Remote ischemic preconditioning in patients with intermittent claudication

OBJECTIVE: Remote ischemic preconditioning (RIPC) is a phenomenon in which a short period of sub-lethal ischemia in one organ protects against subsequent bouts of ischemia in another organ. We hypothesized that RIPC in patients with intermittent claudication would increase muscle tissue resistance to ischemia, thereby resulting in an increased ability to walk. METHODS: In a claudication clinic, 52 ambulatory patients who presented with complaints of intermittent claudication in the lower limbs associated with an absent or reduced arterial pulse in the symptomatic limb and/or an ankle-brachial index <0.90 were recruited for this study. The patients were randomly divided into three groups (A, B and C). All of the patients underwent two tests on a treadmill according to the Gardener protocol. Group A was tested first without RIPC. Group A was subjected to RIPC prior to the second treadmill test. Group B was subjected to RIPC prior to the first treadmill test and then was subjected to a treadmill test without RIPC. In Group C (control group), both treadmill tests were performed without RIPC. The first and second tests were conducted seven days apart. Brazilian Clinical Trials: RBR-7TF6TM. RESULTS: Group A showed a significant increase in the initial claudication distance in the second test compared to the first test. CONCLUSION: RIPC increased the initial claudication distance in patients with intermittent claudication; however, RIPC did not affect the total walking distance of the patients

Walking training improves systemic and local pathophysiological processes in intermittent claudication

Objective: This study examined the impact of submaximal walking training (WT) on local and systemic nitric oxide (NO) bioavailability, inflammation, and oxidative stress in patients with intermittent claudication (IC). Methods: The study employed a randomised, controlled, parallel group design and was performed in a single centre. Thirty-two men with IC were randomly allocated to two groups: WT (n = 16, two sessions/week, 15 cycles of two minutes walking at an intensity corresponding to the heart rate obtained at the pain threshold interspersed by two minutes of upright rest) and control (CO, n = 16, two sessions/week, 30 minutes of stretching). NO bioavailability (blood NO and muscle nitric oxide synthase [eNOS]), redox homeostasis (catalase [CAT], superoxide dismutase [SOD], lipid peroxidation [LPO] measured in blood and muscle), and inflammation (interleukin-6 [IL-6], C-reactive protein [CRP], tumour necrosis factor α [TNF-α], intercellular adhesion molecules [ICAM], vascular adhesion molecules [VCAM] measured in blood and muscle) were assessed at baseline and after 12 weeks. Results: WT statistically significantly increased blood NO, muscle eNOS, blood SOD and CAT, and muscle SOD and abolished the increase in circulating and muscle LPO observed in the CO group. WT decreased blood CRP, ICAM, and VCAM and muscle IL-6 and CRP and eliminated the increase in blood TNF-α and muscle TNF-α, ICAM and VCAM observed in the CO group. Conclusion: WT at an intensity of pain threshold improved NO bioavailability and decreased systemic and local oxidative stress and inflammation in patients with IC. The proposed WT protocol provides physiological adaptations that may contribute to cardiovascular health in these patients

Walking Training Increases microRNA-126 Expression and Muscle Capillarization in Patients with Peripheral Artery Disease

Patients with peripheral artery disease (PAD) have reduced muscle capillary density. Walking training (WT) is recommended for PAD patients. The goal of the study was to verify whether WT promotes angiogenesis in PAD-affected muscle and to investigate the possible role of miRNA-126 and the vascular endothelium growth factor (VEGF) angiogenic pathways on this adaptation. Thirty-two men with PAD were randomly allocated to two groups: WT (n = 16, 2 sessions/week) and control (CO, n = 16). Maximal treadmill tests and gastrocnemius biopsies were performed at baseline and after 12 weeks. Histological and molecular analyses were performed by blinded researchers. Maximal walking capacity increased by 65% with WT. WT increased the gastrocnemius capillary-fiber ratio (WT = 109 ± 13 vs. 164 ± 21 and CO = 100 ± 8 vs. 106 ± 6%, p < 0.001). Muscular expression of miRNA-126 and VEGF increased with WT (WT = 101 ± 13 vs. 130 ± 5 and CO = 100 ± 14 vs. 77 ± 20%, p < 0.001; WT = 103 ± 28 vs. 153 ± 59 and CO = 100 ± 36 vs. 84 ± 41%, p = 0.001, respectively), while expression of PI3KR2 decreased (WT = 97 ± 23 vs. 75 ± 21 and CO = 100 ± 29 vs. 105 ± 39%, p = 0.021). WT promoted angiogenesis in the muscle affected by PAD, and miRNA-126 may have a role in this adaptation by inhibiting PI3KR2, enabling the progression of the VEGF signaling pathway

Reproducibility of heart rate recovery in patients with intermittent claudication

Background: Postexercise heart rate recovery (HRR) is a non-invasive tool for cardiac autonomic function assessment. Reproducibility of HRR has been established in healthy subjects; however, no study has evaluated this reproducibility in clinical populations who may present autonomic dysfunction. Patients with peripheral artery disease and intermittent claudication (IC) often present altered cardiac autonomic function and HRR could be an interesting tool for evaluating autonomic responses to interventions in this population. Therefore, the reproducibility of HRR should be determined in this specific population. Objective: To determine the reproducibility of HRR indices in patients with IC. Methods: Nineteen men with IC underwent two repeated maximal treadmill tests. Raw HR and relative HRR (difference to exercise peak) indices measured at 30, 60, 120, 180, 240 and 300s of recovery were evaluated. The presence of systematic bias was assessed by comparing test and retest mean values via paired t-test. Reliability was assessed by intraclass correlation coefficient (ICC), and agreement by typical error (TE), coefficient of variation (CV) and minimal detectable difference (MDD). Results: There were no significant differences between the test and retest values of all raw HR and relative HRR indices (P ≥ 0·05), except for HR120s (P = 0·032). All indices exhibited excellent reliability (ICC ≥ 0·78). Raw HR and relative HRR indices showed TEs ≤ 6·4 bpm and MDDs ≤ 17·8 bpm. In addition, all indices showed CVs ≤ 13·2%, except HRR30s (CV = 45·6%). Conclusions: The current results demonstrated that most HRR indices were highly reproducible with no systematic error, excellent reliability and good agreement in patients with IC following maximal graded exercise

Política Nacional de Saúde Integral da População Negra: implementação, conhecimento e aspectos socioeconômicos sob a perspectiva desse segmento populacional

A Política Nacional de Saúde Integral da População Negra tem o objetivo de garantir a equidade na atenção à saúde para esse segmento populacional. Tal medida possui um caráter compensatório em virtude das discriminações raciais existentes ao longo da história do Brasil. A população negra apresenta maior vulnerabilidade social e econômica, o que reflete uma menor expectativa de vida e maior susceptibilidade a agravos. O objetivo do estudo é investigar o conhecimento da população negra acerca da política, seus potenciais benefícios e as dificuldades de acesso à saúde. Trata-se de uma pesquisa transversal, descritiva e quantitativa. Foram realizadas entrevistas estruturadas com 391 indivíduos negros, usuários do SUS, da cidade de Juiz de Fora. A amostra foi estratificada de acordo com raça (preto e pardo), renda e escolaridade. Cerca de 90% dos entrevistados relataram desconhecer a existência de uma política de saúde para a população negra e 53% declararam uma possível discriminação racial. Observou-se também associação positiva entre discriminação e menor escolaridade e renda. Apesar de desconhecerem a existência da PNSIPN, a maioria dos entrevistados aprovou seus objetivos, mesmo relatando a possibilidade de discriminação dela advinda

Erro médico: a perspectiva de estudantes de medicina e direito

Nas últimas décadas, houve um crescimento das implicações em sociedade do erro médico, assunto em que se entrelaçam Medicina e Direito. Este estudo procurou conhecer a percepção de estudantes de Medicina e Direito sobre erro médico, avaliando nível de interesse e informação, e a necessidade de abordar o tema na graduação e como ela ocorre para cada área, na sua ótica. Estudo observacional descritivo transversal foi realizado na Universidade Federal de Juiz de Fora (MG) em 2008 com 185 alunos de Medicina e 119 de Direito. 88,7% dos alunos de Medicina (MED) e 92,4% de Direito (DIR) referiram conhecimento sobre erro médico. O interesse se dá por ser um tema muito discutido atualmente. Os alunos consideram necessária sua abordagem na graduação (97,8% MED e 94,9% DIR). É importante discutir um tema tão atual na graduação de Medicina e de Direito pela contribuição que pode ser oferecida para diminuir o ciclo vicioso de erros, iatrogenias e processos jurídicos, além de possibilitar uma reflexão acerca do papel da educação médica na construção ética de novos profissionais

Relacao entre o nivel de atividade fisica estimado pelo Baltimore Activity Scale for Intermittent Claudication e a pedometria em pacientes com claudicacao intermitente

CONTEXTO: Os pacientes com claudicação intermitente apresentam níveis reduzidos de atividade física. A Baltimore Activity Scale for Intermittent Claudication (BASIC) foi validada para quantificar o nível de atividade física destes pacientes. No entanto, esta validação se baseou em apenas dois dias de monitoramento com acelerômetros, de modo que ainda permanece incerto se a BASIC fornece informações sobre os níveis de atividade física semanal. OBJETIVO: Analisar a correlação entre o nível de atividade física estimada pela BASIC e o nível obtido pelo pedômetro em uma semana, em pacientes com claudicação intermitente. MÉTODOS: Foram estudados 150 pacientes com claudicação intermitente, com idade entre 30 e 80 anos. Foram obtidos os dados sociodemográficos e verificada a presença de comorbidades e de fatores de risco cardiovascular, e a BASIC. O pedômetro foi utilizado por sete dias consecutivos, sendo a análise feita em três diferentes períodos de monitorização (todos os dias, dias da semana e do fim de semana). RESULTADOS: Foi observada correlação entre a BASIC e a média de passos de todos os dias (rho=0,343; p<0,001), dos dias de semana (rho=0,336; p<0,001) e dos dias do final de semana (rho=0,317; p<0,001). CONCLUSÃO: Em pacientes com claudicação intermitente, o nível de atividade física estimado pela BASIC se correlaciona com o nível de atividade física semanal