Cirurgia Bariátrica Em Indivíduos Com Déficits Cognitivos Graves: Relato De Dois Casos

Bariatric surgery has become the gold-standard treatment for refractory morbid obesity. Obesity is frequently associated with certain syndromes that include coexisting cognitive deficits. However, the outcomes from bariatric surgery in this group of individuals remain incompletely determined. CASE REPORT: A 25-year-old male with Prader-Willi syndrome, whose intelligence quotient (IQ) was 54, was admitted with a body mass index (BMI) of 55 kg/m2, associated with glucose intolerance. He underwent the Scopinaro procedure for biliopancreatic diversion, with uneventful postoperative evolution, and presented a 55% loss of excess weight one year after the surgery, with resolution of glucose intolerance, and without any manifestation of protein-calorie malnutrition. A 28-year-old male with Down syndrome, whose IQ was 68, was admitted with BMI of 41.5 kg/m2, associated with hypertension. He underwent Roux-en-Y gastric bypass, with uneventful postoperative evolution. He presented a 90% loss of excess weight one year after the surgery, with resolution of the hypertension. CONCLUSION: Bariatric surgery among individuals with intellectual impairment is a controversial topic. There is a tendency among these individuals to present significant weight loss and comorbidity control, but less than what is observed in the general obese population. The severity of the intellectual impairment may be taken into consideration in the decision-making process regarding the most appropriate surgical technique. Bariatric surgery is feasible and safe among these individuals, but further research is necessary to deepen these observations

Effects of tiotropium and formoterol on dynamic hyperinflation and exercise endurance in COPD

Background: It is currently unclear whether the additive effects of a long-acting beta(2)-agonist (LABA) and the antimuscarinic tiotropium bromide (TIO) on resting lung function are translated into lower operating lung volumes and improved exercise tolerance in patients with chronic obstructive pulmonary disease (COPD).Methods: On a double-blind and cross-over study, 33 patients (FEV(1) = 47.4 +/- 12.9% predicted) were randomly allocated to 2-wk formoterol fumarate 12 mu g twice-daily (FOR) plus TIO 18 mu g once-daily or for plus placebo (PLA). Inspiratory capacity (IC) was obtained on constant-speed treadmill tests to the limit of tolerance (Tlim).Results: FOR-TIO was superior to FOR-PLA in increasing post-treatment FEV(1) and Tlim (1.34 +/- 0.42 L vs. 1.25 +/- 0.39 L and 124 +/- 27% vs. 68 +/- 14%, respectively; p < 0.05). FOR-TIO slowed the rate of decrement in exercise IC compared to FOR-PLA (Delta isotime-rest = -0.27 +/- 0.40 L vs. -0.45 +/- 0.36 L, p < 0.05). in addition, end-expiratory lung volume (% total lung capacity) was further reduced with FOR-TIO (p < 0.05). of note, patients showing greater increases in Tlim with FOR-TIO (16/26, 61.6%) had more severe airways obstruction and lower exercise capacity at baseline. Improvement in Tlim with FOR-TIO was also related to larger increases in FEN(1) (p < 0.05).Conclusions: Compared to for monotherapy, FOR-TIO further improved effort-induced dynamic hyperinflation and exercise endurance in patients with moderate-to-severe COPD. These beneficial consequences were more likely to be found in severely-disabled patients with larger resting functional responses to the combination therapy.Trial registration: Clinicaltrials.gov Identifier: NCT00680056 [ClinicalTrials.gov]. (C) 2010 Elsevier B.V. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Paulista Sch Med UNIFESP EPM, Pulm Funct & Clin Exercise Physiol Unit SEFICE, Resp Div,Dept Med, BR-04020050 São Paulo, BrazilFeevale Univ, Hlth Sci Inst, Novo Hamburgo, BrazilUniversidade Federal de São Paulo, Dept Prevent & Social Med, BR-04020050 São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Sch Med UNIFESP EPM, Pulm Funct & Clin Exercise Physiol Unit SEFICE, Resp Div,Dept Med, BR-04020050 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Prevent & Social Med, BR-04020050 São Paulo, BrazilWeb of Scienc

Chronic adaptations of lung function in breath-hold diving fishermen

Objectives: The aim of this study was to verify and analyze the existence of chronic adaptations of lung function in freediving fishermen whose occupation is artisanal fishing. Material and Methods: This was a cross-sectional study involving 11 breath-hold diving fishermen and 10 non-breath-hold diving fishermen (control) from the village of Bitupitá in the municipality of Barroquinha (Ceará - Brazil). Anthropometric measurements, chest and abdominal circumferences as well as spirometric and respiratory muscle strength tests were conducted according to the specifications of the American Thoracic Society/European Respiratory Society (ATS/ERS). In order to compare the measured values versus the predicted values, Student t test was used in the case of parametric test and Wilcoxon test in the case of nonparametric test. To compare the inter-group means Student t test was used for parametric test and Mann-Whitney test for the nonparametric one. The level of significance was set at α = 5%. Results: The forced vital capacity (FVC) (4.9±0.6 l vs. 4.3±0.4 l) and forced expiratory volume in 1 s (FEV1) (4.0±0.5 l vs. 3.6±0.3 l) were, respectively, higher in the group of divers compared to the control group (p ≤ 0.05). Furthermore, in the group of free divers, the measured FVC, FEV1 and FEV1/FVC ratios were significantly greater than the predicted ones. No differences were found between the measured respiratory pressures. Conclusions: These results indicate that breath-hold diving seems to produce chronic adaptations of the respiratory system, resulting in elevated lung volumes with no airway obstruction

Probiotic yogurt offers higher immune-protection than probiotic whey beverage

AbstractThe probiotics can be useful to improve the immune response in experimental challenges, like the exhausting exercise, that cause immunosuppression. We have evaluated a probiotic yogurt and a probiotic whey beverage using an exhausting physical-exercise protocol with rats. Wistar rats were given a daily 4-mL supplement of each type of conventional or probiotic yogurt and whey beverage, manufactured with lactic culture Streptococcus thermophilus TA040 and Lactobacillus bulgaricus LB340, and probiotic culture Lactobacillus acidophilus LA 14 and Bifidobacterium longum BL 05. The effects on the immune system were compared to those of pair-treated cohorts receiving for 14days. Results demonstrated that the probiotic yogurt outperformed the probiotic whey beverage in blood-cell indicators (neutrophils and lymphocytes), cytokines (TNF-α and IL-1β) and various standard health parameters. In conclusion, in this study, the treadmill exercise assay successfully produced immunosuppression in the rat and the combination of the nutrients and probiotic bacteria of the yogurt reduces more effectively the adverse effects developed over the prolonged strenuous exercise than did a similar probiotic whey beverage