Cardiorespiratory optimal point in post-COVID-19 patients: a cross-sectional study

ABSTRACT The varied clinical presentations of SARS-CoV-2 infection have raised concerns about long-term consequences, especially "long-COVID" or "post-COVID-19 syndrome." In this context, the cardiorespiratory optimal point (COP) within the Cardiopulmonary Exercise Test (CPET) emerges as a crucial metric for evaluating functional capacities and detecting cardiovascular and pulmonary anomalies post-COVID-19. This study aimed to assess COP values among post-COVID-19 patients and categorized them based on the initial severity of their disease. In this cross-sectional study conducted in the Northeast Brazil, 80 patients (26 females and 54 males) previously infected with SARS-CoV-2 underwent CPET. We clinically stratified patients into mild, moderate, or severe COVID-19 categories and assessed COP values and other cardiorespiratory metrics. We found differences in the predicted COP between patients with mild and severe COVID-19 (p=0.042). Additionally, patients with moderate and severe COVID-19 record had an average COP value exceeding 22. Other parameters, including respiratory exchange ratio, heart rate, and oxygen uptake efficiency slope, did not differ across the groups. Patients with a history of severe COVID-19 showed altered COP values, suggesting potential discrepancies in cardiovascular and respiratory system integration. The outcomes emphasize the importance of continuous monitoring and assessment of the cardiorespiratory domain for post-COVID-19 patients. Further research is needed to understand the relationship between elevated COP in post-severe COVID-19 and its long-term prognostic implications.

A systematic review to investigate whether birth weight affects the autonomic nervous system in adulthood / Uma revisão sistemática para investigar se o peso ao nascer afeta o sistema nervoso autônomo na vida adulta

ABSTRACT Objective: To evaluate the relationship between birth weight and the autonomic nervous system in adulthood through a systematic review. Data source: This is a systematic review of publications without limitation of year and language. We included studies involving the autonomic nervous system and birth weight in adults. Manuscripts were selected based on electronic searches of Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science Cochrane Library and Scopus databases, using "Autonomic Nervous System" OR "Heart Rate" OR "Heart Rate Variability" AND "Birth Weight" as a search strategy. This review is registered on the International Prospective Register of Systematic Reviews — PROSPERO (ID: CRD42020165622). Data synthesis: We found 894 articles; 215 were excluded for duplicity. Of the remaining 679 studies, 11 remained. Two were excluded because they did not specifically treat the autonomic nervous system or birth weight. There were nine publications, two cohort and seven cross-sectional studies. The main findings were that extreme, very low, low or high birth weight may have some impact on the autonomic nervous system in adult life. Conclusions: Birth weight outside the normality rate may have a negative influence on the autonomic nervous system, causing autonomic dysfunction and increasing the risk of cardiovascular diseases in adult life. Thus, the importance of the follow-up of health professionals from pregnancy to gestation and throughout life, with preventive care being emphasized.

RESUMO Objetivo: Avaliar a relação entre o peso ao nascer e o sistema nervoso autônomo na vida adulta por meio de uma revisão sistemática. Fontes de dados: Esta é uma revisão sistemática de publicações, sem limitação de ano e idioma. Incluímos estudos envolvendo o sistema nervoso autônomo e peso ao nascer em adultos. Os manuscritos foram selecionados das bases de dados eletrônicos Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science Cochrane Library e Scopus, utilizando "Autonomic Nervous System" OR "Heart Rate" OR "Heart Rate Variability" AND "Birth Weight" como estratégia de busca. Esta revisão está registrada pelo International Prospective Register of Systematic Reviews — PROSPERO (ID: CRD42020165622). Síntese dos dados: Nós encontramos 894 artigos. Deles, 215 foram excluídos por duplicidade. Entre os 679 remanescentes, 11 permaneceram, dos quais dois foram excluídos por não tratarem especificamente do sistema nervoso autônomo ou do peso ao nascer. Restaram nove publicações, sendo duas longitudinais e sete transversais. Os principais achados foram que o peso extremo baixo, muito baixo, baixo ou alto ao nascer pode ter algum impacto no sistema nervoso autônomo na vida adulta. Conclusões: O peso ao nascer fora da normalidade pode influenciar negativamente o sistema nervoso autônomo, causando disfunção autonômica e aumentando o risco de doenças cardiovasculares na vida adulta. Assim, ressalta-se a importância do acompanhamento dos profissionais de saúde desde a gravidez até a gestação, pré-natal e ao longo da vida, com cuidados preventivos para esta situação.

A pandemia do coronavírus: o isolamento social × a morbimortalidade do aparelho circulatório / The coronavirus pandemic: social isolation × the morbidity and mortality of the circulatory system / La pandemia del coronavirus: aislamiento social × morbimortalidad del sistema circulatorio

O processo de isolamento social causou muitas polêmicas e provocou impactos na vida das pessoas, principalmente no início da pandemia da covid-19, despertando, em grande parte da população brasileira, o medo de frequentar ambientes hospitalares mesmo em situações de emergência, como em caso de doenças do aparelho circulatório. O objetivo desta pesquisa foi caracterizar os impactos do isolamento social durante a pandemia da covid-19 no número de internações, assim como na mortalidade por doenças do aparelho circulatório. Trata-se de estudo quantitativo, de caráter exploratório e descritivo, que considerou como unidade de análise o estado de Goiás, com dados coletados a partir do Departamento de Informática do Sistema Único de Saúde (Datasus) entre março e dezembro de 2019, bem como de março a dezembro de 2020. Os dados foram submetidos à análise estatística e apresentados de forma descritiva por meio de tabelas. Como resultado, foi possível identificar que o isolamento provocado pela pandemia trouxe impactos relacionados à morbimortalidade do aparelho cardiovascular. Nesse sentido, precisamente, houve queda nas internações no período de isolamento, e as internações eletivas foram as de maior declínio. Ademais, em relação à mortalidade por doença do aparelho circulatório no período analisado de 2020, foram registradas 142 mortes a menos que no mesmo período do ano anterior, com predomínio no sexo masculino. Por fim, foi possível perceber que agosto de 2020 foi o mês em que coincidiu o pico de mortalidade por covid-19 com a maior queda nas internações por doenças do aparelho circulatório.

The process of social isolation caused many controversies and impacted people's lives, especially at the beginning of the COVID-19 pandemic, arousing in a large part of the Brazilian population the fear of going to hospital environments, even in emergency situations, as in the case of diseases of the circulatory system. This study aimed to characterize the impacts of social isolation during the COVID-19 pandemic on the number of hospitalizations and on mortality from diseases of the circulatory system. This is a quantitative, exploratory, and descriptive study that considered the state of Goiás as its unit of analysis and used data collected from the Brazilian Department of Informatics of the Unified Health System (DATASUS) from March to December 2019 and from March to December 2020. Data were subjected to statistical analysis and are shown descriptively in tables. As a result, we could that the isolation due to the pandemic brought impacts related to morbidity and mortality of the cardiovascular system and decreased the number of hospitalizations in the isolation period (of which elective hospitalizations decreased the most). Moreover, regarding mortality from circulatory system diseases in the analyzed period (2020), 142 fewer deaths were recorded than in the same period in the previous year, showing a predominance of men. Finally, we found that August 2020 was the month that coincided with the peak of mortality from COVID-19 and the greatest drop in hospitalizations for diseases of the circulatory system.

El proceso de aislamiento social causó mucha controversia e impactó la vida de las personas, especialmente al inicio de la pandemia de la covid-19, despertando en gran parte de la población brasileña el temor a acudir a ambientes hospitalarios, incluso en situaciones de emergencia, como en el caso de las enfermedades del sistema circulatorio. El objetivo de esta investigación fue caracterizar los impactos del aislamiento social durante la pandemia de la covid-19 sobre el número de hospitalizaciones, así como sobre la mortalidad por enfermedades del sistema circulatorio. Se trata de un estudio cuantitativo, exploratorio y descriptivo, que consideró el estado de Goiás (Brasil) como unidad de análisis, con datos recolectados del Departamento de Informática del Sistema Único de Salud (DATASUS) entre marzo y diciembre de 2019, y de marzo a diciembre de 2020. Los datos se sometieron a análisis estadístico y se presentaron de forma descriptiva en tablas. Como resultado se pudo identificar que el aislamiento ocasionado por la pandemia trajo impactos relacionados con la morbimortalidad del sistema cardiovascular. En ese sentido precisamente hubo una disminución de las hospitalizaciones durante el período de aislamiento y las hospitalizaciones electivas tuvieron la mayor caída. Además, con relación a la mortalidad por enfermedad del aparato circulatorio en el periodo analizado de 2020 se registraron 142 defunciones menos que en el mismo periodo del año anterior, con predominio del sexo masculino. Por último, agosto de 2020 fue el mes que coincidió con el pico de mortalidad por la covid-19 con la mayor caída de hospitalizaciones por enfermedades del sistema circulatorio.

Frequent Cardiovascular Manifestations Associated With SARS Cov-2 Infection: Experience at a Tertiary Hospital In Cali, Colombia

Abstract Background: Coronavirus disease 2019 (COVID-19) mainly affects the respiratory system, while the most common extrapulmonary complication of COVID-19 is cardiovascular involvement. Objective: To identify the frequency of electrocardiographic changes and cardiac arrhythmias in patients hospitalized with COVID-19 infection. Methods: This was a cross-sectional study, including patients aged >18 years with diagnosis of severe acute respiratory syndrome coronavirus 2 infection in a high-complexity hospital in Santiago de Cali, Colombia, from March to September 2020. A descriptive analysis with an analytical component and multiple logistic regression analysis were performed; all estimates were established with a 95% confidence level (CI) and a 5% significance level. Results: This study included 183 individuals; of whom 160 were considered for electrocardiographic analysis, 63% of which evidenced significant findings, the most frequent being sinus tachycardia (29.4%). The frequency of myocardial injury was 21.9% and was more common among non-survivors than among survivors (41.7% vs. 12.2%, p < 0.001). Myocardial injury was also significantly more common in patients who presented electrocardiographic findings than those who did not (26.5% vs. 12.1%, p = 0.032) and in those who required intensive care admission (31.8% vs 10.5%, p < 0.001). The strongest mortality-associated factor was the need for mechanical ventilation — odds ratio (OR), 9.14; 95% confidence interval, 3.4-24.5. Conclusions: Electrocardiographic findings in patients with COVID 19 are frequent, including newly diagnosed arrhythmias, justifying the use of cost-effective tools for the initial approach and follow-up of this affected population. Worse outcomes depend on factors such as invasive mechanical ventilation, comorbidities, age, and superinfection.

Marcador de lesão miocárdica troponina e o desfecho na covid-19: scoping review / Troponin myocardial injury marker and outcome in covid-19: scoping review / Marcador de lesión miocárdica troponina y resultado en covid-19: revisión del alcance

RESUMO: Objetivo: Analisar evidências científicas sobre alterações do marcador de lesão miocárdica troponina e o desfecho clínico em pacientes hospitalizados com Covid-19. Método: Adotou-se scoping review, nas bases Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online e Biblioteca Virtual em Saúde, de maio a julho de 2022. Utilizando como descritores: troponin; covid-19; cardiovascular system. Resultados: 23 estudos revelaram alterações cardíacas em pacientes hospitalizados com Covid-19 pelo exame do biomarcador cardioespecífico troponina, além de relacioná-lo a altas taxas de mortalidade. Estudos têm demonstrado grande relação entre lesão miocárdica aguda, evidenciada por elevação da troponina a um pior desfecho durante a hospitalização. Conclusão: Mapearam-se as alterações cardiovasculares de pacientes hospitalizados com Covid-19 que evoluíram para quadros graves da doença. Este estudo pode contribuir para o planejamento assistencial através de protocolos voltados para o manejo clínico, específicos para pacientes com a doença, tanto na fase aguda quando na fase pós Covid-19.

ABSTRACT Objective: To analyze scientific evidence on changes in the myocardial injury marker troponin and clinical outcome in patients hospitalized with COVID-19. Method: A scoping review was adopted, in the Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online and Virtual Health Library bases, from May to July 2022. Using as descriptors: Troponin; COVID-19; Cardiovascular System. Results: 23 studies revealed cardiac alterations in hospitalized patients with COVID-19 by examining the cardio specific biomarker troponin, in addition to relating it to high mortality rates. Studies have shown a great relationship between acute myocardial injury, evidenced by elevated troponin, and a worse outcome during hospitalization. Conclusion: Cardiovascular changes were mapped in patients hospitalized with COVID -19 who progressed to severe cases of the disease. This study can contribute to care planning through protocols aimed at clinical management, specific for patients with the disease, both in the acute phase and in the post- COVID -19 phase.

RESUMEN Objetivo: Analizar la evidencia científica sobre los cambios en el marcador de lesión miocárdica troponina y el resultado clínico en pacientes hospitalizados con Covid-19.Método: Se adoptó una revisión del alcance, en las bases Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online y Biblioteca Virtual de Salud, de mayo a julio de 2022. Utilizando como descriptores: troponin; covid-19; cardiovascular system. Resultados: 23 estudios revelaron alteraciones cardiacas en pacientes hospitalizados por COVID-19 mediante el examen del biomarcador cardioespecífico troponina, además de relacionarlo con altas tasas de mortalidad. Los estudios han demostrado una fuerte relación entre la lesión miocárdica aguda, evidenciada por la elevación de la troponina, y un peor pronóstico durante la hospitalización. Conclusión: Se mapearon alteraciones cardiovasculares en pacientes hospitalizados con Covid-19 que progresaron a enfermedad grave. Este estudio puede contribuir a la planificación asistencial mediante protocolos dirigidos al manejo clínico, específicos para pacientes con la enfermedad, tanto en la fase aguda como en la fase post-Covid-19.

Monitorización hemodinámica integrada: clínica, gasométrica y ecocardiográfica / Integrated hemodynamic monitoring: clinical, gasometric and echocardiographic / Monitorização hemodinâmica integrada: clínica, gasométrica e ecocardiográfica

Introducción: la monitorización hemodinámica constituye un conjunto de técnicas y parámetros que permiten valo rar si la función cardiovascular es la adecuada para mantener la perfusión y la oxigenación tisular que permita sa tisfacer las demandas metabólicas del organismo, valorar el estado y el comportamiento del sistema cardiovascular, orientando sobre la mejor estrategia terapéutica. La presente revisión busca proporcionar una descripción general e integrada de las diferentes técnicas de monitorización, así como aspectos fisiológicos relevantes para su entendi miento y empleo terapéutico. La monitorización hemodinámica acompañada de un adecuado conocimiento de la fisiología cardiovascular permite determinar el estado del sistema cardiovascular, la condición hemodinámica del paciente y la estrategia terapéutica requerida. Su interpretación debe partir de la integración y la correlación de diversos parámetros hemodinámicos.

Introduction: hemodynamic monitoring is a set of techniques and parameters that allow evaluating whether cardio vascular function is adequate to maintain tissue perfusion and oxygenation to satisfy metabolic demands of the or ganism, assess the condition and behavior of the cardiovascular system, providing guidance on the best therapeutic strategy. This review seeks to provide a general and integrated description of the different monitoring techniques, as well as physiological aspects relevant to their understanding and therapeutic use. Hemodynamic monitoring accompanied by an adequate knowledge of cardiovascular physiology allows to determine the state of the cardiovascular system, hemodynamic condition of the patient and therapeutic strategy required, its interpretation must start from the integration and correlation of different hemodynamic parameters.

Introdução: a monitorização hemodinâmica constitui um conjunto de técnicas e parâmetros que permitem avaliar se a função cardiovascular é adequada para manter a perfusão e oxigenação tecidual que permite satisfazer as exi gências metabólicas do organismo, avaliar o estado e comportamento do sistema cardiovascular, orientando sobre a melhor estratégia terapêutica. Esta revisão procura fornecer uma descrição geral e integrada das diferentes técnicas de monitorização, bem como aspectos fisiológicos relevantes para a sua compreensão e utilização terapêutica. A monitorização hemodinâmica acompanhada de um conhecimento adequado da fisiologia cardiovascular permite determinar o estado do sistema cardiovascular, a condição hemodinâmica do doente e a estratégia terapêutica neces sária, a sua interpretação deve partir da integração e correlação de vários parâmetros hemodinâmicos.

Periodontal disease and quality of life in patients with circulatory diseases / Doença periodontal e qualidade de vida em pacientes com doenças circulatórias

Introduction: Circulatory system diseases are one of the leading causes of death. Periodontal health is a component of oral and general health that contributes to quality of life. Objective: To analyze periodontal conditions and quality of life in patients with circulatory diseases. Material and method: Cross-sectional study, with patients with circulatory diseases (n=125). The clinical periodontal examination was performed considering: biofilm, bleeding on probing, suppuration, probing depth, gingival recession, and clinical attachment level. Quality of life was assessed with the Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) and Oral Health Impact Profile - short form (OHIP-14). Data were analyzed with parametric and nonparametric tests (α=5%). Result: Elderly and men had a greater severity of periodontal disease. The Elderly had lower values in the domains of "Functional capacity" and "Physical aspects" (SF-36). The domain "Pain" had lower values in subjects with health/gingivitis. OHIP-14 did not show differences in the comparisons. There was no correlation between quality of life and the severity of periodontal disease. Conclusion: Among patients with circulatory diseases, the elderly and men had greater severity of periodontal disease. The elderly had a poorer quality of life (functional capacity and physical aspects). There was no correlation between the severity of periodontal disease and quality of life.

Introdução: As doenças do aparelho circulatório representam uma das principais causas de mortes. A saúde periodontal é um componente da saúde bucal e saúde geral que contribui para a qualidade de vida. Objetivo: Analisar as condições periodontais e a qualidade de vida em pacientes com doenças circulatórias. Material e método: Estudo transversal, com pacientes com doenças circulatórias (n=125). O exame clínico periodontal foi realizado considerando: biofilme, sangramento à sondagem, supuração, profundidade de sondagem, recessão gengival e nível de inserção clínica. A qualidade de vida foi avaliada com o Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) e Oral Health Impact Profile - short form (OHIP-14). Os dados foram analisados com testes paramétricos e não paramétricos (α=5%). Resultado Idosos e os homens tiveram maior severidade da doença periodontal. Idosos apresentaram menores valores nos domínios "Capacidade funcional" e "Aspectos físicos" (SF-36). O domínio "Dor" teve menor valor nos indivíduos com saúde/gengivite. OHIP-14 não apresentou diferenças nas comparações. Não houve correlação entre qualidade de vida a severidade da doença periodontal. Conclusão Entre os pacientes com doenças circulatórias, os idosos e os homens tiveram maior severidade da doença periodontal. Idosos tiveram pior qualidade de vida (capacidade funcional e aspectos físicos). Não houve correlação entre a severidade da doença periodontal e a qualidade de vida.

Relationship of irisin expression with metabolic alterations and cardiovascular risk in type 2 diabetes mellitus: a preliminary study

SUMMARY OBJECTIVE: The aim of this study was to investigate the role of irisin in type 2 diabetes mellitus and its association with metabolic alterations and obesity. METHODS: A cross-sectional case-control study was conducted on participants treated at Centro Universitário FMABC between August 2018 and July 2019, by comparing a control group (n=14) with type 2 diabetes mellitus patients (n=16). The control group consisted of participants aged above 21 years with no chronic diseases, diabetes, smoking, or illicit drug use. The type 2 diabetes mellitus group included patients aged above 21 years, who were diagnosed with type 2 diabetes for at least 5 years (glycated hemoglobin>7%). Exclusion criteria were not willing to continue, recent hospitalization, and failure to meet inclusion criteria. Biochemical parameters included blood glucose, glycated hemoglobin, plasma irisin levels, and irisin gene expression in peripheral blood. RESULTS: Type 2 diabetes mellitus patients exhibited significantly higher plasma glucose levels [143 (40) vs. 92 (13) mg/dL, *p<0.05] and glycated hemoglobin levels [7.1% (1.6) vs. 5.6% (0.5), *p<0.05] compared to the control group. Irisin gene expression in type 2 diabetes mellitus patients was lower 0.02288 (0.08050) than the control group 8.506e-006 (1.412e-005) (p=0.06). Correlation analysis revealed a positive association between irisin expression and body mass index in type 2 diabetes mellitus (Rho=0.5221, 95%CI -0.058 to 0.838, p=0.06), while plasma irisin showed a negative correlation with body mass index (Rho=-0.656, 95%CI -0.836 to 0.215, p=0.03). No significant correlations were found between plasma glucose or glycated hemoglobin levels and irisin expression. CONCLUSION: The data suggests that body mass index directly influences plasma irisin levels and the regulation of irisin gene expression, possibly linking irisin to adiposity changes observed in obesity-related type 2 diabetes mellitus.

Research progress of the relationship between fluorosis and cardiovascular disease / 中华地方病学杂志

Fluorosis is widely prevalent worldwide, and China is one of the countries with a high incidence of endemic fluorosis. In recent years, study on non skeletal damage caused by fluorosis, especially cardiovascular system damage, has gradually increased. Fluoride can cause cardio vascular arteriosclerosis, hypertension and other diseases, while cardiovascular disease have hidden and acute onset, and the mortality rate has increased year by year in recent years. At present, the mechanism of cardiovascular diseases caused by fluoride is not yet clear, and further clarification is needed. This article provides an overview of the effects of fluoride on cardiovascular diseases from three aspect: epidemiological investigation, animals experiment, and in vitro cell experiment. It categorizes and analyzes the pathogenesis, providing new ideas for the study of cardiovascular system damage caused by fluorosis.

Research progress on the effects of ionizing radiation exposure on cardiovascular systems / 中国辐射卫生

With the rapid development and widespread application of medical imaging technologies, ionizing radiation has become unavoidable in human lives. Accurate assessment of healthy effects of ionizing radiation is of great significance to reduce the risk of exposure to radiation. Increasing evidence has proven the impact of ionizing radiation on cardiovascular systems. This article reviews the effects of ionizing radiation on heart, blood pressure, and blood vessels and the possible mechanisms, so as to provide insights into implementation of targeted protective interventions and reduction of ionizing radiation hazard.

A review of the impact of school based interventions on cardiovascular metabolic risk in children / 中国学校卫生

Abstract@#School based lifestyle interventions have many advantages, which can effectively reduce the prevalence of overweight and obesity, improve children and their families knowledge of overweight and obesity, and enhance their cognition of behaviors related to energy balance. Moreover, it can improve the level of cardiometabolic risk (CMR). By searching PubMed, CNKI and Wanfang databases, the article review the effects of school based physical activity and dietary interventions on children s blood pressure, blood lipids, blood glucose, and other CMR indicators, and analyze the differences among different groups of people, such as gender, age, and race, in order to provide the evidence for future school based intervention studies on overweight and obesity in children.

Research progress on the association and mechanism between dietary rhythm, circadian rhythm and cardiovascular health in children and adolescents / 中国学校卫生

Abstract@#Hypertension in children can have adverse health effects such as vascular damage, cardiac metabolic risk, and organ damage during childhood, and can also increase the risk of hypertension in adulthood. Obesity has been recognized as an important cause of elevated blood pressure in children. By reviewing and summarizing relevant literature at home and abroad, the study analyzes the relationship between dietary and circadian rhythm and explores the role and mechanism of circadian rhythm in terms of the metabolic health of youth, thereby providing a scientific basis for the prevention and treatment of cardiovascular diseases in this population and to identify directions for future research.

Association between early life factors and cardiometabolic risk factors in children and adolescents / 中国学校卫生

Objective@#To understand the early life factors that influence cardiometabolic risk factors in children and adolescents, so as to provide effective measures to curb cardiometabolic risk factors such as hypertension and diabetes in children and adolescents.@*Methods@#Data were sourced from the 2020 follow up survey of the Xiamen Adolescent Development Cohort. The study involved 1 197 subjects for whom completed anthropometric examination and blood biochemistry testing data, as well as early life data. Early life and sociodemographic data were obtained through questionnaire surveys, while cardiometabolic indicator data were sourced through physical examinations and blood testing. Logistic regression analysis was performed to analyze the impact of early life factors on the cardiometabolic risk factors after adjusting for gender, age, and family history.@*Results@#The prevalence rate of cardiometabolic risk factors clustering in children and adolescents in Xiamen was 17.96%, with boys (26.67%) reporting higher rates than girls (9.64%), and the difference was statistically significant ( χ 2=57.69, P <0.01). For every additional early life risk factor, the risk factors of obesity increased 0.35 times ( OR=1.35, 95%CI=1.03-1.78, P <0.05). Post term pregnancy may be a primary early life risk factors for cardiometabolic risk factors, and it was associated with an increased risk of cardiometabolic risk factors clustering (OR=2.45, 95% CI =1.11-5.41) and high triglycerides ( OR=3.25, 95%CI =1.39-7.61)( P <0.05).@*Conclusion@#Increased cardiometabolic risk factors in youth is associated with early life adverse factors. It is crucial to pay greater attention to post term pregnancy as an early life factor and to consider obesity as a cardiometabolic risk factors. Controlling early life adverse factors is important for the prevention of cardiovascular disease.

Effects of antenatal corticosteroids exposure on multiple systems of preterm infants: a review / 中华围产医学杂志

Administration of antenatal corticosteroids (ACS) to pregnant women at risk of preterm delivery can significantly reduce the incidence of preterm-related complications, such as respiratory distress syndrome and necrotizing enterocolitis. However, ACS may have adverse effects on multiple systems including nervous system, cardiovascular system and carbohydrate metabolism in preterm infants. Whether ACS could influence neonatal development is still controversial. On this account, this review, focusing on short- and long-term effects of ACS therapy on nervous, cardiovascular, endocrine and other systems of infants born prematurely, will help clinical management and scientific research.

Advances in Cardiovascular Biomechanics and Mechanobiology Research in 2022 / 医用生物力学

The cardiovascular system plays a crucial role in the entire organism. It performs many important functions, such as providing organs and tissues with nutrients, hormones, delivering oxygen to cells, and maintaining physiological temperature. For a long time, accurately identifying the nonlinear and anisotropic mechanical properties of the vascular wall within the body has been regarded as a key challenge in cardiovascular biomechanics, as these properties are critical determinants of overall cardiac function. Currently, the roles of mechanical and tissue properties in cardiovascular diseases such as arterial aneurysms and atherosclerosis remain hot topics in both basic and clinical researches. This review aims to summarize the latest research advances in the field of cardiovascular biomechanics and mechanobiology in the year 2022. In terms of cardiovascular biomechanics, researchers focus on the structure, function, and pathophysiology of the cardiovascular system, and use experimental methods such as mechanical modeling to study these issues. These include studies about biomechanical properties of diseases such as atherosclerosis, arterial aneurysms, and myocardial infarction, as well as the development and testing of treatment methods based on dynamics of the cardiovascular system. In terms of mechanobiology, researchers explore mechanical properties of cardiovascular cells and extracellular matrix, including prediction of cell mechanical properties based on machine learning, studies of biological material mechanical properties, and the role of mechanical properties in cardiovascular cell phenotype changes. These research findings provide new ideas and methods for diagnosing and treating cardiovascular diseases and offer new insights into researches in biomechanics and mechanobiology fields.

Animal experimental study on the effects of different levels of amputation on cardiovascular system / 生物医学工程学杂志

Vascular injury resulting from lower limb amputation leads to the redistribution of blood flow and changes in vascular terminal resistance, which can affect the cardiovascular system. However, there was no clear understanding of how different amputation levels affect the cardiovascular system in animal experiments. Therefore, this study established two animal models of above-knee amputation (AKA) and below-knee amputation (BKA) to explore the effects of different amputation levels on the cardiovascular system through blood and histopathological examinations. The results showed that amputation caused pathological changes in the cardiovascular system of animals, including endothelial injury, inflammation, and angiosclerosis. The degree of cardiovascular injury was higher in the AKA group than in the BKA group. This study sheds light on the internal mechanisms of amputation's impact on the cardiovascular system. Based on the amputation level of patients, the findings recommend more comprehensive and targeted monitoring after surgery and necessary interventions to prevent cardiovascular diseases.

Lower extremity thermographic profile of individuals undergoing ulcerative wound treatment: a qualitative exploration of images / Perfil termográfico de los miembros inferiores en individuos en tratamiento por lesiones ulcerativas: una exploración cualitativa de imágenes / Perfil termográfico das extremidades inferiores de indivíduos em tratamento de feridas ulcerativas: uma exploração qualitativa das imagens

ABSTRACT Thermography proves to be a new concept in measuring the thermogenesis of biological systems, a valuable method for confirming clinical diagnosis discarding subjective analysis and personal criteria. The result of the thermographic evaluation is the subject of qualitative and quantitative analyses. This study aimed to identify the thermal profile of the lower extremities of individuals diagnosed with cardiovascular and endocrine and metabolic diseases in the treatment of ulcerative wounds. A thermographic evaluation was performed from 19 dorsal, plantar, lateral, and medial extremities. In the qualitative analysis, images with and without a wound were divided according to diagnosis. After the division, a checklist was elaborated for the qualitative evaluation of the images. A total of 100 individuals (49 women and 51 men) participated, 65 with cardiovascular disease and 35 with endocrine and metabolic disease. There was a difference in the thermal pattern between the extremities in both diagnoses. The groups presented similar thermographic characteristics with signs of more radiation in the wounds, predominantly with red and white stains. More regions of interest with lesions on the medial foot, lateral, and medial ankle border were observed in individuals with chronic cardiovascular disease. Those with endocrine and metabolic disease presented more regions with lesions in the plantar (forefoot), dorsal, and medial ankle regions. The profile showed a discrepancy in the thermal pattern in the regions of interest of wounded and without wound extremities according to the diagnoses. Signs of wounds emitting high levels of radiation were similar in both groups, but the physiology of the disease and treatment differed.

RESUMEN La termografía es un nuevo procedimiento para la medición de la termogénesis de los sistemas biológicos y un método valioso para confirmar el diagnóstico clínico que no requiere análisis subjetivos y criterios personales. El resultado de la evaluación termográfica está sujeto a dos análisis: cualitativo y cuantitativo. El objetivo de este estudio fue identificar el perfil térmico de los miembros inferiores en individuos con diagnóstico de enfermedades endocrinometabólicas y circulatorias en tratamiento por lesiones ulcerativas. Para ello, se realizó una evaluación termográfica de 19 regiones, distribuidas en las regiones dorsal, plantar, lateral y medial de los miembros. En el análisis cualitativo, las imágenes con y sin lesiones se dividieron por diagnóstico. Después de la división, se elaboró una lista de verificación para la evaluación cualitativa de las imágenes. Participaron 100 individuos (49 mujeres y 51 hombres), de los cuales 65 tenían enfermedad circulatoria y 35 enfermedad endocrinometabólica. Hubo una diferencia en el estándar de color entre los miembros en ambos diagnósticos. Los grupos mostraron características termográficas similares, con signos de hiperradiación en las lesiones, predominantemente de colores rojo y blanco. Se observó un mayor número de lesiones en el borde medial del pie y en el lateral y medial del tobillo en individuos con enfermedad circulatoria. Aquellos con enfermedad endocrinometabólica presentaron mayor número de lesiones en la región plantar (antepié), dorsal y medial del tobillo. El perfil reveló discrepancia en el color en las regiones de interés de los miembros con y sin lesiones según los diagnósticos. Aunque los signos de hiperradiación de las lesiones fueron similares en ambos grupos, la fisiología de las enfermedades y los tratamientos difirieron.

RESUMO A termografia revela-se como um novo conceito na mensuração da termogênese de sistemas biológicos e um método valioso para confirmação de diagnóstico clínico que dispensa análises subjetivas e critérios pessoais. O resultado da avaliação termográfica é alvo de duas análises: qualitativa e quantitativa. O objetivo deste estudo foi identificar o perfil térmico das extremidades inferiores de indivíduos diagnosticados com doenças de base endocrinometabólica e circulatória em tratamento de feridas ulcerativas. Para tanto, foi realizada avaliação termográfica de 19 regiões, distribuídas nas áreas dorsal, plantar, lateral e medial das extremidades. Na análise qualitativa, as imagens com e sem ferida foram divididas de acordo com o diagnóstico. Após a divisão, elaborou-se um checklist para a avaliação qualitativa das imagens. Participaram 100 indivíduos (49 mulheres e 51 homens), sendo 65 com doença circulatória e 35 com doença endocrinometabólica. Houve diferença no padrão de coloração entre as extremidades em ambos os diagnósticos. Os grupos apresentaram características termográficas semelhantes, com sinais de hiperradiação nas feridas, predominantemente de colorações vermelho e branco. Foi observado maior número de lesões na borda medial de pé e na lateral e medial de tornozelo nos indivíduos com doença de base circulatória. Já aqueles com doença de base endocrinometabólica apresentaram maior número de lesões nas regiões plantar (antepé), dorsal e medial de tornozelo. O perfil revelou discrepância na coloração das regiões de interesse da extremidade com e sem ferida, de acordo com os diagnósticos. Os sinais de hiperradiação das feridas foram semelhantes nos dois grupos, porém a fisiologia das doenças e os tratamentos diferiram.

Aquatic physical therapy effects on cardiorespiratory variables in Parkinson's disease / Efeitos da fisioterapia aquática sobre variáveis cardiorrespiratórias na doença de Parkinson

Abstract Introduction Parkinson's (PD) is a neurodegenerative disease characterized by the loss of dopaminergic neurons in the substantia nigra. It has motor and non-motor symptoms which is directly related to these people's decreased autonomy and quality of life. Aquatic physical therapy (APT) is a non-drug treatment option that is a resource to complement functional rehabilitation and/or prevention. Objective To analyze the effects of an APT program on cardiovascular and fatigue conditions in individuals with PD. Methods The cardiorespiratory conditions were assessed with vital signs - heart rate (HR) and blood pressure (BP), measured before and after each intervention. The double product (DP) and the Fatigue Severity Scale (FSS), measured pre- and post-intervention, were also used as variables. The intervention had eight 40- minute biweekly sessions over 4 weeks, with immersion in a heated swimming pool at 33 ºC on average. The statistical analysis was made with the paired t-test (to analyze the FSS) and the repeated measures ANOVA test (for DP, BP and HR); significance was set at p < 0.05. Results Fatigue perception with FSS improved significantly (p = 0.037), from 4.7 ± 1.6 (pre-intervention) to 4.3 ± 1.6 (post-intervention). There were no statistically significant differences in DP, BP and HR (p = 1). Conclusion HR and BP remained at appropriate values for older people, and DP remained within a safe submaximal training range. Furthermore, the proposed APT program statistically decreased fatigue in this specific group of people with PD.

Resumo Introdução A Doença de Parkinson (DP) é uma doença neurodegenerativa caracterizada pela perda de neurônios dopaminérgicos na substância negra. Apresenta sintomas motores e não motores ligados à diminuição da autonomia e qualidade de vida. Entre os tratamentos prescritos está a fisioterapia aquática (FA), sendo um recurso na reabilitação e/ou prevenção de alterações funcionais. Objetivo Analisar os efeitos de um programa de FA nas condições cardiovasculares e fadiga em indivíduos com DP. Métodos Foram utilizados os sinais vitais frequência cardíaca (FC) e pressão arterial (PA), mensurados antes e depois de cada intervenção, e o duplo-produto (DPr) e Escala de Severidade da Fadiga (ESF) pré e pós-intervenção. A intervenção consistiu em oito encontros, durante quatro semanas, duas vezes por semana, com 40 minutos de imersão em piscina aquecida com média de 33 ºC. A análise estatística deu-se pelo test T pareado para a ESF e teste Anova para medidas repetidas do DPr, PA e FC, adotando p < 0,05. Resultados Houve melhora significativa na percepção de fadiga pela ESF (p = 0,037) de 4,7 ± 1,6 (pré-intervenção) para 4,3 ± 1,6 (pós-intervenção). DPr, PA e FC não apresentaram diferença significativa (p = 1). Conclusão Os sinais vitais de FC e PA se mantiveram em valores apropriados para idosos, bem como o DPr se manteve dentro de uma faixa segura de treinamento submáximo. Assim, o programa de FA proposto foi capaz de diminuir de forma significativa a fadiga nesta amostra de pessoas com DP.

Fenotipo motor y disautonomía cardiovascular de pacientes con enfermedad de Parkinson en la consulta de neurología de un hospital en Táchira (Venezuela) / Motor phenotype and cardiovascular dysautonomia in patients with Parkinson's disease from a neurology outpatient clinic in Táchira (Venezuela)

RESUMEN INTRODUCCIÓN: La enfermedad de Parkinson es un trastorno neurodegenerativo frecuente que se caracteriza por manifestaciones de tipo motor y no motor, tales como disautonomía, trastornos del sueño, disfunción sexual, alteraciones psiquiátricas y cognitivas, entre otros. Según su fenotipo motor, se puede clasificada en tremórica dominante (TD), dificultad para la marcha/inestabilidad postural (DMI) y un fenotipo indeterminado. En el estudio se determina la influencia del fenotipo motor en la disautonomía cardiovascular del paciente con Parkinson en los pacientes de la consulta de neurología del hospital del IVSS "Dr. Patrocinio Peñuela Ruiz" entre mayo del 2015 y abril del 2016. METODOS: Estudio observacional, descriptivo, transversal en pacientes mayores de 40 años con EP idiopática. Se evaluó el MDS-UPDRS, Hoehn y Yahr, Scopa-AUT , Hipotensión Ortostática y Rines-Valcardi. RESULTADOS: Se obtuvo una muestra de 57 pacientes; luego de la aplicación de los criterios de inclusión y exclusión se estudiaron 37 sujetos. Todos los pacientes tuvieron algún grado de disautonomía (medida con la escala Scopa-AUT). El Scopa-AUT fue mayor en los pacientes con hipotensión ortostática (p = ,003), observándose igual diferencia para la subescala cardiovascular (p = ,026). Se observó que la neuropatía autonómica (medida con Rines-Valcardi) fue más frecuente en aquellos pacientes con fenotipo DMI (p = < ,001), y que la hipotensión ortostática fue también más frecuente en aquellos pacientes con dicho fenotipo (DMI) (p = ,016). CONCLUSIÓN: La presencia de disautonomía es frecuente en los pacientes con EP; hubo diferencias en la puntuación total y la subescala cardiovascular del Scopa-AUT, de acuerdo CON la presencia de hipotensión ortostática; aquellos sujetos que cursan con fenotipo motor DMI tienen mayor riesgo de presentar hipotensión ortostática y neuropatía autonómica cardíaca.

ABSTRACT INTRODUCTION: Parkinson's disease is a frequent neurodegenerative disorder characterized by motor and non-motor manifestations, such as dysautonomia, sleep disorders, sexual dysfunction, and psychiatric and cognitive disorders. It can be classified according to their motor phenotype in tremor-dominant (TD), postural instability/gait difficulty (DMI), and indeterminate subtypes. This study established the influence of motor phenotype on the cardiovascular dysautonomia of patients with Parkinson's disease from the neurology outpatient clinic at the IVSS hospital "Dr. Patrocinio Peñuela Ruiz," from May 2015 to April 2016. METHODS: Observational, descriptive, cross-sectional study in patients older than 40 years with idiopathic PD. The MDS-UPDRS scale, Hoehn and Yahr scale, Scopa-AUT scale, Orthostatic Hypotension, and RINES-VALCARDI were evaluated. RESULTS: A sample of 57 was obtained, and after applying inclusion and exclusion criteria, 37 subjects were studied. All the patients had some degree of dysautonomia (measured with SCOPA- AUT scale). The SCOPA-AUT was higher in patients with orthostatic hypotension (p= .003), finding this same difference for the cardiovascular subscale (p = .026). Both autonomic neuropathy (measured with RINES-VALCARDI) and orthostatic hypotension were found more frequently on the DMI phenotype (p= <.001 and p=.016). CONCLUSION: Dysautonomia is frequent in PD patients; there was a difference between SCOPA-AUT total score and cardiovascular subscale according to orthostatic hypotension; those with DMI phenotype have a greater risk of orthostatic hypotension and cardiac autonomic neuropathy.

Raciocínio Clínico em Cardiologia: Passado, Presente e Futuro / Clinical Reasoning in Cardiology: Past, Present and Future

Resumo O raciocínio clínico nasceu 2500 anos atrás com Hipócrates, tendo evoluído ao longo dos séculos, e se tornado uma mistura de arte e ciência. Várias personalidades ao longo da história contribuíram para melhorar a acurácia diagnóstica. Contudo, o erro diagnóstico é ainda comum e causa um grande impacto nos sistemas de saúde. Para lidar com esse desafio, vários modelos de raciocínio clínico surgiram para sistematizar o processo de pensamento clínico. Este artigo descreve a história do raciocínio clínico e os métodos atuais de raciocínio diagnóstico, propõe um novo modelo de raciocínio clínico chamado Raciocínio Integrativo, e traz perspectivas sobre o futuro do raciocínio clínico.

Abstract Clinical reasoning was born 2,500 years ago with Hippocrates, having evolved over the centuries, becoming a mixture of art and science. Several personalities throughout history have contributed to improving diagnostic accuracy. Nonetheless, diagnostic error is still common and causes a severe impact on healthcare systems. To face this challenge, several clinical reasoning models have emerged to systematize the clinical thinking process. This paper describes the history of clinical reasoning and current diagnostic reasoning methods, proposes a new clinical reasoning model, called Integrative Reasoning, and brings perspectives about the future of clinical reasoning.