Avaliação funcional em pacientes com sequela pulmonar de tuberculose

ResumoIntroduçãoNa tuberculose pulmonar, a presença de lesões pulmonares residuais extensas pode ser um fator preditor de invalidez permanente por conta de insuficiência respiratória.ObjetivoComparar as alterações respiratórias e funcionais em pacientes com sequela pulmonar de tuberculose que finalizaram o tratamento.MétodoO estudo foi realizado no Ambulatório de Tisiologia do Hospital Sanatório Partenon. Foram incluídos no estudo pacientes que finalizaram único tratamento com 6 meses de duração (grupo I) e pacientes com tuberculose pulmonar multirresistente que finalizaram tratamento de maior duração após falência aos tratamentos iniciais (grupo II). Foram avaliadas a função pulmonar através da espirometria (ML 3500 Microlab, Microlab, EUA), a força dos músculos respiratórios através da manovacuometria e a distância percorrida no teste da caminhada dos 6 minutos (TC6M). Os dados foram analisados no programa SPSS versão 13.0, sendo utilizado o teste de qui-quadrado e o t para amostras independentes. O nível de significância adotado foi de 5%.ResultadosForam incluídos 27 pacientes sendo que 12 pertenciam ao grupo de tuberculose multirresistente. O distúrbio ventilatório mais prevalente no grupo de múltiplos tratamentos foi a obstrução grave, presente em 9 pacientes. O grupo que realizou múltiplos tratamentos (grupo II) apresentou redução significativa quando comparado ao grupo I nas variáveis CVF (72,06±14,95 vs. 43,58±16,03% predito), VEF1 (66,13±19,87 vs. 33,08±15,64% predito), PImax (68,40±22,78 vs. 49,58±12,55 cmH2O), PEmax (87,20±27,30 vs. 59,08±12,23 cmH2O) e distância percorrida no TC6M (484,21±74,01 vs. 334,75±104,07 metros).ConclusãoPacientes com tuberculose pulmonar multirresistente que realizaram múltiplos tratamentos apresentam comprometimentos respiratórios e funcionais maiores do que pacientes que realizaram único tratamento.AbstractIntroductionIn pulmonary tuberculosis, the presence of extensive residual lung lesions can be a predictor of permanent disability due to respiratory failure.ObjectiveTo compare functional and respiratory changes in patients with pulmonary tuberculosis sequel who have completed treatment.MethodThe study included patients who completed treatment within a period of 6 months (group I) and multidrug-resistant pulmonary tuberculosis patients who completed treatments of longer duration after the failure of the initial treatment (group II). We evaluated lung function by spirometry (Microlab ML 3500), the strength of respiratory muscles through the manovacuometry (MEP-maximal expiratory pressure and MIP- maximal inspiratory pressure) and the distance walked during the 6-minute walk (6MWT).Results27 patients were included, 12 of whom belonged to group II, multidrug-resistant tuberculosis (MDRTB). Severe combined respiratory disorder was the most prevalent problem in group II of MDRTB; it was present in 9 patients. The MDRTB group (group II) showed significantly lower values when compared to Group I in FVC (72.06±14.95 vs 43.58±16.03% predicted), FEV1 (66.13±19.87 vs 33.08±15.64% predicted), MIP (68.40±22.78 vs 49.58±12.55 cmH2O), MEP (87.20±27.30 vs 59.08±12.23 cmH2O) and distance covered in 6MWT (484.21±74.01 vs 334.75±104.07 meters).ConclusionPatients with multidrug resistant pulmonary tuberculosis who have undergone multiple treatments have more severe respiratory and functional impairment than patients who have had just a single treatment

Prioritisation of Anti-SARS-Cov-2 Drug Repurposing Opportunities Based on Plasma and Target Site Concentrations Derived from their Established Human Pharmacokinetics.

There is a rapidly expanding literature on the in vitro antiviral activity of drugs that may be repurposed for therapy or chemoprophylaxis against SARS-CoV-2. However, this has not been accompanied by a comprehensive evaluation of the target plasma and lung concentrations of these drugs following approved dosing in humans. Accordingly, EC90 values recalculated from in vitro anti-SARS-CoV-2 activity data was expressed as a ratio to the achievable maximum plasma concentrations (Cmax) at an approved dose in humans (Cmax/EC90 ratio). Only 14 of the 56 analysed drugs achieved a Cmax/EC90 ratio above 1. A more in-depth assessment demonstrated that only nitazoxanide, nelfinavir, tipranavir (ritonavir-boosted) and sulfadoxine achieved plasma concentrations above their reported anti-SARS-CoV-2 activity across their entire approved dosing interval. An unbound lung to plasma tissue partition coefficient (Kp Ulung ) was also simulated to derive a lung Cmax/EC50 as a better indicator of potential human efficacy. Hydroxychloroquine, chloroquine, mefloquine, atazanavir (ritonavir-boosted), tipranavir (ritonavir-boosted), ivermectin, azithromycin and lopinavir (ritonavir-boosted) were all predicted to achieve lung concentrations over 10-fold higher than their reported EC50 . Nitazoxanide and sulfadoxine also exceeded their reported EC50 by 7.8- and 1.5-fold in lung, respectively. This analysis may be used to select potential candidates for further clinical testing, while deprioritising compounds unlikely to attain target concentrations for antiviral activity. Future studies should focus on EC90 values and discuss findings in the context of achievable exposures in humans, especially within target compartments such as the lung, in order to maximise the potential for success of proposed human clinical trials

Internet of Things for Sustainable Human Health

The sustainable health IoT has the strong potential to bring tremendous improvements in human health and well-being through sensing, and monitoring of health impacts across the whole spectrum of climate change. The sustainable health IoT enables development of a systems approach in the area of human health and ecosystem. It allows integration of broader health sub-areas in a bigger archetype for improving sustainability in health in the realm of social, economic, and environmental sectors. This integration provides a powerful health IoT framework for sustainable health and community goals in the wake of changing climate. In this chapter, a detailed description of climate-related health impacts on human health is provided. The sensing, communications, and monitoring technologies are discussed. The impact of key environmental and human health factors on the development of new IoT technologies also analyzed