Search

Anamelia Costa Faria, Cláudia Henrique da Costa, Rogério Rufino Cardiopulmonology Department, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil Introduction: The Sleep Apnea Clinical Score (SACS) and the Berlin Questionnaire (BQ) are used to predict the likelihood of obstructive sleep apnea (OSA). The Epworth Sleepiness Scale (ESS) is used to assess daytime sleepiness, a common OSA symptom. These clinical tools help prioritize individuals with the most severe illness regarding on whom polysomnography (PSG) should be performed. It is necessary to check the applicability of these tools in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to compare SACS, BQ, and ESS performance in patients with COPD. Methods: The SACS, BQ, and ESS were applied to 91 patients with COPD. From this group, 24 underwent PSG. In this transversal study, these three tests were compared regarding their likelihood to predict OSA in patients with COPD using receiver-operating characteristic curve statistics. Results: In this sample, 58 (63.7%) patients were men, and their mean age was 69.4±9.6 years. Fourteen patients (15.4%) had a high probability of OSA by SACS, 32 (32.5%) had a high probability by BQ, and 37 (40.7%) had excessive diurnal somnolence according to the ESS. From the 24 patients who underwent PSG, OSA diagnosis was confirmed in five (20.8%), according to the American Academy of Sleep Medicine criteria. BQ and ESS did not accurately predict OSA in this group of patients with COPD, with a receiver-operating characteristic curve area under the curves of 0.54 (95% CI: 0.329–0.745, P=0.75) and 0.69 (95% CI: 0.47–0.860, P=0.10), respectively. SACS performance was significantly better, with an area under the curve of 0.82 (95% CI: 0.606–0.943, P=0.02). Conclusion: SACS was better than BQ and ESS in predicting OSA in this group of patients with COPD. Keywords: overlap syndrome, COPD, emphysema, questionnaire, polysomnography, diagnosis

Samária Ali Cader,1 Rodrigo Gomes de Souza Vale,1 Victor Emmanuel Zamora,2 Claudia Henrique Costa,2 Estélio Henrique Martin Dantas11Laboratory of Human Kinetics Bioscience, Federal University of Rio de Janeiro State, 2Pedro Ernesto University Hospital, School of Medicine, State University of Rio de Janeiro, Rio de Janeiro, BrazilBackground: The purpose of this study was to evaluate the extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training (IMT) and identify predictors of successful weaning.Methods: Twenty-eight elderly intubated patients in an intensive care unit were randomly assigned to an experimental group (n = 14) that received conventional physiotherapy plus IMT with a Threshold IMT® device or to a control group (n = 14) that received only conventional physiotherapy. The experimental protocol for muscle training consisted of an initial load of 30% maximum inspiratory pressure, which was increased by 10% daily. The training was administered for 5 minutes, twice daily, 7 days a week, with supplemental oxygen from the beginning of weaning until extubation. Successful extubation was defined by the ventilation time measurement with noninvasive positive pressure. A vacuum manometer was used for measurement of maximum inspiratory pressure, and the patients' Tobin index values were measured using a ventilometer.Results: The maximum inspiratory pressure increased significantly (by 7 cm H2O, 95% confidence interval [CI] 4–10), and the Tobin index decreased significantly (by 16 breaths/min/L, 95% CI −26 to 6) in the experimental group compared with the control group. The Chi-squared distribution did not indicate a significant difference in weaning success between the groups (Χ2 = 1.47; P = 0.20). However, a comparison of noninvasive positive pressure time dependence indicated a significantly lower value for the experimental group (P = 0.0001; 95% CI 13.08–18.06). The receiver-operating characteristic curve showed an area beneath the curve of 0.877 ± 0.06 for the Tobin index and 0.845 ± 0.07 for maximum inspiratory pressure.Conclusion: The IMT intervention significantly increased maximum inspiratory pressure and significantly reduced the Tobin index; both measures are considered to be good extubation indices. IMT was associated with a reduction in noninvasive positive pressure time in the experimental group.Keywords: inspiratory muscle training, rehabilitation, extubation

Epidemics of visceral leishmaniasis (VL) in major Brazilian cities are new phenomena since 1980. As determinants of transmission in urban settings probably operate at different geographic scales, and information is not available for each scale, a multilevel approach was used to examine the effect of canine infection and environmental and socio-economic factors on the spatial variability of incidence rates of VL in the city of Teresina. Details on an outbreak of greater than 1200 cases of VL in Teresina during 1993-1996 were available at two hierarchical levels: census tracts (socio-economic characteristics, incidence rates of human VL) and districts, which encompass census tracts (prevalence of canine infection). Remotely sensed data obtained by satellite generated environmental information at both levels. Data from census tracts and districts were analysed simultaneously by multilevel modelling. Poor socio-economic conditions and increased vegetation were associated with a high incidence of human VL. Increasing prevalence of canine infection also predicted a high incidence of human VL, as did high prevalence of canine infection before and during the epidemic. Poor socio-economic conditions had an amplifying effect on the association between canine infection and the incidence of human VL. Focusing interventions on areas with characteristics identified by multilevel analysis could be a cost-effective strategy for controlling VL. Because risk factors for infectious diseases operate simultaneously at several levels and ecological data usually are available at different geographical scales, multilevel modelling is a valuable tool for epidemiological investigation of disease transmission. [ABSTRACT FROM AUTHOR]

In this study, the metabolomics characterization focusing on the carotenoid composition of ten cassava (Manihot esculenta) genotypes cultivated in southern Brazil by UV-visible scanning spectrophotometry and reverse phase-high performance liquid chromatography was performed. Cassava roots rich in β-carotene are an important staple food for populations with risk of vitamin A deficiency. Cassava genotypes with high pro-vitamin A activity have been identified as a strategy to reduce the prevalence of deficiency of this vitamin. The data set was used for the construction of a descriptive model by chemometric analysis. The genotypes of yellow-fleshed roots were clustered by the higher concentrations of cis- β-carotene and lutein. Inversely, cream-fleshed roots genotypes were grouped precisely due to their lower concentrations of these pigments, as samples rich in lycopene (redfleshed) differed among the studied genotypes. The analytical approach (UV-Vis, HPLC, and chemometrics) used showed to be efficient for understanding the chemodiversity of cassava genotypes, allowing to classify them according to important features for human health and nutrition.

Propolis is a chemically complex biomass produced by honeybees (Apis mellifera) from plant resins added of salivary enzymes, beeswax, and pollen. The biological activities described for propolis were also identified for donor plant’s resin, but a big challenge for the standardization of the chemical composition and biological effects of propolis remains on a better understanding of the influence of seasonality on the chemical constituents of that raw material. Since propolis quality depends, among other variables, on the local flora which is strongly influenced by (a)biotic factors over the seasons, to unravel the harvest season effect on the propolis chemical profile is an issue of recognized importance. For that, fast, cheap, and robust analytical techniques seem to be the best choice for large scale quality control processes in the most demanding markets, e.g., human health applications. For that, UV-Visible (UV-Vis) scanning spectrophotometry of hydroalcoholic extracts (HE) of seventy-three propolis samples, collected over the seasons in 2014 (summer, spring, autumn, and winter) and 2015 (summer and autumn) in Southern Brazil was adopted. Further machine learning and chemometrics techniques were applied to the UV-Vis dataset aiming to gain insights as to the seasonality effect on the claimed chemical heterogeneity of propolis samples determined by changes in the flora of the geographic region under study. Descriptive and classification models were built following a chemometric approach, i.e. principal component analysis (PCA) and hierarchical clustering analysis (HCA) supported by scripts written in the R language. The UV-Vis profiles associated with chemometric analysis allowed identifying a typical pattern in propolis samples collected in the summer. Importantly, the discrimination based on PCA could be improved by using the dataset of the fingerprint region of phenolic compounds ( λ= 280-400 ηm), suggesting that besides the biological activities of those secondary metabolites, they also play a relevant role for the discrimination and classification of that complex matrix through bioinformatics tools. Finally, a series of machine learning approaches, e.g., partial least square-discriminant analysis (PLS-DA), k-Nearest Neighbors (kNN), and Decision Trees showed to be complementary to PCA and HCA, allowing to obtain relevant information as to the sample discrimination.

Abstract Background Chronic ankle stiffness can develop for numerous reasons after traumatic injury, and may adversely affect patient gait, mobility, and function. Although standard physical therapeutic techniques typically resolve this stiffness, some cases may be recalcitrant to these measures, making it difficult to restore range-of-motion. The purpose of this study was to evaluate a static progressive stretch orthosis for the treatment of chronic ankle stiffness. Methods Twenty-six patients (26 ankles) who had chronic post-traumatic ankle stiffness were studied. The patients began treatment at a mean of 47 weeks (range, 6 to 272 weeks) following their initial injury using a static progressive stretch orthosis. A patient-directed protocol was used for 30 minutes per day, 1 to 3 times per day, until the range-of-motion was considered to have plateaued. Mean treatment time was 10 weeks (range, 3 to 19 weeks). Treatment duration, range-of-motion, and complications with the device were assessed. Results The overall mean improvement in motion (combined dorsiflexion and plantar flexion) was 17 degrees (range, 2 to 44 degrees). There was a mean improvement in dorsiflexion of 9 degrees (range, -2 to 20 degrees), and a mean improvement of 8 degrees of plantar flexion (range, -10 to 35 degrees). There were no reports of numbness or skin problems. Conclusions The outcomes of this study suggest that a patient-directed treatment protocol using a static progressive stretch orthosis was an effective ancillary method for the treatment of chronic post-traumatic ankle stiffness that was refractory to standard physical therapy techniques.

Background and Objectives: Cardiopulmonary and skeletal muscle impairment and poor physical activity are potential contributors to reduced functional capacity in cystic fibrosis (CF). The Glittre-ADL test (TGlittre) has great potential for clinical use in adult CF adults, as it meets the need for a comprehensive assessment of physical function using tasks similar to activities of daily living. This study aimed to evaluate the performance of TGlittre in CF adults compared to the 6-min walk test (6MWT) and, secondarily, to quantify the associations of their results with pulmonary function, muscle strength, and health-related quality of life (HRQoL)., Methods: This cross-sectional study evaluated 34 CF adults and compared them with 34 subjects from a control group. The participants underwent the following assessments: functional capacity using TGlittre and 6MWT; spirometry; respiratory muscle strength; handgrip strength (HGS); and HRQoL using the Cystic Fibrosis Questionnaire-Revised (CFQ-R)., Results: While CF patients showed a longer time to perform TGlittre compared to controls (134 (119-150) versus 107 (95-126) % of the predicted time p = 0.0002), no difference between these groups was observed in the 6MWT. When the second TGlittre was compared to the first TGlittre, there was a significant decrease in total time for both CF patients (p < 0.0001) and controls (p = 0.0001). TGlittre time correlated with 6MWT distance (6MWD) (r s  = -0.641, p < 0.0001), HGS (r s  = -0.364, p = 0.034), peripheral oxygen saturation at the end of the test (r s  = -0.463, p = 0.006) and the "digestive symptoms" domain of CFQ-R (r s  = 0.376, p = 0.028). TGlittre time was shorter in patients who engaged in regular physical activity (3.10 (2.49-3.39) min versus 3.28 (2.95-3.53) min, p = 0.016)., Conclusions: TGlittre is more effective than the 6MWT in detecting limitations during exercise. There is an important learning effect of TGlittre in adult CF patients. TGlittre time was correlated with 6MWD, HGS, oxygen saturation level, and the patient's level of physical activity., (© 2024 John Wiley & Sons Ltd.)

COVID-2019 has resulted in an emerging respiratory infection that has spread as a pandemic since January 2020. Nuclear Medicine Services and its workers experienced a dramatic change in their clinical routine. They were required to adjust protocols for this new health condition. Regarding radioiodine therapy (RIT), initial orientations were to postpone treatments. In Brazil, National Nuclear Energy Commission prepared guidelines. It authorized RIT to employ activities over 1850 MBq in an outpatient setting on an exceptional basis. This study reports the RIT experience of a Brazilian hospital during the COVID-19 pandemic, intending to evaluate the applicability of outpatient treatment employing over 1850 MBq of I-131 on a large scale. During referred period, 106 patients at our service had an indication for RIT, of which 58 agreed to participate in the research and provided informed consent. Majority of patients did not meet the minimum requirements for outpatient treatment using doses > 1850 MBq., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

COPD, one of world's leading contributors to morbidity and mortality, is characterized by airflow limitation and heterogeneous clinical features. Three main phenotypes are proposed: overlapping asthma/COPD (ACO), exacerbator, and emphysema. Disease severity can be classified as mild, moderate, severe, and very severe. The molecular basis of inflammatory amplification, cellular aging, and immune response are critical to COPD pathogenesis. Our aim was to investigate EP300 (histone acetylase, HAT), HDAC 2 (histone deacetylase), HDAC3, and HDAC4 gene expression, telomere length, and differentiation ability to M1/M2 macrophages. For this investigation, 105 COPD patients, 42 smokers, and 73 non-smoker controls were evaluated. We identified a reduced HDAC2 expression in patients with mild, moderate, and severe severity; a reduced HDAC3 expression in patients with moderate and severe severity; an increased HDAC4 expression in patients with mild severity; and a reduced EP300 expression in patients with severe severity. Additionally, HDAC2 expression was reduced in patients with emphysema and exacerbator, along with a reduced HDAC3 expression in patients with emphysema. Surprisingly, smokers and all COPD patients showed telomere shortening. COPD patients showed a higher tendency toward M2 markers. Our data implicate genetic changes in COPD phenotypes and severity, in addition to M2 prevalence, that might influence future treatments and personalized therapies.

Visceral leishmaniasis (VL) is a clinical form of leishmaniasis with high mortality rates when not treated. Diagnosis suffers from invasive techniques and sub-optimal sensitivities. The current (affordable) treatment with pentavalent antimony as advised by the WHO is possibly harmful to the patient. There is need for an improved diagnosis to prevent possibly unnecessary treatment. N -glycan analysis may aid in diagnosis. We evaluated the N -glycan profiles from active VL, asymptomatic infections (ASYMP) and controls from non-endemic (NC) and endemic (EC) areas. Active VL has a distinct N -glycome profile that associates with disease severity. Our study suggests that the observed glycan signatures could be a valuable additive to diagnosis and assist in identifying possible markers of disease and understanding the pathogenesis of VL. Further studies are warranted to assess a possible future role of blood glycome analysis in active VL diagnosis and should aim at disease specificity., Competing Interests: The authors declare no competing interests., (© 2023 The Author(s).)

In recent years the research about topological photonic structures has been a very attractive topic in nanoscience from both a basic science and a technological point of view. In this work we propose a two-dimensional topological photonic structure, composed of a trivial and a topological photonic crystals, made of dumbbell-shaped dielectric rods. The topological behavior is induced by introducing an angular perturbation in the dumbbell-shaped dielectric rods. We show that this composed structure supports pseudospin interface states at the interface between the trivial and topological crystals. Our numerical results show that a bandgap is opened in the band structure by introducing the angular perturbation in the system, lifting the double degeneracy of the double Dirac cone at the [Formula: see text] point of the Brillouin zone, despite keeping the [Formula: see text] symmetry group. A pseudospin topological behavior was observed and analyzed with emphasis on the photonic bands at the [Formula: see text] point. We have also investigated the robustness of these pseudospin interface states and, according with our numerical results, we conclude that they are robust against defects, disorder and reflection. Finally, we have shown that the two edge modes present energy flux propagating in opposite directions, which is the photonic analogue of the quantum spin Hall effect., (© 2023. The Author(s).)

Aims: This study aimed to identify the symptoms associated with early stage SARS-CoV-2 (COVID-19) infections in healthcare professionals (HCPs) using both clinical and laboratory data., Methods: A total of 1297 patients, admitted between 18 March and 8 April 2020, were stratified according to their risk of developing COVID-19 using their responses to a questionnaire designed to evaluate symptoms and risk conditions., Results: Anosmia/hyposmia (p<0.0001), fever (p<0.0001), body pain (p<0.0001) and chills (p=0.001) were all independent predictors for COVID-19, with a 72% estimated probability for detecting COVID-19 in nasopharyngeal swab samples. Leucopenia, relative monocytosis, decreased eosinophil values, C reactive protein (CRP) and platelets were also shown to be significant independent predictors for COVID-19., Conclusions: The significant clinical features for COVID-19 were identified as anosmia, fever, chills and body pain. Elevated CRP, leucocytes under 5400×10 9 /L and relative monocytosis (>9%) were common among patients with a confirmed COVID-19 diagnosis. These variables may help, in the absence of reverse transcriptase PCR tests, to identify possible COVID-19 infections during pandemic outbreaks., Summary: From 19 March to 8 April 2020, 1297 patients attended the Polyclinic Piquet Carneiro for COVID-19 detection. HCP data were analysed, and significant clinical features were anosmia, fever, chills and body pain. Elevated CRP, leucopenia and monocytosis were common in COVID-19., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To assess the emergent zoonotic disease risk posed by the voracious human-biting blackfly species Simulium oyapockense in the peripheral regions of an expanding urban centre situated deep in the Brazilian Amazon rainforest., Methods: We performed nine human landing catches at three periurban sites surrounding the Brazilian Amazon town of São Gabriel da Cachoeira. Using the detection of non-human primate filarial parasites as an indicator of the zoonotic disease threat posed by a biting insect, we screened 3328 S. oyapockense blackflies for the presence of zoonotic filarial DNA with an ITS-1 PCR assay and Sanger sequencing., Results: Between 98 and 100% of the biting insects captured during our nine collections were identified as S. oyapockense; at our three collection sites and during our three seasonally-distinct collections this species was captured at rates between 28 and 294 blackflies per hour. PCR screening of the march-collected S. oyapockense detected infectious-stage (L3) Mansonella mariae parasites (which are only known to infect non-human primates) in >0.15% of the tested head samples., Conclusions: Our results show that residents of the periurban regions of São Gabriel da Cachoeira are routinely exposed to the bites of S. oyapockense blackflies which have previously fed on non-human primates., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Although COPD patients commonly present respiratory complaints despite pharmacological treatment, dyspnea does not correlate directly and linearly with spirometric data, a fact that makes it difficult to select patients for pulmonary rehabilitation. Thus, seems logical that the measurement of respiratory muscle strength could help in this initial assessment if it presents a good correlation with exercise capacity. The aim of this study is to assess whether patients with muscle weakness, characterized as a reduction in maximal inspiratory pressure (PImax) below 70% of predicted value, have a good relationship between the assessed respiratory muscle strength and the exercise capacity measured by the 6-min walk test (6MWT) in patients with COPD., Methods: Patients diagnosed with COPD according to the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) on regular use of their medications, without exacerbations for 3 months or more and with respiratory muscle weakness (PImax < 70% of predicted) performed 6MWT in a 30-m-long flat corridor., Results: Data from 81 patients were analyzed. There was a strong correlation between the distance of the 6MWD with the PImax (r = 0.764, p < 0.0001). When separating the sample by the 350-m cut in the 6MWD, we found that the patients with the worst performance in the test are those who present the greatest respiratory muscle weakness., Conclusion: PImax correlates well with exercise capacity, and patients with respiratory muscle weakness could be referred to a pulmonary rehabilitation protocol tied to inspiratory muscle training., (© 2021 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.)

Background/objective: The aim of this study was to explore the associations between nailfold videocapillaroscopy (NVC) and pulmonary function tests (PFTs) in systemic sclerosis (SSc) patients., Methods: This was a longitudinal study with follow-up of unselected Brazilian SSc patients. Baseline clinical examination, serological workup, high-resolution chest tomography, and NVC were performed. Pulmonary function test was performed at baseline and after 24 months. Pulmonary function test worsening over time was defined as either a ΔFVC decline ≥10% or a ΔFVC decline ≥5% and <9%, combined with a ΔDLCO decline ≥15%, at 24 months. The NVC parameters were quantitatively (capillary density number, dimension, morphology, and hemorrhages) and qualitatively (NVC pattern) evaluated according to the consented standardized definitions of the EULAR Study Group on Microcirculation in Rheumatic Diseases., Results: Seventy-nine patients were included. Fifty-nine were rated to have a scleroderma pattern (6 "early"/16 "active"/37 "late"). The mean FVC and DLCO were 76.8% and 67.2% at baseline and 73.8% and 64.3% at 24 months, respectively. After multivariate analysis, we found that a reduced baseline FVC was associated with reduced capillary density (odds ratio [OR], 11; 95% confidence interval [CI], 1.5-90.7; p = 0.03) and a reduced baseline DLCO associated with the late scleroderma pattern (OR, 6.75; 95% CI, 1.09-42; p = 0.03). No association between worsening of PFT over time and NVC was found., Conclusions: The association between NVC and PFTs might corroborate the link between microangiopathy and interstitial lung disease in patients with SSc. This finding might strengthen the idea of incorporating NVC as a tool to predict progressive interstitial lung disease in these patients in the future., Competing Interests: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brasil (finance code 001). V.S. is a senior clinical investigator of the Research Foundation–Flanders (Belgium; FWO; 1.8.029.20N). The FWO was not involved in the study design, collection, analysis, and interpretation of data; writing of the report; or in the decision to submit the manuscript for publication. V.S. received a research grant from Boehringer Ingelheim, received an unrestricted educational chair on systemic sclerosis of Janssen-Cilag NV, and received research funding from Actelion Pharmaceuticals Ltd, Bayer AG, F. Hoffman–La Roche AG, Galapagos NV, and Sanofi. R.R. is supported by FAPERJ as a scientist from the state of Rio de Janeiro to develop the project. The other authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Current evidence points to a state of hypercoagulability (consequence of hyperinflammation) as an important pathogenic mechanism that contributes to the increase in mortality in cases of COVID-19. The aim of the present study was to investigate the influence of deep-vein thrombosis on mortality patient's infected with SARS-CoV-2., Method: A clinical trial was conducted involving 200 consecutive patients with COVID-19-100 patients who were positive for deep-vein thrombosis (venous Doppler ultrasound) and 100 who were negative for deep-vein thrombosis at a public hospital., Results: The mortality rate was 67% in the group positive for DVT and 31% in the group negative for DVT., Conclusion: Deep-vein thrombosis is associated with an increase in mortality in patients with COVID-19 and failures can occur with conventional prophylaxis for deep-vein thrombosis.

Background: Because impulse oscillometry (IOS) can detect changes in the small airways and is safer to perform during the COVID-19 pandemic than other pulmonary function tests, it may have value in investigating pulmonary sequelae in COVID-19 survivors. This study evaluated the performance of IOS in detecting lung abnormalities in COVID-19 survivors and investigated the associations of the findings with those of lung ultrasound (LUS) and spirometry., Methods: In this cross-sectional study, 117 subjects underwent IOS at a frequency range of 4-20 Hz 2 months after COVID-19 diagnosis. They also underwent spirometry and LUS, and their aeration scores were calculated., Results: On IOS, the resonance frequency was > 12 Hz, and the area under the reactance curve was > 3.60 cm H 2 O/L/s in 70 (59.8%) and 55 (47.0%) subjects, respectively. A heterogeneity of resistance between R4 and R20 (R4-R20) > 20% was observed in 60 (51.3%) participants. Based on their abnormalities in resistive and reactive parameters, 76 (65.0%) participants had abnormal IOS. Spirometry abnormalities were detected in 40 (34.2%) cases. LUS was abnormal in 51 (43.6%) participants, and the median aeration score was 0 (0-8) points. Abnormal IOS was associated with abnormal LUS (P < .001) and abnormal spirometry (P = .002). Abnormal spirometry had a significant but weaker association with abnormal LUS (P = .031). In participants who reported hospitalization, abnormal IOS was associated with both abnormal LUS (P = .001) and abnormal spirometry (P = .006). In participants who did not report hospitalization, abnormal IOS was associated with abnormal LUS (P < .001) but not abnormal spirometry (P = .063)., Conclusions: In COVID-19 survivors, IOS detected changes even when spirometry was normal. In these individuals, IOS parameters were more strongly associated with abnormalities on LUS than with abnormalities on spirometry., Competing Interests: The authors have no conflicts to disclose., (Copyright © 2021 by Daedalus Enterprises.)

Background: Systemic sclerosis (SSc) is a rare disease, and the presence of pulmonary hypertension can be a determining factor in prognosis. The aim of this study was to evaluate the diagnosis, profile, and prognosis of systemic sclerosis pulmonary hypertension (SSc-PH) diagnosed by systematic screening in a Brazilian population., Methods: A cohort of SSc patients underwent systematic screening for SSc-PH. Patients were referred for right heart catheterization (RHC) according to transthoracic echocardiogram or a combination of diagnostic tools. The clinical, immunological, and hemodynamic features and prognosis after 3 years were evaluated., Results: Twenty patients underwent RHC. SSc pulmonary arterial hypertension (SSc-PAH) was the most common group of SSc-PH. These patients had long disease duration, high urate levels and highly elevated mean pulmonary arterial pressure (mPAP) and peripheral vascular resistance (PVR) on hemodynamics. Patients with mPAP > 20- < 25 mmHg had hemodynamic features of intermediate disease. Patients with SSc-PH associated to interstitial lung disease (SSc-ILD-PH) had signs of vasculopathy on hemodynamics. In patients with no-SSc-PH, the survival at 1, 2, and 3 years was 96%, 92% and 92%, respectively and in patients with SSc-PH it was 86.7%, 60% and 53.3%, respectively., Conclusions: Patients identified with SSc-PAH and SSc-ILD-PH in our screening had severe clinical and hemodynamic features. Mortality remains high in SSc-PH but was more related to Bo-PAH and SSc-ILD-PH, while in SSc-PAH, the prognosis was better., Trial Registration: Current Controlled Trials ISRCTN 72968188, July 8th, 2021. Retrospectively registered., (© 2021. The Author(s).)

Objectives: The aim of this study was to describe findings from lung ultrasound (LUS) and computed tomography (CT) in health professionals with coronavirus disease 2019 pneumonia and to evaluate the associations of the findings of both tests., Methods: This cross-sectional observational study evaluated 45 health professionals who were initially seen in screening tents and had a diagnosis of coronavirus disease 2019 as confirmed by a reverse transcription polymerase chain reaction and lung involvement diagnosed by LUS. Subsequently, these individuals were admitted to the hospital, where chest CT was performed. Aeration scores were obtained for the LUS examinations based on the following findings: more than 2 B-lines, coalescent B-lines, and subpleural consolidations. A subjective assessment of the extent of lung disease on CT was performed on the basis of the percentage of lung parenchyma involvement as follows: 25% or less, 25% to 50%, and greater than 50%., Results: Regarding LUS signs, more than 2 B-lines, coalescent B-lines, and subpleural consolidations were present in 73.3%, 68.2%, and 24.4% of cases, respectively. The main findings on CT were ground glass opacities, a crazy-paving pattern, and consolidations (66.7%, 20%, and 20% of cases); 17.8% of cases had examinations without abnormalities. Patients with more than 2 B-lines on LUS had more ground glass opacity areas on CT (P = .0007), whereas patients with subpleural consolidations on LUS had more consolidations on CT (P < .0001). In addition, patients with higher LUS aeration scores had more extensive disease on CT (P < .0001)., Conclusions: Lung ultrasound can detect lung injury even in the presence of normal CT results. There are associations between the abnormalities detected by both methods, and a relationship also exists between LUS aeration scores and the disease extent on CT., (© 2020 American Institute of Ultrasound in Medicine.)

Tyrosinases belong to the functional copper-containing proteins family, and their structure contains two copper atoms, in the active site, which are coordinated by three histidine residues. The biosynthesis of melanin in melanocytes has two stages depending on the actions of the natural substrates L-DOPA and L-tyrosine. The dysregulation of tyrosinase is involved in skin cancer initiation. In the present study, using molecular modeling tools, we analyzed the inhibition activity of tyrosinase activity using kojic acid (KA) derivatives designed from aromatic aldehydes and malononitrile. All derivatives showed conformational affinity to the enzyme active site, and a favorable distance to chelate the copper ion, which is essential for enzyme function. Molecular dynamics simulations revealed that the derivatives formed promising complexes, presenting stable conformations with deviations between 0.2 and 0.35 Å. In addition, the investigated KA derivatives showed favorable binding free energies. The most stable KA derivatives showed the following binding free energies: -17.65 kcal mol -1 (D6), -18.07 kcal mol -1 (D2), -18.13 (D5) kcal mol -1 , and -10.31 kcal mol -1 (D4). Our results suggest that these derivatives could be potent competitive inhibitors of the natural substrates of L-DOPA (-12.84 kcal mol -1 ) and L-tyrosine (-9.04 kcal mol -1 ) in melanogenesis.

Background: The role of lung ultrasound (LUS) in evaluating the mid- and long-term prognoses of patients with COVID-19 pneumonia is not yet known. The objectives of this study were to evaluate associations between LUS signs at the time of screening and clinical outcomes 1 month after LUS and to assess LUS signs at the time of presentation with known risk factors for COVID-19 pneumonia., Methods: This was a retrospective study of data prospectively collected 1 month after LUS screening of 447 adult patients diagnosed with COVID-19 pneumonia. Sonographic examination was performed in screening tents with the participants seated. The LUS signs (B-lines > 2, coalescent B-lines, and subpleural consolidations) were captured in six areas of each hemithorax and a LUS aeration score was calculated; in addition, the categories of disease probability based on patterns of LUS findings (high-probability, intermediate-probability, alternate, and low-probability patterns) were evaluated. The LUS signs at patients' initial evaluation were related to the following outcomes: symptomatology, the need for hospitalization or invasive mechanical ventilation (IMV), and COVID-19-related death., Results: According to the evaluations performed 1 month after LUS screening, 36 patients were hospitalised, eight of whom required intensive care unit (ICU) admission and three of whom died. The presence of coalescent B-lines was associated with the need for hospitalization (p = 0.008). The presence of subpleural consolidations was associated with dyspnoea (p < 0.0001), cough (p = 0.003), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.002). A higher aeration score was associated with dyspnoea (p < 0.0001), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.003). In addition, patients with a high-probability LUS pattern had a higher aeration score (p < 0.0001) and more dyspnoea (p = 0.024) and more often required hospitalization (p < 0.0001) and ICU admission (p = 0.031)., Conclusions: In patients with COVID-19 pneumonia, LUS signs were related to respiratory symptoms 1 month after LUS screening. Strong relationships were identified between LUS signs and the need for hospitalization and death.

In this work we theoretically investigate the influence of disorder and external perpendicular magnetic field on terahertz (THz) absorption in graphene/SiC cap layers on top of one-dimensional photonic structures. We show that left-handed circularly polarized light absorption can be achieved up to 0.9 and even nearly perfect absorption at magnetic fields over 4 T. It is also demonstrated that multichannel absorption can be obtained, in a broad frequency range, by increasing the disorder strength in the layer thicknesses, outperforming the corresponding periodic structures. Altogether, our results reveal the potentialities of introducing disorder to not only enhance but also to tune absorption in photonic superlattices with graphene under the influence of an external magnetic field, allowing for applications such as THz circular polarization selective sensors and photodetectors.

Purpose: To evaluate ultrasound signs of coronavirus disease-19 (COVID-19) pneumonia in symptomatic healthcare professionals and to correlate those changes with clinical findings., Methods: All patients underwent real-time polymerase chain reaction (RT-PCR), lung ultrasound (LUS) and clinical evaluation on the same day. In each of the 12 areas evaluated in the LUS, the LUS signs were scored to generate the aeration score., Results: A total of 409 participants had positive PCR, with a median age of 41 (35-51) years. All participants had clinical symptoms, with cough in 84.1%, fever in 69.7%, and dyspnea in 36.2% of cases. In the LUS, 72.6% of participants had B-lines >2, 36.2% had coalescent B-lines, and 8.06% had subpleural consolidations. The median aeration score was 3 (2-7). The aeration score differed significantly regarding the presence of cough (P = .002), fever (P = .001), and dyspnea (P < .0001). The finding of subpleural consolidations in the LUS showed significant differences between participants with or without dyspnea (P < .0001)., Conclusions: In healthcare professionals with COVID-19, LUS plays a key role in the characterization of lung involvement. Although B-lines are the most common ultrasound sign, subpleural consolidations are those that most impact the respiratory condition., (© 2020 Wiley Periodicals LLC.)

Purpose: To elaborate and show an innovative speech and language guidance program for smartphones, tablets, and computers, with technological support. The program aims to help parents of children at risk for language disorder in order to minimize the consequences of a developmental language disorder (DLD)., Method: An app was developed to provide a dynamic interaction between the researcher and the families for at a distance intervention, aiming to reach the greatest number of children to promote language development in a broad, low-cost and effective way., Results: The content was organized in video-lessons (theoretical orientations were carried out in the form of video-lessons, taught by the researcher), videos (documentaries and videos from YouTube), reports (reports linked to sites specializing in child development), complementary content (cultural and leisure activities to be done in family) and activities (activities to stimulate the skills worked on in each week's video lesson proposed in the application)., Conclusion: We created a remote orientation program proposing an innovative, technological, and motivating therapeutic environment compatible with the reality of today's families.

We investigate the photonic band structure, using the transfer-matrix method, in one-dimensional structures composed of a dispersive metamaterial A juxtaposed with a non-dispersive dielectric B according to the generalized Fibonacci and Thue-Morse sequences, which are ruled and characterized by two positive integer numbers, p  and q. We present the band structures of different generations of these sequences for both TE and TM modes and discuss how they are affected by the p  and q parameters and the ratio between the thicknesses of the building blocks. We obtain a new and very important analytical expression for the frequency in which the average refraction index vanishes, i.e. when the [Formula: see text] gap condition is satisfied, and we investigate, in detail, the behavior of this emergent scale insensitive gap, as a function of the thicknesses ratio, for all structures considered. For the metamaterial considered, we show that the reduced frequency for [Formula: see text] converges faster or slower to 0.41 depending on the sequence. By adjusting the p  and q parameters, we can obtain a higher concentration of the pass bands inside (outside) the n A   <  0 region when there are more (less) blocks A than B in the unit cell. Our results also show the presence of omnidirectional and complete band gaps, which have various practical and technological applications.

Cancer is one of the leading causes of death worldwide, and the number of patients has only increased each year, despite the considerable efforts and investments in scientific research. Since natural products (NPs) may serve as suitable sources for drug development, the cytotoxicity against cancer cells of 2221 compounds from the Nuclei of Bioassays, Ecophysiology, and Biosynthesis of Natural Products Database (NuBBE DB ) was predicted using CDRUG algorithm. Molecular modeling, chemoinformatics, and chemometric tools were then used to analyze the structural and physicochemical properties of these compounds. We compared the positive NPs with FDA-approved anticancer drugs and predicted the molecular targets involved in the anticancer activity. In the present study, 46 families comprising potential anticancer compounds and at least 19 molecular targets involved in oncogenesis. To the best of our knowledge, this is the first large-scale study conducted to evaluate the potentiality of NPs sourced from Brazilian biodiversity as anticancer agents, using in silico approaches. Our results provided interesting insights about the mechanism of action of these compounds, and also suggested that their structural diversity may aid structure-based optimization strategies for developing novel drugs for cancer therapy., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: Activity/remission differentiation is a great challenge in the follow-up and treatment of sarcoidosis patients. Angiotensin-converting enzyme (ACE) and high sensitivity C-reactive protein (hs-CRP) were proposed as sarcoidosis biomarkers. More recently, chitotriosidase (CHITO) has been described as a better alternative. This study has the aim to evaluate the association of CHITO activity, ACE, hs-CRP or a combination of these biomarkers and to construct a clinical algorithm to differentiate between sarcoidosis activity/remission status., Methods: Forty-six patients with either active sarcoidosis or sarcoidosis in remission and 21 healthy individuals were included. ACE, hs-CRP, and CHITO were evaluated in serum samples. Comparisons of the laboratory variable means among groups were performed by linear models. The cutoff points of the biomarkers for activity/remission differentiation were calculated using the Youden's index. Biomarker cutoff points and decision tree classifier (DTC) performance were estimated by their leave-one-out cross-validation (LOOCV) accuracy (Acc), sensitivity (Se), and specificity (Sp)., Results: A 55% mean Se and a 100% mean Sp were found for CHITO, while an 88% Se and a 47% Sp were found for ACE, and a 66% Se and a 68% Sp for hs-CRP cutoff points for activity/remission differentiation. The DTC algorithm with CHITO, hs-CRP, and ACE information had an LOOCV mean Acc of 82%, Se of 78%, and Sp of 89% for sarcoidosis activity/remission differentiation., Conclusions: The algorithm involving CHITO, hs-CRP, and ACE could be a suitable strategy for differentiation between sarcoidosis activity/remission status.

Objective: Alpha-1-antitrypsin deficiency is a relatively prevalent, but under-diagnosed, genetic disease. The objective of this study was to assess whether the systematic screening for alpha-1-antitrypsin deficiency in all patients with chronic obstructive pulmonary disease from a tertiary service has an impact on the number of patients being diagnosed with this condition., Results: Chronic obstructive pulmonary disease patients were screened for alpha-1-antitrypsin deficiency using immunonephelometry. The presence of a mutation was confirmed by molecular study of the SERPINA1 gene or by genetic sequencing, as needed. A total of 551 patients with chronic obstructive pulmonary disease were analyzed. Among these, 40 (7.2%) had some genetic mutation, while 11 (2%) had a Pi*ZZ genotype, resulting in severe respiratory illness. The systematic evaluation of chronic obstructive pulmonary disease patients revealed that screening is an effective method to diagnose alpha-1-antitrypsin deficiency. Early diagnosis may facilitate smoking cessation and initiation of treatment to maintain lung function.

Objective: To investigate the effect of rituximab on microcirculation in long-term SSc., Results: Four patients with diffuse SSc over 3 years of disease received rituximab cycles of two 1-g infusions every 6 months for 2 years. Videocapillaroscopy was performed at baseline, 12 months, and 24 months and semi-quantitative scoring of videocapillaroscopy abnormalities was performed and the microangiopathy evolution score (MES: range 0-9) was calculated. The mean disease duration was 5 years (range 3-15). On videocapillaroscopy, giant capillaries and hemorrhages remained stable from baseline to 24 months. Capillary loss, abnormally-shaped capillaries, and MES stabilized at 12 months and increased by 24.5% and 28% at 24 months. Rituximab improves microcirculation in long-term SSc. Stabilization and reduced progression of microcirculation abnormalities were achieved at 12 and 24 months, respectively.

Background: Pulmonary rehabilitation programs improve exercise capacity and quality of life in patients with COPD. Domiciliary strategies to maintain these benefits have been proposed., Objective: This study aimed to determine whether a rehabilitation manual would facilitate the maintenance of the benefits acquired during out-patient pulmonary rehabilitation., Methods: Fifty subjects with stable COPD were included (26 women and 24 men). All the subjects were evaluated during screening and after 12 wk of out-patient rehabilitation, and then were randomly divided into 2 groups, with one group that received the rehabilitation manual for home use (manual group) and the other group only received verbal recommendations (control group). At this point, the 2 groups were similar. After 12 wk at home, both groups were evaluated a third time. All evaluations included a 6-min walk test (6MWT), 6-min step test, COPD Assessment Test, and measurement of dyspnea by using the modified Medical Research Council dyspnea scale., Results: When comparing the results of the 6MWT and 6-min step test done at out-patient discharge and after 12 wk at home, the manual group presented no differences (6MWT, 0 ± 25 m; 6-min step test, 1 ± 32 steps), whereas the control subjects lost part of the gain obtained during rehabilitation (6MWT -46 ± 36 m; 6-min step test -39 ± 33 steps). There was a significant difference between the groups ( P < .05). When comparing the same time points, the change in the COPD Assessment Test score was -1 ± 1 for the manual group and 1 ± 2 for the control group ( P = .01). For the modified Medical Research Council dyspnea scale, the change in score was 0 ± 1 for the manual group and 1 ± 1 for the control group ( P = .01)., Conclusions: The use of a simple, well-illustrated manual facilitated the maintenance of the benefits acquired in out-patient pulmonary rehabilitation over a period of 3 months after study termination., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2018 by Daedalus Enterprises.)

The INHALATOR study was a randomized, multicentre, open label, two-period of 7 days each, crossover study, with 7 days of washout in-between, aiming to evaluate the correct use, satisfaction and preference between Breezhaler ® and Respimat ® devices in patients under daily use of open Spiriva ® or open Onbrize ® , as monotherapy for treatment of mild or moderate COPD. Patients aged ≥40 years with a smoking history of at least 10 pack-year were included in the study. Primary endpoint was the rate of correct use of each device at the first day of treatment after reading the drug leaflet information and was evaluated under the supervision of a trained evaluator. At the end of each treatment phase, the inhaler use was re-evaluated and a satisfaction questionnaire was completed. The patients' preference for the inhaler devices was assessed at the end of the study. After exclusions due to screening failures, 140 patients were randomized: 136 received at least one dose of Breezhaler ® and 135 of Respimat ® . At treatment start, the rate of correct inhaler use was 40.4% (95%CI: 32.2%-48.7%) for Breezhaler ® and 36.3% (95%CI: 28.2%-44.4%) for Respimat ® (p = 0.451). After 7 days, the rates were 68.9% (95%CI: 61.1%-76.7%) and 60.4% (95%CI: 52.2%-68.7%), respectively (p = 0.077). According to the Feeling of Satisfaction with Inhaler Questionnaire - FSI 10 patients were more satisfied using Breezhaler ® than Respimat ® and 57.1% preferred using Breezhaler ® (p = 0.001) while 30.1% preferred Respimat ® (p < 0.001)., (Copyright © 2018. Published by Elsevier Ltd.)

Background: In scleroderma, excessive collagen production can alter tracheal geometry, and computed tomography (CT) volumetry of this structure may aid in detecting possible abnormalities. The objectives of this study were to quantify the morphological abnormalities in the tracheas of ​​patients with scleroderma and to correlate these findings with data on clinical and pulmonary function., Methods: This was a cross-sectional study in which 28 adults with scleroderma and 27 controls matched by age, gender and body mass index underwent chest CT with posterior segmentation and skeletonization of the images. In addition, all participants underwent pulmonary function tests and clinical evaluation, including the modified Rodnan skin score (mRSS)., Results: Most patients (71.4%) had interstitial lung disease on CT. Compared to controls, patients with scleroderma showed higher values ​​in the parameters measured by CT trachea volumetry, including area, eccentricity, major diameter, minor diameter, and tortuosity. The tracheal area and equivalent diameter were negatively correlated with the ratio between forced expiratory flow and forced inspiratory flow at 50% of forced vital capacity (FEF50%/FIF50%) (r = -0.44, p = 0.03 and r = -0.46, p = 0.02, respectively). The tracheal tortuosity was negatively correlated with peak expiratory flow (r = -0.51, p = 0.008). The mRSS showed a positive correlation with eccentricity (r = 0.62, p < 0.001) and tracheal tortuosity (r = 0.51, p = 0.007), while the presence of anti-topoisomerase I antibody (ATA) showed a positive correlation with tracheal tortuosity (r = 0.45, p = 0.03)., Conclusions: In a sample composed predominantly of scleroderma patients with associated interstitial lung disease, there were abnormalities in tracheal geometry, including greater eccentricity, diameter and tortuosity. In these patients, abnormalities in the geometry of the trachea were associated with functional markers of obstruction. In addition, tracheal tortuosity was correlated with cutaneous involvement and the presence of ATA., Competing Interests: The authors have declared that no competing interests exist.

Background: Visceral leishmaniasis (VL) is considered an urban endemic that may be related to sociodemographic factors and urban infrastructure. The objective of this study was to analyze the conditions of vulnerability and the incidence of VL, and to identify the spatiotemporal pattern of the disease., Methods: Data on reported cases of VL were collected from 2007 to 2016. Thematic maps on the spatiotemporal distribution were produced using values normalized by the area of the neighborhoods. The primary indicators of vulnerability were normalized for later construction of the synthetic indicators of vulnerability of social structure, household structure, and urban infrastructure, and from these, a vulnerability index was developed. The bivariate global Moran index was used to verify the existence of spatial autocorrelation between the incidence of VL and the conditions of vulnerability, while the bivariate local Moran index was used to identify the existence of spatial clusters., Results: The 695 cases reported presented a diffuse distribution when the spatial pattern was evaluated. The incidence of the disease was correlated with worsened living conditions. Statistically significant clusters were revealed between the incidence of the disease and the vulnerability indicators of social structure, household structure, urban infrastructure and composite vulnerability index., Conclusion: Addressing the local vulnerability conditions is important to the understanding of the distribution of visceral leishmaniasis, identifying the most susceptible areas, and planning control strategies.

Visceral leishmaniasis (VL) caused by Leishmania infantum is a lethal disease transmitted by sand flies. Although, considered a zoonosis with dogs held as the main reservoirs, humans are also sources of infection. Therefore, control policies currently focused on dog culling may need to consider that VL and human immunodeficiency virus (HIV)/VL patients may also be infectious, contributing to transmission. Reservoir competence of patients with VL without and with HIV infection and of persons asymptomatically infected with Leishmania was assessed by xenodiagnosis with the vector Lutzomyia longipalpis . Parasites in sand fly's guts were identified by using optical microscopy and by conventional polymerase chain reaction (PCR). Leishmania infantum blood parasite burden was determined by quantitative PCR. Among the 61 participants, 27 (44%) infected sand flies as seen by microscopy or PCR. When infectiousness was assessed by microscopy, xenodiagnosis was positive in five (25%) patients not infected with HIV, whereas nine (45%) of those harboring HIV were positive. Among the 19 asymptomatic patients four (21%) infected sand flies only demonstrated by PCR. One (50%) asymptomatic patient with HIV had a positive xenodiagnosis by microscopy. 9/372 (2.4%) and 37/398 (9.2%) sand flies were infected when feeding in patients without and with HIV, respectively. Infectiousness was poorly correlated with quantitative PCR. The study shows that asymptomatic humans are capable of transmitting L. infantum , that ill persons with HIV infection are more infectious to sand flies, and that humans are more important reservoirs than previously thought. This fact may be considered when designing control policies for zoonotic VL.

Due to the diversified nature of municipal solid waste and the different stages of its decomposition, the formed leachates result in a complex chemical mixture with toxic potential. These chemicals can cause environmental problems, such as the contamination of surface or groundwater, thus affecting the balance of aquatic ecosystems. The aim of our study was to evaluate the acute toxicity of leachates in Daphnia magna and Aliivibrio fischeri and to identify the main physicochemical variables that influence the toxicity of the landfill leachates produced in reactors within pilot simulations. Acute toxicity tests carried out on D. magna and A. fischeri showed that the leachates produced inside the reactors are highly toxic, presenting EC50 48h  < 1% for D. magna and EC50 15min  < 12% for A. fischeri. This result indicates that microcrustaceans are more sensitive to leachates, making them more suitable to our study. Pb showed the highest correlation with EC50 48h , suggesting that Pb is the main chemical variable indicative of toxicity for the conditions of the experiment. In smaller scale, phosphate (PO 4 3- ) and nitrate (NO 3- ) were the macronutrients that most influenced the toxicity. Clearly, this correlation should be viewed with caution because the synergistic effects of this complex mixture are difficult to observe.

Cerdocyon thous presents a wide geographic distribution in Brazil and its role as a possible Leishmania infantum reservoir in a visceral leishmaniasis (VL) transmission cycle regardless of dogs (Canis familiaris) has been discussed. From this perspective, this work describes the occurrence and use of the habitat by Cerdocyon thous in a Lutzomyia longipalpis occurrence area Teresina (Piaui - Brazil), VL endemic region. Three specimens of C. thous were monitored with the use of radio telemetry and trails and footprints, seeking to find possible natural dens in order to collect the sanflies from the site. Luminous CDC and Damasceno traps were simultaneously installed at the visited sites, where two specimens of L. longipalpis and one L. termitophila were captured. The identification of the dens and trails, allows us to infer that the dens are not used only by the C. thous. Finding the VL vector in natural C. thous natural dens, reinforces the hypothesis of transmission of Le. infantum in the outskirts of the large urban centers, in a cycle that independs from dogs., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Burkholderia cepacia complex is a group of opportunistic pathogens in cystic fibrosis (CF) patients believed to be associated with poor prognosis and patient-to-patient transmissibility. Little is known about clinical outcomes after B. vietnamiensis chronic colonization/infection., Case Presentation: A 33 yo male patient had diagnosis of CF by 7 yo, after recurrent pneumonia during infancy and lobectomy (left upper lobe) at 6 yo. Burkholderia cepacia complex (Bcc) was first isolated by 13 yo, and the patient fulfilled the criteria for chronic colonization by 15 yo. In the following 16 years (1997-2013), there was intermittent isolation of P. aeruginosa and continuous isolation of Bcc, identified as B. vietnamiensis. There was clinical and laboratorial stability for 16 years with annual rate of decline in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) of 1.61 and 1.35%, respectively. From 2013 to 2015, there was significant clinical and lung function deterioration: annual rate of decline in FEV1 and FVC was 3 and 4.1%, respectively while body mass index decreased from 18.1 to 17.1. Episodes of hemoptysis and respiratory exacerbations (with hospital admissions) became more frequent. CF related diabetes was diagnosed (fasting glycemia: 116 mg/dL, oral glucose tolerance test: 305 mg/dL). Because of the severity of the disease in the last years, in addition to traditional microbiological surveillance, microbiome analysis by next generation sequencing (NGS) was performed on respiratory secretions. The NGS showed that 97% of the sequencing data were attributed to genus Burkholderia., Conclusions: We report the case of a 33-year-old male CF patient known to have chronic infection with B. vietnamiensis who remained clinically stable for 16 years and presented recent clinical and laboratorial deterioration. Microbiome analysis of respiratory secretions was performed in 3 samples collected in 2014-2015. Clinical deterioration overlapped with cystic fibrosis-related diabetes and microbiome composition revealed no significant differences when compared microbiome results to culture dependent methods.

Background: Despite the importance of traditional pulmonary function tests (PFTs) in managing systemic sclerosis (SSc), many patients with pulmonary disease diagnosed by computed tomography (CT) present with normal PFTs., Objective: To evaluate the efficacy of the nitrogen single-breath washout (N 2 SBW) test in diagnosing SSc and to correlate N 2 SBW parameters with the PFT indexes used in the follow-up of these patients, clinical data, and CT findings., Methods: Cross-sectional study in which 52 consecutive SSc patients were subjected to spirometry, body plethysmography, analysis of the diffusing capacity for carbon monoxide (DLCO), analysis of respiratory muscle strength, N 2 SBW testing, and CT analysis., Results: Twenty-eight patients had a forced vital capacity (FVC) that was <70% of the predicted value. In the N 2 SBW test, 44 patients had a phase III slope (Phase III slope N2SBW ) that was >120% of the predicted value, while 15 patients had a closing volume/vital capacity (CV/VC) that was >120% of the predicted value. A significant difference in Phase III slope N2SBW was observed when the patients with predominant traction bronchiectasis and honeycombing were compared to the patients with other CT patterns (p<0.0001). The Phase III slope N2SBW was correlated with FVC (r s =-0.845, p<0.0001) and DLCO (r s =-0.600, p<0.0001), and the CV/VC was correlated with FVC (r s =-0.460, p=0.0006) and residual volume/total lung capacity (r s =0.328, p=0.017)., Conclusion: Ventilation heterogeneity is a frequent finding in SSc patients that is associated with restrictive damage, changes in pulmonary diffusion, and CT patterns. In addition, approximately one-third of the patients presented with findings that were compatible with small airway disease., (Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

The aim of the present study was to provide new spirometry reference equations in a sample of the Brazilian population for the following parameters: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, peak of expiratory flow (PEF), forced expiratory flow at 50% (FEF50%), 75% average vital capacity (FEF25-75%), and average forced expiratory flow time (FEFT). This was a prospective study using results from chest radiographs, electrocardiograms, and questionnaires to investigate the participants' respiratory symptoms, sedentarism, and comorbidities (Charlson comorbidity index). From December 2010 to July 2014, individuals were randomly selected from various locations in the state of Rio de Janeiro. All individuals were examined by a single technician in the morning at the laboratory, and performed the spirometry with the same spirometer. Spirometry values were tabulated for the creation of three equation models: linear regression, logarithmic regression, and logarithms through a method that incorporates the lambda, median, and coefficient of variation (LMS method). Initially, 7003 individuals from both genders were contacted, and 454 were recruited. The data from the new equations were compared with one Brazilian and eight international equations, resulting in a high correlation (r>0.9). The values derived from the LMS method and linear regression were very similar (P>0.5), and both could be used to acquire the reference values for Brazilian spirometry. Data derived from the equations of this study were different from the current Brazilian equation, which could be justified by the different method used.

Objective: To verify whether or not heart rate is maintained below the calculated submaximal level in healthy, sedentary subjects when they perform the 6-minute step test (6MST) and the 6-minute walking test (6MWT), and to compare the maximal heart rate achieved by the subjects at the end of each test., Design: Observational, cross-sectional study., Setting: One tertiary centre., Participants: Two hundred and fifty-three participants from a pool of 330 healthy and sedentary subjects between 20 and 80 years of age., Interventions: Both the 6MWT and the 6MST were performed in accordance with the American Thoracic Society's statement. Dyspnoea, blood pressure, oxygen saturation and heart rate were measured before and after each test., Results: Mean heart rate immediately after the 6MST was significantly higher than mean heart rate immediately after the 6MWT {125 [standard deviation (SD) 19] vs 111 (SD 17) beats/minute; mean difference 13 (95% confidence interval of the difference 10 to 16); P<0.001}. Moreover, mean heart rate during (3minutes after commencement) the 6MST [118 (SD 18) beats/minute] was statistically higher than mean heart rate at the end of the 6MWT [111 (SD 18) beats/minute; P<0.001]. None of the subjects achieved the calculated submaximal heart rate., Conclusions: The 6MST and 6MWT are safe and produce submaximal effort in healthy participants. However, they are not interchangeable, and the 6MST requires more energy than the 6MWT., (Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Background: HLA-E products, class Ib human leukocyte antigens, act in the immunology of human reproduction as modulators of the maternal immune system during pregnancy., Aims: To evaluate HLA-E role in the establishment of a viable pregnancy., Materials & Methods: HLA-E was genotyped by sequence-based typing (SBT) and analyzed for specific polymorphisms, comparing couples who underwent assisted reproduction treatment (ART) and fertile control couples., Results: There was a significant difference in HLA-E allele and genotype distributions between ART couples and control couples. The allele HLA-E*01:03 was observed in 63.2% of ART men and in 35.1% of fertile men (P = 0.0032)., Conclusion: These results suggest that HLA-E allelic variants may play a role in the modulation of immune responses in the context of the inability of natural conception and establishment of a viable pregnancy., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)