Efectividad de un programa de rehabilitación respiratoria en pacientes con síndrome de apnea obstructiva del sueño: estudio cuasi-experimental / Effectiveness of a respiratory rehabilitation programme in patients with sleep obstructive apnoea syndrome: Quasi experimental study

OBJETIVOS: El objetivo del estudio fue analizar la efectividad de un programa de rehabilitación respiratoria en pacientes obesos sedentarios con síndrome de apnea obstructiva del sueño (SAOS) en el que se incluyó la realización de ejercicio físico terapéutico. Participantes y métodos: Estudio cuasi-experimental de 2 grupos, grupo intervención y grupo control, no aleatorizados con evaluación pre/post. Se seleccionaron 47 pacientes del hospital diagnosticados de SAOS con obesidad y en tratamiento médico, los cuales fueron tratados por el mismo equipo y siguiendo los mismos criterios diagnósticos. Se registraron las siguientes variables: índice de masa corporal, poligrafía respiratoria, capacidad de ejercicio, patrón de comportamiento sedentario y calidad de vida. Se realizó una comparación pre/post a los 3 meses. RESULTADOS: Se analizaron 38 pacientes y los resultados obtenidos al comparar los valores pre/post de todos los individuos muestran diferencias significativas en forma de mejora en todas las variables analizadas a excepción del comportamiento sedentario. En la comparación pre/post entre los grupos se aprecia una diferencia significativa (p = 0,049) en la percepción de la calidad de vida, concretamente, en la dimensión de los síntomas diurnos (0,42; IC 95%: 0,48-1,33), indicando una tendencia a la mejora en el grupo que ha realizado el programa de ejercicio propuesto. CONCLUSIÓN: La combinación del tratamiento médico de los pacientes durante un mínimo de 6 meses junto con la realización del programa de rehabilitación respiratoria en el que se incluye el ejercicio físico terapéutico genera una tendencia a la mejora clínica de estos, aumentando su calidad de vida, pero sin ningún tipo de cambio en su comportamiento sedentario

OBJECTIVES: The objective of the study was to analyse the effectiveness of a respiratory rehabilitation programme in sedentary, obese patients with Obstructive Sleep Apnoea Syndrome (OSAS) which included therapeutic physical exercise. Participants and methods: A quasi-experimental study of two groups, an intervention group and a control group, not randomised and with pre/post evaluation. Forty-seven hospital patients diagnosed with obesity and under medical treatment were selected and treated by the same team, following the same diagnostic criteria. The following variables were recorded: body mass index, respiratory polygraph, exercise capacity, sedentary behaviour pattern and quality of life. A pre/post comparison was made at 3 months. RESULTS: 38 patients were analysed, and the results obtained when comparing the pre/post values of all the individuals show significant differences in the form of improvement in all variables analysed except for sedentary behaviour. In the pre/post comparison between the groups, a significant difference (p=.049) was observed in perception of quality of life, specifically in the daytime symptom dimension (.42; 95% CI: .48-1.33), indicating a trend towards improvement in the group that undertook the proposed exercise programme. CONCLUSION: The combination of the patients' medical treatment over a minimum of 6 months together with completion of the respiratory rehabilitation programme which included therapeutic physical exercise resulted in a tendency to clinical improvement for the patients, increasing their quality of life, but with no change in their sedentary behaviour

Flavonoids from Boldoa purpurascens inhibit proinflammatory cytokines (TNF-α and IL-6) and the expression of COX-2.

The flavonoids comprise a large class of plant metabolites distributed in food plants. These compounds have antioxidant, antitumor, antiallergic, and anti­inflammatory effects. The molecular mechanisms of their biological activities remain to be clearly understood. We investigated the in vitro anti­inflammatory potential of a flavonoid mixture and isolated compounds from the leaves of Boldoa purpurascens. Our results provide direct evidence of the anti­inflammatory effects of the mixture, which are mediated by the inhibition of the proinflammatory cytokines tumor necrosis factor α and interleukin 6 as well as the modulation of the expression of cyclooxygenase 2.

Safety assessment of a traditionally used extract from leaves of Boldoa purpurascens.

ETHNOPHARMACOLOGICAL RELEVANCE: Boldoa purpurascens Cav. (Nyctaginaceae) is a plant species used in traditional medicine in Cuba as a diuretic. AIM OF THE STUDY: The aim of the present investigation was to evaluate the safety profile of a hydroalcoholic extract from leaves of Boldoa purpurascens. MATERIALS AND METHODS: First, an experimental study to assess the oral acute toxicity at a dose of 2000mg/kg body weight of the extract was carried out. Potential genotoxicity of the extract was evaluated using the Ames test and the micronucleus induction assay in mouse bone marrow. In the Ames test a concentration range of 50, 100, 150, 300 and 500µg/plate was tested. In the micronucleus induction assay, doses of 500, 1000 and 2000mg/kg of body weight were tested. For completeness, since the extract contains saponins, the evaluation of the hemolytic activity, ocular and skin irritation were included. RESULTS: No signs or symptoms of toxicity were observed in the oral acute toxicity test (body weight at baseline, seven days and end of the experiment of 236.41±20.07, 256.81±30.44 and 240.02±26.16 respectively for the treated group). The hydroalcoholic extract from the leaves was not mutagenic in the Ames test, and no genotoxicity was observed in the micronucleus assay. A hemolysis test at concentration of 1mg/mL confirmed hemolytic activity, which is not a safety concern since saponins are not absorbed after oral administration. In order to evaluate the percentage of protein denaturation, the ocular irritability index was calculated. The extract was found to be irritating. Finally, skin irritability was evaluated and the irritation index was equal to zero. CONCLUSIONS: Based on the toxicological evaluation of a traditionally used hydroalcoholic extract from the leaves of Boldoa purpurascens we can confirm the safety of its oral use.

Antihyperglycemic activity of extracts from Boldoa purpurascens leaves in alloxan-induced diabetic rats.

In order to investigate the potential use of Boldoa purpurascens against diabetes, the antihyperglycemic effect of an ethanol extract obtained from its leaves was evaluated at doses of 50, 100 and 200 mg/kg in rats after induction of hyperglycemia by alloxan. Insulin 5 IU/kg was used as positive control and NaCl 0.9% as negative control. A similar experiment was performed with the aqueous extract used at doses of 50 and 100 mg/kg using metformin at a dose of 50mg/kg as positive control. Statistical analysis was carried using the Kruskal-Wallis test with an interval of trust of 99%. The ethanolic and aqueous extract of B. purpurascens showed a significant decrease of blood glucose levels 72 h after administration. Phytochemical analysis of the ethanol extract showed the presence of D-pinitol, a compound known for its hypoglycemic properties. In conclusion, ethanolic as well as aqueous extracts of B. purpurascens leaves show antihyperglycemic activity, possibly due to the presence of D-pinitol and flavonoids.

Trends in incidence and mortality from abdominal aortic aneurysm in New Zealand.

BACKGROUND: This study examined trends in abdominal aortic aneurysm (AAA) incidence and mortality in New Zealand (NZ) and compared these with mortality rates from England and Wales. METHODS: Cause-specific death data were obtained from the NZ Ministry of Health, UK Office for National Statistics and National Archives (for England and Wales). The NZ National Minimum Data Set provided hospital discharge data from July 1994 to June 2009. RESULTS: In 2005-2007 the age-standardized AAA mortality rate for men was 33·3 per cent less in NZ than in England and Wales (5·21 versus 7·81 per 100 000), whereas for women it was 9·8 per cent less (2·12 versus 2·35 per 100 000). Standardized mortality rates in NZ fell by 53·0 per cent for men and 34·1 per cent for women from 1991 to 2007. Between 1991-1992 and 2005-2007 the probability of a 65-year-old dying from an AAA fell by 28·2 per cent (from 1·872 to 1·344 per cent) in men, and by 6·3 per cent (from 0·837 to 0·784 per cent) in women. New AAA admission and hospital death rates in NZ peaked in 1999 for men, and in 2001 for women, and have since declined sharply. Hospital mortality ratios have also fallen, except for women with a ruptured aneurysm. CONCLUSION: The burden of AAA disease has been falling since at least 1991 in NZ, and since 1995 in England and Wales. Although survival appears to be improving, most of the reduction is due to lower disease incidence.

IPNV carrier Atlantic salmon growers do not express Mx mRNA and poly I:C-induced Mx response does not cure the carrier state.

Injection of infectious pancreatic necrosis virus (IPNV) in post-smolt Atlantic salmon induced a rapid and persistent expression of Mx mRNA from day 1 to at least day 11 when Mx:beta actin ratios were still at peak values of about 1.0. In contrast, an Atlantic salmon grower population, shown to be carriers of IPNV by culture of the virus from plastic adherent kidney leucocytes, showed no evidence of the expression of Mx transcripts. Nevertheless, IPNV-carrier growers showed a typical Mx response following injection of poly I:C, beginning on day 1, peaking on day 3 (mean Mx:beta actin ratio 0.82) and disappearing by day 7. Notwithstanding such treatment, IPNV continued to persist in growers as the virus could still be isolated 14 days after poly I:C injection.

Rubratoxin B elicits antioxidative and DNA repair responses in mouse brain.

Rubratoxin B (RB) is a mycotoxin with potential neurotoxic effects that have not yet been characterized. Based on existing evidence that RB interferes with mitochondrial electron transport to produce oxidative stress in peripheral tissues, we hypothesized that RB would produce oxidative damage to macromolecules in specific brain regions. Parameters of oxidative DNA damage and repair, lipid peroxidation, and superoxide dismutase (SOD) activity were measured across six mouse brain regions 24 h after administration of a single dose of RB. Lipid peroxidation and oxidative DNA damage were either unchanged or decreased in all brain regions in RB-treated mice compared with vehicle-treated mice. Concomitant with these decreased indices of oxidative macromolecular damage, SOD activity was significantly increased in all brain regions. Oxyguanosine glycosylase activity (OGG1), a key enzyme in the repair of oxidized DNA, was significantly increased in three brain regions--cerebellum (CB), caudate/putamen (CP), and cortex (CX)--but not in the hippocampus (HP), midbrain (MB), and pons/medulla (PM). The RB-enhanced OGG1 catalytic activity in these brain regions was not due to increased OGG1 protein expression, but was a result of enhanced catalytic activity of the enzyme. In conclusion, specific brain regions responded to an acute dose of RB by significantly altering SOD and OGG1 activities to maintain the degree of oxidative DNA damage equal to, or less than, that of normal steady-state levels.

Expression of brain natriuretic peptide by human bone marrow stromal cells.

Bone marrow stromal cells (BMSC) have been shown to generate neural cells under experimental conditions in vitro and following transplantation into animal models of stroke and traumatic CNS injury. Hastened recovery from the neurological deficit has not correlated with structural repair of the lesion in the stroke model. Secretory functions of BMSC, such as the elaboration of growth factors and cytokines, have been hypothesized to play a role in the enhanced recovery of neurological function. Using gene expression arrays, real time RT-PCR and radioimmunoassay, we have found that brain natriuretic peptide (BNP) is synthesized and released by BMSC at physiologically relevant levels in vitro. BNP, like its close homolog atrial natriuretic peptide (ANP), exerts powerful natriuretic, diuretic and vasodilatory effects. We speculate that transplanted BMSCs facilitate recovery from brain and spinal cord lesions by releasing BNP and other vasoactive factors that reduce edema, decrease intracranial pressure and improve cerebral perfusion.

Stable isotopes data (delta13C, delta15N) from the cave bear (Ursus spelaeus): a new approach to its palaeoenvironment and dormancy.

Palaeoclimatic data that can be extracted from the isotopic signatures of delta13C and delta15N, which are found in fossil bone collagen, should be analysed according to the specific metabolism of each species. Although Ursus spelaeus is an extinct species, its metabolism is assimilated to current, closely related species of bear. In this study, bone collagen isotopic signatures (delta13C and delta15N) of cave bears from Late Pleistocene Alpine sites were compared to those that have already been documented. The delta13C signature did not seem to follow a systematic trend according to climatic conditions, probably as a consequence of the high variability present in the values of C3 plants, which were the basis of feeding. On the contrary, the delta15N signature displayed higher values in sites corresponding to colder periods in which the delta15N signature appeared to be dominated by the physiology of dormancy. Then, due to the reuse of urea in synthesizing amino acids, the delta15N signature systematically increased along with dormancy duration. This was related to the length of winter and, in turn, depended on climate.

The effect of age on radiocephalic fistula patency.

BACKGROUND: Inferior patency rates for radiocephalic fistulae in the elderly have been reported and may explain the increasing use of prosthetic grafts for vascular access. The aim of this study was to assess whether the patency rates of primary radiocephalic fistulae are affected by age. METHODS: A retrospective casenote review of 53 consecutive patients undergoing primary fistula formation between 1995 and 1998 under the care of a single consultant vascular surgeon. The setting was a specialist vascular surgical unit where the protocol is to offer all new patients a radiocephalic fistula. Fistula patency was defined as successful use for dialysis. RESULTS: Cumulative patency rates at 2 years were 60% in patients over 60 years (n=27), and 53% in patients under 60 years (n=26). The higher patency rates in the older age group were not significant on log rank testing (p=0.39). CONCLUSION: Age over 60 years did not influence patency rates of primary radiocephalic fistulae, which should remain the haemodialysis access procedure of choice at all ages.

Thrombophilia, polymorphisms, and vascular disease.

Thrombophilia traditionally refers to rare inherited defects leading to enhanced coagulation, especially of the venous system. In recent years, a broader search for genetic polymorphisms of prothrombotic genes has been carried out to determine the relative impact on venous and arterial thrombosis. The bulk of evidence is drawn from numerous, often small, heterogeneous, case control association studies, with a variety of end points (deep venous thrombosis, myocardial infarction, or stroke). The data are often conflicting and inconclusive with only factor V Leiden and prothrombin polymorphisms having clear associations with venous thrombosis. Many of the polymorphisms interact with established cardiovascular risk factors, in particular smoking, to increase greatly the risk of a thrombotic episode. Future studies will need to consider the confounding factors of sample size, race, and clinical end points as well gene-environment interactions.

Bascom's operation for pilonidal sinus.

During 1985 in England and Wales, 7000 patients were treated for pilonidal disease with an average hospital stay of 5 days. The aim of this paper is to report our early experience with Bascom's operation for pilonidal sinus--a procedure relatively untried in the UK.

Surgical audit without autopsy: tales of the unexpected.

To establish our current practice and the potential value of the autopsy in general surgery, a retrospective review of general surgical autopsies was performed at one district general hospital from January 1989 to August 1991. There was considerable interconsultant variation in autopsy practice with a low 25% overall autopsy rate reflecting a low autopsy request rate. There were discrepancies between the clinical and pathological cause of death in 40 (63%) cases. There were important discrepancies which may have changed management in life in 18 (28%) autopsies, 7 (39%) of which were untreated visceral perforations. Autopsy is an important part of the surgical audit and will disclose considerable unsuspected pathology. Present autopsy rates are low and need to be improved. The unexpected finding of seven untreated visceral perforations requires further study.

Vascular access surgery: a 2-year study and comparison with the Permcath.

The results of a 2-year prospective study of primary and secondary vascular access surgery for haemodialysis have been compared with a retrospective study of central venous access via a flexible silicone catheter (Permcath). Cumulative patency for 61 primary fistulae in 57 patients was 64.8% at 1 year and 57.7% at 2 years. The patency of 55 secondary procedures in 43 patients was 48.1% at 1 and 2 years. Cumulative survival of 64 Permcaths inserted into 51 patients was 74% at 1 year and 43% at 2 years. Surgical complications included explorations for bleeding (2), haematomas (4), swollen arms (4), and inadequately dilated veins (4). Permcath complications included explorations for bleeding (3) and a temporary recurrent laryngeal nerve palsy (1). Exit site infection and septicaemia rates were 4.95 and 3.36 per 1000 catheter days respectively, but 20.6% of septicaemic episodes occurred in a patient who refused catheter removal. For haemodialysis, the Permcath is comparable with secondary vascular access. The Permcath may have a primary access role in patients with limited life expectancy.