No abstract

Functional electrical stimulation (FES) produces beneficial effects in the treatment of patients with chronic heart failure (CHF), but studies carried out in these patients show small sample sizes and conflicting results. The aim of this meta-analysis was to systematically review the effect of treatment with FES compared with conventional aerobic exercise training (CA) or control group in patients with CHF. The search strategy included MEDLINE, LILACS, Physiotherapy Evidence Database and Cochrane Library. Randomized trials comparing FES versus CA or control group in the treatment of patients with CHF were included. Two reviewers independently extracted the data. Main analysis used a fixed-effects model. The search retrieved 794 articles, from which seven studies were included. Treatment with FES provided a smaller gain in peak VO2 compared with CA {-0.74 ml/kg per min [95% confidence interval (CI): -1.38 to -0.10]}. There was no difference in the muscle strength [-0.33 Nm (95% CI: -4.56 to 3.90)] and in the distance of the 6-min walk test [2.73 m (95% CI: -15.39 to 20.85)] on comparing FES with CA. An increase in peak VO2 of 2.78 ml/kg per min (95% CI: 1.44-4.13) was observed in FES versus the control group. Treatment with FES provides a similar gain in the distance of the 6-min walk test and in the muscle strength when compared with CA, but a small gain in the peak VO2. An increase in the peak VO2 can be obtained with FES as compared with the control group. Thus, FES may be an alternative in relation with CA for patients with CHF and with those who are unable to perform this kind of exercise.

BackgroundObesity has been identified as an important risk factor in the development of cardiovascular diseases; however, other factors, combined or not with obesity, can influence cardiovascular risk and should be considered in cardiovascular risk stratification in pediatrics. ObjectiveTo analyze the association between anthropometry measures and cardiovascular risk factors, to investigate the determinants to changes in blood pressure (BP), and to propose a prediction equation to waist circumference (WC) in children and adolescents. MethodsWe evaluated 1,950 children and adolescents, aged 7 to 18 years. Visceral fat was assessed by WC and waist hip relationship, BP and body mass index (BMI). In a randomly selected subsample of these volunteers (n = 578), total cholesterol, glucose and triglycerides levels were evaluated. ResultsWC was positively correlated with BMI (r = 0.85; p < 0.001) and BP (SBP r = 0.45 and DBP = 0.37; p < 0.001). Glycaemia and triglycerides showed a weak correlation with WC (r = 0.110; p = 0.008 e r = 0.201; p < 0.001, respectively). Total cholesterol did not correlate with any of the variables. Age, BMI and WC were significant predictors on the regression models for BP (p < 0.001). We propose a WC prediction equation for children and adolescents: boys: y = 17.243 + 0.316 (height in cm); girls: y = 25.197 + 0.256 (height in cm). ConclusionWC is associated with cardiovascular risk factors and presents itself as a risk factor predictor of hypertension in children and adolescents. The WC prediction equation proposed by us should be tested in future studies.

BackgroundInterleukin-6 (IL-6) plays a central role in atherosclerosis and inflammation. It may improve risk prediction in patients at intermediate cardiovascular risk.ObjectiveTo analyze the impact of serum IL-6 in predicting early angiographic coronary artery disease in patients at intermediate cardiovascular risk with chest pain.MethodsIn a cross-sectional study, patients referred for coronary angiography due to suspected coronary artery disease (CAD) were included. Coronary artery disease was defined as the presence of at least 30% stenosis in one or more coronary artery. Severity of CAD was classified by the anatomic burden score. Performance of serum IL-6 assay was compared with ACC/AHA atherosclerotic cardiovascular disease (ASCVD) risk score and hs-CRP through receiver operating characteristic (ROC) curves.ResultsWe have included 48 patients with a mean 10-year ASCVD risk of 10.0 ± 6.8%. The prevalence of CAD was 72.9%. The presence of CAD was associated with higher mean levels of IL-6 (p = 0.025). Patients with CAD had significantly more overweight than subjects without CAD. In 27% of patients, IL-6 was >1.0 pg/mL and 100% of these patients had CAD, while only 64% in those with IL-6 <1.0 pg/mL, corresponding to a positive predictive value of 100% (p = 0.015). The area under the receiver operating characteristic (ROC) curve of IL-6, hs-CRP and ASCVD were respectively 0.72, 0.60 and 0.54. Intermediate risk patients with IL-6 >1.0 pg/mL were further reclassified into ASCVD high risk due to the presence of coronary lesions.ConclusionIn intermediate risk patients referred for coronary angiography, a serum IL-6 level above 1 pg/mL is predictive of significant CAD. IL-6 determination may be useful to reclassify ASCVD intermediate risk patients into higher risk categories.

No abstract

Endothelial dysfunction is common in T1DM adolescents with less than 5 yr of disease. It is associated with duration of disease, microalbuminuria, and mean second-year HbA1c but not with mean first-year HbA1c. These data support the metabolic memory hypothesis.

Análise comparativa entre idosos praticantes de exercício físico e sedentários quanto ao risco de quedas Comparative analysis of old people practicing physical exercises and sedentary ones regarding the risk of falling Análisis comparativo entre envejecidos practicantes de ejercicios físicos y sedentarios en cuanto al risco de caídas

OBJECTIVES:The six-minute walk test has been widely used to evaluate functional capacity and predict mortality in several populations. Thus, the aim of this study was to evaluate the prognostic value of the six-minute walk test for the life expectancy of end-stage renal disease patients.METHODS:Patients over 18 years old who underwent hemodialysis for at least six months were included. Patients with hemodynamic instability, smoking, chronic obstructive pulmonary disease, physical incapacity and acute myocardial stroke in the preceding three months were excluded.RESULTS:Fifty-two patients (54% males; 36±11 years old) were followed for 144 months. The distance walked in the six-minute walk test was a survival predictor for end-stage renal disease patients. In the multivariate analysis, for each 100 meters walked with a 100-meter increment, the hazard ratio was 0.53, with a 95% confidence interval of 0.37-0.74. There was a positive correlation between the distance walked in the six-minute walk test and peak oxygen consumption (r = 0.508). In the multivariate analysis, each year of dialysis treatment represented a 10% increase in death probability; in the severity index analysis, each point on the scale represented an 11% increase in the death risk.CONCLUSIONS:We observed that survival increased approximately 5% for every 100 meters walked in the six-minute walk test, demonstrating that the test is a viable option for evaluating the functional capacity in patients with end-stage renal disease.