Recommendations on the use of azole antifungals in hematology-oncology patients.

The administration of antifungals for therapeutic and, especially, prophylactic purposes is virtually a constant in patients requiring hematology-oncology treatment. Any attempt to prevent or treat Aspergillus or Mucor infections requires the administration of some drugs in the azole group, which include voriconazole, posaconazole and isavuconazole, noted for their activity against these pathogens. One very relevant aspect is the potential risk of interaction when associated with one of the antineoplastic drugs used to treat hematologic tumors, with serious complications. In this regard, acalabrutinib, bortezomib, bosutinib, carfilzomib, cyclophosphamide, cyclosporine A, dasatinib, duvelisib, gilteritinib, glasdegib, ibrutinib, imatinib, nilotinib, ponatinib, prednisone, ruxolitinib, tacrolimus, all-transretinoic acid, arsenic trioxide, venetoclax, or any of the vinca alkaloids, are very clear examples of risk, in some cases because their clearance is reduced and in others because of increased risk of QTc prolongation, which is particularly evident when the drug of choice is voriconazole or posaconazole.

Immunostimulatory effect of faecal Bifidobacterium species of breast-fed and formula-fed infants in a peripheral blood mononuclear cell/Caco-2 co-culture system.

Bifidobacterium spp. typical of the human intestinal microbiota are believed to influence the balance of immune responses in the intestinal mucosa. The aim of the present study was to investigate the effect of different bifidobacterial species and their mixtures in in vitro experiments with peripheral blood mononuclear cells (PBMC) and Caco-2 cells. Bifidobacterium adolescentis, B. angulatum, B. breve, B. catenulatum, B. infantis, B. longum and two combinations of these bifidobacteria simulating the species composition found in faecal samples from breast-fed (BF) and formula-fed (FF) infants were used. The levels of several cytokines were measured by direct stimulation of PBMC and by stimulation of a Caco-2/PBMC co-culture with bifidobacteria. B. catenulatum and B. breve were the strongest enhancers of interferon-γ (IFN-γ) production by direct stimulation of PBMC. B. longum was the highest inducer of IL-10 and the lowest TNF-α stimulus. In the Caco-2/PBMC system, B. breve was the highest inducer of IL-8 production by Caco-2 cells, significantly different from B. infantis, B. adolescentis and the FF mixture (P < 0·05). IFN-γ produced by PBMC stimulated with the BF mixture (containing 22 % B. breve, compared with 7 % in the FF mixture) was significantly higher compared with B. adolescentis, B. infantis and B. longum. B. adolescentis also inhibited IFN-γ production compared with the FF mixture and B. longum. The proportion of different Bifidobacterium strains seems to be an important determinant of the cytokine balance in the simulated intestinal environment studied. B. breve and the combination of the Bifidobacterium species typically found in the microbiota of BF infants have shown the most significant effects.

Usefulness of Video-EEG monitoring in patients with drug-resistant epilepsy.

OBJECTIVE: To evaluate the characteristics of patients on whom long-term Video-EEG monitoring is performed in a specialist centre and to assess its suitability to study refractory epilepsy patients. METHODS: A prospective analysis and study of Video-EEG monitoring was performed in a series of 100 refractory epilepsy patients from a single centre. The analysis included demographic data, the time until the first seizure, the methods used to provoke seizures, and the outcome (usefulness, change in the management, pharmacological and surgical improvement). A subgroup analysis based on diagnosis was performed. RESULTS: The study was performed mainly on young people (mean 34.4 years) and the first seizure appeared in a mean of 30hours, requiring most of the patients to withdraw the medication. Nevertheless, there were no cases of status epilepticus. The usefulness of the test was high in all the groups. The management was changed in 65% of the patients with pharmacological and surgical improvement. CONCLUSION: Long-term Video-EEG monitoring is a suitable test to study refractory epilepsy patients. The main problem in our country is accesibility.

[Treatment of anterior shoulder instability with remplissage for Hill-Sachs injuries and Bankart injury compared to pure Bankart injuries]. / Tratamiento de la inestabilidad anterior de hombro con remplissage para lesiones de Hill-Sachs y lesión de Bankart comparado con lesiones de Bankart pura.

BACKGROUND: Anterior shoulder dislocation occurs in more than 90% of the time, the main cause is traumatic, describing two main lesions in this pathology: Bankarts and Hill-Sachss injury, the recurrence rate is not similar in open repair and with a possible advantage of arthroscopic surgery with less loss of movement range, lower risk of subscapular muscle damage, faster return to daily activities and increased patient satisfaction. OBJECTIVE: Assessing functionality, mobility and stability of the shoulder in patients treated: arthroscopic Bankart repair versus arthroscopic Bankart repair + remplissage. METHODS: Clinical records of patients with shoulder instability were reviewed Hill-Sachs and Bankart lesions were doumented; 21 post-surgical patients and were physically examined to evaluate the range of motion, Rowe functional scales and Western Ontario Shoulder Instability Index were used. 13 months of follow up as an average. RESULTS: There was no recurrence of dislocation with either technique, greater satisfaction was observed in the remplissage group; however, the limitation of the motion arc is greater. CONCLUSION: Both groups reduce instability, control pain and mostly satisfy patients in the 13-month follow-up.

INTRODUCCIÓN: Las luxaciones anteriores de hombro ocurren en 90% de las inestabilidades de hombro, la principal causa es traumática, describiéndose dos principales lesiones en esta patología: la lesión de Bankart y la de Hill-Sachs, existiendo una tasa de recurrencia similar en la reparación quirúrgica abierta y con ventaja de la cirugía artroscópica de realizar incisiones pequeñas, menor pérdida del rango de movimiento, menor riesgo de daño del músculo subescapular, retorno más rápido a las actividades diarias y mayor satisfacción de los pacientes. OBJETIVO: Valorar la funcionabilidad, movilidad y estabilidad postquirúrgica del hombro de los pacientes sometidos a tratamiento con dos técnicas artroscópicas: reparación de lesión de Bankart pura versus reparación Bankart + remplissage. MATERIAL Y MÉTODOS: Se revisaron expedientes clínicos, se valoraron pacientes con inestabilidad de hombro y con lesiones de Hill-Sachs y Bankart; con un total de 21 pacientes postquirúrgicos se realizaron exploraciones físicas para valoración de los arcos de movimiento y aplicación de escalas funcionales de Rowe y Western Ontario Shoulder Instability Index, con el fin de medir la estabilidad postquirúrgica. RESULTADOS: No hubo recurrencia de luxación con ninguna de las dos técnicas, se observó mayor satisfacción en el grupo de remplissage; sin embargo, la limitación del arco de movimiento es mayor. CONCLUSIÓN: Ambas técnicas artroscópicas fueron capaces de restaurar la función, disminuir el dolor y satisfacer en su mayoría a los pacientes de nuestra serie de casos en el seguimiento a corto y mediano plazo.

[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]. / Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte.

INTRODUCTION: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. MATERIAL AND METHODS: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. RESULTS: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. CONCLUSIONS: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

INTRODUCCIÓN: Es fundamental que los médicos residentes de ortopedia (traumatología) sean altamente competentes en todos los aspectos, considerando el equilibrio entre la oferta, demanda, necesidad y contexto. Es primordial identificar la capacidad y calidad instalada para su formación en México. MATERIAL Y MÉTODOS: Estudio observacional, transversal, muestreo no probabilístico-conglomerados, en dos fases. El instrumento tiene ocho dominios, 57 variables y 4,867 ítems. Sesenta profesores de postgrado de 20 estados, 50 sedes hospitalarias, 22 programas universitarios. RESULTADOS: 1,038 años de experiencia (inteligencia colectiva), 17 años de experiencia/profesor (01 a 50 años). Se identificó: patología aguda 30 (2 a 90%), patología crónica 30 (5 a 96%), pacientes 15 años, 10 (3 a 30%), pacientes entre 15 y 65 años, 47 (2 a 78%), pacientes 65 años, 20 (2 a 60%), número de camas/sede 20 (2 a 510), número de consultorios 3 (1 a 48), el número de procedimientos quirúrgicos/sede al año a nivel nacional fue de 960 (50 a 24,650). La media nacional por médico residente es de 362 cirugías/año con 1,450 momentos quirúrgicos/año. CONCLUSIONES: Las necesidades y recursos para la formación de médicos especialistas en ortopedia/traumatología son en alto grado heterogéneos, por lo cual se debería adaptar a las necesidades epidemiológicas de la región de influencia, en un ámbito de transición epidemiológica. Sesenta y dos punto dos por ciento expresó no tener o tener deficiente infraestructura académica y científica en su sede, más de 50% sin rotación al extranjero y 90% sin producción científica regular.

Post-marketing safety of antineoplasic monoclonal antibodies: rituximab and trastuzumab.

PURPOSE: The aim of this study was to analyse the suspected adverse reactions associated with rituximab or trastuzumab reported to the Spanish Pharmacovigilance System. METHODS: From this national database, we selected the spontaneous reports registered between 1 January 1999 and 1 June 2006 and analysed both age and gender of the patient, the dose prescribed, the severity of the report, the evolution, the latency and recovery periods of the adverse reaction, the reporting odds ratio (ROR) and the presence of other suspected drugs. RESULTS: From 49 927 records registered in the period of analysis, 69 were associated with rituximab and 23 with trastuzumab. White cell disorders (n = 18), hypotension (n = 7), dyspnoea (n = 6) and pneumonitis (n = 4) were the most common adverse reactions associated with rituximab. The mean latency period of white cell disorders was 20.9 +/- 7.8 days, except in two cases where it was clearly longer (87 +/- 13 days). Hypotension and dyspnoea appeared immediately or a few days after the administration of the drug, and rapidly resolved. Pneumonitis seems to be a delayed adverse reaction, which required on average, 3 months to develop. Cardiac failure was the adverse reaction more frequently associated with trastuzumab (n = 7). In five of the seven cases of cardiac failure reported patients had been taking other suspected medications. CONCLUSION: Our results are consistent with the safety profile of rituximab and trastuzumab observed in large randomised clinical trials.

[Merkel cell carcinoma. On one case]. / Carcinoma de células de Merkel. A propósito de un caso.

We present the case of an 86 year old woman who was sent for consultation at General Surgery due to asymptomatic tumouration on the back face of the left thigh whose size had increased during the 2 previous months. Physical exploration revealed tumouration that was painless, excrescent, indurated, mobile and well delimited, with a diameter of 5 cm, a reddish colour and a rough surface. Tumoural extirpation was carried out with broad margins, with a hystopathological result of primary cutaneous neuro-endocrynal carcinoma or Merkel cell carcinoma. Computerised tomography was carried out, observing tumoural adenopathies in the para-aortic spaces, iliac chains and left femorals, as well as edema in the lower left extremity. The patient was sent to the Oncology service for treatment, without presenting a satisfactory evolution and with a progressive deterioration of her general state, dying within the first year after diagnosis.

[Intestinal endometriosis]. / Endometriosis intestinal.

Endometriosis is a chronic, benign gynaecological disorder that is frequent in women of a child-bearing age. It is estimated that there is some degree of endometriosis in as many as 15% of pre-menopausal women, associated with a history of infertility, caesarean antecedents, dysmenorrhoea and abnormality in uterine bleeding. It is believed to be due to the rise of menstrual contents through the Fallopian tubes (retrograde menstruation). In the intestinal affectation, the colon is the segment most frequently affected, above all at the rectosigmoidal level. The clinical features are unspecific, with abdominal pain the most frequent and/or pelvic pain of a cholic type that coincides with, or is exacerbated by, menstruation. Differential diagnosis includes intestinal inflammatory disease, diverticulitis, ischemic colitis and neoplastic processes, with the definitive diagnosis being anatomopathological. With respect to treatment, this will depend on the clinical features and the age of the patient, as well as her wishes with regard to pregnancy.

[A case of mesenteric panniculitis]. / Paniculitis mesentérica. A propósito de un caso.

Mesenteric panniculitis can be considered as an evolved state of a mesenteric disease, with a first phase of mesenteric lipodystrophy without inflammatory signs, followed by a second phase of panniculitis, ending in fibrosis, at which point it is denominated retractile mesentiritis, which principally affects males over the age of 50. Its aetiology is unknown, with a description made of different associated factors, and its clinical presentation is variable, depending on the stage of the disease. The image test indicated for its diagnosis is the TAC, while an histopathological study provides the definitive diagnosis. There are different medicines and therapeutic guidelines, although studies establishing the ideal treatment are lacking. We present the case of a patient diagnosed with mesenteric panniculitis who evolved favourably followed treatment with cyclophosphamide associated with corticoids.

[Calcinosis cutis: on one case]. / Calcinosis cutis: a propósito de un caso.

We present the case of a woman of 72 years with high blood pressure evaluated in Surgery Outpatient Unit for overinfected and recurring pretibial cutaneous ulcers. In the radiographies of the extremity, calcifications were observed in soft parts and the biopsy showed calcified subepidermic nodules. Because of these findings, she was sent to Internal Medicine Consultations to complete the study. In the anamnesis, traumatism in the zone was ruled out, and was there consumption of calcium or phosphorous rich medicines; the physical exploration was normal, except for the lesions described previously. A study was requested to rule out any underlying pathology that might justify the clinical picture, without a possible etiological pathological cause in evidence. Given that the cutaneous calcinosis of the patient was not secondary to titular lesions, nor was there evidence of metabolic alterations or medical procedures that might justify it, and no lesions at another level were found, the diagnosis was established of idiopathic localised cutaneous calcinosis. It was treated with diltiazem.

[Paget-Schroetter síndrome associated with hyperhomocsyteinemia]. / Síndrome de Paget-Schroetter asociado a hiperhomocisteinemia.

Venous thromboembolic disease (VTED) in the upper extremities is an infrequent entity, although its incidence has increased in relation to the use of central venous catheters. Its etiology can be primary (idiopathic, spontaneous, due to effort or traumatic) or secondary (related to tumours, central venous catheters, etc.). We present a case of primary venous thrombosis of the upper right extremity, also called the Paget-Schroetter syndrome. This clinical picture is usually associated with intensive and/or repetitive exercise or effort of the affected extremity, anatomical alterations in the zone, or it can be the first manifestation of a previously unknown thrombophilic state, as in the case that concerns us. The clinical picture usually consists of pain in the affected extremity, frequently accompanied by edema and collateral circulation. Echography-Doppler frequently presents false negatives, and it is recommendable to carry out CAT, due to its greater specificity and for evaluating the neighbouring structures, although flebography continues to be the cardinal test for diagnosing this picture. There is no unanimity of opinion concerning treatment, and it is recommendable that this should be individualised in accordance with the characteristics of each case.

Safety profile of proton pump inhibitors according to the spontaneous reports of suspected adverse reactions.

OBJECTIVE: [corrected] To evaluate similarities and differences in safety among proton pump inhibitors (PPIs) under the usual conditions of prescription. METHODS: A search of spontaneous reports on adverse reactions associated with these drugs and registered between January 1, 2004 and December 31, 2004 was undertaken in the Spanish Pharmacovigilance System Database. We compared the frequency of reports with the consumption of PPIs, and analyzed the organ and system distribution for each PPI. Of the organ and system groups more commonly affected, diarrhea, myalgia, abnormal vision and hepatitis were selected for further analysis. RESULTS: Nearly 8 times more reports for omeprazole compared to other drugs were found but a similar difference was observed in their consumption. Skin and appendage disorders were more frequently reported for omeprazole and rabeprazole, the urinary, female reproductive and endocrine systems for lansoprazole, musculoskeletal for omeprazole and esomeprazole, vision for pantoprazole, rabeprazole and esomeprazole, gastrointestinal tract for omeprazole and lansoprazole and liver and biliary systems for omeprazole, lansoprazole and pantoprazole. Myalgia appears more often in younger patients than diarrhea, abnormal vision or hepatitis and shows longer periods of latency and recovery. The four adverse reactions analyzed were mainly reversible. CONCLUSION: A direct relationship was found between consumption and the number of reports. Some organ and system groups were affected by more than one PPI and this showed a specific pattern of group toxicity to these pharmacological agents. Some reports involved only lansoprazole and these require further analysis.

[Intestinal invagination in the adult secondary to jejunal lipoma]. / Invaginación intestinal en el adulto secundaria a lipoma yeyunal.

Small bowel intussusception is an unusual pathology in the adult. Most commonly, it is secondary to intestinal wall organic disorders. A complete small bowel obstruction is the most frequent clinical presentation, which requires emergency surgery in many cases. The preoperative diagnosis is infrequent. The best treatment is surgical resection.

[Non-invasive home mechanical ventilation in the COPD patient]. / La ventilación mecánica no invasiva domiciliaria en el paciente EPOC.

BACKGROUND: The potential benefits of non-invasive mechanical breathing in clinically stable COPD patients are still not well known, nor have they been sufficiently studied. We evaluate whether non-invasive mechanical ventilation is beneficial to these patients. METHODS: A cross sectional study was carried out evaluating the application of non-invasive home mechanical ventilation (BIPAP), during the nocturnal rest in 23 COPD patients, who presented hypercapnia in basal arterial gasometry during clinical stability. Clinical, gasometric and spirometric evaluations were carried out 3, 6 and 12 months after initiating this therapy. Similarly, an evaluation was made of the number of admissions due to worsening of the underlying respiratory pathology during one year. Results. The patients included in the study had an average age of 68.83 years. Sixty point nine percent (60.9%) presented a severe degree of COPD. Sixty-nine point six percent (69.6%) of the total sample had previously received continuous oxygenotherapy at home; 75% of them presented severe or very severe COPD. During the period of time of the study a fall was recorded in the number of hospital admissions due to worsening (0.61+/-0.15 annual admissions on average) with respect to the period of time prior to the non-invasive mechanical ventilation (1.07+/-0.16 admissions on average), with greater benefits obtained by those who had previously shown a higher number of admissions and those with associated comorbidity. A reduction was also appreciated in the arterial pressure of carbon dioxide (PaCO2) in the majority of cases, principally those who at the start of the study presented a PaCO2>63.32 mm of Hg; this improvement was appreciated from the first three months of treatment.

[Abdominal tuberculosis]. / Tuberculosis abdominal.

Abdominal tuberculosis develops according to a non-specific clinical picture, with a difficult differential diagnosis with respect to other entities of similar semiology. We present the case of a male who was admitted because of abdominal pain, progressive and notable loss of body weight and a fever of two months evolution. The culture from the colon biopsy showed the presence of Koch bacilli.

Restoration of wild-type virus by double recombination of tombusvirus mutants with a host transgene.

Nicotiana benthamiana plants transformed with the coat protein gene of tomato bushy stunt virus (TBSV) failed to elicit effective virus resistance when inoculated with wildtype virus. Subsequently, R1 and R2 progeny from 13 transgenic lines were inoculated with a TBSV mutant containing a defective coat protein gene. Mild symptoms typical of those elicited in nontransformed plants infected with the TBSV mutant initially appeared. However, within 2 to 4 weeks, up to 20% of the transgenic plants sporadically began to develop the lethal syndrome characteristic of wild-type virus infections. RNA hybridization and immunoblot analyses of these plants and nontransformed N. benthamiana inoculated with virus from the transgenic lines indicated that wild-type virus had been regenerated by a double recombination event between the defective virus and the coat protein transgene. Similar results were obtained with a TBSV deletion mutant containing a nucleotide sequence marker, and with a chimeric cucumber necrosis virus (CNV) containing the defective TBSV coat protein gene. In both cases, purified virions contained wild-type TBSV RNA or CNV chimeric RNA derived by recombination with the transgenic coat protein mRNA. These results thus demonstrate that recombinant tombus-viruses can arise frequently from viral genes expressed in transgenic plants.

Ciprofloxacin: comparative data in cystic fibrosis.

Ciprofloxacin, a 4-quinolone bactericidal antimicrobial, has a high activity against a broad spectrum of bacterial microorganisms, including Pseudomonas aeruginosa. The fact that ciprofloxacin can be administered orally would represent a cost-efficient advance in the management of patients with cystic fibrosis, most of whom must be treated frequently with anti-pseudomonal antibiotics. In this study, 11 adult patients received 26 therapeutic courses of ciprofloxacin at a dose of 750 mg orally every 12 hours. In addition, a 13-year-old patient received 500 mg orally every 12 hours. The length of therapy was usually two weeks, but some patients received treatment for up to eight weeks. The mean serum concentration at two to three hours after administration of a dose was 3.68 micrograms/ml (range, 1.85 to 7.25 micrograms/ml). The mean trough level was 0.85 microgram/ml (range, 0.36 to 1.65 micrograms/ml). A comparable group of 11 patients matched by age and severity of disease were treated with conventional doses of tobramycin and azlocillin administered intravenously for at least two weeks. Sputum cultures from all the patients grew P. aeruginosa, except for one patient with Pseudomonas cepacia infection; the minimal inhibitory concentration of ciprofloxacin for these organisms ranged from 0.05 to 1.56 micrograms/ml. The clinical and microbiologic results obtained with these two antimicrobial regimens were similar. A therapeutic failure was noted in the patient infected with P. cepacia whose organism became resistant after one week of therapy (minimal inhibitory concentration greater than 4.58 micrograms/ml). Emergence of resistant strains was not observed in any of the other patients.

Infection in patients with cystic fibrosis.

Cystic fibrosis is the most common lethal genetic disease of Caucasians. The disease affects the exocrine gland secretions throughout the body, and as a result, major pathologic changes develop in the pancreas and in the bronchi. Obstruction of the respiratory airways results in chronic infection, and in time, this leads to progressive deterioration of lung function. In the initial stages of the disease, usually during infancy, infection with Staphylococcus aureus plays an important role. Hemophilus influenzae infections are also common. As the disease progresses, infection with Pseudomonas aeruginosa develops. Exacerbation of bronchopulmonary infection is often initiated by respiratory viral or mycoplasmal infection, with superimposed S. aureus and P. aeruginosa infections contributing to the severity of the infection. Frequent courses of antibiotic therapy are usually required, and some patients may have to receive antibiotics continuously. Oral cephalosporins, ampicillin, and the combination of trimethoprim/sulfamethoxazole are commonly used for relatively mild infections. In the treatment of exacerbation of infection, intravenous penicillinase-resistant penicillins and anti-Pseudomonas antibiotics are the drugs of choice. For Pseudomonas infections, ticarcillin, carbenicillin, the ureidopenicillins, and the aminoglycosides are indicated. The combination of an anti-Pseudomonas penicillin and an aminoglycoside are most commonly used. Of the third-generation cephalosporins, ceftazidime appears to be the most efficacious. The quinolones (such as ciprofloxacin) are also active against P. aeruginosa, and preliminary studies of these drugs in patients with cystic fibrosis appear to indicate that they are as efficacious as the already available antibiotics. In many centers, Pseudomonas cepacia has emerged as a serious problem in patients with cystic fibrosis. This organism tends to develop resistance to multiple antibiotics. In some centers, infection with P. cepacia has been associated with a severe, frequently fatal, pneumonia.

Inspiratory muscle training in patients with COPD: effect on dyspnea, exercise performance, and quality of life.

OBJECTIVE: The aim of the study was to assess the effect of target-flow inspiratory muscle training (IMT) on respiratory muscle function, exercise performance, dyspnea, and health-related quality of life (HRQL) in patients with COPD. PATIENTS AND METHODS: Twenty patients with severe COPD were randomly assigned to a training group (group T) or to a control group (group C) following a double-blind procedure. Patients in group T (n = 10) trained with 60 to 70% maximal sustained inspiratory pressure (SIPmax) as a training load, and those in group C (n = 10) received no training. Group T trained at home for 30 min daily, 6 days a week for 6 months. MEASUREMENTS: The measurements performed included spirometry, SIPmax, inspiratory muscle strength, and exercise capacity, which included maximal oxygen uptake (VO(2)), and minute ventilation (VE). Exercise performance was evaluated by the distance walked in the shuttle walking test (SWT). Changes in dyspnea and HRQL also were measured. RESULTS: Results showed significant increases in SIPmax, maximal inspiratory pressure, and SWT only in group T (p < 0.003, p < 0.003, and p < 0.001, respectively), with significant differences after 6 months between the two groups (p < 0.003, p < 0.003, and p < 0.05, respectively). The levels of VO(2) and VE did not change in either group. The values for transitional dyspnea index and HRQL improved in group T at 6 months in comparison with group C (p < 0.003 and p < 0.003, respectively). CONCLUSIONS: We conclude that targeted IMT relieves dyspnea, increases the capacity to walk, and improves HRQL in COPD patients.

Results of a home-based training program for patients with COPD.

OBJECTIVES: To have a group of COPD patients undergo a simple program of home-based exercise training, using the shuttle walking test (SWT) to standardize the intensity of training. METHODS: Sixty patients participated, randomly distributed into two groups (rehabilitation and control) of 30 patients each. The following evaluations were carried out at baseline and at 12 weeks: (1) pulmonary function studies; (2) SWT; (3) submaximal intensity resistance test; (4) cycle ergometer test; (5) quality of life; and (6) dyspnea. The rehabilitation group underwent a lower-extremity training program. Walking was selected as the type of exercise. The intensity of training was set at 70% of the maximum speed attained on the SWT. Divided sessions were held, lasting 1 h, 6 days/wk, at home, with a checkup every 2 weeks. The duration of the program was 12 weeks. RESULTS: The following patients completed the study: 20 patients (66.6%) from the rehabilitation group (mean [+/- SD]) age, 64.3 +/- 8.3 years; mean FEV(1), 41.7 +/- 15.6% of predicted); and 17 patients (56.6%) from the control group (mean age, 63.1 +/- 6.9 years; mean FEV(1), 40 +/- 16.4% of predicted). We found no changes in pulmonary function or effort parameters (SWT or cycle ergometer) in the rehabilitation group at 12 weeks. A twofold increase (1,274 +/- 980 to 2,651 +/- 2,056 m; p < 0.001) was achieved in the submaximal intensity resistance test, with less dyspnea at the conclusion of the test (p = 0.05). Significant improvement also was achieved in basal dyspnea and, both statistically and clinically, in the quality of life. Significant changes were not achieved in the control group patients. CONCLUSIONS: A simple home-based program of exercise training achieved improvement in exercise tolerance, posteffort dyspnea, basal dyspnea, and quality of life in COPD patients.