Ivete Alonso Bredda Saad

Ocorrência de desvios posturais em escolares do ensino público fundamental de Jaguariúna, São Paulo

OBJECTIVE: Evaluate the posture of students from a public school in Brazil and to identify the differences between normal deviation during growth and compensatory alterations. METHODS: Students from first to fourth grade of a public school in the city of Jaguariuna, Sao Paulo, Brazil, were evaluated. The students were positioned at sagital anterior and posterior coronal planes for postural assessment. Kendall points were used as the normal reference. RESULTS: 247 students were evaluated, 131 boys and 116 girls, and the main postural deviations found were: shoulder unbalance (50.2%), protracted shoulder (39.7%), abducted scapula (40.5%), knock-knee (29.6%), pelvic unbalance (21.5%), pelvic anteversion (19%), knee hyperextension (19%), medial rotation of hip (12.9%), protracted cervical (11.7%), head tilt (15.4%), thoracic hyperkyphosis (9.7%) and lumbar hyperlordosis (26.3%). CONCLUSIONS: A high incidence of postural alterations was detected in school children. Some of the postural alterations, such as abducted scapula, unbalance and protraction of the shoulders, knock-knee and lumbar hiperlordosis, normally occur and they are naturally corrected during growth. However, some postural problems, such as protraction and inclination of the cervical spine, were also prevalent and they require early intervention.

Predictors of quality-of-life improvement following pulmonary resection due to lung cancer

CONTEXT AND OBJECTIVE There is increasing involvement of health professionals in organizing protocols to determine the impact of lung surgery on functional state and activities of daily living, with the aim of improving quality of life (QoL). The objective of this study was to investigate predictors of QoL improvement among patients undergoing parenchyma resection due to lung cancer. DESIGN AND SETTING Prospective study, at teaching hospital of Universidade Estadual de Campinas (Unicamp). METHODS 36 patients with lung cancer diagnosis were assessed before surgery and on the 30th, 90th and 180th days after surgery. The Short-Form Health Survey (SF-36) was used as the dependent variable. The independent variables were the Hospital Anxiety and Depression (HAD) scale, a six-minute walking test (6-MWT), a visual analogue scale for pain, forced vital capacity (FVC), type of surgery and use of radiotherapy and chemotherapy. Generalized estimation equations (GEE) were utilized. RESULTS The median age for these 20 men and 16 women was 55.5 +/- 13.4 years. Both FVC and 6-MWT were predictors of improvement in the physical dimensions of QoL (p = 0.011 and 0.0003, respectively), as was smaller extent of surgical resection (p = 0.04). The social component of QoL had improved by the third postoperative month (p = 0.0005). CONCLUSION The predictors that affected QoL positively were better FVC and 6-MWT results and less extensive lung resection. Three months after the surgery, an improvement in social life was already seen.

Clinical variables of preoperative risk in thoracic surgery

CONTEXT Pulmonary complications are the most common forms of postoperative morbidity in thoracic surgery, especially atelectasis and pneumonia. The first step in avoiding these complications during the postoperative period is to detect the patients that may develop them. OBJECTIVE To identify risk variables leading to early postoperative pulmonary complications in thoracic surgery. DESIGN Prospective study. SETTING Hospital das Clínicas, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. PATIENTS 145 patients submitted to elective surgery were classified as low, moderate and high risk for postoperative pulmonary complications using a risk assessment scale. PROCEDURES The patients were followed up for 72 hours after the operation. Postoperative pulmonary complications were defined as atelectasis, pneumonia, tracheobronchitis, wheezing, prolonged intubation and/or prolonged mechanical ventilation. MAIN MEASUREMENTS Univariate analysis was applied in order to study these independent variables: age, nutritional status, body mass index, respiratory disease, smoking habit, spirometry and surgery duration. Multivariate logistic regression analysis was performed in order to evaluate the relationship between independent and dependent variables. RESULTS The incidence of postoperative complications was 18.6%. Multivariate logistic regression analysis showed that the variables increasing the chances of postoperative pulmonary complications were wheezing (odds ratio, OR = 6.2), body mass index (OR = 1.15), smoking (OR = 1.04) and surgery duration (OR = 1.007). CONCLUSION Wheezing, body mass index, smoking and surgery duration increase the chances of postoperative pulmonary complications in thoracic surgery

Avaliação da qualidade de vida de acordo com o nível de controle e gravidade da asma em crianças e adolescentes

OBJETIVO: Avaliar a qualidade de vida de acordo com o nivel de controle e gravidade da asma em criancas e adolescentes. METODOS: Foram selecionados criancas e adolescentes com asma (7-17 anos de idade) acompanhados no Ambulatorio de Pneumologia Pediatrica do Hospital de Clinicas da Universidade Estadual de Campinas, localizado na cidade de Campinas (SP). O nivel de controle e a gravidade da asma foram avaliados pelo Teste de Controle da Asma e pelo questionario baseado na Global Initiative for Asthma, respectivamente. Os pacientes responderam o Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validado para uso no Brasil, para a avaliacao de sua qualidade de vida. RESULTADOS: A media de idade dos asmaticos foi de 11,22 ± 2,91 anos, com mediana de 11,20 (7,00-17,60) anos. Foram selecionados 100 pacientes, dos quais 27, 33 e 40, respectivamente, foram classificados com asma controlada (AC), asma parcialmente controlada (APC) e asma nao controlada (ANC). Quanto a gravidade da asma, 34, 19 e 47 foram classificados, respectivamente, com asma leve (AL), asma moderada (AM) e asma grave (AG). Os grupos AC e APC, quando comparados ao grupo ANC, apresentaram maiores valores no escore geral do PAQLQ e em seus dominios (limitacao de atividades, sintomas e funcao emocional; p < 0,001 para todos). O grupo AL apresentou os maiores escores em todos os componentes do PAQLQ quando comparado aos grupos AM e AG. CONCLUSOES: A qualidade de vida parece estar diretamente relacionada com o nivel de controle e a gravidade da asma, uma vez que as criancas e adolescentes com maior controle e menor gravidade da doenca apresentaram melhor qualidade de vida.

Evaluation of quality of life according to asthma control and asthma severity in children and adolescents

ABSTRACT OBJECTIVE: To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents. METHODS: We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global Initiative for Asthma, respectively. The patients also completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validated for use in Brazil, in order to evaluate their quality of life. RESULTS: The mean age of the patients was 11.22 ± 2.91 years, with a median of 11.20 (7.00-17.60) years. We selected 100 patients, of whom 27, 33, and 40 were classified as having controlled asthma (CA), partially controlled asthma (PCA), and uncontrolled asthma (UA), respectively. As for asthma severity, 34, 19, and 47 were classified as having mild asthma (MiA), moderate asthma (MoA), and severe asthma (SA), respectively. The CA and the PCA groups, when compared with the NCA group, showed higher values for the overall PAQLQ score and all PAQLQ domains (activity limitation, symptoms, and emotional function; p < 0.001 for all). The MiA group showed higher scores for all of the PAQLQ components than did the MoA and SA groups. CONCLUSIONS: Quality of life appears to be directly related to asthma control and asthma severity in children and adolescents, being better when asthma is well controlled and asthma severity is lower.

Eficácia da reabilitação pulmonar uma vez na semana em portadores de doença pulmonar obstrutiva

Effectiveness of pulmonary rehabilitation once a week for patients with obstructive pulmonary disease Background: Obstructive pulmonary diseases may interfere negatively with patients’ quality of life (QOL). Specific QOL questionnaires such as the Chronic Respiratory Questionnaire (CRQ) have been used to quantify the impact of the disease and measure the effects of different rehabilitation protocols. Objective: To evaluate the effectiveness of pulmonary rehabilitation performed once a week in association with exercises at home among patients with obstructive pulmonary disease, by means of CRQ comparisons, maximum respiratory pressures (MIP and MEP) and six-minute walking distance test (6MWD), before and after treatment. Methods: This study was developed in the physical therapy outpatient clinic of the hospital. Thirty-four patients of both sexes with obstructive pulmonary disease were evaluated, and nineteen (mean age: 60.8 ± 14.2 years) were included in the study. These subjects all underwent physiotherapeutic evaluation and reevaluation with the CRQ and measurements of MIP, MEP and 6MWD. The physical therapy consisted of respiratory, aerobic and resistance exercises once a week for 12 weeks, together with home exercises twice a week. Results: The Wilcoxon test and Spearman correlation were used. Statistically significant differences between evaluations before and after rehabilitation were found for all CRQ domains (p≤ 0.05), MIP (p= 0.01) and MEP (p= 0.002). Conclusion: The proposed program improved QOL and promoted increases in maximum respiratory pressures among these patients with obstructive pulmonary disease, even though the current literature suggests that higher frequency of training is needed.AbstrAct Background: obstructive pulmonary diseases may interfere negatively with patients’ quality of life (Qol). Specific Qol questionnaires such as the Chronic Respiratory Questionnaire (CRQ) have been used to quantify the impact of the disease and measure the effects of different rehabilitation protocols. objective: to evaluate the effectiveness of pulmonary rehabilitation performed once a week in association with exercises at home among patients with obstructive pulmonary disease, by means of CRQ comparisons, maximum respiratory pressures (mIp and mEp) and six-minute walking distance test (6mwd), before and after treatment. methods: this study was developed in the physical therapy outpatient clinic of the hospital. thirty-four patients of both sexes with obstructive pulmonary disease were evaluated, and nineteen (mean age: 60.8 ± 14.2 years) were included in the study. these subjects all underwent physiotherapeutic evaluation and reevaluation with the CRQ and measurements of mIp, mEp and 6mwd. the physical therapy consisted of respiratory, aerobic and resistance exercises once a week for 12 weeks, together with home exercises twice a week. Results: the wilcoxon test and Spearman correlation were used. Statisti-cally significant differences between evaluations before and after rehabilitation were found for all CRQ domains (p≤ 0.05), mIp (p= 0.01) and mEp (p= 0.002). Conclusion: the proposed program improved Qol and promoted increases in maximum respiratory pressures among these patients with obstructive pulmonary disease, even though the current literature suggests that higher frequency of training is needed.

Continuous positive airway pressure (CPAP) after lung resection: a randomized clinical trial

CONTEXT AND OBJECTIVE Noninvasive mechanical ventilation during the postoperative period (PO) following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP) associated with physiotherapy, compared with physiotherapy alone after lung resection. DESIGN AND SETTING Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas. METHOD Sessions were held in the immediate postoperative period (POi) and on the first and second postoperative days (PO1 and PO2), and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI), Borg scale, pain scale and presence of thoracic drains and air losses were evaluated. RESULTS There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP) group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042), than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028), but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001), but there were no statistically significant differences between the groups regarding the pain score. CONCLUSION CPAP after lung resection is safe and improves oxygenation, without increasing the air losses through the drains. CLINICAL TRIAL REGISTRATION NCT01285648.

Utilização da ventilação não invasiva em edema agudo de pulmão e exacerbação da doença pulmonar obstrutiva crônica na emergência: preditores de insucesso

Objective: This study analyzed acute respiratory failure caused by acute pulmonary edema, as well as chronic obstructive pulmonary disease exacerbation, that was treated with non-invasive mechanical ventilation to identify the factors that are associated with the success or failure non-invasive mechanical ventilation in urgent and emergency service. Methods: This study was a prospective, descriptive and analytical study. We included patients of both genders aged ≥18 years who used non- invasive mechanical ventilation due to acute respiratory failure that was secondary to acute pulmonary edema or chronic obstructive pulmonary disease exacerbation. Patients with acute respiratory failure that was secondary to pathologies other than acute pulmonary edema and chronic obstructive pulmonary disease or who presented with contraindications for the technique were excluded. Expiratory pressures between 5 and 8 cmH 2 O and inspiratory pressures between 10 and 12 cmH 2 O were used. Supplemental oxygen maintained peripheral oxygen saturation at >90%. The primary outcome was endotracheal intubation. Results: A total of 152 patients were included. The median non-invasive mechanical ventilation time was 6 hours (range 1 - 32 hours) for chronic obstructive pulmonary disease patients (n=60) and 5 hours (range 2 - 32 hours) for acute pulmonary edema patients (n=92). Most (75.7%) patients progressed successfully. However, reduced APACHE II scores and lower peripheral oxygen saturation were observed. These results were statistically significant in patients who progressed to intubation (p 25 rpm, higher APACHE II scores, BiPAP use and chronic obstructive pulmonary disease diagnosis were associated with endotracheal intubation. Higher GCS and SpO 2 values were associated with NIV success. Non- invasive mechanical ventilation can be used in emergency services in acute respiratory failure cases caused by acute pulmonary edema and chronic obstructive pulmonary disease exacerbation, but patients with variables related to a higher percentage of endotracheal intubation should be specially monitored.

Inspiratory Muscle Training in the Intensive Care Unit: A New Perspective

Background Prolonged use of mechanical ventilation (MV) leads to weakening of the respiratory muscles, especially in patients subjected to sedation, but this effect seems to be preventable or more quickly reversible using respiratory muscle training. The aims of the study were to assess variations in respiratory and hemodinamic parameters with electronic inspiratory muscle training (EIMT) in tracheostomized patients requiring MV and to compare these variations with those in a group of patients subjected to an intermittent nebulization program (INP). Methods This was a pilot, prospective, randomized study of tracheostomized patients requiring MV in one intensive care unit (ICU). Twenty-one patients were randomized: 11 into the INP group and 10 into the EIMT group. Two patients were excluded in experimental group because of hemodynamic instability. Results In the EIMT group, maximal inspiratory pressure (MIP) after training was significantly higher than that before (P = 0.017), there were no hemodynamic changes, and the total weaning time was shorter than in the INP group (P = 0.0192). Conclusion The EIMT device is safe, promotes an increase in MIP, and leads to a shorter ventilator weaning time than that seen in patients treated using INP.

Evolução do status de performance, índice de massa corpórea e distância percorrida no teste de caminhada de seis minutos em pacientes com câncer de pulmão avançado submetidos à quimioterapia

OBJECTIVE: To evaluate the effect of chemotherapy on the physical condition of patients with advanced lung cancer. METHODS: We evaluated 50 patients with non-small cell lung cancer (in stages IIIB and IV) and Eastern Cooperative Oncology Group (ECOG) performance status scale scores between zero and two. All patients underwent chemotherapy using paclitaxel and platinum derivatives and were evaluated at three time points (prechemotherapy, postchemotherapy and six months after starting the treatment), at which the ECOG scale, the body mass index (BMI) and the six-minute walk distance (6MWD) were assessed. RESULTS: Of the 50 patients included in the study, 14 died, 5 were excluded due to the worsening of their performance status, and 31 completed the six-month follow-up. There was no statistically significant difference between the time points of assessment for BMI (prechemotherapy vs. postchemotherapy, p = 1.00; and prechemotherapy vs. six months later, p = 0.218) or for 6MWD. Performance status improved, and this was especially due to the increase in the number of asymptomatic patients after the six-month follow-up (p = 0.031). CONCLUSIONS: Chemotherapy had a beneficial effect on the performance status of the patients. No significant changes in BMI or 6MWD were found during the study period, which might suggest the maintenance of the physical condition of the patients.