Respiratory inductive plethysmography: a comparative study between isovolume maneuver calibration and qualitative diagnostic calibration in healthy volunteers assessed in different positions

Objective: To compare two methods of respiratory inductive plethysmography (RIP) calibration in three different positions. Methods: We evaluated 28 healthy subjects (18 women and 10 men), with a mean age of 25.4 +/- 3.9 years. For all of the subjects, isovolume maneuver calibration (ISOCAL) and qualitative diagnostic calibration (QDC) were used in the orthostatic, sitting, and supine positions. In order to evaluate the concordance between the two calibration methods, we used ANOVA and Bland-Altman plots. Results: The values of the constant of proportionality (X) were significantly different between ISOCAL and QDC in the three positions evaluated: 1.6 +/- 0.5 vs. 2.0 +/- 1.2, in the supine position, 2.5 +/- 0.8 vs. 0.6 +/- 0.3 in the sitting position, and 2.0 +/- 0.8 vs. 0.6 +/- 0.3 in the orthostatic position (p < 0.05 for all). Conclusions: Our results suggest that QDC is an inaccurate method for the calibration of RIP. The K values obtained with ISOCAL reveal that RIP should be calibrated for each position evaluated

Desenvolvimento de um recurso didático multimídia para o ensino de higiene brônquica

As novas tecnologias da informação têm sido amplamente utilizadas no ensino em saúde. No entanto, não há descrição na literatura do desenvolvimento de recurso multimídia para o ensino de fisioterapia respiratória. O objetivo deste trabalho foi desenvolver material didático multimídia para o ensino de manobras de higiene brônquica (MHB) disponibilizado na internet. O material elaborado foi dividido em três módulos: Princípios fisiológicos, Fisiopatologia e MHB. O material foi disponibilizado em diversos formatos (páginas on-line, apostila e recursos audiovisuais) e inserido no sítio da internet Ambiente Colaborativo de Aprendizagem. A página on-line de introdução contém links para acesso aleatório aos módulos e um link para acesso à apostila. No módulo Princípios fisiológicos há links para informações sobre o aparelho mucociliar, produção do muco e fatores prejudiciais à defesa pulmonar. No módulo Fisiopatologia há links para informações sobre as principais doenças ou condições causadoras de hipersecreção pulmonar. No módulo MHB há links para informações sobre as manobras e para vídeos. Este recurso didático multimídia para o ensino de MHB, disponibilizado na internet, pode facilitar o aprendizado em fisioterapia respiratória. Entretanto, há necessidade de se avaliar sua efetividade.Advances in information technology have been widely used in teaching health care providers. However, no reports were found on its use in the instruction on respiratory therapy. The purpose here was to develop audiovisual supporting material for teaching bronchial hygiene techniques (BHT) available through the internet. The material was organized into three modules: Physiological principles, Physiopathology, and BHT. Each module is available in several formats (online page, booklet and audiovisual resources) and is inserted in a collaborative learning environment at the internet. The opening online page has links for random access to the modules and to the booklet. The Physiological principles module has links to information on the mucociliary system, mucous formation and factors that affect the defence mechanisms. The Physiopathology module has links to access information on diseases that lead to hypersecretion. The BHT module has links to access information on techniques and videos. This multimedia material for teaching BHT, available through the internet, may ease respiratory therapy learning. However, an evaluation of its effectiveness is needed

Efeito da continuidade da fisioterapia respiratória até a alta hospitalar na incidência de complicações pulmonares após esofagectomia por câncer

This study assessed the effects of chest physical therapy all through hospital stay until discharge onto the incidence of pulmonary complications in patients having undergone esophagectomy for cancer. Medical records of esophagectomy patients were examined and 40 subsequent ones selected (none excluded), and divided into two groups: one having received chest physiotherapy only in the intensive care unit (ICUg, n=20) and the other having received it during full hospital stay (DISg, n=20). Information concerning pre-, peri- and postoperative periods were drawn from patients' records. Results show that ICUg and DISg were similar (mean±sd) concerning age (55.5±9.9 vs 57.1±10.8 years old), BMI (22.5±3.3 vs 18±4 kg/m²), operating time (400±103.8 vs 408.5±142 min), anesthesia time (498.3±107.3 vs 516±148.9 min) and number of chest physical therapy sessions in the ICU (9.6±14.9 vs 8.3±7.6 sessions). Despite the fact that DISg patients had higher tobacco consumption than ICUg ones (35.7±17.6 vs 26.1±18.4 packs-year, pO presente estudo avaliou os efeitos na incidência de complicações pulmonares do cuidado contínuo de fisioterapia respiratória no pós-operatório de esofagectomia, até a alta hospitalar. Examinaram-se retrospectivamente 40 prontuários de pacientes de esofagectomia consecutivos (nenhuma exclusão), que foram divididos em dois grupos: um dos que receberam fisioterapia respiratória apenas na unidade de tratamento intensivo (gUTI, n=20) e outro dos que a receberam até a alta hospitalar (gALTA, n=20). Foram coletadas informações referentes ao pré, intra e pós-operatório. Os resultados mostram que gUTI e gALTA, respectivamente, apresentaram-se similares (média±dp) quanto a idade (55,5±9,9 e 57,1±10,8 anos), IMC (22,5±3,3 e 18±4 kg/m²), tempo de cirurgia (400±103,8 e 408,5±142 min), tempo de anestesia (498,3±107,3 e 516±148,9 min) e número de atendimentos de fisioterapia na UTI (9,6±14,9 e 8,3±7,6). Apesar de o gALTA apresentar história de tabagismo superior (35,7±17,6 vs 26,1±18,4 maços-ano,

Effects of creatine oral supplementation on the hepatic metabolism and morphology of rats

A creatina é uma amina nitrogenada e tem sido utilizada principalmente por atletas e praticantes de atividade física que desejam aumentar a massa muscular e o desempenho físico. Entretanto seu uso não está somente relacionado à prática esportiva, pois inúmeros trabalhos apresentam efeitos benéficos na prática médica. Alguns estudos demonstraram que a suplementação oral com creatina resulta em aumento da sua biodisponibilidade plasmática e também de seus estoques em inúmeros órgãos. Entretanto, estudos sobre possíveis efeitos tóxicos da suplementação com creatina são escassos. Portanto, o objetivo deste trabalho foi avaliar os possíveis efeitos tóxicos da suplementação oral com creatina sobre a função e morfologia hepáticas em ratos após 14 dias de suplementação oral com creatina na dose de 0.5 g/kg/dia. A função hepática foi avaliada através de testes bioquímicos e a estrutura hepática foi avaliada através da massa hepática relativa e da análise histológica. Os resultados demonstraram que 14 dias de suplementação com creatina não alteraram a função hepática quando comparado os grupos controle e suplementado: AST (39.5 x 44.4 U/L), ALT (18.6 x 30.8 U/L), ALP (38.5 x 31.4 U/L), GGT (134.8 x 143.8 U/L), proteínas totais (5.1 x 5.5 g/dl), triglicérides (141.0 x 141.0 mg/dl), colesterol total (130.1 x 126.2 mg/dl), colesterol LDL (36.1 x 36.1 mg/dl), colesterol HDL (65.6 x 62.4 mg/dl), colesterol VLDL (25.0 x 28.0 mg/dl), e também estrutura hepática, exceto nos níveis plasmáticos de albumina (3.0 x 3.5 mg/dl - p<0.02). Nossos resultados demonstraram claramente que, ao menos na dose utilizada, a suplementação oral com creatina não induziu a nenhum tipo de efeito tóxico sobre o fígado.Creatine is a nitrogenated amine and it has been used mainly by athletes and physical activity practitioners who wish to increase muscle mass and performance. However its use is not just related to sports practice, once several studies have shown beneficial effects on medical practice. Some studies have demonstrated that oral creatine supplementation increases its plasmatic bioavailability and also its concentration in several organs. However, studies about the possible toxic effects followed by creatine supplementation are scarce. Therefore, the aim of this work was to evaluate the hepatic structure and function in rats after 14 days of oral creatine supplementation at dose of 0.5g/kg/day. The hepatic function was evaluated through biochemical assays and the hepatic structure was analyzed through the relative hepatic mass and histological analysis. The results showed that 14 days of creatine supplementation did not alter the hepatic function and structure when compared with the control and supplemented groups, AST (39.5 x 44.4 U/L), ALT (18.6 x 30.8 U/L), ALP (38.5 x 31.4 U/L), GGT (134.8 x 143.8 U/L), total proteins (5.1 x 5.5 g/dl), triglycerides (141.0 x 141.0 mg/dl), total cholesterol (130.1 x 126.2 mg/dl), LDL cholesterol (36.1 x 36.1 mg/dl), HDL cholesterol (65.6 x 62.4 mg/dl), VLDL cholesterol (25.0 x 28.0 mg/dl), and also the hepatic structure, except for the albumin plasmatic levels (3.0 x 3.5 mg/dl - p<0.02). Our results clearly demonstrated that, at least at the used dosage, oral creatine supplementation did not induce any toxic effect on the liver

Efeito da estimulação elétrica nervosa transcutânea no tratamento da dor no ombro de pacientes com doença renal crônica: relato de casos

Chronic kidney disease (CKD) may bring about several clinical complications associated to long-term dialysis. Amyloidosis is one of such complications and may lead to shoulder pain, common among CKD patients, for which no studies could be found in literature on the use of transcutaneous electrical nerve stimulation (TENS) - only surgical and medicine treatments are reported. The purpose here was to assess benefits of TENS in treating shoulder pain due to amyloidosis in patients with CKD. Two female patients were assessed four times in a three-month period. At the initial evaluation, patients were guided as to its use and given a TENS device for use at home (10 Hz, 150 µs, twice a day, for 40 minutes) for three months. Pain was assessed by means of a visual analog scale and of the Wisconsin brief pain questionnaire. Results show that TENS reduced shoulder pain in both patients. Treatment with TENS may hence be effective in reducing shoulder pain in patients with CKD.A doença renal crônica (DRC) pode causar muitas complicações clínicas associadas ao tempo de diálise. A amiloidose é uma dessas complicações e pode levar à dor no ombro, comum em pacientes com DRC. Só foram encontrados na literatura relatos de tratamento cirúrgico e/ou medicamentoso para esse tipo de dor. O objetivo aqui foi avaliar o benefício da estimulação elétrica nervosa transcutânea (TENS) no tratamento da dor no ombro devida à amiloidose em pacientes com DRC. Duas pacientes foram avaliadas quatro vezes num período de três meses. Na avaliação inicial as pacientes foram orientadas e receberam um aparelho de TENS para uso domiciliar (10Hz, 150 µs, duas vezes por dia, por 40 minutos) durante três meses. A dor foi avaliada utilizando-se uma escala visual analógica e o questionário de dor de Wisconsin. Os resultados mostram que o tratamento com TENS reduziu a dor no ombro em ambas as pacientes. O tratamento com a TENS pode pois ser eficaz em reduzir a dor no ombro em pacientes com DRC

Occurrence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age

Objective: To determine the prevalence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age, as well as to assess the awareness of asthma and asthma management among these swimmers, their parents, and their coaches. Methods: Our sample comprised 1,116 amateur swimmers who completed a modified version of the International Study of Asthma and Allergies in Childhood written questionnaire, to which questions regarding the reasons to initiate swimming and regarding asthma management had been added. In addition, the participants underwent spirometry prior to a swimming competition. Results: The prevalence of asthma symptoms in the last 12 months was 11.5%, and 327 (29.4%) of the participants reported "wheezing or whistling" in the past. Of the 223 swimmers who reported "asthma ever" or "bronchitis ever", only 102 (45.7%) reported having ever been treated: the most common "treatment" was swimming (in 37.3%), and only 12.7% used inhaled corticosteroids. Of the 254 participants (22.7%) with airflow obstruction, only 52 (20.5%) reported having asthma symptoms. Conclusions: Asthma symptoms are present in amateur swimmers, and a considerable number of such swimmers have airflow obstruction without symptoms. It is therefore likely that the prevalence of asthma is underestimated in this population. It is worrisome that, in our study sample, the swimmers previously diagnosed with asthma were not using the recommended treatments for asthma. The clinical implications of these findings underscore the importance of implementing educational measures for amateur swimmers, as well as for their parents and coaches, to help them recognize asthma symptoms and the consequent risks in the sports environment, in order to allow prompt diagnosis and early clinical intervention.Novartis S.A.Novartis S.A

Effect of clinical treatment of a long distance runner presenting exercise-induced bronchoespasm: a case report

O broncoespasmo induzido pelo exercício (BIE) é uma condição que se caracteriza pelo estreitamento transitório das vias aéreas durante ou após o esforço físico e afeta principalmente portadores de asma. Em atletas profissionais que praticam esportes de alta intensidade, a prevalência também é alta; no entanto, seu diagnóstico permanece subestimado. O presente estudo descreve o caso de um atleta do sexo masculino, 23 anos, corredor de longa distância sem histórico de asma, que após um teste gradual de exercício apresentou chiado no peito e queda da função pulmonar. Após um teste específico, o atleta foi diagnosticado como BIE positivo. Iniciou-se, então, um tratamento clínico com broncodilatador e após 30 dias verificou-se melhora importante em seu consumo máximo de oxigênio, obtido no pico do esforço (VO2 pico).Exercise induced bronchoconstriction (EIB) is characterized by a transient airway constriction during or after vigorous physical activity. This clinical condition is more prevalent in asthmatic patients. The prevalence of EIB in competitive athletes is high; however, EIB is under-diagnosed in this specific athlete population. The present study described a case report of a male 23 year-old long distance runner who, despite not presenting previous asthma history, presented chest squeak and decline on spirometric performance after a cardiopulmonary exercise testing. After specific testing, the athlete was diagnosed as positive EIB. A clinical treatment with bronchodilator was then initiated and after 30 days an important increase in his oxygen uptake peak (VO2peak) was observed

Walking training improves ambulatory blood pressure variability in claudication

Background: Walking training (WT) improves walking capacity and reduces clinic blood pressure (BP) in patients with peripheral artery disease (PAD), but its effects on ambulatory BP remains unknown. Objectives: To investigate the effect of 12 weeks of WT on ambulatory BP and its variability in patients with PAD. Methods: Thirty-five male patients with PAD and claudication symptoms were randomly allocated into two groups: control (n = 16, 30 min of stretching) and WT (n = 19, 15 bouts of 2 min of walking at the heart rate of leg pain threshold interspersed by 2 min of upright rest). Before and after 12 weeks, 24-hour ambulatory BP was assessed. Ambulatory BP variability indices assessed at both time points included the 24-hour standard deviation (SD24), the awake and asleep weighted standard deviation (SDdn), and the 24-hour average real variability (ARV24). Data were analyzed by mixed two-way ANOVAs, considering P<0.05 as significant. Results: After 12 weeks, neither group had significant changes in 24-hour, awake and sleep BPs. The WT decreased systolic and mean BP variabilities (Systolic BP – 13.3±2.8 vs 11.8±2.3, 12.1±2.84 vs 10.7±2.5 and 9.4±2.3 vs 8.8±2.2 mmHg); Mean BP – 11.0±1.7 vs 10.4±1.9, 10.1±1.6 vs 9.1±1.7 and 8.0.±1.7 vs 7.2±1.5 mmHg for SD24, SDdn and ARV24, respectively). Neither group had significant changes in diastolic BP variabilities after 12 weeks. Conclusion: The WT does not change ambulatory BP levels but decreases ambulatory BP variability in patients with PAD. This improvement may have a favorable impact on the cardiovascular risk of patients with symptomatic PAD