A evolução clínica do paciente portador de abscesso pulmonar: Clinical evolution of patients with lung abscess

Atualmente, com a era da antibioticoterapia e demais meios terapêuticos, o abscesso pulmonar decaiu em termos de morbimortalidade, mas ainda permanece como um desafio em termos diagnósticos e manejo clínico. O abscesso pulmonar corresponde a uma cavidade com pus no pulmão, envolvido por tecido inflamado e geralmente oriunda de uma infecção. O artigo objetivou descrever de modo narrativo a evolução clínica do portador de abscesso pulmonar, ressaltando os principais dados para a compreensão deste fenômeno. Um abscesso pulmonar é causado principalmente por bactérias existentes na boca ou garganta, a qual são aspiradas até os pulmões. A sintomatologia é inespecífica, abordando fadiga, inapetência, sudorese noturna, febre, perda ponderal e tosse com expectoração. O quadro clínico geralmente necessita do complemento de exames de imagem, principalmente a radiografia torácica para diagnóstic

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Acute glucocorticoid effects on the multicomponent model of working memory

Objective in comparison with basal physiological levels, acute, high levels of cortisol affect learning and memory. Despite reports of cortisol-induced episodic memory effects, no study has used a comprehensive battery of tests to evaluate glucocorticoid effects on the multicomponent model of working memory. Here, we report the results of a double-blind, placebo-controlled, between-subjects study.Methods Twenty healthy young men were randomly assigned to either acute cortisol (30 mg hydrocortisone) or placebo administration. Participants were subjected to an extensive cognitive test battery that evaluated all systems of the multicomponent model of working memory, including various executive domains (shifting, updating, inhibition, planning and access to long-term memory).Results Compared with placebo, hydrocortisone administration increased cortisol blood levels and impaired working memory in storage of multimodal information in the episodic buffer and maintenance/reverberation of information in the phonological loop. Hydrocortisone also decreased performance in planning and inhibition tasks, the latter having been explained by changes in storage of information in working memory.Conclusions Thus, hydrocortisone acutely impairs various components of working memory, including executive functioning. This effect must be considered when administering similar drugs, which are widely used for the treatment of many clinical disorders. Copyright (C) 2011 John Wiley & Sons, Ltd.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Associacao Fundo de Incentivo a Pesquisa (AFIP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Psychobiol, Escola Paulista Med, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, Escola Paulista Med, São Paulo, BrazilFAPESP: 2005/00362-3Web of Scienc

Possible relationship between performance and oxidative stress in endurance horses

The purpose of this study was to evaluate oxidative stress, antioxidant biomarkers, and performance during a multiday 210-km endurance race. Nine endurance athlete horses participated in this study. Samples were always taken at the same times of day, before the beginning of the race and after every day of competition. Analytic measurements included glutathione reductase (GR) and catalase activity, thiobarbituric acid–reactive substances (TBARs), and reactive carbonylated derivatives. Competition intensity was low, with an average speed of 12.56 ± 0.9 km/h. Four horses were unable to finish the race because of metabolic problems or fatigue. GR activity increased progressively (P < .001) throughout the competition, and TBARs showed a significant rise compared with baseline values (P < .01) but remained at the same levels throughout the 3 days of competition. Catalase and reactive carbonylated derivatives did not show any significant alterations in any time period. The best performance was obtained from horses who demonstrated higher GR capacity and/or lower TBAR concentration. In conclusion, redox status seems to modulate horses' performance in endurance races, but further studies are needed to better determine the adequate oxidant/antioxidant ratio to acquire optimal performance294206212CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPsem informação97/03889-

Possible Relationship Between Performance and Oxidative Stress in Endurance Horses

The purpose of this study was to evaluate oxidative stress, antioxidant biomarkers, and performance during a multiday 210-km endurance race. Nine endurance athlete horses participated in this study. Samples were always taken at the same times of day, before the beginning of the race and after every day of competition. Analytic measurements included glutathione reductase (GR) and catalase activity, thiobarbituric acid-reactive substances (TBARs), and reactive carbonylated derivatives. Competition intensity was low, with an average speed of 12.56 +/- 0.9 km/h. Four horses were unable to finish the race because of metabolic problems or fatigue. GR activity increased progressively (P < .001) throughout the competition, and TBARs showed a significant rise compared with baseline values (P < .01) but remained at the same levels throughout the 3 days of competition. Catalase and reactive carbonylated derivatives did not show any significant alterations in any time period. The best performance was obtained from horses who demonstrated higher GR capacity and/or lower TBAR concentration. In conclusion, redox. status seems to modulate horses` performance in endurance races, but further Studies are needed to better determine the adequate oxidant/antioxidant ratio to acquire optimal performance

Association between cardiorrespiratory fitness and cognitive control: is somatic maturity an important mediator?

Recently some articles presented information related to the possible effect of maturity over the cognitive control and cardiorespiratory fitness, however little is known about the real effects of maturity in the relation of these variables. In this sense, the purpose of this study was to examine the potential mediating role of somatic maturity on the association between cardiorespiratory fitness (CRF) and cognitive control. This three-year longitudinal research comprises two data collection groups: a baseline conducted in 2016 with 394 adolescents (aged 11.7 ± 0.6 years) and a follow-up in 2019 with 134 adolescents (aged 14.9 ± 0.7 years). Anthropometry data, 20-m shuttle run test and peak height velocity (PHV) to determine the maximum oxygen uptake (VO2max) and somatic maturity, respectively, were collected at both sampling times. In parallel, the Sociodemographic and cognitive control function variables were included in the follow-up to evaluate the inhibitory control (by the Stroop test) and the visuo-spatial working memory (by the Corsi block-tapping test). Associations between CRF and cognitive functions were computed by multiple linear regression, with mediation as a function of PHV. CRF exhibited transversal associations with reaction time in congruent (β = -0.004; p = 0.001) and incongruent (β = -0.005; p = 0.004) stimulus-responses. Meanwhile, the variation in VO2max over the three year-study had a significant impact on the reaction time of congruent (β = -0.006; p = 0.001) and incongruent (β = -0.006; p = 0.012) responses at follow-up. However, PHV did not show a significant association with the cognitive functions, indicating no mediating role. Although the associations between CRF and the cognitive functions exhibited great transversal and longitudinal impacts, somatic maturity did not affect the cognitive control functions, associating exclusively with CRF

Neuropsychological Assessment of Current and Past Crack Cocaine Users

Background: Cognitive changes due to crack cocaine consumption remain unclear Methods: for clarification, 55 subjects were assigned to three groups: control group, crack cocaine current users, and ex-users. Participants were submitted to Mini-Mental State Examination (MMSE) and tasks evaluating executive functioning and verbal memory Mood state was also measured. Intergroup comparisons were carried out. Results: Control group performance on the MMSE was better than that of users and ex-users. Verbal memory performance for logical memory of users was impaired. Ex-users scored lower on DSST and Trail Making Test (Part B). Conclusion: Chronic crack cocaine use seems to disrupt general cognitive functioning (MMSE), verbal memory, and attentional resources, but findings suggest that some of these effects could be reversed by abstinence.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Psychopharmacology Incentive Fund Association (AFIP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ São Paulo, Sch Med, Dept Psychiat, São Paulo, BrazilUniv São Paulo, Dept Stat, São Paulo, BrazilCtr Informat Hlth & Alcohol CISA, São Paulo, BrazilBrazilian Ctr Informat Psychotrop Drugs CEBRID, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilFAPESP: Process 04/07153-8Web of Scienc

Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database

Background: Survival benefit from low tidal volume (VT) ventilation (LTVV) has been demonstrated for patients with acute respiratory distress syndrome (ARDS), and patients not having ARDS could also benefit from this strategy. Organizational factors may play a role on adherence to LTVV. The present study aimed to identify organizational factors with an independent association with adherence to LTVV. Methods: Secondary analysis of the database of a multicenter two-phase study (prospective cohort followed by a cluster-randomized trial) performed in 118 Brazilian intensive care units. Patients under mechanical ventilation at day 2 were included. LTVV was defined as a VT ≤ 8 ml/kg PBW on the second day of ventilation. Data on the type and number of beds of the hospital, teaching status, nursing, respiratory therapists and physician staffing, use of structured checklist, and presence of protocols were tested. A multivariable mixed-effect model was used to assess the association between organizational factors and adherence to LTVV. Results: The study included 5719 patients; 3340 (58%) patients received LTVV. A greater number of hospital beds (absolute difference 7.43% [95% confidence interval 0.61–14.24%]; p = 0.038), use of structured checklist during multidisciplinary rounds (5.10% [0.55–9.81%]; p = 0.030), and presence of at least one nurse per 10 patients during all shifts (17.24% [0.85–33.60%]; p = 0.045) were the only three factors that had an independent association with adherence to LTVV. Conclusions: Number of hospital beds, use of a structured checklist during multidisciplinary rounds, and nurse staffing are organizational factors associated with adherence to LTVV. These findings shed light on organizational factors that may improve ventilation in critically ill patients