Bile-acid levels and lung maturity test in patients with intrahepatic cholestasis of pregnancy.

OBJECTIVES: Prolonged fetal exposure to maternal bile acids have been linked to fetal lung injury, but it is not known if it affects production of surfactant or fetal lung maturity tests. We set out to determine if elevated total bile acid (TBA) levels predict delayed fetal lung maturity (FLM) in patients with intrahepatic cholestasis of pregnancy (ICP). METHODS: A retrospective cohort study examining patients with ICP who underwent amniocentesis between 36+0 and 37+6 between 2005 and 2014. Primary goal was to identify if a relationship exists between TBA levels and FLM defined as Lecithin:Sphingomyelin >2.5, detectable Phosphatidylglycerol, or lamellar body count of >50,000. RESULTS: Among the 113 patients, there was no statistically significant difference in TBA levels between women with FLM and those with immaturity (31.3 [21.6, 44.5] µmol/L and 34.9 [23.9, 62.3] µmol/L respectively; p=0.16). Logistic regression performed using predefined TBA levels of 20, 30, 40 and 50 µmol/L revealed that TBA levels did not predict a negative FLM test at time of amniocentesis. CONCLUSIONS: TBA levels do no predict presence or absence of FLM between 36+0 and 37+6 weeks of gestation. Though certain pregnancy complications can affect FLM, we could not identify a correlation between TBA levels and an accelerated or delayed lung maturation process.

Intervención fisioterápica preventiva del deterioro de la musculatura respiratoria en ancianas institucionalizadas con limitación funcional / Physiotherapy Intervention for Preventing the Respiratory Muscle Deterioration in Institutionalized Older Women with Functional Impairment

Introducción: En el anciano de edad avanzada (> 80 años) la función respiratoria puede verse afectada cuando a la presencia de comorbilidad y la pérdida de movilidad se suma el descenso de la fuerza de la musculatura respiratoria (MR). La literatura médica ha mostrado que el entrenamiento de la MR puede ser una intervención efectiva para mejorar la funcionalidad y prevenir el deterioro clínico, especialmente en la población con debilidad de la MR. El objetivo del estudio fue evaluar la efectividad del entrenamiento de la MR en la fuerza y resistencia de esta musculatura, en ancianas institucionalizadas con limitación funcional. Método: Se asignaron aleatoriamente 54 residentes con limitación para deambular (media 85 años, DE 6,7) a un grupo control (n = 27) y entrenado (n = 27). Se desarrolló un programa de entrenamiento supervisado, mediante Threshold ®IMT, 5 días por semana durante 6 semanas. Las variables principales fueron: la presión inspiratoria máxima (PImáx), la presión espiratoria máxima (PEmáx) y la ventilación voluntaria máxima (MVV), medidas en las semanas 0, 4, 7 y 10.ResultadosLos análisis estadísticos no revelaron cambio en la PImáx (F3,114 = 1,04, p = 0,368, R2 = 0,027), PEmáx (F3,114 = 1,86, p = 0,14, R2 = 0,047) y MVV (F3,114 = 1,74, p = 0,162, R2 = 0,044) entre ambos grupos tras la intervención. No obstante, la carga de trabajo mejoró significativamente con el entrenamiento (F5,100 = 72,031, p < 0,001, R2 = 0,791). Conclusión: El dispositivo de entrenamiento umbral en un programa interválico de 6 semanas no produce una mejora significativa de los parámetros relacionados con la fuerza y la resistencia de la MR, en la población estudiada(AU)

Introduction: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness. The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10.ResultsStatistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p<0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population(AU)