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PURPOSE: The purpose of this study is to assess whether the Dunning-Kruger effect occurs in surgical residents when performing laparoscopic cholecystectomy in a porcine model. METHODS: Prospective blinded study, which counted with forty PGY-1 general surgery residents who agreed to participate in the study were blindly recruited to perform a laparoscopic cholecystectomy in a porcine model. At the end of the procedure, the participants assigned a score of 0-10 for their own performance and the video of the operation was independently assessed by 2 experienced laparoscopic surgeons using a validated tool. RESULTS: Participants were divided into groups of 10 individuals according to objective performance and compared. The group with the worst objective result was inferior to the group with the best objective result (3.77 ± 0.44 vs. 8.1 ± 0.44, p < 0.001), but they were similar in self-perception of performance (5.11 ± 1.69 vs. 6.1 ± 1.79, p = 0.999). CONCLUSIONS: In the studied sample, it was possible to demonstrate the presence of the Dunning-Kruger effect.
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Colecistectomia Laparoscópica , Competência Clínica , Internato e Residência , Colecistectomia Laparoscópica/educação , Internato e Residência/estatística & dados numéricos , Estudos Prospectivos , Competência Clínica/estatística & dados numéricos , Animais , Humanos , Suínos , Masculino , Feminino , Cirurgia Geral/educação , Adulto , Método Simples-Cego , Modelos AnimaisRESUMO
Bovine Dewclaw Dermatitis (BDCD) is a hoof disease characterized by inflammation of the second and fifth accessory digits and the skin in this region. This pathology is poorly described in the literature; however, it has recently been observed in beef cattle in the Amazon Biome, Brazil. The objective of this study was to perform a clinical diagnosis and identify the risk factors associated with BDCD onset in cattle in the studied biome. Samples were collected from eight farms with extensive breeding systems located in Xinguara, Rondon do Pará, Curionópolis, and Ipixuna do Pará in the state of Pará, Brazil. A total of 706 Nellore and Nellore crossbred with taurine bovine of both sexes were evaluated, with males aged between 2 and 4 years and a mean weight of 650 kg, and females aged between 2 and 11 years and a mean weight of 400 kg. Distal extremities were inspected during cattle management, and in cases of dewclaw lesions, a specific examination was carried out after proper restraint. Cattle were diagnosed with BDCD on all farms analyzed. Of the 706 cattle inspected, 49 (6.94%) showed BDCD, of which 19 (38.77%) were Nellore and 30 (61.22%) were crossbred. This was the first study to determine BDCD's occurrence in extensive farming systems in the Amazon region, also showing that pastures with large amounts of stumps and stones, the physical structure of pens, and trauma and injury incidence during animal management are the most important predisposing factors for the onset of BDCD.
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This is the first report of parasitic granulomatous dermatitis caused by Pelodera spp. in a buffalo. The affected buffalo was about seven years old, was a female of the Murrah breed and belonged to a property located on Marajó Island in the State of Pará. During the clinical examination, the animal was in a standing position and presented several multifocal nodular and placoid masses throughout the body, mostly on the forelimbs, hindlimbs, abdomen, mammary glands, perineum, vulva and tail. These masses were also observed on the nasal mucosa, head, neck, back and chest. On macroscopic examination, the skin had several multifocal-to-coalescent sessile nodular and placoid lesions. Histopathology of the skin showed a marked reduction in the number of hair follicles. In the superficial dermis, there was significant multifocal-to-coalescent inflammatory infiltration, consisting of macrophages, epithelioid macrophages, lymphocytes, plasma cells and multinucleated giant cells. In the remaining hair follicles, there were numerous cross and longitudinal sections of small rhabditoid nematodes characterized by a thin cuticle, platymyarian musculature, an intestinal tract, a rhabditiform esophagus and lateral alae (morphologically compatible with Pelodera spp.). The diagnosis of parasitic dermatitis was confirmed by histopathological skin lesions associated with the presence of intralesional rhabditiform larvae morphologically compatible with Pelodera spp.
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An allergy to bites from Culicoides (Diptera: Ceratopogonidae) occurs because of a hypersensitivity reaction caused by the inoculation of insect salivary antigens during the bite, resulting in immune-mediated dermatitis. To the best of our knowledge, no previous studies have focused on allergic dermatitis in donkeys in Brazil. Therefore, this study aimed to describe the epidemiological, clinicopathological, and therapeutic aspects of allergic dermatitis in donkeys and to identify the insects involved in its epidemiology. This study reported the occurrence of dermatitis in 17 animals. The clinical signs were restlessness and severe itching. Skin lesions were found on the head, depigmented areas of the muzzle and cheeks, flanks, pelvic and thoracic limbs, and the scrotal sac. The lesions were characterized by areas of alopecia with crusts accompanied by serosanguineous exudates. Histologically, the lesions were characterized as moderate superficial dermatitis with irregular epidermal acanthosis and pronounced diffuse orthokeratotic hyperkeratosis. In total, 378 Culicoides specimens were collected, with Culicoides ocumarensis Ortiz being the most abundant species. The combined application of copaiba oil and a multivitamin emulsion exhibited potential for topical treatment of allergic dermatitis caused by insect bites in donkeys. Our study revealed an association between allergic dermatitis in donkeys and Culicoides.
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This study evaluates a new multiport device with single access to the abdominal cavity produced with routine hospital supplies that could be applied to laparoscopically assisted cryptorchidectomy in standing horses. Initially, the new device was evaluated on five cadavers of bovine fetuses (n = 5), placed assisted in a minilaparotomy performed in the flank region. Subsequently, the device was evaluated in four cryptorchid horses treated during the hospital routine. During the evaluation of the new device, the possibilities of exploring the abdominal cavity, inspection, and intra-abdominal manipulation with two Babcock forceps were verified. The possibilities were described, and surgical time data were recorded and analyzed using descriptive statistics. In the cadavers, a wide exploration of the abdominal cavity was possible, with a laparoscopic inspection through the right paralumbar fossa and manipulation of intra-abdominal structures with Babcock forceps inserted by the new device. In cryptorchid horses, laparoscopically assisted cryptorchidectomy with a new device was feasible in two patients, and in the others, it allowed the diagnosis of adhesions and ectopic locations in the inguinal region of testicles retained in the cavity. Therefore, the new device was efficient in exploring the inguinal region of cryptorchid horses in the standing position. The present study is preliminary and can support future studies that aim to improve the developed prototype.
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Purpose: The purpose of this study is to assess whether the Dunning-Kruger effect occurs in surgical residents when performing laparoscopic cholecystectomy in a porcine model. Methods: Prospective blinded study, which counted with forty PGY-1 general surgery residents who agreed to participate in the study were blindly recruited to perform a laparoscopic cholecystectomy in a porcine model. At the end of the procedure, the participants assigned a score of 0-10 for their own performance and the video of the operation was independently assessed by 2 experienced laparoscopic surgeons using a validated tool. Results: Participants were divided into groups of 10 individuals according to objective performance and compared. The group with the worst objective result was inferior to the group with the best objective result (3.77 ± 0.44 vs. 8.1 ± 0.44, p < 0.001), but they were similar in self-perception of performance (5.11 ± 1.69 vs. 6.1 ± 1.79, p = 0.999). Conclusions: In the studied sample, it was possible to demonstrate the presence of the Dunning-Kruger effect.
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Humanos , Cirurgia Geral , Colecistectomia Laparoscópica , Educação , Corpo Clínico HospitalarRESUMO
Melanomas are tumors arising from externally uncontrolled melanocytes that produce varying amounts of melanin. In this study, we report a case of melanoma with neurological impairment without evidence of cutaneous neoplastic lesions in an adult buffalo in the state of Pará, Brazil. Clinically, the buffalo exhibited apathy, decreased mandibular tone, and occasionally an open mouth with motor incoordination, and eventually succumbed to the condition. Necropsy revealed multifocal tumor masses in the brain, pituitary gland, trigeminal ganglion, and spinal cord. The neoplastic cells showed strong positive signals for vimentin, Melan-A, PNL-2, and SOX10. The diagnosis was made via necropsy, histopathology, and positive immunostaining for Melan-A and PNL-2, which are specific markers for melanocyte identification.
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This study aims to describe the clinical signs and ultrasonographic and necropsy findings of the first cases of proximal (Buffalo 1) and distal (Buffalo 2) vagal indigestion in two Bubalus bubalis in the Brazilian Amazon biome. The clinical histories of the buffaloes were characterized by progressive weight loss, recurrent tympany, abdominal distention (apple and pear shapes), anorexia, and scant feces. Buffalo 1 was submitted to orogastric intubation, and due to the recurrent tympany, an exploratory laparotomy. Buffalo 2 was submitted to ultrasound examination, and a segment of the pylorus was shown to be adhered to the eventration by ultrasonography. Both animals produced positive results for the atropine test. In the necropsy evaluation, Buffalo 1 was shown to have dilation of the esophagus, rumen, and reticulum; the ruminal contents of animal 1 were olive green and foamy with bubbles within the ingesta. On the other hand, Buffalo 2 was shown to have distention of the forestomach and abomasum; the complex rumen-reticulum and omasum contents were semi-liquid and had a yellowish color. In animal 2, in the eventration region, there was adherence to the pyloric region. The diagnosis of vagal indigestion was based on the history, clinical signs, and ultrasound and necropsy findings, in addition to the results of the atropine test.
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PURPOSE: To evaluate the estimated pulmonary arterial systolic pressure (PASP) through transthoracic echocardiography in hemodialysis (HD) patients and associate it with cardiorespiratory fitness and pulmonary function. METHODS: This study was a cross-sectional analysis of HD patients that performed evaluations of cardiac function, cardiorespiratory fitness, and pulmonary function, through transthoracic echocardiography, cardiopulmonary exercise test, spirometry, and manovacuometry, respectively. All patients underwent the evaluations on a non-dialysis day. RESULTS: Thirty-five HD patients were evaluated and separated according to the presence of probable pulmonary hypertension (PH) (estimated PASP ≥ 35 mmHg) or not (estimated PASP < 35 mmHg). Those HD patients with probable PH had the worst cardiorespiratory fitness, evaluated by the peak oxygen consumption (VO2peak) (17.11 ± 4.40 versus 12.90 ± 2.73 mL/kg/min; p = 0.011), and pulmonary function, evaluated by absolute and predicted of forced vital capacity (FVC) (85.52 ± 12.29 versus 71.38 ± 11.63%; p = 0.005) and absolute and predicted of forced expiratory volume in the first second (FEV1) (83.37 ± 14.98 versus 69.21 ± 13.48%; p = 0.017). The secondary analysis showed that estimated PASP was correlated with VO2peak (r = - 0.508; p = 0.002), FVC (r = - 0.450; p = 0.007), and FEV1 (r = - 0.361; p = 0.033). Moreover, the adjusted odds ratio by HD vintage, dry weight and gender showed that increments in VO2peak (OR 1.62; CI 95% 1.04-2.54; p = 0.034), FVC (OR 39.67; CI 95% 1.74-902.80; p = 0.021), and FEV1 (OR 39.54; CI 95% 1.89-826.99; p = 0.018) were associated with 1-fold and 39-fold higher chance, respectively, for not having PH. However, all these associations were lost when age was included in the analysis. CONCLUSIONS: The HD patients with probable PH had the worst cardiorespiratory fitness and pulmonary function. Exploratory analyses showed that greater cardiopulmonary fitness was associated with better cardiac function. Moreover, increments in cardiorespiratory fitness and pulmonary function may increase the chance of not having PH.
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Aptidão Cardiorrespiratória , Hipertensão Pulmonar , Humanos , Artéria Pulmonar , Pressão Sanguínea , Estudos Transversais , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Diálise Renal/efeitos adversosRESUMO
Background: Caudal vena cava thrombosis (CVCT) is a serious disease that affects cattle. Due to being commonly a fatal pathology, it causes economic losses for producers and national livestock. Thus, the present study describes the epidemiological, clinical, ultrasonographic imaging and pathological findings in 4 cattle with CVCT attended at the Veterinary Hospital (HV) of the Institute of Veterinary Medicine (IMV) of the Federal University of Pará (UFPA). Cases: The animals were crossbreds of the Gir x Holstein and Jersey x Holstein breeds, aged between 4 and 8 years old, raised in semi-extensive and intensive systems. The main clinical signs were pale mucous membranes, reluctance to move, markedly positive venous pulse, engorged jugular with positive stasis test, and serous to mucopurulent nasal exudation. The auscultation of the lung fields revealed tachypnea, silent areas, wheezing, and pleural friction, in addition to coughing, expiratory dyspnea, mouth breathing, and expiratory grunts. One animal had severe hemoptysis. The ultrasound examination performed on a bovine revealed a circular and dilated caudal vena cava in cross-section. Laboratory tests in 3 cattle revealed anemia, leukocytosis with neutrophil left shift, and increased liver enzymes. At necropsy, all cattle had thrombi in the hepatic segment of the caudal vena cava. In the lung, multiple abscesses and areas of parenchymal consolidation, crateriform areas, as well as thrombi in the arteries were observed. Pleural effusion and ascites were seen in all cattle. Clotted blood was seen in the trachea, bronchi, and on rumen contents of an animal. Histopathological alterations seen in the liver were centrilobular hepatocytes with frequent intensely eosinophilic cytoplasm, and pyknotic, karyorrhexic, or absent nuclei and cell borders barely distinguishable. In the lung were nodular and random formations, with a thick wall of mature connective tissue and a central area full of cellular debris, necrotic cells, and intact and degenerated neutrophils (abscesses). Discussion: The set of diagnostic tools that include epidemiology, clinical signs and clinical examinations, ultrasound, necropsy, and histopathology were efficient in the diagnosis of CVCT. The possible causes that led the animals to develop CVCT were diffuse septic pododermatitis in the medial nail of the right pelvic limb associated with traumatic reticuloabomasitis and liver abscesses. In 1 cow, it was not possible to establish the probable cause of CVCT, but for the other cattle in the present study, the probable causes are in agreement with studies that have shown that this disease can occur as a sequel to several septic conditions such as jugular phlebitis, mastitis, hoof rot, enteritis, pneumonia, traumatic reticulopericarditis, acidosis and rumen laminitis, as well as omphalophlebitis in calves. The tachypnea, serous to purulent nasal exudation, pulmonary wheezing, pleural friction, coughing, and expiratory dyspnea, usually with open mouth breathing and expiratory grunts evidenced in the animals of this study, occurred as a result of embolic abscess pneumonia. The presence of multiple lung abscesses, areas of parenchymal consolidation, crateriform foci, and thrombi in the pulmonary arteries and chronic suppurative pneumonia, found at necropsy of the animals in the present study, are related to the development of a thrombus in the caudal vena cava that detaches and embolizes and lodges in the pulmonary arteries. The histopathological findings in 1 cow are compatible with lesions found at necropsy and draw attention to embolic pneumonia and liver lesions, which, are related to thrombi in pulmonary arteries and abscesses formed from CVCT, as well as venous stasis exerted in the return circulation.
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Animais , Bovinos , Cauda/patologia , Vasos Sanguíneos/diagnóstico por imagem , Trombose Venosa/veterináriaRESUMO
Background: The peroneus tertius muscle is responsible for tarsal flexion and coordinate extension of the stifle joint. The most common causes of rupture are excessive effort when trying to rise on a slippery surface, mounting, or being mounted. Rupture of the peroneus tertius muscle is characterized by an inability to flex the hock. Most cases are not curable, presenting an unfavorable to poor prognosis, and the animal has to be euthanized. This study aimed to report the clinical picture and treatment of a bilateral rupture of the peroneus tertius muscle in a cow from the municipality of Castanhal, state of Pará (Amazonian biome). Case: We report the clinical picture and treatment of a bilateral rupture of the peroneus tertius muscle in a 4-year-old cow, mixed breed, weighing approximately 400 kg, calved 3 months ago, belonging to a batch of 40 cattle kept on extensive breeding system in a pasture of Urochloa (Brachiaria) brizantha. The clinical signs appeared after the cow was mounted by a 1,100 kg bull and consisted of lameness, falling into sternal decubitus with hind limbs extended backward, hyperextension of the hocks with flexed stifle, with the tibia and metatarsus in a straight line, which lead to a 90-degree position of the femur and knee. Abrasions in the dorsal region of the fetlocks reinforce evidence of dragging hooves. Diagnosis of bilateral rupture of the peroneus tertius muscle was performed by a clinical examination and semiological test. Nonsteroidal anti-inflammatory drugs (flunixin meglumine, 2,2 mg/kg, every 24 h for 4 days) were prescribed for treatment, in addition to resting in a paddock with good availability of pasture, water, and mineral salt. After 3 months, we observed an improvement of the clinical signs, and after 6 months, an almost complete recovery. Only a slight difficulty in flexing the hock when moving remained. Discussion: In the present report, bull mounting was the probable cause of the hyperextension of both hocks and the bilateral rupture of the peroneus tertius muscle. According to the handler, these clinical signs were only evidenced after the animal was mounted. As stated in the literature, accidents such as falls, slips, mounting or being mounted, as well as excessive traction and over-elevation of the limb are considered predisposing factors for the onset of the disease. Rupture of the peroneus tertius muscle is unusual in production animals; therefore, the low occurrence of reports on this kind of rupture in the literature makes this case even more unique. The bilateral injury differs from cases described in the literature, in which the reported injuries were always unilateral. Our findings reinforce the hypothesis that the act of mounting was the triggering factor for the bilateral rupture of the animal peroneus tertius muscle. The breeding system also differs from the cases diagnosed by the same authors, since they describe the disease in bovines kept on intensive or semi-intensive breeding. In the present case, the cattle were kept on an extensive breeding system. The extension and flexion tests used in the clinical examination allowed for the diagnosis of rupture of the peroneus tertius muscle in both limbs, similarly to what has been reported by other authors. Anamnesis, clinical findings, and exclusion of different diagnoses were decisive for establishing the diagnosis. The treatment chosen was efficient, even though the case was severe, as the injury occurred in both hind limbs.
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Animais , Feminino , Bovinos , Ruptura/veterinária , Músculo Esquelético/lesões , Claudicação Intermitente/veterinária , Traumatismos da Perna/veterináriaRESUMO
This study was conducted to evaluate the effects of two methods of provision of açai seed (AS) as a fiber source (coarsely broken or whole) for feedlot beef cattle on the intake, digestibility, and ruminal parameters. Four bulls (male, non-castrated, and rumen fistulated), with an average body weight of 340 ± 31 kg, distributed in two simultaneous 2 × 2 Latin squares, were used. The treatments were two methods of processing of the açai seed, as follows: whole açai seed (WAS), and coarsely broken açai seed (CBAS). The dry matter (DM), crude protein (CP), and neutral detergent fiber (NDF) intake were higher (P < 0.10) with the use of CBAS. The digestibility of DM and nutrients was not affected (P > 0.10) by AS processing. Acetate and total volatile fatty acids concentrations, and acetate:propionate ratio were higher with the CBAS diet, whereas the pH was higher with the WAS diet. The concentrations of propionate, butyrate, and ruminal ammonia nitrogen (NH3) did not change with AS processing. Thus, coarsely broken açai seed increases the intake of DM and nutrients without altering the digestibility. Furthermore, it increases the concentrations of total fatty acids and acetate.
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Fibras na Dieta , Rúmen , Ração Animal/análise , Animais , Bovinos , Dieta/veterinária , Fibras na Dieta/metabolismo , Digestão , Fermentação , Masculino , Propionatos/metabolismo , Rúmen/metabolismo , Sementes/químicaRESUMO
BACKGROUND: Chronic kidney disease (CKD) is a factor that predisposes to gradual physical deconditioning from its early stages leading to cardiorespiratory fitness and musculoskeletal system impairment. We evaluated the effects of combined and periodized intradialytic exercise training on cardiopulmonary fitness and respiratory function in HD subjects. METHODS: A randomized controlled trial with HD subjects was allocated into two groups: exercise group (EXG) and usual care group (UCG). EXG performed a 12-week combined and periodized intradialytic training. UCG maintained the HD routine. RESULTS: Thirty-nine HD subjects were analyzed (EXG = 20; UCG = 19). The EXG in comparison with the UCG showed improvements in peak oxygen consumption (Δ3.1[0.4-5.5] vs. -0.2[-2.0-1.5] ml/kg/min; p = 0.003), forced expiratory volume in the first second (Δ0.1[-0.0-0.1] vs. -0.0[-0.1-0.0] L; p = 0.022), forced vital capacity (Δ0.1[0.0-0.2] vs. -0.1[-0.2-0.0] L; p = 0.005), peak expiratory flow (Δ0.4[-0.7-1.2] vs. -0.1[-0.5-0.2] L; p = 0.046), and maximal inspiratory pressure (Δ7.35[-8.5-17.5] vs. -4.0[-18.0-12.0] cmH2 O; p = 0.028). The EXG, different from the UCG, did not worsen the maximal expiratory pressure (Δ0.1[-8.8-7.5] vs. -2.5[-15.0-9.0] cmH2 O; p = 0.036). Besides, EXG showed a significant improvement in quadriceps strength (32.05 ± 10.61 vs. 33.35 ± 11.62 kg; p = 0.042). CONCLUSIONS: The combined and periodized intradialytic exercise training improved cardiopulmonary fitness, respiratory function, inspiratory muscle strength, and quadriceps strength, beyond maintaining the expiratory muscle strength in HD subjects.
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Força Muscular , Diálise Renal , Exercício Físico , Volume Expiratório Forçado , Humanos , Força Muscular/fisiologia , Diálise Renal/efeitos adversos , Testes de Função RespiratóriaRESUMO
Post-thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT). Residual vein thrombus (RVT) on Doppler Ultrasound can be associated with PTS. Limited data are available on the effect of direct oral anticoagulants (DOACs) on the long-term outcome of PTS. This study aimed to compare the prevalence of PTS and RVT, in patients with previous DVT treated with rivaroxaban or enoxaparin/warfarin. A total of 129 patients with previous proximal lower limb DVT and treated with rivaroxaban (nâ¯=â¯71) or enoxaparin/warfarin (nâ¯=â¯58) for at least 3â¯months were included. The Villalta scale for PTS was performed after treatment. The median duration of the DVT symptoms before anticoagulation was 7â¯days for both groups. The rate of PTS was 50.7% in the patients treated with rivaroxaban and 69% in the enoxaparin/warfarin group. Enoxaparin/warfarin showed an increased prevalence of PTS (Pâ¯=â¯.018). An analysis in 3 different models showed that the relative risk of PTS decreased by 76% with rivaroxaban use when compared with enoxaparin/warfarin treatment. In addition, 93 of the 129 patients were evaluated regarding the presence of RVT, of which, 11 (24.4%) and 31 (64.6%) presented with RVT for rivaroxaban and enoxaparin/warfarin, respectively (Pâ¯<â¯.0001). The RVT analysis excluded the possibility of RVT as a mediator of the association between type of treatment and PTS when comparing rivaroxaban with enoxaparin/warfarin (odds ratio (OR)â¯=â¯0.14; 95% confidence interval (CI): 0.1-1.0, Pâ¯=â¯.051) with rivaroxaban compared with enoxaparin/warfarin. Rivaroxaban treatment was associated with a lower risk of PTS when compared to enoxaparin/warfarin; RVT however, was not a mediator in the association between PTS and type of treatment.
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Anticoagulantes/uso terapêutico , Enoxaparina/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Síndrome Pós-Trombótica/epidemiologia , Rivaroxabana/uso terapêutico , Trombose Venosa/tratamento farmacológico , Varfarina/uso terapêutico , Adulto , Anticoagulantes/efeitos adversos , Brasil/epidemiologia , Estudos Transversais , Enoxaparina/efeitos adversos , Inibidores do Fator Xa/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/diagnóstico , Prevalência , Estudos Retrospectivos , Fatores de Risco , Rivaroxabana/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Varfarina/efeitos adversosRESUMO
Patients with chronic kidney disease show poorer functional and cardiorespiratory capacity than healthy individuals, and these impairments result in sedentarism. The aim of this study was to conduct a systematic review and meta-analysis of randomized clinical trials on the effects of different intradialytic exercise protocols on cardiopulmonary capacity in chronic kidney disease patients. The primary outcome was peak oxygen consumption (VO2peak) and the secondary outcomes were exercise duration and ventilation in the cardiopulmonary test. The quality of the evidence was evaluated using the GRADE guidelines. Seven studies with a total of 124 participants met the inclusion criteria. Compared to the non-exercise group, the exercise group improved in mean VO2peak (MD 4.06 [IC 0.81; 7.31]). In a separate analysis according to exercise modality, aerobic exercise plus strength training performed better than aerobic exercise alone (MD 5.28 [IC 3.90; 6.66]). In the exercise group, both exercise tolerance values (MD 3.10 [IC 1.70; 4.51]) and ventilation values in the cardiopulmonary test were better than those of the control group (MD 13.10 [IC 7.12; 19.09]). Thus, intradialytic exercise protocols can improve cardiopulmonary function, exercise tolerance and ventilatory efficiency in chronic kidney disease patients.
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Aptidão Cardiorrespiratória/fisiologia , Terapia por Exercício/métodos , Diálise Renal , Insuficiência Renal Crônica/terapia , Tolerância ao Exercício/fisiologia , Humanos , Consumo de Oxigênio/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Renal Crônica/complicações , Resultado do TratamentoRESUMO
Abstract Objectives: The aims of the study were to determine the frequency of hepatobiliary disease in patients with cystic fibrosis and to describe the sociodemographic, clinical, and laboratory profile of these patients. Methods: This was a retrospective, descriptive, and analytical study of 55 patients diagnosed with cystic fibrosis, aged between 3 months and 21 years, followed-up from January 2008 to June 2016 in a referral center. Medical records were consulted and sociodemographic, clinical and laboratory data, including hepatobiliary alterations, imaging studies, genetic studies, liver biopsies, and upper digestive endoscopies were registered. Results: Hepatobiliary disease was diagnosed in 16.4% of the patients and occurred as an initial manifestation of cystic fibrosis in 55.6% of these cases. The diagnosis of hepatopathy occurred before or concomitantly with the diagnosis of cystic fibrosis in 88.9% of the children. All patients with hepatobiliary disease were considered non-white, with a predominance of females (77.8%) and median (IQR) of 54 (27-91) months. Compared with the group without hepatobiliary disease, children with liver disease had a higher frequency of severe mutations identified in the CFTR gene (77.8% vs. 39.6%, p = 0.033) and severe pancreatic insufficiency (88.9% vs. 31.6%, p = 0.007). Conclusion: The frequency of hepatobiliary disease was high, with a very early diagnosis of the disease and its complications in the studied series. A statistical association was observed between the occurrence of hepatobiliary disease and the presence of pancreatic insufficiency and severe mutations in the CFTR gene. It is emphasized that cystic fibrosis is an important differential diagnosis of liver diseases in childhood.
Resumo Objetivos: Os objetivos do estudo foram determinar a frequência da doença hepatobiliar em pacientes com fibrose cística e descrever o perfil sociodemográfico, clínico e laboratorial destes. Métodos: Estudo retrospectivo, descritivo e analítico de 55 pacientes com diagnóstico de fibrose cística, entre três meses e 21 anos, acompanhados de janeiro de 2008 a junho de 2016 em um centro de referência. Foi realizada consulta aos prontuários médicos, registrando-se os dados sociodemográficos, clínicos e laboratoriais, incluindo-se alterações hepatobiliares, exames de imagem, estudos genéticos, biópsias hepáticas e endoscopias digestivas altas. Resultados: A doença hepatobiliar foi diagnosticada em 16,4% dos pacientes e ocorreu como manifestação inicial da fibrose cística em 55,6% destes casos. O diagnóstico da hepatopatia ocorreu antes ou concomitante ao diagnóstico da fibrose cística em 88,9% das crianças. Todos os pacientes com doença hepatobiliar foram considerados não brancos, havendo predominância do sexo feminino (77,8%) e mediana (I.I.Q) de idade de 54 (27-91) meses. Em comparação com o grupo sem doença hepatobiliar, as crianças com hepatopatia tiveram maior frequência de mutações graves no gene CFTR identificadas (77,8% vs 39,6%; p = 0,033) e de insuficiência pancreática grave (88,9% vs 31,6%; p = 0,007). Conclusão: A frequência de doença hepatobiliar foi elevada, observando-se um diagnóstico muito precoce da mesma e de suas complicações na casuística estudada. Houve associação estatística entre a ocorrência de doença hepatobiliar e a presença de insuficiência pancreática e de mutações graves do gene CFTR. Enfatiza-se que a fibrose cística represente um importante diagnóstico diferencial de hepatopatias na infância.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Insuficiência Pancreática Exócrina/etiologia , Fibrose Cística/complicações , Hepatopatias/etiologia , Mutação/genética , Insuficiência Pancreática Exócrina/genética , Fatores Socioeconômicos , Estudos Retrospectivos , Fibrose Cística/genética , Genótipo , Hepatopatias/genéticaRESUMO
OBJECTIVES: The aims of the study were to determine the frequency of hepatobiliary disease in patients with cystic fibrosis and to describe the sociodemographic, clinical, and laboratory profile of these patients. METHODS: This was a retrospective, descriptive, and analytical study of 55 patients diagnosed with cystic fibrosis, aged between 3 months and 21 years, followed-up from January 2008 to June 2016 in a referral center. Medical records were consulted and sociodemographic, clinical and laboratory data, including hepatobiliary alterations, imaging studies, genetic studies, liver biopsies, and upper digestive endoscopies were registered. RESULTS: Hepatobiliary disease was diagnosed in 16.4% of the patients and occurred as an initial manifestation of cystic fibrosis in 55.6% of these cases. The diagnosis of hepatopathy occurred before or concomitantly with the diagnosis of cystic fibrosis in 88.9% of the children. All patients with hepatobiliary disease were considered non-white, with a predominance of females (77.8%) and median (IQR) of 54 (27-91) months. Compared with the group without hepatobiliary disease, children with liver disease had a higher frequency of severe mutations identified in the CFTR gene (77.8% vs. 39.6%, p=0.033) and severe pancreatic insufficiency (88.9% vs. 31.6%, p=0.007). CONCLUSION: The frequency of hepatobiliary disease was high, with a very early diagnosis of the disease and its complications in the studied series. A statistical association was observed between the occurrence of hepatobiliary disease and the presence of pancreatic insufficiency and severe mutations in the CFTR gene. It is emphasized that cystic fibrosis is an important differential diagnosis of liver diseases in childhood.
Assuntos
Fibrose Cística/complicações , Insuficiência Pancreática Exócrina/etiologia , Hepatopatias/etiologia , Mutação/genética , Adolescente , Criança , Pré-Escolar , Fibrose Cística/genética , Insuficiência Pancreática Exócrina/genética , Feminino , Genótipo , Humanos , Hepatopatias/genética , Masculino , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
BACKGROUND: Hematological changes can drive damage of endothelial cells, which potentially lead to an early endothelial dysfunction in patients with sickle cell anemia (SCA). An association may exist between endothelial dysfunction and several clinical manifestations of SCA. The present study aims to evaluate the links between changes in endothelial function and clinical and laboratory parameters in children and adolescents with SCA. METHODS: This study included 40 children and adolescents with stable SCA as well as 25 healthy children; aged 6-18 years. All study subjects were evaluated for endothelial function using Doppler ultrasonography. In addition, a number of laboratory assays were performed, including reticulocyte and leukocyte counts as well as measurement of circulating levels of total bilirubin, C-reactive protein (CRP), glucose, lipoproteins and peripheral oxyhemoglobin saturation. These parameters were also compared between SCA patients who were undertaking hydroxyurea (HU) and those who were not. RESULTS: Flow-mediated vasodilation (FMD) values were found to be reduced in SCA patients compared with those detected in healthy controls. SCA individuals with lower FMD values exhibited higher number of hospital admissions due to vaso-occlusive events. Additional analyses revealed that patients who had decreased FMD values exhibited higher odds of acute chest syndrome (ACS) episodes. A preliminary analysis with limited number of individuals failed to demonstrate significant differences in FMD values between SCA individuals who were treated with HU and those who were not. CONCLUSIONS: Children and adolescents with SCA exhibit impaired endothelial function. Reductions in FMD values are associated with ACS. These findings underline the potential use of FMD as screening strategy of SCA patients with severe prognosis at early stages.
Assuntos
Anemia Falciforme/sangue , Anemia Falciforme/complicações , Endotélio Vascular/fisiopatologia , Doenças Vasculares/sangue , Doenças Vasculares/complicações , Adolescente , Antidrepanocíticos/uso terapêutico , Bilirrubina/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Criança , Células Endoteliais/patologia , Feminino , Glucose/análise , Humanos , Hidroxiureia/uso terapêutico , Contagem de Leucócitos , Lipoproteínas/sangue , Masculino , Oxiemoglobinas/análise , Reticulócitos/citologia , Ultrassonografia Doppler , Doenças Vasculares/diagnóstico por imagemRESUMO
A thermostable variant of the mesophilic xylanase A from Bacillus subtilis (BsXynA-G3_4x) contains the four mutations Gln7His, Gly13Arg, Ser22Pro, and Ser179Cys. The crystal structure of the BsXynA-G3_4x has been solved, and the local environments around each of these positions investigated by molecular dynamics (MD) simulations at 328K and 348K. The structural and MD simulation results were correlated with thermodynamic data of the wild-type enzyme, the 4 single mutants and the BsXynA-G3_4x. This analysis suggests that the overall stabilizing effect is entropic, and is consistent with solvation of charged residues and reduction of main-chain flexibility. Furthermore, increased protein-protein hydrogen bonding and hydrophobic interactions also contribute to stabilize the BsXynA-G3_4x. The study revealed that a combination of several factors is responsible for increased thermostability of the BsXynA-G3_4x; (i) introduction of backbone rigidity in regions of high flexibility, (ii) solvation effects and (iii) hydrophobic contacts.