Doença pulmonar obstrutiva crônica

The present review summarizes the clinical aspects, diagnostics criteria and treatment of Chronic Obstructive Pulmonary Disease (COPD). Besides, will be reviewed the systemic manifestations associated with COPD and its clinical relevance in the patient's follow up. © Copyright Moreira Jr. Editora.

Contribuição da terapia celular com células tronco em fibrose em ratos

Pós-graduação em Pesquisa e Desenvolvimento (Biotecnologia Médica) - FMB

Evolução de pacientes portadores de peumopatias crônicas e hipoxemia transitória ao esforço tratados com oxigenoterapia domiciliar prolongada durante o sono e ao esforço

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a prospective, double blind, randomized controlled clinical trial

Background: Chronic kidney disease (CKD) is one of the most serious public health problems. The increasing prevalence of CKD in developed and developing countries has led to a global epidemic. The hypothesis proposed is that patients undergoing dialysis would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity, compromising quality of life.Methods/Design: A prospective, consecutive, double blind, randomized controlled clinical trial is proposed to address the effect of dialysis on sleep, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life in patients with CKD. The measurement protocol will include body weight (kg); height (cm); body mass index calculated as weight/height(2); circumferences (cm) of the neck, waist, and hip; heart and respiratory rates; blood pressures; Mallampati index; tonsil index; heart rate variability; maximum ventilatory pressures; negative expiratory pressure test, and polysomnography (sleep study), as well as the administration of specific questionnaires addressing sleep apnea, excessive daytime sleepiness, depression, anxiety, stress, and quality of life.Discussion: CKD is a major public health problem worldwide, and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension. Sleep disorders are common in patients with renal insufficiency. Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep, and to investigate the negative influences of haemodialysis in the physiological variables of sleep, and autonomic nervous system, and respiratory mechanics and thereby compromise the quality of life of patients.

Nonalcoholic fatty liver disease and metabolic syndrome in postmenopausal women

Nonalcoholic fatty liver disease (NAFLD) is considered the most common cause of chronic liver disease in the Western countries. NAFLD includes a spectrum ranging from a simple steatosis to a nonalcoholic steatohepatitis (NASH) which is defined by the presence of inflammatory infiltrate, cellular necrosis, hepatocyte ballooning, and fibrosis and cirrhosis that can eventually develop into hepatocellular carcinoma. Studies emphasize the role of insulin resistance, oxidative stress, pro-inflammatory cytokines, adipokines in the development and progression of NAFLD. It seems to be independently associated with type II diabetes mellitus, increased triglycerides, decreased HDL-cholesterol, abdominal obesity and insulin resistance. These findings are in accordance with the criteria used in the diagnosis of metabolic syndrome (MetS). Here, we will discuss the current knowledge on the epidemiology, pathophysiology and diagnosis of NAFLD and the association of metabolic syndrome in postmenopausal women.

Mannose-binding lectin gene polymorphism and risk factors for cardiovascular disease in postmenopausal women

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

Metabolic Syndrome Criteria As Predictors of Insulin Resistance, Inflammation and Mortality in Chronic Hemodialysis Patients

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influence of Parstatin on Experimental Periodontal Disease and Repair in Rats

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

Haplotypes of susceptibility to chronic periodontitis do not influence MMP-8 levels or the outcome of non-surgical periodontal therapy

Introduction: Chronic periodontitis (CP) is a multifactorial condition, presenting immunoinflammatory reaction, in which a myriad of molecules including cytokines and matrix metalloproteinases (MMPs) interplays, making the system extremely intricate. There is scarce information regarding interconnections of biological influence among IL-4, IL-8 and MMP-8, mainly considering genetic polymorphisms, and also, whether this can influence the outcome of periodontal therapy. Previously, we reported that variants in the interleukin 4 (IL4) and interleukin 8 (IL8) genes were associated with CP in Brazilians. The aim of this study was to investigate, in individuals with different genetic backgrounds with regard to the IL4 or IL8 haplotypes, differences in the immunological levels of MMP-8 in gingival crevicular fluid (GCF) before and after non-surgical periodontal treatment. A total of 141 patients participated of this study, classified as susceptible or not to CP, according to the presence of haplotypes formed by polymorphysms in the IL4 or IL8 genes. All individuals received non-surgical periodontal therapy and follow–up continued for 45 days. The GCF samples were collected at baseline and on the 45th day. The MMP-8 levels were determined by ELISA. Results: No association was found between genetic backgrounds and MMP-8 levels in GCF or the outcome of non-surgical periodontal therapy. Conclusions: In this longitudinal clinical study, the presence of IL4 or IL8 haplotypes previously associated with CP did not influence the outcome of non-surgical periodontal therapy and the MMP-8 levels in the GCF. Additional studies are necessary to determine the mechanisms by which the IL4 or IL8 haplotypes affect individual susceptibility to CP.

Bone marrow cytological evaluation in dogs with chronic kidneydisease

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

Peritoneal dialysis per se is a risk factor for sclerostin-associated adynamic bone disease

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Greater level of physical activity associated with better cognitive function in hemodialysis in end stage renal disease

Patients with chronic kidney disease (CKD) have a lower exercise tolerance and poor functional capacity, carry on a sedentary lifestyle. Another important change found in patients with CKD is cognitive dysfunction. Physical inactivity has been associated with cognitive dysfunction in the general population, but few studies have evaluated this association in CKD. To assess the association between physical activity and cognitive function in patients with CKD on hemodialysis (HD). We evaluated 102 patients undergoing HD. The participants completed the International Physical Activity Questionnaire, which assesses the level of physical activity and the Mini Mental State Examination, used for cognitive screening. Patients were divided into three groups according to their level of physical activity (GI: active/GII: irregularly active/GIII: sedentary). It was applied logistic regression analysis and adopted as outcome variable the presence of cognitive impairment and preserving as independent variables those with a probability of statistical difference between groups of less than 0.1. It was considered statistically significant when p less than 0.05. The groups were similar in age, duration of HD, and smoking. Statistically significant difference regarding race, body mass index, diabetes mellitus, underlying disease and degree of cognitive impairment. Regarding laboratory data, the groups differed in terms of creatinine, glucose, hemoglobin and hematocrit. There was significant association with better physical activity and cognitive function, even adjusting for confounding variables. the highest level of physical activity was associated with better cognitive function in CKD patients undergoing HD.

Avaliação funcional pré e pós programa de exercício físico de pacientes em hemodialise

Model Study: An experimental study Introduction: Chronic Kidney Disease (CKD) refers to a syndromic diagnosis which leads to a progressive and irreversible loss of renal function. A hemodialysis patient may have limitations in functional capacity, pulmonary function and respiratory musclular strength impacting in quality of life. Objective: To evaluate the effects of an exercise program on pulmonary function, functional capacity, quality of life and pain in patients undergoing hemodialysis. Methodology: The study included 28 patients of both genders, women and men aged between 40 and 60 years undergoing dialysis at the Kidney Institute, Santa Casa de Misericordia in Presidente Prudente-SP. Primary outcomes included respiratory muscular strength measurements assessed by manovacuometry. The functional capacity was evaluated by a six minute walking test. A life quality questionnaire was applied to evaluate quality of life (SF36-KDQOL). Lung function was evaluated by spirometry. Pain was assessed by a visual analogue scale. The exercise program consisted of training 3 times a week for 40 minutes on hemodialysis during eight weeks. At the end of the program all patients were reassessed. Results: There was no significant difference in the values of FVC and FEV1 before and after the exercise program as well as the index Tiffenau. The value of post MIP was significantly higher than the value obtained in the pre program. For variable MEP no significant difference was found. Functional capacity evaluations showed that there were no significant differences (p> 0.05). The evaluation of quality of life, about the domains of specific areas of CKD showed statistical significance when comparing the list of symptoms and problems with overloading of renal disease and professional role. Indicators related to pain were significantly reduced after the program (P <0.05). Discussion: A chronic kidney patient faces complex situations of physical, social and financial aspects. Although no statistically significant results were found in all variables, the study corroborates to others found in the literature, which suggests that an exercise program can be positive for this population. Conclusion: Although lung capacity and functional capacity did not submit changes to the end of the study, reduced levels of pain, fatigue and dyspnea suggest improvement in functional performance after exercise programs.

Ovine leptospirosis in Brazil

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

Participação da excreção renal de cálcio, fósforo, sódio e potássio na homeostase em cães sadios e cães com doença renal crônica

Na doença renal crônica (DRC) a manutenção da homeostase de água e sódio é o primeiro problema a ser contornado pelo organismo e com o agravamento das lesões renais surgem outros problemas graves relacionados à homeostase de cálcio e fósforo. O presente estudo tem por escopo avaliar a excreção renal de cálcio, fósforo, sódio e potássio, e o perfil sérico destes eletrólitos em cães normais e em cães com DRC naturalmente adquirida. Foram avaliados três grupos de cães adultos, machos ou fêmeas, de raças variadas. Animais normais compuseram o grupo controle (G1) e os cães com DRC foram distribuídos em dois grupos de acordo com os estágios de comprometimento da função renal (G2 e G3, respectivamente, estágios 1-2 e estágios 3-4, descritos pela IRIS 2006 staging CKD). Os cães do G3 apresentaram aumento das concentrações séricas de cálcio ionizado e fósforo, além de diminuição da concentração sérica de sódio. Quanto à excreção renal dos eletrólitos analisados, os animais dos grupos G1 e G2 apresentaram diminuição de carga filtrada e aumento de excreção fracionada, mas as excreções urinárias não variaram significativamente. Os resultados são indicativos de que os rins de cães com DRC podem manter a excreção urinária dos eletrólitos em valores se melhantes aos dos normais. O mecanismo envolve aumento da excreção fracionada na medida em que haja diminuição da filtração glomerular. Esse processo de compensação, entretanto, pode perder a eficiência nos estágios mais avançados da enfermidade no que se refere à manutenção das concentrações séricas de fósforo e sódio.