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Biomedical subjects

A L Fernandes

Publications and source records attributed to A L Fernandes.

At least 19 recordsLinked to original sources
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

[General situation and perspectives of chagas disease in Northeastern Region, Brazil].

Primary and secondary data show the importance and distribution of human Chagas disease (HCD) in Northeast Brazil. Among the 27 detected vector species, Triatoma infestans, Panstrongylus megistus, Triatoma brasiliensis and Triatoma pseudomaculata are epidemiologically important. Major medical impact is attributed to T. infestans and P. megistus, the most domiciliated and vulnerable species, while the other two are native and more difficult to control. Regional differences in transmission and medical impact of HCD exist in the Northeast, where in general the disease appears to be less harmful than in other Brazilian regions like the Southeast and State of Goiás. There is a downward trend in HCD transmission and morbidity in the Northeast, its control in the region is a cause of concern because of the decommissioning of the National Health Foundation without a corresponding assimilation of its routine activities by regional and municipal institutions.

Adolescent↗
PubMed1999

Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery.

OBJECTIVE: To investigate associations between preoperative variables and postoperative pulmonary complications (PPC) in elective upper abdominal surgery. DESIGN: Prospective clinical trial. SETTING: A tertiary university hospital. PATIENTS: 408 patients were prospectively analyzed during the preoperative period and followed up postoperatively for pulmonary complications. MEASUREMENTS: Patient characteristics, with clinical and physical evaluation, related diseases, smoking habits, and duration of surgery. Preoperative pulmonary function tests (PFT) were performed on 247 patients. RESULTS: The postoperative pulmonary complication rate was 14 percent. The significant predictors in univariate analyses of postoperative pulmonary complications were: age >50, smoking habits, presence of chronic pulmonary disease or respiratory symptoms at the time of evaluation, duration of surgery >210 minutes and comorbidity (p <0.04). In a logistic regression analysis, the statistically significant predictors were: presence of chronic pulmonary disease, surgery lasting >210 and comorbidity (p <0.009). CONCLUSIONS: There were three major clinical risk factors for pulmonary complications following upper abdominal surgery: chronic pulmonary disease, comorbidity, and surgery lasting more than 210 minutes. Those patients with three risk factors were three times more likely to develop a PPC compared to patients without any of these risk factors (p <0.001). PFT is indicated when there are uncertainties regarding the patient's pulmonary status.

Abdomen↗
PubMed1999

Evaluation of an educational programme for socially deprived asthma patients.

The aim of this study was to evaluate the effectiveness of an asthma education programme in moderate and severe asthma patients in a longitudinal, prospective and randomized study with a control group. Fifty-three asthmatic patients were studied, 26 of whom were assigned to the educational group and 27 to the control group. The educational group attended the programme regularly for a period of 6 months. The programme included information about asthma, instruction on the appropriate use of medication and training in the metered dose inhaler (MDI) technique, and information about the identification and control of asthma attacks and the recognition of early signs of exacerbation. The control group was submitted to the routine care provided at the Asthma Clinic, with no formal instruction regarding asthma control. The groups were identical with regard to severity parameters, skills, lung function and quality of life at the beginning of the trial. At the end of the study, the education group showed significant differences when compared with the control group (education/control (mean values)) with respect to: visits to the asthma emergency room over the previous 6 months, 0.7/2 (p=0.03); nocturnal symptoms, 0.3/0.7 (p=0.04); score of symptoms, 1.3/2 (p=0.04). Improvements were also observed in skills and quality of life, knowledge of how to deal with attacks and how to control the environmental triggering factors, 73/35 (<0.05); correct use of the MDI, 8/4 (0.001); understanding of the difference between relief and anti-inflammatory medication, 86/20 (<0.05); and in the global limitation quality of life score, 28/50 (0.02). It is concluded that the educational programme led to a significant improvement in asthma morbidity and that the implantation of educational programmes is possible for special populations when these programmes are adapted to the socioeconomic profile of the patients, with a significant gain in terms of the reduction of symptoms and improved pulmonary function and quality of life of asthmatics.

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↗
PubMed1999

Short-term effects of aerobic training in the clinical management of moderate to severe asthma in children.

BACKGROUND: Aerobic training has a number of well known beneficial effects in both normal and asthmatic children. However, the impact of training on the clinical management of the underlying bronchial asthma remains controversial, particularly in the most severe patients. METHODS: Clinical evaluation, spirometric tests, symptom limited maximum exercise testing, and exercise challenge tests were performed in a group of children with stable moderate to severe asthma. Forty two patients (24 boys) aged 8-16 were evaluated twice: before and after supervised aerobic training (group 1, n = 26) and two months apart (untrained group 2, n = 16). RESULTS: Spirometric and maximal exercise variables in the initial evaluation were significantly reduced in group 1 (p < 0.05) but medication and clinical scores and the occurrence of exercise induced bronchospasm (EIB) did not differ between the two groups. Aerobic improvement with training (maximal oxygen uptake and/or anaerobic threshold increment > 10% and 100 ml) was inversely related to the baseline level of fitness and was independent of disease severity. Although the clinical score and the occurrence of EIB did not change after training, aerobic improvement was associated with a significant reduction in the medication score and the daily use of both inhaled and oral steroids (p < 0.05). CONCLUSIONS: Aerobic improvement with training in less fit asthmatic children is related to a short term decrease in the daily use of inhaled and oral steroids, independent of the severity of the disease.

Adolescent↗
PubMed1998

Interrelationship between adipocytes and fibroblasts during acute damage to the subcutaneous adipose tissue of rats: an ultrastructural study.

Ultrastructural phenotypic transitional features were noted between adult adipocytes and fibroblasts in the subcutaneous adipose tissue of the dorsal pad of normal adult Wistar rats of both sexes, weighing 180-260 g, after acute injury either by the implantation of small (1.8 x 1 x 0.4 cm) perforated plastic boxes or by local heat application. Soon after the inflicted damage, fat-containing cells presented variable shapes. Early after damage, some of these cells were round, adipocyte-like, with numerous and large cytoplasmic fat droplets. A few days later, fat-containing cells became elongated, with the fat droplets in their cytoplasm becoming smaller and less numerous. The cells also showed a prominent active rough endoplasmic reticulum and newly formed collagenous matrix accumulated in the interstices. Although current views consider adult adipocytes to be terminal cells, the present findings, in their time sequence, strongly suggest the transformation of adipocytes into fibroblasts after acute injury to adipose tissue.

Adipocytes↗
PubMed1997

Evaluation of an educational program for asthma control in adults.

We have developed a 6-month educational plan associated with outpatient follow-up and special clinical care for asthmatic patients in a deprived population, with serious socioeconomic problems and a very low level of education. The objective was to determine the effects of the program on clinical asthma outcomes, lung function, and quality of life. Forty patients were enrolled in the program with a regular schedule of outpatient visits, and 31 finished the 6-month intervention, which included information about asthma, instruction in appropriate use of medication, training in metered-dose inhaler technique, how to identify and control asthma triggers, how to use symptom diary cards, and how to recognize early signs of deterioration. Patients included 8 males and 23 females, 47.8 +/- 16.5 years old, with 77.4% elementary school education and 22.6% illiterate, and an average monthly income of around $450. After the 6-month program there was a significant change in asthma control with a reduction in asthma emergency visits and hospitalization, reduction of score symptoms, and improvement in quality of life. Based on the results, educational programs are recommended and should be adapted to the socioeconomic and cultural characteristics of the target population.

Administration, Inhalation↗
PubMed1994

The effect of pre-exposure to 0.12 ppm of ozone on exercise-induced asthma.

Ozone (O3) is a common air pollutant that has been associated with a dose-dependent increased bronchial responsiveness and airway inflammation. Previous investigations have shown increased airway responsiveness to allergens in asthmatics pre-exposed to 0.12 ppm of O3 for 1 h. In the present study, we investigated whether inhalation of relatively low levels of O3 would modify the degree of exercise-induced bronchoconstriction. We studied 15 "never smokers" with mild stable asthma (7 male and 8 female) (mean age [+/- SD] 25.6 +/- 6.8 years) who had exhibited a fall in FEV1 > 15 percent after a standard 6-min treadmill exercise challenge test on the screening day. This was a double-blind, placebo-controlled study. The patients were randomized to receive either O3 or air (placebo) before performing the exercise challenge again. The average highest 1-h daily O3 concentrations in Toronto during O3 days and air days were 0.017 +/- 0.017 and 0.014 +/- 0.005 ppm, respectively. The O3 concentration inside the chamber averaged 0.122 +/- 0.005 ppm on O3 days and 0.002 +/- 0.001 on placebo days. Partial and complete flow volume curves were done before and after this exposure, and also 5, 10, 15, 20, 30, and 60 min postexercise. The percent fall in FEV1 on the O3 chamber day and on the air chamber day was the same (F = 0.67, p = 0.67, NS) as well as the percent fall in V40p (F = 0.91, p = 0.49, NS). A repeated measures analysis of variance to test the effects of exposure on the time course of the airway response after exercise showed no significant difference between the 2 days. There was also no significant difference in maximal percentage fall in FEV1 (25.6 +/- 8.6) or V40p (62.2+18.6) following O3 exposure, and FEV1 (26.8 +/- 9.4)(p = 0.64) or V40p (65.3+4.31)(p = 0.60) following air. Our data indicate that previous exposure at rest to a concentration of O3 that has previously been shown to augment the bronchoconstriction response to allergens did not increase the bronchoconstriction response to subsequent exercise nor did it change the time course of such bronchoconstriction.

Adult↗
PubMed1985

Lung inhalation scintigraphy: development of a new aerosol system.

A new technique for lung inhalation scintigraphy is reported, developing a new aerosol system, based on the original system of Taplin [1]. With two small compact polypropylene reservoirs, this 99Tcm DTPA technique allowed continuous breathing during the inhalation period. This system proved to be a useful alternative to that using radioactive gases and the system of Taplin, due to its low cost and the ease with which several projections may be obtained.

Adult↗
PubMed1980

[Lennox-Gastaut syndrome of late onset. I. Incidence of cases with onset before and after 6 years of age, etiological factors and intellectual level].

Of 66 patients with Lennox-Gastaut syndrome, 15 exhibited the first clinical manifestations after 6 years of age. Twelve of these were followed for a mean period of 2 years and 6 months, with neurological evaluations at about 2-month intervals. A review of the literature showed that, in 20% of the cases studied, the Lennox-Gastaut syndrome begins after the 6th year of life. Clinical evaluation allowed us to find out that our patients exhibited serious neurological damage preceding by several years the onset of the syndrome. The psychometric evaluation showed extensive involvement of the intellectual level, in contrast with the data in the literature on late-onset Lennox-Gastaut syndrome.

Adolescent↗
PubMed1979

[Acute respiratory insufficiency associated with the ingestion of central nervous system depressants].

The study of twenty patients with poisoning by central nervous system depressant drugs is reported. The authors emphasized clinical aspects, complications and mainly the lung function impairment. Barbiturates were the most common drugs, at least in 60% of the cases, used alone or in combination with sedatives and tranquilizers. In 55% of patients the amount of the drug ingested could not be measured. In 60% of the cases we didn't know the period of time between drug ingestion by the patients and their admission to the hospital. On admisson all patients were in coma. The coma was of varying degrees and the deeper the coma the worse was lung function and complications were more frequent. Whenever a cardiovascular collapse was present there was also a high mortality rate. The authors emphasized the importance of a follow-up of these patients in intensive care units, mainly with cardiovascular and ventilatory support.

Adolescent↗
PubMedDate not supplied

Myofibroblasts in schistosomal portal fibrosis of man.

Myofibroblasts, cells with intermediate features between smooth muscle cells and fibroblasts, have been described as an important cellular component of schistosomal portal fibrosis. The origin, distribution and fate of myofibroblasts were investigated by means of light, fluorescent, immunoenzymatic and ultrastructural techniques in wedge liver biopsies from 68 patients with the hepatosplenic form of schistosomiasis. Results demonstrated that the presence of myofibroblasts varied considerably from case to case and was always related to smooth muscle cell dispersion, which occurred around medium-sized damaged portal vein branches. By sequential observation of several cases, it was evident that myofibroblasts derived by differentiation of vascular smooth muscle and gradually tended to disappear, some of them further differentiating into fibroblasts. Thus, in schistosomal pipestem fibrosis myofibroblasts appear as transient cells, focally accumulated around damaged portal vein branches, and do not seem to have by themselves any important participation in the pathogenesis of hepatosplenic schistosomiasis.

Adolescent↗