Metahemoglobinemia congénita. Reporte de caso / Congenital Methemoglobinemia. A Case Report

Resumen La metahemoglobinemia ocasionalmente causa cianosis, particularmente cuando es congénita. Debido a sus vías enzimáticas deficientes y a la disminución de la capacidad de transporte de oxígeno, para los pacientes con metahemoglobinemia congénita es importante evitar la exposición a agentes oxidantes. A continuación, presentamos un paciente pediátrico con metahemoglobinemia congénita no diagnosticada preoperatoriamente que fue sometido a cateterismo con diagnóstico probable de hipertensión pulmonar bajo anestesia general. El paciente pediátrico era un niño de 10 años que presentaba una lectura de oximetría de pulso (SpO2) 92% antes de la inducción de la anestesia. La metahemoglobinemia se sospechó intraoperatoriamente por primera vez debido a un desajuste de la SpO2 de la oximetría de pulso digital y la SaO2 (saturación arterial de oxígeno), y luego se confirmó mediante múltiples longitudes de onda con la CO-oximetría. Se discuten la fisiopatología, etiología, manifestaciones clínicas, consideraciones anestésicas y opciones de tratamiento de la metahemoglobinemia.

Abstract Methemoglobinemia occasionally causes cyanosis particularly in congenital methemoglobinemia. Avoidance of exposure to oxidizing agents is important for patients with congenital methemoglobinemia because of their deficient enzymatic pathways and decreased oxygen-carrying capacity. Here, we present a pediatric patient with preoperatively undiagnosed congenital methemoglobinemia who underwent catheterization with probably diagnosis of pulmonar hypertension under general anesthesia. The pediatric patient was a 10-year-old who displayed a low pulse oximetry reading of 92% prior to induction of anesthesia. Methemoglobinemia was first suspected intraoperatively because of a mismatch of SpO2 of finger pulse oximetry and SaO2 of arterial blood, and was later confirmed by multiplewavelength CO-oximetry. The pathophysiology, etiology, clinical manifestations, anesthetic considerations, and treatment options of methemoglobinemia are discussed.

Effects of Different Tidal Volumes and PEEPs on Cardiac Output in Pigs Measured by Pulmonary Artery Catheter， Pulse Contour Analysis and Transpulmonary Thermodilution / 中山大学学报(医学科学版)

ObjectiveTo compare the effects of different tidal volumes and positive end expiratory pressures （PEEPs） during mechanical ventilation on the cardiac output of pigs measured by pulmonary artery catheter， transpulmonary thermodilution and pulse contour analysis， and to explore their consistency in cardiac output determination. MethodsTwelve experimental pigs were selected and randomly divided into 3 groups， with 4 pigs in each. Cardiac output was measured by different methods， control group by pulmonary artery catheter， group A by transpulmonary thermodilution and group B by pulse contour analysis. Then we compared the effects of different tidal volumes and PEEPs on the cardiac output of pigs and to explore the consistency. The correlation coefficient between pulse contour analysis and pulmonary artery catheter was r=0.754， and they were positively correlated. The correlation coefficient between transpulmonary thermodilution and pulmonary artery catheter was r=0.771， and they were positively correlated. In determining cardiac output， pulse contour analysis was consistent with pulmonary artery catheter， with a relative error of 13.5% between them； transpulmonary thermodilution was consistent with pulmonary artery catheter， with a relative error of 12.9% between them. The cardiac output decreased significantly along with the increase of tidal volumes or PEEPs and the differences were statistically significant （P<0.05） ConclusionPulmonary artery catheter， transpulmonary thermodilution and pulse contour analysis are well consistent with each other in measuring the cardiac output of pigs. The pigs’cardiac output gradually decreased along with the increase of tidal volumes or PEEPs during mechanical ventilation.

Analysis of the Treatment Strategy of Heart Failure with Preserved Ejection Fraction Based on ZHANG Boli's Theory of “Damp-turbidity and Phlegm-rheum Type of Diseases” / 中医杂志

Professor ZHANG Boli believed that the core pathogenesis of heart failure with preserved ejection fraction （HFpEF） is weak pulse at yang and wiry pulse at yin. By referring to the theory of “damp-turbidity and phlegm-rheum type of diseases”， he proposed that yin pathogens of damp-turbidity and phlegm-rheum may damage yang qi in each stage of HFpEF， thus aggravating the trend of weak pulse at yang and wiry pulse at yin， which played an important role in the deterioration of HFpEF. Therefore， Professor ZHANG Boli advocated that importance should be attached to the elimination of yin pathogen and the protection of yang qi during the various stages of HFpEF in order to delay the aggravation of weak pulse at yang and wiry pulse at yin； he put forward the idea of staged treatment that “yin pathogen should be dispelled and yang qi should be demonstrated”； and he formulated the treatment strategy of treating the disease as early as possible， eliminating pathogens and protecting yang， interrupting the disease trend， using warm-like medicinals， and activating blood circulation， to enrich the theoretical system of traditional Chinese medicine in the treatment of HFpEF.

Vascular stiffness and healthy arterial aging in older patients with optimal blood pressure / Rigidez vascular e envelhecimento arterial saudável em pacientes idosos com pressão arterial ideal

ABSTRACT Introduction: Pulse wave velocity is used to diagnose central arterial stiffness (CAS) and quantify healthy vascular aging (HVA). Objective: To evaluate the CAS and HVA in elderly patients with systemic blood pressure levels classified as optimal/normal. Methods: A total of 102 patients without comorbidities and with systolic pressure (SP) < 120 mmHg and diastolic pressure (DP) < 80 mmHg were selected from the EVOPIU database (Pulse Wave Velocity of Elderly Individuals in an Urban area of Brazil). The carotid-femoral pulse wave velocity (c-fPWV) and the central and peripheral pressures were evaluated in all patients. The patients were divided into four groups: G1: (n = 19, with c-fPWV < 7.6 m/s, without medication), G2 (n = 26, c-fPWV ≥ 7.6 m/s; without medication), G3 (n = 25, c-fPWV < 7.6 m/s with antihypertensive medication), and G4 (n = 32, c-fPWV ≥ 7.6 m/s with antihypertensive medication). Results: In our sample, 56.7% of patients had c-fPWV ≥ 7.6 m/s. The central systolic pressure in G1 [99 (10) mmHg] was lower than that found in the other three groups [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0.05)]. Conclusion: Older people with optimal arterial blood pressure do not necessarily have HVA and could have c-fPWV values close to the limits established for CAS diagnosis.

RESUMO Introdução: A velocidade da onda de pulso é usada para diagnosticar a rigidez arterial central (RAC) e quantificar o envelhecimento vascular saudável (EVS). Objetivo: Avaliar a RAC e o EVS em pacientes idosos com níveis pressóricos sistêmicos classificados como ideais/normais. Métodos: Um total de 102 pacientes sem comorbidades e com pressão sistólica (PS) < 120 mmHg e pressão diastólica (PD) < 80 mmHg foram selecionados do banco de dados EVOPIU (Estudo da Velocidade de Onda de Pulso em Idosos em área Urbana no Brasil). Foram avaliadas a velocidade da onda de pulso carotídeo-femoral (VOPcf) e as pressões central e periférica em todos os pacientes. Os pacientes foram divididos em quatro grupos: G1: (n = 19; com VOPcf < 7,6 m/s; sem medicação), G2 (n = 26; VOPcf ≥ 7,6 m/s; sem medicação), G3 (n = 25; VOPcf < 7,6 m/s com medicação anti-hipertensiva), e G4 (n = 32; VOPcf ≥ 7,6 m/s com medicação anti-hipertensiva). Resultados: Em nossa amostra, 56,7% dos pacientes apresentaram VOPcf ≥ 7,6 m/s. A pressão sistólica central no G1 [99 (10) mmHg] foi inferior à encontrada nos outros três grupos [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0,05)]. Conclusão: Pessoas idosas com pressão arterial ideal não necessariamente têm EVS e podem apresentar valores de VOPcf próximos aos limites estabelecidos para o diagnóstico de RAC.

Arterial oxygen saturation in healthy Mexican full-term newborns at different altitudes above sea level / Saturación arterial de oxígeno en recien nacidos mexicanos a término sanos a diferentes altitudes sobre el nivel del mar

Abstract Background: Arterial oxygen saturation (SaO2) values are used to make clinical decisions that might change a patient's prognosis, and it has been proposed as the fifth vital sign. This study aimed to determine the variation of SaO2 at different altitudes above sea level (ASL) in healthy Mexican full-term newborns. Methods: From July 2018 to June 2019, a cross-over study was conducted in six hospitals at different altitudes ASL in Mexico. SaO2 was measured in 4015 newborns after the first 24 h of birth and before leaving the hospital using pulse oximetry. We analyzed three groups: < 250 m ASL (group 1), 1500 m ASL (group 2), and 2250 m ASL (group 3). Results: The mean SaO2 was 97.6 ± 1.8%. For group 1, mean oxygen saturation was 98.2 ± 1.9%; for group 2, 96.7 ± 1.9%, and for group 3, 96.0 ± 2.1%. A statistically significant difference was observed among the groups (p < 0.001), and this difference was higher between groups 1 and 2 (1.5%, p < 0.001). Linear regression analysis showed a decrease in oxygen saturation of 1.01% for every 1000 m ASL. Conclusions: We demonstrated a statistically significant reduction in SaO2 levels at higher altitudes. This observation can be relevant for clinical decision-making based on pulse oximetry such as critical congenital heart disease screening in Mexico, where more than half of the population lives above 1500 m ASL.

Resumen Introducción: Los valores de SaO2 (saturación de oxígeno) se utilizan para la toma de decisiones clínicas que podrían cambiar el pronóstico del paciente. El objetivo de este estudio fue determinar la variación de la SaO2 en recién nacidos mexicanos a término sanos a diferentes altitudes en México. Métodos: Se llevó a cabo un estudio transversal en seis hospitales situados a diferentes altitudes en México. Se determinó la SaO2 usando oximetría de pulso en 4015 recién nacidos después de las primeras 24 horas de vida, pero antes del egreso del hospital de nacimiento. Se formaron tres grupos para el análisis: grupo 1 con altitud < 250 m sobre el nivel del mar (SNM); grupo 2, altitud de 1500 m SNM y grupo 3, altitud de 2250 m SNM. Resultados: El promedio de la SaO2 fue de 97.6 ± 1.8%. Para el grupo 1, la media fue 98.2 ± 1.9%, para el 2, 96.7 ± 1.9% y para el 3, 96.0 ± 2.1%. Se observó una diferencia estadísticamente significativa entre los grupos (p < 0.001), que fue mayor entre los grupos 1 y 2 (1.5%, p < 0.001). El análisis de regresión lineal mostró una reducción de 1.01% en la SaO2 por cada 1000 m SNM. Conclusiones: Se demostró una disminución estadísticamente significativa de los valores de SaO2 conforme aumenta la altitud. Esto puede ser de particular relevancia en la toma de decisions clínicas basadas en la oximetría de pulso, como el tamiz neonatal cardiaco, sobre todo en México donde mas de la mitad de la población vive a una altitud superior a 1500 m SNM.

Sensibilidad y especificidad de la oximetría de pulso para detectarcardiopatías congénitas en recién nacidos / Sensitivity and specificity of pulse oximetry to detect congenital heart disease in newborns

Resumen Objetivo: Determinar la sensibilidad y especificidad de la oximetría de pulso, para detectar cardiopatías congénitas en recién nacidos sanos en alojamiento conjunto. Material y métodos: El estudio es de tipo multicéntrico, prospectivo y transversal, evaluando pacientes del Hospital Regional de Alta Especialidad "Bicentenario 2010" y el Hospital General "Dr. Norberto Treviño Zapata", en ciudad Victoria Tamaulipas, en un periodo que comprendió desde marzo del 2015 a marzo de 2017. Se determinó la oximetría de pulso a recién nacidos sanos antes del egreso hospitalario. Resultados: Se estudiaron 511 recién nacidos. La sensibilidad detectada fue del 88.89 % y una especificidad del 99.80%. Conclusión: Las cardiopatías congénitas en recién nacidos sanos en alojamiento conjunto, se pueden determinar mediante la oximetría de pulso pre y post-ductal.

Abstract Objective: To determine the sensitivity and specificity of pulse oximetry to detect congenital heart disease in healthy newborns in rooming-in. Material and methods: The study is multicenter, prospective and cross-sectional, evaluating patients from the Regional Hospital of High Specialty "Bicentenario 2010" and the General Hospital "Dr. Norberto Treviño Zapata", in the city of Victoria Tamaulipas, in a period from march 2015 to March 2017. Pulse oximetry was determined in healthy newborns before hospital discharge. Results: 511 newborns were studied. The sensitivity detected was 88.89% and a specificity of 99.80%. Conclusion: Congenital heart disease in healthy newborns in rooming-in can be determined by pre- and post-ductal pulse oximetry.

Comparison of Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in the Management of Arterial Stiffness and Target Organ Damage in Patients with Hypertension

Abstract Background Arterial stiffness and hypertension are strong predictors of cardiovascular disease and mortality. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line antihypertensive agents in reducing blood pressure and arterial stiffness. Objective The objective of this study was to compare the effects of ACEI and ARB in reducing arterial stiffness and preventing target organ damage in patients with hypertension. Methods This observational study included 654 participants who attend routine consultations at an outpatient hypertension clinic in 2 university hospitals. Patients were interviewed, and they underwent central and peripheral blood pressure measurements. Doppler echocardiography, carotid ultrasound, biochemical tests, and anthropometric parameters were carried out. Shapiro-Wilk, chi-square, and Fisher's exact test were used. A significance level of 5% was adopted. Results A total of 659 participants were evaluated in the study (398 from the ARB group and 256 from the ACEI group). Age, body mass index (BMI), central and peripheral blood pressure measurements, pulse wave velocity (PWV), left ventricular mass index, and carotid intima-media thickness did not show differences between the groups (p > 0.05). After linear regression analysis, the ACEI group had lower values of total vascular resistance (TVR) (p = 0.003) and augmentation pressure (p = 0.008), when compared to the ARB group. Conclusion This study showed that the ACEI group had a greater reduction in augmentation pressure and PWV. There were no differences between the groups regarding the improvement of outcomes related to central arterial pressure, PWV, and cardiac and vascular target organ damage.

Pancycle Aortic Incompetence and Double Alternans in Pediatric Heart Failure

A 12?year?old boy presented with bicuspid aortic valve, severe aortic regurgitation, and dilated dysfunctional left ventricle in heart failure. He underwent aortic valve replacement with a 23 mm TTK Chitra heart valve prosthesis (tilting disk). He was gradually weaned off milrinone and noradrenaline in the intensive care. Echocardiography showed severe left ventricular dysfunction with an ejection fraction of 24%. The radial pulse was regular and of normal volume but exactly half that of the heart rate. Evaluation of the rhythm and echocardiography revealed an interesting hemodynamic phenomenon with double alternans.

Oximetría de pulso y toma de decisión

Introducción: La enfermad producida por el COVID-19 constituye un problema sanitario mundial. La identificación precoz de las manifestaciones clínicas y del compromiso respiratorio resulta vital para minimizar las complicaciones de la enfermedad; en este sentido, la utilización del oxímetro de pulso constituye una alternativa interesante. Objetivo: Describir las ventajas aportadas por la utilización del oxímetro de pulso en la toma de decisión de pacientes para acudir oportunamente a solicitar atención médica. Métodos: Investigación básica, diseño descriptivo y retrospectivo. Universo constituido por 348 pacientes con diagnóstico de COVID-19 y la muestra por 184 casos. Se determinó frecuencia de complicaciones e influencia del uso de oxímetro de pulso en la toma de decisiones. Se utilizó prueba no paramétrica de Odd Ratio y Fisher exacta para identificar rango de ocurrencia. Resultados: promedio de edad de 54,47 años con predominio de pacientes femeninas (60,33 %) y con comorbilidades asociadas (66,85 %). El 25,00 % de los pacientes presentó afectación respiratoria como complicación de la OVID-19. El 47,83 % de los pacientes con complicaciones uso oxímetro de pulso, aunque solo el 27,27 % acudió tempranamente a consulta, pero si en el 90,91 % la decisión de asistir a servicio de urgencia estuvo influenciada por el uso del oxímetro de punto y sus resultados. Conclusiones: La oximetría de pulso ayudó a los pacientes a tomar la decisión de acudir en busca de atención médica. Puede considerarse el monitoreo de la saturación de oxígeno como una acción positiva en torno a la sospecha clínica de afección respiratoria severa.

Introduction: The disease caused by COVID-19 constitutes a global health problem. The early identification of clinical manifestations and respiratory compromise is vital to minimize the complications of the disease; in this sense, the use of the pulse oximeter constitutes an interesting alternative. Objective: To describe the advantages provided by the use of the pulse oximeter in the decision-making of patients to go in a timely manner to request medical attention. Methods: Basic research, descriptive and retrospective design. Universe made up of 348 patients diagnosed with COVID-19 and the sample of 184 cases. The frequency of complications and the influence of the use of pulse oximeter in decision making were determined. Non-parametric Odd Ratio and Fisher's exact tests were used to identify the range of occurrence. Results: average age of 54.47 years with a predominance of female patients (60.33 %) and with associated comorbidities (66.85 %). 25.00 % of the patients presented respiratory involvement as a complication of OVID-19. 47.83 % of the patients with complications used a pulse oximeter, although only 27.27 % attended the consultation early, but in 90.91 % the decision to attend the emergency service was influenced by the use of the oximeter point and its results. Conclusions: Pulse oximetry helped patients make the decision to seek medical attention. Oxygen saturation monitoring can be considered as a positive action around the clinical suspicion of severe respiratory disease.

Estimated continuous cardiac output based on pulse wave transit time in critically ill children: a report of two cases / Débito cardíaco contínuo estimado baseado no tempo de trânsito da onda de pulso em crianças em estado crítico: relato de dois casos

ABSTRACT Cardiac output is an essential determinant of oxygen delivery, although unreliably measured on clinical examination and routine monitoring. Unfortunately, cardiac output monitoring is rarely performed in pediatric critical care medicine, with a limited availability of accurate methods for children. Herein, we report two pediatric cases in which noninvasive pulse-wave transit time-based cardiac output monitoring (esCCO, Nihon Kohden, Tokyo, Japan) was used. The esCCO system calculates cardiac output continuously by using the negative correlation between stroke volume and pulse wave transit time and requires only electrocardiogram monitoring, noninvasive blood pressure, and pulse oximetry signals. Before starting its use, esCCO should be calibrated, which can be done using patient information (gender, age, height, and body weight) or entering cardiac output values obtained by other methods. In both cases, when calibrations were performed using patient information, the agreement between esCCO and echocardiographic measurements was poor. However, after calibration with transthoracic echocardiography, the cardiac output values obtained by both methods remained similar after 2 hours and 18 hours. The results indicate that the esCCO system is suitable for use in children; however, further studies are needed to optimize its algorithm and determine its accuracy, precision, and trend in children.

RESUMO O débito cardíaco é um determinante importante do fornecimento de oxigênio, embora a sua mensuração seja realizada de forma pouco confiável no exame clínico e no monitoramento de rotina. Infelizmente, o monitoramento do débito cardíaco raramente é realizado na medicina intensiva pediátrica, com disponibilidade limitada de métodos precisos para crianças. Relatamos aqui dois casos pediátricos nos quais utilizouse o monitoramento não invasivo do débito cardíaco por meio da análise do tempo de trânsito de ondas de pulso (esCCO, Nihon Kohden, Tóquio, Japão). O sistema esCCO calcula o débito cardíaco continuamente pela correlação negativa entre o volume sistólico e o tempo de trânsito de ondas de pulso e requer apenas o monitoramento por eletrocardiograma, pressão arterial não invasiva e sinais de oximetria de pulso. Antes de iniciar seu uso, o esCCO deve ser calibrado, o que pode ser feito com informações do paciente (sexo, idade, altura e peso corporal) ou informando os valores do débito cardíaco obtidos mediante outros métodos. Em ambos os casos, quando as calibragens foram realizadas com informações do paciente, a concordância entre o débito cardíaco contínuo estimado e as medidas ecocardiográficas foi insatisfatória. Entretanto, após a calibragem com ecocardiografia transtorácica, os valores do débito cardíaco obtidos pelos dois métodos permaneceram semelhantes após 2 horas e 18 horas. Os resultados indicam que o sistema esCCO pode ser útil em crianças; entretanto, são necessários mais estudos para otimizar seu algoritmo e determinar sua exatidão, precisão e tendência em crianças.

Role of machine learning techniques in classification of peripheral pulse morphology

Recording of peripheral pulse serves as a very important and essential non-invasive tool used widely by doctors for the diagnosis of various diseases. The morphology of pulse is seen to vary as a function of time in a given individual and also from individual to individual. There are many variations in morphological patterns of peripheral pulse in different disease conditions, which lead to difficulty in accurate diagnosis. The peripheral pulse waveforms are extracted from radial arteries as time series data using a peripheral pulse analyzer which is designed on the principle of impedance plethysmography. It was first introduced by Nyober in the mid-nineteen hundreds and ameliorated further by Kubicek. It involves the recording of the instantaneous blood volume by the measurement of electrical impedance as a function of time. Therefore, the study of peripheral pulse morphology has gained much attention in the past few years among researchers. Physiological variability is one of the recent investigations added during the last two decades for the objective assessment of autonomic function and the assessment of prognosis in severe sicknesses namely myocardial infarction, diabetic neuropathy, etc. In addition to heart rate variability studied worldwide, few researchers have studied blood pressure variability and peripheral blood flow variability. In this computer era, artificial intelligence and machine learning techniques have become more important day-by- day, and different types of algorithms were used for the identification of hidden patterns from plethysmographic observations on the radial pulse such as support vector machine as well as crisp and fuzzy clustering. Eight patterns were classified with a yield of 80%–90% and helped with the diagnosis of disorders such as myocardial infarction, pulmonary tuberculosis, coronary artery disorders, cirrhosis of the liver, and bronchial asthma. This paper briefly describes the use of machine learning techniques for the classification of peripheral pulse morphologies.

Associação entre síndrome metabólica e rigidez arterial / Association between metabolic syndrome and arterial stiffness

Introdução: A síndrome metabólica (SM) é considerada um importante fator de risco para doenças cardiovasculares por promover mudanças biomecânicas nas paredes dos vasos que acarretam rigidez arterial (RA). Objetivo: Analisar a associação entre a síndrome metabólica e rigidez arterial. Além de descrever a população de estudo segundo características sociodemográficas e clínicas. Métodos: Estudos transversal de base populacional, na área restrita do Vale do Ogunjá, Salvador-Bahia. Foram obtidos dados sociodemográficos, por meio de questionário e dados clínicos. A VOP foi avaliada por tonometria de aplanação com o aparelho SphygmoCor® (AtCor Medical Pty Ltd, New South Wales, Austrália). Foram obtidas medidas de frequência e descritivas de central e dispersão, e o teste Qui-quadrado para análise estatística. Resultados: A VOP alterada foi mais prevalente em indivíduos que foram diagnosticados com a síndrome metabólica (37,2%), com uma razão de prevalência 2,0 vezes maiores quando comparados aos indivíduos hígidos (IC95%: 0,86 ­ 4,45). Houve também maior prevalência da RA no sexo masculino (30,4%), na faixa etária entre 40 a 74 anos (38,7%), em autodeclarados preto/pardo (27,4%), em divorciados/viúvos (38,9%) e com baixo nível de escolaridade (38,5%). As diferenças proporcionais entre os indivíduos com e sem rigidez arterial foram estatisticamente significantes entre as variáveis escolaridade (p=0,022), faixa etária (p=0,001) e hipertensão arterial (p=0,000). Por outro lado, não foram encontradas diferenças proporcionais estatisticamente significantes (p>0,05) entre as variáveis sexo, cor e estado civil, assim como para a síndrome metabólica e as variáveis que fazem parte da sua definição (hipertrigliceridemia, HDL, glicemia de jejum e obesidade abdominal), com exceção da hipertensão arterial. Conclusão: Apesar da maior prevalência de rigidez arterial em indivíduos com síndrome metabólica, não foi encontrada uma associação estatisticamente significante entre essas duas variáveis. Foi possível verificar uma associação estatisticamente significante entre a hipertensão arterial, indivíduos com idade mais avançada e com baixo nível de escolaridade e a rigidez arterial. (AU)

iomechanical changes in the walls of the vessels that cause arterial stiffness (AR). Objetive: Analyze the association between Metabolic Syndrome (MS) and arterial stiffness and to characterize the study population according to sociodemographic and clinical characteristics. Methods: Cross-sectional population-based studies, in the restricted area of Vale do Ogunjá, Salvador-Bahia. Sociodemographic data, through questionnaire and clinical data were obtained. A PWV was evaluated by applanation tonometry using the device SphygmoCor® (AtCor Medical Pty Ltd, New South Wales, Australia). Frequency and descriptive measurements of central and dispersion were obtained, and the Chi-square test to statistical analysis. Results: The altered PWV was more prevalent in individuals who were diagnosed with the metabolic syndrome (37.2%), with a prevalence ratio 2.0 times higher when compared to healthy individuals (95% CI: 0.86 - 4.45). There was also a higher prevalence of AR in males (30.4%), aged between 40 and 74 years (38.7%), in self-declared black / brown (27.4%), in divorced / widowed (38, 9%) and with a low level of education (38.5%). The proportional differences between individuals with and without arterial stiffness were statistically significant between the variables education (p = 0.022), age group (p = 0.001) and arterial hypertension (p = 0.000). On the other hand, there were no statistically significant proportional differences (p> 0.05) between the variables gender, color and marital status, as well as for the metabolic syndrome and the variables that are part of its definition (hypertriglyceridemia, HDL, blood glucose) fasting and abdominal obesity), with the exception of arterial hypertension. Conclusion: Despite the higher prevalence of arterial stiffness in individuals with metabolic syndrome, no statistically significant association was found between these two variables. It was possible to verify a statistically significant association between arterial hypertension, individuals with older age and with low level of education and arterial stiffness.

Could We Predict POAF With a Simple Ambulatory Oscillometry Evaluating Aortic Stiffness?

ABSTRACT Objective: To investigate the relationship between aortic stiffness and postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). Methods: This study included 110 patients undergoing elective isolated CABG. Aortic stiffness was measured using a noninvasive oscillometric sphygmomanometer before surgery. Characteristics of patients with and without POAF were compared. Results: POAF developed in 32 (29.1%) patients. Patients with POAF were older (63.7±8.6 vs. 58.3±8.4; P=0.014). Chronic obstructive pulmonary disease (COPD) was more common in patients with POAF (11.5% vs. 37.5%; P=0.024), whereas the frequency of hypertension, diabetes mellitus, smoking, and previous coronary artery disease did not differ. C-reactive protein and cholesterol levels were similar between patients with and without POAF. Left atrial diameter was greater in patients with POAF (35.9±1.6 vs. 36.7±1.7; P<0.039). Peripheral (p) and central (c) systolic and diastolic blood pressures were also similar between the groups, whereas both p and c pulse pressures (PP) were greater in patients with POAF (pPP: 44.3±11.9 vs. 50.3±11.6; P=0.018, cPP: 31.4±8.1 vs. 36.2±8.9; P=0.008). Pulse wave velocity (PWV) was significantly higher in POAF (8.6+1.3 vs. 9.4+1.3; P=0.006). PWV, pPR and COPD were independent predictors of POAF in multivariate regression analysis. In receiver operating characteristic analysis, PWV and pPP have similar accuracy for predicting POAF (PWV, area under the curve [AUC]: 0.661, 95% confidence interval [CI] [0.547-0.775], P=0.009) (pPP, AUC: 0.656, 95% CI [0.542-0.769], P=0.012). Conclusion: COPD, PWV, and PP are predictors of POAF. PP and PWV, easily measured in office conditions, might be useful for detecting patients with a higher risk of POAF.

Dexamethasone-cyclophosphamide pulse therapy outcomes comparing pemphigus vulgaris and pemphigus foliaceus groups in a Brazilian cohort study

Abstract Background Dexamethasone-cyclophosphamide pulse (DCP) and dexamethasone pulse (DP) have been successfully used to treat pemphigus, but DCP/DP outcomes comparing pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are scarce. Objective To compare DCP/DP outcomes in a Brazilian cohort of PV and PF patients according to demographic and clinical data. Methods Retrospective analytical cohort study, reviewing medical charts of PV and PF patients (for DCP/DP Phases I‒IV consult Pasricha et al.16‒18). Results 37 PV and 41 PF patients non responsive to usual treatments were included similarly for DCP or DP therapy. Disease duration was longer among PF before DCP/DP prescription (p < 0.001); PF required a higher number of monthly pulses to acquire remission in Phase I (median 10 and 6 pulses, respectively; p = 0.005). DCP/DP outcomes were similar in both groups: remission in 37.8% of PV and 34.1% of PF after completed DCP/DP cycles following a median of 13 months (1-56 months follow-up); failure occurred in 13.5% of PV and 14.6% of PF in Phase I; relapse in 13.5% of PV and 12.2% of PF, and dropout in 27% of PV and 24.4% of PF in Phases II to IV. Mild side effects were documented. Study limitations The severity of PV and PF disease was not assessed by score indexes. Conclusions PV and PF patients presented similar DCP/DP outcomes. DCP/DP should be initiated earlier in PF patients due to the longer duration of their disease in order to decrease the number of pulses and the duration of Phase I to acquire remission.

Velocidade de Onda de Pulso de 8,2m/s como Limiar Associado à Presença de Lesão de Órgão Alvo Cardiovascular / Pulse Wave Velocity of 8.2 m/s as a Threshold Associated with Cardiovascular Target Organ Damage Presence

Resumo Fundamento Estudos prévios estabeleceram valores de normalidade e de referência da Velocidade de Onda de Pulso (VOP). Porém, qual valor de VOP que apresenta a associação mais forte com biomarcadores cardiovasculares ainda é pouco conhecido. Objetivo Identificar o valor de VOP com maior possibilidade de estar associado com hipertrofia ventricular esquerda (HVE), aumento da espessura íntima-média carotídea (EIMC), e presença de placas carotídeas em pacientes hipertensos. Métodos Este é um estudo transversal de 119 pacientes. Análise de curvas características de operação do receptor (ROC) foi realizada para cada biomarcador cardiovascular. A diferença estatística foi estabelecida em p<0,05. Resultados Segundo análises das curvas ROC, valores de VOP de 8,1m/s para HVE, 8,2m/s para EMIC aumentada e 8,7m/s para a presença de placa carotídea foram encontrados, respectivamente. O valor de VOP de 8,2m/s foi definido como melhor o parâmetro para encontrar os três biomarcadores de LOA. A VOP acima de 8,2m/s associou-se ao aumento da EMIC (p = 0,004), à presença de placas carotídeas (p = 0,003) e à HVE (p < 0,001). A VOP acima de 8,2m/s apresentou maior sensibilidade para EMIC aumentada (AUC = 0,678, sensibilidade 62,2), HVE (AUC = 0,717, sensibilidade 87,2), e presença de placas (AUC = 0,649, sensibilidade 74,51) na análise das curvas ROC. Conclusão O valor de 8,2m/s de VOP foi mais sensível em identificar, precocemente, a existência de biomarcadores cardiovasculares de LOA.

Abstract Background Previous studies have established normal and reference values for Pulse Wave Velocity (PWV). However, the PWV value that has the strongest association with cardiovascular biomarkers remains poorly understood. Objective This study aimed to determine the PWV value more likely to be associated with left ventricular hypertrophy (LVH), increased intima-media thickness (IMT), and presence of carotid plaques in patients with hypertension. Methods This cross-sectional study included 119 patients. Analysis of receiver operating characteristic (ROC) curves was performed for each cardiovascular biomarker. Statistical significance was set at p < 0.05. Results According to the ROC curve analysis, the PWV values were 8.1 m/s, 8.2 m/s, and 8.7 for the LVH, IMT, and presence of carotid plaques, respectively. A PWV value of 8.2 m/s was identified as the best parameter to determine the three TOD biomarkers. PWV above 8.2 m/s was associated with increased CIMT (p = 0.004) and the presence of carotid plaques (p = 0.003) and LVH (p<0.001). PWV above 8.2 showed greater sensitivity for increased CIMT (AUC = 0.678, sensitivity = 62.2), LVH (AUC = 0.717, sensitivity = 87.2), and the presence of plaques (AUC = 0.649, sensitivity = 74.51) in the ROC curve analysis. Conclusion The PWV value 8.2 m/s was more sensitive in early identifying the existence of cardiovascular biomarkers of TOD.

Efeito da idade no equilíbrio corporal e nos resultados do vídeo teste do impulso cefálico em pacientes com insuficiência cardíaca / Effect of age on body balance and on the results of the video head impulse test in patients with heart failure

RESUMO Objetivo verificar se existe associação entre a avaliação clínica do equilíbrio e o ganho do reflexo vestíbulo-ocular com o avanço da idade em pacientes com insuficiência cardíaca. Métodos estudo transversal analítico-descritivo, de caráter observacional, que incluiu pacientes com diagnóstico de insuficiência cardíaca, divididos em dois grupos, por idade (G1, menos de 60 anos e G2, 60 anos ou mais). Os pacientes foram avaliados por meio de anamnese, avaliação cardiológica, avaliação clínica do equilíbrio corporal (triagem da função cerebelar e avaliação do equilíbrio estático e dinâmico) e instrumental da função vestibular (Video Head Impulse Test-vHIT). Os achados obtidos foram descritos e comparados por meio de análise estatística inferencial. Resultados foram avaliados 34 pacientes com média de idade de 55 anos e 9 meses, a maioria homens (71,49%). Não houve associação do ganho do reflexo vestíbulo-ocular, simetria dos canais semicirculares e avaliações do equilíbrio corporal com o avanço da idade. Observaram-se associações entre os resultados da prova de Unterberger-Fukuda com o ganho do reflexo vestíbulo-ocular do canal semicircular lateral direito e posterior esquerdo e com os percentuais de simetria dos canais semicirculares anteriores para os pacientes do Grupo 2. Para os indivíduos do Grupo 1, foi observada associação entre os resultados da prova de Unterberger-Fukuda com os valores de simetria dos canais semicirculares anteriores e do ganho de reflexo vestíbulo-ocular dos canais semicirculares anterior esquerdo e posterior direito. Conclusão não houve associação entre os resultados da avaliação clínica do equilíbrio corporal e dos achados do vHIT com o avanço da idade, em pacientes com insuficiência cardíaca. Entretanto, observou-se diferença entre o ganho do reflexo vestíbulo-ocular específico para alguns canais semicirculares, com maiores índices de alteração na prova de equilíbrio dinâmico, em ambos os grupos. Os resultados dos testes aplicados permitiram caracterizar o predomínio da hipofunção vestibular crônica de origem periférica nos pacientes com insuficiência cardíaca, independentemente da faixa etária.

ABSTRACT Purpose to verify whether there is an association between the clinical assessment of balance and the gain in the vestibulo-ocular reflex with advancing age in patients with heart failure. Methods analytical-descriptive, observational cross-sectional study, which included patients diagnosed with heart failure, divided into two groups by age (G1, under 60 years old and G2, 60 years old or older). The patients were evaluated through anamnesis, cardiac assessment, clinical assessment of body balance (cerebellar function screening and assessment of static and dynamic balance) and instrumental assessment of vestibular function (Video Head Impulse Test-vHIT). The findings were described and compared through inferential statistical analysis. Results 34 patients with a mean age of 55 years and 9 months, mostly men (71.49%). There was no association between vestibulo-ocular reflex gain, symmetry of the semicircular canals and body balance with advancing age. Associations were observed between the results of the Unterberger-Fukuda test with the gain in the vestibulo-ocular reflex of the right lateral and left posterior semicircular canals and with the percentages of symmetry of the anterior semicircular canals for patients in Group 2. In Group 1, an association was observed between the results of the Unterberger-Fukuda test and the symmetry values of the anterior semicircular canals and the gain in the vestibulo-ocular reflex of the left anterior and right posterior semicircular canals. Conclusion there was no association between the results of the clinical assessment of body balance and the vHIT findings with advancing age in patients with heart failure. However, there was a difference between the gain of the specific vestibulo-ocular reflex for some semicircular canals, with higher rates of alteration in the dynamic balance test, in both groups. The results of the applied tests allowed characterize the predominance of chronic vestibular hypofunction of peripheral origin in patients with heart failure, regardless of age group.

Discriminative value of pulse wave velocity for arterial stiffness and cardiac injury in prediabetic patients / Valor discriminativo da velocidade da onda de pulso para rigidez arterial e lesão cardíaca em pacientes pré-diabéticos

Abstract Background Prediabetes (PD) is defined as impaired fasting glucose and/or impaired glucose tolerance (IGT) and may be associated with high risk of cardiovascular injury. It is recommended that PD patients be screened for signs of arterial stiffness and cardiovascular injury to reinforce therapeutic strategies. Objectives To identify pulse wave velocity values discriminative for arterial stiffness and cardiovascular injury in PD patients. Methods A cross-sectional study was conducted with PD (N=43) and normoglycemic (N=37) patients who underwent clinical evaluation, arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor, laboratory blood analysis, investigation of morphological and functional cardiac variables by transthoracic echocardiogram, and assessment of carotid intima-media-thickness (CIMT) by carotid ultrasonography. A statistical analysis was performed using SPSS software and values of p<0.05 were considered significant. Results A cfPWV cut-off value of 6.9 m/s was identified for IGT (Sensitivity [SE]: 74% and Specificity [SP]: 51%). Comparison of general data and risk factors between subsets with values above and below this cutoff value revealed higher rates of fasting glucose (p=0.02), obesity (p=0.03), dyslipidemia (p=0.004), early signs of left ventricle (p=0.017) and right ventricle (p=0.03) impaired diastolic function, and elevated CIMT in subjects with cfPWV ≥ 6.9m/s (p=0.04). Conclusions In PD patients, a cfPWV cutoff of 6.9 m/s was considered a discriminative value for arterial stiffness. These findings highlight the value of early investigation of cardiovascular injury and aggressive therapy strategies with good control of risk factors in PD.

Resumo Contexto O pré-diabetes (PD) é definido como glicemia de jejum alterada e/ou tolerância à glicose alterada (TGA) e pode estar associado a alto risco de lesão cardiovascular. Recomenda-se discriminar quais pacientes com PD podem apresentar sinais de rigidez arterial e lesão cardiovascular para reforçar as estratégias terapêuticas. Objetivos Identificar os valores discriminativos da velocidade de onda de pulso determinantes de rigidez arterial e lesão cardiovascular em pacientes com PD. Métodos Estudo transversal em pacientes com PD (N=43) e normoglicêmicos (N=37) submetidos a avaliação clínica, avaliação da rigidez arterial pela velocidade da onda de pulso carótido-femoral (cfPWV) utilizando SphygmoCor, análise laboratorial de sangue, investigação de alterações morfológicas e variáveis cardíacas funcionais por ecocardiograma transtorácico e avaliação da espessura íntima-média carotídea (EIMC) pela ultrassonografia da carótida. A análise estatística foi realizada no software SPSS, e valores de p<0,05 foram considerados significativos. Resultados Foi identificado um valor de corte cfPWV de 6,9 m/s para TGA (sensibilidade 74% e especificidade 51%). A comparação dos dados e fatores de risco entre valores acima e abaixo do valor de corte estabelecido revelou glicemia de jejum elevada (p=0,02), obesidade (p=0,03), dislipidemia (p=0,004), sinais precoces de função diastólica prejudicada do ventrículo esquerdo (p=0,017) e ventrículo direito (p=0,03) e maior EIMC em cfPWV ≥6,9m/s (p=0,04). Conclusões Em pacientes com PD, o cfPWV de 6,9 m/s foi considerado um valor discriminativo de rigidez arterial. Esses achados reforçam que a investigação precoce da lesão cardiovascular e uma estratégia com terapia agressiva são valiosas no controle dos fatores de risco na PD.

Association of acute COVID-19 with 24 hours-pulse wave velocity in cameroonian workers

Introduction. COVID-19appears to have a vascular tropism responsible for diffuse vasculitis-like cell damage. The aim of our study was to evaluate the impact of Sars-Cov-2 infection on arterial stiffness.Material and methods. This was a cross-sectional analytical case-controlstudy with 1:1 matching (1 case to 1 control) over a six-month period from January 1, 2021 to June 30, 2021 at the medical-social centerof the autonomous port of Douala. We measured the pulse wave velocity (PWV) in two groups of patients (group 1: COVID-19and group 2: non-COVID-19) using a MOBIL-O-GRAPH 24h PWA MonitorTM. A p-value < 0.05 was considered significant.Result. A total of 122 patients (61 COVID-19and 61 non-covid) were included in this study, among which 68 (55.7%) male. The mean age was 41±11 years. PWV as well as POV adjusted for age and mean BP were similar in both groups. The mean 24-hour, diurnal and nocturnal PWV were slightly higher in COVID-19patients than in controls by 0.1 m/s (p=0.67), 0.2m/s (p=0.37) and 0.2m/s (p=0.25) respectively. COVID-19infection was not significantly associated with PWV (p=0.082).Conclusion. PWV were slightly higher in COVID-19patients and increased arterial stiffness was not significantly associated with COVID-19status in the acute phase of infection.