Correlations Between Small Airway Function,Ventilation Distribution,and Functional Exercise Capacity in COPD Patients

Background

Interest in using the nitrogen single-breath washout (N₂SBW) test to measure ventilation inhomogeneity and small airway function in COPD patients has grown in recent years. Our aim was to assess the correlation of the measures obtained by the N₂SBW test and other pulmonary function parameters with the six-minute walk distance (6MWD), the degree of dyspnea score, and health status in COPD patients.

Methods

In this cross-sectional study, 31 patients with COPD were subjected to the N₂SBW test, spirometry, whole-body plethysmography, carbon monoxide diffusing capacity measurement, the six-minute walk test, the modified Medical Research Council (mMRC) scale, and the COPD Assessment Test (CAT).

Results

We found a strong correlation between the 6MWD and the phase III slope of the nitrogen single-breath washout (Phase III slope_N2SBW) (r = ?0.796; p = 0.0001). We found moderate correlations between the 6MWD and the residual volume (RV) (r = ?0.651; p = 0.0001) and RV/total lung capacity (RV/TLC) (r = ?0.600; p = 0.0004). We also found moderate correlations between the CAT score and Phase III slope_N2SBW (r = 0.728; p = 0.0001), RV (r = 0.646; p = 0.0001) and RV/TLC (r = 0.603; p = 0.0003). There was a significant difference between the mMRC grades for the following variables: Phase III slope_N2SBW (p = 0.0001), RV (p = 0.0001), and smoking history (p = 0.008). Multivariate analysis showed that Phase III slope_N2SBW was the only independent predictor of the 6MWD (R ²  = 0.703; p = 0.0001), CAT score (R ²  = 0.586; p = 0.0001), and mMRC scale (relative risk = 1.14; p = 0.0001).

Conclusions

In patients with COPD, our findings suggest that the ventilation inhomogeneity impacts the functional exercise capacity, the degree of dyspnea, and health status.     

Plasmatic ADAMTS-13 metalloprotease and von Willebrand factor in children with cyanotic congenital heart disease

Changes in plasma von Willebrand factor concentration (VWF:Ag) and ADAMTS-13 activity (the metalloprotease that cleaves VWF physiologically) have been reported in several cardiovascular disorders with prognostic implications. We therefore determined the level of these proteins in the plasma of children with cyanotic congenital heart disease (CCHD) undergoing surgical treatment. Forty-eight children were enrolled (age 0.83 to 7.58 years). Measurements were performed at baseline and 48 h after surgery. ELISA, collagen-binding assays and Western blotting were used to estimate antigenic and biological activities, and proteolysis of VWF multimers. Preoperatively, VWF:Ag and ADAMTS-13 activity were decreased (65 and 71% of normal levels considered as 113 (105-129) U/dL and 91 ± 24% respectively, P < 0.003) and correlated (r = 0.39, P = 0.0064). High molecular weight VWF multimers were not related, suggesting an interaction of VWF with cell membranes, followed by proteolytic cleavage. A low preoperative ADAMTS-13 activity, a longer activated partial thromboplastin time and the need for cardiopulmonary bypass correlated with postoperative bleeding (P < 0.05). Postoperatively, ADAMTS-13 activity increased but less extensively than VWF:Ag (respectively, 2.23 and 2.83 times baseline, P < 0.0001), resulting in an increased VWF:Ag/ADAMTS-13 activity ratio (1.20 to 1.54, respectively, pre- and postoperative median values, P = 0.0029). ADAMTS-13 consumption was further confirmed by decreased ADAMTS-13 antigenic concentration (0.91 ± 0.30 to 0.70 ± 0.25 µg/mL, P < 0.0001) and persistent proteolysis of VWF multimers. We conclude that, in pediatric CCHD, changes in circulating ADAMTS-13 suggest enzyme consumption, associated with abnormal structure and function of VWF.     

Association between Sickle Cell Anemia and Pulp Necrosis

IntroductionThe purpose of this study was to evaluate the association between sickle cell anemia (SCA) and pulp necrosis (PN).MethodsOne hundred thirteen individuals with SCA (ie, the exposed group) from the Supervision of Hematology and Hemotherapy of Maranhão (HEMOMAR), Maranhão, Brazil, and 226 individuals without SCA, the sickle cell trait, or other diseases (ie, the nonexposed group) were enrolled in this study. All participants were over 16 years old and had at least 1 clinically intact permanent tooth. Patients with SCA and a history of lower alveolar nerve paresthesia and those who had suffered from vasoocclusive crises within the previous 6 months were excluded. PN of clinically intact permanent teeth without a history of orofacial trauma was diagnosed using the cold thermal test (CTT) and pulse oximetry adapted for dentistry (POD). Poisson regression was used to estimate the associations (P < .05).ResultsIn an unadjusted analysis, the occurrence of PN in clinically intact permanent teeth was 8.33 times higher in the exposed group than in the nonexposed group (P < .001). This association remained significant after adjusting for a history of orofacial trauma and folic acid use for the CTT and POD evaluations.ConclusionsIn conclusion, SCA is a potential risk factor for PN in clinically intact permanent tooth.     

The approach of ameloblastoma of the mandible: a case treated by hyperbaric oxygen therapy and bone graft reconstruction

Background

Reconstruction of mandibular defects after tumor resection is a challenge to the head and neck surgeon because of associated functional and esthetic problems. The intention of mandibular reconstructive surgery is to achieve maximum possible functionality, which means the restoration of masticatory function and speech with a good esthetic result. Hyperbaric oxygen therapy (HBO) is already a well-accepted adjunct in the treatment of extensive bone defects. It has been shown to enhance osteogenesis and improve soft tissue wound healing in a variety of circumstances.

Case report

The following case report describes a 29-year-old woman who was diagnosed with mandibular ameloblastoma. The treatment of choice is resection with mandibular base maintenance. The patient underwent 10 sessions of hyperbaric oxygen therapy and subsequent nonvascularized iliac crest graft. Six months after, mandibular reconstruction is possible to observe the preservation of mandibular contouring and facial esthetics. A panoramic radiograph revealed good positioning of the bone graft and volume maintenance.

Discussion

The mandibular reconstruction is extremely important for the rehabilitation of the patient who underwent bone resection. The restoration of mandibular function and facial esthetics is essential to maintain the quality of life. The use of HBO in mandibular reconstruction is an important adjunct to successful treatment, however, more studies are needed to establish the best modalities of rehabilitation.     

Intragastric Balloon for the Treatment of Obesity: Evaluation of Pulmonary Function Over a 3-Month Period

Background

Obesity has become a global epidemic in the 21st century, and the placement of an intragastric balloon (IB) is a therapeutic modality used to treat it. Our objectives for this study were to evaluate changes in lung function resulting from IB use and to correlate the pattern of body fat distribution with changes in lung function.

Methods

This was an interventional study with 30 overweight and obese patients with metabolic syndrome. All of the subjects underwent anthropometric measurements, assessment of their body fat distribution pattern by dual-energy X-ray absorptiometry, and pulmonary function testing before implantation of the IB.

Results

During the initial evaluations, the main pulmonary function abnormalities observed were decreased expiratory reserve volume (ERV), decreased total lung capacity (TLC), and increased diffusing capacity of carbon monoxide (DL_CO), which occurred in 56.7, 40, and 23.3?% of patients, respectively. We observed a statistically significant positive correlation between the DL_CO and the percentage of trunk fat mass (???=?0.42; p?<?0.01). Three months after placement of the IB, there was a significant reduction in the body mass index (p?<?0.0001) and the maximal inspiratory pressure (p?<?0.009). We also observed a significant increase in the forced vital capacity (p?<?0.0001), TLC (p?<?0.001), and ERV (p?<?0.0001).

Conclusions

Weight loss as a result of IB causes increased static lung volumes and decreased inspiratory muscle strength. Additionally, being overweight and obese is related to increased DL_CO, especially in individuals with truncal obesity.     

Hepatitis B virus prevalence and vaccination response in health care workers and students at the Federal University of Bahia, Brazil

Background and rationale for the study. Hepatitis B (HB) is one of the most prevalent occupational infections in health attendance environments. According to the Brazil Ministry of Health, health professionals must be vaccinated against the hepatitis B virus (HBV) and provide laboratory proof of immunization. Aims. To evaluate the seroprevalence of HBV infection and to analyze the response to vaccine by measuring serum antibodies against HBV surface antigen (anti-HBs) levels in a sample of students and health professionals at the Federal University of Bahia.Results. As part of this cross-sectional study, a campaign against occupational HB was launched in 2007 and vaccination and blood samples were collected for analysis of the following serological markers: HBV surface antigen (HBsAg) and anti-HBs (measured by enzyme-linked immunoassay) and total antibodies against HBV core antigen (anti-HBc). The study sample comprised 766 people. Global seropositivity for HBV was 1.7%: 0.5% in the students and 8.8% in the professionals. In a group of volunteers, a serological profile compatible with postvaccine immunity was shown by 95% of volunteers with proof of vaccination and by 81.8% of volunteers without proof of vaccination. Conclusions. In conclusion, this study shows that it is important to promote vaccination campaigns and improve knowledge and awareness about HB among health care workers and higher education students.     

Adult peripheral neuroblastoma.

Report of clinical features, diagnostic and surgical aspects observed in a case of adult peripheral neuroblastoma infiltrative of the lumbosacral plexuses. The patient, a 39-year-old male, presented with sciatalgia and progressive crural monoplegia. Characteristic histological features of this rare tumor are described. Surgical resection was attempted via a posterior transgluteal approach to the retroperitoneum through the greater sciatic foramen.     

Prenatal diagnosis of 48,XYY, + 21 ascertained through ultrasound anomalies

During a routine ultrasound study on a fetus at 21 weeks, nuchal edema was noted. At 21 weeks, repeat ultrasound study at our unit showed scalp and neck edema and a femur length/biparietal diameter ratio below the mean. Transabdominal chorionic villus sampling identified a 48.XYY, + 21 chromosome constitution. The fetus had normal internal/external genitalia and signs of Down syndrome.