Intensified peginterferon α-2a dosing increases sustained virologic response rates in heavy, high viral load hepatitis c genotype 1 patients with high low-density lipoprotein

BACKGROUND AND GOAL: Patients infected with hepatitis C virus (HCV) with elevated low-density lipoprotein (LDL) levels achieve higher sustained virologic response (SVR) rates after peginterferon (PegIFN)/ribavirin treatment versus patients with lower LDL. Our aim was to determine whether SVR rates in patients with low/elevated LDL can be improved by dose intensification. STUDY: In PROGRESS, genotype 1 patients with baseline HCV RNA≥400,000 IU/mL and body weight ≥85 kg were randomized to 48 weeks of 180 μg/wk PegIFN α-2a (40 kDa) plus ribavirin (A: 1200 mg/d; B: 1400/1600 mg/d) or 12 weeks of 360 μg/wk PegIFN α-2a followed by 36 weeks of 180 μg/wk, plus ribavirin (C: 1200 mg/d; D: 1400/1600 mg/d). This retrospective analysis assessed SVR rates among patients with low (<100 mg/dL) or elevated (≥100 mg/dL) LDL. Patients with high LDL (n=256) had higher baseline HCV RNA (5.86×10 IU/mL) versus patients with low LDL (n=262; 4.02×10 IU/mL; P=0.0003). RESULTS: Multiple logistic regression analysis identified a significant interaction between PegIFN α-2a dose and LDL levels on SVR (P=0.0193). The only treatment-related SVR predictor in the nested multiple logistic regression was PegIFN α-2a dose among patients with elevated LDL (P=0.0074); therefore, data from the standard (A+B) and induction (C+D) dose arms were pooled. Among patients with low LDL, SVR rates were 40% and 35% in the standard and induction-dose groups, respectively; SVR rates in patients with high LDL were 44% and 60% (P=0.014), respectively. CONCLUSIONS: Intensified dosing of PegIFN α-2a increases SVR rates in patients with elevated LDL even with the difficult-to-cure characteristics of genotype 1, high baseline viral load, and high body weight. Copyright © 2013 by Lippincott Williams & Wilkins.

Case report: Disseminated Mycobacterium tuberculosis infection in a dog

An uncommon disseminated Mycobacterium tuberculosis infection is described in a 12-year-old female dog presenting with fever, dyspnea, cough, weight loss, lymphadenopathy, melena, epistaxis, and emesis. The dog had a history of close contact with its owner, who died of pulmonary tuberculosis. Radiographic examination revealed diffuse radio-opaque images in both lung lobes, diffuse visible masses in abdominal organs, and hilar and mesenteric lymphadenopathy. Bronchial washing samples and feces were negative for acid-fast organisms. Polymerase chain reaction (PCR)-based species identification of bronchial washing samples, feces, and urine revealed M. tuberculosis using PCR-restriction enzyme pattern analysis-PRA. Because of public health concerns, which were worsened by the physical condition of the dog, euthanasia of the animal was recommended. Rough and tough colonies suggestive of M. tuberculosis were observed after microbiological culture of lung, liver, spleen, heart, and lymph node fragments in Löwenstein-Jensen and Stonebrink media. The PRA analysis enabled diagnosis of M. tuberculosis strains isolated from organs. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene.

Intoxicação experimental de cães com sementes de Crotalaria spectabilis (Leg. Papilionoideae)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Prevalência de tabagismo no Campus de Botucatu/UNESP

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Avaliação das atividades mutagênica, pró-inflamatória e estrogênica de Machaerium hirtum e Crotalaria pallida

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Comparação da efetividade do preenchimento do balonete do tubo traqueal com lindocaína alcalinizada ou solução fisiológica, associada à lubrificação do balonete com gel hidrossolúvel, na prevenção de morbidades laringotraqueais em pacientes tabagistas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

BackgroundThis is an update of a Cochrane Review first published in The Cochrane Library 2008, Issue 3.Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry compared to no therapy or physiotherapy, including coughing and deep breathing, on all-cause postoperative pulmonary complications andmortality in adult patients admitted to hospital for upper abdominal surgery.ObjectivesOur primary objective was to assess the effect of incentive spirometry (IS), compared to no such therapy or other therapy, on postoperative pulmonary complications and mortality in adults undergoing upper abdominal surgery.Our secondary objectives were to evaluate the effects of IS, compared to no therapy or other therapy, on other postoperative complications, adverse events, and spirometric parameters.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE, EMBASE, and LILACS (from inception to August 2013). There were no language restrictions. The date of the most recent search was 12 August 2013. The original search was performed in June 2006.Selection criteriaWe included randomized controlled trials (RCTs) of IS in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures.Data collection and analysisTwo authors independently assessed trial quality and extracted data.Main resultsWe included 12 studies with a total of 1834 participants in this updated review. The methodological quality of the included studies was difficult to assess as it was poorly reported, so the predominant classification of bias was 'unclear'; the studies did not report on compliance with the prescribed therapy. We were able to include data from only 1160 patients in the meta-analysis. Four trials (152 patients) compared the effects of IS with no respiratory treatment. We found no statistically significant difference between the participants receiving IS and those who had no respiratory treatment for clinical complications (relative risk (RR) 0.59, 95% confidence interval (CI) 0.30 to 1.18). Two trials (194 patients) IS compared incentive spirometry with deep breathing exercises (DBE). We found no statistically significant differences between the participants receiving IS and those receiving DBE in the meta-analysis for respiratory failure (RR 0.67, 95% CI 0.04 to 10.50). Two trials (946 patients) compared IS with other chest physiotherapy. We found no statistically significant differences between the participants receiving IS compared to those receiving physiotherapy in the risk of developing a pulmonary condition or the type of complication. There was no evidence that IS is effective in the prevention of pulmonary complications.Authors' conclusionsThere is low quality evidence regarding the lack of effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large RCTs with high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.

Avaliação do efeito do citral na dor neuropática e na inflamação

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Viscoelastic properties of bronchial mucus after respiratory physiotherapy in subjects with bronchiectasis

BACKGROUND: Previous studies have evaluated the effectiveness of postural drainage (PD), percussion (PERC), the coughing technique (CT), and other types of coughing in subjects with bronchiectasis. However, the application times of these techniques and the quality of the expectorated mucus require further study. The aim of our study was to evaluate the effectiveness of PD, percussion, CT, and huffing in subjects with bronchiectasis and assess the quantity and quality of bronchial mucus produced (measurement of wet and dry weight and determination of viscoelastic properties). METHODS: Twenty-two subjects with stable bronchiectasis (6 men; mean age: 51.5 y) underwent 4 d of experimental study (CT, PD+CT, PD+PERC+CT, and PD+huffing). The techniques were performed in 3 20-min periods separated by 10 min of rest. Before performing any technique (baseline) and after each period (30, 60, and 90 min), expectorated mucus was collected for analysis of viscoelasticity. RESULTS: A significant increase in the dry weight/wet weight ratio was found after 60 min of PD+PERC+CT (P = .01) and 90 min of PD+huffing (P = .03) and PD+PERC+CT (P = .007) in comparison with CT. PD+PERC+CT and PD+huffing led to the greatest removal of viscoelastic mucus at 60 min (P = .02 and P = .002, respectively) and continued to do so at 90 min (P = .02 and P = .01, respectively) in comparison with CT. An interaction effect was found, as all techniques led to a greater removal of elastic mucus in comparison with CT at 60 min (PD+CT, P = .001; PD+PERC+CT, P < .001; PD+huffing, P < .001), but only PD+PERC+CT and PD+huffing led to a greater removal of elastic mucus than CT at 90 min (P < .001 and P = .005, respectively). CONCLUSIONS: PD+PERC+CT and PD+huffing performed similarly regarding the removal of viscoelastic mucus in 2 and 3 20-min periods separated by 10 min of rest. PD+PERC+CT led to the greatest removal of mucus in the shortest period (2 20-min periods separated by 10 min of rest). (C) 2015 Daedalus Enterprises

Efeitos da estabulação sobre o trato respiratório de equinos em dois tipos diferentes de camas e a pasto

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)