Background: The dual antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel is the cornerstone of treatment for patients undergoing angioplasty with coronary stent implantation. However, some of these patients, despite the use of aspirin and clopidogrel, are not effectively anti-aggregated, a phenomenon known as resistance to antiplatelet agents. Its prevalence, as well as the conditions associated with it, is unknown in our country.

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Background:The World Health Organization (WHO) recommends as a weekly "target dose" of exercise 150 minutes of moderate exercise or 75 minutes of intense exercise. Public health policies have prioritized the practice of exercise as a strategy for disease prevention and health promotion, with health professionals as their main promoters.Objective: To assess the interaction between the amount of exercise per week and the knowledge about recommendations for fighting a sedentary lifestyle among health care professionals attending a congress of cardiology.Methods: Participants of the 2017 Rio de Janeiro Society of Cardiology Congress were interviewed. Knowledge about the World Health Organization (WHO) recommendations for fighting a sedentary lifestyle was assessed by asking participants the question: "How much weekly exercise is recommended by the WHO?" Responders were stratified by the weekly exercise load reported. A multivariate logistic model was created to determine independent predictors of knowledge.Results: A total of 426 participants were interviewed (45.5% men, median age 31 years, 37.8% physicians, 65.8% of the physicians were cardiologists). The overall knowledge level was 44.6%; 38.1%, 52.7% and 56.6% among nonphysicians, non-cardiologists and cardiologists, respectively (p = 0.002). Of all participants, 21.8% were inactive, 15% were lightly active, 34.7% moderately active and 28.4% highly active, and the percentage of individuals who gave a correct answer to the question on exercise recommendations was 30.1%, 42%, 48% and 52.9% respectively (p < 0.0001). In the multivariate analysis, being highly active (OR = 2.25, IC95%, 1.238 -4.089), moderately active (OR = 1.93, IC 95% 1.105 -3.39) and being a cardiologist (OR = 2.01, IC 95% 1.243 -3,267) were predictors of knowledge. Conclusions:There was a linear association between exercise level and knowledge about the WHO recommendations on exercise. Policies to stimulate the practice of exercise among health professionals can positively impact campaigns for reducing sedentary lifestyle in the general population.

BackgroundPhysical examination and B-type natriuretic peptide (BNP) have been used to estimate hemodynamics and tailor therapy of acute decompensated heart failure (ADHF) patients. However, correlation between these parameters and left ventricular filling pressures is controversial.ObjectiveThis study was designed to evaluate the diagnostic accuracy of physical examination, chest radiography (CR) and BNP in estimating left atrial pressure (LAP) as assessed by tissue Doppler echocardiogram.MethodsPatients admitted with ADHF were prospectively assessed. Diagnostic characteristics of physical signs of heart failure, CR and BNP in predicting elevation (> 15 mm Hg) of LAP, alone or combined, were calculated. Spearman test was used to analyze the correlation between non-normal distribution variables. The level of significance was 5%.ResultsForty-three patients were included, with mean age of 69.9 ± 11.1years, left ventricular ejection fraction of 25 ± 8.0%, and BNP of 1057 ± 1024.21 pg/mL. Individually, all clinical, CR or BNP parameters had a poor performance in predicting LAP ≥ 15 mm Hg. A clinical score of congestion had the poorest performance [area under the receiver operating characteristic curve (AUC) 0.53], followed by clinical score + CR (AUC 0.60), clinical score + CR + BNP > 400 pg/mL (AUC 0.62), and clinical score + CR + BNP > 1000 pg/mL (AUC 0.66).ConclusionPhysical examination, CR and BNP had a poor performance in predicting a LAP ≥ 15 mm Hg. Using these parameters alone or in combination may lead to inaccurate estimation of hemodynamics.

Background: In pandemic times, social isolation is of utmost importance to minimize the spread of the SARS-Cov-2 virus. At times like these, home fitness becomes extremely necessary to avoid sedentarism and decompensation in chronic disease patients.Objectives: Evaluate the engagement of rehabilitation patients to a tele-oriented exercise program at home (TOEP).Materials and Methods: 66 of 94 patients (63.8% males; 65.5±14 years old; 5.2±2.6 months in rehabilitation) agreed to take part. Subjects were grouped in three levels of functionality to guide the exercise prescription. Weekly Training Rates (WTR) were compared using the Friedman test and corrected by Dunn's test. A multivariate logistic model was designed to determine independent predictors in program engagement. Statistical significance was determined by a p<0.05.Results: TOEP provided WTR similar to the pre-quarantine values of 2.8/week (p>0.05), and 91.8% of patients took part until the end of those 5 weeks. The presence of diabetes was a predicted factor for low engagement to TOEP with relative risk of 0.41 (CI95%: 0.25 to 0.66). Conclusion:TOEP provided satisfactory engagement in rehabilitation patients. Most of them increased WTR during quarantine. Patients with diabetes displayed lower engagement to the minimum standard frequency.

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We usually avoid subjects that make us feel uncomfortable. As in general these subjects are those we cannot deal with, the consequences of such omission can be really bad. Problems with our children are classical examples of topics we avoid. Published in 2003, "We Need to Talk About Kevin" is a novel written by Lionel Shriver, adapted to the big screen in 2011. The film addresses the vicious cycle of problems caused by the mother who neglects her child with overt psychopathy, culminating in a catastrophe. In this fiction, avoiding the subject cost the lives of many people.