Physical Training Programs After Coronary Artery Bypass Grafting

Exercise-based rehabilitation is considered an important adjunct therapy for secondary prevention in patients with coronary artery disease, mainly in populations with coronary artery bypass graft (CABG) and percutaneous coronary intervention. Thus, the increasing number of cardiac surgeries along the years is enlarging the participation of patients in cardiac rehabilitation programs. Encouraging exercise-based cardiac rehabilitation might decreases in-hospital stay, speeds returns to work and reduces costs in public health. Recently, two training modalities of exercise gained much attention in cardiac rehabilitation programs: continuous exercise and high-intensity interval aerobic training (HIIAT). The aim of this chapter is to review the effects of HIIAT in patients that undergone to CABG or other cardiac surgeries regarding clinical and physiological parameters such as death, cardiovascular outcomes, aerobic capacity, anaerobic capacity, quality of life and other parameters, beyond to evaluate the feasibility and safety of HIIAT in this patient’s group

Avaliação in vivo da interação leucócito-endotélio mesentérico após ligadura e punção cecal e remoção cirúrgica do foco sééptico

PURPOSE: Cecal ligation and puncture (CLP) has been used as a useful model for the induction of polymicrobial sepsis. Necrotic tissue resection and peritoneal lavage (REL) are the surgical procedures for controlling perforated appendicitis. The aim of this study was to evaluate leukocyte-endothelial interactions in the rat mesentery in vivo after CLP and REL. METHODS: Thirty-seven male Wistar rats (250-300 g) underwent laparotomy and were randomly assigned to the following groups: 1) SHAM; 2) CLP: animals submitted to CLP, 3) CLP+REL: animals submitted to CLP and REL. Mesenteric leukocyte-endothelial interactions were studied by intravital microscopy assessed once in each animal (3-5 postcapillary venules, 15-25 µm diameter) 24 hours after intervention. Follow-up was performed in all animals; this included analysis of glycemia, lactate, hematocrit, white blood cell count as well as a functional score that was the sum of scoring on the following parameters: alertness, mobility, piloerection, diarrhea, encrusted eyes, and dirty nose and tail. RESULTS: None of the animals showed significant changes in body weight (265 ± 20 g) or in hematocrit levels (46% ± 2%) during the experimental protocol. Compared to SHAM animals, CLP animals showed an increased number of rolling (2x), adherent, and migrating leukocytes (7x) in the mesenteric microcirculation, an increase in blood glucose (136 ± 8 mg/dL), lactate (3.58 ± 0.94 mmol/L), white cell count (23,570 ± 4,991 cells/mm³) and functional alterations (score 11 ± 1), characterized by impaired alertness and mobility, and presence of piloerection, diarrhea, encrusted eyes, and dirty nose and tail. The REL procedure normalized the number of rolling, adherent, and migrated leukocytes in the mesentery; glycemia; lactate; and white blood cell count. The REL procedure also improved the functional score (7 ± 1). CONCLUSION: Local and systemic inflammation was induced by CLP, while REL completely overcame the inflammatory process.OBJETIVO: O procedimento de ligadura cecal e perfuração (CLP) tem sido usado como um modelo útil de indução de sepse polimicrobiana. A ressecção do tecido necrosado e lavagem peritoneal (REL) são procedimentos cirúrgicos freqüentemente utilizados para controlar uma apendicite perfurada. O objetivo desse estudo foi avaliar in vivo as interações leucócito-endotélio no mesentério de ratos após a CLP e REL. MÉTODOS: Trinta e sete ratos Wistar machos (250-300 g) foram submetidos à laparotomia e aleatoriamente divididos em grupos: 1) SHAM, 2) CLP: ratos submetidos à CLP, 3) CLP+REL: animais submetidos à CLP e REL. As interações leucócito-endotélio no mesentério foram estudadas através de microscopia intravital somente uma vez em cada animal (3-5 vênulas pós-capilares, 15-25 µm diâmetro), 24-horas após as intervenções. A evolução clínica foi realizada em todos os animais, incluindo glicemia, lactato, hematócrito, número total de células brancas e um escore funcional, o qual foi considerado como a somatória dos seguintes parâmetros: estado de alerta, mobilidade, piloereção, diarréia, olhos encrustados, e nariz e cauda sujos. RESULTADOS: Os animais não apresentaram alterações significantes no peso (265 ± 20 g) e hematócrito (46 ± 2%) ao longo do estudo. Comparados ao SHAM, os animais CLP apresentaram aumento no número de leucócitos em rolamento (2x), aderidos (7x) e migrados (7x) na microcirculação mesentérica, aumentos da glicemia (136 ± 8 mg/dL), lactato (3,58 ± 0,94 mmol/L), leucocitose (23.570 ± 4.991 células/mm³) e alterações clínicas (escore 11±1), caracterizadas por comprometimento do estado de alerta e mobilidade, e presença de piloereção, diarréia, olhos encrustados, nariz e cauda sujos. REL normalizou o número de leucócitos em rolamento, aderidos e migrados no mesentério, a glicemia, o lactato e o número de leucócitos circulantes. REL também melhorou o escore clínico (7 ± 1). CONCLUSÃO: A CLP induziu inflamação local e sistêmica. A REL resolveu, por completo, o processo inflamatório

HÁBITOS DE VIDA DE PACIENTES SUBMETIDOS A CIRURGIA DE REVASCULARIZAÇÃO DO MIOCÁRDIO EM RIO GRANDE/ RS/BRASIL.

The aim of this research was to evaluate patient’s life habits after six months of coronary artery bypass graft (CABG) surgery to delineate a profile and direct therapeutic practice. It was conducted a prospective, quantitative and descriptive study. Patients were submitted to CABG in the Santa Casa Cardiology Hospital of Rio Grande/ Rio Grande do Sul/Brazil between 01/01/2011 and 30/06/2011. It was investigated socioeconomic, demographic, behavioral and healthy characteristics through International Physical Activity Questionnaire and Level of Stress Quesrtionnaire. Data were analyzed through SPSS statistic program. Between the nineteen subjects selected, the mean age was 63,8 + 9,6 years.All of them are not used to smoke, to drink and to take care of nutrition, nevertheless 74% was physically inactive and 58% presented physical stress in the alert phase and 69% presented psychic stress in the exhaustion phase. It was concluded that sedentarism and stress are much presented in the life of this group of people. Thus, it became necessary the development of public healthactions to promote acute myocardial infarction (AMI) risk factors awareness and health knowledge in general to propose for these subjects a healthy quality life.El objetivo de la investigación fue evaluar los hábitos de vida de los pacientes 6 meses después de la cirugía de revascularización miocárdica (CABG), para delinear un perfil y prácticas terapéuticas directas. Un estudio se realizó en un estudio prospectivo, cuantitativo y descriptivo. Los pacientes fueron sometidos a CABG en el Hospital de Cardiología de la Santa Casa de la Grande / RioGrande Rio do Sul / Brasil, en el período del 01/01/2011 al 30/06/2011. Problemas se investigaron las cuestiones socioeconómicas, demográficas, de comportamiento y de salud en el nivel de actividad física a través delCuestionario Internacional de Actividad Física y el nivel de estrés del Cuestionario Stress Level. Los datos fueron analizados utilizando el programa SPSS. Entre los temas seleccionados diecinueve la edad promedio fue de 63,8 + 9,6 años, tenía el hábito de no fumar, no usar bebidas alcohólicas y cuidar la alimentación, pero el 74% eran físicamente inactivos e 58% tenían estrésfísico en fase de alerta y el 69% el estrés psicológico en la etapa de agotamiento. Se encontró que la inactividad física y el estrés están muy presentes en la vida de este grupo de personas. En este sentido, es esencialpara el desarrollo de acciones de salud que promueven el conocimiento relacionado con factores de riesgo de infarto agudo de miocardio (IAM) y la salud general, de manera que estas personas puedan disfrutar de un estilo de vida saludable y de calidad.O objetivo da pesquisa foi avaliar os hábitos de vida de pacientes com 6 meses pós Cirurgia de Revascularização do Miocárdio (CRM), para delinear um perfil edirecionar práticas terapêuticas. Foi conduzido um estudo de caráter prospectivo, quantitativo e descritivo. Os pacientes realizaram a CRM no Hospital de Cardiologia da Santa Casa do Rio Grande/Rio Grande do Sul/ Brasil no período de 01/01/2011 a 30/06/2011. Foram investigadas questões socioeconômicas, demográficas, comportamentais e de saúde, questões sobre o Nível de Atividade Física através do Questionário Internacional de Atividade Física e o Nível de estress com o Questionário de Nível de Estresse. Os dados foram analisadosatravés do programa estatístico SPSS. Entre os dezenove sujeitos selecionados a média de idade foi de 63,8 + 9,6 anos, tinham hábito de não fumar, não usarbebida alcoólica e cuidar da alimentação, porém 74% eram inativos fisicamente e 58% apresentaram estresse físico na fase de alerta e 69% estresse psíquico na fase de exaustão. Foi possível constatar que o sedentarismo e o estresse estão muito presente na vida desse grupo de pessoas. Nesse sentido, torna-se imprescindível o desenvolvimento de ações em saúde para que seja promovida a conscientização relacionada aos fatores de risco para Infarto Agudo do Miocárdio (IAM) e a saúde em geral para que esses indivíduos possam desfrutarde uma vida saudável e com qualidade

Effects of Different Peep Levels on Mesenteric Leukocyte-Endothelial Interactions in Rats During Mechanical Ventilation

INTRODUCTION: Mechanical ventilation with positive end expiratory pressure (PEEP) improves oxygenation and treats acute pulmonary failure. However, increased intrathoracic pressure may cause regional blood flow alterations that may contribute to mesenteric ischemia and gastrointestinal failure. We investigated the effects of different PEEP levels on mesenteric leukocyte-endothelial interactions. METHODS: Forty-four male Wistar rats were initially anesthetized (Pentobarbital I.P. 50mg/kg) and randomly assigned to one of the following groups: 1) NAIVE (only anesthesia; n=9), 2) PEEP 0 (PEEP of 0 cmH2O, n=13), 3) PEEP 5 (PEEP of 5 cmH2O, n=12), and 4) PEEP 10 (PEEP of 10 cmH2O, n=13). Positive end expiratory pressure groups were tracheostomized and mechanically ventilated with a tidal volume of 10 mL/kg, respiratory rate of 70 rpm, and inspired oxygen fraction of 1. Animals were maintained under isoflurane anesthesia. After two hours, laparotomy was performed, and leukocyte-endothelial interactions were evaluated by intravital microscopy. RESULTS: No significant changes were observed in mean arterial blood pressure among groups during the study. Tracheal peak pressure was smaller in PEEP 5 compared with PEEP 0 and PEEP 10 groups (11, 15, and 16 cmH2O, respectively; p<0.05). After two hours of MV, there were no differences among NAIVE, PEEP 0 and PEEP 5 groups in the number of rollers (118±9,127±14 and 147±26 cells/10minutes, respectively), adherent leukocytes (3±1,3±1 and 4±2 cells/100µm venule length, respectively), and migrated leukocytes (2±1,2±1 and 2±1 cells/5,000µm², respectively) at the mesentery. However, the PEEP 10 group exhibited an increase in the number of rolling, adherent and migrated leukocytes (188±15 cells / 10 min, 8±1 cells / 100 µm and 12±1 cells / 5,000 µm², respectively; p<0.05). CONCLUSIONS: High intrathoracic pressure was harmful to mesenteric microcirculation in the experimental model of rats with normal lungs and stable systemic blood pressure, a finding that may have relevance for complications related to mechanical ventilation

The lack of knowledge on acute stroke in Brazil: A cross-sectional study with children, adolescents, and adults from public schools

Objective: Stroke is an important cause of disability and death in adults worldwide. However, it is preventable in most cases and treatable as long as patients recognize it and reach capable medical facilities in time. This community-based study investigated students' stroke knowledge, Emergency Medical Services (EMS) activation, associated risk factors, warning signs and symptoms, and prior experience from different educational levels in the KIDS SAVE LIVES BRAZIL project. Methods: The authors conducted the survey with a structured questionnaire in 2019‒2020. Results: Students from the elementary-school (n&nbsp;=&nbsp;1187, ∼13&nbsp;y.o., prior experience:&nbsp;14%, 51%&nbsp;women), high-school (n&nbsp;=&nbsp;806, ∼17&nbsp;y.o., prior experience:&nbsp;13%, 47%&nbsp;women) and University (n&nbsp;=&nbsp;1961, ∼22&nbsp;y.o., prior experience:&nbsp;9%, 66%&nbsp;women) completed the survey. Among the students, the awareness of stroke general knowledge, associated risk factors, and warning signs and symptoms varied between&nbsp;42%‒66%. When stimulated, less than&nbsp;52% of the students associated stroke with hypercholesterolemia, smoking, diabetes, and hypertension. When stimulated, 62%‒65% of students recognized arm weakness, facial drooping, and speech difficulty; only fewer identified acute headache (43%). Interestingly, 67%&nbsp;knew the EMS number; 81%&nbsp;wanted to have stroke education at school, and ∼75%&nbsp;wanted it mandatory. Women, higher education, and prior experience were associated with higher scores of knowing risk factors (OR&nbsp;=&nbsp;1.28, 95%&nbsp;CI:&nbsp;1.10‒1.48; OR&nbsp;=&nbsp;2.12, 95%&nbsp;CI:&nbsp;1.87‒2.40; OR&nbsp;=&nbsp;1.46, 95%&nbsp;CI:&nbsp;1.16‒1.83; respectively), and warning signs- symptoms (OR&nbsp;=&nbsp;2.22, 95%&nbsp;CI:&nbsp;1.89‒2.60; OR&nbsp;=&nbsp;3.30, 95%&nbsp;CI:&nbsp;2.81‒3.87; OR&nbsp;=&nbsp;2.04, 95%&nbsp;CI:&nbsp;1.58‒2.63; respectively). Conclusion: Having higher education, prior experience, and being a woman increases stroke-associated risk factors, and warning signs and symptoms identification. Schoolchildren and adolescents should be the main target population for stroke awareness

Impacto da cirurgia de revascularização do miocárdio em pacientes idosos

Objective: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients >= 65 years-old.Methods: Patients undergoing isolated on-pump CABG from December 1st 2010 to July 31th 2012 were divided in two groups: GE (elderly >= 65 years-old, n=103) and GA (adults = 65-year-old was associated with greater morbidity, but it was not independent predictive factor for in-hospital mortality. Considering in-hospital mortality, stay in ward time length (P=0.006), cardiac (P=0.011) and respiratory complications (P=0.026) were independent predictive factors.Conclusion: This study suggests that patients >= 65-yearold were at increased risk of postoperative complications when submitted to isolated on-pump CABG in comparison to patients < 65-year-old, but not under increased risk of death.FUNADESP, São Paulo/BrazilUniv São Paulo, Fac Med, Fac Anhanguera Rio Grande, Assoc Caridade Santa Casa Rio Grande, Rio Grande, RS, BrazilUniv Estadual Campinas, Fac Med, Fac Anhanguera Campinas, São Paulo, BrazilUniversidade Federal de São Paulo, Fac Anhanguera Santo Andre 1, São Paulo, BrazilUniv Mogi das Cruzes, Fac Anhanguera Santo Andre 3, São Paulo, BrazilFac Anhanguera Rio Grande, Rio Grande, RS, BrazilFed Univ Rio Grande, Fac Med, Rio Grande, RS, BrazilAssoc Caridade Santa Casa Rio Grande, Rio Grande, RS, BrazilUniversidade Federal de São Paulo, Fac Anhanguera Santo Andre 1, São Paulo, BrazilFUNADESP, São Paulo/Brazil: 5500255Web of Scienc