Rastreamento, Diagnóstico e Manejo da Fibrilação Atrial em Pacientes com Câncer: Evidências Atuais e Perspectivas Futuras / Screening, Diagnosis and Management of Atrial Fibrillation in Cancer Patients: Current Evidence and Future Perspectives

Resumo A fibrilação atrial (FA) é a arritmia cardíaca sustentada mais comum na população geral, tendo uma alta carga de morbimortalidade, e isso também é válido para pacientes com câncer. A associação entre FA e câncer vai ainda mais longe, com alguns estudos sugerindo que a FA pode ser um marcador de câncer oculto. Há, no entanto, uma notável escassez de dados sobre os desafios específicos do manejo da FA em pacientes com câncer. O reconhecimento e o manejo imediatos da FA nesta população especial podem diminuir a morbidade relacionada à arritmia e ter um importante benefício prognóstico. Esta revisão se concentrará nos desafios atuais de diagnóstico e manejo da FA em pacientes com câncer, com ênfase especial nas estratégias e dispositivos de rastreamento da FA e na terapia de anticoagulação com anticoagulantes orais não antagonistas da vitamina K (NOACs) para prevenção tromboembólica nesses pacientes. Alguns insights sobre as perspectivas futuras para a prevenção, diagnóstico e tratamento da FA nesta população especial também serão abordados.

Abstract Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, carrying a high morbimortality burden, and this also holds true in cancer patients. The association between AF and cancer goes even further, with some studies suggesting that AF can be a marker of occult cancer. There is, however, a remarkable paucity of data concerning specific challenges of AF management in cancer patients. AF prompt recognition and management in this special population can lessen the arrhythmia-related morbidity and have an important prognostic benefit. This review will focus on current AF diagnosis and management challenges in cancer patients, with special emphasis on AF screening strategies and devices, and anticoagulation therapy with non-vitamin K antagonist oral anti-coagulants (NOACs) for thromboembolic prevention in these patients. Some insights concerning future perspectives for AF prevention, diagnosis, and treatment in this special population will also be addressed.

Biological maturation assessment methods in adolescent soccer players considering zinc status / Métodos de evaluación de la maduración biológica en jugadores adolescentes de fútbol considerando el estado de zinc

SUMMARY: The purpose of this study was to compare different methods of maturity evaluation and their relation with performance-related physical and anthropometric variables in young soccer players, with different plasma zinc status. A total of 53 healthy male young soccer players (age: 13±1 years; body mass: 48±10 kg; stature: 160±10 cm) participated in this study. Variables from physical fitness (stature, ST; fat-free mass, FFM; handgrip strength in the dominant hand, DHS), testosterone and zinc plasma concentration were measured. Biological maturity was evaluated by sexual maturity (development of: pubic hair, PH; genitals, GD; axillary hair; AH), bone maturity (TW3 method; BA), and testosterone plasma concentration methods. We observed that: (i) the frequency of hypozincemics and normozincemics children stratified by BA-CA, PH and GD were similar in each category; (ii) the BA allowed the identification of differences between the three categories, in at least two performance-related variables (FFM and DHS, p<0.0001); (iii) the AH method was able to discriminate only for DHS (p<0.0001); and (iv) the testosterone method was not able to identify differences between the four maturation categories with regard to ST, FFM, and DHS. Results suggested that Zinc deficiency did not influence the results obtained for the maturation categories defined by the different assessment methods. The assessment of biological maturation by BA seems to be the most effective for the stratification of performance-related and anthropometric variables in young soccer players. Nevertheless, the AH method should also be considered as a fair option to be used in field studies and practice.

RESUMEN: El objetivo de este estudio fue comparar diferentes métodos de evaluación de madurez y su relación con variables físicas y antropométricas relacionadas con el desempeño en jóvenes jugadores de fútbol, con diferentes niveles plasmáticos de zinc. Participaron en este estudio 53 jugadores de fútbol jóvenes sanos (edad: 13 ± 1 años, masa corporal: 48 ± 10 kg, estatura: 160 ± 10 cm). Se midieron las variables de la aptitud física (estatura, ST, masa libre de grasa, FFM, fuerza de agarre en la mano dominante, DHS), testosterona y concentración plasmática de zinc. Se evaluaron la madurez sexual (desarrollo de vello púbico, PH, genitales, DG, cabello axilar, AH), madurez ósea (método TW3, BA) y concentración plasmática de testosterona. Se observó que: (i) la frecuencia de los niños hipoxincémicos y normozincémicos estratificados por BA-CA, PH y GD fueron similares en cada categoría; (ii) el BA permitió la identificación de diferencias entre las tres categorías, en al menos dos variables relacionadas con el desempeño (FFM y DHS, p <0,0001); (iii) el método AH fue capaz de discriminar sólo para DHS (p <0,0001); y (iv) el método de testosterona no fue capaz de identificar diferencias entre las cuatro categorías de maduración con respecto a ST, FFM y DHS. Los resultados sugirieron que la deficiencia de zinc no influyó en los resultados obtenidos para las categorías de maduración definidas por los diferentes métodos de evaluación. La evaluación de la maduración biológica por BA parece ser la más efectiva para la estratificación de variables de rendimiento y antropométricas en jóvenes jugadores de fútbol. Sin embargo, el método AH también debe ser considerado como una opción justa para ser utilizado en estudios de campo y práctica.

Methodological agreement between body-composition methods in young soccer players stratified by zinc plasma levels / Acuerdo metodológico entre los métodos de composición corporal en jugadores jóvenes de fútbol estratificados por los niveles plasmáticos de zinc

It is feasible to think that the body composition assessment may be influenced by maturational and zinc status, especially in young athletes, which perform regularly high volume of physical training. In accordance, it seems important to clarify the impact of these factors in body composition assessment in athletes, since errors may lead to mistakes in training prescription and diet elaboration, and therefore affect the athletic performance. The objective was to compare (1) different methods of body composition evaluation in young soccer players stratified by zinc plasma levels; and (2) the two reference methods using skinfolds thickness in children (Slaughter's and Lohman's equations), considering the maturation level. In this cross-sectional study, fifty tree young soccer players (13.3±0.7 y) were submitted to blood collection, electric bioimpedance (BIA), dual energy X-ray absorptiometry (DXA), anthropometric measures (body mass, stature and skinfolds thickness (ST)) and hand-wrist X-ray. Body composition evaluation was performed by: DXA, ST (Lohman and Slaughter equations) and BIA (Houtkooper equation) methods. Zinc status provided two groups: Normozincemic and Hypozincemic athletes, determined by cut-off point of 11.0 µmol/L. Significant difference on descriptive data for all participants after zinc status stratification was observed only for plasma zinc concentration; (2) Significant correlations were observed between the assessment methods (fat percentage: r= 0.34 to 0.98 and p<0.001 to 0.013; fat free mass: r= 0.95 to 0.9998 and p<0.001), and lowers correlations were observed when electric impedance was involved; and (3) Bland-Altman plots across methods showed a closer agreement when DXA and ST were compared. In conclusion (1) The ST method was better than BIA to assess the body composition (in young soccer players) when DXA scans are not available; (2) The comparison of models based on ST showed that the best association with the values from DXA were obtained for the Slaughter equation, followed by the Lohman equation using bone age instead of chronological age; and (3) Plasma zinc levels seem not to influence the body composition assessment, which certainly warrants further studies.

Es factible pensar que la evaluación de la composición corporal puede estar influenciada por el estado de maduración y los niveles plasmáticos de zinc, especialmente en atletas jóvenes, que regularmente realizan un alto volumen de entrenamiento físico. Por tanto, es importante aclarar el impacto de estos factores en la evaluación de la composición corporal de los atletas, ya que errores en su análisis pueden conducir al desarrollo de una equivocada prescripción de entrenamiento, además de una dieta determinada, y por lo tanto afectar el rendimiento deportivo. El objetivo de esta investigación consistió en: (1) comparar los diferentes métodos de evaluación de la composición corporal en futbolistas jóvenes estratificados por los niveles plasmáticos de zinc; (2) comparar los dos métodos de referencia utilizando el espesor de los pliegues cutáneos en niños (ecuaciones de Slaughter y Lohman), teniendo en cuenta el nivel de maduración. En este estudio transversal, cincuenta futbolistas jóvenes (13,3±0,7 años) fueron sometidos a un perfil bioquímico de sangre, bioimpedancia eléctrica (BIA), absorciometría de rayos X de energía dual (DXA), medidas antropométricas (masa corporal, estatura y pliegues cutáneos de espesor (ST)) y radiografía de mano-muñeca. La evaluación de la composición corporal se realizó por: DXA, ST (ecuaciones Lohman y Slaughter) y BIA (ecuación Houtkooper). El nivel de zinc identificó dos grupos: deportistas normozincémicos e hipozincémicos, determinados por un punto de corte de 11,0 mmol/L. Se observó una diferencia significativa en los datos descriptivos de todos los participantes después de la estratificación del estado de zinc sólo para la concentración de zinc en plasma; se observaron correlaciones significativas entre los métodos de evaluación (porcentaje de grasa: r= 0,34 a 0,98 y p <0,001 a 0,013; masa libre de grasa: r= desde 0,95 hasta 0,9998 y p <0,001), y disminuyeron las correlaciones al estar involucrada la impedancia eléctrica. Los resultados a través de los métodos Bland y Altman mostraron un acuerdo más cercano al comparar DXA y ST. El método ST fue mejor que el BIA para evaluar la composición corporal (en los jugadores jóvenes de fútbol), cuando no estaban disponibles los escaneos DXA. La comparación de los modelos basados en ST mostró que la mejor asociación de valores DXA se obtuvieron para la ecuación Slaughter, seguidos por la ecuación Lohman utilizando la edad ósea en lugar de la edad cronológica. Los niveles de zinc en plasma parecen no influir en la evaluación de la composición corporal, lo que amerita más estudios.

Do talento ao alto rendimento: indicadores de acesso à excelência no handebol / From talent to a high level of performance: key requirements to access the excellence in handball

O talento constitui uma das condições fundamentais para acender à excelência no desporto de competição e a sua identificação representa o primeiro passo de um longo processo de especialização que permite selecionar os sujeitos certos. Para conhecer as variáveis que os treinadores julgam mais influentes no sucesso do atleta de handebol (do sexo masculino), foi aplicado um questionário a 71 treinadores de handebol ("Questionário aos Técnicos de Andebol - QTA"; MASSUÇA, 2007). Neste instrumento, solicitava-se aos participantes que avaliassem o grau de importância de cada fator e indicador de rendimento no sucesso em geral (Handebolista, A) e, que o fizessem igualmente para cada uma das posições de jogo que caracterizam a modalidade desportiva (Ponta, P; Lateral, L; Central, C; Pivot, Pi; Guarda-redes, GR). Os resultados permitem constatar que não existe um perfil de atleta de handebol, mas vários. Pode assim concluir-se que no jogo de handebol o sucesso pode ser experimentado por atletas com diferentes características. Em complemento, julgamos que o inventário apresentado (das qualidades necessárias ao atleta de handebol de alto rendimento) poderá servir de referência para a construção de um modelo de seleção de talentos.

Talent is a key requirement to access the excellence in a competitive sport and its identification is the first step of a long process of specialization that allows the correct selection of subjects. To understand what the most influent variables to achieve success are, a questionnaire was administered to 71 handball coaches ("Questionnaire to Handball Coaches - QTA"; MASSUÇA, 2007). The coaches were asked to rate the importance of each factor and performance indicator considering the success of the general male handball player (A) and to do exactly the same for each specific playing position (wing, P; backward left/right, L; backward centre, C; pivot, Pi; goalkeeper, GR). Results showed that there is not a handball athlete profile, but several. In conclusion, this versatility and number of profiles showed that handball is a sport game that enables the integration of individuals with different characteristics and that success can be achieved by athletes with very different features. Moreover, the obtained list of qualities necessary to experience high-level of performance can be a useful reference to the study and development of a talent selection model.