HEART RATE VARIABILITY IN METABOLIC SYNDROME

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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

Vectocardiographic analysis of right ventricular electrical conduction delay

Introduction: The electrocardiographic interpretation of end conduction delay (ECD) in the right ventricular branch of the heart has already generated some hypotheses that this right branch is not single, as anatomically demonstrated, and can be divided into distinct terminal branches when we analyze tracings through the vectorcardiogram. Methods: There were 227 electrocardiograms selected, with typical characteristics defined as ECD of patients from the electrocardiography service of the Centro Universitário Saúde ABC, of both sexes, in the age range of 18 to 87 years, with varied ethnicities, weight and height, with cardiovascular risk factors or without them. We performed vectorcardiograms in these patients to observe the behavior of the final portion of electrical conduction. Results: Analyzing the vectorcardiographic tracings of patients who presented ECD in electrocardiogram, we confirmed in the recording by the frontal plane, the presence of ECD but recorded in three distinct regions; 103 patients in the right upper quadrant between -120° and -150°, 45 patients in the right lower quadrant between +170° and -170°, and medial, and 79 patients in the right lower quadrant between +110° and + 140°. Conclusion: Electrical depolarization of the heart in the right ventricle in electrocardiographic tracings apparently records typical alterations that we can diagnose as depolarization of a single bundle; but when we performed vectorcardiograms, we recorded three distinct zones of right ventricular depolarization with delay; i.e., three distinct sectors of right ventricle free wall delay, such as type I (upper), type II (lower) and type III (medial).publishedVersionPeer reviewe

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

Modulação autonômica cardíaca durante diferentes modos de desmame em ventilação mecânica

Introduction: Heart rate variability (HRV) is a noninvasive method to analyze variations of time intervals between heart beats. HRV is a promising method to analyze autonomic balance quantitatively. During the weaning process of mechanical ventilation, alterations occur in the autonomic activity. Methods to identify increased risk for weaning failure are needed. Objective: To analyze the behavior of cardiac autonomic modulation in different phases of weaning mechanical ventilation. Methods: Cardiorespiratory parameters (SBP, DBP, MAP, RR, SpO2) of 18 participants were collected and a cardio-frequency meter was placed. The subjects were kept in supine Fowler's position t, ventilating for 10 minutes in the assist-controlled (A/C) ventilation mode the synchronized intermittent mandatory ventilation (SIMV) mode, pressure support ventilation (PSV) 18 and 10, and with nebulization through a T-piece. At the end of all ventilator modes, the pre-specified variables were measured. The HRV parameters were analyzed in the domains of time, frequency and geometric indexes. Results: There was an increase in the mean rMSSD of the A/C moment of 20.67 ± 19.36ms for the PSV 10 time 29.96 ± 21.26ms (p = 0.027), increase between the SIMV moments of 24.04 ± 18.31ms and PSV 10 to 29.96 ± 21.26ms (p = 0.042), but reduced between PSV 10 and T-Tube moments 21.22 ± 13.84ms (p = 0.035). There was an increase in the LF mean of the SIMV moments 158.46 ± 229.77ms2 and PSV 10 265.50 ± 359.88ms2 for T-tube 408.92 ± 392.77ms2 (p = 0.011 and p = 0.037 respectively). The mean LF showed a decrease between C/A and SIMV moments, respectively, 62.48 ± 17.99nu and 54.29 ± 15.29nu (p = 0.024), increase in SIMV moments 54.29 ± 15.29nu and PSV 10 55.05 ± 23.07nu for TUBE T 65.57 ± 17.08nu (p = 0.049 and p = 0.027 respectively). HF increased between SIMV moments 162.89 ± 231.19ms2 and PSV 10 247.83 ± 288.99ms2 (p = 0.020) and also between SIMV and T-Tube moments 248.28 ± 214.46 ms2 (p = 0.044). There was a reduction in mean HF between PSV 10 times 44.71 ± 22.95nu and T-tube 34.22 ± 17.03nu (p = 0.026). Conclusions: The present study showed that in comparison with spontaneous breathing, controlled breathing was associated with lower HRV during weaning from mechanical ventilation.Introdução: A variabilidade da frequência cardíaca (VFC) é um método não invasivo para analisar variações de intervalos de tempo entre batimentos cardíacos. A VFC é um método promissor para analisar o balanço autonômico quantitativamente. Durante o processo de desmame da ventilação mecânica, ocorrem alterações na atividade autonômica. Objetivo: Analisar o comportamento da modulação autonômica da frequência cardíaca em diferentes modos do desmame da VM. Método: 18 pacientes foram estudados. Os parâmetros cardiorrespiratórios (PAS, PAD, PAM, FR, SpO2) iniciais e finais foram registrados em uma ficha. Um cardiofrequencimetro foi posicionado (relógio no punho e cinta no tórax). Os pacientes foram mantidos em decúbito Fowler e permaneceram 10’ em cada modo ventilatório (A/C, SIMV, PSV 18 e 10 e nebulização com Tubo T). Os sinais captados pelo cardiofrequencimetro foram analisados através do software Kubios®. Resultados: Os parâmetros da Variabilidade da Frequência Cardíaca foram analisados nos domínios do tempo, frequência e índices geométricos. Houve aumento na média rMSSD - modulação parassimpática, do momento A/C para o momento PSV 10 (p=0,027), aumento entre os momentos SIMV e PSV 10 (p=0,042), mas reduziu entre os momentos PSV 10 e TUBO T (p=0,035). Houve aumento na média do LF (low frequency) -modulação simpática, dos momentos SIMV e PSV 10 para TUBO T (p=0,011 e p=0,037). A média de LF apresentou queda entre os momentos A/C e SIMV (p=0,024), aumento nos momentos SIMV e PSV 10 para TUBO T (p =0,049 e p=0,027). HF (high frequency) - modulação simpática aumentou entre os momentos SIMV e PSV 10 (p=0,020) e também entre os momentos SIMV e TUBO T (p=0,044). Houve redução na média HF entre os momentos PSV e TUBO T (p=0,026). Conclusão: Modos controlados apresentaram diminuição da VFC e maior predomínio simpático em relação a modos espontâneos

Fatores associados a casos de Dengue na área industrial brasileira: um estudo ecológico

Introduction: Dengue is an acute systemic viral infectious disease, established worldwide in epidemic and endemic transmission cycles. High levels of precipitation, adequate temperatures, proximity between urban and peri-urban centers, human movement between population centers and urban solid waste (USW) production may facilitate dengue transmission and spread. Objective: To identify the relationship between diagnosed dengue cases and socioeconomic factors, USW mass generation and rainfall index. Methods: Ecological study, with secondary data collection from 2010 to 2016 for each municipality of the Greater ABC Region in São Paulo, Brazil. Total population, gross domestic product (GDP) per capita, USW, number of dengue cases and rainfall index were investigated. Data were collected on the websites of the Brazilian Institute of Geography and Statistics (IBGE), the municipalities of the Greater ABC Region, the Greater ABC Intermunicipal Consortium, the Greater ABC Economic Development Agency, the National Sanitation Information System, Surveillance Epidemiological Survey of the State of São Paulo and the Department of Water and Electric Energy of the State of São Paulo. Relationships between variables were tested by Spearman correlation. Results: Data analysis of all municipalities showed a positive correlation between dengue cases with total population (r=0.675, p<0.01), gross domestic product per capita (r=0.539, p<0.01) and MSW by inhabitant per year (r=0.492, p<0.01). Positive correlations were also observed between total population and gross domestic product per capita (r=0.583, p<0.01), MSW / Day (r=0.302, p<0.05) and MSW/year (r=0.961, p<0.01); gross domestic product per capita and MSW/day (r=0.849, p<0.01), MSW/year (r=0.410, p<0.05) and rainfall index (RI) (r=0.416, p<0.05); MSW / day and MSW / year (r=0.389, p<0.01) and RI (r=0.388, p<0.05). Conclusion: The larger the total population, purchasing power or socioeconomic status (GDP per capita) and the generation of MSW, the greater the number of dengue cases. Proper packaging of MSW seems to be a way to help in dengue cases control.Introdução: A dengue é uma doença infecciosa viral sistêmica aguda, estabelecida mundialmente em ciclos de transmissão epidêmica e endêmica. Altos níveis de precipitação, temperaturas adequadas, proximidade entre centros urbanos e peri-urbanos, movimento humano entre centros populacionais e produção de resíduos sólidos urbanos (RSU) podem facilitar a transmissão e a disseminação da dengue. Objetivo: Identificar a relação entre casos diagnosticados de dengue e fatores socioeconômicos, geração de massa de RSU e índice pluviométrico.   Método: Estudo ecológico, com coleta secundária de dados de 2010 a 2016 para cada município da Região do Grande do ABC, em São Paulo, Brasil. Foram investigados a população total, o produto interno bruto (PIB) per capita, RSU, número de casos de dengue e índice pluviométrico. Os dados foram coletados nos sites do Instituto Brasileiro de Geografia e Estatística (IBGE), os municípios da Região do Grande ABC, o Consórcio Intermunicipal do Grande ABC, a Agência de Desenvolvimento Econômico do Grande ABC, o Sistema Nacional de Informação sobre Saneamento, Centro de Vigilância Epidemiológica do Estado de São Paulo e o Departamento de Água e Energia Elétrica do Estado de São Paulo. As relações entre variáveis foram testadas pela correlação de Spearman.   Resultados: A análise dos dados de todos os municípios mostrou correlação positiva entre casos de dengue com população total (r = 0,675, p <0,01), produto interno bruto per capita (r = 0,539, p <0,01) e RSU por habitante por ano (r = 0,492, p <0,01). Também foram observadas correlações positivas entre população total e produto interno bruto per capita (r = 0,583, p <0,01), RSU / dia (r = 0,302, p <0,05) e RSU / ano (r = 0,961, p <0,01); produto interno bruto per capita e RSU / dia (r = 0,849, p <0,01), RSU / ano (r = 0,410, p <0,05) e índice de precipitação (IR) (r = 0,416, p <0,05); RSU / dia e RSU /ano (r = 0,389, p <0,01) e IR (r = 0,388, p <0,05). Conclusão: Quanto maior a população total, poder de compra ou condição socioeconômica (PIB per capita) e a geração de RSU, maior o número de casos de dengue. O descarte adequada dos RSU parece ser uma maneira de ajudar no controle dos casos de dengue

Síndrome da insensibilidade androgênica completa e revisão de literatura

Backgroung: Complete Androgen Insensitivity Syndrome (CAIS) has been reported since 1923, but in 1953 it became known as “testicular feminization”. It is a rare recessive genetic disorder linked to the X chromosome that results in different mutations in the androgen receptor. The main clinical presentation in childhood is the presence of bilateral inguinal hernia in phenotypically female subjects. Incidence of androgen  insensitivity syndrome in phenotypically females with inguinal hernia is estimated in 0.8% to 2.4%. This is a case report of complete androgen insensitivity syndrome and literature review of preoperative diagnostic methods. Case Summary: We present a 3 years and 6 months old child with female phenotype, born in São Paulo, Brazil which was diagnosed intraoperatively with complete androgen insensitivity syndrome, during inguinal hernia repair and present potential diagnostic alternatives that we consider viable options in order to avoid this kind of surprise during surgery. Conclusion: Investigation of CAIS should be standard in prepubertal girls with bilateral inguinal hernia, genetic techniques involving X chromatin or Y chromosome tests present the best choices.Introdução: A síndrome da insensibilidade androgênica completa (SIAC) é relatada desde 1923, mas foi em 1953 que ficou conhecida como “feminilização testicular”. É uma doença genética recessiva rara, ligada ao cromossomo X, causando diversas mutações no receptor de androgênio. A principal apresentação clínica na infância é a presença de hérnia inguinal bilateral em indivíduos fenotipicamente femininos com uma incidência estimada de 0,8% a 2,4%. Apresentamos um caso de insensibilidade androgênica completa, com revisão de literatura dos métodos diagnósticos pré operatórios. Relato do Caso: Apresentamos uma criança de 3 anos e 6 meses de idade com fenótipo feminino, nascida em São Paulo, Brasil diagnosticada com síndrome da insensibilidade androgênica completa, durante a cirurgia de herniorrafia inguinal bilateral e apresentamos potenciais alternativas diagnósticas a fim de evitar esse tipo de surpresa durante a cirurgia. Conclusão: Em meninas pré-puberes, portadoras de hérnia inguinal bilateral, a pesquisa de SIAC se faz necessária, técnicas genéticas que utilizam a pesquisa da cromatina X ou do cromossomo Y seriam as melhores escolhas

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

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