Use of Pulmonary Artery Catheter (PAC) is still a debatable issue, mainly due to questions raised... more Use of Pulmonary Artery Catheter (PAC) is still a debatable issue, mainly due to questions raised about its security and efficacy. This study reproduced in a sample of Brazilian physicians, another one conducted amidst American doctors, in which was pointed out the heterogeneity of clinical decisions guided by data obtained from PAC. During the Brazilian Congress of Intensive Care Medicine (Curitiba 2004), doctors were asked to answer a survey form with three vignettes. Each of them contained PAC data and one half of the surveys contained echocardiographic information. Every doctor was asked to select one of six interventions for each vignette. A homogeneous answer was considered when it was selected by at least 80% of the respondents. Two hundred and thirty seven doctors answered the questionnaires. They selected completely different therapeutic interventions in all three vignettes and none of the interventions achieved more than 80% agreement. Variability persisted with the choice...
Sepsis represents the major cause of death in the ICUs all over the world. Many studies have show... more Sepsis represents the major cause of death in the ICUs all over the world. Many studies have shown an increasing incidence over time and only a slight reduce in mortality. Many new treatment strategies are arising and we should define the incidence and features of sepsis in Brazil. Prospective cohort study in sixty-five hospitals all over Brazil. The patients who were admitted or who developed sepsis during the month of September, 2003 were enrolled. They were followed until the 28th day and/or until their discharge. The diagnoses were made in accordance to the criteria proposed by ACCP/SCCM. It were evaluated demographic features, APACHE II score, SOFA (Sepsis-related Organ Failure Assessment) score, mortality, sources of infections, microbiology, morbidities and length of stay (LOS). Seventy-five ICUs from all regions of Brazil took part in the study.3128 patients were identified and 521 (16.7%) filled the criteria of sepsis, severe sepsis or septic shock. Mean age was 61.7 (IQR 3...
To determine the prevalence of intensive care unit (ICU)-acquired infections and the risk factors... more To determine the prevalence of intensive care unit (ICU)-acquired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship between ICU-acquired infection and mortality. A 1-day point prevalence study. Sixteen ICU of the State of Rio Grande do Sul-Brazil, excluding coronary care and pediatric units. All patients < 12 yrs occupying an ICU bed over a 24-hour period. The 16 ICU provided 174 case reports. rates of ICU-acquired infection, resistance patterns of microbiological isolates, and potential risks factors for ICU-acquired infection and death. A total of 122 patients (71%) was infected and 51 (29%) had ICU-acquired infection. Pneumonia (58.2%), lower tract respiratory infection (22.9%), urinary tract infection (18%) were the most frequents types of ICU infection. Most frequently microorganisms reported were staphylococcus aureus (42% [64% resistant to oxacilin]) and pseudomonas aeruginosa (31%). Six risk f...
Revista da Sociedade Brasileira de Medicina Tropical
For the first time we provide the description of the melanic (dark) morphotype of Rhodnius nasutu... more For the first time we provide the description of the melanic (dark) morphotype of Rhodnius nasutus and determine the pattern of genetic inheritance for this characteristic. Dark morph R. nasutus specimens were crossbred with standard (typically patterned) R. nasutus. We present the first occurrence of the melanic morphotype in the genus Rhodnius. The crossbreeding results demonstrate that the inheritance pattern of this characteristic follows Mendel's simple laws of segregation and an independent assortment of alleles. Phenotypic variation of R. nasutus reinforces the heterogeneity found in the Triatominae. Descriptions of new species in this subfamily require rigorous validation criteria.
Septic shock presents as a continuum of infectious events, generating tissue hypoxia and hypovole... more Septic shock presents as a continuum of infectious events, generating tissue hypoxia and hypovolemia, and increased oxidative stress. Chest physiotherapy helps reduce secretion, improving dynamic and static compliance, as well as improving secretion clearance and preventing pulmonary complications. The purpose of this study was to evaluate the immediate effect of chest physiotherapy on hemodynamic, metabolic, inflammatory, and oxidative stress parameters in subjects in septic shock. We conducted a quasi-experimental study in 30 subjects in septic shock, who underwent chest physiotherapy, without associated heart diseases and with vasopressors < 0.5 μg/kg/min. Venous and arterial blood gases, clinical and hemodynamic data, inflammatory data, lactate, and oxidative stress were evaluated before and 15 min after physiotherapy. Thirty subjects with a mean age of 61.8 ± 15.9 y and Sequential Organ Failure Assessment of 8 (range 6-10) were included. Chest physiotherapy caused a normaliz...
Chagas disease incidence has sharply declined over the last decade. Long-term disease control wil... more Chagas disease incidence has sharply declined over the last decade. Long-term disease control will, however, require extensive, longitudinal surveillance systems capable of detecting (and dealing with) reinvasion-reinfestation of insecticide-treated dwellings by non-domiciliated triatomines. Sound surveillance design calls for reliable data on vector ecology, and these data must cover different spatial scales. We conducted a multi-scale assessment of ecological and evolutionary trends in members of the tribe Rhodniini, including (i) a macroscale analysis of Rhodniini species richness and composition patterns across the Americas, and (ii) a detailed, mesoscale case-study of ecological and behavioural trends in Rhodnius neglectus and R. nasutus. Our macroscale overview provides some comprehensive insights about key mechanisms/processes probably underlying ecological and genetic diversification in the Rhodniini. These insights translate into a series of testable hypotheses about current species distributions and their likely causes. At the landscape scale, we used geometric morphometrics to identify dubious specimens as either R. neglectus or R. nasutus (two near-sibling species), and studied palm tree populations of these two vector taxa in five geographical areas. The data suggest that deforestation and the associated loss of habitat and host diversity might increase the frequency of vector-human contact (and perhaps Trypanosoma cruzi infection rates in vectors). Surveillance in central-northeastern Brazil should prioritise deforested landscapes where large palm trees (e.g., Attalea, Mauritia, Copernicia, Acrocomia or Syagrus) occur near houses. We anticipate that, by helping define the distribution patterns and ecological preferences of each species, multi-scale research will significantly strengthen vector surveillance systems across Latin America.
The aim of this review is to evaluate the effectiveness of educational interventions on improving... more The aim of this review is to evaluate the effectiveness of educational interventions on improving the control of blood pressure in patients with hypertension. Randomised controlled trials including patients over 18 years of age, regardless of sex and ethnicity, with a diagnosis of hypertension (either treated or not treated with antihypertensive medications) will be assessed in our analysis. We will electronically search four databases: MEDLINE, CINAHL, PEDro and ScienceDirect. There will be no language restrictions in the search for studies. The data will be extracted independently by two authors using predefined criteria. Disagreements will be resolved between the authors. The risk of bias will be assessed using the Cochrane risk of bias tool. After searching and screening of the studies, we will run a meta-analysis of the included randomised controlled trials. We will summarise the results as risk ratio for dichotomous data and mean differences for continuous data. The review wil...
| Objective: The current study evaluated the costs and benefits of a simple aerobic walking progr... more | Objective: The current study evaluated the costs and benefits of a simple aerobic walking program for patients with chronic obstructive pulmonary disease (COPD). Method: This was a blinded randomized controlled clinical trial that recruited 72 patients diagnosed with COPD, 40 of whom were included in the study and divided into two groups [control group (CG) and pulmonary rehabilitation group (G PR )]. We assessed pulmonary function, distance covered during the 6-minute walk test (6MWT), respiratory and peripheral muscle strength, health-related quality of life (HRQOL), body composition, and level of activities of daily living (ADLs) before and after an 8-week walking program. The financial costs were calculated according to the pricing table of the Brazilian Unified Health System (SUS). Results: Only 34 of the 40 patients remained in the final sample; 16 in the CG and 18 in the G PR (FEV 1 : 50.9±14% predicted and FEV 1 : 56±0.5% predicted, respectively). The intervention group exhibited improvements in the 6MWT, sensation of dyspnea and fatigue, work performed, BODE index (p<0.01), HRQOL, ADL level (p<0.001), and lower limb strength (p<0.05).
We investigated the role of inducible NOS (iNOS) on cardiac function during the development of le... more We investigated the role of inducible NOS (iNOS) on cardiac function during the development of left ventricular hypertrophy. Hypertrophy was induced by pressure-overload via short-term (2.5 months) or long-term (6.5 months) aortic banding (AoB) in wild-type (WT) and iNOS knock out (iNOSKO) mice. Cardiac function was then assessed via echocardiography, in situ hemodynamics and papillary muscle force measurements. Quantitative RT-PCR and Western blots were used to measure expression of hypertrophic gene markers and proteins respectively. Our data demonstrate that increased afterload via AoB leads to increased expression of iNOS that is associated with cardiac dysfunction. In pressure-overload induced hypertrophy, iNOSKO delays both the expression of hypertrophic markers and contractile dysfunction without causing significant changes in the level of hypertrophy. Moreover, after long-term AoB, iNOSKO animals exhibited increased basal cardiac function and an improved response to beta-adrenergic stimulation compared to long-term AoB WT animals. In conclusion, our data demonstrate that NO production via iNOS plays an important role in modulating cardiac function after moderate AoB that mimics long-term hypertension in humans.
Journal of Molecular and Cellular Cardiology, 2006
Although it has been suggested that in cardiac muscle the phosphorylation level of myosin regulat... more Although it has been suggested that in cardiac muscle the phosphorylation level of myosin regulatory light chain (RLC) correlates with frequency of stimulation, its significance in the modulation of the force-frequency and pressure-frequency relationships remains unclear. We examined the role of RLC phosphorylation on the force-frequency relation (papillary muscles), the pressure-frequency relation (Langendorff perfused hearts) and shortening-frequency relation (isolated cardiac myocytes) in nontransgenic (NTG) and transgenic mouse hearts expressing a nonphosphorylatable RLC protein (RLC(P−)). At 22°C, NTG and RLC(P−) muscles showed a negative force-frequency relation. At 32°C, at frequencies above 1 Hz, both groups showed a flat force-frequency relation. There was a small increase in RLC phosphorylation in NTG muscles when the frequency of stimulation was increased from 0.2 Hz to 4.0 Hz. However, the level of RLC phosphorylation in these isolated muscles was significantly lower compared to samples taken from NTG intact hearts. In perfused hearts, there was no difference in the slope of pressurefrequency relationship between groups, but the RLC(P−) group consistently developed a reduced systolic pressure and demonstrated a decreased contractility. There was no difference in the level of RLC phosphorylation in hearts paced at 300 and 600 bpm. In RLC(P−) hearts, the level of TnI phosphorylation was reduced compared to NTG. There was no change in the expression of PLB between groups, but expression of SERCA2 was increased in hearts from RLC(P−) compared to NTG. In isolated cardiac myocytes, there was no change in shortening-frequency relationship between groups. Moreover, there was no change in Ca 2+ transient parameters in cells from NTG and RLC(P−) hearts. Our data demonstrate that in cardiac muscle RLC phosphorylation is not an essential determinant of force-and pressure-frequency relations but the absence of RLC phosphorylation decreases contractility in force/pressure developing preparations.
Use of Pulmonary Artery Catheter (PAC) is still a debatable issue, mainly due to questions raised... more Use of Pulmonary Artery Catheter (PAC) is still a debatable issue, mainly due to questions raised about its security and efficacy. This study reproduced in a sample of Brazilian physicians, another one conducted amidst American doctors, in which was pointed out the heterogeneity of clinical decisions guided by data obtained from PAC. During the Brazilian Congress of Intensive Care Medicine (Curitiba 2004), doctors were asked to answer a survey form with three vignettes. Each of them contained PAC data and one half of the surveys contained echocardiographic information. Every doctor was asked to select one of six interventions for each vignette. A homogeneous answer was considered when it was selected by at least 80% of the respondents. Two hundred and thirty seven doctors answered the questionnaires. They selected completely different therapeutic interventions in all three vignettes and none of the interventions achieved more than 80% agreement. Variability persisted with the choice...
Sepsis represents the major cause of death in the ICUs all over the world. Many studies have show... more Sepsis represents the major cause of death in the ICUs all over the world. Many studies have shown an increasing incidence over time and only a slight reduce in mortality. Many new treatment strategies are arising and we should define the incidence and features of sepsis in Brazil. Prospective cohort study in sixty-five hospitals all over Brazil. The patients who were admitted or who developed sepsis during the month of September, 2003 were enrolled. They were followed until the 28th day and/or until their discharge. The diagnoses were made in accordance to the criteria proposed by ACCP/SCCM. It were evaluated demographic features, APACHE II score, SOFA (Sepsis-related Organ Failure Assessment) score, mortality, sources of infections, microbiology, morbidities and length of stay (LOS). Seventy-five ICUs from all regions of Brazil took part in the study.3128 patients were identified and 521 (16.7%) filled the criteria of sepsis, severe sepsis or septic shock. Mean age was 61.7 (IQR 3...
To determine the prevalence of intensive care unit (ICU)-acquired infections and the risk factors... more To determine the prevalence of intensive care unit (ICU)-acquired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship between ICU-acquired infection and mortality. A 1-day point prevalence study. Sixteen ICU of the State of Rio Grande do Sul-Brazil, excluding coronary care and pediatric units. All patients < 12 yrs occupying an ICU bed over a 24-hour period. The 16 ICU provided 174 case reports. rates of ICU-acquired infection, resistance patterns of microbiological isolates, and potential risks factors for ICU-acquired infection and death. A total of 122 patients (71%) was infected and 51 (29%) had ICU-acquired infection. Pneumonia (58.2%), lower tract respiratory infection (22.9%), urinary tract infection (18%) were the most frequents types of ICU infection. Most frequently microorganisms reported were staphylococcus aureus (42% [64% resistant to oxacilin]) and pseudomonas aeruginosa (31%). Six risk f...
Revista da Sociedade Brasileira de Medicina Tropical
For the first time we provide the description of the melanic (dark) morphotype of Rhodnius nasutu... more For the first time we provide the description of the melanic (dark) morphotype of Rhodnius nasutus and determine the pattern of genetic inheritance for this characteristic. Dark morph R. nasutus specimens were crossbred with standard (typically patterned) R. nasutus. We present the first occurrence of the melanic morphotype in the genus Rhodnius. The crossbreeding results demonstrate that the inheritance pattern of this characteristic follows Mendel's simple laws of segregation and an independent assortment of alleles. Phenotypic variation of R. nasutus reinforces the heterogeneity found in the Triatominae. Descriptions of new species in this subfamily require rigorous validation criteria.
Septic shock presents as a continuum of infectious events, generating tissue hypoxia and hypovole... more Septic shock presents as a continuum of infectious events, generating tissue hypoxia and hypovolemia, and increased oxidative stress. Chest physiotherapy helps reduce secretion, improving dynamic and static compliance, as well as improving secretion clearance and preventing pulmonary complications. The purpose of this study was to evaluate the immediate effect of chest physiotherapy on hemodynamic, metabolic, inflammatory, and oxidative stress parameters in subjects in septic shock. We conducted a quasi-experimental study in 30 subjects in septic shock, who underwent chest physiotherapy, without associated heart diseases and with vasopressors < 0.5 μg/kg/min. Venous and arterial blood gases, clinical and hemodynamic data, inflammatory data, lactate, and oxidative stress were evaluated before and 15 min after physiotherapy. Thirty subjects with a mean age of 61.8 ± 15.9 y and Sequential Organ Failure Assessment of 8 (range 6-10) were included. Chest physiotherapy caused a normaliz...
Chagas disease incidence has sharply declined over the last decade. Long-term disease control wil... more Chagas disease incidence has sharply declined over the last decade. Long-term disease control will, however, require extensive, longitudinal surveillance systems capable of detecting (and dealing with) reinvasion-reinfestation of insecticide-treated dwellings by non-domiciliated triatomines. Sound surveillance design calls for reliable data on vector ecology, and these data must cover different spatial scales. We conducted a multi-scale assessment of ecological and evolutionary trends in members of the tribe Rhodniini, including (i) a macroscale analysis of Rhodniini species richness and composition patterns across the Americas, and (ii) a detailed, mesoscale case-study of ecological and behavioural trends in Rhodnius neglectus and R. nasutus. Our macroscale overview provides some comprehensive insights about key mechanisms/processes probably underlying ecological and genetic diversification in the Rhodniini. These insights translate into a series of testable hypotheses about current species distributions and their likely causes. At the landscape scale, we used geometric morphometrics to identify dubious specimens as either R. neglectus or R. nasutus (two near-sibling species), and studied palm tree populations of these two vector taxa in five geographical areas. The data suggest that deforestation and the associated loss of habitat and host diversity might increase the frequency of vector-human contact (and perhaps Trypanosoma cruzi infection rates in vectors). Surveillance in central-northeastern Brazil should prioritise deforested landscapes where large palm trees (e.g., Attalea, Mauritia, Copernicia, Acrocomia or Syagrus) occur near houses. We anticipate that, by helping define the distribution patterns and ecological preferences of each species, multi-scale research will significantly strengthen vector surveillance systems across Latin America.
The aim of this review is to evaluate the effectiveness of educational interventions on improving... more The aim of this review is to evaluate the effectiveness of educational interventions on improving the control of blood pressure in patients with hypertension. Randomised controlled trials including patients over 18 years of age, regardless of sex and ethnicity, with a diagnosis of hypertension (either treated or not treated with antihypertensive medications) will be assessed in our analysis. We will electronically search four databases: MEDLINE, CINAHL, PEDro and ScienceDirect. There will be no language restrictions in the search for studies. The data will be extracted independently by two authors using predefined criteria. Disagreements will be resolved between the authors. The risk of bias will be assessed using the Cochrane risk of bias tool. After searching and screening of the studies, we will run a meta-analysis of the included randomised controlled trials. We will summarise the results as risk ratio for dichotomous data and mean differences for continuous data. The review wil...
| Objective: The current study evaluated the costs and benefits of a simple aerobic walking progr... more | Objective: The current study evaluated the costs and benefits of a simple aerobic walking program for patients with chronic obstructive pulmonary disease (COPD). Method: This was a blinded randomized controlled clinical trial that recruited 72 patients diagnosed with COPD, 40 of whom were included in the study and divided into two groups [control group (CG) and pulmonary rehabilitation group (G PR )]. We assessed pulmonary function, distance covered during the 6-minute walk test (6MWT), respiratory and peripheral muscle strength, health-related quality of life (HRQOL), body composition, and level of activities of daily living (ADLs) before and after an 8-week walking program. The financial costs were calculated according to the pricing table of the Brazilian Unified Health System (SUS). Results: Only 34 of the 40 patients remained in the final sample; 16 in the CG and 18 in the G PR (FEV 1 : 50.9±14% predicted and FEV 1 : 56±0.5% predicted, respectively). The intervention group exhibited improvements in the 6MWT, sensation of dyspnea and fatigue, work performed, BODE index (p<0.01), HRQOL, ADL level (p<0.001), and lower limb strength (p<0.05).
We investigated the role of inducible NOS (iNOS) on cardiac function during the development of le... more We investigated the role of inducible NOS (iNOS) on cardiac function during the development of left ventricular hypertrophy. Hypertrophy was induced by pressure-overload via short-term (2.5 months) or long-term (6.5 months) aortic banding (AoB) in wild-type (WT) and iNOS knock out (iNOSKO) mice. Cardiac function was then assessed via echocardiography, in situ hemodynamics and papillary muscle force measurements. Quantitative RT-PCR and Western blots were used to measure expression of hypertrophic gene markers and proteins respectively. Our data demonstrate that increased afterload via AoB leads to increased expression of iNOS that is associated with cardiac dysfunction. In pressure-overload induced hypertrophy, iNOSKO delays both the expression of hypertrophic markers and contractile dysfunction without causing significant changes in the level of hypertrophy. Moreover, after long-term AoB, iNOSKO animals exhibited increased basal cardiac function and an improved response to beta-adrenergic stimulation compared to long-term AoB WT animals. In conclusion, our data demonstrate that NO production via iNOS plays an important role in modulating cardiac function after moderate AoB that mimics long-term hypertension in humans.
Journal of Molecular and Cellular Cardiology, 2006
Although it has been suggested that in cardiac muscle the phosphorylation level of myosin regulat... more Although it has been suggested that in cardiac muscle the phosphorylation level of myosin regulatory light chain (RLC) correlates with frequency of stimulation, its significance in the modulation of the force-frequency and pressure-frequency relationships remains unclear. We examined the role of RLC phosphorylation on the force-frequency relation (papillary muscles), the pressure-frequency relation (Langendorff perfused hearts) and shortening-frequency relation (isolated cardiac myocytes) in nontransgenic (NTG) and transgenic mouse hearts expressing a nonphosphorylatable RLC protein (RLC(P−)). At 22°C, NTG and RLC(P−) muscles showed a negative force-frequency relation. At 32°C, at frequencies above 1 Hz, both groups showed a flat force-frequency relation. There was a small increase in RLC phosphorylation in NTG muscles when the frequency of stimulation was increased from 0.2 Hz to 4.0 Hz. However, the level of RLC phosphorylation in these isolated muscles was significantly lower compared to samples taken from NTG intact hearts. In perfused hearts, there was no difference in the slope of pressurefrequency relationship between groups, but the RLC(P−) group consistently developed a reduced systolic pressure and demonstrated a decreased contractility. There was no difference in the level of RLC phosphorylation in hearts paced at 300 and 600 bpm. In RLC(P−) hearts, the level of TnI phosphorylation was reduced compared to NTG. There was no change in the expression of PLB between groups, but expression of SERCA2 was increased in hearts from RLC(P−) compared to NTG. In isolated cardiac myocytes, there was no change in shortening-frequency relationship between groups. Moreover, there was no change in Ca 2+ transient parameters in cells from NTG and RLC(P−) hearts. Our data demonstrate that in cardiac muscle RLC phosphorylation is not an essential determinant of force-and pressure-frequency relations but the absence of RLC phosphorylation decreases contractility in force/pressure developing preparations.
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Papers by Fernando Dias