Cardiac sodium channel, its mutations and their spectrum of arrhythmia phenotypes

The mechanisms of cellular excitability and propagation of electrical signals in the cardiac muscle are very important functionally and pathologically. The heart is constituted by three types of muscle: atrial, ventricular, and specialized excitatory and conducting fi bers. From a physiological and pathophysiological point of view, the conformational states of the sodium channel during heart function constitute a signifi cant aspect for the diagnosis and treatment of heart diseases. Functional states of the sodium channel (closed, open, and inactivated) and their structure help to understand the cardiac regulation processes. There are areas in the cardiac muscle with anatomical and functional differentiation that present automatism, thus subjecting the rest of the fi bers to their own rhythm. The rate of these (pacemaker) areas could be altered by modifi cations in ions, temperature and especially, the autonomic system. Excitability is a property of the myocardium to react when stimulated. Another electrical property is conductivity, which is characterized by a conduction and activation process, where the action potential, by the all-or-nothing law, travels throughout the heart. Heart relaxation also stands out as an active process, dependent on the energetic output and on specificion and enzymatic actions, with the role of sodium channel being outstanding in the functional process. In the gene mutation aspects that encode the rapid sodium channel (SCN5A gene), this channel is responsible for several phenotypes, such as Brugada syndrome, idiopathic ventricular fibrillation, dilated cardiomyopathy, early repolarization syndrome, familial atrial fibrillation, variant 3 of long QT syndrome, multifocal ectopic ventricular contractions originating in Purkinje arborizations, progressive cardiac conduction defect (Lenègre disease), sudden infant death syndrome, sick sinus syndrome, sudden unexplained nocturnal death syndrome, among other sodium channel alterations with clinical overlapping. Finally, it seems appropriate to consider the “sodium channel syndrome” (mutations in the gene of the α subunit of the sodium channel, SCN5A gene) as a single clinical entity that may manifest in a wide range of phenotypes, to thus have a better insight on these cardiac syndromes and potential outcomes for their clinical treatment

Analysis of quality indexes of the provided health services in public and private services of Angola

Introduction: Quality indices are being increasingly used by leaders, managers and health professionals as operational tools to improve processes and reduce costs. Noting that there is a greater tendency of private hospitals operating in the regulatory model for market mechanisms, it is expected that the quality indicators that serve as a reference for monitoring the health management are more critical in public hospitals. Objective: Evaluate the quality of health services provided in public and private service in Angola. Methods: We analyzed 142 patients of a public and a private institutions in Angola in a structured interview on health indicators. The indices were collected according to the process structure components and results. Results: There are 51,453 calls in the public institution, remaining hospitalized a day, an average of 184 patients,  with an annual rate of bed occupancy of 90.84%. 50% of respondents praised the services and 22% complained about the quality of services. He was appointed as the main grounds for complaint the slow service (17%). The private institution received 2,222 patients, with an average of 570 patients. The mean hospital stay was 4.5 days. The average monthly rate of bed occupancy was 59.9%. In assessing the degree of satisfaction of care, regular or bad satisfaction obtained a rate of 60% in the private institution. Conclusion: There was no favorable results for quality in health management both in public service and in private.Introduction: Quality indices are being increasingly used by leaders, managers and health professionals as operational tools to improve processes and reduce costs. Noting that there is a greater tendency of private hospitals operating in the regulatory model for market mechanisms, it is expected that the quality indicators that serve as a reference for monitoring the health management are more critical in public hospitals. Objective: Evaluate the quality of health services provided in public and private service in Angola. Methods: We analyzed 142 patients of a public and a private institutions in Angola in a structured interview on health indicators. The indices were collected according to the process structure components and results. Results: There are 51,453 calls in the public institution, remaining hospitalized a day, an average of 184 patients,  with an annual rate of bed occupancy of 90.84%. 50% of respondents praised the services and 22% complained about the quality of services. He was appointed as the main grounds for complaint the slow service (17%). The private institution received 2,222 patients, with an average of 570 patients. The mean hospital stay was 4.5 days. The average monthly rate of bed occupancy was 59.9%. In assessing the degree of satisfaction of care, regular or bad satisfaction obtained a rate of 60% in the private institution. Conclusion: There was no favorable results for quality in health management both in public service and in private

Higuchi fractal dimension applied to RR intervals in children with Attention Defi cit Hyperactivity Disorder

Background: Attention defi cit hyperactivity disorder (ADHD) is categorized by a lowered attention span, recklessness, and hyperactivity. Autonomic nervous system inequality has previously been studied using the same data by chaotic global techniques. We aim to compare the autonomic function of children with ADHD and controls by analyzing heart rate variability (HRV). Methods: 28 children with ADHD (22 boys, mean age 10.0 years ± 1.9 years) and 28 controls (15 boys, mean age 9.9 years ± 1.8 years) rested in supine position with spontaneous breathing for 20 minutes. Heart rate was recorded beat by beat. HRV analysis was performed by Higuchi Fractal Dimension technique. Results: ADHD promoted an increase in the Higuchi Fractal Dimension. The optimum value of Kmax was 10. Conclusion: ADHD signifi cantly altered cardiac autonomic modulation as measured by the Higuchi fractal dimension of HRV. It can therefore be stated that ADHD has increased the complexity of the HRV  signal through cardiac autonomic modulation

KNOWLEDGE OF HEALTH SCIENCES UNDERGRADUATE STUDENTS IN OBJECTIVE TESTS ON BASIC LIFE SUPPORT

Introduction: Sudden Cardiac Arrest (SCA) is a serious public health problem and represents one of the leading causes of death in the world. In emergency situations the assessment of the victim and care must be effective, to reduce negative outcomes and to increase the survival rate. Objective: To analyze graduation students in the Health Sciences through objective testing on Basic Life Support (BLS). Methods: This is a descriptive, observational and cross sectional study, performed in the State of São Paulo, Brazil. The study population consisted of 664 graduation students in Medicine, Nursing, Physiotherapy, Pharmacy, Nutrition and Occupational Therapy. Data collection occurred through an instrument in the form of objective tests based on the guidelines for Basic Life Support from the American Heart Association. For analysis the Shapiro-Wilk, Chi-square, Mann-Whitney and Kruskal-Wallis tests were used. The adopted confidence level was 95%. The statistical program used was Stata 11.0. Result: There was found to be a prevalence of students who were female (82.23%), single (77.56%), on the physiotherapy course (53.16%), in the freshmen year (32.2%) with previous training (54.45%) and with a median age of 22 years old. When the association between the scores was analyzed according to sex, marital status, previous training, course and year of study, the relation between the number of correct answers and previous training, course and year of study showed statistically significant differences (p < 0.001). Conclusion: 99.9% of subjects had lower score than the minimum score of 84% of Americam Heart Association, which characterizes insufficient knowledge about the basic support of life theme. Thus, there is need for continued training of health sciences students on the subject, at the undergraduate level

Análise da manobra de compressão-descompressão no volume corrente de pacientes sob ventilação mecânica

Objetivo: Avaliar a alteração do volume corrente e de variáveis hemodinâmicas após uma manobra de compressão-descompressão em pacientes sob ventilação mecânica Método: 32 pacientes sob ventilação mecânica invasiva, com média de idade de 43±18 anos. Foram colhidas as variáveis de Pressão Arterial Sistólica, Pressão Arterial Diastólica, Pressão Arterial Média, Frequência Cardíaca, Saturação de Oxigênio e Volume Corrente nos momentos antes (M1), após imediatamente (M2) e após 10 minutos (M3) da aplicação do protocolo, que consistiu em 10 repetições da manobra de compressão-descompressão em cada paciente. Resultados: Foi encontrada diferença significativa para as variáveis, Volume Corrente, com média que aumentou no M1 de 596±126ml para 648±110ml no M2, e diminuiu no M3 para 607±12ml (p<0,001); Pressão Arterial Sistólica, que aumentou no M1 de 127±19mmHg para no M2 141±18mmHg e diminuiu no M3 para 124±16mmHg (p=0,008) e Frequência Cardíaca, que aumentou no M1 de 81±14bpm para no M2 de 96±18bpm e diminuiu novamente no M3 para 87±16bpm (p<0,001). Conclusão: A manobra de compressão-descompressão em pacientes que estão sob ventilação mecânica invasiva, aumenta o volume corrente de forma significativa no momento imediato após a aplicação, e esse aumento não se mantém após 10 minutos

Socio-Environmental and Hematological Profile of Landfill Residents (Sao Jorge Landfill-Sao Paulo, Brazil)

We are experiencing an unprecedented urbanization process that, alongside physical, social and economic developments, has been having a significant impact on a population's health. Due to the increase in pollution, violence and poverty, our modern cities no longer ensure a good quality of life so they become unhealthy environments. This study aims to assess the effect of social, environmental and economic factors on the hematologic profile of residents of Santo Andre's landfill. In particular, we will assess the effect of social, economic, and environmental factors on current and potential disease markers obtained from hematological tests. The research method is the observational type, from a retrospective cohort, and by convenience sampling in Santo Andre in the Greater ABC (municipalities of Santo Andre, Sao Bernardo do Campo and Sao Caetano do Sul, southeast part of the Greater Sao Paulo Metropolitan Area, Brazil). The study determined a socio-environmental profile and the hematologic diseases screening related to a close location to the landfill. The disease manifests itself within a broad spectrum of symptoms that causes changes in blood count parameters. The objective of this work is to show that there is an association between social, environmental and economic factors and a variety of serious disease outcomes that may be detected from blood screening. A causal study of the effect of living near the landfill on these disease outcomes would be a very expensive and time-consuming study. This work we believe is sufficient for public health officials to consider policy and attempt remediation of the effects of living near a landfill.ABC Medical SchoolSchool of Health Technology Coimbra-IPC-Polytechnic Institute of Coimbra-PortugalDepartment of Environmental Health and Public HealthSEMASA-Sanitation and Insurance CentralABC MedSch, Environm Hlth Management Dept, BR-09060650 Santo Andre, SP, BrazilUniv Fed Sao Paulo, Inst Environm Chem & Pharmaceut Sci, Dept Biol Sci, BR-04060650 Diadema, SP, BrazilCoimbra Hlth Sch, EsTesC, Dept Environm Hlth Sci, P-3046854 Coimbra, PortugalBiological Sciences Department, Institute of Environmental, Chemistry and Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), Diadema 04060-650, SP, BrazilWeb of Scienc

Autonomic Modulation in Duchenne Muscular Dystrophy during a Computer Task: A Prospective Control Trial

Introduction Duchenne Muscular Dystrophy (DMD) is characterized by progressive muscle weakness that can lead to disability. Owing to functional difficulties faced by individuals with DMD, the use of assistive technology is essential to provide or facilitate functional abilities. In DMD, cardiac autonomic dysfunction has been reported in addition to musculoskeletal impairment. Consequently, the objective was to investigate acute cardiac autonomic responses, by Heart Rate Variability (HRV), during computer tasks in subjects with DMD. Method HRV was assessed by linear and nonlinear methods, using the heart rate monitor Polar RS800CX chest strap Electrocardiographic measuring device. Then, 45 subjects were included in the group with DMD and 45 in the healthy Typical Development (TD) control group. They were assessed for twenty minutes at rest sitting, and five minutes after undergoing a task on the computer. Results Individuals with DMD had a statistically significant lower parasympathetic cardiac modulation at rest when compared to the control group, which further declined when undergoing the tasks on the computer. Conclusion DMD patients presented decreased HRV and exhibited greater intensity of cardiac autonomic responses during computer tasks characterized by vagal withdrawal when compared to the healthy TD control subjects.FAPESP (Fundacao de Amparo a Pesquisa do Estado de Sao Paulo)Univ Sao Paulo, Sch Med, Phys Therapy Speech & Occupat Therapy Dept, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Dept Neurol Neurosurg, Sao Paulo, SP, BrazilUniv Estadual Paulista, Speech Therapy Dept, Auton Nervous Syst Ctr Study, Fac Sci,UNESP, Marolia, SP, BrazilABC Med Sch, Dept Community Hlth, Lab Design & Sci Writing, Santo Andre, SP, BrazilUniv Estadual Paulista, Dept Physiotherapy, UNESP, Sao Paulo, SP, BrazilOxford Brookes Univ, Fac Hlth & Life Sci, Dept Biol & Med Sci, Cardioresp Res Grp, Gipsy Lane, Oxford OX3 0BP, EnglandUniv Sao Paulo, Sch Arts Sci & Humanities, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Dept Neurol Neurosurg, Sao Paulo, SP, BrazilFAPESP: 2012/16970-6Web of Scienc

Três necessidades urgentes na batalha contra COVID-19: medicamentos específicos, informações e aceitação da Pandemia

The first confirmed case of COVID-19 was notified to the Brazilian Ministry of Health on February 26, 2020. On November 20, 2021, by the end of Epidemiological Week-46 (EW-46) 257,168,692 confirmed cases of COVID-19 reported worldwide. Among the countries with the highest number of accumulated cases the United States of America ranks number one (47,701,872), followed by India (34,510,413), Brazil (22,012,150), the United Kingdom (9,857,658), and Russia (9,135,149). Concerning deaths, 5,146,467 were confirmed worldwide until November 20, 2021. The United States was the country with the highest accumulated number of deaths (771,013), followed by Brazil (612,587), India (465,662), Mexico (292,145), and Russia (257,891).ResumoO primeiro caso confirmado de COVID-19 foi notificado ao Ministério da Saúde (MS) do Brasil em 26 de fevereiro de 2020. Até o final da Semana Epidemiológica (SE) 46 de 2021, no dia 20 de novembro de 2021, foram confirmados 257.168.692 casos de covid-19 no mundo. Os Estados Unidos foram o país com o maior número de casos acumulados (47.701.872), seguido pela Índia (34.510.413), Brasil (22.012.150), Reino Unido (9.857.658) e Rússia (9.135.149). Em relação aos óbitos, foram confirmados 5.146.467 no mundo até o dia 20 de novembro de 2021. Os Estados Unidos foram o país com maior número acumulado de óbitos (771.013), seguido do Brasil (612.587), Índia (465.662), México (292.145) e Rússia (257.891