Uso de estatinas é associado à menor mortalidade de causa cardiovascular em pacientes em diálise candidatos ao transplante renal

Objetivo: avaliar a associação entre variáveis clínicas, laboratoriais, achados de cinecoronariografia e uso de medicamentos com mortalidade de causa cardiovascular (CV) em pacientes em diálise candidatos ao transplante renal. Métodos: Foi realizado estudo longitudinal observacional em 103 candidatos ao TR de dois centros. Verificou-se a associação entre a ocorrência de óbito cardiovascular e variáveis clínicas. Variáveis que apresentaram associação com a variável desfecho ao nível de p<0,1 foram selecionadas para a análise de Cox. Idade e presença de diabetes melito foram forçadas no modelo. Resultados: foram rastreados 128 pacientes, dos quais, 20 foram excluídos por se recusarem a participar do estudo e 3 por óbito antes do início do estudo. Dos 105 pacientes restantes, dois foram excluídos por falha de registro dos desfechos, portanto 103 foram incluídos em análise longitudinal. Análise univariada não identificou variável clínica que se associou a ocorrência de óbito de causa cardiovascular, entretanto, a modalidade de diálise e uso de estatina foram selecionadas para análise múltipla, pois se associaram ao desfecho ao nível de p<0,1. Análise de Cox para avaliar a associação entre variáveis clínicas e a ocorrência de óbito CV em diálise identificou apenas uso de estatina como preditor de menor risco de óbito CV (HR: 0,106; IC95%: 0,013-0,852; p=0,035). Conclusão: nos pacientes em diálise candidatos ao TR apenas o uso de estatina apresentou associação inversa, estatisticamente significante, com a ocorrência de óbito de causa cardiovascular

La percepción subjetiva del esfuerzo para el control de la carga de entrenamiento en una temporada en un equipo de balonmano

The aim of this research is to study the applicability of the Rate of Perceived Exertion (RPE) from a double perspective. Firstly, RPE helps coaches monitor training load over a season in team sports. Secondly RPE is used as an ad hoc tool for daily monitoring of planned training by the coaching staff. Heart rate reserve (HRR) was used to regulate the internal load of each session. Thirteen players from a Top Division Handball team participated in the research carried out over a complete season. The results showed RPE is a good indicator of training load in team sports and RPE is also a valid procedure to compare load values planned by coaches (RPEp) with actual values (RPEg) (rxy = .792; p < .01). It can be concluded that RPE and HRR (rxy = .839; p < .01) together are reliable, non-invasive measures for monitoring training load and they also help determine the physical fitness of players throughout the season

The level of physical activity for hypertensive and diabetic patients and the damage caused by the physical exercise requirement / O nível de actividade física para doentes hipertensos e diabéticos e os danos causados pela necessidade de exercício físico

Physical exercise has been identified as a major non-pharmacological agent, assuming a protective role in the treatment of chronic non-communicable diseases, especially in hypertension and diabetes mellitus. The levels of physical activity as well as its intensity are of great impact for the full benefits to come of this practice. We know that the level of physical activity is a relevant factor for maintaining good health, however, little attention has been paid to what is established in relation to high-intensity daily exercise adjusted to cardiac damage or adaptation. The objective was to reflect on the prescription of physical activity in the treatment of hypertensive and diabetic patients and how eccentric exercise is related to the cardiomyocyte tissue in the damage process. We observed that the highest level of physical activity was associated with better quality of life, and that active patients have an 80% chance of survival when compared to sedentary ones. Thus, despite the potential benefits from the metabolic point of view, public health efforts should also focus on maintaining and protocols of physical activity levels since our study showed that intense eccentric physical activity had harmful effects at the cardiac level

Inflammation, Diabetes, and Chronic Kidney Disease: Role of Aerobic Capacity

The persistent inflammatory state is common in diabetes and chronic kidney disease (CKD). These patients present exercise intolerance and increased arterial stiffness. Long-term aerobic exercise has been associated with better arterial compliance, antidiabetic and antiinflammatory benefits. We assessed the hypothesis that in patients with diabetes and CKD, better aerobic capacity is associated with less inflammatory state and arterial stiffness. Thirty-nine CKD patients (17 in hemodialysis) were evaluated. According to CKD etiology two patient groups were obtained: group of diabetics (GD) was formed by 11 patients and nondiabetics (GND) formed by 28 patients. Central blood pressure and arterial stiffness were evaluated by Sphygmocor device. Carotida intima-media thickness (CA-IMT) was evaluated by ultrasonography. Aerobic capacity was measured by estimated VO2max according to treadmill test by Bruce protocol. The GD showed a higher frequency of C-reactive protein above laboratory cutoff (P = 0.044), higher frequency of male gender, and a non significant higher value of VO2max (P = 0.099). The CA-IMT was similar. Only better aerobic capacity was associated with lower frequency of high C-reactive protein when adjusted to diabetes and gender in a logistic regression model. In conclusion, aerobic capacity was associated with inflammatory state, in CKD patients, independently of diabetes presence

Inflammation, Diabetes, and Chronic Kidney Disease: Role of Aerobic Capacity

The persistent inflammatory state is common in diabetes and chronic kidney disease (CKD). These patients present exercise intolerance and increased arterial stiffness. Long-term aerobic exercise has been associated with better arterial compliance, antidiabetic and antiinflammatory benefits. We assessed the hypothesis that in patients with diabetes and CKD, better aerobic capacity is associated with less inflammatory state and arterial stiffness. Thirty-nine CKD patients (17 in hemodialysis) were evaluated. According to CKD etiology two patient groups were obtained: group of diabetics (GD) was formed by 11 patients and nondiabetics (GND) formed by 28 patients. Central blood pressure and arterial stiffness were evaluated by Sphygmocor device. Carotida intima-media thickness (CA-IMT) was evaluated by ultrasonography. Aerobic capacity was measured by estimated VO2max according to treadmill test by Bruce protocol. The GD showed a higher frequency of C-reactive protein above laboratory cutoff (P = 0.044), higher frequency of male gender, and a non significant higher value of VO2max (P = 0.099). The CA-IMT was similar. Only better aerobic capacity was associated with lower frequency of high C-reactive protein when adjusted to diabetes and gender in a logistic regression model. In conclusion, aerobic capacity was associated with inflammatory state, in CKD patients, independently of diabetes presence

The critical dialogical method in Educommunication to develop narrative thinking

En la conceptualización de la Educomunicación se ha de avanzar hacia la integración de sus dos grandes perspectivas. Fomentar el diálogo crítico es un objetivo compartido por ambas, por lo que es preciso profundizar en sus propiedades, métodos y funciones educativas. Se presenta un modelo formativo en educomunicación que ha sido testado mediante una investigación empírica. Durante dos semanas, 246 niños entre seis y once años asisten a sesiones formativas con dos tipos de productos audiovisuales. La mitad de los niños sigue un proceso formativo según la metodología dialógicocrítica y la otra mitad una metodología de diálogo-conversacional. Los resultados muestran que los niños que siguen la formación dialógico-crítica se benefician significativamente en la construcción de su competencia mediática y pensamiento narrativo, en comparación con los niños de los grupos dialógico-conversacional. Los resultados revelan también que no todos los tipos de contenidos audiovisuales son beneficiosos para la formación del pensamiento del niño. Esta investigación pone de manifiesto cuáles son las propiedades del método dialógico-crítico propuesto que permiten al niño mejorar su competencia mediática e ilustra la complementariedad entre el proceso de diagnóstico-estático de competencias y el proceso formativo-dinámico que conduce al pensamiento crítico. Desde un punto de vista aplicado, este método ha mostrado su utilidad para ser utilizado por el profesor para fomentar en su grupo de alumnos una educación mediática que contribuya al desarrollo del pensamiento narrativoIn the conceptualization of Educommunication, progress must be made towards the integration of its two great perspectives. Encouraging critical dialogue is a goal shared by both, so it is necessary to delve into its educational properties, methods and functions. A training model in Educommunication that has been tested through empirical research is presented. For two weeks, 246 children between six and eleven years old, attended training sessions with two types of audiovisual products. Half of the children were involved in a training process using critical dialogical methodology, whereas the training process for the other half of the children followed conversational dialogue methodology. The results show that children who follow the critical dialogical training benefit significantly in the construction of their media competence and narrative thinking, compared to the children of the conversational dialogical groups. The results also reveal that not all types of audiovisual content are beneficial to the construction of children's thinking. This research reveals the properties of the proposed critical dialogical method that allows children to improve their media competence and illustrates the complementarity between the diagnostic-static process of competences and the formative-dynamic process that leads to critical thinking. From an applied point of view, the critical dialogical method has been useful for use by teachers to foster a media education in their group of students that contributes to the development of narrative thinkin

Association between chronic kidney disease stages and changes in ambulatory blood pressure monitoring parameters

Abstract Introduction: Blood pressure (BP) assessment affects the management of arterial hypertension (AH) in chronic kidney disease (CKD). CKD patients have specific patterns of BP behavior during ambulatory blood pressure monitoring (ABPM). Objectives: The aim of the current study was to evaluate the associations between progressive stages of CKD and changes in ABPM. Methodology: This is a cross-sectional study with 851 patients treated in outpatient clinics of a university hospital who underwent ABPM examination from January 2004 to February 2012 in order to assess the presence and control of AH. The outcomes considered were the ABPM parameters. The variable of interest was CKD staging. Confounding factors included age, sex, body mass index, smoking, cause of CKD, and use of antihypertensive drugs. Results: Systolic BP (SBP) was associated with CKD stages 3b and 5, irrespective of confounding variables. Pulse pressure was only associated with stage 5. The SBP coefficient of variation was progressively associated with stages 3a, 4 and 5, while the diastolic blood pressure (DBP) coefficient of variation showed no association. SBP reduction was associated with stages 2, 4 and 5, and the decline in DBP with stages 4 and 5. Other ABPM parameters showed no association with CKD stages after adjustments. Conclusion: Advanced stages of CKD were associated with lower nocturnal dipping and greater variability in blood pressure

Clinical and echocardiographic predictors of left ventricular remodeling following anterior acute myocardial infarction

OBJECTIVES: Coronary artery disease is the primary cause of death and is responsible for a high number of hospitalizations worldwide. Ventricular remodeling is associated with worse prognosis following ST-segment elevation myocardial infarction (STEMI) and is a risk factor for ventricular dysfunction and heart failure. This study aimed to identify the predictors of ventricular remodeling following STEMI. Additionally, we evaluated the clinical, laboratory, and echocardiographic characteristics of patients with anterior wall STEMI who underwent primary percutaneous intervention in the acute phase and at 6 months after the infarction. METHODS: This prospective, observational, and longitudinal study included 50 patients with anterior wall STEMI who were admitted to the coronary care unit (CCU) of a tertiary hospital in Brazil between July 2017 and August 2018. During the CCU stay, patients were evaluated daily and underwent echocardiogram within the first three days following STEMI. After six months, the patients underwent clinical evaluation and echocardiogram according to the local protocol. RESULTS: Differences were noted between those who developed ventricular remodeling and those who did not in the mean±standard deviation levels of creatine phosphokinase MB isoenzyme (CKMB) peak (no remodeling group: 323.7±228.2 U/L; remodeling group: 522.4±201.6 U/L; p=0.008) and the median and interquartile range of E/E’ ratio (no remodeling group: 9.20 [8.50–11.25] and remodeling group: 12.60 [10.74–14.40]; p=0.004). This difference was also observed in multivariate logistic regression. CONCLUSIONS: Diastolic dysfunction and CKMB peak in the acute phase of STEMI can be predictors of ventricular remodeling following STEMI

Predictors of autosomal dominant polycystic kidney disease progression: a Brazilian single-center cohort

Abstract Introduction: Identifying risk factors for autosomal dominant polycystic kidney disease (ADPKD) progression is important. However, studies that have evaluated this subject using a Brazilian sample is sparce. Therefore, the aim of this study was to identify risk factors for renal outcomes and death in a Brazilian cohort of ADPKD patients. Methods: Patients had the first medical appointment between January 2002 and December 2014, and were followed up until December 2019. Associations between clinical and laboratory variables with the primary outcome (sustained decrease of at least 57% in the eGFR from baseline, need for dialysis or renal transplantation) and the secondary outcome (death from any cause) were analyzed using a multiple Cox regression model. Among 80 ADPKD patients, those under 18 years, with glomerular filtration rate <30 mL/min/1.73 m2, and/or those with missing data were excluded. There were 70 patients followed. Results: The factors independently associated with the renal outcomes were total kidney length – adjusted Hazard Ratio (HR) with a 95% confidence interval (95% CI): 1.137 (1.057–1.224), glomerular filtration rate – HR (95% CI): 0.970 (0.949–0.992), and serum uric acid level – HR (95% CI): 1.643 (1.118–2.415). Diabetes mellitus - HR (95% CI): 8.115 (1.985–33.180) and glomerular filtration rate - HR (95% CI): 0.957 (0.919–0.997) were associated with the secondary outcome. Conclusions: These findings corroborate the hypothesis that total kidney length, glomerular filtration rate and serum uric acid level may be important prognostic predictors of ADPKD in a Brazilian cohort, which could help to select patients who require closer follow up

Clinical Study Inflammation, Diabetes, and Chronic Kidney Disease: Role of Aerobic Capacity

The persistent inflammatory state is common in diabetes and chronic kidney disease (CKD). These patients present exercise intolerance and increased arterial stiffness. Long-term aerobic exercise has been associated with better arterial compliance, antidiabetic and antiinflammatory benefits. We assessed the hypothesis that in patients with diabetes and CKD, better aerobic capacity is associated with less inflammatory state and arterial stiffness. Thirty-nine CKD patients (17 in hemodialysis) were evaluated. According to CKD etiology two patient groups were obtained: group of diabetics (GD) was formed by 11 patients and nondiabetics (GND) formed by 28 patients. Central blood pressure and arterial stiffness were evaluated by Sphygmocor device. Carotida intima-media thickness (CA-IMT) was evaluated by ultrasonography. Aerobic capacity was measured by estimated VO 2 max according to treadmill test by Bruce protocol. The GD showed a higher frequency of C-reactive protein above laboratory cutoff (P = 0.044), higher frequency of male gender, and a non significant higher value of VO 2 max (P = 0.099). The CA-IMT was similar. Only better aerobic capacity was associated with lower frequency of high C-reactive protein when adjusted to diabetes and gender in a logistic regression model. In conclusion, aerobic capacity was associated with inflammatory state, in CKD patients, independently of diabetes presence