Congenital heart disease promotes hemodynamic changes that can contribute to reduce exercise capacity. The aim of the study was to evaluate the exercise capacity of children and adolescents with cyanotic congenital heart disease and to assess respiratory muscle strength, plasma levels of B-type natriuretic peptide and ventricular ejection fraction, as well the associations between these variables. Cross-sectional study that evaluated 48 patients between 6 and 18 years-old that underwent a six-minute walk test (6MWT), respiratory muscle strength, dosage of B-type natriuretic peptide and echocardiography. The mean age was 13.3 ± 4.1 years, and the most prevalent heart disease was tetralogy of Fallot (54.2 %). The average distance walked was 452.7 ± 73.2 m, significantly below the predicted (69 %) (p < 0.001). The maximum inspiratory pressure was above the predicted result (111.4 %), average 58.2 ± 22.3 (p = 0.56), and the maximum expiratory pressure was 63.2 ± 23.3 cm H2O, significantly below the predicted (63 %) (p < 0.001). The level of B-type natriuretic peptide was elevated in all patients, with a median of 2087.17 (502.54-4,768.05). The ventricular ejection fraction showed a median of 65.9 (41-100). There was no correlation between the 6MWT, ventricular ejection fraction (r = -0.05; p = 0.72), inspiratory muscle strength (r = 0.03; p = 0.81), expiratory muscle strength (r = 0.09; p = 0.05) and B-type natriuretic peptide (r = -0.04; p = 0.77). Children and adolescents with cyanotic congenital heart disease present a lower exercise capacity and expiratory muscle strength. No associations were found between exercise capacity, respiratory muscle strength, B-type natriuretic peptide and left ventricular ejection fraction.

Patients with severe COVID-19 may have endothelial dysfunction and a hypercoagulable state that can cause skin damage. In the presence of external pressure on the tissues, the local inflammatory process regulated by inflammatory cytokines can increase and prolong itself, contributing to the formation of pressure injury (PI). PI is defined as localized damage to the skin or underlying tissues. It usually occurs as a result of intense and/or prolonged pressure in combination with shear. The aim of the study is to perform a narrative review on the physiological evidence of increased risk in the development of PI in critically ill patients with COVID-19.In patients with severe COVID-19 a pattern of tissue damage consistent with complement-mediated microvascular injury was found in the lungs and skin of critically ill COVID-19 patients, suggesting sustained systemic activation of complement pathways. Theoretically, the same thrombogenic vascular changes related to COVID-19 that occur in the skin also occur in the underlying tissues, making patients less tolerant to the harmful effects of pressure and shear. Unlike the syndromes typical of acute respiratory illnesses and other pathologies that commonly lead to intensive care unit admission, COVID-19 and systemic viral spread show that local and systemic factors overlap. This fact may be justified by current epidemiological data showing that the prevalence of PI among intensive care unit patients with COVID-19 was 3 times higher than in those without COVID-19. This narrative review presents physiological evidence to suggesting an increased risk of developing PI in critically ill patients with COVID-19.Abbreviations: ACE2 = angiotensin-converting enzyme 2, AP = alternative complement pathway, ARDS = acute respiratory distress syndrome, C4d = complement component 4d, C5b-9 = complement membrane attack complex, CoVs = coronaviruses, ECM = extracellular matrix, eNOS = endothelial nitric oxide sintetase, ICU = intensive care unit, IL-1 = interleukin-1, IL-10 = interleukin-10, IL-1alpha = interleukin-1alpha, IL-1beta = interleukin-1beta, IL-6 = interleukin-6, LP = lectin complement pathway, MASP-2 = mannose-binding protein-associated serine protease 2, MBL = mannose-binding lectin, NOX2 = NADPH oxidase 2, PAI-1 = plasminogen activator inhibitor 1, PI = pressure injury, PubMed = Public Medline, RAAS = renin-angiotensin-aldosterone system, SARS-CoV = severe acute respiratory syndrome-related coronavirus, SciELO = Scientific Electronic Library Online, TNF-alpha = alpha tumor necrosis factor.

Objective: To evaluate the physical activity level and functional capacity of children and adolescents with congenital heart disease and to describe correlations between functionality, surgical and echocardiographic findings, metabolic and inflammatory profile and differences between acyanotic and cyanotic heart defects.Methods: A cross-sectional study including children and adolescents with congenital heart disease between six and 18 years old that were evaluated with the 6-minute walk test (6MWT) to assess functional capacity. The short version form of the International Physical Activity Questionnaire (IPAQ) was performed to evaluate physical activity levels. Also, echocardiography and blood collection, to evaluate the metabolic (blood glucose, lipids, insulin) and inflammatory markers (C-reactive protein), were assessed.Results: Twenty-five individuals were evaluated. Of them, 14 had acyanotic heart defects and 11 cyanotic heart defects. Mean age was 12.0±3.7 years, and 20 (80%) were male. IPAQ showed that six (24%) individuals were very active, eight (32%) were active, nine (36%) had irregular physical activity, and two (8%) were sedentary. The mean distance walked in the 6MWT, considering all studied individuals, was 464.7±100.4 m, which was 181.4±42.0 m less than the predicted (p=0.005). There was a positive correlation between Z score 6MWT and the number of surgical procedures (r=-0.455; p=0.022).Conclusions: Children and adolescents with congenital heart disease have low functional capacity, but they are not completely sedentary.

Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital's emergency department with irregular heart rhythm and palpitations.

Introdução: A taxa de depuração pulmonar do 99mTcDTPA constitui um índice da permeabilidade pulmonar. A aplicação da pressão positiva expiratória (EPAP), um recurso fisioterapêutico, promove aumento da expansão pulmonar, entretanto são escassos os estudos abordando a associação entre o tempo de aplicação deste recurso e a permeabilidade pulmonar. Objetivo: Comparar o tempo de depuração pulmonar do 99mTc-DTPA no 15º e 30º minuto de aplicação da EPAP nas pressões de 10 e 15 cmH2O. Hipotetiza-se que a aplicação de apenas 15 minutos da técnica já poderia influenciar positivamente o aumento do volume pulmonar. Material e métodos: Mensurou-se a taxa de depuração pulmonar do 99mTc-DTPA na posição sentada em indivíduos hígidos (n = 20) respirando sob o efeito de 10 e 15 cmH2O de EPAP, após avaliou-se o comportamento do T1/2 no 15º e 30º minuto. Resultados: Observou-se o aumento da taxa de depuração quando 15 cmH2O de EPAP foi aplicada (p = 0,012), porém não houve alteração com 10 cmH2O (p = 0,064). Não houve diferença estatisticamente significativa no T1/2 do 99mTc-DTPA do 15º minuto (p = 0,182) para o 30º (p = 0,489). Conclusão: Os resultados demonstraram o efeito de 15 cmH2O da EPAP no aumento da depuração pulmonar do 99mTc-DTPA sugerindo não haver diferença entre o 15º e 30º minuto.Palavras-chave: barreira alveolocapilar, pentetato de tecnécio Tc 99m, respiração com pressão positiva.