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Immunizations for influenza and pneumococcus are effective interventions in reducing morbidity and mortality. The objective of this study was to describe the vaccination rates in volunteers from three regions of Argentina during the COVID-19 pandemic. In 2020, 3853 adults were surveyed, 61.6 % were females, 45 % were aged between 40 and 60 and 18.6 % were > 60 years old. The commonest comorbidities were hypertension (12.9 %), dyslipidemia (8.5 %), and smokers or former smokers (9.2 %). The global influenza vaccination rate was 37.7 %, pneumococcal vaccination 24.7 %, and both 17.8 %. Multivariable regression showed that the vaccination rate increased with age and the presence of comorbidities. However, in the subgroup with indications for both vaccines, 71.7 % had the influenza vaccine, 59 % had the pneumococcal vaccine, and 28.3 % received neither. Our study suggests that influenza and pneumococcal vaccine percentages in high-risk patients in Argentina remain sub-optimal. Immunizations with proven reductions in morbimortality could have also been relegated during the COVID pandemic.

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Purpose: The purpose of this review is to evaluate the effect of resistance training (RT) as a unique intervention on muscle strength, body composition, and immune-inflammatory markers in people living with HIV (PLHIV).Methods: The searches were conducted in seven databases and included published randomized clinical trials that assessed the effect of RT vs. no exercise on muscle strength, body composition, and immune-inflammatory markers in PLHIV until June 2021. Random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CI) were performed, and the effect size was estimated by Hedges' g test.Results: Seven RCTs were included (n= 258 PLHIV) and the study duration lasted between six and 24 weeks. In comparison to no exercise, RT improved muscle strength in bench press (MD 10.69 kg, 95%IC 3.44 to 17.93, p= 0.004, g =2.42) and squat (MD 22.66 kg, 95%IC 7.82 to 37.50, p= 0.003, g = 3.8) exercises, lean body mass (MD 2.96 kg, 95%CI 0.98 to 4.94, p= 0.003, g = 1.99), fat body mass(MD -2.67 kg; 95%CI -4.95 to -0.39, p= 0.02, g=-0.99), body fat percentage (MD -3.66%, 95%CI -6.04 to -1.29, p= 0.003, g=-1.99) and CD4+ cells count(MD 100.15 cells/mm3, 95%CI 12.21 to 188.08, p = 0.03, g = 2.91) in PLHIV. There was no effect of RT on IL-6 (MD -1.18 pg/mL, 95%CI -3.71 to 1.35, p = 0.36, g = 0.001) and TNF-α (MD -4.76 pg/mL, 95%CI -10.81 to 1.29, p = 0.12, g=-1.3) concentrations in PLHIV. Conclusions: RT as a unique intervention improves muscle strength, body composition and CD4+ count cells in PLHIV.

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Epicardial adipose tissue (EAT) is correlated with endothelial dysfunction, metabolic syndrome, increased mortality and recent studies showed a possible association with the increased risk of stroke. We performed a systematic review of studies evaluating the association between EAT and stroke. Eighty studies met the inclusion criteria and were consequently analyzed. The review had Five main findings. First, the increased epicardial fat thickness (EFT) may be associated with the stroke episode. Second, regardless of the imaging method (echocardiography, MRI, and CT) this association remains. Third, the association of metabolic syndrome and atrial fibrillation seems to increase the risk of stroke. Fourth, this systematic review was considered as low risk of bias. Despite being unable to establish a clear association between EAT and stroke, we have organized and assessed all the research papers on this topic, analyzing their limitations, suggesting improvements in future pieces of research and pointing out gaps in the literature. Furthermore, the mechanistic links between increased EAT and stroke incidence remains unclear, thus, further research is warranted.

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BACKGROUND: Coronavirus disease 2019 (COVID-19) primarily causes lung infection, but recent studies have shown that cardiac involvement is associated with a worse prognosis. OBJECTIVES: We conducted a systematic review and meta-analysis to examine the prevalence of cardiac arrhythmias detected by the electrocardiogram and their relationships with adverse outcomes in patients with COVID-19. METHODS: PubMed and Google were searched for studies that reported on cardiac arrhythmias and/or examined the relationship between arrhythmias and adverse outcomes. RESULTS: Thirty studies with 12,713 participants were included in the systematic review, and 28 studies (n = 12,499) in the meta-analysis. The mean age was 61.3 ± 16.8 years; 39.3% were female. In 25 studies with 7578 patients, the overall prevalence of cardiac arrhythmias was 10.3% (95% confidence interval [CI]: 8.4%-12.3%). The most common arrhythmias documented during hospitalization were supraventricular arrhythmias (6.2%, 95% CI: 4.4%-8.1%) followed by ventricular arrhythmias (2.5%, 95% CI: 1.8%-3.1%). The incidence of cardiac arrhythmias was higher among critically ill patients (relative risk [RR]: 12.1, 95% CI: 8.5-17.3) and among non-survivors (RR: 3.8, 95%, CI: 1.7-8.7). Eight studies reported changes in the QT interval. The prevalence of QTc > 500 ms was 12.3% (95% CI: 6.9%-17.8%). ST-segment deviation was reported in eight studies, with a pooled estimate of 8.7% (95% CI: 7.3% to 10.0%). CONCLUSION: Our meta-analysis showed that QTc prolongation, ST-segment deviation, and various other cardiac arrhythmias were observed in patients hospitalized with COVID-19. The presence of cardiac arrhythmias was associated with a worse prognosis.

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According to previous epidemiological studies, we can reduce the thickness of epicardial fat and improve cardiovascular risk factors through exercise, and the changes may depend on the form of exercise. We systemically reviewed published studies that evaluated exercise intervention on epicardial adipose tissue (EAT) levels. We included randomized controlled trials (RCTs) comparing one exercise with another exercise or diet for the treatment to reduce EAT. We used fixed effects models for meta-analyses; effects of exercise on outcomes were described as mean differences (MD) or standardized difference of means (SMD) was used, their 95% confidence intervals (CI). Five RCTs were included (n = 299), 156 in exercise group and 143 in the control. In comparison to the control group, exercise significantly reduced EAT (SMD - 0.57, 95%CI - 0.97 to - 0.18) and waist circumference (MD - 2.95 cm, 95%CI - 4.93 to - 0.97). Exercise did not have an effect on BMI (MD - 0.23 kg/m2, 95%CI - 0.73 to 0.27), weight (MD - 0.06 kg, 95%CI - 1.46 to 1.34), or HDL (SMD 0.26, 95%CI - 0.06 to 0.57).VO2 was significantly increased by exercise (SMD 1.58, 95%CI 1.17 to 1.99). Risk of bias was high for 3 studies, and GRADE quality of evidence was very low to moderate. Exercise reduced epicardial adipose tissue and waist circumference, and did not have effect on weight, BMI, or HDL. Newer trials with better design and methods are necessary to improve the quality of the evidence. PROSPERO registration number (CRD42018096581).

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PURPOSE OF REVIEW: The aim of this study was to determine the effects of aerobic exercise on peak oxygen uptake (peak VO2), minute ventilation/carbon dioxide production (VE/VCO2 slope), and health-related quality of life (HRQoL) among patients with heart failure (HF) and preserved ejection fraction (HFpEF). RECENT FINDINGS: We conducted a Cochrane Library, MEDLINE/PubMed, Physiotherapy Evidence Database, and SciELO search (from 1985 to May 2019) for randomized controlled trials that evaluated the effects of aerobic exercise in HFpEF patients. We calculated the mean differences (MD) and 95% confidence interval (CI). Ten intervention studies were included providing a total of 399 patients. Compared with control, aerobic exercise resulted in improvement in peak VO2 MD 1.9 mL kg-1 min-1 (95% CI 1.3 to 2.5; N = 314) and HRQoL measured by Minnesota Living with Heart Failure MD 5.4 (95% CI - 10.5 to - 0.2; N = 256). No significant difference in VE/VCO2 slope was found between participants in the aerobic exercise group and the control group. The quality of evidence for peak VO2 and HRQoL was assessed as being moderate. Aerobic exercise moderately improves peak VO2 and HRQoL and should be considered a strategy of rehabilitation of HFpEF individuals.

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PURPOSE OF REVIEW: High-intensity exercise may beneficially impact on insulin sensitivity. However, there is still uncertainty on the actual impact of high-intensity interval training (HIIT) on chronic physiologic adaptations among patients with type 2 diabetes mellitus (T2DM). We aimed to systematically search and appraise the evidence base on the effects of HIIT in comparison to mild- or moderate-intensity interval training (MMIIT) on glycemic control inT2DM. RECENT FINDINGS: A total of 5 RCT met the inclusion criteria. Most studies presented significant differences for weight and BMI with HIIT, and with both interventions for total body fat. For the other health-related variables (systolic and diastolic BP, fasting cholesterol, LDL and HDL, triglycerides, fasting glucose, and HbAc1), only 1 study provided detailed results for HIIT, showing significant differences for systolic BP and HDL cholesterol in 2 studies, total cholesterol, LDL, and triglycerides, whereas for MIIT, only 1 study brought significant differences for LDL cholesterol. For glucose levels, significant differences were reported in 4 studies for both HIIT and MMIT, but only two studies used the percentage delta assessment tool, whereas 1 study only showed significant improvements for HIIT. The number of studies for the analysis is not precise as to the statements regarding the results of the intervention proposed for this public, since they do not allow identifying a consistency of the findings, not presenting diversity between the training methods and the different methods of volume control and intensity of training.

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Atrial fibrillation (AF) is one of the cardiovascular risk factors for dementia. Several longitudinal studies have reported an association between AF and dementia independently of stroke history. Although the mechanisms underlying this association are not fully understood, proposed mechanisms include cerebral hypoperfusion, inflammation, genetic factors, cerebral microbleeds, and recurrent silent cerebral ischemia. Oral anticoagulation can be used to minimize risk of cognitive decline and dementia, given that brain insults can be caused by chronic microemboli or microbleeds. However, controversy on the effects of warfarin and direct oral anticoagulants on this risk exists. This article will address these aspects, with data on the studies already published and a critical view on this subject.

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PURPOSE OF REVIEW: Resting heart rate is an independent risk factor for all-cause and cardiovascular mortality in patients with heart failure. The main objectives are to discuss the prognosis of heart rate, its association with coronary atherosclerosis, and the modalities of control of the heart rate in sinus rhythm and in the rhythm of atrial fibrillation in patients with chronic heart failure. RECENT FINDINGS: As a therapeutic option for control heart rate, medications such as beta-blockers, digoxin, and finally ivabradine have been studied. Non-dihydropyridine calcium channel blockers are contraindicated in patients with heart failure and reduced ejection fraction. The influence of the magnitude of heart rate reduction and beta-blocker dose on morbidity and mortality will be discussed. Regarding the patients with heart failure and atrial fibrillation, there are different findings in heart rate control with the use of a beta-blocker. Patients eligible for ivabradine have clinical benefits and increased ejection fraction. Vagal nerve stimulation has low efficacy for the control of heart rate. Complementary therapies such as tai chi and yoga showed no effect on heart rate. In this review, we discuss the main therapeutic options for the control of heart rate in patients with atherosclerosis and heart failure. More research is needed to examine the effects of therapeutic options for heart rate control in different population types, as well as their effects on clinical outcomes and impact on morbidity and mortality.

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