No abstract

The favorable effects of RV bifocal pacing could not be maintained beyond the first 6 months, likely due to the ventricular arrhythmias. Therefore, CRT combined with ICD from the outset may be recommended for this patient group.

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

169The autonomic nervous system (ANS) plays a fundamental role in the control of arterial blood pressure and heart rate, and, therefore, may be considered an important pathophysiologic factor in the development of arterial hypertension 1 . Currently, the status of autonomic action of the heart may be known through the study of heart rate variability. Heart rate varies per beat as a consequence of the constant adaptations promoted by the ANS to maintain cardiovascular system balance. These alterations may be assessed through the variations in R-R intervals, therefore, constituting the heart rate variability 2 . The integration between the sympathetic and parasympathetic modulations determines heart rate variability 3 . As a research tool, assessment of heart rate variability has provided a better understanding of the participation of the ANS in different physiological and pathological situations of the cardiovascular system. The assessment of heart rate variability has stimulated a large number of observations, indicating the potential value of that approach in the diffusion of knowledge about the alterations in the mechanisms of blood pressure control involved in hypertension 4-6 .The existence of sympathetic hyperactivity has been frequently associated with arterial hypertension 7,8 . Evidence exists indicating that the sensitivity of baroreceptor control, impaired in some hypertensive individuals 9-11 , involves mainly parasympathetic mechanisms 12-14 .Although several studies indicate that sympathetic and parasympathetic alterations are simultaneously involved in the pathogenesis and development of arterial hypertension, the results obtained using heart rate variability are controversial. Populationbased studies have reported reduced heart rate variability in patients with long-term arterial hypertension, despite treatment with antihypertensive drugs 15 . However, one does not know whether abnormal autonomic cardiovascular regulation is a primary characteristic preceding the onset of hypertension, or whether it may be reversed with antihypertensive therapy. In addition, it is not known whether the improvement in autonomic regulation is related to a reduction in blood pressure or whether it is an immediate effect of the drug 16 . The present study aimed at analyzing and comparing heart rate variability in normotensive and hypertensive individuals and at observing the behavior of the ANS after administration of ACE inhibitors to these hypertensive patients. Original Article Analysis of Heart Rate Variability in Hypertensive Patients Before and After Treatment with Angiotensin II-Converting Enzyme Inhibitors ResultsThe SDNN and PNN50 parameters (TD), and the LF spectrum (FD)

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

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

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

RESUMO Este estudo expõe a propagação de Colégios Militares na sociedade goiana e a influência desses na formação cidadã. Tem o objetivo de refletir sobre a militarização das escolas públicas ser ou não a melhor solução educacional para formar integralmente os alunos. Trata-se de pesquisa bibliográfica com revisão narrativa e análise epistemológica a partir da Teoria do Agir Comunicativo de Jürgen Habermas. Como resultado, compreende-se que o ensino autoritário dos Colégios Estaduais da Polícia Militar de Goiás, ainda que proponha a disciplina como elemento relevante para o Mundo da Vida, apropria-se da criatividade e da liberdade do aluno e as cerceia, representando retrocesso e estagnação na luta e na conquista de uma educação mais democrática.