Beyond pulmonary rehabilitation: can the PICk UP programme fill the gap? A randomised trial in COPD.

INTRODUCTION AND OBJECTIVES: Pulmonary rehabilitation (PR) is a fundamental intervention to manage COPD, however, maintaining its benefits is challenging. Engaging in physical activity might help to prolong PR benefits. This study assessed the efficacy and effectiveness of a personalised community-based physical activity programme to sustain physical activity and other health-related PR benefits, in people with COPD. MATERIALS AND METHODS: This was a multicentre, assessor blinded, randomised controlled trial. Following 12-weeks of PR, people with COPD were assigned to a six-months personalised community-based physical activity programme (experimental group), or to standard care (control group). Physical activity was assessed via: time spent in moderate to vigorous physical activities per day (primary outcome measure), steps/day and the brief physical activity assessment tool. Secondary outcomes included sedentary behaviour, functional status, peripheral muscle strength, balance, symptoms, emotional state, health-related quality of life, exacerbations and healthcare utilization. Assessments were performed immediately post-PR and after three- and six-months. Efficacy and effectiveness were evaluated using intention-to-treat and per-protocol analysis with linear mixed models. RESULTS: Sixty-one participants (experimental group: n = 32; control group: n = 29), with balanced baseline characteristics between groups (69.6 ± 8.5 years old, 84 % male, FEV1 57.1 ± 16.7 %predicted) were included. Changes in all physical activity outcomes and in one-minute sit-to-stand were significantly different (P < 0.05) between groups at the six-month follow-up. In the remaining outcomes there were no differences between groups. CONCLUSIONS: The community-based physical activity programme resulted in better physical activity levels and sit-to-stand performance, six-months after completing PR, in COPD. No additional benefits were observed for other secondary outcomes.

Effect of lipid sources and inclusion levels in diets for broiler chickens / Efeito de fontes lipídicas e níveis de inclusão em dietas para frangos de corte

This research aimed to evaluate the interactions and effects of 2 and 4% addition levels of poultry slaughterhouse fat (chicken tallow) and soybean oil in diets for broiler chickens. Two experiments were carried out using one-day-old male Cobb chicks in an entirely random design with a 2x2 factorial scheme. In the first experiment, 560 chicks were used to evaluate performance and carcass characteristics. In the second experiment, 100 chicks were used to determine the nutrient digestibility, dietary energy utilization and the lipase and amylase pancreatic activity. There was no interaction between the fat sources and the addition levels for any of the analyzed variables, except for the digestibility coefficient of dry matter (DCDM), which was higher in diets added with 2% soybean oil when compared to chicken tallow. The addition of 4% fat in the diet, regardless of fat source, improved the digestibility coefficient of ethereal extract (DCEE) and increased weight gain and feed intake. Moreover, in the initial phase, the addition of 4% fat to the diet increased lipase activity when compared to diets with 2% addition, and a positive correlation between DCEE and pancreatic lipase activity was observed. In conclusion, there is no interaction between fat sources and addition levels, except for DCDM. Carcass characteristics are not influenced by any of the studied factors. The addition of 4% fat increases pancreatic lipase activity and improves DCEE, resulting in greater weight gain, regardless of the tested fat source, making chicken tallow a great alternative to soybean oil...

O objetivo deste trabalho foi avaliar as interações e os efeitos da utilização de gordura de abatedouro avícola (gordura de frango) e de óleo de soja com níveis de inclusão de 2 e 4% em dietas para frangos de corte. Foram conduzidos dois experimentos com pintos de corte de um dia de idade, machos, da linhagem Cobb, alojados num delineamento inteiramente ao acaso em esquema fatorial 2x2. No primeiro experimento utilizaram-se 560 aves para avaliar o desempenho e as características de carcaça. No segundo experimento foram alojadas 100 aves para determinar o aproveitamento dos nutrientes e da energia da dieta, e também a atividade de lipase e amilase pancreática. Não houve interações entre as fontes lipídicas e os níveis de inclusão para nenhuma das variáveis analisadas, com exceção do coeficiente de metabolizabilidade da matéria seca (CMMS), que foi maior nas dietas com inclusão de 2% de óleo de soja em relação à gordura de frango. A inclusão de 4% de lipídios na dieta, independente da fonte lipídica, melhorou o coeficiente de metabolizabilidade do extrato etéreo (CMEE) e aumentou o ganho de peso e o consumo de ração das aves. Ainda, na fase inicial, a adição de 4% de lipídios na dieta aumentou a atividade de lipase em relação às dietas com inclusões de 2%, observando-se uma correlação positiva entre o CMEE e a atividade de lipase pancreática. Como conclusão, não há interação entre as fontes lipídicas e os níveis de inclusão estudados, com ressalva para o CMMS. As características de carcaça não são influenciadas por nenhum dos fatores estudados. A adição de 4% de lipídio aumenta a atividade de lipase pancreática e melhora o CMEE, refletindo em maior ganho de peso das aves, indiferentemente da fonte lipídica testada, o que torna a gordura de frango uma boa alternativa ao óleo de soja...

Síndrome de Ivemark recidivante / Recurrent Ivemark syndrome

Resumen

The Ivemark syndrome is one of the heterotaxy syndromesor also named cardiosplenic syndromes. During the normal embryological development, as the body left-right axis is established also the organs assume their definitive positions. When variation of the body organs arrangement occurs precociously in embryogenesis, there is a tendency toward symmetric development of normally asymmetric organs or organ systems, with concomitant complex cardiac defects. The most significant forms of heterotaxy syndromes are the polysplenia syndrome and the Ivemark syndrome. Both are rare syndromes and seem to be responsible for 1% of all congenital cardiac defects. The Ivemark syndrome is usually manifested as asplenia, bilaterally trilobed lungs, symmetric liver, with a central position in the upper abdomen, gallbladder centrally positioned or in the left side, and complex cardiopathy. The authors describe a case report of a second gestation of an healthy young couple, to whom a diagnosis of Ivemark syndrome was made at 20th gestacional week. In her obstetric history she had a term pregnancy, with an Ivemark syndrome newborn -anatomo-pathological diagnosis-, who died of cardio-pulmonary insufficiency in the neonatal period. In the current pregnancy an increased nuchal translucency was detected in the first trimester ultrasound. Amniocentesis for fetal cariotype revealed a normal cariotype for a male fetus. In the ultrasound at 21th gestational week a complex cardiopathy was identified and echocardiography confirmed the diagnosis of right isomerism. The couple decided for a pregnancy interruption, which was accepted. The anatomo-pathological exam confirmed the diagnosis of Ivemark syndrome

Trissomia parcial do cromossoma 9 e trissomia parcial do cromossoma 2 / Partial trisomy of the chromosome 9 and partial trisomy of the chromosome 2

La trisomía parcial del cromosoma 9 puede ser la cuarta trisomía autosómica más frecuente, precedida únicamente por las trisomías 21, 13 Y 18]. La trisomía parcial del cromosoma 9 junto con la trisomía parcial del cromosoma 2 originan un fenotipo overlapping, con caracteristicas de cada una de las trisomías. Los autores describen un caso clínico de una primigesta de 28 años, fenotípicamente normal y sin patología conocida, a quien, tras haberle sido detectada una cardiopatía fetal compleja en ecografía obstétrica de rutina realizada en el tercer trimestre del embarazo, con posterior confirmación ecocardiográfica, le fue realizada amniocentesis con el diagnóstico de trisomía 9. El estudio del cariotipo de los progenitores permitió revísar el cariotipo fetal y concluir que se trata de trisomía parcial del cromosoma 9 y trisomía parcial del cromosoma 2

Partial trisomy of the chromosome 9 can be the fourth most common autosomal trisomy, after trisomies 21, 13 and 181. Partial trisomy of the chromosome 9 with partial trisomy of the chromosome 2 results in a distinctive appearance, an overlapping phenotype, with characteristic patterns recognized of each trisomy. The authors describe a case of a primigravid 28 years old, healthy and with a normal phenotype, who had a prenatal diagnosis of trisomy of the chromosome 9 by amniocentesis, after detection of a major complex fetal cardiopathy in a routine ultrasound of the third trimester of the pregnancy, which had echocardiograph confirmation. Genetic investigation of both progenitors was done and it was possible to review the fetal cariotype then, which permitted to establish the final diagnosis of partial trisomy of the chromosome 9 with parcial trisomy of the chromosome 2