REHABILITACIÓN CARDÍACA EN PRE-ADOLESCENTES Y ADOLESCENTES CON CARDIOPATÍA CONGÉNITA: REVISIÓN SISTEMÁTICA

Las cardiopatías congénitas mediante el advenimiento de los métodos de diagnóstico y terapéuticos ha incrementado la esperanza de vidaen la población. Los programas de rehabilitación cardíaca hacen que esta población puede ser activa y aprovechar los beneficios de laactividad física en su día a día. El estudio presenta una pregunta en la que se trata de identificar si la rehabilitación cardiaca es una forma eficazde mejorar el contexto físico y psicosocial de los niños y adolescentes portadores de una cardiopatía congénita. La metodología que se empleó para este estudio fue la búsqueda sistemática de artículos referentes a programas de rehabilitación en las bases de datos MEDLINE, PubMed, EMBASE y LILACS. Obedeciendo a los criterios de descriptores, de inclusión y exclusión se revisaron sesenta y seis artículos, tres excluidos por no ser gratuitos, cuarenta y siete excluidos en el análisis del resumen y diecinueve artículos incluidos en su totalidad. El debate de la revisión se dividió en tópicos para la evaluación analítica de los resultados. Se abordó el tipo ejercicio, características de los pacientes, método de entrenamiento, con una frecuencia semanal, la duración y la intensidad del ejercicio subdivididos en hospitalario o domiciliaria; además de los beneficios, seguridad y complicaciones. Los trabajos presentaron beneficios de la rehabilitación cardíaca para este grupo de pacientes tanto física como psicológica respondiendo al objetivo principal del estudio

Marcadores de predição de lesão miocárdica em mulheres com câncer submetidas à quimioterapia com doxorrubicina

Introdução: A cardiotoxicidade decorrente do tratamento do câncer com Doxorrubicina é uma complicação que aumenta a morbimortalidade dos pacientes portadores de neoplasias sólidas e hematológicas. A identificação precoce desta complicação modifica o prognóstico, permitindo medidas de cardioproteção sem comprometer a eficácia terapêutica oncológica. Objetivo: O objetivo deste estudo foi identificar qual é o marcador mais precoce de cardiomiotoxicidade em pacientes com câncer submetidos à quimioterapia cujo plano terapêutico incluiu o uso de Doxorrubicina. Casuística e métodos: foi realizado um estudo prospectivo em 40 mulheres portadoras de câncer, procedentes do serviço de oncologia do Hospital Universitário Antônio Pedro e da Unidade de Assistência de Alta Complexidade em Oncologia do município de Rio Bonito (RJ), no período de agosto de 2012 a julho de 2015. Foram realizados exame clínico e os biomarcadores Troponina I (TnI), Peptídeo Natriurético tipo B (BNP), Mioglobina e Creatinofosfoquinase fração-MB (CK-MB), antes do início da quimioterapia (QT) e 24h a 48h após a primeira, terceira, sexta ou última QT; e exames de ecocardiograma com a técnica do speckle tracking antes de iniciar a QT, após a terceira, quarta ou sexta QT e após um ano de início da QT. Resultados: das 40 pacientes, 37 tinham câncer de mama, 2 linfomas e1 sarcoma. A média de idade foi 55,9±10,8 anos. Os fatores de risco para cardiotoxicidade foram sexo feminino (100%), hipertensão arterial (50%), tabagismo (30%), obesidade (35%) e diabetes (20%). A dose cumulativa média de Doxorrubicina administrada foi de 423±119mg/m2, 24 (60%) receberam doses maiores de 400mg/m2 e 16 (40%) entre 200 e 400mg/m2. Nenhuma paciente apresentou desfecho clínico de insuficiência cardíaca sintomática. A ocorrência de cardiotoxicidade subclínica, caracterizada por queda da fração de ejeção do ventrículo esquerdo (FEVE) maior que 10% para <53% em relação à medida basal ocorreu em cinco pacientes (12,5%) em até12 meses após o início da QT. Houve um aumento progressivo e sustentável dos níveis do BNP e da Mioglobina durante todos os ciclos de QT, alcançando valores significativamente mais elevados 12 meses após início da QT (p<0,001 e p<0,008, respectivamente). Os parâmetros de função sistólica FEVE por Simpson e pelo speckle tracking não apresentaram alteração evolutiva significativa. Houve piora significativa da função diastólica de VE em 17% entre a pré-QTe após a terceira QT, assim como de 48% entre a pré-QT e 12 meses após (p<0,0001). Conclusões: Cardiotoxicidade subclínica ocorreu em 12,5% das pacientes que receberam DOXO para tratamento de câncer. O BNP, a Mioglobina e a função diastólica aferida ao ecocardiograma foram os marcadores que mais precocemente se elevaram, sendo o BNP o único marcador que se correlacionou com a progressão da dose cumulativa de DOXO nesta população estudadaIntroduction: cardiotoxicity secondary to cancer treatment with Doxorubicin is a complication that increases morbidity and mortality of patients with solid and hematologic malignancies. Early identification of this complication changes the prognosis and allows cardioprotective measures without compromising the oncological therapeutic efficacy. Objective: to identify the earliest marker of cardiomyotoxicity in cancer patients undergoing chemotherapy treatment plan which included the use of Doxorubicin. Patients and methods: we performed a prospective study with 40 women with the diagnosis of cancer from the Antonio Pedro University Hospital and the Oncology High Complexity Unity Care of Rio Bonito City, Rio de Janeiro State, Brazil, from August 2012 to July 2015. Clinical exam was performed and the biomarkers Troponin I (TnI), type-B Natriuretic Peptide (BNP), myoglobin and creatine kinase-MB fraction (CK-MB) were measured before the beginning of chemotherapy (CT) and 24 to 48 hours after the first, third, fourth or last CT. Echocardiograms with speckle tracking technique were performed before starting the CT and after the third, sixth, or last CT and after a year of beginning of the CT. Results: Among the 40 patients, 37 had breast cancer, 2 had lymphoma and 1 sarcoma. The mean age was 55.9±10.8 years old. The risk factors for cardiotoxicity were female gender (100 %), hypertension (50 %), tobacco (30 %), obesity (35%) and diabetes (20 %). The average cumulative dose of doxorubicin administered was 423±119mg/m2, 24(60 %) received higher doses than 400mg/m2 and 16(40 %) between 200 and 400mg/m2. No patient had clinical outcome of symptomatic heart failure. The occurrence of subclinical cardiotoxicity, characterized by decrease in left ventricular ejection fraction (LVEF ) greater than 10% to <53% compared to baseline values occurred in five patients (12.5 %) at 12 months. There was a gradual and sustainable increase in the levels of BNP and myoglobin for all CT cycles, achieving significantly higher levels 12 months after the start of the chemotherapy ( p<0.001 and p<0.008, respectively). The parameters of systolic function LVEF by Simpson and those from speckle tracking had no significant evolutionary change. A significant worsening of the diastolic function occurred in 17% of patients from the pre-CT to the trird CT, as well as 48% from the pre-CT to 12 months (p<0,0001). Conclusions: subclinical cardiotoxicity occurred in 12.5% of patients receiving Doxo for cancer treatment. BNP, myoglobin and diastolic function parameters by echocardiogram were the markers that earlier changed, BNP being the only marker that correlates with the progression of cumulative dose of Doxo in this study population117f

Hypertension in Patients with Cancer

There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality

The effect of the austenite grain refinement on the tensile and impact properties of cast Hadfield steel

<div><p>This paper studied the effect of the austenite grain refinement on the tensile and impact properties of a cast Hadfield steel (12 % Mn, 1.2 %C and 0.65 % Si). The austenite grain refinement was obtained by hafnium inoculation. Microstructural characterization showed that the Hf-refined cast Hadfield steel featured a grain size of 600 µm, while the non-refined condition presented a grain size of 3000 µm. Mechanical test results indicated that the austenite grain refinement promoted an increase in the values of the yield stress (6%), the ultimate tensile strength (37%), the toughness (88%), the work-hardening coefficient (50%) and the Charpy absorbed energy (15%). Microscopic characterization of the fractured test-pieces indicated that the grain refinement increased the proportion of plastic deformation by the twinning mechanism and furthermore improved the values of the mechanical properties of the cast Hadfield steel considerably.</p></div