Rural general practice and ethical issues. A rapid review of the literature.

Introduction Key New Zealand ethical documents that describe appropriate ethical behaviour for doctors do not consider rurality and how this might impact on the practice of medicine. Aim The aim of this study was to understand the literature on key ethical issues experienced by general practitioners in a rural context that might inform the development of a New Zealand agenda of rural medical ethics Methods A rapid review was undertaken of three databases using a variety of key words relating to rurality, ethics, professionalism and medicine. Inclusion criteria were research articles focussing on the experience of doctors working in a rural healthcare setting, commentaries and narratives. The findings from the paper were synthesised and broad ethical categories created. Results Twelve studies were identified that met the inclusion and exclusion criteria. Synthesis of the data revealed five ethical issues that predominately arose from living and working within communities. These ethical issues related to juggling personal and professional lives, managing friendships with patients, managing loss of privacy and anonymity, assuring confidentiality and practicing outside of comfort zones. Discussion The majority of ethical issues arose from managing overlapping relationships. However, these overlapping relationships and roles are considered normal in rural settings. A tension is created between adhering to urban normative ethical guidelines and the reality of living in a rural environment. Professional ethical guidelines, such as those developed by the New Zealand Medical Council, do not account for this rural lived reality. Rural practitioners in New Zealand should be engaged with to progress a specific rural ethics agenda.

Margaritaria nobilis L.f. (Phyllanthaceae) Ethanolic Extract: Low Acute Oral Toxicity and Antinociceptive Activity.

Margaritaria nobilis L.f. (Phyllanthaceae), a native Brazilian tree occurring mainly in the Amazon, is used in folk medicine for the treatment of abscesses (bark) and cancer-like symptoms (leaves). The present study evaluates the safety of its acute oral administration and its effects on nociception and plasma leakage. The chemical constitution of the leaf's ethanolic extract is determined by ultra-performance liquid chromatography-high-resolution mass spectrometry (LC-MS. Its acute oral toxicity is evaluated in female rats at a dose of 2000 mg/kg, evaluating the occurrence of deaths and Hippocratic, behavioral, hematological, biochemical, and histopathological changes, as well as food and water consumption and weight gain. Antinociceptive activity is evaluated in male mice with acetic-acid-induced peritonitis (APT) and formalin (FT) tests. An open field (OF) test is performed to verify possible interferences in the animals' consciousness or locomotion. LC-MS analysis shows the presence of 44 compounds classified as phenolic acid derivatives, flavonoids and O-glycosylated derivatives, and hydrolyzable tannins. No deaths or significant behavioral, histological, or biochemical changes are observed in the toxicity assessment. In nociception tests, M. nobilis extract significantly reduces abdominal contortions in APT, demonstrating selectivity for inflammatory components (FT second phase), not interfering in neuropathic components (FT first phase) or consciousness and locomotion levels in OF. Additionally, M. nobilis extract inhibits plasma acetic-acid-induced leakage. These data demonstrate the low toxicity of M. nobilis ethanolic extract, as well as its effectiveness in modulating inflammatory nociception and plasma leakage, possibly related to the flavonoids and tannins present in its composition.

Risk clusters of Schistosoma mansoni infection in an endemic state of Brazil: space-time modelling and association with socio-economic and environmental factors.

BACKGROUND: We analysed the spatial distribution and the socio-economic and environmental factors (SEFs) associated with Schistosoma mansoni infection in the state of Alagoas, an important tourist area in northeastern Brazil. METHODS: We conducted an ecological time-series study (2007-2016) on schistosomiasis cases and SEFs. We evaluated the temporal trends of schistosomiasis cases (annual percentage change [APC]) and their correlation with SEFs. Spatial analysis maps were built using QGIS and TerraView software. RESULTS: We observed that 4.9% of the municipalities had a high prevalence of S. mansoni infection and were located mainly in the coastal strip of Alagoas state. The positivity rate for schistosomiasis decreased during the period (8.1% in 2007 to 4.9% in 2016; APC=-5.71). There was a reduction in the number of tests performed (APC=-5.05). There was a negative correlation between S. mansoni infection and the municipal human development index (ρ=-0.34) and schooling rate (ρ=-0.24). The main species of snail was Biomphalaria glabrata (94.79%), but Biomphalaria straminea showed a higher percentage of S. mansoni detection (10.11%). Lastly, Biomphalaria tenagophila specimens were identified for the first time in Alagoas (n=28). CONCLUSIONS: Despite a reduction in the number of cases, intestinal schistosomiasis still represents a serious public health concern in Alagoas. It urgently requires planning and improvements in diagnosis, prevention programs and the state's socio-economic indicators.

Pulmonary function, functional capacity and quality of life in adults with cystic fibrosis.

BACKGROUND: As there are few studies on the impact of respiratory and functional status on the quality of life domains in adults with cystic fibrosis, this study aimed to evaluate the association between respiratory function, functional capacity and quality of life in these subjects. METHODS: This is a cross-sectional study, where adults with clinical and laboratorial diagnoses of CF fibrosis underwent pulmonary function tests, the six-minute walk distance test (6MWT) and responded to the Cystic Fibrosis Questionnaire-Revised (CFQ-R). Descriptive statistics was used to summarize the findings. The associations were tested by means of Pearson's or Spearman tests, and the significance level was set at 5%. RESULTS: The 21 patients who completed the study presented with reduced quality of life in all CFQ-R domains, obstructive pulmonary disease and reduced 6MWT distance. The following associations were found between pulmonary function and CFQ-R domains: forced vital capacity - FVC (%) and treatment burden and digestive symptoms (r=-0.433, p<0.05; r=-0.443, p<0.05, respectively), forced expiratory volume in one second - FVC ratio - FEV1/FVC (%) and physical functioning, social and respiratory symptoms (r=0.5, p<0.05; r=0.58, p<0.01; r=0.45, p<0.05, respectively), residual volume (%) and physical functioning (r=0.49, p<0.05), airways' resistance - Raw and physical functioning and emotional functioning (r=-0.44, p<0.05; r=-0,46, p<0.05, respectively), carbon monoxide diffusing capacity (%pred) and physical functioning (r=-0,51; p<0.05). CONCLUSION: Adults with CF have reduced quality of life, which in part is associated with the severity of their lung function.

Exodontia de terceiro molar ectópico no seio maxilar – relato de caso / Extraction of an ectopic third molar in the maxillary sinus – case report

Os dentes ectópicos não possuem etiologia definida e podem estar associados, ou não, a cistos dentígeros. Sua erupção ectópica ocorre de forma rara, em diferentes regiões da cavidade oral, tais como septo nasal, côndilo mandibular, processo coronoide, palato. Ocasionalmente, um dente pode erupcionar no seio maxilar e se apresentar com sintomas nasossinusais locais atribuídos à sinusite crônica. Diante do exposto, cabe ao cirurgião dentista ter conhecimento sobre a anatomia e técnicas cirúrgicas, a fim de realizar o planejamento cirúrgico seguro e efetivo, através do auxílio de exames radiográficos e de imagens evitando complicações e transtorno ao paciente. Este estudo tem como objetivo reportar um caso clínico raro, no qual foi realizada exodontia de um terceiro molar ectópico posicionado horizontalmente no interior do seio maxilar.

Ectopic teeth have no defined etiology, and may or may not be associated with dentigerous cysts. Its ectopic eruption occurs in rare form in different regions of the oral cavity, such as the nasal septum, mandibular condyle, coronoid process, palate. Occasionally, a tooth can erupt in the maxillary sinus and present local sinonasal symptoms attributed to chronic sinusitis. Given the above, it is up to the dentist to have knowledge about the anatomy and surgical techniques, in order to carry out a safe and effective surgical planning through the aid of radiographic images and avoiding complications and inconvenience to the patient. This study aimed to report a rare clinical case, in which was performed the extraction of an ectopic third molar horizontally positioned inside the maxillary sinus

Proteomic response of Moniliophthora perniciosa exposed to pathogenesis-related protein-10 from Theobroma cacao.

TcPR-10, a member of the pathogenesis-related protein 10 family, was identified in EST library of interactions between Theobroma cacao and Moniliophthora perniciosa. TcPR-10 has been shown to have antifungal and ribonuclease activities in vitro. This study aimed to identify proteins that are differentially expressed in M. perniciosa in response to TcPR-10 through a proteomic analysis. The fungal hyphae were subjected to one of four treatments: control treatment or 30-, 60- or 120-min treatment with the TcPR-10 protein. Two-dimensional maps revealed 191 differentially expressed proteins, 55 of which were identified by mass spectrometry. The proteins identified in all treatments were divided into the following classes: cell metabolism, stress response, zinc binding, phosphorylation mechanism, transport, autophagy, DNA repair, and oxidoreductases. The predominant class was stress-response proteins (29%), such as heat shock proteins; these proteins exhibited the highest expression levels relative to the control treatment and are known to trigger defense mechanisms against cytotoxic drugs as well as TcPR-10. Oxidoreductases (25%) were overexpressed in the control and in 30-min treatments but exhibited reduced expression at 120 min. These proteins are involved in the repair of damage caused by oxidative stress due to the contact with TcPR- 10. Consistent with the antifungal activity of TcPR-10, several proteins identified were related to detoxification, autophagy or were involved in mechanisms for maintaining fungal homeostasis, such as ergosterol biosynthesis. These results show that the sensitivity of the fungus to TcPR-10 involves several biochemical routes, clarifying the possible modes of action of this antifungal protein.

[Correlation between pulmonary function, posture, and body composition in patients with asthma]. / Correlação entre função pulmonar, postura e composição corporal em pacientes com asma.

AIM: Asthma may result in postural disorders due to increased activity of accessory respiratory muscles and hyperinflation. Our primary objective was to assess the correlation between pulmonary function and posture in adult patients with asthma. Secondarily, we aimed to study the correlation between body composition and body posture in this group of patients. METHOD: This was a cross-sectional study including 34 patients with asthma who were subjected to postural assessment (photogrammetry), pulmonary function testing (spirometry, whole-body plethysmography, diffusing capacity for carbon monoxide, and respiratory muscle strength), and body composition estimation by means of bioelectrical impedance. RESULTS: Most patients were female (70.6%) with a median age of 32.5 years (range: 23-42 years old). We found a significant correlation between horizontal alignment of head (anterior view) and the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC; ρ=-0,37; P=.03), total lung capacity (TLC; ρ=0,42; P=.01), and residual volume (RV; ρ=0,45; P<.001). Bronchial obstruction and respiratory muscle strength variables also correlated with postural assessment measures on the right and left lateral views. Both body mass index and the percentage of fat mass correlated with horizontal alignment of head, horizontal alignment of the pelvis, and the frontal angle of the lower limbs. CONCLUSION: Adult patients with asthma exhibit specific postural disorders that correlate with pulmonary function and body composition. The assessment of postural variables may provide a better pulmonary rehabilitation approach for these patients.

A long-term pulmonary rehabilitation program progressively improves exercise tolerance, quality of life and cardiovascular risk factors in patients with COPD.

BACKGROUND: Support and treatment options have been widely discussed in recent decades with the aim of improving morbidity, mortality and quality of life of chronic respiratory disease (COPD) patients. Although it is believed that longer pulmonary rehabilitation programs can provide better results, most of the evidence comes from short-term programs. AIM: To determine the effects of an outpatient pulmonary rehabilitation program on exercise tolerance, dyspnoea, hemodynamic variables and quality of life. DESIGN: Case series study. SETTING: Rehabilitation Centre. POPULATION AND METHODS: A convenience sample of COPD patients was enrolled in this study. The intervention consisted of a 96-wk exercise training program, including aerobic training, upper-limb exercises and inspiratory muscle training. Pulmonary function tests, blood biochemistry, six-minute walking distance test and health-related quality of life were recorded at baseline and after completion of the 6th, 12th, 18th, 24th months. RESULTS: Forty one consecutive COPD patients were recruited and thirty six completed the study. There was a significant improvement in hemodynamics, demonstrated by the gradual reduction in heart rate, blood pressure and MvO2 (double product) starting from the 12th month. Lipid profile showed a reduction of low density lipids and an increase of the high density lipids levels starting from the 6th month. Exercise tolerance, dyspnoea, respiratory muscle strength and quality of life also improved starting from the 6th month. CONCLUSION: A 24-month pulmonary rehabilitation program leads to a progressive improvement in quality of life, dyspnoea and exercise tolerance, and reduces cardiovascular risk factors in patients with chronic obstructive pulmonary disease. IMPACT: Our study suggests that long-term pulmonary rehabilitation programs can result in further improvements in the aforementioned cardiorespiratory variables.

Silicosis in sandblasters of shipyard versus silicosis in stone carvers in Brazil: a comparison of imaging findings, lung function variables and cardiopulmonary exercise testing parameters.

OBJECTIVES: To compare imaging findings, lung function variables and cardiopulmonary exercise testing (CPET) results between Brazilian sandblasters of shipyard and stone carvers with silicosis. METHODS: Of the 41 patients, 25 subjects were sandblasters and 16 were stone carvers, with median ages of 52 and 46.4 years, respectively. All of the patients underwent pulmonary function tests and CPET. Chest radiographs were classified according to the International Labour Organization recommendations. The following parameters were examined through the use of high-resolution computerized tomography (HRCT): nodules, progressive massive fibrosis (PMF), emphysema, and intrathoracic lymph node enlargement. RESULTS: Large opacities on chest radiography were observed in 76% of sandblasters and only 18.7% of stone carvers. Using HRCT, PMF was identified in 92% of sandblasters and only 43.7% of stone carvers. Although carbon monoxide diffusing capacity results were significantly different between the sandblasters and stone carvers, these differences were more pronounced in the CPET results. While 92% of sandblasters failed to reach at least 80% of their predicted peak oxygen uptake (VO(2)), this was observed for only 43.7% of stone carvers. A breathing reserve of less than 25% was observed in 40.5% of sandblasters but not in any of the stone carvers. CONCLUSION: In silicosis, imaging findings, lung function and CPET results are strongly influenced by the type of exposure to silica dust. Additionally, CPET abnormalities are more pronounced compared to measurements taken at rest.

Cardiopulmonary exercise testing variables as predictors of long-term outcome in thoracic sarcoidosis

Cardiopulmonary exercise testing (CPET) plays an important role in the assessment of functional capacity in patients with interstitial lung disease. The aim of this study was to identify CPET measures that might be helpful in predicting the vital capacity and diffusion capacity outcomes of patients with thoracic sarcoidosis. A longitudinal study was conducted on 42 nonsmoking patients with thoracic sarcoidosis (median age = 46.5 years, 22 females). At the first evaluation, spirometry, the measurement of single-breath carbon monoxide diffusing capacity (D LCOsb) and CPET were performed. Five years later, the patients underwent a second evaluation consisting of spirometry and D LCOsb measurement. After 5 years, forced vital capacity (FVC) percent and D LCOsb percent had decreased significantly [95.5 (82-105) vs 87.5 (58-103) and 93.5 (79-103) vs 84.5 (44-102), respectively; P < 0.0001 for both]. In CPET, the peak oxygen uptake, maximum respiratory rate, breathing reserve, alveolar-arterial oxygen pressure gradient at peak exercise (P(A-a)O2), and Δ SpO2 values showed a strong correlation with the relative differences for FVC percent and D LCOsb percent (P < 0.0001 for all). P(A-a)O2 ≥22 mmHg and breathing reserve ≤40 percent were identified as significant independent variables for the decline in pulmonary function. Patients with thoracic sarcoidosis showed a significant reduction in FVC percent and D LCOsb percent after 5 years of follow-up. These data show that the outcome measures of CPET are predictors of the decline of pulmonary function.

Cardiopulmonary exercise testing variables as predictors of long-term outcome in thoracic sarcoidosis.

Cardiopulmonary exercise testing (CPET) plays an important role in the assessment of functional capacity in patients with interstitial lung disease. The aim of this study was to identify CPET measures that might be helpful in predicting the vital capacity and diffusion capacity outcomes of patients with thoracic sarcoidosis. A longitudinal study was conducted on 42 nonsmoking patients with thoracic sarcoidosis (median age = 46.5 years, 22 females). At the first evaluation, spirometry, the measurement of single-breath carbon monoxide diffusing capacity (D LCOsb) and CPET were performed. Five years later, the patients underwent a second evaluation consisting of spirometry and D LCOsb measurement. After 5 years, forced vital capacity (FVC)% and D LCOsb% had decreased significantly [95.5 (82-105) vs 87.5 (58-103) and 93.5 (79-103) vs 84.5 (44-102), respectively; P < 0.0001 for both]. In CPET, the peak oxygen uptake, maximum respiratory rate, breathing reserve, alveolar-arterial oxygen pressure gradient at peak exercise (P(A-a)O2), and Δ SpO2 values showed a strong correlation with the relative differences for FVC% and D LCOsb% (P < 0.0001 for all). P(A-a)O2 ≥22 mmHg and breathing reserve ≤40% were identified as significant independent variables for the decline in pulmonary function. Patients with thoracic sarcoidosis showed a significant reduction in FVC% and D LCOsb% after 5 years of follow-up. These data show that the outcome measures of CPET are predictors of the decline of pulmonary function.

Parricides by mentally disordered offenders in Zimbabwe.

AIM: The aim of this study was to examine the similarities and differences between matricide and patricide committed by mentally disordered offenders in Zimbabwe. METHODS: A comprehensive, retrospective and national study was carried out of all individuals in Zimbabwe who, between 1980 and 1990 inclusive, were charged with homicide of their biological parents. The data were obtained from a hospital-wide survey, in a written semistructured format. RESULTS: The sample size was 39 offenders (34 men, 5 women) and there were 39 victims (20 matricides and 19 patricides). Sons committed 18 patricides and 16 matricides, and daughters committed one patricide and four matricides. The mean age of the offenders was 35 years with a standard deviation of 9.8, and the mean age of the victims was 60 years with a standard deviation of 9.3. Ethnicity of all the offenders and their victims was African. About one-third of the offenders were known to the psychiatric services and the rest were found to be mentally ill at the time of the crime when they were tried in the court of law. Most of the offenders were suffering from a psychotic illness and one offender had a diagnosis of personality disorder. Half of the offenders had been to a traditional healer some time before committing the crime. Most of the offenders used a blunt instrument, 15 used sharp instruments and one woman used strangulation. Firearms were not used in committing parricide. CONCLUSION: The study showed that sons committed most parricides. However, daughters committed matricide more frequently than patricide. Male offenders were 10 years younger than female offenders. In all cases both the offender and victim were African, and lived in the same house in the rural areas of Zimbabwe. Psychosis among the offenders had substantially increased the risk of parricide.

Efficacy of nimesulide versus meloxicam in the control of pain, swelling and trismus following extraction of impacted lower third molar.

This study compared the efficacy of nimesulide and meloxicam in the control of pain, swelling and trismus, following the extraction of impacted inferior third molars. Twenty patients with two impacted inferior third molars, in similar positions, were selected. The patients were designated randomly to the meloxicam group (MEL: 7.5mg twice a day for 5 days) or the nimesulide group (NIM: 100mg for 5 days). Following the extractions, swelling was more pronounced in the MEL group than in the NIM group (P0.05). At the 72-h evaluation, reduction was significantly larger in mouth opening in the MEL group compared with the NIM group (P<0.05). In conclusion, pain control was similar in both treatment groups. NIM was more effective than MEL in the control of swelling and trismus following the extraction of impacted lower third molars.

Inspirometria de incentivo e breath stacking: repercussões sobre a capacidade inspiratória em indivíduos submetidos à cirurgia abdominal / Incentive spirometry and breath stacking: effects on the inspiratory capacity of individuals submitted to abdominal surgery

CONTEXTUALIZAÇÃO: As complicações respiratórias são as principais causas de aumento da morbidade e da mortalidade em indivíduos submetidos à cirurgia de andar superior do abdômen. A eficácia dos procedimentos fisioterapêuticos precisa ser melhor definida, assim como é necessário o conhecimento da melhor estratégia terapêutica a ser implementada. OBJETIVO: Comparar o volume inspiratório mobilizado durante a técnica de breath stacking, com o volume na inspirometria de incentivo em pacientes submetidos à cirurgia abdominal. MATERIAIS E MÉTODOS: Doze pacientes, no primeiro dia de pós-operatório, foram orientados a inspirar profundamente por meio do inspirômetro de incentivo Voldyne® e a realizar esforços inspiratórios sucessivos pela máscara facial adaptada para realização da manobra de breath stacking. Cada técnica foi realizada cinco vezes de acordo com a randomização. No período pré-operatório, os pacientes realizaram prova espirométrica, foram avaliados e instruídos quanto à realização das técnicas. Um ventilômetro de Wright® permitiu o registro da capacidade inspiratória. RESULTADOS: A capacidade inspiratória foi significativamente maior durante o breath stacking do que durante a inspirometria de incentivo, tanto no pré quanto no pós-operatório. Houve redução significativa dos volumes após o procedimento cirúrgico, independentemente da técnica realizada. CONCLUSÕES: A técnica de breath stacking mostrou-se eficaz e superior à inspirometria de incentivo para a geração e sustentação de volumes inspiratórios. Por não haver descrição de efeitos adversos, essa técnica pode, provavelmente, ser utilizada de forma segura e eficaz, principalmente em pacientes pouco cooperativos.

BACKGROUND: Respiratory complications are the main causes of increased morbidity and mortality in individuals who undergo upper abdominal surgery. The efficacy of physical therapy procedures needs clarification, and it is necessary to know which therapeutic approaches are the best ones to implement. OBJECTIVE: To compare the inspiratory volume during the breath stacking maneuver with the volume during incentive spirometry, in abdominal surgery patients. METHODS: Twelve patients, on their first postoperative day, were instructed to take a deep breath through the VoldyneTM incentive spirometer and to make successive inspiratory efforts using a facemask that had been adapted for performing the breath stacking maneuver. Each technique was performed five times according to the randomization. Before the operation, the patients performed a spirometric test. They were also assessed and instructed about the procedures. A WrightTM ventilometer allowed inspiratory capacity to be recorded. RESULTS: The inspiratory capacity during breath stacking was significantly higher than during incentive spirometry, both before and after the operation. There was a significant reduction in volumes after the surgical procedure, independent of the technique performed. CONCLUSIONS: The breath stacking technique was shown to be effective. This technique was better than incentive spirometry for generating and sustaining inspiratory volumes. Since no adverse effects have been described, this technique can probably be used safely and effectively, particularly in uncooperative patients.

Mentally disordered offenders in Zimbabwe and in England and Wales: a socio-demographic study.

Our aim was to compare socio-demographic, clinical and criminal characteristics of mentally disordered offender patients in a special institution in a developing and a developed country. Zimbabwe data from 1980-1990 was obtained from a hospital patient survey, in a written semistructured format. The English special (high security) hospital patients' data for the same period was obtained from the case register. The sample size for Zimbabwe was 367 patients (337 males, 30 females) and for England and Wales it was 1,966 patients (1,643 males, 323 females). The average age for Zimbabwean patients was 36 years, with standard deviation of 9.7; for England and Wales the average age was 29.7 with standard deviation of 9.6. There was significant difference in marital status in the two countries. Seventy-eight per cent of patients were single in England and Wales, compared with 49% in Zimbabwe. There were 20% illiterate patients in Zimbabwe, compared with 4% in England and Wales. Thirty-seven per cent of the patients in England and Wales had a diagnosis of personality disorder, compared with 6% in Zimbabwe. There were 53% of homicides in Zimbabwe, compared with 20% in England and Wales. Employment in the two countries was similar: 34% in Zimbabwe and 33% in England and Wales. There were differences in the socio-demographic characteristics in the two countries, except for employment status. Differences were also noticed in the diagnoses of the patients, types of crime and the methods of assault.

Avaliação da pressão inspiratória máxima em pacientes críticos não-cooperativos: comparação entre dois métodos / Maximal inspiratory pressure evaluation among non-cooperative critical patients: comparison between two methods

CONTEXTUALIZAÇÃO: A ventilação mecânica, embora necessária para o tratamento da insuficiência respiratória aguda, pode estar associada ao descondicionamento e à disfunção muscular respiratória. A avaliação da pressão inspiratória máxima (PiMáx) é utilizada para estimar a força muscular inspiratória de pacientes ventilados artificialmente, porém não há uma definição quanto à melhor forma de realizar esta medida. OBJETIVO: Comparar 2 métodos de avaliação da PiMáx, por meio de 4 protocolos diferentes, em pacientes não cooperativos ventilados artificialmente. MÉTODO: Foram avaliados 30 pacientes não cooperativos e em processo de desmame da ventilação mecânica. De acordo com a randomização em blocos, o Método de Oclusão Simples (MO) e o Método da Válvula Unidirecional (VU) foram aplicados com tempo de duração de 20 e 40 segundos para cada paciente. Adicionalmente, durante as medições em 40s, foi anotado o valor da PiMáx em 30s. RESULTADOS: Os valores de PiMáx foram maiores em 40s do que em 20s para MO (48,2 ± 21,7 vs 36 ± 18,7 cmH2O; p< 0,001) e VU (56,6 ± 23,3 vs 43,4 ± 24 cmH2O; p< 0,001). Os valores de PiMáx foram maiores no método VU em 40s (VU40) do que MO em 40s (MO40) (56,6 ± 23,3 vs 48,2 ± 21,7 cmH2O; p< 0,001). Houve diferença entre VU em 30 e 40s (51,5 ± 20,8 vs 56,6 ± 23,3 cmH2O; p< 0,001). CONCLUSÃO: Em pacientes não-cooperativos, valores maiores de PiMax são obtidos com o método da válvula unidirecional com oclusão durante 40 segundos em comparação com os outros protocolos avaliados.

BACKGROUND: Although mechanical ventilation is necessary for treating acute respiratory insufficiency, it may be associated with deconditioning and respiratory muscle dysfunction. Maximal inspiratory pressure (MIP) evaluation is used to estimate inspiratory muscle strength in artificially ventilated patients, but there is no definition as to the best way to make this measurement. OBJECTIVE: To compare two methods for MIP evaluation, using four different protocols, among non-cooperative artificially ventilated patients. METHOD: Thirty non-cooperative patients undergoing the process of weaning off mechanical ventilation were evaluated. In accordance with block randomization, the simple occlusion method (OM) or the unidirectional valve method (UV) was applied to each patient for time periods of 20 and 40 seconds. Additionally, during the 40s measurements, the MIP value at 30s was recorded. RESULTS: The MIP values were higher at 40s than at 20s, both from OM (48.2 ± 21.7 vs. 36 ± 18.7 cmH2O; p< 0.001) and from UV (56.6 ± 23.3 vs. 43.4 ± 24 cmH2O; p< 0.001). The MIP values were higher from UV at 40s (UV40) than from OM at 40s (OM40) (56.6 ± 23.3 vs. 48.2 ± 21.7 cmH2O; p< 0.001). There was a difference between UV at 30 and 40s (51.5 ± 20.8 vs. 56.6 ± 23.3 cmH2O; p< 0.001). CONCLUSION: Among non-cooperative patients, higher MIP values were obtained from the unidirectional valve method with 40s of occlusion than from the other protocols evaluated.

Respiratory mechanics and pleural remodelling in pleurodesis induced by barium sulphate.

The aim of this study was to determine whether an intrapleural injection of barium sulphate would produce pleurodesis in rats. Additionally, respiratory mechanics and pleural remodelling were analysed. Single intrapleural injection of barium sulphate (100%) or saline was given to Wistar rats. Respiratory system, lung, and chest wall elastic, resistive and viscoelastic/inhomogeneous pressures were measured by the end-inflation occlusion method at 2 and 30 days after injection. The pleura were examined for gross and histopathological evidence of pleural inflammation and fibrosis, and the underlying lungs were also studied by morphometry. All pulmonary mechanical parameters increased at day 2, but were not different from control at 30 days after injection. Chest wall mechanical parameters did not change. Macroscopic evaluation demonstrated pleural adherence without haemothorax. Histopathologic analysis showed pleural inflammation and fibrosis. There was no alveolar inflammation or fibrosis in both groups. In conclusion, barium sulphate induced pleurodesis with either no changes in respiratory mechanics or lung lesion at day 30.