Intraoral Radiographic Study of the Pulp Cavity of the Shortfin Mako Shark (Isurus Oxyrinchus).

The shortfin mako shark (Isurus oxyrinchus) is a large pelagic predator that inhabits coastal and ocean waters. It has several teeth arranged in rows that run from the rostral to the lingual face. These teeth are in several stages of maturation, where the teeth closest to the rostral face are more mature and functional and the teeth closest to the lingual face are still in development. The tooth supply of the shark is unlimited throughout its life. The mechanism of tooth replacement follows that, when the front teeth are discarded physiologically, the posterior teeth replace it. This study us used a head and dental arch of I. oxyrinchus. Intraoral radiographs were obtained with the aim to show details of the pulp cavity. The study concluded that the pulp diameter varies according to the stage of dental maturation.

Prevalence of Perceived Barriers to Physical Activity Among Pre- and Post-Metabolic and Bariatric Surgery Patients: A Cross-Sectional Study.

OBJECTIVE: This study aims to describe and compare the prevalence of perceived barriers to physical activity (PBPA) in pre- and post-metabolic and bariatric surgery (MBS) patients and assess the association of these barriers with their physical activity levels. METHODS: A cross-sectional study included pre-operative (n = 63) and post-operative (n = 119) groups. Sociodemographic characteristics, leisure-time physical activity levels, and PBPA data were collected. Descriptive statistics, chi-square, and Fisher's exact tests, and binomial logistic regression analyses were used for comparisons and associations. RESULTS: Compared to the pre-operative group, the post-operative group had a lower prevalence of barriers in the physical domain (p = 0.036) and the behavioral domain (p = 0.004). However, there were no significant differences in the environmental (p = 0.531) or social (p = 0.597) domains. Pre-MBS patients were more likely to be physically inactive when perceiving barriers in the environmental (p = 0.048) and behavioral (p = 0.048) domains. In contrast, post-surgical patients were more likely to be physically inactive when perceiving barriers in the environmental (p = 0.027), social (p = 0.020), and behavioral (p = 0.037) domains. CONCLUSION: The results show that individuals who underwent metabolic and bariatric surgery have a lower prevalence of behavioral and physical PBPA compared to those awaiting the procedure. The perception of barriers to physical activity in the environmental and behavioral domains increases the likelihood of physical inactivity in both pre- and post-MBS patients, while in the social domain, it was only associated with physical activity in post-MBS patients.

Andrology of shortnose guitarfish Zapteryx brevirostris (Müller & Henle, 1841) (Chondrichthyes, Trygonorrhinidae).

The andrological study of a species involves the macro- and microscopic analyses of the internal reproductive organs and the evaluation of seminal parameters and ultrastructural characteristics of the spermatozoa. As in other vertebrates, the male reproductive tract in chondrichthyans consists of testes and reproductive ducts (efferent duct, epididymis, Leydig's gland, ductus deferens and seminal vesicle). In this study the authors used three adult specimens of Zapteryx brevirostris from wild capture kept at the Ubatuba Aquarium, Brazil. Semen was collected by abdominal massage over the location of the seminal vesicle, preceded by ultrasonographic evaluation. The semen collected was diluted 1:200 and subject to quantitative and morphological analyses. Ultrastructural analysis was performed using transmission and scanning electron microscopy. Correlation was observed between successful collection and ultrasonographic image of an engorged seminal vesicle, as well as testicles with easily delimitable margins and higher echogenicity. It was possible to identify free spermatozoa with helical filiform appearance, as well as spermatozeugmata. The average sperm concentration resulted in 5 million packets per millilitre and 140 million spermatozoa per millilitre. The sperm nucleus is described as follows: cone shaped, parachromatin sheath less dense than the chromatin of the nucleus, smooth depression of the nuclear fossa, abaxial axoneme 9 + 2 and accessory axonemal columns in positions 3 and 8 and oval shaped, with flattened inner surface in cross-section. These results broaden the knowledge of the andrology of this species, contributing to ex situ breeding programmes.

Sarcopenia in Non-Dialysis Chronic Kidney Disease Patients: Prevalence and Associated Factors.

Background: Sarcopenia is related to morbidity and mortality in non-dialysis Chronic Kidney Disease (ND-CKD) patients; however, the pathophysiology of sarcopenia remains unclear. The study aimed to assess the prevalence and factors associated with sarcopenia in ND-CKD individuals. Methods: We cross-sectionally evaluated 139 prevalent ND-CKD patients attending our outpatient clinic at Hospital das Clínicas of the Federal University of Pernambuco, between April and October 2019. Patients older than 18 years old and at G3-G5 CKD stages were included. Hand grip strength, Muscle Mass appendicular Index, and Gait Speed (GS) were defined by the standards of the European Working Group on Sarcopenia in Older People 2 guideline. Results: Sarcopenia prevalence was 20.9% and severe sarcopenia 2.9%. Sarcopenic were mostly found in elderly ones (64.8 ± 13.5 years vs. 54.9 ± 12.8 years, p < 0.001), revealing lower body mass index [26.1 (6.8) vs. 28.6 (6.2), p = 0.023], lower phase angle (PhA) [4.50 (1.10) vs. 5.60 (1.20), p < 0.001] and lower GS [1.00 (0.50) vs. 1.40 (0.4), p < 0.001]. They also presented lower serum creatinine levels [2.40 (1.50) vs. 3.0 (1.8), p = 0.032], lower Albumin-to-Creatinine Ratio [72.60 (1008.30) vs. 342.30 (1172.1), p = 0.039] and Hemoglobin levels [11.45 (1.8) vs. 12.60 (2.40), p = 0.003], and higher levels of C-reactive protein [0.2 (0.80) vs. 0.03 (0.3), p = 0.045] compared to non-sarcopenic. Under Poisson Multivariate Model, PhA [Relative precision (RP): 0.364, Confidence Interval (CI) (95%):0.259-0.511, p < 0.001], Interleukin six (IL-6) [RP: 1.006, CI (95%):1.001-1.01, p = 0.02] and serum creatinine levels [RP: 0.788, CI (95%): 0.641-0.969, p = 0.024] were associated with sarcopenia. Conclusions: Sarcopenia predominance was identified in our ND-CKD population, and was associated with lower PhA values, higher IL-6 levels, and lower serum creatinine levels.

Ecomorphological, space, and mineral relations of dermal denticles in angular angel shark (Squatina guggenheim).

Shark skin is predominantly specialized for swimming and protection, with the dermal denticle being the main structure associated with these abilities. The dermal denticle is a mineral structure with a unique morphology for each species, which allows its use as a taxonomic tool. Few studies have investigated the microscopy aspects of skin and dermal denticles, considering the high diversity of sharks. Here, we investigated the three-dimensional morphoquantitative aspects and mineral composition of dermal denticles in different regions of the angular angel shark, Squatina guggenheim, using scanning electron microscopy and dispersive energy system. With the microscopy, we were able to observe that the dermal denticle morphology changes according to the area it is located. It was possible to describe the dermal denticles individually, from root to the crown, highlighting all of their individualities. Through the dispersive energy system, we showed the proportions of each mineral found in the denticle, by area, demonstrating the composition and the particularities of crown, body, and root, where whitlockite was described for the first time in elasmobranchs. In this way, the present study presented the specificities of the dermal denticles of S. guggenheim, as well sought to understand the different structure functions for the animal, thus assisting future research in animal morphology.

Presence of the protein indoleamine 2,3-dioxygenase (IDO) in the maternal-fetal interface of the yolk sac placenta of blue shark, Prionace glauca.

Indoleamine 2 3-dioxygenase (IDO) is a protein usually described in mammals, which, among other functions, participates in the maternal-fetal tolerance process. The blue-shark, Prionace glauca (Linnaeus, 1758) is a viviparous placentary species in which the yolk sac develops during the pregnancy, turning into a placenta for matrotrophic nutrition of the embryo. The purpose of this study was to investigate the expression of IDO in the P. glauca maternal-fetal interface along three gestation phases and describe its distribution and the meaning of its presence. The results showed IDO labelling during the yolk sac/placenta development in the ectoderm on the three development phases and in the endoderm at the two first phases. In the uterine epithelium, IDO was observed in the last two phases. These interface tissues are major contact areas between the mother and the semiallogeneic conceptus and this relation could induce an immunological response against the fetus. Therefore, the presence of IDO may indicate that it could have a similar role in the mechanism of maternal-fetal tolerance in the P. glauca placental interface, as described in eutherian mammals.

Imunofenotipagem dos linfócitos positivos para indoleamina 2, 3 dioxigenase (IDO) em cultura de células de placenta bovina / Phenotyping of the indoleamine 2, 3 dioxygenase (IDO) positive lymphocytes in bovine placental cell culture

A gestação é um estado fisiológico que exige adaptações imunológicas para que transcorra normalmente. Nesse período a mãe e o feto apresentam uma relação imunológica, ou seja, a interface materno fetal. A enzima indoleamina 2,3 dioxigenase (IDO) desempenha um papel importante na tolerância materno fetal, por ser responsável pela metabolização do triptofano, impedindo por diversas vias a proliferação principalmente de linfócitos TCD8. Diversos tipos celulares estão presentes na interface materno fetal e vários deles podem expressar a IDO. Os leucócitos com perfil Th1 produzem uma citocina conhecida: o interferon γ que estimula a expressão da IDO em vários tipos celulares. Os linfócitos são divididos em subpopulações de acordo com sua função e fenótipo. Seus tipos incluem linfócitos T, linfócitos B e as células natural killer (NK). Hormônios também atuam nesse processo a progesterona que exerce função determinante sobre a resposta imunológica materna podendo alterar o prognóstico gestacional e o estrógeno essencial para a tolerância materno fetal e manutenção da prenhez. Dessa maneira este trabalho tem por objetivo principal identificar os linfócitos presentes na placenta bovina em cultivo que expressam IDO (linfócitos T, linfócitos B e células NK), frente a estimulação por progesterona, estrógeno e interferon γ nas diversas fases gestacionais utilizando a citometria de fluxo. Segundo os resultados no período de 67,5 a 77, 5 dias com a adição de interferon γ a expressão da enzima IDO aumentou discretamente nos linfócitos TCD3, TCD4, e diferente dos linfócitos T CD8 apresentaram uma elevada expressão da enzima (4,48 ± 2,12 - 8,65± 4,91)....

Pregnancy is a physiological state that requires immune adaptation in order to be successfully carried on. During this period, mother and fetus establish an immune tolerance status at the maternal fetal interface. Indoleamine 2,3-dioxygenase (IDO) plays an important role in maternal-fetal tolerance by metabolizing tryptophan, impairs by several pathways, mainly T CD8 cells proliferation. Several cell types are present in the maternal fetal interface and several of them can express IDO. Leucocytes with Th1 produce a cytokine known as interferon γ that stimulates the expression of IDO in several cell types. Lymphocytes are divided into sub-populations according to their function and phenotype: T lymphocytes, B lymphocytes and natural killer cells (NK). Hormones also involved in this process where progesterone exerts decisive role on maternal immune response that may change gestational outcome and estrogen is essential for fetal maternal tolerance and maintenance of pregnancy. Therefore, the main objective of this study was to identify lymphocytes in the bovine placental cell culture that are sensitive to progesterone, estrogen and interferon γ, IDO expression in various gestational stages using flow cytometry. According to the results in the gestational period from 67.5 to 77.5 days with the addition of interferon γ expression IDO was slightly increased in TCD3 lymphocytes, CD4, and differently from the other T cells CD8 displayed an higher expression of the enzyme (4.48±2.12 to 8.65±4.91)...

Allelopathic potential and phytochemistry of cambarazinho (Vochysia haenkeana (Spreng. ) Mart. ) leaves in the germination and development of lettuce and tomato / Potencial alelopático e fitoquímica das folhas de cambarazinho na germinação e desenvolvimento

The interference of chemicals in the germination and growth of plant species, known as allelopathy, is one of the main ways of eliminating competition for resources through the release of allelochemicals. The aim of this study was to determine the presence of secondary metabolites in extracts prepared from leaves of Vochysia haenkeana, evaluating their allelopathic action on the germination and seedling growth of lettuce and tomato. The plant material was collected in the Taboco region, Mato Grosso do Sul state, and after drying and grinding, underwent extraction with the use of water and ethanol, concentration of 200.0 g L-1. The method using an ultrasound bath was followed by maceration for 24 h in the refrigerator without the presence of light. The extracts were subjected to classical phytochemical analysis and the determination of pH, electrical conductivity, soluble solids and allelopathic tests. For bioassays, the extracts were diluted at concentrations of 25.0, 50.0, 100.0 and 150.0 g L-1 and the experimental design was completely randomized. There was a reduction in the percentage and speed of germination at concentrations of 25.0 and 50.0 g L-1 in both extracts. The seedling growth was also adversely affected, both in the germination chamber and in the greenhouse. These results are probably associated with the presence of different allelochemicals in the extracts, such as phenolic compounds and flavonoids, indicating that this species presented allelopathic action.

A interferência de substâncias químicas na germinação e/ou crescimento de espécies vegetais é denominada alelopatia e tem como uma das principais funções eliminar a competição por recursos através da liberação de compostos aleloquímicos. O objetivo deste trabalho foi determinar a presença de metabólicos secundários em extratos preparados com folhas de Vochysia haenkeana, avaliando sua ação alelopática na germinação e crescimento inicial de plântulas de alface e tomate. O material vegetativo foi coletado na região do Taboco, Mato Grosso do Sul e após secagem e trituração, sofreram extração com a utilização de água e etanol, na concentração de 200,0 g L-1. O método utilizado foi banho de ultrasson seguido de maceração por 24 h na geladeira sem a presença de luz. Os extratos foram submetidos a análise fitoquímica clássica e a determinação de pH, condutividade elétrica, sólidos solúveis e testes alopáticos. Para os bioensaios, os extratos foram diluídos em concentrações de 25,0, 50,0 100,0 e 150,0 g L-1 e o delineamento estatístico utilizado foi o inteiramente casualizado. Ocorreu redução na percentagem e velocidade de germinação, a partir da concentração de 25,0 ou 50,0 g L-1, em ambos os extratos. O crescimento das plântulas também foi afetado de maneira negativa, tanto em câmara de germinação como em casa de vegetação. Estes resultados provavelmente estão associados a presença de diferentes aleloquímicos nos extratos, tais como compostos fenólicos e flavonoides, indicando que a espécie apresenta ação alelopática.

Morphological analysis of the oviduct, oviducal gland and isthmus of the blue shark Prionace glauca (Linnaeus, 1758) (Elasmobranchii: Carcharhiniformes)

Oviducal gland present in elasmobranchs is correlated to the organism's reproductive strategy, and its functions are to produce mucus, to form the egg's tertiary envelope and to store sperm. The gland contains four zones: club, papillary,baffle and terminal. The structures of the oviduct, oviducal gland and isthmus of blue shark Prionace glauca were described using macroscopic, light microscopy and scanning electron microscopy techniques. The epithelium of the oviduct and isthmus is folded and is a simple, columnar, ciliated lining epithelium with glandular cells. In the oviducal gland, the lining tissues in the four zones are similar to the oviduct and isthmus lining. The terminal zone shows the presence of sperm in the lumen of the secretory tubules, which remains stored even in the absence of recent copulation. Here, these organs were studied and their connections in an attempt to elucidate the mechanisms of reproduction in the blue shark, showing the three-dimensional aspects, thus adding morphological information important for the understanding of the structure and functioning of these organs of fundamental importance in the life of the majority of elasmobranchs.

A glândula oviducal presente nos elasmobrânquios está correlacionada com a estratégia reprodutiva, cuja função é de produzir o muco, formar o envelope terciário do ovo e armazenar espermatozóides. A glândula contém quatro zonas: club, papilar, baffle e terminal. Foi descrita a estrutura do oviduto, glândula oviducal e istmo do tubarão-azul, Prionace glauca , pelas técnicas macroscópica, microscópica de luz e eletrônica de varredura. Foi observado que no oviduto e istmo o epitélio é pregueado de revestimento simples, colunar, ciliado com células glandulares. Na glândula oviducal o tecido de revestimento é semelhante ao oviduto e istmo nas quatro zonas. Na zona terminal observou-se a presença de espermatozoides no lúmen dos túbulos secretores que permanecem estocados mesmo na ausência de copula recente. Aqui, estudaram-se esses órgãos e suas conexões na tentativa de elucidar os mecanismos da reprodução no tubarão azul, apresentando os aspectos tridimensionais, desta forma agregando informações morfológicas importantes para o entendimento da estrutura e funcionamento desses órgãos de fundamental importância na vida da maioria dos elasmobrânquios.

Amyotrophic Lateral Sclerosis: New Perpectives and Update.

Amyotrophic lateral sclerosis (ALS), Charcot's disease or Lou Gehrig's disease, is a term used to cover the spetrum of syndromes caracterized by progressive degeneration of motor neurons, a paralytic disorder caused by motor neuron degeneration. Currently, there are approximately 25,000 patients with ALS in the USA, with an average age of onset of 55 years. The incidence and prevalence of ALS are 1-2 and 4-6 per 100,000 each year, respectively, with a lifetime ALS risk of 1/600 to 1/1000. It causes progressive and cumulative physical disabilities, and leads to eventual death due to respiratory muscle failure. ALS is diverse in its presentation, course, and progression. We do not yet fully understand the causes of the disease, nor the mechanisms for its progression; thus, we lack effective means for treating this disease. In this chapter, we will discuss the diagnosis, treatment, and how to cope with impaired function and end of life based on of our experience, guidelines, and clinical trials. Nowadays ALS seems to be a more complex disease than it did two decades - or even one decade - ago, but new insights have been plentiful. Clinical trials should be seen more as experiments on pathogenic mechanisms. A medication or combination of medications that targets more than one pathogenic pathway may slow disease progression in an additive or synergistic fashion.

Expressão da enzima indoleamina-2, 3-dioxigenase em truta arco-íris (Oncorhynchus mykiss) / Expression of the enzyme indoleamine-2, 3-dioxygenase in Rainbow Trout (Oncorhynchus mykiss

A indoleamina 2,3-dioxigenase (IDO) é uma enzima que cataboliza o aminoácido triptofano, levando à inibição da proliferação de linfócitos T, seja pela exaustão desse aminoácido no ambiente, ou pela indução via catabólitos induzindo-os a apoptose. Em mamíferos, esta enzima atua em diversas condições do organismo como a gestação, infecções, inflamações crônicas, transplantes e tumores, atuando na regulação imunológica. Estudos recentes identificaram a presença de moléculas homólogas a IDO em espécies filogeneticamente inferiores, cuja função parece estar restrita ao metabolismo do triptofano como fonte de energia. Este estudo teve por objetivo averiguar a expressão da IDO em células sanguíneas e órgãos hematopoiéticos de truta arco-íris pela imuno-histoquímica, buscando evidências de que a mesma poderia, nesta espécie, estar relacionada ao sistema imune. A expressão de IDO foi observada nos órgãos hematopoiéticos estudados incluindo o rim cefálico que apresentou marcação em células interrenais e leucócitos; baço, na qual a marcação restringiu à alguns leucócitos; no fígado a marcação ficou limitada à apenas algumas células dentro dos vasos sanguíneos e nas extensões sanguíneas pode-se visualizar a marcação de alguns leucócitos como os monócitos, linfócitos e neutrófilos. A predominância da marcação da IDO nesses tecidos pode constituir uma evidência de que a IDO identificada na O. mykiss esteja relacionada ao sistema imunológico nessa espécie...

Indoleamine 2,3-dioxygenase (IDO) is an enzyme that catabolizes the amino acid tryptophan, leading to inhibition of T lymphocyte proliferation, whether by depletion of this amino acid in the environment, or by induction via the catabolites inducing apoptosis. In mammals, this enzyme acts on various conditions of the body such as pregnancy, infections, chronic inflammation, transplantation and tumors, acting in immune regulation. Recent studies have identified the presence of homologous molecules IDO lower phylogenetically related species, whose function appears to be confined to the tryptophan metabolism as an energy source. This study aimed to investigate the expression of IDO in blood cells and hematopoietic organs of rainbow trout by immunohistochemistry, seeking evidence that it could, this species is related to the immune system. The expression of IDO was observed in hematopoietic organs studied including head kidney that show labeling in interrenal cells and leukocytes; spleen, in which the marking restricted to a few leukocytes in the liver;, labeling was restricted to only certain cells within the blood vessels and the blood extensions can view the marking of some leukocytes including monocytes, lymphocytes and neutrophils. The predominance of IDO marking these tissues may constitute evidence that IDO identified in O. mykiss is related to the immune system in this species...

Palm to Finger Ulnar Sensory Nerve Conduction.

Ulnar neuropathy at the wrist (UNW) is rare, and always challenging to localize. To increase the sensitivity and specificity of the diagnosis of UNW many authors advocate the stimulation of the ulnar nerve (UN) in the segment of the wrist and palm. The focus of this paper is to present a modified and simplified technique of sensory nerve conduction (SNC) of the UN in the wrist and palm segments and demonstrate the validity of this technique in the study of five cases of type III UNW. The SNC of UN was performed antidromically with fifth finger ring recording electrodes. The UN was stimulated 14 cm proximal to the active electrode (the standard way) and 7 cm proximal to the active electrode. The normal data from amplitude and conduction velocity (CV) ratios between the palm to finger and wrist to finger segments were obtained. Normal amplitude ratio was 1.4 to 0.76. Normal CV ratio was 0.8 to 1.23.We found evidences of abnormal SNAP amplitude ratio or substantial slowing of UN sensory fibers across the wrist in 5 of the 5 patients with electrophysiological-definite type III UNW.

Single oral flecainide dose to unmask type 1 Brugada syndrome electrocardiographic pattern.

BACKGROUND: Brugada syndrome (BrS) includes a group of patients with a typical pattern of ST segment elevation in right precordial leads who are at risk for sudden cardiac death. The electrocardiogram pattern may be intermittent and unmasked by sodium channel blockers. The main objective of this study is to describe a serie of consecutive patients in whom oral administration of flecainide was used to unmask BrS type I electrocardiographic pattern. METHODS: We prospectively studied 14 symptomatic (palpitations/syncope) patients referred to our laboratory presenting a suggestive but not diagnostic Brugada ECG or family history of sudden death. Single oral dose of flecainide 400 mg was administered. Resting 12-lead ECG with upper and standard right precordial leads were performed after flecainide administration at 15, 30, 60 and 90 min and hourly until ECG became normal. RESULTS: Median age was 37.5 years (range = 22-50). None of them had structural heart disease. In 7 patients (50%) the typical coved-type ECG pattern of BrS was unmasked. PR interval, QRS duration and QTc median difference after-before test was 20 msec (min-max = -17-+57), 21 ms (min-max = 0 to +59) and 20 ms (min-max = -11-+77), respectively. There were no episodes of AV block, atrial or ventricular tachyarrhythmia. CONCLUSIONS: In our experience we found that oral administration of flecainide in a single dose of 400 mg is useful to unmask type 1 Brugada electrocardiographic pattern.

Derrame pericárdico grave: Ventana pericárdica percutánea con balón / Severe Pericardial Effusion: Percutaneous Balloon Pericardial Window

La mayoría de los pacientes con derrame pericárdico crónico son mujeres y mayores de 50 años. En esta presentación se describe el caso de una paciente de 63 años con derrame pericárdico crónico grave, con antecedente de carcinoma de mama izquierda irradiado, diagnóstico presuntivo no confirmado de tuberculosis pulmonar e hipotiroidea sustituida. Ante la recurrencia del derrame luego de pericardiocentesis y el fracaso del tratamiento antiinflamatorio con AINE se decidió realizar una ventana pericárdica percutánea, sin que se presentaran complicaciones técnicas. Se inició tratamiento con colchicina y se evaluaron las posibles causas: tuberculosa, oncológica, secundaria a hipotiroidismo o por radiación. Por exclusión se llegó a la etiología radiante. Al mes de la realización de la ventana pericárdica no se observaba derrame pericárdico en el ecocardiograma.

Most patients with chronic pericardial effusion are women aged 50 years or older. This presentation describes a 63- year old female patient with severe chronic pericardial effusion; she had received radiotherapy for cancer of the left breast, had a history an unconfirmed presumptive diagnosis of pulmonary tuberculosis and was under treatment for hypothyroidism. A pericardiocentesis was performed; nevertheless the patient presented recurrence of the pericardial effusion and was treated with NSAIDs. As this therapy failed, she underwent a percutaneous pericardial window with no adverse outcomes. The patient started treatment with colchicine. The potential causes of the pericardial effusion were tuberculosis, malignant neoplasms, hypothyroidism or radiotherapy. The latter etiology was considered as the most probable once the others had been excluded. An echocardiogram performed one month after the procedure showed no signs of pericardial effusion.

O efeito da assistência psicológica em um programa de reabilitação pulmonar para pacientes com doença pulmonar obstrutiva crônica / The effect of psychotherapy provided as part of a pulmonary rehabilitation program for the treatment of patients with chronic obstructive pulmonary disease

OBJETIVO: Avaliar o efeito da psicoterapia sobre os níveis de ansiedade, depressão, qualidade de vida e capacidade de exercício em portadores de doença pulmonar obstrutiva crônica, submetidos a um programa de reabilitação pulmonar. MÉTODOS: Ensaio clínico prospectivo, controlado e cego realizado com 49 portadores de doença pulmonar obstrutiva crônica randomizados em três grupos: programa de reabilitação pulmonar completo (grupo 1), sem exercícios físicos (grupo 2) e sem psicoterapia (grupo 3). Foram utilizados para avaliação: inventários de ansiedade e de depressão de Beck, questionário respiratório de Saint George e o produto da distância caminhada pelo peso. RESULTADOS: Os grupos 1 e 2 demonstraram melhora absoluta estatisticamente significativa na capacidade de realizar exercícios (p = 0,007, p = 0,008 e p = 0,06, respectivamente). Os grupos 1 e 2 demonstraram redução significativa dos níveis de ansiedade e depressão, e melhora no índice de qualidade de vida: grupo 1 - p = 0,0000, p < 0,0003 e p = 0,0007; e grupo 2 - p = 0,0001, p = 0,0014 e p = 0,002, respectivamente. O grupo 3 demonstrou redução no nível de ansiedade (p = 0,03), mas não no nível de depressão e no índice de qualidade de vida, significativamente. CONCLUSÃO: Sessões de psicoterapia num programa de reabilitação pulmonar auxiliaram portadores de doença pulmonar obstrutiva crônica no manejo das limitações impostas pela doença, através da redução dos níveis de sintomas comportamentais, especialmente depressão, influindo na melhora da capacidade de realizar exercícios físicos e na qualidade de vida relacionada à saúde.

OBJECTIVE: To assess the effect of psychotherapy on levels of anxiety and depression, as well as on quality of life and exercise capacity in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program. METHODS: A randomized, controlled, blind clinical trial was conducted involving 49 chronic obstructive pulmonary disease patients. Patients were randomized into three groups: those submitted to the complete pulmonary rehabilitation program, which included psychotherapy and an exercise regimen (group 1); those submitted to the program minus physical exercise (group 2); and those submitted to the program minus psychotherapy (group 3). The three groups underwent a 12-week treatment program. All patients were evaluated at baseline and at completion of the pulmonary rehabilitation program through four instruments: The Beck Anxiety Inventory, Beck Depression Inventory and St. George's Respiratory Questionnaire were applied. The distance walked-weight product was also calculated. RESULTS: Statistically significant absolute improvements in exercise capacity were found for groups 1 and 2, although not for group 3 (p = 0.007, p = 0.008 and p = 0.06, respectively). In groups 1 and 2, levels of anxiety and depressions were also significantly reduced (group 1: p = 0.0000 and p < 0.0003; group 2: p = 0.0001 and p = 0.0014), and quality of life was significantly improved (p = 0.0007 and p = 0.002, respectively). Anxiety levels were also reduced in group 3 (p = 0.03), although levels of depression were not, and quality of life was unaffected. CONCLUSION: Psychotherapy sessions provided as part of a pulmonary rehabilitation program assist patients with chronic obstructive pulmonary disease in coping with disease-related limitations by reducing behavioral symptoms, especially depression, thereby influencing exercise capacity and health-related quality of life.

Rinossinusite fúngica em pacientes com infecção nasossinusal crônica / Fungal rhinosinusitis in patients with chronic sinusal disease

OBJETIVO: Estudar a rinossinusite fúngica em pacientes com infecção nasossinusal crônica. Nas últimas décadas houve aumento das infecções fúngicas, e a rinossinusite fúngica (RSF) tem sido mais freqüentemente diagnosticada. O conhecimento da flora fúngica, da sua prevalência e da apresentação sintomática em pacientes portadores de rinossinusite crônica (RSC) permitirá um melhor entendimento da doença, fato importante para a realização do diagnóstico, estabelecimento do tratamento e formulação do prognóstico. FORMA DE ESTUDO: clínico retrospectivo com coorte transversal. MATERIAL E MÉTODO: 62 pacientes com diagnóstico de RSF foram selecionados entre 890 portadores de RSC submetidos à cirurgia endoscópica. Avaliou-se anamnese, exame otorrinolaringológico com videoendoscopia nasal, TC dos seios da face e exames microbiológicos e histopatológico. RESULTADOS: A prevalência de RSF foi de 6,7% em portadores de RSC submetidos à cirurgia endoscópica dos seios paranasais, e o tipo de fungo mais encontrado foi do gênero Aspergillus. Bola fúngica foi encontrada em mais da metade dos casos, e RSFA, em mais de um terço dos pacientes. CONCLUSÕES: A evolução sintomática após a cirurgia endoscópica foi mais favorável nos portadores de bola fúngica, que necessitaram menor número de reintervenções.

Aim: Fungal rhinosinusitis in patients with chronic sinusal disease study. In the past decades, there has been an increase in fungal infections, and fungal rhinosinusitis (FRS) has been diagnosed more frequently. Knowing the fungal flora, its prevalence and symptomatic presentation in patients with chronic rhinosinusitis (CRS) will allow a better understanding of this disease, permitting a correct diagnosis, and treatment and formulating its prognosis. Study design: clinical retrospective with transversal cohort. Material and method: 62 patients diagnosed with FRS were selected among 890 cases of CRS undergoing endoscopic surgery. We assessed clinical history otolaryngologic examination with nasal videoendoscopy, CT scan, microbiologic and histopatologic tests. Results: The prevalence of FRS was 6.7 percent and the fungal type most frequently found was the gender Aspergillus. Fungal ball was found in more than half the cases, and allergic fungal rhinosinusitis (AFRS) in more than one third of the patients. Evolution after endoscopic sinus surgery was more favorable in patients with fungus ball, with a minor number of recurrences. Conclusions: The symptomatic evolution following endoscopic surgery was more favorable in patients with fungal ball, who require a lower number of re-interventions.

Fungal rhinosinusitis in patients with chronic sinusal disease.

AIM: Fungal rhinosinusitis in patients with chronic sinusal disease study. In the past decades, there has been an increase in fungal infections, and fungal rhinosinusitis (FRS) has been diagnosed more frequently. Knowing the fungal flora, its prevalence and symptomatic presentation in patients with chronic rhinosinusitis (CRS) will allow a better understanding of this disease, permitting a correct diagnosis, and treatment and formulating its prognosis. STUDY DESIGN: clinical retrospective with transversal cohort. MATERIAL AND METHOD: 62 patients diagnosed with FRS were selected among 890 cases of CRS undergoing endoscopic surgery. We assessed clinical history otolaryngologic examination with nasal videoendoscopy, CT scan, microbiologic and histopatologic tests. RESULTS: The prevalence of FRS was 6.7% and the fungal type most frequently found was the gender Aspergillus. Fungal ball was found in more than half the cases, and allergic fungal rhinosinusitis (AFRS) in more than one third of the patients. Evolution after endoscopic sinus surgery was more favorable in patients with fungus ball, with a minor number of recurrences. CONCLUSIONS: The symptomatic evolution following endoscopic surgery was more favorable in patients with fungal ball, who require a lower number of re-interventions.