Coronaviruses (CoV) make up a large family of viruses, known since the mid-1960s, which received this name due to the spikes on its surface, which resemble a crown (from the Latin corona). CoV infections can cause everything from a common cold to severe respiratory syndromes, such as severe acute respiratory syndrome (SARS-CoV) and Middle Eastern respiratory syndrome (MERS-CoV). COVID-19 is a new variant of the coronavirus, and its isolation occurred in China on January 7th, 2020. COVID-19 has stood out with a high impact on public health due to the high number of cases with infection in a short period of time. However, it is possible to observe that 17% of patients confirmed with COVID-19 have severe infections and about 2.5% of these patients die. Current studies have shown that the number of mild and asymptomatic cases may be even greater. Thus, the challenges for controlling unreported cases of patients with mild symptoms that are spreading the virus and interfering with the magnitude and real data of the cases stand out. The transmission of the coronavirus occurs between humans, and it can occur from person to person through the air, through coughing or sneezing, by touching or shaking hands or by contact with contaminated objects or surfaces, followed by contact with the mouth, nose or eyes. Given the fluctuation in the incidence and the lethality rate, it is essential to stand out the precepts of health promotion in search of reorienting hygiene practices, considering that there is validity in health care models, still with a curative approach and the current situation experienced by the world population requires a preventive stance.

BackgroundAn upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF.MethodsSFAVFs were evaluated using the following variables: immediate results, early and late complications, intraoperative and postoperative complications (up to day 30), efficiency of the fistula after the onset of needling and complications associated to its use.ResultsFifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10 transplanted (20%), 12 deaths (24%), 1 low flow (2%) and 20 thrombosis (39%) (first two months of preparation). One patient had severe hypotension during surgery, which caused thrombosis of the fistula, which was successfully thrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the first postoperative day. After 59 months of follow-up, primary patency was 44%.ConclusionSFAVF is an adequate alternative for patients without the possibility for other access in the upper limbs, allowing efficient dialysis with good long-term patency with a low complication rate.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is considered a multisystem degenerative disease due to its autonomic dysfunction effects. Autonomic cardiac control disorders can be seen in ALS and influence the quality of life and the life expectancy of affected individuals. We evaluated heart rate variability in subjects with ALS and with variable lung capacity. METHODS: We conducted a prospective cross-sectional study performed in 42 subjects with ALS. The subjects were classified into 2 groups according to their FVC: (FVC > 50% of the predicted value [n ‫؍‬ 19] and FVC < 50% of the predicted value [n ‫؍‬ 23]). Heart rate was recorded at rest during spontaneous breathing by using a heart rate monitor. Linear indices in the time and frequency domains were analyzed, and non-linear analysis was performed by using Poincaré plots. RESULTS: The results showed a decrease of heart rate variability in the subjects with lower lung capacity and who needed ventilatory support. Qualitative analysis when using the plots supported the quantitative analysis, wherein the group with a lower lung capacity showed reduced heart rate variability. No significant differences were found in the other heart rate variability indices. CONCLUSIONS: The subjects with ALS and with decreased pulmonary capacity had reduced heart rate variability.

In this minireview we describe the involvement of the atrial natriuretic peptide (ANP) in cardiovascular pathophysiology and exercise. The ANP has a broad homeostatic role and exerts complex effects on the cardio-circulatory hemodynamics, it is produced by the left atrium and has a key role in regulating sodium and water balance in mammals and humans. The dominant stimulus for its release is atrial wall tension, commonly caused by exercise. The ANP is involved in the process of lipolysis through a cGMP signaling pathway and, as a consequence, reducing blood pressure by decreasing the sensitivity of vascular smooth muscle to the action of vasoconstrictors and regulate fluid balance. The increase of this hormone is associated with better survival in patients with chronic heart failure (CHF). This minireview provides new evidence based on recent studies related to the beneficial effects of exercise in patients with cardiovascular disease, focusing on the ANP.

BackgroundThe analysis of hemodialysis services is relevant for the quality of life of patient. In this study we investigated the profile of vascular access used for hemodialysis patients in our Unit.MethodsWe evaluated 219 patients of both genders aged over 18 years old who have undergone implant or manufacture of vascular hemodialysis access. We excluded patients on renal replacement therapy by peritoneal dialysis.ResultsAssociated diseases were hypertension and diabetes mellitus. 161 had arteriovenous fistula, with 153 held by the same dialysis and nine of them were still maturing. 27 patients on dialysis used central venous catheter. 148 were indigenous and five were made using polytetrafluoroethylene prosthesis (PTFE). Among the 27 patients with central venous catheters, ten used short-term catheter and 17 used long-term catheter. The most frequent type of fistula use was on the radio distal cephalic, in 85 patients (52.5%), followed by radio cephalic proximal in 26 patients (16%). The number of fistulas in dialysis patients conducted by this kind of therapy ranged from one to ten and in 64 patients (41.83%) fistula was the first and only to be made. Among the fistula for dialysis patients, the highest prevalence was radio cephalic fistula in 111 patients (72.5%) and mean duration of use was 48.1 months, ranging from two months to 17 years.ConclusionOur Unit of hemodialysis is above the limits established by international norms.