Copd Phenotypes On Computed Tomography And Its Correlation With Selected Lung Function Variables In Severe Patients

Computed tomography (CT) phenotypic characterization helps in understanding the clinical diversity of chronic obstructive pulmonary disease (COPD) patients, but its clinical relevance and its relationship with functional features are not clarified. Volumetric capnography (VC) uses the principle of gas washout and analyzes the pattern of CO2 elimination as a function of expired volume. The main variables analyzed were end-tidal concentration of carbon dioxide (ETCO2), Slope of phase 2 (Slp2), and Slope of phase 3 (Slp3) of capnogram, the curve which represents the total amount of CO2 eliminated by the lungs during each breath. Objective: To investigate, in a group of patients with severe COPD, if the phenotypic analysis by CT could identify different subsets of patients, and if there was an association of CT findings and functional variables. Subjects and methods: Sixty-five patients with COPD Gold III-IV were admitted for clinical evaluation, high-resolution CT, and functional evaluation (spirometry, 6-minute walk test [6MWT], and VC). The presence and profusion of tomography findings were evaluated, and later, the patients were identified as having emphysema (EMP) or airway disease (AWD) phenotype. EMP and AWD groups were compared; tomography findings scores were evaluated versus spirometric, 6MWT, and VC variables. Results: Bronchiectasis was found in 33.8% and peribronchial thickening in 69.2% of the 65 patients. Structural findings of airways had no significant correlation with spirometric variables. Air trapping and EMP were strongly correlated with VC variables, but in opposite directions. There was some overlap between the EMP and AWD groups, but EMP patients had signicantly lower body mass index, worse obstruction, and shorter walked distance on 6MWT. Concerning VC, EMP patients had signicantly lower ETCO2, Slp2 and Slp3. Increases in Slp3 characterize heterogeneous involvement of the distal air spaces, as in AWD. Conclusion: Visual assessment and phenotyping of CT in COPD patients is feasible and may help identify functional and clinically different subsets of patients. VC may provide useful information about the heterogeneous involvement of lung structures in COPD.1150351

Notes from the youth mental health field: Using movement towards goals as a potential indicator of service change and quality improvement

The aim of this paper is to report our notes from the field on using movement toward goals at an aggregate level as an inference of service effectiveness. Analysis of routinely collected data from UK youth mental health services was conducted (N = 8,172, age M = 13.8, 67% female, 32% male) to explore the impact of including goal-based outcome data in combined calculations of standardized measures based on the principles of reliable change (“measurable change”). Due to the broad nature of standardized measures, inferred validity becomes diluted in any team or service level aggregate analysis. To make inferences that are closer to the person's interpretation of their difficulties, we argue that Idiographic Patient Reported Outcome Measures (I-PROMs) counterbalance these limitations. This is supported by our findings. The measurable change metric is the first step towards enabling national analysis of aggregated I-PROMs. I-PROMs, supplemented by standardized measures should be used to consider service evaluation

Effects of 3 Topical Plant Extracts on Wound Healing in Beef Cattle

Eleven heifers of the Purunã cattle breed were used to evaluate wound healing by second intention. An experimental wound excision model in bovines was created by means of a skin punch of diameter 2cm. The animals were topically treated for 17 days with a saline control or decoctions of Schinus terebinthifolius Raddi (Aroeira mansa), Tabebuia avellanedae Lorentz ex Griseb (Ipê Roxo), and Casearia sylvestris Sw.(Guaçatonga) mixed with carboxymethyl cellulose. Centripetal retraction, clinical, and histological aspects of the wounds were observed until complete healing. Decoctions of T. avellanedae and S. terebinthifolius, but not C. sylvestris, had a beneficial effect on wound healing by second intention

A thermoregulation model for whole body cooling hypothermia

This paper presents a thermoregulation model based on the finite element method to perform numerical analyses of brain cooling procedures as a contribu tion to the investigation on the use of therapeutic hypothermia after ischemia in adults. The use of computational methods can aid clinicians to observe body temperature using different cooling methods without the need of invasive techniques, and can thus be a valuable tool to assist clinical trials simulat ing different cooling options that can be used for treatment. In this work, we developed a finite element method (FEM) package using isoparametric linear three-dimensional elements which is applied to the solution of the continuum bioheat Pennes equation. Blood temperature changes were considered using a blood pool approach and a lumped analysis for intravascular catheter methods of blood cooling. Some analyses are performed using a three-dimensional mesh based on a complex geometry obtained from computed tomography medical images, considering a cooling blanket and an intravascular catheter. A com parison is made between the results obtained with the two techniques and the effects of each case in brain temperature reduction in a required period of time, maintainance of body temperature at moderate hypothermia levels and gradual rewarming

CONTRIBUIÇÃO DAS ORIENTAÇÕES DE ENFERMAGEM PRÉ-OPERATÓRIAS PARA CLIENTES SUBMETIDOS À CIRURGIA CARDÍACA

El presente estudio fue elaborado como parte integrante de una disertación vinculada al Departamento de Enfermería Fundamental de la Escuela de Enfermería Alfredo Pinto/ UNIRIO. Nuestro objetivo es realizar un levantamiento bibliográfico sobre la temática: contribución de la orientación de enfermería preoperatoria para clientes sometidos a cirugía cardíaca, publicados entre 2000 y 2007. Concluimos con la investigación que las orientaciones preoperatorias son capaces de reducir problemas en la enfermería postoperatoria pautados en el miedo y en el desconocimiento presentados por el cliente. Además de apuntar la necesidad de publicación de artículos que comprueben los resultados mensurables de las repercusiones de las orientaciones prestadas para el cliente sometido a cirugía cardíaca.Este estudo foi elaborado enquanto parte integrante de uma dissertação vinculada ao Departamento de Enfermagem Fundamental da Escola de Enfermagem Alfredo Pinto/ UNIRIO. Nosso objetivo é realizar um levantamento bibliográfico acerca da temática: contribuição da orientação de enfermagem pré-operatória para clientes submetidos à cirurgia cardíaca, publicados entre 2000 e 2007. Concluímos com a investigação que as orientações pré-operatórias são capazes de reducir problemas de enfermagem pós-operatórios pautados no medo e no desconhecimento apresentados pelo cliente. Além de apontarmos a necessidade de publicação de artigos que comprovem os resultados mensuráveis das repercussões das orientações prestadas para o cliente submetido à cirurgia cardíaca

Microplastics and nanoplastics in haemodialysis waters: Emerging threats to be in our radar

Microplastics are present in the environment, in drinking water, in human blood and there is evidence of nanoplastics in tap water. The objective of this work was to analyze the possibility of hemodialysis patients being contaminated by micro and nanoplastics (MNPs) during dialysis treatment. The motivation for this investigation is the fact that hemodialysis patients use about 300–600 L of drinking water per week, which may be contaminated by MNPs. A literature review, a field investigation in a London hospital and an estimation of MNPs intake in patients were carried out. The results showed potential points of risk of contamination of patients by MNPs in hemodialysis. It was also estimated that for a filtration efficiency of 99 % for MNPs, the amount of microplastics that can penetrate the kidneys of patients is 0.0021–3768 particles/week. The assessment concludes that hemodialysis patients are at high risk of MNP contamination

Função Sexual após Braquiterapia Prostática de Baixa Taxa de Dose

A braquiterapia prostática de baixa taxa de dose é considerada uma opção terapêutica adequada para o carcinoma da próstata. É habitualmente, apresentada como a melhor forma de preservar a função eréctil de entre os diversos tratamentos de carcinoma da próstata. Contudo, estudos recentes demonstram que, também a braquiterapia prostática pode, no longo prazo, provocar algum grau de disfunção eréctil (DE). As taxas de DE nas diversas séries publicadas, são muito variáveis. Os resultados da influência da dose de radiação, isoladamente (D90) ou quando incidindo sobre o feixe neurovascular ou o bulbo são contraditórios. O tipo de isótopo utilizado não tem qualquer influência sobre a DE. No entanto factores como a idade, a função eréctil pré-tratamento, a diabetes, a utilização de radioterapia externa adjuvante e/ou hormonoterapia neoadjuvante podem condicionar os resultados obtidos. Otratamento da disfunção eréctil deve ser efectuado com inibidores da fosfodiesterase, obtendo-se boas taxas de resposta. Podem surgir outras alterações da função sexual, nomeadamente, hematospermia, dor durante o orgasmo e alteração da intensidade do orgasmo

Serological survey for rabies in serum samples from vampire bats (Desmodus rotundus) in Botucatu region, SP, Brazil

The chiropterans constitute 25% of the world's mammal fauna. Due to the destruction of their natural ecosystem, the vampire bats have moved from nature to artificial roosts closer to man and domestic animals. This phenomenon has happened particularly in rural areas. Rabies is a viral anthropozoonosis, 100% lethal, and vampire bats (Desmodus rotundus) represent an important role in its epidemiology. D. rotundus were captured at night with mesh nets in partnership with the Botucatu Defense Office and sent to the Zoonosis Diagnostic Service, at the School of Veterinary Medicine and Animal Husbandry, UNESP. Serum samples from 204 bats were analyzed by enzyme-linked immunosorbent assay (ELISA) and fluorescent antibody viral neutralization test (FAVN) for rabies antibody detection. The results showed 7.4% of sera with titers higher or equal to 0.5 U for rabies antibodies, which demonstrated viral flow circulation among the studied region. Data suggest a need for constant monitoring accomplished by epidemiological and sanitary measures