Impacts of a fraction of inspired oxygen adjustment protocol in COVID-19 patients under mechanical ventilation: A prospective cohort study.

Objective: We examined weather a protocol for fraction of inspired oxygen (FiO2) adjustment can reduce hyperoxemia and excess oxygen use in COVID-19 patients mechanically ventilated. Design: Prospective cohort study. Setting: Two intensive care units (ICUs) dedicated to COVID-19 patients in Brazil. Patients: Consecutive patients with COVID-19 mechanically ventilated. Interventions: One ICU followed a FiO2 adjustment protocol based on SpO2 (conservative-oxygen ICU) and the other, which did not follow the protocol, constituted the control ICU. Main variables of interest: Prevalence of hyperoxemia (PaO2 >100 mmHg) on day 1, sustained hyperoxemia (present on days 1 and 2), and excess oxygen use (FiO2 > 0.6 in patients with hyperoxemia) were compared between the two ICUs. Results: Eighty two patients from the conservative-oxygen ICU and 145 from the control ICU were included. The conservative-oxygen ICU presented lower prevalence of hyperoxemia on day 1 (40.2% vs. 75.9%, p < 0.001) and of sustained hyperoxemia (12.2% vs. 49.6%, p < 0.001). Excess oxygen use was less frequent in the conservative-oxygen ICU on day 1 (18.3% vs. 52.4%, p < 0.001). Being admitted in the control ICU was independently associated with hyperoxemia and excess oxygen use. Multivariable analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FiO2 use and adverse clinical outcomes. Conclusions: Following FiO2 protocol was associated with lower hyperoxemia and less excess oxygen use. Although those results were not associated with better clinical outcomes, adopting FiO2 protocol may be useful in a scenario of depleted oxygen resources, as was seen during the COVID-19 pandemic.

Objetivo: Evaluar si un protocolo para el ajuste de la FiO2 reduce la hiperoxemia y el uso excesivo de oxígeno en pacientes con COVID-19 en ventilación mecánica. Diseño: Estudio de cohorte prospectivo. Ámbito: Unidades de cuidados intensivos (UCI) dedicadas a pacientes con COVID-19 en Brasil. Pacientes: Pacientes con COVID-19. Intervenciones: Una UCI siguió un protocolo de ajuste de FiO2 basado en SpO2 (UCI de oxigenoterapia conservadora, N = 82) y la otra no siguió el protocolo (UCI control, N = 145). Principales variables de interés: Prevalencia de hiperoxemia (PaO2 > 100 mmHg) en el día 1, hiperoxemia sostenida (presente en los días 1 y 2) y exceso de uso de oxígeno (FiO2 > 0,6 en pacientes con hiperoxemia) entre las 2 UCI. Resultados: La UCI de oxigenoterapia conservadora presentó menor prevalencia de hiperoxemia en el día 1 (40,2 vs. 75,9%; p < 0,001) y de hiperoxemia sostenida (12,2 vs. 49,6%; p < 0,001). El uso excesivo de oxígeno fue menos frecuente en la UCI de oxigenoterapia conservadora el día 1 (18,3 vs. 52,4%; p < 0,001). El ingreso en la UCI control se asoció de forma independiente con la hiperoxemia y el uso excesivo de oxígeno. Los análisis multivariables no encontraron una relación independiente entre hiperoxemia o uso excesivo de FiO2 y resultados clínicos adversos. Conclusiones: Seguir el protocolo de FiO2 se asoció con menor hiperoxemia y menor consumo de oxígeno en exceso. Aunque esos resultados no se asociaron con mejores resultados clínicos, la adopción del protocolo FiO2 puede ser útil en un escenario de recursos de oxígeno agotados, como se vio durante la pandemia de COVID-19.

Fluoxetine reduces periodontal disease progression in a conditioned fear stress model in rats.

BACKGROUND AND OBJECTIVE: Recent evidence suggests that the use of fluoxetine could reduce periodontal disease severity. However, the effect of fluoxetine on periodontal disease has not been tested in the context of conditioned fear stress (CFS). We hypothesized that inhibition of chronic stress by fluoxetine might decrease the levels of bone loss in periodontal disease. The aim of the present study was to analyze the effect of fluoxetine on bone loss in chronic periodontitis. MATERIAL AND METHODS: Fourteen Wistar rats were submitted to ligature-induced periodontal disease and divided into four groups (A-D). Groups A (n = 3) and B (n = 4) were not stressed, while Groups C (n = 3) and D (n = 4) were submitted to a CFS paradigm for 38 d. Daily fluoxetine (20 mg/kg) was administered to Groups B and D from day 20 to day 39, at which point the rats were submitted to an open field test and killed on day 40. Mandibles were removed for histological and immunohistochemical analyses. RESULTS: Stress was associated with a higher level of bone loss in Group C compared with Group A. Additionally, no differences in bone loss were observed among Groups A, B and D. CONCLUSION: We showed that stress is associated with the progression of bone loss in a CFS model in rats and that fluoxetine treatment reduces the bone loss.

Diazepam reverses the alveolar bone loss and hippocampal interleukin-1beta and interleukin-6 enhanced by conditioned fear stress in ligature-induced periodontal disease in rats.

BACKGROUND AND OBJECTIVE: Stress and anxiety have been associated with chronic periodontitis, but few studies examining the effects of psychotropic drugs on periodontal health have been performed. Therefore, we aimed to investigate the effects of diazepam on the progression of periodontitis in chronically stressed rats. MATERIAL AND METHODS: Fourteen Wistar rats were submitted to ligature-induced periodontal disease and were divided into four groups . Two groups were not stressed, whereas two groups were submitted to a conditioned fear stress paradigm for 38 d. Daily diazepam treatment (2 mg/kg, orally) was administered to one unstressed group and to one group submitted to a conditioned fear stress paradigm from day 2 to the day 39, at which point the rats were submitted to an open field test and were killed on day 40. Brains and mandibles were removed for histological and immunohistochemical analyses. RESULTS: Animals exposed to conditioned fear stress presented an increase in freezing behavior, a decrease in locomotor activity, enhanced alveolar bone loss and higher levels of hippocampal interleukin-1beta (IL-1ß) and interleukin-6 (IL-6), compared with the control group. Diazepam, at the dose used in the current study, had no effect on freezing behavior but reversed the decrease in locomotor activity provoked by stress. Additionally, the treatment reduced the levels of hippocampal IL-1ß and IL-6 and alveolar bone loss in Wistar rats. Neither conditioned fear stress nor diazepam treatment had an effect on periodontal IL-1ß or IL-6 levels in animals. CONCLUSION: Our results suggest that diazepam treatment reduces bone loss in rats submitted to conditioned fear stress. In addition, diazepam treatment led to decreased IL-1ß and IL-6 levels in the hippocampus.

Impacts of a fraction of inspired oxygen adjustment protocol in COVID-19 patients under mechanical ventilation: A prospective cohort study.

OBJECTIVE: We examined weather a protocol for fraction of inspired oxygen (FiO2) adjustment can reduce hyperoxemia and excess oxygen use in COVID-19 patients mechanically ventilated. DESIGN: Prospective cohort study. SETTING: Two intensive care units (ICUs) dedicated to COVID-19 patients in Brazil. PATIENTS: Consecutive patients with COVID-19 mechanically ventilated. INTERVENTIONS: One ICU followed a FiO2 adjustment protocol based on SpO2 (conservative-oxygen ICU) and the other, which did not follow the protocol, constituted the control ICU. MAIN VARIABLES OF INTEREST: Prevalence of hyperoxemia (PaO2>100mmHg) on day 1, sustained hyperoxemia (present on days 1 and 2), and excess oxygen use (FiO2>0.6 in patients with hyperoxemia) were compared between the two ICUs. RESULTS: Eighty two patients from the conservative-oxygen ICU and 145 from the control ICU were included. The conservative-oxygen ICU presented lower prevalence of hyperoxemia on day 1 (40.2% vs. 75.9%, p<0.001) and of sustained hyperoxemia (12.2% vs. 49.6%, p<0.001). Excess oxygen use was less frequent in the conservative-oxygen ICU on day 1 (18.3% vs. 52.4%, p<0.001). Being admitted in the control ICU was independently associated with hyperoxemia and excess oxygen use. Multivariable analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FiO2 use and adverse clinical outcomes. CONCLUSIONS: Following FiO2 protocol was associated with lower hyperoxemia and less excess oxygen use. Although those results were not associated with better clinical outcomes, adopting FiO2 protocol may be useful in a scenario of depleted oxygen resources, as was seen during the COVID-19 pandemic.

Adherence to protective mechanical ventilation in COVID-19 versus non-COVID-19-associated acute respiratory distress syndrome: Comparison between two prospective cohorts.

OBJECTIVE: To compare adherence to protective mechanical ventilation (MV) parameters in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 with patients with ARDS from other etiologies. DESIGN: Multiple prospective cohort study. SETTING: Two Brazilian cohorts of ARDS patients were evaluated. One with COVID-19 patients admitted to two Brazilian intensive care units (ICUs) in 2020 and 2021 (C-ARDS, n=282), the other with ARDS-patients from other etiologies admitted to 37 Brazilian ICUs in 2016 (NC-ARDS, n=120). PATIENTS: ARDS patients under MV. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Adherence to protective MV (tidal volume ≤8mL/kg PBW; plateau pressure ≤30cmH2O; and driving pressure ≤15cmH2O), adherence to each individual component of the protective MV, and the association between protective MV and mortality. RESULTS: Adherence to protective MV was higher in C-ARDS than in NC-ARDS patients (65.8% vs. 50.0%, p=0.005), mainly due to a higher adherence to driving pressure ≤15cmH2O (75.0% vs. 62.4%, p=0.02). Multivariable logistic regression showed that the C-ARDS cohort was independently associated with adherence to protective MV. Among the components of the protective MV, only limiting driving pressure was independently associated with lower ICU mortality. CONCLUSIONS: Higher adherence to protective MV in patients with C-ARDS was secondary to higher adherence to limiting driving pressure. Additionally, lower driving pressure was independently associated with lower ICU mortality, which suggests that limiting exposure to driving pressure may improve survival in these patients.

Clustering of traditional risk factors and precocity of coronary disease in women.

BACKGROUND: Women usually develop coronary artery disease (CAD) 10 years later than men do. CAD in women is associated with menopausal status and the number and intensity of risk factors. But, when the age gap between men and women narrows, less is known about the influence of risk factors on CAD. METHODS: We assessed the prevalence of traditional risk factors in 850 men and 468 women with stable CAD who had mean age, 58.3+/-8.6 and 58.8+/-10.3 years (P=NS), respectively. RESULTS: Univariate analysis of risk factors showed that body mass index (BMI), hypertension (all three stages), diabetes, triglycerides (> or =2.8 mmol/l), cholesterol (> or =6.2 mmol/l) and family history were more prevalent in women. Smoking and previous myocardial infarction (MI) were more prevalent in men. Multivariable analysis disclosed hypertension, diabetes, dyslipidemia and family history as independent risk factors for women with stable CAD and smoking and previous MI as independent risk factors for men. CONCLUSION: Clustering of traditional risk factors may explain the precocity of CAD in women who are near in age to men.

[Drug treatment for stable coronary artery disease at primary and tertiary medical centers]. / Tratamento medicamentoso da doença arterial coronária estável em centros de atendimento primário e terciário.

PURPOSE: To observe the distribution of the main drugs used in patients with stable coronary heart disease, in primary and tertiary medical care centers (MCC). METHODS: We studied 300 consecutive out patients at the Hetat Institute with the diagnosis of stable coronary artery disease, 205 (68%) males and 95 (32%) female, aged from 31 to 80 (mean 58 +/- 8.0) years old. Drug intake was evaluated. RESULTS: We observed that the use of nitrates (48% vs 55%; p = NS) and calcium antagonists (46% vs 37%; p = NS), respectively in both primary and tertiary MCC was similar. The beta blockers were used more often in the primary MCC (50% vs 35%; p = 0.02). Angiotensin converting enzyme inhibitors (11% vs 42%; p < 0.001), diuretics (30% vs 49%; p = 0.002) and aspirin (44% vs 76%; p = 0.0001) were more frequently used in the tertiary MCC. CONCLUSION: We observed similar frequency of use of nitrates and calcium antagonists in both centers. There was a higher use of beta blockers in primary MCC. The angiotensin converting enzyme inhibitors and antiplatelet agents were more used in the tertiary MCC. In relation to the updated literature, the best pharmacotherapy to coronary artery disease should be optimized in both centers.

Mortality and recruitment of trees in a secondary montane rain forest in southeastern Brazil.

Mortality and recruitment rates were obtained for tree species over a 5.6 year period in a 1-ha fragment of secondary montane rain forest in Southeastern Brazil. All plants with a diameter at breast height (dbh) > or = 8 cm were sampled in 1989-1990 and 1995. There was an increase from 90 to 96 species, and 669 ind./ha to 749 ind./ha over the period. The mortality rate of 1.67%/yr was similar to findings for other forests, while recruitment of 3.46%/yr was the highest rate reported. Both mortality and recruitment were significantly higher in the smaller dbh classes. Recruitment was higher among rare species, and the relatively slow-growing species had significantly higher mortality rates. Differences between species dynamics were marked. Species with high values of lambda were mainly early successional and understorey trees but some understorey species also suffered a marked population decline. The classification system of species in response to light which divides understorey species into "partial shade-bearers" and "shade-bearers" groups showed to be the most suitable to the obtained results. The results suggest that this forest is undergoing a process of recovery from past disturbance.

Physical activity in daily life assessed by an accelerometer in kidney transplant recipients and hemodialysis patients.

BACKGROUND: Sedentary lifestyle is a problem among hemodialysis (HD) patients, potentially attenuated after kidney transplantation. However, the effect of kidney transplantation on physical activity has not been thoroughly investigated. OBJECTIVE: This study sought to evaluate the physical activity in daily life in kidney transplant recipients (KTRs) compared with HD patients and to explore its relationship with clinical variables. METHODS: A cross-sectional study enrolled KTRs who received transplants at least 6 months before the study (N = 23; 48.3 ± 10.3 years) and patients undergoing HD for at least 6 months (N = 20; 47.3 ± 12.6 years). Time spent in different activities (walking, standing, sitting, and lying down) and number of steps taken, measured by a multiaxial accelerometer used for 12 h/d on 2 consecutive days for KTRs and on 4 consecutive days for HD patients, were evaluated. RESULTS: KTRs engaged in more active time per day (sum of walking and standing time) than HD patients (311 ± 87 vs 196 ± 54 min/d; P = .001), with longer walking (106 ± 53 vs 70 ± 27 min/d; P = .008) and standing time (205 ± 55 vs 126 ± 42 min/d; P < .001). Sixty-five percent of KTRs were classified as active (>7500 steps/d) compared with only 20% of the HD group (P < .05). The multivariate analysis showed that time posttransplantation was significantly associated with walking time and active time. CONCLUSIONS: By using an accelerometer, a precise method, this study showed that KTRs are significantly more active in daily life than HD patients, and that daily physical activity increases with time since transplantation.

Mortality and recruitment of trees in a secondary montane rain forest in Southeastern Brazil

Mortality and recruitment rates were obtained for tree species over a 5.6 year period in a 1-ha fragment of secondary montane rain forest in Southeastern Brazil. All plants with a diameter at breast height (dbh) > 8 cm were sampled in 1989-1990 and 1995. There was an increase from 90 to 96 species, and 669 ind./ha to 749 ind./ha over the period. The mortality rate of 1.67 percent/yr was similar to findings for other forests, while recruitment of 3.46 percent/yr was the highest rate reported. Both mortality and recruitment were significantly higher in the smaller dbh classes. Recruitment was higher among rare species, and the relatively slow-growing species had significantly higher mortality rates. Differences between species dynamics were marked. Species with high values of l were mainly early successional and understorey trees but some understorey species also suffered a marked population decline. The classification system of species in response to light which divides understorey species into "partial shade-bearers" and "shade-bearers" groups showed to be the most suitable to the obtained results. The results suggest that this forest is undergoing a process of recovery from past disturbance

Tratamento medicamentoso da doença arterial coronária estável em centros de atendimento primário e terciário / Clinical therapheutics for stable coronary artery disease. Differences between primary and tertiary medical care centers

OBJETIVO - Observar a distribuição das drogas em pacientes com doença arterial coronária (DAC) estável, em centros de atendimento (CA) primário e terciário. MÉTODOS - Foram analisados, 300 pacientes, consecutivos, no ambulatório do Grupo de Coronariopatias do INCOR com diagnóstico de DAC, idades entre 31 a 80 (58,5ñ8,0) anos, sendo 205 (68 por cento) do sexo masculino e 95 (32 por cento) do feminino e estudadas as características clínicas e hemodinâmicas. Avaliaram-se as drogas utilizadas, inicialmente, nos CA primários (comunitários) e, posteriormente, no CA terciário. RESULTADOS - As drogas mais utilizadas nos CA primários foram os ß-bloqueadores (50 por cento dos pacientes), nitratos (48 por cento), bloqueadores dos canais de cálcio (46 por cento), ácido acetil-salicílico (44 por cento), diuréticos (30 por cento) e os inibidores da enzima de conversão de angiotensina (ECA), em 11 'por cento' dos pacientes. No CA terciário as drogas mais utilizadas foram o ácido acetil-salicílico (76 por cento dos casos), nitratos (55 por cento), diuréticos (49 por cento), inibidores da ECA (42 por cento), os antagonistas dos canais de cálcio (37 por cento ) e os betabloqueadores (35 por cento dos pacientes). Os ß-bloqueadores foram mais prescritos em CA primário, p=0,02, já os inibidores da ECA, p<0,0001, o ácido acetil-salicílico, p<0,0001 e os diuréticos, p=0,002, foram mais prescritos no CA terciário. CONCLUSÄO - O tratamento farmacológico preconizado para a DAC estável deve ser otimizado em ambos os CA, dando prioridade às drogas que modificam a história natural da doença, como os betabloqueadores, antiagregantes plaquetários, e os inibidores da ECA nos pacientes com disfunção ventricular esquerda.