RÉSUMÉ
We are reporting, a case of 52 year old male, with obstructive uropathy who underwent cystolithotripsy surgery associated with chronic kidney disease presented with respiratory distress, tachypnea and hypoxia on 3rd post-operative day. He was on maintenance hemodialysis. Examination revealed absent air-entry on right side, dull percussion note on right side and positive trail sign. Chest X-ray and HRCT showed complete collapse of right lung with ipsilateral shift of trachea with mediastinum. Conventional physiotherapy postural drainage, breathing exercises, active cycle of breathing technique, forced expiratory techniques, spirometry, nebulization given for a day, no improvement seen because patient had strong cough reflex but unable to expectorate; any effort to cough caused more distress and breathing difficulty. Mechanical insufflation-exsufflation, a therapy in which the device which inflates the lungs(Insufflation pressure start at 15-20 cmH2O and increase to give an inspiration to total lung capacity, last for 2 second) followed by an immediate and abrupt change to negative pressure (exsufflation pressure same as the insufflation, then increase up to 10–20cmH2O, held for 3-6 second), which produces rapid exhalation, simulates cough and thus moves secretions cephaladly. Thus device helps patient cough out effectively. Lung collapse resolved within 1 day, regular physiotherapy was given to prevent recurrent lung collapse until discharge, X-ray and auscultation findings and oxygen saturation improved. It concludes, successful utilization of chest physiotherapy and mechanical insufflators-exsufflators aids in the resolution of lung collapse in an urgent situation.
RÉSUMÉ
Background: Liver is a major metabolic organ, interfering with the function of all organs and systems. So, the patients with severe liver disease may display wide manifestations of metabolic disorders, loss of muscle mass and function. Combination of these factors leads to decreased exercise tolerance and physical inactivity and it may be exaggerated with increasing severity of liver disease. The functional capacity could be severely affected due to multiple physiological derangements in these population. Hence, a liver transplant is the only cure for end stage liver disease. Currently only few literature are available that evaluated and described the status of frailty and functional capacity in these population. So we have tried to evaluate the same in Indian Population. Methodology: After ethical commttee approval and written inform consent, 85 cirrhotic atients who fulfilled the Inclusion and Exclusion criteria were included in the study. Disease specific history, Severity of Liver disease, Physical evalution of frailty via Hand grip strength, Balance and time taken to do 5 chair stands , subjective functional capacity evaluation was done through Duke activity status Index (DASI). Result: In 85 patients, the average Hand grip strength was 23.70 ± 10.60kg in males and 15.02± 5.08kg in females , average value of timed chair stands (TCS) was 18.18± 6.60 in males and 14.18± 8.65 in females , average balance score was 28.00 ±4.99 in males and 29.33± 2.58 in females and the average value of MELDNa was 22.2± 6.9. Conclusion: When compared with normal Indian standard Liver cirrhotic patient, form of frailty and reduced functional capacity non predominant. That stressed emphasis on rehabilitation and nutritional counselling during waiting period for Transplantation.