Impacto de la rehabilitación pulmonar en pacientes con enfermedad pulmonar restrictiva / Impact of pulmonary rehabilitation in patients with restrictive pulmonary disease

Introducción: Las enfermedades pulmonares restrictivas presentan alteraciones en la mecánica toracopulmonar, reducción de la capacidad funcional y de la función pulmonar. Se pueden encontrar las alteraciones intrínsecas y extrínsecas donde se ven alterados el intersticio, la expansibilidad torácica e incluso afecciones del parénquima pulmonar. La rehabilitación pulmonar podría beneficiar a pacientes con la condición restrictiva y mejorar su condición funcional. Objetivo Establecer el impacto de la rehabilitación pulmonar en pacientes con compromiso respiratorio restrictivo intrínseco y extrínseco en la disnea, capacidad funcional, ansiedad/depresión y calidad de vida relacionada con la salud. Métodos Estudio descriptivo longitudinal con 50 pacientes con enfermedad pulmonar restrictiva y quienes realizaron rehabilitación pulmonar en una clínica de la ciudad de Cali, Colombia. Los participantes vinculados al estudio fueron separados en dos grupos: el primero con enfermedad restrictiva intrapulmonar (ERI) y el segundo grupo con enfermedad restrictiva extrapulmonar (ERE). Resultados La edad media de los pacientes fue de 53,3años. Entre las enfermedades restrictivas intrapulmonares se presentaron: enfermedad intersticial pulmonar difusa (EPID), postcondición de neumonías o síndrome de dificultad respiratoria aguda (SDRA) y secuelas de tuberculosis pulmonar. Y entre las enfermedades respiratorias extrapulmonares: resección pulmonar, resección de lóbulo pulmonar y resección en cuña. Al finalizar la rehabilitación pulmonar el grupo ERI presentó mejorías estadísticamente significativas en la distancia recorrida, consumo de oxígeno estimado (VO2e), disnea, ansiedad y calidad de vida. El grupo ERE presentó incremento significativo en la distancia recorrida y VO2e (AU)

Introduction: Restrictive lung diseases present alterations in thoracic-pulmonary mechanics, reduced functional capacity and lung function. Intrinsic and extrinsic alterations can be found where the interstitium, thoracic expandability and even lung parenchymal conditions are altered. Pulmonary rehabilitation could benefit patients with the restrictive condition and improve their functional condition. Objective Establish the impact of pulmonary rehabilitation in patients with intrinsic and extrinsic restrictive respiratory compromise on dyspnea, functional capacity, anxiety/depression and health-related quality of life. Methods Longitudinal descriptive study with 50 patients with restrictive lung disease who performed pulmonary rehabilitation in a clinic in the city of Cali, Colombia. The participants linked to the study were separated into two groups, the first with intrapulmonary restrictive disease (IRD) and the second group with extrapulmonary restrictive disease (ERD). Results The mean age of the patients was 53.3years. Among the restrictive intrapulmonary diseases there were: diffuse interstitial lung disease (ILD), post-condition pneumonia and/or acute respiratory distress syndrome (ARDS) and sequelae of pulmonary tuberculosis. Extrapulmonary respiratory diseases: lung resection, pulmonary lobe resection, and wedge resection. At the end of pulmonary rehabilitation, the IRD group presented statistically significant improvements in distance covered, estimated oxygen consumption (VO2e), dyspnea, anxiety, and quality of life. The ERD group presented a significant increase in the distance traveled and VO2e. Conclusion Patients with restrictive lung disease improve the distance traveled, VO2e, dyspnea, anxiety and quality of life; patients with extrapulmonary respiratory disease show improvements in functional capacity (AU)

BRCA1 expression in canine mammary dysplasias and tumours: relationship with prognostic variables.

BRCA1 is a nuclear phosphoprotein that participates in the regulation of the cell cycle. The role of the BRCA1 gene in canine mammary tissue and mammary tumours has not been studied. The present study examined immunohistochemically the expression and intracellular distribution of BRCA1 protein in two normal, seven dysplastic and 44 neoplastic canine mammary glands and its relationship with clinical and pathological variables and other prognostic parameters. Strong nuclear immunolabelling of BRCA1 protein was observed in the epithelial cells of the normal mammary glands and mammary dysplasias. The majority of benign tumours, and more especially of malignant tumours, showed a significant reduction in the nuclear expression of BRCA1 protein and an increase in cytoplasmic expression. Loss of BRCA1 expression was associated with high proliferation marker Ki-67 and ER-alpha negative tumours. The reduction and aberrant distribution of BRCA1 in canine mammary tumours were significantly associated with malignant characteristics. The results may indicate that BRCA1 has a role in the malignant behaviour of these tumours.

Factors influencing the incidence and prognosis of canine mammary tumours.

Factors relating to the incidence of canine mammary tumours are reviewed. Increased age, intact status or ovariectomy after 2.5 years of age, as well as progestagen treatment, can all lead to an increased risk of mammary neoplasia in the bitch. In addition, obesity early in life, and a habitual diet based on home-made food (rich in beef and pork, and poor in chicken) as opposed to commercial food, are also associated with the occurrence of mammary tumours. Other aspects related to incidence are also discussed. Increased age at diagnosis, invasive growth (fixed to adjacent tissues), large tumour size, ulceration of skin, and axillary or inguinal node involvement are clinical parameters associated with a low chance of survival after surgical excision of mammary tumours. Histological typing and grading of the tumour allows the establishment of a prognosis, which is poor where there is tumour proliferation as measured by S-phase fraction determination and Ki-67 immunostaining.

[Lack of air conditioning and mycotoxin poisoning are basic co-factors in tropical spastic paraparesis]. / La falta de refrigeración y la intoxicación por micotoxinas son cofactores fundamentales en la paraparesia espástica tropical.

INTRODUCTION: Chronic idiopathic spastic paraparesis (CHISPA) have been associated to HTLV-I virus infection, and unknown environmental factors have been suggested to play a role in its pathogenesis. METHOD: Based in our previous studies we wanted to know if the lack of refrigerators and the mycotoxin contamination of food might have any relationship with the presence of CHISPA in patients living at southeastern Colombia. RESULTS: Interestingly only four out of 15 patients with CHISPA had some method of refrigeration, in, 14 out of these 15 patients at least a metabolite of Fusarium was detected. CONCLUSIONS: The fact that mycotoxins found in the urine samples of these patients are immunosuppressors and demyelinating allow us to suggest that these toxins could be the most important environmental cofactors leading to the susceptible people to the clinically established disease.

Effects of losartan on the treatment of posttransplant erythrocytosis.

Erythrocytosis is a relatively common complication of renal transplantation. Recent observations indicate that angiotensin-converting enzyme inhibitors correct renal transplant erythrocytosis. Other drugs to inhibit the renin-angiotensin system have been developed recently. The newest of these is losartan, a specific antagonist of the angiotensin II type I receptor. We report three patients in which the use of losartan controlled posttransplant erythrocytosis. Our findings suggest that losartan can be effective and safe in the treatment of posttransplant erythrocytosis.

Hemodialysis urea rebound and membrane biocompatibility: accuracy of Kt/V estimations.

To date, the magnitude, causes, and factors that govern urea rebound are not clearly defined. This study was undertaken to determine the possible influence of the biocompatibility of dialyzer membrane on urea rebound and to assess the participation of rebound in the calculation of Kt/V-urea by different methods. Blood urea samples were obtained before, and at 2, 30, and 60 min posthemodialysis in 8 patients undergoing dialysis with 2 different membranes, Cuprophan and polyacrylonitrile (24 sessions with each membrane). Urea rebound was documented in all patients. The degree of rebound was large, 20%, and it was achieved within 30 min after the end of dialysis. Urea rebound was observed with both Cuprophan and polyacrylonitrile membranes, without significant differences. Kt/V-urea significantly decreased (p < 0.001) by all methods when urea rebound was incorporated. We conclude that urea rebound is clinically very important and is not influenced by the biocompatibility of the dialyzer membrane. This phenomenon must be taken into account in the calculation of Kt/V; otherwise, it might be overestimated.

Effects of angiotensin-converting enzyme inhibitors on anemia and erythropoietin requirements in peritoneal dialysis patients.

In an attempt to assess the effect of angiotensin-converting enzyme inhibitors (ACEIs) on anemia and recombinant human erythropoietin (rHuEPO) requirements in peritoneal dialysis patients, we evaluated 5 patients treated with ACEIs for one year, and the results were compared with data from a control group (N = 5). In response to ACEIs, the mean hemoglobin value decreased progressively, reaching statistical significance after 6 months and thereafter (basal, 10.7 +/- 0.8; month 6, 10.3 +/- 0.9; month 12, 10.3 +/- 0.5 g/dL, p < 0.05), with no variations in the control group. The rHuEPO requirements experienced a progressive increase in ACEI-treated patients, from 4400 +/- 1516 U/week at basal to 8600 +/- 2880 U/week at the conclusion of the study (p < 0.01). Serum erythropoietin concentration remained stable during the study in both groups of patients. In conclusion, rHuEPO requirements necessary to maintain a stable hemoglobin concentration are greater in subjects under ACEI therapy. ACEI may be an important cause of resistance to rHuEPO, an effect not mediated by a decrease in endogenous erythropoietin.