New treatments for chronic obstructive pulmonary disease using ergogenic aids

Chronic obstructive pulmonary disease is currently considered a systemic disease, presenting structural and metabolic alterations that can lead to skeletal muscle dysfunction. This negatively affects the performance of respiratory and peripheral muscles, functional capacity, health-related quality of life and even survival. The decision to prescribe ergogenic aids for patients with chronic obstructive pulmonary disease is based on the fact that these drugs can avert or minimize catabolism and stimulate protein synthesis, thereby reducing the loss of muscle mass and increasing exercise tolerance. This review summarizes the available data regarding the use of anabolic steroids, creatine, L-carnitine, branched-chain amino acids and growth hormones in patients with chronic obstructive pulmonary disease. The advantage of using these ergogenic aids appears to lie in increasing lean muscle mass and inducing bioenergetic modifications. Within this context, most of the data collected deals with anabolic steroids. However, to date, the clinical benefits in terms of increased exercise tolerance and muscle strength, as well as in terms of the effect on morbidity and mortality, have not been consistently demonstrated. Dietary supplementation with substances of ergogenic potential might prove to be a valid adjuvant therapy for treating patients with advanced chronic obstructive pulmonary disease, especially those presenting loss of muscle mass or peripheral muscle weakness.A doença pulmonar obstrutiva crônica é considerada, atualmente, uma doença sistêmica, cujas alterações estruturais e metabólicas podem levar à disfunção muscular esquelética. Esta afeta negativamente o desempenho muscular respiratório e periférico, a capacidade funcional, a qualidade de vida relacionada à saúde e mesmo a sobrevida. A indicação de suplementação de substâncias ergogênicas para pacientes com doença pulmonar obstrutiva crônica baseia-se no fato de que estas drogas podem evitar, ou minimizar, o catabolismo e/ou estimular a síntese protéica, diminuindo a depleção de massa muscular e aumentando a capacidade de exercício. A presente revisão sumariza o conhecimento disponível acerca da utilização de esteróides anabolizantes, creatina, L-carnitina, aminoácidos de cadeia ramificada e hormônio de crescimento em pacientes com doença pulmonar obstrutiva crônica. A vantagem do uso dessas substâncias ergogênicas parece residir no aumento da massa magra e/ou na indução de modificações bioenergéticas. Nesse contexto, a maior experiência acumulada é com os esteróides anabolizantes. Entretanto, os benefícios clínicos em relação à melhora da capacidade de exercício e força muscular, bem como os efeitos na morbimortalidade, não foram, até a presente data, consistentemente demonstrados. A suplementação ergogênica pode vir a se constituir numa ferramenta adjuvante para o tratamento de pacientes com doença pulmonar obstrutiva crônica avançada, especialmente naqueles com depleção muscular e/ou fraqueza periférica.Universidade Federal de São Paulo (UNIFESP) Setor de Função Pulmonar e Fisiologia Clínica do ExercícioUniversidade Federal de São Paulo (UNIFESP)UNIFESP, Setor de Função Pulmonar e Fisiologia Clínica do ExercícioUNIFESPSciEL

Prevalencia de sindrome da fragilidade em idosos de uma instituicao hospitalar

OBJETIVO: medir la prevalencia del síndrome de fragilidad en adultos mayores internados en una institución hospitalaria. MÉTODO: estudio transversal, teniendo como muestra a 99 adultos mayores de 65 años o más, internados en el mes de noviembre/2010 en el Hospital São Vicente de Paulo, en Passo Fundo, Rio Grande do Sul (RS). Fueron obtenidos datos relacionados al fenotipo de la fragilidad, variables sociodemográficas, clínicas y antropométricas. RESULTADOS: la edad promedio fue de 74,5±6,8 años y 50 (50,5%) eran mujeres. Fueron clasificados no frágiles cuatro (4%), pre frágiles 49 (49,5%) y frágiles 46 (46,5%). No fueron identificados factores estadísticamente asociados a la fragilidad. CONCLUSIONES: como era esperado, la prevalencia en esta población se mostró alta cuando fue comparada a otros estudios con foco en la comunidad. Se cree que la detección precoz y la intervención interdisciplinaria evitarán la progresión del cuadro, reduciendo la incidencia de complicaciones y hospitalizaciones.OBJETIVO: medir a prevalência da síndrome da fragilidade em idosos internados numa instituição hospitalar. MÉTODO: estudo transversal, tendo como amostra 99 idosos com 65 anos ou mais, internados no mês de novembro de 2010, no Hospital São Vicente de Paulo, em Passo Fundo, Rio Grande do Sul. Foram coletados dados relacionados ao fenótipo da fragilidade, variáveis sociodemográficas, clínicas e antropométricas. RESULTADOS: a idade média foi de 74,5±6,8 anos e 50 (50,5%) eram mulheres. Foram classificados não frágeis quatro (4%), pré-frágeis 49 (49,5%) e frágeis 46 (46,5%). Não se identificaram fatores estatisticamente associados à fragilidade. CONCLUSÕES: como era esperado, a prevalência nessa população mostrou-se alta quando comparada a outros estudos com foco na comunidade. Acredita-se que a detecção precoce e a intervenção interdisciplinar evitem a progressão do quadro e reduzam a incidência de complicações e hospitalizações.OBJECTIVE: to measure the prevalence of frailty syndrome in elderly inpatients in a hospital institution. METHODS: cross-sectional study using a sample of 99 subjects aged 65 or older, hospitalized in the month of November/2010 in São Vicente de Paulo Hospital in Passo Fundo, Rio Grande do Sul state (RS). Data were collected regarding the phenotype of the frailty, along with social and demographic, clinical and anthropometric information. RESULTS: the mean age was 74.5±6.8 years and 50 (50.5%) were women. 4% were classified as non-frail, 49 (49.5%) as pre-frail and 46 (46.5%) as frail. No statistically significant factors were identified that were associated with frailty. CONCLUSIONS: as was expected, the prevalence in this population was found to be high compared to other studies that focused on the community. It is believed that early detection and interdisciplinary intervention can prevent the progression of the condition and reduce the incidence of complications and hospitalization

NMR metabolomic analysis of exhaled breath condensate of asthmatic patients at two different temperatures

Exhaled breath condensate (EBC) collection is a noninvasive method to investigate lung diseases. EBC is usually collected with commercial/custom-made condensers, but the optimal condensing temperature is often unknown. As such, the physical and chemical properties of exhaled metabolites should be considered when setting the temperature, therefore requiring validation and standardization of the collecting procedure. EBC is frequently used in nuclear magnetic resonance (NMR)-based metabolomics, which unambiguously recognizes different pulmonary pathological states. Here we applied NMR-based metabolomics to asthmatic and healthy EBC samples collected with two commercial condensers operating at -27.3 and -4.8 °C. Thirty-five mild asthmatic patients and 35 healthy subjects were included in the study, while blind validation was obtained from 20 asthmatic and 20 healthy different subjects not included in the primary analysis. We initially analyzed the samples separately and assessed the within-day, between-day, and technical repeatabilities. Next, samples were interchanged, and, finally, all samples were analyzed together, disregarding the condensing temperature. Partial least-squares discriminant analysis of NMR spectra correctly classified samples, without any influence from the temperature. Input variables were either integral bucket areas (spectral bucketing) or metabolite concentrations (targeted profiling). We always obtained strong regression models (95%), with high average-quality parameters for spectral profiling (R(2) = 0.84 and Q(2) = 0.78) and targeted profiling (R(2) = 0.91 and Q(2) = 0.87). In particular, although targeted profiling clustering is better than spectral profiling, all models reproduced the relative metabolite variations responsible for class differentiation. This warrants that cross comparisons are reliable and that NMR-based metabolomics could attenuate some specific problems linked to standardization of EBC collection

Basic amino acids and dimethylarginines targeted metabolomics discriminates primary hepatocarcinoma from hepatic colorectal metastases

Hepatocellular carcinoma (HCC) is a very aggressive neoplasia requiring early and accurate diagnosis to improve patient outcomes with timely treatment. The liver is also very frequently colonized by metastases, and the most frequent differential diagnosis is HCC against intrahepatic cholangiocarcinoma or metastatic adenocarcinoma. Metabolomics is a powerful tool for identification of altered biomarkers in cancer, and to evaluate the efficacy of drug treatments. Here we analyzed by HILIC-MS/MS methylated arginines, basic amino acids (Arg, Cit, Orn), and their ratios in the extracts of primary HCC tissues, liver metastases from colorectal carcinoma (MET), cirrhotic related hepatitis-C-virus (CIR), and non-cirrhotic normal liver (NT) adjacent tissues. We found high levels of Arg (p < 0.0001) and Arg/Orn (p < 0.01) in MET compared to other tissues. In MET, compared to NT and CIR, Arg concentration was fivefold higher, while in HCC it was twofold higher. ADMA increased twofold compared to NT and CIR, while in HCC it was 50 % higher. Arg/Cit and ADMA/SDMA ratios were significantly higher in MET compared to NT and CIR (p < 0.005). Arg/Orn, Arg/Cit, and ADMA/SDMA ratios increased progressively from NT, CIR, HCC, to MET tissues. Arg/Cit correlated significantly with Arg/Orn ratios (r = 0.77; p < 0.0001), and discriminates tumor from non-tumor samples. In addition, the discriminant lactate/glucose ratio we previously found by NMR, also correlated significantly with the Arg levels (r = 0.64; p < 0.0001), and discriminated MET from all other tissues. The results indicated that Arg in MET is higher than other tissue classes, suggesting that, together with the lactate/glucose ratio, it can be considered a further biomarker for HCC-metastases differentiation

Respiratory evaluation through volumetric capnography among grade III obese and eutrophic individuals: a comparative study

Excess trunk body fat in obese individuals influences respiratory physiological function. The aims of this study were to compare volumetric capnography findings (VCap) between severely obese patients and normal-weight subjects and to assess whether there is any association between neck circumference (NC), waist-hip ratio (WHR) and VCap among grade III obese individuals. DESIGN AND SETTING:Analytical observational case-matched cross-sectional study, University of Campinas. METHODS: This cross-sectional study compared VCap variables between 60 stage III obese patients and 60 normal-weight individuals. RESULTS: In comparison with the normal-weight group, obese patients presented higher alveolar minute volume (8.92 +/- 4.94 versus 6.09 +/- 2.2; P = < 0.0001), CO2 production (278 +/- 91.0 versus 209 +/- 60.23; P < 0.0001), expiratory tidal volume (807 +/- 365 versus 624 +/- 202; P = 0.005), CO2 production per breath (21.1 +/- 9.7 versus 16.7 +/- 6.16; P = 0.010) and peak expiratory flow (30.9 +/- 11.9 versus 25.5 +/- 9.13; P = 0.004). The end-expiratory CO2 (PetCO(2)) concentration (33.5 +/- 4.88 versus 35.9 +/- 3.79; P = 0.013) and the phase 3 slope were normalized according to expired tidal volume (0.02 +/- 0.05 versus 0.03 +/- 0.01; P = 0.049) were lower in the obese group. CONCLUSIONS: The greater the NC was, the larger were the alveolar minute volume, anatomical dead space, CO2 production per minute and per breath and expiratory volume; whereas the smaller were the phase 2 slope (P2SIp), phase 3 slope (P3SIp) and pressure drop in the mouth during inspiration1372177183COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPES01-P-4354-1