An adverse effect of intense exercise?

Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.Regular physical exercise is responsible for various health benefits, and is recommended for primary and secondary cardiovascular (CV) prevention. Despite these recognized benefits, various clinical events can occur in athletes, including acute myocardial infarction and sudden cardiac death (SCD); the main cause of SCD in veteran athletes is coronary artery disease (CAD). The relationship between intense exercise training and CAD is controversial, and a U-shaped association has been hypothesized. If this is the case, screening for subclinical CAD in older athletes may be justified, and various different methodologies have been proposed. However, the methodology for screening veteran athletes is not consensual, and several markers of CAD, in addition to clinical CV risk factors, could improve risk stratification in this population. In the present paper we review the published data on CAD in athletes, focusing on the relationship between the dose of exercise and CAD, as well as the implications for pre-participation screening of veteran athletes.publishersversionpublishe

The potential role of peak nasal inspiratory flow to evaluate active sinonasal inflammation and disease severity

Although the pathophysiology of nasal polyposis is incompletely understood, rhinologists have seldom studied it with rhinomanometry or peak nasal inspiratory flow (PNIF) due to technical limitations and the perception that polyp size might impair reproducibility and the usefulness of recordings. The objective of this study is to assess how measures of rhinomanometry and PNIF relate to disease activity. Nineteen patients with polyps, 15 patients with chronic sinusitis without polyps and 11 negative controls were evaluated with active anterior rhinomanometry and PNIF. Sinusitis and polyp patients were re-evaluated after medical treatment. Polyp patients had the highest median Lund-Mackay score (14) and a median Johansen score of 1. PNIF and its variation after treatment were also lowest in this group (median 90 L/min before and after treatment; median variation of 0 L/min). Nasal resistance was similar between groups, and only correlated with Johansen score (Spearman = 0.517, p = 0.048) after treatment. Our study suggests that evaluating polyp patients using rhinomanometry and PNIF may provide useful and reproducible data. Several findings considered together suggest that polyp size is not the main determinant of nasal functional changes in these patients, warranting further studies to verify whether PNIF changes reflect sinus inflammation or merely airway obstruction.publishersversionpublishe

A score methodology to assess concept maps in medical education in the context of pathophysiology teaching

The main objective of pathophysiology teaching is to facilitate the learning of mechanisms of diseases and the understanding of their expressions in patients (symptoms, signs and tests). This objective requires the application of basic biomedical science to explain the abnormalities expressed by the patients. The capacity to integrate this new organization of knowledge is essential to the understanding of pathophysiological mechanisms, which explain expressions of specific diseases. Our group has a longstanding experience in the teaching of pathophysiology to medical students using problem-based learning (PBL) and concept mapping (CM). This semestral discipline has a yearly intake of 190 students, divided into 18 tutorial groups and supported by 14 tutors. The students’ learning progress is evaluated by their performance during the tutorial sessions and the CM methodology has been introduced as an additional tool to visualize the integration of knowledge and how it is displayed in the different pathophysiological mechanisms. Until now, the evaluation of CM has been qualitative and used as an additional assessment tool by the tutors. This study reports how we are changing this approach by training the tutors and developing a scoring methodology, which will be described in detail, together with a preliminary application in selected mapsFonseca, M.; Oliveira, B.; Carreiro-Martins, P.; Neuparth, N.; Rendas, A. (2020). A score methodology to assess concept maps in medical education in the context of pathophysiology teaching. En 6th International Conference on Higher Education Advances (HEAd'20). Editorial Universitat Politècnica de València. (30-05-2020):867-874. https://doi.org/10.4995/HEAd20.2020.11163OCS86787430-05-202

Ventilatory defects and treatable traits in very elderly patients

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This study was supported by AstraZeneca – Projecto OLDER (CEDOC/2015/59) and Finnee Project (PTDC/CCI-BIO/29702/2017).Though the approach used to classify chronic respiratory diseases is changing to a treatable-traits (TT) approach, data regarding very elderly patients is lacking. The objectives of this study were to assess TT frequency in very elderly patients and to study the link between extrapulmonary TT and ventilatory defects. Individuals (≥75 years) residing in elderly care centres answered a standardised questionnaire, underwent spirometry, atopy and fractional exhaled nitric oxide assessments and had their blood pressure and peripheral pulse oximetry measured. Pulmonary, extrapulmonary and behavioural TT were evaluated. Outcome variables were an airflow limitation (post-bronchodilator z-score FEV1/FVC<-1.64) and a restrictive spirometry pattern (z-score FEV1/FVC ≥ +1.64 and z-score FVC<-1.64). Seventy-two percent of the individuals who took part in the study (n = 234) were women, and the median age of participants was 86 (IQR: 7.4). At least one pulmonary TT was identified in 105 (44.9%) individuals. The most frequent extrapulmonary TTs were: persistent systemic inflammation (47.0%), anaemia (34.4%), depression (32.5%) and obesity (27.4). Airflow limitation was exclusively associated with smoking (OR 5.03; 95% CI 1.56-16.22). A restrictive spirometry pattern was associated with cognitive impairment (OR: 3.89; 95% CI: 1.55-9.79). A high frequency of various TTs was found. The novel association between a restrictive spirometry pattern and cognitive impairment highlights the urgency of clinical research on this vulnerable age group.publishersversionpublishe

Colaboração na realização da espirometria numa população de idosos: estudo GERIA

A espirometria é o método de eleição para a identificação de alterações ventilatórias, porém é pouco utilizada em idosos pelo fato de habitualmente se considerar que estes não conseguem colaborar. Este estudo tem como objetivo avaliar a colaboração na realização da espirometria antes e após administração de broncodilatador numa população de idosos residente num lar de Lisboa

Obstrução brônquica máxima induzida em crianças asmáticas: análise dos indicadores de susceptibilidade brônquica aumentada à metacolina

Rev. Port. de Pneumologia. 1997,1:p. 5-37.Neste trabalho, efectuaram-se testes de provocação brônquica máxima com metacolina em 17 crianças asmáticas, com dois dos métodos de administração de aerossóis mais frequentemente usados, dosimétrico e de volume corrente, com os objectivos de: I) avaliar a reprodutibilidade dos indicadores de susceptibilidade brônquica aumentada: P020/PC20 FEV15 declive da curva de dose-resposta (COR)e grau de redução máxima do FEV1(MFEV,) ou plateau; 2) verificar se a fórmula de cálculo do declive e a tilização de diferente numero de pontos se traduzem por valores semelhantes, para o que se compararam, na mesma COR, os declives calculados por regressão linear: entre si, em diferentes fases da curva de dose-resposta e também com os calculados pela fórmula simplificada de O'CONNOR; 3) determinar se o valor do declive de uma prova de obstrução máxima pode ser extrapolado a partir dos testes de provocação recomendados para a clíníca (que terminam imediatamente após o limiar de 20% de redução do FEV, ler sido atingido); e 4) comparar os declives e os valores do grau de obstrução máxima induzidos pelo método do dosimetro com os obtidos pelo método do volume corrente. Para esse efeito, administraram-se doses/concentrações crescentes de cloridrato de metacolina até se atingir um plateou (variação entre dois pontos consecutivos 50% do valor medido após inalação do solvente. A SaO2 foi medida em condições basais e 90 segundos após a inalação do solvente e de cada dose de metacolina, através de um oximetro de pulso. Não se observaram diferenças significativas entre os indicadores de susceptibilidade brônquica em dois testes realizados com 5 a 10 dias de intervalo, tanto para o método do dosimetro (n=6) como para o método do volume corrente (n=5), quer os PD20 e FEV1 quer os PC20 FEV1 encontravam-se dentro dos limites de reprodutibilidade recomendados e não se observaram diferenças significativas entre os declives qualquer que fosse o método de cálculo ou a fase da curva analisada. Por outro lado, encontraram-se diferenças significativas entre os declives calculados por regressão linear nas diferentes fases da COR. O mesmo se verificou em relação aos valores deste parâmetro determinados por fórmulas diferentes. Não se observaram diferenças entre os declives das CDR obtidas, no mesmo indivíduo, pelo método do dosimetro e pelo método do volume corrente. As variações da SaO2 durante as provas não excederam -7% do valor basal, sugerindo não terem existido repercussões significativas sobre a trocas gasosas, mmesmo com reduções do FEV1>50

A concept map template to be used by medical students for displaying pathophysiological mechanisms within clinical cases

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A scoping review comparing different mapping approaches pointing to the need for standardizing concept maps in medical education: A preliminary analysis

This study aims to analyze how visual tools, labeled as maps, are built, and used in medical education. Based on the educational model of concept maps (CMs), proposed by Novak and Cañas (2008), and adapted to medicine by Daley and Torre (2010), we are currently analyzing the results of a scoping review following the PRISMA extension methodology, specifically for these purposes. Other visual tools, such as knowledge maps (KMs) and mind maps (MMs), used in medical education, were also included. The search was made through the databases EBSCO, PubMed/MEDLINE, PsycINFO, Scopus, and Eric, using the following items: “concept map*”, “knowledge map*”, “mind map*” and “medical education”. Only articles in English were considered and exclusively in medical education, from undergraduate to resident training. The analysis of selected articles included the following features: construction rules (if they followed Novakian instructions), teaching area, student level (undergraduate, postgraduate/residents), and use for assessment. Other features were the capacity to relate basic science knowledge to clinical concepts, the use of maps with other educational methods, such as problem-based learning (PBL), and providing feedback to students. From a quantitative perspective, the use of CMs is dominant in all phases of medical education. A failure to follow Novakian rules was found in around half of the articles labeled as CMs and KMs. As for MMs, which follow different rules for construction and use, they were considered relevant in helping students to summarize and retain information. Simultaneous use with other educational methods was only found with CMs

Teste de provocação brônquica com metacolina em crianças asmáticas: standardização do método com um dosímetro

Arquivos da Sociedade Portuguesa de Patologia Respiratória. 1988 V-2:p.7-15O objectivo deste trabalho foi standardizar os testes de provocação brônquica inespecífica com um dosímetro. (...