Caracterización de parámetros del intercambio gaseoso en la Ciudad de México / Characterization of gas exchange parameters in Mexico City

Introducción: en las grandes altitudes, el intercambio gaseoso suele estar deteriorado; en la altitud moderada de la Ciudad de México esto no está aún plenamente definido. Objetivo: caracterizar el intercambio gaseoso en la altitud moderada de la Ciudad de México. Material y métodos: mediante un estudio transversal analítico se estudiaron sujetos nacidos y habitantes de la Ciudad de México, de ambos géneros, con edades de 20 a 59 años sin enfermedad cardiopulmonar. Se registraron sus variables demográficas, espirometría simple y de gasometría arterial. Las diferencias en las variables se calcularon con ANOVA de una vía para grupos independientes y ajuste de Bonferroni. Una p < 0.05 se aceptó como significativa. Resultados: se estudiaron 335 sujetos, de los cuales 168 (50.15%) fueron hombres, la edad grupal fue de 45 ± 11 años, con índice de masa corporal 22.97 ± 1.54 Kg/m2. La relación volumen espiratorio forzado en el primer segundo/Capacidad vital forzada (VEF1/CVF) de 91.58 ± 12.86%. La presión arterial de oxígeno fue de 66 ± 5.02 mmHg, el bióxido de carbono: 32.07 ± 2.66 mmHg, la saturación arterial de oxígeno: 93.03 ± 1.80% y la hemoglobina: 14.07 ± 1.52 gr/dL. Conclusiones: la presión arterial de oxígeno y del bióxido de carbono están disminuidos a la altura de la Ciudad de México.

Background: At high altitude the gas exchange is impaired, in the moderate altitude of Mexico City they are not yet defined. Objective: To characterize the gas exchange in the moderate altitude of Mexico City. Material and methods: Through an analytical cross-sectional study, subjects born and inhabitants of Mexico City, both genders, aged 20 to 59 years without cardiopulmonary disease, were studied. Their demographic variables, simple spirometry and arterial blood gas were recorded. Differences in variables were calculated with one-way ANOVA for independent groups and Bonferroni adjustment. p < 0.05 was accepted as significant. Results: 335 subjects were studied, 168 (50.15%) men. Group age 45 ± 11 years old, body mass index 22.97 ± 1.54 Kg/m2. Forced expiratory volume ratio in the first second / Forced vital capacity (FEV1/FVC) 91.58 ± 12.86%. The arterial oxygen pressure was: 66 ± 5.02 mmHg, carbon dioxide: 32.07 ± 2.66 mmHg, arterial oxygen saturation: 93.0 3 ± 1.80%, and hemoglobin: 14.07 ± 1.52 gr/dL. Conclusions: The arterial oxygen pressure and carbon dioxide are lowered at the Mexico City altitude.

Functional performance in the modified shuttle test in children and adolescents with cystic fibrosis / Desempenho funcional no teste modificado de shuttle em crianças e adolescentes com fibrose cística

ABSTRACT Objective: To evaluate factors associated with the performance of children and adolescents with cystic fibrosis (CF) in the Modified Shuttle Test (MST) and compare it with healthy children and adolescents. Methods: This is a cross-sectional study, with children and adolescents divided into two groups: cystic fibrosis (CFG) and control (CG). Variables evaluated in the MST: walking distance, test level, heart rate variation (∆Hr), post-test mean arterial pressure (MAP Pt) and peripheral oxygen saturation variation (∆SPO2). Statistical analysis included Mann Whitney and Spearman coefficient tests, being significant p<0.05. Results: Sixty individuals aged 6-16 years old were evaluated. Anthropometric data was similar between groups. Differences between groups were shown for: baseline heart rate (BHr), peak heart rate (PHr), ∆Hr, recovery heart rate (RHr), post-test respiratory rate (PtBr), saturation variables, peripheral oxygen level (SpO2B) and level test. The ∆Hr and MAP Pt had a moderate positive correlation with distance and level test for both groups (respectively: r=0.6 / p<0.001; r=0.6 / p<0.001). In CFG, the level test had a significant association (r=0.4 - p=0.02) with %FEV1. Conclusions: Children with cystic fibrosis presented functional limitation in the Modified Shuttle Test, which was influenced by lung function.

RESUMO Objetivo: Avaliar os fatores que estão associados ao desempenho de crianças e adolescentes com fibrose cística (FC) no teste modificado de Shuttle (MST) e compará-los com os de crianças e adolescentes saudáveis. Métodos: Estudo de corte transversal com crianças e adolescentes divididos em dois grupos: grupo controle (GC) e grupo FC (GFC). As variáveis avaliadas no MST foram: distância caminhada, nível do teste, variação da frequência cardíaca (∆Fc), pressão arterial média pós-teste (PAMPt) e variação da saturação periférica de oxigênio (∆SpO2). Na análise dos dados, foram utilizados o Teste Mann-Whitney e o coeficiente de Spearman, sendo significante p<0,05. Resultados: Avaliaram-se 60 indivíduos (6-16 anos). Os grupos foram homogêneos em relação aos dados antropométricos. Foi observada diferença significante na frequência cardíaca basal (FcB), na frequência cardíaca de pico (FcP), na ∆Fc, na frequência cardíaca de recuperação (FcR), na frequência respiratória pós-teste (FRPt), na saturação periférica de oxigênio basal (SpO2B) e no nível do teste. A ∆Fc e a PAMPt tiveram correlação moderada positiva (respectivamente, r=0,6 / p<0,001; r=0,6 / p<0,001) com a distância caminhada e o nível do teste em ambos os grupos. No GFC o nível do teste teve associação (r=0,4 / p=0,02) com a porcentagem do predito do volume expiratório forçado do primeiro segundo (%VEF1). Conclusões: Crianças e adolescentes com FC apresentaram limitação funcional no teste modificado de Shuttle, influenciada pela função pulmonar.

Pulmonary function and imaging characteristics of acute exacerbation of chronic obstructive pulmonary disease with elevated eosinophils / 中国医学影像技术

Objective: To explore the characteristic differences of clinical data, inflammatory markers, pulmonary function test, impulse oscillometry system (IOS) and CT parameters of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with peripheral blood eosinophils (EOS) ≥300/μl and those EOS<300/μl, in order to provide strategic guidance for treatment. Methods: A total of 357 AECOPD patients were enrolled, including 41 cases in EOS≥300/μl group (study group) and 316 cases in EOS<300/μl group (control group).Then the clinical indicators, such as inflammation indicators from chronic obstructive pulmonary disease (COPD) assessment test (CAT) score and modified medical research council dyspnea scale (mMRC) assessment, traditional lung functions, IOS indicators, lung volume, emphysema index, emphysema density and other imaging parameters were compared between groups. Results: ①Neutrophils ratio in study group was lower than in control group (64.70% vs 73.00%, P<0.001), while fibrinogen lower (3.59 vs 3.97, P=0.031), C reactive protein lower (3.30 mg/L vs 8.63 mg/L, P=0.012) as well as smoking number lower (25 pack/years vs 40 pack/years, P=0.009) in study group were all lower than those in control group. ②RV/TLC in study group was lower than that in control group (51.91% vs 57.44%, P=0.041), whereas R5 (0.56 vs 0.49, P=0.036) and R5%pred (178.65% vs 155.70%, P=0.027) were higher in study group than those in control group. ③Mean pulmonary emphysema density and PD15 in the whole lung, right lung and left lung in study group were all higher than those in control group (all P<0.05), suggesting that patients in control group had more serious pulmonary parenchymal destruction. Conclusion: AECOPD patients with EOS≥300/μl have more significant pulmonary function impairment due to increased airway resistance, in whom emphysema is less severe than those with EOS<300/μl.

Characterization of Flow Efficiency, Pulsatility, and Respiratory Variability in Different Types of Fontan Circuits Using Quantitative Parameters

PURPOSE: Details on the hemodynamic differences among Fontan operations remain unclear according to respiratory and cardiac cycles. This study was undertaken to investigate hemodynamic characteristics in different types of Fontan circulation by quantification of blood flow with the combined influence of cardiac and respiratory cycles. MATERIALS AND METHODS: Thirty-five patients [10 atriopulmonary connections (APC), 13 lateral tunnels (LT), and 12 extracardiac conduits (ECC)] were evaluated, and parameters were measured in the superior vena cava, inferior vena cava (IVC), hepatic vein (HV), baffles, conduits, and left and right pulmonary artery. Pulsatility index (PIx), respiratory variability index (RVI), net antegrade flow integral (NAFI), and inspiratory/expiratory blood flow (IQ/EQ) were measured by intravascular Doppler echocardiography. RESULTS: The PIx between APC and total cavopulmonary connection (TCPC; LT and ECC) showed significant differences at all interrogation points regardless of respiratory cycles. The PIxs of HVs and IVCs in APC significantly increased, compared with that in LT and ECC, and the RVI between APC and TCPC showed significant differences at all interrogation points (p < 0.05). The NAFI and IQ/EQ between APC and TCPC showed significant differences at some interrogation points (p < 0.05). CONCLUSION: Patients with different types of Fontan circulation show different hemodynamic characteristics in various areas of the Fontan tract, which may lead to different risks causing long-term complications. We believe the novel parameters developed in this study may be used to determine flow characteristics and may serve as a clinical basis of management in patients after Fontan operations.

Efeito do sobrepeso e da obesidade sobre função pulmonar e qualidade de vida de idosos vinculados ao Programa Estratégia da Saúde da Família no município de Cruz Alta­RS / Effect of overweight and obesity on lung function and quality of life in elderly linked to the Family Health Strategy Program in Cruz Alta-RS city

O presente estudo tem por objetivo avaliar o efeito do sobrepeso e da obesidade sobre a função pulmonar (FP) e a qualidade de vida (QV) em idosos vinculados ao Programa Estratégia de Saúde da Família (ESF) em Cruz Alta-RS. Foram avaliados cem idosos, sendo noventa mulheres. A FP foi avaliada através da Capacidade Vital Forçada (CVF), Volume Expiratório Forçado no Primeiro Segundo (VEF1 ) e Pico de Fluxo Expiratório (PFE). O questionário Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) foi utilizado para avaliar a QV. Observaram-se 54 indivíduos com sobrepeso ou obesos. A FP apresentou-se dentro da normalidade. As maiores pontuações de QV foram nos domínios Capacidade Funcional (CF), Estado Geral de Saúde (EGS) e Aspectos Sociais (AS). Os indivíduos com sobrepeso e obesos apresentaram escore inferior nos domínios Vitalidade e AS quando comparado aos eutróficos (p = 0,01 e p = 0,03, respectivamente). Foram encontradas correlações inversas entre IMC e os Domínios Vitalidade (r = -0,23, p = 0,01), AS (r = -0,23, p = 0,01) e AE (r = -0,27, p = 0,01). Conclui-se que os idosos avaliados apresentaram níveis satisfatórios de FP e QV, entretanto o sobrepeso e a obesidade influenciaram negativamente a QV. (AU)

The present study aims to evaluate the influence of overweight and obesity on the pulmonary function (PF), and quality of life (QoL) in elderly people linked to the Family Health Strategy Program in Cruz Alta-RS. We evaluated hundred elderly, ninety women. The PF was measured by forced vital capacity (FVC), forced expiratory volume in the first second (FEV1 ) and peak expiratory flow (PEF). The Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) was used to assess QoL. It was observed 54 people with overweight or obesity. The PF was within the normal range. The higher QL scores were in the Functional Capacity (FC), General Health (EGS), and Social Aspects (SA). The overweight, and obese individuals showed lower scores in the Vitality and SA domains when compared to the eutrophic ones (p = 0.01 and p = 0.03, respectively). There was an inverse correlation between the Pain domain and the PF. Furthermore, inverse correlations were found between BMI and Vitality (r = -0.23, p = 0.01), AS (r = -0.23, p = 0.01) and EA (r = -0.27, p = 0.01) domains. Then, it was conclude that the evaluated subjects presented satisfactory levels of PF and QoL. However, high levels of BMI negatively influence their QoL. (AU)

A murine model of elastase- and cigarette smoke-induced emphysema / Modelo murino de enfisema induzido por instilação de elastase e exposição a fumaça de cigarro

ABSTRACT Objective: To describe a murine model of emphysema induced by a combination of exposure to cigarette smoke (CS) and instillation of porcine pancreatic elastase (PPE). Methods: A total of 38 C57BL/6 mice were randomly divided into four groups: control (one intranasal instillation of 0.9% saline solution); PPE (two intranasal instillations of PPE); CS (CS exposure for 60 days); and CS + PPE (two intranasal instillations of PPE + CS exposure for 60 days). At the end of the experimental protocol, all animals were anesthetized and tracheostomized for calculation of respiratory mechanics parameters. Subsequently, all animals were euthanized and their lungs were removed for measurement of the mean linear intercept (Lm) and determination of the numbers of cells that were immunoreactive to macrophage (MAC)-2 antigen, matrix metalloproteinase (MMP)-12, and glycosylated 91-kDa glycoprotein (gp91phox) in the distal lung parenchyma and peribronchial region. Results: Although there were no differences among the four groups regarding the respiratory mechanics parameters assessed, there was an increase in the Lm in the CS + PPE group. The numbers of MAC-2-positive cells in the peribronchial region and distal lung parenchyma were higher in the CS + PPE group than in the other groups, as were the numbers of cells that were positive for MMP-12 and gp91phox, although only in the distal lung parenchyma. Conclusions: Our model of emphysema induced by a combination of PPE instillation and CS exposure results in a significant degree of parenchymal destruction in a shorter time frame than that employed in other models of CS-induced emphysema, reinforcing the importance of protease-antiprotease imbalance and oxidant-antioxidant imbalance in the pathogenesis of emphysema.

RESUMO Objetivo: Descrever um modelo murino de enfisema induzido por exposição a fumaça de cigarro (FC) e instilação de elastase pancreática porcina (EPP). Métodos: Trinta e oito camundongos C57BL/6 foram aleatoriamente divididos em quatro grupos: controle (uma instilação intranasal de solução salina a 0,9%); EPP (duas instilações intranasais de EPP); FC (exposição a FC durante 60 dias) e FC + EPP (duas instilações intranasais de EPP + exposição a FC durante 60 dias). No fim do protocolo experimental, todos os animais foram anestesiados e traqueostomizados para o cálculo de parâmetros de mecânica respiratória. Em seguida, todos os animais foram sacrificados e seus pulmões foram removidos para a medição da intercepção linear média (Lm) e a determinação do número de células imunorreativas a antígeno macrofágico (MAC)-2, metaloproteinase da matriz (MMP)-12 e glicoproteína glicosilada de 91 kDa (gp91phox) no parênquima pulmonar distal e na região peribrônquica. Resultados: Embora não tenha havido diferenças entre os quatro grupos quanto aos parâmetros de mecânica respiratória avaliados, houve aumento da Lm no grupo FC + EPP. O número de células positivas para MAC-2 na região peribrônquica e no parênquima pulmonar distal foi maior no grupo FC + EPP do que nos outros grupos, assim como o foi o número de células positivas para MMP-12 e gp91phox, porém somente no parênquima pulmonar distal. Conclusões: Nosso modelo de enfisema induzido por instilação de EPP e exposição a FC resulta em um grau significativo de destruição parenquimatosa em um período de tempo menor que o empregado em outros modelos de enfisema induzido por FC, o que reforça a importância do desequilíbrio entre proteases e antiproteases e entre oxidantes e antioxidantes na patogênese do enfisema.

Comparação dos Efeitos Hemodinâmicos e Respiratórios no Uso dos Sistemas de Aspiração Traqueal Aberto e Fechado / Comparison of Hemodynamic and Respiratory Effects in the Use of Open and Closed Tracheal Suctioning Systems

Objetivo do estudo foi comparar o sistema fechado de aspiração (SFA) com o sistema aberto de aspiração (SAA) e, para cada sistema, comparar variáveis hemodinâmicas e respiratórias para cada um dos momentos. Incluídos pacientes adultos, em ventilação mecânica em pós-operatório eletivo. Variáveis registradas pré-coleta, 15 e 30 minutos após a adaptação do SFA, imediatamente, após a oxigenação pós-aspiração com SFA, nos minutos 6, 16, 31 e 61 após aspiração com o SFA. O mesmo processo foi repetido para o SAA. Foram incluídos quarenta pacientes. Quando comparado o momento imediato a pós-oxigenação com o momento 6 minutos após a aspiração foi encontrado aumento da frequência cardíaca (FC) (p = 0,04), diminuição (p= 0,034) com o momento 31 minutos e diminuição (p= 0,032) com o momento 61 minutos. Observou-se que a FC teve diminuição significativa, em todos os momentos analisados após a aspiração, comparando com o momento imediato pós-oxigenação, no SAA. Também foi evidenciado aumento (p=0,03) no valor de volume corrente (VT), quando comparado o momento 31 minutos do SFA com o SAA. Conclusão: Apesar de apresentar alterações significativas, em algumas variáveis, quando comparados os sistemas, as modificações se mantiveram dentro da normalidade e retornaram ao valor basal em uma hora após a aspiração. (AU)

The goal was to compare the closed suction system - CSS to the open suction system - OSS and, for each system, compare hemodynamic and respiratory parameters in different moments. The group was comprised of mechanically ventilated adult patients in pos operatory period. Variables were recorded before CSS adaptation, 15 and 30 minutes after CSS adaptation , immediately after post-oxygenation aspiration with CSS, 6, 16, 31 and 61 minutes after aspiration with CSS. The same process was repeated for the OSS. Forty patients were included. When compared the post-oxygenation increased heart rate was found (p=0,04) to the 6 minutes after CSS, decreased heart rate after 31 minutes (p=0.034) and 61 minutes (p=0,032) after CSS. It was observed that the HR was significantly reduced at all times examined after aspiration, compared to the time immediately post-oxygenation for the OSS. It was also demonstrated an increase (p = 0.03) in the amount of tidal volume (TV), when CSS was compared to the OSS 31 minutes after suction. Despite showing significant changes in some variables, it remained within the normal range and returned to baseline one hour after suction. (AU)

Modulation of the ultradian human nasal cycle by sleep stage and body position / Modulação do ciclo nasal humano ultradiano pelo estágio do sono e a posição corporal

ABSTRACT Objective: The nasal cycle, which is present in a significant number of people, is an ultradian side-to-side rhythm of nasal engorgement associated with cyclic autonomic activity. We studied the nasal cycle during REM/non-REM sleep stages and examined the potentially confounding influence of body position on lateralized nasal airflow. Methods: Left- and right-side nasal airflow was measured in six subjects during an eight-hour sleep period using nasal thermistors. Polysomnography was performed. Simultaneously, body positions were monitored using a video camera in conjunction with infrared lighting. Results: Significantly greater airflow occurred through the right nasal chamber (relative to the left) during periods of REM sleep than during periods of non-REM sleep (p<0.001). Both body position (p < 0.001) and sleep stage (p < 0.001) influenced nasal airflow lateralization. Conclusions: This study demonstrates that the lateralization of nasal airflow and sleep stage are related. Some types of asymmetrical somatosensory stimulation can alter this relationship.

RESUMO Objetivo: O ciclo nasal é um ritmo ultradiano de lado a lado de ingurgitamento associado com o ciclo da atividade autônoma. O objetivo deste estudo foi abordar a questão assim como a relação presente entre o ciclo nasal e os estágios de sono REM/não-REM. Também analisamos a confusão potencial da influência da posição corporal no fluxo de ar nasal. Métodos: Mensuramos o ciclo nasal em seis sujeitos durante um sono de oito horas usando um termistor nasal. Foi realizada uma polissonografia. Simultaneamente, nós monitoramos a posição corporal usando uma câmera de vídeo juntamente com luzes infravermelhas. Resultados: Um fluxo de ar maior ocorreu através da cavidade nasal direita durante as fases de sono REM do que nos períodos de sono não-REM (p < 0,001). Assim como a posição corporal [F(2.2340) = 86,99, p < 0,001] e o estágio de sono [F(1.2340) = 234.82, p < 0,001] influenciaram a lateralização do fluxo de ar nasal. Conclusões: Este estudo evidencia que a lateralização do fluxo de ar nasal e o estágio do sono estão relacionados. Alguns tipos de estimulação somatosensitiva assimétrica podem alterar esta relação.

Larger Testicular Volume Is Independently Associated with Favorable Indices of Lung Function / 결핵및호흡기질환

BACKGROUND: Men with chronic obstructive pulmonary disease, have reduced endogenous testosterone levels, but the relationship between pulmonary function and endogenous testosterone levels, is inconsistent. Testicular volume is a known indicator of endogenous testosterone levels, male fertility, and male potency. In the present study, the authors investigated the relationship, between testicular volume and lung function. METHODS: One hundred and eighty-one South Korean men age 40-70, hospitalized for urological surgery, were retrospectively enrolled, irrespective of the presence of respiratory disease. Study subjects underwent pulmonary function testing, prior to procedures, and testicular volumes were measured by orchidometry. Testosterone levels of patients in blood samples collected between 7 AM and 11 AM, were measured by a direct chemiluminescent immunoassay. RESULTS: The 181 study subjects were divided into two groups, by testicular volume (≥35 mL vs. <35 mL), the larger testes group, had better lung functions (forced vital capacity [FVC]: 3.87±0.65 L vs. 3.66±0.65 L, p=0.037; forced expiratory volume in 1 second [FEV1]: 2.92±0.57 L vs. 2.65±0.61 L, p=0.002; FVC % predicted: 98.2±15.2% vs. 93.8±13.1%, p=0.040; FEV1 % predicted: 105.4±19.5% vs. 95.9±21.2%, p=0.002). In addition, the proportion of patients with a FEV1/FVC of <70%, was lower in the larger testes group. Univariate analysis conducted using linear regression models, revealed that testicular volume was correlated with FVC (r=0.162, p=0.029), FEV1 (r=0.218, p=0.003), FEV1/FVC (r=0.149, p=0.046), and FEV1 % predicted (r=0.178, p=0.017), and multivariate analysis using linear regression models, revealed that testicular volume was a significant predictive factor for FEV1 % predicted (β=0.159, p=0.041). CONCLUSION: Larger testicular volume was independently associated, with favorable indices of lung function. These results suggest that androgens, may contribute to better lung function.

Effect of respiratory motion on radiation dose to the margin of target volume in stereotactic body radiotherapy for lung cancer / 中华放射肿瘤学杂志

Objective To investigate the effect of respiratory motion on inadvertent irradiation dose (ⅡD)to the microscopic disease(MD)and expanding margin of target volume in stereotactic body radiotherapy for lung cancer. Methods Based on the pattern of respiration-induced tumor motion during lung radiotherapy, a probability model of MD entry into or exit from internal target volume(ITV)was established and the theoretical dose to MD was calculated according to the static dose distribution by four-dimensional computed tomography. The experimental dose to MD during respiratory motion was measured using a respiration simulation phantom and optically stimulated luminescence(OSL)and then compared with the theoretical value for model validation.Results For the target volume in periodic motion,the deviation of the theoretical dose to MD from the experimental value measured by OSL was less than 5%. A 10-mm margin around ITV received a biological dose higher than 80 Gy. Conclusions The dose model established in this study can accurately predict the irradiation dose to MD in the target volume in periodic motion. Respiratory motion increases ⅡD to MD and there is no need to expand clinical target volume.

A mecânica da ventilação mecânica / The mechanics of mechanical ventilation

A ventilação mecânica tem representado um grande avanço no suporte respiratório dos pacientes em anestesia ou em tratamento intensivo. O suporte ventilatório aumenta a chance de sobrevida nos pacientes com insuficiência respiratória e/ou grandes procedimentos cirúrgicos. O trabalho consiste em um resumo dos avanços no suporte ventilatório, na descrição dos mecanismos fisiológicos e, principalmente, no funcionamento dos principais modos ventilatórios. Os limites de pressão, volume, PEEP e os conceitos de ventilação segura, estresse e cisalhamento são importantes para o tratamento adequado. Novos modos ventilatórios, apesar de não estarem ainda disponíveis em grande parte das unidades de saúde, também são descritos devido à sua grande importância para a melhor sincronia e menor número de complicações com o uso da ventilação mecânica.

The Ventilator has represented an advance in the respiratory support for patients on anesthesia and intensive care. The ventilatory support increases the chance of survival in patients with respiratory failure, and / or major surgical procedures. This paper consists of a summary of advances in the ventilatory support, in describing the physiological mechanisms and especially the functioning of the main ventilation modalities. The limits of pressure, volume, PEEP, and the concepts of safe ventilation, Stress, Strain, are important for proper treatment. New ventilation modalities, despite not yet available in most health care units, are also described because of its great importance for better sync and fewer complications with the use of mechanical ventilation.

Descritores de dispnéia e percepção de dispnéia crônica nos variados graus de obesidade / Descriptors of dyspnea and perception of dyspnea in varying levels of obesity

JUSTIFICATIVA E OBJETIVO: Embora frequente e importante na prática médica, estudar dispneia permanece um desafio. Os objetivos deste estudo foram verificar os principais descritores de dispneia mencionados por obesos utilizando-os na determinação da percepção de dispneia crônica em diferentes graus de obesidade, e avaliar a influência do excesso de peso. MÉTODOS: Estudo transversal, incluindo 140 pacientes com peso normal e sobrepeso (Grupo Controle) e obesidade graus I, II e III, que foram subdivididos em seis subgrupos. A dispneia crônica foi avaliada utilizando-se os principais descritores de dispneia, na amostra geral e nos subgrupos de obesos. RESULTADOS: A percepção de dispneia na amostra total estudada foi de 57,1% (IC95%: 48,5-65,5) e em cada subgrupo foi: Grupo I: 3,8% (IC95%: 0,1-19,6); Grupo II: 33,3% (IC95%:13,3-59,0); Grupo III: 62,5% (IC95%: 40,6-81,2); Grupo IV: 86,7% (IC95%: 69,3-96,2); Grupo V: 65,2% (IC95%: 42,7-83,6); e Grupo VI: 89,5% (IC95%: 66,9-98,7). Os principais descritores de dispneia foram cansaço no peito (58,7%), fôlego curto (47,5%), dificuldade de respirar (36,2%), falta de ar (31,2%) e respiração rápida (17,5%), com diferenças significativas entre os grupos (p<0,0001 e p<0,002, respectivamente). CONCLUSÃO: Observou-se elevada prevalência da percepção de dispneia em todos os graus de obesidade, com aumentos progressivos à medida que se elevou o índice de massa corporal, principalmente em obesos mórbidos. A utilização dos descritores de dispneia na investigação de dispneia crônica em obesos é útil, e os principais descritores de dispneia relatados foram cansaço no peito, fôlego curto e dificuldade de respirar...

BACKGROUND AND OBJECTIVE: Despiteits frequency and importance in medical practice, the study of dyspnea remains a challenge. The objective of this study was to verify the main descriptors of dyspnea mentioned by the obese, and use them to determine the perception of chronic dyspnea in varying levels of obesity, and to evaluate the influence of excess weight. METHODS: Cross-sectional study including 140 patients with normal weight and overweight (control group) and obesity grades I, II and III, who were subdivided into six subgroups. Chronic dyspnea was evaluated using the main descriptors of dyspnea in the overall sample and in the subgroups of the obese. RESULTS: The perception of dyspnea in the total sample studied was 57.1% (95%CI: 48.5-65.5); and in each group was: Group I: 3.8% (95%CI: 0.1-19, 6); GroupII: 33.3% (95%CI: 13.3-59.0); Group III: 62.5% (95% CI:40.6-81.2); Group IV: 86.7% (95% CI: 69.3-96.2); Group V:65.2% (95%CI: 42.7-83.6); Group VI: 89.5% (95%CI: 66.9-98.7). The main descriptors of dyspnea were chest tiredness (58.7%), shortness of breath (47.5%), difficulty to breathe (36.2%), breathlessness (31.2%), rapid breathing (17.5%), with significant differences between groups (p<0.0001 and p<0.002, respectively). CONCLUSION: We observed a high prevalence of perception of dyspnea in all levels of obesity, with progressive increases as body mass index rises - especially in morbidly obese patients. The use of descriptors of dyspnea in the investigation of chronic dyspnea in obese individuals is useful, and the main descriptors of dyspnea were chest tiredness, shortness of breathand difficulty to breathe...

Estatus ponderal y aptitud cardiorrespiratoria en escolares de la región central del Perú / Weight status and cardiorespiratory fitness in school students in the central region of Peru

Objetivos. Determinar la frecuencia del sobrepeso y obesidad, en función a los niveles de aptitud cardiorrespiratoria (AptCR) en escolares de cuatro distritos de la región central del Perú, y analizar la asociación entre estas variables. Materiales y métodos. El peso, altura y la AptCR fueron evaluados en 7841 escolares que residen en cuatro distritos ubicados en la costa, sierra y selva de la región central del Perú. El sobrepeso y la obesidad fueron clasificados según los criterios propuestos por Cole. La AptCR fue evaluada mediante la prueba de correr/caminar de doce minutos de la batería de la American Alliance for Health, Recreation and Dance. Se utilizó el ANOVA y la regresión logística para examinar las diferencias de las medias y asociaciones entre estas variables. Resultados. Escolares de ambos sexos presentan frecuencias semejantes de sobrepeso y obesidad (20,9% en mujeres y 20,1% en varones). Residentes en la costa (Barranco) manifiestan elevadas frecuencias de sobrepeso y obesidad (37,8%). La edad, el sexo, área geográfica y la AptCR fueron predictores significativos para el sobrepeso y la obesidad. Escolares que viven en Barranco tienen cinco veces más probabilidades de ser obesos (OR=4,67; IC95%: 3,55-6,14); los que residen en la sierra (Junín) tienen una menor probabilidad de ser obesos (OR=0,03; IC95%: 0,01-0,20); y quienes muestran una baja AptCR tienen una mayor probabilidad de ser obesos (OR=11 ,82; IC95%: 7,25-19,27), en comparación con aquellos con alta AptCR. Conclusiones. Los escolares que residen en Barranco presentan frecuencias de sobrepeso y obesidad elevados. Una baja AptCR está asociada al desarrollo del sobrepeso y la obesidad.

Objectives. To determine the frequency of overweight and obesity in relation to cardiorespiratory fitness (CRF) levels in school students in 4 districts of the central region of Peru, and to analyze the relations among these variables. Materials and methods. Weight, height and CRF were evaluated in 7841 school students who reside in four districts located on the coast, in the highlands and in the jungle of the central region of the country. Overweight and obesity were classified according to the criteria proposed by Cole. CRF was evaluated by a 12-minute run/walk test taken from the American Alliance for Health, Physical Education, Recreation and Dance’s test battery. ANOVA and logistic regression were used to examine the differences of the averages and the associations among these variables. Results. Both male and female school students have similar frequency of overweight and obesity (20.9% in women and 20.1% in men). Residents of the coast (Barranco) presen thigh frequency of overweight and obesity (37.8%). Age, sex, geographical area and CRF were significant predictors of overweight and obesity. School students who live in Barranco are five times more likely to be obese (OR=4.67; CI95%: 3.55-6.14), while those who reside in the highlands (Junin) are less likely to be obese (OR=0.03; CI95%: 0.01-0.20). Furthermore, in contrast with students with high CRF, those with low CRF are more likely to be obese (OR=11.82; CI95%: 7.25-19.27). Conclusions. There was a high frequency of overweight and obesity among school students who reside in Barranco. Low CRF is associated with overweight and obesity.