Fernando Rocha Oliveira

Sidestream cigarette smoke and cardiac autonomic regulation.

Background The literature has already demonstrated that cigarette influences the cardiovascular system. In this study, we performed a literature review in order to investigate the relationship between sidestream cigarette smoke (SSCS) and cardiac autonomic regulation. Methods Searches were performed on Medline, SciELO, Lilacs and Cochrane databases using the crossing between the key-words: “cigarette smoking”, “autonomic nervous system”, “air pollution” and “heart rate variability”. Results The selected studies indicated that SSCS exposure affects the sympathetic and parasympathetic responses to changes in arterial blood pressure. Moreover, heart rate responses to environmental tobacco smoke are increased in smokers compared to non-smokers. The mechanism involved on this process suggest increased oxidative stress in brainstem areas that regulate the cardiovascular system. Conclusion Further studies are necessary to add new elements in the literature to improve new therapies to treat cardiovascular disorders in subjects exposed to sidestream cigarette smoke.

Chronic obstructive pulmonary disease and heart rate variability: a literature update

Background The literature indicates that chronic obstructive pulmonary disease (COPD) affects cardiac autonomic control. In this study, we conducted a literature review in order to investigate the heart rate variability (HRV) in COPD subjects. Methods A search was performed in Medline database, using the link between the keywords: “autonomic nervous system”, “cardiovascular system”, “COPD” and “heart rate variability”. Results The search resulted in a total of 40 references. Amongst these references, the first exclusion resulted in the barring of 29 titles and abstracts, which were not clearly related to the purpose of review. This resulted in a total of 11 articles that were then read and utilized in the review. The selected studies indicated that there is significant reduction of HRV in patients with COPD, characterized by reduction of indices that assess parasympathetic activity in addition to dealing with the global autonomic modulation. We also established that supervised exercise can reduce these harmful effects in COPD patients. Also, it was reported that the use of non-invasive ventilation in these patients may contribute to the improvement of respiratory symptoms, with no impairing, and may even induce positive responses in cardiac autonomic regulation. Conclusion The studies indicate a need for further investigations to guide future therapies to improve the treatment of cardiovascular system in the respiratory diseases.

Heart Rate Variability and Cardiopulmonary Dysfunction in Patients with Duchenne Muscular Dystrophy: A Systematic Review

Duchenne muscular dystrophy (DMD) is a genetic recessive disorder with progressive muscle weakness. Despite the general muscle wasting, degeneration and necrosis of cardiomyocytes have been the main causes of morbidity and death in individuals with DMD. Cardiac failure is generally preceded by disturbances in heart rate variability (HRV), and non-invasive measurement of the autonomic nervous system has been an important tool to predict adverse cardiovascular events. Hence, the application of HRV to study autonomic modulation in DMD individuals, and the establishment of correlations between HRV and heart/lung diseases, age, and mortality will have the potential to improve quality of life and life expectancy of individuals with DMD. In order to evaluate the state of the art in this field, we conducted a systematic search in Medline/PubMed and BVS (virtual library in health) databases. We selected 8 studies using pre-defined criteria and meta-analysis revealed decreased parasympathetic activity and increased sympathetic predominance in individuals with DMD as major observations. Moreover, there is a strong association between diminished HRV and myocardial fibrosis with DMD. These patterns are evident in patients at early-stage DMD and become more prominent as disease severity and age increase. Thus, data minning clearly indicates that HRV assessment can be used as a predictor for sudden death in individuals with DMD. The use of the HRV, which is inexpensive, ubiquitously available in clinics and hospitals, and a non-invasive analysis tool, can save lives and decrease the morbity in DMD by alerting care givers to consider autonomic nervous system intervention.

Patient-Reported and Performance Outcomes Significantly Improved in Elderly Patients with Vestibular Impairment following Rehabilitation: A Retrospective Study

Objective To describe the results of a vestibular rehabilitation (VR) program in the timed up and go (TUG), gait speed (GS), and dizziness handicap inventory (DHI) scores for elderly vestibular patients in a developing country. Methods Descriptive study with retrospective data collected from the clinical records of vestibular patients. The following information was recorded: sex, age, type of vestibular disorder, DHI score, and performance in TUG and GS, before and after participation in a VR program taking place from January 1 to August 30, 2017. The VR program consisted of 10 twice weekly sessions in the clinic and daily exercises at the patients home. We used Students t-test for paired and Wilcoxons test according to the data distribution. The level of significance was 5%. Results Data from 57 patients (49 females; 78 ± 5.8 years old) were used. There were statistically significant differences in TUG (12.52 versus 11.56), GS (0.81 versus 0.90 m/s), DHI total handicap (46 versus 24), physical (14 versus 8), emotional (14 versus 6), and functional (18 versus 12) domains. Conclusion The functional outcome measures reported, including TUG, gait speed, and DHI, reflect statistically significant improvements in elderly patients after vestibular rehabilitation; the DHI improvements are clinically relevant.

Analysis of the Action Strategies of the Brazilian National Health Policy of the Elderly from the Perspective of Nurses

Introduction: Increase of the elderly population, which is a characteristic of developed countries, also occurs in developing countries in a fastest way. Changes in the demographic profile reflect changes in the epidemiological profile of the population, and they require the applicability of public policies such as the Brazilian National Health Policy of the Elderly, which enable the priority for structuration of services and programs encompassing emergent demands Objective: analyze the action strategies of the Brazilian National Health Policy of the Elderly from the perspective of nurses. Method: This is a cross-sectional study of quantitative and qualitative approaches, performed with nurses from the teams of the Family Health Strategy (FHS), situated in the urban area of the city of Juazeiro do Norte, Ceara, Brazil, from March to April of 2015. Variables of both nurses (sex, age, time of professional formation, and time of experience) and dichotomous (developed strategies in the teams) were extracted from the questionnaire for Evaluation of Quality Improvement of the Family Health Strategy, modified from the Self-Assessment Notebooks 4 and 5, regarding the health of the elderly in session II, from the Brazilian Ministry of Health. Data were presented in tables as speeches and as absolute and relative frequency. Results: From the 16 nurses, 87.5% developed health promotion actions; 75% promoted educational activities addressing the statute of the elderly; 62.5% kept the registry of the elderly updated; 93.7% have ensured that 80% or more of their elderly patients were with updated vaccination; 81.3% and 68.8% answered that the oral examination and monitoring of oral health, respectively, are not established as routine activities. 75% did not conduct the examination of the body surface as a routine work; 75% said they promoted training for family caregivers, and 68.7% did not perform interventions for early detection of dementia. Although they pointed having performed health-promoting practices, when they described the performed and discussed actions with the elderly people, they were limited to medication delivery, to preferences in access to health care services, and to the rights of the elderly. Conclusion: Most of the actions performed by nurses are linked to immunization and training educational activities. However, practices restricted to the transmission of information about specific policy issues and actions of curative nature have been identified, such as medication delivery, only. The applicability of the policy still represents a challenge regarding clinical interventions and maintenance of the updated registry of the elderly.

Cardiovascular Risk in HIV/AIDS and Lipodystrophy Syndrome Patients

Background: The treatment of people living with AIDS , known a highly active antiretroviral therapy (HAART), has increased considerably, and the disease has therefore acquired chronic features. Several changes have been observed, especially in cardiovascular disease risk. Objective: To assess cardiovascular risk in HIV/AIDS patients treated with HAART and compare this with Lipodystrophy Syndrome (LS) carriers. Methods: This is a descriptive cross-sectional study. 192 patients were recruited from a lipodystrophy outpatient centre, using Framingham risk scores. Results: After criteria inclusion/exclusion, the final sample consisted of 81 patients divided into two groups (HIV/AIDS - without lipodystrophy and HIV/LS - with lipodystrophy). The mean age of HIV/AIDS was 46.5 years, and of the HIV/LS patients was 52 years. In accordance with Framingham scores the cardiovascular risk in HIV/AIDS was 46.59% and 14.29% in HIV/LS. Conclusion: The risk of cardiovascular disease over 10 years is significantly higher in patients with lipodystrophy syndrome.