Distribuição regional da ventilação pulmonar em indivíduos com insuficiência cardíaca crônica após serem submetidos a um programa de treinamento da musculatura inspiratória e sua correlação com dados funcionais

Introduction: Chagas Disease is a serious public health problem, with 5 million infected individuals in Brazil. Of these, approximately 30% develop chronic Chagas cardiomyopathy (CCC), where the main symptoms are fatigue and dyspnea. Objective: To correlate maximal exercise capacity with pulmonary function, inspiratory muscle strength and quality of life in patients with CCC. Methodology: Twelve individuals suffering from CCC were evaluated (7 men), with a mean age of 54.91± 8.60 years and the following inclusion criteria: functional class II and III according to the New York Heart Association (NYHA); left ventricle ejection fraction below 45%; clinical stability (> 3 months); symptom duration > 1 year, body mass index (BMI) < 35Kg/m2 and non-smokers or ex-smokers with a history of smoking <10 packs/day. All subjects were submitted to spirometry, manometer testing, maximal cardiopulmonary exercise testing (CPX) and a quality of life questionnaire (Minnesota). Results: A negative correlation was observed between VO2máx and MLHFQ scores (r=-0.626; p=0.03) and a positive association with MIP (r=0.713; p=0.009). Positive correlations were also recorded between MIP and spirometric variables [FEV1(r=0.825;p=0.001 ), FVC(r=0.66;p=0.01 and FEF25-75%(r=0.639;p=0.02)]. Conclusion: The present study demonstrated that in patients with CCC: VO2MAX is directly related to inspiratory muscle strength and quality of life, while deteriorating lung function is directly associated with respiratory muscle weakness

Estudo dos fatores associados à infecção chagásica em área endêmica do Rio Grande do Norte

The Chagas disease is a infectious and parasite disease that has as the causative agent a Trypanosoma cruzi, a protozoan parasite that can be transmitted to humans by the faeces of triatomines ( barbeiros ) in the blood-sucking. To understand the relationship between factors associated with chagasic infection and the risk of transmission of Trypanosoma cruzi, this work aimed to make a correlation between the results of serology, obtained by different immunological techniques, used for diagnosis of Chagas disease and risk factors to which the population of the city of Apodi-RN is exposed, to be considered a endemic area. The case-control study was conducted with 199 individuals, which initially was applied a questionary about socio-economic questions and some risk factors which they were exposed and also favor the spread of disease. Then was given the diagnosis by immunological techniques of serology by indirect hemagglutination, ELISA and indirect immunofluorescence. From the diagnosis, the subjects were divided into case group (presence of infection) and control group (no infection). Regarding the descriptive characteristics of the sample, were found a higher frequency of female individuals (59.3%), between 36 and 50 years of age (36.7%), with low education level (91%) and income monthly up to 1 minimum wage (67.8%). The serology, performed by three techniques of different principles, had a reactivity of 38.9% by Indirect Hemagglutination, 39.7% by ELISA and 38.7% by Indirect Immunofluorescence. As the result of the serology, 71 of samples showed reactivity in 2 or more techniques. On some risk variables, was found a significant relationship between individuals who had been bitten by the triatomines and had positive serology for Chagas disease (93.3%). Other variables of risk revealed individuals who had positive serology and had domestic animal (80.3%), lived in poorly maintained homes (97.2%) and near the forest (84.5%). A better understanding of the dynamics of transmission of T. cruzi and the risk factors that contribute to its occurrence in a region are needed to develop effective strategies for control of Chagas disease in these áreas

Ánálise da capacidade funcional e da distribuição regional da ventilação pulmonar em pacientes com doença de chagas

INTRODUCTION: Cardiac and pulmonary manifestations of the Chagas disease (CD) affect between 20-30% of the infected subjects. The chronic Chagas cardiomyopathy (CCC) has some peculiarities such as arrhythmias and, especially heart failure (HF) and is potentially lethal due to left ventricular dysfunction. How respiratory disorders, patients get progressive loss of functional capacity, which contributes to a poor quality of life related to disease. Measurements of lung volume by the movement of the chest wall surface are an alternative evaluation of lung function and kinematics of complex thoracoabdominal for these patients. OBJECTIVE: evaluate the kinematics of the thoracoabdominal complex through the regional pulmonary volumes and to correlate with functional evaluation of the cardiorrespiratory system in patients with Chagas disease at rest. MATERIALS AND METHODS: a cross-section study with 42 subjects had been divided in 3 groups, 15 composed for patients with CCC, 12 patients with HF of different etiologies and 15 healthful presented control group. An optoelectronic plethysmography (POE), Minnesota questionnaire, six minute walk test, spirometer and manovacuometer was used. RESULTS: It was observed in the 6MWT where group CRL presented greater distance 464,93±44,63m versus Group HF with 399,58± 32,1m (p=0,005) and group CCC 404±68,24m (p=0,015), both the groups presented difference statistics with regard to Group CRL. In the manovacuometer 54,59±19,98; of the group CCC and 42,11±13,52 of group IC found group CRL presented 81,31±15,25 of the predicted versus, presenting in relation to group CRL. In the POE it observed a major contribution in abdominal compartment in patients with IC if compared like CCC and control groups. On the basis of the questionnaire of quality of life of Minessota, verified a low one groups CCC and IC 43,2±15,2 and 44,4±13,1, respectively (p<0,05) when compared with the control group (19,6±17,31). CONCLUSION: it seems that the patients with CCC possess same functional and respiratory characteristics, observed for the POE, 6MWT, manovacuometer and spirometer to the patients of group HF, being able to consider similar interventions for this complementary group as therapeutical of this neglected disease