Genetic Mutations and Mitochondrial Redox Signaling as Modulating Factors in Hypertrophic Cardiomyopathy: A Scoping Review.

Hypertrophic cardiomyopathy (HCM) is a heart condition characterized by cellular and metabolic dysfunction, with mitochondrial dysfunction playing a crucial role. Although the direct relationship between genetic mutations and mitochondrial dysfunction remains unclear, targeting mitochondrial dysfunction presents promising opportunities for treatment, as there are currently no effective treatments available for HCM. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines. Searches were conducted in databases such as PubMed, Embase, and Scopus up to September 2023 using "MESH terms". Bibliographic references from pertinent articles were also included. Hypertrophic cardiomyopathy (HCM) is influenced by ionic homeostasis, cardiac tissue remodeling, metabolic balance, genetic mutations, reactive oxygen species regulation, and mitochondrial dysfunction. The latter is a common factor regardless of the cause and is linked to intracellular calcium handling, energetic and oxidative stress, and HCM-induced hypertrophy. Hypertrophic cardiomyopathy treatments focus on symptom management and complication prevention. Targeted therapeutic approaches, such as improving mitochondrial bioenergetics, are being explored. This includes coenzyme Q and elamipretide therapies and metabolic strategies like therapeutic ketosis. Understanding the biomolecular, genetic, and mitochondrial mechanisms underlying HCM is crucial for developing new therapeutic modalities.

Dual PPRαϒ Agonists for the Management of Dyslipidemia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Saroglitazar is a novel medication for dyslipidemia, but its specific effects remain unclear. Therefore, we performed a systematic review and meta-analysis to assess the efficacy and safety of saroglitazar for managing dyslipidemia. The PubMed, Scopus, and EMBASE databases were systematically searched for randomized controlled trials (RCTs) comparing 2 and 4 mg of saroglitazar with placebos for treating dyslipidemia. A random-effects model calculated the pooled mean differences for continuous outcomes with 95% confidence intervals. The study included seven RCTs involving 1975 patients. Overall, 340 (31.0%) and 513 (46.8%) participants received 2 and 4 mg of saroglitazar, respectively; 242 (22.11%) received the placebo. The mean ages ranged from 40.2 to 62.6 years, and 436 (39.8%) were women. Compared to the control group, 4 mg of saroglitazar significantly decreased the triglyceride and low-density lipoprotein (LDL) cholesterol levels but did not affect the high-density lipoprotein cholesterol level. Furthermore, the alanine aminotransferase level significantly decreased, the creatine level significantly increased, and body weight did not differ between the groups. Finally, 4 mg of saroglitazar, compared to 2 mg, significantly lowered the triglyceride level. Saroglitazar (4 mg) may be an effective treatment, but safety concerns remain.

Circulating MicroRNAs as Specific Biomarkers in Atrial Fibrillation: A Meta-Analysis.

Atrial fibrillation (AF) is the most frequently occurring supraventricular arrhythmia. Although microRNAs (miRNAs) have been associated with AF pathogenesis, standard protocols for quantifying and selecting specific miRNAs for clinical use as biomarkers should be optimized. In this study, we evaluated the clinical application of miRNAs as biomarkers for the prognosis and diagnosis of AF. Literature searches were conducted on PubMed, Cochrane Library, and EMBASE. We included prospective or retrospective observational studies that had been published as of 14 February 2022; our main objective was to analyze the relationship between circulating miRNAs and AF. The data were extracted using the descriptors "Atrial fibrillation AND miRNA", "Atrial fibrillation AND diagnostic AND miRNA", and "Atrial fibrillation AND prognosis AND miRNA". No filters were applied for period delimitation, type of publication, or language. Studies using samples isolated from blood plasma and TaqMan and RT-qPCR for detecting and quantifying miRNAs were selected, and those that used atrial tissue samples were excluded. We identified 272 articles and excluded 102 duplicated articles. Two authors independently read the titles and abstracts of 170 out of 272 articles and selected 56 potential articles, 6 of which were selected for final review. Our analysis revealed a significant association between AF and miR-4798 [OR = 1.90 (95% CI 1.45-2.47)], AF and miRNA-133a [2.77 (2.73-2.82)], AF and miRNA-150 [3.77 (1.50-9.46); I2 = 70%], AF and miRNA-21 [2.23 (1.20-4.17); I2 = 99%], AF and hsa-miRNA4443 [2.32 (2.20-2.44)], and AF and miR-20a-5p [3.67 (1.42-9.49)]. The association between miRNAs and AF showed an OR of 2.51 [95% CI 1.99-3.16; I2 = 99%]. Our meta-analysis demonstrated that circulating miRNAs are potential biomarkers of AF, as they exhibit stable expression post-sample collection. In addition to regulating cellular processes, such as proliferation, differentiation, development, and cell death, miRNAs were found to be linked to arrhythmia development.

Ensino médico on-line durante a pandemia em diferentes países / Online medical education during the pandemic in different countries

Resumo: Introdução: Ao final de 2019, um dos grandes desafios do século XXI veio à tona e atingiu o mundo todo. O longo período de isolamento levou as pessoas a se adaptar a uma nova forma de trabalho e estudo. A mesma medida foi adotada pelos cursos de Medicina, o que resultou em novas metodologias de aprendizagem. Objetivo: Este estudo teve como objetivo analisar, por meio de uma revisão integrativa, dados referentes ao processo de adaptação da educação médica on-line durante a pandemia. Método: Trata-se de uma revisão integrativa de literatura em que se utilizaram os dados das seguintes plataformas: PubMed, Biblioteca Virtual em Saúde (BVS), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes), Scientific Electronic Library Online (SciELO) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). A pesquisa teve início em julho de 2021. Resultado: Inicialmente, com a aplicação dos critérios de inclusão, obteve-se um total de 841 artigos oriundos das bases de dados selecionadas. Após a exclusão de artigos duplicados, esse número foi reduzido a 242 artigos. Após a aplicação dos critérios de exclusão, chegou-se a 22 artigos selecionados para o estudo. Conclusão: Como a Medicina é um curso prático em sua maioria, é fundamental o contato físico dos estudantes com os pacientes, de modo a desenvolver habilidades essenciais para um médico de qualidade, tanto em técnicas da semiologia médica como na desenvoltura da relação médico-paciente. Porém, a necessidade de um modo de aprendizagem surgiu com a pandemia, e o ensino não podia parar. Diante dos pontos levantados na literatura pesquisada, o senso comum seria a aplicação de um método de ensino híbrido - on-line e presencial - (visando à otimização de tempo e ao rompimento de barreiras geográficas, sem deixar de lado a importância da prática clínica), excepcionalmente on-line (quando houver situações extraordinárias, a exemplo da pandemia de Covid-19) ou somente presencial (em regiões onde é inviável a aplicação do e-learning).

Abstract: Introduction: At the end of 2019, one of the great challenges of the 21st century emerged, affecting the whole world. The long period in isolation made people adapt to the way they work and study, and this same measure was taken in the medical course, bringing new methodologies and learning. Objective: To analyze, through an Integrative Review, data on how the process of adapting online medical education was carried out during the pandemic. Methods: This is an Integrative Literature Review and data search was conducted in the PubMed, Virtual Health Library (BVS), Coordination for the Improvement of Higher Education Personnel (CAPES), Scientific Electronic Library Online (SCIELO) and Latin American and Caribbean Literature on Health Sciences (LILACS) databases. The search began in July 2021. Results: Initially, with the application of the inclusion criteria, a total of 841 articles were obtained from the selected databases. After excluding duplicate articles, this number was reduced to 242 articles. After applying the exclusion criteria, 22 articles were selected for the study. Conclusion: It is known that Medicine is mostly a practical course, the physical contact of students with patients is essential to develop essential skills for a quality physician, both in medical semiology techniques and in the skills necessary to establish the doctor-patient relationship. However, the need for a way of learning arose with the pandemic and teaching could not stop. In view of the points raised in the literature research, the common sense would be the application of a hybrid teaching method - online and face-to-face - (aimed at optimizing time and breaking geographic barriers, without neglecting the importance of clinical practice), exceptionally online (when there are extraordinary situations, such as the COVID-19 pandemic) or only in person (in regions where the application of e-learning is not feasible).

Developing Pharmacological Therapies for Atrial Fibrillation Targeting Mitochondrial Dysfunction and Oxidative Stress: A Scoping Review.

Atrial fibrillation (AF) is a cardiac arrhythmia caused by electrophysiological anomalies in the atrial tissue, tissue degradation, structural abnormalities, and comorbidities. A direct relationship exists between AF and altered mitochondrial activity resulting from membrane potential loss, contractile dysfunction, or decreased ATP levels. This review aimed to elucidate the role of mitochondrial oxidative mechanisms in AF pathophysiology, the impact of mitochondrial oxidative stress on AF initiation and perpetuation, and current therapies. This review followed the Preferred Reporting Items for Systematic Reviews and the Meta-Analysis Extension for Scoping Reviews. PubMed, Excerpta Medica Database, and Scopus were explored until June 2023 using "MESH terms". Bibliographic references to relevant papers were also included. Oxidative stress is an imbalance that causes cellular damage from excessive oxidation, resulting in conditions such as AF. An imbalance in reactive oxygen species production and elimination can cause mitochondrial damage, cellular apoptosis, and cardiovascular diseases. Oxidative stress and inflammation are intrinsically linked, and inflammatory pathways are highly correlated with the occurrence of AF. AF is an intricate cardiac condition that requires innovative therapeutic approaches. The involvement of mitochondrial oxidative stress in the pathophysiology of AF introduces novel strategies for clinical treatment.

ONLINE MEDICAL EDUCATION AND ITS LEVELS BETWEEN COUNTRIES WITH DIFFERENT HUMAN DEVELOPMENT INDICES / EDUCACIÓN MÉDICA EN LÍNEA Y SUS NIVELES ENTRE PAÍSES CON DIFERENTES ÍNDICES DE DESARROLLO HUMANO / ENSINO MÉDICO ONLINE E SEUS NÍVEIS ENTRE PAÍSES COM DIFERENTES ÍNDICES DE DESENVOLVIMENTO HUMANO

The objective of this study is to analyze, through an Integrative Review, the process of adapting online medical education at graduation, pointing out similarities and differences between countries with different Human Development Index. At the end of 2019, the biggest challenge of the 21st century came to light, reaching the world with COVID-19, high contagion and little information, social isolation measures and new forms of teaching had to be adapted because teaching was essential. Medicine is mostly a practical course, physical contact between students and patients is essential for the development of essential skills. In view of the points raised in the research literature, the consensual would be the application of a hybrid teaching method - online and face-to-face with a view to optimizing time and breaking geographical barriers, despite the importance of clinical practice.

El objetivo de este estudio es analizar, a través de una Revisión Integrativa, el proceso de adaptación de la educación médica en línea en la graduación, señalando similitudes y diferencias entre países con diferente Índice de Desarrollo Humano. A finales de 2019 salió a la luz el mayor desafío del siglo XXI, llegar al mundo con el COVID-19, alto contagio y poca información, las medidas de aislamiento social y las nuevas formas de enseñanza tuvieron que adaptarse. La medicina es un curso práctico, el contacto físico entre estudiantes y pacientes es esencial para el desarrollo de habilidades. En vista la literatura de investigación, lo consensuado sería la aplicación de un método de enseñanza híbrido - online y presencial con vistas a optimizar el tiempo y romper las barreras geográficas, a pesar de la importancia de la práctica clínica.

O objetivo deste estudo é analisar através de uma Revisão Integrativa, o processo de adaptação da educação médica online na graduação, pontuando semelhanças e diferenças entre países com Índice de Desenvolvimento Humano diferentes.  Ao final de 2019, o maior desafio do século XXI veio à tona, atingindo o mundo com a covid-19, alto contágio e poucas informações, medidas de isolamento social e novas formas de ensino tiveram que ser adaptadas pois o ensino era imprescindível.  A medicina é um curso prático em sua maioria, é essencial o contato físico entre estudantes e pacientes, para o desenvolvendo habilidades essenciais.  Diante dos pontos levantados na literatura pesquisa o consensual seria a aplicação de um método de ensino híbrido - online e presencial visando a otimização de tempo e rompimento de barreiras geográficas, não obstante a importância da prática clínica.  

Cardiac Autonomic Function in Long COVID-19 Using Heart Rate Variability: An Observational Cross-Sectional Study.

BACKGROUND: Heart rate variability is a non-invasive, measurable, and established autonomic nervous system test. Long-term COVID-19 sequelae are unclear; however, acute symptoms have been studied. OBJECTIVES: To determine autonomic cardiac differences between long COVID-19 patients and healthy controls and evaluate associations among symptoms, comorbidities, and laboratory findings. METHODS: This single-center study included long COVID-19 patients and healthy controls. The heart rate variability (HRV), a quantitative marker of autonomic activity, was monitored for 24 h using an ambulatory electrocardiogram system. HRV indices were compared between case and control groups. Symptom frequency and inflammatory markers were evaluated. A significant statistical level of 5% (p-value 0.05) was adopted. RESULTS: A total of 47 long COVID-19 patients were compared to 42 healthy controls. Patients averaged 43.8 (SD14.8) years old, and 60.3% were female. In total, 52.5% of patients had moderate illness. Post-exercise dyspnea was most common (71.6%), and 53.2% lacked comorbidities. CNP, D-dimer, and CRP levels were elevated (p-values of 0.0098, 0.0023, and 0.0015, respectively). The control group had greater SDNN24 and SDANNI (OR = 0.98 (0.97 to 0.99; p = 0.01)). Increased low-frequency (LF) indices in COVID-19 patients (OR = 1.002 (1.0001 to 1.004; p = 0.030)) and high-frequency (HF) indices in the control group (OR = 0.987 (0.98 to 0.995; p = 0.001)) were also associated. CONCLUSIONS: Patients with long COVID-19 had lower HF values than healthy individuals. These variations are associated with increased parasympathetic activity, which may be related to long COVID-19 symptoms and inflammatory laboratory findings.

Health-Related Quality of Life in Elderly Patients with Pacemakers

Abstract Introduction: Cardiac pacemaker (PM) therapy is of paramount importance. PM use increases with age, with an estimated increased use of 70% to 80% in patients over 65 years. This study evaluated the perception of the health-related quality of life (HRQoL) of elderly patients with PM, comparing them with patients without PM, by applying two quality of life questionnaires: EuroQoL 5-dimensions (EQ-5D) and 36-Item Short Form Health Survey (SF-36). Methods: This study included elderly patients divided into a group with PM and another without PM. Information on HRQoL was obtained using the EQ-5D and SF-36 questionnaires. Results: The study involved 104 elderly patients with PM and 150 without PM. The distribution of responses to the EQ-5D was similar between groups. Statistical differences within the gender variable in the group of elderly people with PM were significant for the mobility, habitual activities, and anxiety/depression domains and for the average EQoL utility score and visual analogue scale (EQ-VAS). Elderly patients with PM presented significant differences between New York Heart Association classes 1 and 2 for the mobility domain and EQ-VAS, while those evaluated through SF-36 presented higher averages in vitality, general health status, and pain. However, a different analysis was observed in the physical aspect domain. Conclusion: The SF-36 demonstrated that elderly patients with PM had an HRQoL similar to or greater than those without PM. However, the results of the EQ-5D did not show significant differences regarding the implantation of PM and HRQoL between the two groups of elderly individuals in the study.

Physical training in athletes: analysis of cardiac autonomic modulation / Treinamento físico em esportistas: análise da modulação autonômica cardíaca / Entrenamiento físico en deportistas: análisis de la modulación autonómica cardíaca

ABSTRACT Introduction Cardiac autonomic modulation (CAM) is a result of the balance between the sympathetic and parasympathetic systems. This interaction results in heart rate variation (HRV), analyzed by specific electrocardiographic parameters. These parameters are modified by the practice of physical activity, indicating better cardiac conditioning. Objectives To evaluate the cardiac autonomic modulation of athletes of the XXVIII Ecological Walk at two separate times during their period of physical training. Also, to link the practice of physical activity with stress reduction in these individuals. Methods 24-hour Holter exams were performed at two times (before and after a 2-month period of non-standard physical training), and the results were analyzed using the software programs Epi-Info 7 and BioEstat 5.0. Inferential analysis was performed by the nonparametric Shapiro-Wilk test. Statistical significance was assigned to p values less than 0.05, with 95% confidence interval (95% CI). Results The sample was mostly male (n = 14; 77.78%), with a mean age of 49.55 years. No individual trained for less than 60 days; most (47.06%) trained for 151-200 days, with walking being the predominant modality (64.71%). No statistically significant difference was found in the parameters HRV pNN50 (p = 0.18), rMSSD (p = 0.14) or HF (p = 0.117) after the evaluated training period. Conclusions Participants who are longtime sportsmen and physically active showed parasympathetic saturation, therefore, they did not show significant changes in HRV. Also, low levels of stress were observed in those who practiced physical activity. Level of evidence II; Prognosis Study.

RESUMO Introdução A modulação autonômica cardíaca (MO) é resultado do equilíbrio entre os sistemas simpático e parassimpático. Essa interação resulta na variação da frequência cardíaca (VFC) analisada por parâmetros eletrocardiográficos específicos, que são modificados pela prática de atividade física, indicando melhor condicionamento cardíaco. Objetivos Analisar a modulação autonômica cardíaca em esportistas da XXVIII Caminhada Ecológica em dois momentos durante seu período de treinamento físico. Além disso, relacionar a prática de atividade física com a redução do estresse nesses indivíduos. Métodos Foram realizados exames de Holter de 24 horas em dois momentos (antes e depois de um período de dois meses de treinamento físico não padronizado), sendo os resultados analisados por meio dos programas Epi-Info 7 e BioEstat 5.0. A análise inferencial foi feita pelo teste não paramétrico de Shapiro-Wilk. A significância estatística foi atribuída aos valores de p menores que 0,05 e intervalo de confiança de 95% (IC 95%). Resultados A amostra era majoritariamente masculina (n = 14; 77,78%), com média de idade de 49,55 anos. Nenhum indivíduo treinou por menos de 60 dias, a maioria (47,06%) treinou por 151 a 200 dias, sendo a caminhada a modalidade predominante (64,71%). Não foi encontrada diferença estatisticamente significativa nos parâmetros de VFC pNN50 (p = 0,18), rMSSD (p = 0,14) e HF (p = 0,117) depois do período de treinamento avaliado. Conclusão Os participantes que são esportistas de longa data e fisicamente ativos apresentaram saturação parassimpática, por isso não evidenciaram alterações significativas na VFC. Além disso, observou-se menor nível de estresse nos praticantes de atividade física. Nível de evidência II; Estudo prognóstico.

RESUMEN Introducción La modulación autonómica cardíaca (MO) es el resultado del equilibrio entre los sistemas simpático y parasimpático. Esta interacción resulta en la variación de la frecuencia cardíaca (VFC), analizada por parámetros electrocardiográficos específicos, que son modificados por la práctica de actividad física, indicando mejor acondicionamiento cardíaco. Objetivos Analizar la modulación autonómica cardíaca en deportistas de la XXVIII Caminata Ecológica en dos momentos durante su período de entrenamiento físico. Además, relacionar la práctica de actividad física con la reducción del estrés en estos individuos. Métodos Fueron realizados exámenes Holter de 24 horas en dos momentos (antes y después de un período de dos meses de entrenamiento físico no estandarizado), siendo los resultados analizados por medio de los programas Epi-Info 7 y BioEstat 5.0. El análisis inferencial se realizó mediante el test no paramétrico de Shapiro-Wilk. La significancia estadística fue atribuida a los valores de p inferiores a 0,05 e intervalo de confianza del 95% (IC 95%). Resultados La muestra era mayoritariamente masculina (n = 14; 77,78%), con un promedio de edad de 49,55 años. Ningún individuo entrenó durante menos de 60 días, la mayoría (47,06%) entrenó durante 151-200 días, siendo la caminata la modalidad predominante (64,71%). No fue encontrada diferencia estadísticamente significativa en los parámetros de VFC pNN50 (p = 0,18), rMSSD (p = 0,14) y HF (p = 0,117) después del período de entrenamiento evaluado. Conclusión Los participantes que son deportistas de larga data y físicamente activos presentaron saturación parasimpática, por eso no evidenciaron alteraciones significativas en la VFC. Además, se observó un menor nivel de estrés en los practicantes de actividad física. Nivel de evidencia II; Estudio pronóstico.

A relação com o médico na era do paciente expert: uma análise epistemológica / Doctor-patient relationships in the era of the expert patient: an epistemological analysis / La relación con el médico en la era del paciente expert: un análisis epistemológico

Trata-se de uma pesquisa bibliográfica de cunho epistemológico, com objetivo de evidenciar possibilidades na relação do médico com paciente expert. Selecionaram-se vinte artigos, os quais foram analisados dialeticamente com obras específicas de Foucault e Buber e integrados em quatro categorias de análise, intituladas: "a descontinuidade de paradigmas"; "a relação"; "a informação"; e "navegar é preciso". Para tanto, colocou-se em foco o papel da Internet na gestão da saúde e do paciente expert munido pelas informações pesquisadas da Internet. O encontro clínico pode ser compreendido a partir das perspectivas: "relações de poder", "encontro dialógico" e "fuga da relação". Contudo, a possibilidade do empoderamento do paciente expert perante a autoridade do médico ainda permanece questionável, sobretudo quando se trata da redistribuição do poder que emana do saber.(AU)

Taking the epistemological point of departure, a bibliographic research was conducted to evidence possibilities in doctor-expert patient relationships. Using specific works of Foucault and Buber, twenty articles were selected and analyzed dialectically based four analytical categories: "discontinuity of paradigms "; "the relationship"; "information"; and "it is necessary to navigate". Focus was given to the role of the Internet in the management of health and the expert patient equipped with information found on the Internet. The clinical encounter can be understood from the following perspectives: "power relations", "dialogical encounter", and "evading the relationship". However, the possibility of empowering the expert patient in the face of doctor authority remains questionable, especially when it comes to the redistribution of the power that emanates from knowledge.(AU)

Se trata de una investigación bibliográfica de cuño epistemológico, con el objetivo de poner en evidencia las posibilidades en la relación del médico con el paciente expert. Se seleccionaron veinte artículos, que se analizaron dialécticamente con obras específicas de Foucault y Buber e integrados en cuatro categorías de análisis, tituladas: "la discontinuidad de paradigmas", "la relación", "la información", y "navegar es preciso". Para ello, se colocó el enfoque en el papel de la internet en la gestión de la salud y del paciente expert que investiga las informaciones en Internet. El encuentro clínico puede entenderse a partir de las perspectivas: "relaciones de poder", "encuentro dialógico" y "fuga de la relación". No obstante, la posibilidad del empoderamiento del paciente expert ante la autoridad del médico todavía permanece cuestionable, principalmente cuando se trata de la redistribución del poder que emana del saber.(AU)

Percutaneous Lead Extraction in Infection of Cardiac Implantable Electronic Devices: a Systematic Review.

INTRODUCTION: In the last two decades, the increased number of implants of cardiac implantable electronic devices has been accompanied by an increase in complications, especially infection. Current recommendations for the appropriate treatment of cardiac implantable electronic devices-related infections consist of prolonged antibiotic therapy associated with complete device extraction. The purpose of this study was to analyze the importance of percutaneous extraction in the treatment of these devices infections. METHODS: A systematic review search was performed in the PubMed, BVS, Cochrane CENTRAL, CAPES, SciELO and ScienceDirect databases. A total of 1,717 studies were identified and subsequently selected according to the eligibility criteria defined by relevance tests by two authors working independently. RESULTS: Sixteen studies, describing a total of 3,354 patients, were selected. Percutaneous extraction was performed in 3,081 patients. The average success rate for the complete percutaneous removal of infected devices was 92.4%. Regarding the procedure, the incidence of major complications was 2.9%, and the incidence of minor complications was 8.4%. The average in-hospital mortality of the patients was 5.4%, and the mortality related to the procedure ranged from 0.4 to 3.6%. The mean mortality was 20% after 6 months and 14% after a one-year follow-up. CONCLUSION: Percutaneous extraction is the main technique for the removal of infected cardiac implantable electronic devices, and it presents low rates of complications and mortality related to the procedure.

Chronic Chagas Cardiomyopathy Patients and Resynchronization Therapy: a Survival Analysis.

INTRODUCTION: Chagas disease represents an important health problem with socioeconomic impacts in many Latin-American countries. It is estimated that 20% to 30% of the people infected by Trypanosoma cruzi will develop chronic Chagas cardiomyopathy (CCC), which is generally accompanied by heart failure (HF). Cardiac resynchronization therapy (CRT) may be indicated for patients with HF and electromechanical dysfunctions. OBJECTIVE: The primary endpoint of this study was to analyze the response to CRT in patients with CCC, while the secondary endpoint was to estimate the survival rates of CRT responder patients. METHODS: This is an observational, cross-sectional and retrospective study. The records of 50 patients with CRT pacing devices implanted between June 2009 and March 2017 were analyzed. For statistical analyses, Pearson's correlation was used along with Student's t-test, and survival was analyzed using the Kaplan-Meier method. A P value of <0.05 was considered significant. RESULTS: Out of 50 patients, 56% were male, with a mean age of 63.4±13.3 years and an average CRT duration of 61.2±21.7 months. The mean QRS duration was 150.12±12.4 ms before and 116.04±2.2 ms after the therapy (P<0.001). The mean left ventricular ejection fractions (LVEF) were 29±7% and 39.1±12.2% before and after CRT, respectively (P<0.001). A total of 35 (70%) patients had a reduction of at least one New York Heart Association (NYHA) functional class after six months of therapy (P=0.014). The survival rate after 72 months was 45%. CONCLUSION: This study showed clinical improvement and a nonsignificant survival rate in patients with CCC after the use of CRT.

Percutaneous lead extraction in infection of cardiac implantable electronic devices: a systematic review

Abstract Introduction: In the last two decades, the increased number of implants of cardiac implantable electronic devices has been accompanied by an increase in complications, especially infection. Current recommendations for the appropriate treatment of cardiac implantable electronic devices-related infections consist of prolonged antibiotic therapy associated with complete device extraction. The purpose of this study was to analyze the importance of percutaneous extraction in the treatment of these devices infections. Methods: A systematic review search was performed in the PubMed, BVS, Cochrane CENTRAL, CAPES, SciELO and ScienceDirect databases. A total of 1,717 studies were identified and subsequently selected according to the eligibility criteria defined by relevance tests by two authors working independently. Results: Sixteen studies, describing a total of 3,354 patients, were selected. Percutaneous extraction was performed in 3,081 patients. The average success rate for the complete percutaneous removal of infected devices was 92.4%. Regarding the procedure, the incidence of major complications was 2.9%, and the incidence of minor complications was 8.4%. The average in-hospital mortality of the patients was 5.4%, and the mortality related to the procedure ranged from 0.4 to 3.6%. The mean mortality was 20% after 6 months and 14% after a one-year follow-up. Conclusion: Percutaneous extraction is the main technique for the removal of infected cardiac implantable electronic devices, and it presents low rates of complications and mortality related to the procedure.

Chronic chagas cardiomyopathy patients and resynchronization therapy: a survival analysis

Abstract Introduction: Chagas disease represents an important health problem with socioeconomic impacts in many Latin-American countries. It is estimated that 20% to 30% of the people infected by Trypanosoma cruzi will develop chronic Chagas cardiomyopathy (CCC), which is generally accompanied by heart failure (HF). Cardiac resynchronization therapy (CRT) may be indicated for patients with HF and electromechanical dysfunctions. Objective: The primary endpoint of this study was to analyze the response to CRT in patients with CCC, while the secondary endpoint was to estimate the survival rates of CRT responder patients. Methods: This is an observational, cross-sectional and retrospective study. The records of 50 patients with CRT pacing devices implanted between June 2009 and March 2017 were analyzed. For statistical analyses, Pearson's correlation was used along with Student's t-test, and survival was analyzed using the Kaplan-Meier method. A P value of <0.05 was considered significant. Results: Out of 50 patients, 56% were male, with a mean age of 63.4±13.3 years and an average CRT duration of 61.2±21.7 months. The mean QRS duration was 150.12±12.4 ms before and 116.04±2.2 ms after the therapy (P<0.001). The mean left ventricular ejection fractions (LVEF) were 29±7% and 39.1±12.2% before and after CRT, respectively (P<0.001). A total of 35 (70%) patients had a reduction of at least one New York Heart Association (NYHA) functional class after six months of therapy (P=0.014). The survival rate after 72 months was 45%. Conclusion: This study showed clinical improvement and a nonsignificant survival rate in patients with CCC after the use of CRT.

Morte súbita cardíaca: perfil epidemiológico na região metropolitana de Goiânia / Sudden cardiac death: epidemiological profile in the metropolitan area of Goiania

Introdução: A morte súbita cardíaca é um evento de grande importância e repercussão na saúde pública e se configura como a manifestação mais letal de uma doença cardíaca. Este estudo teve como objetivo traçar as características da morte súbita cardíaca na região metropolitana de Goiânia (GO).Método: O presente estudo analisou 2.681 relatórios completos de necropsia, dos quais 314 foram selecionados como morte súbita cardíaca.Foram coletados dados como sexo das vítimas, faixa etária, local e horário do óbito, presença de tabagismo, além das comorbidades hipertensão arterial sistêmica, diabetes melito, dislipidemia e histórico de doença de Chagas. Resultados: Dos 314 casos de morte súbita cardíaca, os mais acometidos foram homens, entre a sexta e a sétima décadas de vida. O local em que houve mais casos foi o domicílio, ocorrendo a maioria no período matutino. A hipertensão foi a comorbidade mais prevalente, com alta proporção (58,9%). Mais de 10% dos pacientes apresentavam histórico de doença de Chagas. Conclusão: Percebe-se a importância de um maior entendimento da morte súbita cardíaca dentro da realidade da região metropolitana estudada. Entender o perfil epidemiológico local é um passo fundamental para que estratégias preventivas sejam implementadas pelas lideranças políticas

Background: Sudden cardiac death is an important event which has an impact on public health and is the most lethal manifestation of heart disease. This study is aimed at describing the characteristics of sudden cardiac death in the metropolitan area of Goiania (GO). Methods: This study examined 2,681 necropsy reports of which 314 were selected as sudden cardiac death. Data such as gender, age, location and time of death, presence of smoking, comorbidities such as hypertension, diabetes mellitus, dyslipidemia and Chagas disease history were collected. Results: Among 314 cases of sudden cardiac death, the most affected patients were males, between 60 and 70 years of age. The most common location for the event was the patient's own house, and most of them occurred in the morning. Hypertension was the most prevalent comorbidity, with a high incidence (58.9%). More than 10% of the patients had a history of Chagas disease. Conclusion: A better understanding of sudden cardiac death in the metropolitan area should be further studied. Understanding the local epidemiological profile is a crucial step towards the development of preventive strategies that must be implemented by political leaders

Políticas curriculares na formação médica: aproximações e distanciamentos entre Brasil e Portugal / Curricular policies in medical education: similarities and differences between Brazil and Portugal / Políticas curriculares en la formación médica: aproximaciones y distanciamientos entre Brasil y Portugal

ResumoEste artigo trata de uma pesquisa qualitativa sobre as práticas e políticas curriculares relacionadas à formação médica. O método adotado foi o materialismo histórico dialético, num estudo comparado de dois casos. A amostra foi intencional, com recorte em dois cursos de Medicina: o da Pontifícia Universidade Católica de Goiás (Brasil) e o da Faculdade de Ciências da Saúde, da Universidade da Beira do Interior (Portugal). O objetivo geral era comparar as políticas curriculares para o ensino médico nos dois países e analisar as práticas de organização curricular vigentes nas duas instituições tendo em vista as políticas de cada país. Filosoficamente, a pesquisa se fundamentou na teoria do agir comunicativo de Habermas. As aproximações entre os dois cursos perseveram na matriz curricular com o ensino-aprendizagem centrado no aluno e no perfil do egresso. Os maiores distanciamentos se evidenciaram na proposta de inserção social, preconizada pela Pontifícia Universidade Católica de Goiás, e no pressuposto da pesquisa e internacionalização da Faculdade de Ciências da Saúde, da Universidade da Beira do Interior. Concluiu-se que há necessidade de solidificação dos projetos pedagógicos atuais e de adoção de uma escola reflexiva com propostas reais, no sentido de vislumbrar a possibilidade de transformações sociais na realidade concreta.

AbstractThis article is a qualitative survey of curricular practices and policies related to medical training. The method used was dialectical historical materialism based on a comparative study of two cases. The sample was intentional, making a cross section of two medical schools: the Catholic University of Goiás (Brazil) and the College of Health Sciences of the University of Beira Interior (Portugal). The overall goal was to compare the curricular policies for medical education in both countries and to analyze the curriculum organization practices prevailing in the two institutions with a view of each country's policies. Philosophically, the study was based on Habermas’ theory of communicative action. The similarities between the two courses remain in the curricular matrix, with teaching-learning focused on the student and on the graduate's profile. The greatest differences appeared in the social inclusion proposal advocated by the Catholic University of Goiás, and in the assumption of research and internationalization of the College of Health Sciences of the University of Beira Interior. It was concluded that there is a need to solidify the current educational projects and to adopt a reflective school with real proposals aiming to gain a glimpse into the possibility of social change in concrete reality.

ResumenEste artículo trata de una investigación cualitativa sobre las prácticas y políticas curriculares relacionadas con la formación médica. El método adoptado fue el materialismo histórico dialéctico, en un estudio comparado de dos casos. La muestra fue intencional, con recorte en dos cursos de Medicina: el de la Pontificia Universidad Católica de Goiás (Brasil) y el de la Facultad de Ciencias de la Salud, de la Universidad de Beira do Interior (Portugal). El objetivo general era comparar las políticas curriculares para la enseñanza médica en los dos países y analizar las prácticas de organización curricular vigentes en las dos instituciones, teniendo en vista las políticas de cada país. Filosóficamente, la investigación se fundamentó en la teoría de la acción comunicativa de Habermas. Las aproximaciones entre los dos cursos perseveran en la matriz curricular con la enseñanza-aprendizaje centrada en el alumno y en el perfil del egresado. Los mayores distanciamientos se pusieron de manifiesto en la propuesta de inserción social, preconizada por la Pontificia Universidad Católica de Goiás, y en el presupuesto de la investigación e internacionalización de la Facultad de Ciencias de la Salud, de la Universidad de Beira do Interior. Se concluyó que hay necesidad de solidificación de los proyectos pedagógicos actuales y de adopción de una escuela reflexiva con propuestas reales, en el sentido de vislumbrar la posibilidad de transformaciones sociales en la realidad concreta.

Chronotropic incompetence in Chagas disease: effectiveness of blended sensor (volume/minute and accelerometer) / Competência cronotrópica em chagásicos: eficácia do duplo sensor (volume/minuto e acelerômetro)

AbstractIntroduction:Technological progress of pacemakers has allowed the association of two or more sensors in one heart rate system response. The accelerometer sensor measures the intensity of the activity; it has a relatively rapid response to the beginning of it, however, it may present insufficient response to less strenuous or of less impact exercise. The minute ventilation sensor changes the pacing rate in response to changes in respiratory frequency in relation to tidal volume, allowing responses to situations of emotional stress and low impact exercises.Objective:To evaluate the cardiorespiratory response of the accelerometer with respect to the blended sensor (BS=accelerometer sensor+minute ventilation sensor) to exercise in chagasic patients undergoing cardiopulmonary exercise test.Methods:This was a prospective, observational, randomized, cross-sectional study. Patients who met the inclusion criteria were selected. The maximum heart rate of the sensor was programmed by age (220-age). The results were analyzed through t test with paired samples (P<0.05).Results:Sample was comprised of 44 patients, with a mean age of 66±10.4 years, 58% were female, 54% as first implant, in 74% were functional class I and 26% were functional class II, left ventricular ejection fraction was 58±7. As for the cardiopulmonary test, maximum expected heart rate and VO2 were not achieved in both the accelerometer sensor and the blended sensor, however, metabolic equivalent in the blended sensor was higher than the expected, all data with P<0.001.Conclusion:Even though the maximal heart rate was not reached, the blended sensor provided a physiological electrical sequence when compared to the accelerometer sensor, providing better physical fitness test in cardiopulmonary hemodynamics and greater efficiency.

ResumoIntrodução:O progresso tecnológico dos marca passos permitiu a associação de dois ou mais sensores em um único sistema de resposta de frequência cardíaca. O sensor acelerômetro afere a intensidade da atividade, possui uma resposta relativamente rápida ao início da mesma, porém pode apresentar respostas insuficientes a exercícios físicos menos intensos ou de menor impacto. O sensor volume-minuto altera a taxa de estimulação cardíaca em resposta à variação da frequência respiratória quanto ao volume corrente, permitindo, assim, respostas a situações de estresse emocional e exercícios de baixo impacto.Objetivo:Avaliar a resposta cardiorrespiratória do acelerômetro em relação ao duplo sensor ao exercício em pacientes chagásicos submetidos ao teste ergoespirométrico.Métodos:Pesquisa prospectiva, observacional, randomizada e cruzada. Foram selecionados pacientes que preenchiam os critérios de inclusão. A frequência cardíaca máxima do sensor foi programada por idade (220-idade). Os resultados obtidos foram analisados pelo Teste T com amostras pareadas (P<0,05).Resultados:Amostra de 44 pacientes, com idade média de 66±10,4, com 58% do sexo feminino, 54% como primeiro implante, classe funcional I em 74% e II em 26%, fração de ejeção do ventrículo esquerdo de 58±7. Quanto ao ergoespirométrico, a frequência cardíaca máxima prevista e a VO2 máxima prevista não foram atingidas tanto no sensor acelerômetro quanto no sensor volume-minuto, contudo, o equivalente metabólico no sensor volume- minuto foi superior à prevista, todos os dados com P<0,001.Conclusão:Apesar da frequência cardíaca máxima não ter sido atingida, o duplo sensor proporcionou uma sequência elétrica mais fisiológica quando comparado ao sensor acelerômetro.

Chronotropic incompetence in Chagas disease: effectiveness of blended sensor (volume/minute and accelerometer).

INTRODUCTION: Technological progress of pacemakers has allowed the association of two or more sensors in one heart rate system response. The accelerometer sensor measures the intensity of the activity; it has a relatively rapid response to the beginning of it, however, it may present insufficient response to less strenuous or of less impact exercise. The minute ventilation sensor changes the pacing rate in response to changes in respiratory frequency in relation to tidal volume, allowing responses to situations of emotional stress and low impact exercises. OBJECTIVE: To evaluate the cardiorespiratory response of the accelerometer with respect to the blended sensor (BS=accelerometer sensor+minute ventilation sensor) to exercise in chagasic patients undergoing cardiopulmonary exercise test. METHODS: This was a prospective, observational, randomized, cross-sectional study. Patients who met the inclusion criteria were selected. The maximum heart rate of the sensor was programmed by age (220-age). The results were analyzed through t test with paired samples (P<0.05). RESULTS: Sample was comprised of 44 patients, with a mean age of 66±10.4 years, 58% were female, 54% as first implant, in 74% were functional class I and 26% were functional class II, left ventricular ejection fraction was 58±7. As for the cardiopulmonary test, maximum expected heart rate and VO2 were not achieved in both the accelerometer sensor and the blended sensor, however, metabolic equivalent in the blended sensor was higher than the expected, all data with P<0.001. CONCLUSION: Even though the maximal heart rate was not reached, the blended sensor provided a physiological electrical sequence when compared to the accelerometer sensor, providing better physical fitness test in cardiopulmonary hemodynamics and greater efficiency.

Preditores de morte súbita cardíaca em jovens universitários / Predictors of sudden cardiac death in young university students

Introdução: A morte súbita cardíaca é definida como morte de ocorrência inesperada, que ocorre ematé uma hora do início dos sintomas. Este estudo teve como objetivo identificar fatores de risco para morte súbita cardíaca em população de jovens universitários. Método: Estudo observacional com aplicação do questionárioSudden Cardiac Death – Screening of risk factors a 142 jovens universitários de diferentes cursos na cidade de Goiânia (GO), na faixa etária entre 18 anos e 35 anos e realização de eletrocardiograma. Os laudos dos exames foram elaborados por um único médico cardiologista e enviados por e-mail. Os jovens que tiveram resultado alterado receberam o exame e foram orientados a procurar um especialista para melhor investigação. Foi realizada análise descritiva das respostas e alterações eletrocardiográficas. Resultados: Encontrou-se média de idade de22,4 anos e predomínio do sexo feminino. História de síncope foi referida por 39,4% dos jovens, dos quais 49,1%relataram 2 episódios a 5 episódios nos últimos 5 anos. Os contextos mais associados à síncope foram jejum eestresse (ambos com 19,64%), 39,4% afirmaram ter crises de taquiarritmia e 38% relataram precordialgia com frequência. História de doenças cardíacas familiares foi referida por 33,8% dos participantes, dos quais 54,1% relataram ocorrência de morte súbita em familiares com idade < 50 anos. Alterações eletrocardiográficas foram observadas em 27,4%, sendo as mais frequentes a repolarização precoce e o distúrbio de condução do ramo direito (ambos com 23%). Conclusão: Identificou-se a presença de fatores preditores de morte súbita cardíaca na população estudada. No entanto, não foi possível definir ou estratificar o risco do evento pelos meios propostos.

Background: Sudden cardiac death is defined as the unexpected occurrence of death occurring within one hour of symptom onset. This trial aimed to identify risk factors for sudden cardiac death in a population of university students. Method: Observational study including the application of the Sudden Cardiac Death - Screening of risk factors questionnaire to 142 university students between 18 to 35 years of age taking different courses in the city of Goiânia (GO) and an electrocardiogram. The reports were made by the same cardiologist and emailed. Those with abnormal test results were instructed to visit a specialist for further investigation. A descriptive analysis of there sponses and electrocardiographic changes were performed. Results: Mean age was 22.4 years with a prevalence of females. History of syncope was reported by 39.4% of the participants, of which 49.1% reported 2-5 episodes in the last five years. The events associated with syncope were fasting and stress (both with 19.64%), 39.4% reported having tachyarrhythmia and 38% reported frequent chest pain. Family history of heart disease was reported by 33.8% of the respondents, of whom 54.1% had sudden death before 50 years of age. Electrocardiographic changes were identified in 27.4% and the most frequent were early repolarization and right bundle branch conduction disturbance (both with 23%). Conclusion: Predictors of sudden cardiac death were identified in this population. However, it was not possible to define or stratify the risk of the event using the proposed methods.

Sensor de variabilidade da frequência cardíaca como preditor de descompensação da insuficiência cardíaca e terapia de ressincronização cardíaca / Heart rate variability sensor as a predictor of heart failure decompensation and cardiac resynchronization therapy

A insuficiência cardíaca é a via final comum à maioria das doenças cardiovasculares, sendo um dosmais importantes desafios clínicos atuais na área da saúde. Em 2007 foi a causa mais frequente de internaçõespor doenças cardiovasculares no Sistema Único de Saúde. Em pacientes com insuficiência cardíaca, a atividadeneuro-hormonal previne o resultado cardiovascular. A variabilidade da frequência cardíaca é uma medida indireta do tônus autonômico e serve como forma de predizer a possibilidade de morte súbita cardíaca e não súbita. Avariabilidade da frequência cardíaca tem sido proposta não só para prever a falência cardíaca grave, mas tambémpara conduzir o tratamento e talvez antecipar o diagnóstico da insuficiência cardíaca agudamente descompensada.A melhora clínica do paciente com insuficiência cardíaca após terapia de ressincronização cardíaca demanda algum tempo, independentemente da melhora rápida dos parâmetros ecocardiográficos, sugerindo ser o remodelamento cardíaco reverso um processo dinâmico e que deve ser aguardado após a terapia de ressincronização cardíaca. Nestetrabalho é feita revisão bibliográfica complementada com a análise do prontuário de uma paciente com insuficiência cardíaca submetida a terapia de ressincronização cardíaca, demonstrando que há melhora ecocardiográfica rápida mas que a melhora clínica se dá após algum tempo do implante do ressincronizador cardíaco. Conclui-se que oremodelamento reverso necessita, em alguns casos, de maior espaço de tempo após o implante do ressincronizadorcardíaco para que haja resultados clínicos, os quais podem não ocorrer ainda que haja melhora da fração de ejeção ao ecocardiograma...

Heart failure is the final common pathway for most cardiovascular diseases, being one of the mostimportant current clinical challenges in healthcare. In 2007 it was the most frequent cause of hospital admissionsfor cardiovascular diseases in the Brazilian Public Healthcare System. In patients with heart failure, neuro-hormonal activity prevents cardiovascular outcome. Heart rate variability is an indirect measure of autonomic tone and serves as a way to predict the possibility of sudden and non-sudden cardiac death. Heart rate variability has been proposed not only as a predictor of severe heart failure, but also to conduct treatment and eventually anticipate the diagnosis of acute decompensated heart failure. The clinical improvement of patients with heart failure after cardiacresynchronization therapy takes some time regardless of the rapid improvement in echocardiographic parameters suggesting that reverse cardiac remodeling is a dynamic process that takes time after cardiac resynchronization therapy. This study reviewed the literature and evaluated the records of a patient with heart failure undergoing cardiac resynchronization therapy demonstrating that there is rapid echocardiographic improvement but thatclinical improvement occurs sometime after the implantation of a cardiac resynchronizer. In conclusion, in somecases a longer time is required after cardiac resynchronization for the clinical outcomes of reverse remodelling tobe observed, which is not always the case, despite ejection fraction improvements at the echocardiogram...