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ABSTRACT The increase in inflammatory markers associated with persistent chronic fibrosing myocarditis, a characteristic of chronic Chagas disease, can result in a reduction in inspiratory muscle strength (IMS) in Chagas cardiomyopathy (CC). However, literature in this field is still scarce. This review aimed to map and summarize the evidence regarding IMS in patients with CC. The inclusion criteria included reports with adult participants with a CC diagnosis, with or without heart failure (HF). The core concept examined was the maximum inspiratory pressure evaluated in the untrained and trained groups in the pre-training period. The context was open, including but not limited to hospitals and health centers. Two authors independently identified eligible studies and extracted the data. Descriptive synthesis was used as the primary strategy for analyzing the results. Nine studies (five clinical trials, three cross-sectional, and one cohort) were included. The CC classification differed among the studies, with no mention of HF in five and no CC staging specification in six. IMS was assessed using a manovacuometer, and only six studies analyzed and interpreted the data concerning the predicted values. The CC population with HF appeared to have impaired IMS. All studies involved only Brazilian volunteers. In conclusion, randomized clinical trials evaluating IMS and the effects of inspiratory muscle training need to be conducted to better understand the prevalence and risk of inspiratory muscle weakness in the CC population, as well as the effects of training. Such studies should be conducted at different stages of CC in different populations and countries. myocarditis disease (IMS . (CC) However scarce diagnosis HF. (HF) pretraining pre period open centers results crosssectional, crosssectional cross sectional, sectional cross-sectional cohort manovacuometer values volunteers conclusion countries (CC (HF

https://doi.org/10.1590/0037-8682-0389-2023

Guidelines for Trypanosoma cruzi-HIV Co-infection and other Immunosuppressive Conditions: Diagnosis, Treatment, Monitoring, and Implementation from the International Network of Care and Studies - 2023 cruziHIV cruzi HIV Coinfection Co infection Conditions Diagnosis Treatment Monitoring 202 20 2
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Almeida, Eros Antonio de

; Mendes, Fernanda de Souza Nogueira Sardinha

; Ramos Júnior, Alberto Novaes

; Sousa, Andréa Silvestre de

; Pavan, Tycha Bianca Sabaini

; Mediano, Mauro Felippe Felix

; Ostermayer, Alejandro Luquetti

; Hasslocher-Moreno, Alejandro Marcel

; Britto, Constança Felicia De Paoli de Carvalho

; Novaes, Christina Gallafrio

; Correia, Dalmo

; Santos, Fred Luciano Neves

; Silva, Gilberto Marcelo Sperandio da

; Fernandez, Marisa Liliana

; Lima, Mayara Maia

; Carvalho, Noêmia Barbosa de

; Moreira, Otacílio da Cruz

; Albajar-Viñas, Pedro

; Leite, Ruth Moreira

; Palmeira, Swamy Lima

; Costa, Veruska Maia da

; Yasuda, Maria Aparecida Shikanai

Revista da Sociedade Brasileira de Medicina Tropical

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2023, Volume 56 elocation e0549-2023

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.1590/0037-8682-0549-2023

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023 202 20 2
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Marin-Neto, José Antonio

; Rassi Jr, Anis

; Oliveira, Gláucia Maria Moraes

; Correia, Luís Claudio Lemos

; Ramos Júnior, Alberto Novaes

; Luquetti, Alejandro Ostermayer

; Hasslocher-Moreno, Alejandro Marcel

; Sousa, Andréa Silvestre de

; Paola, Angelo Amato Vincenzo de

; Sousa, Antônio Carlos Sobral

; Ribeiro, Antonio Luiz Pinho

; Correia Filho, Dalmo

; Souza, Dilma do Socorro Moraes de

; Cunha-Neto, Edecio

; Ramires, Felix Jose Alvarez

; Bacal, Fernando

; Nunes, Maria do Carmo Pereira

; Martinelli Filho, Martino

; Scanavacca, Maurício Ibrahim

; Saraiva, Roberto Magalhães

; Oliveira Júnior, Wilson Alves de

; Lorga-Filho, Adalberto Menezes

; Guimarães, Adriana de Jesus Benevides de Almeida

; Braga, Adriana Lopes Latado

; Oliveira, Adriana Sarmento de

; Sarabanda, Alvaro Valentim Lima

; Pinto, Ana Yecê das Neves

; Carmo, Andre Assis Lopes do

; Schmidt, Andre

; Costa, Andréa Rodrigues da

; Ianni, Barbara Maria

; Markman Filho, Brivaldo

; Rochitte, Carlos Eduardo

; Macêdo, Carolina Thé

; Mady, Charles

; Chevillard, Christophe

; Virgens, Cláudio Marcelo Bittencourt das

; Castro, Cleudson Nery de

; Britto, Constança Felicia De Paoli de Carvalho

; Pisani, Cristiano

; Rassi, Daniela do Carmo

; Sobral Filho, Dário Celestino

; Almeida, Dirceu Rodrigues de

; Bocchi, Edimar Alcides

; Mesquita, Evandro Tinoco

; Mendes, Fernanda de Souza Nogueira Sardinha

; Gondim, Francisca Tatiana Pereira

; Silva, Gilberto Marcelo Sperandio da

; Peixoto, Giselle de Lima

; Lima, Gustavo Glotz de

; Veloso, Henrique Horta

; Moreira, Henrique Turin

; Lopes, Hugo Bellotti

; Pinto, Ibraim Masciarelli Francisco

; Ferreira, João Marcos Bemfica Barbosa

; Nunes, João Paulo Silva

; Barreto-Filho, José Augusto Soares

; Saraiva, José Francisco Kerr

; Lannes-Vieira, Joseli

; Oliveira, Joselina Luzia Menezes

; Armaganijan, Luciana Vidal

; Martins, Luiz Cláudio

; Sangenis, Luiz Henrique Conde

; Barbosa, Marco Paulo Tomaz

; Almeida-Santos, Marcos Antonio

; Simões, Marcos Vinicius

; Yasuda, Maria Aparecida Shikanai

; Moreira, Maria da Consolação Vieira

; Higuchi, Maria de Lourdes

; Monteiro, Maria Rita de Cassia Costa

; Mediano, Mauro Felippe Felix

; Lima, Mayara Maia

; Oliveira, Maykon Tavares de

; Romano, Minna Moreira Dias

; Araujo, Nadjar Nitz Silva Lociks de

; Medeiros, Paulo de Tarso Jorge

; Alves, Renato Vieira

; Teixeira, Ricardo Alkmim

; Pedrosa, Roberto Coury

; Aras Junior, Roque

; Torres, Rosalia Morais

; Povoa, Rui Manoel dos Santos

; Rassi, Sergio Gabriel

; Alves, Silvia Marinho Martins

; Tavares, Suelene Brito do Nascimento

; Palmeira, Swamy Lima

; Silva Júnior, Telêmaco Luiz da

; Rodrigues, Thiago da Rocha

; Madrini Junior, Vagner

; Brant, Veruska Maia da Costa

; Dutra, Walderez Ornelas

; Dias, João Carlos Pinto

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 6 elocation e20230269

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.36660/abc.20230269

Double Product and Autonomic Function as Predictors of Quality of Life in Heart Transplant Recipients: A Cross-Sectional Study Recipients CrossSectional Cross Sectional
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Rodrigues Junior, Luiz Fernando

; Moreira, Beatriz Robert

; Duque, Alice Pereira

; Oliveira, Juliana Rega de

; Figueiredo, Pedro Henrique Scheidt

; Oliveira, Cláudia Rosa de

; Colafranceschi, Alexandre Siciliano

; Mediano, Mauro Felippe Felix

; Guimarães, Tereza Cristina Felippe

Brazilian Journal of Cardiovascular Surgery

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aug 2022, Volume 37 N. 4 Pages 454 - 465

Abstract: En | Text: En | PDF: En

ABSTRACT Introduction: Heart rate control by the autonomic nervous system (ANS) is impaired in heart transplant (HT) recipients, leading to increased resting heart rate, metabolic demand, and fatigue, which can impair their quality of life (QoL). In this study, we hypothesized the association of hemodynamics and autonomic function as predictors of QoL in HT recipients. Methods: This is a cross-sectional study conducted with HT recipients aged ≥ 18 years at ambulatorial accompaniment. Blood pressure was used for hemodynamics assessment, and heart rate variability (HRV) was used for ANS assessment. QoL was assessed by the 36-item Short Form Health Survey. The significance level was set as P≤0.05. Results: Twenty-two volunteers were included in the study. Systolic blood pressure (SBP) and double product (DP) were significantly negatively associated with the physical functioning domain of QoL. DP, the number of consecutive normal RR interval differences > 50 ms (NN50), and the percentage of normal RR intervals that differed by > 50 ms from the adjacent interval (PNN50) exhibited negative association with the physical role domain. NN50 and PNN50 were significantly associated with bodily pain, social functioning, and emotional role domains. SBP was negatively associated with the vitality domain. Considering general and mental health domains, no variable demonstrated significant association. DP, NN50, and PNN50 were negatively associated with the total score of QoL. Conclusion: This study demonstrated DP and HRV as predictors of QoL in HT recipients. These innovative results can become a relevant therapeutic target for improving QoL in HT recipients prior to its deterioration. Introduction (ANS (HT demand fatigue . (QoL) Methods crosssectional cross sectional 1 accompaniment assessment (HRV 36item item 36 Survey P005 P 0 05 P≤0.05 Results Twentytwo Twenty two (SBP (DP 5 NN , (NN50) PNN (PNN50 NN5 PNN5 pain domains Conclusion deterioration (QoL 3 P00 P≤0.0 (NN50 (PNN5 P0 P≤0. (NN5 (PNN P≤0 (NN P≤

https://doi.org/10.21470/1678-9741-2021-0083

Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center
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Hasslocher-Moreno, Alejandro Marcel

; Sousa, Andréa Silvestre de

; Xavier, Sergio Salles

; Mendes, Fernanda de Souza Nogueira Sardinha

; Nunes, Estevão Portela

; Grinsztejn, Beatriz Gilda Jegerhorn

; Mediano, Mauro Felippe Felix

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0240-2022

Abstract: En | Text: En | PDF: En

ABSTRACT Background: The recent urbanization of Chagas disease (CD) has contributed to a greater risk of coexistence with human immunodeficiency virus (HIV) and AIDS. Methods: This retrospective observational study included patients who were followed at INI-Fiocruz between July 1986 and October 2021. All patients underwent an assessment protocol that included sociodemographic profile, epidemiological history, and clinical evaluation. Descriptive data analyses included reports of the medians and frequencies of variables of interest. Differences in medians between groups were tested using the Mann-Whitney U test. Differences in frequency were tested using Fisher's exact test. Results: Among 2201 patients, 11 (0.5%) were identified with Trypanosoma cruzi/HIV coinfection. Of these, 63.6% were women with a median age of 51.0 years old. Two patients had the indeterminate form of CD, six had the cardiac form, two had the digestive form and one had the cardio-digestive form. Half of the patients were undergoing antiretroviral treatment at the time of coinfection diagnosis with a median CD4+ count of 350 cells/μL and a viral load of 1500 copies/μL. Four patients underwent a xenodiagnosis test at coinfection diagnosis, which all yielded positive results; two of them presented high parasitemia under the risk of reactivation. Prophylaxis for CD reactivation was administered to four patients; two with ketoconazole and two with benznidazole. Six patients died after a median follow-up of 22.5 months, with AIDS being the most common cause of death. Only one case of reactivation was observed. Conclusions: Early diagnosis and prompt treatment of CD reactivation dramatically reduced mortality. Identification of Trypanosoma cruzi/HIV co-infection is crucial to planning a close follow-up of coinfected patients.

https://doi.org/10.1590/0037-8682-0240-2022

Chagas disease mortality during the coronavirus disease 2019 pandemic: A Brazilian referral center experience
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Hasslocher-Moreno, Alejandro Marcel

; Saraiva, Roberto Magalhães

; Silva, Gilberto Marcelo Sperandio da

; Xavier, Sergio Salles

; Sousa, Andréa Silvestre de

; Costa, Andrea Rodrigues da

; Mendes, Fernanda de Souza Nogueira Sardinha

; Mediano, Mauro Felippe Felix

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0562-2021

Abstract: En | Text: En | PDF: En

ABSTRACT Background We investigated the mortality rates of patients with Chagas disease (CD) during the coronavirus disease 2019 (COVID-19) pandemic and assessed the association between this mortality and CD clinical presentation and comorbidities. Methods: This was an observational retrospective study with clinical data retrieved from medical records. Results: Comorbidities were more prevalent among patients who died from COVID-19 than those who died from other causes. The proportion of patients according to CD clinical presentation was similar between the two groups. Conclusions: The prevalence of comorbidities seems to be related to a poorer prognosis in CD and COVID-19.

https://doi.org/10.1590/0037-8682-0562-2021

The health-related quality of life in patients with post-COVID-19 after hospitalization: a systematic review
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Figueiredo, Eduardo Augusto Barbosa

; Silva, Whesley Tanor

; Tsopanoglou, Sabrina Pinheiro

; Vitorino, Débora Fernandes de Melo

; Oliveira, Luciano Fonseca Lemos de

; Silva, Keity Lamary Souza

; Luz, Hiago Daniel Herédia

; Ávila, Matheus Ribeiro

; Oliveira, Lucas Fróis Fernandes de

; Lacerda, Ana Cristina Rodrigues

; Mendonça, Vanessa Amaral

; Lima, Vanessa Pereira

; Mediano, Mauro Felippe Felix

; Figueiredo, Pedro Henrique Scheidt

; Rocha, Manoel Otávio Costa

; Costa, Henrique Silveira

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0741-2021

Abstract: En | Text: En | PDF: En

ABSTRACT Symptoms in post-COVID-19 patients who require hospitalization can persist for months, significantly affecting their health-related quality of life (HRQoL). Thus, the present study aimed to discuss the main findings regarding HRQoL in post-COVID-19 patients who required hospitalization. An electronic search was performed in the MEDLINE, EMBASE, CINAHL, Web of Science, LILACS, and Scopus databases, without date and language restrictions, until July 2021. Twenty-four articles were included in the analysis. It seems that HRQoL partially improved soon after hospital discharge, although the negative impact on HRQoL may persist for months. The physical and mental aspects are affected because patients report pain, discomfort, anxiety, and depression. The HRQoL of COVID-19 infected patients was worse than that of uninfected patients. Additionally, HRQoL seemed worse in patients admitted to the intensive care unit than in those who remained in the ward. Improvements in HRQoL after hospital discharge are independent of imaging improvement, and there seems to be no association between HRQoL after hospital discharge and disease severity on hospital admission. Many factors have been identified as determinants of HRQoL, with women and advanced age being the most related to worse HRQOL, followed by the duration of invasive mechanical ventilation and the need for intensive care. Other factors included the presence and number of comorbidities, lower forced vital capacity, high body mass index, smoking history, undergraduate education, and unemployment. In conclusion, these findings may aid in clinical management and should be considered in the aftercare of patients.

https://doi.org/10.1590/0037-8682-0741-2021

The health-related quality of life in patients with Chagas disease: the state of the art
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Almeida, Igor Lucas Geraldo Izalino de

; Oliveira, Luciano Fonseca Lemos de

; Figueiredo, Pedro Henrique Scheidt

; Oliveira, Rafael Dias de Brito

; Damasceno, Thayrine Rosa

; Silva, Whesley Tanor

; Oliveira, Lucas Frois Fernandes de

; Ávila, Matheus Ribeiro

; Lima, Vanessa Pereira

; Lages, Ana Thereza Chaves

; Mediano, Mauro Felippe Felix

; Rocha, Manoel Otávio Costa

; Costa, Henrique Silveira

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0657-2021

Abstract: En | Text: En | PDF: En

ABSTRACT Chagas disease (CD) is a neglected tropical disease associated with poverty in which patients are surrounded by stigma. These factors can contribute to reducing health-related quality of life (HRQoL). Therefore, a broad discussion of HRQoL in the CD population is required. This study aimed to discuss the main findings of HRQoL in patients with CD, focusing on the association between sociodemographic and lifestyle factors, echocardiographic and functional determinants, and the effect of non-invasive interventions on HRQoL. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed with no data or language restrictions. Twenty-two articles were included in this meta-analysis. In general, HRQoL is worse in patients with CD than in healthy individuals, particularly in the presence of cardiovascular and/or gastrointestinal symptoms. Sex, age, functional class, level of physical activity, healthy habits, and medications received could affect HRQoL. Among the echocardiographic and functional determinants, decreased systolic function seems to negatively affect HRQoL. No association with the peak oxygen uptake was observed in the maximal tests. By contrast, well-tolerated field tests with submaximal intensities were associated with HRQoL. Both pharmaceutical care and exercise training have a positive effect on the HRQoL of patients with Chagas cardiomyopathy, and the mental component can be a prognostic marker in this population. In conclusion, assessment of HRQoL can provide important information about the health status of patients with CD, and its use in clinical practice is warranted.

https://doi.org/10.1590/0037-8682-0657-2021

Environment modification at school to promote physical activity among adolescents: a cluster randomized controlled trial
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Benthroldo, Raycauan Silva

; Paravidino, Vitor Barreto

; Cunha, Diana Barbosa

; Mediano, Mauro Felippe Felix

; Sichieri, Rosely

; Marques, Emanuele Souza

Revista Brasileira de Epidemiologia

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2022, Volume 25 elocation e220019

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO: Objetivo: Avaliar o efeito da modificação do ambiente escolar sobre a atividade física em estudantes adolescentes brasileiros. Métodos: Sete escolas públicas em Duque de Caxias (Brasil) foram aleatorizadas em grupos controle e intervenção. O grupo de intervenção sofreu modificações no ambiente escolar (pintura de quadra esportiva e amarelinhas) e no fornecimento de equipamento esportivo (bolas, tabela de basquete, gol, rede para vôlei e outros) para estimular a atividade física. Além disso, foram pintados passos em direção à quadra e materiais, e foi introduzida uma personagem de super-herói chamada Super Ativa. A atividade física total foi medida com o uso de um questionário validado para adolescentes. Foram utilizados modelos lineares generalizados para avaliar o efeito da intervenção, ajustados por sexo. Resultados: A amostra consistiu em 975 adolescentes, com idade média de 11,52 anos (desvio padrão — DP 1,43) e 56,7% eram meninos. Após a intervenção de um mês, o tempo total de atividade física aumentou em ambos os grupos. Contudo, as mudanças estimadas em relação à linha de base não foram diferentes entre os grupos de intervenção e controle (Δ=102,75 e Δ=99,76, respectivamente; p=0,52). Conclusão: A pintura, o fornecimento de equipamentos e as demais estratégias de estímulo à prática de atividade física no ambiente escolar não promoveram efeito positivo na melhoria da atividade física entre os adolescentes. São necessários estudos futuros para avaliar o efeito da intervenção em longo prazo, particularmente em outros contextos populacionais, em países de média renda.

ABSTRACT: Objective: To assess the effect of modifications of the school environment on physical activity in Brazilian adolescent students. Methods: Seven public schools in Duque de Caxias (Brazil) were randomized into control and intervention groups. The intervention group underwent modifications in the school environment (painting of hopscotch and school courts) and the provision of sports equipment (balls, basketball table, soccer goalpost, volleyball nets, and others) to stimulate physical activity. Additionally, footsteps towards the court and materials were painted, and a superhero character called Super Active was introduced. Total physical activity was measured using a validated questionnaire for adolescents. Generalized linear models were used to evaluate the effect of the intervention, adjusted by sex. Results: The sample consisted of 975 adolescents, with a mean age of 11.52 years (standard deviation — SD 1.43), and 56.7% were boys. After the one-month intervention, both groups’ total physical activity time increased. The estimated changes from baseline were not different between the intervention and control groups (Δ=102.75 and Δ=99.76, respectively; p=0.52). Conclusion: The painting, supply of equipment and other strategies to encourage physical activity in the school environment did not promote a positive effect on improving physical activity among adolescents. Future research is necessary to evaluate the effect of the intervention in the long-term period, particularly in other population contexts in middle-income countries.

https://doi.org/10.1590/1980-549720220019

10.

Health-Related Quality of Life Reported by Patients With Chagas Disease: A Systematic Review of Qualitative Evidence With GRADE Recommendations
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Silva, Whesley Tanor

; Oliveira, Lucas Frois Fernandes

; Xavier, Diego Mendes

; Figueiredo, Pedro Henrique Scheidt

; Lacerda, Ana Cristina Rodrigues

; Mendonça, Vanessa Amaral

; Ávila, Matheus Ribeiro

; Ferreira Júnior, Cláudio Luiz

; Lima, Márcia Maria Oliveira

; Mediano, Mauro Felippe Felix

; Rocha, Manoel Otávio da Costa

; Costa, Henrique Silveira

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0377-2022

Abstract: En | Text: En | PDF: En

ABSTRACT Patients with Chagas disease have reduced health-related quality of life (HRQoL). Hence, we aimed to identify the factors that mostly affected their HRQoL. This was a systematic review of qualitative studies. The Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Web of Science, and SciVerse Scopus databases were searched for relevant studies without language or date restrictions. The search and data analysis were performed by independent reviewers; all qualitative studies that reported the factors that had an impact on the HRQoL of patients with Chagas disease were included. The risk of bias was assessed using the Critical Appraisal Skills Program Qualitative Study Checklist; confidence in the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative approach. Five studies were included in this review: four in Brazil and one in California, United States, with immigrants from Central and South America. The sample consisted of 207 patients with chronic Chagas disease. Stigma, physical limitations, work absenteeism, emotional or mental aspects, fear of treatment, and fear of the future had the strongest impact on the HRQoL. All items showed moderate confidence except for fear of treatment (low confidence). The physical, emotional, mental, and cultural aspects affected the HRQoL of patients with chronic Chagas disease. Identification of these factors is important in the development of strategies aimed at improving the HRQoL of this population.

https://doi.org/10.1590/0037-8682-0377-2022

11.

Physical Exercise, Energy Expenditure and Weight Loss: An Assumption not Always Observed in Practice Exercise Loss
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Paravidino, Vitor Barreto

; Mediano, Mauro Felippe Felix

; Sichieri, Rosely

International Journal of Cardiovascular Sciences

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dec 2021, Volume 34 N. 6 Pages 734 - 736

Abstract: En | Text: En | PDF: En

https://doi.org/10.36660/ijcs.20200090

12.

Temporal changes in the clinical-epidemiological profile of patients with Chagas disease at a referral center in Brazil
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Hasslocher-Moreno, Alejandro Marcel

; Saraiva, Roberto Magalhaes

; Brasil, Pedro Emmanuel Alvarenga Americano do

; Sangenis, Luiz Henrique Conde

; Xavier, Sergio Salles

; Sousa, Andréa Silvestre de

; Sperandio-da-Silva, Gilberto Marcelo

; Mendes, Fernanda de Souza Nogueira Sardinha

; Costa, Andréa Rodrigues da

; Holanda, Marcelo Teixeira de

; Veloso, Henrique Horta

; Mazzoli-Rocha, Flavia

; Carneiro, Fernanda Martins

; Portela, Luciana Fernandes

; Mediano, Mauro Felippe Felix

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e0040-2021

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION We aimed to describe the sociodemographic, epidemiological, and clinical characteristics of patients with chronic Chagas disease (CD) at an infectious disease referral center. Changes in patient profiles over time were also evaluated. METHODS This retrospective study included patients with CD from November 1986-December 2019. All patients underwent an evaluation protocol that included sociodemographic profile; epidemiological history; anamnesis; and physical, cardiologic, and digestive examinations. Trend differences for each 5-year period from 1986 to 2019 were tested using a nonparametric trend test for continuous and generalized linear models with binomial distribution for categorical variables. RESULTS A total of 2,168 patients (52.2% women) were included, with a mean age of 47.8 years old. White patients with low levels of education predominated. The reported transmission mode was vectorial in 90.2% of cases. The majority came from areas with a high prevalence (52.2%) and morbidity (67.8%) of CD. The most common clinical presentation was the indeterminate form (44.9%). The number of patients referred gradually decreased and the age at admission increased during the study period, as did the patients’ levels of education. CONCLUSIONS The clinical profile of CD is characterized by a predominance of the indeterminate form of the disease. Regarding the patients who were followed up at the referral center, there was a progressive increase in the mean age and a concomitant decrease in the number of new patients. This reflects the successful control of vector and transfusion transmission in Brazil as well as the aging population of patients with CD.

https://doi.org/10.1590/0037-8682-0040-2021 158 downloads

13.

Functional capacity and rehabilitation strategies in Covid-19 patients: current knowledge and challenges
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Frota, Aline Xavier

; Vieira, Marcelo Carvalho

; Soares, Carla Cristiane Santos

; Silva, Paula Simplício da

; Silva, Gilberto Marcelo Sperandio da

; Mendes, Fernanda de Souza Nogueira Sardinha

; Mazzoli-Rocha, Flavia

; Veloso, Henrique Horta

; Costa, Ananda Dutra da

; Lamas, Cristiane da Cruz

; Valete-Rosalino, Claudia Maria

; Gonçalves, Tatiana Rehder

; Costa, Henrique Silveira

; Rodrigues Junior, Luiz Fernando

; Mediano, Mauro Felippe Felix

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e07892020

Abstract: En | Text: En | PDF: En

Abstract Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.

https://doi.org/10.1590/0037-8682-0789-2020 4144 downloads

14.

Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges
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Costa, Henrique Silveira

; Lima, Márcia Maria Oliveira

; Figueiredo, Pedro Henrique Scheidt

; Lima, Vanessa Pereira

; Ávila, Matheus Ribeiro

; Menezes, Kenia Kiefer Parreiras de

; Mendonça, Vanessa Amaral

; Lacerda, Ana Cristina Rodrigues

; Nunes, Maria Carmo Pereira

; Mediano, Mauro Felippe Felix

; Rocha, Manoel Otávio da Costa

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20200100

Abstract: En | Text: En | PDF: En

Abstract Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.

https://doi.org/10.1590/0037-8682-0100-2020 1043 downloads

15.

Adverse drug events and the associated factors in patients with chronic Chagas disease
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Lopes, Luiza Braz da Cunha

; Pereira, Raquel Rodrigues

; Andrade, Patricia Mello

; Carneiro, Fernanda Martins

; Mediano, Mauro Felippe Felix

; Kilgore, Sophia Isabel Linnemann

; Hasslocher-Moreno, Alejandro Marcel

; Sousa, Andréa Silvestre de

; Oliveira, Manoel Marques Evangelista

; Saraiva, Roberto Magalhães

; Holanda, Marcelo Teixeira de

; Silva, Gilberto Marcelo Sperandio da

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20190443

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: Herein, we aimed to identify the factors associated with adverse drug events (ADEs) in chronic Chagas disease (CD) patients. METHODS: We analyzed 320 medical notes from 295 patients. The Naranjo algorithm was applied to determine the cause of ADEs. Mixed effects logistic regression was performed to evaluate the factors associated with ADEs. RESULTS: ADEs were described in 102 medical notes (31.9%). Captopril was most frequently associated with ADEs. Age (RR 0.96; 95%CI 0.94-0.99) and cardiac C/D stages (RR 3.24; 95%CI 1.30-4.58) were the most important clinical factors associated with ADEs. CONCLUSIONS: Close follow-up is warranted for CD patients.

https://doi.org/10.1590/0037-8682-0443-2019 452 downloads

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