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Biomedical subjects

J R Jardim

Publications and source records attributed to J R Jardim.

At least 19 recordsLinked to original sources
PubMed2006

Body composition in patients with chronic obstructive pulmonary disease: which method to use in clinical practice?

The objective of the present study was to compare anthropometry with bioelectrical impedance (BIA) in relation to densitometry (dual-energy X-ray absorptiometry; DEXA) as methods of nutritional assessment and body composition in out-patients with chronic pulmonary obstructive disease (COPD). We conducted a cross-sectional clinical study with sixty-one patients with COPD (forty-two men and nineteen women), mean age of 66.5 (sd 7.9) years and forced expiratory volume in 1 s of 1.3 (sd 0.6) litres (52.2 (sd 19.8) % predicted), referred to the Pulmonary Rehabilitation Center. The patients were evaluated regarding nutrition status and body composition as determined by anthropometry, BIA and DEXA. In the results, 34.4 % showed mild obstruction, 31.2 %, moderate and 34.4 %, severe obstruction. According to the BMI (mean 24.5 (sd 4.5) kg/m2), 45.9 % of the patients exhibited normal weight, while 27.9 % were underweight and 26.2 % were obese. Related to fat-free mass (FFM), anthropometry and BIA compared with DEXA presented high correlations (r 0.96 and 0.95 respectively; P < 0.001) and high reliability between the methods (alpha 0.98; P < 0.001). Agreement analysis between the methods shows that anthropometry overestimates (0.62 (sd of the difference 2.89) kg) while BIA underestimates FFM (0.61 (sd of the difference 2.82) kg) compared with DEXA. We concluded that according to the nutritional diagnosis, half of our population of patients with COPD showed normal weight, while the other half comprised equal parts obese and underweight patients. Body composition estimated by BIA and anthropometry presented good reliability and correlation with DEXA; the three methods presented satisfactory clinical accuracy despite the great disparity of the limits of agreement.

Absorptiometry, Photon↗
PubMed2005

[Variability in walk test conditions in pulmonary rehabilitation programs in Latin America and on the Iberian peninsula].

OBJECTIVE: 1) To determine the frequency of use of the 6-minute walk test in pulmonary rehabilitation programs in Latin America and on the Iberian Peninsula; 2) to identify how the test is performed and possible variations from center to center. MATERIALS AND METHODS: A questionnaire was sent to 55 pulmonary rehabilitation centers in Latin America, Portugal, and Spain. RESULTS: Forty-nine (89.1%) centers answered the questionnaire. Forty-seven (95.9%) perform a walk test lasting 6 minutes; 22 (46.8%) take the longest distance of 2 tests as the real one; and 35 (74.5%) carry out the test in a corridor. The course distance ranged from 17 to 90 meters, but in 21 (44.7%) centers, the corridor was between 17 and 30 meters long. In 29 (61.7%) centers, the patients are routinely informed about the time that had elapsed during the test. Verbal encouragement is used in 44 (93.6%) centers. Thirty-eight (80.8%) use supplemental oxygen when a patient needs it. An increase in absolute values in the distance covered is used as a parameter indicating improvement at 21 (46.7%) sites while at 15 (33.3%) other centers the percentage increase is taken as a measure of improvement. CONCLUSIONS: The 6-minute walk test is widely used for the evaluation of the exercise capacity at the pulmonary rehabilitation centers of Latin America and the Iberian Peninsula. However, there is great variability in the way the test is performed.

Exercise Test↗
PubMed2003

Evaluation of two 99mTc-DTPA radioaerosols with different characteristics in lung ventilation studies.

Two radioaerosol preparations, TechneScan -DTPA (99mTc-DTPA, 40 mCi/3 ml; IPEN-CNEN, São Paulo, SP, Brazil) and TechneScan -DTPA/AEROSOL (99mTc-DTPA/A, 15 mCi/1.5 ml with 0.5 ml ethanol; Mallinckrodt Medical, St. Louis, MO, USA), were compared in pulmonary ventilation studies in terms of total radiocounts and clearance after inhalation. An aerosol with ethanol is supposed to better distribute the radioparticles in the lungs. Twenty normal nonsmoking volunteers (10 men and 10 women), mean age of 23.2 years (range: 20 to 35 years), were studied. Images were obtained immediately and 30, 60 and 90 min after inhalation. Total and regional counts were obtained and the clearance half-lives of both lungs were determined. There was no difference in total counts between the two types of radioaerosol at any time (mean of approximately 188,000 cpm for male and female subjects at time zero in both aerosols). The highest count was obtained in the middle region of both lungs (P<0.001) with both preparations. The clearance half-life did not differ between aerosols (mean of ~80-88 min for male and female subjects for both aerosols). Small nonsignificant regional differences were observed. No differences between genders or between right and left lung were observed. 99mTc-DTPA/A generated the highest output of radioaerosol. 99mTc-DTPA with alcohol costs approximately five times more than the aerosol without alcohol. The present results show that either kind of aerosol may be adopted routinely for use in pulmonary examinations without affecting diagnosis. We suggest that the amount of 740 mBq (20 mCi) of 99mTc-DTPA in 1.5 ml saline can be used for routine examinations resulting in reduction of costs in pulmonary ventilation studies without diagnostic impairment.

Adult↗
PubMed2003

[A comparison of moxifloxacin and amoxicillin in the treatment of community-acquired pneumonia in Latin America: results of a multicenter clinical trial].

Since community-acquired pneumonia (CAP) is a common disease with a high morbidity rate, it is important to obtain information concerning its etiology and susceptibility to antibiotics across different geographic areas. This study presents data obtained in 5 Latin American counties in the course of an international clinical trial that evaluated the efficacy and safety of treatment with either moxifloxacin or amoxicillin administered for 10 days to patients suspected of having CAP caused by a pneumococcal infection. Details are given of the pathogens identified, the patterns of sensitivity to antibiotics observed, and the clinical and microbiological results obtained.A total of 84 patients were studied, of whom 70 (83.3%) were evaluated at the end of the trial to determine the efficacy and safety of the treatment received. Gram-positive bacteria were found in samples from 29 patients (80.5%). The pathogen was Streptococcus pneumoniae in 28 of those cases (77.7%). Gram-negative bacteria were found in 7 patients (19.4%), the most common being Haemophilus influenzae in 3 patients (8.3%). The presence of atypical microorganisms was detected in 18 of the 70 patients (25%), mainly Mycobacterium pneumoniae (n=11), and in 6 cases (8.5%) the infection was mixed. Ten strains of S. pneumoniae (35.7%) were shown to be susceptible to penicillin, 2 (7.1%) were highly resistant, and 16 (57.1%) showed moderate resistance. The clinical success rate at the final visit after treatment was 94.1% for moxifloxacin and 91.7% for amoxicillin. The results of this trial demonstrate a high prevalence of S. pneumoniae with reduced susceptibility to penicillin in patients with CAP in Latin America. It also revealed a high incidence of atypical pathogens and mixed infection in 8.6% of patients. This information should be taken into account when establishing protocols for empirical treatment of CAP in Latin America.

Amoxicillin↗
PubMed2003

[Pharmacoeconomic study of antibiotic therapy for exacerbations of chronic bronchitis and chronic obstructive pulmonary disease in Latin America].

Chronic obstructive pulmonary disease (COPD) and chronic bronchitis are highly prevalent diseases. Studies designed to analyze the economic impact of these diseases in Latin American countries have not previously been published. In the present study we analyzed the direct health care costs of treating patients with exacerbations of chronic bronchitis and COPD in Argentina, Brazil, Colombia, Ecuador, Mexico, Peru, and Venezuela, applying the real cost of drugs and medical acts in those 7 countries to the pattern of treatment and outcomes obtained from a study carried out in primary care settings in Spain. The mean direct health care cost ranged from US $98 in Colombia to $329 in Argentina. Most of the cost was related to failure of therapy, which accounted for 52% of the total cost of exacerbation, with the lowest rate in Colombia at 28.6% and the highest in Ecuador at 59.3% The cost of antibiotic therapy represented 19% of the total cost; the rest was owing to other drugs or medical visits. Exacerbations generate significant costs for health care systems. There are considerable variations related mainly to differences between systems. Antibiotic therapy represents a small part of the overall cost. The use of more effective antibiotics, if they can reduce failure rates, may be a cost-effective strategy.

Acute Disease↗
PubMed2001

Inhaled budesonide for adults with mild-to-moderate asthma: a randomized placebo-controlled, double-blind clinical trial.

CONTEXT: Budesonide is an inhaled corticosteroid with high topical potency and low systemic activity recommended in the treatment of chronic asthma. OBJECTIVE: This study was conducted to determine the efficacy and safety of inhaled budesonide via a breath-activated, multi-dose, dry-powder inhaler. TYPE OF STUDY: Multicenter randomized parallel-group, placebo-controlled, double-blind, clinical trial. SETTING: Multicenter study in the university units. PARTICIPANTS: Adult patients with mild-to-moderate asthma that was not controlled using bronchodilator therapy alone. PROCEDURES: Comparison of budesonide 400 microg administered twice daily via a breath-activated, multi-dose, dry-powder inhaler with placebo, in 43 adult patients (aged 15 to 78 years) with mild-to-moderate asthma (FEV1 71% of predicted normal) that was not controlled using bronchodilator therapy alone. MAIN MEASUREMENTS: Efficacy was assessed by pulmonary function tests and asthma symptom control (as perceived by the patients) and the use of rescue medication. RESULTS: Budesonide 400 microg (bid) was significantly more effective than placebo in improving morning peak expiratory flow (mean difference: 67.9 l/min; P < 0.005) and FEV1 (mean difference: 0.60 l; P < 0.005) over the 8-week treatment period. Onset of action, assessed by morning peak expiratory flow, occurred within the first two weeks of treatment. CONCLUSIONS: Budesonide via a breath-activated, multi-dose, dry-powder inhaler results in a rapid onset of asthma control, which is maintained over time and is well tolerated in adults with mild-to-moderate asthma.

Administration, Inhalation↗
PubMed2000

The influence of temperature and length of time of storage of frog mucus samples.

Frozen, stored mucus has been extensively used for transport studies but there is no clear evidence of the influence that the temperature and length of time of storage may have on the results. We stored frog mucus samples at -20 and -80 degrees C and analysed them on days zero, 2, 10, 30 and 90. At each temperature, a sample was thawed, studied and refrozen on each of the study days, at the same time that one sample was thawed only on the study day. Displacement in a simulated cough machine and on the frog palate, as well as contact angle measurements, were determined for the mucus samples on each study day. Mucus cytologic analyses on each of the study days were done with special regard to neutrophil counts and cell integrity. Friedman analysis of variance did not show any difference between the different periods of storage and the two temperatures for any of the parameters studied. The medians for the relative transport velocity on the frog palate varied between 0.88 and 1.03, for the contact angle between 21 and 28 degrees, and for the displacement in the simulated cough machine between 58 and 95 mm over the 90 days of the experiment. There were no cytologic alterations compatible with cell degeneration. We conclude that the storage of frog mucus either at -20 or -80 degrees C for periods up to 90 days does not lead to any significant differences in mucus transportability.

Animals↗
PubMed1999

[Attitude toward smoking among smoking and non-smoking officials of the Federal University of Sao Paulo, Brazil: comparative analysis of smokers and non-smokers].

OBJECTIVE: To study the attitudes toward smoking of employees of the Federal University of Sao Paulo as a step toward implanting a consensualized anti-smoking program for the institution. METHOD: We designed and distributed anonymous, self-completed questionnaires with 51 multiple-choice questions, which were returned by 2,613 (48.6%) employees, professors, medical residents, nurses and students. RESULTS: Four hundred thirty-eight (16.8% of the population) of the respondents were smokers and 456 (17.5%) were non-smokers. For 84% smoking started between the ages of 11 and 20 years. Most smokers were between 31 and 40 years of age, and the prevalence of ex-smokers was highest in respondents over the age of 60. Seventy-eight percent of the smokers smoked at work. Both smokers and non-smokers reported some type of discomfort caused by cigarette smoke, mainly smell in clothes and hair (62.7% of smokers versus 59% of non-smokers, NS). The proportion who opted for a totally smoke-free environment was 37.5% among non-smokers and 10% among smokers (p < 0.05). Restrictions on smoking in specific places, on the other hand, met with the approval of 82.8% of smokers and 59% of non-smokers (p < 0.05). CONCLUSIONS: We believe that surveys such as this one should be carried out at all institutions, particularly in health care centers, in order to assure that smoking restriction policies are successful and receive the support of most employees, whether they smoke or not. Our data suggest the advisability of creating restricted-smoking zones in the early phase of an institutional anti-smoking campaign designed to lead to a totally smoke-free workplace environment.

Adult↗
PubMed1999

Evaluation of bone metabolism after the use of an inhaled glucocorticoid (flunisolide) in patients with moderate asthma.

OBJECTIVE: We have investigated the effects of the inhaled corticosteroid flunisolide on bone metabolism and adrenal function in patients with moderate asthma. SUBJECTS AND DESIGN: Twenty ambulatory patients (13 females, 7 males, mean age +/- SD of 36.4 +/- 12.4 years) with moderate asthma were recruited. None had taken corticosteroids for at least 1 month. Flunisolide 500 microg was given twice a day for 10 weeks, without any other medication. Blood and urine were collected before and at the end of treatment course. Cortisol (basal and 1 h after ACTH 250 microg i.v.) was measured to evaluate adrenal function. A peak cortisol response of 496 nmol/l was considered an adequate response. Serum ionized calcium, intact PTH, plasma osteocalcin (OC) and urinary pyridinoline (Pyr) and deoxy-pyridinoline (D-Pyr) were measured to evaluate bone metabolism. Wilcoxon paired test was performed for statistical analysis. Results are expressed as mean +/- SD. RESULTS: In most patients (85%), there was no difference after treatment with flunisolide on basal and stimulated cortisol levels. We found a significant decrease of OC (3.55 +/- 1.42 to 2.97 +/- 1.05 nmol/l) and Pyr (66.4 +/- 20.0 to 59.5 +/- 24.9 pmol/micromol creatinine) levels after treatment (P < 0.05). We also observed a positive correlation between the variations seen in pre and post treatment values of OC and Pyr/D-Pyr. CONCLUSIONS: The use of inhaled flunisolide 1000 microg/day for 10 weeks had no suppressive effect on adrenal function in the majority of asthmatic patients studied. However, the effects seen on bone and mineral metabolism, evidenced by the significant fall in osteocalcin and pyridinoline levels, may indicate a possible systemic effect of this drug. Clinical consequences of long-term treatment with flunisolide need to be further evaluated.

Administration, Inhalation↗
PubMed1998

The influence of 6 months of oral anabolic steroids on body mass and respiratory muscles in undernourished COPD patients.

STUDY OBJECTIVE: To evaluate the influence of oral anabolic steroids on body mass index (BMI), lean body mass, anthropometric measures, respiratory muscle strength, and functional exercise capacity among subjects with COPD. DESIGN: Prospective, randomized, controlled, double-blind study. SETTING: Pulmonary rehabilitation program. PARTICIPANTS: Twenty-three undernourished male COPD patients in whom BMI was below 20 kg/m2 and the maximal inspiratory pressure (PImax) was below 60% of the predicted value. INTERVENTION: The study group received 250 mg of testosterone i.m. at baseline and 12 mg of oral stanozolol a day for 27 weeks, during which time the control group received placebo. Both groups participated in inspiratory muscle exercises during weeks 9 to 27 and cycle ergometer exercises during weeks 18 to 27. MEASUREMENTS AND RESULTS: Seventeen of 23 subjects completed the study. Weight increased in nine of 10 subjects who received anabolic steroids (mean, +1.8+/-0.5 kg; p<0.05), whereas the control group lost weight (-0.4+/-0.2 kg). The study group's increase in BMI differed significantly from that of the control group from weeks 3 to 27 (p<0.05). Lean body mass increased in the study group at weeks 9 and 18 (p<0.05). Arm muscle circumference and thigh circumference also differed between groups (p<0.05). Changes in PImax (study group, 41%; control group, 20%) were not statistically significant. No changes in the 6-min walk distance or in maximal exercise capacity were identified in either group. CONCLUSION: The administration of oral anabolic steroids for 27 weeks to malnourished male subjects with COPD was free of clinical or biochemical side effects. It was associated with increases in BMI, lean body mass, and anthropometric measures of arm and thigh circumference, with no significant changes in endurance exercise capacity.

Administration, Oral↗
PubMed1995

Effects of almitrine on the ventilatory control, breathing pattern and maximal exercise tolerance in hypoxemic patients with chronic obstructive pulmonary disease.

Almitrine bismesylate improves arterial blood gases in patients with chronic obstructive pulmonary disease (COPD), but side effects such as increase of ventilatory drive and dyspnea have been reported in some studies. We studied 18 COPD patients (mean age = 59.1 years; mean FEV1 = 0.92 1; mean PaO2 = 58.6 mmHg) in a double-blind randomized study using placebo or almitrine 50 mg twice a day by mouth, for 60 days. In contrast to the placebo group, 40% of the patients in the almitrine group presented a significant increase in PaO2 and a decrease in P(A-a)O2 > or = 5 mmHg during submaximal exercise after 60 days of treatment. Ventilatory drive and the breathing pattern were measured at rest and during submaximal exercise. Both groups showed high levels of ventilatory drive and a tachypneic breathing pattern before drug treatment and no modification was found 30 and 60 days after treatment. Metabolic, cardiovascular and ventilatory variables were studied during an incremental to maximum exercise symptom-limited test (cycloergometry). Maximal VO2 ranged from 46 to 52% and heart rate from 76 to 78% in relation to the predicted values. The percent ratio of ventilation at maximal exercise to maximal voluntary ventilation at rest ranged from 86 to 94%. These results show that the reduction of ventilatory capacity was the main factor decreasing the aerobic performance of our COPD patients. Maximal exercise tolerance (VO2 max) did not change after almitrine treatment. Negative factors like an increase in neuromuscular drive did not occur, and positive factors like an increase in PaO2 and oxygen transport had no critical influence on exercise performance in our ventilatory-limited COPD patients.

Adult↗
PubMed1989

Comparison of daily and twice-weekly regimens to treat pulmonary tuberculosis.

A randomised controlled trial compared the effectiveness and toxicity in pulmonary tuberculosis of two drug regimens containing rifampicin and isoniazid given daily or twice-weekly for 4 months after a 2-month period of intensive treatment with daily isoniazid, rifampicin, and pyrazinamide. 667 patients with newly diagnosed pulmonary tuberculosis were randomly allocated to continue daily treatment with isoniazid (400 mg) and rifampicin (600 mg) or to twice-weekly treatment with isoniazid (900 mg) and rifampicin (600 mg). 544 of the 667 patients (81%) completed the 6-month course (287 of 337 [85%] treated daily and 257 of 330 [79%] treated twice-weekly). Drug toxicity was not a great problem; the treatment was permanently discontinued in only 2% of patients. There was no significant difference at the end of months 5 and/or 6 of chemotherapy between the groups treated daily and twice-weekly in the proportions with bacteriological failure (at least one positive sputum culture with more than 20 colonies) or who had died from tuberculosis (17 [6%] vs 10 [3%]). Nor was there a significant difference in the relapse rate (17 [7%] treated daily vs 10 [4%] treated twice-weekly) during follow-up of 12 months. Thus, the twice-weekly regimen was at least as effective as the daily regimen for treatment of pulmonary tuberculosis.

Administration, Oral↗
PubMed1988

The effects of smoking and silica exposure on pulmonary epithelial permeability: a radioaerosol study with 99mTc-DTPA.

1. Pulmonary epithelial permeability (PEP) as evaluated by the clearance rate (K, %/min) of 99mTc-DTPA from lung to blood was measured in 4 groups of individuals: 10 normal controls; 10 smokers; 15 silica dust-exposed ceramic workers, 7 without chest X-ray alternations; and 8 with mild radiographic alterations, consistent with silicosis (small opacities of up to 1.5 mm diameter). 2. All subjects had normal pulmonary function tests. The mean clearance rates of smokers (3.0 %/min) and silica-exposed workers with X-ray changes (2.9 %/min) were accelerated compared to controls (1.2%/min) (P less than 0.05). Ceramic workers with normal X-rays had mean clearance rates (2.0 %/min) similar to controls. However, 3 of 7 (43%) had K values higher than the upper limit of the 95% confidence interval for the control mean. 3. Comparison of regional K (%/min) values with controls indicated faster clearance of 99mTc-DTPA in the upper lung regions of smokers. There was also increased clearance in the silicotic workers although of more uniform distribution over the lung regions analyzed. 4. Both smokers and ceramic workers exposed to a silica dust environment, with or without chest X-ray alterations, may show increased PEP compared to controls. As measurement of this parameter appears to be a sensitive index of lung injury, follow-up studies involving workers exposed to noxious dust are proposed to relate alterations in PEP to early silicosis and to the extent of lung injury.

Capillary Permeability↗