Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Remodelação miocárdica na sobrecarga crônica de pressão ou de volume no coração de ratos

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

Avaliação do desempenho diagnóstico e do valor de corte para o índice de respiração rápida e superficial na predição do insucesso da extubação

OBJETIVO: Avaliar o desempenho diagnóstico do índice de respiração rápida e superficial (IRRS) na predição do insucesso da extubação de pacientes adultos em terapia intensiva e verificar a adequação do valor de corte clássico para esse índice. MÉTODOS: Estudo prospectivo realizado na unidade de terapia intensiva de adultos do Hospital das Clínicas da Faculdade de Medicina de Botucatu, através da avaliação do IRRS em 73 pacientes consecutivos considerados clinicamente prontos para extubação. RESULTADOS: O IRRS com valor de corte clássico (105 ciclos/min/L) apresentou sensibilidade de 20% e especificidade de 95% (soma = 115%). A análise da curva receiver operator characteristic (ROC) demonstrou melhor valor de corte (76,5 ciclos/min/L), o qual forneceu sensibilidade de 66% e especificidade de 74% (soma = 140%), e a área sob a curva ROC para o IRRS foi de 0,78. CONCLUSÕES: O valor de corte clássico do IRRS se mostrou inadequado nesta casuística, prevendo apenas 20% dos pacientes com falha na extubação. A obtenção do novo valor de corte permitiu um acréscimo substancial de sensibilidade, com aceitável redução da especificidade. O valor da área sob a curva ROC indicou satisfatório poder discriminativo do índice, justificando a validação de sua aplicação.

Comunicação da equipe multiprofissional e indivíduos portadores de hipertensão arterial

O presente estudo tem como objetivos levantar dados sobre o que os indivíduos portadores de hipertensão arterial pensam sobre a sua doença e verificar a ocorrência do processo de comunicação entre estes e os profissionais que atuam junto aos mesmos. Foram entrevistados 66 clientes, obtendo-se 73 narrativas, constatando-se que a maioria (69 narrativas) dos participantes da pesquisa faz correlação com o conceito de hipertensão arterial, ainda que de maneira pouco elaborada. Apesar de 95% dos clientes fazerem alguma referência à doença, não significa que as orientações recebidas anteriormente foram aprendidas. Espera-se que o enfermeiro por desempenhar um importante papel dentro da equipe multiprofissional, identifique as possíveis barreiras relativas ao processo de comunicação, havendo daí a intervenção junto aos elementos que podem estar dificultando ou impedindo a compreensão necessária para que o cliente assuma seu autocuidado.

Infecção em idosos internados em instituição de longa permanência

OBJETIVO: Avaliar ocorrência de infecção em idosos de instituição de longa permanência (ILP) durante 13 meses consecutivos. MÉTODOS: Cinqüenta e cinco idosos foram avaliados segundo critérios de infecção e de comunicação padronizada. RESULTADOS: A idade mediana foi de 75 (66-81) anos. O conjunto de dados constituiu-se de 20.896 pacientes-dia (PD) durante o período, com um total de 76 infecções para uma taxa média de infecção de 3,2 por 1000 PD. A taxa de pacientes com infecção foi de 63,6%. As topografias prevalentes foram respiratória (50%), trato urinário (32%), pele e partes moles (12%) e gastrintestinal (7%), com taxa de infecção/1000 PD de 1,60; 1,01; 0,38; e 0,2, respectivamente. A taxa de mortalidade por infecção foi de 5%. Agentes microbiológicos foram isolados em 30,5% dos episódios infecciosos e Escherichia coli e Staphylococcus aureus foram os mais freqüentes. CONCLUSÃO: Infecção apresentou elevada incidência nos idosos institucionalizados, porém nenhum evento extraordinário foi observado.

Modulatory effect of prostaglandins on human monocyte activation for killing of high- and low-virulence strains of Paracoccidioides brasiliensis

The effect of indomethacin (Indo), a cyclo-oxygenase inhibitor, on the monocyte-mediated killing of a low-(Pb265) and a high-(Pb18) virulence strain of Paracoccidioides brasiliensis was examined. The Pb18 strain was not killed by either non-activated or interferon-gamma (IFN-gamma)-activated human monocytes but these cells did show fungicidal activity if pretreated with Indo. In contrast with IFN-gamma tumour necrosis factor-alpha (TNF-alpha) was very effective at stimulating the fungicidal activity of monocytes. While the low-virulence strain, Pb265, could not be killed by monocytes, cells preincubated with IFN-gamma demonstrated fungicidal activity. The killing of this strain was also induced by pretreatment of monocytes with Indo. The results suggest a negative role for prostaglandins, which are synthesized via the cyclo-oxygenase pathway, in the regulation of monocyte-mediated killing of virulent and avirulent strains of P. brasiliensis and that TNF-alpha generation during the fungus-monocyte interaction is more important in the killing of Pb265 than Pb18.

Tomato-oleoresin supplement prevents doxorubicin-induced cardiac myocyte oxidative DNA damage in rats

Doxorubicin (DOX) is an efficient chemotherapeutic agent used against several types of tumors; however, its use is limited due to severe cardiotoxicity. Since it is accepted that reactive oxygen species are involved in DOX-induced cardiotoxicity, antioxidant agents have been used to attenuate its side effects. To determine tomato-oleoresin protection against cardiac oxidative DNA damage induced by DOX, we distributed Wistar male rats in control (C), lycopene (L), DOX (D) and DOX+lycopene (DL) groups. They received corn oil (C, D) or tomato-oleoresin (5 mg/kg body wt. day) (L, DL) by gavage for a 7-week period. They also received saline (C, L) or DOX (4 ma/kg body wt.) (D, DL) intraperitoneally at the 3rd, 4th, 5th, and at 6th week. Lycopene absorption was checked by HPLC. Cardiac oxidative DNA damage was evaluated by the alkaline Comet assay using formamidopyrimidine-DNA glycosylase (FPG) and endonuclease III (endo 111). Cardiomyocyte levels of SBs, SBs FPG and SBs Endo III were higher in rats from D when compared to other groups. DNA damage levels in cardiomyocytes from DL were not different when compared to C and L groups. The viability of cardiomyocytes from D or DL was lower than C or L groups (p < 0.01). Lycopene levels (mean +/- S.D. nmol/kg) in saponified hearts were similar between L (47.43 +/- 11.78) and DL (49.85 +/- 16.24) groups. Our results showed: (1) lycopene absorption was confirmed by its cardiac levels; (2) DOX-induced oxidative DNA damage in cardiomyocyte; (3) tomato-oleoresin supplementation protected against cardiomyocyte oxidative DNA damage. (c) 2007 Elsevier B.V. All rights reserved.

Effect of lycopene on doxorubicin-induced cardiotoxicity: An echocardiographic, histological and morphometrical assessment

Doxorubicin is an excellent chemotherapeutic agent utilized for several types of cancer but the irreversible doxorubicin-induced cardiac damage is the major limitation for its use. Oxidative stress seems to be associated with some phase of the toxicity mechanism process. To determine if lycopene protects against doxorubicin-induced cardiotoxicity, male Wistar rats were randomly assigned either to control, lycopene, doxorubicin or doxorubicin + lycopene groups. They received corn oil (control, doxorubicin) or lycopene (5 mg/kg body weight a day) (lycopene, doxorubicin + lycopene) by gavage for a 7-week period. They also received saline (control, lycopene) or doxorubicin (4 mg/kg) (doxorubicin, doxorubin + lycopene) intraperitoneally by week 3, 4 5 and 6. Animals underwent echocardiogram and were killed for tissue analyses by week 7. Mean lycopene levels (nmol/kg) in liver were higher in the doxorubicin + lycopene group (5822.59) than in the lycopene group (2496.73), but no differences in lycopene were found in heart or Plasma of these two groups. Lycopene did not prevent left ventricular systolic dysfunction induced by doxorubicin. However, morphologic examination revealed that doxorubicin-induced myocyte damage was significantly suppressed in rats treated with lycopene. Doxorubicin treatment was followed by increase of myocardium interstitial collagen volume fraction. Our results show that: (i) doxorubicin-induced cardiotoxicity was confirmed by echocardiogram and morphological evaluations; (ii) lycopene absorption was confirmed by its levels in heart, liver and plasma; (iii) lycopene supplementation provided myocyte protection without preventing interstitial collagen accumulation increase; (iv) doxorubicin-induced cardiac dysfunction was not prevented by lycopene supplementation; and (v) lycopene depletion was not observed in plasma and tissues from animals treated with doxorubicin.

Effects of Inhaled Nitric Oxide on Oxidative Stress and Histopathological and Inflammatory Lung Injury in a Saline-Lavaged Rabbit Model of Acute Lung Injury

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

High-frequency oscillatory ventilation attenuates oxidative lung injury in a rabbit model of acute lung injury

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

Biomarkers for oxidative stress in acute lung injury induced in rabbits submitted to different strategies of mechanical ventilation

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

Valores séricos de cálcio, fósforo, sódio, potássio e proteínas totais em caprinos fêmeas da raça Parda Alpina

Por ser de grande importância o conhecimento de valores séricos referenciais do mineralograma e do proteinograma, a sua utilização na medicina veterinária, e a escassez de trabalhos brasileiros relacionados à espécie caprina, este estudo objetivou determinar e comparar os níveis séricos de cálcio, fósforo, sódio, potássio e proteínas (proteína total, albumina, globulina e a relação albumina/globulina) em caprinos fêmeas da raça Parda Alpina, em três idades diferentes. Foram utilizadas 30 fêmeas caprinas da raça Parda Alpina criadas em regime intensivo, sendo separadas em três grupos: Grupo 1 - 10 fêmeas jovens com idade de quatro meses; Grupo 2 - 10 fêmeas adultas jovens com idade de 18 meses; Grupo 3 - 10 fêmeas adultas lactantes com idade de 24 a 60 meses. Os animais foram avaliados por meio de exames clínico e coproparasitológico. Foram encontrados os seguintes valores médios de cálcio, fósforo, sódio e potássio no grupo G1: 10,10± 1,70, 10,13± 2,04, 151± 3,30 e 5,16± 0,41; no grupo G2: 10,36± 0,94, 7,49± 1,34, 145,9± 3,35 e 4,56± 0,48; e para o grupo G3: 9,47± 1,45, 5,90± 1,21, 153,3± 5,17 e 4,20± 0,55. Para as variáveis proteína total sérica, albumina, globulina e relação albumina/globulina foram encontrados os seguintes valores médios, para o grupo G1: 6,29± 0,94, 3,5± 10,41, 2,78± 0,95 e 1,40± 0,48; para o grupo G2: 7,27± 0,73, 4,92± 1,06, 3,06± 0,56, 1,43± 0,44; e para o grupo G3: 7,14± 0,84, 3,70± 0,20, 3,44± 0,79 e 1,14± 0,30. A análise estatística dos dados demonstra que existe influência da faixa etária nas variáveis fósforo, sódio, potássio, proteína total e albumina.

First Autochthonous Case of Canine Visceral Leishmaniasis in the Center of Rio Grande do Sul State, Brazil

Background: Leishmaniasis is one of the most important vector-borne diseases of humans. This parasitic disease can be caused by many species of Leishmania. In humans, different species of the parasite are associated with different forms of the disease, cutaneous and visceral. Among domesticated animals, dogs are the most important species in the epidemiology of this disease. Leishmania chagasi, an important zoonosis, is well established as the agent of visceral leishmaniasis in Brazil. The disease is endemic in north, northeast, midwest and southeast, and is transmitted to mammals by hematophagous insects such as the Lutzomyia longipalpis. In 2008, our research group has diagnosed a case of canine leishmaniasis in the municipality of Uruguaiana and subsequently there were several cases in the city and the neighbor municipality of Sao Borja. Most Brazilian states are endemic for leishmaniasis, with the exception of Rio Grande do Sul. In southern Brazil, the reports of humans and dogs infected by Leishmania spp. are the source of endemic area in the country. Therefore, the aim of this study is register the first clinical case of canine visceral leishmaniasis in the municipality of Santa Maria, RS.Case: In october 2010, a veterinary clinic of Santa Maria received a canine, female, Doberman, with two years of age. The animal had severe skin lesions on the head and limbs, pale mucous membranes, and enlarged lymph nodes. According to the owner, the animal showed progressive weight loss and anorexia for more than five days. During the clinical examination the blood was collected for hemogram and cytology of lymph nodes was performed by puncture aspiration with a fine needle. In the erythrogram, it was observed a decrease in the total number of erythrocytes (2.8 x 10(6)/mu L), hematocrit (21%), hemoglobin (6.8 g/dL) and platelets (98 x 10(3)/mu L). In the leucogram, any alteration was observed. The cytology of lymph nodes showed amastigotes forms, suggestive of the Leishmania spp. Based on this finding; we performed the blood collection for PCR, to confirm parasitism and to determine the species of Leishmania. At the molecular test was used PCR-specific for L. chagasi, and the result was positive.Discussion: This is the first autochthonous clinical case in the central region of the RS, non-endemic area for leishmaniasis. In serological studies of visceral leishmaniasis it was diagnosed in five asymptomatic dogs in the municipalities of Santa Maria, Julio de Castilhos and Itaara, however not confirmed by molecular analysis. In the municipalities of Cruz Alta and Uruguaiana cases of L. chagasi have been reported in dogs which previously resided in Leishmania sp. endemic areas. The municipality of Sao Borja had the first record of L. longipalpis in the RS during the leishmaniasis outbreak in 2008-2009. In the central region of the RS vector has not been found, but because in this first autochthonous case dog in Santa Maria believe that the parasite is present and/or doing other insect transmission of leishmaniasis. Clinical signs associated with hematologic and coagulation disorders observed in the canine are commonly described in symptomatic dogs in endemic regions. This case of autochthonous leishmaniasis reinforces the idea of the vector presence in Santa Maria, center of the RS. We believe that canine leishmaniasis is an emerging disease in the southern region of Brazil.