Translation, Cross-Cultural Adaptation, and Validation of the Hypertension Self-Care Profile (HBP-SCP) for the Brazilian Population

Abstract Background Self-care in the management of systemic arterial hypertension (SAH) is crucial, and validated instruments can help researchers and health professionals to plan strategies to improve self-care in people with SAH. Objective The main objective of this study was to translate, cross-culturally adapt, and validated the Hypertension Self-Care Profile (HBP-SCP) for Brazilian Portuguese. Methods The translation and cross-cultural adaptation was performed in five phases, and the pre-final version was tested in 30 individuals, native speakers of Portuguese with a diagnosis of hypertension. The final version was administered in 100 individuals. The inclusion criteria were: diagnosis of SAH, characterized by systolic arterial blood pressure ≥ 140 mmHg and/or diastolic arterial blood pressure ≥ 90mmHg, regular use of antihypertensive medications and over 18 years of age. The present study also used two other questionnaires, previously validated for the Brazilian population, to verify the validity of the construct, the Healthy Habits Perception Questionnaire (HHPQ) and the Quality of Life in Hypertension Mini-Questionnaire (MINICHAL-BRASIL). Results During the translation and cross-cultural adaptation phase, there were no disagreements. Adequate reliability — intraclass correlation coefficient (ICC) ≥ 0.89, standard error of measurement (SEM) % ≤ 4.34, minimum detectable change (MDC) % ≤ 12.04 — and internal consistency (Cronbach's alpha ≥ 0.75) were observed. The behavior domain of HBP-SCP obtained significant correlations (p < 0.05) with the self-efficacy domain and HHPQ; the motivation domain with the self-efficacy domain; and the self-efficacy domain with the somatic manifestation domain of MINICHAL-BRASIL. No ceiling and floor effects were observed. Conclusions The Brazilian Portuguese version of the HBP-SCP has adequate psychometric properties, according to the best scientific recommendations.

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.

Measurement properties of the Brazilian version of the Kidney Symptom Questionnaire

SUMMARY OBJECTIVE: The aim of this study was to measure the reliability, internal consistency, and construct validity of the Kidney Symptom Questionnaire for the Brazilian population. METHODS: This is a cross-cultural adaptation and questionnaire validation study. We included native Brazilians of both sex aged>18 years, as well as hypertensive and/or diabetic patients. All participants were assessed using Screening for Occult Renal Disease, EuroQol 5 Dimensions, 36-Item Short Form Survey, and the Kidney Symptom Questionnaire. We used Spearman's coefficient (rho) to measure the correlations between the Kidney Symptom Questionnaire and other instruments; Cronbach's alpha to measure internal consistency; and intraclass correlation coefficient, standard error of measurement, and minimum detectable change to measure test-retest reliability. RESULTS: The sample was formed by 121 adult participants, mostly female, with systemic arterial hypertension and/or diabetes mellitus. We found excellent reliability (intraclass correlation coefficient≥0.978), adequate internal consistency (Cronbach's alpha≥0.860), and adequate construct validity on the Kidney Symptom Questionnaire domains; besides, we observed significant correlations between the Kidney Symptom Questionnaire and other instruments. CONCLUSION: The Brazilian version of the Kidney Symptom Questionnaire has adequate measurement properties to assess chronic/occult kidney disease in patients who do not require renal replacement therapy.

Case-Finding tool for COPD in LMIC (COLA) - translation and cross-cultural adaptation into Brazilian Portuguese language

ABSTRACT OBJECTIVE To translate and cross-culturally adapt the COPD in Low- and middle-income countries (LMICs) Assessment (COLA) questionnaire into Brazilian Portuguese, a case-finding instrument for chronic obstructive pulmonary disease (COPD). METHODS Translation and cross-cultural adaptation were completed in six steps: the original version was translated into Brazilian Portuguese by two native speakers of the target language; the translated versions were synthesized; back-translation was performed by two native speakers of the original language; the back-translation and the Brazilian Portuguese version of the COLA were reviewed and harmonized by an expert committee of specialists; and, then, the pre-final version was tested by 30 health professionals who were asked if the items were clear to understand. The acceptability, clarity, and understandability of the translated version were evaluated. A final review of the questionnaire was produced by the authors and approved by the author of the original questionnaire. RESULTS Some idiomatic, semantic, and experiential inconsistencies were identified and properly adjusted. Item 3 was considered the most unclear item (23,3%). Items 7, 8, and 9 presented clarity above 80% (93%, 90%, and 90%, respectively). Suggestions were discussed and incorporated into the tool and COLA was found to be clear and easy to understand. CONCLUSIONS The Brazilian version of the COLA was easily understood by healthcare professionals and adapted to Brazilian culture. Translation and cultural adaptation of the COLA instrument into Brazilian Portuguese can be an important case-finding instrument for chronic obstructive pulmonary disease in Brazil.

Mobilização passiva precoce aumenta a resposta de reatividade vascular em pacientes graves com sepse: um estudo quase-experimental / Early passive mobilization increases vascular reactivity response in critical patients with sepsis: a quasi-experimental study

RESUMO Objetivo: Investigar a influência de uma sessão de mobilização passiva na função endotelial de pacientes com sepse. Métodos: Este foi um estudo quase-experimental duplo-cego e de braço único com desenho pré e pós-intervenção. Participaram 25 pacientes com diagnóstico de sepse hospitalizados em unidade de terapia intensiva. Avaliou-se a função endotelial basal (pré-intervenção) e imediatamente pós-intervenção por meio de ultrassonografia da artéria braquial. Foram obtidas a dilatação mediada pelo fluxo, a velocidade pico de fluxo sanguíneo e a taxa de cisalhamento pico. A mobilização passiva consistiu na mobilização bilateral (tornozelos, joelhos, quadris, pulsos, cotovelos e ombros), com três séries de dez repetições cada, totalizando 15 minutos. Resultados: Após a mobilização, encontramos aumento da função de reatividade vascular em relação à pré-intervenção: dilatação mediada pelo fluxo absoluta (0,57mm ± 0,22 versus 0,17mm ± 0,31; p < 0,001) e dilatação mediada pelo fluxo relativa (17,1% ± 8,25 versus 5,08% ± 9,16; p < 0,001). O pico de fluxo sanguíneo na hiperemia (71,8cm/s ± 29,3 versus 95,3cm/s ± 32,2; p < 0,001) e a taxa de cisalhamento (211s ± 113 versus 288s ± 144; p < 0,001) também aumentaram. Conclusão: Uma sessão de mobilização passiva foi capaz de aumentar a função endotelial em pacientes graves com sepse. Estudos futuros são necessários para investigar se um programa de mobilização pode ser aplicado como intervenção benéfica para melhorar clinicamente a função endotelial em pacientes hospitalizados por sepse.

ABSTRACT Objective: To investigate the influence of a passive mobilization session on endothelial function in patients with sepsis. Methods: This was a quasi-experimental double-blind and single-arm study with a pre- and postintervention design. Twenty-five patients with a diagnosis of sepsis who were hospitalized in the intensive care unit were included. Endothelial function was assessed at baseline (preintervention) and immediately postintervention by brachial artery ultrasonography. Flow mediated dilatation, peak blood flow velocity and peak shear rate were obtained. Passive mobilization consisted of bilateral mobilization (ankles, knees, hips, wrists, elbows and shoulders), with three sets of ten repetitions each, totaling 15 minutes. Results: After mobilization, we found increased vascular reactivity function compared to preintervention: absolute flow-mediated dilatation (0.57mm ± 0.22 versus 0.17mm ± 0.31; p < 0.001) and relative flow-mediated dilatation (17.1% ± 8.25 versus 5.08% ± 9.16; p < 0.001). Reactive hyperemia peak flow (71.8cm/s ± 29.3 versus 95.3cm/s ± 32.2; p < 0.001) and shear rate (211s ± 113 versus 288s ± 144; p < 0.001) were also increased. Conclusion: A passive mobilization session increases endothelial function in critical patients with sepsis. Future studies should investigate whether a mobilization program can be applied as a beneficial intervention for clinical improvement of endothelial function in patients hospitalized due to sepsis.

Braden scale has low reliability in different patients under care in intensive care unit

SUMMARY OBJECTIVE: The aim of this study was to assess the inter-reliability of the Braden scale and its subscales for different patients assisted in the intensive care unit. We hypothesized that the Braden scale has low reliability in different populations. METHODS: This reliability study involved the Braden scale in intensive care unit of a hospital. A total of 200 patients were admitted to the intensive care unit in four different groups: neurological patients, sepsis, elderly, and adults affected by trauma. The Braden scale is a tool composed of six subscales for patient assessment: sensory perception, humidity, activity, mobility, nutrition, and friction. The total score was also calculated. The Braden scale was applied by two different nurses with an interval of 20-30 min between applications. RESULTS: For all populations, kappa values considered unsuitable were observed for most categories of the Braden scale, ranging from 0.06-0.25. Only for the total Braden scale score was moderate reliability identified in all groups evaluated, with intraclass correlation coefficient values ranging from 0.48-0.75. CONCLUSIONS: Braden scale is not a reliable tool to be used in the intensive care unit, and we do not recommend the use of this scale to assess the risk of developing pressure injury.

Results and effects of patients who have recovered from COVID-19: identifying the relationship with risk factors and comorbidities / Resultados e efeitos dos pacientes que se recuperaram da COVID-19: identificação da relação com fatores de risco e comorbilidades

Abstract The number of deaths from COVID-19 is closely associated with multimorbidities. This study aimed to review the clinical and functional conditions of patients who recovered from COVID-19. Additionally, identify the relationship with risk factors and comorbidities. Systemic arterial hypertension (SAH) was more frequently observed in patients with severe COVID-19. Diabetes mellitus (DM) is one of the comorbidities that has contributed the most to the increase in the number of hospitalizations due to complications and the number of deaths due to infection by COVID-19. Obesity has been shown to be a risk factor for hospitalization in patients with COVID-19 under 60 years of age. Most survivors of COVID-19 suffer primarily from muscle fatigue or weakness. In addition, patients who were more seriously ill during their hospital stay have greater impairment of functional capacity, pulmonary diffusion and fatigue symptoms, and are the main target population for long-term recovery interventions. To optimize the post-hospitalization rehabilitation of patients after discharge from COVID-19, the need for multidisciplinary work in rehabilitation, the reinforcement of public policies to ensure equity in access to the public health system and training should be considered of the health team in view of the new demands and realities generated by COVID-19.

Resumo O número de mortes por COVID-19 está intimamente associado a multimorbidades. O presente estudo teve como objetivo revisar as condições clínicas e funcionais de pacientes que se recuperaram da COVID-19. Adicionalmente, identificar a relação com fatores de risco e comorbidades. A hipertensão arterial sistêmica (HAS) foi observada com mais frequência em pacientes com COVID-19 grave. O diabetes mellitus (DM) é uma das comorbidades que mais tem contribuído para o aumento do número de internações por complicações e do número de óbitos por infecção por COVID-19. A obesidade demonstrou ser um fator de risco para hospitalização em pacientes com COVID-19 com menos de 60 anos. A maioria dos sobreviventes da COVID-19 sofre principalmente de fadiga ou fraqueza muscular. Além disso, os pacientes que estiveram mais gravemente enfermos durante sua internação hospitalar apresentam maior prejuízo da capacidade funcional, pior difusão pulmonar e sintomas de fadiga, sendo assim a população-alvo para intervenções de recuperação a longo prazo.. Para otimizar a reabilitação pós-hospitalização de pacientes após alta por COVID-19, deve-se considerar a necessidade de trabalho multiprofissional na reabilitação, o reforço das políticas públicas para garantir a equidade no acesso ao sistema público de saúde e o treinamento da equipe de saúde frente às novas demandas e realidades geradas pelo COVID-19.

Comparing cardiac function and structure and their relationship with exercise capacity between patients with stable COPD and recent acute exacerbation: a cross-sectional study / Comparação da função e estrutura cardíaca e sua relação com a capacidade de exercício entre pacientes com DPOC estável e exacerbação aguda recente: estudo transversal

ABSTRACT Objective: Patients with COPD are prone to cardiac remodeling; however, little is known about cardiac function in patients recovering from an acute exacerbation of COPD (AECOPD) and its association with exercise capacity. The aim of this study was to evaluate the cardiac function and structure and to compare their relationship with exercise capacity in patients with a recent AECOPD and patients with clinically stable COPD. Methods: This was a cross-sectional study including 40 COPD patients equally divided into two groups: recent AECOPD group (AEG) and clinically stable COPD group (STG). Echocardiography was performed to assess cardiac function and chamber structure. The six-minute walk distance (6MWD) and the Duke Activity Status Index (estimated Vo2) were used in order to assess exercise capacity. Results: No significant differences in cardiac function and structure were found between the groups. The 6MWD was associated with early/late diastolic mitral filling velocity ratio (r = 0.50; p < 0.01), left ventricular posterior wall thickness (r = −0.33; p = 0.03), and right atrium volume index (r = −0.34; p = 0.04), whereas Vo2 was associated with right atrium volume index (r = −0.40; p = 0.02). Conclusions: Regardless of the clinical condition (recent AECOPD vs. stable COPD), the cardiac function and structure were similar between the groups, and exercise capacity (determined by the 6MWD and Vo2) was associated with cardiac features.

RESUMO Objetivo: Pacientes com DPOC são propensos a remodelamento cardíaco; no entanto, pouco se sabe sobre a função cardíaca em pacientes em recuperação de exacerbação aguda da DPOC (EADPOC) e sua associação com a capacidade de exercício. O objetivo deste estudo foi avaliar a função e estrutura cardíaca e comparar sua relação com a capacidade de exercício em pacientes com EADPOC recente e pacientes com DPOC clinicamente estável. Métodos: Estudo transversal com 40 pacientes com DPOC divididos igualmente em dois grupos: grupo EADPOC recente (GEA) e grupo DPOC clinicamente estável (GCE). Realizou-se ecocardiografia para avaliar a função cardíaca e a estrutura das câmaras. A distância percorrida no teste de caminhada de seis minutos (DTC6) e o Duke Activity Status Index (Vo2 estimado) foram utilizados para avaliar a capacidade de exercício. Resultados: Não foram encontradas diferenças significativas na função e estrutura cardíaca entre os grupos. A DTC6 apresentou associação com a razão entre as velocidades de enchimento diastólico mitral precoce e tardia (r = 0,50; p < 0,01), a espessura da parede posterior do ventrículo esquerdo (r = −0,33; p = 0,03) e o índice de volume do átrio direito (r = −0,34; p = 0,04), enquanto o Vo2 apresentou associação com o índice de volume do átrio direito (r = −0,40; p = 0,02). Conclusões: Independentemente da condição clínica (EADPOC recente vs. DPOC estável), a função e estrutura cardíaca eram semelhantes entre os grupos, e a capacidade de exercício (determinada pela DTC6 e pelo Vo2) apresentou associação com as características cardíacas.

Arterial stiffness in type 2 diabetes: determinants and indication of a discriminative value

OBJECTIVES: To identify the clinical discriminative value and determinants of arterial stiffness in individuals with type 2 diabetes mellitus (T2DM). METHODS: This prospective cohort study included 51 individuals (53.57±9.35 years) diagnosed with T2DM (stage glucose≥126 mg/dL; diagnostic time: 87.4±69.8 months). All participants underwent an initial evaluation of personal habits, medications, and history; arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor; and blood laboratory analysis. A statistical analysis was performed using SPSS software, and values of p≤0.05 were considered significant. RESULTS: A cut-off cfPWV value of 7.9 m/s was identified for T2DM [Sensitivity (SE): 90% and Specificity (SP): 80%]. A subgroup analysis revealed higher glycated hemoglobin (Hb1Ac) (p=0.006), obesity (p=0.036), and dyslipidemia (p=0.013) than those with cfPWV ≥7.9 m/s. Multivariate analysis identified higher stage glucose (p=0.04), Hb1Ac (p=0.04), hypertension (p=0.001), and dyslipidemia (p=0.01) as determinant factors of cfPWV; positive and significant correlation between cfPWV and glucose (r=0.62; p=0.0003) and Hb1Ac (r=0.55; p=0.0031). CONCLUSIONS: In T2DM, an indicator of the discriminative value of arterial stiffness was cfPWV of 7.9 m/s. Clinical findings and comorbidities, such as hypertension, glucose, poor glycemic control, and dyslipidemia, were associated with and were determinants of arterial stiffness in T2DM. Reinforcement of monitoring risk factors, such as hypertension, dyslipidemia, and glycemic control, seems to be essential to the process of arterial stiffening. Confirmation of this discriminative value in larger populations is recommended.

Falha de extubação em unidade de terapia intensiva pediátrica: estudo de coorte retrospectivo / Fracaso de la extubación en una unidad de cuidados intensivos pediátrica: un estudio de cohorte retrospectivo / Extubation failure in pediatric intensive care unit: a retrospective cohort study

RESUMO Na unidade de terapia intensiva (UTI) pediátrica, a falha de extubação pode aumentar o risco de mortalidade. Este estudo objetivou: (1) verificar a taxa de falha de extubação na UTI pediátrica de um hospital público do município de Bauru (São Paulo, Brasil); (2) identificar a principal causa atribuída à falha de extubação; (3) avaliar se características como a idade e o tempo de ventilação mecânica invasiva (VMI) estão associadas à falha de extubação; (4) avaliar se o tempo de permanência na UTI e hospital é maior entre os pacientes que apresentaram falha de extubação. Foi realizado estudo de coorte retrospectivo com 89 pacientes internados de maio de 2017 até julho de 2018. Os resultados mostraram taxa de falha de extubação correspondente a 16%. A principal causa atribuída à falha de extubação foi o estridor laríngeo, totalizando 57% dos casos. A comparação intergrupos (sucesso vs. falha de extubação) não mostrou diferenças em relação à idade (p=0,294) e ao tempo de VMI (p=0,228). No entanto, observamos que o grupo falha de extubação apresentou maior tempo de UTI (p=0,000) e hospital (p=0,010). Desta forma, concluímos que a taxa de extubação está de acordo com a observada em outros estudos. O estridor laríngeo foi responsável por mais da metade dos casos de falha de extubação. Embora a idade e o tempo de VMI não tenham sido características associadas à falha de extubação, esta contribuiu para o maior período de permanência na UTI e no hospital.

RESUMEN En la unidad de cuidados intensivos (UCI) pediátrica, el fracaso de la extubación puede aumentar el riesgo de mortalidad. Este estudio tuvo el objetivo de: (1) verificar el índice de fracaso de la extubación en la UCI pediátrica de un hospital público en el municipio de Bauru (São Paulo, Brasil); (2) identificar la causa principal atribuida al fracaso de la extubación; (3) evaluar si las características edad y tiempo de ventilación mecánica invasiva (VMI) están asociadas al fracaso de la extubación; (4) evaluar si la duración en la UCI y el hospital es mayor entre los pacientes que experimentaron este fracaso. Se realizó un estudio de cohorte retrospectivo con 89 pacientes hospitalizados desde mayo de 2017 hasta julio de 2018. Los índices del fracaso de la extubación fueron del 16%. El estridor laríngeo fue la causa principal atribuida al fracaso de la extubación, lo que totaliza el 57% de los casos. La comparación intergrupal (éxito versus fracaso de la extubación) no presentó diferencias en relación con la edad (p=0,294) y el tiempo VMI (p=0,228). Se observó que el grupo fracaso de la extubación estuvo más tiempo en la UCI (p=0,000) y el hospital (p=0,010). Se concluye que el índice de extubación está en consonancia con lo observado en otros estudios. El estridor laríngeo fue el responsable de más de la mitad de los casos de fracaso de la extubación. Las características edad y el tiempo de VMI no estuvieron asociadas al fracaso de la extubación, pero esta contribuyó a un período más prolongado en la UCI y en el hospital.

ABSTRACT In the pediatric intensive care unit (ICU), extubation failure may increase mortality risk. This study aimed: (1) to verify the rate of extubation failure in the pediatric ICU of a public hospital located in the city of Bauru (São Paulo, Brazil); (2) to identify the main cause attributed to extubation failure; (3) to evaluate whether age and time of invasive mechanical ventilation (IMV) are characteristics associated to extubation failure; (4) to evaluate whether the length of stay in the ICU/hospital is longer among patients who presented extubation failure. A retrospective study was performed with 89 hospitalized patients from May 2017 to July 2018. Results showed an extubation failure rate corresponding to 16%. The main cause attributed to extubation failure was laryngeal stridor, totaling 57% of the cases. Intergroup comparison (success vs. failure of extubation) showed no differences in relation to age (p=0.294) and IMV time (p=0.228). However, we observed that the extubation failure group had longer ICU (p=0.000) and hospital time (p=0.010). In this way, we conclude that the rate of extubation failure is in agreement with other studies. Laryngeal stridor was responsible for more than half of cases of extubation failure. Although IMV time and age were not associated with the extubation failure, they contributed to a longer stay in the ICU and in the hospital.

Glycemic behavior in patients with type 2 diabetes during a short period of a combined training program

The present study investigated the behavior of glycemia in subjects with type 2 diabetes (T2DM) during 36 sessions of a combined training program. Methods: This is a single arm clinical study with 20 patients with T2DM submitted to combined exercise training (strength and aerobic exercise). The sessions occurred on alternate days, 3x/week, lasting ~ 80 minutes, totaling ~ 240 minutes/week, for 12 weeks, over a total of 36 sessions. Capillary glycemia was measured before and 10 to 15 minutes after the end of each combined exercise session. Results: There was a significant reduction (p<0.05) in glycemia after application of the combined training program in 27 (75%) of the 36 sessions. Regarding the maintenance of this reduction after about 48 hours, no significant differences were identified (p>0.05). When investigating the cumulative effect of the 36 sessions of combined training program on capillary glycemia, no significant differences were observed (p>0.05). Conclusion: Glycemia exhibits a behavior of reduction immediately after concurrent strength and aerobic training programs in patients with T2DM. However, the immediate reduction of glycemia is not maintained until 48 hours, nor is there a cumulative effect of the 36 training sessions on baseline glycemia.(AU)

Exploring vascular function biomarkers: implications for rehabilitation

Abstract The endothelium plays an important role in maintaining vascular homeostasis and regulating blood vessel function. Endothelial function is considered an independent predictor for risk of future cardiovascular events in cardiovascular and non-cardiovascular patients, as well as a predictor for postoperative complications in cardiovascular surgery patients. Brachial artery flow-mediated dilation by high-resolution ultrasound is widely used to evaluate endothelium-dependent vasodilation, which is mainly mediated by nitric oxide release. Physical exercise exerts beneficial effects on endothelial function and can be used in both primary and secondary prevention of cardiac and peripheral artery diseases, even in the postoperative period of cardiovascular surgery.

Poor glycemic control impacts linear and non-linear dynamics of heart rate in DM type 2 / Pobre controle glicêmico impacta a dinâmica linear e não linear da frequência cardíaca no DM2 / Control glucémico deficiente impacta la dinámica lineal y no lineal de la frecuencia cardíaca en el DM2

INTRODUCTION: It is well known that type 2 diabetes mellitus (T2DM) produces cardiovascular autonomic neuropathy (CAN), which may affect the cardiac autonomic modulation. However, it is unclear whether the lack of glycemic control in T2DM without CAN could impact negatively on cardiac autonomic modulation. Objective: To evaluate the relationship between glycemic control and cardiac autonomic modulation in individuals with T2DM without CAN. Descriptive, prospective and cross sectional study.METHODS: Forty-nine patients with T2DM (51±7 years) were divided into two groups according to glycosylated hemoglobin (HbA1c): G1≤7% and G2>7.0%. Resting heart rate (HR) and RR interval (RRi) were obtained and calculated by linear (Mean iRR; Mean HR; rMSSD; STD RR; LF; HF; LF/HF, TINN and RR Tri,) and non-linear (SD1; SD2; DFα1; DFα2, Shannon entropy; ApEn; SampEn and CD) methods of heart rate variability (HRV). Insulin, HOMA-IR, fasting glucose and HbA1c were obtained by blood tests.RESULTS: G2 (HbA1c≤7%) showed lower values for the mean of iRR; STD RR; RR Tri, TINN, SD2, CD and higher mean HR when compared with G1 (HbA1c > 7%). Additionally, HbA1c correlated negatively with mean RRi (r=0.28, p=0.044); STD RR (r=0.33, p=0.017); RR Tri (r=-0.35, p=0.013), SD2 (r=-0.39, p=0.004) and positively with mean HR (r=0.28, p=0.045). Finally, fasting glucose correlated negatively with STD RR (r=-0.36, p=0.010); RR Tri (r=-0.36, p=0.010); TINN (r=-0.33, p=0.019) and SD2 (r=-0.42, p=0.002).CONCLUSION: We concluded that poor glycemic control is related to cardiac autonomic modulation indices in individuals with T2DM even if they do not present cardiovascular autonomic neuropathy.

INTRODUÇÃO: É de conhecimento geral que o diabetes mellitus tipo 2 (DM2) produz neuropatia autonômica cardiovascular (NAC), que pode afetar a modulação autonômica cardíaca. Entretanto, não é claro se a falta de controle glicêmico em diabéticos tipo 2 sem NAC, poderia impactar negativamente na modulação autonômica cardíaca. Objetivo: Avaliar a relação entre controle glicêmico e modulação autonômica cardíaca em indivíduos com DM2 sem neuropatia autonômica cardiovascular. Estudo descritivo, prospectivo e transversal.MÉTODOS: Quarenta e nove pacientes com DM2 (51±7 anos) foram divididos em dois grupos de acordo com a hemoglobina glicosilada (HbA1c): G1: ≤ 7% e G2: >7,0%. A frequência cardíaca de repouso (FC) e intervalo RR (iRR) foram obtidos e calculados por métodos lineares (média iRR; média FC; rMSSD; STD RR; LF; HF; LF/HF, TINN e RR Tri) e não lineares (SD1; SD2; DFα1; DFα2, Entropia de Shannon; ApEn; SampEn e CD) de variabilidade de frequência cardíaca. Insulina, HOMA-IR, glicemia de jejum e HbA1c foram obtidas por análises sanguíneas.RESULTADOS: G2 (HbA1c ≤ 7%) mostrou valores menores para média de iRR; STD RR; RR Tri, TINN, SD2, CD e maiores para média de FR quando comparado com G1 (HbA1c > 7%). Adicionalmente, HbA1c correlacionou-se negativamente com media iRR (r=0,28, p=0,044); STD RR (r=0,33, p=0,017); RR Tri (r=-0,35, p=0,013), SD2 (r=-0,39, p=0,004) e positivamente com média FC (r=0,28, p=0,045). Finalmente, a glicemia de jejum correlacionou-se negativamente com STD RR (r=-0,36, p=0,010); RR Tri (r=-0,36, p=0,010); TINN (r=-0,33, p=0,019) e SD2 (r=-0,42, p=0,002).CONCLUSÃO: Conclui que o controle glicêmico deficiente relaciona-se com índices de modulação autonômica cardíaca em indivíduos com DM2, ainda que não apresentem neuropatia autonômica cardiovascular.

INTRODUCCIÓN: Es de conocimiento general que la diabetes mellitus tipo 2 (DM2) produce neuropatía autonómica cardiovascular (NAC), que puede afectar la modulación autonómica cardíaca. Entretanto, no es claro si la falta de control glucémico en diabéticos tipo 2 sin NAC, podría impactar negativamente en la modulación autonómica cardíaca. Objetivo: Evaluar la relación entre control glucémico y modulación autonómica cardíaca en individuos con DM2 sin neuropatía autonómica cardiovascular. Estudio descriptivo, prospectivo y transversal.MÉTODOS: Cuarenta y nueve pacientes con DM2 (51±7 años) fueron divididos en dos grupos de acuerdo con la hemoglobina glucosilada (HbA1c): G1: ≤ 7% y G2: >7,0%. La frecuencia cardíaca de reposo (FC) e intervalo RR (iRR) fueron obtenidos y calculados por métodos lineales (promedio iRR; promedio FC; rMSSD; STD RR; LF; HF; LF/HF, TINN y RR Tri) y no lineales (SD1; SD2; DFα1; DFα2, Entropía de Shannon; ApEn; SampEn y CD) de variabilidad de frecuencia cardíaca. Fueron obtenidas insulina, HOMA-IR, glucemia en ayunas y HbA1c a través de análisis sanguíneos.RESULTADOS: G2 (HbA1c ≤ 7%) mostró valores menores para el promedio de iRR; STD RR; RR Tri, TINN, SD2, CD y mayores para el promedio de FR al ser comparado con G1 (HbA1c > 7%). Adicionalmente, HbA1c se correlacionó negativamente con el promedio iRR (r=0,28, p=0,044); STD RR (r=0,33, p=0,017); RR Tri (r=-0,35, p=0,013), SD2 (r=-0,39, p=0,004) y positivamente con el promedio FC (r=0,28, p=0,045). Finalmente, la glucemia en ayunas se correlacionó negativamente con STD RR (r=-0,36, p=0,010); RR Tri (r=-0,36, p=0,010); TINN (r=-0,33, p=0,019) e SD2 (r=-0,42, p=0,002).CONCLUSIÓN: Concluimos que el control glucémico deficiente se relaciona con índices de modulación autonómica cardíaca en individuos con DM2, aunque no presenten neuropatía autonómica cardiovascular.

Acute application of bilevel positive airway pressure influences the cardiac autonomic nervous system

INTRODUCTION: Noninvasive positive pressure has been used to treat several diseases. However, the physiological response of the cardiac autonomic system during bilevel positive airway pressure (Bilevel) remains unclear. OBJECTIVE: The aim of this study was to evaluate the heart rate variability (HRV) during Bilevel in young healthy subjects. METHODS: Twenty men underwent 10-minute R-R interval recordings during sham ventilation (SV), Bilevel of 8-15 cmH2O and Bilevel of 13-20 cmH2O. The HRV was analyzed by means of the parallel R-R interval (mean R-Ri), the standard deviation of all R-Ri (SDNN), the root mean square of the squares of the differences between successive R-Ri (rMSSD), the number of successive R-Ri pairs that differ by more than 50 milliseconds (NN50), the percentage of successive R-Ri that differ by more than 50 milliseconds (pNN50), the low frequency (LF), the high frequency (HF) and SD1 and SD2. Additionally, physiological variables, including blood pressure, breathing frequency and end tidal CO2, were collected. Repeated-measures ANOVA and Pearson correlation were used to assess the differences between the three studied conditions and the relationships between the delta of Bilevel at 13-20 cmH2O and sham ventilation of the HRV indexes and the physiological variables, respectively. RESULTS: The R-Ri mean, rMSSD, NN50, pNN50 and SD1 were reduced during Bilevel of 13-20 cmH2O as compared to SV. An R-Ri mean reduction was also observed in Bilevel of 13-20 cmH2O compared to 8-15 cmH2O. Both the R-Ri mean and HF were reduced during Bilevel of 8-15 cmH2O as compared to SV, while the LF increased during application of Bilevel of 8-15 cmH2O as compared to SV. The delta (between Bilevel at 13-20 cmH2O and sham ventilation) of ETCO2 correlated positively with LF, HF, the LF/HF ratio, SDNN, rMSSD and SD1. Acute application of Bilevel was able to alter the cardiac autonomic nervous system, resulting in a reduction in parasympathetic...

Força muscular respiratória é marcantemente reduzida em mulheres obesas mórbidas / Respiratory muscle strength is markedly reduced in morbid obese women

Comparar a força muscular respiratória (FMR)entre obesas mórbidas com mulheres eutróficas da mesmafaixa etária. Método: Foram avaliadas doze mulheres obesasmórbidas (média de idade de 26 ± 5 anos e IMC – índice demassa corpórea de 47 ± 6 kg/m2) e doze mulheres eutróficas(27 ± 4 anos e IMC de 24 ± 2 kg/m2). Em ambos os grupos,foram realizadas as medidas antropométricas e testada a FMRcom um manovacuômetro (Gerar MVD300) sendo obtidas aspressões inspiratória máxima (PImax) e expiratória máxima(PEmax). As voluntárias foram previamente instruídas quantoà realização correta das manobras, permanecendo sentadas eusando um clipe nasal. A PImax foi obtida a partir do volumeresidual e a PEmax a partir da capacidade pulmonar total. O testet de Student não pareado foi utilizado para comparar os valorespressóricos entre os grupos, e o teste t de Student pareado paracomparar os valores obtidos com os previstos, sendo o nívelde significância de 5%, para ambos os testes. Resultados: Foiverificada redução significativa tanto dos valores da PImax (74± 32 versus 102 ± 9 cmH20) como da PEmax (66 ± 28 versus107 ± 12cmH20) no grupo de mulheres obesas em relação aogrupo de mulheres eutróficas, respectivamente. Quando comparadocom os valores previstos, foi verificado que as mulheres obesasapresentaram menores valores para PImax (76% do predito) epara a PEmax (67% do predito), respectivamente. Conclusão: Aforça muscular respiratória parece estar prejudicada na presençade obesidade mórbida.

To compare respiratory muscle strength betweenmorbid obesity women with matched paired eutrophic women.Method: Twelve morbid obese women (26 ± 5 years and bodymass index – BMI = 47 ± 6 kg/m2) and twelve eutrophic women(27 ± 4 years and BMI = 24 ± 2 kg/m2) were evaluated. In bothgroups, the anthropometric measurements were taken andrespiratory muscle strength (RMS) was tested with a digitalmanovacuometer (Gerar MVD300) obtaining the maximal inspiratoryand expiratory pressures (PImax and PEmax; respectively). Allsubjects were previously instructed regarding the correct conductduring the maneuvers, maintaining sitting position and using anasal clip. PImax was inferred from residual volume and PEmaxwas obtained from total lung capacity. Unpaired Student t testwas used to compare inter-group pressure values, and pairedStudent t test was used to compare the real and predictedvalues, considering significant level 5%, for both tests. Results:It was verified significant reduction in both PImax and PEmaxfor morbid obese women when compared with control grouprespectively (PImax = 74 ± 32 versus 102 ± 9 cmH20 andPEmax = 66 ± 28 versus 107 ± 12 cmH20). When comparedthe reference with obtained values, lower values for PImax andPEmax (76% and 67% of predicted, respectively) in morbid obesewomen were observed. Conclusion: The respiratory musclestrength may be harmed in morbid obesity.

Medida da amplitude tóraco-abdominal como método de avaliação dos movimentos do tórax e abdome em indivíduos jovens saudáveis / Thoracoabdominal amplitude as evaluation method of thorax and abdomen movement in healthy young individual

Introdução: A medida da amplitude tóraco-abdominal (ATA), por meio da cirtometria, é um método utilizado para avaliar os movimentos do tórax e abdome de pacientes submetidos à reabilitação pulmonar, durante intervenções terapêuticas e cirúrgicas. Objetivos: Padronizar a medida de expansibilidade tóraco-abdominal por meio da cirtometria de indivíduos jovens saudáveis, realizando-a por três examinadores diferentes, em dias alternados. Método: Foram estudados 100 indivíduos jovens saudáveis, com 20,8 ± 2 anos, sendo 50 do sexo masculino e 50 do sexo feminino. A medida da ATA foi realizada durante 3 inspirações e expirações máximas nos pontos da prega axilar, processo xifóide e cicatriz umbilical, por meio de fita métrica, por três examinadores diferentes, em dias alternados, considerando a maior medida para análise. Resultados: Não foram observadas diferenças estatisticamente significativas pela ANOVA entre as medidas. O padrão respiratório costal foi predominante, em ambos os sexos, entretanto, este maior no sexo feminino (p < 0,05). Conclusão: Pela padronização da medida da amplitude dos movimentos tóraco-abdominais proposta neste estudo, foi possível verificar que esta metodologia mostrou-se confiável na avaliação fisioterapêutica quando obtida por diferentes examinadores.

Introduction: The thoracoabdominal amplitude measurement, by cirtometry, is a method that has been used to evaluate the thoracoabdominal movements of patients submitted to the pulmonary rehabilitation, during therapeutical interventions and surgeries. Objectives: To standardize the thoracoabdominal expansibility measurement by cirtometry in health young individual realized by different examiners on alternate dates. Method: One hundred individual, with 20,8 ± years, being 50 men and 50 women, were studied. The thoracoabdominal amplitude measurement was realized, during 3 maximal inspirations and expirations, at the axillary fold, xiphoid process and umbilical scar, using a tape measure by 3 different examiners on alternate dates, it has being considered the highest measure to the analysis. Results: No were observed by ANOVA significant statistical differences among the three examiners measures. The respiratory pattern presented costal predominance in both sexes, but it was higher in the female sex, p < 0,05. Conclusion: By measurement standardization of the thoracoabdominal amplitude proposed in this study was possible observed that this methodology was reliable in the physiotherapeutic evaluate when obtained by different examiners.

The influences of positive end expiratory pressure (PEEP) associated with physiotherapy intervention in phase I cardiac rehabilitation

OBJETIVO: Avaliar os efeitos da pressão positiva expiratória final e da intervenção fisioterápica na fase I da reabilitação cardiovascular sobre o comportamento da função pulmonar e da força muscular inspiratória e sobre o pós-operatório de cirurgia cardíaca. MÉTODO: Estudo prospectivo, randomizado, com 24 pacientes, separados em 2 grupos: GEP (n=8), que realizaram exercícios respiratórios com pressão positiva expiratória nas vias aéreas associados à intervenção fisioterápica; e GFI (n=16), que realizaram somente a intervenção fisioterápica. A função pulmonar foi avaliada pela espirometria no pré e 5º dia pós-operatório; a força muscular inspiratória pela pressão inspiratória máxima no pré, 1º e 5º dias pós-operatório. RESULTADOS: As variáveis espirométricas mostraram reduções significativas do pré para o 5º dia pós-operatório no GFI, porém no GEP, observou-se redução apenas para capacidade vital (p<0,05). Com relação às diferenças entre os tratamentos, foram observados menores valores no GFI para o pico de fluxo no 5º dia pós-operatório. Foram observadas reduções significativas da pressão inspiratória máxima do pré para 1º dia pós-operatório em ambos os grupos. A pressão inspiratória máxima mostrou reduções significativas da situação pré para o 5º pós-operatório somente no GFI (p<0,05). CONCLUSÕES: Estes dados sugerem que a cirurgia cardíaca produz reduções da força muscular inspiratória, dos volumes e fluxos pulmonares e que a pressão positiva associada à intervenção fisioterápica foi mais eficiente em minimizar essas alterações do que quando a fisioterapia foi realizada de forma isolada. Entretanto, os volumes pulmo nares não foram completamente restabelecidos até o 5º dia pós-operatório em ambos os grupos, sendo necessária a continuidade dos tratamentos após a convalescença hospitalar.