Is 44-hour better than 24-hour ambulatory blood pressure monitoring in hemodialysis?

The aim of this study is to evaluate if hemodialysis (HD) patients with similar blood pressure (BP) in the whole inter-HD period could have different target organ lesions and survival if the behavior of BP differs from the first to the second day of the inter-HD period. The present study compares 44-hour ambulatory BP monitoring (ABPM) patterns in 45 HD patients. Three BP patterns emerged: group A (n = 15) had similar BPs throughout (138 ± 11/88 ± 12 in the first 22 h vs. 140 ± 11/87 ± 12 mm Hg in the second 22-hour period); group B (n = 15) had a significant systolic BP rise from the first to the second period (132 ± 15/80 ± 12 vs. 147 ± 12/86 ± 13 mm Hg, p < 0.05); group C (n = 15) had significantly higher BPs (p < 0.05) than the other 2 groups throughout the whole inter-HD period, with no significant change between the 2 halves (172 ± 14/108 ± 12 vs. 173 ± 18/109 ± 14 mm Hg). Ventricular mass and survival during the 30-month follow-up period were statistically significantly better in group A, intermediate in group B and worse in group C. The data suggest that a 44-hour ABPM is more accurate than a 24-hour one in evaluating organ lesion and prognosis in HD patients. Copyright © 2006 S. Karger AG.

Acurácia do teste de escada utilizando o consumo máximo de oxigênio como padrão-ouro

Objective: To determine the accuracy of the variables related to the fixed-height stair-climbing test (SCT) using maximal oxygen uptake (V̇O 2 max) as the gold standard. Methods: The SCT was performed on a staircase consisting of 6 flights (72 steps; 12.16 m total height), with verbal encouragement, in 51 patients. Stair-climbing time was measured, the variables 'work' and 'power' also being calculated. The V̇O2 max was measured using ergospirometry according to the Balke protocol. We calculated the Pearson linear correlation (r), as well as the values of p, between the SCT variables and V̇O2 max. To determine accuracy, the V̇O 2 max cut-off point was set at 25 mL/kg/min, and individuals were classified as normal or altered. The cut-off points for the SCT variables were determined using the receiver operating characteristic curve. The Kappa statistic (k) was used in order to assess concordance. Results: The following values were obtained for the variable 'time': cut-off point = 40 s; mean = 41 ± 15.5 s; r = -0.707; p < 0.005; specificity = 89%; sensibility = 83%; accuracy = 86%; and k = 0.724. For 'power', the values obtained were as follows: cut-off point = 200 w; mean = 222.3 ± 95.2 w; r = 0.515; p < 0.005; specificity = 67%; sensibility= 75%; accuracy = 71%; and k = 0.414. Since the correlation between the variable 'work' and V̇O2 max was not significant, that variable was discarded. Conclusion: Of the SCT variables tested, using V̇O2 max as the gold standard, the variable 'time' was the most accurate.

Ventricular Systolic Reserve in Asymptomatic Children Previously Treated With Low Doses of Anthracyclines

Doppler echocardiography has been used for the diagnosis of anthracycline-induced cardiotoxicity. However, few data are available that include asymptomatic children previously treated with a low cumulative dose of this drug and therefore have a low risk of cardiac dysfunction. The aim of this study was to evaluate after-exercise cardiac function in asymptomatic children previously treated with a low cumulative dose of anthracycline and no clinical or laboratory evidence of cardiotoxicity. Doppler echocardiography was performed before and immediately after physical exercise in 29 children aged 5 to 17 years (anthracycline [ADRIA] group). All had finished cancer treatment with anthracycline derivatives for ≥1 year (cumulative dose 100 mg/m2). Results were compared with those from age- and gender-matched healthy children (control group; n = 26) using the Mann-Whitney rank test. Exercise-induced cardiac function changes within groups were analyzed using Wilcoxon's signed-rank test. Exercise induced significant increases in left ventricular systolic function indexes in both groups. However, the ADRIA group had significantly lower changes in left ventricular ejection fraction (ADRIA group 0.71 ± 0.02 vs 0.80 ± 0.04 and control group 0.71 ± 0.02 vs 0.89 ± 0.05, p = 0.0017) and end-systolic stress-volume index (ADRIA group 4.59 ± 0.69 vs 6.4 ± 2.0 g.cm-2/ml.m-2 and control group 5.49 ± 0.98 vs 11.54 ± 2.86 g.cm-2/ml.m-2; p <0.0001), indicating decreased functional systolic reserve. In conclusion, asymptomatic children previously treated with low cumulative doses of anthracycline had decreased functional systolic reserve evidenced by exercise, suggesting a nonclinically manifested cardiotoxicity. © 2007 Elsevier Inc. All rights reserved.

Effects of active smoking on airway and systemic inflammation profiles in patients with chronic obstructive pulmonary disease

Background: The markers that characterize local and systemic inflammation in chronic obstructive pulmonary disease (COPD) remain unclear, as do their correlations with smoking status and presence of disease. The aim of this study was to assess markers of inflammation in the peripheral blood and airways of current smokers without COPD, of current smokers with COPD and of ex-smokers with COPD. METHODS: In this study, 17 current smokers with COPD (mean age: 58.2 ± 9.6 years; mean forced expiratory volume in 1 second [FEV1]: 56.1 ± 15.9%), 35 ex-smokers with COPD (mean age: 66.3 ± 7.3 years; mean FEV1: 47.9 ± 17.2%) and 20 current smokers without COPD (mean age: 49.1 ± 6.2 years; mean FEV1: 106.5 ± 15.8%) were evaluated. Spirometry findings, body composition and serum/induced sputum concentrations of tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-8 and IL-10, together with serum C-reactive protein (CRP) levels, were assessed. RESULTS: Serum TNF-α concentration was higher in all current smokers than in ex-smokers with COPD. In current smokers without COPD, serum CRP level was lower than in ex-smokers with COPD and significantly lower than in current smokers with COPD. Sputum TNF-α concentration was higher in current and ex-smokers with COPD than in current smokers without COPD. Multiple regression analyses showed that serum TNF-α was associated with active smoking, and serum CRP and sputum TNF-α were associated with COPD diagnosis. CONCLUSIONS: Smoking is associated with higher systemic inflammation in patients with COPD. Current findings also support the hypothesis that smoking and COPD have different effects on the regulation of airway and systemic inflammatory processes. © 2013 Lippincott Williams and Wilkins.

Estudo da alterações funcionais cardiorrespiratórias em pacientes submetidos a simpatectomia toráxica videoassistida

Pós-graduação em Bases Gerais da Cirurgia - FMB

Avaliação ultrassonigráfica da glândula tireóide em cães hígidos de diferentes faixas etárias

Pós-graduação em Medicina Veterinária - FMVZ

Avaliação hematológica, bioquímica e parasitológica de cães, naturalmente acometidos por leishmaniose visceral, submetidos a diferentes protocolos de tratamento

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

Estudo de correlação entre as provas bioquímicas de função hepática, no diagnóstico de hepatite aguda pelo vírus da hepatite A em crianças

Pós-graduação em Pediatria - FMB

Doença de von Willebrand em cães: estudo da prevalência e caracterização da doença em cães normais e fêmeas durante o ciclo estral, gestação e lactação

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Cardiorespiratory evaluation in pre and post operative moments of laparoscopic cholecystectomy

PURPOSE: To analyze the changes in both respiratory function and cardiopulmonary exercise tests results in patients subjected to laparoscopic cholecystectomy. METHODS: Fifty patients were evaluated (76% women) and the average age was 47.8±14.2 years. All individuals underwent the measurement of spirometry, manovacuometry, 6-minute walk test (6MWT) and stair-climbing test (SCT). All tests were performed at the first (PO1), fifth (PO5) and thirtieth (PO30) postoperative days. RESULTS: BMI average was 28.8±4.8 kg/m2. Sample comprised 68% non-smokers, 20% current smokers, and 12% former smokers. There was no incidence of postoperative complication whatsoever. There was a significant decrease in spirometric values at PO1, but values were similar to the ones of PRE at PO30. Manovacuometry showed alterations at PO1 displaying values that were similar to the ones of PRE at PO30. 6MWT was significantly shorter at until PO5, but at PO30 values were similar to ones of PRE. As for SCT, values were significantly compromised at PO5 and PO30 since they were similar to the ones of PRE. CONCLUSION: Patients submitted to laparoscopic cholecystectomy present a decrease in cardiorespiratory function on the first postoperative moments but there is a rapid return to preoperative conditions.

Higher Insulin Sensitivity and Impaired Insulin Secretion in Cachetic Solid Ehrlich Tumour-Bearing Mice

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

Do Thyroid Ultrasonographic Features Change According to Age in Euthyroid Dogs?

The thyroid gland was assessed by ultrasound in healthy euthyroid mixed-breed medium size dogs in different age groups. The objective was to verify ultrasonographic imaging patterns in these groups, as well as to identify possible changes in imaging features resulting from ageing. Thirty dogs - 10 young (<1 year), 10 adult and 10 elderly - without clinical signs or history of thyroid gland disease with complete blood count and thyroid function tests within the reference values were evaluated. Each thyroid lobe was examined by ultrasound for shape, size, echogenicity and echotexture. The analysis of echogenicity and echotexture was made by histogram. Thyroid volume was estimated by the equation for ellipsoid (length x width x height) pi/6. The thyroid volume of the young dogs in this study had a tendency to be higher than in adult dogs (P = 0.068) and older dogs (P = 0.120). The height of the thyroid lobe in the longitudinal plane was significantly higher (P = 0.026) in young dogs compared with the other dogs. The echotexture and echogenicity had no significant differences between groups, but the echogenicity was greater in older dogs. The results point out that ultrasound imaging of the thyroid volume is influenced by age in euthyroid dogs.

Hipotireoidismo em cães: aspectos gerais

Hypothyroidism is a common endocrine disorder in dogs caused by insufficient production and secretion of thyroid hormones. Most affected dogs have primary hypothyroidism that results from lymphocytic thyroiditis, idiopathic thyroid atrophy, or more rarely, neoplastic destruction. Secondary hypothyroidism resulting from inadequate secretion of thyrotropin (thyroid-stimulating hormone –TSH) from the pituitary gland is less commonly recognized. Tertiary hypothyroidism resulting from a deficiency of hypothalamic thyrotropin-releasing hormone (TRH) has not been documented in dogs. The diagnosis of hypothyroidism in dogs is made on the basis of clinical findings, results of routine laboratory and thyroid gland function tests and response to thyroid hormone replacement. Unfortunately, these tests have high sensitivity, but low specificity, for use in the diagnosis of hypothyroidism. Thyroid hormone supplementation is indicated for the treatment of confirmed hypothyroidism and for the diagnoses of the disease through clinical response to trial therapy

Testes funcionais, torque isocinético em inversão e eversão e capacidade de reposicionamento articular: um estudo sobre a estabilidade dinâmica do tornozelo

Introdução: A lesão mais comumente encontrada na população ativa é a entorse de tornozelo. Cerca de 40% destes casos continuam a manifestar sensação de instabilidade articular mesmo após a fase aguda da lesão, caracterizando a instabilidade funcional do tornozelo (IFT). A IFT está relacionada com déficits proprioceptivos e redução na capacidade de produção de força e potência muscular. Haja vista que o basquetebol é um esporte com grande incidência de lesões no tornozelo faz-se necessário o entendimento de métodos de avaliação de baixo custo, que possam contribuir para a prevenção deste tipo de lesão em atletas. Objetivo: Nesse sentido, o presente estudo, tem como objetivo identificar os parâmetros de torque, atividade eletromiográfica, senso de reposicionamento articular e a pontuação em teste funcional em jogadoras de basquetebol com tornozelo estável. Correlacionar os valores de torque, atividade eletromiográfica e do senso de reposionamento articular com a pontuação dos testes funcionais em individuos saudáveis. Método: Participaram deste estudo 6 atletas do gênero feminino praticantes do basquetebol com idade entre 18 e 25 anos. As voluntárias realizaram os seguintes testes: torque isocinético concêntrico em inversão (INV) e eversão (EVE) nas velocidades de 60º e 120º, cinco testes funcionais e teste de reposicionamento articular com os ângulos-alvo de 10º e 20º de inversão. Após a verificação da normalidade de distribuição dos dados com o teste Shapiro-Wilk, utilizou-se o teste de Correlação Spearman para verificar a correlação dos testes funcionais com o pico de torque, o sinal EMG e o reposicionamento articular. Resultados: Não foi encontrados resultados esperados no estudo, exceto na correlação negativa para os valores de RMS do TA na velocidade de 120º nas contrações isocinética...(Resumo completo, clicar acesso eletrônico abaixo)

Safety of kidney transplantation using anti-HBc-positive donors

Background. Prospective studies evaluating the risk of hepatitis B virus (HBV) transmission in transplants of kidneys from hepatitis B core antibody (anti-HBc)-positive/ hepatitis B surface antibody (anti-HBs) negative donors are still lacking. The objective of this study was to assess the safety of kidney transplantation with the use of anti-HBc positive donors.Methods. This prospective case series study included 50 kidney transplant recipients from anti-HBc positive donors with or without anti-HBs positivity. Recipients were required to test positive for anti-HBs (titers >10 mUI/mL), regardless of anti-HBc status, and negative for hepatitis B surface antigen (HBsAg). Recipient and donor data were retrieved from medical records, databases, and organ procurement organization sheets. Liver function tests were performed at progressively increasing post-transplantation intervals. Complete serologic tests for HBV were performed before transplantation, 3 and 6 months after transplantation, and annually thereafter.Results. Six months after transplantation, all recipients were negative for HBsAg, HBeAg, anti-HBe, and anti-HBcIgM. No seroconversion was observed among the 20 patients who received kidneys from anti-HBc positive/anti-HBs negative donors. No patient showed elevated liver enzymes during follow-up.Conclusions. Kidney transplantation using organs from anti-HBeIgG positive donors (even when they are concurrently anti-HBs negative) in anti-HBs positive recipients is a safe procedure and may be considered as a way to expand the donor pool.