Effect of AT1 receptor blockade on cardiovascular outcome after cardiac arrest: an experimental study in rats.

Angiotensin II receptor 1(AT1) antagonists are beneficial in focal ischemia/reperfusion (I/R). However, in cases of global I/R, such as cardiac arrest (CA), AT1 blocker's potential benefits are still unknown. Wistar male rats were allocated into four groups: Control group (CG)-animals submitted to CA by ventricular fibrillation induced by direct electrical stimulation for 3 min, and anoxia for 5 min; Group AT1 (GAT1)-animals subjected to CA and treated with 0.2 mg/kg of candesartan diluted in dimethylsulfoxide (DMSO) (0.1%); Vehicle Group (VG): animals subjected to CA and treated with 0.2 ml/kg of DMSO and Sham group (SG)-animals submitted to surgical interventions, without CA. Cardiopulmonary resuscitation consisted of group medications, chest compressions, ventilation, epinephrine (20 mcg/kg) and defibrillation. The animals were observed up to 4 h after spontaneous circulation (ROSC) return, and survival rates, hemodynamic variables, histopathology, and markers of tissue injury were analyzed. GAT1 group had a higher rate of ROSC (62.5% vs. 42.1%, p < 0.0001), survival (100% vs. 62.5%, p = 0.027), lower incidence of arrhythmia after 10 min of ROSC (10% vs. 62.5%, p = 0.000), and lower neuronal and cardiac injury scores on histology evaluation (p = 0.025 and p = 0.0052, respectively) than GC group. The groups did not differ regarding CA duration, number of adrenaline doses, or number of defibrillations. AT1 receptor blockade with candesartan yielded higher rates of ROSC and survival, in addition to neuronal and myocardial protection.

Sildenafil in endotoxin-induced pulmonary hypertension: an experimental study.

BACKGROUND: Sepsis and septic shock still represent great challenges in critical care medicine. Sildenafil has been largely used in the treatment of pulmonary arterial hypertension, but its effects in sepsis are unknown. The aim of this study was to investigate the hypothesis that sildenafil can attenuate endotoxin-induced pulmonary hypertension in a porcine model of endotoxemia. METHODS: Twenty pigs were randomly assigned to Control group (n.ß=.ß10), which received saline solution; or to Sildenafil group (n.ß=.ß10), which received sildenafil orally (100.ßmg). After 30.ßminutes, both groups were submitted to endotoxemia with intravenous bacterial lipopolysaccharide endotoxin (LPS) infusion (4.ß..g.kg-1.h-1) for 180.ßminutes. We evaluated hemodynamic and oxygenation functions, and also lung histology and plasma cytokine (TNF.., IL-1.., IL6, and IL10) and troponin I response. RESULTS: Significant hemodynamic alterations were observed after 30.ßminutes of LPS continuous infusion, mainly in pulmonary arterial pressure (from Baseline 19.ß...ß2.ßmmHg to LPS30 52.ß...ß4.ßmmHg, p.ß<.ß0.05). There was also a significant decrease in PaO2/FiO2 (from Baseline 411.ß...ß29 to LPS180 334.ß...ß49, p.ß<.ß0.05). Pulmonary arterial pressure was significantly lower in the Sildenafil group (35.ß...ß4.ßmmHg at LPS30, p.ß<.ß0.05). The Sildenafil group also presented lower values of systemic arterial pressure. Sildenafil maintained oxygenation with higher PaO2/FiO2 and lower oxygen extraction rate than Control group but had no effect on intrapulmonary shunt. All cytokines and troponin increased after LPS infusion in both groups similarly. CONCLUSION: Sildenafil attenuated endotoxin-induced pulmonary hypertension preserving the correct heart function without improving lung lesions or inflammation.

Pleistocene expansion and connectivity of mesic forests inside the South American Dry Diagonal supported by the phylogeography of a small lizard.

Traditionally focused on Amazonian and Atlantic rainforests, studies on the origins of high Neotropical biodiversity have recently shifted to also investigate biodiversity processes in the South American dry diagonal, encompassing Chaco, Cerrado savannas, and Caatinga seasonally dry tropical forests. The plateau/depression hypothesis states that riparian forests in the Brazilian Shield in central Brazil are inhabited by Pleistocene lineages, with shallow divergences and signatures of population expansion. Moreover, riparian forests may have acted as a vegetation network in the Pleistocene, allowing gene/species flow across the South American dry diagonal. We tested these hypotheses using Colobosaura modesta, a small gymnophthalmid lizard from forested habitats in the Cerrado savannas and montane/submontane forests in the Caatinga. We conducted phylogeographic analyses using a multi-locus dataset, tested alternative demographic scenarios with Approximate Bayesian Computation, and also employed species delimitation tests. We recovered a history of recent colonization and expansion along riparian forests, associated with Pleistocene climate shifts, and the existence of a new species of Colobosaura restricted to the Serra do Cachimbo region. We also present evidence that riparian forests have provided an interconnected network for forest organisms within the South American dry diagonal and that Pleistocene events played an important role in their evolutionary history.

Bronchodilator test in extreme old age: Adverse effects of short-acting beta-2 adrenergic agonists with clinical repercussion and bronchodilator response.

OBJECTIVE: To evaluate chronological age as a limiting factor to perform the bronchodilator test, determine significant adverse effects of short-acting beta 2 agonists with clinical repercussions, and assess bronchodilator response in extreme-old-age patients who undergo the spirometry test. METHODS: This is a cross-sectional and retrospective study. The sample was extracted from the database (spirometer and respiratory questionnaire) of a pulmonary function service. Patients over 90 years old were included in the research, and we evaluated their bronchodilator response and its significant adverse effects that may have clinical repercussions related to the bronchodilator. RESULTS: A sample of 25 patients aged 92.12 ± 2.22 years (95% CI, 91.20 - 93.04), with a minimum age of 90 years and a maximum of 97 years and a predominance of females with 72% (18/25). The bronchodilator test was performed in 84% (21/25) of the patients. The bronchodilator response was evaluated in 19 of the 21 patients (90.47%) who underwent the bronchodilator test. Two tests did not meet the criteria of acceptability and reproducibility. No clinical adverse effects were observed with the bronchodilator medication (salbutamol) during or after the exam. CONCLUSIONS: Chronological age is not a limiting factor for the bronchodilator test, short-acting beta-2 agonists did not present adverse effects with significant clinical repercussion and were useful in the diagnosis and therapeutic guidance of extreme-old-age patients.

Bronchodilator test in extreme old age: Adverse effects of short-acting beta-2 adrenergic agonists with clinical repercussion and bronchodilator response

SUMMARY OBJECTIVE: To evaluate chronological age as a limiting factor to perform the bronchodilator test, determine significant adverse effects of short-acting beta 2 agonists with clinical repercussions, and assess bronchodilator response in extreme-old-age patients who undergo the spirometry test. METHODS: This is a cross-sectional and retrospective study. The sample was extracted from the database (spirometer and respiratory questionnaire) of a pulmonary function service. Patients over 90 years old were included in the research, and we evaluated their bronchodilator response and its significant adverse effects that may have clinical repercussions related to the bronchodilator. RESULTS: A sample of 25 patients aged 92.12 ± 2.22 years (95% CI, 91.20 - 93.04), with a minimum age of 90 years and a maximum of 97 years and a predominance of females with 72% (18/25). The bronchodilator test was performed in 84% (21/25) of the patients. The bronchodilator response was evaluated in 19 of the 21 patients (90.47%) who underwent the bronchodilator test. Two tests did not meet the criteria of acceptability and reproducibility. No clinical adverse effects were observed with the bronchodilator medication (salbutamol) during or after the exam. CONCLUSIONS: Chronological age is not a limiting factor for the bronchodilator test, short-acting beta-2 agonists did not present adverse effects with significant clinical repercussion and were useful in the diagnosis and therapeutic guidance of extreme-old-age patients.

RESUMO OBJETIVOS: Avaliar se idade cronológica é um fator limitante para realizar prova broncodilatadora, determinar efeitos adversos significativos com repercussão clínica dos beta-2 agonistas de curta ação e avaliar a resposta broncodilatadora na espirometria, na velhice extrema. MÉTODOS: Estudo transversal, retrospectivo. Amostra extraída do banco de dados (espirômetro e questionário respiratório) de um serviço de função pulmonar. Incluídos na pesquisa pacientes com ≥90 anos, sendo avaliados a resposta broncodilatadora e efeitos adversos significativos com repercussão clínica ao broncodilatador. RESULTADOS: Amostra de 25 pacientes com idade de 92,12 ± 2,22 anos (IC 95%; 91,20 - 93,04), idade mínima de 90 anos e máxima de 97 anos, predominando o sexo feminino, com 72% (18/25). A prova broncodilatadora foi realizada em 84% (21/25) dos pacientes. A avaliação da resposta ao broncodilatador foi feita em 19 dos 21 pacientes (90,47%) que realizaram a prova broncodilatadora, uma vez que dois desses exames não preencheram os critérios de aceitabilidade e reprodutibilidade. A resposta broncodilatadora foi significativa em 10,52% (2/19) dos pacientes, ambos portadores de pneumopatia obstrutiva. Não foram observados efeitos adversos com repercussão clínica da medicação broncodilatadora (salbutamol) durante ou após sua realização. CONCLUSÕES: A idade cronológica não é um fator limitante para a realização da prova broncodilatadora, os beta-2 agonistas de curta ação não apresentaram efeitos adversos com repercussão clínica significativa e foram bastante úteis para auxiliar no diagnóstico e orientação terapêutica na velhice extrema.

Evaluating the extremely elderly at a pulmonary function clinic for the diagnosis of respiratory disease: frequency and technical quality of spirometry.

OBJECTIVE: To determine the frequency of spirometry in elderly people, by age group, at a pulmonary function clinic, to assess the quality of spirometry in the extremely elderly, and to determine whether chronological age influences the quality of spirometry. METHODS: This was a cross-sectional retrospective study evaluating information (spirometry findings and respiratory questionnaire results) obtained from the database of a pulmonary function clinic in the city of Aracaju, Brazil, for the period from January of 2012 to April of 2017. In the sample as a whole, we determined the total number of spirometry tests performed, and the frequency of the tests in individuals ≥ 60 years of age, ≥ 65 years of age, and by decade of age, from age 60 onward. In the extremely elderly, we evaluated the quality of spirometry using criteria of acceptability and reproducibility, as well as examining the variables that can influence that quality, such a cognitive deficit. RESULTS: The sample comprised a total of 4,126 spirometry tests. Of those, 961 (23.30%), 864 (20.94%), 102 (2.47%), and 26 (0.63%) were performed in individuals ≥ 60, ≥ 65, ≥ 86, and ≥ 90 years of age (defined as extreme old age), respectively. In the extremely elderly, the criteria for acceptability and reproducibility were met in 88% and 60% of the spirometry tests (95% CI: 75.26-100.00 and 40.80-79.20), respectively. The cognitive deficit had a negative effect on acceptability and reproducibility (p ≤ 0.015 and p ≤ 0.007, respectively). CONCLUSIONS: A significant number of elderly individuals undergo spirometry, especially at ≥ 85 years of age, and the majority of such individuals are able to perform the test in a satisfactory manner, despite their advanced age. However, a cognitive deficit could have a negative effect on the quality of spirometry.

Evaluating the extremely elderly at a pulmonary function clinic for the diagnosis of respiratory disease: frequency and technical quality of spirometry / Velhice extrema em um centro diagnóstico respiratório: frequência e qualidade técnica da espirometria

ABSTRACT Objective: To determine the frequency of spirometry in elderly people, by age group, at a pulmonary function clinic, to assess the quality of spirometry in the extremely elderly, and to determine whether chronological age influences the quality of spirometry. Methods: This was a cross-sectional retrospective study evaluating information (spirometry findings and respiratory questionnaire results) obtained from the database of a pulmonary function clinic in the city of Aracaju, Brazil, for the period from January of 2012 to April of 2017. In the sample as a whole, we determined the total number of spirometry tests performed, and the frequency of the tests in individuals ≥ 60 years of age, ≥ 65 years of age, and by decade of age, from age 60 onward. In the extremely elderly, we evaluated the quality of spirometry using criteria of acceptability and reproducibility, as well as examining the variables that can influence that quality, such a cognitive deficit. Results: The sample comprised a total of 4,126 spirometry tests. Of those, 961 (23.30%), 864 (20.94%), 102 (2.47%), and 26 (0.63%) were performed in individuals ≥ 60, ≥ 65, ≥ 86, and ≥ 90 years of age (defined as extreme old age), respectively. In the extremely elderly, the criteria for acceptability and reproducibility were met in 88% and 60% of the spirometry tests (95% CI: 75.26-100.00 and 40.80-79.20), respectively. The cognitive deficit had a negative effect on acceptability and reproducibility (p ≤ 0.015 and p ≤ 0.007, respectively). Conclusions: A significant number of elderly individuals undergo spirometry, especially at ≥ 85 years of age, and the majority of such individuals are able to perform the test in a satisfactory manner, despite their advanced age. However, a cognitive deficit could have a negative effect on the quality of spirometry.

RESUMO Objetivo: Determinar a frequência de idosos que realizaram espirometria num serviço de função pulmonar, e avaliar a qualidade da realização do exame na velhice extrema e se a idade cronológica influencia essa qualidade. Métodos: Estudo transversal retrospectivo utilizando informações (espirometria e questionário respiratório) de um banco de dados de um serviço de função pulmonar em Aracaju (SE) entre janeiro de 2012 e abril de 2017. Com base na amostra geral, determinou-se o número total de espirometrias realizadas em todas as idades, em idosos ≥ 60 anos, ≥ 65 anos, e por década de idade a partir da sexta década. Na velhice extrema, avaliou-se a qualidade da espirometria utilizando critérios de aceitabilidade e reprodutibilidade, e investigaram-se variáveis que influenciam essa qualidade, tal como déficit cognitivo. Resultados: A amostra geral foi composta por 4.126 espirometrias. Dessas, 961 (23,30%), 864 (20,94%), 102 (2,47%) e 26 (0,63%) foram realizadas em idosos com ≥ 60 anos de idade, ≥ 65 anos, ≥ 86 anos e ≥ 90 anos (velhice extrema), respectivamente. Na velhice extrema, os critérios de aceitabilidade e reprodutibilidade foram preenchidos em 88% (IC95%: 75,26-100,00) e 60% (IC95%: 40,80-79,20) das espirometrias, respectivamente. O déficit cognitivo influenciou negativamente a aceitabilidade e a reprodutibilidade (p ≤ 0,015; e p ≤ 0,007, respectivamente). Conclusões: Idosos na velhice extrema são uma realidade atual nos serviços de função pulmonar, e a maioria deles é capaz de realizar espirometrias adequadamente, apesar da idade avançada. O déficit cognitivo influencia negativamente a qualidade da espirometria.

DNA barcode sheds light on systematics and evolution of neotropical freshwater trahiras.

We assessed the presence of independent evolving lineages of the trahira, Hoplias malabaricus, one of the few freshwater fish species having wide distribution in the Neotropics which is the region with the highest global diversity of freshwater fish. To achieve that goal, 58 mitochondrial sequences of cytochrome c oxidase subunit I (COI; DNA barcoding) were generated from collected samples and 85 obtained from public databases, which were analyzed in comparison to chromosomal and geological data. The magnitude of genetic diversity found among different sampling sites was greater than 2%. Molecular species delimitation methods indicated the existence of a least four distinct lineages. The recognised cytotypes did not form monophyletic groups, suggesting that the karyotypic macrostructure could be a homoplastic character. The haplotype relationships suggested secondary contacts between the ecoregions of Northern and Northeastern Brazil that were shaped by coastal routes between adjacent watersheds during the Pleistocene epoch and probable exchanges of their ichthyofaunas. Our results indicated that multiple factors have driven the diversification of H. malabaricus, from ancient geological events linked to the reactivation of tectonic faults to more recent occurrences related to eustatic changes in ocean levels. Ultimately, the magnitude of its genetic diversity suggests the necessity of revising its taxonomic status.

Variation in Mitochondrial Cytochrome c Oxidase I DNA Can Successfully Identify Culex (Melanoconion) pedroi (Diptera: Culicidae) and Culex (Melanoconion) ribeirensis (Diptera: Culicidae).

Culex (Melanoconion) pedroiSirivanakarn & Belkin 1980 and Culex (Melanoconion) ribeirensisForattini & Sallum 1985 are two morphologically very similar species of the Pedroi subgroup of mosquitoes in the Spissipes section of the subgenus Melanoconion of the genus Culex L. 1758. We carried out an analysis of the mitochondrial cytochrome c oxidase I (COI) DNA variation between these two species. The recent observation of sympatric coexistence in a forested area of Rio de Janeiro State (Brazil) triggered the need to validate these two species previously identified based on morphology. We concluded that the COI is a useful tool for identification of Cx. pedroi and Cx. ribeirensis.

FAMACHA(©) scores history of sheep characterized as resistant/resilient or susceptible to H. contortus in artificial infection challenge.

With the aim of validating the FAMACHA(©) as a method for phenotypic selection of sheep resistant/resilient to gastrointestinal nematodes, 27 Suffolk ewes with known FAMACHA(©) score histories were experimentally infected with 25,000 larvae of Haemonchus contortus. From the day of infection (day 0) to 60 days post-infection, at intervals of 7-15 days, ewes were evaluated for packed cell volume (PCV) and fecal egg counts (FEC). A statistically significant increase (p<0.05) in FEC occurred between day 0 and day 60. PCV values showed a decrease (p<0.05) starting from day 21, compared to day 0. Based on the changes in FEC and PCV values from day 0 to day 60, 15 ewes (55.56%) were classified as susceptible (S) and 12 ewes (44.44%) as resistant/resilient (RR). A comparison of the average FEC after infection between susceptible (4487.6 eggs per gram-epg) and resistant/resilient (1317.9epg) ewes showed a significant difference (p<0.05) between the two groups. The difference in average PCV values after infection (24.8% and 30.3% for S and RR, respectively) was also significant (p<0.05). Data from 980 previous evaluations of FAMACHA(©) scores from the 27 ewes showed that 58.33% of the ewes classified as RR and 46.67% of the S group had a history of only F1 and F2 scores. In the RR group, only one animal (8.33%) had an F4 score, occurring one time out of the 61 evaluations of this ewe. In contrast, 40.0% of S group ewes had F4 and/or F5 scores. During the period of FAMACHA(©) score history that was evaluated, 69.56% of the total number of anthelmintic treatments in the flock were administered to ewes from group S. Since ewes with F4 and/or F5 scores during the FAMACHA(©) score time period were classified as susceptible during the experimental infection (with the exception of one ewe), we conclude that the FAMACHA(©) score history is a useful tool for the selection of ewes that are resistant/resilient, as well as for the identification of susceptible animals that should be culled.

High maternal sodium intake alters sex-specific renal renin-angiotensin system components in newborn Wistar offspring.

This study aimed to evaluate the systemic and renal renin-angiotensin-aldosterone system (RAAS) at birth in male and female offspring and in mothers fed a high sodium diet (HSD) before and during gestation. Female Wistar rats were fed a HSD (8.0% NaCl) or a normal sodium diet (1.3% NaCl) from 8 weeks of age until delivery of their first litter. Maternal body weight, tail blood pressure, and food and water intake were evaluated. The litter sizes were assessed, and the body and kidney weights of the offspring were measured. Both mothers and offspring were euthanized immediately following the birth of the pups to evaluate plasma renin activity (PRA), renal renin content (RRC), renal angiotensin-converting enzyme (ACE) activity, renal angiotensin (Ang) II content, serum aldosterone (ALDO) levels, and renal cortical and medullary renin messenger RNA expression. In mothers in the HSD group, water intake and kidney mass were higher, whereas renal ACE activity, Ang II, PRA, ALDO and RRC were decreased. In the offspring of HSD-fed dams, the body and kidney mass were lower in both genders, renal ACE activity was lower in females and renal Ang II was lower in males. PRA, RRC, renin gene expression and ALDO levels did not differ between the groups of offspring. The data presented herein showed that a maternal HSD during pregnancy induces low birth weight and a sex-specific response in the RAAS in offspring.

Evaluation of Respiratory Muscle Strength and Pulmonary Function in Patients with Charcot-Marie-Tooth Disease Type 2.

The aim of this study was to evaluate the pulmonary condition in a large family with Charcot-Marie-Tooth disease type 2 (CMT2). Eighteen participants diagnosed with CMT2 and 20 healthy individuals were evaluated by spirometry and maximal expiratory and maximal inspiratory pressures (MEP and MIP, respectively). Clinical disability was measured with CMT neuropathy score (CMTNS; range 0-36). One control group (CG) comprising 20 individuals, matched for age, sex and body mass index, were used for comparison. Eight patients were female (44.5%) and 10 patients were male (55.5%); mean age was 31.8 years (range 11-79) and CMTNS range was 6-26. Differences between CMT2 and CG in the spirometry and respiratory muscle strength were statistically significant for all dimensions. There were significant correlations between CMTNS and MIP (Pearson = -0.581) and MEP (Pearson = -0.5090). The results of this study show that patients with CMT, in spite of not showing clinical signs of advanced respiratory impairment, may present subclinical respiratory changes. The respiratory comprise in the CMT disease can be silent and insidious without presenting characteristic clinical signals.

Percepção de dispneia em repouso e em atividades físicas habituais em diferentes graus de obesidade / Perception of dyspnea at rest and in daily physical activities in varying degrees of obesity

JUSTIFICATIVA E OBJETIVO: Dispneia é uma experiência subjetiva de desconforto respiratório, cujos mecanismos fisiopatológicos e de percepção são complexos. O objetivo deste estudo foi avaliar a percepção de dispneia dos obesos em repouso e em atividades físicas habituais, utilizando três escalas de dispneia, e verificar a influência do peso corporal na percepção de dispneia crônica. MÉTODOS: Estudo transversal, incluindo 140 pacientes com peso normal e sobrepeso (grupo controle) e obesidade graus I, II e III, que foram subdivididos em seis subgrupos. Dispneia crônica foi avaliada utilizando-se descritores de dispneia e percepção de dispneia em repouso e em atividades físicas habituais por meio três escalas de dispneia: Escala Analógica Visual, Escala de Diagrama de Custo de Oxigênio e Medical Research Council modificada. RESULTADOS: Os grupos tiveram distribuição homogênea quanto a gênero, idade, cor da pele, altura, status tabágico e atividade física. O peso corporal médio foi 109,5±30,9kg e o índice de massa corporal de 39,91±10,57kg/m², com diferenças significativas entre os grupos (p<0,001). Nenhum dos pacientes referiu dispneia em repouso em posição sentada, nas três escalas utilizadas. Houve diferenças significativas entre os grupos quanto à percepção de dispneia em atividades físicas habituais, que se intensificaram nos grupos com o índice de massa corporal mais elevada (p<0,0001). CONCLUSÃO: Indivíduos obesos livres de comorbidades que influenciam a percepção de dispneia não demonstram dispneia em repouso; todavia, apresentaram dispneia crônica em atividades físicas habituais da vida diária, que sofre influência do aumento progressivo do peso corporal...

BACKGROUND AND OBJECTIVE: Dyspnea is a subjective experience respiratory distress whose pathophysiological mechanisms and perception are complex. The objective of this study was to evaluate the perception of dyspnea in obese at rest and in habitual physical activities, using three scales of dyspnea, and check the influence of body weight on the perception of chronic dyspnea. METHDOS: Cross-sectional study including 140 patients with normal weight and overweight (control group) and obesity grades I, II and III, which were subdivided into six subgroups. Chronic dyspnea was assessed using descriptors of dyspnea and perception of dyspnea at rest and in daily physical activities through three dyspnea scales: Visual Analog Scale, Oxygen Cost Diagram scale and modified Medical Research Council. RESULTS: The groups were homogeneous distributed according to gender, age, skin color, height, smoking status and physical activity. The average body weight was 109.5±30.9kg and body mass index 39.91±10.57kg/m², with significant differences between groups (p<0.001). None of the patients reported dyspnea at rest in a sitting position according to the three scales used. There were significant differences between the groups regarding the perception of dyspnea in daily physical activities, which were intensified in the groups with higher body mass index (p<0.0001). CONCLUSION: Obese individuals with no comorbidities which can influence the perception of dyspnea had no dyspnea at rest; however, they presented with chronic dyspnea in daily physical activities of daily living, influenced by the progressive increase in body weight...

Descritores de dispnéia e percepção de dispnéia crônica nos variados graus de obesidade / Descriptors of dyspnea and perception of dyspnea in varying levels of obesity

JUSTIFICATIVA E OBJETIVO: Embora frequente e importante na prática médica, estudar dispneia permanece um desafio. Os objetivos deste estudo foram verificar os principais descritores de dispneia mencionados por obesos utilizando-os na determinação da percepção de dispneia crônica em diferentes graus de obesidade, e avaliar a influência do excesso de peso. MÉTODOS: Estudo transversal, incluindo 140 pacientes com peso normal e sobrepeso (Grupo Controle) e obesidade graus I, II e III, que foram subdivididos em seis subgrupos. A dispneia crônica foi avaliada utilizando-se os principais descritores de dispneia, na amostra geral e nos subgrupos de obesos. RESULTADOS: A percepção de dispneia na amostra total estudada foi de 57,1% (IC95%: 48,5-65,5) e em cada subgrupo foi: Grupo I: 3,8% (IC95%: 0,1-19,6); Grupo II: 33,3% (IC95%:13,3-59,0); Grupo III: 62,5% (IC95%: 40,6-81,2); Grupo IV: 86,7% (IC95%: 69,3-96,2); Grupo V: 65,2% (IC95%: 42,7-83,6); e Grupo VI: 89,5% (IC95%: 66,9-98,7). Os principais descritores de dispneia foram cansaço no peito (58,7%), fôlego curto (47,5%), dificuldade de respirar (36,2%), falta de ar (31,2%) e respiração rápida (17,5%), com diferenças significativas entre os grupos (p<0,0001 e p<0,002, respectivamente). CONCLUSÃO: Observou-se elevada prevalência da percepção de dispneia em todos os graus de obesidade, com aumentos progressivos à medida que se elevou o índice de massa corporal, principalmente em obesos mórbidos. A utilização dos descritores de dispneia na investigação de dispneia crônica em obesos é útil, e os principais descritores de dispneia relatados foram cansaço no peito, fôlego curto e dificuldade de respirar...

BACKGROUND AND OBJECTIVE: Despiteits frequency and importance in medical practice, the study of dyspnea remains a challenge. The objective of this study was to verify the main descriptors of dyspnea mentioned by the obese, and use them to determine the perception of chronic dyspnea in varying levels of obesity, and to evaluate the influence of excess weight. METHODS: Cross-sectional study including 140 patients with normal weight and overweight (control group) and obesity grades I, II and III, who were subdivided into six subgroups. Chronic dyspnea was evaluated using the main descriptors of dyspnea in the overall sample and in the subgroups of the obese. RESULTS: The perception of dyspnea in the total sample studied was 57.1% (95%CI: 48.5-65.5); and in each group was: Group I: 3.8% (95%CI: 0.1-19, 6); GroupII: 33.3% (95%CI: 13.3-59.0); Group III: 62.5% (95% CI:40.6-81.2); Group IV: 86.7% (95% CI: 69.3-96.2); Group V:65.2% (95%CI: 42.7-83.6); Group VI: 89.5% (95%CI: 66.9-98.7). The main descriptors of dyspnea were chest tiredness (58.7%), shortness of breath (47.5%), difficulty to breathe (36.2%), breathlessness (31.2%), rapid breathing (17.5%), with significant differences between groups (p<0.0001 and p<0.002, respectively). CONCLUSION: We observed a high prevalence of perception of dyspnea in all levels of obesity, with progressive increases as body mass index rises - especially in morbidly obese patients. The use of descriptors of dyspnea in the investigation of chronic dyspnea in obese individuals is useful, and the main descriptors of dyspnea were chest tiredness, shortness of breathand difficulty to breathe...

Bariatric surgery: severity, level of control, and time required for preoperative asthma control.

BACKGROUND: There is an increased prevalence of asthmatic, obese patients undergoing bariatric surgery. The objective of our study is to evaluate the severity, level of control, respiratory medication use, and time required for prebariatric surgery asthma control. METHODS: This is a prospective study in which 88 obese asthmatics were evaluated by a pulmonologist in two steps, prebariatric surgery. In the first step, patients were evaluated for severity, level of control, and respiratory medication in use, categorized as bronchodilators and corticosteroids. In the second step, the time required for asthma control between steps and appropriate respiratory medication was determined. RESULTS: Thirty-eight obese patients (43.2%) had intermittent asthma, 22 had mildly persistent (25.0%), 24 moderately persistent (27.3%), and 4 severely persistent (4.5%). There were 43 patients with controlled asthma (48.9%), 31 partly controlled (35.2%), and 14 uncontrolled (15.9%). The study sample showed a significant increase in bronchodilators in the first step and corticosteroids in the second step (p ≤ 0.0001). Comparisons between steps showed significant differences with a reduction of bronchodilators and increase in corticosteroids in the second step (p ≤ 0.0001). The mean time (days) required for asthma control between steps was 28.98 ± 33.40 days, with significant differences between groups (p ≤ 0.001). CONCLUSIONS: In prebariatric surgery, there was a higher proportion of intermittent asthma and uncontrolled asthma, with asthma severity influencing the achievement of asthma control and the time required for surgical release.

Sensory tricks in focal dystonia and hemifacial spasm.

BACKGROUND AND PURPOSE: Sensory tricks are sensory, often but not exclusively tactile, stimuli usually in the body part affected by the movement disorder that produce a meaningful alleviation of dystonia. The frequency and clinical features of sensory tricks in different types of dystonia are poorly studied in the literature. There is no information regarding the presence of a similar phenomenon in HFS. METHODS: We enrolled consecutive patients who had the diagnosis of HFS (26) or the following types of dystonia: cervical dystonia (CD; 21); blepharospasm (BS; 20); and writer's cramp (WC; 10). Patients underwent a structured interview to assess the following items related to sensory trick: presence, type and effectiveness. Statistical analysis used the Verisimilitude Reason test and the significance level was set at 5%. RESULTS: Sensory trick was more frequent in the CD group (81%) when compared with HFS (38.5%; P=0.004) and WC (20%; P=0.001), but there was no statistical difference from the frequency in BS patients (55%; P=0.078). The most common sensory tricks were facial massage (60%) in HFS; to touch the head with the hands (35.3% in CD); to touch the upper eyelid with the index finger and thumb (81.8%) in BS; and to touch the hand with the contralateral hand (100%) in WC. CONCLUSIONS: Sensory tricks are common in all types of focal dystonia herein studied, although they are more frequent in CD. Patients with HFS also often display improvement of the movement disorder with tactile stimulation.

Nonalcoholic Fatty liver disease in chronic hepatitis B and C patients from Western Amazon.

Nonalcoholic fatty liver disease (NAFLD) includes a wide spectrum of histological conditions, extending from simple steatosis to end-stage liver failure. The aim of this study was to examine the prevalence of NAFLD and its associations in chronic hepatitis B and C patients. Methods. We included all patients diagnosed with chronic hepatitis B and C who underwent a liver biopsy between January 2010 and October 2011 (n = 104). Parameters studied included hepatitis type, anthropometric data, histologic, hepatic, metabolic and lipid assessments, presence of hypertension and viral load. Results. Hepatitis B was presented in 28.8% (n = 30) of patients, while hepatitis C was presented in 71.2% (n = 74). In addition, hepatic steatosis was present in 25% (n = 26) of the patients. Steatosis was frequently found in hepatitis C patients (31.1%; 25% n = 23), but infrequently in hepatitis B patients (10%; n = 3) (P = 0.024). It was also found that steatosis was frequently present in hepatitis C patients with intense fibrosis (52.94%) (P = 0.025). Discussion. Our results suggest that steatosis is a common feature in patients with viral chronic hepatitis, and that it plays a different role in each type of hepatitis.