Living near the port area is associated with physical inactivity and sedentary behavior

CONTEXT AND OBJECTIVE: The impact of the port of Santos, Brazil, on the population's health is unknown. We aimed to evaluate the association between living near the port area and physical inactivity and sedentary behavior. DESIGN AND SETTING: Cross-sectional study developed at a university laboratory and a diagnostic clinic. METHODS: 553 healthy adults were selected and their level of physical activity in daily life was assessed using accelerometers. Multiple linear and logistic regressions were performed using physical inactivity and sedentary behavior as the outcomes and living near the port area as the main risk factor, with adjustments for the main confounders. RESULTS: Among all the participants, 15% were resident near the port area. They took 699 steps/day and presented, weekly, 2.4% more sedentary physical activity, 2.0% less time in standing position and 0.9% more time lying down than residents of other regions. Additionally, living near the port area increased the risk of physical inactivity by 2.50 times and the risk of higher amounts of sedentary behavior (>= 10 hours/day) by 1.32 times. CONCLUSION: Living near the port of Santos is associated with physical inactivity and higher sedentary behavior among adults, regardless of confounders. The reasons for this association should be investigated in longitudinal studies.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ Fed Sao Paulo, Lab Epidemiol & Human Movement Epidemiol & Movime, Santos, SP, BrazilUniv Fed Sao Paulo Unifesp, Dept Human Movement Sci, Ave Ana Costa 95, BR-11060001 Santos, SP, BrazilAngiocorpore Inst Cardiovasc Med, Dept Cardiovasc Med, Santos, SP, BrazilInst Coracao InCor, Sao Paulo, SP, BrazilHarvard TH Chan Sch Publ Hlth, Cardiovasc Hlth Program, Boston, MA USADepartment of Human Movement Sciences, Universidade Federal de São Paulo (Unifesp), Santos (SP), BrazilDepartment of Human Movement Sciences, Universidade Federal de São Paulo (Unifesp), Ave Ana Costa 95, BR-11060001, Santos (SP), BrazilFAPESP: 2011/07282-6Web of Scienc

Giant paraselar aneurysm simulating pituitary tumour

Revisamos 7 pacientes com comprometimento da sela turca ao raio X do crânio que apresentavam aneurisma gigante da porção intracavernosa da artéria carótida (6 casos) e aneurisma da artéria comunicante anterior (1 caso). As alterações encontradas foram: cefaléia (7/7), oftalmoplegia complexa interessando III, IV e VI nervos cranianos (5/7) e comprometimento do V nervo (4/7), dor ocular (4/7). Outras alterações encontradas foram: sinais meníngeos (2/7), cegueira unilateral (1/7), hemiparesia (1/7) cacosmia (1/7) e quadrantanopsia bitemporal inferior (1/7). Cinco pacientes com aneurisma da porção intracavernosa da artéria carótida beneficiaram-se com a ligadura progressiva da artéria carótida interna a nível cervical; o outro paciente faleceu antes da realização da operação. O paciente com aneurisma da artéria comunicante anterior foi submetido a clipagem do aneurisma, tendo boa evolução. Baseados neste estudo e em concordância com a literatura, concluímos que o diagnóstico diferencial entre aneurisma localizado na região parasselar e outras patologias dessa área freqüentemente apresenta dificuldade. O diagnóstico definitivo requer a realização de angiografia cerebral. O tratamento cirúrgico, por ligadura da carótida interna na região cervical, é benéfico e quase desprovido de complicações.Seven cases of compromised pituitary fossa at the conventional skull X-ray, who had the final diagnosis of giant aneurysm of the intracavernous portion of the carotid artery (6 cases) and one of the anterior communicant artery, are reported. The main findings were: headache (7/7), complex ophtalmoplegia involving the III, IV and VI cranial nerves (5/7), compromised V cranial nerve (4/7) and eyeball pain (4/7). Other manifestations were: meningeal signs (2/7), unilateral blindness (1/7), hemiparesis (1/7), cacosmia (1/7) and inferior bitemporal quadrantanopsia (1/7). Five patients with intracavernous carotid artery aneurysm showed benefits with progressive occlusion of the internal carotid artery at the cervical level. One died before surgery. The case with anterior communicant artery aneurysm improved after its surgical clipping. Our data, in accord with the literature, support the conclusion that the differential diagnosis of aneurysms in the parasellar egion remains a very difficult task. The accurate final diagnosis requires cerebral angiography and the surgical treatment with progressive occlusion at the cervical portion of the internal carotid artery has a relatively low risk with promising results

Intensity and physiological responses to the 6-minute walk test in middle-aged and older adults: a comparison with cardiopulmonary exercise testing

The 6-minute walk test (6MWT) is a simple field test that is widely used in clinical settings to assess functional exercise capacity. However, studies with healthy subjects are scarce. We hypothesized that the 6MWT might be useful to assess exercise capacity in healthy subjects. the purpose of this study was to evaluate 6MWT intensity in middle-aged and older adults, as well as to develop a simple equation to predict oxygen uptake (V) over dotO(2)) from the 6-min walk distance (6MWD). Eighty-six participants, 40 men and 46 women, 40-74 years of age and with a mean body mass index of 28 +/- 6 kg/m(2), performed the 6MWT according to American Thoracic Society guidelines. Physiological responses were evaluated during the 6MWT using a K4b2 Cosmed telemetry gas analyzer. On a different occasion, the subjects performed ramp protocol cardiopulmonary exercise testing (CPET) on a treadmill. Peak (V) over dotO(2) in the 6MWT corresponded to 78 +/- 13% of the peak (V) over dotO(2) during CPET, and the maximum heart rate corresponded to 80 +/- 23% of that obtained in CPET. Peak (V) over dotO(2) in CPET was adequately predicted by the 6MWD by a linear regression equation: (V) over dotO(2) mL.min(-1).kg(-1) = -2.863 + (0.0563 x 6MWD(m)) (R-2 = 0.76). the 6MWT represents a moderate-to-high intensity activity in middle-aged and older adults and proved to be useful for predicting cardiorespiratory fitness in the present study. Our results suggest that the 6MWT may also be useful in asymptomatic individuals, and its use in walk-based conditioning programs should be encouraged.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Lab Epidemiol & Movimento Humano EPIMOV, Dept Ciencias Movimento Humano, Santos, SP, BrazilInst Med Cardiovasc Angiocorpore, Santos, SP, BrazilUniversidade Federal de São Paulo, Lab Epidemiol & Movimento Humano EPIMOV, Dept Ciencias Movimento Humano, Santos, SP, BrazilFAPESP: 2007/08673-3Web of Scienc

Correlation between heart rate variability and pulmonary function adjusted by confounding factors in healthy adults

The autonomic nervous system maintains homeostasis, which is the state of balance in the body. That balance can be determined simply and noninvasively by evaluating heart rate variability (HRV). However, independently of autonomic control of the heart, HRV can be influenced by other factors, such as respiratory parameters. Little is known about the relationship between HRV and spirometric indices. In this study, our objective was to determine whether HRV correlates with spirometric indices in adults without cardiopulmonary disease, considering the main confounders (e.g., smoking and physical inactivity). In a sample of 119 asymptomatic adults (age 20-80 years), we evaluated forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). We evaluated resting HRV indices within a 5-min window in the middle of a 10-min recording period, thereafter analyzing time and frequency domains. To evaluate daily physical activity, we instructed participants to use a triaxial accelerometer for 7 days. Physical inactivity was defined as <150 min/week of moderate to intense physical activity. We found that FVC and FEV1, respectively, correlated significantly with the following aspects of the RR interval: standard deviation of the RR intervals (r= 0.31 and 0.35), low-frequency component (r= 0.38 and 0.40), and Poincare plot SD2 (r= 0.34 and 0.36). Multivariate regression analysis, adjusted for age, sex, smoking, physical inactivity, and cardiovascular risk, identified the SD2 and dyslipidemia as independent predictors of FVC and FEV1 (R-2= 0.125 and 0.180, respectively, for both). We conclude that pulmonary function is influenced by autonomic control of cardiovascular function, independently of the main confounders.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ Fed Sao Paulo, Dept Ciencias Movimento Humano, Lab Epidemiol & Movimento Humano, Santos, SP, BrazilUniv Fed Sao Paulo, Dept Biociencias, Santos, SP, BrazilAngioCorpore Inst Med Cardiovasc, Santos, SP, BrazilUniv Fed Sao Paulo, Dept Ciencias Movimento Humano, Lab Epidemiol & Movimento Humano, Santos, SP, BrazilUniv Fed Sao Paulo, Dept Biociencias, Santos, SP, BrazilFAPESP: 2011/07282-6Web of Scienc

Prevalence of exercise intolerance in obese adults undergoing cardiopulmonary exercise testing

We hypothesized that the prevalence of exercise intolerance (EI, peak O2 uptake < 83%pred.) is not significantly affected by body mass index (BMI) in adults undergoing cardiopulmonary exercise testing (CPET). We aimed to evaluate the prevalence of EI and the influence of BMI in asymptomatic adults. The results of 780 adults (age 41 ± 13 years) who underwent CPET were evaluated. Participants were stratified according to BMI: normal weight (n = 227), overweight (n = 198), and obese class 1 (n = 155), 2 (n = 131), and 3 (n = 69). After cardiovascular risk assessment, the participants underwent CPET on a treadmill ramp protocol. The prevalence of EI was 20, 16, 21, 25, and 21% in the stratified groups respectively, and no significant differences were found. Predictors of EI were physical inactivity, age, and smoking. The prevalence of EI in asymptomatic adults is considerable, regardless of BMI. The obesity-related reduction in cardiorespiratory fitness seems to be as clinically relevant as in non-obese counterparts

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research