Role of coronary artery calcium score for risk stratification in patients with non significant perfusion defects by myocardial perfusion single photon emission computed tomography

Background: Myocardial perfusion scintigraphy (MPS) is an important diagnostic tool in the management of patients with suspected coronary artery disease (CAD). However, the presence of mild-moderate perfusion defects can be challenging and may lead to unnecessary cardiac catheterization. The coronary artery calcium (CAC) score is a method with excellent negative predictive value in the evaluation of CAD, but its role in this setting of patients has not been fully defined. This study aims to assess the potential of CAC in the prediction of cardiac adverse events in patients with suspected CAD with mild-moderate perfusion by MPS. Methods and results: We conducted a cohort study in 292 patients presenting with mild-moderate perfusion defects by MPS undergoing a CAC measurement. The patients were followed for a mean of 34 months for occurrence of major cardiac adverse events (MACE). The majority of the patients (64.7%) were male, mean age of 57.9 ± 12.6 years. During the follow-up there were 37 MACE. In multivariate Cox proportional hazards model, hypertension and CAC were independent predictors of MACE. The patients who presented a CAC score of ≥ 400 had a high risk of MACE (HR 20.9; 95% CI 4.79–91.42; p < 0.001). Kaplan-Meier curve showed a significant difference (log-rank c2; p< 0.001) using CAC scores in predicting MACE. Conclusions: CAC score carries a powerful prognostic value in predicting adverse events in patients with suspected CAD and MPS with mild-moderate perfusion defects and may be useful in risk stratification of these patients

Reviewing Atrial Fibrillation Pathophysiology from a Network Medicine Perspective: The Relevance of Structural Remodeling, Inflammation, and the Immune System

Atrial fibrillation (AF) is the most common type of sustained arrhythmia. The numerous gaps concerning the knowledge of its mechanism make improving clinical management difficult. As omics technologies allow more comprehensive insight into biology and disease at a molecular level, bioinformatics encompasses valuable tools for studying systems biology, as well as combining and modeling multi-omics data and networks. Network medicine is a subarea of network biology where disease traits are considered perturbations within the interactome. With this approach, potential disease drivers can be revealed, and the effect of drugs, novel or repurposed, used alone or in combination, may be studied. Thus, this work aims to review AF pathology from a network medicine perspective, helping researchers to comprehend the disease more deeply. Essential concepts involved in network medicine are highlighted, and specific research applying network medicine to study AF is discussed. Additionally, data integration through literature mining and bioinformatics tools, with network building, is exemplified. Together, all of the data show the substantial role of structural remodeling, the immune system, and inflammation in this disease etiology. Despite this, there are still gaps to be filled about AF

Aerobic Training Associated with Arginine Supplementation Reduces Collagen-Induced Platelet Hyperaggregability in Rats under High Risk to Develop Metabolic Syndrome

Background. Increased platelet response is seen in individuals with metabolic syndrome. Previous reports have shown that arginine supplementation and aerobic exercise training enhance vascular nitric oxide (NO) activity and inhibit platelet hyperaggregability; however, the effects of their association remain unknown. Aim. To investigate whether arginine supplementation and aerobic exercise association may exert beneficial effects, reducing platelet hyperaggregability in rats under high risk to develop metabolic syndrome. Methods. Wistar rats were divided into two groups: control (C) and fructose (F – water with 10% of fructose). After two weeks, the F group was subdivided into four groups: F, the same as before; fructose + arginine (FA – 880 mg/kg/day of L-arginine by gavage); fructose + training (FT); and fructose + arginine + training (FTA). Treatment lasted for eight weeks. Results. The fructose administration was able to increase the collagen-induced platelet aggregation (27.4 ± 2.7%) when compared to the C group (8.0 ± 3.4%). Although the arginine supplementation (32.2 ± 6.3%) or aerobic training (23.8 ± 6.5%) did not promote any change in platelet collagen-induced hyperaggregability, the association of arginine supplementation and aerobic exercise promoted an inhibition of the platelet hyperaggregability induced by fructose administration (13.9 ± 4.4%) (P<0.05). These effects were not observed when ADP was employed as an agonist. In addition, arginine supplementation associated with aerobic exercise promoted a decrease in interleukin-6 (IL-6) and interleukin-8 (IL-8) serum levels when compared to the fructose group, demonstrating an anti-inflammatory effect. Conclusions. Our data indicate an important role of arginine supplementation associated with aerobic exercise, reducing platelet hyperaggregability and inflammatory biomarker levels in rats under high risk to develop metabolic syndrome

Asma no cenário da pandemia da COVID-19: guia de orientações e exercícios

This book originated from a patients with asthma demand's, their families and friends in relation to the better management of this disease during the COVID-19 pandemic. The book was prepared by the group of researchers, professors and students of the Research Laboratory for Evaluation and Pulmonary Rehabilitation at UFRJ (LiRP / UFRJ) and had the collaboration of a multiprofessional team formed by doctors, physiotherapists, nutritionists, pharmacists and physical education teachers with extensive clinical experience in caring for people with asthma.Esse livro foi originado de uma demanda dos pacientes com asma, seus familiares e amigos em relação ao melhor manejo dessa doença durante a pandemia da COVID-19. O livro foi elaborado pelo grupo de pesquisadores, professores e alunos do Laboratório de Investigação em Avaliação e Reabilitação Pulmonar da UFRJ (LiRP/UFRJ) e contou com a colaboração de uma equipe multiprofissional formada por médicos, fisioterapeutas, nutricionistas, farmacêuticos e professores de educação física com vasta experiência clínica no atendimento a pessoas com asma