Exercise Tolerance in Patients Treated With Praziquantel for Chronic Schistosomiasis and No Signs of Cardiopulmonary Impairment

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Estudio multicéntrico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M Valencia Arango, A Torres Martí, J Insausti Ordeñana, F Álvarez Lerma, N Carrasco Joaquinet, M Herranz Casado, JP Tirapu León" "autores" => array:7 [ 0 => array:2 [ "Iniciales" => "M" "apellidos" => "Valencia Arango" ] 1 => array:2 [ "Iniciales" => "A" "apellidos" => "Torres Martí" ] 2 => array:2 [ "Iniciales" => "J" "apellidos" => "Insausti Ordeñana" ] 3 => array:2 [ "Iniciales" => "F" "apellidos" => "Álvarez Lerma" ] 4 => array:2 [ "Iniciales" => "N" "apellidos" => "Carrasco Joaquinet" ] 5 => array:2 [ "Iniciales" => "M" "apellidos" => "Herranz Casado" ] 6 => array:2 [ "Iniciales" => "JP" "apellidos" => "Tirapu León" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13051510?idApp=UINPBA00003Z" "url" => "/15792129/0000003900000009/v0_201307090907/13051510/v0_201307090907/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "Exercise Tolerance in Patients Treated With Praziquantel for Chronic Schistosomiasis and No Signs of Cardiopulmonary Impairment" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "400" "paginaFinal" => "404" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M Montes de Oca, M Sánchez, C Tálamo, B de Noya, JM López" "autores" => array:5 [ 0 => array:3 [ "Iniciales" => "M" "apellidos" => "Montes de Oca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "M" "apellidos" => "Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "C" "apellidos" => "Tálamo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "B" "apellidos" => "de Noya" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 4 => array:3 [ "Iniciales" => "JM" "apellidos" => "López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología y Cirugía de Tórax, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela." "etiqueta" => "a" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Consulta de Schistosomiasis, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela." "etiqueta" => "b" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la tolerancia al ejercicio en pacientes con schistosomiasis crónica sin evidencias clínicas de compromiso cardiopulmonar tratados con praziquantel" ] ] "textoCompleto" => "Introduction Schistosomiasis produced by Schistosoma mansoni is an endemic disease in the Arabian Peninsula, Africa, northern South America, and the Caribbean. In some countries, like Brazil, it constitutes a public health problem affecting thousands of people. In Venezuela the estimated prevalence, based on an examination of feces in endemic zones, is 1.39%. However, more sensitive diagnostic methods show a greater prevalence (enzyme-linked immunosorbent assay [ELISA] on soluble egg antigen [SEA], 20.6%). There have been reports in the last several years of the presence of S mansoni eggs in the lungs of patients with chronic visceral disease.1 These eggs act as emboli obstructing the pulmonary arterioles but generally not affecting capillaries. Autopsy studies have indicated that the principal changes caused by S mansoni eggs are the appearance of fibrin deposits and marked hyperplasia of endothelial cells in the small arteries and arterioles. The formation of complex fibrin thrombi and revascularization, followed by congestion and the focal dilation of blood vessels with plexiform lesions, have also been described.1 The inflammatory process heals by fibrosis, which causes narrowing, thickening, and occlusion of the pulmonary arterioles. Although treatment with praziquantel can effectively eradicate infection by S mansoni with minimal toxicity, certain functional abnormalities will probably persist in view of the fibrotic changes that may leave residual lesions in the small pulmonary vessels with minimal functional alterations.2 Physiological measurements during exercise are considered a useful diagnostic tool in evaluating patients with chronic obstructive pulmonary disease.3-9 Abnormal values are generally associated with alterations related to low cardiac output and gas exchange anomalies. The progressive cycle ergometer test (PCET) can contribute useful information for evaluating patients with such problems.3-9 It has also been suggested that this test offers greater sensitivity than others in measuring a series of parameters in patients with minimal functional abnormalities that cannot be identified with functional tests carried out at rest.The literature to date does not supply adequate information on cardiopulmonary impairment and pulmonary vascular occlusive disease in schistosomiasis.1,2,10-14 For this reason our study was designed to evaluate cardiopulmonary response to exercise in patients successfully treated with praziquantel for chronic schistosomiasis with no clinical evidence of cardiopulmonary impairment and to determine the existence of functional abnormalities (oxygen consumption [VO2], oxygen transport, or gas exchange) compatible with the obstruction of the pulmonary vascular bed.Patients and MethodPatient SelectionWe studied 9 patients with a confirmed diagnosis of chronic schistosomiasis from the service specializing in schistosomiasis at the institute of tropical medicine at the Universidad Central de Venezuela. Four of the patients had signs of hepatosplenic involvement, 1 with signs of portal hypertension. The rest were asymptomatic and had received medical treatment 20 years earlier. None of the patients had clinical signs of cardiopulmonary abnormalities and all had given written consent to participate in the study. We also studied 10 healthy subjects from the same age group. After epidemiological diagnosis of contact with waters potentially infested with cercariae of the parasite, patients who had tested serologically positive for S mansoni infection underwent clinical, parasitological, and immunological evaluation. The parasitological tests were based on evidence of the presence of parasite eggs in the patients' feces. Our populations had low parasite loads, which accounted for the fact that the number of eggs per gram of feces was low, making diagnosis by the Kato-Katz or any other concentration method difficult. For this reason we also did 2 immunological assays: ELISA-SEA and circumoval precipitin tests. The latter is a highly sensitive and specific indicator of parasite activity, which diminishes or may even become negative after medical treatment. Patients with S mansoni eggs in their stool or with a positive circumoval precipitin test (>10%) were included as cases of schistosomiasis.All patients diagnosed with schistosomiasis with associated cardiopathology (ischemic, hypertensive, myocardiopathic, valvular, etc), pulmonary disease with involvement of the pleura (chronic obstructive pulmonary disease, asthma, bronchiectasis, cancer, tuberculosis, interstitial disease, etc), a history of chest surgery, neuromuscular or osteoarticular disease, obesity, or any other medical problem that could interfere with the stress test were excluded from the protocol.Lung Function Tests Simple spirometry was performed with a MedGraphics CardiO2 System spirometer (MedGraphics CardiO System, St. Paul, MN, USA). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio were calculated following the recommendations of the American Thoracic Society.15 The results were expressed as absolute values and percentage of predicted values.16 Carbon monoxide diffusing capacity was measured with the standard technique. Maximal voluntary ventilation was obtained directly using the 12-second maneuver and was used in the stress test as the maximal ventilatory capacity.Cardiopulmonary Stress TestThe PCET was administered with an ergometric cycle (MedGraphics CardiO2 System, St. Paul, MN, USA) using the standard ramp protocol. The protocol begins with 2 minutes of rest, followed by a 3-minute period of pedaling with no resistance, and finally with a progressive increase in the work load (ramp) at a rate of 25 W/min.3-6 Patients and control subjects were encouraged to continue pedaling until symptoms limited their ability to exercise. The end of the test was determined by the appearance of symptoms, by the fact that submaximal heart rate (HR) had been reached, by a respiratory quotient more than 1.15, or by the presence of electrocardiographic abnormalities. HR and heart rhythm were monitored with a 12-lead electrocardiograph. Blood pressure was measured noninvasively with a pressure cuff connected to a mercury sphygmomanometer. Minute ventilation (VE) and its components were measured using a pneumotachograph (MedGraphics CardiO2 System, St. Paul, MN, USA). Oxygen concentration was analyzed with a zirconium dioxide cell oxygen analyzer and expired carbon dioxide with an infrared ray carbon dioxide analyzer (MedGraphics CardiO2 System, St. Paul, MN, USA). The measurements and flow signals were electronically integrated by a computerized system that averaged VE, tidal volume, respiratory frequency, VO2, carbon dioxide production, and respiratory quotient every 30 seconds.HR was used to evaluate HR reserve and oxygen transport indices (oxygen pulse and ΔHR/ΔVO2). Predicted maximal oxygen consumption (VO2max) was calculated in accordance with the recommendations of Jones and Campbell.17 The anaerobic threshold was determined noninvasively using the modified V-slope method.18 Maximum predicted HR was calculated with the following formula: maximum HR=220-age. Arterial oxygen saturation was monitored noninvasively with a fiber optic digital transducer (Ohmeda Biox 3740 pulse oximeter, Miami, FL, USA). Blood samples to measure arterial gases were taken at rest and immediately after exercise in order to evaluate pulmonary gas exchange and the dead space (VD) to tidal volume (VT) ratio. Intensity of exercise-induced dyspnea, evaluated at rest and at the end of exercise, was quantified using the Borg scale.19Echocardiographic and Doppler EvaluationAn ultrasound machine with transducer (Hewlett Packard, model 5500 or 1800) was used, which allowed us to obtain and record echo-Doppler, M-mode, and 2-dimensional (2D) echocardiographic signals. The study was carried out on all patients diagnosed with schistosomiasis to rule out the existence of other cardiovascular diseases that could cause alterations in functional tests. Analysis of the M-mode and 2D signals included the following parameters: diastolic diameters of both ventricles, right ventricular wall, interventricular septum and posterior left ventricular wall, area of the left and right atria, and tricuspid annular plane systolic excursion to calculate right ventricle ejection fraction. Aortic root and pulmonary artery diameters were also measuredThe analysis of the velocity signals obtained by continuous Doppler allowed us to estimate systolic blood pressure, which was calculated by measuring the maximal tricuspid regurgitation flow velocity (TRVmax) and applying the following formula: (TRVmaxx4)+right atrial pressure Right atrial pressure was estimated from the 2D image of the degree of inferior vena cava inspiratory collapse (>50%= 5 cm H2O; <50%=10 cm H2O; 0%=5 cm H2O). Diastolic pulmonary artery pressure was obtained from the recording of the pulmonary valve regurgitation gradient at the end of diastole with continuous Doppler using the following formula: (end-diastolic velocityx4)+right atrial pressure Systolic pulse and Doppler velocity curve analyses included the following variables: right ventricular ejection time, from the onset of right ventricular ejection until right ventricular ejection was zero; isovolumetric contraction period or right ventricular pre-ejection period, from the onset of the QRS complex of the electrocardiogram until the onset of right ventricular ejection; pulmonary acceleration time, from the onset of pulmonary ejection until peak flow velocity was reached. Mean pulmonary pressure was also calculated using the following formula: 79-(0.45xright ventricular acceleration time)Statistical AnalysisThe results of lung function tests, PCET, and echocardiography were expressed as means (SD). To compare the results of anthropometric data, lung function tests, and PCET between patients and control subjects the Student t test for independent samples was used. A level of statistical significance with a probability value less than .05 (P<.05) was accepted. The results are presented in the tables and figure.<img src="260v39n09-13051511tab01.gif"></img>Figure. Comparison of maximal oxygen consumption (VO2max) (percentages) of patients and control subjects. Results Mean anthropometric data and static lung function findings for patients and control subjects are detailed in Table 1. The mean ages of patients (38[18] years) and control subjects (32[14] years) were similar. As can be observed in Table 1, lung function, including carbon monoxide diffusing capacity, was similar in both groups, indicating that patients with schistosomiasis had normal resting lung function.<img src="260v39n09-13051511tab02.gif"></img> Table 2 shows mean values for the PCET. This table and the figure show that patients had a slightly lower exercise capacity (VO2max:74%[23%]) than did control group subjects (VO2max:95%[16%]). The stratification of the degree of functional impairment on the basis of peak aerobic capacity (VO2 in mL//kg/min), at 25[9] mL/kg/min, showed that patients had a minimal decrease in exercise tolerance (functional class A: VO2/kg≥20 mL/kg/min).20,21<img src="260v39n09-13051511tab03.gif"></img> Exercise intolerance in patients was related to signs of cardiovascular limitations or physical detraining, and was characterized by a decrease in the recruitment of HR reserve (92%[8]%) for the amount of effort exerted (VO2max:74%[23]%).3-6 It was also observed that the anaerobic threshold (58%[16]%) and oxygen transport indices (maximum oxygen pulse and ΔHR/ΔVO2) of the patients were similar to those of the control subjects. Nor were differences observed between patients and control subjects in ventilatory parameters (maximal minute ventilation [VEmax], VEmax/minimum voluntary ventilation), gas exchange indexes (PaO2, PaCO2, arterial-alveolar oxygen gradient, VD/VT), or shortness of breath during exercise.The echocardiographic results in Table 3 show no alterations that would indicate the presence of heart disease associated with pulmonary artery hypertension.<img src="260v39n09-13051511tab04.gif"></img>Discussion Ours is the first controlled study to compare changes in exercise tolerance and cardiopulmonary response to exercise between patients with no evidence of cardiopulmonary impairment treated with praziquantel for chronic schistosomiasis and healthy individuals of similar age. The most important findings were a) resting lung function including carbon monoxide diffusing capacity of patients with chronic schistosomiasis was normal; b) evidence of minimal cardiovascular limitation and normal respiratory response indicated that patients had only a slight decrease in exercise capacity, corresponding to functional class A; and c) no echocardiographic abnormalities that might indicate the presence of pulmonary hypertension or pulmonary vascular occlusive disease were observed. There has been little information published on lung function and pulmonary complications in patients with chronic schistosomiasis with or without cor pulmonale.1,2,10-14 Some studies show histological evidence of fibrin deposits and marked hyperplasia of endothelial cells in the small pulmonary arteries and arterioles with complex fibrin thrombus formation and revascularization in patients with schistosomiasis and cor pulmonale.1 However, no study has been carried out that would determine histological alterations in the pulmonary vascular bed of patients with schistosomiasis but without cor pulmonale or in those who have received successful medical treatment. As this inflammatory process heals by fibrosis, it is thought that these changes are irreversible with treatment and that residual fibrotic lesions capable of affecting pulmonary vascular function may remain. Frayser and Alonso10 observed that maximal voluntary ventilation and FEV1 decreased slightly with no significant desaturation in stress tests compared to resting values in 14 chronic schistosomiasis patients in an uncontrolled study. However, the increase in carbon monoxide diffusing capacity after exercise of the patients was significantly lower than values used for reference (8.8 mL in the patients vs the reference of 16.4 mL).10 It is important to point out that such a difference is open to question, as the characteristics of the patients compared were quite dissimilar. Lemle et al11 evaluated resting lung function in 5 patients with chronic schistosomiasis and cardiopulmonary complications. The results showed spirometric values within the normal range. The only abnormality reported was the presence of hypoxia due to an increase in right-to-left shunt in 2 patients with cyanosis. Unfortunately no echocardiographic studies were done to rule out the possibility of other associated diseases. Until the present study, exercise tolerance and cardiopulmonary response to effort in patients with chronic schistosomiasis with no evidence of cardiopulmonary impairment had not been studied by direct measurement of VO2 and blood gas analysis. Our study represents the first such attempt and the results indicate that these patients have resting lung function similar to those of the control group. These findings differ from the assertion of Frayser and Alonso10 that maximal voluntary ventilation and FEV1 decrease. It is probable that the differences can be explained by methodological flaws in the data described by Frayser and Alonso,10 as they performed no measurements of the altered parameters in control subjects for comparison with patients' values.The other findings of the present study were the changes observed in the PCET. The results indicated that patients with chronic schistosomiasis had a slight decrease in exercise tolerance compared to the control subjects. However, the patients as a group were functional class A, with an average VO2/kg/min of over 20 mL/kg/min (minimal cardiopulmonary limitation). This exercise intolerance is related to diminished HR reserve for the amount of effort exerted, indicative of cardiovascular limitation or physical detraining. It is impossible, however, to distinguish between these two possibilities with this test.3-6 The rest of the cardiovascular, oxygen transport, and respiratory parameters were similar to those of the control group. The presence in these patients of an anaerobic threshold, oxygen transport parameters (ΔHR/ΔVO2 and oxygen pulse), and gas exchange indexes (VD/VT, PaO2, arterial-alveolar oxygen gradient) similar to those of the control group makes the existence of pulmonary vascular occlusive disease in patients previously treated with praziquantel for chronic schistosomiasis unlikely.It is difficult to compare our results with those of previous studies,10,11 as the methods of the studies and the clinical characteristics of the patients evaluated were very different. The present study included patients with no evidence of cardiopulmonary impairment treated with praziquantel, while the others evaluated either patients in advanced stages of the disease who did show evidence of cardiopulmonary impairment11 or who were untreated.10In conclusion, the results of the present study indicate that patients treated with praziquantel for chronic schistosomiasis with no signs of cardiopulmonary impairment have normal resting lung function. However, exercise tolerance is slightly decreased, which is probably related to physical detraining. The data during effort show normal oxygen transport and gas exchange, which would make the existence of any type of pulmonary vascular disease in these patients unlikely. Abnormalities may appear in later stages of the disease or in patients who do not receive early successful medical treatment.Acknowledgments This study was carried out with the support of the National Council for Scientific and Technological Research (Consejo Nacional de Investigaciones Científicas y Tecnológicas), project S1-97001105.<hr></hr>Correspondence: Dra. M. Montes de Oca de Loyo. CS 5150. P.O. Box 025323. Miami, FL, 33102-5323. USA. E-mail: <a href="mailto:jgloyo@telcel.net.ve" class="elsevierStyleCrossRefs"> jgloyo@telcel.net.ve</a>Manuscript received August 27, 2002. Accepted for publication April 29, 2003." "pdfFichero" => "260v39n09a13051511pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec191413" "palabras" => array:3 [ 0 => "Stress test" 1 => "Chronic schistosomiasis" 2 => "Exercise capacity" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec191414" "palabras" => array:3 [ 0 => "Pruebas de esfuerzo" 1 => "Schistosomiasis crónica" 2 => "Capacidad de esfuerzo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "Objective: The purpose of this study was to evaluate whether a progressive cycle ergometer test (PCET) can detect minimal functional abnormalities that might indicate compromise of the pulmonary vascular bed in patients treated with praziquantel for chronic schistosomiasis who have no clinical signs of cardiopulmonary impairment. Patients and method: We studied 9 patients (whose mean (SD) age was 38 (18) years and 10 control subjects aged 32 (14) years. Both groups were evaluated by spirometry and a PCET to determine maximum oxygen consumption, heart rate, minute ventilation and gas exchange. Echocardiograms were used to rule out the presence of associated heart disease. Results: Lung function was similar among patients and controls. Slight decreases in maximum oxygen consumption and heart rate reserve were observed with effort during the PCET, with normal respiratory response. No echocardiographic abnormalities that might indicate the presence of pulmonary vascular occlusive disease were observed. Conclusions: The results showed that the resting lung function is normal in these patients. However, there was a slight decrease in exercise tolerance, probably related to physical detraining. The data obtained during exercise indicated that pulmonary vascular occlusive disease is unlikely in these patients. Abnormalities may appear in later stages of the disease or in patients who do not receive early medical treatment." ] "es" => array:1 [ "resumen" => "Objetivo: El propósito del estudio es evaluar si la prueba de esfuerzo progresiva en cicloergómetro (PECP) puede detectar anormalidades funcionales mínimas que indiquen compromiso del lecho vascular pulmonar, en pacientes con schistosomiasis crónica sin evidencias clínicas de compromiso cardiopulmonar tratados con praziquantel. Pacientes y método: Se estudió a 9 pacientes (38 ± 18 años) y a 10 controles (32 ± 14 años). Ambos grupos fueron evaluados con espirometría y PECP para determinar el consumo de O2 máximo, la frecuencia cardíaca, la ventilación minuto y el intercambio gaseoso. Se realizó un ecocardiograma a los pacientes para descartar la presencia de cardiopatías asociadas. Resultados: Los pacientes tenían una función pulmonar similar al grupo control. En la PECP se observó una discreta disminución del consumo de O2 máximo y de la reserva de la frecuencia cardíaca para el esfuerzo realizado, con respuesta respiratoria normal. No se observaron anormalidades ecocardiográficas que indicasen la presencia de enfermedad vascular pulmonar oclusiva. Conclusiones: Los resultados indican que estos pacientes tienen una función pulmonar en reposo normal. Sin embargo, la tolerancia al ejercicio presenta una discreta disminución, hecho probablemente secundario a desentrenamiento físico. Los datos durante el esfuerzo hacen improbable la existencia de enfermedad vascular pulmonar oclusiva en estos pacientes. 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Evaluación de la tolerancia al ejercicio en pacientes con schistosomiasis crónica sin evidencias clínicas de compromiso cardiopulmonar tratados con praziquantel

M. Montes de Ocaa, M. Sáncheza, C. Tálamoa, B. de Noyab, JM. Lópeza

a Servicio de Neumología y Cirugía de Tórax, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela.

b Consulta de Schistosomiasis, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela.

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      "titulo" => "Diagnostic Value of Quantitative Cultures of Endotracheal Aspirate in Ventilator-Associated Pneumonia&#58; A Multicenter Study"
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    "titulo" => "Exercise Tolerance in Patients Treated With Praziquantel for Chronic Schistosomiasis and No Signs of Cardiopulmonary Impairment"
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        "titulo" => "Evaluaci&#243;n de la tolerancia al ejercicio en pacientes con schistosomiasis cr&#243;nica sin evidencias cl&#237;nicas de compromiso cardiopulmonar tratados con praziquantel"
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction</span></p><p class="elsevierStylePara"> Schistosomiasis produced by <span class="elsevierStyleItalic">Schistosoma mansoni</span> is an endemic disease in the Arabian Peninsula&#44; Africa&#44; northern South America&#44; and the Caribbean&#46; In some countries&#44; like Brazil&#44; it constitutes a public health problem affecting thousands of people&#46; In Venezuela the estimated prevalence&#44; based on an examination of feces in endemic zones&#44; is 1&#46;39&#37;&#46; However&#44; more sensitive diagnostic methods show a greater prevalence &#40;enzyme-linked immunosorbent assay &#91;ELISA&#93; on soluble egg antigen &#91;SEA&#93;&#44; 20&#46;6&#37;&#41;&#46;</p><p class="elsevierStylePara"> There have been reports in the last several years of the presence of <span class="elsevierStyleItalic">S mansoni</span> eggs in the lungs of patients with chronic visceral disease&#46;<span class="elsevierStyleSup">1</span> These eggs act as emboli obstructing the pulmonary arterioles but generally not affecting capillaries&#46; Autopsy studies have indicated that the principal changes caused by <span class="elsevierStyleItalic">S mansoni</span> eggs are the appearance of fibrin deposits and marked hyperplasia of endothelial cells in the small arteries and arterioles&#46; The formation of complex fibrin thrombi and revascularization&#44; followed by congestion and the focal dilation of blood vessels with plexiform lesions&#44; have also been described&#46;<span class="elsevierStyleSup">1</span> The inflammatory process heals by fibrosis&#44; which causes narrowing&#44; thickening&#44; and occlusion of the pulmonary arterioles&#46;</p><p class="elsevierStylePara"> Although treatment with praziquantel can effectively eradicate infection by <span class="elsevierStyleItalic">S mansoni</span> with minimal toxicity&#44; certain functional abnormalities will probably persist in view of the fibrotic changes that may leave residual lesions in the small pulmonary vessels with minimal functional alterations&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara"> Physiological measurements during exercise are considered a useful diagnostic tool in evaluating patients with chronic obstructive pulmonary disease&#46;<span class="elsevierStyleSup">3-9</span> Abnormal values are generally associated with alterations related to low cardiac output and gas exchange anomalies&#46; The progressive cycle ergometer test &#40;PCET&#41; can contribute useful information for evaluating patients with such problems&#46;<span class="elsevierStyleSup">3-9</span> It has also been suggested that this test offers greater sensitivity than others in measuring a series of parameters in patients with minimal functional abnormalities that cannot be identified with functional tests carried out at rest&#46;</p><p class="elsevierStylePara">The literature to date does not supply adequate information on cardiopulmonary impairment and pulmonary vascular occlusive disease in schistosomiasis&#46;<span class="elsevierStyleSup">1&#44;2&#44;10-14</span> For this reason our study was designed to evaluate cardiopulmonary response to exercise in patients successfully treated with praziquantel for chronic schistosomiasis with no clinical evidence of cardiopulmonary impairment and to determine the existence of functional abnormalities &#40;oxygen consumption &#91;VO<span class="elsevierStyleInf">2</span>&#93;&#44; oxygen transport&#44; or gas exchange&#41; compatible with the obstruction of the pulmonary vascular bed&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients and Method</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Patient Selection</span></p><p class="elsevierStylePara">We studied 9 patients with a confirmed diagnosis of chronic schistosomiasis from the service specializing in schistosomiasis at the institute of tropical medicine at the Universidad Central de Venezuela&#46; Four of the patients had signs of hepatosplenic involvement&#44; 1 with signs of portal hypertension&#46; The rest were asymptomatic and had received medical treatment 20 years earlier&#46; None of the patients had clinical signs of cardiopulmonary abnormalities and all had given written consent to participate in the study&#46; We also studied 10 healthy subjects from the same age group&#46;</p><p class="elsevierStylePara"> After epidemiological diagnosis of contact with waters potentially infested with cercariae of the parasite&#44; patients who had tested serologically positive for <span class="elsevierStyleItalic">S mansoni</span> infection underwent clinical&#44; parasitological&#44; and immunological evaluation&#46; The parasitological tests were based on evidence of the presence of parasite eggs in the patients&#39; feces&#46; Our populations had low parasite loads&#44; which accounted for the fact that the number of eggs per gram of feces was low&#44; making diagnosis by the Kato-Katz or any other concentration method difficult&#46; For this reason we also did 2 immunological assays&#58; ELISA-SEA and circumoval precipitin tests&#46; The latter is a highly sensitive and specific indicator of parasite activity&#44; which diminishes or may even become negative after medical treatment&#46; Patients with <span class="elsevierStyleItalic">S mansoni</span> eggs in their stool or with a positive circumoval precipitin test &#40;&#62;10&#37;&#41; were included as cases of schistosomiasis&#46;</p><p class="elsevierStylePara">All patients diagnosed with schistosomiasis with associated cardiopathology &#40;ischemic&#44; hypertensive&#44; myocardiopathic&#44; valvular&#44; etc&#41;&#44; pulmonary disease with involvement of the pleura &#40;chronic obstructive pulmonary disease&#44; asthma&#44; bronchiectasis&#44; cancer&#44; tuberculosis&#44; interstitial disease&#44; etc&#41;&#44; a history of chest surgery&#44; neuromuscular or osteoarticular disease&#44; obesity&#44; or any other medical problem that could interfere with the stress test were excluded from the protocol&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Lung Function Tests</span></p><p class="elsevierStylePara"> Simple spirometry was performed with a MedGraphics CardiO<span class="elsevierStyleInf">2</span> System spirometer &#40;MedGraphics CardiO System&#44; St&#46; Paul&#44; MN&#44; USA&#41;&#46; Forced vital capacity &#40;FVC&#41;&#44; forced expiratory volume in 1 second &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#44; and the FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio were calculated following the recommendations of the American Thoracic Society&#46;<span class="elsevierStyleSup">15</span> The results were expressed as absolute values and percentage of predicted values&#46;<span class="elsevierStyleSup">16</span> Carbon monoxide diffusing capacity was measured with the standard technique&#46; Maximal voluntary ventilation was obtained directly using the 12-second maneuver and was used in the stress test as the maximal ventilatory capacity&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Cardiopulmonary Stress Test</span></p><p class="elsevierStylePara">The PCET was administered with an ergometric cycle &#40;MedGraphics CardiO<span class="elsevierStyleInf">2</span> System&#44; St&#46; Paul&#44; MN&#44; USA&#41; using the standard ramp protocol&#46; The protocol begins with 2 minutes of rest&#44; followed by a 3-minute period of pedaling with no resistance&#44; and finally with a progressive increase in the work load &#40;ramp&#41; at a rate of 25 W&#47;min&#46;<span class="elsevierStyleSup">3-6</span> Patients and control subjects were encouraged to continue pedaling until symptoms limited their ability to exercise&#46; The end of the test was determined by the appearance of symptoms&#44; by the fact that submaximal heart rate &#40;HR&#41; had been reached&#44; by a respiratory quotient more than 1&#46;15&#44; or by the presence of electrocardiographic abnormalities&#46; HR and heart rhythm were monitored with a 12-lead electrocardiograph&#46; Blood pressure was measured noninvasively with a pressure cuff connected to a mercury sphygmomanometer&#46;</p><p class="elsevierStylePara"> Minute ventilation &#40;VE&#41; and its components were measured using a pneumotachograph &#40;MedGraphics CardiO<span class="elsevierStyleInf">2</span> System&#44; St&#46; Paul&#44; MN&#44; USA&#41;&#46; Oxygen concentration was analyzed with a zirconium dioxide cell oxygen analyzer and expired carbon dioxide with an infrared ray carbon dioxide analyzer &#40;MedGraphics CardiO<span class="elsevierStyleInf">2</span> System&#44; St&#46; Paul&#44; MN&#44; USA&#41;&#46; The measurements and flow signals were electronically integrated by a computerized system that averaged VE&#44; tidal volume&#44; respiratory frequency&#44; VO<span class="elsevierStyleInf">2</span>&#44; carbon dioxide production&#44; and respiratory quotient every 30 seconds&#46;</p><p class="elsevierStylePara">HR was used to evaluate HR reserve and oxygen transport indices &#40;oxygen pulse and &#916;HR&#47;&#916;VO<span class="elsevierStyleInf">2</span>&#41;&#46; Predicted maximal oxygen consumption &#40;VO<span class="elsevierStyleInf">2max</span>&#41; was calculated in accordance with the recommendations of Jones and Campbell&#46;<span class="elsevierStyleSup">17</span> The anaerobic threshold was determined noninvasively using the modified V-slope method&#46;<span class="elsevierStyleSup">18</span> Maximum predicted HR was calculated with the following formula&#58; maximum HR&#61;220&#173;-age&#46; Arterial oxygen saturation was monitored noninvasively with a fiber optic digital transducer &#40;Ohmeda Biox 3740 pulse oximeter&#44; Miami&#44; FL&#44; USA&#41;&#46; Blood samples to measure arterial gases were taken at rest and immediately after exercise in order to evaluate pulmonary gas exchange and the dead space &#40;V<span class="elsevierStyleInf">D</span>&#41; to tidal volume &#40;V<span class="elsevierStyleInf">T</span>&#41; ratio&#46;</p><p class="elsevierStylePara"> Intensity of exercise-induced dyspnea&#44; evaluated at rest and at the end of exercise&#44; was quantified using the Borg scale&#46;<span class="elsevierStyleSup">19</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Echocardiographic and Doppler Evaluation</span></p><p class="elsevierStylePara">An ultrasound machine with transducer &#40;Hewlett Packard&#44; model 5500 or 1800&#41; was used&#44; which allowed us to obtain and record echo-Doppler&#44; M-mode&#44; and 2-dimensional &#40;2D&#41; echocardiographic signals&#46; The study was carried out on all patients diagnosed with schistosomiasis to rule out the existence of other cardiovascular diseases that could cause alterations in functional tests&#46;</p><p class="elsevierStylePara"> Analysis of the M-mode and 2D signals included the following parameters&#58; diastolic diameters of both ventricles&#44; right ventricular wall&#44; interventricular septum and posterior left ventricular wall&#44; area of the left and right atria&#44; and tricuspid annular plane systolic excursion to calculate right ventricle ejection fraction&#46; Aortic root and pulmonary artery diameters were also measured</p><p class="elsevierStylePara">The analysis of the velocity signals obtained by continuous Doppler allowed us to estimate systolic blood pressure&#44; which was calculated by measuring the maximal tricuspid regurgitation flow velocity &#40;TRV<span class="elsevierStyleInf">max</span>&#41; and applying the following formula&#58;</p><p class="elsevierStylePara"> &#40;TRV<span class="elsevierStyleInf">max</span>x4&#41;&#43;right atrial pressure</p><p class="elsevierStylePara"> Right atrial pressure was estimated from the 2D image of the degree of inferior vena cava inspiratory collapse &#40;&#62;50&#37;&#61; 5 cm H<span class="elsevierStyleInf">2</span>O&#59; &#60;50&#37;&#61;10 cm H<span class="elsevierStyleInf">2</span>O&#59; 0&#37;&#61;5 cm H<span class="elsevierStyleInf">2</span>O&#41;&#46; Diastolic pulmonary artery pressure was obtained from the recording of the pulmonary valve regurgitation gradient at the end of diastole with continuous Doppler using the following formula&#58;</p><p class="elsevierStylePara"> &#40;end-diastolic velocityx4&#41;&#43;right atrial pressure</p><p class="elsevierStylePara"> Systolic pulse and Doppler velocity curve analyses included the following variables&#58; right ventricular ejection time&#44; from the onset of right ventricular ejection until right ventricular ejection was zero&#59; isovolumetric contraction period or right ventricular pre-ejection period&#44; from the onset of the QRS complex of the electrocardiogram until the onset of right ventricular ejection&#59; pulmonary acceleration time&#44; from the onset of pulmonary ejection until peak flow velocity was reached&#46; Mean pulmonary pressure was also calculated using the following formula&#58;</p><p class="elsevierStylePara"> 79-&#173;&#40;0&#46;45xright ventricular acceleration time&#41;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Statistical Analysis</span></p><p class="elsevierStylePara">The results of lung function tests&#44; PCET&#44; and echocardiography were expressed as means &#40;SD&#41;&#46; To compare the results of anthropometric data&#44; lung function tests&#44; and PCET between patients and control subjects the Student <span class="elsevierStyleItalic">t</span> test for independent samples was used&#46; A level of statistical significance with a probability value less than &#46;05 &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41; was accepted&#46; The results are presented in the tables and figure&#46;</p><p class="elsevierStylePara"><img src="260v39n09-13051511tab01.gif"></img></p><p class="elsevierStylePara">Figure&#46; Comparison of maximal oxygen consumption &#40;VO<span class="elsevierStyleInf">2max</span>&#41; &#40;percentages&#41; of patients and control subjects&#46;&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results</span></p><p class="elsevierStylePara"> Mean anthropometric data and static lung function findings for patients and control subjects are detailed in Table 1&#46; The mean ages of patients &#40;38&#91;18&#93; years&#41; and control subjects &#40;32&#91;14&#93; years&#41; were similar&#46; As can be observed in Table 1&#44; lung function&#44; including carbon monoxide diffusing capacity&#44; was similar in both groups&#44; indicating that patients with schistosomiasis had normal resting lung function&#46;</p><p class="elsevierStylePara"><img src="260v39n09-13051511tab02.gif"></img></p><p class="elsevierStylePara"> Table 2 shows mean values for the PCET&#46; This table and the figure show that patients had a slightly lower exercise capacity &#40;VO<span class="elsevierStyleInf">2max</span>&#58;74&#37;&#91;23&#37;&#93;&#41; than did control group subjects &#40;VO<span class="elsevierStyleInf">2max</span>&#58;95&#37;&#91;16&#37;&#93;&#41;&#46; The stratification of the degree of functional impairment on the basis of peak aerobic capacity &#40;VO<span class="elsevierStyleInf">2</span> in mL&#47;&#47;kg&#47;min&#41;&#44; at 25&#91;9&#93; mL&#47;kg&#47;min&#44; showed that patients had a minimal decrease in exercise tolerance &#40;functional class A&#58; VO<span class="elsevierStyleInf">2</span>&#47;kg&#8805;20 mL&#47;kg&#47;min&#41;&#46;<span class="elsevierStyleSup">20&#44;21</span></p><p class="elsevierStylePara"><img src="260v39n09-13051511tab03.gif"></img></p><p class="elsevierStylePara"> Exercise intolerance in patients was related to signs of cardiovascular limitations or physical detraining&#44; and was characterized by a decrease in the recruitment of HR reserve &#40;92&#37;&#91;8&#93;&#37;&#41; for the amount of effort exerted &#40;VO<span class="elsevierStyleInf">2max</span>&#58;74&#37;&#91;23&#93;&#37;&#41;&#46;<span class="elsevierStyleSup">3-6</span> It was also observed that the anaerobic threshold &#40;58&#37;&#91;16&#93;&#37;&#41; and oxygen transport indices &#40;maximum oxygen pulse and &#916;HR&#47;&#916;VO<span class="elsevierStyleInf">2</span>&#41; of the patients were similar to those of the control subjects&#46; Nor were differences observed between patients and control subjects in ventilatory parameters &#40;maximal minute ventilation &#91;VE<span class="elsevierStyleInf">max</span>&#93;&#44; VE<span class="elsevierStyleInf">max</span>&#47;minimum voluntary ventilation&#41;&#44; gas exchange indexes &#40;PaO<span class="elsevierStyleInf">2</span>&#44; PaCO<span class="elsevierStyleInf">2</span>&#44; arterial-alveolar oxygen gradient&#44; V<span class="elsevierStyleInf">D</span>&#47;V<span class="elsevierStyleInf">T</span>&#41;&#44; or shortness of breath during exercise&#46;</p><p class="elsevierStylePara">The echocardiographic results in Table 3 show no alterations that would indicate the presence of heart disease associated with pulmonary artery hypertension&#46;</p><p class="elsevierStylePara"><img src="260v39n09-13051511tab04.gif"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion</span></p><p class="elsevierStylePara"> Ours is the first controlled study to compare changes in exercise tolerance and cardiopulmonary response to exercise between patients with no evidence of cardiopulmonary impairment treated with praziquantel for chronic schistosomiasis and healthy individuals of similar age&#46; The most important findings were <span class="elsevierStyleItalic">a&#41;</span> resting lung function including carbon monoxide diffusing capacity of patients with chronic schistosomiasis was normal&#59; <span class="elsevierStyleItalic">b&#41;</span> evidence of minimal cardiovascular limitation and normal respiratory response indicated that patients had only a slight decrease in exercise capacity&#44; corresponding to functional class A&#59; and <span class="elsevierStyleItalic">c&#41;</span> no echocardiographic abnormalities that might indicate the presence of pulmonary hypertension or pulmonary vascular occlusive disease were observed&#46;</p><p class="elsevierStylePara"> There has been little information published on lung function and pulmonary complications in patients with chronic schistosomiasis with or without cor pulmonale&#46;<span class="elsevierStyleSup">1&#44;2&#44;10-14</span></p><p class="elsevierStylePara"> Some studies show histological evidence of fibrin deposits and marked hyperplasia of endothelial cells in the small pulmonary arteries and arterioles with complex fibrin thrombus formation and revascularization in patients with schistosomiasis and cor pulmonale<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">1</span> However&#44; no study has been carried out that would determine histological alterations in the pulmonary vascular bed of patients with schistosomiasis but without cor pulmonale or in those who have received successful medical treatment&#46; As this inflammatory process heals by fibrosis&#44; it is thought that these changes are irreversible with treatment and that residual fibrotic lesions capable of affecting pulmonary vascular function may remain&#46;</p><p class="elsevierStylePara"> Frayser and Alonso<span class="elsevierStyleSup">10</span> observed that maximal voluntary ventilation and FEV<span class="elsevierStyleInf">1</span> decreased slightly with no significant desaturation in stress tests compared to resting values in 14 chronic schistosomiasis patients in an uncontrolled study&#46; However&#44; the increase in carbon monoxide diffusing capacity after exercise of the patients was significantly lower than values used for reference &#40;8&#46;8 mL in the patients vs the reference of 16&#46;4 mL&#41;&#46;<span class="elsevierStyleSup">10</span> It is important to point out that such a difference is open to question&#44; as the characteristics of the patients compared were quite dissimilar&#46;</p><p class="elsevierStylePara"> Lemle et al<span class="elsevierStyleSup">11</span> evaluated resting lung function in 5 patients with chronic schistosomiasis and cardiopulmonary complications&#46; The results showed spirometric values within the normal range&#46; The only abnormality reported was the presence of hypoxia due to an increase in right-to-left shunt in 2 patients with cyanosis&#46; Unfortunately no echocardiographic studies were done to rule out the possibility of other associated diseases&#46;</p><p class="elsevierStylePara"> Until the present study&#44; exercise tolerance and cardiopulmonary response to effort in patients with chronic schistosomiasis with no evidence of cardiopulmonary impairment had not been studied by direct measurement of VO<span class="elsevierStyleInf">2</span> and blood gas analysis&#46; Our study represents the first such attempt and the results indicate that these patients have resting lung function similar to those of the control group&#46; These findings differ from the assertion of Frayser and Alonso<span class="elsevierStyleSup">10</span> that maximal voluntary ventilation and FEV<span class="elsevierStyleInf">1</span> decrease&#46; It is probable that the differences can be explained by methodological flaws in the data described by Frayser and Alonso&#44;<span class="elsevierStyleSup">10</span> as they performed no measurements of the altered parameters in control subjects for comparison with patients&#39; values&#46;</p><p class="elsevierStylePara">The other findings of the present study were the changes observed in the PCET&#46; The results indicated that patients with chronic schistosomiasis had a slight decrease in exercise tolerance compared to the control subjects&#46; However&#44; the patients as a group were functional class A&#44; with an average VO<span class="elsevierStyleInf">2</span>&#47;kg&#47;min of over 20 mL&#47;kg&#47;min &#40;minimal cardiopulmonary limitation&#41;&#46; This exercise intolerance is related to diminished HR reserve for the amount of effort exerted&#44; indicative of cardiovascular limitation or physical detraining&#46; It is impossible&#44; however&#44; to distinguish between these two possibilities with this test&#46;<span class="elsevierStyleSup">3-6</span> The rest of the cardiovascular&#44; oxygen transport&#44; and respiratory parameters were similar to those of the control group&#46; The presence in these patients of an anaerobic threshold&#44; oxygen transport parameters &#40;&#916;HR&#47;&#916;VO<span class="elsevierStyleInf">2</span> and oxygen pulse&#41;&#44; and gas exchange indexes &#40;V<span class="elsevierStyleInf">D</span>&#47;V<span class="elsevierStyleInf">T</span>&#44; PaO<span class="elsevierStyleInf">2&#44;</span> arterial-alveolar oxygen gradient&#41; similar to those of the control group makes the existence of pulmonary vascular occlusive disease in patients previously treated with praziquantel for chronic schistosomiasis unlikely&#46;</p><p class="elsevierStylePara">It is difficult to compare our results with those of previous studies&#44;<span class="elsevierStyleSup">10&#44;11</span> as the methods of the studies and the clinical characteristics of the patients evaluated were very different&#46; The present study included patients with no evidence of cardiopulmonary impairment treated with praziquantel&#44; while the others evaluated either patients in advanced stages of the disease who did show evidence of cardiopulmonary impairment<span class="elsevierStyleSup">11</span> or who were untreated&#46;<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara">In conclusion&#44; the results of the present study indicate that patients treated with praziquantel for chronic schistosomiasis with no signs of cardiopulmonary impairment have normal resting lung function&#46; However&#44; exercise tolerance is slightly decreased&#44; which is probably related to physical detraining&#46; The data during effort show normal oxygen transport and gas exchange&#44; which would make the existence of any type of pulmonary vascular disease in these patients unlikely&#46; Abnormalities may appear in later stages of the disease or in patients who do not receive early successful medical treatment&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Acknowledgments</span></p><p class="elsevierStylePara"> This study was carried out with the support of the National Council for Scientific and Technological Research &#40;Consejo Nacional de Investigaciones Cient&#237;ficas y Tecnol&#243;gicas&#41;&#44; project S1-97001105&#46;</p><hr></hr><p class="elsevierStylePara">Correspondence&#58; Dra&#46; M&#46; Montes de Oca de Loyo&#46;<br></br> CS 5150&#46; P&#46;O&#46; Box 025323&#46;<br></br> Miami&#44; FL&#44; 33102-5323&#46; USA&#46;<br></br> E-mail&#58; <a href="mailto&#58;jgloyo&#64;telcel&#46;net&#46;ve" class="elsevierStyleCrossRefs"> jgloyo&#64;telcel&#46;net&#46;ve</a></p><p class="elsevierStylePara">Manuscript received August 27&#44; 2002&#46;<br></br> Accepted for publication April 29&#44; 2003&#46;</p>"
    "pdfFichero" => "260v39n09a13051511pdf001.pdf"
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            0 => "Stress test"
            1 => "Chronic schistosomiasis"
            2 => "Exercise capacity"
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        "resumen" => "Objective&#58; The purpose of this study was to evaluate whether a progressive cycle ergometer test &#40;PCET&#41; can detect minimal functional abnormalities that might indicate compromise of the pulmonary vascular bed in patients treated with praziquantel for chronic schistosomiasis who have no clinical signs of cardiopulmonary impairment&#46; Patients and method&#58; We studied 9 patients &#40;whose mean &#40;SD&#41; age was 38 &#40;18&#41; years and 10 control subjects aged 32 &#40;14&#41; years&#46; Both groups were evaluated by spirometry and a PCET to determine maximum oxygen consumption&#44; heart rate&#44; minute ventilation and gas exchange&#46; Echocardiograms were used to rule out the presence of associated heart disease&#46; Results&#58; Lung function was similar among patients and controls&#46; Slight decreases in maximum oxygen consumption and heart rate reserve were observed with effort during the PCET&#44; with normal respiratory response&#46; No echocardiographic abnormalities that might indicate the presence of pulmonary vascular occlusive disease were observed&#46; Conclusions&#58; The results showed that the resting lung function is normal in these patients&#46; However&#44; there was a slight decrease in exercise tolerance&#44; probably related to physical detraining&#46; The data obtained during exercise indicated that pulmonary vascular occlusive disease is unlikely in these patients&#46; Abnormalities may appear in later stages of the disease or in patients who do not receive early medical treatment&#46;"
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        "resumen" => "Objetivo&#58; El prop&#243;sito del estudio es evaluar si la prueba de esfuerzo progresiva en cicloerg&#243;metro &#40;PECP&#41; puede detectar anormalidades funcionales m&#237;nimas que indiquen compromiso del lecho vascular pulmonar&#44; en pacientes con schistosomiasis cr&#243;nica sin evidencias cl&#237;nicas de compromiso cardiopulmonar tratados con praziquantel&#46; Pacientes y m&#233;todo&#58; Se estudi&#243; a 9 pacientes &#40;38 &#177; 18 a&#241;os&#41; y a 10 controles &#40;32 &#177; 14 a&#241;os&#41;&#46; Ambos grupos fueron evaluados con espirometr&#237;a y PECP para determinar el consumo de O2 m&#225;ximo&#44; la frecuencia card&#237;aca&#44; la ventilaci&#243;n minuto y el intercambio gaseoso&#46; Se realiz&#243; un ecocardiograma a los pacientes para descartar la presencia de cardiopat&#237;as asociadas&#46; Resultados&#58; Los pacientes ten&#237;an una funci&#243;n pulmonar similar al grupo control&#46; En la PECP se observ&#243; una discreta disminuci&#243;n del consumo de O2 m&#225;ximo y de la reserva de la frecuencia card&#237;aca para el esfuerzo realizado&#44; con respuesta respiratoria normal&#46; No se observaron anormalidades ecocardiogr&#225;ficas que indicasen la presencia de enfermedad vascular pulmonar oclusiva&#46; Conclusiones&#58; Los resultados indican que estos pacientes tienen una funci&#243;n pulmonar en reposo normal&#46; Sin embargo&#44; la tolerancia al ejercicio presenta una discreta disminuci&#243;n&#44; hecho probablemente secundario a desentrenamiento f&#237;sico&#46; Los datos durante el esfuerzo hacen improbable la existencia de enfermedad vascular pulmonar oclusiva en estos pacientes&#46; Posiblemente estas anormalidades se presenten en estadios m&#225;s avanzados de la enfermedad o en aquellos pacientes que no han recibido tempranamente tratamiento m&#233;dico&#46;"
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Article information

ISSN: 15792129
Original language: English

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Year/Month	Html	Pdf	Total

2024 November	9	1	10
2024 October	31	16	47
2024 September	38	13	51
2024 August	52	37	89
2024 July	41	18	59
2024 June	30	20	50
2024 May	37	20	57
2024 April	36	21	57
2024 March	30	24	54
2024 February	28	42	70
2023 March	5	2	7
2023 February	39	13	52
2023 January	43	34	77
2022 December	40	28	68
2022 November	41	25	66
2022 October	42	29	71
2022 September	33	31	64
2022 August	30	33	63
2022 July	34	37	71
2022 June	35	38	73
2022 May	53	38	91
2022 April	41	31	72
2022 March	54	37	91
2022 February	44	36	80
2022 January	45	43	88
2021 December	41	33	74
2021 November	47	49	96
2021 October	51	41	92
2021 September	56	43	99
2021 August	41	27	68
2021 July	37	33	70
2021 June	41	36	77
2021 May	46	29	75
2021 April	67	57	124
2021 March	44	16	60
2021 February	35	19	54
2021 January	37	28	65
2020 December	51	26	77
2020 November	34	10	44
2020 October	32	14	46
2020 September	37	6	43
2020 August	31	16	47
2020 July	25	16	41
2020 June	25	10	35
2020 May	43	28	71
2020 April	35	16	51
2020 March	41	12	53
2020 February	33	22	55
2020 January	41	22	63
2019 December	43	19	62
2019 November	33	26	59
2019 October	38	10	48
2019 September	34	22	56
2019 August	33	23	56
2019 July	33	15	48
2019 June	34	11	45
2019 May	36	22	58
2019 April	57	45	102
2019 March	45	24	69
2019 February	38	16	54
2019 January	32	15	47
2018 December	32	21	53
2018 November	33	18	51
2018 October	36	16	52
2018 September	35	10	45
2018 May	17	0	17
2018 April	36	5	41
2018 March	35	7	42
2018 February	22	4	26
2018 January	17	7	24
2017 December	34	3	37
2017 November	34	5	39
2017 October	21	7	28
2017 September	29	13	42
2017 August	43	4	47
2017 July	32	8	40
2017 June	61	15	76
2017 May	62	7	69
2017 April	55	26	81
2017 March	42	11	53
2017 February	32	4	36
2017 January	24	7	31
2016 December	34	4	38
2016 November	49	7	56
2016 October	72	16	88
2016 September	105	7	112
2016 August	34	9	43
2016 July	25	7	32
2016 March	1	0	1
2016 February	2	0	2
2015 December	2	0	2
2015 October	38	2	40
2015 September	29	4	33
2015 August	31	9	40
2015 July	42	7	49
2015 June	26	8	34
2015 May	47	5	52
2015 April	26	6	32
2015 March	37	6	43
2015 February	29	8	37
2015 January	32	4	36
2014 December	27	6	33
2014 November	29	5	34
2014 October	40	10	50
2014 September	37	11	48
2014 August	36	6	42
2014 July	31	10	41
2014 June	48	6	54
2014 May	43	12	55
2014 April	36	5	41
2014 March	52	10	62
2014 February	55	7	62
2014 January	35	4	39
2013 December	32	7	39
2013 November	28	7	35
2013 October	44	11	55
2013 September	34	4	38
2013 August	34	5	39
2013 July	55	12	67
2013 June	39	8	47
2013 May	39	7	46
2013 April	40	4	44
2013 March	5	1	6

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