Fall-related causes in patients with COPD might be associated to functional balance impairments and greater disease severity. We aimed to evaluate the reasons for falls in patients with COPD who had presented any fall during the previous year. This is a cross-sectional study. All COPD’s GOLD classifications (mild, moderate, severe, and very severe) patients were recruited. In order to participate, patients ought to be clinically stable and without any exacerbation within 30 days prior to study entry. History of falls was self-reported by patients through an interview. Pre and post bronchodilator (salbutamol 400 μg) spirometry was performed. All patients accomplished postural balance tests such as the Berg Balance Scale, Falls Efficacy Scale-International, Time up and Go, Functional Reach test, Tinetti test and Chalder Scale; furthermore, lower limbs muscle strength (muscle dynamometry) and the COPD Assessment Test (CAT) were assessed. Ninety-six patients with COPD were evaluated and divided into two groups stratified according to any positive history of falls in the previous year. Patients with COPD who had any fall in the previous year presented older age (p=0.01), higher BMI (p=0.04) and worse pulmonary function than those who did not fall. The risk of falls was increased in patients with lower muscle strength in the lower limbs (OR 2.9, CI 95%;1.6 to 3.9), age greater than 65 years (OR 2.7, CI 95%;1.3 to 3.4), BMI greater than 28.8 kg/m2 (OR 3.2, CI 95%;1.1 to 5.6), very severe airway obstruction (OR 3.9, CI 95%;2.2 to 3.9) and fatigue (OR 3.2, CI 95%;1.5 to 5.3). Impaired body balance, reduced lower limb strength, disease severity, presence of fatigue and elevated BMI are important factors for falls in patients with COPD.

Background: Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors usually related to central fat deposition, insulin resistance, hypertension, and dyslipidemia. It is associated with accelerated atherosclerosis in response to chronic inflammation and vascular endothelial dysfunction, increasing overall mortality. Objective: We aimed to evaluate the effect of a cardiac rehabilitation program on cardiovascular risk factors in patients with metabolic syndrome. Methods: This is prospective interventional study. All patients underwent a 20-session cardiac rehabilitation program with aerobic and resisted exercises as well as an educational program for lifestyle changes. Results: Forty-seven patients participated in the present study. After the cardiac rehabilitation program (CRP), a significant reduction (p = 0,0092) for cardiovascular risk and fatigue (p > 0.001) was observed; 78% of the patients had positive effects on physical capacity, 72% of the patients presented HbA1c reduction, 51% increased HDL-cholesterol, 70% reduced total cholesterol, 63% reduced triglycerides, 61% reduced systolic blood pressure and 53% reduced diastolic blood pressure. Conclusion: Cardiac rehabilitation program with aerobic and resisted exercises associated with educational program for lifestyle changes is an effective approach in the treatment of patients with metabolic syndrome mainly seen by a reduced cardiovascular risk factors and reducing fatigue, improved physical capacity and reduced components of metabolic syndrome.

Objetivos: Comparar o desfecho dos modos ventilatórios VCV, PCV e PRVC em relação a mecânica ventilatória, o tempo de ventilação mecânica, tempo de internação em UTI e sobrevida em pacientes neurológicos. Métodos: Estudo de coorte randomizado comparando três modalidades ventilatórias VCV, PCV e PRVC em pacientes neurológicos com diagnóstico de AVC isquêmico ou hemorrágico e TCE, ventilados mecanicamente e internados em UTI. O ventilador mecânico era ajustado conforme modo sorteado e com parâmetros ventilatórios ajustados para manter volume corrente de 6 a 8 ml/Kg e parâmetros gasométricos dentro da normalidade. Foram coletados dados demográficos, parâmetros hemodinâmicos, gasométricos e ventilatórios e as escalas APACHE II, RASS e Glasgow. Ao final do protocolo foram registrados os dados de mortalidade/sobrevida, tempo de internação em UTI e alta da unidade. Resultados: O grupo PVC apresentou maior tempo de permanência em ventilação assisto controlada em relação aos grupos VCV e PRVC (p=0,04). Além disso, o grupo PCV apresentou maior tempo de ventilação mecânica (p=0,002), maior tempo de internação em UTI (p=0,01). Ainda, não houve diferença entre os grupos quanto a sobrevida, o grupo VCV e PRVC apresentou uma tendência a sobrevida quando comparado ao PCV (p=0,4).  Por fim, não houve diferença entre os grupos em relação às características clínicas, mecânica ventilatória e gasométricas. Conclusão: Pacientes neurológicos devem ser ventilados mecanicamente preferencialmente em modo VCV e PRVC, pois estes modos apresentam vantagens sobre o modo PCV em pacientes neurológicos.