Inspiratory muscle training as adjuvant therapy in obstructive sleep apnea: a randomized controlled trial

The aim of this randomized controlled trial was to analyze the effects of an inspiratory muscle training (IMT) program on apnea and hypopnea index (AHI), inspiratory muscle strength, sleep quality, and daytime sleepiness in individuals with obstructive sleep apnea (OSA), whether or not they used continuous positive airway pressure (CPAP (+/−) therapy. The intervention group underwent IMT with a progressive resistive load of 40-70% of the maximum inspiratory pressure (PImax) for 30 breaths once a day for 12 weeks. The control group was submitted to a similar protocol, but with at a minimum load of 10 cmH2O. Changes in the AHI were the primary outcome. PImax was measured with a digital vacuometer, daytime somnolence was measured by the Epworth sleepiness scale (ESS), and the quality of sleep by the Pittsburgh Sleep Quality Index (PSQI). CPAP use was treated as a confounder and controlled by stratification resulting in 4 subgroups: IMT−/CPAP−, IMT−/CPAP+, IMT+/CPAP−, and IMT+/CPAP+. Sixty-five individuals were included in the final analysis. Significant variations were found in the 4 parameters measured throughout the study after the intervention in both CPAP− and CPAP+ participants: PImax was increased and AHI was reduced, whereas improvements were seen in both ESS and PSQI. The twelve-week IMT program increased inspiratory muscle strength, substantially reduced AHI, and had a positive impact on sleep quality and daytime sleepiness, whether or not participants were using CPAP. Our findings reinforce the role of an IMT program as an adjunct resource in OSA treatment.

Sindrome nefrotico congenito. / Congenital nephrotic syndrome

Se presentan dos casos de sindrome nefrotico congenito idiopatico: uno de tipo Finlandes en que no se confirmo caracter hereditario autosomico y recesivo y el segundo, una glomeruloesclerosis focal siendo ambos de mal pronostico por la refractariedad a la terapia y su evolucion invariable a la insuficiencia renal o muerte por infeccion

Sindrome de Alport. / Alport's syndrome

Se analizan las historias clinicas de 6 ninos portadores de sindrome de Alport. Se incluyeron aquellos pacientes que presentaban signos de nefropatia con caracter familiar asociado a sordera y alteraciones caracteristicas al microscopio electronico en la membrana basal glomerular. Se efectuo en 18 familiares de los ninos afectados mediante sedimento urinario, estudio oftalmologico, audiometria y hemograma con recuento plaquetario. Se comprueba que las manifestaciones son mas frecuentes y mas graves en el sexo masculino. La sordera en todos los pacientes fue de tipo neurosensorial y predominantemente a tonos agudos.De los seis casos analizados han fallecido dos por insuficiencia renal. Solo un caso presento alteraciones con macrotrombocitopenia. En ningun caso se encontraron las alteraciones oculares descritas como caracteristicas de este sindrome

Sindrome de Bartter a proposito de un caso con microscopia electronica. / Bartter's syndrome apropos of a case with electron microscopy

Se describe el caso de una nina de 9 meses de edad portadora de un Sindrome de Bartter. El diagnostico se sustento en la presencia de alcalosis hipokalemica severa, retardo de crecimiento, hiperaldosteronismo, hiperreninemico y normotension arterial. Se discuten las consideraciones actuales respecto a etiologia y tratamiento de este sindrome, y presentamos los hallazgos con microscopia de luz y electronica

Atividades das fosfatases acida e alcalina em celulas cultivadas in vitro expostas ao DDT. / Activities of acid and alkaline phosphatases in vitro cultured cells exposed to DDT

As atividades das fosfatoses acida e alcalina foram determinadas em celulas IB-RS-2 e CHO tratadas com DDT (20,0 micrograma/ml) por um periodo de 24 horas. Verificou-se que o DDT aumenta a atividade da fosfatase acida, efeito que e mais acentuado nas celulas IB-RS-2 do que nas celulas CHO.O DDT tambem aumenta a atividade da fosfatase alcalina, porem em niveis semelhantes, nos dois sistemas celulares

Sindrome nefrotico idiopatico en ninos tratados con ciclofosfamida. / Idiopathic nephrotic syndrome in children treated with cyclophosphamide

Se analizan 31 pacientes con sindrome nefrotico sensibles con recaidas frecuentes y resistentes a la terapia esteroidal tratados con ciclofosfamida 2-3mg./kg. por 2 meses. Se observa una respuesta favorable tanto en los enfermos sensibles con recaidas frecuentes, como en los resistentes junto con una menor frecuencia de aparicion de efectos toxicos inherentes al uso de ciclofosfamida