Potentially modifiable predictors of mortality in patients treated with long-term oxygen therapy

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Predictors of first-year survival in patients with advanced COPD treated using long-term oxygen therapy

Little evidence-based guidance is available to aid clinicians in determining short-term prognoses in very severe COPD patients. Therefore, the present study was designed to provide a prospective assessment (1) of the mortality rates and (2) whether the baseline measurements may be determinants of 1-year mortality in hypoxemic COPD patients receiving long-term oxygen therapy (LTOT).Seventy-eight clinically stable patients with advanced COPD treated using LTOT were enrolled in a prospective cohort study. Outcome variable: first-year mortality. Baseline measurements: categorical variables: age (<60 or >= 60 years); gender; body mass index (<20 or >= 20 kg/m(2)); fat-free mass (FFM) index (<16 [men] and <15kg/m(2) [women]; baseline dyspnea index (BDI) (<= 3 or >3); and corticosteroid use. Continuous variables: smoking history; lung function; FFM; fat mass; hemoglobin; hematocrit; arterial blood gases; forearm muscle strength; St. George's Respiratory Questionnaire (SGRQ); and comorbidity score. By the end of 1-year of follow-up, 12 patients (15.4%) had died. Kaplan-Meier curves showed that BDI <= 3 was the only variable associated with higher mortality. Cox proportional hazards analysis revealed that tower PaO2 and SPO2, higher PaCO2 and SGRQ scores were associated with reduced survival. In the multivariate analysis, BDI remained predictive of mortality (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.31-0.81), as did PaO2 (HR, 0.49; 95% CI, 0.26-0.95). These data suggest that readily available parameters as dyspnea intensity and hypoxemia severity may be useful in predicting first-year survival rates in advanced COPD patients receiving LTOT (C) 2007 Elsevier Ltd. All rights reserved.

Transfusão de eritrócitos em crianças internadas em unidade de terapia intensiva pediátrica

JUSTIFICATIVA E OBJETIVOS: As indicações de transfusão de eritrócitos não estão bem estabelecidas em crianças gravemente enfermas. O objetivo deste estudo foi descrever a prática da transfusão de eritrócitos na UTI Pediátrica do Hospital de Clínicas da Universidade Estadual Paulista (HC-UNESP). MÉTODO: Estudo retrospectivo observacional realizado durante o ano de 2003. RESULTADOS: Setenta e cinco pacientes receberam transfusão, havendo registro de 105 indicações. Mais da metade dos pacientes (53,3%) tinha menos que um ano de idade. Taquipnéia (75,2%), palidez (65,7%) e hipotensão (51,4%) foram os registros mais freqüentemente observados antes da transfusão. Além disso, a gasometria evidenciou acidose metabólica (68,08%) e hipoxemia (63,8%). Dos 93 registros de valores de hemoglobina (Hb), 54 (58,1%) estavam entre 7 e 10 g/dL e dos 90 registros de hematócrito (Ht) observou-se que 66 (73,3%) apresentavam valores entre 21% e 30%. As principais indicações de transfusão foram anemia em 75 crianças (71,4%) e sangramento ativo em 26 (24,7%). O valor médio de Hb antes da transfusão foi de 7,82 ± 2,82 g/dL. Sete transfusões foram indicadas para pacientes com valores de Hb > 10 g/dL, crianças estas em pós-operatório imediato de intervenção cirúrgica cardíaca e casos de choque séptico. CONCLUSÕES: A transfusão de eritrócitos vem sendo utilizada criteriosamente, com indicações restritivas (Hb entre 7 e 10 g/dL). Nem sempre há anotação dos valores de Hb imediatamente antes da transfusão. A partir deste estudo, foi elaborado um protocolo de indicação de transfusão na unidade.

Systemic evaluation on ischemia and reperfusion injury of splanchnic organs in rats

OBJETIVO: Avaliar as alterações hemodinâmicas e sistêmicas decorrentes de isquemia e reperfusão (I/R) esplâncnica em ratos. MÉTODOS: Vinte ratos foram divididos em dois grupos: grupo controle: os animais foram submetidos à cirurgia, mas não a I/R e foram tratados com solução fisiológica (5 ml/kg/h) por 150 minutos; grupo I/R: os animais foram submetidos à administração contínua de solução fisiológica e à oclusão do tronco celíaco, artéria mesentérica superior e artéria mesentérica inferior por 30 minutos, seguidos por 120 minutos de reperfusão. Avaliou-se a pressão arterial média, pressão venosa, fluxo sangüíneo na aorta e na artéria mesentérica superior, freqüência cardíaca, temperatura esofágica e hematócrito. RESULTADOS: Durante a reperfusão, no grupo I/R, houve uma diminuição progressiva da pressão arterial média, fluxo sangüíneo na aorta e artéria mesentérica superior, freqüência cardíaca e temperatura esofágica; pressão venosa e hematócrito não sofreram alteração. CONCLUSÃO: O modelo de isquemia provocado por oclusão da artéria mesentérica superior, artéria mesentérica inferior e tronco celíaco por 30 minutos seguidos por 120 minutos de reperfusão provoca alterações sistêmicas evidenciadas por hipotensão, diminuição do fluxo sangüíneo mesentérico, da freqüência cardíaca e da temperatura esofágica.

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.

Redução da proteína da dieta com base no conceito de proteína ideal para tilápias-do-nilo (Oreochromis niloticus) criadas em tanques-rede

Avaliou-se o desempenho de tilápias-do-nilo (Oreochromis niloticus) criadas em tanques-rede e alimentadas com dietas contendo 27,0 (controle); 25,2; 24,3 e 22,7% de proteína digestível. Aminoácidos cristalinos (L-lisina, DL-metionina e L-treonina) foram adicionados à dieta considerando o conceito de proteína ideal e simulando o perfil de aminoácidos da dieta controle. Os peixes (34,63±19 g) foram alimentados manualmente com dietas isoenergéticas (3.075 kcal de energia digestível/kg de dieta) até saciedade aparente, três vezes ao dia, durante 91 dias. Utilizou-se um delineamento inteiramente casualizado, com quatro tratamentos, três repetições e 25 peixes/unidade experimental. Não foram observados efeitos dos níveis de proteína digestível sobre o ganho de peso, a conversão alimentar, a taxa de eficiência protéica, o peso da carcaça eviscerada, o rendimento de carcaça, o peso e o rendimento de filé, a sobrevivência e o hematócrito. Houve efeito quadrático dos níveis de proteína digestível sobre o consumo; o maior valor foi estimado para a dieta contendo 24,41% de proteína digestível e excreção de nitrogênio, na qual o melhor resultado estimado foi obtido com peixes que receberam a dieta contendo 24,92% de PD. Com a redução nos níveis de proteína digestível, observou-se aumento linear na retenção de nitrogênio. É possível reduzir o nível de proteína digestível, de 27 (29,1% de PB) para 24,3% (26,6% de PB), em dietas para tilápias-do-nilo criadas em tanques-rede. Essa redução deve ser feita por meio da suplementação de aminoácidos (com base no conceito de proteína ideal), considerando o desempenho e o custo da dieta/kg ganho em filé.

Suplementação de cloreto de potássio para frangos de corte submetidos a estresse calórico

O experimento foi realizado com objetivo de avaliar os efeitos do estresse calórico e da suplementação de cloreto de potássio (KCl) sobre o desempenho e algumas características fisiológicas de frangos de corte. Quarenta aves, no período de 42 a 49 dias, foram submetidas ao estresse calórico (16 horas a 25 ± 1ºC; duas horas com temperatura crescente; quatro horas a 35 ± 1ºC; e duas horas com temperatura decrescente até a termoneutralidade e com umidade relativa de 63,5 ± 5%), recebendo os seguintes tratamentos: 0,50 e 1,00% KCl na ração; 0,25 e 0,50% KCl na água de bebida. A ração à base de milho e farelo de soja, com 20% de proteína bruta e 3200 kcal EM/kg, foi fornecida ad libitum. A suplementação de KCl na ração ou na água de beber não influiu no ganho de peso, nos consumos de ração e água, na conversão alimentar, na mortalidade, na relação água/ração, no teor de matéria seca das excretas e nas características hematológicas. O estresse calórico aumentou a temperatura retal, o hematócrito, a hemoglobina, o heterófilo e a relação heterófilo/linfócito e reduziu as hemácias, o linfócito, o sódio e o potássio sérico. A suplementação de KCl na água regulou o número de eritrócitos e a hemoglobina em frangos estressados pelo calor. A relação heterófilo:linfócito e a temperatura retal podem ser usadas como índices de estresse.

Sources of organic trace minerals in diets for weaned piglets

One hundred and twenty six piglets from a commercial genetic strain weaned at 21 days of age (6.11±0.42 kg) were used to evaluate the effects of supplementation levels of organic sources of trace minerals in the diets of weaned piglets on performance, occurrence of diarrhea, excretion of copper and zinc in the feces, and hematological parameters. A completely randomized block design was adopted, composed of six treatments (diets containing 100% of inorganic trace minerals premix at 3.00 kg/T; diets containing 0, 25, 50, 75 or 100% of organic trace minerals premix, equivalent to 0; 0.75; 1.50; 2.25 or 3.00 kg/T, respectively), seven replicates and three animals per plot. During the experimental period (from 21 to 63 days of age), the increasing levels of organic trace minerals premix in the diets determined a quadratic effect on daily weight gain (DWG), feed conversion (FC), percentage of hematocrit (Ht), hemoglobin (Hb), mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), platelets (Pt), and a linear increase of Cu and Zn concentrations in feces. The comparison of means between the treatment with inorganic trace minerals premix and the other treatments showed that piglets fed diets without trace minerals premix had lower values of DWG, Ht, Hb, MCH, MCV, Pt and the worst FC value of piglets fed diets containing 25% of organic trace minerals premix presented lower values of Ht and Hb, in comparison with those fed diets with 100% of inorganic trace minerals premix. Inorganic trace minerals premix can be substituted by organic trace minerals premix at a lower level of inclusion in diets for weaned piglets.

Fish ladders select fish traits on migration - still a growing problem for natural fish populations

We investigated the potential selective effect of fish ladders on physiological and morphological profiles of the curimbata, Prochilodus lineatus, during reproductive migration in Brazil. We registered sex, body weight and length, plasma glucose, hepatosomatic and gonadosomatic indices (HSI and GSI, respectively), hematocrit, leucocrit, blood cell and nucleus areas, and the diameter of white and red muscle fibers in fish sampled at the bottom (downstream) and at the top (upstream) of a fish ladder at a hydroelectric dam. Males and females at the top of the ladder showed higher size (weight and length), white muscle fiber diameters, plasma glucose levels and lower hematocrit when compared with those at the bottom. These size and muscle traits assist fish to overcome the ladder barrier and bypass the dam, an effort that might be reflected in the glucose levels. Females also showed higher GSI at the top of the fish ladder, a trait possibly facilitating their reproduction upstream. These results indicate that a dam system favors fish with specific morphological-physiological profile. This may have a strong influence upon upstream fish populations over generations and implies the presence of artificial selective pressure.

Effects of short-term physical training on the liver IGF-I in diabetic rats

To investigate the influence of short-term physical training on IGF-I concentrations in diabetic rats, male wistar rats were distributed into four groups: sedentary control, trained control, sedentary diabetic and trained diabetic. Diabetes was induced by Alloxan (32 mg/kg b.w.) and training protocol consisted of swimming 1 h/day, 5 days/week, during 4 weeks, supporting 5% b.w. At the end of this period, rats were sacrificed and blood was collected for determinations of serum glucose, insulin, albumin, IGF-I and hematocrit. Liver samples were used to determine glycogen, protein, DNA and IGF-I concentrations. Diabetes reduced insulin and IGF-I concentrations in blood and liver protein, ratio protein/DNA and IGF-I concentrations in liver and increased glycemia. Physical training reduced serum glucose and recovered hepatic glycogen stores in diabetic rats and reduced serum and liver IGF-I concentrations. In conclusion, short-term physical training improved the metabolic conditions of diabetic rats, despite of impairing liver and blood IGF-I concentrations.

Effects of physical training on the immune system in diabetic rats

Aims: This study aims to investigate the influence of physical training on the immune system of diabetic rats. Materials and Methods: Adult male Wistar rats were distributed into Sedentary Control (SC), Trained Control (TC), Sedentary Diabetic (SD) and Trained Diabetic (TD) groups were used. Diabetes was induced by alloxan (32 mg/bw-i.v.). Training protocol consisted of swimming, at 32 18C, one hour/day, five days/week, supporting an overload equivalent to 5 of the body weight, during four weeks. At the end of the experiment the rats were sacrificed by decapitation and blood samples were collected for glucose, insulin, albumin, hematocrit determinations, total and differential leukocyte counting. Additionally, liver samples for glycogen analyses were obtained. Results: The results were analyzed by one way at a significance level of 5. Diabetes reduced blood insulin, liver glycogen stores and increased blood glucose and neutrophil count. Physical training restored glycemia, liver glycogen levels, neutrophils and lymphocytes count in diabetic rats. Conclusions: In summary, physical training was able to improve metabolic and immunological aspects in the experimental diabetic rats.

RESPONSES of HEMATOLOGICAL PARAMETERS and AEROBIC PERFORMANCE of ELITE MEN and WOMEN SWIMMERS DURING A 14-WEEK TRAINING PROGRAM

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Long-term physical training increases liver IGF-I in diabetic rats

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Obesity: effects of physical exercise and metformin on metabolic aspects of monosodium glutamate treated rats

The present study investigated the effects of swimming training and metformin on metabolic aspects of obese rats. Wistar rats were divided into control (C), obese (O), Trained Obese (TO) and metformin obese (MO) groups. Obesity was induced by subcutaneous monosodium glutamate injection (4 mg/g body weight). Exercise program consisted in swimming 1 h/day, 5 days/week, for 8 weeks, supporting a load corresponding to 5% of body weight. Metformin was dissolved in the drinking water (1.4 mg/ml) for 8 weeks. At the end of the experimental period, rats were sacrificed and blood was collected for determinations of serum glucose, insulin and triglycerides and hematocrit. Samples of gastrocnemius muscle and liver were removed to evaluate triglycerides content MSG-induced obesity, increased serum glucose, insulin and triglycerides, while physical training was able to recover serum glucose and insulin and metformin treatment recovered serum insulin and slightly reduced the serum glucose. MSG-induced obesity also increased liver triglycerides content and physical training and metformin administration recovered these parameters. It was concluded that in MSG obese rats, physical exercise and metformin induced important metabolic alterations associated with an improvement in glucose homeostasis and in liver fat content. Obesity and Metabolism 2009; 5: 129-133.

Toxin jararhagin in low doses induces interstitial edema and increases the metabolic rate and red blood cells in mice

Jararhagin is a metalloproteinase from Bothrops jararaca responsible for hemorrhage, inflammation, necrosis and edema. Effects of low doses of the toxin were analyzed on the energy metabolism of mice as well as its physiological implications. Measures of O-2 consumption (VO2) were quantified after 4 and 24 h of the jarathagin administration during four weeks. Hematocrit and histology of the lungs were also analyzed after the end of the treatment. Results showed that animals that received subcutaneous doses of jararhagin had significant increase in VO2 from second (120 ng) and third weeks (60 ng) after 4 and 24 h, comparing to control, as well as in the number of erythrocytes after four weeks. Histology of the lungs showed interstitial edema within the alveolar septum. Results suggest that the jararhagin toxin caused an increase in VO2 and edema of intra-alveolar septum. The increase of the erythrocytes could be a physiological response to adjust the higher necessity of oxygen, due to diffusional abnormalities caused by the edema. Thus, low doses of jararhagin promote endothelial edema which lead to changes in several physiological conditions. (c) 2006 Elsevier Ltd. All rights reserved.