Efeitos da deficiência de vitamina A na função pulmonar de crianças após infecção respiratória viral

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Técnica para avaliação da pressão arterial pulmonar de equinos durante o exercício progressivo em esteira rolante

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

Efeitos do apoio dos membros superiores sobre a força muscular respiratória e função pulmonar de pacientes com doença pulmonar obstrutiva crônica

Objective: To analyze the effect of arm bracing posture on respiratory muscle strength and pulmonary function in patients with Chronic Obstructive Pulmonary Disease (COPD).Methods: 20 patients with COPD (11 male; 67 +/- 8 years; BMI 24 +/- 3 Kg . m(-2)) were submitted to assessments of Maximal Inspiratory and Expiratory Pressures (MIP and MEP, respectively) and spirometry with and without arm bracing in a random order. The assessment with arm bracing was done on standing position and the height of the support was adjusted at the level of the ulnar styloid process with elbow flexion and trunk anterior inclination of 30 degrees promoting weight discharge in the upper limbs. Assessment without arm bracing was also performed on standing position, however with the arms relaxed alongside the body. The time interval between assessments was one week.Results: MIP, MEP and maximal voluntary ventilation (MW) were higher with arm bracing than without arm bracing (MIP 64 +/- 22 cmH(2)O versus 54 +/- 24 cmH(2)O, p = 0,00001; MEP 104 +/- 37 cmH(2)O versus 92 +/- 37 cmH(2)O, p = 0,00001 and MW 42 +/- 20 L/min versus 38 +/- 20 L/min, p = 0,003). Other variables did not show statistical significant difference.Conclusion: The arm bracing posture resulted in higher capacity to generate force and endurance of the respiratory muscles in patients with COPD. (C) 2009 Published by Elsevier Espana, S.L. on behalf of Sociedade Portuguesa de Pneumologia. All rights reserved.

Índices geométricos de variabilidade da frequência cardíaca na doença pulmonar obstrutiva crônica

Background: It was already evidenced decreased heart rate variability (HRV) in chronic obstructive pulmonary disease (COPD) patients at rest.Objective: In order to insert new elements in the literature regarding this issue, we evaluated geometric index of HRV in COPD subjects.Method: We analyzed data from 34 volunteers, divided into two groups according to spirometric values: COPD (17 volunteers, FEV1/FVC = 47.3 +/- 10.2; FEV1 = 50.8 +/- 15.7) and control (17 volunteers, FEV1/FVC = 78.8 +/- 10.8; FEV1 = 100.1 +/- 14.7). For analysis of HRV indexes the volunteers remained in the supine position for 30 minutes. We analyzed the following indexes: triangular index (RRtri), triangular interpolation of RR intervals (TINN) and Poincare plot (SD1, SD2 and SD1/SD2). Student t test for unpaired samples and Mann-Whitney test were used for data analysis.Results: We observed statistically significant reductions in geometric indexes in the COPD group: RRtri (0.043 +/- 0.01 vs. 0.059 +/- 0.02; p = 0.018), TINN (105.88 +/- 51.82 vs. 151.47 +/- 49.9; p=0.014), SD1 (9.76 +/- 4.66 vs. 14.55 +/- 6.04; p = 0.014) and SD2 (34.86 +/- 17.02 vs. 51.51 +/- 18.38; p = 0.010). SD1/5D2 (0.30 +/- 0.11 vs. 0.28 +/- 0.07; p = 0.605) were not significantly different between groups. Patients with COPD presented a visual analysis of Poincare plot of lower dispersion of RR intervals both beat to beat and the long term.Conclusion: Subjects with COPD present reduction of geometric indexes of HRV, indicating reduced heart rate variability. (C) 2010 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espana, S.L. All rights reserved.

Avaliação da função pulmonar em obesos mórbidos com sonolência diurna excessiva

Background: Obesity impairment to the pulmonary function related to the magnitude of adiposity and is associated with excessive daytime sleepiness (EDS) and snoring, among others symptoms of respiratory disorders related to sleep. It is possible that obese individuals with excessive daytime sleepiness may make changes in lung function on spirometry monitored during the day as a consequence of fragmented sleep or episodes of nocturnal hypoventilation that cause respiratory and changes that can persist throughout the day. The combination of these findings alone sleepiness observed by subjective scales with pulmonary function in obese patients is unknown. Objective: To assess the influence of EDS and snoring on pulmonary function in morbidly obese and distinguish between different anthropometric markers, the snoring and sleepiness which the best predictors of spirometric function and respiratory muscle strength and endurance of these patients. Methods: We evaluated 40 morbidly obese markers on the anthropometric, spirometric respiratory variables, maximal inspiratory and expiratory pressures (MIP and MEP) and maximal voluntary ventilation (MVV) and the measured excessive daytime sleepiness (the Epworth sleepiness scale) and snoring (snoring scale of Stanford). The data were treated when the differences between the groups of obese patients with and without sleepiness, whereas the anthropometric variables, respiratory and snoring. Pearson's correlation was performed, and multiple regression analysis assessed the predictors of pulmonary function. For this we used the software SPSS 15.0 for windows and p <0.05. Results: 39 obese patients were included (28 women), age 36.92+11.97y, body mass index (BMI) 49.3+5.1kg/m², waist-hip ratio (WHR) 0.96+0.07 and neck circumference (NC) 44.1+4.2 cm. Spirometric values and respiratory pressures were up 80% of predicted values, except for endurance (MVV <80%). Obese with EDS have lower tidal volume. Positive correlation was observed between BMI and EDS, EDS and NC and between snoring and BMI, and negative correlation between EDS and tidal volume (TV), and between snoring and snoring FVC and FEV1. In linear regression the best predictor of pulmonary function was snoring, followed by NC. NC has more obese with higher strength (MEP, p = 0.031) and endurance (MVV p = 0.018) respiratory muscle. Conclusion: Obese with EDS tend to have lower TV. In addition, snoring and NC can better predict pulmonary function in obese when compared with other anthropometric markers or EDS. Obese patients with higher NC tend to have greater capacity for overall strength of respiratory muscles, but may have low muscle endurance

Ánálise da capacidade funcional e da distribuição regional da ventilação pulmonar em pacientes com doença de chagas

INTRODUCTION: Cardiac and pulmonary manifestations of the Chagas disease (CD) affect between 20-30% of the infected subjects. The chronic Chagas cardiomyopathy (CCC) has some peculiarities such as arrhythmias and, especially heart failure (HF) and is potentially lethal due to left ventricular dysfunction. How respiratory disorders, patients get progressive loss of functional capacity, which contributes to a poor quality of life related to disease. Measurements of lung volume by the movement of the chest wall surface are an alternative evaluation of lung function and kinematics of complex thoracoabdominal for these patients. OBJECTIVE: evaluate the kinematics of the thoracoabdominal complex through the regional pulmonary volumes and to correlate with functional evaluation of the cardiorrespiratory system in patients with Chagas disease at rest. MATERIALS AND METHODS: a cross-section study with 42 subjects had been divided in 3 groups, 15 composed for patients with CCC, 12 patients with HF of different etiologies and 15 healthful presented control group. An optoelectronic plethysmography (POE), Minnesota questionnaire, six minute walk test, spirometer and manovacuometer was used. RESULTS: It was observed in the 6MWT where group CRL presented greater distance 464,93±44,63m versus Group HF with 399,58± 32,1m (p=0,005) and group CCC 404±68,24m (p=0,015), both the groups presented difference statistics with regard to Group CRL. In the manovacuometer 54,59±19,98; of the group CCC and 42,11±13,52 of group IC found group CRL presented 81,31±15,25 of the predicted versus, presenting in relation to group CRL. In the POE it observed a major contribution in abdominal compartment in patients with IC if compared like CCC and control groups. On the basis of the questionnaire of quality of life of Minessota, verified a low one groups CCC and IC 43,2±15,2 and 44,4±13,1, respectively (p<0,05) when compared with the control group (19,6±17,31). CONCLUSION: it seems that the patients with CCC possess same functional and respiratory characteristics, observed for the POE, 6MWT, manovacuometer and spirometer to the patients of group HF, being able to consider similar interventions for this complementary group as therapeutical of this neglected disease

Função pulmonar de crianças com leucemia aguda

Introduction: The leukemias are the most common malignancy in children and adolescents. With the improvement in outcomes, there is a need to consider the morbidity to generate the protocols used in children under treatment. Aim: To evaluate pulmonary function in children with acute leukemia. Method: This study is an observational cross sectional. We evaluated 34 children distributed in groups A and B. Group A comprised 17 children with acute leukemia in the maintenance phase of chemotherapy treatment and group B with 17 healthy students from the public in the city of Natal / RN, matched for gender, age and height. The thoracic mobility was evaluated by thoracic expansion in the axillary and xiphoid levels. Spirometry was measured using a spirometer Microloop Viasys ® following the rules of the ATS and ERS. Maximal respiratory pressures were measured with digital manometer MVD300 (Globalmed ®). The maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured from residual volume and total lung capacity, respectively. The data were analyzed using the SPSS 17.0 software assigning the significance level of 5%. Descriptive analysis was expressed as mean and standard deviation. T'student test was used to compare unpaired values found in group A with group B values, as well as with the reference values used. To compare the respiratory coefficients in the axillary level with the xiphoid in each group, we used paired testing t student. Results: Group A was significantly decreased thoracic mobility and MIP compared to group B, and MIP compared to baseline. There was no significant difference between spirometric data from both groups and the values of group A with the reference values Mallozi (1995). There was no significant difference between the MIP and MEP values and lower limits of reference proposed by Borja (2011). Conclusion: Children with acute leukemia, myeloid or lymphoid, during maintenance phase of chemotherapy treatment have reduced thoracic mobility and MIP. However, to date, completion of clinical treatment, the spirometric variables and the strength of the expiratory muscles appear to remain preserved in children between five and ten years

Custos e benefícios de um programa de exercício aeróbios na doença pulmonar obstrutica crônica: ensaio cliníco aleatório controlado

Pulmonary Rehabilitation, especially due to aerobic exercise, positive impact in reducing morbidity/mortality of patients with COPD, however the economic impact with costs of implementing simple programs of aerobic exercise are scarce. This is a blind randomized clinical trials, which aimed to evaluate the costs and benefits of a simple program of aerobic exercise in individuals with COPD, considering the financial costs of the Public Health System and its secondary endpoints. We evaluated lung function, the distance walked during six minutes of walking, the respiratory and peripheral muscle strength, quality of life related to health (QLRH), body composition and level of activity of daily living (ADL) before and after eight weeks of an aerobic exercise program consisting of educational guidance for both groups, control and intervention and supervised walks to the intervention group. The health costs generated in both groups were calculated following table Brazilian Public Health System. The sample consisted of forty patients, two being excluded in the initial phase of desaturation during the walk test six minutes. Were randomized into control and intervention group thirty-eight patients, three were excluded from the control group and one was excluded from the intervention group. At the end, thirty-four COPD comprised the sample, 16 in the control group and 18 in the intervention group (FEV1: 50.9 ± 14% pred and FEV1: 56 ± 0.5% pred, respectively). After for intervention, the intervention group showed improvement in meters walked, the sensation of dyspnea and fatigue at work, BODE index (p <0.01) in QLRH, ADL level (p <0.001) as well as increased strength lower limbs (p <0.05). The final cost of the program for the intervention group was R $ 148.75, including: assessments, hiking supervised by a physiotherapist and reassessments. No patient had exacerbation of IG, while 2 patients in the CG exacerbated, generating an average individual cost of R $ 689.15. The aerobic exercises in the form of walking showed significant clinical benefits and economic feasibility of its implementation, due to low cost and easy accessibility for patients, allowing them to add their daily practice of aerobic exercises

Aspectos da função pulmonar após revascularização do miocárdio relacionados com risco pré-operatório

OBJETIVOS: Comparar os valores das complacências dinâmica e estática, da resistência de vias aéreas (Cdin, Cest e Raw) e do índice de troca gasosa (PaO2/FiO2), no pós-operatório de cirurgia de revascularização miocárdica (RM) com os parâmetros de normalidade e comparar os valores destas variáveis entre grupos com e sem fatores de risco no pré-operatório. MÉTODO: Questionamento aos doentes a respeito de antecedentes pulmonares, sintomas respiratórios, tabagismo e comorbidades. Após cirurgia de RM, foram feitas as medidas de Cdin, Cest, Raw e do PaO2/FiO2. As variáveis foram comparadas com a normalidade e relacionadas às variáveis pré e pós-operatórias pelo Teste não-paramétrico de Mann-Whitney e pelo Teste para uma proporção (p<0,05). RESULTADO: Foram avaliados 70 doentes (61% homens), com idade entre 26 e 77 anos. em relação à normalidade, apresentaram diminuição da Cdin e da Cest, 64 e 66 pacientes, respectivamente, e 24 apresentaram aumento da Raw. Aproximadamente 50% apresentaram redução do PaO2/FiO2. Não houve diferença significante das variáveis pós-operatórias com respeito aos antecedentes pulmonares, sintomas respiratórios e tabagismo. Nos pacientes com comorbidades, o PaO2/FiO2 foi significativamente menor e, nos homens, a Cdin e a Cest foram maiores que nas mulheres. CONCLUSÃO: As complacências pulmonares estão diminuídas na maioria dos pacientes, e a resistência das vias aéreas está aumentada em um terço deles. O índice de troca gasosa encontra-se diminuído em metade deles. A presença de antecedentes pulmonares, sintomas respiratórios e tabagismo não influencia as variáveis mecânicas, mas o índice de troca gasosa é influenciado pela presença de comorbidades.

Programa de cessação de tabagismo como ferramenta para o diagnóstico precoce de doença pulmonar obstrutiva crônica

OBJETIVO: A doença pulmonar obstrutiva crônica (DPOC) é subdiagnosticada e subtratada, o que resulta em subestimação do impacto da doença. O objetivo deste estudo foi avaliar se a inclusão da espirometria na avaliação dos fumantes que ingressam em programas de cessação do tabagismo contribui para o diagnóstico precoce da DPOC. MÉTODOS: Análise retrospectiva de dados médicos de 158 fumantes atendidos no programa cessação de tabagismo (Faculdade de Medicina de Botucatu, São Paulo, Brasil), de janeiro 2003 a novembro 2005. Todos os indivíduos tinham mais de 40 anos (idade média: 55 ± 8,5 anos), sendo 99 (62,6%) do sexo feminino. Foram analisados os dados clínicos, os diagnósticos médicos prévios e os resultados da espirometria. RESULTADOS: Dos 158 fumantes avaliados, 57 (36,1%) indivíduos preenchiam os critérios diagnósticos para DPOC e 14 (8,9%) foram considerados em risco para o desenvolvimento da doença. Dos 57 que preenchiam os critérios diagnósticos para DPOC, 39 (68,4%) foram diagnósticos novos e 18 (31,6%) foram confirmação de diagnóstico prévio da doença. Entre os 18 com diagnóstico anterior, 10 (56%) tinham doença leve/moderada e 8 (44%) doença grave. Sete pacientes com diagnóstico anterior de DPOC apresentaram resultados de função de pulmonar não compatíveis com os critérios diagnósticos da doença. Entre os 39 novos diagnósticos, 38 (97,4%) eram de doença leve/moderada e apenas 1 (2,6%) tinha DPOC grave CONCLUSÃO: A inclusão da espirometria na avaliação inicial dos fumantes admitidos em programa de cessação de tabagismo pode ser uma ferramenta útil para o diagnóstico precoce da DPOC.

Mannheimiose pulmonar experimental em bezerros: swab nasal e nasofaringeano como auxílio diagnóstico

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

Segurança e eficácia da técnica de biopsia pulmonar transtorácica percutânea para avaliação histopatológica do parênquima pulmonar de ovinos clinicamente sadios

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

Avaliação da utilização de biópsia transbrônquica em pacientes com suspeita clínica de doença pulmonar intersticial

OBJETIVO: Estudar os padrões clínicos, radiológicos e histopatológicos da biópsia transbrônquica (BTB) utilizados para a confirmação diagnóstica em pacientes com suspeita clinica de doença pulmonar intersticial (DPI) atendidos em um hospital universitário de nível terciário. MÉTODOS: Os prontuários, laudos radiológicos e de biópsias transbrônquicas de todos os pacientes com suspeita de DPI submetidos a BTB entre janeiro de 1999 e dezembro de 2006 no Hospital das Clínicas de Botucatu, localizado na cidade de Botucatu (SP), foram revisados. RESULTADOS: Foram incluídos no estudo 56 pacientes. Desses, 11 (19,6%) apresentaram o diagnóstico definitivo de fibrose pulmonar idiopática (FPI), que foi significativamente maior nos casos nos quais DPI era uma possibilidade diagnóstica em comparação com aqueles nos quais DPI era a principal suspeita (p = 0,011), demonstrando a contribuição da BTB para a definição diagnóstica dessas doenças. O exame histopatológico dessas biópsias revelou que 27,3% dos pacientes com FPI apresentavam o padrão de pneumonia organizante, o que pode sugerir doença mais avançada. O padrão histológico indeterminado foi o mais frequente, refletindo a característica periférica da FPI. Entretanto, o padrão fibrose apresentou alta especificidade e alto valor preditivo negativo. Para os padrões sugestivos de FPI em TC, a curva ROC indicou que a melhor relação entre sensibilidade e especificidade ocorreu com a presença de cinco alterações radiológicas, sendo o aspecto de favo de mel fortemente sugestivo de FPI (p = 0,01). CONCLUSÕES: Nas DPIs, a TC de tórax deve ser sempre realizada e a BTB usada em situações individualizadas, conforme a suspeita e distribuição das lesões.

Origem anômala de artéria coronária esquerda do tronco pulmonar: síndrome de Bland-White-Garland

A origem anômala da artéria coronária esquerda a partir do tronco pulmonar, conhecida como síndrome de Bland-White-Garland (BWG), é uma doença rara, que, habitualmente, leva à morte antes do primeiro ano de vida. Os autores relatam o caso de uma criança branca, com 2 anos e 6 meses de idade, portadora da síndrome de BWG, e revisam a apresentação clínica, a fisiopatologia, o diagnóstico e o tratamento desses pacientes.