Association between ventilatory efficiency, oxygen uptake, and Glittre-ADL test results in patients with chronic heart failure: a preliminary study.

OBJECTIVE: The Glittre-ADL test (GA-T) is a functional capacity test that stands out for encompassing multiple tasks similar to activities of daily living. As ventilatory efficiency is one of the variables valued in the prognosis of chronic heart failure (CHF), this study aimed to evaluate associations between functional capacity and ventilatory variables in patients with CHF during the GA-T. RESULTS: Eight patients with CHF and New York Heart Association (NYHA) functional classification II-III underwent the GA-T coupled with metabolic gas analysis to obtain data by means of telemetry. The median total GA-T time was 00:04:39 (00:03:29-00:05:53). Borg dyspnoea scale scores before and after the GA-T were 2 (0-9) and 3 (1-10), respectively (P = 0.011). The relationship between the regression slope relating minute ventilation to carbon dioxide output (VE/VCO2 slope) was correlated with the total GA-T time (rs = 0.714, P = 0.047) and Borg dyspnoea score (rs = 0.761, P = 0.028). The other ventilatory variables showed no significant correlations. Our results suggest that the total GA-T time can be applied to estimate the ventilatory efficiency of patients with CHF. Future studies may use the GA-T in conjunction with other functional capacity tests to guide the treatment plan and evaluate the prognosis.

Impact of different etiologies of bronchiectasis on the pulmonary function tests.

BACKGROUND: Bronchiectasis develops along the natural course of several respiratory and systemic conditions and induces significant changes in the morphofunctional structure of airways. Our objective was to assess the impact of various causes of bronchiectasis on clinical data, pulmonary function tests, and high-resolution computed tomography (HRCT). METHODS: The present report was a cross-sectional study that was conducted with 112 consecutive patients with bronchiectasis, who were allocated to five groups, as follows: sequelae of tuberculosis, history of non-tuberculosis infection, cystic fibrosis (CF), primary ciliary dyskinesia (PCD), and rheumatoid arthritis. All of the participants underwent spirometry, whole-body plethysmography, measurement of the diffusing capacity for carbon monoxide (DLco), and HRCT. RESULTS: The highest HRCT score was exhibited in patients with CF (6.03 ± 1.03). The values of forced expiratory volume in 1 second (FEV1) (52.2 ± 17.7%) and DLco (74.1 ± 15.2%) were lower in patients with sequelae of tuberculosis. The increase in the residual volume was more accentuated in the patients with CF (193.5 ± 39.5%) and PCD (189 ± 36.4%). By the multivariate analysis, the cause of FEV1 and bronchiectasis, HRCT score, and degree of dyspnea behaved as independent predictors of DLco. CONCLUSION: In individuals with bronchiectasis, the pulmonary function abnormalities are associated with the etiology of the underlying disease.

Expiratory rib cage Compression in mechanically ventilated subjects: a randomized crossover trial [corrected].

BACKGROUND: Expiratory rib cage compression (ERCC) has been empirically used by physiotherapists with the rationale of improving expiratory flows and therefore the airway clearance in mechanically ventilated patients. This study evaluates the acute mechanical effects and sputum clearance of an ERCC protocol in ventilated patients with pulmonary infection. METHODS: In a randomized crossover study, sputum production and respiratory mechanics were evaluated in 20 mechanically ventilated subjects submitted to 2 interventions. ERCC intervention consisted of a series of manual bilateral ERCCs, followed by a hyperinflation maneuver. Control intervention (CTRL) followed the same sequence, but instead of the compressive maneuver, the subjects were kept on normal ventilation. Static (Cst) and effective (C(eff)) compliance and total (R(tot)) and initial (R(init)) resistance of the respiratory system were measured pre-ERCC (baseline), post-ERCC or CTRL (POST1), and post-hyperinflation (POST2). Peak expiratory flow (PEF) and the flow at 30% of the expiratory tidal volume (flow 30% VT) were measured during the maneuver. RESULTS: ERCC cleared 34.4% more secretions than CTRL (1 [0.5-1.95] vs 2 [1-3.25], P < .01). Respiratory mechanics showed no differences between control and experimental intervention in POST1 for Cst, Ceff, R(tot), and R(init). In POST2, ERCC promoted an increase in Cst (38.7 ± 10.3 vs 42.2 ± 12 mL/cm H2O, P = .03) and in C(eff) (32.6 ± 9.1 vs 34.8 ± 9.4 mL/cm H2O, P = .04). During ERCC, PEF increased by 16.2 L/min (P < .001), and flow 30% VT increased by 25.3 L/min (P < .001) compared with CTRL. Six subjects (30%) presented expiratory flow limitation (EFL) during ERCC. The effect size was small for secretion volume (0.2), Cst (0.15), and C(eff) (0.12) and negligible for R(tot) (0.04) and R(init) (0.04). CONCLUSIONS: Although ERCC increases expiratory flow, it has no clinically relevant effects from improving the sputum production and respiratory mechanics in hypersecretive mechanically ventilated patients. The maneuver can cause EFL in some patients. (ClinicalTrials.gov registration NCT01525121).

Thalamic alexia with agraphia.

Alexia with agraphia is defined as an acquired impairment affecting reading and writing ability. It can be associated with aphasia, but can also occur as an isolated entity. This impairment has classically been associated with a left angular gyrus lesion In the present study, we describe a case involving a patient who developed alexia with agraphia and other cognitive deficits after a thalamic hemorrhage. In addition, we discuss potential mechanisms of this cortical dysfunction syndrome caused by subcortical injury. We examined a patient who presented with alexia with agraphia and other cognitive deficits due to a hemorrhage in the left thalamus. Neuropsychological evaluation showed attention, executive function, arithmetic and memory impairments. In addition, language tests revealed severe alexia with agraphia in the absence of aphasia. Imaging studies disclosed an old thalamic hemorrhage involving the anterior, dorsomedial and pulvinar nuclei. Tractography revealed asymmetric thalamocortical radiations in the parietal region (left

Benign fasciculations and corticosteroid use: possible association? An update.

Fasciculations are characterized by visible subtle and fast contractions of muscle, even wormlike in movement, by the contraction of a fascicle of muscle fibers. The authors present the case study of a 28-year-old patient with the appearance of migratory and diffuse fasciculations with an onset after partial tapering off of oral corticosteroides (60 mg total dose) indicated for treatment of Minimal change Glomerulopathy. Clinical Neurological physical exam allied with an ENMG, besides other complementary laboratory exams were used for screening the above-mentioned patient. Afterwards, current research relating to the topic at hand was made in order to update the data available in the Bireme, Scielo and PubMed Data Banks using the following key words: Fasciculation's, motor neuron disease, and benign fasciculations in the Portuguese, English as well as Spanish language. Although fasciculation's are most commonly associated with Motor neuron disease as well as with certain metabolic disorders, they may also be present in individuals with absolutely no underlying pathological disorders. In our case, fasciculation potentials that have been present for six months, with no other signs of a neurogenic disorder as well as absence of laboratory findings, the patient received a diagnosis of Benign Fasciculation Syndrome (BFS).We believe that the use of corticosteroides in high doses with subsequent tapering contributed to the fasciculation's, especially due to the changes that this causes on the ionic channels. Fasciculation's are symptoms seen in a large range of conditions, and also being the main symptom of the so-called Benign Fasciculation Syndrome. We have presented an example of this clinical syndrome in a patient whose complaint was fasciculation's, with complete clinical remission of symptoms following complete tapering off of corticosteroid six months previously.

Comparison between cardiopulmonary exercise testing parameters and computed tomography findings in patients with thoracic sarcoidosis.

BACKGROUND: Cardiopulmonary exercise testing (CPET) is a safe and clinically useful method to assess functional capacity and to follow disease progression and the response to treatment in several clinical conditions. AIM: We set out to determine the relationship between outcome measures of CPET and high-resolution computed tomography (HRCT) findings in thoracic sarcoidosis. METHODS: A cross-sectional study was carried out in which 42 nonsmoking outpatients (22 females; median age = 46.5 years) were evaluated. All the patients underwent pulmonary function tests (PFTs) and CPET. By using CPET, the most probable causes of exercise limitation were separated into respiratory mechanics (n = 25) and cardiovascular (n = 17). By using HRCT, the following patterns were recorded: predominant nodules (n = 18), predominant ground-glass opacity (n = 10), and predominant traction bronchiectasis and honeycombing (n = 14). RESULTS: Although significant differences have been shown for both PFT parameters and CPET results, only the latter were able to distinguish between patients with ground-glass opacity and patients with traction bronchiectasis and honeycombing on HRCT. A statistically significant difference was found for peak VO(2), breathing reserve, and P(A-a)O(2) when patients with predominant traction bronchiectasis and honeycombing were compared to patients with other HRCT patterns (p < 0.0001). There was no statistical difference among the patterns with abnormal CPET and the patterns of abnormalities on HRCT (p > 0.05). CONCLUSION: The functional capacity assessed by CPET was strongly influenced by HRCT patterns in sarcoidosis. Patients with traction bronchiectasis and honeycombing have lower exercise capacity measured by CPET.