Paulo Ricardo Nazário Viecili

Addition of inspiratory muscle training to aerobic training improves cardiorespiratory responses to exercise in patients with heart failure and inspiratory muscle weakness

BACKGROUNDnThis small clinical trial tested the hypothesis that the addition of inspiratory muscle training (IMT) to aerobic exercise training (AE) results in further improvement in cardiorespiratory responses to exercise than those obtained with AE in patients with chronic heart failure (CHF) and inspiratory muscle weakness (IMW).nnnMETHODSnTwenty-four patients with CHF and IMW (maximal inspiratory pressure <70% of predicted) were randomly assigned to a 12-week program of AE plus IMT (AE + IMT, n = 12) or to AE alone (AE, n = 12). Before and after intervention, the following measures were obtained: maximal inspiratory muscle pressure (PI(max)), peak oxygen uptake (Vo(2)peak), peak circulatory power, oxygen uptake efficiency slope, ventilatory efficiency, ventilatory oscillation, oxygen uptake kinetics during recovery (T(1/2)Vo(2)), 6-minute walk test distance, and quality of life scores.nnnRESULTSnCompared to AE, AE + IMT resulted in additional significant improvement in PI(max) (110% vs 72%), Vo(2)peak (40% vs 21%), circulatory power, oxygen uptake efficiency slope, ventilatory efficiency, ventilatory oscillation, and T(1/2)Vo(2). Six-minute walk distance and quality of life scores improved similarly in the 2 groups.nnnCONCLUSIONnThis randomized trial demonstrates that the addition of IMT to AE results in improvement in cardiorespiratory responses to exercise in selected patients with CHF and IMW. The clinical significance of these findings should be addressed by larger randomized trials.

Effects of Campomanesia xanthocarpa on biochemical, hematological and oxidative stress parameters in hypercholesterolemic patients.

ETHNOPHARMACOLOGICAL RELEVANCEnIn Southern Brazil, the plant Campomanesia xanthocarpa Berg. (Myrtaceae), popularly known as guavirova, has been empirically used for its potential effect in reducing blood cholesterol levels.nnnAIM OF THE STUDYnSince there are no scientific data confirming its popular use, the aim of the present study was to investigate the effect of Campomanesia xanthocarpa on biochemical, hematological, anthropometrical and oxidative stress parameters in hypercholesterolemic patients.nnnMATERIALS AND METHODSnThirty three patients were selected according to total cholesterol (TC) levels: 200-240 mg/dL, undesirable level (UL), and >240 mg/dL, hypercholesterolemic level (HL). UL or HL patients were randomly divided into control group (CG), which received placebo capsules, and experimental group 250 (EG 250) or 500 (EG 500), which received either 250 or 500 mg of encapsulated Campomanesia xanthocarpa. All groups received a cholesterol restriction diet and capsules once a day. The biochemical (TC, triglycerides, HDL, LDL and VLDL), hematological (hematocrit and hemoglobin), anthropometrical (weight and abdominal circumference) and oxidative stress (protein carbonyl) parameters were measured before, 45 and 90 days after the treatment started.nnnRESULTSnThere was no alteration on biochemical, hematological, anthropometric or oxidative stress parameters in UL patients of all groups. However, a significant decrease in TC and LDL levels was observed in HL patients from EG 500 group (reduction of 28+/-3% and 45+/-4% to levels before treatment) in relation to CG group patients (reduction of 12+/-2% and 29+/-4%). Moreover, a significant reduction in oxidative stress was observed in HL patients of EG 250 (51+/-12%) and EG 500 groups (34+/-18%) when compared to levels before treatment. A positive correlation between plasma oxidative stress PC and TC levels was observed. Finally, we found that Campomanesia xanthocarpa extract possesses anti-oxidant properties and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitory activity in vitro.nnnCONCLUSIONnConfirming its popular use, the treatment with Campomanesia xanthocarpa encapsulated reduced blood TC and LDL levels in hypercholesterolemic patients.

Curva dose-resposta do exercício em hipertensos: análise do número de sessões para efeito hipotensor

BACKGROUNDnThe effect of exercise on blood pressure (BP) is already known; however, the dose-response curve of the hypotensive effect of exercise in hypertensive individuals is yet to be clarified.nnnOBJECTIVEnTo evaluate the dose-response curve of the number of sessions that are necessary to cause a hypotensive effect in hypertensive individuals.nnnMETHODSn88 individuals, aged 58 +/- 11 years, divided in Experimental group (EG), with 48 that participated in a physical exercise program (PEP), which consisted of 40 minutes of aerobic exercises performed 3x/week, for 3 months, at 70% of the VO2max, and muscular exercises at 40% of the maximal voluntary contraction (MVC) and Control Group (CG) with 40 individuals that did not participate in the PEP. The systolic (SAP) and diastolic (DAP) arterial pressures were measured before each of the 36 sessions in the EG and assessed by ambulatory blood pressure monitoring (ABPM) in the CG. Differences in BP, the variation rate (D%) and the maximum hypotensive effect (MHE%) were observed between sessions. The data were expressed as means +/- SD; the t test and correlation were used, with p<0.05 being considered significant.nnnRESULTSnThere was no difference regarding BP values in the CG. The EG showed an important decrease of 15 mmHg in SAP and 7 mmHg in DAP, with a large part of this effect occurring as early as the first session and the majority up to the 5th session. There was a strong inverse correlation (R:-0.66) with the number of sessions.nnnCONCLUSIONnAn important hypotensive effect was observed from the 1st session on and it was observed that the dose-response curve can be abrupt and decrescent, instead of flat.FUNDAMENTO: Ya se conoce el efecto del ejercicio en la presion arterial, sin embargo, la curva dosis-respuesta del efecto hipotensor del ejercicio en hipertensos no esta aclarada aun. OBJETIVO: Evaluar la curva dosis-respuesta del numero de sesiones necesarias para causar efecto hipotensor en individuos hipertensos. METODOS: El estudio estaba conformado por 88 individuos, con 58 ± 11 anos, divididos en grupo experimental (GE) -conformado por 48 integrantes de un programa de ejercicio fisico (PEF) de tres meses, tres veces por semana, con 40 de ejercicio aerobio al 70% del VO2max y ejercicios musculares al 40% de la capacidad voluntaria maxima (CVM); y grupo-control (GC) con 40 individuos que no realizaron el PEF. Se midieron las presiones arteriales sistolica (PAS) y diastolica (PAD) del GE antes de cada una de las 36 sesiones y en el GC se las evaluaron por monitoreo ambulatorio de presion arterial (MAPA). Se observaron las diferencias en la PA, el indice de variacion (D%) y el efecto hipotensor maximo (EHM%) entre las sesiones. Los datos estaban expresados por promedio ± desviacion estandar, y se utilizo la prueba t y correlacion, tomando p < 0,05 como valor significativo. RESULTADOS: En el GC no hubo diferencia en los valores de presion arterial. En el GE, luego del PEF, ocurrio un descenso importante de 15 mmHg en la PAS y de 7 mmHg en la PAD; y una gran parte de ese efecto tuvo lugar ya en la primera sesion, y la mayor parte sucedio hasta la quinta sesion. Hubo una fuerte correlacion inversa (R: -0,66) con el numero de sesiones. CONCLUSION: En la primera sesion, ya ocurrio efecto hipotensor importante. Tambien se evidencio que la curva dosis-respuesta pode ser abrupta y decreciente en lugar de achatada.

Mortalidade por doenças circulatórias e evolução da saúde da família no Brasil: um estudo ecológico

The scope of this study was to describe aspects of the food intake of Brazilian children and its association with social and demographic factors. The 2006 food intake data of the National Survey on Demography and Health for women and children were analyzed. The analysis considered the complexity of the sample and included 3,083 children aged two to five years old. The outcome was evaluated by considering food intake markers. The estimates of these markers was described taking into account the childrens gender, age and neighborhood as well as their mothers age and education. Chi-square heterogeneity and linear tendency tests were used in the statistical analyses. It was seen that during the seven days before the interview 50% and 25.9% of the children evaluated, respectively, had not eaten greens and vegetables. In at least one day during the previous week the prevalence of consumption of fried food was of approximately 60% and for soda and artificial juice was of 82%. Female children whose mothers were older and had more education presented the highest prevalence in consumption of healthy food. As a result of these data, it is possible to say that the intensification of campaigns of nutritional education with innovatory approaches might help improve the food intake of children.O objetivo deste estudo foi analisar a mortalidade por doencas circulatorias paralelamente a evolucao da Estrategia Saude da Familia no Brasil. Estudo ecologico, retrospectivo, baseado na evolucao temporal da ESF e nas taxas de mortalidade por doencas circulatorias no Brasil. Foi realizada uma descricao da razao de cobertura habitante x ESF e dos indicadores de saude relacionados a mortalidade por doencas circulatorias. Para a associacao estatistica utilizou-se o teste de Correlacao de Spearman. Houve aumento populacional no Brasil em 15%, evolucao de 761% no numero de ESF e 5% de aumento na mortalidade por doencas circulatorias. A razao populacao x ESF passou de 52.838 (1998) para 7.084 (2006) pessoas assistidas por ESF. As regioes norte e nordeste apresentaram crescimento nas taxas de mortalidade por doencas circulatorias e em 21 (81%) estados houve correlacao positiva entre mortalidade por doencas circulatorias e ESF (r: > 0,7; p < 0,01). Por fim, considera-se a ESF uma importante politica publica de saude, tendo obtido resultados exitosos no Brasil desde a sua implementacao. Entretanto, em um contexto geral, sua expansao nao influenciou a reducao da mortalidade por doencas circulatorias, tendo apresentado aumento deste indicador no pais.

Effects of Campomanesia xanthocarpa on inflammatory processes, oxidative stress, endothelial dysfunction and lipid biomarkers in hypercholesterolemic individuals

In Brazil, the edible plant Campomanesia xanthocarpa Berg. (Myrtaceae), popularly known as guavirova, has been studied in hypercholesterolemic individuals. The present work investigated the effects of C. xanthocarpa on inflammatory processes, oxidative stress, endothelial dysfunction and lipid biomarkers in hypercholesterolemic individuals. A total of 156 individuals were selected in a double-blind fashion and randomly divided into two groups in accordance with the intervals used in the criteria for hypercholesterolemia: individuals with total cholesterol (TC) levels between 200 and 240 mg/dL (undesirable level individuals - UL) and individuals with TC levels >240 mg/dL (hypercholesterolemic individuals - HL). Both groups had a control group (CG), which received placebo treatment, an encapsulated excipient group (lactose) and an experimental group that received 500 mg (EG 500), 750 mg (EG 750) or 1000 mg (EG 1000) of encapsulated C. xanthocarpa. The inflammatory processes (high-sensitivity C-reactive protein - hs-CRP), oxidative stress (advanced oxidation protein products-AOPPs; ischemia-modified albumin-IMA), endothelial dysfunction (nitric oxide - NOx) and biochemical (TC, triglycerides, high-density lipoprotein - HDL, low-density lipoproteins - LDL, and very low-density lipoprotein - VLDL) parameters were measured before and 90 days after the initiation of treatment. A significant decrease in TC and LDL levels was observed in HL individuals from the EG 500 group (reduction of 29 ± 3% and 41 ± 5% to levels before treatment) compared to the CG group individuals. A significant reduction in oxidative stress and inflammatory process components (reduction of 52 ± 11% in AOPPs, 32 ± 10% in IMA and 57 ± 7% in hs-CRP) and a significant increase in NOx (increase of 84 ± 27%) was observed in HL individuals in the EG 1000 group when compared to the CG group individuals. Treatment with encapsulated C. xanthocarpa reduced blood TC and LDL levels in hypercholesterolemic individuals. In addition to its effect on cholesterol levels, this plant reduced oxidative stress in hypercholesterolemic individuals and improved the levels of NOx.

Redução dos níveis pressóricos em indivíduos hiper-reativos após treinamento físico aeróbio

BACKGROUNDnSome normotensive sedentary individuals have an exaggerated increase in blood pressure (BP) during physical activity, which is a behavior that is called blood pressure hyper-reactivity.nnnOBJECTIVEnTo investigate the effect of an aerobic exercise program (AEP) on blood pressure in individuals with blood pressure hyper-reactivity (BPH).nnnMETHODSnTen male volunteers with BPH, aged 45 ± 10 years, referred to as the experimental group (EG), took part in an AEP on a treadmill, 3 times a week for two months. They were compared to 14 men with BPH, aged 48 ± 8 years, referred to as the control group (CG), who remained sedentary. The subjects were evaluated before and after the AEP by stress test for comparison purposes. We evaluated the initial, peak and test-end heart rates (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP).nnnRESULTSnThere a significant decrease in the initial SBP (-5%; p=0.01), initial DBP (-4.6%; p=0.01), peak SBP (-12.4%; p=0.001), peak DBP (-14.7%; p=0.03), final SBP (-4.6%, p=0.03) in the EG. The CG continued with its hyper-reactive behavior, which evolved to more exaggerated levels when the results before and after the study were compared (p<0.04). In the HR, there was an increase only in the final HR, of 11.3 bpm, after training (p=0.02). The test-peak VO2 increased by 4.4 ml.kg(-1) x min(-1) in the EG (p=0.01) and remained similar in the CG.nnnCONCLUSIONnThe AEP normalized the behavior of the blood pressure hyper-reactivity in sedentary men.

Hospitalization due to conditions sensitive to primary care and expansion of the Family Health Program in Brazil: an ecological study

OBJECTIVEnTo evaluate the relationship between hospitalization due to conditions that are sensitive to primary care and the population coverage by the Family Health Strategy (ESF) Units of the Brazilian Federation Units in the last decade.nnnMETHODSnThis is an ecological study that investigated preventable hospitalizations and coverage of primary health care in Brazil in the historic series from 1998 to 2006. Statistical analysis was performed using the Pearson correlation test and simple linear regression.nnnRESULTSnIn the studied period, we found an association between population coverage and reduced ESF admissions for primary care sensitive conditions in Brazil (β = -28.78, p ≤ 0.01), which occurred in 38.4% of the Federation Units.nnnCONCLUSIONnThere was a positive relationship between the expansion of ESF coverage and a decline in hospitalizations for ACSC in the country. The findings of this study help to evaluate the ESF and primary care in Brazil.

Ausência de influência da massa corporal na redução da pressão arterial após exercício físico

BACKGROUNDnHypertension (H) is associated with a large number of co-morbidities, including obesity. The correlation between two variables has been investigated.nnnOBJECTIVEnTo analyze the correlation between the loss of body mass and blood pressure reduction in hypertensive patients undergoing exercising programs (EP).nnnMETHODSnOne hundred eleven hypertensive patients with overweight or obesity were randomly divided into an experimental group (EG). Out of these, 57 (58 +/- 8.9 years old) participated in a three-month EP conducted three times a week in aerobic exercise sessions from 50% to 70% of VO2 peak for 30 to 60 minutes and resistance exercises; and a control group (CG) with 54 (60 +/- 7.7 years old) who did not participate in the EP. In the EG, blood pressure (BP) was measured before each session and the measurement of anthropometric variables (AV) at the beginning of the program and after three months. In the CG the BP and the VA were evaluated in the doctors office at the beginning and at the end of the study. Data were expressed as mean +/- standard deviation (SD). Pearson correlation and t test were used. A value of p < 0.05 was considered significant.nnnRESULTSnIn the CG there was no significant difference in AV and BP at the beginning and at the end of the study. In the EG, there was no significant alteration in the AV, however, there was blood pressure reduction of 12% in systolic BP (-17.5 mmHg, p = 0.001) and 9% in Diastolic BP (-8.1 mmHg, p = 0. 01) at the end of the study. There was no correlation between the AV and decrease in BP (r = 0.1).nnnCONCLUSIONnThe blood pressure reduction was not correlated with reduction of anthropometric measures after the exercising period.FUNDAMENTO: A hipertensao arterial (HA) e associada com um grande numero de comorbidades, dentre elas, a obesidade. A correlacao entre essas duas variaveis tem sido alvo de investigacao. OBJETIVO: Analisar a correlacao entre a perda de massa corporal e reducao pressorica em hipertensos submetidos a programa de exercicios fisicos (PEF). METODOS: Cento e onze hipertensos com sobrepeso ou obesidade, divididos aleatoriamente em um grupo experimental (GE), com 57 (58 ± 8,9 anos) que participaram de um PEF de tres meses, tres vezes por semana, em sessoes de exercicio aerobio de 50% a 70% do VO2pico, por 30 a 60 minutos, alem de exercicios resistidos; e um grupo controle (GC), com 54 (60 ± 7,7 anos) que nao participaram do PEF. No GE, a pressao arterial (PA) foi aferida antes de cada sessao e a mensuracao das variaveis antropometricas (VA) no inicio do programa e apos tres meses. No GC a PA e as VA foram avaliadas em consultorio medico no inicio e fim do estudo. Os dados foram expressos por media ± desvio padrao (DP), usou-se teste t e correlacao de Pearson. Considerou-se significativo p < 0,05. RESULTADOS: No GC nao ocorreu diferenca significativa nas VA e PA no inicio e fim do estudo. No GE nao ocorreu alteracao significativa nas VA, no entanto, a reducao pressorica de 12% na PA Sistolica (-17,5 mmHg; p = 0,001) e de 9% na PA Diastolica (-8,1 mmHg; p = 0,01) ao final do estudo. Nao houve correlacao entre as VA e queda da PA (r = 0,1). CONCLUSAO: A reducao pressorica nao se correlacionou com reducao das medidas antropometricas apos periodo de exercicio fisico.

Study of oxidative and inflammatory parameters in LDLr-KO mice treated with a hypercholesterolemic diet: Comparison between the use of Campomanesia xanthocarpa and acetylsalicylic acid

BACKGROUNDnAtherosclerosis is an inflammatory disease that affects the arterial wall leading to myocardial, cerebral, and peripheral ischemic syndromes. The use of low doses of aspirin inhibits platelet aggregation and inflammation and prevents cardiovascular mortality. However, ASA may produce hemorrhagic events. Thus, several studies have sought new natural compounds to suppress platelet aggregation without causing serious adverse effects.nnnPURPOSEnIn this sense, this study aims to compare the effects of Campomanesia xanthocarpa plant extract with those of acetylsalicylic acid (ASA) on inflammatory parameters observed in homozygous mice knockout for the low-density lipoprotein receptor (LDLr-KO) treated with a hypercholesterolemic diet.nnnMATERIAL AND METHODSnIn this study, 28 male LDLr-KO mice were divided into three groups and fed a hypercholesterolemic diet for 4 weeks. Thereafter, the animals that received the hypercholesterolemic diet were treated for 5 days with (1) distilled water, (2) C. xanthocarpa extract, or (3) acetylsalicylic acid. The levels of inflammatory markers were assessed in the blood samples. The gastric tolerability of the animals after oral administration of the treatments was assessed through quantification of the lesions in the gastric mucosa.nnnRESULTSnThe levels of proinflammatory cytokines IL-1, IL-6, TNF-α, and INF-γ were reduced to 19.2xa0±xa03%, 20.4xa0+xa01.3%, 24.7xa0±xa01.2%, and 20.8xa0±xa01.7%, respectively, in the group treated with C. xanthocarpa, when compared to control group. Furthermore, treatment with plant extract significantly increased the levels of the anti-inflammatory cytokine IL-10 by 27.3xa0±xa05.9%, but ASA showed no significant effect on the same cytokines when compared to the control group, with the exception of IL-10, which presented an increase of 8.6xa0±xa03.5%. Treatments with C. xanthocarpa and ASA also caused significant reductions of 26.4xa0±xa03% and 38.4± 6% in the serum levels of oxLDL, respectively. However, only treatment with C. xanthocarpa reduced the levels of anti-oxLDL antibodies when compared with the control (25.8xa0±xa06%). In addition, the analyzed extract did not induce ulcerogenic activity, while ASA induced the formation of lesions.nnnCONCLUSIONnIn conclusion, treatment with C. xanthocarpa causes anti-inflammatory activity in hypercholesterolemic animals, with results superior to those obtained with the use of ASA.

Association between hypertriglyceridemia and protein oxidation and proinflammatory markers in normocholesterolemic and hypercholesterolemic individuals

BACKGROUNDnAlthough hypercholesterolemia is a well-established risk factor for coronary heart disease, evidence suggests that increased triglyceride (TG) concentrations are also an independent risk factor. TG concentrations >150mg/dl are observed nearly twice as often in subjects with atherosclerosis. We assessed the association between hypertriglyceridemia and protein oxidation and proinflammatory markers in normocholesterolemic and hypercholesterolemic individuals.nnnMETHODSnWe included 127 volunteers enrolled in Cruz Alta, RS, Brazil. The patients were stratified based on total cholesterol and TG concentrations for analysis of associations with inflammation (high-sensitivity C-reactive protein - hs-CRP), endothelial dysfunction (nitric oxide - NOx) and oxidative stress (advanced oxidation protein products - AOPPs; ischemia-modified albumin - IMA). Correlations between variables were determined and multiple regression analysis was employed to investigate whether some variables correlate with TG concentrations.nnnRESULTSnHypertriglyceridemia was related to oxidative stress and proinflammatory markers in individuals independent of total cholesterol concentrations. Moreover, the results indicate a stronger association of tested biomarkers with TG concentrations than with total cholesterol. The results indicate a positive correlation between oxidative stress and TG concentrations in the sera of hypercholesterolemia subjects. AOPPs and IMA concentrations were associated with the presence of hypertriglyceridemia in a manner that was independent of age, gender, hypertension and diabetes mellitus disease, smoking habits, sedentary lifestyle, BMI, waist circumference, LDL, HDL and total cholesterol concentrations.nnnCONCLUSIONSnWe speculate that TG concentrations can reflect the enhancement of protein oxidation and proinflammation.