Elmiro Santos Resende

The effects of aerobic, resistance, and combined exercise on metabolic control, inflammatory markers, adipocytokines, and muscle insulin signaling in patients with type 2 diabetes mellitus

The purpose of this study was to compare the effects of 3 different modalities of exercise on metabolic control, insulin resistance, inflammatory markers, adipocytokines, and tissue expression of insulin receptor substrate (IRS)-1 after 12 weeks of training among patients with type 2 diabetes mellitus. Forty-eight patients with type 2 diabetes mellitus were randomly assigned to 4 groups of training (3 times a week, 60 minutes per session): aerobic group (n = 12), resistance group (n = 12), combined (aerobic and resistance) group (n = 12), and control group (n = 12). Fasting and postprandial blood glucose, glycated hemoglobin, lipid profile, insulin resistance index (homeostasis model assessment of insulin resistance), adipocytokines (adiponectin, visfatin, and resistin), tumor necrosis factor, interleukin, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline and at the end of the study. Patients also underwent a muscle microbiopsy before and after training to quantify IRS-1 expression. All 4 groups displayed decreases in blood pressure, fasting plasma glucose, postprandial plasma glucose, lipid profile, and hs-CRP (P < .05); and there was no difference across the groups. After training, the IRS-1 expression increased by 65% in the resistance group (P < .05) and by 90% in the combined group (P < .01). Exercise training favorably affects glycemic parameters, lipid profile, blood pressure, and hs-CRP. In addition, resistance and combined training can increase IRS-1 expression.

Implementation of a telecardiology system in the state of Minas Gerais: the Minas Telecardio Project

FUNDAMENTO: Embora as doencas cardiovasculares sejam a maior causa de morbimortalidade em todo Brasil, o acesso das populacoes de cidades pequenas a eletrocardiografia e a avaliacao cardiologica e limitado. O uso da telecardiologia para facilitar o acesso da populacao de municipios remotos a eletrocardiografia e a segunda opiniao em cardiologia e promissora, entretanto nao foi formalmente testada. OBJETIVO: Avaliar a viabilidade de se implantar o sistema publico de telecardiologia de baixo custo em pequenas cidades brasileiras. METODOS: Foram selecionadas 82 cidades do Estado de Minas Gerais, com populacao 70% de cobertura pelo Programa Saude da Familia (PSF), com interesse do gestor e acesso pela internet. Em cada municipio foi instalado um aparelho de eletrocardiografo (ECG) digital, com subsequente treinamento da equipe. A implantacao foi coordenada pelo HC/UFMG, em conjunto com outros quatro hospitais universitarios mineiros (UFU, UFTM, UFJF e UNIMONTES). Os ECGs foram realizados nos municipios e enviados pela internet para analise imediata em plantao de telecardiologia. Realizaram-se discussoes de casos medicos on-line e off-line e cursos de atualizacao via web. RESULTADOS: No periodo de implantacao, foram treinados 253 profissionais de saude. De julho de 2006 a novembro de 2008, o projeto atendeu 42.664 pacientes, realizando 62.865 ECGs. Foram efetuados 2.148 atendimentos de urgencia e 420 teleconsultorias. A avaliacao intermediaria apontou boa aceitacao da tecnologia implantada e uma diminuicao de 70% de encaminhamentos de pacientes para outros centros de referencia. CONCLUSAO: E factivel a utilizacao de recursos habituais de informatica para facilitar o acesso de populacoes de cidades pequenas a eletrocardiografia e avaliacao cardiologica especializada.BACKGROUND Although cardiovascular diseases are the main cause of morbimortality in Brazil, the access of small-town populations to electrocardiography and cardiology assessment is limited. The use of telecardiology to assist the access of distant towns to electrocardiography and a second opinion in cardiology is promising; however, it has not been formally assessed. OBJECTIVE To assess the feasibility of implementing a low-cost public telecardiology system in small Brazilian towns. METHODS A total of 82 towns in the state of Minas Gerais, with a population < 10,500 inhabitants, presenting > 70% coverage by the Family Health Program (Programa Saude da Familia-PSF), local government compliance and internet access, were selected. Each town was supplied with digital electrocardiography (ECG) device and a team was trained. The implementation was coordinated by HC/UFMG, together with four university hospitals in the state of Minas Gerais (UFU, UFTM, UFJF and UNIMONTES). The ECG assessments were carried out in the towns and sent through the Internet for prompt analysis by an on-duty telecardiology team. Online and offline discussions on the medical cases were carried out through the Internet, as well as refreshment courses. RESULTS During the implementation period, a total of 253 health professionals were trained. From July 2006 to November 2008, the project assisted 42,664 patients, with a total of 62,865 ECG assessments being performed. A total of 2,148 emergency cases were treated, as well as 420 teleconsultations. The intermediate evaluation showed good acceptance of the implemented technology and a 70% decrease in patient referrals to other reference centers. CONCLUSION The use of the customary resources in informatics to assist the access of small-town populations to electrocardiography and specialized cardiology assessment is feasible.

Effect of Thyroid Hormones on Cardiovascular and Muscle Systems and on Exercise Tolerance: a Brief Review

Thyroid disorders (hypothyroidism and hyperthyroidism) have been the focus of studies in the most diverse areas of health sciences, because of their repercussion on various parts of the human body.Among the many consequences of these disorders, decreased exercise tolerance, due to direct involvement of cardiovascular and muscle systems, is rarely reported in literature

Implantação de um sistema de telecardiologia em Minas Gerais: projeto Minas Telecardio

FUNDAMENTO: Embora as doencas cardiovasculares sejam a maior causa de morbimortalidade em todo Brasil, o acesso das populacoes de cidades pequenas a eletrocardiografia e a avaliacao cardiologica e limitado. O uso da telecardiologia para facilitar o acesso da populacao de municipios remotos a eletrocardiografia e a segunda opiniao em cardiologia e promissora, entretanto nao foi formalmente testada. OBJETIVO: Avaliar a viabilidade de se implantar o sistema publico de telecardiologia de baixo custo em pequenas cidades brasileiras. METODOS: Foram selecionadas 82 cidades do Estado de Minas Gerais, com populacao 70% de cobertura pelo Programa Saude da Familia (PSF), com interesse do gestor e acesso pela internet. Em cada municipio foi instalado um aparelho de eletrocardiografo (ECG) digital, com subsequente treinamento da equipe. A implantacao foi coordenada pelo HC/UFMG, em conjunto com outros quatro hospitais universitarios mineiros (UFU, UFTM, UFJF e UNIMONTES). Os ECGs foram realizados nos municipios e enviados pela internet para analise imediata em plantao de telecardiologia. Realizaram-se discussoes de casos medicos on-line e off-line e cursos de atualizacao via web. RESULTADOS: No periodo de implantacao, foram treinados 253 profissionais de saude. De julho de 2006 a novembro de 2008, o projeto atendeu 42.664 pacientes, realizando 62.865 ECGs. Foram efetuados 2.148 atendimentos de urgencia e 420 teleconsultorias. A avaliacao intermediaria apontou boa aceitacao da tecnologia implantada e uma diminuicao de 70% de encaminhamentos de pacientes para outros centros de referencia. CONCLUSAO: E factivel a utilizacao de recursos habituais de informatica para facilitar o acesso de populacoes de cidades pequenas a eletrocardiografia e avaliacao cardiologica especializada.BACKGROUND Although cardiovascular diseases are the main cause of morbimortality in Brazil, the access of small-town populations to electrocardiography and cardiology assessment is limited. The use of telecardiology to assist the access of distant towns to electrocardiography and a second opinion in cardiology is promising; however, it has not been formally assessed. OBJECTIVE To assess the feasibility of implementing a low-cost public telecardiology system in small Brazilian towns. METHODS A total of 82 towns in the state of Minas Gerais, with a population < 10,500 inhabitants, presenting > 70% coverage by the Family Health Program (Programa Saude da Familia-PSF), local government compliance and internet access, were selected. Each town was supplied with digital electrocardiography (ECG) device and a team was trained. The implementation was coordinated by HC/UFMG, together with four university hospitals in the state of Minas Gerais (UFU, UFTM, UFJF and UNIMONTES). The ECG assessments were carried out in the towns and sent through the Internet for prompt analysis by an on-duty telecardiology team. Online and offline discussions on the medical cases were carried out through the Internet, as well as refreshment courses. RESULTS During the implementation period, a total of 253 health professionals were trained. From July 2006 to November 2008, the project assisted 42,664 patients, with a total of 62,865 ECG assessments being performed. A total of 2,148 emergency cases were treated, as well as 420 teleconsultations. The intermediate evaluation showed good acceptance of the implemented technology and a 70% decrease in patient referrals to other reference centers. CONCLUSION The use of the customary resources in informatics to assist the access of small-town populations to electrocardiography and specialized cardiology assessment is feasible.

Abdominal Obesity and Association With Atherosclerosis Risk Factors: The Uberlândia Heart Study

AbstractEctopic visceral fat (VF) and subcutaneous fat (SCF) are associated with cardiovascular risk factors. Gender differences in the correlations of cardiovascular disease risk factors and ectopic fat in the Brazilian population still lacking.Cross-sectional study with 101 volunteers (50.49% men; mean age 56.5 ± 18, range 19–74 years) drawn from the Uberlândia Heart Study underwent ultrasonography assessment of abdominal visceral adipose tissue with convex transducer of 3.5 MHz of frequency. The thickness of VF was ultrasonographically measured by the distance between the inner face of the abdominal muscle and the posterior face of abdominal aorta, 1 cm above the umbilicus. The SCF thickness was measured with a 7.5 MHz linear transducer transversely positioned 1 cm above the umbilical scar. The exams were always performed by the same examiner. Ectopic fat volumes were examined in relation to waist circumference, blood pressure, and metabolic risk factors.The VF was significantly associated with the levels of triglycerides (P < 0.01, r = 0.10), HDL cholesterol (P < 0.005, r = 0.15), total cholesterol (P < 0.01, r = 0.10), waist circumference (P < 0.0001, r = 0.43), systolic blood pressure (P < 0.001, r = 0.41), and diastolic blood pressure (P < 0.001, r = 0.32) in women, and with the levels of triglycerides (P < 0.002, r = 0,14), HDL cholesterol (P < 0.032, r = 0.07), glucose (P < 0.001, r = 0.15), alanine aminotransferase (ALT) (P < 0.008, r = 0.12), gamma-GT (P < 0.001, r = 0.30), waist circumference (P < 0.001, r = 0.52), systolic blood pressure (P < 0.001, r = 0.32), and diastolic blood pressure (P < 0.001, r = 0.26) in men. SCF was significantly associated with the levels of triglycerides (P < 0.01, r = 0.34), LDL cholesterol (P < 0.001, r = 0.36), total cholesterol (P < 0.05, r = 0.36), waist circumference (P < 0.0001, r = 0.62), systolic and diastolic blood pressure (P < 0.05, r = 0.34) in women, and with the waist circumference (P < 0.001, r = 0.065)), and MetS (P < 0.05, r = 0.11) in men.The VF and SCF were correlated with most cardiovascular risk factors in both genders but our findings support the idea that there are gender differences in the correlations between ectopic fat deposition and the cardiovascular risk factors.

Bivariate and Multivariate Analyses of the Influence of Blood Variables of Patients Submitted to Roux-en-Y Gastric Bypass on the Stability of Erythrocyte Membrane against the Chaotropic Action of Ethanol

The stability of the erythrocyte membrane, which is essential for the maintenance of cell functions, occurs in a critical region of fluidity, which depends largely on its composition and the composition and characteristics of the medium. As the composition of the erythrocyte membrane is influenced by several blood variables, the stability of the erythrocyte membrane must have relations with them. The present study aimed to evaluate, by bivariate and multivariate statistical analyses, the correlations and causal relationships between hematologic and biochemical variables and the stability of the erythrocyte membrane against the chaotropic action of ethanol. The validity of this type of analysis depends on the homogeneity of the population and on the variability of the studied parameters, conditions that can be filled by patients who undergo bariatric surgery by the technique of Roux-en-Y gastric bypass since they will suffer feeding restrictions that have great impact on their blood composition. Pathway analysis revealed that an increase in hemoglobin leads to decreased stability of the cell, probably through a process mediated by an increase in mean corpuscular volume. Furthermore, an increase in the mean corpuscular hemoglobin (MCH) leads to an increase in erythrocyte membrane stability, probably because higher values of MCH are associated with smaller quantities of red blood cells and a larger contact area between the cell membrane and ethanol present in the medium.

The Role for Cardiovascular Remodeling in Cardiovascular Outcomes

Purpose of ReviewIschemic and non-ischemic injury to the heart causes deleterious changes in ventricular size, shape, and function. This adverse remodeling is mediated by neurohormonal and hemodynamic alterations and is reflected in non-invasive measures of left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and left ventricular end-diastolic volume (LVEDV). These measures are closely linked to cardiovascular outcomes and have become key surrogate endpoints for evaluating the therapeutic efficacy of contemporary treatments for heart failure with reduced ejection fraction (HFrEF). In this review, we critically evaluate recent published data (2015–2016) from randomized clinical trials (RCTs) and observational studies of HFrEF therapies to assess the role of ventricular remodeling on outcomes.Recent FindingsThese data highlight the benefits of certain guideline-directed medical therapies (GDMT) such as cardiac resynchronization therapy, surgical revascularization, and mechanical circulatory support on remodeling, while revealing the limitations of other therapies—routine mitral valve repair for patients with moderate ischemic mitral regurgitation and adjuncts to percutaneous coronary intervention in patients with ST elevation myocardial infarction (cyclosporine A and bioabsorbable cardiac matrix). The new angiotensin receptor blocker/neprilysn inhibitor, sacubitril/valsartan, demonstrates convincing improvements in clinical outcomes with a study of remodeling parameters to follow; the new cardiac myosin activator, omecamtiv mecarbil, demonstrates improvement in remodeling parameters without a clear early clinical benefit.SummaryThe concepts and contemporary trials reviewed in this paper reinforce the value of non-invasive measures of ventricular remodeling (LVEF, LVESV, and LVEDV) as important metrics across a range of cardiovascular therapies. Global non-invasive measures of cardiovascular remodeling have roughly paralleled or preceded hard clinical outcomes. Additionally, the capacity for reverse remodeling in HFrEF with GDMT motivates continued research in the fields of implementation science, diagnostic imaging, and gene-based therapeutics.

Spironolactone effects on myocardium changes induced by thyroid hormone in rats

BACKGROUND To study the possible role of aldosterone on thyroid hormone-induced myocardium hypertrophy, using spironolactone. OBJECTIVE To evaluate morphological changes in the myocardium induced by thyroid hormone and the possible effects of spironolactone use on these alterations. METHODS Forty Wistar rats were studied. The animals were allocated to four groups and were given: the vehicle used for dilution of the thyroid hormone (C); sodium levothyroxin at 50 microg/rat/day (H); spironolactone, 0.3 mg/kg/day (S); or thyroid hormone plus spironolactone (HS), at the same doses mentioned above, for 28 consecutive days. All the animals were weighed, had blood drawn for hormonal measurements and underwent ECG at the start and the end of the experiment. At the end of experiment all animals were euthanized, the weight of the left ventricle (LV) was determined and LV slices were obtained for morphological analysis. RESULTS There was an increase in T3 levels, decrease of body weight and higher heart rate in the animals from group H. The LV weight was significantly higher in the H e HS groups. The histometric analyses that measured the diameter of the myocytes showed higher values in group H and a progressive decrease in groups HS, S and C, with a significant difference among all the groups. The addition of spironolactone decreased the transversal myocyte hypertrophy by 14.6%. CONCLUSION Rats treated with thyroid hormone present cardiac hypertrophy with increased LV weight and greater myocyte diameter. Spironolactone, when associated with thyroid hormone, can partially prevent this hypertrophy through mechanisms that are yet to be determined.

Coronary microvascular dysfunction

The use of the term microvascular angina (MVA) for this population of patients has been explained by the higher sensitivity of the coronary microcirculation to local vasoconstrictors, and its association with limited microvascular vasodilatory capacity2,3. Over the past 20 years, studies used for assessing coronary physiology have brought information to enable the better understanding of coronary microvascular dysfunction (CMD) and microvascular ischemia. Specifically speaking, studies using positron emission tomography (PET) have allowed to establish the normal and absolute range of myocardial blood flow (MBF, mL/min/g) and coronary flow reserve (CFR)4-11. The availability of normal WSF and CFR values allowed the investigation of coronary physiology in individuals at increased risk for CAD and in different categories of patients with symptoms and signs suggestive of myocardial ischemia, despite normal coronary angiographies12.

Cardiac Tumors: A Brief Commentary

Patients with cardiac tumors may present with cardiovascular related or constitutional symptoms, but more often than not a cardiac mass is discovered incidentally during an imaging examination performed for an unrelated indication. Cardiac myxoma is generally considered to be a surgical emergency. Echocardiography, including the transesophageal approach, is the most important means of diagnosis; computed tomography and magnetic resonance imaging. The clinical presentation has changed, and the management of cardiac myxoma now needs to be reviewed.