Circulating Plasma miRNA and Clinical/Hemodynamic Characteristics Provide Additional Predictive Information About Acute Pulmonary Thromboembolism, Chronic Thromboembolic Pulmonary Hypertension and Idiopathic Pulmonary Hypertension.

Idiopathic pulmonary artery hypertension (IPAH), chronic thromboembolic pulmonary hypertension (CTEPH), and acute pulmonary embolism (APTE) are life-threatening cardiopulmonary diseases without specific surgical or medical treatment. Although APTE, CTEPH and IPAH are different pulmonary vascular diseases in terms of clinical presentation, prevalence, pathophysiology and prognosis, the identification of their circulating microRNA (miRNAs) might help in recognizing differences in their outcome evolution and clinical forms. The aim of this study was to describe the APTE, CTEPH, and IPAH-associated miRNAs and to predict their target genes. The target genes of the key differentially expressed miRNAs were analyzed, and functional enrichment analyses were carried out. The miRNAs were detected using RT-PCR. Finally, we incorporated plasma circulating miRNAs in baseline and clinical characteristics of the patients to detect differences between APTE and CTEPH in time of evolution, and differences between CTEPH and IPAH in diseases form. We found five top circulating plasma miRNAs in common with APTE, CTEPH and IPAH assembled in one conglomerate. Among them, miR-let-7i-5p expression was upregulated in APTE and IPAH, while miRNA-320a was upregulated in CTEP and IPAH. The network construction for target genes showed 11 genes regulated by let-7i-5p and 20 genes regulated by miR-320a, all of them regulators of pulmonary arterial adventitial fibroblasts, pulmonary artery endothelial cell, and pulmonary artery smooth muscle cells. AR (androgen receptor), a target gene of hsa-let-7i-5p and has-miR-320a, was enriched in pathways in cancer, whereas PRKCA (Protein Kinase C Alpha), also a target gene of hsa-let-7i-5p and has-miR-320a, was enriched in KEGG pathways, such as pathways in cancer, glioma, and PI3K-Akt signaling pathway. We inferred that CTEPH might be the consequence of abnormal remodeling in APTE, while unbalance between the hyperproliferative and apoptosis-resistant phenotype of pulmonary arterial adventitial fibroblasts, pulmonary artery endothelial cell and pulmonary artery smooth muscle cells in pulmonary artery confer differences in IPAH and CTEPH diseases form. We concluded that the incorporation of plasma circulating let-7i-5p and miRNA-320a in baseline and clinical characteristics of the patients reinforces differences between APTE and CTEPH in outcome evolution, as well as differences between CTEPH and IPAH in diseases form.

Dispnéia / Dyspnea

Dispnéia é o termo usado para designar a sensação de dificuldade respiratória, experimentada por pacientes acometidos por diversas moléstias, e indivíduos sadios, em condições de exercício extremo. Ela é um sintoma muito comum na prática médica, sendo particularmente referida por indivíduos com moléstias dos aparelhos respiratório e cardiovascular. Esse sintoma é o principal fator limitante da qualidade de vida relacionada à saúde de pacientes pneumopatas crônicos. Apesar de sua importância, os mecanismos envolvidos com seu surgimento ainda não são completamente conhecidos. Neste artigo, os autores fazem uma pequena revisão de aspectos clínicos e fisiopatológicos desse sintoma

Clonidine as a pre-anesthetic agent for flexible bronchoscopy.

Several drugs have been employed for sedation during flexible fiberoptic bronchoscopy (FOB). Clonidine attenuates stress-induced sympathoadrenal responses and has sedative properties. We investigate the effects of clonidine premedication on hemodynamic and comfort parameters of patients submitted to FOB under airway topical anesthesia only. Patients received placebo (n = 22; men = 16; median age = 50.5 years) or intravenous clonidine (3 microg/kg; n = 20; men = 15; median age = 46.0 years) 15 min before FOB. Blood pressure (BP), heart rate (HR), plasma norepinephrine (nor) and cortisol levels were measured before, during, and 1 h after FOB. Comfort was assessed by the examiner and by the patients using a visual numerical scale (0-10). The placebo group showed significant increases in systolic BP, HR, and nor levels during FOB (SBP = 125 mmHg x 145 mmHg; HR = 74 bpm x 85 bpm; nor = 316.2 pg/dl x 483.1 pg/dl), whereas clonidine group did not display such changes. Clonidine group showed a lower frequency of cardiac arrhythmias than the placebo group during and after FOB (supraventricular = 39% x 50%; ventricular = 22% x 40%). Levels of comfort were high and comparable in both groups. We concluded that although clonidine led to a somewhat better hemodynamic profile, it did not contribute to better comfort in this setting.

Insuficiência respiratória / Respiratory failure

O conceito de insuficiência respiratória (IR) compreende a dificuldade encontrada pelo Sistema Respiratório em desempenhar adequadamente sua principal função, ou seja, a promoção das trocas gasosas. Por ser decorrente de várias condições, pode apresentar-se, clinicamente, de forma muito variada. Seu diagnóstico depende da análise dos níveis de oxigênio e gás carbônico através da gasometria arterial. O presente artigo fornece uma visão geral da fisiologia das trocas gasosas e suas alterações, conceitos fundamentais para a compreensão da classificação e mecanismos envolvidos nos diferentes tipos de insuficiência respiratória. São ainda enfatizados aspectos gerais, relacionados com a terapêutica, na forma de noções oxigenioterapia e indicações de suporte ventilatório

Bronquiectasias associadas à síndrome de Sjõgren / Bronchiectasis associated to Sjõgren syndrome: case report

Diversas formas de comprometimento pulmonar têm sido descritas na síndrome de Sjõgren, incluindo raros casos em que bronquiectasias foram o achado predominante. Relata-se o caso de uma paciente com história de infecções respiratórias de repetição e dispnéia progressiva de longa evolução, cuja tomografia computadorizada de alta resolução evidenciava inúmeras bronquiectasias. A revisão de uma biópsia pulmonar realizada no início dos sintomas mostrava alterações bronquiolares de natureza inflamatória e fibrótica. Apesar da presença de sintomas de síndrome seca há anos, o diagnóstico de SS foi feito apenas tardiamente. São discutidos os possíveis mecanismos patogenéticos que possam ter levado ao desenvolvimento das bronquiectasias e a necessidade de um apurado senso clínico para o diagnóstico precoce de tais condições.