Comparison of the timed inspiratory effort index with the T-piece trial as a decision-making tool for extubation: a randomized controlled non-inferiority trial

The "timed inspiratory effort" (TIE) index, a new predictor of weaning outcome, normalizes the maximal inspiratory pressure with the time required to reach this value up to 60 s, incorporating the time domain into the assessment of inspiratory muscle function. The objective of this study was to determine whether the TIE predicts successful extubation at a similar rate as the T-piece trial with less time required. A non-inferiority randomized controlled trial was performed with ICU subjects eligible for weaning. The participants were allocated to the TIE or the T-piece groups. The primary outcome was successful weaning, and the main secondary outcome was ICU mortality. Eighty participants of each group were included in the final analysis. Time from the start of a successful test to effective extubation was significantly lower in the TIE group than in the T-piece group, 15 (10 to 24) vs 55 (40 to 75) min, P<0.001. In the Kaplan-Meier analysis, no significant differences were found in successful weaning (79.5 vs 82.5%, P=0.268) or survival rate (62.9 vs 53.8%, P=0.210) between the TIE and T-piece groups at the 30th day. In this preliminary study, the TIE index was not inferior to the T-piece trial as a decision-making tool for extubation and allowed a reduction in the decision time.

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.

Atividade biológica do extrato hidroalcoólico de Bauhinia forficata Link sobre Herpetomonas samuelpessoai (Galvão. ) Roitman / Biologic activity of the hydroalcoholic extract of Bauhinia forficata Link on Herpetomonas samuelpessoai (Galvão. ) Roitman

Inúmeros esforços têm sido dirigidos para conferir às plantas seu real papel e valor na terapia. Este estudo teve como objetivo avaliar a atividade antimicrobiana, mutagênica, toxicidade, e os efeitos no crescimento e diferenciação de Herpetomonas samuelpessoai, do extrato hidroalcoólico de Bauhinia forficata. Para avaliar a atividade antimicrobiana foi realizado o teste de difusão em ágar, bem como a determinação das concentrações inibitória (CIM) e microbicida mínimas (CMM). O potencial clastogênico e/ou aneugênico, in vivo, foi avaliado usando o teste do micronúcleo em medula óssea de camundongos Swiss albinus. Foi determinada também a dose letal média (DL50). O extrato inibiu o crescimento de oito bactérias, mostrando-se mais ativo para Gram-positivas e não foi eficiente para os fungos, tendo sido ativo nas concentrações de 2000, 1000, 500 e 250 mg/mL contra os microrganismos testados. Os resultados mostraram que nas concentrações administradas (500, 1000 e 2000 mg/Kg), não houve aumento estatisticamente significativo de micronúcleos. Não houve ação no crescimento e diferenciação de Herpetomonas samuelpessoai nas concentrações testadas. Com relação a DL50, o extrato não apresentou toxicidade.

Numerous efforts have been directed to discover the role and the value of plants in therapy. This work aimed to evaluate the antimicrobial activity, mutagenicity, toxicity and effects on growth and differentiation of Herpetomonas samuelpessoai of the hydroalcoholic extract of Bauhinia forficata. To evaluate the antimicrobial activity it was performed the agar diffusion test, minimum inhibitory (MIC) and microbicidal (MMC) concentrations. The in vivo clastogenic and / or aneugênic potential was evaluated using the micronucleus test in mice bone marrow Swiss albinus. It was also determined the median lethal dose (LD50). The extract inhibited the growth of eight bacteria, being more active against Gram-positiveones, and was not active against fungi. The microorganisms tested had MIC concentrations of 2000, 1000, 500 and 250 mg / mL. The results showed that the tested concentrations (500, 1000 and 2000 mg / kg) had no statistically significant increasedthe micronucleus. There was no action on the growth and differentiation of Herpetomonas samuelpessoai at the concentrations tested. In respect to the LD50, the extract showed no toxicity.

Where was Joseph Babinski born? / Onde Joseph Babinski nasceu?

There is controversy in the neurological literature about where Joseph Babinski was born, including a myth propounded by various important authors that he was born in Lima, Peru. However, according to the most consistent biographical data, he was in fact born in Paris, France, and became a medical celebrity there and in Poland as well as around the world.

Existe uma controvérsia na literatura neurológica acerca do local de nascimento de Joseph Babinski, incluindo a lenda nutrida por vários autores de importância, de que ele teria nascido em Lima no Peru. Contudo, os dados biográficos mais consistentes definem que ele nasceu de fato, na cidade de Paris, França, tornando-se uma celebridade da medicina francesa, polonesa e mundial.

Leptospira spp. and Toxoplasma gondii antibodies in vampire bats (Desmodus rotundus) in Botucatu region, SP, Brazil

The destruction of natural ecosystems has caused several problems to humans and other animals; herein we investigate the close relationship among vampire bats, humans and domestic animals. Toxoplasma gondii and Leptospira spp. infections are two worldwide zoonoses that provoke serious damage to animals. To determine the prevalence of bats seropositive for toxoplasmosis and leptospirosis in the Botucatu region, 204 serum samples of vampire bats (Desmodus rotundus) were tested for T. gondii antibodies by modified agglutination test (MAT-t) and for Leptospira spp. by microscopic agglutination test (MAT-l). No animal was tested positive for T. gondii while leptospiral positivity was 7.8 percent for Pyrogenes, Shermani and Javanica serovars, with titers varying from 100 to 1,600. Thus, it was verified that D. rotundus does not play a relevant role in toxoplasmosis epidemiology. However, these bats can be important in the maintenance of Leptospira spp. in the environment.(AU)

Factors associated with depression symptoms in high school students in São Paulo, Brazil

OBJECTIVE: To assess factors associated with depression symptoms in high school students. METHODS: A cross-sectional study involving high school students was conducted in the city of São Paulo, Brazil, 2001. A total of 724 students aged 14-18 years answered questionnaires on life and health conditions. Another questionnaire was applied to working (44.8 percent) and unemployed (22.9 percent) students to collect information on working conditions. Factors associated to depressive disorders were analyzed using multiple logistic regression controlled for occupational status. RESULTS: Overall prevalence rate of depression was 7.5 percent. Rates according to gender were 39 (10.3 percent) in females and 15 (4.3 percent) in males. The multiple logistic regression analysis showed that factors associated with depressive disorders were: poor self-perception of health (OR=5.78), being female (OR = 2.45), and alcohol consumption (OR=2.35). CONCLUSIONS: The study results showed that sociodemographic, lifestyle and health variables were associated with symptoms of depression in this population. These ndings suggest that it is important to have mental health professionals available in high schools for early detection of mental conditions and student counseling.

OBJETIVO: Investigar os fatores associados a sintomas depressivos em estudantes do ensino médio. MÉTODOS: Foi realizado estudo transversal com estudantes residentes no Município de São Paulo, Brasil, em 2001. O total de 724 estudantes com idades entre 14 e 18 anos preencheram questionários de condições de vida e saúde. Dentre eles, os estudantes trabalhadores (44,8 por cento) e desempregados (22,9 por cento) também responderam a um outro questionário de condições de trabalho. A regressão logística foi utilizada para determinar os fatores associados para apresentar distúrbios depressivos, utilizando-se a "situação ocupacional" para ajustar o modelo. RESULTADOS: A prevalência dos sintomas depressivos na população estudada foi de 7,5 por cento; as taxas de acordo com o sexo foram de 39 (10,3 por cento) e 15 (4,3 por cento) nos adolescentes dos sexos feminino e masculino, respectivamente. A regressão logística mostrou que os fatores associados aos distúrbios depressivos são: baixo escore na auto-avaliação da saúde (OR=5,78), ser do sexo feminino (OR=2,45) e consumo de bebidas alcoólicas (OR=2,35). CONCLUSÕES: Os resultados mostraram que variáveis sociodemográficas, de estilo de vida e de saúde estavam associadas aos distúrbios depressivos. Esses achados sugerem a importância de que profissionais de saúde mental em escolas de ensino médio efetuem rastreio para reconhecer precocemente problemas mentais e fornecer aconselhamento aos estudantes.

Brazilian spotted fever: a reemergent zoonosis: [review]

Brazilian spotted fever is caused by the bacterium Rickettsia rickettsii, which is the most pathogenic species of the spotted-fever rickettsiae group and is transmitted by the bite of infected ticks. Amblyomma cajennense is the most important tick species involved in the cycle of this zoonosis in Brazil as it presents low host specificity, great number of natural reservoirs and wide geographic distribution. It was first described in the state of São Paulo in 1929 and later in Rio de Janeiro, Minas Gerais and Bahia. The number of cases decreased in the 1940's with the development of new plague control techniques and antibiotics. In the last decades, the number of new cases has increased. The current review aimed at reporting some of the epidemiological and public health aspects of this reemergent disease with new foci, mainly in the southeastern region of Brazil.

Brazilian spotted fever: a reemergent zoonosis

Brazilian spotted fever is caused by the bacterium Rickettsia rickettsii, which is the most pathogenic species of the spotted-fever rickettsiae group and is transmitted by the bite of infected ticks. Amblyomma cajennense is the most important tick species involved in the cycle of this zoonosis in Brazil as it presents low host specificity, great number of natural reservoirs and wide geographic distribution. It was first described in the state of São Paulo in 1929 and later in Rio de Janeiro, Minas Gerais and Bahia. The number of cases decreased in the 1940's with the development of new plague control techniques and antibiotics. In the last decades, the number of new cases has increased. The current review aimed at reporting some of the epidemiological and public health aspects of this reemergent disease with new foci, mainly in the southeastern region of Brazil.

Serological survey for rabies in serum samples from vampire bats (Desmodus rotundus) in Botucatu region, SP, Brazil

The chiropterans constitute 25% of the world's mammal fauna. Due to the destruction of their natural ecosystem, the vampire bats have moved from nature to artificial roosts closer to man and domestic animals. This phenomenon has happened particularly in rural areas. Rabies is a viral anthropozoonosis, 100% lethal, and vampire bats (Desmodus rotundus) represent an important role in its epidemiology. D. rotundus were captured at night with mesh nets in partnership with the Botucatu Defense Office and sent to the Zoonosis Diagnostic Service, at the School of Veterinary Medicine and Animal Husbandry, UNESP. Serum samples from 204 bats were analyzed by enzyme-linked immunosorbent assay (ELISA) and fluorescent antibody viral neutralization test (FAVN) for rabies antibody detection. The results showed 7.4% of sera with titers higher or equal to 0.5 U for rabies antibodies, which demonstrated viral flow circulation among the studied region. Data suggest a need for constant monitoring accomplished by epidemiological and sanitary measures.(AU)

Hantaviruses as emergent zoonoses

Hantaviruses belong to the Bunyaviridae family, which consists of vector-borne viruses. These viruses can provoke two infection types: hemorrhagic fever with renal syndrome (HFRS) - which occurs in the Old World - and hantavirus cardiopulmonary syndrome (HCPS) - an emergent zoonosis that can be found in many countries of the western hemisphere. Rodents are hantavirus reservoirs and each species seems to host a different virus type. Humans acquire the infection by inhaling contaminated aerosol particles eliminated by infected animals. The factors involved in the emergence of hantavirus infections in the human population include ecological modifications and changes in human activities. The most important risk factor is contact between man and rodents, as a result of agricultural, forestry or military activities. Rodent control remains the primary strategy for preventing hantavirus diseases, including via health education and hygienic habits.(AU)

Expression of inducible nitric oxide synthase is increased in patients with heart failure due to ischemic disease

The objective of the present study was to determine the relationship between nitric oxide synthases (NOS) and heart failure in cardiac tissue from patients with and without cardiac decompensation. Right atrial tissue was excised from patients with coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) <35 percent (N = 10), and from patients with CAD and LVEF >60 percent (N = 10) during cardiac surgery. NOS activity was measured by the conversion of L-[H ]-arginine to L-[H ]-citrulline. Gene expression was quantified by the competitive reverse transcription-polymerase chain reaction. Both endothelial NOS (eNOS) activity and expression were significantly reduced in failing hearts compared to non-failing hearts: 0.36 ± 0.18 vs 1.51 ± 0.31 pmol mg-1 min-1 (P < 0.0001) and 0.37 ± 0.08 vs 0.78 ± 0.09 relative cDNA absorbance at 320 nm (P < 0.0001), respectively. In contrast, inducible NOS (iNOS) activity and expression were significantly higher in failing hearts than in non-failing hearts: 4.00 ± 0.90 vs 1.54 ± 0.65 pmol mg-1 min-1 (P < 0.0001) and 2.19 ± 0.27 vs 1.43 ± 0.13 cDNA absorbance at 320 nm (P < 0.0001), respectively. We conclude that heart failure down-regulates both eNOS activity and expression in cardiac tissue from patients with LVEF <35 percent. In contrast, iNOS activity and expression are increased in failing hearts and may represent an alternative mechanism for nitric oxide production in heart failure due to ischemic disease.

Produçäo de milho em cultivo exclusivo ou consorciado com soja e qualidade de suas silagens / Forage production and silage quality of corn plant consortiated or not with soybean

Com o objetivo de produzir silagens mais protéicas, foram testados quatro cultivares de soja consorciados com milho em dois arranjos culturais: linhas alternadas de milho e soja ou linha alternada com duas linhas de soja, em delineamento de blocos ao acaso. Mediram-se as produçöes de MS e de PB e determinou-se a qualidade das silagens. A produçäo de MS e de PB näo foi aumentada no arranjo com maior concentraçäo de soja. As silagens apresentaram reduzido teor de MS, pH normal e elevada porcentagem de PB. Foi recomendado para a regiäo o arranjo alternado de linhas de milho e soja, utilizando os cultivares Dourados e Ocepar-9 e também que o corte das forrageiras para ensilagem fosse mais tardio, quando o milho estivesse no estádio fisiológico de farináceo para semiduro

Fraturas do complexo zigomatico: analise de 140 casos. / Fractures of the zygomatic complex: analysis of 140 cases

Os AA apresentam sua experiencia no diagnostico e tratamento de 140 pacientes com fraturas do complexo zigomatico. Destas fraturas 108 foram do malar, enquanto 32 do arco zigomatico. O diagnostico foi baseado nos dados clinicos e radiograficos (Rx em posicao de Waters) e o tratamento nas fraturas do arco zigomatico foi a reducao por via temporal (tecnica de Gilies) com bons resultados; nas fraturas do malar variou desde reducao com uso de instrumento em forma de gancho usado percutaneamente para reduzir o osso fraturado, ate a osteossintese dos fragmentos osseos nos casos mais complexos

Fratura dos ossos da face - analise de 455 casos. / Fractures of the facial bons analysis of 455 cases

Os autores atenderam 455 casos de fraturas da face num periodo de 24 meses. A distribuicao das fraturas foi a seguinte: mandibula = 105; maxila = 25; complexo zigomatico = 141; nariz = 170 e dentoalveolares = 14. As fraturas osseas sao apresentadas e analisadas individualmente, uma vez que apresentam fisiopatologia e tratamento diferentes, apesar de manterem ligacoes entre si. O exame clinico detalhado e o exame radiografico pre-operatorio sao imprescindiveis para o planejamento cirurgico, devendo-se ter em mente que a reducao dos fragmentos osseos e a consequencia imobilizacao devem ser objetivo do tratamento

Endarteriectomia eletiva e revascularização do miocárdio / Elective endarterectomy and myocardial revascularization

Entre abril de 1981 e setembro de 1982, foram submetidos a revascularização do miocárdio 1.289 pacientes. Em 84 deles, a endarteriectomia foi proposta na fase de avaliação para a operação e realizada como processo eletivo. A idade variou de 34 a 72 anos. Cinquenta e sete deles pertenciam a faixa de 51 a 70 anos. Foram realizadas 273 pontes (3,2 pontes por paciente). Destas, 100 foram implantadas em artérias submetidas a endarteriectomia. Em 66 vezes, a coronária direita foi a arteria tratada e, em 34 vezes, ramos da coronária esquerda. Houve 2 obitos (2,4%), 1 por baixo debito, no 2o. dia de pós-operatório e outro, por arritmia, no 6o. dia. Em 13 pacientes, foi realizado reestudo cineangiográfico, antes da alta hospitalar. Todas as pontes estavam pérvias. Os detalhes da técnica são discutidos, bem como a indicação. Apesar do curto período de seguimento, nossa experiência parece confirmar os resultados de outros autores e justificar a aplicação deste procedimento para casos selecionados

Reoperação em cirurgia de revascularização do miocárdio / Reoperation in myocardial revascularization surgery

Em 7536 revascularizacao do miocardio realizadas no Instituto "Dante Pazzanese" de Cardiologia, consta que 182 (2,4%) foram praticadas em pacientes que sofreram intervencao anterior e 4 (0,05%) duas operacoes anteriores. A oclusao de ponte (88 pacientes) foi a causa mais comum das reoperacoes (48,3%). A oclusao de ponte associada a progressao de lesao foi o motivo em 54 pacientes (29,6%). Progressao de lesao, isoladamente, ocorreu em 25 casos (13,7%). Os demais sofreram a nova operacao em decorrencia de implante de arteria mamaria insuficiente (10 casos) ou obstrucao de retalho de veia ou pericardio (5 casos). A mortalidade operatoria foi de 4,9%: 4 pacientes faleceram em consequencia de insuficiencia miocardica; 3 de insuficiencia respiratoria; 1 de arritmia incontrolavel e 1, de coma neurologico. A evolucao tardia revelou que 15 pacientes faleceram: 7 por causas nao relacionadas com cardiopatia (5 carcinomas, 1 acidente vascular cerebral hemorragico e 1 hepatite, varios anos apos a operacao). Dos 142 pacientes com seguimento completo (10% nao estao sob controle) 126 (88,7%) estavam assintomaticos, com tempo medio de observacao de 56,5 meses. Os autores concluem que a revascularizacao do miocardio pela segunda ou terceira vez pode ser acompanhada de baixa morbidade e baixa mortalidade, quando se adotam criterios precisos para a indicacao