Effects of multimodal exercise program on postural balance in patients with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial.

BACKGROUND: Evidence has shown that patients with chronic obstructive pulmonary disease present significant deficits in the control of postural balance when compared to healthy subjects. In view of this, it is pertinent to investigate the effects of different therapeutic strategies used alone or in association with pulmonary rehabilitation with the potential to improve postural balance and other outcomes with clinical significance in patients with chronic obstructive pulmonary disease. This study will investigate the effects of an 8-week (short-term) multimodal exercise program [inspiratory muscle training (IMT) plus neuromuscular electrical stimulation (NMES)] on postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program compared to individualized addition of IMT or NMES to pulmonary rehabilitation or standard pulmonary rehabilitation. METHODS: This is a randomized, single-blind, 4-parallel-group trial. Forty patients with chronic obstructive pulmonary disease will be included prospectively to this study during a pulmonary rehabilitation program. Patients will be randomly assigned to one of four groups: multimodal exercise program (IMT + NMES + pulmonary rehabilitation group) or (IMT + pulmonary rehabilitation group) or (NMES + pulmonary rehabilitation group) or standard pulmonary rehabilitation group. Patients will receive two sessions per week for 8 weeks. The primary outcome will be static postural balance and secondary outcomes will include as follows: static and dynamic postural balance, fear of falling, muscle strength and endurance (peripheral and respiratory), functional capacity, health-related quality of life, muscle architecture (quadriceps femoris and diaphragm), and laboratory biomarkers. DISCUSSION: This randomized clinical trial will investigate the effects of adding of short-term multimodal exercise program, in addition to pulmonary rehabilitation program, in postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation. Furthermore, this randomized control trial will enable important directions regarding the effectiveness of short-term intervention as part of the need to expand the focus of pulmonary rehabilitation to include balance management in chronic obstructive pulmonary disease patients which will be generated. TRIAL REGISTRATION: ClinicalTrials.gov NCT04387318. Registered on May 13, 2020.

Relationship between Perme ICU Mobility Score and length of stay in patients after cardiac surgery

Background: Patients undergoing cardiac surgery can experience functional impairment. Objective: Assess the influence of Perme Score on the intensive care unit (ICU) length of stay in patients after cardiac surgery. As a secondary objective, investigate if preoperative variables can predict the patient's mobility status after surgery. Methods: A prospective observational study was conducted in ICU in a university hospital. The mobility status (Perme Score) was collected from the first postoperative day until ICU discharge. The preoperative assessment of respiratory muscle strength, pulmonary function, and handgrip strength were collected. Results: A total of 44 patients, mean age of 62.3 years, 28 men were included in the study. A high Perme Score on the second postoperative day among patients who underwent Coronary artery bypass grafting and the third postoperative day on three types of intervention (Coronary artery bypass grafting, valve replacement, or both simultaneously) was associated with shorter ICU length of stay). The preoperative pulmonary function was one of the main independent predictors of mobility status on the first three days of ICU stay, in addition to left ventricular ejection fraction and cardiopulmonary bypass time on the first day, age, and left ventricular ejection fraction on the second day and maximum expiratory pressure on third day Conclusion: An increase in mobility status (Perme Score), mainly on the third postoperative day, reduced the ICU stay, mainly influenced by preoperative pulmonary function.

Antecedentes: Los pacientes sometidos a cirugía cardiaca pueden experimentar deterioro funcional. Objetivo: Evaluar la influencia del Perme Score en la estancia hospitalaria en la unidad de cuidados intensivos (UCI) en pacientes postoperados de cirugía cardiaca. Como objetivo secundario fue investigar si las variables preoperatorias pueden predecir el estado de movilidad del paciente después de la cirugía. Métodos: Se realizó un estudio observacional prospectivo en la UCI de un hospital universitario. El estado de movilidad (Perme Score) se monitoreó desde el primer día postoperatorio, hasta el alta de la UCI. Se recolectó la evaluación preoperatoria de la fuerza de los músculos respiratorios, la función pulmonar y la fuerza de agarre. Resultados: Fueron incluidos en el estudio 44 pacientes, con edad media de 62.3 años y 28 hombres. Se obruvo una puntuación alta de Perme entre los pacientes que se sometieron a un injerto de derivación de la arteria coronaria a partir del segundo día posoperatorio y al tercer día posoperatorio en tres tipos de intervención (injerto de derivación de la arteria coronaria, reemplazo de válvula o ambos simultáneamente), se asoció con una estancia más corta en la UCI. La función pulmonar preoperatoria fue uno de los principales predictores independientes del estado de movilidad en los tres primeros días de estancia en la UCI, además de la fracción de eyección del ventrículo izquierdo y el tiempo de circulación extracorpórea al primer día, la edad y la fracción de eyección del ventrículo izquierdo al segundo día y presión espiratoria máxima al tercer día. Conclusión: Un aumento en el estado de movilidad (Perme Score), principalmente en el tercer día postoperatorio, redujo la estancia en la UCI, influenciado principalmente por la función pulmonar preoperatoria.

Relationship between Perme ICU Mobility Score and length of stay in patients after cardiac surgery.

Background: Patients undergoing cardiac surgery can experience functional impairment. Objective: Assess the influence of Perme Score on the intensive care unit (ICU) length of stay in patients after cardiac surgery. As a secondary objective, investigate if preoperative variables can predict the patient's mobility status after surgery. Methods: A prospective observational study was conducted in ICU in a university hospital. The mobility status (Perme Score) was collected from the first postoperative day until ICU discharge. The preoperative assessment of respiratory muscle strength, pulmonary function, and handgrip strength were collected. Results: A total of 44 patients, mean age of 62.3 years, 28 men were included in the study. A high Perme Score on the second postoperative day among patients who underwent Coronary artery bypass grafting and the third postoperative day on three types of intervention (Coronary artery bypass grafting, valve replacement, or both simultaneously) was associated with shorter ICU length of stay). The preoperative pulmonary function was one of the main independent predictors of mobility status on the first three days of ICU stay, in addition to left ventricular ejection fraction and cardiopulmonary bypass time on the first day, age, and left ventricular ejection fraction on the second day and maximum expiratory pressure on third day. Conclusion: An increase in mobility status (Perme Score), mainly on the third postoperative day, reduced the ICU stay, mainly influenced by preoperative pulmonary function.

Antecedentes: Los pacientes sometidos a cirugía cardiaca pueden experimentar deterioro funcional. Objetivo: Evaluar la influencia del Perme Score en la estancia hospitalaria en la unidad de cuidados intensivos (UCI) en pacientes postoperados de cirugía cardiaca. Como objetivo secundario fue investigar si las variables preoperatorias pueden predecir el estado de movilidad del paciente después de la cirugía. Métodos: Se realizó un estudio observacional prospectivo en la UCI de un hospital universitario. El estado de movilidad (Perme Score) se monitoreó desde el primer día postoperatorio, hasta el alta de la UCI. Se recolectó la evaluación preoperatoria de la fuerza de los músculos respiratorios, la función pulmonar y la fuerza de agarre. Resultados: Fueron incluidos en el estudio 44 pacientes, con edad media de 62.3 años y 28 hombres. Se obruvo una puntuación alta de Perme entre los pacientes que se sometieron a un injerto de derivación de la arteria coronaria a partir del segundo día posoperatorio y al tercer día posoperatorio en tres tipos de intervención (injerto de derivación de la arteria coronaria, reemplazo de válvula o ambos simultáneamente), se asoció con una estancia más corta en la UCI. La función pulmonar preoperatoria fue uno de los principales predictores independientes del estado de movilidad en los tres primeros días de estancia en la UCI, además de la fracción de eyección del ventrículo izquierdo y el tiempo de circulación extracorpórea al primer día, la edad y la fracción de eyección del ventrículo izquierdo al segundo día y presión espiratoria máxima al tercer día. Conclusión: Un aumento en el estado de movilidad (Perme Score), principalmente en el tercer día postoperatorio, redujo la estancia en la UCI, influenciado principalmente por la función pulmonar preoperatoria.

Association between the ankle-brachial index, intermittent claudication, and physical activity level: what is the influence on the functional capacity of patients with or at high risk of cardiovascular disease?

BACKGROUND: Patients with or at high risk of cardiovascular disease have a poor functional capacity; however, the influence of association among intermittent claudication (IC), abnormal ankle-brachial index (ABI), and physical activity level on functional capacity of these patients has not been fully studied. OBJECTIVE: The primary objective of this study was to investigate the association between the ABI, IC, and physical activity level, and the influence of these variables on the functional capacity of patients with or at high risk of cardiovascular disease seen in a reference cardiology outpatient clinic in Southern Brazil. The secondary objective was to assess the prevalence of peripheral arterial disease (PAD) in this sample of patients. PATIENTS AND METHODS: This was a prospective cross-sectional study in which 162 consecutive patients were evaluated and classified into three groups according to their ABI: normal ABI (n=104, values between 1.00 and 1.40); borderline PAD (n=23, values between 0.91 and 1.00); and patients with PAD (n=35, ≤0.90). The presence of IC was assessed using the Edinburgh Claudication Questionnaire. The level of physical activity was assessed by the short version of the International Physical Activity Questionnaire (IPAQ) and functional capacity was assessed by the 6-minute walk distance (6MWD). RESULTS: The prevalence of PAD was 21.6% in the total sample. The 6MWD showed strong correlation with the absence of IC (r=0.785; P<0.001), moderate correlation with age (r=-0.347; P<0.001), and weak correlations with IPAQ scores (r=0.164; P=0.038) and ABI (r=0.216; P=0.006). Age, ABI, and absence of IC were independently associated with the outcome (P=0.001, P=0.001, and P=0.028, respectively). CONCLUSION: The current study demonstrates that 6MWD is associated with IPAQ scores, ABI, and absence of IC. Age, ABI and absence of IC were independently associated with functional capacity in patients with or at high risk of cardiovascular disease.

[Increase in breast cancer mortality in Southern Brazil from 1980 to 2002]. / Câncer de mama: mortalidade crescente na Região Sul do Brasil entre 1980 e 2002.

Breast cancer is the most prevalent form of cancer in the world. Breast cancer mortality rates are high in Brazil and show striking variations between geographic regions. A time-trend ecological study was performed in Southern Brazil from 1980 to 2002. Data were collected from the Mortality Information System (Ministry of Health) to assess age-standardized mortality rates. Linear regression for mortality time-trend analysis and multiple regression for mortality differences among three States were calculated. The highest mean mortality rate (14.45) was observed in Rio Grande do Sul, significantly greater (p < 0.001) than in Santa Catarina (8.93) and Paraná (9.95). An annual increase of 0.47 in the mortality rate was observed in the three States of Southern Brazil. According to these results, the South of Brazil and especially the State of Rio Grande do Sul showed a significant upward trend in breast cancer mortality. Continued efforts are needed to help explain these numbers and reverse the present situation.