Ecocardiograma sob exercicio isometrico e cicloergometria na forma indeterminada da doença de Chagas

Orientador: Claudio L. Pereira da CunhaDissertação (mestrado) - Universidade Federal do Parana, Setor de Ciencias da SaudeResumo: Com o objetivo de avaliar o comportamento funcional de pacientes da Forma Indeterminada da Doença de Chagas, face à cicloergometria e à ecocardiografia unidimensional em repouso e exercício isométrico, foram estudados 30 portadores da FIDC, e comparados com igual número de indivíduos normais que compuseram o grupo controle. O grupo FIDC foi composto por candidatos a doadores no Banco de Sangue do Hospital de Clínicas da Universidade Federal do Paraná, que tinham sorologia positiva para doença de Chagas; era formado por 25 homens e 5 mulheres, sem sintomas ou sinais relativos aos aparelhos cardiovascular e digestivo. Apresentavam o eletrocardiograma, a radiografia do tórax com esôfago contrastado e a radiografia simples do abdômen normais. O grupo controle era composto por 25 homens e 5 mulheres hígidos, com reações sorológicas negativas, eletrocardiograma e radiografia do tórax normais. Os grupo eram similares com relação à idade, peso, altura e superfície corporal (p>0,05). Os testes cicloergométricos foram contínuos e máximos, em cargas sucessivas a partir de 25 watts. No ecocardiograma unidimensional foram analisadas, em repouso e durante exercício isométrico, 31 variáveis que envolviam dados anatômicos e de função global e regional do ventrículo esquerdo. O exercício isométrico foi realizado durante 3 minutos com 50% da força máxima pré-estabelecida. No teste cicloergométrico os pacientes do grupo FIDC tiveram um comportamento anormal da pressão arterial sistólica, representado por uma elevação inadequada (resposta deprimida com APS < 40 mmHg; platô; ou queda) comparados ao grupo controle (p<0,005). A resposta cronotrópica foi considerada dentro do normal para ambos os grupos, exceto um paciente da FIDC que não atingiu a FC submáxima. A ocorrência de arritmias foi de extrassístoles ventriculares isoladas em 3 pacientes do grupo FIDC e 1 do Controle. O comportamento da aptidão funcional baseado no consumo de oxigênio e na carga máxima atingida foi semelhante em ambos os grupos. Não tivemos alterações isquêmicas do segmento ST e nem complicações referentes ao método. O ecocardiograma unidimensional, tanto em repouso como em exercício isométrico, mostrou a dimensão diastólica do ventrículo esquerdo com valores maiores para o grupo FIDC (p<0,02), mas ainda com sua média dentro dos padrões normais; dois pacientes do grupo FIDC tinham ventrículo esquerdo dilatado. Os índices de função sistólica e diastólica, avaliados em suas médias, foram normais em ambos os grupos; dois pacientes do grupo FIDC apresentaram também função sistólica diminuída. O exercício isométrico não provocou modificações significativas nos dados ecocardiográficos analisados. Em conclusão, o comportamento funcional dos portadores da Forma Indeterminada da Doença de Chagas no teste cicloergométrico e no ecocardiograma, semelhante ao verificado em indivíduos normais, indica capacidade laborativa preservada nessa população.Abstract: To evaluate the functional capacity of patients with Indeterminate Form of Chagas' Disease, we studied 30 patients (FIDC group) by stress testing and M-mode echocardiography, at rest and during isometric exercise (handgrip). They were compared to 30 normal subjects (control group). The FIDC group was composed by blood donors from the "Hospital de Clínicas da Universidade Federal do Paraná" and included 25 males and 5 females. All of them had positive serologic reactions to Chagas'disease, they were asymptomatic and had normal physical, radiological and electrocardiographic findings upon examination. The control group included 25 males and 5 females who were normal upon examination. The two groups were similar regarding age, weight, height and body surface area. At the stress tests, FIDC group had abnormal blood pressure curves, as shown by "plateau", decreased blood pressure or insufficient blood pressure elevation during exercise. Heart rate response to exercise was normal for both groups. Ventricular premature beats were observed in 3 patients of FIDC group and in 1 patient of control group. Functional capacity, assessed by oxygen comsuption and maximal load, was similar for both groups. Ischemic ST-T changes were not seen on the ECG. M-mode echocardiograms of FIDC group showed left ventricular dimensions larger than control group (p<0,02). Systolic and diastolic functions were normal for both groups. Isometric exercise did not change significantly the echocardiographic data obtained at rest. In conclusion, functional capacity of FIDC patients, assessed by stress test and M-mode echocardiogram, is similar to that of normal subjects, indicating a preserved labor capacity in this population

Classification system for cardiorespiratory fitness based on a sample of the Brazilian population

Background: Peak oxygen consumption (VO2peak) is an important prognostic marker and its classification helps the cardiologist in the therapeutic decision-making process. The most commonly used cardiorespiratory fitness (CRF) classification has not been validated for the Brazilian population. Objective: To elaborate a CRF classification using a Brazilian sample and to compare it with the American Heart Association (AHA), Cooper and UNIFESP classifications. Methods: A total of 6,568 healthy subjects were analyzed through cardiopulmonary exercise testing (CPET). They were distributed by sex and the following age groups (years): 7-12, 13-19, 20-79 (per decades) and > 80 years. After measurement of the VO2peak, participants were distributed into quintiles of CRF in very poor, poor, moderate, high and very high (AEMA Table). The CRF classifications by AEMA, AHA, Cooper, and UNIFESP were compared using the Wilcoxon, Kappa and concordance percentages. Results: VO2peak presented an inverse and moderate correlation with age considering both sexes (R = -0.488, p < 0.001). All paired comparisons between CRF classification systems showed differences (p < 0.001) and disagreement percentage - AEMA versus AHA (k = 0.291, 56.7%), AEMA versus Cooper (k = 0.220, 62.4%) and AEMA versus UNIFESP (k = 0.201, 63.9 %). Conclusion: The AEMA table showed important discrepancies in the classification of CRF when compared to other tables widely used in our setting. Because it was obtained from a large sample of the Brazilian population, the AEMA table should be preferred over other classification systems in our population

Cardiopulmonary Exercise Test: Background, Applicability and Interpretation

Cardiopulmonary exercise test (CPET) has been gaining importance as a method of functional assessment in Brazil and worldwide. In its most frequent applications, CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs. The following parameters are measured: ventilation; oxygen consumption (VO2); carbon dioxide production (VCO2); and the other variables of conventional exercise testing. In addition, in specific situations, pulse oximetry and flow-volume loops during and after exertion are measured. The CPET provides joint data analysis that allows complete assessment of the cardiovascular, respiratory, muscular and metabolic systems during exertion, being considered gold standard for cardiorespiratory functional assessment.1-6 The CPET allows defining mechanisms related to low functional capacity that can cause symptoms, such as dyspnea, and correlate them with changes in the cardiovascular, pulmonary and skeletal muscle systems. Furthermore, it can be used to provide the prognostic assessment of patients with heart or lung diseases, and in the preoperative period, in addition to aiding in a more careful exercise prescription to healthy subjects, athletes and patients with heart or lung diseases. Similarly to CPET clinical use, its research also increases, with the publication of several scientific contributions from Brazilian researchers in high-impact journals. Therefore, this study aimed at providing a comprehensive review on the applicability of CPET to different clinical situations, in addition to serving as a practical guide for the interpretation of that test

COVID-19 outcomes in people living with HIV: Peering through the waves

Objective: To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods: This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to&nbsp;4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results: Throughout the study, 17,101&nbsp;COVID-19 patients were hospitalized, and 130&nbsp;(0.76%) of those were infected with HIV. The median age was&nbsp;54&nbsp;(IQR:&nbsp;43.0;64.0) years in&nbsp;2020 and 53&nbsp;(IQR:&nbsp;46.0;63.5) years in&nbsp;2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In&nbsp;2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9%&nbsp;vs.&nbsp;17.7%; p&nbsp;=&nbsp;0.049), but there was no difference in mortality between groups in&nbsp;2021 (25.0%&nbsp;vs.&nbsp;25.1%; p &gt; 0.999). Conclusions: Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in&nbsp;2021, when the mortality rate is similar to the control group

Brazilian consortium for the study on renal diseases associated with COVID-19 : a multicentric effort to understand SARS-CoV-2-related nephropathy

Kidney involvement appears to be frequent in coronavirus disease 2019 (COVID-19). Despite this, information concerning renal involvement in COVID-19 is still scarce. Several mechanisms appear to be involved in the complex relationship between the virus and the kidney. Also, different morphological patterns have been described in the kidneys of patients with COVID-19. For some authors, however, this association may be just a coincidence. To investigate this issue, we propose assessing renal morphology associated with COVID-19 at the renal pathology reference center of federal university hospitals in Brazil. Data will come from a consortium involving 17 federal university hospitals belonging to Empresa Brasileira de Serviços Hospitalares (EBSERH) network, as well as some state hospitals and an autopsy center. All biopsies will be sent to the referral center for renal pathology of the EBSERH network. The data will include patients who had coronavirus disease, both alive and deceased, with or without pre-existing kidney disease. Kidney biopsies will be analyzed by light, fluorescence, and electron microscopy. Furthermore, immunohistochemical (IHC) staining for various inflammatory cells (i.e., cells expressing CD3, CD20, CD4, CD8, CD138, CD68, and CD57) as well as angiotensin-converting enzyme 2 (ACE2) will be performed on paraffinized tissue sections. In addition to ultrastructural assays, in situ hybridization (ISH), IHC and reverse transcription-polymerase chain reaction (RT-PCR) will be used to detect Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) in renal tissue. For the patients diagnosed with Collapsing Glomerulopathy, peripheral blood will be collected for apolipoprotein L-1 (APOL1) genotyping. For patients with thrombotic microangiopathy, thrombospondin type 1 motif, member 13 (ADAMTS13), antiphospholipid, and complement panel will be performed. The setting of this study is Brazil, which is second behind the United States in highest confirmed cases and deaths. With this complete approach, we hope to help define the spectrum and impact, whether immediate or long-term, of kidney injury caused by SARS-CoV-2

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio