Incorporación a nivel nacional de tecnología no invasiva para valoración del dolor y/o disconfort neonatal / Incorporation of non-invasive technology for the assessment of neonatal pain and/or discomfort at national level / Incorporação a nível nacional de tecnologia não invasiva para avaliação da dor e/ou desconforto neonatal

Introducción: la exposición a estímulos dolorosos y estrés en la etapa neonatal, sin un correcto tratamiento, tiene consecuencias a corto y largo plazo. El diagnóstico adecuado es un desafío, ya que las escalas clínicas son subjetivas y se requieren herramientas de detección con mejor objetividad y capacidad de interpretación del disconfort/dolor neonatal. Newborn Infant Parasympathetic Evaluation (NIPE™) es una tecnología no invasiva de monitorización continua del dolor en neonatos, desarrollada recientemente dada la dificultad de objetivar el dolor mediante los métodos convencionales en la práctica clínica. Esta tecnología se basa en el análisis de la variabilidad de la frecuencia cardíaca (FC), lo que permite aproximarse a la actividad del sistema parasimpático. Objetivos: el objetivo de esta investigación fue valorar el disconfort en un modelo de cerdo recién nacido (RN) y en humanos neonatos expuestos a maniobras nociceptivas con la utilización de tecnología no invasiva (NIPE), en la maternidad del Hospital Universitario. Material y métodos: se realizó un estudio observacional, longitudinal, en seis cerdos RN, anestesiados, monitorizados hemodinámicamente y sometidos a un procedimiento quirúrgico mayor (toracotomía lateral izquierda con abordaje cardíaco, pericardiostomía y acceso vascular pulmonar transventricular derecho) y 12 procedimientos mínimamente invasivos de la práctica clínica habitual, como vacunación BCG, hemoglucotest y pesquisa, que generan un estímulo nociceptivo en ocho RN de término sanos. Se incluyeron RN sanos de término (EG entre 37-41 semanas más seis días) internados en el alojamiento conjunto madre-hijo, se excluyeron de la muestra los RN que presentaron alguna patología y aquellos cuyos padres no aceptaron la participación en el estudio. Resultados: se comparó la variabilidad de la FC mediante detección automatizada (NIPE™) para estimación objetiva del dolor/disconfort. Se comparó en la clínica con una escala validada y ampliamente utilizada en neonatos: Premature Infant Pain Profile (PIPP). Para valorar la asociación entre variables NIPE™ y FC se utilizaron correlación de Spearman, el test de Kruskall-Wallis o test de chi cuadrado con corrección de Fisher, según correspondiera. Se encontró una correlación negativa entre FC y NIPE™ tanto para el grupo de neonatos humanos (r=-1; p=0,008) como para el modelo animal (r=-0,6; p=0,0004). No se encontró asociación significativa entre NIPE™ y la escala PIPP. La variación entre valores de NIPE™ pre y posestímulo en RN humanos fue significativa (p=0,008). Conclusiones: determinamos que en ambos escenarios explorados los valores de NIPE™ descienden ante estímulos nociceptivos y los cambios en la FC se relacionan con sus valores, independientemente de la especie o la agresividad de la maniobra. Este trabajo es el primero a nivel nacional incorporando el uso de esta tecnología, creemos que tendrá impacto en la forma de evaluar y abordar el dolor por parte de los equipos asistenciales y de experimentación.

Introduction: exposure to painful stimuli and stress in the neonatal stage, without correct treatment, has short and long-term consequences. Proper diagnosis is a challenge since clinical scales are subjective, and we require more objective screening tools and a better ability to interpret neonatal discomfort/pain. Newborn Infant Parasympathetic Evaluation (NIPE™) is a non-invasive technology for continuous pain monitoring in neonates, recently developed given the difficulty to objectify pain using conventional methods in clinical practice. This technology is based on the analysis of heart rate variability (HR), which allows us to approximate the activity of the parasympathetic system. Objectives: the objective of this research was to assess discomfort in a newborn pig model (NB) and in human neonates exposed to nociceptive maneuvers with the use of non-invasive technology (NIPE), in the maternity ward of the University Hospital. Material and methods: an observational, longitudinal study was carried out in 6 NB pigs, anesthetized, hemodynamically monitored and subjected to a major surgical procedure (left lateral thoracotomy with cardiac approach, pericardiostomy and right trans ventricular pulmonary vascular access) and 12 minimally invasive procedures, from clinical practice. routine such as BCG vaccination, hemoglucotest and screening, which generate a nociceptive stimulus in 8 healthy term newborns. Healthy term newborns (GA between 37-41 weeks plus 6 days) admitted to the mother-child joint accommodation were included, We excluded those NB patients who presented some pathology or whose parents did not accept participation in the study. Results: HR variability was compared using automated detection (NIPETM) for objective estimation of pain/discomfort. It was compared in the clinic with a validated and widely used scale in neonates: Premature Infant Pain Profile (PIPP). We used the Spearman's correlation, the Kruskall-Wallis test or the Chi square test with Fisher's correction to assess the association between NIPE™ variables and HR, as needed. A negative correlation was found between HR and NIPETM for both the group of neonates. humans (r=-1; p=0.008) and for the animal model (r=-0.6; p=0.0004). No significant association was found between NIPETM and the PIPP scale. The variation between pre- and post-stimulus NIPE™ values in human NBs was significant (p=0.008). Conclusions: we conclude that in both scenarios explored, NIPE™ values decrease when faced with nociceptive stimuli and changes in HR are related to its values, regardless of the species or the aggressiveness of the maneuver. This paper is the first at a national level to incorporate the use of this technology, we believe it will have an impact on the way pain is assessed and addressed by healthcare and experimental teams.

Introdução: a exposição a estímulos dolorosos e ao estresse na fase neonatal, sem tratamento correto, traz consequências a curto e longo prazo. O diagnóstico adequado é um desafio, uma vez que as escalas clínicas são subjetivas e são necessárias ferramentas de triagem com melhor objetividade e capacidade de interpretar o desconforto/dor neonatal. A Avaliação Parassimpática do Recém-Nascido (NIPE™) é uma tecnologia não invasiva para monitoramento contínuo da dor em neonatos, desenvolvida recentemente devido à dificuldade de objetivar a dor usando métodos convencionais na prática clínica. Esta tecnologia baseia-se na análise da variabilidade da frequência cardíaca (FC), o que nos permite aproximar a atividade do sistema parassimpático. Objetivos: o objetivo desta pesquisa foi avaliar o desconforto em recém-nascido modelo suíno (RN) e em neonatos humanos expostos a manobras nociceptivas com uso de tecnologia não invasiva (NIPE), na maternidade do Hospital Universitário. Material e métodos: foi realizado um estudo observacional, longitudinal, em 6 suínos RN, anestesiados, monitorados hemodinamicamente e submetidos a um procedimento cirúrgico de grande porte (toracotomia lateral esquerda com abordagem cardíaca, pericardiostomia e acesso vascular pulmonar transventricular direito) e 12 procedimentos minimamente invasivos, da prática clínica. rotina como vacinação BCG, hemoglicoteste e triagem, que geram estímulo nociceptivo em 8 recém-nascidos a termo saudáveis. Foram incluídos recém-nascidos a termo saudáveis (IG entre 37-41 semanas mais 6 dias) internados no alojamento conjunto mãe-filho, foram excluídos do A amostra incluiu RNs que apresentavam alguma patologia e aqueles cujos pais não aceitaram a participação no estudo. Resultados: a variabilidade da FC foi comparada por meio de detecção automatizada (NIPETM) para estimativa objetiva de dor/desconforto. Foi comparado na clínica com uma escala validada e amplamente utilizada em neonatos: Premature Infant Pain Profile (PIPP). Para avaliar a associação entre as variáveis do NIPE™ e a FC, utilizou-se a correlação de Spearman, o teste de Kruskall-Wallis ou o teste Qui-quadrado com correção de Fisher, conforme apropriado. Foi encontrada correlação negativa entre a FC e o NIPETM para ambos os grupos de neonatos. (r=-1; p=0,008) e para o modelo animal (r=-0,6; p=0,0004). Não foi encontrada associação significativa entre o NIPETM e a escala PIPP. A variação entre os valores de NIPE™ pré e pós-estímulo em RN humanos foi significativa (p=0,008). Conclusões: concluímos que em ambos os cenários explorados, os valores do NIPE™ diminuem diante de estímulos nociceptivos e as alterações na FC estão relacionadas aos seus valores, independente da espécie ou da agressividade da manobra. Este trabalho é o primeiro a nível nacional a incorporar a utilização desta tecnologia, acreditamos que terá impacto na forma como a dor é avaliada e abordada pelas equipas de saúde e experimentais.

Experiencia en un programa de rehabilitación cardíaca extrahospitalario usando cardiotacómetros: seguridad y eficacia / Experience in an outpatient cardiac rehabilitation program using cardiotachometers: safety and effectiveness / Experiência em programa de reabilitação cardíaca extra-hospitalar com uso de cardiotacômetros: segurança e eficácia

Introducción: El ejercicio físico, integrando la rehabilitación cardíaca (RC), tiene un efecto positivo demostrado en el pronóstico de los pacientes con enfermedad cardiovascular, optimizando el rendimiento cardíaco en términos de capacidad funcional. Mediante los programas de RC se pretende obtener los máximos beneficios clínicos del ejercicio físico con un mínimo riesgo para el paciente. Objetivos: Evaluar la seguridad y eficacia de un programa de RC extrahospitalario en pacientes de todos los niveles de riesgo, monitorizando con cardiotacómetros (instrumento de pulsera que detecta frecuencia cardíaca y permite programar alarmas) a pacientes de moderado y alto riesgo, con base en la ausencia de complicaciones cardíacas graves y la mejoría funcional de los participantes. Material y métodos: Estudio de cohorte retrospectiva, sometida a un plan de RC durante 12 semanas en el período comprendido entre enero de 2014 y marzo de 2020. Se evaluaron parámetros clínicos y funcionales al inicio y al final del plan de rehabilitación, controlando la tolerancia al esfuerzo, la presión arterial y la frecuencia cardíaca mediante el uso de cardiotacómetros. Resultados: Se incluyeron 181 pacientes, con edad promedio de 58,7 ± 9,7 años, 87,8% del sexo masculino, mayoritariamente portadores de cardiopatía isquémica (90,1%). Según la clasificación de la Asociación Americana de Rehabilitación Cardiovascular y Pulmonar, 54 pacientes (29,8%) eran de alto riesgo, 29 (16,0%) de moderado riesgo y 98 (54,1%) de bajo riesgo. En más de 10.000 horas de actividad física realizadas, un paciente requirió el implante de un marcapaso definitivo por bloqueo auriculoventricular completo, sin observarse otras complicaciones graves. Se obtuvo una mejoría significativa (p = 0,001) de la capacidad funcional, que aumentó de 7,34 ± 2,68 a 10,20 ± 2,35 METs (incremento relativo individual promedio 28,1%). Conclusiones: La RC es un tratamiento seguro y efectivo en los pacientes cardiópatas, aún en aquellos de moderado y alto riesgo. El uso de cardiotacómetros permite una adecuada monitorización del ejercicio y una oportuna detección de complicaciones.

Introduction: physical exercise, integrating cardiac rehabilitation (CR), has a proven positive effect on the prognosis of patients with cardiovascular disease, optimizing cardiac performance in terms of functional capacity. CR programs aim to obtain maximum clinical benefits with minimal risks to the patient. Objectives: assess the safety and efficacy of a cardiotachometer-monitored out-of-hospital CR program in high- and moderate-risk patients, based on the absence of major cardiac complications and improvement in participant's functional capacity. Materials and methods: retrospective cohort study, submitted to a CR plan for 12 weeks in the period between January 2014 and March 2020. Clinical and functional parameters were evaluated at the beginning and at the end of the rehabilitation plan, controlling effort tolerance, blood pressure and heart rate using cardiotachometers. Results: 181 patients were included, aged 58.7 ± 9.7 years and 87.8% female, of whom 90% were carriers of ischemic heart disease. According to the classification of the American Association of Cardiovascular and Pulmonary Rehabilitation, the patients were distributed as follows: 54 (29.8%) at high risk, 29 (16.0%) at intermediate risk, and 98 (54.1%) low risk. In more than ten thousand hours of physical activity performed, one patient required implantation of a permanent pacemaker due to complete atrioventricular block. A significant improvement (p = 0.001) of the functional capacity, from 7.34 ± 2.68 to 10.2 ± 2.35 (mean relative improvement: 28.1%.) was obtained. Conclusions: the CR is a safe and effective procedure for cardiac patients, even in moderate or high-risk subjects. The use of cardiotachometers allows adequate exercise monitoring and timely detection of complications.

Introdução: o exercício físico, integrando a reabilitação cardíaca (RC), tem comprovado efeito positivo no prognóstico de pacientes com doença cardiovascular, otimizando o desempenho cardíaco em termos de capacidade funcional. Os programas de RC visam obter o máximo de benefícios clínicos com riscos mínimos para o paciente. Objetivos: avaliar a segurança e eficácia de um programa de RC fora do hospital monitorado por cardiotacômetro em pacientes de alto e moderado risco, com base na ausência de complicações cardíacas maiores e na melhora da capacidade funcional dos participantes. Materiais e métodos: trata-se de um estudo descritivo, de um plano de RC de 12 semanas, em um período entre janeiro de 2014 a março de 2020. Os parâmetros clínicos e funcionais foram avaliados no início e no final do plano de reabilitação, a tolerância ao esforço, pressão arterial e frequência cardíaca utilizando cardiotacômetros. Resultados: foram incluídos 181 pacientes, com média de idade de 58,7 ± 9,7 anos e 87,8% do sexo masculino, dos quais 90% eram portadores de cardiopatia isquêmica. De acordo com a classificação da Associação Americana de Reabilitação Cardiovascular e Pulmonar, os pacientes foram distribuídos da seguinte forma: 54 (29,8%) de alto risco, 29 (16,0%) de risco intermediário e 98 (54,1%) de baixo risco. Em mais de dez mil horas de atividade física realizada, um paciente necessitou de implante de marcapasso definitivo por bloqueio atrioventricular total. A avaliação final mostrou melhora significativa (p = 0,001) na capacidade funcional medida em METs; este passou de 7,34 ± 2,68 para 10,2 ± 2,35 (melhora relativa média: 28,1%). Conclusões: este trabalho demonstra que a RC é um tratamento seguro e eficaz para pacientes com doenças cardíacas, mesmo em indivíduos de risco moderado e alto. O uso de cardiotacômetros permite o monitoramento adequado do exercício e a detecção oportuna de complicações.

O uso de aplicativo de celular para medir frequência cardíaca e saturação periférica de oxigênio / The use of cellular application to measure heart rate and peripheral oxygen saturation

Avaliar a associação da medida de frequência cardíaca (FC) e saturação periférica de oxigênio (SpO2 ) utilizando um aplicativo de celular e um monitor multiparamétrico. Métodos: Estudo experimental e randomizado entre participantes saudáveis. Investigou o aplicativo Samsung Health® e o monitor multiparamétrico da marca Midway®, modelo: PM-60. O estudo foi estruturado em quatro etapas. Para análise estatística, aplicou correlação de Pearson e Spearman, com nível de significância de 5%. Resultados: Dos 150 participantes a idade média foi de 22,3±4,5 anos, o sexo feminino foi predominante (71,3%). Verificouse forte correlação da FC medida pelo monitor com a FC do aplicativo de celular (r=0,93) indicando correlação positiva (p<0,001). A SpO2 medida por monitor multiparamétrico e pelo aplicativo de celular revelou um r=0,05 (p=0,51), o que atesta uma correlação nula e não significativa. Conclusão: Não houve correlação entre a medida da SpO2 do monitor multiparamétrico e do aplicativo Samsung Health®, não sendo confiável a utilização deste aplicativo para monitorar e gerenciar o sinal vital SpO2 em pessoas saudáveis. A FC medida com o aplicativo é significativa, e pode ser utilizada para monitorar e gerenciar esse sinal vital.

Assess the association of the measure of heart rate (HR) and oxygen saturation (SpO2 ) using a mobile application and a multiparameter monitor. Methods: Study experimental and randomized healthy participants. Investigated the application Samsung Health® and multiparameter monitor Midway® make, model: PM-60. The study was divided into four stages. Statistical analysis was applied Pearson and Spearman correlation with 5% significance level. Results: Of the 150 participants average age was 22.3±4.5 years, females were predominant (71.3%). There was a strong correlation HR measured by the monitor application to cell FC (r=0.93) indicating a positive correlation (p<0.001). SpO2 measured by multiparameter monitor and the mobile application revealed r=0.05 (p=0.51), which demonstrates a zero and no significant correlation. Conclusion: There was no correlation between the SpO2 measurement of the multiparameter monitor and the Samsung Health® app, not being trusted to use this application to monitor and manage the vital sign SpO2 in healthy people. The HR measured with the application is significant, and can be used to monitor and manage this vital sign.

Detection of Tachyarrhythmias in a Large Cohort of Infants Using Direct-to-Consumer Heart Rate Monitoring.

OBJECTIVE: Current estimates of the incidence of tachyarrhythmias in infants rely on clinical documentation and may not reflect the true rate in the general population. Our aim was to describe the epidemiology of tachyarrhythmia detected in a large cohort of infants using direct-to-consumer heart rate (HR) monitoring. STUDY DESIGN: Data were collected from Owlet Smart Sock devices used in infants in the US with birthdates between February 2017 and February 2019. We queried the HR data for episodes of tachyarrhythmia (HR of ≥240 bpm for >60 seconds). RESULTS: The study included 100 949 infants (50.8% male) monitored for more than 200 million total hours. We identified 5070 episodes of tachyarrhythmia in 2508 infants. The cumulative incidence of tachyarrhythmia in our cohort was 2.5% over the first year of life. The median age at the time of the first episode of tachyarrhythmia was 36 days (range, 1-358 days). Tachyarrhythmia was more common in infants with congenital heart disease (4.0% vs 2.4%; P = .015) and in females (2.7% vs 2.0%; P < .001). The median length of an episode was 7.3 minutes (range, 60 seconds to 5.4 hours) and the probability of an episode lasting longer than 45 minutes was 16.8% (95% CI, 15.4%-18.3%). CONCLUSIONS: We found the cumulative incidence of tachyarrhythmia among infants using direct-to-consumer HR monitors to be higher than previously reported in studies relying on clinical diagnosis. This finding may represent previously undetected subclinical disease in young infants, the significance of which remains uncertain. Clinicians should be prepared to discuss these events with parents.

Validity of the Polar V800 heart rate monitor for assessing cardiac autonomic control in individuals with spinal cord injury

Abstract Aim: Spinal cord injury (SCI) is associated with changes in cardiac autonomic control, that can be evaluated by heart rate variability (HRV), for which the electrocardiogram (ECG) is the gold standard. However, the use of ECG is limited to laboratory environments, and new tools are needed for this purpose and that can be applied in the routine monitoring of individuals with SCI. The present study aimed to investigate the validity of the Polar V800 heart rate monitor in assessing the cardiac autonomic control of individuals with SCI. Methods: Nineteen adult men with SCI (paraplegia n = 10; 44.5 ± 8.5 years and tetraplegia n = 9; 34.4 ± 7.5 years) participated in this cross-sectional study. The participants remained in the sitting position at rest for 10 min for the acquisition of the ECG and Polar V800 signals. The last 5-min window was used to count the beat-by-beat R-R interval series and then calculate the HRV indices (linear methods in the time and frequency domains). The study subgroups were compared, and the validity of the measurements generated with a heart rate monitor was determined using the intraclass correlation coefficient (ICC2,1) and Bland-Altman graphs. Results: Agreement analyses for the R-R intervals, SDNN, rMSSD, PNN50, SD1, LF, HF, and LF: HF ratio tended to show reliability ranging from acceptable to excellent (ICC = 0.579-0.990; P = 0.043-0.001) and acceptably narrow limits of agreement within both the group with tetraplegia and the group with paraplegia. Conclusion: The Polar V800 heart rate monitor is a valid instrument for assessing HRV in individuals with paraplegia and tetraplegia.

Heart Rate Determination in Newborns at Risk for Resuscitation in a Low-Resource Setting: A Randomized Controlled Trial.

OBJECTIVE: To compare 2 different methods (auscultation with a stethoscope and umbilical cord palpation) of heart rate (HR) estimation in newborns at risk for resuscitation in a low-resource setting. STUDY DESIGN: Sixty newborns at risk for resuscitation born at the St. Luke Catholic Hospital in Wolisso (Ethiopia) were randomized to HR assessment by auscultation using a stethoscope or umbilical cord palpation. HR was assessed at 60, 90, 120 seconds, and 5 minutes of life. The primary outcome was the agreement of HR obtained by auscultation or palpation compared with the HR determined by electrocardiogram. RESULTS: Mean difference between auscultation using a stethoscope and electrocardiogram was -13 bpm, -4 bpm, -6 bpm, and -10 bpm at 60, 90, 120 seconds, and at 5 minutes of life. Mean difference between palpation and electrocardiogram of was -20 bpm, -25 bpm, -23 bpm, and -31 bpm at 60, 90, 120 seconds, and at 5 minutes of life. The magnitude of the difference between auscultation and electrocardiogram was lower than that between palpation and electrocardiogram over time (P = .007). HR range was correctly identified in 14 out of 16 measurements (87%) with HR <100 bpm. CONCLUSION: HR assessment by auscultation was more accurate compared with cord palpation, but both may provide adequate clinical information to healthcare providers in terms of HR ranges. The clinical advantage of providing a stethoscope in low-resource settings remains to be established. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03854435.

Analyzing approaches to mathematic modeling of heart sounds

The article introduces the findings of the analysis of the existing approaches to the development of mathematical models of acoustic heart phenomena. The analysis of mathematical methods that can be used to model heart sounds has been performed with the use of reference signals from the 3M Open Library (Littmann Library) and a set of signals obtained by the authors during their previous scientific efforts. The analysis findings have allowed revealing the approaches and methods that are most suitable for developing the mathematical models of human phonocardiograms (normal and pathological) for further research efforts meant to develop methods to single out heart beats against the high level of interference and creating intervalograms to characterize the heart rate at the current moments of time. In addition to the generation of model phonocardiograms, the article reviews the methods to analyze model and real-life phonocardiograms with the assessment of an input from random and deterministic components.

Perrogator: A Portable Energy-Efficient Interrogator for Dynamic Monitoring of Wavelength-Based Sensors in Wearable Applications.

In this paper, we report the development of a portable energy-efficient interrogator (Perrogator) for wavelength-based optical sensors. The interrogator is based on a compact solution encompassing a white light source and the spectral convolution between the sensor and a tunable filter, which is acquired by a photodetector, where a microcontroller has two functions: (i) To control the filter tuning and to (ii) acquire the photodetector signal. Then, the data is sent to a single-board computer for further signal processing. Furthermore, the employed single-board computer has a Wi-Fi module, which can be used to send the sensors data to the cloud. The proposed approach resulted in an interrogator with a resolution as high as 3.82 pm (for 15.64 nm sweeping range) and maximum acquisition frequency of about 210 Hz (with lower resolution ~15.30 pm). Perrogator was compared with a commercial fiber Bragg grating (FBG) interrogator for strain measurements and good agreement between both devices was found (1.226 pm/µÎµ for the commercial interrogator and 1.201 pm/µÎµ for the proposed approach with root mean square error of 0.0144 and 0.0153, respectively), where the Perrogator has the additional advantages of lower cost, higher portability and lower energy consumption. In order to demonstrate such advantages in conjunction with the high acquisition frequency allowed us to demonstrate two wearable applications using the proposed interrogation device over FBG and Fabry-Perot interferometer (FPI) sensors. In the first application, an FBG-embedded smart textile for knee angle assessment was used to analyze the gait of a healthy person. Due to the capability of reconstructing the FBG spectra, it was possible to employ a technique based on the FBG wavelength shift and reflectivity to decouple the effects of the bending angle and axial strain on the FBG response. The measurement of the knee angle as well as the estimation of the angular and axial displacements on the grating that can be correlated to the variations of the knee center of rotation were performed. In the second application, a FPI was embedded in a chest band for simultaneous measurement of breath and heart rates, where good agreement (error below 5%) was found with the reference sensors in all analyzed cases.

Disfunción sinusal transitoria secundaria a tratamiento con lacosamida / Transient sinus dysfunction secondary to lacosamide treatment

RESUMEN Se presenta el caso de una paciente de 84 años de edad, con antecedentes de hipertensión arterial, dislipemia, insuficiencia venosa crónica y osteoartrosis, que -debido a una neuralgia del trigémino- había recibido tratamiento con varios fármacos, sin lograr control del dolor neuropático, por lo que se inició tratamiento con lacosamida en monoterapia, con incremento de dosis hasta lograr el objetivo terapéutico; pero la paciente presentó manifestaciones clínicas y alteraciones electrocardiográficas compatibles con disfunción sinusal, que se resolvieron tras la reducción de la dosis del fármaco.

ABSTRACT The case of an 84-year-old female patient is presented, with a history of high blood pressure, dyslipidemia, chronic venous failure and osteoarthritis, which -due to trigeminal neuralgia- had received treatment with several drugs, without achieving neuropathic pain control; that was why the treatment with lacosamide was started in monotherapy, with an increase in dose until the therapeutic objective was achieved; but the patient presented clinical manifestations and electrocardiographic alterations compatible with sinus dysfunction, which were solved after reducing the dose of the drug.

Effect of a novel vital sign device on maternal mortality and morbidity in low-resource settings: a pragmatic, stepped-wedge, cluster-randomised controlled trial.

BACKGROUND: In 2015, an estimated 303 000 women died in pregnancy and childbirth. Obstetric haemorrhage, sepsis, and hypertensive disorders of pregnancy account for more than 50% of maternal deaths worldwide. There are effective treatments for these pregnancy complications, but they require early detection by measurement of vital signs and timely administration to save lives. The primary aim of this trial was to determine whether implementation of the CRADLE Vital Sign Alert and an education package into community and facility maternity care in low-resource settings could reduce a composite of all-cause maternal mortality or major morbidity (eclampsia and hysterectomy). METHODS: We did a pragmatic, stepped-wedge, cluster-randomised controlled trial in ten clusters across Africa, India, and Haiti, introducing the device into routine maternity care. Each cluster contained at least one secondary or tertiary hospital and their main referral facilities. Clusters crossed over from existing routine care to the CRADLE intervention in one of nine steps at 2-monthly intervals, with CRADLE devices replacing existing equipment at the randomly allocated timepoint. A computer-generated randomly allocated sequence determined the order in which the clusters received the intervention. Because of the nature of the intervention, this trial was not masked. Data were gathered monthly, with 20 time periods of 1 month. The primary composite outcome was at least one of eclampsia, emergency hysterectomy, and maternal death. This study is registered with the ISRCTN registry, number ISRCTN41244132. FINDINGS: Between April 1, 2016, and Nov 30, 2017, among 536 223 deliveries, the primary outcome occurred in 4067 women, with 998 maternal deaths, 2692 eclampsia cases, and 681 hysterectomies. There was an 8% decrease in the primary outcome from 79·4 per 10 000 deliveries pre-intervention to 72·8 per 10 000 deliveries post-intervention (odds ratio [OR] 0·92, 95% CI 0·86-0·97; p=0·0056). After planned adjustments for variation in event rates between and within clusters over time, the unexpected degree of variability meant we were unable to judge the benefit or harms of the intervention (OR 1·22, 95% CI 0·73-2·06; p=0·45). INTERPRETATION: There was an absolute 8% reduction in primary outcome during the trial, with no change in resources or staffing, but this reduction could not be directly attributed to the intervention due to variability. We encountered unanticipated methodological challenges with this trial design, which can provide valuable learning for future research and inform the trial design of future international stepped-wedge trials. FUNDING: Newton Fund Global Research Programme: UK Medical Research Council; Department of Biotechnology, Ministry of Science & Technology, Government of India; and UK Department of International Development.

Respostas cardiorrespiratórias e percepção subjetiva do esforço de hemiparéticos submetidos à prática de exergames / Cardiorrespiratory responses and subjective perception of the effort in hemiparetics after exergames practice / Respuestas cardiorrespiratorias y percepción subjetiva del esfuerzo de hemipareticos después de la práctica de exergames

Objetivo: avaliar as respostas cardiorrespiratórias e percepção subjetiva do esforço de pacientes hemiparéticos submetidos à prática dos jogos de vídeo do XBOX Kinect. Método: estudo de casos múltiplos com abordagem quantitativa, com avaliação da frequência cardíaca, frequência respiratória, saturação de oxigênio, pressão arterial e percepção do esforço durante prática do jogo Your Shape Fitness Evolved 2012® cinco e dez minutos após o término da atividade, sendo considerados também os valores de frequência cardíaca máxima e de treino para fornecer mais segurança a pesquisa. Resultados: a amostra foi composta por dois sujeitos que apresentaram respostas adequadas a prática dos jogos ativos de vídeo game. Para o sujeito 1 a atividade foi considerada como leve e para o sujeito 2 uma atividade moderada. Conclusão: evidenciou-se a necessidade de mais estudos científicos para esclarecer os efeitos desses jogos sobre os diversos sistemas e a necessidade de profissionais habilitados a utilização desses jogos para fins terapêuticos.(AU)

Objective: to evaluate the cardiorespiratory responses and subjective perception of the effort of hemiparetic patients submitted to XBOX Kinect video games. Method: multiple case study with quantitative approach, with evaluation of heart rate, respiratory rate, oxygen saturation, blood pressure and perception of effort during practice of the game Your Shape Fitness Evolved 2012® five and ten minutes after the end of the activity, being also considered the values of maximum heart rate and training to provide more safety to the research. Results: the sample consisted of two subjects who presented adequate responses to the practice of active video game games. For subject 1 the activity was considered as mild and for subject 2 a moderate activity. Conclusion: the need for more scientific studies to clarify the effects of these games on the different systems and the need for professionals qualified to use these games for therapeutic purposes was evidenced.(AU)

Objetivo: evaluar las respuestas cardiorrespiratorias y percepción subjetiva del esfuerzo de pacientes hemiparéticos despúes de la práctica de los juegos de vídeo del XBOX Kinect. Método: Estudio de casos múltiples con abordaje cuantitativo, con evaluación de la frecuencia cardíaca, respiratoria, saturación de oxígeno, presión arterial y percepción del esfuerzo durante la práctica del juego Your Shape Fitness Evolved 2012® después de cinco y diez minutos del término de la actividad. Se consideran también los valores de frecuencia cardiaca máxima y de entrenamiento para proporcionar más seguridad a la investigación. Resultados: la muestra fue compuesta por dos sujetos, éstos presentaron respuestas adecuadas a la práctica de los juegos activos de video. Para el sujeto 1 la actividad fue considerada como leve y para el sujeto 2 una actividad moderada. Conclusión: se evidenció la necesidad de más estudios científicos para aclarar los efectos de estos juegos sobre los diversos sistemas y la necesidad de profesionales habilitados para la utilización de esos juegos para fines terapéuticos.(AU)

Correlation between degree of autonomic nervous system impairment and quality of life indices in older adults / Correlação entre grau de comprometimento do sistema nervoso autônomo e índices de qualidade de vida em idosos

INTRODUCTION: The increase in the world's elderly population in recent decades calls for research on quality of life during the aging process. Heart rate variability (HRV) evaluates the modulation of the autonomic nervous system (ANS) and indicates the heart's ability to respond to multiple physiological and environmental stimuli, as well as to disease. OBJECTIVE: To investigate the perceived quality of life of older people and its association with HRV. METHOD: Twenty-nine subjects (69 ± 7.76 years) were selected at a preventive medicine center and completed a questionnaire (World Health Organization quality of life assessment ­ old module: WHOQOL-OLD). The HRV data were collected for 20 minutes in the supine position using a Polar RS800CX frequency meter. RESULTS: Using the median value as a cut-off point, the sample was divided into two groups: WHOQOL-OLD ≥ 92 (n = 15: better quality of life) and WHOQOL-OLD ≤ 91 (n = 13; lower quality of life). For the HRV timedomain variables RMSSD and pNN50, there were higher values in the WHOQOL-OLD ≥ 92 group (p = 0.0413 and p = 0.0222, respectively). For the frequency-domain variables, low-frequency (LF), high-frequency (HF) and Total Power, there were also higher values in the WHOQOL-OLD group ≥ 92 (p = 0.0195, p = 0.0170 and p = 0.0287, respectively). The non-linear variable SD1 was significantly higher in the WHOQOL-OLD ≥ 92 group (p = 0.0413), while DET% was significantly higher in the WHOQOLOLD ≤ 91 group (p = 0.0253). CONCLUSIONS: Better quality of life in older adults is associated with normal ANS function,represented by higher values found through three HRV analysis methods. This indicates the importance of a healthy lifestyle for healthy aging, which includes improvement in autonomic function and, consequently, quality of life.

INTRODUÇÃO: O aumento do tamanho da população idosa mundial nas últimas décadas tem demandado investigações sobre a qualidade de vida durante o processo de envelhecimento. A Variabilidade da Frequência Cardíaca (HRV) avalia a modulação do Sistema Nervoso Autônomo (SNA) e indica a capacidade do coração em responder a múltiplos estímulos fisiológicos e ambientais, bem como em doenças. OBJETIVOS: Investigar a percepção da qualidade de vida de idosos e sua associação com a VFC. MÉTODOS: Vinte e nove indivíduos (69 ± 7,76 anos) foram selecionados em um Centro de Medicina Preventiva, e preencheram um questionário (World Health Organization quality of life assessment ­ old module: WHOQOL-OLD). Os dados da VFC foram coletados durante 20 minutos, com indivíduos em posição supina, com uso do frequencímetro Polar RS800CX. RESULTADOS: Utilizando o valor de mediana como ponto de corte, a amostra foi dividida em dois grupos: WHOQOL-OLD ≥ 92 (N = 15: idosos com melhor qualidade de vida) e WHOQOL-OLD ≤ 91 (N = 13: idosos com menor qualidade de vida). Considerando a VFC, no domínio do tempo, as variáveis RMSSD e pNN50 apresentaram maiores valores no grupo WHOQOL-OLD ≥ 92 (p = 0,0413 e p = 0,0222, respectivamente). No domínio da frequência, as variáveis LF, HF e Total Power apresentaram maiores valores no grupo WHOQOL-OLD ≥ 92 (p = 0,0195, p = 0,0170 e p = 0,0287, respectivamente). No domínio não linear da VFC, a variável SD1 foi significativamente maior em WHOQOL-OLD ≥ 92 (p = 0,0413), enquanto o DET% apresentou-se significativamente maior em WHOQOL-OLD ≤ 91 (p = 0,0253). CONCLUSÕES: Melhor qualidade de vida está associada ao bom funcionamento do SNA, representado pela maiores valores nos três domínios da VFC em idosos, enfatizando a importância de estilo de vida saudável no envelhecimento saudável, com melhora da função autonômica e, consequentemente, da qualidade de vida.

Evaluación del comportamiento cardíaco mediante una metodología diagnóstica basada en sistemas dinámicos en 16 horas / Evaluation of the cardiac behaviour with a diagnostic methodology sustained in dynamical systems in 16 hours

Antecedentes: Con conceptos provenientes de la teoría de sistemas dinámicos y la geometría fractal, se ha logrado caracterizar el comportamiento de la dinámica cardíaca, dando resultados objetivos y estableciendo distinciones entre estados de normalidad y enfermedad. Objetivo: Aplicar una ley matemática exponencial de la dinámica cardíaca, inscrita en el contexto de los sistemas dinámicos y la geometría fractal, para evidenciar su utilidad diagnóstica en 16 horas. Materiales y métodos: Fueron empleados 200 Holters y registros electrocardiográficos continuos, entre normales y con diferentes alteraciones cardíacas. Se simuló una secuencia de frecuencias cardíacas en 16 y 21 horas, con la cual se construyó el atractor de cada dinámica. También se calculó la dimensión fractal y la ocupación de los atractores en el espacio fractal. Se estableció el diagnóstico físico-matemático en 16 y 21 horas y la subsecuente validación estadística. Resultados: Fueron obtenidos valores en la rejilla Kp entre 44 y 198 para estados patológicos y entre 221 y 377 para estados de normalidad en 16 horas, la sensibilidad y especificidad fue del 100% y el coeficiente Kappa de 1. Conclusión: Se logró diferenciar de manera adecuada estados normales de patológicos mediante la ley exponencial aplicada en registros de 16 horas

Background: With concepts derived from dynamical systems theory and fractal geometry, it has been possible to characterize the behavior of the cardiac dynamics, giving objective results and estabishing distinctions between states of normality and disease. Objective: To apply an exponential mathematical law of cardiac dynamics, inscribed in the context of dynamical systems and fractal geometry, to demonstrate its diagnostic utility in the context of a reduction in the evaluation time, originally of 21 hours. Materials and methods: There were used 200 Holters and cotinuous electrocardiographic records, between normal and with different cardiac alterations. A sequence of heart rates was simulated in 16 and 21 hours, with which the attractor of each dynamic was constructed. There were also calculated the fractal dimension and the occupation of the attractors in the fractal space. The physical-mathematical diagnosis was establishd at 16 and 21 hours, and the staqtistical validation was performed. Results: Values obtained in the Kp grid were between 44 y 198 for pathological sttes, and between 221 and 377 for normal states in 16 hours. The sensitivity and specificity was 100% and the Kappa coefficient was 1. Conclusion: It was possible to differentiate adequately normal states of pathological by means fo the exponential law applied in registers of 16 hours

Determinação da frequência cardíaca como auxiliar na avaliação do bem-estar de cavalos destinados a equoterapia / Determination of heart rate as anadjunct in the evaluation of wellfare ofhorses destined to equine therapy / Determinación de la frecuenciacardíaca como auxiliar em laevaluación del bienestar de caballosdestinados a la equinoterapia

O presente trabalho foi realizado em 15 Centros de Equoterapia da América do Sul, totalizando 46 animais, entre machos e fêmeas, com idade variando entre 4 e 25 anos. Teve como objetivo determinar a frequência cardíaca de cavalos durante a atividade de equoterapia como auxiliar na avaliação do estresse a que o animal era submetido. A FC foi aferida em repouso, na baia (TO), após encilhamento (T1), ao final de cada sessão de equoterapia (T2 a T6) e após a última sessão (Tf). Cada sessão de equoterapia teve a duração média de 30 minutos. Também foram colhidas informações sobre o manejo, alimentação, descanso, temperatura ambiente e umidade relativa do ar por meio de questionárioelaborado para esse fim.As médias (± desvio padrão) dos valores da FC em TOvariaram de 36,3±4,69; em T1 37,4±4,38; em T2 39,3±6,31; em T3 38,9±6,49; em T4 39,1 ±5; em T5 38,9±5,86; em T6 39,7±6,62 e em Tf 39,5±5,62. Com base nos resultados obtidos podemos inferir que o trabalho de equoterapia realizado pelos cavalos pode ser classificado como leve pois mesmo ocorrendo variação (10%) entre os tempos aferidos, os valores permaneceram dentro dos padrões de referência (repouso) para espécie.

The present work was carried out in 15 Equine Therapy Centers of South America, totalizing 46 animais, between males and females, with ages varying between 4 and 25 years. The objective of this study was to determine the heart rate of horses during equine therapy as an aid in evaluating the stress to which the animal is subjected. The HR was measured at rest, in the bay (TO), after enciliation (T1), at the end of each session of equine therapy (T2 to T6) and after the last session (Tf). Each session of equine therapy had an average duration of 30 minutes. Information on management, feeding, rest, ambient temperature and relative humidity was also collected through a questionnaire developed for this purpose. The means (± standard deviation) of HR values at TO ranged from 36.3 ± 4.69; in T1 37.4 ± 4.38; in T2 39.3 ± 6.31; in T3 38.9 ± 6.49; in T4 39.1 ± 5; in T5 38.9 ± 5.86; in T6 39.7 ± 6.62 and in Tf 39.5 ± 5.62. Based on the results obtained, we can infer that the equine work performed by the horses can be classified as light because even though variation (10%) occurs between the times measured, the values remained within the reference standards (rest) for the species.

El trabajo fue realizado en 15 centros de equinoterapia de América del Sur, con un total de 46 animales, entre machos y hembras, con edad entre 4 y 25 anos. El objetivo fue determinar la frecuencia cardiáca(FC) de caballos mientras ejecutaban la actividad de equinoterapia como auxiliar en la evaluación del estrés al qual el animal es sumetido. La frecuencia cardiáca fue evaluada de tal manera en reposo, en el establo (TO), Después de la flexión (T1), Al final de cadasesión de equinoterapia (T2 a T6), Después de la última sesión (TF). Cada sesión de equinoterapia tuvo la duración média de 30 minutos. También se recogieron informaciones referentes al manejo, alimentación, descanso, temperatura ambiente y humedad del aire, por medio de uncuestionário elaborado para esa finalidad. Los valores medios de la FC (±desviación estándar) variaron, en TO de 36,3 ±4,69; T1 de 37,4 ± 4,38; T2 de 39,3±6,31; T3 de 38,9 ± 6,49; T4 de 39,1 ± 5,00; T5 de 38,9 ± 5,86; T6 de 39,7 ± 6,62; TF de 39,5 ± 5,62. Con base en los resultados obtenidos concluimos que el trabajo de equinoterapia realizado por los caballos pueden ser clasificados como sueves, pues, incluso sufriendo variaciones de unos 10% entre los tiempos evaluados, los valores permanecieron dientro de los patrones de referencia (reposo) para la especie.

Determinação da frequência cardíaca como auxiliar na avaliação do bem-estar de cavalos destinados a equoterapia / Determination of heart rate as anadjunct in the evaluation of wellfare ofhorses destined to equine therapy / Determinación de la frecuenciacardíaca como auxiliar em laevaluación del bienestar de caballosdestinados a la equinoterapia

O presente trabalho foi realizado em 15 Centros de Equoterapia da América do Sul, totalizando 46 animais, entre machos e fêmeas, com idade variando entre 4 e 25 anos. Teve como objetivo determinar a frequência cardíaca de cavalos durante a atividade de equoterapia como auxiliar na avaliação do estresse a que o animal era submetido. A FC foi aferida em repouso, na baia (TO), após encilhamento (T1), ao final de cada sessão de equoterapia (T2 a T6) e após a última sessão (Tf). Cada sessão de equoterapia teve a duração média de 30 minutos. Também foram colhidas informações sobre o manejo, alimentação, descanso, temperatura ambiente e umidade relativa do ar por meio de questionárioelaborado para esse fim.As médias (± desvio padrão) dos valores da FC em TOvariaram de 36,3±4,69; em T1 37,4±4,38; em T2 39,3±6,31; em T3 38,9±6,49; em T4 39,1 ±5; em T5 38,9±5,86; em T6 39,7±6,62 e em Tf 39,5±5,62. Com base nos resultados obtidos podemos inferir que o trabalho de equoterapia realizado pelos cavalos pode ser classificado como leve pois mesmo ocorrendo variação (10%) entre os tempos aferidos, os valores permaneceram dentro dos padrões de referência (repouso) para espécie.(AU)

The present work was carried out in 15 Equine Therapy Centers of South America, totalizing 46 animais, between males and females, with ages varying between 4 and 25 years. The objective of this study was to determine the heart rate of horses during equine therapy as an aid in evaluating the stress to which the animal is subjected. The HR was measured at rest, in the bay (TO), after enciliation (T1), at the end of each session of equine therapy (T2 to T6) and after the last session (Tf). Each session of equine therapy had an average duration of 30 minutes. Information on management, feeding, rest, ambient temperature and relative humidity was also collected through a questionnaire developed for this purpose. The means (± standard deviation) of HR values at TO ranged from 36.3 ± 4.69; in T1 37.4 ± 4.38; in T2 39.3 ± 6.31; in T3 38.9 ± 6.49; in T4 39.1 ± 5; in T5 38.9 ± 5.86; in T6 39.7 ± 6.62 and in Tf 39.5 ± 5.62. Based on the results obtained, we can infer that the equine work performed by the horses can be classified as light because even though variation (10%) occurs between the times measured, the values remained within the reference standards (rest) for the species.(AU)

El trabajo fue realizado en 15 centros de equinoterapia de América del Sur, con un total de 46 animales, entre machos y hembras, con edad entre 4 y 25 anos. El objetivo fue determinar la frecuencia cardiáca(FC) de caballos mientras ejecutaban la actividad de equinoterapia como auxiliar en la evaluación del estrés al qual el animal es sumetido. La frecuencia cardiáca fue evaluada de tal manera en reposo, en el establo (TO), Después de la flexión (T1), Al final de cadasesión de equinoterapia (T2 a T6), Después de la última sesión (TF). Cada sesión de equinoterapia tuvo la duración média de 30 minutos. También se recogieron informaciones referentes al manejo, alimentación, descanso, temperatura ambiente y humedad del aire, por medio de uncuestionário elaborado para esa finalidad. Los valores medios de la FC (±desviación estándar) variaron, en TO de 36,3 ±4,69; T1 de 37,4 ± 4,38; T2 de 39,3±6,31; T3 de 38,9 ± 6,49; T4 de 39,1 ± 5,00; T5 de 38,9 ± 5,86; T6 de 39,7 ± 6,62; TF de 39,5 ± 5,62. Con base en los resultados obtenidos concluimos que el trabajo de equinoterapia realizado por los caballos pueden ser clasificados como sueves, pues, incluso sufriendo variaciones de unos 10% entre los tiempos evaluados, los valores permanecieron dientro de los patrones de referencia (reposo) para la especie.(AU)

Neonatal Intensive Care Unit Length of Stay Reduction by Heart Rate Characteristics Monitoring.

OBJECTIVE: To examine the effect of heart rate characteristics (HRC) monitoring on length of stay among very low birth weight (VLBW; <1500 g birth weight) neonates in the HeRO randomized controlled trial (RCT). STUDY DESIGN: We performed a retrospective analysis of length of stay metrics among 3 subpopulations (all patients, all survivors, and survivors with positive blood or urine cultures) enrolled in a multicenter, RCT of HRC monitoring. RESULTS: Among all patients in the RCT, infants randomized to receive HRC monitoring were more likely than controls to be discharged alive and prior to day 120 (83.6% vs 80.1%, P = .014). The postmenstrual age at discharge for survivors with positive blood or urine cultures was 3.2 days lower among infants randomized to receive HRC monitoring when compared with controls (P = .026). Although there were trends in other metrics toward reduced length of stay in HRC-monitored patients, none reached statistical significance. CONCLUSIONS: HRC monitoring is associated with reduced mortality in VLBW patients and a reduction in length of stay among infected surviving VLBW infants. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00307333.

Heart Rate and its Variability Assessed by Spectral Analysis in Elderly Subjects with Orthostatic Hypotension: A Case-Control Study / Frequência Cardíaca e sua Variabilidade por Meio da Análise Espectral em Idosos com Hipotensão Ortostática: Estudo de Caso-Controle

Abstract Background: The prevalence of orthostatic hypotension (OH) increases with age and is associated with changes in autonomic regulation of blood pressure (BP) and heart rate (HR). Objective: to assess HR and HR variability (HRV) in elderly subjects with OH and determine OH predictors. Methods: a total of 105 patients aged ≥ 60 years, 39 with OH (case group) and 66 without OH (control group) (age-matched) were studied. Patients underwent clinical assessment, electrocardiogram, biochemistry tests and Holter monitoring for spectral analysis of HRV (Fourier transform) in the supine and orthostatism positions to identify low frequency (LF) and high frequency (HF) components, as well as the LF/HF ratio. Results: median age was 73.0 years, 64 patients were women. In all participants, there was a reduction in HF (133.0 versus 76.0 ms2, p = 0.001) and increase in LF/HF (1.6 vs 2.1; p < 0.001) and no change in LF (233.0 versus 218.0 ms2, p = 0.080). Between-group comparisons revealed significant differences in the median values of HR in the supine position (62.0 vs. 69.0 bpm, p = 0.001) and LF in the supine position (157.0 in case group vs. 275.0 ms2 in the control group, p = 0.014). Spearman's correlation coefficient of 0.27 was found between the groups. Multivariate analysis revealed that HR in the supine position was an independent variable for OH (p = 0.001- 95%CI = -0.022 and -0.006). Using the operating characteristic curve, the best cutoff point was 61 bpm, with a sensitivity of 77.3% and specificity of 51.3%, positive predictive value of 61.3%, and negative predictive value 69.3%. Odds ratio was 3.23 for OH in patients with a HR lower than 61 bpm. Conclusions: lower LF and HR in the supine position were found in patients with OH, regardless of age and gender. The independent predictor for OH was HR in the supine position, with an odds ratio of 3.23 for values lower than 61 bpm.

Resumo Fundamento: A prevalência de hipotensão ortostática (HO) aumenta com a idade e está relacionada a alterações da regulação autonômica da pressão arterial (PA) e da frequência cardíaca (FC). Objetivos: Avaliar a FC e variabilidade da FC (VFC) em idosos com HO e verificar os preditores de HO. Métodos: foram avaliados 105 pacientes, com idade ≥ 60 anos, 39 com HO (grupo caso) e 66 sem HO (grupo controle), pareados por idade. Foram submetidos à avaliação clínica, eletrocardiograma, exames de bioquímica e monitoramento pelo Holter para análise espectral da VFC (transformação de Fourier), na posição supina e em ortostatismo, para detectar os componentes de baixa frequência (LF), de alta frequência (HF) e sua relação LF/HF. Resultados: A mediana de idade foi de 73,0 anos, 64 dos pacientes eram mulheres. Em toda a população, com a mudança de posição, houve redução do HF (133,0 versus 76,0 ms2, p = 0,001) e aumento da relação LF/HF (1,6vs2,1; p < 0,001), sem alteração quanto à mediana do componente LF (233,0 versus 218,0 ms2, p = 0,080). Quando comparado o grupo caso ao grupo controle, houve diferença quanto às medianas da FC nas posições supina (62,0 vs 69,0 bpm, p = 0,001) e do componente LF na posição supina (157,0 no grupo caso vs 275,0 ms2 no grupo controle, p = 0,014). Quanto ao gênero, o coeficiente de Spearman foi de 0,27 entre os grupos. Pela análise multivariada, a FC na posição supina foi a variável independente para a ocorrência de HO (p = 0,001- IC95% = -0,022 e -0,006). Pela curva de operação característica, o melhor ponto de corte para FC foi de 61 bpm, com sensibilidade de 77,3%, especificidade de 51,3%, valor preditivo positivo de 61,3%, e o valor preditivo negativo de 69,3%. A razão de chance foi de 3,23 para HO entre os pacientes com FC < 61 bpm. Conclusões: Houve menor valor do LF e da FC na posição supina entre os pacientes com HO, sem influência da idade e do gênero. O preditor independente para HO foi a FC na posição supina, a qual apresentou uma razão de chance de 3,23 se inferior a 61 bpm.

Heart Rate and its Variability Assessed by Spectral Analysis in Elderly Subjects with Orthostatic Hypotension: A Case-Control Study.

BACKGROUND: The prevalence of orthostatic hypotension (OH) increases with age and is associated with changes in autonomic regulation of blood pressure (BP) and heart rate (HR). OBJECTIVE: to assess HR and HR variability (HRV) in elderly subjects with OH and determine OH predictors. METHODS: a total of 105 patients aged ≥ 60 years, 39 with OH (case group) and 66 without OH (control group) (age-matched) were studied. Patients underwent clinical assessment, electrocardiogram, biochemistry tests and Holter monitoring for spectral analysis of HRV (Fourier transform) in the supine and orthostatism positions to identify low frequency (LF) and high frequency (HF) components, as well as the LF/HF ratio. RESULTS: median age was 73.0 years, 64 patients were women. In all participants, there was a reduction in HF (133.0 versus 76.0 ms2, p = 0.001) and increase in LF/HF (1.6 vs 2.1; p < 0.001) and no change in LF (233.0 versus 218.0 ms2, p = 0.080). Between-group comparisons revealed significant differences in the median values of HR in the supine position (62.0 vs. 69.0 bpm, p = 0.001) and LF in the supine position (157.0 in case group vs. 275.0 ms2 in the control group, p = 0.014). Spearman's correlation coefficient of 0.27 was found between the groups. Multivariate analysis revealed that HR in the supine position was an independent variable for OH (p = 0.001- 95%CI = -0.022 and -0.006). Using the operating characteristic curve, the best cutoff point was 61 bpm, with a sensitivity of 77.3% and specificity of 51.3%, positive predictive value of 61.3%, and negative predictive value 69.3%. Odds ratio was 3.23 for OH in patients with a HR lower than 61 bpm. CONCLUSIONS: lower LF and HR in the supine position were found in patients with OH, regardless of age and gender. The independent predictor for OH was HR in the supine position, with an odds ratio of 3.23 for values lower than 61 bpm.

O frequencímetro Polar® RS800CX é sensível à manobra de alteração postural / The Polar® RS800CX frequencymeter is sensitive to the postural maneuver

Objetivo: Verificar a sensibilidade do frequencímetro Polar® RS800CX na variação postural a partir da frequência cardíaca (FC) e parâmetros da variabilidade da FC (VFC). Método: Homens jovens (n=20) saudáveis tiveram registradas as medidas de FC e dos intervalos R-R da VFC (RRi) nos domínios do tempo (RRi, RMSSD, pNN50) e da frequência (LF, HF e LF.HF-1) utilizando o Polar® RS800CX. Resultados: Diferenças (p<0,05) foram encontradas para Posição Supina (PS) 5' e PS10' vs. Posição Ortostática (PO) 5' e PO10' para FC (61,1±1,1 e 61,0±1,3 bpm vs. 79,5±3,9 e 80,8±3,5 bpm), RRi (990,0±19,9 e 994,5±23,2 ms vs. 787,4±34,0 e 768,6±30,1 ms), rMSSD (70,5±8,4 e 71,1±8,5 ms vs. 32,2±3,4 e 30,7±3,7 ms), pNN50 (41,1±6,0 e 46,3±5,3% vs. 15,4±2,5 e 14,3±2,6%), LF (52,3±6,4 e 55,4±6,5 n.u. vs. 82,0±4,2 e 80,7±4,8 n.u.), HF (47,7±6,4 e 44,6±6,5 n.u. vs. 18,0±4,2 e 19,3±4,8 n.u.) e LF.HF-1 (2,9±0,8 e 3,1±0,8 vs. 14,1±2,9 e 14,3±3,1). Conclusão: O frequencímetro Polar® RS800CX se apresentou sensível a variações na postura corporal.

Purpose: To determine the sensitivity of the frequency meter Polar® RS800CX in postural maneuver from the heart rate (HR) and HR variability (HRV) parameters. Method: Young (n=20) healthy men had registered HR and RR intervals (RRi) measurements in the time domain (RRi, RMSSD, pNN50) and frequency (LF, HF and LF.HF-1) using the Polar® RS800CX. Results: Differences were found to supine position (SUP) 5 'and SUP10' vs. standing position (STP) 5 'and STP10' in HR (61.1 ± 1.1 and 61.0 ± 1.3 bpm vs. 79.5 ± 3.9 and 80.8 ± 3.5 bpm), RRi (990.0 ± 19.9 and 994.5 ± 23,2 ms vs. 787.4 ± 34.0 ms and 768.6 ± 30.1 ms), rMSSD (70.5 ± 8.4 and 71.1 ± 8.5 ms vs. 32.2 ± 3.4 and 30.7 ± 3.7 ms), pNN50 (41.1 ± 6 0 and 46.3 ± 5.3% vs. 15.4 ± 2.5 and 14.3 ± 2.6%), LF (52.3 ± 6.4 and 55.4 ± 6.5 n.u. vs. 82.0 ± 4.2 and 80.7 ± 4.8 n.u), HF (47.7 ± 6.4 and 44.6 ± 6.5 n.u. vs. 18.0 ± 4.2 and 19.3 ± 4.8 n.u.) and LF.HF-1 (2.9 ± 0.8 and 3.1 ± 0.8 vs. 14.1 ± 2.9 and 14.3 ± 3.1). Conclusion: The frequency meter RS800CX Polar® appeared sensitive to variations in body posture.

El análisis de la variabilidad de frecuencia cardiaca como una herramienta para evaluar los efectos de la meditación chi sobre la regulación cardiovascular / Heart Rate Variability analysis as a tool for assessing the effects of chi meditation on cardiovascular regulation

Approximately 30 indices have been proposed for assessing heart rate variability (HRV). Some are mathematically identical or very closely related to each other, and results can be interpreted from completely different viewpoints. Comparing various indices from a tachogram, and combining statistical significance with physiological plausibility could improve the result's interpretation. Using the KubiosHRV package, we studied the chi-meditation R-R database available at Physionet.org, addressing the following questions: i) Which HRV indices are the most suitable for describing meditation effects? ii) Are the effects of meditation beneficial, harmful or insubstantial? iii) Which are the most likely physiological events associated to meditation? It was concluded that power spectrum low frequency component (LF), LF/HF ratio, and nonlinear indices α 1 and α 2, recurrence rate and Shannon entropy performed the best (p<0.05). Observed changes suggest that they harmonize with changes observed in other health-pursuing circumstances as physical training, stress combating; whereas they are in the opposite tendency of changes associated to aging, heavy smoking, high blood glucose levels, autonomic heart denervation and congestive heart failure. Changes induced by chi meditation seem to be associated to increases in respiratory component around0.04 Hz, lower entropy and reduced long-term correlation with higher cardio vascular complexity(AU)

Alrededor de 30 índices han sido propuestos para evaluar la Variabilidad de la Frecuencia Cardiaca. Algunos de esos índices son matemáticamente idénticos o muy semejantes a otros y los resultados pueden ser interpretados desde puntos de vista completamente distintos. Al comparar varios índices estimados a partir de un tacograma y combinando la significación estadística con la plausibilidad biológica pudiera mejorarse la interpretación de los resultados. Utilizando el paquete de análisis KubiosHRV estudiamos la base de datos de señales R-R Chi meditation, disponible en el portal Physionet.org, centrándonos en las interrogantes siguientes: i) ¿cuáles índices son los más adecuados para describir los efectos de la meditación? ii) ¿son los efectos de la meditación beneficiosos, nocivos o insustanciales? iii) ¿cuáles son los eventos fisiológicos asociados a la meditación? Se concluye que el componente de baja frecuencia del espectro de potencia (LF), la relación LF/HF y los índices no lineales α 1 yα 2, la razón de recurrencia y la entropía de Shannon, fueron los indicadores más apropiados (p < 0.05). Los cambios observados parecen armonizar con cambios observados en otras acciones promotoras de salud como entrenamiento físico, combatir el estrés, mientras que exhiben una tendencia opuesta a los cambios asociados al envejecimiento, hábito de fumar, elevados niveles de glucosa, denervación cardiaca, e insuficiencia cardiaca congestiva. Los cambios inducidos por la meditación chi parecen estar asociados a incrementos en el componente respiratorio próximo a los 0.04 hertzios, a una menor entropía y una menor correlación a largo término combinadas a una mayor complejidad cardiovascular(AU)