Eliandra da Silveira de Lima

Incidence and endoscopic characteristics of acute laryngeal lesions in children undergoing endotracheal intubation

INTRODUCTION Acute laryngeal lesions after intubation appear to be precursors of chronic lesions. OBJECTIVE To describe the incidence and type of acute laryngeal lesions after extubation in a pediatric intensive care unit (PICU). METHODS A cohort study involving children from birth to <5 years, submitted to intubation for more than 24h in the PICU of an university hospital. In the first eight hours after extubation, a flexible fiberoptic laryngoscopy (FFL) was performed at the bedside. Those with moderate to severe abnormalities underwent a second examination seven to ten days later. RESULTS 177 patients were included, with a median age of 2.46 months. The mean intubation time was 8.19 days. Seventy-three (41.2%) patients had moderate or severe alterations at the FFL, with the remaining showing only minor alterations or normal results. During follow-up, 16 children from the group with moderate to severe lesions developed subglottic stenosis. One patient from the normal FFL group had subglottic stenosis, resulting in an incidence of 9.6% of chronic lesions. CONCLUSION Most children in the study developed mild acute laryngeal lesions caused by endotracheal intubation, which improved in a few days after extubation.

Exercise on Progenitor Cells in Healthy Subjects and Patients with Type 1 Diabetes.

PURPOSE To evaluate the acute effect of aerobic exercise (AE) and resistance exercise (RE) on the release of endothelial progenitor cell (EPCs, CD34+/KDR+/CD45 dim) and vascular function in type 1 diabetes (T1DM). METHODS Fourteen men with T1DM and 5 nondiabetic controls were randomly assigned to 40-min AE (60% VO 2peak) and RE sessions (60% 1-RM). The study had a crossover design, and interventions were 1 wk apart. Venous occlusion plethysmography (blood flow, reactive hyperemia, and vascular resistance) and blood collection (EPC levels, flow cytometry) were done immediately before and after exercise sessions. RESULTS Patients were 30.3 ± 1.6 yr-old, HbA1c 7.7% ± 0.2%; controls were 26.8 ± 2.3 yr-old. Groups did not differ in EPC levels at baseline or in relation to exercise. Over time, exercise did not induce changes in patients with T1DM, whereas, in controls, EPCs were decreased after AE (-10.7%, P = 0.017) and increased after RE (+12.2%, P = 0.004). Compared with baseline, blood flow increased and vascular resistance decreased after RE in both groups. Reactive hyperemia was increased 10 min after AE and RE sessions in patients with T1DM (36.5% and 42.0%, respectively) and in controls (35.4% and 74.3%), but no group differences were observed between groups in response to exercise. CONCLUSIONS Despite the increased vascular reactivity in both groups after both exercise sessions, EPCs were only influenced by exercise in controls. The unchanged number of EPCs in T1DM after exercise sessions might indicate a blunted endothelium regenerating capacity, revealing an early deterioration of the functional arterial characteristics not disclosed by only evaluating vascular functional variables.

A single session of aerobic or resistance exercise modifies the endothelial progenitor cell levels in healthy subjects, but not in individuals with type 1 diabetes

Materials and methods We conducted a crossover randomized clinical trial, in which 14 men with T1D and 5 healthy controls were randomly assigned to a 40-min AE session (60% VO2peak) and a 40-min RE session (60% maximal load), 1 week apart. Venous blood was collected 10 min pre and postexercise sessions to evaluate circulating EPCs (percentage of CD34+/KDR+/CD45dim of 200.000 mononuclear cells gated and analyzed by flow cytometry). Forearm BF and RH were evaluated by venous occlusion plethysmography before and after the sessions. Generalized Estimation Equation adjusted for baseline values was used. Results Patients were 30.3±1.6 yrs-old, HbA1c 7.7±0.2%; controls were 26.8±2.3 yrs-old. Exercise did not change EPCs in T1D [AE (-5.075±0.250 vs. -5.303±0.250, P=0.102); RE (-5.217±0.250 vs. -5.056±0.250, P=0.310)]; EPCs decreased after AE (-4.383±0.353 vs. 4.854±0.353, P=0.017) and increased after RE (-5.270±0.353 vs. -4.629±0.353, P=0.004) in controls. Blood flow increased after RE in patients with diabetes (28.7±11.4%, P=0.009) and controls (41.7±18.5%, P=0.024). Reactive hyperemia was increased after AE (36.5±7.3%, P<0.001), and RE (42.0±10.0%, P<0.001) in patients with diabetes and controls (AE: 35.4±11.0%, P=0.001; RE: 74.3±33.0%, P=0.005).