ABSTRACT
OBJECTIVE: This study aimed to determine the effects of inspiratory muscle training (IMT) on exercise capacity, respiratory muscle strength, length of hospital stay (LOS), and quality of life (QOL) following coronary artery bypass graft surgery. METHODS: The search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook and included the databases MEDLINE, EMBASE, CINAHL, Scopus, and CENTRAL. The review included randomized controlled trials utilizing IMT during phase 1 or 2 postoperative cardiac rehabilitation (PoCR) versus alternative treatment (active or passive control) in patients following coronary artery bypass graft surgery. RESULTS: Fifteen studies were included (11 phase 1 studies, 4 phase 2 studies) with no reported adverse events. In phase 1 PoCR, IMT reduced the LOS (-1.02 days; 95% CI = -2.00 to -0.03) and increased exercise capacity (6-minute walk distance) (+75.46 m; 95% CI = 52.34 to 98.57), and maximal inspiratory pressure (MIP) (10.46 cm H2O; 95% CI = 2.83 to 18.10), but had no effect on maximal expiratory pressure. In phase 2 PoCR, IMT increased 6-minute walk distance (45.84 m; 95% CI = 10.89 to 80.80), MIP (-23.19 cm H2O; 95% CI = -31.31 to -15), maximal expiratory pressure (20.18 cm H2O; 95% CI = 9.60 to 30.76), and QOL (-11.17; 95% CI = -17.98 to -4.36), with no effect on peak oxygen uptake. There was a high risk of bias for MIP (75% of the phase 1 studies) and 6MWT (1 of 4 phase 2 studies). The quality of the evidence ranged from very low to moderate. CONCLUSION: IMT significantly improves exercise capacity, respiratory muscle strength, LOS, and QOL in phase 1 and 2 PoCR. IMPACT: IMT may benefit patients during phase 1 and 2 of PoCR, considering the safety, low cost, and potential benefits.
Subject(s)
Breathing Exercises , Cardiac Rehabilitation , Coronary Artery Bypass , Length of Stay , Muscle Strength , Quality of Life , Respiratory Muscles , Humans , Coronary Artery Bypass/rehabilitation , Breathing Exercises/methods , Cardiac Rehabilitation/methods , Respiratory Muscles/physiopathology , Respiratory Muscles/physiology , Length of Stay/statistics & numerical data , Muscle Strength/physiology , Exercise Tolerance/physiology , Randomized Controlled Trials as TopicABSTRACT
BACKGROUND: Recent open-label trials show that psychedelics, such as ayahuasca, hold promise as fast-onset antidepressants in treatment-resistant depression. METHODS: To test the antidepressant effects of ayahuasca, we conducted a parallel-arm, double-blind randomized placebo-controlled trial in 29 patients with treatment-resistant depression. Patients received a single dose of either ayahuasca or placebo. We assessed changes in depression severity with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating scale at baseline, and at 1 (D1), 2 (D2), and 7 (D7) days after dosing. RESULTS: We observed significant antidepressant effects of ayahuasca when compared with placebo at all-time points. MADRS scores were significantly lower in the ayahuasca group compared with placebo at D1 and D2 (p = 0.04), and at D7 (p < 0.0001). Between-group effect sizes increased from D1 to D7 (D1: Cohen's d = 0.84; D2: Cohen's d = 0.84; D7: Cohen's d = 1.49). Response rates were high for both groups at D1 and D2, and significantly higher in the ayahuasca group at D7 (64% v. 27%; p = 0.04). Remission rate showed a trend toward significance at D7 (36% v. 7%, p = 0.054). CONCLUSIONS: To our knowledge, this is the first controlled trial to test a psychedelic substance in treatment-resistant depression. Overall, this study brings new evidence supporting the safety and therapeutic value of ayahuasca, dosed within an appropriate setting, to help treat depression. This study is registered at http://clinicaltrials.gov (NCT02914769).
Subject(s)
Antidepressive Agents/therapeutic use , Banisteriopsis , Depressive Disorder, Treatment-Resistant/drug therapy , Hallucinogens/therapeutic use , Phytotherapy/methods , Adult , Double-Blind Method , Female , Humans , Male , Psychiatric Status Rating Scales , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: There is growing evidence pointing to an involvement of cytokines and growth factors in renal osteodystrophy. In this study, the expression of interleukin-l beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), transforming growth factor-beta (TGF-beta), and basic fibroblast growth factor (bFGF) in bone biopsies taken from uremic patients before and 1 year after parathyroidectomy (PTX) was evaluated. Biochemical features and histomorphometric outcome were also studied. METHODS: Iliac bone biopsies were taken before and 1 year after PTX in nine uremic patients with severe hyperparathyroidism (HPT). Immunohistochemical techniques were used to identify the expression of IL-1 beta, TNF-alpha, TGF-beta, and bFGF in these bone samples. RESULTS: At the time of the second bone biopsy, the mean serum total alkaline phosphatase activity was normal, whereas mean serum intact parathyroid hormone (iPTH) level was slightly above the upper limit of normal values. Histomorphometric analysis showed a decrease in resorption parameters and static bone formation parameters after PTX. Dynamically, mineral apposition rate (MAR) and mineralization surface (MS/BS) decreased significantly. There was a marked local expression of IL-1beta, TNF-alpha, TGF-beta, and bFGF in bone biopsies before PTX, particularly in fibrous tissue and resorption areas. One year after PTX, IL-1beta decreased from 23.6 +/- 7.5% to 9.9 +/- 3.1%, TNF-alpha from 4.5 +/- 1.5% to 0.7 +/- 0.8%, TGF-beta from 49.6 +/- 9.8% to 15.2 +/- 4.6%, and bFGF from 50.9 +/- 12.7% to 12.9 +/- 7.9% (P < 0.001). A significant correlation was documented between cytokines and growth factors expression in bone with iPTH levels before and after PTX (P < 0.05). CONCLUSIONS: Based on these results, we suggest that IL-1beta, TNF-alpha, TGF-beta, and bFGF are involved in bone remodeling regulation, acting as local effectors, possibly under the control of PTH.
Subject(s)
Chronic Kidney Disease-Mineral and Bone Disorder/metabolism , Fibroblast Growth Factor 2/metabolism , Interleukin-1/metabolism , Parathyroidectomy , Transforming Growth Factor beta/metabolism , Tumor Necrosis Factor-alpha/metabolism , Adolescent , Adult , Biopsy , Bone and Bones/metabolism , Bone and Bones/pathology , Chronic Kidney Disease-Mineral and Bone Disorder/pathology , Chronic Kidney Disease-Mineral and Bone Disorder/surgery , Female , Humans , Immunohistochemistry , Male , Middle Aged , Uremia/metabolism , Uremia/pathologyABSTRACT
Retinoblastoma é o tumor ocular mais freqüente da infância. Suas características à apresentação em serviços especializados podem depender do tempo que medeia entrte seu reconhecimento e o início de seu tratamento. Este trabalho objetiva avaliar esta hipótese e verificar a distribuição quanto à lateralidade e idade de aparecimento de uma amostra brasileira de portadores de retinoblastoma. Material e método: foram revisados de 451 prontuários do Hospital A. C. Camargo do período de janeiro de 1975 até dezembro de 1995. A análise foi feita com uma ficha clínica que continha a identificação e dados oftalmológicos. Resultados: eram 279 unilaterais e 172 bilaterais. Dos 451 casos e, 214 (47,5 por cento) tiveram o primeiro sinal antes de um ano de idade, metade destes era bilateral. Dentre os casos reconhecidos após a idade de um ano, 27,8 por cento eram bilaterais. Chamamos de intervalo de tempo o tempo decorrido entre a observação do primeiro sinal e a admissão. Com relação ao estadiamento, no intervalo de tempo de até 1 ano os tumores extra-oculares são 28,3 por cento, depois dos 12 meses os extra-oculares são 57,4 por cento do total. Conclusão: aproximadamente metade (47,5 por cento) dos retinoblastomas foi observada pelos pais nos primeiros 12 meses de vida da criança. Os bilaterais se concentraram no período de até 1 ano de idade; com o aumento da idade de aparecimento, passam a predominar os unilaterais. O aumento do intervalo de tempo entre a observação de um sinal ocular e o início do tratamento aumentou a possibilidade de doença extra-ocular. Considerados os anos calendários de admissão, observou-se aumento na média anual de encaminhamentos a partir de 1986 e uma discreta tendência de maior precocidade no diagnóstico a partir do período iniciado nesse mesmo ano. Correlações entre os dados são discutidas.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adult , Eye Neoplasms , Retinoblastoma , BrazilABSTRACT
Trata-se de estudo multicêntrico visando levantar as necessidades de saúde da populaçäo de idosos residentes em zona urbana, conduzido em 6 países na América Latina e coordenado pela Organizaçäo Panamericana da Saúde. No Brasil, 1.602 idosos (60 anos e +) residentes no Distrito de Säo Paulo, participaram de inquérito domiciliar com questionário de avaliaçäo funcional multidimensional - amostra populacional aleatória, em múltiplos estágios, estratificada por nível socioeconômico. Os resultados mostraram uma populaçäo bastante carente (70 por cento tinha uma renda per capita de menos de 100 dólares por mês), vivendo predominantemente em domicílios multigeracionais (59 por cento viviam com os filhos e/ou com netos), com alta prevalência de doenças crônicas (somente 14 por cento referiu näo ter nenhuma doença) e distúrbios psiquiátricos (27 por cento foram considerados casos psiquiátricos), e com uma elevada proporçäo de pessoas com perda de autonomia (47 por cento precisavam de ajuda para realizar pelo menos uma das atividades da vida diária). Os resultados säo analisados tendo em vista as demandas futuras por serviços de saúde especializados e suporte por parte da crescente populaçäo de idosos no Brasil