Smoking is a risk factor for progression of CKD.
OBJECTIVE:The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients.METHODS:This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol.RESULTS:Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups.CONCLUSION:We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.
Early mobilization is beneficial for critically ill patients because it reduces muscle weakness acquired in intensive care units. The objective of this study was to assess the effect of functional electrical stimulation (FES) and passive cycle ergometry (PCE) on the nitrous stress and inflammatory cytometry in critically ill patients. This was a controlled, randomized, open clinical trial carried out in a 16-bed intensive care unit. The patients were randomized into four groups: Control group (n=10), did not undergo any therapeutic intervention during the study; PCE group (n=9), lower-limb PCE for 30 cycles/min for 20 min; FES group (n=9), electrical stimulation of quadriceps muscle for 20 min; and FES with PCE group (n=7), patients underwent PCE and FES, with their order determined randomly. The serum levels of nitric oxide, tumor necrosis factor alpha, interferon gamma, and interleukins 6 and 10 were analyzed before and after the intervention. There were no differences in clinical or demographic characteristics between the groups. The results revealed reduced nitric oxide concentrations one hour after using PCE (Po0.001) and FES (Po0.05), thereby indicating that these therapies may reduce cellular nitrosative stress when applied separately. Tumor necrosis factor alpha levels were reduced after the PCE intervention (P=0.049). PCE and FES reduced nitric oxide levels, demonstrating beneficial effects on the reduction of nitrosative stress. PCE was the only treatment that reduced the tumor necrosis factor alpha concentration.
Introduction: Proximal femur fractures affect the mortality and morbidity of elderly individuals. Recent studies have shown an association between fragility fractures and hyponatremia, a common fluid and electrolyte balance disorder. Objectives: This study aimed to investigate the occurrence of hyponatremia in patients with fragility fractures of the proximal femur. Methods: The authors looked into the data from the medical records of patients admitted to the emergency unit of the Real Hospital Português for fragility fractures of the proximal femur from 2014 to 2017. The study included patients with serum sodium levels recorded in their charts. Results: Fourteen of 69 (20.3%) patients with proximal femur fractures had hyponatremia. The main factors linked to hyponatremia were lung disease, and prescription of amiodarone and/or antidepressants. Conclusion: In elderly individuals, fragility fractures of the proximal femur may correlate with hyponatremia, particularly among patients on amiodarone or antidepressants.
No final de 2019, emergiu um grupo de casos de pneumonia associados a um novo coronavírus de RNA envelopado, espalhando-se rapidamente pelos continentes e sendo rotulado como pandemia global por COVID-19. Uma proporção considerável da população doente não necessitará de hospitalização, entretanto, alguns pacientes podem desenvolver a forma grave da doença e apresentar complicações como a síndrome do desconforto respiratório agudo (SDRA), requerendo ventilação mecânica invasiva (VMI). Pacientes com SDRA por COVID-19 podem apresentar algumas características específicas em comparação com as formas típicas da síndrome, desenvolvendo fenótipos distintos que ainda tem sido estudados. As pesquisas têm, então, se concentrado em esclarecer estratégias ventilatórias protetoras do pulmão (EPP) para estes pacientes. Esta revisão narrativa teve como objetivo investigar a experiência mundial atual em relação à EPP como manejo da SDRA associada à COVID-19 e destacar considerações para as práticas de VMI durante a pandemia. Após um processo de rastreamento de estudos nas bases de dados PubMed e BVS, foram selecionados 20 estudos a serem analisados. Na maior parte dos estudos o manejo ventilatório dos pacientes se assemelhou ao da SDRA “clássica” e, portanto, a EPP destacou-se como importante aliada na regressão da SDRA nos pacientes COVID-19. No entanto, deve ser levado em consideração a heterogeneidade fenotípica dos pacientes, principalmente quanto à mecânica pulmonar e capacidade de recrutamento. Este estudo possibilitou aprofundamento cientifico sobre as semelhanças e diferenças da SDRA por COVID-19 e por outras causas, além de permitir a formação de orientações quanto aos ajustes ventilatórios iniciais em pacientes com SDRA/COVID-19.
The novel coronavirus (SARS-CoV-2) has distinct clinical manifestations that can vary from an asymptomatic condition to severe acute respiratory failure. Phenotypes are attributable to different pathophysiological mechanisms and require different treatment strategies. The assessment and identification of different phenotypes can guide therapy configurations such as oxygen therapy, non-invasive ventilation, airway management, and tracheal intubation. Further studies are essential to provide information on the influence of phenotypes in the decision of rehabilitation strategies. The sequelae left in the respiratory system of COVID-19 survivors and its limitations will be a challenge for rehabilitation services worldwide. Lung injuries are directly related to the phenotypes presented, and depending on the degree of these injuries, rehabilitation strategies can be targeted. We believe that differentiating patients, according to their respective phenotypes, can improve decision-making in treatment and individualized rehabilitation.
Background. Renal replacement therapy (RRT) is a public health problem worldwide. Kidney transplantation (KT) is the best treatment for elderly patients’ longevity and quality of life. Objectives. The primary endpoint was to compare elderly versus younger KT recipients by analyzing the risk covariables involved in worsening renal function, proteinuria, graft loss, and death one year after KT. The secondary endpoint was to create a robot based on logistic regression capable of predicting the likelihood that elderly recipients will develop worse renal function one year after KT. Method. Unicentric retrospective analysis of a cohort was performed with individuals aged ≥60 and <60 years old. We analysed medical records of KT recipients from January to December 2017, with a follow-up time of one year after KT. We used multivariable logistic regression to estimate odds ratios for elderly vs younger recipients, controlled for demographic, clinical, laboratory, data pre- and post-KT, and death. Results. 18 elderly and 100 younger KT recipients were included. Pretransplant immune variables were similar between two groups. No significant differences (P>0.05) between groups were observed after KT on laboratory data means and for the prevalences of diabetes mellitus, hypertension, acute rejection, cytomegalovirus, polyomavirus, and urinary infections. One year after KT, the creatinine clearance was higher (P = 0.006) in youngers (70.9 ± 25.2 mL/min/1.73 m2) versus elderlies (53.3 ± 21.1 mL/min/1.73 m2). There was no difference in death outcome comparison. Multivariable analysis among covariables predisposing chronic kidney disease epidemiology collaboration (CKD-EPI) equation <60 mL/min/1.73 m2 presented a statistical significance for age ≥60 years (P = 0.01) and reduction in serum haemoglobin (P = 0.03). The model presented goodness-fit in the evaluation of artificial intelligence metrics (precision: 90%; sensitivity: 71%; and F1 score: 0.79). Conclusion. Renal function in elderly KT recipients was lower than in younger KT recipients. However, patients aged ≥60 years maintained enough renal function to remain off dialysis. Moreover, a learning machine application built a robot (Elderly KTbot) to predict in the elderly populations the likelihood of worse renal function one year after KT.
Este é um artigo publicado em acesso aberto (Open Access) e distribuído sob a licença Creative Commons Attribution NonComercial ShareAlike License, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que sem fins comerciais e que o trabalho original seja corretamente citado e de forma que não indique endosso ao trabalho feito. Adicionalmente, qualquer trabalho derivado deverá ser publicado sob a mesma licença. ResumoIntrodução: A perda do recolhimento elástico pulmonar e a limitação ao fluxo aéreo em pacientes com DPOC estão relacionadas as alterações na biomecânica dos músculos respiratórios e na função pulmonar. A dispneia, sintoma comum nesses pacientes está associada a limitação ao exercício e redução na força e endurance muscular respiratória. Objetivo: Avaliar se há associação da capacidade vital forçada (CPF) com a endurance muscular respiratória e a capacidade funcional de pacientes DPOC. Métodos: Trata-se de um estudo analítico, observacional e transversal. A amostra foi composta por 40 pacientes com DPOC, de ambos os sexos, atendidos no ambulatório de pneumologia de um hospital público da cidade de João Pessoa, Paraíba.Os dados referentes a CVF foram extraídos através da análise de resultados da espirometria. A endurance muscular respiratória foi avaliada pelo índice de resistência a fadiga (IRF) e a capacidade funcional pelo teste de caminha de 6 minnutos (TC6). Resultados: Apenas 22,5% dos participantes (n=9) tinham redução na endurance muscular respiratória, porém em relação a distância percorrida no TC6, 97,4% (n=38) apresentaram uma capacidade funcional limitada. Observamos que não houve associação entre os valores da CVF com a endurance muscular respiratória (p = 0,825). No entanto, encontramos uma associação positiva entre a CVF com a distância percorrida no TC6 (p = 0,012), demonstrando que quanto maior a CVF melhor era o desempenho no TC6. Conclusão: O presente estudo demonstrou que a redução da CVF pode ser um fator de limitação da capacidade funcional em pacientes com DPOC.
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