Viral protease inhibitors affect the production of virulence factors in Cryptococcus neoformans.

The effects of the protease inhibitors saquinavir, darunavir, ritonavir, and indinavir on growth inhibition, protease and phospholipase activities, as well as capsule thickness of Cryptococcus neoformans were investigated. Viral protease inhibitors did not reduce fungal growth when tested in concentrations ranging from 0.001 to 1.000 mg/L. A tendency toward increasing phospholipase activity was observed with the highest tested drug concentration in a strain-specific pattern. However, these drugs reduced protease activity as well as capsule production. Our results confirm a previous finding that antiretroviral drugs affect the production of important virulence factors of C. neoformans.

Sesquiterpene farnesol contributes to increased susceptibility to ß-lactams in strains of Burkholderia pseudomallei.

This study aimed to evaluate the in vitro combination of farnesol and ß-lactams against Burkholderia pseudomallei. A total of 12 ß-lactamase-positive strains were tested according to CLSI standards. All strains were inhibited by farnesol, with MICs ranging from 75 to 150 µM. The combination of this compound with ß-lactams resulted in statistically significant ß-lactam MIC reduction (P ≤ 0.05). This study provides new perspectives for the use of farnesol combined with ß-lactam antibiotics against strains of B. pseudomallei.

Respiratory pattern, thoracoabdominal motion and ventilation in chronic airway obstruction.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) present abnormal respiratory mechanics, but its relation to ventilation variables at rest is not fully understood. METHODS: We evaluated breathing pattern, thoracoabdominal motion, and ventilation in moderate and severe COPD patients by means of respiratory inductive plethysmograph and analysis of respiratory metabolism in semirecumbent position at rest. Diaphragmatic movement was measured using radiographs. RESULTS: COPD patients showed an increase in mean inspiratory flow, minute ventilation, dead space ventilation, oxygen and carbon dioxide ventilatory equivalents and reduction of respiratory times and pulse oxymetry. These findings were more pronounced in severe COPD. Changes in ventilatory efficiency were correlated with decreased respiratory times, reduced diaphragmatic movement, and lower oxygen uptake. CONCLUSIONS: Rapid shallow breathing and reduced diaphragmatic movement have led to ventilatory inefficiency without changes in thoracoabdominal motion.

[Cardiopulmonary exercise testing for evaluation of muscle diseases]. / Teste de esforço cardiopulmonar na avaliação de doenças musculares.

PURPOSE: To evaluate the cardiopulmonary exercise testing (CPX) for the diagnosis of myopathies. METHODS: 27 patients with myopathy were submitted to CPX testing (symptom limited bike protocol). RESULTS: Dystrophic patients and patients with mitochondrial disease, compared with controls, showed significant differences for the power of work perfomed (watt) and the maximum oxygen consumption (VO2 max). Patients with mitochondrial disease presented significantly lower values of anaerobic threshold when compared to controls and elevation of exercise peak respiratory exchange ratio (RER) values when compared to the others groups. CONCLUSIONS: CPX testing may be useful in evaluating degree of physical limitation of patients with myopathy at inicial stage as well on follow-up examinations. Power of work performed, VO2 max, anaerobic threshold and RER at exercise peak may suggest the diagnosis of myopathy and its sub-types and therefore exclude psychologic causes of limitation.

High-resolution CT scan in the evaluation of exercise-induced interstitial pulmonary edema in cardiac patients.

OBJECTIVE: To evaluate the onset of exercise-induced interstitial pulmonary edema in cardiac patients by high-resolution CT (HRCT). DESIGN: Prospective, normal controlled. PARTICIPANTS: Thirty subjects divided into three groups: group 1--10 outpatients with chronic congestive heart failure (CCHF), New York Heart Association (NYHA) class I; group 2--10 outpatients with CCHF, NYHA class II/III; and group 3 (control)--10 normal subjects. METHOD: HRCT scans were obtained at rest and 4, 8, 12, 16, and 20 min after progressive treadmill exercise test. RESULTS: The following HRCT findings consistent with interstitial edema were significantly different (p<0.05) in group 2 when compared with groups 1 and 3: artery/bronchus ratio > 1 in the upper lobes, peripheral increase in the vascular markings, interlobular septal thickening, and peribronchial "cuffing." These differences were maximal at 12 min after exercise and returned to normal values after 20 min. CONCLUSION: Interstitial pulmonary edema was present immediately after exercise in CCHF patients. It may be important in the genesis of dyspnea of these patients.

[Hematologic aspects of the national hockey team athletes]. / Aspectos hematológicos da seleção nacional de hóquei.

Athletes tend to have lower hemoglobin (Hb) concentrations than sedentary counterparts. Sports anemia is used to describe both pseudodilutional anemia and the true anemia of athletes. Pseudodilutional anemia is a beneficial adaptation to endurance training; the two most common causes of true anemia are iron deficiency and intravascular hemolysis. We used questionnaires, physical examination and laboratory investigation to study 19 highly trained hockey athletes and laboratory investigation to study 32 outpatients without hematological diseases. One athlete had anemia (Hb 10.5 g/ dL; 5.44 million red cells/mL; serum iron-13 micrograms/dL; without parasites in the stools); the athletes had Hb = 14.88 +/- 1.33 g/dL and the outpatients had 15.24 +/- 0.74 g/dL; the maximal oxygen uptake of the athletes was 54.0 +/- 6.03 ml/kg/min (112.15 +/- 14.35% of the predicted values). The maximal oxygen uptake of the anemic athlete was 86% of the predicted value. The three athletes with the best maximal uptake had a mean Hb = 15.8 g/dL. In São Paulo-Brazil anemia is uncommon among males but elite athletes are in a borderline anemic state, that may impair the physical fitness.

Capacidade física em idosos submetidos a programa de condicionamento físico / Physical capacity in elderly subjects engaged in an exercise training program

No presente trabalho, säo relatados resultados obtidos a partir de avaliaçäo ergométrica e cardiorrespiratória ao exercício (ergoespirométrica), em idosos, sadios ou portadores de doença cardiovascular, incluídos em programa de condicionamento físico em nosso Serviço. Nossa experiência tem confirmado que um programa de atividade física regular supervisionada, mesmo quando iniciado em idade avançada, pode trazer benefícios para indivíduos sadios ou näo, independentemente do sexo. A adoçäo de hábitose vida ativa atenua a reduçäo da capacidade física associada a idade ou doençae, portanto, pode melhorar a qualidade de vida nessa populaçäo. A heterogeneidade de comportamento do idoso implica a necessidade de individualizaçäo de condutas. Assim, a avaliaçäo da capacidade física ao início e no decorrer do treinamento físico tem-se mostrado essencial para adequaçäo da prescriçäo da intensidade de exercício. Ademais, individualizaçäo do tratamento parece ser ponto importante para a permanência nos prograade reabilitaçäo. A prescriçäo de treinamento físico baseada na resposta cronotrópica, ou seja, na reserva de frequência cardíaca ou na frequência cardíaca máxima, exibe limitaçöes, podendo superestimar a capacidade funcional de indivíduos jovens e idosos. A popularizaçäo de avaliaçäo cardiorrespiratória ao exercício pode proporcionar a realizaçäo rotineira de prescriçäo de treinamento físico baseada näo apenas na frequência cardíaca, mas principalmente no estresse metabólico causado pelo exercício, torano os programas mais preciosos e adequados. Apesar dos benefícios aqui demostrados, em diversas condiçöes, altos índices de desistência e obsenteísmo enfatizam a importância de conscientizar o idoso e o profissional de saúde quanto à necessidade de adoçäo e/ou manutençäo de um estilo de vida ativo.

Latissimus dorsi cardiomyoplasty in the treatment of patients with dilated cardiomyopathy.

Stimulated skeletal muscle grafts have been proposed as a means to reinforce ventricular wall in the treatment of severe myocardial failure. Latissimus dorsi cardiomyoplasty was performed in 11 patients with advanced heart failure due to cardiomyopathy who were in New York Heart Association (NYHA) class III or IV despite maximal medical therapy. There were no operative deaths. Eight patients were followed for a mean of 10.8 months. Two patients remain in muscle conditioning protocol. One patient died with latissimus dorsi ischemia and congestive heart failure. Four of the eight patients in long-term follow-up are in NYHA class I, three in class II, and one in class III. At 3 months of follow-up, rest radioisotopic left ventricular ejection fraction increased from 20.5 +/- 3.6% to 26.8 +/- 8.1% (p less than 0.01). Doppler-echocardiography demonstrated that left ventricular segmental wall shortening improved from 11.3 +/- 2.5% to 16.5 +/- 3.9% (p less than 0.01) and left ventricular stroke volume from 22.9 +/- 4.6 to 33.1 +/- 10 ml (p less than 0.01). Cardiopulmonary exercise test showed that maximal oxygen consumption during treadmill test increased from 14.8 +/- 3.7 to 18.2 +/- 3.3 ml/kg.min (p less than 0.05). At 6 months of follow-up, all the above values remained essentially unchanged. Furthermore, nonsustained ventricular tachycardia was abolished without specific medical therapy in four patients. Thus, cardiomyoplasty improves left ventricular function, reverses congestive heart failure, and may improve long-term survival in severe cardiomyopathies.

Vetorcardiografia de esforço / Exercise vectocardiography

Neste trabalho apresentamos estudos preliminares na pesquisa de parâmetros e/ou métodos que melhoram a sensibiliade e especificidade do teste ergométrico. Adotamos a configuraçäo ortogonal de FRANK de eletrodos para aquisiçäo das projeçöes X, Y e Z do ECG. O índice IND incorpora variaçöes, com exercício, da área do segmento ST-T em relaçäo ao repouso, e é independente da posiçäo do coraçäo na caixa torácica ou volume torácico. Mostra-se que as médias do IND säo estatisticamente diferentes entre os grupos de normais e isquêmicos. empregando-se a Regressäo Logística, foram selecionadas variáveis capazes de diferenciar estes grupos com sensibilidade de 81,3% e especificidade de 91,4%

Experimental myocardial infarction: effect of methylprednisolone on myocardial blood flow after reperfusion.

The effect of methylprednisolone on the distribution of myocardial flow during ischemia and after reperfusion was determined in 10 treated and 11 control dogs. Methylprednisolone, 30 mg/kg, was administered iv after occlusion. Transmural blood flow and the endo/epicardial ratio in the normal and ischemic zones was measured by injecting 141Ce- and 85Sr-labelled microspheres after 90 min of ischemia and 30 min after reperfusion, respectively. During ischemia, transmural blood flow (ml g-1 min-1) in the ischemic zone was higher in treated animals than in controls (0.25 +/- 0.04 vs 0.15 +/- 0.03; P less than 0.05) but not different in the normal zone for both groups (1.36 +/- 0.14 vs 1.15 +/- 0.10; P greater than 0.05). The endo/epicardial ratio of the ischemic zone was low but similar for both groups during ischemia (0.43 +/- 0.07 vs 0.40 +/- 0.09; P greater than 0.05). After reperfusion, transmural blood flow increased significantly in treated (0.25 +/- 0.13 vs 1.36 +/- 0.13; P less than 0.0005) as well as in control animals (0.15 +/- 0.03 vs 1.63 +/- 0.14; P greater than 0.0005), reaching similar values (1.36 +/- 0.13 vs 1.63 +/- 0.14; P greater than 0.05). The endo/epicardial ratio also increased during reperfusion in both treated (0.43 +/- 0.07 vs 1.12 +/- 0.12; P less than 0.0005) and control animals (0.40 +/- 0.90 vs 1.03 +/- 0.19; P less than 0.025). These data show that although methylprednisolone-treated dogs had higher myocardial blood flow during ischemia, after reperfusion the increase in flow in the ischemic zone of treated and control dogs was of the same magnitude.