RESUMO
Introduction: Functional capacity is decreased in people with Cardiovascular Diseases and Chronic Respiratory Diseases. These diseases have also been associated with cognitive dysfunction. The study examines the efficacy of a cardiopulmonary rehabilitation program in the recovery of functional capacity and analyzes whether subjects with cardiopulmonary diseases suffer from cognitive dysfunction. Materials and methods: Participated 50 adults with medium-high education who completed a cardiopulmonary rehabilitation program of between 3 and 6 months based on physical education, nutritional education, promotion of healthy habits and medication management. Functional capacity was evaluated with the Duke index at the beginning and end of the program. Memory and language tests were also administered, for the only time, at the beginning of the program, comparing the values obtained with Argentine normative studies. The data was analyzed with the Wilcoxon test, bivariate correlations, and linear regression. Results: Functional capacity increased significantly at the end of the program. In any case, the post-program Duke value suggests that the functional capacity of the patients continues to be affected. On the other hand, a memory test explained 10,8% of the variance in the Duke index, and there are no findings of cognitive dysfunction. Conclusion: The functional capacity of cardiopulmonary patients improved with the rehabilitation program, although this improvement is clinically insufficient. Better memory performance predicted greater functional capacity, which is why it is suggested to add cognitive stimulation workshops to cardiopulmonary rehabilitation programs. This sample with cardiopulmonary disease does not present cognitive dysfunction, probably due to its high cognitive reserve. Introduction: Functional capacity is decreased in people with Cardiovascular Diseases and Chronic Respiratory Diseases. These diseases have also been associated with cognitive dysfunction. The study examines the efficacy of a cardiopulmonary rehabilitation program in the recovery of functional capacity and analyzes whether subjects with cardiopulmonary diseases suffer from cognitive dysfunction. Materials and methods: Participated 50 adults with medium-high education who completed a cardiopulmonary rehabilitation program of between 3 and 6 months based on physical education, nutritional education, promotion of healthy habits and medication management. Functional capacity was evaluated with the Duke index at the beginning and end of the program. Memory and language tests were also administered, for the only time, at the beginning of the program, comparing the values obtained with Argentine normative studies. The data was analyzed with the Wilcoxon test, bivariate correlations, and linear regression. Results: Functional capacity increased significantly at the end of the program. In any case, the post-program Duke value suggests that the functional capacity of the patients continues to be affected. On the other hand, a memory test explained 10,8% of the variance in the Duke index, and there are no findings of cognitive dysfunction. Conclusion: The functional capacity of cardiopulmonary patients improved with the rehabilitation program, although this improvement is clinically insufficient. Better memory performance predicted greater functional capacity, which is why it is suggested to add cognitive stimulation workshops to cardiopulmonary rehabilitation programs. This sample with cardiopulmonary disease does not present cognitive dysfunction, probably due to its high cognitive reserve.
Introducción: La capacidad funcional está disminuida en personas con Enfermedades Cardiovasculares y Enfermedades Respiratorias Crónicas. Estas enfermedades también han sido asociadas a disfunción cognitiva. El estudio examina la eficacia de un programa de rehabilitación cardiopulmonar en la recuperación de la capacidad funcional, y analiza si sujetos con enfermedades cardiopulmonares sufren disfunción cognitiva. Materiales y métodos: Participaron 50 personas adultas con instrucción media-alta que completaron un programa de rehabilitación cardiopulmonar de entre 3 y 6 meses basado en educación física, educación nutricional, promoción de hábitos saludables y manejo de medicación. Se evaluó la capacidad funcional con el índice Duke al iniciar y finalizar el programa. Se administró también, por única vez, al iniciar el programa, pruebas de memoria y de lenguaje, comparando los valores obtenidos con estudios normativos argentinos. Se analizó los datos con test Wilcoxon, correlaciones bivariadas y regresión lineal. Resultados: La capacidad funcional aumentó significativamente al finalizar el programa. De todos modos el valor Duke pos- programa sugiere que la capacidad funcional de los pacientes continúa afectada. Por otro lado, una prueba de memoria explicó el 10,8% de la varianza en el índice Duke, y no hay hallazgos de disfunción cognitiva. Conclusión: La capacidad funcional de los pacientes cardiopulmonares mejoró con el programa de rehabilitación, aunque dicha mejora, es clínicamente insuficiente. Mejor rendimiento de memoria predijo mayor capacidad funcional, por lo que se sugiere añadir talleres de estimulación cognitiva a los programas de rehabilitación cardiopulmonares. Esta muestra con enfermedad cardiopulmonar no presenta disfunción cognitiva, probablemente por su elevada reserva cognitiva.
Assuntos
CogniçãoRESUMO
A cyclical corticosteroid-cyclophosphamide regimen is recommended for patients with primary membranous nephropathy at high risk of progression. We hypothesized that sequential therapy with tacrolimus and rituximab is superior to cyclical alternating treatment with corticosteroids and cyclophosphamide in inducing persistent remission in these patients. This was tested in a randomized, open-label controlled trial of 86 patients with primary membranous nephropathy and persistent nephrotic syndrome after six-months observation and assigned 43 each to receive six-month cyclical treatment with corticosteroid and cyclophosphamide or sequential treatment with tacrolimus (full-dose for six months and tapering for another three months) and rituximab (one gram at month six). The primary outcome was complete or partial remission of nephrotic syndrome at 24 months. This composite outcome occurred in 36 patients (83.7%) in the corticosteroid-cyclophosphamide group and in 25 patients (58.1%) in the tacrolimus-rituximab group (relative risk 1.44; 95% confidence interval 1.08 to 1.92). Complete remission at 24 months occurred in 26 patients (60%) in the corticosteroid-cyclophosphamide group and in 11 patients (26%) in the tacrolimus-rituximab group (2.36; 1.34 to 4.16). Anti-PLA2R titers showed a significant decrease in both groups but the proportion of anti-PLA2R-positive patients who achieved immunological response (depletion of anti-PLA2R antibodies) was significantly higher at three and six months in the corticosteroid-cyclophosphamide group (77% and 92%, respectively), as compared to the tacrolimus-rituximab group (45% and 70%, respectively). Relapses occurred in one patient in the corticosteroid-cyclophosphamide group, and three patients in the tacrolimus-rituximab group. Serious adverse events were similar in both groups. Thus, treatment with corticosteroid-cyclophosphamide induced remission in a significantly greater number of patients with primary membranous nephropathy than tacrolimus-rituximab.