Inspiratory loading exercises on respiratory muscle function in post-operative gastroplasty patients: a randomized clinical trial / Exercícios com carga inspiratória na função muscular respiratória no pós-operatório de gastroplastia: um ensaio clínico randomizado / Ejercicios con carga inspiratoria en la función muscular respiratoria en el postoperatorio de gastroplastia: un ensayo clínico aleatorizado

Abstract Introduction: The gastroplasty post-operative period can alter respiratory mechanics and predispose patients to respiratory complications. Objective: The objective was to evaluate the effects of exercises with inspiratory load on respiratory muscle function and on the prevalence of atelectasis after gastroplasty. Method: 40 participants were randomly allocated into two groups: Control Group (CG), its members underwent conventional respiratory physical therapy (CRP) and the Inspiratory Load Group (ILG), its members performed exercises with linear inspiratory pressure load, with 40% of the maximum inspiratory pressure (MIP), associated with CRP. Therapy procedures were conducted twice during the immediate post-operative period and thrice on the first post-operative day. In addition to evaluating the MIP, the nasal inspiratory pressure (NIP) and the sustained maximum inspiratory pressure (SMIP) were evaluated before and after treatment. Analysis of variance followed by the Bonferroni correction were applied considering a 5% significance level (p < 0.05). Results: There was no significant difference in NIP and SMIP values when the pre- and post-operative periods were compared for the ILG; however, these values were significantly lower for the CG, also with intergroup differences in NIP values. Atelectasis prevalence was 5% for ILG and 15% for CG, with no intergroup difference. Conclusion: The inspiratory muscle strength and resistance of the respiratory muscles were maintained in the group that performed exercises with inspiratory load associated with CRP, with a low rate of atelectasis after gastroplasty.

Resumo Introdução: O pós-operatório de gastroplastia pode alterar a mecânica respiratória e predispor a complicações respiratórias. Objetivo: Avaliar os efeitos de exercícios com carga inspiratória na função muscular respiratória e na prevalência de atelectasias após gastroplastia. Método: 40 voluntárias foram alocadas randomicamente em: Grupo Controle (GC), que recebeu Fisioterapia Respiratória Convencional (FRC) e Grupo Carga Inspiratória (GCI), que executou exercícios com carga inspiratória linear pressórica com 40% da pressão inspiratória máxima (PImáx), associados à FRC. Os tratamentos foram realizados duas vezes no pós-operatório imediato e três vezes no primeiro dia pós-operatório. Além da PImáx, foram avaliadas a pressão inspiratória nasal (PIN) e a pressão inspiratória máxima sustentada (PImáxS) antes e após o tratamento. Foi realizada análise de variância seguida de ajuste de Bonferroni, e o nível de significância estatística foi de 5% (p < 0,05). Resultados: Não houve diferença significativa nos valores de PIN e na PImáxS no GCI quando comparados o pré e pós-operatório, diferentemente do GC, no qual esses valores foram significativamente menores além de diferença entre os grupos no valor de PIN. A prevalência de atelectasias foi de 5% para GCI e 15% para GC, sem diferenças intergrupos. Conclusão: Houve manutenção da força muscular inspiratória e da resistência dos músculos respiratórios no grupo que realizou exercícios com carga inspiratória, associado a FRC com baixo índice de atelectasias após gastroplastia.

Resumen Introducción: El postoperatorio de gastroplastia puede alterar la mecánica respiratoria y predisponer a complicaciones respiratorias. Objetivo: Evaluar los efectos de ejercicios con carga inspiratoria en la función muscular respiratoria y en la prevalencia de atelectasias después de la gastroplastia. Método: 40 voluntarias fueron asignadas en: Grupo Control (GC), que recibió Fisioterapia Respiratoria Convencional (FRC) y Grupo Carga Inspiratoria (GCI), que ejecutó ejercicios con carga inspiratoria, realizados con carga lineal inspiratoria con un 40% de la presión inspiratoria máxima (PIM) asociados a la FRC. Ambos tratamientos se realizaron dos veces en el postoperatorio inmediato y tres veces en el primer día postoperatorio. Además de la PIM, se evaluaron la presión inspiratoria nasal (PIN) y la presión inspiratoria máxima sostenida (PImáxS) antes y después del tratamiento. Se realizó el análisis de varianza seguida de ajuste de Bonferroni. Se adoptó nivel de significancia estadística del 5% (p < 0,05). Resultados: No hubo diferencia significativa en los valores de PIN y en la PImáxS en el GCI cuando se compararon en el pre y en postoperatorio, a diferencia del GC, en el cual estos valores fueron significativamente menores más allá de diferencia entre los grupos en el valor de PIN. La prevalencia de atelectasias fue de 5% para GCI y 15% para GC, sin diferencia entre grupos. Conclusión: Hubo mantenimiento de la fuerza muscular inspiratoria y de la resistencia de los músculos respiratorios en el grupo que realizó ejercicios con carga inspiratoria, asociados a la FRC, con bajo índice de atelectasias tras gastroplastia.

Micronutrient supplementation in gastric bypass surgery: prospective study on inflammation and iron metabolism in premenopausal women.

BACKGROUND: Low-grade chronic inflammation in morbid obesity is associated with impaired iron metabolism. Bariatric surgery is effective in weight loss; however, it can induce specific nutritional deficiencies, such as iron, especially in premenopausal women. Alternatively, after surgery, there is an improvement in systemic inflammation, raising questions concerning the dosages of micronutrient supplementation. OBJECTIVES: This study aimed to assess the effect of two micronutrient supplementation schemes before and 6 months after a Roux-en-Y gastric bypass (RYGB) surgery on inflammation and iron metabolism in premenopausal women. METHODS: This prospective study included 45 premenopausal women (aged 20-45 years; body mass index [BMI] ≥ 35 kg/m2) divided into two supplementation schemes: group 1 (n = 34): daily supplemental dose of 1 RDA 30 days before surgery and 2 RDAs during the six months following surgery; and group 2 (n = 11): daily supplementation of 1 RDA during the 6 months postsurgery. Anthropometry, dietary intake, inflammation, and iron metabolism were monitored. RESULTS: Evident reductions in BMI, high-sensitivity C-reactive protein, and ferritin levels for both groups occurred 6 months after surgery. Additionally, anemia was 9% in both groups after surgery. However, group 1 exhibited an increased transferrin saturation index and reduced transferrin levels. Multivariate regression analysis suggested serum iron, hepcidin, and iron intake determined ferritin values before and after RYGB surgery. CONCLUSION: Six months after RYGB, systemic inflammation was reduced in both supplementation schemes. However, supplementation of 1 RDA before and 2 RDAs after surgery resulted in better improvements on iron metabolism.

Micronutrient supplementation in gastric bypass surgery: prospective study on inflammation and iron metabolism in premenopausal women / Suplementación con micronutrientes en pacientes con cirugía de bypass gástrico: estudio prospectivo sobre la inflamación y el metabolismo del hierro en mujeres premenopáusicas

Background: Low-grade chronic inflammation in morbid obesity is associated with impaired iron metabolism. Bariatric surgery is effective in weight loss; however, it can induce specific nutritional deficiencies, such as iron, especially in premenopausal women. Alternatively, after surgery, there is an improvement in systemic inflammation, raising questions concerning the dosages of micronutrient supplementation. Objectives: This study aimed to assess the effect of two micronutrient supplementation schemes before and 6 months after a Roux-en-Y gastric bypass (RYGB) surgery on inflammation and iron metabolism in premenopausal women. Methods: This prospective study included 45 premenopausal women (aged 20-45 years; body mass index [BMI] ≥ 35 kg/m2) divided into two supplementation schemes: group 1 (n = 34): daily supplemental dose of 1 RDA 30 days before surgery and 2 RDAs during the six months following surgery; and group 2 (n = 11): daily supplementation of 1 RDA during the 6 months postsurgery. Anthropometry, dietary intake, inflammation, and iron metabolism were monitored. Results: Evident reductions in BMI, high-sensitivity C-reactive protein, and ferritin levels for both groups occurred 6 months after surgery. Additionally, anemia was 9% in both groups after surgery. However, group 1 exhibited an increased transferrin saturation index and reduced transferrin levels. Multivariate regression analysis suggested serum iron, hepcidin, and iron intake determined ferritin values before and after RYGB surgery. Conclusion: Six months after RYGB, systemic inflammation was reduced in both supplementation schemes. However, supplementation of 1 RDA before and 2 RDAs after surgery resulted in better improvements on iron metabolism (AU)

Introducción: la inflamación crónica de bajo grado en la obesidad mórbida se asocia con una alteración del metabolismo del hierro. La cirugía bariátrica es eficaz en la pérdida de peso, sin embargo, puede inducir deficiencias específicas nutricionales, como es el caso del hierro, especialmente en las mujeres premenopáusicas. Por otra parte, después de la cirugía, hay una mejora en la inflamación sistémica, planteando el tema de las dosis de suplementos de micronutrientes. Objetivos: este estudio tuvo como objetivo evaluar el efecto de dos esquemas de suplementación de micronutrientes antes y 6 meses después de una cirugía de by-pass gástrico con Y de Roux (RYGB) sobre la inflamación y el metabolismo del hierro en las mujeres premenopáusicas. Métodos: estudio prospectivo que incluyó 45 mujeres premenopáusicas (edades 20-40 años, índice de masa corporal [IMC] ≥ 35 kg/m2) divididos en dos esquemas de suplementación: grupo 1 (n = 34): dosis suplementaria diaria de 1 vez las RDA 30 días antes de la cirugía y 2 veces las RDA durante los seis meses posteriores a la cirugía; y el grupo 2 (n = 11): la suplementación diaria de 1RDA durante los 6 meses después de la cirugía. Se monitorizaron las medidas antropométricas, la ingesta alimentaria, la inflamación y el metabolismo del hierro. Resultados: se observó una disminución en el IMC, la proteína C reactiva de alta sensibilidad y los niveles de ferritina en ambos grupos después de 6 meses tras la cirugía. Además, la anemia fue del 9% en ambos grupos tras de la cirugía. Sin embargo, el grupo 1 exhibió un incremento del índice de saturación de transferrina y una reducción en los niveles de transferrina. En el análisis multivariante se apreció que los niveles de hierro sérico, hepcidina y la ingesta de hierro determinaron los valores de ferritina antes y después de la cirugía. Conclusión: seis meses después de RYGB, la inflamación sistémica se redujo en ambos esquemas de suplementación. Sin embargo, la suplementación de 1 vez las RDA antes y 2 veces las RDA después de la cirugía consiguió mejorar el metabolismo del hierro (AU)

Effects of chest physiotherapy on the respiratory function of postoperative gastroplasty patients

INTRODUCTION: Bariatric surgery has become increasingly more recommended for the treatment of morbidly obese individuals for whom it is possible to identify co-morbidities other than alterations in pulmonary function. The objective of this study was to evaluate the effects of conventional chest physiotherapy (CCP) and of conventional physiotherapy associated with transcutaneous electrical diaphragmatic stimulation (CCP+TEDS) on pulmonary function and respiratory muscle strength in patients who have undergone Roux-en-Y gastric bypass. METHODS: In total, 44 female patients with an average age of 37 ± 7.3 years and an average body mass index (BMI) of 47.4 ± 6.5 K/m² were selected as candidates for Roux-en-Y gastric bypass laparoscopy. They were evaluated for pulmonary volume and flow using spirometry and maximum respiratory pressure through manovacuometry during the preoperative period and on the fifteenth and thirtieth postoperative days. RESULTS: No differences were detected between CCP and CCP+TEDS, and both factors contributed to the maintenance of pulmonary flow and volume as well as inhalation muscle strength. Exhalation muscle strength was not maintained in the CCP group at fifteen or thirty days postoperative, but it was maintained in patients treated with conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation. DISCUSSION: These results suggest that both conventional chest physiotherapy and conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation prevent the reduction of pulmonary function during the Roux-en-Y gastric bypass postoperative period, and that transcutaneous electric diaphragmatic stimulation also contributes to expiratory muscle strength.

Tratamento cirúrgico das hérnias inguinais com anestesia local / Surgical treatment of inguinal hernias with local anesthesia

Foi realizado bloqueio regional inguinal por infiltraçäo com lidocaína a 1% em 84 pacientes, para serem submetidos à hernioplastia inguinal pelo método de Bassini modificado. O estudo objetivou avaliar a utilizaçäo da anestesia local no tratamento das hérnias inguinais. Nos 84 pacientes estudados, as hérnias eram pequenas, redutíveis e näo recidivadas. Foram tratados a nível ambulatorial 58 casos e em regime de internaçäo hospitalar 26 casos. Quando a hérnia era a única afecçäo, os pacientes eram operados no centro cirúrgico ambulatorial e recebiam alta duas horas após a intervençäo, os pacientes eram operados no centro cirúrgico ambulatorial e recebiam alta duas horas após a intervençäo cirúrgica. Os pacientes que apresentavam doenças associadas compensadas foram internado e recebiam alta hospitalar no 2§ dia de pós-operatório. Em ambos os grupos, houve boa aceitaçäo da técnica anestésica; a incidência de complicaçöes foi reduzida, sendo a dor local a mais freqüente. Os autores concluem ser a anestesia local procedimento adequado para o tratamento cirúrgico das hérnias inguinais