Publications

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    Claudio Gil Soares de Araújo

    Full-text · Article · Jan 2016 · Arquivos Brasileiros de Cardiologia
  • C. G. S. Araújo · J. Scharhag

    No preview · Article · Jan 2016 · Scandinavian Journal of Medicine and Science in Sports
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    Ricardo Stein · Aline Sardinha · Claudio Gil S. Araújo
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    ABSTRACT: Sexual activity (SA) encompasses several behaviors such as kissing (Ki), touching (T), oral (O) stimulation, masturbation (M), and vaginal/anal intercourse (I). The acronym KiTOMI is proposed here to represent these behaviors. SA, particularly coitus, is a major aspect of health-related quality of life and is often considered the most pleasant and rewarding exercise performed during an entire lifetime. Although several studies have been conducted on sexuality, relatively limited information is available regarding SA in patients with heart disease. Moreover, the level of evidence of this limited information is nearly always B or C. This article provides a comprehensive and updated review of the relevant literature and offers evidence and expert-based practical messages regarding SA in patients with heart disease. Considering the rationale for exercise prescription, SA is typically well tolerated by most clinically stable patients with heart disease. Even in more debilitated and sicker individuals, KiT activities would most likely be feasible and desirable. The absolute risk of major adverse cardiovascular events during SA is typically very low. Even lower death rates have been reported for specific groups, such as women in general, aerobically fit men, and asymptomatic young adults with congenital heart disease. Finally, we emphasize the relevance of sexual counselling for patients and their partners, including the proper use of medications to treat erectile dysfunction. Counselled patients will be reassured and adequately informed regarding how to gradually resume habitual SA after a major cardiac event or procedure, starting with KiT and progressively advancing to KiTOM until all KiTOMI activities are allowed.
    Full-text · Article · Oct 2015 · The Canadian journal of cardiology
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    Christina G. de Souza e Silva · Claudio Gil S. Araújo
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    ABSTRACT: Background: Aerobic fitness, assessed by measuring VO2max in maximum cardiopulmonary exercise testing (CPX) or by estimating VO2max through the use of equations in exercise testing, is a predictor of mortality. However, the error resulting from this estimate in a given individual can be high, affecting clinical decisions. Objective: To determine the error of estimate of VO2max in cycle ergometry in a population attending clinical exercise testing laboratories, and to propose sex-specific equations to minimize that error. Methods: This study assessed 1715 adults (18 to 91 years, 68% men) undertaking maximum CPX in a lower limbs cycle ergometer (LLCE) with ramp protocol. The percentage error (E%) between measured VO2max and that estimated from the modified ACSM equation (Lang et al. MSSE, 1992) was calculated. Then, estimation equations were developed: 1) for all the population tested (C-GENERAL); and 2) separately by sex (C-MEN and C-WOMEN). Results: Measured VO2max was higher in men than in WOMEN: -29.4 ± 10.5 and 24.2 ± 9.2 mL.(kg.min)-1 (p < 0.01). The equations for estimating VO2max [in mL.(kg.min)-1] were: C-GENERAL = [final workload (W)/body weight (kg)] x 10.483 + 7; C-MEN = [final workload (W)/body weight (kg)] x 10.791 + 7; and C-WOMEN = [final workload (W)/body weight (kg)] x 9.820 + 7. The E% for MEN was: -3.4 ± 13.4% (modified ACSM); 1.2 ± 13.2% (C-GENERAL); and -0.9 ± 13.4% (C-MEN) (p < 0.01). For WOMEN: -14.7 ± 17.4% (modified ACSM); -6.3 ± 16.5% (C-GENERAL); and -1.7 ± 16.2% (C-WOMEN) (p < 0.01). Conclusion: The error of estimate of VO2max by use of sex-specific equations was reduced, but not eliminated, in exercise tests on LLCE.
    Full-text · Article · Aug 2015 · Arquivos Brasileiros de Cardiologia
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    ABSTRACT: Physiological reflexes modulated primarily by the vagus nerve allow the heart to decelerate and accelerate rapidly after a deep inspiration followed by rapid movement of the limbs. This is the physiological and pharmacologically validated basis for the 4-s exercise test (4sET) used to assess the vagal modulation of cardiac chronotropism. To present reference data for 4sET in healthy adults. After applying strict clinical inclusion/exclusion criteria, 1,605 healthy adults (61% men) aged between 18 and 81 years subjected to 4sET were evaluated between 1994 and 2014. Using 4sET, the cardiac vagal index (CVI) was obtained by calculating the ratio between the duration of two RR intervals in the electrocardiogram: 1) after a 4-s rapid and deep breath and immediately before pedaling and 2) at the end of a rapid and resistance-free 4-s pedaling exercise. CVI varied inversely with age (r = -0.33, p < 0.01), and the intercepts and slopes of the linear regressions between CVI and age were similar for men and women (p > 0.05). Considering the heteroscedasticity and the asymmetry of the distribution of the CVI values according to age, we chose to express the reference values in percentiles for eight age groups (years): 18-30, 31-40, 41-45, 46-50, 51-55, 56-60, 61-65, and 66+, obtaining progressively lower median CVI values ranging from 1.63 to 1.24. The availability of CVI percentiles for different age groups should promote the clinical use of 4sET, which is a simple and safe procedure for the evaluation of vagal modulation of cardiac chronotropism.
    Full-text · Article · Mar 2015 · Arquivos brasileiros de cardiologia
  • Claudio Gil Soares de Araújo · Carlos Vieira Duarte

    No preview · Article · Feb 2015 · International Journal of Cardiology
  • P S Ramos · B da Costa da Silva · L O da Silva · C G de Araújo
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    ABSTRACT: Inspiratory muscle training (IMT) has been shown to generate significant benefits in different clinical conditions, however, there is scarce information regarding acute clinical and hemodynamic effects. To evaluate clinical, hemodynamic and electrocardiographic responses during a single short inspiratory muscle training (IMT) session in patients enrolled in cardiopulmonary rehabilitation program (CRP). Cross--sectional study SETTING: Patients referred and regularly attending a non--hospital based medically--supervised exercise program. 160 patients who regularly performed inspiratory muscle training METHODS: A convenience sample of 21 elderly patients (16 men; 60--87 years of age) had an electrocardiogram (ECG) continuously recorded and heart rate (HR) and blood pressure (BP) measured before, during and one--minute after a single IMT session -- two sets of 15 cycles with one--minute interval. Comparing values obtained before, during second set and one--minute after IMT, no differences were found to HR (bpm) -- 68±2 vs. 70±2 vs. 66±3 (p=0.05) and in systolic and diastolic BP (mm Hg) values, respectively, -- 105±3 vs. 111±4 vs. 108±3 (p=0.06) and -- 68±2 vs. 72±3 vs. 68±2 (p=0.14); (before, during second set and one--minute after TMI). During IMT, seven (33%) of patients presented minor cardiac arrhythmias, most of them isolated premature ventricular contractions. Additionally, no abnormal signs or symptoms were found. Apart of minor and clinically irrelevant ECG abnormalities seen in 1/3 of the patients, a short IMT session did not induce significant hemodynamic responses or relevant clinical abnormalities. Based on these results, for elderly patients involved in CPR, IMT seems to be clinically safe and continuous ECG monitoring did not seem to add significant or relevant information. For elderly patients participating in CPR, short IMT sessions do not induce major hemodynamic responses and seem to be clinically safe. This is potentially useful information if IMT is to be prescribed in home--based programs.
    No preview · Article · Feb 2015 · European journal of physical and rehabilitation medicine
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    Plínio Santos Ramos · Aline Sardinha · Antonio Egidio Nardi · Claudio Gil Soares de Araújo
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    ABSTRACT: Panic disorder (PD) patients often report respiratory symptoms and tend to perform poorly during maximal cardiopulmonary exercise testing (CPX), at least partially, due to phobic anxiety. Thus, we hypothesized that a submaximal exercise variable, minimum VE/VO2 - hereafter named cardiorespiratory optimal point (COP) -, may be useful in their clinical assessment. Data from 2,338 subjects were retrospectively analyzed and 52 (2.2%) patients diagnosed with PD (PDG) (70% women; aged 48±13 years). PD patients were compared with a healthy control group (CG) precisely matched to number of cases, age and gender profiles. PDG was further divided into two subgroups, based on having achieved a maximal or a submaximal CPX (unwilling to continue until exhaustion). We compared COP, VO2 max, maximum heart rate (HR max) between PDG and CG, and also COP between maximal and submaximal PD subgroups. COP was similar between PDG and CG (21.9±0.5 vs. 23.4±0.6; p = 0.07), as well as, for PD subgroups of maximal and submaximal CPX (22.0±0.5 vs. 21.6±1.3; p = 0.746). Additionally, PD patients completing a maximal CPX obtained VO2 max (mL.kg-1.min-1) (32.9±1.57 vs 29.6±1.48; p = 0.145) and HR max (bpm) similar to controls (173±2.0 vs 168±2.7; p = 0.178). No adverse complications occurred during CPX. Although clinically safe, it is sometimes difficult to obtain a true maximal CPX in PD patients. Normalcy of cardiorespiratory interaction at submaximal effort as assessed by COP may contribute to reassure both patients and physicians that there is no physiological substrate for exercise-related respiratory symptoms often reported by PD patients.
    Full-text · Article · Aug 2014 · PLoS ONE
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    ABSTRACT: In this document, the Inter-American Committee of Cardiovascular Prevention and Rehabilitation, together with the South American Society of Cardiology, aimed to formulate strategies, measures, and actions for cardiovascular disease prevention and rehabilitation (CVDPR). In the context of the implementation of a regional and national health policy in Latin American countries, the goal is to promote cardiovascular health and thereby decrease morbidity and mortality. The study group on Cardiopulmonary and Metabolic Rehabilitation from the Department of Exercise, Ergometry, and Cardiovascular Rehabilitation of the Brazilian Society of Cardiology has created a committee of experts to review the Portuguese version of the guideline and adapt it to the national reality. The mission of this document is to help health professionals to adopt effective measures of CVDPR in the routine clinical practice. The publication of this document and its broad implementation will contribute to the goal of the World Health Organization (WHO), which is the reduction of worldwide cardiovascular mortality by 25% until 2025. The study group’s priorities are the following: • Emphasize the important role of CVDPR as an instrument of secondary prevention with significant impact on cardiovascular morbidity and mortality; • Join efforts for the knowledge on CVDPR, its dissemination, and adoption in most cardiovascular centers and institutes in South America, prioritizing the adoption of cardiovascular prevention methods that are comprehensive, practical, simple and which have a good cost/benefit ratio; • Improve the education of health professionals and patients with education programs on the importance of CVDPR services, which are directly targeted at the health system, clinical staff, patients, and community leaders, with the aim of decreasing the barriers to CVDPR implementation. © 2015, Arquivos Brasileiros de Cardiologia. All rights reserved.
    Full-text · Article · Aug 2014 · Arquivos Brasileiros de Cardiologia
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    Claudio Gil Soares de Araujo
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    ABSTRACT: In their professional practices, physicians often face unexpected situations or chance on innovative proposals and ideas. As a result of their training and competence, they usually come up with hypotheses to be tested and research is conducted. This research is completed and their results submitted for presentations at conferences as free communications. Nevertheless, the realization of this creative process is only complete when a scientific manuscript is published in a journal. At this ultimate stage, most efforts seem not be brought to a standstill 1,2 . There are several reasons why scholars, interns, residents, graduate students and even experienced physicians may find it difficult to move forward from congress' abstracts to full manuscripts published in journals. However, the most significant hindrance rests with the difficulty writing the mere 25-30 paragraphs of an original manuscript. Many freeze and give up in front of a blank paper or a blinking cursor on a blank word processor's page on the monitor screen. In the previous manuscript 3 , we analyzed and suggested improvements to the process of peer review. In this point of view, we propose a practical strategy to systematize the writing of scientific paragraphs, aiming to simplify the task of scientific writing. This way, our intent is to increase the rate of publication of full manuscripts based on several outstanding abstracts presented annually at major medical conferences, and facilitate the currently overburdened process of peer review. The format of scientific communication has been evolving greatly over the centuries 4-7 , making reading more objective and standardized. One of the important tools in this process is the IMRaD format 4,5,7 , an acronym derived from the initials of the main sections of a manuscript -introduction, methods, results and discussion. Throughout the twentieth century, the IMRaD format has been increasingly applied, accounting for about 10% of the manuscripts in the 1950s, being dominant in the 1960s, and reaching 80% in the 1970s 7 . Presently, IMRad is the format recommended and adopted by the main medical journals all over the world, including the ABC (Arquivos Brasileiros de Cardiologia). In addition to the IMRaD format, original manuscripts submitted for publication should meet specific standards and rules of each journal. Although a fairly uniform pattern tends to prevail, there are differences that should be observed at the time of writing. For instance, the number of words is limited to 4,500 in ABC and 5,000 in JACC, including text and references. Considering that the references are usually limited to 30-40, and have around 1,000 words, circa 3,500-4,000 are left for the text's body, i.e., to be used in the 25-30 paragraphs of IMRaD, representing about 130 words each. In the pursuit for evidence and objective data, as a convenience sample, all original manuscripts published in the January 2012 and 2013 editions of ABC and JACC journals have been analyzed (the first two numbers of these months for the latter). There was a fairly clear trend about the total number of paragraphs and distribution of paragraphs in four sections of the IMRaD of a manuscript. For the 20 ABC's manuscripts and 34 JACC's ones, the average number of paragraphs was 28.9 and 28.2 (p = 0.703), respectively, with 1/3 of them having 25-30 paragraphs, and 57% of the total manuscripts having overall 22-33 paragraphs. This relative constancy should be observed and highlighted, considering that the topics and areas covered, as well as the background and the nationality of the authors, are quite different. Thus, this confirms the assumption that there is a basic format to be followed for an effective publication. Figure 1 illustrates the distribution of paragraphs for the various IMRaD sections in the two journals analyzed. Although there is some variability among the manuscripts, the introduction is clearly a section with fewer paragraphs (p < 0.001), while the remaining sections are somewhat balanced (p > 0.05), especially for original manuscripts of JACC, in which the sections of methods, results and discussion tend to have eight to nine paragraphs. When the distributions of paragraphs between ABC and JACC are compared, introductions and discussions tend to have more paragraphs in ABC than in JACC, respectively, 3.8 versus 2.4 (p < 0.01) and 10.4 versus 8.8 (p = 0.04). Based on these results, in our personal experience as authors of original manuscripts and according to other authors' opinions 4,8-10 , a simple content model may be proposed within the IMRaD format, taking 25-30 paragraphs as standard for an original manuscript. For practical purposes, one page is considered one page in a word processor, with conventional margins and with a 1.5 line spacing and font size 11. Unfolding the sections Introduction: 1 page (ideally), maximum 400 words over 1-4 paragraphs (ideally 3) – some journals restrict this to 350 words (E.g.: ABC); 5-10 references. e21 Viewpoint Araújo 25-30 paragraphs to write the manuscript Arq Bras Cardiol. 2014; 102(2):e21-e23 *These paragraphs are optional, and often the contents can se incorporated into the previous paragraph(s). Figure 1 -Comparative analysis on the number of paragraphs per section of IMRaD for original manuscripts between Arquivos Brasileiros de Cardiologia (Arq Bras Cardiol) and Journal of The American College of Cardiology (JACC). I: introduction; M: methods; R: results; D: discussion. The box-plot represents median values, the first and third quartiles and 5 th and 95 th percentiles.*Significant difference between the number of paragraphs of the two journals for this section. Methods: 2-3 pages (possibly higher in experiments resorting to innovative methods or plenty of techniques or sophisticated statistics) – not exceeding 750 words over 6-9 paragraphs; 5-15 references Results: 2-3 pages of text, figures and tables, as strictly necessary; not exceeding 1,000 words over 4-9 paragraphs; usually without references. Discussion: 3-4 pages of text; this is usually the most extensive part of the manuscript relating to word count (4,8-10) , with 1,000-1,500 words distributed over up to 10 paragraphs; including a conclusion paragraph, although some journals consider the latter another text section. The discussion usually has 10-20 references, with some of them possibly appearing in previous text sections.
    Full-text · Article · Mar 2014 · Arquivos brasileiros de cardiologia
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    Claudio Gil Araujo · Luciano Belém · Ilan Gottlieb

    Full-text · Dataset · Mar 2014
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    Claudio Gil Araujo · Luciano Belém · Ilan Gottlieb
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    ABSTRACT: It is well established that regular physical exercise is of para-mount importance for a healthy lifestyle 1 in a clear dose– effect relationship between exercise volume and health benefits. A considerable increase in the number of people training and competing has been seen lately, particularly middle-aged individuals, both recreationally and profession-ally, especially in long-distance/duration mass sport events, most likely exceeding two million subjects in United States. 2 Sanchis-Gomar et al. 3 retrieved data from 834 European cyclists who had completed the Tour de France between 1930 and 1964 and found that they lived 8 years longer as compared with their native general population. In the same line of thinking, Pelliccia et al. 4 studied 114 Olympic athletes submitted to several years of intense long-term exercise and did not find adverse consequences to the heart. Nonetheless, there is still some concern about the risks of sudden death during the races (although absolute risk seems to be quite low and lower than 1/100,000 participations) 2,5 and to a potential harm from "exercise exaggeration." 6,7 While this is one area far from consensus, 8,9 there is some evidence sug-gesting that competing in marathons and/or longer events could lead to deleterious structural heart changes and a slightly higher risk of atrial fibrillation in later life. 8–10 This article presents a very unique case report of a 47-year-old male athlete who has been highly successful in competing at international level for over 35 years in long-and very long– duration sport events. By carefully examining the structure and function of his heart, some structural and functional changes would be expected. Just 2 weeks after an outstanding victory at 2012 edi-tion of the Ultraman competition, Mr Ribeiro, a Brazilian athlete born in 1965, after reading and signing a consent form, volunteered to be submitted to clinical examination, resting and exercise electrocardiogram (ECG), transtho-racic echocardiogram, cardiac magnetic resonance (CMR), and a maximal treadmill cardiopulmonary exercise testing (CPET). He has also agreed in sharing with us his amazing sport history as summarized in Table 1. His typical training schedule for the last three decades involves swimming, cycling, and running, divided in two or three daily A six-time Ultraman winner and a normal heart: A case report
    Full-text · Dataset · Feb 2014
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    Claudio Gil Soares De Araújo
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    ABSTRACT: Artigo recebido em 24/07/13; revisado em 09/08/13; aceito em 12/08/13. Palavras-chave Artigo de Revista; Redação; Metodologia; Bibliometria. DOI: xxx/abc.2013xxxx No exercício profissional, o médico se depara frequentemente com situações inéditas ou propostas e ideias inovadoras. Muitas vezes, como fruto do seu treinamento e competência, surgem hipóteses a serem testadas e são realizadas pesquisas. Essas pesquisas são concluídas e os seus resultados submetidos a apresentações como temas livres em congressos. Contudo, a efetiva concretização desse processo criativo só ocorre com a publicação do artigo científico e é nesta última etapa que a grande maioria dos esforços esbarra e não avança 1,2 . Há várias razões pelas quais os acadêmicos, os internos, os residentes e os estudantes de pós-graduação e até mesmo os médicos profissionalmente mais experientes podem não avançar do resumo em congresso para o artigo completo em um periódico científico, porém, muito provavelmente, a mais importante é a dificuldade na redação dos apenas 25-30 parágrafos que compõem um artigo original. Diante de uma folha de papel vazia ou de um cursor piscando em uma página em branco do processador de texto na tela do monitor, muitos param e desistem. Em artigo anterior 3 , analisamos e sugerimos aprimoramentos para o processo de revisão por pares. No presente ponto de vista, propomos uma estratégia prática de sistematização da redação dos parágrafos científicos, visando simplificar essa tarefa. Pretende-se, assim, aumentar a taxa de publicação como artigo completo de muitos dos excelentes resumos de comunicações apresentadas anualmente nos principais congressos médicos e facilitar o atualmente congestionado processo de revisão por pares. O formato da comunicação científica vem evoluindo bastante ao longo dos séculos 4-7 , tornando a leitura mais objetiva e padronizada. Dentro desse processo, destaca-se a formatação IMRaD 4,5,7 , sigla derivada das iniciais das principais seções do artigo -introdução, métodos, resultados e discussão. Ao longo do século XX, o formato IMRaD passou a ser cada vez mais utilizado, representando cerca de 10% dos artigos na década de 1950, passando a predominar nos anos 1960 e alcançando 80% nos anos 1970 7 . Atualmente, o IMRaD é o formato recomendado e adotado pelos principais periódicos científicos da área médica de todo o mundo, incluindo os Arquivos Brasileiros de Cardiologia (ABC). Além da formatação IMRaD, o artigo original submetido para publicação deve atender a normas e regras específicas de cada um dos periódicos. Ainda que tenda a prevalecer um padrão razoavelmente uniforme, diferenças existem e devem ser observadas por ocasião da redação. Por exemplo, o número de palavras é limitado a 4.500 nos ABC e a 5.000 no JACC, incluindo o texto propriamente dito e as referências. Considerando que a parte das referências, em geral limitadas a 30-40, usa cerca de mil palavras, sobram algo como 3.500-4.000 para o corpo do texto, ou seja, para serem utilizados nos 25-30 parágrafos do IMRaD, correspondendo a cerca de 130 palavras cada um. Na busca por evidências e dados objetivos, foram analisados, como amostra de conveniência, todos os artigos originais publicados nos números de janeiro de 2012 e de 2013 dos ABC e do JACC (neste somente os dois primeiros números desses meses). Observou-se uma tendência bastante clara para o número total de parágrafos e para a sua distribuição dos parágrafos pelas quatro seções do IMRaD de um artigo. Para os 20 artigos dos ABC e os 34 artigos do JACC, o número médio de parágrafos foi de 28,9 e de 28,2 (p = 0,703), respectivamente, com 1/3 deles contendo 25-30 parágrafos e 57% do total de artigos com o total de 22-33 parágrafos. Essa relativa constância é bastante interessante de observar e destacar, considerando que os tópicos e áreas abordados, assim como a formação e até mesmo a nacionalidade dos autores, são bastante diversos. Sendo assim, corrobora-se a ideia de que existe um formato básico a ser seguido para uma efetiva publicação. A Figura 1 ilustra a distribuição dos parágrafos para as diversas seções do IMRaD nos dois periódicos analisados. Embora haja alguma variabilidade entre os artigos, a introdução é claramente a seção com menor número de parágrafos (p < 0,001), enquanto há certo equilíbrio entre as demais seções (p > 0,05), especialmente para os artigos originais do JACC, no qual as seções de métodos, resultados e discussão tendem a ter entre oito e nove parágrafos. Quando são comparadas as distribuições de parágrafos entre os ABC e o JACC, verifica-se que a introdução e a discussão tendem a ter mais parágrafos nos ABC do que no JACC, respectivamente, 3,8 versus 2,4 (p < 0,01) e 10,4 versus 8,8 (p = 0,04). Com base nesses resultados, na nossa experiência pessoal como autor de artigos originais e na opinião de outros autores 4,8-10 , é possível propor, dentro da formatação IMRaD, um modelo simples do conteúdo a ser abordado nos 25-30 parágrafos que costumam compor um artigo científico original. Para efeito prático, considera-se uma lauda como uma página no processador de texto, com margens convencionais e utilizando o espaçamento de 1,5 linhas e fonte de tamanho 11. e21 Ponto de Vista Araújo 25 a 30 parágrafos para escrever o artigo Arq Bras Cardiol. 2014; 102(2):e21-e23 Desdobrando as seções Introdução: 1 lauda (idealmente); máximo de 400 palavras em 1-4 parágrafos (ideal 3) – algumas revistas limitam a 350 palavras (p. ex., ABC); 5-10 referências. Métodos: 2-3 laudas (eventualmente maior em experimentos com métodos inovadores ou com muitas técnicas ou estatística muito complexa) – não exceder 750 palavras em 6-9 parágrafos; 5-15 referências. Resultados: 2-3 laudas de texto, e figuras e tabelas conforme o estritamente necessário; não exceder 1.000 palavras em 4-9 parágrafos; normalmente sem referências. Discussão: 3-4 laudas de texto; costuma ser a parte mais extensa do artigo em número de palavras (4, 8-10), com 1.000-1.500 palavras distribuídas em até 10 parágrafos; inclui um parágrafo de conclusões, ainda que alguns periódicos o coloquem como mais uma seção do texto; costuma contemplar 10-20 referências, algumas delas podendo já ter aparecido em seções anteriores do texto. Desdobrando os parágrafos Introdução 1. Problema – o que se sabe?
    Full-text · Dataset · Feb 2014
  • Carlos Vieira Duarte · Jonathan Myers · Claudio Gil Soares de Araújo
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    ABSTRACT: Although substantial evidence relates reduced exercise heart rate (HR) reserve and recovery to a higher risk of all-cause mortality, a combined indicator of these variables has not been explored. Our aim was to combine HR reserve and recovery into a single index and to assess its utility to predict all-cause mortality. Retrospective cohort analysis. Participants were 1476 subjects (937 males) aged between 41 and 79 years who completed a maximal cycle cardiopulmonary exercise test while not using medication with negative chronotropic effects or having an implantable cardiac pacemaker. HR reserve (HR maximum - HR resting) and recovery (HR maximum - HR at 1-min post exercise) were calculated and divided into quintiles. Quintile rankings were summed yielding an exercise HR gradient (EHRG) ranging from 2 to 10, reflecting the magnitude of on- and off-HR transients to exercise. Survival analyses were undertaken using EHRG scores and HR reserve and recovery in the lowest quintiles (Q1). During a mean follow up of 7.3 years, 44 participants died (3.1%). There was an inverse trend for EHRG scores and death rate (p < 0.05) that increased from 1.2% to 13.5%, respectively, for scores 10 and 2. An EHRG score of 2 was a better predictor of all-cause mortality than either Q1 for HR reserve (<80 bpm) or HR recovery alone (<27 bpm): age-adjusted hazard ratios: 3.53 (p = 0.011), 2.52 (p < 0.05), and 2.57 (p < 0.05), respectively. EHRG, a novel index combining HR reserve and HR recovery, is a better indicator of mortality risk than either response alone.
    No preview · Article · Jan 2014
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    Full-text · Article · Jan 2014
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    ABSTRACT: Resumo Fundamentos: A ansiedade cardíaca (AC) é o medo de sensações cardíacas, caracterizado por sintomas recorrentes de ansiedade em pacientes com ou sem doença cardiovascular. O Questionário de Ansiedade Cardíaca (QAC) é uma ferramenta para avaliar a AC, já adaptado, mas não validado em português. Objetivo: Este trabalho apresenta as três fases dos estudos de validação do QAC brasileiro. Métodos: Foram recrutados 98 pacientes com doença arterial coronária, a fim de extrair a estrutura fatorial e avaliar a confiabilidade do QAC (fase 1). O objetivo da fase 2 foi explorar a validade convergente e divergente. Cinquenta e seis pacientes completaram o QAC, juntamente com o Escala de sensações corporais (ESC) e o Versão brasileira do Social Phobia Inventory (SPIN). Para determinar a validade discriminante (fase 3), comparamos os escores do QAC de dois subgrupos formados por pacientes da fase 1 (n = 98), de acordo com os diagnósticos de transtorno do pânico e agorafobia obtidos com o MINI – Mini International Neuropsychiatric Interview (Mini Entrevista Neuropsiquiátrica Internacional). Resultados: A solução de dois fatores foi a mais interpretável (46,4% da variância). As subescalas foram denominadas de "Medo e Hipervigilância" (n = 9; alfa = 0,88) e "Evitação" (n = 5; alfa = 0,82). Foi encontrada correlação significativa do fator 1 com o escore total do ESC (p < 0,01), mas não com o fator 2. Os fatores do SPIN apresentaram correlações significativas com as subescalas do QAC (p < 0,01). Na fase 3, os escores dos pacientes "Cardíacos com pânico" foram significativamente maiores no fator 1 do QAC (t = -3,42; p < 0,01, IC = -1,02 a -0,27), e maiores, mas não significativamente diferentes, no fator 2 (t = -1,98; p = 0,51, IC = -0.87 a 0,00).
    Full-text · Dataset · Nov 2013
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    Antonio Felipe Simão · Dalton Precoma · Jadelson Andrade · Claudio Gil Soares de Araújo

    Full-text · Dataset · Nov 2013
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    Carlos Vieira Duarte · Claudia Lucia Barros de Castro · Claudio Gil Soares de Araújo
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    ABSTRACT: Treinamento para disfunção vagal cardíaca com repetições da transição repouso-exercício Título em inglês: Training for cardiac vagal dysfunction with repetitions of rest-exercise transition Resumo Disfunção vagal cardíaca está associada com um pior prognóstico clínico e um dos potenciais benefícios do exercício físico regular é aumentar o tônus vagal cardíaco (TVC). Como nas tran-sições repouso-exercício-repouso o TVC é rapidamente inibido e reativado, hipotetizou-se que um treinamento repetido desta transição -denominado treinamento vagal (TV) -, em indiví-duos com TVC reduzido, poderia reverter essa disfunção. Participantes que ingressaram em um programa de exercício supervisionado (PES) com índice vagal cardíaco (IVC) baixo (≤ 1,30 no 44 pacientes (64% homens; 65,5 ±11,4 anos) finalizaram o estudo. Houve discreta melhora no IVC ao final de 16 semanas (1,19 vs 1,22; p=0,02), mas não se pôde afirmar que a diferença no IVC se deveu ao período em que foi realizado o TV (p=0,36). Portanto, 16 semanas de PES incluindo oito semanas de TV aumentou a resposta vagal à transição repouso -exercício, embora não tenha sido possível atribuir os resultados exclusivamente ao TV. Futuros estudos são necessários para esclarecer se o TV, com maior número de repetições e/ou período de duração mais longo, poderá promover uma melhora mais acentuada do TVC em indivíduos com níveis iniciais baixos. Palavras-chave Sistema nervoso parassimpático; Reabilitação cardíaca; Teste de 4 segundos; Testes autonômicos. Abstract Vagal dysfunction is related to a worse clinical prognosis and one of the potential benefits of regular exercise is to increase cardiac vagal tone (CVT). Since CVT is quickly inhibited and reactivated in the fast rest-exercise-rest transition, it was hypothesized that a training of this transition – called vagal training (VT) -in individuals with reduced CVT could reverse this condition. Patients with low cardiac vagal index (CVI) (≤ 1.30 on the 4-secondexercise test) starting a supervised exercise program (SEP) were randomized in a crossover design (two phases, eight weeks each), with or without three weekly VT sessions. VT consisted of five repetitions of sudden, fast unloaded pedaling for five seconds in a cyclergometer, and resting seated for 55 seconds. After applying strict inclusion and exclusion criteria (medication use, clinical condition and adherence to SEP), 44 patients (64 % men and 65.5 ± 11.4 years) completed the study. There was a slight improvement in the CVI at the end of 16 weeks (1.19 vs 1.22, p = 0.02), but it could not be stated this difference was due to the VT (p = 0.36). Therefore, 16 weeks of SEP, including eight weeks of VT training, increased the CVI of those with lower CVI, but this improvement could not be attributed exclusively to the additional VT. Further studies are needed to clarify if more repetitions or a longer period of VT would promote even greater CVT recovery.
    Full-text · Dataset · Nov 2013
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    ABSTRACT: Hypertension, or the chronic elevation in resting arterial blood pressure (BP), is a significant risk factor for cardiovascular disease and estimated to affect ~1 billion adults worldwide. The goals of treatment are to lower BP through lifestyle modifications (smoking cessation, weight loss, exercise training, healthy eating and reduced sodium intake), and if not solely effective, the addition of antihypertensive medications. In particular, increased physical exercise and decreased sedentarism are important strategies in the prevention and management of hypertension. Current guidelines recommend both aerobic and dynamic resistance exercise training modalities to reduce BP. Mounting prospective evidence suggests that isometric exercise training in normotensive and hypertensive (medicated and non-medicated) cohorts of young and old participants may produce similar, if not greater, reductions in BP, with meta-analyses reporting mean reductions of between 10 and 13 mmHg systolic, and 6 and 8 mmHg diastolic. Isometric exercise training protocols typically consist of four sets of 2-min handgrip or leg contractions sustained at 20-50 % of maximal voluntary contraction, with each set separated by a rest period of 1-4 min. Training is usually completed three to five times per week for 4-10 weeks. Although the mechanisms responsible for these adaptations remain to be fully clarified, improvements in conduit and resistance vessel endothelium-dependent dilation, oxidative stress, and autonomic regulation of heart rate and BP have been reported. The clinical significance of isometric exercise training, as a time-efficient and effective training modality to reduce BP, warrants further study. This evidence-based review aims to summarize the current state of knowledge regarding the effects of isometric exercise training on resting BP.
    Full-text · Article · Oct 2013 · Sports Medicine
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    ABSTRACT: Cardiac Anxiety (CA) is the fear of cardiac sensations, characterized by recurrent anxiety symptoms, in patients with or without cardiovascular disease. The Cardiac Anxiety Questionnaire (CAQ) is a tool to assess CA, already adapted but not validated to Portuguese. This paper presents the three phases of the validation studies of the Brazilian CAQ. To extract the factor structure and assess the reliability of the CAQ (phase 1), 98 patients with coronary artery disease were recruited. The aim of phase 2 was to explore the convergent and divergent validity. Fifty-six patients completed the CAQ, along with the Body Sensations Questionnaire (BSQ) and the Social Phobia Inventory (SPIN). To determine the discriminative validity (phase 3), we compared the CAQ scores of two subgroups formed with patients from phase 1 (n = 98), according to the diagnoses of panic disorder and agoraphobia, obtained with the MINI - Mini International Neuropsychiatric Interview. A 2-factor solution was the most interpretable (46.4% of the variance). Subscales were named "Fear and Hypervigilance" (n=9; alpha = 0.88), and "Avoidance", (n = 5; alpha = 0.82). Significant correlation was found between factor 1 and the BSQ total score (p<0.01), but not with factor 2. SPIN factors showed significant correlations with CAQ subscales (p < 0.01). In phase 3, "Cardiac with panic" patients scored significantly higher in CAQ factor 1 (t = -3.42; p < 0.01, CI = -1.02 to -0.27), and higher, but not significantly different, in factor 2 (t = -1.98; p = 0.51, CI = -0.87 to 0.00). These results provide a definite Brazilian validated version of the CAQ, adequate to clinical and research settings.
    Full-text · Article · Oct 2013 · Arquivos brasileiros de cardiologia

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