Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease

OBJECTIVES: The prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease according to disease severity has not yet been established. The aim of this study was to assess the prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease patients according to disease severity. METHODS: The study included 25 mild/moderate chronic obstructive pulmonary disease patients and 25 severe/very severe chronic obstructive pulmonary disease patients. All participants underwent clinical evaluation, spirometry and electrocardiography/echocardiography. RESULTS: Electrocardiography and echocardiography showed Q-wave alterations and segmental contractility in five (10%) patients. The most frequent echocardiographic finding was mild left diastolic dysfunction (88%), independent of chronic obstructive pulmonary disease stage. The proportion of right ventricular overload (

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Comparação da espirometria, da qualidade de vida e da capacidade funcional de exercício em pacientes com doença arterial coronariana estável de acordo com a história tabágica

A doença cardiovascular (DCV) é a principal causa de morte no mundo. Embora o tabagismo seja um dos principais fatores de risco para o desenvolvimento e progressão da doença arterial coronariana (DAC), estudos sugerem que independentemente do tabagismo, o diagnóstico concomitante de doença pulmonar obstrutiva crônica (DPOC) ou a redução do volume expiratório forçado no primeiro segundo (VEF1) são marcadores de morbidade e mortalidade cardiovascular. Por outro lado, não foram identificados estudos que avaliassem as características de pacientes com DAC de acordo com o estado tabágico. O presente estudo tem como objetivos comparar a prevalência de alterações da espirometria, do estado geral de saúde, da percepção de dispneia e da capacidade funcional nos pacientes com DAC estável de acordo com o estado tabágico e também estudar as associações entre os atributos avaliados. Foram avaliados 53 pacientes (68% do gênero masculino e idade média de 66 ± 9 anos) com DAC estável, não tabagistas, ex-tabagistas ou tabagistas ativos, separados em dois grupos de acordo com o estado tabágico [(não tabagistas (n=23) vs tabagistas/ex-tabagistas(n=30)]. Todos os indivíduos foram submetidos à avaliação clínica e laboratorial, da espirometria pré e pós-broncodilatador, das trocas gasosas, das comorbidades, do estado de saúde por meio do Medical Outcomes Study 36- item Shot-Form Health Suvery (SF-36), da Escala Hospitalar de Ansiedade e Depressão, da intensidade de dispneia [índice de dispneia basal (BDI) e Medical Research Council (MRC)], da composição do corpo, da capacidade funcional de exercício, da força muscular periférica do eletrocardiograma. Pacientes tabagistas/ex-tabagistas...Cardiovascular disease (CVD) is the main cause of death worldwide. Although smoking is one of the major risk factors for the development and progression of coronary arterial disease (CAD), studies suggest that regardless of smoking, the concomitant diagnosis of chronic obstructive pulmonary disease (COPD) or reduction in the forced expiratory volume in one second (FEV1) are markers cardiovascular morbidity and mortality. On the other hand, studies evaluating the characteristics of patients with CAD according to their smoking status have not been identified. The present study aimed at comparing the prevalence of alterations in spirometry, general health conditions, dyspnea perception and functional capacity in patients with stable CAD according to their smoking status as well as at studying the associations between the evaluated attributes. Fifty-three patients (68% of males at a mean age of 66 ± 9 years) with stable CAD were evaluated. The group comprised nonsmokers, former smokers and active smokers who were separated into two groups according to their smoking stage [non-smokers (n= 23) vs. smokers/former smokers (n= 30)]. All the individuals were submitted to clinical evaluation and laboratory, pre- and post-bronchodilator spirometry, gas-exchange, comorbidity, health condition assessments by means of the Medical Outcomes Study - 36-item Short-Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale, dyspnea intensity [basal dyspnea index (BDI) and the Medical Research Council (MRC)], body composition, functional exercise capacity, peripheral muscle strength and electrocardiogram assessments. Smokers and former smokers showed higher prevalence of pulmonary function... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Quality of Honey Produced by Four Species Of Stingless Bees in the Central Region of the State of Tocantins

Meliponiculture, the rational breeding of native stingless bees, is considered an excelente sustainable alternative to assist in the pollination process and is an economically viable activity. In the cerrado of Tocantins, the meliponine species that stand out most due to their wide distribution are: Scaptotrigona tubiba, Melipona fasciculata,M. rufiventris and Tetragonisca angustula. The bibliographic collection about these species is still little explored, hence there is a need for research to deepen the existing knowledge in the area. For this reason, the aim of this study was: a) to quantify the honey production of four meliponine species: T. angustula, M. fasciculata, M. rufiventris, and S. tubiba; b) to determine the physicochemical characteristics of the product; c) measure the biological parameters of the colony and d) evaluate the profile and sensory acceptance of honey in the municipalities, Palmas and Miracema, in the Tocantins. The study evaluated the biological parameters of the colony, honey production, and physicochemical analysis. The highest honey production came from the species T. angustula in the two collections for the municipality of Palmas. For Miracema, the species S. tubiba and M. fasciculata were evaluated, respectively. The physicochemical parameters evaluated fit the norms assigned to honey quality control. Results showed that honey from M. fasciculata was the sensory profile that obtained the best average among the characteristics observed in the study. There was a positive and negative correlation between the biological parameters, with a significant difference only between the characters’ height and diameter of the honey pot