Eduardo Garcia

Functional Capacity, Respiratory Muscle Strength, and Oxygen Consumption Predict Mortality in Patients with Cirrhosis

Introduction. Liver diseases influence musculoskeletal functions and may negatively affect the exercise capacity of patients with cirrhosis. Aim. To test the relationship between the six-minute walk test (6MWT), maximal inspiratory pressure (MIP), and exercise capacity (VO2peak) measures and the survival rate of patients with cirrhosis. Methods. This prospective cohort study consisted of 86 patients diagnosed with cirrhosis with the following aetiology: hepatitis C virus (HCV), hepatitis B virus (HBV), and/or alcoholic cirrhosis (AC). All patients were followed up for three years and submitted to the 6MWT, pressure measurements with a compound gauge, and an exercise test (VO2peak). Results. The survival analysis showed that the individuals who covered a distance shorter than 410 m during the 6MWT had a survival rate of 55% compared with a rate of 97% for the individuals who walked more than 410 m (p = 0.0001). Individuals with MIPs below −70 cmH2O had a survival rate of 62% compared with a rate of 93% for those with MIPs above −70 cmH2O (p = 0.0001). The patients with values below 17 mL/kg had a survival rate of 55% compared with a rate of 94% for those with values above 17 mL/kg (p = 0.0001). Conclusion. The 6MWT distance, MIP, and oxygen consumption are predictors of mortality in patients with cirrhosis.

Molde brônquico devido ao uso de interferon peguilado e ribavirina

We report the case of a 50-year-old male patient with a rare profile: bronchial casts associated with the use of pegylated interferon and ribavirin. The patient sought treatment in a pulmonology clinic with a history of progressive dyspnea for four months that had evolved to progressive cough followed by frequent and abundant elimination of bronchial casts. The patient was initially treated with bronchodilators, as well as with oral and inhaled corticosteroids. Fiberoptic bronchoscopy, bronchoalveolar lavage and sputum analysis were carried out but did not contribute to the elucidation of the diagnosis. The symptoms developed while the patient was receiving pegylated interferon and ribavirin for the treatment of hepatitis C. The symptoms resolved 30 days after the discontinuation of the treatment. To our knowledge, this is the first report of bronchial casts caused by the use of pegylated interferon and ribavirin.

A comparative study on the recruitment of shoulder stabilizing muscles and types of exercises

The shoulder is susceptible to disturbances caused by microtraumas due to direct contact of the surrounding skeletal structures or failure of the soft parts of the rotator cuff and other muscles inserted into the glenohumeral joint. The purpose of the study was to compare the electromyographic signal in the stabilizing muscles of the shoulder during the diagonal elevation exercise as recommended by the proprioceptive neuromuscular facilitation (PNF) method and dumbbell exercise. This study is classified as Quase-experiment. Subjects were instructed to perform diagonal standard exercises and the electromyographic signal was detected from pectoralis muscles, middle and upper trapezius of dominant limb in each subject. We observed greater muscular recruitment when the PNF method was adopted in comparison with the dumbbell workouts for the trapezius upper and middle fiber muscles and for the major pectoralis (267,30 μv/181,02 μv; 235,76 μv/;164,47 μv; 299,87 μv/148,69 μv; P<0.001). The PNF method promotes a greater recruitment of the shoulder dynamic stabilizing muscles during diagonal elevation exercises. Being so, such kinesiotherapeutic technique may be effectively used in the prevention, treatment and rehabilitation of shoulder disorders.

Prevalence of eosinophilia in COPD patients in Brazil

Introduction: COPD (Chronic Obstructive Lung Disease) is a heterogeneous disease of multiple phenotypes, on which eosinophilia in peripheral blood is increasingly discussed as a biomarker in the therapeutic response to corticosteroids, indicating inflammation and association with an increased risk of exacerbations. In Brazil, there is still no large study evaluating the serum dosage of eosinophils in COPD patients. Objective: The study aims to show the prevalence of eosinophilia in COPD patients. Methods: 252 patients diagnosed with COPD according to GOLD criteria (FEV/FVC Results: Out of the 252 patients, 132 (52.38%) had eosinophils ≥ 2% and, of these, 80 (31.7% of the total) presented eosinophils ≥ 3%. Of the total, 51 patients (20.2%) had eosinophils ≥ 300. In a secondary analysis, 53 patients (21%) had previous clinical history of atopy, of which only 13 had eosinophils ≥ 300 or 3%. The associated diagnosis of asthma (according to GOLD criteria) was present in 18 patients (7.14%), 4 of these with eosinophils ≥ 300 ou 3%. Conclusion: A large proportion of COPD patients have increased serum eosinophils, with an even greater difference when a cutoff point of 2% is used. Serum eosinophils dosage is important for therapeutic definition in COPD patients and still needs to be extensively studied in different populations.

Ergospirometry and Echocardiography in Early Stage of Heart Failure with Preserved Ejection Fraction and in Healthy Individuals

Background Heart failure with preserved ejection fraction is a syndrome characterized by changes in diastolic function; it is more prevalent among the elderly, women, and individuals with systemic hypertension (SH) and diabetes mellitus. However, in its early stages, there are no signs of congestion and it is identified in tests by adverse remodeling, decreased exercise capacity and diastolic dysfunction. Objective To compare doppler, echocardiographic (Echo), and cardiopulmonary exercise test (CPET) variables - ergospirometry variables - between two population samples: one of individuals in the early stage of this syndrome, and the other of healthy individuals. Methods Twenty eight outpatients diagnosed with heart failure according to Framingham’s criteria, ejection fraction > 50% and diastolic dysfunction according to the european society of cardiology (ESC), and 24 healthy individuals underwent Echo and CPET. Results The group of patients showed indexed atrial volume and left ventricular mass as well as E/E’ and ILAV/A´ ratios significantly higher, in addition to a significant reduction in peak oxygen consumption and increased VE/VCO2 slope, even having similar left ventricular sizes in comparison to those of the sample of healthy individuals. Conclusion There are significant differences between the structural and functional variables analyzed by Echo and CPET when comparing two population samples: one of patients in the early stage of heart failure with ejection fraction greater than or equal to 50% and another of healthy individuals.