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Campos R.A.,Federal University of Bahia | Valle S.O.R.,Federal University of Rio de Janeiro | Franca A.T.,Federal University of Rio de Janeiro | Cordeiro E.,Recurrent Infections Outpatient Group | And 7 more authors.
Sao Paulo Medical Journal | Year: 2014

CONTEXT AND OBJECTIVE: Hereditary angioedema (HAE) with C1 inhibitor deficiency manifests as recurrent episodes of edema involving the skin, upper respiratory tract and gastrointestinal tract. It can be lethal due to asphyxia. The aim here was to evaluate the response to therapy for these attacks using icatibant, an inhibitor of the bradykinin receptor, which was recently introduced into Brazil. DESIGN AND SETTING: Prospective experimental single-cohort study on the efficacy and safety of icatibant for HAE patients. METHODS: Patients with a confirmed HAE diagnosis were enrolled according to symptoms and regardless of the time since onset of the attack. Icatibant was administered in accordance with the protocol that has been approved in Brazil. Symptom severity was assessed continuously and adverse events were monitored. RESULTS: 24 attacks in 20 HAE patients were treated (female/male 19:1; 19-55 years; median 29 years of age). The symptoms were: subcutaneous edema (22/24); abdominal pain (15/24) and upper airway obstruction (10/24). The time taken until onset of relief was: 5-10 minutes (5/24; 20.8%); 10-20 (5/24; 20.8%); 20-30 (8/24; 33.4%); 30-60 (5/24; 20.8%); and 2 hours (1/24; 4.3%). The time taken for complete resolution of symptoms ranged from 4.3 to 33.4 hours. Adverse effects were only reported at injection sites. Mild to moderate erythema and/or feelings of burning were reported by 15/24 patients, itching by 3 and no adverse effects in 6. CONCLUSION: HAE type I patients who received icatibant responded promptly; most achieved improved symptom severity within 30 minutes. Local adverse events occurred in 75% of the patients.

De Araujo M.T.M.,Federal University of Espirito Santo | Bissoli N.S.,Federal University of Espirito Santo | Gouvea S.A.,Federal University of Espirito Santo | Pacheco M.C.T.,Federal University of Espirito Santo | And 3 more authors.
Sleep and Breathing | Year: 2013

Objective: The aim of this study was to investigate the efficacy of continuous positive airway pressure (CPAP) therapy following uvulopalatopharyngoplasty (UPPP) to prevent blood pressure (BP) elevation during sleep. Methods: Sixteen normotensive patients with OSA were subjected to UPPP with or without septoplasty. These patients were instrumented for 24 h of ambulatory BP recording, polysomnography, nocturnal urinary catecholamine and pain evaluation using a visual analogue scale in the day prior to surgery (D-1), following the surgery (D+1) and 30 days later (D+30). For the D+1, the patients were divided into two groups: the without CPAP therapy group and the with CPAP therapy group. Results: The apnoea-hypopnoea index (AHI) significantly increased in the patients without CPAP therapy compared with the D-1 (74 ± 23 vs. 35 ± 6 times/h, p < 0.05), and in the CPAP group, there was a significant reduction in the average AHI value to 14 ± 6 times/h, p < 0.01. During D+1, we observed an increase in the nocturnal systolic BP (10 %), diastolic BP (12 %) and heart rate (14 %) in the group without CPAP. These metrics were re-established in the CPAP group to values that were similar to those that were observed on the D-1. The absence of nocturnal dipping in the group without CPAP was followed by a significant increase in nocturnal norepinephrine (42 ± 12 μg/l/12 h) and epinephrine (8 ± 2 μg/l/12 h) levels compared with the D-1 (norepinephrine 17 ± 3; epinephrine 2 ± 0.3 μg/l/12 h, p < 0.001). In the patients who used the CPAP treatment, the nocturnal catecholamine levels were similar to D-1. The effectiveness of intravenous analgesic therapy was verified by a significant decrease in the pain scores in patients both with and without CPAP therapy. Conclusion: These data confirm an increase in the AHI on the night following UPPP with or without septoplasty. This increase promotes an absence of nocturnal dipping and a significant increase in urinary catecholamine levels. CPAP therapy was effective to prevent the transitory increase in BP. © 2013 Springer-Verlag Berlin Heidelberg.

Paganotti M.A.,University Of Vila Velha Uvv | Valim V.,Federal University of Espirito Santo | Serrano E.V.,Escola Superior de Ciencias da Santa Casa de Misericordia de Vitoria EMESCAM | Serrano E.V.,Federal University of Espirito Santo | And 3 more authors.
Revista Brasileira de Reumatologia | Year: 2015

Objective: To carry out the cross-cultural adaptation of EULAR Sjögren's Syndrome PatientReported Index (ESSPRI) for Portuguese language and evaluate its psychometric properties.Method: Cross-sectional study of patients with primary Sjögren's syndrome (SS). The psy-chometric properties (intraobserver reproducibility and construct validity) were studied. Inconstruct validity, ESSPRI was compared with the Patient's Global Assessment (PGA), Profileof Fatigue and Discomfort (Profad), Sicca Symptoms Inventory (SSI) and Functional Assess-ment of Chronic Illness Therapy (Facit-F). Statistical tests used were: Cronbach's alpha,intraclass correlation coefficient (ICC), Bland-Altman method and Spearman coefficient.A value of p = 0.05 was considered significant.Results: There was no difference between versions in both languages; thus, a Brazilian con-sensual version was obtained. All subjects were women aged 49.4 ± 11.6 years, with onsetof symptoms of 7.2 ± 5.4 years, and time of diagnosis of 3.0 ± 3.3 years. The mean ESSPRIwas 6.87 ± 1.97. The intraobserver reproducibility was high and significant (0.911) and, withBland-Altman method, there was no systematic bias in the agreement of measures amongevaluations. A moderate correlation of ESSPRI with all tested instruments was observed. © 2015 Elsevier Editora Ltda.

Vidotto M.C.,University of Sao Paulo | Sogame L.C.M.,Escola Superior de Ciencias da Santa Casa de Misericordia de Vitoria EMESCAM | Gazzotti M.R.,University of Sao Paulo | Prandini M.N.,University of Sao Paulo | Jardim J.R.,University of Sao Paulo
Respiratory Care | Year: 2012

BACKGROUND: Extubation failure is defined as the re-institution of respiratory support ranging from 24 to 72 hours following scheduled extubation and occurs in 2% to 25% of extubated patients. The aim of this study was to determine clinical and surgical risk factors that may predict extubation failure in patients submitted to non-emergency intracranial surgery. METHODS: This was a prospective observational cohort study. The study was carried out on 317 subjects submitted to nonemergency intracranial surgery for tumors, aneurysms, and arteriovenous malformation. Preoperative assessment was performed and subjects were followed up for the determination of extubation failure until either discharge from hospital or death. RESULTS: Twenty-six (8.2%) of the 317 subjects experienced extubation failure following surgery. The following variables were considered for the multivariate analysis: level of consciousness at the time of extubation, duration of mechanical ventilation prior to extubation, sex and the use of intraoperative mannitol. The multivariate analysis determined that the most important variable for extubation failure was the level of consciousness at the time of extubation (P=.001), followed by female sex, which also showed to be significant (P=.006). CONCLUSIONS: Lower level of consciousness (GCS 8T-10T) and female sex were considered risk factors for extubation failure in subjects submitted to elective intracranial surgery. © 2012 Daedalus Enterprises.

Maia T.C.,Escola Superior de Ciencias da Santa Casa de Misericordia de Vitoria EMESCAM | Brazolino M.A.N.,Escola Superior de Ciencias da Santa Casa de Misericordia de Vitoria EMESCAM | de Batista P.R.,Orthopedics and Traumatology Sector | Izoton A.L.C.,Vila Velha Hospital | And 2 more authors.
Acta Ortopedica Brasileira | Year: 2012

Objective: The prevalence of osteoporosis in patients with Adolescent Idiopathic Scoliosis (AIS) is believed to be higher than in the general adolescent population. An alternative to radiology for the characterization of bone mineral density may be through correlative indexes like the Osteorisk index, which is easy to access and low in cost, and which helps the doctor in the request for Bone Densitometry. Our belief that osteoporosis can affect the evolution and treatment of AIS was what motivated us to conduct this study. Our objective was to subjectively evaluate bone mineral density by the Osteorisk index in patients with AIS. Methods: Healthy patients (control group, n=30) and patients with AIS (n = 30) were evaluated, documenting age, weight and height, and establishing the Osteorisk. The unpaired Student t test was performed, with a level of significance of p <0.05. Results: The mean Osteorisk found for the patients with AIS was 6.38 ± 2.2 while in the control group, it was 8.27 ± 2.14, which represents a low risk of developing osteoporosis in both groups. Comparing these means between the groups, a lower Osteorisk was observed in the AIS group. Conclusion: Our study showed that there is low risk of developing osteoporosis in patients with AIS. Level of Evidence I, Prospective study.

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