Tânia Fernandes Campos

Reversal of Bronchial Obstruction with Bi-level Positive Airway Pressure and Nebulization in Patients with Acute Asthma

Jet nebulization (JN) and non-invasive mechanical ventilation (NIMV) through bi-level pressure is commonly used in emergency and intensive care of patients experiencing an acute exacerbation of asthma. However, a scientific basis for effect of JN coupled with NIMV is unclear. Objective. To evaluate the effect of jet nebulization administered during spontaneous breathing with that of nebulization with NIV at two levels of inspiratory and expiratory pressures resistance in patients experiencing an acute asthmatic episode. Methods. A prospective, randomized controlled study of 36 patients with severe asthma (forced expiratory volume in 1 second [FEV1] less than 60% of predicted) selected with a sample of patients who presented to the emergency department. Subjects were randomized into three groups: control group (nebulization with the use of an unpressured mask), experimental group 1 (nebulization and non-invasive positive pressure with inspiratory positive airway pressure [IPAP] = 15 cm H2O, and expiratory positive airway pressure [EPAP] = 5 cm H2O), and experimental group 2 (nebulization and non-invasive positive pressure with IPAP = 15 cm H2O and EPAP = 10 cm H2O). Bronchodilators were administered with JN for all groups. Dependent measures were recorded before and after 30 minutes of each intervention and included respiratory rate (RR), heart rate (HR), oxygen saturation (SpO2), peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and forced expiratory flow between 25 and 75% (FEF25 − 75). Results. The group E2 showed an increase of the peak expiratory flow (PEF), forced vital capacity (FVC), FEV1 (p < 0.03) and F25 − 75% (p < 0.000) when compared before and 30 minutes after JN+NIMV. In group E1 the PFE (p < 0.000) reached a significant increase after JN+ NIMV. RR decreased before and after treatment in group E1 only (p = 0.04). Conclusion. Nebulization coupled with NIV in patients with acute asthma has the potential to reduce bronchial obstruction and symptoms secondary to augmented PEF compared with nebulization during spontaneous breathing. In reversing bronchial obstruction, this combination appears to be more efficacious when a low pressure delta is used in combination with a high positive pressure at the end of expiration.

Homocysteine (Hcy) and cognitive performance in a population sample of elderly Brazilians

Hyperhomocysteinemia (HHcy) has been suggested as a predictive factor of cognitive alterations. Brazil has one of the highest aging dementia rates among the worlds emerging countries. The objective of this study was to assess the influence of Hcy levels on the cognitive performance of low-income elderly. This cross-sectional study was developed in an urban center in the Northeast of Brazil and included 205 eligible community-dwelling older adults. A multidimensional questionnaire was used to evaluate sociodemographic aspects, health status and overall clinical aspects. Cognitive performance was assessed by the Portuguese version of Mini Mental State Examination (MMSE). Folic acid, vitamin B(12) and Hcy levels were determined by chemical luminescence. The association between sociodemographic variables, Hcy, serum vitamin B(12), folic acid levels and total MMSE score was assessed by multiple linear regression. Values indicative of HHcy (>12micromol/l) were found in 34.8% of the individuals. Age, schooling and HHcy showed a negative correlation with the MMSE score. The R(2) values of isolated HHcy explain only 4% of the MMSE score variance, however when associated to schooling and age, this model explained up to 25% of this association.

Acute Effects of Volume-Oriented Incentive Spirometry on Chest Wall Volumes in Patients After a Stroke

BACKGROUND: The aim of the present study was to assess how volume-oriented incentive spirometry applied to patients after a stroke modifies the total and compartmental chest wall volume variations, including both the right and left hemithoraces, compared with controls. METHODS: Twenty poststroke patients and 20 age-matched healthy subjects were studied by optoelectronic plethysmography during spontaneous quiet breathing (QB), during incentive spirometry, and during the recovery period after incentive spirometry. RESULTS: Incentive spirometry was associated with an increased chest wall volume measured at the pulmonary rib cage, abdominal rib cage and abdominal compartment (P = .001) and under 3 conditions (P < .001). Compared with healthy control subjects, the tidal volume (VT) of the subjects with stroke was 24.7, 18.0, and 14.7% lower during QB, incentive spirometry, and postincentive spirometry, respectively. Under all 3 conditions, the contribution of the abdominal compartment to VT was greater in the stroke subjects (54.1, 43.2, and 48.9%) than in the control subjects (43.7, 40.8, and 46.1%, P = .039). In the vast majority of subjects (13/20 and 18/20 during QB and incentive spirometry, respectively), abdominal expansion precedes rib cage expansion during inspiration. Greater asymmetry between the right and left hemithoracic expansions occurred in stroke subjects compared with control subjects, but it decreased during QB (62.5%, P = .002), during incentive spirometry (19.7%), and postincentive spirometry (67.6%, P = .14). CONCLUSIONS: Incentive spirometry promotes increased expansion in all compartments of the chest wall and reduces asymmetric expansion between the right and left parts of the pulmonary rib cage; therefore, it should be considered as a tool for rehabilitation.

Teste de labirinto: instrumento de análise na aquisição de uma habilidade motora

BACKGROUND: Analysis of the acquisition of motor skills by means of a simple and easily used instrument may assist in physiotherapeutic diagnosis and treatment. OBJECTIVE: To verify whether the maze test can be used as an instrument for analyzing the acquisition of motor skills, by means of measurements such as the time taken and number of attempts required for performance stabilization, under the influence of visual clues. METHOD: The sample consisted of 70 healthy male university students, aged 20 ± 2 years, divided into two groups that underwent maze tests with and without visual clues. Thirty attempts were made and two retention tests were performed. The data were analyzed using two-way ANOVA with repeated measurements (with post hoc Newman-Keuls test). RESULTS: There were significant differences in the time taken between attempts, with performance stabilization from the eighth attempt in the maze without clues and from the sixth attempt in the maze with clues, and this was maintained after the retention tests. In the maze test with clues, stabilization occurred earlier and the time taken to perform the movement was greater. CONCLUSION: The evidence showed that the maze test enables identification of the appropriate quantity of practice for training motor skills and verifying the influence of visual clues on performance stabilization of performance, thereby suggesting that this instrument can be used in physical therapy.

Comparação das pressões respiratórias máximas entre escolares das redes pública e privada

Objective: To compare the values of maximal inspiratory pressures (MIP) and maximal expiratory pressures (MEP) between students from public and private schools. Methods: Observational cross-sectional study of 144 children from public and private schools. Maximal respiratory pressures were measured with an MVD300 (Globalmed). Student’s t-test was applied to compare average pressures and chi-square test was used to compare the frequency of children who performed or not physical activity. Results: Students from private and public schools showed a mean MIP of 77.0±21.5 and 65.7±18.7cmH 2 O (p=0.002) and MEP of 90.1±22.5 and 79.4±19.0cmH 2 O (p=0.005),OBJETIVO: Comparar los valores obtenidos de las presiones inspiratorias maximas (PImax) y presiones espiratorias maximas (PEmax) entre estudiantes de las redes publica y privada de ensenanza. METODOS: Estudio observacional de tipo descriptivo transversal. Se evaluo a 144 ninos en las dos redes de ensenanza. Las presiones respiratorias maximas fueron medidas con el MVD300 (Gobalmed®). Se aplico la prueba t de Student no pareada para comparar los promedios de las variables y la prueba de chi cuadrado para comparar la frecuencia de ninos que realizaban o no actividad fisica. RESULTADOS: Los alumnos de las escuelas privadas y publicas presentaron, respectivamente, promedio de PImax 77,0±21,5 y 65,7±18,7cmH2O (p=0,002) y PEmax 90,1±22,5 y 79,4±19,0cmH2O (p=0,005). Los muchachos de las escuelas privadas y publicas presentaron promedios de PImax 85,0±20,8 y 74,4±17,1cmH2O (p=0,051) y PEmax 98,5±2,5 y 89,2±16,3cmH2O (p=0,103), respectivamente. Las muchachas de las escuelas privadas y publicas presentaron promedios de PImax 70,0±19,8 y 60,2±17,8cmH2O (p=0,027) y PEmax 82,6±20,0 y 73,2±18,1cmH2O (p=0,035), respectivamente. Un 40% de los alumnos de la red publica y un 95% de los alumnos de la red privada realizaban actividad fisica. Los ninos que realizaban o no actividad fisica presentaron PImax 76,0±20,7 y 63,2±20,0cmH2O (p=0,002) y PEmax 89±21,6 y 77,4±20,5cmH2O (p=0,006), respectivamente. CONCLUSIONES: La fuerza muscular respiratoria de los alumnos de la red privada fue significativamente superior a la de los alumnos de la red publica, especialmente entre las muchachas, y posiblemente esa diferencia este relacionada a la practica de actividad fisica, observada con mas frecuencia en las escuelas privadas.

Pressões respiratórias máximas de pico e sustentada na avaliação da força muscular respiratória de crianças

OBJECTIVES: to compare peak and sustained values of PImax and PEmax in a sample of schoolaged children. METHODS: a descriptive observational crosssection analysis. 144 healthy boys and girls between the ages of 7 and 11 were evaluated. An anthropometric assessment was performed and measurements of peak and sustained respiratory muscle strength with the use of a digital manometer. The child chose at random what initial respiratory pressure to hold. The measurement of PImax was taken from total lung capacity and the measurement of PEmax from residual volume. Data was analyzed using SPSS 17.0 and was attributed a significance level of 5%. RESULTS: the following findings were produced bythe study: 78.53 ± 22.53 cmH2O for PIpeak and 72.95 ± 21.22 cmH2O and 86.25 ± 21.8 cmH2O for PIsust and PEsust respectively. The values obtained throughpeak respiratory pressures (PIpeak and PEpeak) were significantly higher than the measurements obtained for sustained respiratory pressures (PIsust and PEsust)regardless of gender or age assessment (p=0.001). CONCLUSIONS: the use of measures in assessing peak maximum respiratory pressure, more easily obtained in clinical practice, may undermine the real measurements of respiratory muscle strength in children between 7 and 11 years of age.

Observational practice of incentive spirometry in stroke patients

Highlights • Stroke patients performed differently to healthy individuals when learning to use incentive spirometry.• Stroke patients can benefit from learning rehabilitation techniques.• Observational techniques improve the performance of tasks in stroke patients.

Comparación de las presiones respiratorias máximas entre escolares de las redes pública y privada

Objective: To compare the values of maximal inspiratory pressures (MIP) and maximal expiratory pressures (MEP) between students from public and private schools. Methods: Observational cross-sectional study of 144 children from public and private schools. Maximal respiratory pressures were measured with an MVD300 (Globalmed). Student’s t-test was applied to compare average pressures and chi-square test was used to compare the frequency of children who performed or not physical activity. Results: Students from private and public schools showed a mean MIP of 77.0±21.5 and 65.7±18.7cmH 2 O (p=0.002) and MEP of 90.1±22.5 and 79.4±19.0cmH 2 O (p=0.005),OBJETIVO: Comparar los valores obtenidos de las presiones inspiratorias maximas (PImax) y presiones espiratorias maximas (PEmax) entre estudiantes de las redes publica y privada de ensenanza. METODOS: Estudio observacional de tipo descriptivo transversal. Se evaluo a 144 ninos en las dos redes de ensenanza. Las presiones respiratorias maximas fueron medidas con el MVD300 (Gobalmed®). Se aplico la prueba t de Student no pareada para comparar los promedios de las variables y la prueba de chi cuadrado para comparar la frecuencia de ninos que realizaban o no actividad fisica. RESULTADOS: Los alumnos de las escuelas privadas y publicas presentaron, respectivamente, promedio de PImax 77,0±21,5 y 65,7±18,7cmH2O (p=0,002) y PEmax 90,1±22,5 y 79,4±19,0cmH2O (p=0,005). Los muchachos de las escuelas privadas y publicas presentaron promedios de PImax 85,0±20,8 y 74,4±17,1cmH2O (p=0,051) y PEmax 98,5±2,5 y 89,2±16,3cmH2O (p=0,103), respectivamente. Las muchachas de las escuelas privadas y publicas presentaron promedios de PImax 70,0±19,8 y 60,2±17,8cmH2O (p=0,027) y PEmax 82,6±20,0 y 73,2±18,1cmH2O (p=0,035), respectivamente. Un 40% de los alumnos de la red publica y un 95% de los alumnos de la red privada realizaban actividad fisica. Los ninos que realizaban o no actividad fisica presentaron PImax 76,0±20,7 y 63,2±20,0cmH2O (p=0,002) y PEmax 89±21,6 y 77,4±20,5cmH2O (p=0,006), respectivamente. CONCLUSIONES: La fuerza muscular respiratoria de los alumnos de la red privada fue significativamente superior a la de los alumnos de la red publica, especialmente entre las muchachas, y posiblemente esa diferencia este relacionada a la practica de actividad fisica, observada con mas frecuencia en las escuelas privadas.

Comparison of maximal respiratory pressures between schoolchildren from public and private schools

Objective: To compare the values of maximal inspiratory pressures (MIP) and maximal expiratory pressures (MEP) between students from public and private schools. Methods: Observational cross-sectional study of 144 children from public and private schools. Maximal respiratory pressures were measured with an MVD300 (Globalmed). Student’s t-test was applied to compare average pressures and chi-square test was used to compare the frequency of children who performed or not physical activity. Results: Students from private and public schools showed a mean MIP of 77.0±21.5 and 65.7±18.7cmH 2 O (p=0.002) and MEP of 90.1±22.5 and 79.4±19.0cmH 2 O (p=0.005),OBJETIVO: Comparar los valores obtenidos de las presiones inspiratorias maximas (PImax) y presiones espiratorias maximas (PEmax) entre estudiantes de las redes publica y privada de ensenanza. METODOS: Estudio observacional de tipo descriptivo transversal. Se evaluo a 144 ninos en las dos redes de ensenanza. Las presiones respiratorias maximas fueron medidas con el MVD300 (Gobalmed®). Se aplico la prueba t de Student no pareada para comparar los promedios de las variables y la prueba de chi cuadrado para comparar la frecuencia de ninos que realizaban o no actividad fisica. RESULTADOS: Los alumnos de las escuelas privadas y publicas presentaron, respectivamente, promedio de PImax 77,0±21,5 y 65,7±18,7cmH2O (p=0,002) y PEmax 90,1±22,5 y 79,4±19,0cmH2O (p=0,005). Los muchachos de las escuelas privadas y publicas presentaron promedios de PImax 85,0±20,8 y 74,4±17,1cmH2O (p=0,051) y PEmax 98,5±2,5 y 89,2±16,3cmH2O (p=0,103), respectivamente. Las muchachas de las escuelas privadas y publicas presentaron promedios de PImax 70,0±19,8 y 60,2±17,8cmH2O (p=0,027) y PEmax 82,6±20,0 y 73,2±18,1cmH2O (p=0,035), respectivamente. Un 40% de los alumnos de la red publica y un 95% de los alumnos de la red privada realizaban actividad fisica. Los ninos que realizaban o no actividad fisica presentaron PImax 76,0±20,7 y 63,2±20,0cmH2O (p=0,002) y PEmax 89±21,6 y 77,4±20,5cmH2O (p=0,006), respectivamente. CONCLUSIONES: La fuerza muscular respiratoria de los alumnos de la red privada fue significativamente superior a la de los alumnos de la red publica, especialmente entre las muchachas, y posiblemente esa diferencia este relacionada a la practica de actividad fisica, observada con mas frecuencia en las escuelas privadas.