) is the main cause of death for women in Uruguay, they do not perceive it. Objectives: the purpose of this study was to evaluate the perception, knowledge, and prevention behaviors of CVD among women by age group, socioeconomic level (SEL), and region, as well as knowledge of risk factors, symptoms, and heart-healthy behaviors. Method and result: online survey of 700 women residents of Uruguay (Montevideo: 301, interior of the country: 399), was conducted in 2020, ages between 20 and 70 years. Advertising was scheduled on social networks, calling the target population to participate in that research by completing a selfadministered survey, obtaining a set of cases with a similar distribution to the general population in terms of SEL and age. CVD was perceived in 10% as the main health problem (HP) and 18% as the first CD. Women from Montevideo vs. interior had higher levels of perception (HP: 13% vs. 7%-CD: 20% vs. 17%); as well as those of high vs. those of mediumlow SEL (HP: 17% vs. 8%-CD: 29% vs. 14%). The perception and knowledge about CVD are low, with young women being the least informed (little/very little: 62%). Doctors report little on symptoms (23%) and prevention (48%). Conclusion: the perception of the women surveyed about CVD is low, with gaps by age, NSE and region. Doctors inform little about this topic during clinical visits. A continuous effort is necessary to improve women's perception of CVD in their own gender, trying to reach mainly the populations at greatest risk.

Antecedentes: embora a doença cardiovascular (DCV) seja a principal causa de morte das mulheres no Uruguai, elas não a percebem. Objetivos: o objetivo deste estudo foi avaliar a percepção, conhecimento e comportamentos de prevenção de DCV entre mulheres por faixa etária, nível socioeconômico (NSE) e região, bem como o conhecimento de fatores de risco, sintomas, doenças cardíacas e comportamentos saudáveis para o coração. Método e resultado: em 2020, 700 mulheres entre 20 e 70 anos, residentes no Uruguai, foram entrevistadas via web (Montevidéu: 301, interior do país: 399). A publicidade foi agendada nas redes sociais, convocando a população alvo a participar da referida pesquisa através do preenchimento de um inquérito autoaplicável, obtendose um conjunto de casos com distribuição semelhante à população geral em termos de NSE e idade. As mulheres pesquisadas perceberam a DCV como principal problema de saúde (PS) em 10% e como principal CM em 18%. As mulheres de Montevidéu vs. interior apresentaram níveis mais elevados de percepção (PS: 13% vs. 7%-CM: 20% vs. 17%); bem como as de NSE alto vs. as de médiobaixo (PS: 17% vs. 8%-CM: 29% vs. 14%). A percepção e o conhecimento sobre DCV são baixos, sendo as mulheres jovens as menos informadas (pouco/muito pouco: 62%). Os médicos informam pouco sobre síntomas (23%) e prevenção (48%). Conclusão: a percepção das mulheres pesquisadas sobre DCV é baixa, com diferenças por idade, NSE e região. Os médicos informam pouco sobre esse tema durante as consultas clínicas. É necessário um esforço contínuo para melhorar a percepção das mulheres sobre as DCV em seu próprio gênero, tentando atingir principalmente as populações de maior risco.

Periodontitis and its associated factors in patients at the faculty of southern Brazil: a cross - sectional study

To verify the presence of periodontitis, its severity, and their association with associated factors based on medical records of patients who attended the Dental Clinic of the Faculty of Southern Brazil over 4 years. This is a cross-sectional study, which included 422 medical records of patients aged ≥ 18 years. The clinically analyzed data were: plaque index (PI),bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Sociodemographic data, dental hygiene, harmful habits and chronic systemic diseases were described. Statistical analysis of binary logistic regression was used to verify the relationship between the severity of periodontitis and the exposure variables. The older adults [odds ratio (OR) = 2.36; 95% confidence interval (CI): 1.23-4.54 ­41 to 55 years and OR = 3.0; 95% CI: 1.49-6.09 ­56 to 87 years], and men (OR = 1.9; 95% CI: 1.18-3.14) showed higher chances of periodontitis severity. Smokers (OR = 3.54; 95% CI: 2.05-6.12), those with hypertension (OR = 2.11; 95% CI: 1.23-3.63) and with diabetes (OR = 2.10; 95% CI: 1.08-4.12) showed higher chances of developing advanced periodontitis. Advanced or severe periodontitis occurred in one-third of the patients. The findings showed that men, older adults, with systemic arterial hypertension, diabetes mellitus, and smokers are more susceptible to severe periodontitis.

Ação dos isglt2 no hipertenso diabético, quando indicar? / Effect of sglt-2 inhibitor in diabetic hypertensive patients, when to indicate?

A doença cardiovascular (DCV) representa um fardo individual e social em pacientes com diabetes mellitus tipo 2 (DM2). A diabetes é uma doença crônica onerosa do ponto de vista social e econômico. O seu tratamento inclui medidas não farmacológicas, como dieta e exercício físico, bem como a adição de medicamentos em pacientes que não atingem controle glicêmico satisfatório através de medidas comportamentais. Medicamentos da classe inibidores de SGLT2 (iSGLT2), objeto deste manuscrito, têm sido associados com a redução de eventos cardiovasculares e mortalidade, além de redução da pressão arterial e peso, sem conferir aumento de risco de hipoglicemia

Cardiovascular disease (CVD) represents an individual and social burden in patients with type 2 diabetes mellitus (T2DM). Diabetes is a chronic, socially and economically costly disease. Its treatment includes non-pharmacological measures, such as diet and exercise, as well as the addition of medication in patients who do not achieve satisfactory glycemic control through behavioral approach. Drugs as SGLT2 inhibitor (SGLT2i), object of this manuscript, have been associated with a reduction in cardiovascular events and mortality, in addition to a reduction in blood pressure and weight, without increasing the risk of hypoglycemia.

Hyperuricemia and chronic kidney disease: to treat or not to treat / Hiperuricemia e doença renal crônica: tratar ou não tratar

Abstract Hyperuricemia is common in chronic kidney disease (CKD) and may be present in 50% of patients presenting for dialysis. Hyperuricemia can be secondary to impaired glomerular filtration rate (GFR) that occurs in CKD. However, hyperuricemia can also precede the development of kidney disease and predict incident CKD. Experimental studies of hyperuricemic models have found that both soluble and crystalline uric acid can cause significant kidney damage, characterized by ischemia, tubulointerstitial fibrosis, and inflammation. However, most Mendelian randomization studies failed to demonstrate a causal relationship between uric acid and CKD, and clinical trials have had variable results. Here we suggest potential explanations for the negative clinical and genetic findings, including the role of crystalline uric acid, intracellular uric acid, and xanthine oxidase activity in uric acid-mediated kidney injury. We propose future clinical trials as well as an algorithm for treatment of hyperuricemia in patients with CKD.

Resumo A hiperuricemia é comum na doença renal crônica (DRC) e pode estar presente em até 50% dos pacientes que se apresentam para diálise. A hiperuricemia pode ser secundária ao comprometimento da taxa de filtração glomerular (TFG) que ocorre na DRC. No entanto, ela também pode preceder o desenvolvimento da doença renal e mesmo prever uma DRC incidente. Estudos experimentais de modelos hiperuricêmicos descobriram que tanto o ácido úrico solúvel quanto o cristalino podem causar danos renais significativos, caracterizados por isquemia, fibrose tubulointersticial e inflamação. Entretanto, a maioria dos estudos de randomização Mendeliana falhou em demonstrar uma relação causal entre o ácido úrico e a DRC, e os ensaios clínicos têm apresentado resultados variáveis. Aqui sugerimos explicações potenciais para os achados clínicos e genéticos negativos, incluindo o papel do ácido úrico cristalino, do ácido úrico intracelular e da atividade da xantina oxidase na lesão renal mediada por ácido úrico. Propomos ensaios clínicos futuros, bem como um algoritmo para o tratamento de hiperuricemia em pacientes com DRC.

Factores de riesgo cardiovascular en pacientes en hemodiálisis / Cardiovascular risk factors in patients on hemodialysis

Introducción: La enfermedad cardiovascular es la primera causa de muerte en los pacientes con enfermedad renal crónica. En los hipertensos, la enfermedad renal crónica es la segunda causa de muerte, el daño vascular sistémico es la norma. Objetivo: Identificar los factores de riesgo cardiovascular tradicionales y no tradicionales y su asociación con la enfermedad cardiovascular en pacientes en hemodiálisis. Material y Métodos: Estudio de corte transversal en 247 pacientes en hemodiálisis crónica. Las variables analizadas fueron: causas de enfermedad renal crónica, factores de riesgo cardiovascular tradicionales y no tradicionales y enfermedades cardiovasculares. Se determinaron tablas de frecuencias y estadísticas de asociación mediante Chi cuadrado. Para determinar el riesgo de mortalidad se utilizó la razón de prevalencia (RP). Se consideró como nivel de significación estadística a p<0,05 con 95 % de confiabilidad. Resultados: Las causas de enfermedad renal crónica predominantes fueron la hipertensión arterial con 35,6 por ciento y la Diabetes Mellitus tipo 2 con 33,1 por ciento. Los pacientes hipertensos tuvieron más probabilidades de presentar una enfermedad cardiovascular con 2,63 veces mayor que el grupo de referencia. En los factores de riesgo cardiovascular no tradicionales la mayor probabilidad la presentaron los pacientes con proteína C reactiva elevada con 5,19 veces, seguido de la hiperuricemia con 3,79 veces y las alteraciones del producto calcio-fósforo con una probabilidad de 3,27 veces. Conclusiones: Los factores de riesgo cardiovasculares tradicionales se relacionan significativamente con la presencia de enfermedad cardiovascular(AU)

Introduction: Cardiovascular disease is the leading cause of death in patients with chronic kidney disease. In hypertensive patients, chronic kidney disease is the second cause of death, and systemic vascular damage has become the norm. Objective: To identify traditional and non-traditional cardiovascular risk factors and their association with cardiovascular disease in patients on hemodialysis. Material and Methods: Cross-sectional study conducted on 247 patients on chronic hemodialysis. The variables analyzed included: causes of chronic kidney disease, traditional and non-traditional cardiovascular risk factors, and cardiovascular diseases. Frequency tables and association statistics were determined by the chi-square test. The prevalence ratio (PR) was used to determine the risk of mortality. The level of statistical significance was considered to be at p value of less than 0,05 with a reliability of 95 percentResults: The most frequent causes of chronic kidney disease were arterial hypertension (35,6 percent) and type 2 diabetes mellitus (33,1 percen). Hypertensive patients were 2,63 times more likely to present cardiovascular disease than the reference group. In the case of non-traditional cardiovascular risk factors, the patients with elevated C-reactive protein were 5,19 more likely to develop cardiovascular disease, followed by those with hyperuricemia that were 3,79 more likely, and the patients with alterations in calcium and phosphorous who were 3,27 times more likely to suffer from this disease. Conclusions: Traditional cardiovascular risk factors are significantly related to the presence of cardiovascular disease(AU)

Prevalencia y factores de riesgo del síndrome metabólico / Prevalence and risk factors of metabolic syndrome

In the population of Manabí, there is a tendency to develop new forms and lifestyles with less energy expenditure and a high degree of stress, and massive consumption of foods rich in saturated fat. An observational, prospective cross-sectional study was carried out with the objective of determining the prevalence of metabolic syndrome in the Las Pampas commune of the Montecristi canton in a sample of 96 people over 30 years of age, whose weight and height were determined calculating the body mass index. Blood pressure, glycaemia, and lipid profile were measured in all of them, after fasting for 12 hours. The data collected from the surveys and the taking of metabolic measurements were tabulated and graphical representations with percentages were made, they were entered into an Access database by a data entry clerk. For the diagnosis of metabolic syndrome, the recommendations of the ALAD 2010 guidelines were taken into account. It is concluded that the risk factors in the population are overweight and obesity, a prevalence of hypertension of 60.42%, and in relation to the syndrome metabolic, female sex predominates with 52%, compared to men with 44%. According to the results obtained, the said results of the project should be indicated to the studied population in order to carry out actions that promote chronic disease prevention campaigns and thus improve the quality of life of the population.

En la población de Manabí existe una tendencia a desarrollar nuevas formas y estilos de vida, con menos gasto de energía y alto grado de estrés, así como un consumo masivo de alimentos ricos en grasas saturadas. Se realizó un estudio observacional, prospectivo, de corte transversal, con el objetivo de determinar la prevalencia de síndrome metabólico en la comuna Las Pampas del cantón Montecristi, en una muestra de 96 personas mayores de 30 años, a las que se les determinaron el peso y la talla, con lo que se calculó el índice de masa corporal. A todos se les midieron la presión arterial, la glucemia y el perfil lipídico, previo ayuno de 12 horas. Los datos recolectados de las encuestas y la toma de medidas metabólicas fueron tabulados y se realizaron representaciones gráficas con porcentajes; se ingresaron a un digitador en una base de datos Access. Para el diagnóstico de síndrome metabólico se tuvieron en cuenta las recomendaciones de las guías ALAD 2010. Se concluye que los factores de riesgo en la población analizada son el sobrepeso y la obesidad, con una prevalencia de hipertensión arterial del 60.42%. En relación con el síndrome metabólico, predomina en el sexo femenino, con un 52%, en comparación con el 44% de los hombres. De acuerdo con los resultados obtenidos, se debe indicar a la población estudiada los resultados del proyecto para poder realizar acciones que promuevan campañas de prevención de enfermedades crónicas y, de esta forma, mejorar la calidad de vida de la población.

Descripción del riesgo cardiovascular en pacientes diabéticos tipo 1 en República Dominicana / Type 1 diabetes cardiovascular risk description in Dominican Republic

Introducción: la diabetes tipo 1 es una enfermedad crónica de alto impacto económico con gran capacidad de ser controlada, la misma no tiene ninguna descripción local previa. Su principal causa de mortalidad es los eventos cardiovasculares y el manejo adecuado la disminuye considerablemente. Objetivo: determinar el riesgo cardiovascular en pacientes adultos con diabetes tipo 1 en la ciudad de Santiago de los Caballeros, República Dominicana. Método: se realizó un estudio descriptivo transversal multicéntrico con 39 pacientes en el período de junio a noviembre de 2019. La calculadora "Steno T1 Risk Engine" se utilizó para estimar el riesgo cardiovascular. Resultados: se obtuvo una relación significativa entre la albuminuria (p = 0.0127), presión arterial sistólica (p = 0.0002), tiempo de diagnóstico (p = 0.0037) y nivel de riesgo cardiovascular. La hemoglobina glucosilada (p = 0,7884) y la actividad física (p = 0.706) no mostraron una relación significativa con el riesgo cardiovascular. Conclusión: el nivel de riesgo cardiovascular promedio es bajo, con probabilidades <10 % de un evento cardiovascular agudo dentro de los 10 años. Esta herramienta permite incluir una evaluación cardiovascular rutinaria con datos que perfilen el tratamiento orientado a disminuir complicaciones vasculares, mortalidad y aumentar adherencia al tratamiento.

Introduction: Type 1 diabetes is a chronic condition with a high economic impact but potentially controllable. There is no previous local description of this condition. Its main fatality cause is due to cardiovascular events and its proper management can diminish it. Objective: This study aimed to determine the cardiovascular risk in adult patients with type 1 diabetes mellitus in the city of Santiago de los Caballeros, Dominican Republic. Method: A descriptive multicenter cross-sectional study was done on 39 patients in the period of June-November 2019. "Steno T1 Risk Engine" calculator estimated the cardiovascular risk. Results: A significant relationship was obtained between albuminuria (p = 0.0127), systolic blood pressure (p = 0.0002), diagnosis time (p = 0.0037) and cardiovascular risk level. Glycated hemoglobin (p = 0.7884) and physical activity (p = 0.7063) did not show a significant relationship with cardiovascular risk. Conclusion: Average cardiovascular risk level is low with <10% probabilities of an acute cardiovascular event within 10 years. This tool could lead to quick cardiovascular risk evaluations to guide the treatment lowering vascular complications, mortality and increasing treatment adherence.

Prevalencia de periodontitis crónica moderada y avanzada generalizada como factor de riesgo cardiovascular / Prevalence of chronic periodontitis moderate and advanced generalized as a cardiovascular risk factor

Introducción: La periodontitis es una enfermedad infecciosa que afecta a los tejidos de sostén de los dientes, su prevalencia se estima entre el 35 y 45% de la población adulta. Las enfermedades cardiovasculares tienen relación directa con la periodontitis crónica, las bacterias periodontales pueden pasar la barrera epitelial de los tejidos periodontales y lograr la propagación sistémica a través de los vasos sanguíneos, causando la inflamación del endocardio. Objetivo: Determinar prevalencia de enfermedad periodontal como factor de riesgo cardiovascular en adultos de 25 a 60 años en Nacajuca, Tabasco. Material y métodos: Se realizó un estudió observacional, prospectivo, transversal y analítico, con muestra de 40 participantes entre 25 y 60 años, el 52% (21) son hombres y el 49% (19) mujeres, se empleó el sistema no probabilístico por conveniencia. Las variables fueron edad, género, grado de conocimiento sobre enfermedad periodontal, nivel de alimentación, grado de tabaquismo, grado de higiene bucal y grado de periodontitis. Resultado: La prevalencia de enfermedad periodontal como factor de riesgo cardiovascular es 48% (19 personas) con periodontitis crónica moderada y avanzada generalizada. Conclusión: Con base en la revisión bibliográfica, las personas con el grado de periodontitis crónica moderada y avanzada generalizada son propensas a desencadenar una enfermedad cardiovascular (infarto agudo de miocardio). Sin embargo, son necesarios más estudios de experimentación longitudinal, con base en el vínculo que tiene la enfermedad periodontal y cardiovascular (AU)

Introduction: Periodontitis is an infectious disease that affects the tissue of the teeth, its prevalence is estimated between 35 and 45% of the adult population. Cardiovascular diseases are directly related to chronic periodontitis, periodontal bacteria can pass the epithelial barrier of periodontal tissues and achieve systemic propagation through the blood vessels causing Inflammation of the endocardio. Objective: To determine the prevalence of periodontal disease as a cardiovascular risk factor in adults from 25 to 60 years Nacajuca, Tabasco. Material and methods: An observational, prospective, transverse and analytical study was carried out, with a sample of 40 participants between 25 and 60 years, 52% (21) corresponds to the masculine genus and 49% (19) represents the female genus, the non-probabilistic system was employed by Convenience. The variables were age, gender, degree of knowledge on periodontal disease, feeding level, degree of smoking, degree of oral hygiene and degree of periodontitis. Result: the prevalence of periodontal disease as a cardiovascular risk factor is 48% (19 people) with chronically moderate and advanced generalized periodontitis. Conclusion: Based on the bibliographical review people with the degree of chronic periodontitis moderate and advanced generalized are prone to trigger a cardiovascular disease (acute myocardial infarction). However, more studies of longitudinal experimentation are necessary, based on the link which has the periodontal and cardiovascular disease (AU)

Bariloche: contrastes ocultos en un paraíso alpino: desigualdades socio-sanitarias en el espacio urbano / Bariloche: hidden contrasts in an alpine paradise: socio-sanitary inequalities in the urban space

INTRODUCCIÓN. La mayor parte de las desigualdades en salud observadas están relacionadas con desigualdades de otros planos de la vida social. Estudios de pequeñas áreas nos permiten visibilizar estos gradientes al descender el análisis a escalas más pequeñas. El objetivo de este estudio es relacionar la distribución espacial de enfermedad cardiovascular según condiciones de vida y lugar de atención. MATERIALES Y MÉTODOS. Se caracterizó la ciudad de Bariloche en base a las condiciones de vida de sus vecindarios seleccionando indicadores mediante un análisis factorial. Se ubicó espacialmente a la población atendida por diabetes e hipertensión arterial en los centros de salud. Se relevaron los registros médicos de esta población para analizar sus problemas de salud. Se analizó la distribución de cada dimensión y se calcularon las proporciones de las personas atendidas según condiciones de vida y lugar de atención. RESULTADOS. Casi la mitad (47,6%) de la población vive en vecindarios con condiciones de vida deficitarias y críticas. El 63,2% de las personas atendidas en centros de salud viven en vecindarios con peores condiciones de vida. Y la identificación de un gradiente positivo: ante peores condiciones de vida, mayor es la proporción de enfermedad cardiovascular. DISCUSIÓN. En el espacio urbano se entrelazan condiciones de vida con problemas de salud, configurándose distintas posibilidades de desarrollarlos. Al interior de una ciudad, pertenecer a determinada área implica la posibilidad/imposibilidad de acceder a niveles relativos de satisfacción de necesidades y presentar determinados problemas de salud. Permite identificar grupos y zonas críticas podría ser un insumo para el diseño de políticas públicas.

INTRODUCTION. Most of the observed health inequalities are related to inequalities in other contexts of social life. Local studies allow us to visualize these variations on a smaller scale. AIM. To examine spatial distribution of cardiovascular disease based on the living conditions and geographical location of health-care attention. Materials and Methods. Bariloche was characterized according to the living conditions of its neighborhoods by the selection of indicators through a factor analysis. The population treated for diabetes or hypertension in health-care centers was spatially distributed. Health problems were obtained from medical records. The distribution of each dimension was analyzed and the proportions of treated individuals according to living conditions and location of health-care attention were obtained. RESULTS. Almost half (47.6%) of the population lived in neighborhoods with deficient and cri-tical living conditions. Of those individuals treated for diabetes and/or hypertension, 63.2% lived in the neighborhoods with the worst living conditions. A positive gradient was identified: We identified a clear correlation between the overall quality of life and cardiovascular disease. DISCUSSION. In urban space, living conditions are closely related to health problems, establi-shing different possibilities to address the latter . In a city, residency in specific neighborhoods informs the possibilities / impossibilities to access to relative levels of needs satisfaction, and to develop certain outcomes. Identification of groups and critical zones could contribute to the development of specific public policies

Análise de dislipidemia em pacientes com insuficiência renal crônica sob tratamento por hemodiálise pelo sistema único de saúde: estudo longitudinal / Analysis of dyslipidemia in patients with chronic kidney failure under hemodialysis treatment by the brazilian health system: a longitudinal study

Introdução: A atual transição demográfica e epidemiológica no Brasil, refletida no envelhecimento populacional, apresenta maior prevalência de doenças crônicas não transmissíveis (DCNT) como as doenças cardiovasculares (DC), neoplasias, distúrbios metabólicos, doenças respiratórias crônicas e insuficiência renal crônica. Essas podem ser decorrentes de fatores risco modificáveis como dislipidemia, hipertensão arterial, diabetes, tabagismo, anemia, sedentarismo, estresse, obesidade e alcoolismo. A insuficiência renal no estágio crônico ocorre devido à perda lenta, progressiva e irreversível da função renal e tem as doenças cardiovasculares como principal causa de morbimortalidade ocasionada por ateromas decorrentes de dislipidemias. Objetivos: Embasados na dislipidemia como fator de risco modificável para as doenças cardiovasculares e na suscetibilidade do desenvolvimento da mesma por pacientes renais crônicos, o objetivo deste estudo foi analisar se o tratamento por hemodiálise com acompanhamento médico é eficiente para minimizar ou evitar a dislipidemia nesses pacientes. Metodologia: Trata-se de um estudo descritivo longitudinal realizado por meio da análise de dados laboratoriais dos exames relacionados ao perfil lipídico: Colesterol Total, HDL, LDL e Triglicérides de novembro de 2018 a junho de 2019. Resultados: Foram acompanhados e analisados 20 pacientes, sendo 50% idosos com idade entre 60 e 69 anos e com doença de base prévia como hipertensão arterial (45%), hipertensão associada à diabetes (25,0%) e diabetes isolada (10,0%). Para análise da presença de dislipidemia, os exames laboratoriais que mais apresentaram alterações foram o HDL com resultado abaixo do desejado (<40,0mg/dl) e o triglicérides com resultados considerados acima da normalidade (> 150,0 mg/dl ) com risco para DC. Do total de pacientes, apenas 1 (5,0%) do sexo feminino apresentou todos os resultados do perfil lipídico alterados durante todo o estudo mesmo fazendo uso do medicamento estatina, enquanto a maioria (95%) dos pacientes obteve resultados desejáveis. Ao analisar conjuntamente todos os resultados do perfil lipídico, observou-se que apenas um paciente do sexo masculino apresentou alteração em todo período de estudo com Triglicerídeos e HDL indesejáveis. No sexo feminino, destaca-se a paciente número 14 que apresentou alterações em todos os exames durante todo o período de análise, com Colesterol Total, Triglicerídeos e LDL-colesterol com valores indesejáveis acima da normalidade e HDL-colesterol indesejável com valor abaixo do desejável. O exame que mais apresentou alteração com resultados indesejáveis foi o de Triglicerídeos em 11 (55,0%) pacientes, principalmente no sexo feminino, com subsequente LDL acima da normalidade e HDL reduzidos, sendo considerado importante fator de risco cardiovascular pela formação de ateromas. Conclusão: Para os pacientes com IRC, é de extrema importância o acompanhamento médico e o tratamento por hemodiálise realizado em sua maioria pelo SUS no Brasil, demonstrado neste estudo como método eficaz para controle e prevenção das dislipidemias minimizando o risco para as doenças cardiovasculares na população vulnerável.

Introduction: The current demographic and epidemiological transition in Brazil, reflected in the aging population, has a higher prevalence of chronic non-communicable diseases (NCDs) such as cardiovascular diseases (CD), neoplasms, metabolic disorders, chronic respiratory diseases, and chronic renal failure (CRF). These diseases may be due to mod-ifiable risk factors, such as dyslipidemia, high blood pressure, diabetes, smoking, anemia, physical inactivity, stress, obesity, and alcoholism. Chronic renal failure occurs due to the slow, progressive, and irreversible loss of renal function, and cardiovascular diseases are the main cause of morbidity and mortality caused by atheroma resulting from dyslipidemia. Objectives: Based on dyslipidemia as a modifiable risk factor for cardiovascular diseases and on the susceptibility of its development by chronic renal patients, the objective of this study was to analyze whether the hemodialysis treatment and the medical monitoring is efficient to minimize or avoid dyslipidemia in these patients. Methodology: This is a longi-tudinal descriptive study carried out through an analysis of laboratory data of tests related to the lipid profile: Total Cholesterol, HDL, LDL, and Triglycerides from November 2018 to June 2019. Results: Twenty patients were followed up and had their data analyzed, 50% were aged between 60 and 69 years old and had a previous underlying disease, such as arterial hypertension (45%), hypertension associated with diabetes (25.0%), and isolated diabetes (10.0%). The analysis of the presence of dyslipidemia showed the laboratory tests that had the most changes were HDL with a result under the desirable (<40.0mg / dl) and triglycerides with results considered above normal (> 150.0 mg / dl) with risk for DC. Only 1 female subject (5.0%) presented all the results of the lipid profile altered throughout the study, even using the statin drug, while the majority (95%) of the patients had desirable results. The analysis of all the results of the lipid profile showed that only one male subject presented changes in the entire study period with undesirable triglycerides and HDL, while in the female sex, patient number 14 presented changes in all tests throughout the anal-ysis period, with Total Cholesterol, Triglycerides, and LDL-cholesterol with undesirable values above normal and undesirable HDL-cholesterol with values under the desirable. The triglycerides test showed the most alteration with undesirable results in 11 (55.0%) subjects, mainly female, with subsequent LDL above normal and reduced HDL, considered an important cardiovascular risk factor due to the formation of atheromas. Conclusion: For patients with CRF, medical follow-up and the hemodialysis treatment performed by the Brazilian Health System is extremely important. This study demonstrated it is as an effective method for the control and prevention of dyslipidemias, minimizing the risk for cardiovascular diseases in this vulnerable population.

Impact of chronic obstructive pulmonary disease on linear and nonlinear dynamics of heart rate variability in patients with heart failure

The objective of this study was to investigate the impact of chronic obstructive pulmonary disease (COPD)-heart failure (HF) coexistence on linear and nonlinear dynamics of heart rate variability (HRV). Forty-one patients (14 with COPD-HF and 27 HF) were enrolled and underwent pulmonary function and echocardiography evaluation to confirm the clinical diagnosis. Heart rate (HR) and R-R intervals (iRR) were collected during active postural maneuver (APM) [supine (10 min) to orthostasis (10 min)], respiratory sinus arrhythmia maneuver (RSA-M) (4 min), and analysis of frequency domain, time domain, and nonlinear HRV. We found expected autonomic response during orthostatic changes with reduction of mean iRR, root mean square of successive differences between heart beats (RMSSD), RR tri index, and high-frequency [HF (nu)] and an increased mean HR, low-frequency [LF (nu)], and LF/HF (nu) compared with supine only in HF patients (P<0.05). Patients with COPD-HF coexistence did not respond to postural change. In addition, in the orthostatic position, higher HF nu and lower LF nu and LF/HF (nu) were observed in COPD-HF compared with HF patients. HF patients showed an opposite response during RSA-M, with increased sympathetic modulation (LF nu) and reduced parasympathetic modulation (HF nu) (P<0.05) compared with COPD-HF patients. COPD-HF directly influenced cardiac autonomic modulation during active postural change and controlled breathing, demonstrating an autonomic imbalance during sympathetic and parasympathetic maneuvers compared with isolated HF.

Íntima media carotidea como predictor de enfermedad aterosclerótica en pacientes con psoriasis / Carotid intima media as a predictor of atherosclerotic diseasein psoriasis patients

La psoriasis es una enfermedad inflamatoria cutánea crónica, conocida como un desorden multisistémico. En pacientes con enfermedades inflamatorias crónicas se ha descrito una correlación directa entre el grosor de la arteria carótida común y el desarrollo de futuras complicaciones cardiovasculares. Algunos estudios han demostrado una correlación de psoriasis y el desarrollo de eventos cardiovasculares dado que tienen un riesgo aumentado de desarrollar enfermedad aterosclerótica. En Venezuela las enfermedades cardiovasculares se ubican como primera causa de muerte, y a pesar del creciente número de pacientes con psoriasis no se han llevado a cabo estudios que permitan determinar el papel de psoriasis y la enfermedad arterial coronaria. Por ello la presente investigación se planteó determinar la relación entre el grado de severidad de psoriasis y el grosor de la íntima media carotidea a un grupo de 20 pacientes con diagnóstico de psoriasis. Recopilada la información, se realizó la prueba de chi-cuadrado,considerando un contraste estadísticamente significativo si p< 0,05. El análisis de datos se hizo con JMP-SAS versión 12,obteniéndose como evidencia que existe asociación entre el grado de severidad de psoriasis y el espesor del grosor de la capa íntima media carotidea, por lo que se pudo predecir la existencia de enfermedad aterosclerótica subclínica(AU)

Psoriasis is a chronic inflammatory skin disease, known as a multi-system disorder. A direct correlation between the thickness of the common carotid artery and the development of future cardiovascular complications has been described in patients with chronic inflammatory diseases. Some studieshave shown a correlation of psoriasis and the developmentof cardiovascular events since they have an increased risk of developing atherosclerotic disease. In Venezuela, cardiovascular diseases are the leading cause of death, and despite the increasing number of patients with psoriasis, no studies have been carriedout to determine the role of psoriasis and coronary artery disease. There fore, the present investigation set out to determine the relationship between the degree of severity of psoriasis and thethickness of the carotid intima media in a group of 20 patientsdiagnosed with psoriasis. Once the information was collected, the chi-square test was performed, considering a statistically significant contrast if p <0.05. The data analysis was done withJMP-SAS version 12, obtaining as evidence that there is anassociation between the degree of severity of psoriasis and the thickness of the thickness of the carotid medial intima layer,so the existence of atherosclerotic disease could be predicted. subclinical(AU)

World no tobacco day: Tobacco is a threat to the one health and sustainability / Dia mundial sem tabaco: O tabaco é uma ameaça à saúde e à sustentabilidade

Abstract On 31st May of every year, in honour of the 'World No Tobacco Day (WNTD),' the international community does organise various events and encourages avoiding all forms of Tobacco consumption. To commemorate WNTD-2018, the World Health Organization (WHO) has promoted awareness to highlight the link between Tobacco and cardiovascular disease (CVD). Because, Tobacco use is the second leading cause of CVD, after high blood pressure. In addition to CVD, Tobacco use is also known to cause many non-communicable diseases, including chronic obstructive pulmonary disease (COPD), lung cancer and other complicated disorders caused by smoking. In fact, non-communicable diseases are now emerging as the primary disease burden. Globally, Tobacco use kills about 7 million people each year, and if the trend remains the same, then it will kill more than 8 million people per year by 2030. On the contrary, despite promoting awareness, the Tobacco industry is growing with little or no regulation. However, in the long run, the global community will not be able to afford business as usual as Tobacco has a direct impact on human health, environmental health and sustainable development.

Resumo No dia 31 de maio de cada ano, em homenagem ao Dia Mundial Sem Tabaco (WNTD), a comunidade internacional organiza vários eventos e incentiva a evitar todas as formas de consumo de tabaco. Para comemorar o WNTD-2018, a Organização Mundial da Saúde (OMS) promoveu a conscientização para destacar a ligação entre o tabaco e as doenças cardiovasculares (DCV). Porque, o uso do tabaco é a segunda principal causa de DCV, após a hipertensão arterial. Além do DCV, o uso de tabaco também é conhecido por causar muitas doenças não transmissíveis, incluindo doença pulmonar obstrutiva crônica (DPOC), câncer de pulmão e outros transtornos complicados. De fato, as doenças não transmissíveis estão emergindo como a carga primária da doença. Globalmente, o consumo de tabaco mata cerca de 7 milhões de pessoas a cada ano, e se a tendência permanecer a mesma, matará mais de 8 milhões de pessoas por ano até 2030. Pelo contrário, apesar de promover a conscientização, a indústria do tabaco está crescendo com pouco ou sem regulamentação. No entanto, a longo prazo, a comunidade global não poderá se dar bem, pois o tabaco tem um impacto direto na saúde humana, na saúde ambiental e no desenvolvimento sustentável.