Six-minute walk test and respiratory muscle strength in patients with uncontrolled severe asthma: a pilot study

OBJECTIVE: To evaluate respiratory muscle strength and six-minute walk test (6MWT) variables in patients with uncontrolled severe asthma (UCSA). METHODS: This was a cross-sectional study involving UCSA patients followed at a university hospital. The patients underwent 6MWT, spirometry, and measurements of respiratory muscle strength, as well as completing the Asthma Control Test (ACT). The Mann-Whitney test was used in order to analyze 6MWT variables, whereas the Kruskal-Wallis test was used to determine whether there was an association between the use of oral corticosteroids and respiratory muscle strength. RESULTS: We included 25 patients. Mean FEV1 was 58.8 ± 21.8% of predicted, and mean ACT score was 14.0 ± 3.9 points. No significant difference was found between the median six-minute walk distance recorded for the UCSA patients and that predicted for healthy Brazilians (512 m and 534 m, respectively; p = 0.14). During the 6MWT, there was no significant drop in SpO2. Mean MIP and MEP were normal (72.9 ± 15.2% and 67.6 ± 22.2%, respectively). Comparing the patients treated with at least four courses of oral corticosteroids per year and those treated with three or fewer, we found no significant differences in MIP (p = 0.15) or MEP (p = 0.45). CONCLUSIONS: Our findings suggest that UCSA patients are similar to normal subjects in terms of 6MWT variables and respiratory muscle strength. The use of oral corticosteroids has no apparent impact on respiratory muscle strength

Avaliação da qualidade de vida de aposentados com a utilização do questionário SF-36.

OBJETIVO. O aumento da população idosa no Brasil justifica a necessidade de avaliar os aspectos que podem interferir na qualidade de vida de aposentados. MÉTODOS. A versão brasileira do questionário SF-36 foi aplicada em 87 aposentados para avaliação da qualidade de vida. Os resultados obtidos foram associados às características demográficas, socioeconômicas, condições de saúde e estilo de vida e foram estudados por meio de análise uni e multivariada. RESULTADOS. A idade média foi de 57,3 anos (desvio-padrão de 8,9 anos) e tempo médio de aposentadoria foi de 7,1 anos. A aposentadoria foi por invalidez em 55,2% da amostra e 23,4% dos aposentados trabalhavam no momento da pesquisa. Os fumantes somaram 11,5% e 5,7% eram dependentes de álcool. A depressão e hipertensão arterial sistêmica foram as doenças mais prevalentes, e 56,3% dos aposentados praticavam algum tipo de atividade física regularmente. Após a análise multivariada, evidenciou-se melhor qualidade de vida apenas nos aposentados que praticavam atividade física regular ou que tinham alguma atividade de trabalho no momento da pesquisa. CONCLUSÃO. O questionário SF-36 foi um instrumento adequado, de aplicação relativamente rápida e de fácil uso para avaliação da qualidade de vida em aposentados. A qualidade de vida na amostra estudada foi associada ao estilo de vida dos pacientes e aponta para a necessidade de ações que contribuam de forma positiva para melhorar o estilo de vida nesta nova fase da vida

Schistosomiasis Pulmonary Arterial Hypertension.

Pulmonary arterial hypertension (PAH) is a disease of the lung blood vessels that results in right heart failure. PAH is thought to occur in about 5% to 10% of patients with hepatosplenic schistosomiasis, particularly due to S. mansoni. The lung blood vessel injury may result from a combination of embolization of eggs through portocaval shunts into the lungs causing localized Type 2 inflammatory response and vessel remodeling, triggering of autonomous pathology that becomes independent of the antigen, and high cardiac output as seen in portopulmonary hypertension. The condition is likely underdiagnosed as there is little systematic screening, and risk factors for developing PAH are not known. Screening is done by echocardiography, and formal diagnosis requires invasive right heart catheterization. Patients with Schistosoma-associated PAH show reduced functional capacity and can be treated with pulmonary vasodilators, which improves symptoms and may improve survival. There are animal models of this disease that might help in understanding disease pathogenesis and identify novel targets to screen and treatment. Pathogenic mechanisms include Type 2 immunity and activation and signaling in the TGF-β pathway. There are still major uncertainties regarding Schistosoma-associated PAH development, course and treatment