ABSTRACT Objective: To investigate the association between body mass index (BMI), obesity, clinical outcomes, and mortality following coronary artery bypass grafting (CABG) in Brazil using a large sample with one year of follow-up from the Brazilian Registry of Cardiovascular Surgeries in Adults (or BYPASS) Registry database. Methods: A multicenter cohort-study enrolled 2,589 patients submitted to isolated CABG and divided them into normal weight (BMI 20.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obesity (BMI > 30.0 kg/m2) groups. Inpatient postoperative outcomes included the most frequently described complications and events. Collected post-discharge outcomes included rehospitalization and mortality rates within 30 days, six months, and one year of follow-up. Results: Sternal wound infections (SWI) rate was higher in obese compared to normal-weight patients (relative risk [RR]=5.89, 95% confidence interval [CI]=2.37-17.82; P=0.001). Rehospitalization rates in six months after discharge were higher in obesity and overweight groups than in normal weight group (χ2=6.03, P=0.049); obese patients presented a 2.2-fold increase in the risk for rehospitalization within six months compared to normal-weight patients (RR=2.16, 95% CI=1.17-4.09; P=0.045). Postoperative complications and mortality rates did not differ among groups during time periods. Conclusion: Obesity increased the risk for SWI, leading to higher rehospitalization rates and need for surgical interventions within six months following CABG. Age, female sex, and diabetes were associated with a higher risk of mortality. The obesity paradox remains controversial since BMI may not be sufficient to assess postoperative risk in light of more complex and dynamic evaluations of body composition and physical fitness. Objective BMI, , (BMI) (CABG followup follow up or BYPASS database Methods cohortstudy cohort study 2589 2 589 2,58 20.024.9 200249 20.0 24.9 20 0 24 9 20.0-24. kg/m2, kgm2 kgm kg/m2 kg m2 m 25.029.9 250299 25.0 29.9 25 29 25.0-29. 300 30. events postdischarge post 3 days followup. up. Results SWI (SWI normalweight relative RR=5.89, RR589 RR =5.89, 5 89 [RR]=5.89 95 CI=2.3717.82 CI2371782 CI =2.37 17.82 37 17 82 [CI]=2.37-17.82 P=0.001. P0001 P P=0.001 . 001 P=0.001) χ2=6.03, χ2603 χ χ2 6 03 (χ2=6.03 P=0.049 P0049 049 P=0.049) 2.2fold 22fold fold 2.2 RR=2.16, RR216 16 (RR=2.16 CI=1.174.09 CI117409 CI=1.17 4.09 1 4 09 CI=1.17-4.09 P=0.045. P0045 P=0.045 045 P=0.045) periods Conclusion Age sex fitness 258 58 2,5 024 20.024. 20024 200 20. 249 24. 20.0-24 kg/m 029 25.029. 25029 250 25. 299 29. 25.0-29 RR=5.89 RR58 =5.89 8 [RR]=5.8 3717 CI=2.3717.8 CI237178 237 =2.3 1782 17.8 [CI]=2.37-17.8 P000 P=0.00 00 χ2=6.03 χ260 (χ2=6.0 P=0.04 P004 04 2fold 22 2. RR=2.16 RR21 (RR=2.1 174 CI=1.174.0 CI11740 CI117 CI=1.1 409 4.0 CI=1.17-4.0 2, 02 20.024 2002 20.0-2 25.029 2502 25.0-2 RR=5.8 RR5 =5.8 [RR]=5. 371 CI=2.3717. CI23717 23 =2. 178 17. [CI]=2.37-17. P00 P=0.0 χ2=6.0 χ26 (χ2=6. RR=2.1 RR2 (RR=2. CI=1.174. CI1174 CI11 CI=1. 40 4. CI=1.17-4. 20.02 20.0- 25.02 25.0- RR=5. =5. [RR]=5 CI=2.3717 CI2371 =2 [CI]=2.37-17 P0 P=0. χ2=6. (χ2=6 RR=2. (RR=2 CI=1.174 CI1 CI=1 CI=1.17-4 RR=5 =5 [RR]= CI=2.371 CI237 = [CI]=2.37-1 P=0 χ2=6 (χ2= RR=2 (RR= CI= CI=1.17- RR= [RR] CI=2.37 CI23 [CI]=2.37- P= χ2= (χ2 (RR [RR CI=2.3 CI2 [CI]=2.37 (χ CI=2. [CI]=2.3 CI=2 [CI]=2. [CI]=2 [CI]= [CI] [CI

RESUMO A doença pulmonar obstrutiva crônica (DPOC) é altamente limitante, tanto nos aspectos físicos, quanto socioemocionais, causando dificuldades significativas no cotidiano dos pacientes. Além de afetar os pacientes, a DPOC também influência na vida dos familiares e amigos próximos, pois deles vem a rede de apoio de que os pacientes necessitam. O objetivo deste artigo é avaliar a funcionalidade da família no cotidiano de pacientes acometidos por DPOC. É um estudo transversal que avaliou a funcionalidade de família de pacientes com DPOC em diferentes estágios da doença e que realizam Programa Reabilitação Cardiorrespiratória (PRC). Utilizou-se o instrumento APGAR de Família, sendo este, um acrônimo caracterizado por A = (Adaptation/Adaptação), P = (Partnership/Companheirismo), G = (Grow/Desenvolvimento), A = (Affection/Afetividade), R = (Resolve/Capacidade resolutiva), composto por 5 questões avaliadas em “sempre”, “algumas vezes” e “nunca”, o que somados resultam em “elevada disfunção familiar”, moderada disfunção familiar” e “boa funcionalidade familiar”. Foram avaliados 21 pacientes DPOC [sexo masculino (n=11; 52,3%); idade média 66,3±10 anos], com estadiamento entre moderado a muito severo. Através do APGAR da Família identificamos 2 pacientes com elevada disfunção familiar; 2 pacientes com moderada disfunção familiar; 17 pacientes com boa funcionalidade familiar. Dos que relataram elevada e moderada disfunção familiar, os acrômios mais comprometidos foram “companheirismo”, “afetividade” e “desenvolvimentos”. O grau de obstrução das vias áreas associou-se moderada e positivamente com a funcionalidade da família (r = 0,697; p = 0,004). Pacientes com DPOC participantes do PRC apresentaram boa funcionalidade familiar no seu cotidiano e a gravidade da doença esteve associada a esta funcionalidade. Pacientes que apresentaram maior disfunção familiar relataram falta de “companheirismo”, “afetividade” e “desenvolvimentos”.

ABSTRACT Background: Chronic Obstructive Pulmonary Disease (COPD) is highly limiting, both physically and socio-emotionally, causing significant difficulties in the daily lives of patients. In addition, COPD also influences the lives of family and friends, because theirs who come to the support network that patient need. Objective: To evaluate the family functionality in the daily life of COPD patients. Methods: This cross-sectional study evaluated the family functionality in COPD patients with different stages of disease and underwent Cardiorespiratory Rehabilitation Program (CRP). The Family APGAR instrument was used and it is an acronym characterized by A = (Adaptation / Adaptation), P = (Partnership / Companionship), G = (Grow / Development), A = (Affection / Affectivity), R = (Resolve / Resolving capacity), composed of 5 questions assessed in “always”, “sometimes” and “never”, which together result in “high family dysfunction”, moderate family dysfunction “and” good family functionality”. We evaluated 21 COPD patients [male gender (n = 11; 52.3%); mean age 66.3 ± 10 years], status disease between moderate to very severe. Through of the Family APGAR we identified 2 patients with high family dysfunction; 2 patients with moderate family dysfunction; 17 patients with good family functionality. Among those who reported high and moderate family dysfunction, the most compromised acromia’s were “companionship”, “affection” and “developments”. The degree of airway obstruction was moderately and positively associated with family functionality (r = 0.697; p = 0.004). Patients with COPD who participated in CRP had good family functionality in their daily lives and the severity of the disease was associated with this functionality. Patients with high family dysfunction reported lack of “companionship”, “affection” and “developments”.

RESUMEN La enfermedad pulmonar obstructiva crónica (EPOC) es muy limitante, tanto en aspectos físicos como socioemocionales, causando dificultades significativas en la vida diaria de los pacientes. Además de afectar a los pacientes, la EPOC también influye en la vida de los familiares y amigos cercanos, ya que de ellos proviene la red de apoyo que los pacientes necesitan. El objetivo de este artículo es evaluar la funcionalidad de la familia en la vida cotidiana de los pacientes afectados por EPOC. Se trata de un estudio transversal que evaluó la funcionalidad familiar de pacientes con EPOC en diferentes etapas de la enfermedad y que realizan un Programa de Rehabilitación Cardiaca (PRC). Se utilizó el instrumento APGAR familiar, que es un acrónimo caracterizado por A = (Adaptation/Adaptación), P = (Partnership/Compañerismo), G = (Grow/Desarrollo), A = (Affection/Afectividad), R = (Resolve/Capacidad de resolución), compuesto por 5 preguntas evaluadas en “siempre”, “a veces” y “nunca”, que combinadas resultan en “disfunción familiar severa”, “disfunción familiar moderada” y “buena funcionalidad familiar”. Se evaluaron 21 pacientes con EPOC [sexo masculino (n=11; 52,3%); edad media 66,3±10 años], con una estadificación que varía de moderada a muy grave. A través del APGAR familiar identificamos 2 pacientes con severa disfunción familiar; 2 pacientes con disfunción familiar moderada; 17 pacientes con buena funcionalidad familiar. De los que relataron disfunción familiar severa y moderada, los acrónimos más comprometidos fueron “compañerismo”, “afectividad” y “desarrollo”. El grado de obstrucción de las vías se asoció moderada y positivamente con la funcionalidad de la familia (r=0,697; p=0,004). Los pacientes con EPOC que participaron en el PCR presentaron una buena funcionalidad familiar en su vida diaria y la gravedad de la enfermedad se asoció a esta funcionalidad. Los pacientes que presentaron mayor disfunción familiar relataron falta de “compañerismo”, “afectividad” y “desarrollo”.

Abstract Aim: to evaluate the acute effects of expiratory positive airway pressure on cardiac autonomic modulation in chronic obstructive pulmonary disease patients during spontaneous breathing and slow deep breathing. Methods: 17 patients were evaluated. The R-R intervals were collected (Polar® S810i) during spontaneous breathing (10 minutes) and slow deep breathing (4 minutes), with and without 5 cmH2O expiratory positive airway pressure. Stable signals were analyzed by Kubios®. Heart rate variability indices were computed in time domain and in frequency domain. Results: Expiratory positive airway pressure application affected low frequency (spontaneous breathing: 62.5±4.1 vs slow deep breathing: 28.2±4.2, p<0.001) and high frequency (spontaneous breathing: 37.4±17.3 vs slow deep breathing: 58.9±18.1, p<0.001). Interactions were observed between expiratory positive airway pressure effect and slow deep breathing effect for low frequency (p<0.001), high frequency (p<0.001) and low frequency/high frequency ratio (p<0.001). When patients were stratified by disease’s severity, we identified a significant low frequency reduction (p<0.001) and high frequency increase (p<0.001) for all stages when slow deep breathing was associated with expiratory positive airway pressure. Conclusion: A 5 cmH2O expiratory positive airway pressure during spontaneous and slow deep breathing can elicit an acute response, resulting in a cardiac autonomic control improvement in moderate-to-very severe patients.

RESUMO Objetivo Estabelecer ponto de corte entre as variáveis clínicas e funcionais para avaliar a prevalência de sarcopenia e dinapenia em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC), além de analisar o impacto da Disfunção Muscular Esquelética (DME) nestas variáveis. Métodos Realizado estudo transversal com pacientes diagnosticados com DPOC para determinar sarcopenia ou dinapenia por meio do índice de baixa massa muscular e Força de Preensão Palmar (FPP). Avaliadas a função pulmonar, força muscular respiratória e capacidade funcional (CF). A precisão das variáveis na determinação dos pontos de corte previstos para as doenças em questão foi obtida a partir da curva Receiver Operating Characteristic (ROC) e de uma análise bidirecional da variância. Resultados Ao final da análise, obtiveram-se 20 pacientes com DPOC estratificados por sarcopenia (n = 11) e dinapenia (n = 07). O grupo com sarcopenia apresentou menor massa magra e menor pressão inspiratória máxima (PImáx), diminuição da Força de Preensão Palmar (FPP) e redução da CF (p<0,050). O grupo com dinapenia apresentou redução da PImáx, menor FPP e menor distância percorrida no teste Incremental Shuttle Walk (ISWT) (p<0,050). Foram encontrados pontos de corte no Volume Expiratório Forçado (VEF1) durante o primeiro segundo na PImáx, na Pressão Expiratória Máxima (PEmáx) e no ISWT, o que possibilitou identificar sarcopenia ou dinapenia nestes pacientes. A partir destes resultados, foi possível encontrar coexistência das condições (efeito DME) na DPOC: redução da distância no ISWT (p = 0,002) e % ISWT (p = 0,017). Conclusões Em pacientes com DPOC moderada a muito grave, a sarcopenia pode ser prevista pelo VEF1 (% previsto) <52, PImáx <73 cm H2O, PEmáx <126 cm H2O e distância percorrida de <295 metros no ISWT. Já a dinapenia pode ser prevista pelo VEF1 <40%, PImáx <71 cm H2O, PEmáx <110 cm H2O e distância de <230 metros percorrida no ISWT.

ABSTRACT Objective To establish a cut-off point for clinical and functional variables to determinate sarcopenia and dynapenia in COPD patients, and to analyze the impact of skeletal muscle dysfunction (SMD) on these variables. Methods Cross-sectional study, screened COPD patients for sarcopenia or dynapenia through low muscle mass and hand grip strength (HGS). Clinical variables: pulmonary function, respiratory muscle strength and functional capacity (FC). The precision of the variables in determining points of predictive cut-off for sarcopenia or dynapenia were performed using the Receiver Operating Characteristic curve and two-way analysis of variance. Results 20 COPD patients stratified for sarcopenia (n = 11) and dynapenia (n = 07). Sarcopenia group presented lower lean mass and lower maximal inspiratory pressure (MIP), decreased HGS, reduced FC (p<0.050). Dynapenia group presented reduced MIP, lower HGS and walked a shorter distance at Incremental shuttle walk test (ISWT) (p<0.050). We found cut-off points of forced expiratory volume in one second (FEV1), MIP and maximal expiratory pressure (MEP) and ISWT. It is possible to identify sarcopenia or dynapenia in these patients. We found the coexistence of the conditions (SMD effect) in COPD – reduction in the distance in the ISWT (p = 0.002) and %ISWT (p = 0.017). Conclusion In moderate to very severe COPD patients the sarcopenia could be predicted by FEV1 (%predicted) < 52, MIP < 73 cmH2O, MEP < 126 cmH2O and distance traveled of < 295 m in ISWT. Whereas dynapenia could be predicted by FEV1 < 40%, MIP < 71 cmH2O, MEP < 110 cmH2O and distance of < 230 m traveled in ISWT.

Resumo Contexto A doença pulmonar obstrutiva crônica (DPOC) apresenta uma complexa fisiopatologia e sua compreensão vem se modificando nos últimos anos, com atenção para as manifestações multissistêmicas, em especial a disfunção periférica e sua influência na intolerância ao exercício físico. Objetivo Avaliar o impacto da doença arterial periférica obstrutiva (DAOP) na força muscular periférica e na capacidade de exercício dos portadores de DPOC. Métodos Estudo transversal realizado com 35 portadores de DPOC, que foram avaliados pelo índice tornozelo-braquial, teste de força de preensão palmar (FPP), uma repetição máxima (1RM) de extensores e flexores de joelho, e a distância no incremental shuttle walking test (dISWT). Resultados Portadores de DPOC com DAP coexistente apresentaram menor FPP da mão dominante (33,00 versus 26,66 kgf, p = 0,02) e pior desempenho no dISWT (297,32 versus 219,41 m, p = 0,02) quando comparados aos portadores de DPOC sem DAP. Fortes correlações foram encontradas entre a medida da FPP e a dISWT (r = 0,78; p < 0,001) e a 1RM/extensão de joelho (r = 0,71; p = 0,03); entre a dISWT e a 1RM/extensão de joelho (r = 0,72; p = 0,02) e a 1RM/flexão de joelho (r = 0,92; p < 0,001). O modelo de regressão linear identificou que a variável dISWT explica isoladamente 15,3% do resultado do índice tornozelo braquial (p = 0,01). Conclusão Portadores de DPOC com DAOP coexistente apresentam maior perda da força muscular periférica e pior desempenho da capacidade de exercício quando comparados aos portadores de DPOC sem DAOP.

Abstract Background The pathophysiology of chronic obstructive pulmonary disease (COPD) is complex and understanding of it has been changing in recent years, with regard to its multisystemic manifestations, especially peripheral dysfunction and its influence on intolerance to exercise. Objectives To evaluate the relationship between peripheral arterial occlusive disease (PAOD) and peripheral muscle strength and exercise capacity in COPD patients. Methods We conducted a cross-sectional study of 35 patients with COPD who were evaluated with the Ankle-Brachial Index, handgrip strength test, 1 repetition maximum (1RM) of knee extensors and flexors, and distance covered in the incremental shuttle walking test (dISWT). Results COPD patients with coexisting PAOD had lower dominant handgrip strength test results (33.00 vs. 26.66 kgf, p = 0.02) and worse performance in the dISWT (297.32 vs. 219.41 m, p = 0.02) when compared to the COPD patients without PAOD. Strong correlations were found between the result of the handgrip strength test and both the dISWT (r = 0.78; p < 0.001) and the 1RM/knee extension (r = 0.71; p = 0.03); and also between the dISWT and both the 1RM/knee extension (r = 0.72; p = 0.02) and the 1RM/knee flexion (r = 0.92; p < 0.001). The linear regression model showed that the dISWT variable alone explains 15.3% of the Ankle-Brachial Index result (p = 0.01). Conclusion COPD patients with PAOD exhibit reduced muscle strength and lower exercise capacity than COPD patients without PAOD.

Background: Portable respiratory inductive plethysmography (RIP) systems have been validated for ventilatory assessment during resting conditions and during incremental treadmill exercise. However, in clinical settings and during field-based exercise, intensity is usually constant and submaximal. A demonstration of the ability of RIP to detect respiratory measurements accurately during constant intensity conditions would promote and validate the routine use of portable RIP devices as an alternative to ergospirometry (ES), the current gold standard technique for ventilatory measures. Objective: To investigate the agreement between respiratory variables recorded by a portable RIP device and by ES during rest and constant intensity exercise. Method: Tidal volume (VT), respiratory rate (RR) and minute ventilation (VE) were concurrently acquired by portable RIP and ES in seven healthy male volunteers during standing rest position and constant intensity treadmill exercise. Results: Significant agreement was found between RIP and ES acquisitions during the standing rest position and constant intensity treadmill exercise for RR and during the standing rest position for VE. Conclusion: Our results suggest that portable RIP devices might represent a suitable alternative to ES during rest and during constant submaximal exercise.