This paper presents some limitations. First, possible prognostic factors, such as performance status, visceral pleural invasion, and lymphovascular invasion were not available and these fac- tors could have affected data analysis. Second, smoking is a common risk for lung cancer and COPD. When looking at COPD andlung cancer risk, pack years of smoking is critical. Smok- ing is not available inthe NHIRD, TCRD and NDRD. Third, information regarding ethnicity and occupation was not available inthe database. Fourth, the lack of significance between pul- monary diseases and mortality in female patientswith SqCC may be attributable to the rela- tively small sample size. More studies would need to be done before solid conclusions can be drawn for females. Fifth, laboratory findings, including methacholine challenge test results or bronchodilator reversibility on spirometry were not available inthe NHIRD. Some ofthepatients labeled as “asthma + COPD” may have had only COPD or asthma. The accuracy of diagnosis may vary depending onthe health care professionals. Because ofthe privacy rule pro- tecting care providers, it was impossible to verify who (general practitioners or pulmonary spe- cialists) made these diagnoses from the NHIRD. Sixth, adjustments were not made for the dose of inhaled and oral corticosteroid. Further studies are needed to evaluate the dose effect of medications on SqCC mortality.
Chronicobstructivepulmonarydisease (COPD) has a dramatic effect on quality of life. The need to formulate a different set of parameters for peoples was felt because ofthe differences in risk factors, disease prevalence and pattern, and above all, the different overall health-care infrastructure. Moreover a large burden oftuberculosis, which is an important cause of cough, adds to the difficulties of diagnosis and management. Worldwide, COPD ranked as the sixth leading cause of death in 1990. It is projected to be the fourth leading cause of death worldwide by 2030 due to an increase in smoking rates and demographic changes in many countries. When the damage is severe, it may become difficult to get enough oxygen into the blood and to get rid of excess carbon dioxide. These changes lead to shortness of breath and other symptoms. Unfortunately, the symptoms ofchronicobstructivepulmonarydisease cannot be completely eliminated with treatment andthe condition usually worsens over time. However, treatment can control symptoms and can sometime slow the progression ofthedisease. More than 12 million people are currently diagnosed with COPD. An additional 12 million probably have thediseaseand don't know it. COPD has received scant attention in comparison to other respiratory conditions such as asthmaandlung cancer. Respiratory physicians around the world now believe the attitude of little can done for this self inflicted disease is not justifiable. Attempts have been made to redress this deficit withthe recent introduction of guidelines inthe management and care ofpatientswith COPD by both the American Thoracic Society and European Respiratory Society. So this review provides the overall knowledge about the COPD as well as their management.
Since the 1980s, sputum induction by inhala- tion of hypertonic saline has been successfully used for diagnosing Pneumocystis carinii pneu- monia inpatients infected with HIV. In recent years, sputum induction and its subsequent processing has been refined as a noninvasive research tool providing important information about inflammatory events inthe lower airways, and it has been used for studying various ill- nesses. Inasthma, one application is to use spu- tum inflammatory indices to increase our under- standing of complex relationships between in- flammatory cells, mediators, and cytokine mecha- nisms. Inchronicobstructivepulmonarydisease, sputum assessment could be used as a screen- ing test before deciding on long-term corticoster- oid treatment. Intuberculosis, sputum induction is a valuable diagnostic tool for HIV-seropositive patients who do not produce sputum. Sputum induction appears to be a relatively safe, noninvasive means of obtaining airway secre- tions from subjects with cystic fibrosis, especially from those who do not normally produce spu- tum. Moreover, sputum induction can also be used inchronic cough andlung cancer. Gener- ally, induction is performed through ultrasonic nebulizers, using hypertonic saline. It is recom- mended that sputum be processed as soon as possible, with complete homogenization by the use of dithiothreitol. We have also shown in this article an example of a protocol for inducing and processing sputum employing a nebulizer produced in Brazil.
MCKENZIE, D. K.; BUTLER, J. E.; GANDEVIA, S. C. Respiratory muscle function and activation inchronicobstructive pul- monary disease. J Appl Physiol., 107, p. 621-629, 2009. MINOGUCHI, H.; SHIBUYA, M.; MIYAGAWA, T.; KOKUBU, F.; YAMADA, M. TANAKA, H. Cross-over comparison between respiratory muscle stretch gymnastics and inspiratory mus- cle training. Internal Med., 41(10), p. 805-812, 2002. MORAIS, N.; CRUZ, J.; MARQUES, A. Posture and mobility ofthe upper body quadrant andpulmonary function in COPD: and exploratory study. Braz J Phys Ther., 20(4), p. 345-354, 2016.
pulmonary volumes, unlike DB, in which there is a diaphragmatic excursion with abdominal projection. This more restricted respiratory movement in PB did not promote alteration in any respiratory patterns evaluated inthe individuals with COPD inthe present study. Inthe healthy group, however, PB promoted alterations such as an increase inlung volumes, %RCi, and SpO 2 . %RCi has been described as a measure that represents the percent contribution ofthe rib cage excursions to the tidal volume. Thus, because the movement ofthe rib cage is greater inthe healthy subjects, this was probably detected only inthe healthy group. This fact may also explain the alterations in other measures, for example, lung volume and synchronism, due to the fact that the ribcage ofthe healthy group showed no rigidity and thus the movements were greater.
21. Sintonen H, Pekurinen M. A fifteen-dimensional measure of health- related quality of life (15D) and its applications. In: Walker SR, Rosser R, editors. Quality of life assessment: key issues in 1990s. Dordrecht: Kluwer Academic Publishers; 1993. p.185-195. 22. Jones PW, Quirk FH, Baveystock CM, et al. A self-complete meas-
A FC de repouso se mostrou, em média, maior nos grupos de pacientes em relação ao GC, porém tal diferença só foi significativa para o GTMR. Esse aumento da FC de repouso pode estar relacionado ao aumento da atividade simpática ou da FC intrínseca do coração, porém, sabe-se que os valores absolutos de FC não são confiáveis para permitir inferências sobre o comportamento do sistema nervoso autônomo, no controle da FC em repouso (LONGO et al., 1995). Análises mais acuradas, através de coletas da FC batimento a batimento são necessárias para uma avaliação mais segura deste aspecto (European Society of Cardiology/North American Society of Pacing and Electrophysiology, 1996).
Abstract: Mathematical model for theimpactof pressure drop onthe human body has been investigated inthe present studies. The studies has been aimed at personnel (army and mountaineer) who would be prone for higher altitude effect onthe body and to suggest them appropriate measures (as a precautionary or advisory purpose) who either will be getting inducted onto higher altitudes venturing onto higher peaks. The model accounts for heights of altitudes ranging from 4000-6000 meters and accounting for all the possible cardiovascular diseases
Many telemonitoring systems applied to chronic kidney disease are still under development. Inthe following description ofthe devices, only the first device is already onthe market. With all the rest only case studies were done to see if they are effective inthedisease, having all had great success with proven effectiveness. The systems described are EQ Connect™, eNephro and Prototype Device. All systems present the portable advantage, enabling patients to use them aboard. This feature is largely due to the fact that they are web and android applications that receive the specific disease-related data predefined by specialized healthcare professionals through the manual introduction of data by the patient. The measuring process is non-invasive. The results are sent through Wi-Fi to databases to be analysed by specialized health professionals. The device interface to the patient is simple and customizable to the patient inthe EQ Connect™ and eNephro application. The Prototype Device (still in development) is not customizable to the patient [24, 26, 29].
Objective: Making the differential diagnosis between asthmaandchronicobstructivepulmonarydisease (COPD) based onthe response to inhaled bronchodilators by means of spirometry is controversial.The objective of this study was to identify the most useful spirometric variables in order to distinguish between asthmaand COPD. Methods: Retrospective study conducted from April of 2004 to January of 2006, comparing the spirometric parameters of 103 nonsmoking patientswithasthma to those of 108 patientswith COPD who were smokers for more than 10 pack-years. All ofthepatients included inthe study were older than 40 and presented stable disease at the time ofthe test. Results: Initial forced expiratory volume in one second (FEV 1 ) was the same inthe two groups (pre-bronchodilator FEV 1 = 51%). However,
The ST and CT modalities produced significant and similar changes in health-related quality of life inthe pres- ent study. The magnitude ofthe improvements shown inthe present study (SGRQ total change = 11 ± 10 to 13 ± 14%) has been reported by others in Brazilian patients (33). The dyspnea inthe ST group improved significantly, whereas it did not change significantly inthe CT or LGT groups. The between-group difference for the change in dyspnea, however, was not significant. In fact, a recent systematic review of randomized controlled trials compar- ing different exercise programs for COPD showed that ST produced greater improvements inthe dyspnea domain andinthe total score oftheChronic Respiratory Disease Questionnaire when compared to endurance training (8). The 6-min walking distance andthe endurance time were higher inthe ST and CT groups, in agreement with other reports (5,28). Inthe present study, the mean in- crease inthe 6-min distance walked was less than 54 m. However, for some ofthepatients, the absolute value was greater than 54 m (54.4% inthe ST, 36.4% inthe CT, and 30.8% inthe LGT). Mador et al. (29) reported similar results inpatients submitted to a combined exercise pro- gram (strength and aerobic exercises). Moreover, Spruit et al. (28) and Ortega et al. (5) also showed an improvement in endurance time in COPD patients after an exercise Table 4.
The appropriate selection ofpatients who will benefit most from NACT is crucial. Our pres- ent findings indicate that young patientswith an earlier FIGO stage and SCC showed a more favorable response than older patients. Young responders also had a better prognosis than young non-responders and older patientswith stage IIA-IIB disease, while no difference was found between responders and non-responders among the older patients. These findings indi- cated that the OS of young patients was more strongly affected by NACT than was that of older patients. Our findings also suggested that NACT non-responders were unsuitable for NACT, especially among the young patients. However, no effective method is currently available to identify non-responders before NACT is performed. Additional studies are required to identify markers for the response to NACT. Future clinical studies should take age-related effects into consideration. Age-related effects may be helpful to predict which patients are likely to benefit from NACT and to avoid delaying the administration of effective treatment inpatients who are unlikely to respond. Due to the limitations of retrospective studies, the neoadjuvant chemo- therapy regimens before surgery andthe treatments after surgery were varied. More detailed information that could be used to direct the choice of treatment regimens should be collected. Additional studies are required to validate the results ofthe present study.
Results: In 43 patients, 25 had successful weaning (58.1%). Patientswith high APACHE II score prior to intu- bation was found as associated with weaning failure. High Glasgow coma scale (GCS) scores before entubation and weaning are associated with weaning success. Pre- weaning anxiety, positive endotracheal aspirate culture, pulmonary arterial pressure value, enteral feeding, pre- weaning tachycardia, pre-weaning cuff leaking and FiO 2 values were found to be associated with weaning failure. Pre-weaning cortisol levels were associated with wean- ing success. In successful weaning group, measured NIF and VT in spontaneous mode were found as higher and f/VT ratio was lower compared with unsuccessful group. T-tube during the 15 th and 30 th minutes ofthe symptoms
Inthe present study, however, neither BMI nor FFMI correlated significantly with SGRQ or AQ20 scores. This is in agreement with a study showing no relationship be- tween AQ20 scores and BMI (3). However, significant correlations between body composition attributes and SGRQ have been found inpatientswith COPD (9,10). Assessing 50 patientswith COPD, Shoup et al. (9) showed that underweight patients presented higher scores (indi- cating lower quality of life) inthe activity andimpact do- mains ofthe SGRQ, as well as higher total SGRQ scores, than did patients presenting normal body weight. The authors showed that low FFM was also associated with greater impairment of quality of life. However, when dysp- nea was added to the model, neither weight nor FFM remained significantly related to quality of life. A recent study assessing 49 normal-weight and 34 underweight COPD patients showed that scores in all SGRQ domains, as well as total SGRQ scores, were significantly higher inthe underweight group; in addition, BMI correlated signifi- cantly with all SGRQ scores except the SGRQ symptom score (10). However, stepwise multiple regression analy- sis used to identify variables that predict SGRQ total score showed that dyspnea assessed by OCD was the greatest contributing factor to the total SGRQ score (10).
nize debilitated functional status by gauging the degree of physical limitation in everyday tasks: walking, talking, dressing, climbing stairs, mak- ing the bed, washing dishes, shopping, eating or having sex. Seriously-ill Señor Ignacio plants him- self onthe sofa and shuffles back-and-forth be- tween the bedroom and bathroom. It is a strenu- ous task to even raise his spoon heaped with food from plate to mouth!: “Lately, I’m too fatigued. I get tired holding the spoon up to my mouth for so long! Everything I eat must be mashed. I can’t even eat!” COPD transfigured this gregarious man in- to a bitter scrooge. Oxygen-dependent (1L/min; 17hours/daily), Señor Manolo, 62, gauges disease severity onthe basis of a radical change in his normal lifestyle. He now struggles to overcome physical limitations: “I can’t lead a normal life, I can’t do 90% ofthe things I used to do… making the bed, washing dishes, mopping the floors. It’s tiring. I get so exhausted when I reach the top ofthe stairwell. I must quickly open the window to get some air to keep from suffocating. My daugh- ter must give me oxygen!” Señor Miguel Angel, 72, a successful businessman suffers severe COPD (FEV 1 = 34.1%pred). While working diligently at
O HPV é constituído por uma cadeia dupla de DNA contendo 8000 pares de bases cobertas por um capsídeo não envolvente que se divide em 3 regiões. A primeira região trata-se da Early Region, que corresponde a 45% do genoma viral e aos genes E1, E2, E3, E4, E5, E6 e E7. Alguns destes genes são responsáveis pela regulação e transformação celular. A segunda região trata-se da Late Region, correspondendo a 40% do DNA viral e aos genes L1 e L2, que codificam proteínas do capsídeo viral. A última região, Third Region LCR ou Long Control Region é responsável pela regulação das funções celulares. Este vírus possui uma variação nos genes E6 e E7 levando a que existam mais de 120 subtipos de HPV, que são classificados consoante o seu potencial oncogénico. Os subtipos 16 e 18 são os que apresentam maior risco oncogénico. (Fernández, Marshall and Esguep, 2014) (Tabela 2) (Ver Figura 6 e Tabela 3, presente nos Anexos)
Healthcare costs (J) inthe follow-up were analysed from the perspective ofthe Italian National Health Service. Costs were quantified using charges, i.e. the amount of money the health system reimbursed to providers of care. Healthcare resources were divided into three main cost categories: hospitalizations, prescrip- tions of drugs and outpatient claims. For each category, the cost of resources connected to the management of COPD was highlight- ed. Hospital discharges were divided into hospitalizations for E- COPD and for other reasons. Prescriptions were divided into: antibiotics or corticosteroids used inthe treatment of exacerba- tions, drugs for obstructive airway diseases, cardiovascular, and other treatments. Outpatient use of resources was split into three categories: diagnostic tests usually performed in COPD patients (pulmonary function tests, respiratory pattern examinations, 6- minute walking test, chest computed tomography or radiography, C-reactive protein and sputum examination), all the other diagnostic tests, and check-ups and general visits. A further detailed analysis was performed onpulmonary function tests, including: spirometry andlung volumes, body plethysmography, diffusion capacity, bronchial provocation, and reversibility testing.
The statistical analysis ofthe collected data was performed withthe Statistical Package for the Social Sciences, version 18.0 (SPSS Inc., Chicago, IL, USA). Data were analyzed for normality and homogeneity of variance. The independent sample t-test was used for the comparison between the two groups. Pearson’s correlation test was used for analysis of correlations. For all analyses, the level of significance was set at p < 0.05. Values are expressed as means and standard deviations.
Onthe other hand, in Japan the living donor lobar transplantation (LDLLT) has been practically the only option for most Japanese patients until 2010, when the Japanese Organ Transplant Law was revised, allowing the family ofthe brain dead donors to decide onthe organ donation. Since then, an increasing inthe number of organ donations from brain dead donors has occurred. Nevertheless, Japanese transplant centers have a huge experience with living lobar transplantation. Some ofthe advantages of LDLLT compared to cadaveric lung transplantation include a shorter waiting list time and ischemic time, less primary graft failure and bronchial complications. However, in LDLLT, as only two lobes are implanted, proper size matching between the donor and recipient is crucial, being often inevitable the implantation of small grafts which may lead to high pulmonary artery pressure andlung edema. 35
teste de caminhada de 6 minutos. No entanto, e tendo em conta o nú- mero de doentes que compunham a amostra, procurou-se, por um lado, testar variáveis já citadas na li- teratura como potenciais determi- nantes para a QdV e, por outro, não incluir variáveis que fossem obti- das de forma invasiva ou agressiva para os participantes e que limitas- se a sua participação ou que não fossem passíveis de serem medidas devido a fatores externos aos in- vestigadores. A classe social é exemplo de uma variável que, ape- sar de ser facilmente obtida, não foi incluída pois tem vindo a ser nega-