Efectividad de un programa de rehabilitación respiratoria en pacientes con síndrome de apnea obstructiva del sueño: estudio cuasi-experimental / Effectiveness of a respiratory rehabilitation programme in patients with sleep obstructive apnoea syndrome: Quasi experimental study

OBJETIVOS: El objetivo del estudio fue analizar la efectividad de un programa de rehabilitación respiratoria en pacientes obesos sedentarios con síndrome de apnea obstructiva del sueño (SAOS) en el que se incluyó la realización de ejercicio físico terapéutico. Participantes y métodos: Estudio cuasi-experimental de 2 grupos, grupo intervención y grupo control, no aleatorizados con evaluación pre/post. Se seleccionaron 47 pacientes del hospital diagnosticados de SAOS con obesidad y en tratamiento médico, los cuales fueron tratados por el mismo equipo y siguiendo los mismos criterios diagnósticos. Se registraron las siguientes variables: índice de masa corporal, poligrafía respiratoria, capacidad de ejercicio, patrón de comportamiento sedentario y calidad de vida. Se realizó una comparación pre/post a los 3 meses. RESULTADOS: Se analizaron 38 pacientes y los resultados obtenidos al comparar los valores pre/post de todos los individuos muestran diferencias significativas en forma de mejora en todas las variables analizadas a excepción del comportamiento sedentario. En la comparación pre/post entre los grupos se aprecia una diferencia significativa (p = 0,049) en la percepción de la calidad de vida, concretamente, en la dimensión de los síntomas diurnos (0,42; IC 95%: 0,48-1,33), indicando una tendencia a la mejora en el grupo que ha realizado el programa de ejercicio propuesto. CONCLUSIÓN: La combinación del tratamiento médico de los pacientes durante un mínimo de 6 meses junto con la realización del programa de rehabilitación respiratoria en el que se incluye el ejercicio físico terapéutico genera una tendencia a la mejora clínica de estos, aumentando su calidad de vida, pero sin ningún tipo de cambio en su comportamiento sedentario

OBJECTIVES: The objective of the study was to analyse the effectiveness of a respiratory rehabilitation programme in sedentary, obese patients with Obstructive Sleep Apnoea Syndrome (OSAS) which included therapeutic physical exercise. Participants and methods: A quasi-experimental study of two groups, an intervention group and a control group, not randomised and with pre/post evaluation. Forty-seven hospital patients diagnosed with obesity and under medical treatment were selected and treated by the same team, following the same diagnostic criteria. The following variables were recorded: body mass index, respiratory polygraph, exercise capacity, sedentary behaviour pattern and quality of life. A pre/post comparison was made at 3 months. RESULTS: 38 patients were analysed, and the results obtained when comparing the pre/post values of all the individuals show significant differences in the form of improvement in all variables analysed except for sedentary behaviour. In the pre/post comparison between the groups, a significant difference (p=.049) was observed in perception of quality of life, specifically in the daytime symptom dimension (.42; 95% CI: .48-1.33), indicating a trend towards improvement in the group that undertook the proposed exercise programme. CONCLUSION: The combination of the patients' medical treatment over a minimum of 6 months together with completion of the respiratory rehabilitation programme which included therapeutic physical exercise resulted in a tendency to clinical improvement for the patients, increasing their quality of life, but with no change in their sedentary behaviour

[Computed tomography in injuries to the respiratory system in children. The correlation with adults]. / La Tomografia Computerizzata nei traumi dell'apparato respiratorio nei bambini. Correlazione con gli adulti.

INTRODUCTION: Diagnostic imaging in emergency rooms may be inadequate and delayed, which makes chest traumas in children more severe and difficult to treat. We carried out a retrospective study on adults and children who had survived major chest traumas involving the respiratory tract to assess the differences between the two age groups and the role of emergency CT. MATERIAL AND METHODS: Our series consisted of fourteen children admitted to the emergency department for various accidents. Home accidents prevailed (9/14 = 64.3%). On admission, chest radiography was performed in most cases (11/14 = 78.6%); CT was carried out in 21.4% (3/14 patients). RESULTS: Trauma involved more organs in pediatric patients (11/14 = 78.6%) and lung involvement was always associated with other types of injury, namely contusion (14/14 = 100%), pneumothorax (11/14 = 78.6%), hemothorax (10/14 = 71.4%), tear (4/14 = 28.6%). CT corrected or integrated the radiographic findings of contusion focus in 67% (8/14) and that of pneumothorax in 63.6%; both patterns cannot be demonstrated otherwise. DISCUSSION: Mixed and multiple posterior parenchymal injuries with no rib fractures prevail in young subjects because their bones and ligaments are more elastic, which may lead to trauma underestimation. Tracheobronchial ruptures and pneumomediastinum are much more severe in children than in adults. Chest plain film is often the only diagnostic tool used, despite its major technical and interpretative limitations, also because skull and abdomen are the most investigated regions. Executive limitations are stronger in childhood, increasing the margin of error and the risk of delayed treatment. CT is as cost-effective as radiography and shows even the injuries missed or poorly depicted on conventional images; CT also gives accurate information on damage severity and nature. CONCLUSIONS: Traumatic injuries are more severe in pediatric patients due to their build and to biomechanical, clinical and management factors. Spiral CT should be considered the examination of choice to be performed in the emergency department equipped also for pediatric re-animation.

Herbicide and estrogen effects on the metabolic activity of Elliptio complanata measured by calorespirometry.

Herbicides and estrogen are important contaminants of world water systems with effects on aquatic organisms. The effects of short-time exposure to atrazine, 2,4-Dichlorophenoxyacetic acid (2,4-D), paraquat, and estrogen on the metabolic activity of gill tissue from the freshwater bivalve Elliptio complanata were investigated by isothermal calorimetry and respirometry. Metabolic heat rates were altered following short-time exposure of gill tissue to these compounds over the concentration range from 10(-6) to 10(-3) M. The effects of herbicides and estrogen on metabolic heat rates were compound specific and time and concentration dependent. Treatment of tissue with estrogen caused stimulation of metabolic heat rates. In general, treatment with herbicides at low concentration or short times of exposure caused stimulation of metabolic heat rates, possibly due to uncoupling. Longer exposures and higher concentration subsequently caused inhibition of metabolic activity and decreased metabolic heat rates. Treatment of mitochondria isolated from gill and muscle tissues showed a similar pattern of respiratory rate stimulation at concentrations of 10(-4) M 2, 4-D and inhibition at higher concentration. Analysis of CO2 and O2 from the headspace gases in the calorimeter ampule showed an increase in the respiratory quotient indicating a shift in metabolism following addition of 2,4-D or paraquat.