Reference values for inspiratory muscle related indexes of preschool children in Nanjing / 中国儿童保健杂志

【Objective】 To generate reference values for inspiratory muscle of preschool children in Nanjing, so as to provide a reference index for evaluating children′s lung function and exercise performance. 【Methods】 A total of 236 preschool children were selected from the main urban area of Nanjing by stratified cluster sampling.The inspiratory muscles were evaluated by breath link respiratory function evaluation system to obtain the maximum inspiratory pressure (MIP) and inspiratory peak flow rate.Pearson analysis was used to determine the correlation of MIP and inspiratory peak flow rate with gender, age, height and weight.Multiple linear stepwise regression analysis was used to obtain the formula of MIP and inspiratory peak flow rate. 【Results】 Differences in MIP and peak inspiratory flow rate were not significant between boys and girls (P>0.05), but were statistically significant among different age groups and showed an increasing trend with age (F=13.660, 33.581, P<0.001).MIP and peak inspiratory flow rate were positively correlated with children′s age, height and weight (P<0.001).The regression model, proved to be statistically significant(F=12.913、22.398, P<0.08), indicated that height was the best predictor of MIP and age was the best predictor of inspiratory peak flow rate. 【Conclusions】 This study is the first study on the predicted value of inspiratory muscle in preschool children in China.The predicted value formula can provide a reference for clinical inspiratory muscle evaluation.

Using a peak flow meter to assess severity of exacerbation in patients suffering from chronic obstructive pulmonary disease: a prospective observational study

Background: Chronic obstructive pulmonary disease (COPD) is an important and dangerous public health concern, and deaths due to it has become the leading cause of mortality in several countries. Exacerbations of the disease are very common and is frequently responsible for progressive decline in lung function, quality of life and ultimately death. Through this study, we hypothesize whether estimating peak expiratory flow rate (PEFR) using a simple peak flowmeter could help in early prediction of the intensity and severity of exacerbations of COPD. Methods: This study was conducted amongst 100 patients, at Amrita Institute of Medical Sciences, Kochi, Kerala, who were diagnosed with COPD, based on GOLD criteria and respective pulmonary function tests. Their PEFR and oxygen saturation values were recorded during their routine clinic visits and during an exacerbation episode and results were analyzed. Results: Out of 100 patients, 91 were males and 9 were female patients, with a mean age of 64.4 years and commonest age affected is 55 years. Average duration of COPD amongst the study participants ranged from 4 to 11 years with a mean of 7.19 years. PEFR was graded into 3 zones based on guidelines and measurements noted. Of the 76 male patients with 80-100% PEFR recordings, 10 (13.15%) had a drop to 50-80% PEFR and 66 (86.85%) of them dropped to <50% PEFR reading during an exacerbation. For the female subjects, of the 9 patients with 80-100% of expected PEFR, 3 (33.33%) had dropped to 50-80% and 6 (66.69%) had dropped to <50% of PEFR reading. SpO2 had significant change at exacerbations as compared during normal phase dropping with mean of 94.82 to 81.3 which was statistically significant across age and gender. Wilcoxon signed rank test was done to quantify statistical change showed z score of -9.138 with p<0.0001, which was significant across age and gender groups. Conclusions: As a simple, inexpensive tool, peak flowmeter could be useful for bedside monitoring of severity of exacerbation of COPD. This could be vital for early detection and appropriate medical intervention.

Using a peak flow meter to assess severity of exacerbation in patients suffering from chronic obstructive pulmonary disease: a prospective observational study

Background: Chronic obstructive pulmonary disease (COPD) is an important and dangerous public health concern, and deaths due to it has become the leading cause of mortality in several countries. Exacerbations of the disease are very common and is frequently responsible for progressive decline in lung function, quality of life and ultimately death. Through this study, we hypothesize whether estimating peak expiratory flow rate (PEFR) using a simple peak flowmeter could help in early prediction of the intensity and severity of exacerbations of COPD. Methods: This study was conducted amongst 100 patients, at Amrita Institute of Medical Sciences, Kochi, Kerala, who were diagnosed with COPD, based on GOLD criteria and respective pulmonary function tests. Their PEFR and oxygen saturation values were recorded during their routine clinic visits and during an exacerbation episode and results were analyzed. Results: Out of 100 patients, 91 were males and 9 were female patients, with a mean age of 64.4 years and commonest age affected is 55 years. Average duration of COPD amongst the study participants ranged from 4 to 11 years with a mean of 7.19 years. PEFR was graded into 3 zones based on guidelines and measurements noted. Of the 76 male patients with 80-100% PEFR recordings, 10 (13.15%) had a drop to 50-80% PEFR and 66 (86.85%) of them dropped to <50% PEFR reading during an exacerbation. For the female subjects, of the 9 patients with 80-100% of expected PEFR, 3 (33.33%) had dropped to 50-80% and 6 (66.69%) had dropped to <50% of PEFR reading. SpO2 had significant change at exacerbations as compared during normal phase dropping with mean of 94.82 to 81.3 which was statistically significant across age and gender. Wilcoxon signed rank test was done to quantify statistical change showed z score of -9.138 with p<0.0001, which was significant across age and gender groups. Conclusions: As a simple, inexpensive tool, peak flowmeter could be useful for bedside monitoring of severity of exacerbation of COPD. This could be vital for early detection and appropriate medical intervention.

Equações adimensionais para determinação de vazões máximas para diferentes tempos de retorno em regiões semiáridas / Dimensionless equations for determination of peak flows for different return times in semiarid regions

RESUMO Na concepção de obras hidráulicas, como as barragens, necessita-se, para um dimensionamento seguro, de estudos referentes às vazões máximas. O estado do Ceará é caracterizado por apresentar um número elevado de reservatórios projetados por equações empíricas antigas. Entretanto, devido aos poucos dados existentes em algumas regiões, necessita-se transpor informações das regiões monitoradas para as não monitoradas. Este trabalho elaborou modelos de regionalização para a obtenção de vazões máximas para períodos de retorno de 1.000 e 10.000 anos em barragens localizadas no Ceará. As variáveis empregadas nas equações foram: área de drenagem da bacia, comprimento do rio principal, tempo de concentração, precipitação com duração de uma hora e diferença de cota entre o exultório e o ponto mais remoto da bacia. Utilizaram-se os dados de projeto de 30 barragens e calcularam-se as vazões máximas por meio do software HEC-HMS. Os testes estatísticos e os valores dos coeficientes de determinação (0,95) permitem considerar as equações adimensionais propostas consistentes e passíveis de serem utilizadas em análises preliminares de projetos hidráulicos.

ABSTRACT In the design of hydraulic works, such as dams, studies referring to the peak flow rates are required for safe dimensioning. The state of Ceará is characterized by having a high number of reservoirs designed by ancient empirical equations. However, due to the limited data available in some regions, it is necessary to transpose information from monitored regions to unmonitored ones. This work elaborated regionalization models to obtain peak flows for return periods of 1,000 and 10,000 years in dams located in Ceará. The variables used in the equations were: drainage area of the basin, length of the main river, concentration time, rainfall lasting 1 hour, and the difference in elevation between the basin and the most remote point of the basin. Project data from 30 dams were used and the peak flows were calculated using the HEC-HMS software. The statistical tests and the values of the determination coefficients (0.95) allow to consider the proposed dimensionless equations consistent and capable of being used in preliminary analyzes of hydraulic projects.

Calibração do modelo hidrológico SWMM para a bacia do ribeirão vai e volta — Poços de Caldas, Minas Gerais / Calibration of SWMM's hydrological model for the watershed vai e volta stream — Poços de Caldas, Minas Gerais

RESUMO A impermeabilização de áreas em centros urbanos, resultante do processo de ocupação desordenada do solo, contribui para o aumento e a aceleração do escoamento superficial e, consequentemente, para a ocorrência de enchentes e inundações em bacias urbanas. Nesse contexto, atualmente, modelos hidrológicos vêm sendo empregados no desenvolvimento de políticas públicas de gestão das águas urbanas, com vistas à drenagem urbana sustentável. O presente trabalho teve como objetivo usar um modelo hidrológico para a bacia do ribeirão Vai e Volta, localizada no município de Poços de Caldas, Minas Gerais, para simular o hidrograma de cheia em um canal urbano. Utilizou-se o software Storm Water Management Model (SWMM) calibrando o modelo a dados de chuva e vazão medidos. Realizou-se a calibração manual do modelo para dois eventos de precipitação com a obtenção do coeficiente de eficiência de Nash-Sutcliffe (NSE) médio de 0,73 e erros da vazão de pico e do volume escoado inferiores a 15%. O modelo foi validado para outros três eventos distintos e obteve-se ajuste NSE médio de 0,79 e erros da vazão de pico e do volume escoado inferiores a 5%.

ABSTRACT The waterproofing of areas in urban centers, resulting from the disorderly occupation of the soil, contributes to increase and accelerate the runoff and, consequently, to the occurrence of floods and inundation in urban watersheds. In this context, hydrological models are currently being used in the development of public policies for urban water management, related to sustainable urban drainage. The present work aimed to use a hydrological model for the watershed of the Vai e Volta stream, located in the city of Poços de Caldas, Minas Gerais, to simulate the flood hydrograph in an urban open channel. The Storm Water Management Model (SWMM) software was used, calibrating the model to measured rainfall and flow data. The model was manually calibrated for two rainfall events with an average Nash-Sutcliffe coefficient (NSE) of 0.73 and errors in peak flow and runoff volume below 15%. The model was validated for three other distinct events and an average NSE adjustment of 0.79 was obtained and errors in peak flow and runoff volume below 5%.

Evaluación de la función respiratoria en pacientes con patologías neuromusculares / Evaluation of Respiratory Function in Patients with Neuromuscular Diseases

Introducción: La Enfermedades Neuromusculares se caracterizan por la pérdida progresiva de la fuerza muscular, la morbi-mortalidad aumenta con la exageración de la debilidad muscular determinando mayor riesgo de complicaciones respiratorias. Es de suma importancia evaluar e interpretar adecuadamente la función pulmonar y ventilatoria para poder realizar intervenciones que pueda prevenir dichas complicaciones. Objetivos: El objetivo del estudio fue reportar el estado funcional respiratorio de un grupo de pacientes con ENM en control ambulatorio y relacionar estos hallazgos con umbrales clínicamente relevantes de complicaciones respiratorias, reforzando intervenciones basadas en opiniones de expertos. Materiales y métodos: Se realizó un estudio Descriptivo-Observacional de corte transversal, donde fueron evaluados en forma ambulatoria, de marzo del 2017 a agosto del 2018, 30 niños y adolescentes con enfermedades neuromusculares. Resultados: El 46% del total de pacientes presenta capacidad tusígena no funcional con alto riesgo de complicaciones. No obstante, sólo el 10% del total de pacientes fueron aptos para realizar adecuadamente estudios de espirometría. Durante las pruebas espirométricas, sólo el 50% de los pacientes logró mantener 6 segundos la espiración. Conclusión: Si bien la espirometría es la principal prueba de función pulmonar y una alta proporción de pacientes presentó alteraciones en su morfología, su realización en estados avanzados de enfermedad fue poco factible. Para detectar umbrales de complicaciones respiratorias graves, la medición del flujo generado durante la tos resultó mejor. Conclusión: Si bien la espirometría es la principal prueba de función pulmonar y una alta proporción de pacientes presentó alteraciones en su morfología, su realización en estados avanzados de enfermedad fue poco factible. Para detectar umbrales de complicaciones respiratorias graves, la medición del flujo generado durante la tos resultó mejor.

Introduction: Neuromuscular Diseases are characterized by the progressive loss of muscle mass, morbidity and mortality increases with the progress of muscle weakness due to the increased risk of respiratory complications, so it is very important to properly evaluate and interpret the measurements of lung functions and ventilation to be able to carry out a specific treatment that can reduce respiratory complications. Objectives: The purpose of this work is to present the results of the measurements of flows, volumes, respiratory capacities and spirometric patterns in outpatients with neuromuscular diseases and to verify their usefulness to detect vital risks. Materials and methods: A cross-sectional Descriptive-Observational study was carried out, where 30 children and adolescents with neuromuscular diseases were evaluated on an outpatient basis, from March 2017 to August 2018. Results: 46% of all patients presented a non-functional cough with a high risk of complications and only 10% of all patients were eligible for spirometry studies. During the spirometric tests, 50% of the patients managed to maintain expiration for 6 seconds. In 70% of the patients, abnormalities in the Flow-Volume curve could be detected. Conclusion: Although spirometry is the main pulmonary function test, its usefulness and efficacy in neuromuscular diseases depends on the findings of specific alterations in the morphology of the flow-volume curve, which in many cases are not possible to distinguish.

Cuidados respiratorios de los pacientes con atrofia muscular espinal / Respiratory care approach for patients with spinal muscular atrophy

Spinal Muscular Atrophy (SMA) is a disease of the anterior horn of the spinal cord, which causes muscle weakness that leads to a progressive decrease in vital capacity and diminished cough flows. Respiratory morbidity and mortality are a function of the degree of respiratory and bulbar-innervated muscle. The former can be quantitated by the sequential evaluation of vital capacity to determine the lifetime maximum (plateau) and its subsequent rate of decline, progressing to ventilatory failure. SMA types 1 and 2 benefit from non-invasive respiratory care in early childhood and school age, improving quality and life expectancy. This document synthesizes these recommendations with special reference to interventions guided by stages that include air stacking, assisted cough protocols, preparation for spinal arthrodesis and non-invasive ventilatory support, even in those patients with loss of respiratory autonomy, minimizing the risk tracheostomy. Failure to consider these recommendations in the regular assessment of patients reduces the offer of timely treatments.

La Atrofia Muscular Espinal (AME) es una enfermedad genética del asta anterior de la medula espinal, que cursa con debilidad muscular progresiva. La intensidad y precocidad de la debilidad muscular presenta diferentes grados de afectación de los grupos musculares respiratorios, determinando la meseta en la capacidad vital y progresión a la insuficiencia ventilatoria, como también el compromiso de los músculos inervados bulbares. Los AME tipo 1 y 2, se benefician con cuidados respiratorios no invasivos en la infancia temprana y edad escolar, mejorando la calidad y esperanza de vida. Este documento sintetiza dichas recomendaciones, con especial referencia a intervenciones guiadas por etapas, que incluyan apilamiento de aire, protocolos de tos asistida, preparación para la artrodesis de columna y soporte ventilatorio no invasivo, incluso en aquellos pacientes con pérdida de la autonomía respiratoria, minimizando el riesgo de traqueostomía. La no consideración de estas recomendaciones en la valoración regular de los pacientes resta la oferta de tratamientos oportunos.

A Comparative Study of Peak Expiratory Flow Rate in Acute and Chronic Periodontitis

Periodontal disease is a chronic inflammatory disease of gum which surrounds and supports the teeth. Globally, periodontal disease is one of the most common oral diseases. Unhealthy periodontium has been connected to systemic conditions like pulmonary and cardiovascular diseases. Periodontal disease affects individuals of all ages, but it is most commonly seen in elderly patients. According to the World Health Organization, nearly 65 % of people have respiratory problems due to periodontal disease. Peak Expiratory Flow Rate (PEFR) is defined as the maximum rate and speed of expiration of an individual. We wanted to determine and compare PEFR in acute and chronic periodontitis. METHODSThe present case control study was carried out among patients in the 20 - 40 years age group, who were attending outpatient department of Saveetha Dental College and Hospitals. Study participants were grouped into three categories as ‘normal individuals’, ‘patients with acute periodontitis’ and ‘patients with chronic periodontitis’; each group had 20 people. Spirometer was used to detect the peak expiratory flow rate. Statistical analysis was done using SPSS. P value of less than or equal to 0.05 was taken as statistically significant. RESULTSResults were obtained and expressed as mean ± SD. The Tukey HSD Post-hoc Test was used. Significance value is < 0.05. PEFRs are 420 ± 21.37 and 317 ± 21.05 in control and periodontitis individuals, respectively. P values for these criteria were < 0.05. Males have a high PEFR when compared to females in normal individuals group. This difference was statistically not significant. Females have a high PEFR when compared to males in patients with acute periodontitis. This difference was statistically not significant. Males have a high PEFR when compared to females with chronic periodontitis. When compared within and between groups, it was statistically significant (p = 0.0001). CONCLUSIONSPeriodontitis could be a key source of respiratory disorders. This study shows that acute periodontitis expiratory flow rate was greater than chronic periodontitis expiratory flow rate. Proper maintenance of oral health and early detection of periodontitis may aid in reducing the frequency of respiratory problems due to periodontitis.

Effect of Variations in Neck Position on Peak Expiratory Flow Rate in Supine Posture in Young Healthy Adults - A Cross Sectional Study

Many individuals prefer using a pillow under their head when they sleep or read or use hand held electronic devices in recumbent position. Changes in position of the head with respect to the neck in supine posture may occur depending on the use of a pillow or height of the pillow used. This alteration of head and neck position might have an effect on pulmonary ventilation. The Peak Expiratory Flow Rate (PEFR) is one of the tests to assess pulmonary functions and PEFR can be performed easily and rapidly with the help of Wright’s Mini Peak Flowmeter. This study was undertaken to see the effect of variations in neck position on peak expiratory flow rate in supine posture in young healthy adults. METHODSA cross sectional study was carried out on 150 apparently healthy medical students of both sexes in the age group of 18 - 21 years. PEFR values were recorded using Wright’s Mini Peak Flow Meter. The subjects were asked to lie down in supine position on a wooden couch and recording of the peak expiratory flow rate was performed, initially by placing the subject’s head directly on the wooden couch and then by keeping the head on a pillow of 5 cm height. RESULTSData was analysed using paired ‘T’ Test and the p value of less than 0.05 was considered as statistically significant. We found that the mean PEFR value obtained using a pillow of 5 cm height under the head was more than the mean PEFR value obtained without using the pillow and the change in mean PEFR values was statistically significant (Table 1). CONCLUSIONSAfter comparing the mean PEFR values in the supine position with and without use of a pillow, we found that mean PEFR value was significantly higher when PEFR test was performed with use of a low height pillow (5 cm) under the head. From the result of this study, we conclude that pulmonary ventilation is better when the head and neck are supported with a low height pillow in supine posture.

A Comparative Study To Find Out Immediate Effect Of Chest Mobility Exercise And Incentive Spirometery Exercise On Cement Factory Workers -AN Experimentl Study

Context: As an average normal person spend maximum of its time in his working environment it is major contributor in determining the persons overall health. A good quality of air is an important factor for normal health of an individual. Aim: To find out immediate effect of chest mobility exercise and incentive spirometry exercise on cement factory worker. Setting and design: The interventional study was carried out in cement factories of aburoad. Method and material: 40 subjects were included in the basis of inclusion and exclusion criteria and divided into 2 groups with 20 participants in each group. One group received chest mobility exercise and other group received incentive spirometry exercise. Results: Statistically is significant (p<0.05) the result showed high significant difference within & between the two groups .There was more effect of incentive spirometry exercise compared to chest mobility exercise. Conclusion: The above study concluded that both the technique showed marked improvement but the incentive spirometry exercise is more effective for the cement factory workers and it is easy to perform for the participants.

Effect of Posture on Voluntary Cough Strength in Healthy People / The Japanese Journal of Rehabilitation Medicine

Objective：This study investigated the relationship between posture and voluntary cough strength in healthy people.Methods：The participants were 50 normal adults. We measured cough peak flow (CPF), chest circumferences at maximal inspiratory level and maximal expiratory level, blood pressure, and pulse rate in the supine position, prone position, and prone position with a pillow under the abdomen. The difference between chest circumferences at maximal inspiratory and maximal expiratory levels was calculated and defined as the thoracic expansion difference.Results：CPF and chest circumferences at maximal inspiratory level and maximal expiratory level were significantly higher in the prone position with a pillow under the abdomen than in the supine position. There were no differences in thoracic expansion difference and blood pressure among all the positions. Pulse rate was significantly lower in the supine position compared with the other positions.Conclusion：We concluded that voluntary cough strength would increase in the prone position with a pillow under the abdomen.

Effect of Posture on Voluntary Cough Strength in Healthy People / The Japanese Journal of Rehabilitation Medicine

Objective：This study investigated the relationship between posture and voluntary cough strength in healthy people.Methods：The participants were 50 normal adults. We measured cough peak flow (CPF), chest circumferences at maximal inspiratory level and maximal expiratory level, blood pressure, and pulse rate in the supine position, prone position, and prone position with a pillow under the abdomen. The difference between chest circumferences at maximal inspiratory and maximal expiratory levels was calculated and defined as the thoracic expansion difference.Results：CPF and chest circumferences at maximal inspiratory level and maximal expiratory level were significantly higher in the prone position with a pillow under the abdomen than in the supine position. There were no differences in thoracic expansion difference and blood pressure among all the positions. Pulse rate was significantly lower in the supine position compared with the other positions.Conclusion：We concluded that voluntary cough strength would increase in the prone position with a pillow under the abdomen.

Calibração do Storm Water Management Model (SWMM) utilizando algoritmos evolucionários multiobjetivo / Storm Water Management Model calibration using multiobjective evolutionary algorithms

RESUMO O estudo teve por objetivo a realização da calibração do modelo hidrológico Storm Water Management Model (SWMM) para a Bacia Hidrográfica do Arroio Cancela, localizada em Santa Maria, Rio Grande do Sul, utilizando o algoritmo evolucionário multiobjetivo R-NSGA. Para tanto, foram realizadas modificações na estrutura do SWMM, de modo que permitisse seu acoplamento como Evolucionary Reference Point Based Non-Dominated Sorting Genetic Algorithm (R-NSGA) em ambiente de programação MATLAB. As funções objetivo utilizadas foram o Coeficiente de Eficiência de Nash-Sutcliffe (COE), o Erro da Vazão de Pico (EQP) e o Erro do Volume Escoado (EVOL) aplicadas simultaneamente na calibração do modelo. Foi proposto um método para determinação da maior compatibilidade de modo a elencar as melhores soluções. Os resultados dos parâmetros calibrados do SWMM foram próximos aos valores físicos da bacia, com exceção dos valores relativos à equação de Horton. As soluções de maior compatibilidade apresentam um melhor comportamento para os eventos de validação, evidenciando a importância da otimização multiobjetivo.

ABSTRACT This paper focused on the calibration of Storm Water Management Model (SWMM) for the Cancela River Basin, located in Santa Maria, Rio Grande do Sul, Brazil, using the multi-objective Evolucionary Reference Point Based Non-Dominated Sorting Genetic Algorithm R-NSGA. Modifications were made in SWMM structure to allow its linking with R-NSGA in MATLAB. The objective functions proposed were the efficiency coefficient of Nash-Sutcliffe (eNS), the Peak Flow Error (EQ) and Runoff Volume error (EVOL), which were applied simultaneously to the model calibration. A method for determining the maximum compatibility to rank the best solutions is proposed. The parameters estimated by SWMM calibration were close to physical values of the basin, except those relating to the Horton equation in the most compatible solutions have a better behavior for the validation event, highlighting the importance of multi-objective optimization.

A comparative study of peak expiratory flow rate among healthy working women and housewives of Ahmedabad

Background: The growth of population, industry, number of vehicles and improper implementation of stringent emission standard makes the problem of air pollution worse. Automobile exhaust consists of particulate matter and gases which cause injury to the terminal bronchioles and decrease in the pulmonary compliance and vital capacity and PEFR. Aim: The present study aimed at assessing the Peak expiratory flow rate (PEFR) in healthy working women in the Ahmedabad compared to healthy housewives of same age to see the effect of short duration daily exposure of traffic air pollutants on PEFR. Materials and methods: An observational study was conducted in the community of Ahmedabad with 30 females between the ages of 30-40 years, divided into 2 groups. Group 1 comprised of 15 healthy housewives and Group 2 comprised of 15 healthy working women. Peak expiratory flow rate (PEFR) using a Wrights peak flow meter was measured in liter per minute. Three such readings were taken in standing posture. The highest of the three values obtained was treated as the peak expiratory flow rate. Results: The mean PEFR of the housewives and working women was 304±60.80litres/min and 285.33±45.01 litres/min respectively. There was no statistically significant difference between the two groups of the study (p=0.208, z= -1.259). Conclusion: There is no difference between the Peak Expiratory Flow Rate between healthy housewives and working women in Ahmedabad.

Evaluación de flujos y volúmenes dinámicos en pacientes con compromiso muscular respiratorio / Dynamic flows and volumes evaluation in patients with respiratory muscle impairment

Spirometry measures the forced expiratory volumes and flows. In patients with neuromuscular disease, these are altered since there is some respiratory muscle involvement. The usefulness of this test is based on the interpretation of the shape of the flow / volume loop and values of spirometric variables. In patients with neuromuscular disease, Forced Vital Capacity is the most used especially for its prognosis value.

La espirometría mide volúmenes y flujos espiratorios forzados. En los pacientes con enfermedad neuromuscular (ENM) estos se ven alterados debido al compromiso muscular respiratorio. La utilidad de este examen se basa en la interpretación de la forma de la curva flujo/volumen y los valores de las variables espirométricas. En los pacientes con ENM la Capacidad Vital Forzada es la más utilizada ya que otorga valor pronóstico.

Doença neuromuscular terminal: o cruzamento da pneumologia com a terapia intensiva / End-stage neuromuscular disease: the intersection between pulmonary and intensive care

Doenças neuromusculares evoluem com o acometimento do sistema respiratório, e a insuficiência respiratória crônica é a principal causa de mortalidade na grande maioria dos pacientes. Fraqueza da musculatura de inervação bulbar ou da musculatura respiratória podem causar tosse ineficaz e hipoventilação alveolar crônica. Disfunções de deglutição, aspiração de conteúdo gástrico, infecções de repetição e redução da complacência torácica são outras complicações pulmonares frequentes. O diagnóstico precoce, a prevenção e o tratamento destas complicações, como o uso de ventilação não invasiva e de técnicas de tosse assistida, podem melhorar significativamente a qualidade de vida e até prolongar a sobrevida destes doentes. O manejo terapêutico deve ser feito por equipe multidisciplinar, e de acordo com os desejos e preferências do paciente...

Neuromuscular diseases interfere with respiratory system function, and chronic respiratory failure is the main cause of mortality in these patients. Weakness of bulbar and respiratory muscles can impact cough efficacy and lead to chronic alveolar hypoventilation. Swallowing dysfunction, aspiration of gastric contents, recurrent respiratory infections, and reduction of thoracic compliance are all frequent events during the course of these patients. Early diagnosing, besides prevention and treatment of these events, surely ameliorate the quality of life of neuromuscular patients, and also seem to impact on survival. Therapeutic management should be multidisciplinary and must take into account the patient desires and preferences...

Peak expiratory flow rate; the effect of smoking on younger & middle aged males.

A total of 80 male subjects in age group of 20-50 years were selected for the purpose of the study. They were divided in two groups, smokers and non smokers. Each group subdivided into age groups of 20-35 and 36-50 yrs. The criteria for smoking was about 5-10 cigarettes per day since 6-12 months. Peak Expiratory Flow Rate (P.E.F.R.) was determined by using Wright’s peak flow meter. The results showed that in Non-Smoker of age group 20-35 years, (n= 30) the mean PEFR value was 535±50 L/min, whereas in age group 36-50 years, (n=15) the mean P.E.F.R value was 515±50 L/min. In Smokers of age group 20-35 years, (n=10) mean P.E.F.R. value was 374±128 L/min whereas in age group 36-50 years, (n=25) mean P.E.F.R. value was 357±86 L/min. This shows that in smokers P.E.F.R. value is lower compared to Non-smokers in both age groups and that P.E.F.R. is lower in the elder age group in comparison to younger age group.

A análise da eficácia da manipulação de costelas no aumento do fluxo expiratório medido pelo peak flow meter / The analysis of the efficiency of ribs handling in the increase of the expiratory flow measured by the peak flow meter

A presente pesquisa tem como objetivo demonstrar que a manipulação de costelas do tipo "dog técnica" é eficaz, causando um aumento no valor do fluxo expiratório máximo de sujeitos saudáveis. Este foi um estudo de campo do tipo experimental. O estudo foi realizado com uma amostra (n) de 50 sujeitos, voluntários, com idades diferenciadas entre 30 e 60 anos. O fluxo expiratório máximo foi avaliado antes e depois da manobra, verificando se havia diferença entre ambos. Através da análise dos dados foram verificados resultados favoráveis. Onde 43 voluntários obtiveram aumento entre 1 e 30% do fluxo expiratório máximo. Com este resultado, chegamos a conclusão que a manipulação de costelas é realmente eficaz no tratamento fisioterapêutico, aumentando o fluxo expiratório máximo e consequentemente melhorando a respiração do paciente, pois com um diagnóstico mais preciso e o tratamento eficiente podemos gerar maior qualidade de vida; pois uma boa ou má respiração depende basicamente da mobilidade das costelas.

The present research aims to demonstrate that the ribs handling type "dog technique" is efficient, causing na increase in the value of the maximum expiratory flow of healthy individuals. This was a field research type experimental and quantitative. The research was conducted by a sample (n) of 50 individuals, volunteers with different age, between 30 and 60 years old. The maximum expiratory flow was valued before and after the operation, checking if it had a difference between both. Through analysis of data, favorable results were checked, were 43 volunteers had increased between 1 and 30% of the maximum expiratory flow. With this result, we reached the conclusion that the ribs handling is really efficient in the physiotherapeutic treatment, increasing the maximum expiratory flow and consequently improving the patient's breathing, because through a accurate diagnosis and na efficient treatment we can give higher quality of life, because a good or a bad breath depends essentially of the ribs mobility.(

Pico de fluxo expiratório em trabalhadores de fábricas de fogos de artifício / Expiratory peak flow in employees of firework factories

Objetivo. A pólvora é uma mistura explosiva constituída de 75% de salitre (nitrato de potássio), 12% de carvão e 13% de enxofre, moídos em conjunto. O objetivo deste trabalho foi verificar possível acometimento respiratório de trabalhadores de fábricas de fogos de artifícios por pólvora inalada. Método. Foram medidos os picos de fluxo expiratório de 234 pessoas do Município de Santo Antônio do Monte, Minas Gerais: 41 sem exposição profissional à pólvora (grupo-controle) e 193 trabalhadores de fábricas de fogos de artifícios. Os parâmetros utilizados foram: idade, sexo, estatura, peso, tabagismo e tempo de exposição à pólvora. Resultados. Todos os indivíduos pertencentes ao grupo-controle tiveram seus níveis de pico de fluxo expiratório dentro da normalidade. Em 50 (25,9%) trabalhadores, houve redução desse fluxo, 34 (68%) eram tabagistas, dez (20%) tinham de cinco a dez anos de exposição e dez (20%) tinham mais de dez anos de exposição. Conclusão. A pólvora relaciona-se com a redução de pico de fluxo expiratório, principalmente em indivíduos tabagistas.

Objective. Gunpowder is an explosive blend of potassium nitrate (75%), coal (12%) and sulphur (13%). The present investigation verified respiratory consequences of this powder in employees of firework factories. Method. The expiratory peak flow was assessed in 234 habitants of Santo Antônio do Monte, Minas Gerais State: 41 healthy volunteers (control group) and 193 employees of firework factories. The parameters assessed were age, sex, height, smoking and time of gunpowder exposition. Results. The level of the expiratory peak flow of the control group was normal. Reduction of the expiratory flow occurred in 50 (25.9%) of the factories workers: 34 (68%) of them were smokers and ten (20%) had more than tem years of exposition to gunpowder. Conclusion. Gunpowder is related with reduction of expiratory peak flow, mainly in smokers.

La vaporización fotoselectiva del adenoma prostático con el ktp-láser (kalium-titanyl-phosphat) de 80 watt y la RTU-P de baja presión hidráulica / The photoselective vaporization of prostate adenoma with the 80 watt ktp-laser (kalium-titanyl-phosphat) and the low hydraulic pressure tur-p

El objetivo de este trabajo prospectivo es determinar la eficacia del método KTP-láser de 80 watt para la vaporización y ablación de la HPB sintomática. También se analizan los resultados al combinar el KTP-láser con la RTU-P y su repercusión sobre la hemoglobina. Material y Método: 300 pacientes con HPB sintomática fueron tratados entre agosto del 2004 y noviembre del 2006 con el KTPláser o combinado con RTU-P. La resección adicional fue efectuada en pacientes con adenomas grandes o por lóbulo medio acentuado. El efecto ablativo fue controlado al final de la operación por medio de TRUS. Resultados: 300 pacientes fueron tratados en 2 grupos. El grupo 1 (n: 50) con sólo tratamiento láser y pequeños adenomas, la hemoglobina se redujo un 3,2 por ciento y nadie requirió una transfusión. El grupo 2 (n: 250) con tratamiento combinado de KTP-láser y RTU-P en adenomas grandes, la hemoglobina se redujo en promedio 15,2 por ciento después de la intervención; 2 pacientes (0,8 por ciento) necesitaron una transfusión. Conclusión: El estudio pone de manifiesto, las ventajas de combinar ambos procedimientos quirúrgicos para obtener un mejor resultado en la ablación del adenoma sobre todo en próstatas de gran tamaño.

The objective of this prospective study is to determine the effectiveness of the 80 watt KTP laser method for the vaporization and ablation of the symptomatic BPH. Also the results when combining the KTP-laser with the TUR-P and their repercussion on the haemoglobin are analysed. Material and Method: 300 patients with symptomatic BPH were treated between august 2004and november 2006 with the KTP-Laser or combined with TUR-P. The additional Resection was carried out in those patients with great adenomas or to have accentuated middle lobule. The ablative effect was controlledat the end of the operation with TRUS (transrectal ultrasound). Results: 300 patients were treated in 2 groups. The group 1 (n: 50) just by laser treatment and small adenomas, the haemoglobin was reduced a 3.2 percent and nobody required a transfusion. Group 2 (n: 250) with combined treatment of KTP-laser and TURP in great adenomas, the haemoglobin was reduced in average 15,2 percent after the intervention; 2 patients (0,8 percent) needed a transfusion. Conclusion: Our study puts of open, the advantages to combine both surgical procedures to mainly obtain a better result in the ablation of the prostate adenoma in prostates of great size.