Efeitos da isquemia em membros inferiores na resposta cardiopulmonar e metabólica no ciclismo

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Desportos, Programa de Pós-Graduação em Educação Física, Florianópolis, 2016.O objetivo deste estudo foi investigar o efeito de um modelo de isquemia-reperfusão (IR) prévio (15 minutos de oclusão a 250 mmHg em membros inferiores por 3min de reperfusão) sobre a cinética de VO2 pulmonar em um exercício severo. Participaram deste estudo 10 sujeitos fisicamente ativos (25,7 ± 4,7 anos; 79,3 ± 10,8 kg; 177 ± 5 cm; 44,5 ± 6,2 ml.kg-1.min-1), que realizaram um teste incremental em ciclo-ergômetro para a determinação dos índices fisiológicos necessários (LV1, VO2max, ?50% e potência pico) e então mais 4 visitas em dias separados, sendo elas: 1 e 2 ? ?50% sem IR prévia; 3 e 4 ? ?50% com IR prévia. A análise de variância para medidas repetidas (ANOVA one e two-way) e o teste t de Student para amostras pareadas foram utilizados para verificar os efeitos encontrados sobre as variáveis do estudo (? = 0,05). Não foram encontradas diferenças estatisticamente significantes para nenhum parâmetro da cinética de VO2 pulmonar nem para a cinética de frequência cardíaca (FC) e pulso de O2. Também não foram encontradas diferenças estatisticamente significantes para as concentrações de lactato imediatamente antes e após o exercício entre as condições. Concluímos que o modelo de IR não encontrou efeito sobre a cinética de VO2, FC e pulso de O2 em um exercício severo realizado em ciclo-ergômetro.Abstract : Oxygen uptake adjustment phenomenon at the onset of the exercise is known as an important topic towards understanding energy system distribution an its impact on exercise performance. The main focus of this study was to investigate the effect of an priming ischemia-reperfusion model (15min ischemia/3min reperfusion at 250 mmHg in thighs) on pulmonary VO2 kinetics at ?50% exercise. We studied 10 men physically actives subjects (25,7 ± 4,7 years; 79,3 ± 10,8 kg; 177 ± 5 cm; 44,5 ± 6,2 ml.kg-1.min-1), which realized an maximal incremental test an then 4 more laboratory testing in separate days: 1 and 2 ? ?50% without priming IR (CON); 3 and 4 ? ?50% with priming IR (IR). ANOVA one e two-way for repeated measures and Student?s t test for paired samples were used to access the effects in this study (? = 0,05). We did not found statistically significant differences for any pulmonary VO2 kinetics parameter , as well as for heart rate (HR) and O2 pulse kinetics. Also, there were no differences for blood lactate before and after between conditions. We concluded that ischemia-reperfusion model used in this study did not found any effect on VO2, HR and O2 pulse kinetics during severe cycle-ergometry exercise

Type 2 diabetes mellitus burden of disease in Brazil between 1990 to 2019: a nationwide descriptive analysis of the Global Burden of Disease Study 2019

This is a Brazilian nationwide analysis of the burden of type 2 diabetes mellitus along the 26 states and federal district, between 1990 up to 2019. In summary, through spatiotemporal Gaussian regression methods, we estimated the attributable share of T2DM for prevalence, deaths, DALYs, YLLs and YLDs in Brazilian population. Moreover, we sought to investigate the behavior of top risk factors for T2DM and the attributable impact in burden of disease outcomes accordingly. We also investigated whether the geolocation and time, as well as the socio demographic index, would have any ecological relationship with different levels of disease and risk factors impact. In summary, our major conclusion is that, regardless of any trend pattern overtime, states out of the South/Southeast region in Brazil are more prone to higher burden of diseases attributable to T2DM. Given the ecological pattern with the SDI, it is fair to speculate that socio-economic structural and fundamental matters may be associated with burden of disease pattern (i.e., as high as the SDI, lower is the attributable burden of disease). Top risk factors such high-fasting plasma glucose or physical inactivity may be targeted by policy makers as a potential primary prevention strategy. Our understanding of this ecological analysis is that even though the HTA improvements achieved over 1990 to 2019, population-oriented health care strategies can emphasize socio determinants of health together with the patient-level care, targeting risk factors of relevance

Hemostasis after percutaneous transfemoral access : a protocol for systematic review

Background: Access site hemostasis after percutaneous procedures done in the catheterization laboratory still needs to be better studied in relation to such aspects as the different results achieved with different hemostasis strategies, the impact of different introducer sheath sizes, and arterial versus venous access. The objective of this review is to synthesize the available scientific evidence regarding different techniques for hemostasis of femoral access sites after percutaneous diagnostic and therapeutic procedures. Methods: This review is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The primary outcomes will include the following vascular complications: hematoma, pseudoaneurysm, bleeding, minor, and major vascular complications. The secondary outcomes will include the following: time to hemostasis, repetition of manual compression, and device failure. A structured strategy will be used to search the PubMed/ MEDLINE, Embase, CINAHL, and CENTRAL databases. In addition, a handsearch of the reference lists of selected studies will be conducted. The ERIC research database will be queried for the gray literature and ClinicalTrials.gov, for potential results not yet published in indexed journals. Two reviewers will independently screen citations and abstracts, identify full-text articles for inclusion, extract data, and appraise the quality and risk of bias of included studies. If possible, a meta-analysis will be carried out. All estimations will be made using Review Manager 5.3. Statistical heterogeneity will be assessed by considering the I 2 proxy, accompanied with qualitative indicators such as differences in procedures, interventions, and outcomes among the studies. If synthesis proves inappropriate, a narrative review will be undertaken. Results: This protocol adheres to the PRISMA-P guideline to ensure clarity and completeness of reporting at all phases of the systematic review. Conclusion: This study will provide synthesized information on different methods used to achieve hemostasis after femoral access. Ethics and dissemination: Ethical approval number CAAE 19713219700005327. The results of the systematic review will be disseminated via publication in a peer-reviewed journal and through conference presentations. Systematic review registration: PROSPERO CRD42019140794

Predição do movimento de preços das ações da copel com base em indicadores técnicos e redes neurais / Prediction of copel stock price movement based on technical indicators and neural networks

Técnicas de aprendizagem de máquina tem sido utilizadas de modo recorrente na criação de modelos de predição. O objetivo deste trabalho é analisar a utilização de indicadores financeiros e de uma rede neural artificial para a predição de tendências no mercado mobiliário. Foi realizado um estudo de caso em dados públicos da COPEL, extraídos a partir da BM&FBovespa. O período analisado corresponde ao primeiro semestre de 2015. A previsão foi feita para 20 dias. A análise compara os valores reais do preço de fechamento da ação, com o preço previsto pela rede neural. Os resultados obtidos foram próximos das variações reais, indicando o movimento futuro do valor da ação da COPEL

Thigh Ischemia-Reperfusion Model Does Not Accelerate Pulmonary VO2 Kinetics at High Intensity Cycling Exercise

Background: We aimed to investigate the effect of a priming ischemia-reperfusion (IR) model on the kinetics of pulmonary oxygen uptake (VO2) and cardiopulmonary parameters after high-intensity exercise. Our primary outcome was the overall VO2 kinetics and secondary outcomes were heart rate (HR) and O2 pulse kinetics. We hypothesized that the IR model would accelerate VO2 and cardiopulmonary kinetics during the exercise.Methods: 10 recreationally active men (25.7 ± 4.7 years; 79.3 ± 10.8 kg; 177 ± 5 cm; 44.5 ± 6.2 mL kg−1 min−1) performed a maximal incremental ramp test and four constant load sessions at the midpoint between ventilatory threshold and VO2 max on separate days: two without IR (CON) and two with IR (IR). The IR model consisted of a thigh bi-lateral occlusion for 15 min at a pressure of 250 mmHg, followed by 3 min off, before high-intensity exercise bouts.Results: There were no significant differences for any VO2 kinetics parameters (VO2 base 1.08 ± 0.08 vs. 1.12 ± 0.06 L min−1; P = 0.30; τ = 50.1 ± 7.0 vs. 47.9 ± 6.4 s; P = 0.47), as well as for HR (MRT180s 67.3 ± 6.0 vs. 71.3 ± 6.1 s; P = 0.54) and O2 pulse kinetics (MRT180s 40.9 ± 3.9 vs. 48.2 ± 5.6 s; P = 0.31) between IR and CON conditions, respectively.Conclusion: We concluded that the priming IR model used in this study had no influence on VO2, HR, and O2 pulse kinetics during high-intensity cycling exercise

Efficacy of chlorthalidone and hydrochlorothiazide in combination with amiloride in multiple doses on blood pressure in patients with primary hypertension : a protocol for a factorial randomized controlled trial

Background: Thiazide diuretics have demonstrated favorable blood pressure lowering efficacy, but the equivalent doses of their more common agents, chlorthalidone and hydrochlorothiazide, are still unclear. Further, concerns exist regarding adverse metabolic effects, which may be attenuated with the concomitant administration of a potassium-sparing diuretic, such as amiloride. This trial aims to investigate the efficacy of chlorthalidone and hydrochlorothiazide, in combination with amiloride at different doses, for initial management of patients with primary hypertension. Methods/design: This is a factorial (2 × 2) randomized double-blinded clinical trial comparing the association of a thiazide diuretic (chlorthalidone 25 mg/day or hydrochlorothiazide 50 mg/day) with a potassium-sparing diuretic (amiloride 10 mg/day or amiloride 20 mg/day) in patients with primary hypertension. The primary outcome will be the mean change from baseline in 24-h systolic and diastolic blood pressure measured by ambulatory blood pressure monitoring. The secondary outcomes will be the mean change from baseline in daytime and nighttime systolic and diastolic blood pressure measured by ambulatory blood pressure monitoring, mean change from baseline in systolic and diastolic blood pressure measured by office blood pressure, incidence of adverse events, variation of laboratory parameters, and proportion of patients who achieved blood pressure control. The follow-up will last 12 weeks. For a P alpha of 0.05, power of 80%, standard deviation of 9 mmHg, and absolute difference of 6 mmHg on systolic blood pressure on 24-h ambulatory blood pressure monitoring, it will be necessary to study a total of 76 patients. The sample size will be increased by 10% to compensate for losses, resulting in 84 patients being randomized. Discussion: Diuretics are pivotal drugs for the treatment of hypertension. Chlorthalidone and hydrochlorothiazide, in combination with amiloride in multiple doses, will be tested in terms of blood pressure lowering efficacy and safety. Since the intensity of blood pressure reduction is the major determinant of reduction in cardiovascular risk in hypertensive patients, this study will help to determine which combination of diuretics represents the most appropriate treatment for this population

Sudden death in young Brazilian athletes : isn't it time we created a genuinely national register?

Atletas jovens (≤ 35 anos), com doenças cardiovasculares de diagnóstico conhecido ou não, podem morrer subitamente em atividades competitivas, fato este que pode causar grande impacto na mídia e na sociedade. Embora apresentem risco relativo aproximadamente duas vezes maior em comparação com seus pares não-atletas, a incidência absoluta de morte súbita (MS) é baixa. Entre entidades médicas no mundo todo, é consenso que a detecção precoce dos fatores causais é muito desejável, mas há debate em relação aos diferentes esquemas de rastreamento para esse fim. No Brasil, a recomendação da Sociedade Brasileira de Cardiologia espelha-se nas diretrizes da European Society of Cardiology (ESC), segundo as quais o exame clínico aliado a um eletrocardiograma de repouso de 12 derivações é indicado, independentemente da presença de fatores de risco. A possibilidade de rastreamento genético também existe, uma vez que a maior parte das entidades clínicas causadoras de MS no esporte em jovens atletas se relaciona com o genótipo. Por fim, considerando a diversidade de modalidades esportivas praticadas, e sendo a população brasileira muito miscigenada, salientamos a necessidade de um registro nacional de casos

The “Hypertension Approaches in the Elderly: a Lifestyle study” multicenter, randomized trial (HAEL Study): rationale and methodological protocol

Background: Hypertension is a clinical condition highly prevalent in the elderly, imposing great risks to cardiovascular diseases and loss of quality of life. Current guidelines emphasize the importance of nonpharmacological strategies as a first-line approach to lower blood pressure. Exercise is an efficient lifestyle tool that can benefit a myriad of health-related outcomes, including blood pressure control, in older adults. We herein report the protocol of the HAEL Study, which aims to evaluate the efficacy of a pragmatic combined exercise training compared with a health education program on ambulatory blood pressure and other health-related outcomes in older individuals. Methods: Randomized, single-blinded, multicenter, two-arm, parallel, superiority trial. A total of 184 subjects (92/center), ≥60 years of age, with no recent history of cardiovascular events, will be randomized on a 1:1 ratio to 12-week interventions consisting either of a combined exercise (aerobic and strength) training, three times per week, or an active-control group receiving health education intervention, once a week. Ambulatory (primary outcome) and office blood pressures, cardiorespiratory fitness and endothelial function, together with quality of life, functional fitness and autonomic control will be measured in before and after intervention. Discussion: Our conceptual hypothesis is that combined training intervention will reduce ambulatory blood pressure in comparison with health education group. Using a superiority framework, analysis plan prespecifies an intention-to-treat approach, per protocol criteria, subgroups analysis, and handling of missing data. The trial is recruiting since September 2017. Finally, this study was designed to adhere to data sharing practices. Trial registration: NCT03264443. Registered on 29 August, 2017