[Assessment of respiratory muscle strength, peak expiratory flow and pain after open cholecystectomy]. / Avaliação da força da musculatura respiratória, pico de fluxo expiratório e dor após colecistectomía aberta.

OBJECTIVE: to investigate the behavior of maximal inspiratory and expiratory pressure (MIP and MEP), peak expiratory flow (PEF) and pain after open cholecystectomy. METHODS: were investigated 31 volunteers over 18 years submitted to open cholecystectomy between january and december 2007 at Holy House of Charity in the city of Diamantina-MG. The MIP MEP PEF and pain variables were measured at times pre-operative, 24 and 48 hours post-operative using manovacuometer, peak flow meter Assess and visual numeric scale of pain respectively. The statistical analysis was performed using Wilcoxon and Spearman tests considering significant differences for p<0,05. RESULTS: There was significant reduction of the MIP MEP and PEF values at 24 and 48 hours post-operative compared to the pre-operative values. The levels of pain were significantly higher at all post-operative times compared to the pre-operative time. The MIP, MEP and PEF measures not showed correlation with the levels of post-operative pain. Nevertheless, the PEF after surgery showed significant correlation with the MEP values. CONCLUSION: the open cholecystectomy causes significant impairment of the respiratory muscle strength and the peak expiratory flow at all post-operative times evaluated, with more pronounced reductions at 24 hours post-operative. The MIP MEP and PEF measures presented a different behavior compared to pain evaluation at all times investigated.

Inspiratory muscle training and respiratory exercises in children with asthma.

OBJECTIVE: The aim of the present study was to evaluate the effects that inspiratory muscle training (IMT) and respiratory exercises have on muscle strength, peak expiratory flow (PEF) and severity variables in children with asthma. METHODS: This was a randomized analytical study involving 50 children with asthma allocated to one of two groups: an IMT group, comprising 25 children submitted to IMT via an asthma education and treatment program; and a control group, comprising 25 children who were submitted only to monthly medical visits and education on asthma. The IMT was performed using a pressure threshold load of 40% of maximal inspiratory pressure (MIP). The results were evaluated using analysis of variance, the chi-square test and Fisher's exact test, values of p > 0.05 being considered significant. RESULTS: In the comparative analysis, pre- and post-intervention values of MIP, maximal expiratory pressure (MEP) and PEF increased significantly in the IMT group: MIP from -;48.32 +/- 5.706 to -;109.92 +/- 18.041 (p < 0.0001); MEP from 50.64 +/- 6.55 to 82.04 +/- 17.006 (p < 0.0001); and PEF from 173.6 +/- 50.817 to 312 +/- 54.848 (p < 0.0001). In the control group, however, there were no significant differences between the two time points in terms of MIP or MEP, although PEF increased from 188 +/- 43.97 to 208.80 +/- 44.283 (p < 0.0001). There was a significant improvement in the severity variables in the IMT group (p < 0.0001). CONCLUSIONS: Programs involving IMT and respiratory exercises can increase mechanical efficiency of the respiratory muscles, as well as improving PEF and severity variables.

Treinamento muscular inspiratório e exercícios respiratórios em crianças asmáticas / Inspiratory muscle training and respiratory exercises in children with asthma

OBJETIVO: Avaliar efeitos do treinamento muscular inspiratório (TMI) e exercícios respiratórios na força muscular, pico de fluxo expiratório (PFE) e variáveis de gravidade em crianças asmáticas. MÉTODOS: Estudo analítico, experimental aleatório em 50 crianças asmáticas alocadas aleatoriamente em dois grupos: um grupo composto de 25 crianças que realizaram TMI em um programa de assistência e educação em asma (grupo TMI); e um grupo controle, composto de 25 crianças que foram submetidas apenas às consultas médicas mensais e educação em asma. O TMI foi realizado com o threshold com a carga de 40 por cento da pressão inspiratória máxima (PImáx). A análise dos resultados foi realizada através da análise da variância, teste de qui-quadrado e teste exato de Fisher, sendo considerado significante o valor de p > 0,05. RESULTADOS: Na análise comparativa, observou-se aumento significativo da PImáx, da pressão expiratória máxima (PEmáx) e do PFE pré- e pós-intervenção no grupo TMI, como se segue: PImáx de -;48,32 ± 5,7 para -;109,92 ± 18 (p < 0,0001); PEmáx de 50,64 ± 6,5 para 82,04 ± 17(p < 0,0001); e PFE de 173,6 ± 50 para 312 ± 54 (p < 0,0001). Entretanto, não houve aumento significativo da PImáx e PEmáx no grupo controle, somente no PFE, de 188 ± 43,97 para 208,80 ± 44,283 (p < 0,0001). Houve melhora significativa das variáveis de gravidade no grupo TMI (p < 0,0001). CONCLUSÕES: O TMI e exercícios respiratórios proporcionam uma melhora na eficiência mecânica nos músculos respiratórios, no PFE e variáveis de gravidade.

OBJECTIVE: The aim of the present study was to evaluate the effects that inspiratory muscle training (IMT) and respiratory exercises have on muscle strength, peak expiratory flow (PEF) and severity variables in children with asthma. METHODS: This was a randomized analytical study involving 50 children with asthma allocated to one of two groups: an IMT group, comprising 25 children submitted to IMT via an asthma education and treatment program; and a control group, comprising 25 children who were submitted only to monthly medical visits and education on asthma. The IMT was performed using a pressure threshold load of 40 percent of maximal inspiratory pressure (MIP). The results were evaluated using analysis of variance, the chi-square test and Fisher's exact test, values of p > 0.05 being considered significant. RESULTS: In the comparative analysis, pre- and post-intervention values of MIP, maximal expiratory pressure (MEP) and PEF increased significantly in the IMT group: MIP from -;48.32 ± 5.706 to -;109.92 ± 18.041 (p < 0.0001); MEP from 50.64 ± 6.55 to 82.04 ± 17.006 (p < 0.0001); and PEF from 173.6 ± 50.817 to 312 ± 54.848 (p < 0.0001). In the control group, however, there were no significant differences between the two time points in terms of MIP or MEP, although PEF increased from 188 ± 43.97 to 208.80 ± 44.283 (p < 0.0001). There was a significant improvement in the severity variables in the IMT group (p < 0.0001). CONCLUSIONS: Programs involving IMT and respiratory exercises can increase mechanical efficiency of the respiratory muscles, as well as improving PEF and severity variables.

Estudio exploratorio de la capacidad aerobia en pacientes en hemodiálisis: efecto de la suplementación con L-carnitina / Study of aerobic capacity in chronic hemodialized patients: effect of L-carnitine supplementation

Fundamento y objetivo: Los pacientes en hemodiálisis crónica presentan una baja capacidad aerobia, que es atribuible tanto a las morbilidades propias de su enfermedad como a la escasa actividad física que realizan. Uno de los factores que pueden contribuir a esa baja capacidad aerobia es el déficit muscular de L-carnitina que presentan. La suplementación con L-carnitina ha producido resultados dispares. El objetivo de este trabajo ha sido evaluar el efecto de la administración de L-carnitina sobre el consumo máximo de oxígeno que presentan los pacientes en hemodiálisis. Pacientes y método: Se ha estudiado a un total de 21 pacientes con edades comprendidas entre 20 y 50 años, que se encontraban en un programa de hemodiálisis crónica. Durante 12 semanas, 13 pacientes recibieron L-carnitina ­7 varones y 6 mujeres, con una edad media (desviación estándar) de 38,8 (9,5) años y un índice de masa corporal medio de 24,2 (2,1) kg/m2­ y 8 recibieron placebo ­4 varones y 4 mujeres, con una edad media de 35,8 (11,4) años e índice de masa corporal medio de 24,5 (5,8) kg/m2­. Resultados: En el grupo que recibió L-carnitina se observó un aumento de la media del consumo máximo de oxígeno, de 16,3 (2,8) a 19,5 (3,3) ml * kg­1 * min­1, al igual que en el grupo que recibió placebo, donde aumentó de 14,8 (3,8) a 18,9 (4,8) ml * kg­1 * min­1. Los grupos L-carnitina y placebo no presentaron diferencias significativas al término del estudio (todas las variables con valores de p > 0,05). Conclusiones: En este grupo de pacientes en hemodiálisis la administración de L-carnitina durante 12 semanas no tuvo impacto en la mejoría del consumo máximo de oxígeno

Background and objective: Chronic hemodialyzed patients have a low level of aerobic capacity, caused by the pathologies concomitant to renal insufficiency, according with a low level of physical activity. One of the factors that would contribute to this level of aerobic capacity is the L-carnitine deficit on skeletal muscle. However, the value of the supplementation of L-carnitine to improve the physical fitness has been controversial. The objective of this work was to evaluate the effect of the administration of L-carnitine on VO2 max in hemodialyzed patients. Patients and methods: A group of 21 patients (20-50 years old) on a program of chronic hemodialysis was studied. During 12 weeks, 13 of them received L-carnitine, 7 men and 6 women, 38.8 (9.5) years old; BMI 24.2 (2.1) Kg/m2; 8 of them received placebo, 4 men and 4 women, 35.8 (11.4) years old; BMI 24.5 (5.8) Kg/m2. Results: There was an increase in VO2 peak on L-carnitine group from 16.3 (2.8) mL3 Kg­1 3 min­1 to 19.5 (3.3) mL 3 Kg­1 3 min­1, and the same was seen in the placebo group (increase in VO2peak from 14.8 (3.8) mL 3 Kg­1 3 min­1 to 18.9 (4.8) mL 3 Kg­1 3 min­1). The L-carnitine and placebo groups did not show statistical differences at the end of this study (all values above p > 0.05). Conclusion. In this group of patients, the intravenous supplementation of L-carnitine during 12 weeks did not have an impact on the improvement of the VO2peak

Determinación de la transición aeróbica-anaeróbica mediante parámetros del modelo respiratorio / Determination of the aerobic-anaerobic transition by means of the breathing parameters

El objetivo de este trabajo ha sido analizar la relación entre determinados parámetros del modelo respiratorio y la transición aeróbica-anaeróbica. Veintidós varones (24.9 +/- 4.1) años (Media +/- SD) y 11 mujeres (21.7 +/- 2.1) años, realizaron una prueba de esfuerzo máxima. La transición aeróbica-anaeróbica fue analizada mediante dos métodos: 1º el método ventilatorio y 2º el cambio de los tiempos respiratorios y sus inversos. Los criterios para la determinación de los umbrales ventilatorios por ambos métodos fue llevado a cabo por 4 observadores, 2 sin experiencia y 2 con experiencia. La correlación de Pearson para los valores medios de los 4 observadores fue: r= 0.55 +/- 0.23 para VT1 (ventilatory threshold 1) en los varones y r=0.71 +/- 0.09 para el VT1 en las mujeres. La correlación más alta se observó para VT2 (ventilatory threshold 2): r= 0.78 +/- 0.04 (varones) y r= 0.79+/- 0.07 (mujeres). Los resultados muestran evidencia de la actividad central inspiratoria durante la transición aeróbica-anaeróbica, sugiriendo la validez del método propuesto (AU)

No disponible

Prevalence of asthmatic phenotypes and bronchial hyperresponsiveness in Turkish schoolchildren: an International Study of Asthma and Allergies in Childhood (ISAAC) phase 2 study.

BACKGROUND: Numerous epidemiologic studies have revealed that bronchial asthma affects populations without regard to frontiers. However, standardized methodological approaches are necessary to compare these populations. OBJECTIVE: To investigate objective markers of childhood asthma on an epidemiologic basis and to include Turkish children in international comparisons. METHODS: Parental questionnaires were collected and skin prick tests performed on fourth grade primary schoolchildren, aged 8 to 11 years, residing in Ankara, Turkey. Pulmonary function tests and bronchial challenge with hypertonic saline (HS) were conducted in children selected from this cohort with a stratified random sampling according to the presence of current wheezing. RESULTS: A total of 3,041 questionnaires were included in the evaluation. Skin prick tests were performed on 2,774 children (97.1%). A total of 347 children from this cohort underwent pulmonary function and bronchial challenge tests. In 18 (5.1%) of the 347 children, bronchial challenge tests could not be successfully completed. The prevalence values were 11.5% for current wheezing, 6.9% for physician-diagnosed asthma, and 7.7% for physician-diagnosed recurrent bronchitis. Population-based weighted prevalence of bronchial hyperresponsiveness (BHR) was 21.8%. Frequency of responses to HS was 38.6% among physician-diagnosed asthma cases and 30.5% among patients with current wheezing. Skin test positivity was present in 38.7% of the children with a diagnosis of asthma or asthmatic bronchitis, 35.0% of current asthmatic patients, and 19.2% of patients with current wheezing. CONCLUSIONS: Objective markers, in addition to the questionnaire-based prevalence figures, need to be used in epidemiologic surveys for asthma, especially in countries with inadequate health care facilities or problems with interpretation of the wheeze concept.

Laser acupuncture in children and adolescents with exercise induced asthma.

BACKGROUND: Laser acupuncture, a painless technique, is a widely used alternative treatment method for childhood asthma, although its efficacy has not been proved in controlled clinical studies. METHODS: A double blind, placebo controlled, crossover study was performed to investigate the possible protective effect of a single laser acupuncture treatment on cold dry air hyperventilation induced bronchoconstriction in 44 children and adolescents of mean age 11.9 years (range 7.5-16.7) with exercise induced asthma. Laser acupuncture was performed on real and placebo points in random order on two consecutive days. Lung function was measured before laser acupuncture, immediately after laser acupuncture (just before cold dry air challenge (CACh)), and 3 and 15 minutes after CACh. CACh consisted of a 4 minute isocapnic hyperventilation of -10 degrees C absolute dry air. RESULTS: Comparison of real acupuncture with placebo acupuncture showed no significant differences in the mean maximum CACh induced decrease in forced expiratory volume in 1 second (27.2 (18.2)% v 23.8 (16.2)%) and maximal expiratory flow at 25% remaining vital capacity (51.6 (20.8)% v 44.4 (22.3)%). CONCLUSIONS: A single laser acupuncture treatment offers no protection against exercise induced bronchoconstriction in paediatric and adolescent patients.

Upper airway anesthesia induces airflow limitation in awake humans.

Upper airway receptors are thought to contribute to upper airway stability by reducing collapsing forces. Their activity can be abolished by topical anesthesia. We have measured in 16 healthy volunteers (mean +/- SD age, 23.7 +/- 1.6 yr) specific airway conductance (SGaw), maximal inspiratory (MIFR) and expiratory (MEFR) flow rates before and 15, 35, and 45 min after extensive upper airway anesthesia (UAA) with 10% lidocaine. Average values of MIFR decreased (p less than 0.01) 15 min after UAA, but they returned to or near to control values at 45 min: MIF25 (4.8 versus 6.0 L/s); MIF50 (5.1 versus 6.2 L/s); MIF75 (4.4 versus 5.3 L/s). Transient decreases in flow (V) rates, reaching zero flow in some subjects, were observed in 13 subjects during forced inspiratory vital capacity (FIVC) maneuvers and in seven subjects during forced expiratory vital capacity (FEVC) maneuvers. MEFR at 25, 50, and 75% FVC, SGaw, and FVC did not change after anesthesia. Simultaneous measurements of supraglottic pressure, V, and lung volume in 12 of the 16 subjects showed that the site of flow limitation was localized at the level of the glottis in all except one subject in whom there was both a glottic and a supraglottic obstruction. We conclude that extensive upper airway anesthesia induced a profound but transitory upper airway obstruction during FIVC and FEVC maneuvers. These findings are compatible with the concept of reflex regulation of upper airway caliber.