Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2014-05-22T17:10:14Z No. of bitstreams: 1 Icaro José Santos Ribeiro. Avaliação da... 2013.pdf: 880266 bytes, checksum: df7ddbb3ac2849200cda6a27447ba7f5 (MD5) / Made available in DSpace on 2014-05-22T17:10:14Z (GMT). No. of bitstreams: 1 Icaro José Santos Ribeiro. Avaliação da... 2013.pdf: 880266 bytes, checksum: df7ddbb3ac2849200cda6a27447ba7f5 (MD5) Previous issue date: 2013 / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / INTRODUÇÃO: O cenário de envelhecimento populacional e o aumento das Doenças Crônicas Não Transmissíveis (DCNT) requer o desenvolvimento e validação de métodos diagnóstico e de ferramentas não invasivas para identificação de fatores de risco e estadiamento destas doenças. Entre estes métodos evidencia-se a análise da modulação autonômica do coração por meio da Variabilidade da Frequência Cardíaca (VFC). OBJETIVO: Analisar a variabilidade da frequência cardíaca de idosos diabéticos (DM+) e não diabéticos (DM–) residentes em um município baiano; avaliar a resposta da variabilidade da frequência cardíaca na realização da manobra de levantar-se rapidamente. MÉTODOS: estudo epidemiológico transversal, de abordagem censitária. Desenvolvido com 205 idosos da zona urbana do munícipio de Aiquara-BA, após aplicação os critérios de inclusão e exclusão. Os dados da VFC foram coletados através do monitor Polar RS800CX, com registro inicial de 5 min em repouso, seguido por comando de levantar-se rapidamente para avaliação da razão 30:15. Para análise dos dados, as variáveis categóricas foram apresentadas em frequências (relativa e absoluta), enquanto variáveis contínuas, através de médias e medianas, desvio-padrão e intervalo interquartil. Foram realizados testes de comparação de proporções (chi quadrado ou exato de Fisher) e de mediana (Mann-Whitney). RESULTADOS: A média de idade foi de aproximadamente 71 anos (±7,32 dp). A população foi em sua maioria constituída por mulheres 59,1%, de baixa ou nenhuma escolaridade 60,0% e baixa renda 81,0%. A análise da VFC no domínio da frequência não evidenciou diferença quando comparados os grupos de DM+ e DM–. Doravante, no domínio do tempo, o rMSSD apresentou mediana de 16,09 [IQR 9,91-30,68]; e o pNN50 mediana de 0,79 [IQR 0,00-6,62], havendo diferença estatisticamente significante entre o grupo de DM+ e DM– (p<0,05). Como observado para os índices de atividade parassimpática em repouso, a razão 30:15, o índice de atividade parassimpática durante uma condição dinâmica, mostrou uma diferença significativa entre DM + e DM - idosos (p <0,05). CONCLUSÕES: A análise da VFC entre os grupos evidenciam a possibilidade de degeneração do ramo parassimpático no grupo DM+ pela diminuição nos parâmetros do tempo e a razão 30:15. Isso pode representar repercussões graves no sistema cardiovascular, uma vez que os índices reduzidos nestes indivíduos indicam uma menor cardioproteção. / INTRODUCTION: The scenario of population aging and the increase of Chronic Noncommunicable Diseases (NCDs) requires the development and validation of diagnostic methods and non-invasive tools for identification of risk factors and staging of these diseases.Among these methods, the analysis of autonomic modulation of the heart using the Heart Rate Variability (HRV) becomes evident. OBJECTIVE: To analyze the heart rate variability in diabetic (DM+) and nondiabetic (DM–) elderlies residents in a municipality of Bahia, and also to know the response of heart rate variability in performance of the quickly stand up maneuver. METHODS: cross-sectional study of censitary approach. Carried out with 205 elderlies in the urban area of the municipality of Aiquara-BA, after had applied the inclusion and exclusion criteria. HRV data were collected through the Polar RS800CX monitor with 5 min initial record at rest, followed by the command to quickly stand up. For data analysis, categorical variables were presented as frequencies (relative and absolute), while continuous variables as median, standard deviation and interquartile range (IQR). Tests were conducted to compare proportions (chi square or Fisher's exact test) and median (Mann-Whitney). RESULTS: The mean age was approximately 71 years (± 7.32 sd). The population was mostly made up of women 59.1%, with low or no schooling 60% and low income 81.0%. HRV analysis in the frequency domain showed no difference when comparing the two groups of DM+ and DM–. Henceforth in the time domain the rMSSD showed median of 16.09 [IQR 9.91-30.68]; the pNN50 median of 0.79 [IQR 0.00-6.62], with statistical significance between the group of DM+ and DM–. As observed for parasympathetic activity indexes at rest, the 30:15 ratio, an parasympathetic activity index during a dynamic condition, showed a significant difference between DM + and DM – elderlies (p < 0.05). CONCLUSIONS: HRV analysis between groups showed the possibility of deterioration of the parasympathetic branch of the DM + group, by decreasing the parameters of time and the 30:15 ratio. This can have serious repercussions on the cardiovascular system, since the reduced rates in those individuals indicate less cardioprotection.

BACKGROUND: There are only limited data about peri-interventional pain during cardiac electrophysiological procedures without analgosedation. In this study, peri-interventional pain and recollection of it after the intervention were evaluated. METHODS: A total of 101 patients (43 electrophysiological/ablation procedures and 58 device surgeries) reported pain on a numerical rating scale (NRS; 0-10) before (pre), during (peri), and after (post) the intervention. Maximum pain (maxNRS) and the average of pain (meanNRS) were used for statistical analysis. Peri-interventional pain was compared with postinterventional data of the recollection of peri-interventional pain (peri-post). Patients were allocated into 2 groups (with 51 and 50 patients, respectively) to evaluate the mode of patient-staff interaction on pain recollection. Depressive, anxiety, and somatic symptom scales (Patient Health Questionnaire-15, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-15) were used to analyze their influence on pain recollection. RESULTS: In total, 49.6% of patients (n = 50) complained of moderate to severe pain (maxNRS) at least once during the procedure. The comparison between peri and peri-post data revealed the following (median (range)-maxNRS, peri: 3 (0-10) versus peri-post: 4 (0-9) (ns), and meanNRS, peri: 1.4 (0-7) versus peri-post: 2.0 (0-6) (ns). The mode of patient-staff interaction had no influence on pain. No effect was found for psychosocial factor concerning pain and the recollection of pain. The results of the linear regression showed no influence of low-dose midazolam on recollection of pain. CONCLUSION: Half of the patients reported moderate to severe pain at least once during cardiac electrophysiological procedures without analgosedation. However, on average, patients reported only low pain levels. Postinterventional derived data on discomfort reflect the peri-interventional situation.:Inhaltsverzeichnis 1 Einführung in die Thematik 1.1 Hintergrund zur Thematik 1.2 Inhaltlicher Gegenstand 1.3 Fragestellung 2 Publikation 3 Zusammenfassung der Arbeit 4 Literatur I Darstellung des eigenen Beitrages II Selbstständigkeitserklärung III Lebenslauf IV Publikationen V Danksagung