array:24 [
  "pii" => "S0873215915302440"
  "issn" => "08732159"
  "doi" => "10.1016/S0873-2159(15)30244-0"
  "estado" => "S350"
  "fechaPublicacion" => "2008-05-01"
  "aid" => "4"
  "copyright" => "Sociedade Portuguesa de Pneumologia/SPP"
  "copyrightAnyo" => "2008"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2008;14:363-77"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2626
    "formatos" => array:3 [
      "EPUB" => 233
      "HTML" => 1805
      "PDF" => 588
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0873215915302452"
    "issn" => "08732159"
    "doi" => "10.1016/S0873-2159(15)30245-2"
    "estado" => "S350"
    "fechaPublicacion" => "2008-05-01"
    "aid" => "5"
    "copyright" => "Sociedade Portuguesa de Pneumologia/SPP"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2008;14:379-90"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2449
      "formatos" => array:3 [
        "EPUB" => 273
        "HTML" => 1527
        "PDF" => 649
      ]
    ]
    "pt" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original&#47;Original Article</span>"
      "titulo" => "H&#225;bitos tab&#225;gicos em alunos do 6&#46;&#186; ano de Medicina e medidas anti-tab&#225;gicas"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "379"
          "paginaFinal" => "390"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Smoking habits of sixth year medical students and anti-smoking measures in Portugal"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Andr&#233; Borges, Filipa Marques, Jos&#233; Lima, Lu&#237;s Costa, Patr&#237;cia Gon&#231;alves, Rui Fernandes, N&#237;dia Gon&#231;alves"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Andr&#233;"
              "apellidos" => "Borges"
            ]
            1 => array:2 [
              "nombre" => "Filipa"
              "apellidos" => "Marques"
            ]
            2 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Lima"
            ]
            3 => array:2 [
              "nombre" => "Lu&#237;s"
              "apellidos" => "Costa"
            ]
            4 => array:2 [
              "nombre" => "Patr&#237;cia"
              "apellidos" => "Gon&#231;alves"
            ]
            5 => array:2 [
              "nombre" => "Rui"
              "apellidos" => "Fernandes"
            ]
            6 => array:2 [
              "nombre" => "N&#237;dia"
              "apellidos" => "Gon&#231;alves"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915302452?idApp=UINPBA00004E"
    "url" => "/08732159/0000001400000003/v1_201509151534/S0873215915302452/v1_201509151534/pt/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0873215915302439"
    "issn" => "08732159"
    "doi" => "10.1016/S0873-2159(15)30243-9"
    "estado" => "S350"
    "fechaPublicacion" => "2008-05-01"
    "aid" => "3"
    "copyright" => "Sociedade Portuguesa de Pneumologia&#47;SPP"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2008;14:353-61"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2983
      "formatos" => array:3 [
        "EPUB" => 262
        "HTML" => 2071
        "PDF" => 650
      ]
    ]
    "pt" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original&#47;Original Article</span>"
      "titulo" => "Efeitos do salbutamol e do formoterol sobre press&#227;o arterial&#44; frequ&#234;ncia card&#237;aca e satura&#231;&#227;o de oxig&#233;nio em asm&#225;ticos&#44; durante uma hora"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "353"
          "paginaFinal" => "361"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "One hour effects of salbutamol and formoterol on blood pressure&#44; heart rate and oxygen saturation in asthmatics"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Geraldo Andrade Capuchinho-J&#250;nior, Ricardo Marques Dias, S&#244;nia Regina da Silva de Carvalho"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Geraldo Andrade"
              "apellidos" => "Capuchinho-J&#250;nior"
            ]
            1 => array:2 [
              "nombre" => "Ricardo Marques"
              "apellidos" => "Dias"
            ]
            2 => array:2 [
              "nombre" => "S&#244;nia Regina"
              "apellidos" => "da Silva de Carvalho"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915302439?idApp=UINPBA00004E"
    "url" => "/08732159/0000001400000003/v1_201509151534/S0873215915302439/v1_201509151534/pt/main.assets"
  ]
  "pt" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original&#47;Original Article</span>"
    "titulo" => "Altera&#231;&#245;es ecocardiogr&#225;ficas em doentes asm&#225;ticos"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "363"
        "paginaFinal" => "377"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Andr&#233; Lu&#237;s Mancini, Sonia Regina da Silva Carvalho, Maria do Carmo Valente de Crasto, Ricardo Marques Dias"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "Andr&#233; Lu&#237;s"
            "apellidos" => "Mancini"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "af0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Sonia Regina"
            "apellidos" => "da Silva Carvalho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">2</span>"
                "identificador" => "af0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Maria do Carmo Valente"
            "apellidos" => "de Crasto"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">3</span>"
                "identificador" => "af0015"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "Ricardo Marques"
            "apellidos" => "Dias"
            "email" => array:1 [
              0 => "dias&#46;ricardomarques&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">4</span>"
                "identificador" => "af0020"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cr0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "M&#233;dico formado pela Universidade Federal do Estado do Rio de Janeiro &#8211; UNIRIO&#46; Monitor da disciplina de Inicia&#231;&#227;o Cient&#237;fica 2 &#47; <span class="elsevierStyleItalic">Doctor trained at Universidade Federal do Estado do Rio de Janeiro &#8211; UNIRIO&#46; Teaching Assistant&#44; Inicia&#231;&#227;o Cient&#237;fica 2</span>"
            "etiqueta" => "1"
            "identificador" => "af0005"
          ]
          1 => array:3 [
            "entidad" => "Prof&#46; Assistente da Universidade Federal do Estado do Rio de Janeiro &#8211; UNIRIO&#46; Mestre em medicina &#47; <span class="elsevierStyleItalic">Assistant Professor&#44; Universidade Federal do Estado do Rio de Janeiro &#8211; UNIRIO&#46; MSc&#44; Medicine</span>"
            "etiqueta" => "2"
            "identificador" => "af0010"
          ]
          2 => array:3 [
            "entidad" => "Prof&#46; Adjunto da Universidade Federal do Estado do Rio de Janeiro &#8211; UNIRIO&#46; Doutor em medicina &#47; <span class="elsevierStyleItalic">Adjunct Professor&#44; Universidade Federal do Estado do Rio de Janeiro &#8211; UNIRIO&#46; PhD&#44; Medicine</span>"
            "etiqueta" => "3"
            "identificador" => "af0015"
          ]
          3 => array:3 [
            "entidad" => "Universidade Federal do Estado do Rio de Janeiro &#8211; UNIRIO&#46; Doutor em medicina &#47; <span class="elsevierStyleItalic">Professor at Universidade Federal do Estado do Rio de Janeiro &#8211; UNIRIO&#46; PhD&#44; Medicine</span>"
            "etiqueta" => "4"
            "identificador" => "af0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cr0005"
            "etiqueta" => "&#42;"
            "correspondencia" => "<span class="elsevierStyleBold">Endere&#231;o correspond&#234;ncia &#47; <span class="elsevierStyleItalic">Corresponding author&#58;</span></span> Ricardo Marques Dias&#44; Rua Bar&#227;o da Torre 388&#47;104&#44; Ipanema&#44; Rio de Janeiro&#44; Brasil&#46; CEP 22411&#46;000&#46; Tel&#58; 55 21 22472431&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Echocardiograph alterations in asthma patients"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2007-02-22"
    "fechaAceptado" => "2008-01-22"
    "PalabrasClave" => array:2 [
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec570487"
          "palabras" => array:3 [
            0 => "Asma"
            1 => "ecocardiograma"
            2 => "hipertens&#227;o arterial pulmonar"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key-words"
          "identificador" => "xpalclavsec570486"
          "palabras" => array:3 [
            0 => "Asthma"
            1 => "electrocardiogram"
            2 => "echocardiogram"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introdu&#231;&#227;o&#58;</span> A asma &#233; uma doen&#231;a inflamat&#243;ria cr&#243;-nica cuja preval&#234;ncia vem aumentando nos &#250;ltimos 20 anos&#46; Demanda grande utiliza&#231;&#227;o de recursos&#44; principalmente no grupo grave&#46; Neste&#44; h&#225; consumo cr&#243;nico de cortic&#243;ides inalat&#243;rios e de &#946;2-agonistas&#44; que podem produzir uma s&#233;rie de problemas&#46; O objectivo deste trabalho &#233; o de rastrear as altera&#231;&#245;es electro e ecocardiogr&#225;ficas e relacion&#225;-las ao grau da asma&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Metodologia&#58;</span> Selecion&#225;mos 87 doentes do ambula-t&#243;rio de asma do HUGG&#44; que&#44; por rotina&#44; possuem uma espirografia&#44; um eletrocardiograma &#40;ECG&#41; e um ecocardiograma &#40;ECO&#41; feitos com um intervalo m&#225;ximo de um m&#234;s&#46; As altera&#231;&#245;es ecocardiogr&#225;ficas encontradas foram relacionadas com o grau da asma&#46; Foram usadas estat&#237;sticas n&#227;o param&#233;tricas para essas compara&#231;&#245;es&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados&#58;</span> Encontr&#225;mos diferen&#231;as significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; quanto &#224; idade&#44; tempo de asma e satura&#231;&#227;o da hemoglobina &#40;SaO<span class="elsevierStyleInf">2</span>&#41; entre os grupos leve e grave&#46; Na amostra&#44; foi identificada alta preval&#234;ncia de insufici&#234;ncia tric&#250;spide &#40;41&#44;4&#37;&#41;&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclus&#245;es&#58;</span> O ECO identificou uma s&#233;rie de anor-malidades&#44; dependentes ou n&#227;o da gravidade da asma&#46; O ECO pode identificar a hipertens&#227;o arterial pulmonar&#44; pelo c&#225;lculo da press&#227;o m&#233;dia da art&#233;ria pulmonar&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2008&#59; XIV &#40;3&#41;&#58; 363-377</span></p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introduction&#58;</span> Asthma is a chronic inflammatory disease which has increased during the last 20 years&#44; putting a strain on medical resources&#44; particularly severe forms of the disease&#46; Treatment in such cases is inhaled corticosteroids and beta agonist drugs that can produce a range of side effects&#46; The aim of this study is to identify echocardiograph abnormalities and correlate them with severity of disease&#46;</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Methodology&#58;</span> Eight-seven outpatients were selected at the asthma unit of the Gaffr&#233;e Guinle University Hospital &#40;HUGG&#41;&#46; Each patient underwent spirometry&#44; electrocardiogram &#40;ECG&#41; and echocardiogram &#40;ECO&#41; during the trial within a month maximum&#46; Echocardiograph abnormalities found related to degree of asthma&#46; Statistical analysis was made by non-parametric tests&#46;</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results&#58;</span> We found significant differences &#40;p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; for age&#44; disease duration and haemoglobin saturation &#40;SaO<span class="elsevierStyleInf">2</span>&#41; between the moderate and severe groups&#46; In the sample a high prevalence of tricuspid insufficiency &#40;41&#46;4&#37;&#41; was identified&#46;</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusions&#58;</span> ECO identified a series of abnormalities that were not always dependent on severity of disease&#46; ECO can identify pulmonary hypertension through calculation of mean pressure of the pulmonary artery&#46;</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2008&#59; XIV &#40;3&#41;&#58; 363-377</span></p></span>"
      ]
    ]
    "lecturaRecomendada" => array:1 [
      0 => array:3 [
        "vista" => "all"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia</span>"
        "seccion" => array:1 [
          0 => array:2 [
            "vista" => "all"
            "bibliografiaReferencia" => array:23 [
              0 => array:3 [
                "identificador" => "bb0005"
                "etiqueta" => "1&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:1 [
                        "titulo" => "III Consenso Brasileiro no Manejo da Asma"
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Jornal de Pneumologia"
                          "fecha" => "2002"
                          "volumen" => "28"
                          "numero" => "Supl 1"
                          "paginaInicial" => "S1"
                          "paginaFinal" => "S28"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              1 => array:3 [
                "identificador" => "bb0010"
                "etiqueta" => "2&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults&#58; the Midspan family study surveys of parents and offspring"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:6 [
                              0 => "M&#46;N&#46; Upton"
                              1 => "A&#46; McConnachie"
                              2 => "C&#46; Mcsharry"
                              3 => "C&#46;L&#46; Hart"
                              4 => "G&#46;D&#46; Smith"
                              5 => "C&#46;R&#46; Gillis"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "British Medical Journal"
                          "fecha" => "2000"
                          "volumen" => "321"
                          "paginaInicial" => "88"
                          "paginaFinal" => "92"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10884260"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              2 => array:3 [
                "identificador" => "bb0015"
                "etiqueta" => "3&#46;"
                "referencia" => array:1 [
                  0 => array:1 [
                    "referenciaCompleta" => "Global Initiative for Asthma &#40;GINA&#41; &#8211; <a href="http://www.ginas-thma.com">www&#46;ginas-thma&#46;com</a>&#44; acessado em 14&#47;03&#47;2005 &#224;s 19&#58;00&#46;"
                  ]
                ]
              ]
              3 => array:3 [
                "identificador" => "bb0020"
                "etiqueta" => "4&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Serum potassium levels&#44; CPK-MB and ECG in children suffering asthma treated with beclomethasone or beclomethasone-salmeterol"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:6 [
                              0 => "B&#46;E&#46; Del R&#237;o-Navarro"
                              1 => "J&#46;J&#46; Sienra-Monge"
                              2 => "M&#46; &#193;lvarez-Amador"
                              3 => "N&#46; Reyes-Ruiz"
                              4 => "A&#46; Arevalo-Salas"
                              5 => "A&#46; Berber"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Allergol et Immunopathol"
                          "fecha" => "2001"
                          "volumen" => "29"
                          "numero" => "1"
                          "paginaInicial" => "16"
                          "paginaFinal" => "21"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              4 => array:3 [
                "identificador" => "bb0025"
                "etiqueta" => "5&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Interaction between corticosteroid and beta-agonist drugs"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:4 [
                              0 => "D&#46;R&#46; Taylor"
                              1 => "G&#46;T&#46; Wilkins"
                              2 => "G&#46;P&#46; Herbison"
                              3 => "E&#46;M&#46; Flannery"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:7 [
                          "tituloSerie" => "Biochemical and cardiovascular effects in normal subjects&#46; Chest"
                          "fecha" => "1992"
                          "volumen" => "102"
                          "numero" => "2"
                          "paginaInicial" => "519"
                          "paginaFinal" => "524"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1353717"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              5 => array:3 [
                "identificador" => "bb0030"
                "etiqueta" => "6&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Ozyurek H"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "A&#46;P&#46; Uyan"
                              1 => "C&#46; Uyan"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Assessment of right diastolic filling parameters by Doppler echocardiography Pediatr Int &#91;SI&#93;"
                          "fecha" => "2003"
                          "volumen" => "45"
                          "numero" => "3"
                          "paginaInicial" => "7"
                          "paginaFinal" => "263"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              6 => array:3 [
                "identificador" => "bb0035"
                "etiqueta" => "7&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Left ventricular diastolic dysfunction in patients with bronchial asthma with long-term oral beta2-adrenoceptor agonists"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "O&#46; Hirono"
                              1 => "I&#46; Kubota"
                              2 => "O&#46; Minamihaba"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Am Heart J &#91;SI&#93;"
                          "fecha" => "2001"
                          "volumen" => "142"
                          "numero" => "6"
                          "paginaInicial" => "E11"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              7 => array:3 [
                "identificador" => "bb0040"
                "etiqueta" => "8&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Non invasive assessment of cardiac function in pacients with bronchial asthma &#40;BA&#41; or chronic obstructive pulmonary disease &#40;COPD&#41;"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "G&#46;F&#46; Bagnato"
                              1 => "A&#46; Mileto"
                              2 => "S&#46; Gulli"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Allergol Imminopathol &#40;Madr&#41;"
                          "fecha" => "1999"
                          "volumen" => "27"
                          "numero" => "1"
                          "paginaInicial" => "5"
                          "paginaFinal" => "10"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              8 => array:3 [
                "identificador" => "bb0045"
                "etiqueta" => "9&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Effect of salbutamol on left ventricular function and selected biochemical parameters in patients with bronchial asthma"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "R&#46; Chazan"
                              1 => "M&#46; Jakubowska-Najnigier"
                              2 => "D&#46; Liszewska-Pfejfer"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Pol Arch Med Wewn &#91;SI&#93;"
                          "fecha" => "1994"
                          "volumen" => "92"
                          "numero" => "4"
                          "paginaInicial" => "299"
                          "paginaFinal" => "305"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              9 => array:3 [
                "identificador" => "bb0050"
                "etiqueta" => "10&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "The effect of acute bronchospasm on pulmonary artery pressure"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "R&#46; Sarac"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Lijec Vjesn &#91;SI&#93;"
                          "fecha" => "1991"
                          "volumen" => "113"
                          "numero" => "11&#8211;12"
                          "paginaInicial" => "3"
                          "paginaFinal" => "390"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              10 => array:3 [
                "identificador" => "bb0055"
                "etiqueta" => "11&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Primary pulmonary hypertension&#58; insights into pathogenesis from epidemiology"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "N&#46; Galie"
                              1 => "A&#46; Manes"
                              2 => "L&#46; Uguccioni"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Chest &#91;SI&#93;"
                          "fecha" => "1998"
                          "volumen" => "114"
                          "paginaInicial" => "94"
                          "paginaFinal" => "184"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              11 => array:3 [
                "identificador" => "bb0060"
                "etiqueta" => "12&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Hypokalemic and ECG Sequelae of Combined Beta-Agonist&#47;Diuretic Therapy"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:1 [
                              0 => "B&#46;J&#46; Lipworth"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Chest"
                          "fecha" => "1990"
                          "volumen" => "98"
                          "paginaInicial" => "5"
                          "paginaFinal" => "811"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2361412"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              12 => array:3 [
                "identificador" => "bb0065"
                "etiqueta" => "13&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Changes in the normal maximal expiratory flow volume curve with growth and aging"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "R&#46;J&#46; Knudson"
                              1 => "M&#46;D&#46; Lebowitz"
                              2 => "C&#46;J&#46; Holberg"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Am Rev Respir Dis"
                          "fecha" => "1983"
                          "volumen" => "127"
                          "paginaInicial" => "34"
                          "paginaFinal" => "725"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              13 => array:3 [
                "identificador" => "bb0070"
                "etiqueta" => "14&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Standardization of spirometry&#58; 1994 Update"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "American Thoracic Society"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Am J Respir Crit Care Med"
                          "fecha" => "1995"
                          "volumen" => "152"
                          "paginaInicial" => "36"
                          "paginaFinal" => "1107"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              14 => array:3 [
                "identificador" => "bb0075"
                "etiqueta" => "15&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Epidemiology standardization project&#58; recommended standardization procedure for pulmonary function testing"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "American Thoracic Society"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1164/arrd.1978.118.1.55"
                        "Revista" => array:7 [
                          "tituloSerie" => "Am Rev Respir Dis"
                          "fecha" => "1978"
                          "volumen" => "118"
                          "numero" => "Suppl 2"
                          "paginaInicial" => "55"
                          "paginaFinal" => "88"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/677558"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              15 => array:3 [
                "identificador" => "bb0080"
                "etiqueta" => "16&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:1 [
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "L&#46;E&#46; Febiger"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Libro" => array:4 [
                          "edicion" => "5"
                          "titulo" => "Echocardiography Harvey"
                          "fecha" => "1994"
                          "editorial" => "EUA"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              16 => array:3 [
                "identificador" => "bb0085"
                "etiqueta" => "17&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:1 [
                        "titulo" => "Classifica&#231;&#227;o e avalia&#231;&#227;o diagn&#243;stica da hipertens&#227;o pulmonar"
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "J Br&#225;s Pneumol"
                          "fecha" => "2005"
                          "volumen" => "31"
                          "numero" => "Supl 2"
                          "paginaInicial" => "S1"
                          "paginaFinal" => "S8"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              17 => array:3 [
                "identificador" => "bb0090"
                "etiqueta" => "18&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:1 [
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "J&#46;K&#46; Oh"
                              1 => "J&#46;B&#46; Seward"
                              2 => "A&#46;J&#46; Tajik"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Libro" => array:2 [
                          "titulo" => "Ecocardiografia &#8211; Cl&#237;nica Mayo"
                          "fecha" => "1997"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              18 => array:3 [
                "identificador" => "bb0095"
                "etiqueta" => "19&#46;"
                "referencia" => array:1 [
                  0 => array:1 [
                    "referenciaCompleta" => "Microsoft&#174; Office Excel 2003 vers&#227;o 11&#46;6560&#46;6568 SP2&#46; Microsoft Office Professional Edi&#231;&#227;o&#59; USA&#44; 2003&#46;"
                  ]
                ]
              ]
              19 => array:3 [
                "identificador" => "bb0100"
                "etiqueta" => "20&#46;"
                "referencia" => array:1 [
                  0 => array:1 [
                    "referenciaCompleta" => "GraphPad Instat vers&#227;o 3&#46;01 para Windows 95&#44; Copyright 1992-1998&#46; GraphPad Software Inc&#44; San Diego California USA&#44; <a href="http://www.graphpad.com">www&#46;graphpad&#46;com</a>&#46;"
                  ]
                ]
              ]
              20 => array:3 [
                "identificador" => "bb0105"
                "etiqueta" => "21&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Altera&#231;&#245;es eletrocardiogr&#225;ficas em pacientes asm&#225;ticos"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "A&#46;L&#46; Mancini"
                              1 => "S&#46;R&#46;S&#46; Carvalho"
                              2 => "M&#46;C&#46;V&#46; Crasto"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Pulm&#227;o RJ"
                          "fecha" => "2006"
                          "volumen" => "15"
                          "numero" => "2"
                          "paginaInicial" => "4"
                          "paginaFinal" => "70"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              21 => array:3 [
                "identificador" => "bb0110"
                "etiqueta" => "22&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Medicina Interna"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "Harrison"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "LibroEditado" => array:6 [
                          "titulo" => "Cap"
                          "paginaInicial" => "45"
                          "paginaFinal" => "1539"
                          "edicion" => "15"
                          "serieVolumen" => "II"
                          "serieFecha" => "2002"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              22 => array:3 [
                "identificador" => "bb0115"
                "etiqueta" => "23&#46;"
                "referencia" => array:1 [
                  0 => array:1 [
                    "referenciaCompleta" => "Goodman e Gilman&#46; As bases farmacol&#243;gicas da terap&#234;utica&#46; 28&#58;551-68 &#8211; 10&#46;&#170; Ed&#46; &#8211; Ed&#46; McGraw-Hill&#46;"
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/08732159/0000001400000003/v1_201509151534/S0873215915302440/v1_201509151534/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9575"
    "tipo" => "SECCION"
    "pt" => array:2 [
      "titulo" => "Artigos originais"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "pt"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001400000003/v1_201509151534/S0873215915302440/v1_201509151534/pt/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915302440?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 14. Issue 3.
Pages 363-377 (May - June 2008)
Share
Share
Download PDF
More article options
Vol. 14. Issue 3.
Pages 363-377 (May - June 2008)
Artigo Original/Original Article
Open Access
Alterações ecocardiográficas em doentes asmáticos
Echocardiograph alterations in asthma patients
Visits
5670
André Luís Mancini1, Sonia Regina da Silva Carvalho2, Maria do Carmo Valente de Crasto3, Ricardo Marques Dias4,
Corresponding author
dias.ricardomarques@gmail.com

Endereço correspondência / Corresponding author: Ricardo Marques Dias, Rua Barão da Torre 388/104, Ipanema, Rio de Janeiro, Brasil. CEP 22411.000. Tel: 55 21 22472431.
1 Médico formado pela Universidade Federal do Estado do Rio de Janeiro – UNIRIO. Monitor da disciplina de Iniciação Científica 2 / Doctor trained at Universidade Federal do Estado do Rio de Janeiro – UNIRIO. Teaching Assistant, Iniciação Científica 2
2 Prof. Assistente da Universidade Federal do Estado do Rio de Janeiro – UNIRIO. Mestre em medicina / Assistant Professor, Universidade Federal do Estado do Rio de Janeiro – UNIRIO. MSc, Medicine
3 Prof. Adjunto da Universidade Federal do Estado do Rio de Janeiro – UNIRIO. Doutor em medicina / Adjunct Professor, Universidade Federal do Estado do Rio de Janeiro – UNIRIO. PhD, Medicine
4 Universidade Federal do Estado do Rio de Janeiro – UNIRIO. Doutor em medicina / Professor at Universidade Federal do Estado do Rio de Janeiro – UNIRIO. PhD, Medicine
This item has received

Under a Creative Commons license
Article information
Resumo

Introdução: A asma é uma doença inflamatória cró-nica cuja prevalência vem aumentando nos últimos 20 anos. Demanda grande utilização de recursos, principalmente no grupo grave. Neste, há consumo crónico de corticóides inalatórios e de β2-agonistas, que podem produzir uma série de problemas. O objectivo deste trabalho é o de rastrear as alterações electro e ecocardiográficas e relacioná-las ao grau da asma.

Metodologia: Selecionámos 87 doentes do ambula-tório de asma do HUGG, que, por rotina, possuem uma espirografia, um eletrocardiograma (ECG) e um ecocardiograma (ECO) feitos com um intervalo máximo de um mês. As alterações ecocardiográficas encontradas foram relacionadas com o grau da asma. Foram usadas estatísticas não paramétricas para essas comparações.

Resultados: Encontrámos diferenças significativas (p0,05) quanto à idade, tempo de asma e saturação da hemoglobina (SaO2) entre os grupos leve e grave. Na amostra, foi identificada alta prevalência de insuficiência tricúspide (41,4%).

Conclusões: O ECO identificou uma série de anor-malidades, dependentes ou não da gravidade da asma. O ECO pode identificar a hipertensão arterial pulmonar, pelo cálculo da pressão média da artéria pulmonar.

Rev Port Pneumol 2008; XIV (3): 363-377

Palavras-chave:
Asma
ecocardiograma
hipertensão arterial pulmonar
Abstract

Introduction: Asthma is a chronic inflammatory disease which has increased during the last 20 years, putting a strain on medical resources, particularly severe forms of the disease. Treatment in such cases is inhaled corticosteroids and beta agonist drugs that can produce a range of side effects. The aim of this study is to identify echocardiograph abnormalities and correlate them with severity of disease.

Methodology: Eight-seven outpatients were selected at the asthma unit of the Gaffrée Guinle University Hospital (HUGG). Each patient underwent spirometry, electrocardiogram (ECG) and echocardiogram (ECO) during the trial within a month maximum. Echocardiograph abnormalities found related to degree of asthma. Statistical analysis was made by non-parametric tests.

Results: We found significant differences (p0.05) for age, disease duration and haemoglobin saturation (SaO2) between the moderate and severe groups. In the sample a high prevalence of tricuspid insufficiency (41.4%) was identified.

Conclusions: ECO identified a series of abnormalities that were not always dependent on severity of disease. ECO can identify pulmonary hypertension through calculation of mean pressure of the pulmonary artery.

Rev Port Pneumol 2008; XIV (3): 363-377

Key-words:
Asthma
electrocardiogram
echocardiogram
Full text is only aviable in PDF
Bibliografia
[1.]
III Consenso Brasileiro no Manejo da Asma.
Jornal de Pneumologia, 28 (2002), pp. S1-S28
[2.]
M.N. Upton, A. McConnachie, C. Mcsharry, C.L. Hart, G.D. Smith, C.R. Gillis, et al.
Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring.
British Medical Journal, 321 (2000), pp. 88-92
[3.]
Global Initiative for Asthma (GINA) – www.ginas-thma.com, acessado em 14/03/2005 às 19:00.
[4.]
B.E. Del Río-Navarro, J.J. Sienra-Monge, M. Álvarez-Amador, N. Reyes-Ruiz, A. Arevalo-Salas, A. Berber.
Serum potassium levels, CPK-MB and ECG in children suffering asthma treated with beclomethasone or beclomethasone-salmeterol.
Allergol et Immunopathol, 29 (2001), pp. 16-21
[5.]
D.R. Taylor, G.T. Wilkins, G.P. Herbison, E.M. Flannery.
Interaction between corticosteroid and beta-agonist drugs.
Biochemical and cardiovascular effects in normal subjects. Chest, 102 (1992), pp. 519-524
[6.]
A.P. Uyan, C. Uyan.
Ozyurek H.
Assessment of right diastolic filling parameters by Doppler echocardiography Pediatr Int [SI], 45 (2003), pp. 7-263
[7.]
O. Hirono, I. Kubota, O. Minamihaba, et al.
Left ventricular diastolic dysfunction in patients with bronchial asthma with long-term oral beta2-adrenoceptor agonists.
Am Heart J [SI], 142 (2001), pp. E11
[8.]
G.F. Bagnato, A. Mileto, S. Gulli, et al.
Non invasive assessment of cardiac function in pacients with bronchial asthma (BA) or chronic obstructive pulmonary disease (COPD).
Allergol Imminopathol (Madr), 27 (1999), pp. 5-10
[9.]
R. Chazan, M. Jakubowska-Najnigier, D. Liszewska-Pfejfer, et al.
Effect of salbutamol on left ventricular function and selected biochemical parameters in patients with bronchial asthma.
Pol Arch Med Wewn [SI], 92 (1994), pp. 299-305
[10.]
R. Sarac.
The effect of acute bronchospasm on pulmonary artery pressure.
Lijec Vjesn [SI], 113 (1991), pp. 3-390
[11.]
N. Galie, A. Manes, L. Uguccioni, et al.
Primary pulmonary hypertension: insights into pathogenesis from epidemiology.
Chest [SI], 114 (1998), pp. 94-184
[12.]
B.J. Lipworth, et al.
Hypokalemic and ECG Sequelae of Combined Beta-Agonist/Diuretic Therapy.
Chest, 98 (1990), pp. 5-811
[13.]
R.J. Knudson, M.D. Lebowitz, C.J. Holberg, et al.
Changes in the normal maximal expiratory flow volume curve with growth and aging.
Am Rev Respir Dis, 127 (1983), pp. 34-725
[14.]
American Thoracic Society.
Standardization of spirometry: 1994 Update.
Am J Respir Crit Care Med, 152 (1995), pp. 36-1107
[15.]
American Thoracic Society.
Epidemiology standardization project: recommended standardization procedure for pulmonary function testing.
Am Rev Respir Dis, 118 (1978), pp. 55-88
[16.]
L.E. Febiger.
Echocardiography Harvey, 5, EUA, (1994),
[17.]
Classificação e avaliação diagnóstica da hipertensão pulmonar.
J Brás Pneumol, 31 (2005), pp. S1-S8
[18.]
J.K. Oh, J.B. Seward, A.J. Tajik.
Ecocardiografia – Clínica Mayo, (1997),
[19.]
Microsoft® Office Excel 2003 versão 11.6560.6568 SP2. Microsoft Office Professional Edição; USA, 2003.
[20.]
GraphPad Instat versão 3.01 para Windows 95, Copyright 1992-1998. GraphPad Software Inc, San Diego California USA, www.graphpad.com.
[21.]
A.L. Mancini, S.R.S. Carvalho, M.C.V. Crasto, et al.
Alterações eletrocardiográficas em pacientes asmáticos.
Pulmão RJ, 15 (2006), pp. 4-70
[22.]
Harrison.
Medicina Interna.
Cap, 15, pp. 45-1539
[23.]
Goodman e Gilman. As bases farmacológicas da terapêutica. 28:551-68 – 10.ª Ed. – Ed. McGraw-Hill.
Copyright © 2008. Sociedade Portuguesa de Pneumologia/SPP
Download PDF
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?