Longitudinal evaluation the pulmonary function of the pre and postoperative periods in the coronary artery bypass graft surgery of patients treated with a physiotherapy protocol

<p>Abstract</p> <p>Background</p> <p>The treatment of coronary artery disease (CAD) seeks to reduce or prevent its complications and decrease morbidity and mortality. For certain subgroups of patients, coronary artery bypass graft surgery (CABG) may accomplish these goals. The objective of this study was to assess the pulmonary function in the CABG postoperative period of patients treated with a physiotherapy protocol.</p> <p>Methods</p> <p>Forty-two volunteers with an average age of 63 ± 2 years were included and separated into three groups: healthy volunteers (n = 09), patients with CAD (n = 9) and patients who underwent CABG (n = 20). Patients from the CABG group received preoperative and postoperative evaluations on days 3, 6, 15 and 30. Patients from the CAD group had evaluations on days 1 and 30 of the study, and the healthy volunteers were evaluated on day 1. Pulmonary function was evaluated by measuring forced vital capacity (FVC), maximum expiratory pressure (MEP) and Maximum inspiratory pressure (MIP).</p> <p>Results</p> <p>After CABG, there was a significant decrease in pulmonary function (p < 0.05), which was the worst on postoperative day 3 and returned to the preoperative baseline on postoperative day 30.</p> <p>Conclusion</p> <p>Pulmonary function decreased after CABG. Pulmonary function was the worst on postoperative day 3 and began to improve on postoperative day 15. Pulmonary function returned to the preoperative baseline on postoperative day 30.</p

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Principles of mineral supplementation in ruminants

Although there is solid knowledge on mineral deficiencies and their consequences on health and productivity of cattle in Brazil, paradoxically, those informations, most of the time, are not used by professionals of the agricultural sciences, who persist in stimulating the widespread use of the so-called complete mineral mixtures. The deficiency of many minerals included in these supplements, as iron, chrome, sulfur, and others, do not occur under natural conditions or only in rare and very particular situations. The present paper deals with the misunderstandings and problems related to traditional mineral supplementation and discusses the main aspects of the so-called selective mineral supplementation that is based in supplying exclusively the deficient mineral(s) and these only in necessary amounts. This procedure can result in expressive economy (sometimes up to 700%) when compared with the commercial mineral supplementation usually employed. According to several estimates, mineral supplementation can account for 20 to 30% of the total cost of beef cattle production on tropical pastures. A reversion assay, in which a group of cattle receives the commercial mineral mixture routinely used on the farm, and another group which receives the selective supplement, is the best option for the elucidation of positive or negative effects between the two possibilities of mineral supplementation on a specific farm. Trough this assay, the effects of the two compositions of mineral supplements can be investigated rationally over a sufficient period of time, with no risks and minimal possibilities of economic losses.Muito embora já haja um sólido conhecimento sobre as deficiências minerais e suas conseqüências para a saúde e a produtividade dos bovinos no Brasil, paradoxalmente, essas informações, na maioria das vezes, não vêm sendo empregadas pelos profissionais das ciências agrárias, que persistem em estimular o uso generalizado das misturas minerais ditas completas. A deficiência de diversos minerais incluídos nestes suplementos, como ferro, cromo, enxofre, entre outros, não ocorre sob condições naturais ou só existe em raras situações muito particulares. O presente tópico aborda os equívocos e problemas relacionados com a suplementação mineral tradicionalmente feita e discute os principais aspectos da denominada suplementação mineral seletiva, que é fundamentada no fornecimento exclusivo do(s) mineral(is) deficiente(s) e na(s) quantidade(s) necessária(s). Essa alternativa pode permitir uma economia expressiva (por vezes, de até 700%) em relação à suplementação mineral comercial normalmente utilizada. De acordo com diversas estimativas, a suplementação mineral pode constituir de 20 a 30 % dos custos totais de produção de gado de corte criados em pastagens, daí a importância de diminuir esses gastos. Um ensaio de reversão, no qual um grupo de animais recebe a mistura mineral comercial rotineiramente utilizada na propriedade e outro grupo, o suplemento seletivo, é a melhor opção para discriminar os efeitos (positivos ou negativos) entre dois esquemas de suplementação mineral para uma específica fazenda. Por esse ensaio, investigam-se, racionalmente e por um longo período, os efeitos das duas opções de suplementação mineral em teste, com mínimo risco de perdas econômicas

Schistosoma mansoni: o efeito da dexametasona na transformação da cercaria em esquistossômulo, in vivo

O tratamento com dexametasona (DMS) nas fases iniciais da infecção experimental com S. mansoni leva a um efeito indireto sobre o processo de transformação da cercária em esquistossômulo, quando camundongos isentos de infecção são tratados com esta droga (50 mg/ kg, subcutâneamente) e, 01 hora depois, são infectados intraperitonealmente com cerca de 500 cercárias de S. mansoni (cepa LE). Foi observada uma significativa redução na adesão de células do hospedeiro às larvas, com um atraso simultâneo no processo de transformação das cercárias em esquistossômulos. Este efeito é, provavelmente, devido a um bloqueio inespecifícico da migração neutrofilica para a cavidade peritoneal, através de um bloqueio da liberação de substâncias quimio-táticas. Tal atraso pode permitir a morte das larvas de S. mansoni (ainda em processo de transformação) pelas defesas do hospedeiro vertebrado, como o sistema do complemento.Treatment with dexamethasone (DMS) in the early phases of the experimental Schistosoma mansoni infection causes an indirect effect on the cercaria-schistosomulum transformation process. This is observed when naive albino mice are treated with that drug (50 mg/Kg, subcutaneously) and infected intraperitonealy 01 hour later with about 500 S. mansoni cercariae (LE strain). An inhibition in the host cell adhesion to the larvae, with a simultaneous delay in the cercaria-schistosomulum transformation, is observed. This effect is probably due to a blockade of the neutrophil migration to the peritoneal cavity of mice, by an impairment of the release of chemotactic substances. Such delay probably favors the killing of S. mansoni larvae, still in the transformation process, by the vertebrate host defenses, as the complement system

Monitoramento da Qualidade da Água e Vazão do Ribeirão das Rosas em Juiz de Fora – MG

Detailed information on the dynamics of surface waters and their problems are important for the management of watersheds and their various uses of water. In this sense, the objective of the study was to evaluate the quality and quantity of water in ribeirão das Rosas, in addition to highlighting the role of the preservation area. Three monitoring points were established for the collection of water along the hydrographic basin. The float method was used to estimate the flow and fifteen water quality parameters were analyzed and later compared with the legislation. Seasonal variability was identified for apparent color, true color and total solids. Among the points, there was a recovery in water quality, mainly in relation to the dissolved oxygen (OD) parameter. The parameters turbidity, DO, ammoniacal nitrogen, iron and phosphorus presented values ​​different from those adopted by Brazilian legislation in more than 50% of the analyzes. In addition, campaigns with higher flow rates showed improvements in the variation values, caused by the dilution. The preservation area proved to be fundamental to improve water quality. However, it is necessary to treat the effluents released in Ribeirão das Rosas.Compreender a dinâmica de corpos d’água e questões pertinentes à gestão de bacias hidrográficas é essencial para atender aos usos múltiplos da água. Nesse contexto, o objetivo do estudo foi analisar a qualidade e quantidade de água no ribeirão das Rosas e mostrar a importância da área de preservação. O ribeirão foi avaliado em três pontos. Para a estimativa da vazão, utilizou-se o método do flutuador, e para a qualidade de água foram analisados quinze parâmetros, posteriormente comparados com as legislações. Identificou-se estatisticamente variabilidade sazonal para os parâmetros de cor aparente, cor verdadeira e sólidos totais. Entre os pontos houve uma notória recuperação da qualidade da água, principalmente em relação ao parâmetro de oxigênio dissolvido (OD). Os parâmetros turbidez, OD, nitrogênio amoniacal, ferro e fósforo apresentaram resultados em desacordo com as concentrações limites estabelecidos pelas legislações em mais de 50% das coletas. Ademais, coletas com maiores valores de vazão possuíam melhora dos valores dos parâmetros, causado pela diluição. Assim, conclui-se que área de preservação se mostrou fundamental para a melhora da qualidade da água. Todavia, se faz necessário o tratamento dos efluentes lançados no ribeirão das Rosas

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Getúlio Vargas como requisito de obtenção do título de Doutor e