Sildenafil improves microvascular O-2 delivery-to-utilization matching and accelerates exercise O-2 uptake kinetics in chronic heart failure

Sperandio PA, Oliveira MF, Rodrigues MK, Berton DC, Treptow E, Nery LE, Almeida DR, Neder JA. Sildenafil improves microvascular O-2 delivery-to-utilization matching and accelerates exercise O-2 uptake kinetics in chronic heart failure. Am J Physiol Heart Circ Physiol 303: H1474-H1480, 2012. First published September 28, 2012; doi:10.1152/ajpheart.00435.2012.-Nitric oxide (NO) can temporally and spatially match microvascular oxygen (O-2) delivery (QO(2mv)) to O-2 uptake (VO2) in the skeletal muscle, a crucial adjustment-to-exercise tolerance that is impaired in chronic heart failure (CHF). To investigate the effects of NO bioavailability induced by sildenafil intake on muscle QO(2mv)-to-O-2 utilization matching and VO2 kinetics, 10 males with CHF (ejection fraction = 27 +/- 6%) undertook constant work-rate exercise (70-80% peak). Breath-by-breath VO2, fractional O-2 extraction in the vastus lateralis {similar to deoxy-genated hemoglobin + myoglobin ([deoxy-Hb + Mb]) by near-infrared spectroscopy}, and cardiac output (CO) were evaluated after sildenafil (50 mg) or placebo. Sildenafil increased exercise tolerance compared with placebo by similar to 20%, an effect that was related to faster on-and off-exercise VO2 kinetics (P 0.05). On-exercise [deoxy-Hb + Mb] kinetics were slowed by sildenafil (similar to 25%), and a subsequent response overshoot (n = 8) was significantly lessened or even abolished. in contrast, [deoxy-Hb + Mb] recovery was faster with sildenafil (similar to 15%). Improvements in muscle oxygenation with sildenafil were related to faster on-exercise VO2 kinetics, blunted oscillations in ventilation (n = 9), and greater exercise capacity (P < 0.05). Sildenafil intake enhanced intramuscular QO(2mv)-to-VO2 matching with beneficial effects on VO2 kinetics and exercise tolerance in CHF. the lack of effect on CO suggests that improvement in blood flow to and within skeletal muscles underlies these effects.Universidade Federal de São Paulo, Dept Med, Div Resp Dis, Pulm Funct & Clin Exercise Physiol Unit, BR-04020050 São Paulo, BrazilQueens Univ, Dept Med, Div Resp & Crit Care Med, Kingston, ON K7L 3N6, CanadaUniversidade Federal de São Paulo, Dept Med, Div Cardiol, BR-04020050 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Resp Dis, Pulm Funct & Clin Exercise Physiol Unit, BR-04020050 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Cardiol, BR-04020050 São Paulo, BrazilWeb of Scienc

The use of portable monitoring for sleep apnea diagnosis in adults

Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea (OSA). the implementation of alternative approaches to the current management by full polysomnography (PSG) in the sleep laboratory is necessary for diagnosing this syndrome due to the high cost of full-night PSG. A good alternative option for OSA diagnosis is portable monitoring (PM), which is known for its accuracy, ease of management and lower cost when compared with full PSG. PM has not been well validated for OSA diagnosis in patients with medical comorbidities or in elderly individuals and children. PM may be recommended as an alternative method to PSG for patients with high clinical risk for OSA. in the present review, we describe the use of PM for OSA diagnosis and evaluate the current progress, costs, limitations and applications of these devices in various groups of patients, particularly for patients with comorbid diseases.Universidade Federal de São Paulo, Dept Med, Disciplina Pneumol, BR-04039002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psicobiol, Disciplina Med & Biol Sono, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Disciplina Pneumol, BR-04039002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psicobiol, Disciplina Med & Biol Sono, BR-04024002 São Paulo, BrazilWeb of Scienc

Doença mental, mulheres e transformação social: um perfil evolutivo institucional de 1931 a 2000 Mental health, women and social change: a progressive institutional profile from 1931 to 2000

INTRODUÇÃO: No século XX, as mulheres vivenciaram inúmeras transformações e alcançaram uma participação mais ativa na sociedade.O estudo visa descrever o perfil da clientela feminina, admitida em um serviço de internação psiquiátrica com as transformações históricas, sociais e demográficas.Oferece um retrato comparativo das condições epidemológicas existentes no decorrer da série histórica e os aspectos do meio da condição sociocultural das mulheres do estado. MATERIAIS E MÉTODOS: Estudo epidemiológico descritivo, longitudinal, tipo série histórica de dados, baseado na coleta de dados efetuada no serviço de arquivo médico e de estatísticas de um hospital. Foram analisadas as seguintes variáveis: idade, estado civil, cor, setor profissional, ocupação, classe social e diagnóstico psiquiátrico, todos padronizados conforme os critérios da Classificação Internacional de Doenças, edições 9 e 10. Para identificação dos casos, utilizaram-se todas as primeiras internações de mulheres. RESULTADOS: No decorrer de 70 anos, obteve-se um total de 9.629 indivíduos/casos. Observou-se o predomínio de mulheres na faixa etária de 26 a 45 anos (47,9%), brancas (91,3%), pertencentes ao subproletariado (86,8%), fora da população economicamente ativa (96,7%) e com diagnóstico de transtornos afetivos (28,6%) e psicoses esquizofrênicas (25,2%). Quanto ao estado civil, verificou-se maior presença de mulheres casadas (44,9%). Todavia, na década de 90, as mulheres solteiras representaram 54,4%, enquanto que as casadas perfizeram 39,7% das pacientes. CONCLUSÃO: Foram detectadas mudanças significativas nos motivos para admissão de mulheres nos últimos anos. Sugere-se que as variações tenham sido influenciadas pelos determinantes biológicos das doenças mentais graves e, também de maneira significativa, pelas pressões sociais advindas do novo papel da mulher na sociedade.<br>INTRODUCTION: Along the 20th century, women underwent numerous changes and reached a more active participation in society. This study aims at describing the profile of the female patients admitted to a service of psychiatric hospitalization from May 1931 to December 2000. In addition, it relates the profile of psychiatric morbidity with the historical, social and demographic changes. It also offers a comparison between the epidemiological conditions throughout the historical series and the aspects regarding the environment and the sociocultural status of women from a Southern Brazilian state. MATERIALS AND METHODS: Descriptive, longitudinal, epidemiological study including historical data and based on data collected from the medical files and statistics of a hospital. The following variables were assessed: age, marital status, race, professional area, occupation, social class and psychiatric diagnosis, all standardized according to the International Classification of Diseases (ICD-9 and ICD-10) criteria. To identify the cases, all first hospitalizations of women were used. RESULTS: Along 70 years, a total of 9,629 individuals/cases was obtained. There was a predominance of women in the age group between 26-45 years (47.9%), white (91.3%), belonging to the subproletariat (86.8%), not belonging to the economically active part of the population (96.7%) and with diagnosis of affective disorders (28.6%) and schizophrenic psychoses (25.2%). With regard to marital status, married women were prevalent (44.9%). However, in the 1990's, single women represented 54.4%, whereas married women accounted for 39.7% of the patients. CONCLUSION: Significant changes were detected in the reasons for admitting women to psychiatric services over the past years. It is suggested that the variations might have been influenced by biological determinants of severe mental diseases, and especially by the social pressure resulting from the new role of women in society

Exacerbação aguda da DPOC: mortalidade e estado funcional dois anos após a alta da UTI Patients admitted to the ICU for acute exacerbation of COPD: two-year mortality and functional status

OBJETIVO: Determinar a taxa de mortalidade de pacientes com DPOC e avaliar o estado funcional dos sobreviventes dois anos após a alta da UTI. MÉTODOS: Estudo de coorte prospectiva realizada nas UTIs de dois hospitais na cidade de Porto Alegre (RS) com pacientes com exacerbação aguda de DPOC e internados em UTI entre julho de 2005 e julho de 2006. Dois anos após a alta, os sobreviventes foram entrevistados via telefone. Os dados obtidos foram utilizados na determinação dos escores da escala de Karnofsky e de uma escala de atividades de vida diária (AVD). RESULTADOS: Foram incluídos 231 pacientes. A mortalidade hospitalar foi de 37,7% e a mortalidade extra-hospitalar foi de 30,3%. Dos 74 sobreviventes, foram entrevistados 66 (89%). A média de idade dos pacientes no momento da internação na UTI era de 74 ± 10 anos e a do escore Acute Physiology and Chronic Health Evaluation II era de 18 ± 7. Tinham duas ou mais comorbidades 87,8% dos pacientes. Dos 66 entrevistados, 57 (86,3%) viviam em suas casas, 58 (87,8%) eram capazes de realizar seu autocuidado, 12 (18,1%) utilizavam oxigenoterapia, e 4 (6,1%) necessitavam suporte ventilatório. Houve uma significante redução na qualidade de vida e na autonomia, segundo os escores da escala de Karnofsky (85 ± 9 vs. 79 ± 11; p = 0,03) e de AVD (29 ± 5 vs. 25 ± 7; p = 0,01), respectivamente. CONCLUSÕES: A mortalidade desta amostra de pacientes foi muito elevada nos primeiros dois anos. Embora houvesse evidente redução do estado funcional dos sobreviventes, os mesmos preservaram a capacidade de realizar seu autocuidado<br>OBJECTIVE: To assess ICU patients with COPD, in terms of in-hospital characteristics, two-year mortality and two-year functional status of survivors. METHODS: A prospective cohort study involving patients with acute exacerbation of COPD admitted to the ICUs of two hospitals in the city of Porto Alegre, Brazil, between July of 2005 and July of 2006. At two years after discharge, survivors were interviewed by telephone in order to determine Karnofsky scores and scores on a scale regarding activities of daily living (ADL). RESULTS: The sample comprised 231 patients. In-hospital mortality was 37.7%, and two-year post-discharge mortality was 30.3%. Of the 74 survivors, 66 were interviewed (89%). The mean age at ICU admission was 74 ± 10 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 18 ± 7. Two or more comorbidities were present in 87.8% of the patients. Of the 66 interviewees, 57 (86.3%) lived at home, 58 (87.8%) were self-sufficient, 12 (18.1%) required oxygen therapy, and 4 (6.1%) still required ventilatory support. There was a significant reduction in the quality of life and autonomy of the survivors, as evidenced by the Karnofsky scores (85 ± 9 vs. 79 ± 11, p = 0.03) and ADL scale scores (29 ± 5 vs. 25 ± 7; p = 0.01), respectively. CONCLUSIONS: In this patient sample, two-year mortality was quite high. Although there was a noticeable reduction in the functional status of the survivors, they remained self-sufficien