ABSTRACT OBJECTIVE To update the estimated cost of physical inactivity for the Brazilian Unified Health System (SUS). METHODS The hospitalization costs were accessed via a database of the Ministry of Health – Informatics Department of the Brazilian SUS. Physical inactivity for the year 2017 was accessed via the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel – Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey). Seven chronic non-communicable diseases (NCD) were selected via the international classification of disease (ICD-10). The population fraction attributable to physical inactivity was calculated based on relative risk reported in previous studies and the prevalence of physical inactivity. RESULTS In 2017, the seven NCD considered in the analysis were responsible for 154,017 hospital admissions in adults older than 40 years old, residing in the state capitals and the Federal District, which corresponded to 6.5% of hospitalizations and 10.6% of SUS costs at an estimated US$ 112,524,914.47. Considering the group of individuals with insufficient physical activity in their leisure time, the percentage cost attributed to physical inactivity reached 17.4% of the estimated costs with NCD. At a national level, NCD were responsible for approximately 740 thousand hospitalizations, costing US$ 482 million, from which 17.4%, US$ 83 million were attributed to physical inactivity. CONCLUSION This study provides evidence to conclude that physical inactivity exerts an economic impact on the SUS due to NCD hospitalization. Physical inactivity is a modifiable lifestyle and compelling evidence, including that of this article, supports the promotion of a more active community as one of the major targets of public health care policies. . (SUS) 201 Vigitel Survey. Survey Survey) noncommunicable non communicable (NCD ICD10. ICD10 ICD 10 (ICD-10) 154017 154 017 154,01 4 old District 65 6 5 6.5 106 10.6 US 11252491447 112 524 914 47 112,524,914.47 time 174 17 17.4 level 74 48 8 article policies (SUS 20 ICD1 1 (ICD-10 15401 15 01 154,0 6. 10. 1125249144 11 52 91 112,524,914.4 17. 7 2 (ICD-1 1540 0 154, 112524914 9 112,524,914. (ICD- 11252491 112,524,914 (ICD 1125249 112,524,91 112524 112,524,9 11252 112,524, 1125 112,524 112,52 112,5 112,

ABSTRACT OBJECTIVE To update the estimated cost of physical inactivity for the Brazilian Unified Health System (SUS). METHODS The hospitalization costs were accessed via a database of the Ministry of Health – Informatics Department of the Brazilian SUS. Physical inactivity for the year 2017 was accessed via the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel – Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey). Seven chronic non-communicable diseases (NCD) were selected via the international classification of disease (ICD-10). The population fraction attributable to physical inactivity was calculated based on relative risk reported in previous studies and the prevalence of physical inactivity. RESULTS In 2017, the seven NCD considered in the analysis were responsible for 154,017 hospital admissions in adults older than 40 years old, residing in the state capitals and the Federal District, which corresponded to 6.5% of hospitalizations and 10.6% of SUS costs at an estimated US$ 112,524,914.47. Considering the group of individuals with insufficient physical activity in their leisure time, the percentage cost attributed to physical inactivity reached 17.4% of the estimated costs with NCD. At a national level, NCD were responsible for approximately 740 thousand hospitalizations, costing US$ 482 million, from which 17.4%, US$ 83 million were attributed to physical inactivity. CONCLUSION This study provides evidence to conclude that physical inactivity exerts an economic impact on the SUS due to NCD hospitalization. Physical inactivity is a modifiable lifestyle and compelling evidence, including that of this article, supports the promotion of a more active community as one of the major targets of public health care policies.

Resumo Fundamentos: Poucos estudos utilizaram analisadores de gases portáteis no teste da caminhada de seis minutos (T6m) em portadores de insuficiência cardíaca com fração de ejeção normal (ICFEN). Objetivos: Analisar a cinética das variáveis hemodinâmicas, ventilatórias e metabólicas utilizando analisador de gases portátil em portadores de ICFEN durante o T6m. Métodos: Estudo prospectivo, analítico, com amostra não probabilística, intencional e por conveniência. Foram estudados 24 pacientes portadores de ICFEN com passado de internação por clínica de insuficiência cardíaca (IC), incluídos pelos critérios da European Society of Cardiology 2007. Realizaram-se três avaliações: T6m de aprendizado, T6m com o analisador de gases portátil e teste de esforço cardiopulmonar (TECP). Resultados: As frequências cardíacas (FC) e o consumo de oxigênio (VO2) pico ao final do T6m corresponderam a 85,7% e 86,45% dos valores obtidos no TECP. As FC finais no T6m foram equivalentes às obtidas no limiar anaeróbio (LA) do TECP, com valores de VO2 relativo ao final do T6m acima do VO2 no LA do TECP. Não houve diferença entre os valores máximos do quociente respiratório (QR) entre os dois testes, ambos acima de 1,0. A curva de VE/VO2 demonstrou descenso com posterior ascensão significativa após o quinto minuto de teste, estimando-se a identificação do LA. Conclusões: Para pacientes com ICFEN, o T6m representa um esforço quase máximo, sendo executado acima do LA do TECP e acima dos 85% da FC máxima e do VO2 pico do TECP, com QR máximo semelhante ao do TECP.

Abstract Background: Few studies have used portable gas analyzers during the 6-minute walk test (6MWT) in patients with heart failure and normal ejection fraction (HFNEF). Objectives: To analyze the kinetics of hemodynamic, ventilatory, and metabolic variables in patients with HFNEF during the T6m using a portable gas analyzer. Methods: Prospective, analytical study with an intentional, non-probabilistic, convenience sample. In total, 24 patients with HFNEF and past hospital admissions due to a clinical diagnosis of heart failure (HF) were included using the 2007 criteria established by the European Society of Cardiology. Three assessments were performed: 6MWT familiarization, 6MWT with the portable gas analyzer, and cardiopulmonary exercise test (CPET). Results: The heart rates (HRs) and the peak VO2 at the end of the 6MWT corresponded to 85.7% and 86.45% of the values obtained during the CPET. The final HRs after the T6m were equivalent to those obtained at the CPET anaerobic threshold (AT), with relative VO2 values at the end of the 6MWT above the VO2 of the CPET AT. There was no difference between the maximum respiratory quotient (RQ) values in these two tests, which were both above 1.0. The VE/VO2 slope descended initially and then ascended significantly after the fifth minute of the test, estimating the identification of the AT. Conclusions: In patients with HFNEF, the 6MWT represents an almost maximum effort, and is performed above the CPET AT and 85% above the maximum HR and the CPET peak VO2, with a maximum RQ similar to that in the CPET.

Fundamento: Pacientes com insuficiência cardíaca (IC) apresentam disfunção ventricular esquerda e redução da pressão arterial média (PAM). O aumento do estímulo adrenérgico causa vasoconstrição e resistência dos vasos, mantendo a PAM, enquanto aumenta a resistência vascular periférica e a rigidez dos vasos condutores. O aumento da pressão de pulso (PP) reflete a complexa interação do coração com os sistemas arteriais e venosos. O aumento da PP é um importante marcador de risco em pacientes com insuficiência cardíaca crônica (ICC). A ventilação não invasiva (VNI) tem sido utilizada para IC aguda descompensada para melhorar a congestão e a ventilação pelos efeitos respiratórios e hemodinâmicos. No entanto, nenhum desses estudos relatou o efeito da VNI na PP. Objetivo: O objetivo deste estudo foi determinar os efeitos agudos da VNI com CPAP (pressão positiva contínua nas vias aéreas) sobre a PP em pacientes ambulatoriais com ICC. Métodos: Seguindo um protocolo randomizado, duplo-cego, cruzado e controlado com placebo, 23 pacientes com ICC (17 homens, 60 ± 11 anos, IMC 29 ± 5 kg/cm2, classes II e III da NYHA) foram submetidos à CPAP via máscara nasal durante 30 minutos na posição reclinada. A pressão da máscara foi de 6 cmH2O, enquanto o placebo foi fixado em 0-1 cmH2O. PP e outras variáveis hemodinâmicas não invasivas foram avaliadas antes, durante e depois do placebo e do modo CPAP. Resultados: A CPAP diminuiu a frequência cardíaca de repouso (pré: 72 ± 9; pós 5 min: 67 ± 10 bpm , p < 0,01) e PAM (CPAP: 87 ± 11; controle 96 ± 11 mmHg , p < 0,05 pós 5 min). A CPAP diminuiu a PP (CPAP: 47 ± 20 pré para 38 ± 19 mmHg pós; controle: 42 ± 12 mmHg, pré para 41 ± 18 pós p < 0,05 pós 5 min). Conclusão: A VNI com CPAP diminuiu a pressão de pulso em pacientes com ICC estável. Ensaios clínicos futuros devem investigar se esse efeito está associado com melhora no desfecho clínico.

Background: Patients with heart failure (HF) have left ventricular dysfunction and reduced mean arterial pressure (MAP). Increased adrenergic drive causes vasoconstriction and vessel resistance maintaining MAP, while increasing peripheral vascular resistance and conduit vessel stiffness. Increased pulse pressure (PP) reflects a complex interaction of the heart with the arterial and venous systems. Increased PP is an important risk marker in patients with chronic HF (CHF). Non-invasive ventilation (NIV) has been used for acute decompensated HF, to improve congestion and ventilation through both respiratory and hemodynamic effects. However, none of these studies have reported the effect of NIV on PP. Objective: The objective of this study was to determine the acute effects of NIV with CPAP on PP in outpatients with CHF. Methods: Following a double-blind, randomized, cross-over, and placebo-controlled protocol, twenty three patients with CHF (17 males; 60 ± 11 years; BMI 29 ± 5 kg/cm2, NYHA class II, III) underwent CPAP via nasal mask for 30 min in a recumbent position. Mask pressure was 6 cmH2O, whereas placebo was fixed at 0-1 cmH2O. PP and other non invasive hemodynamics variables were assessed before, during and after placebo and CPAP mode. Results: CPAP decreased resting heart rate (Pre: 72 ± 9; vs. Post 5 min: 67 ± 10 bpm; p < 0.01) and MAP (CPAP: 87 ± 11; vs. control 96 ± 11 mmHg; p < 0.05 post 5 min). CPAP decreased PP (CPAP: 47 ± 20 pre to 38 ± 19 mmHg post; vs. control: 42 ± 12 mmHg, pre to 41 ± 18 post p < 0.05 post 5 min). Conclusion: NIV with CPAP decreased pulse pressure in patients with stable CHF. Future clinical trials should investigate whether this effect is associated with improved clinical outcome.

INTRODUÇÃO: O teste de esforço cardiopulmonar (TECP) fornece dados que orientam tratamento, prognóstico e tomadas de decisões. Entretanto, seu uso na insuficiência cardíaca de fração de ejeção normal (ICFEN) ainda não está bem esclarecido, em especial considerando novas variáveis que vêm despontando. OBJETIVOS: Comparar o comportamento das principais variáveis diagnósticas e prognósticas do TECP entre dois grupos: pacientes com insuficiência cardíaca de fração de ejeção reduzida (ICFER) e pacientes com ICFEN. MÉTODOS: Foram avaliados 36 pacientes com insuficiência cardíaca em classe funcional II-III da NYAH: 20 com ICFEN e 16 com ICFER do ambulatório de insuficiência cardíaca do Hospital Universitário Antônio Pedro (UFF). Os pacientes do Grupo ICFER selecionados foram os com FE < 35% e os do grupo ICFEN seguiram os critérios diagnósticos da Sociedade Europeia de Cardiologia de 2007. Realizou-se TECP, em esteira com protocolo de rampa, com analisador de gases VO2000. Foram aplicados teste t de Student, Mann-Whitney, teste de Fisher, modelo linear generalizado e de Cochran-Mantel-Haenszel para as análises estatísticas. RESULTADOS: O grupo ICFEN apresentou níveis mais elevados da pressão arterial em repouso, na resposta ao esforço, na potência circulatória e ventilatória, além de um maior tempo de recuperação da cinética do consumo de oxigênio. Não houve diferença em relação a outras variáveis prognósticas do TECP para o grupo ICFER. CONCLUSÕES: A pressão arterial de repouso e em esforço, a potência circulatória e ventilatória e a cinética de recuperação do VO2 (T1/2) foram as variáveis que apresentaram maior valor discriminativo entre os grupos pelo TECP.

INTRODUCTION: The cardiopulmonary exercise testing (CPX) provides data that guide treatment, prognosis and decision making. However its use in heart failure with normal ejection fraction (HFnEF) is still not all clear, especially considering new variables that are emerging. OBJECTIVE: To compare the behavior of key diagnostic and prognostic variables of CPX testing between two groups; patients with heart with reduced ejection fraction of (HfrEF) and those with HFnEF). METHODS: 36 patients with heart failure were evaluated in Nyah functional class II-III: 20 with HFnEF and 16 patients with HFrEF at the Hospital Universitário Antônio Pedro (UFF). The patients from HFrEF group were those with EF<35%, and those from the HFnEF group follow the diagnostic criteria of the European Society of Cardiology 2007. CPX was performed on a treadmill with a ramp protocol, with gas analyzer VO2000. The Student t test, Mann-Whitney test and Fisher, generalized linear model and the Cochran-Mantel-Haenszel test for statistical analysis were applied. RESULTS: The HFnEF group presented higher levels of blood pressure at rest, higher response to exertion, higher circulatory and ventilatory power, and longer recovery kinetics of oxygen uptake. There was no difference in relation to other prognostic variables of CPX in the HFrEF group. CONCLUSIONS: The blood pressure at rest and during exercise, the circulatory and ventilatory capacity and the kinetics of VO2 (T1/2), were the variables that showed the highest discriminative value between the two populations by CPX.

INTRODUCCIÓN: La prueba de esfuerzo cardiopulmonar (PECP) suministra datos que orientan tratamiento, pronóstico y tomas de decisiones. No obstante, su uso en la insuficiencia cardíaca de fracción de eyección normal (ICFEN) todavía no está bien aclarado, en especial, considerando nuevas variables que vienen apareciendo. OBJETIVOS: Comparar el comportamiento de las variables principales de diagnóstico y de pronóstico de la PECP, entre dos grupos: pacientes con insuficiencia cardíaca de fracción de eyección reducida (ICFER) y pacientes con ICFEN. MÉTODOS: Se evaluaron 36 pacientes con insuficiencia cardíaca en clase funcional II-III de la NYAH: 20 con ICFEN y 16 con ICFER del dispensario de insuficiencia cardíaca del Hospital Universitário Antonio Pedro (UFF). Los pacientes del grupo ICFER fueron seleccionados con FE <35% y el grupo ICFEN siguieron los diagnósticos de la Sociedad Europea de Cardiología 2007 criterios. Se realizó la PECP, en estera con regulador de rampa, con analizador de gases VO2000. Se aplicaron las pruebas t de Student, Mann-Whitney, prueba de Fisher, modelo linear generalizado y de Cochran-Mantel-Haenszel para los análisis estadísticos. RESULTADOS: El grupo ICFEN presentó niveles más altos de presión arterial en reposo, en la respuesta al esfuerzo, en las potencias circulatoria y ventilatoria, además de un tempo más prolongado de recuperación de la cinética del consumo de oxígeno. No hubo diferencia en relación con otras variables de pronóstico de la PECP para el grupo ICFER. CONCLUSIONES: La presión arterial de reposo y en esfuerzo, las potencias circulatoria y ventilatoria y la cinética de recuperación del VO2 (T1/2) fueron las variables que presentaron más valor discriminativo entre los grupos según la PECP.

RACIONAL: A colonoscopia tem indicação para diagnóstico em pacientes sintomáticos e é eficaz no rastreamento e vigiância de pacientes assintomáticos. Tem potencial terapêutico em diversas situções, principalmente na remoção das lesões polipóides. A proficiência e a competência do endoscopista é o esteio para o sucesso da colonoscopia diagnóstica e terapêutica. OBJETIVO: Analisar as indicações, os achados diagnósticos, e as complicações de colonoscopias realizadas por médicos residentes em um hospital universitário. MÉTODOS: Foram avaliadas 1.000 colonoscopias consecutivas realizadas por residentes de quarto ano, sob supervisão direta de colonoscopistas experientes. Foram obtidas informações sobre os dados demográficos dos pacientes, o preparo intestinal, as indicações para o procedimento, o sucesso do procedimento, os achados diagnósticos e as complicações. RESULTADOS: Foram examinados total de 596 (59,6%) mulheres e 404 (40,4%) homens. A idade variou de três a 99 anos (média 53,8). O preparo intestinal foi realizado com solução de manitol a 10% em 978 pacientes (97,8%), sendo considerada adequada em 97,6% dos casos. Principais indicações foram: diagnóstico (56,4%), terapêutica (9,6%), rastreamento (17,3%) e vigilância (22%). Taxas de intubação do ceco e válvula ileocecal foram 90,3 e 58,6%, respectivamente. A colonoscopia foi normal em 45,8% dos casos. O diagnóstico mais comum foi diverticulose (18,5%), seguido por pólipos (17%) e neoplasias (6,8%). Achados consistentes com um processo inflamatório foram identificados em 122 pacientes (12,2%) e anomalias vasculares foram detectadas em 11 pacientes (1,1%). Outros diagnósticos representaram 3,9% dos casos. Houve dois casos (0,2%) de complicações (hematoma e hemorragia submucosa), ambos após polipectomia, sem necessidade de intervenção cirúrgica. CONCLUSÃO: Os residentes sob supervisão e orientação de especialistas podem realizar colonoscopias com excelente resultado, baixo índice de complicações e com dados finais comparáveis aos obtidos por endoscopistas experientes.

BACKGROUND: Proficiency and competence of endoscopists is perhaps the mainstay of successful diagnostic and therapeutic colonoscopy. AIM: To analyze indications, diagnostic findings, and complications of colonoscopies performed by resident physicians in a university teaching hospital. METHODS: Were analyzed 1,000 colonoscopies consecutively performed by fourth-year residents under direct supervision of experienced colonoscopists. Information on patients' demographic data, bowel preparation, indications for the procedure, success of the procedure, diagnostic findings, and complications were obtained. RESULTS: A total of 596 (59.6%) female and 404 (40.4%) male patients were examined. Age ranged from 3 to 99 years (mean 53.8 years). Bowel preparation was performed with 10% mannitol solution in 978 patients (97.8%), being considered appropriate in 97.6% of cases. Main indications were: diagnosis (56.4%), therapy (9.6%), screening (17.3%), and surveillance (22%). Cecal and ileocecal valve intubation rates were 90.3 and 58.6%, respectively. Colonoscopy was normal in 45.8% of cases. The most common diagnosis was diverticulosis (18.5%), followed by polyps (17%) and malignancies (6.8%). Findings consistent with an inflammatory process were identified in 122 patients (12.2%) and vascular abnormalities were detected in 11 patients (1.1%). Other diagnoses accounted for 3.9% of cases. There were two cases (0.2%) of complications (submucosal hematoma and bleeding), both after polypectomy, with no need for surgical intervention. CONCLUSION: The residents under supervision and guidance of specialists can perform colonoscopies with excellent success and low complication rates, with final results comparable to those achieved by fully trained endoscopists.

INTRODUCTION: High blood pressure during mental stress in subjects with prehypertension is associated with blunted vasodilation in skeletal muscles, which might be improved by an acute bout of exercise. OBJECTIVE: To investigate the hemodynamic responses to mental stress before and after a bout of exercise in subjects with prehypertension. METHOD: Eighteen subjects with prehypertension and 16 with normotension underwent a mental stress test before and after a maximal cardiopulmonary exercise test on a treadmill. Blood pressure was measured by auscultation, and forearm blood flow was measured by venous occlusion plethysmography; from these measurements, the vascular conductance was calculated. RESULTS: Subjects with prehypertension had a higher mean blood pressure during mental stress (prehypertension 112±2 vs. normotension 101±3 mm Hg, p<0.05), and their vascular conductance did not increase (baseline 0.025±0.004 vs. mental stress 0.022±0.003 a.u., p.0.05). After the exercise bout, the mean blood pressure during mental stress was lower in subjects with prehypertension (before exercise 112±2 vs. after exercise 107±2 mm Hg, p<0.05), and vascular conductance increased (baseline 0.011±0.001 vs. mental stress 0.024±0.004 a.u., p<0.05). CONCLUSION: Subjects with prehypertension had elevated blood pressure and a blunted vasodilator response during mental stress, but their blood pressure was attenuated and their vasodilator response was normalized after a single bout of maximal dynamic exercise.

INTRODUCTION: There are no available data addressing the potential clinical risks of open-water swimming competitions. OBJECTIVE: Address the risks of hypothermia and hypoglycemia during a 10-km open-water swimming competition in order to alert physicians to the potential dangers of this recently-introduced Olympic event. METHODS: This was an observational cross-sectional study, conducted during a 10-km open-water event (water temperature 21ºC). The highest ranked elite open-water swimmers in Brazil (7 men, 5 women; ages 21±7 years old) were submitted to anthropometrical measurements on the day before competition. All but one athlete took maltodextrine ad libitum during the competition. Core temperature and capillary glycemia data were obtained before and immediately after the race. RESULTS: Most athletes (83%) finished the race with mild to moderate hypothermia (core temperature <35ºC). The body temperature drop was more pronounced in female athletes (4.2±0.7ºC vs. male: 2.7±0.8ºC; p=0.040). When data from the athlete who did not take maltodextrine was excluded, capillary glycemia increased among athletes (pre 86.6±8.9 mg/dL; post 105.5±26.9 mg/dL; p=0.014). Time to complete the race was inversely related to pre- competition body temperature in men (r=-0.802; p=0.030), while it was inversely correlated with the change in capillary glycemia in women (r=-0.898; p=0.038). CONCLUSION: Hypothermia may occur during open-water swimming events even in elite athletes competing in relatively warm water. Thus, core temperature must be a chief concern of any physician during an open-water swim event. Capillary glycemia may have positive effects on performance. Further studies that include more athletes in a controlled setting are warranted.