ABSTRACT
Objetivo: Avaliar a eficácia de uma estratégia de orientações verbal e escrita sobre transferências na redução da dor lombar em cuidador familiar de pacientes em cuidados paliativos; o impacto no desempenho das tarefas diárias do cuidador antes e após a intervenção e se a adesão às orientações resultou em melhora clínica significativa da dor e do desempenho nas atividades. Método: Trata-se de ensaio clínico piloto, realizado no ambulatório de cuidados paliativos do HCFMUSP. Foram avaliados 4 cuidadores familiares divididos em dois grupos. O grupo intervenção recebeu orientação verbal e escrita e o grupo controle apenas orientação verbal. A análise dos dados foi realizada através de medida de proporção e análise de significância estatística pelo teste exato de Fisher. A correlação entre as variáveis será realizada através de regressão logística. Resultados: Houve dificuldade no recrutamento com influência direta no tamanho reduzido da amostra. Os resultados preliminares sobre a eficácia da intervenção para redução de dor e aumento de desempenho em cuidadores familiares não demonstraram significância estatística. A análise descritiva de aderência às recomendações aponta para uma tendência promissora quanto à viabilidade da intervenção educativa. Conclusão: A relevância deste ensaio piloto deve-se a avaliação preliminar do tempo necessário para se recrutar um número adequado de participantes e a tendência de boa aderência à intervenção. A dificuldade de recrutamento de pacientes em final de vida é previsível devido ao tempo reduzido de sobrevida e a complexidade do cuidado. A eficácia da intervenção somente poderá ser demonstrada com o ajuste do tamanho da amostra.
Objective: To evaluate the efficacy of strategy of verbal and written guidance on transference in the reduction of low back pain in the family caregiver of patients in palliative care; the impact on the performance of the daily tasks of the caregiver before and after the intervention and whether adherence to the guidelines resulted in a significant clinical improvement of pain and performance in the activities. Method: This is a pilot clinical trial, performed at the HCFMUSP palliative care outpatient. Four family caregivers were divided into two groups. The intervention group received verbal and written guidance and the group controlled verbal guidance. The analysis of the data was performed by measurement of proportion and analysis of statistical significance by the Fisher exact test. The correlation between the variables will be performed through logistic regression. Results: Due to the small sample size, preliminary results on the efficacy of the intervention to reduce pain and increase performance in family caregivers did not demonstrate statistical significance. The descriptive analysis of adherence to the recommendations points to a promising tendency towards the feasibility of the educational intervention. Conclusion: The relevance of this pilot test is due to the preliminary evaluation of the time needed to recruit an adequate number of participants and the tendency of good adherence to the intervention. The difficulty of recruiting end-of-life patients is predictable due to reduced survival time and the complexity of care. The effectiveness of the intervention can only be demonstrated by adjusting the sample size.
Subject(s)
Humans , Palliative Care , Caregivers , Low Back Pain , Moving and Lifting Patients , Pilot ProjectsABSTRACT
We previously reported that cholinergic stimulation with pyridostigmine (PY) induces anti-inflammatory cell recruitment soon after myocardial infarction (MI). In this study, we evaluated the anti-inflammatory effects of PY during the proliferative phase of cardiac repair by analyzing the infiltration of macrophages, Treg lymphocytes, oxidative stress and inflammatory cytokines. Wistar rats underwent control sham surgery or ligation of the left coronary artery and were randomly allocated to remain untreated (untreated infarcted group, I) or to receive PY (30 mg·kg(-1)·day(-1)) in the supplied water (infarcted treated group, I + PY). Blood pressure and heart rate variability were registered at day 5 post-MI. The animals were euthanized 7 days after thoracotomy, when the hearts were removed and processed for immunohistochemistry (CD68, CD206, FOXP3), cytokines (IL-1ß, IL-6, IL-10, TNF-α) and oxidative stress (superoxide dismutase, catalase, glutathione peroxidase, lipidic and protein peroxidation). PY treatment increased parasympathetic modulation, M2 macrophages and the anti-oxidant enzyme activity but reduced protein oxidation (carbonyls) and the concentration of IL-1ß, IL-6, TNF-α and IL-10. Cholinergic stimulation induces parasympathetic neuro-immune modulation and anti-inflammatory cell enrollment as well as prevents oxidative stress and cytokine production after MI.
Subject(s)
Cardiotonic Agents/pharmacology , Cholinesterase Inhibitors/pharmacology , Inflammation/drug therapy , Myocardial Infarction/drug therapy , Oxidative Stress/drug effects , Pyridostigmine Bromide/pharmacology , Animals , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Antioxidants/pharmacology , Cytokines/metabolism , Disease Models, Animal , Hemodynamics/drug effects , Inflammation/metabolism , Inflammation/pathology , Male , Myocardial Infarction/metabolism , Myocardial Infarction/pathology , Oxidative Stress/physiology , Random Allocation , Rats, WistarABSTRACT
We tested the hypothesis that an increase in the anti-inflammatory cholinergic pathway, when induced by pyridostigmine (PY), may modulate subtypes of lymphocytes (CD4+, CD8+, FOXP3+) and macrophages (M1/M2) soon after myocardial infarction (MI) in rats. Wistar rats, randomly allocated to receive PY (40 mg·kg(-1)·day(-1)) in drinking water or to stay without treatment, were followed for 4 days and then were subjected to ligation of the left coronary artery. The groups-denominated as the pyridostigmine-treated infarcted (IP) and infarcted control (I) groups-were submitted to euthanasia 3 days after MI; the heart was removed for immunohistochemistry, and the peripheral blood and spleen were collected for flow cytometry analysis. Noninfarcted and untreated rats were used as controls (C Group). Echocardiographic measurements were registered on the second day after MI, and heart rate variability was measured on the third day after MI. The infarcted groups had similar MI areas, degrees of systolic dysfunction, blood pressures, and heart rates. Compared with the I Group, the IP Group showed a significant higher parasympathetic modulation and a lower sympathetic modulation, which were associated with a small, but significant, increase in diastolic function. The IP Group showed a significant increase in M2 macrophages and FOXP3(+)cells in the infarcted and peri-infarcted areas, a significantly higher frequency of circulating Treg cells (CD4(+)CD25(+)FOXP3(+)), and a less extreme decrease in conventional T cells (CD25(+)FOXP3(-)) compared with the I Group. Therefore, increasing cholinergic modulation with PY induces greater anti-inflammatory cell recruitment soon after MY in rats.
Subject(s)
Anti-Inflammatory Agents/pharmacology , CD8-Positive T-Lymphocytes/drug effects , Chemotaxis, Leukocyte/drug effects , Cholinergic Neurons/drug effects , Cholinesterase Inhibitors/pharmacology , Macrophages/drug effects , Myocardial Infarction/drug therapy , Myocardium/immunology , Pyridostigmine Bromide/pharmacology , T-Lymphocytes, Regulatory/drug effects , Animals , Biomarkers/metabolism , Blood Pressure/drug effects , CD8-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/metabolism , Cholinergic Neurons/metabolism , Cholinergic Neurons/pathology , Disease Models, Animal , Forkhead Transcription Factors/metabolism , Heart Rate/drug effects , Interleukin-2 Receptor alpha Subunit/metabolism , Macrophage Activation/drug effects , Macrophages/immunology , Macrophages/metabolism , Male , Myocardial Infarction/immunology , Myocardial Infarction/metabolism , Myocardial Infarction/pathology , Myocardial Infarction/physiopathology , Myocardium/metabolism , Myocardium/pathology , Phenotype , Rats, Inbred WKY , Spleen/drug effects , Spleen/immunology , Spleen/metabolism , T-Lymphocytes, Regulatory/immunology , T-Lymphocytes, Regulatory/metabolism , Time Factors , Ventricular Function, Left/drug effectsABSTRACT
BACKGROUND: The presence of asymptomatic left ventricular diastolic dysfunction (LVDD) in hypertensive patients can be associated with the development of cardiac events. The increase in sympathetic activity may be 1 of the mechanisms that predisposes to this outcome. In this study, we analyzed 2 hypotheses: (i) whether sympathetic activity is higher in the presence of LVDD, independent of blood pressure control and (ii) whether different classes of LVDD have a different effect on sympathetic activity. METHODS: After analyzing left ventricular function using echo Doppler cardiography, 45 hypertensive patients receiving treatment were allocated into 3 groups: normal function (LV-NF, n = 15), impaired relaxation (LV-IR, n = 15), and pseudonormal or restrictive (LV-P/R, n = 15). An age-, sex-, and body mass index-matched control group of normotensive volunteers (N, n = 14) was included. Muscle sympathetic nerve activity (MSNA), heart rate, and systolic blood pressure variabilities and baroreflex sensitivity were evaluated while the patient was in a supine position. RESULTS: Blood pressure and antihypertensive drug use were similar among the hypertensive groups. The LV-IR and LV-P/R groups had similar MSNA (33±1 and 32±1 bursts/min, respectively), which was significantly higher than that of the LV-NF and N groups (26±3 and 15±2 bursts/min, respectively). The LV-IR and LV-P/R groups had significantly higher LF-systolic blood pressure variability and significantly lower baroreflex sensitivity compared with the N group. CONCLUSIONS: The presence of asymptomatic LVDD is associated with increased MSNA, independent of blood pressure control. The sympathetic hyperactivity associated with LVDD is similar in the different patterns of LVDD studied.
Subject(s)
Antihypertensive Agents/therapeutic use , Blood Pressure/physiology , Hypertension/physiopathology , Muscle, Skeletal/innervation , Sympathetic Nervous System/physiopathology , Ventricular Dysfunction, Left/physiopathology , Adult , Baroreflex/physiology , Diastole , Disease Progression , Echocardiography, Doppler , Female , Humans , Hypertension/complications , Hypertension/drug therapy , Male , Middle Aged , Ventricular Dysfunction, Left/etiologyABSTRACT
INTRODUÇÃO: A atuação do sistema nervoso parassimpático em células imunes é conhecida como "Via Anti-inflamatória Colinérgica". Trabalhos prévios demonstraram que a estimulação vagal reduz a inflamação e melhora a sobrevida em modelos experimentais com sepse. Neste estudo avaliamos se o uso do anticolinesterásico piridostigmina: altera o número de linfócitos T (CD4+ e CD8+) convencionais (CD25+Foxp3-) e reguladores (CD25+Foxp3+) no sangue periférico, no baço e no miocárdio; modifica a concentração de citocinas (interleucina 1, interleucina 6, TNFalfa) no miocárdio; e influencia a função ventricular após infarto agudo do miocárdio experimental (IAM) em ratos. MÉTODOS: Utilizamos ratos machos adultos da linhagem Wistar, com peso variando entre 200 e 250 g, divididos em 3 grupos de 20 animais cada: grupo controle (GC), grupo infartado sem tratamento (IC) e grupo infartado tratado com piridostigmina (IP). O infarto agudo do miocárdio (IAM) foi obtido com a técnica da ligadura da artéria coronária esquerda, e o grupo IP recebeu piridostigmina na dose de 40mg/kg/dia na água de beber, iniciada 4 dias antes do IAM. Todos os animais foram submetidos à canulação da artéria femoral no dia seguinte ao IAM para registro das curvas de pressão arterial, e posterior análise dos componentes da variabilidade da freqüência cardíaca (VFC), domínio do tempo (SDNN e RMSSD) e da freqüência (componentes LF e HF); o estudo ecocardiográfico foi realizado no segundo dia pós IAM. No terceiro dia pós IAM, os ratos foram divididos em subgrupos de 10 animais, e sacrificados de forma específica para coleta de materiais: 500 ul de sangue periférico e baço fresco para realização da técnica de citometria de fluxo; ventrículo esquerdo para dosagem de citocinas pela técnica de ELISA; e ventrículo esquerdo para realização de imunohistoquímica. Foram usadas as técnicas padronizadas e de uso corrente nos laboratórios...
INTRODUTION: The role of the parasympathetic nervous system in immune cells is known as "Cholinergic anti-inflammatory pathway". In previous work has demonstrated that vagal stimulation reduces inflammation and improves survival in experimental sepsis models. The aim of the present study evalued the use of anticholinesterase pyridostigmine: change the number of T lymphocytes (CD4+ and CD8+) conventional (CD25+Foxp3-) and regulatory (CD25+Foxp3+) in peripheral blood, spleen, and myocardium: modifies the concentration of cytokines (interleukin-1, interleukin-6, TNFalfa) in the myocardium, and influences ventricular function after experimental myocardial infarction (MI) in rats. METHODS: Adult male rats of Wistar strain, weighing between 200 and 250 g were divided into 3 groups of 20 animals each: control group (GC); untreated group without treatment (IC) and infarcted group treated with pyridostigmine (IP). Acute myocardial infarction (AMI) was obtained with the technique of ligation of the left coronary artery, and the IP group received pyridostigmine dose of 40 mg/Kg/day in drinking water starting 4 days before the AMI. All animals underwent cannulation of the femoral artery on the day following AMI to record the blood pressure curves, and subsequent analysis of the components of heart rate variability (HRV), the time domain (SDNN and RMSSD) and frequency (components LF and HF), the echocardiografic study was performed on the second day after AMI. On the third day post-MI, mice were divided into subgroups of 10 animals, and were sacrificed in order to collet specific materials: 500 ul of fresh peripheral blood and spleen technique for performing flow cytometry left ventricle for measurement of cytokine ELISA, and the left ventricle to perform immunohistochemistry. Techniques used were standardized and commonly used in laboraties. The results were evaluated by analysis of variance (ANOVA) multifactorial, using the GraphPad Prism with Tukey post hoc test...
