Efeitos do estímulo verbal sobre o desempenho no teste de escada e ajustes cardiorrespiratórios em sujeitos saudáveis

Esta pesquisa teve o objetivo de avaliar os efeitos do estímulo verbal (EV) no tempo do teste de escada (TEsc) e nas variáveis cardiorrespiratórias de adultos saudáveis. Trinta e um adultos saudáveis realizaram dois TEsc (com EV e sem EV). Antes e depois de cada teste, foram avaliados os sinais vitais e a Escala de Borg. Os tempos nos TEsc foram comparados por meio do Teste t de Student para amostras pareadas e as diferenças, de acordo com a ordem de realização dos testes utilizando o Teste de Mann-Whitney. Os sinais vitais e a Escala de Borg foram comparados por meio do Teste de Friedman ou ANOVA com post hoc do Teste de Tukey. As variações foram comparadas utilizando o Teste t Student para amostras independentes ou Teste de Mann-Whitney (p<0,05). O tempo no TEsc sem EV foi de 23,48±8,28 segundos, significativamente maior que o teste com EV, que foi de 21,60±7,18 segundos (p<0,05). Todas as variáveis aumentaram após os testes, e a Escala de Borg foi a única que teve maior variação no TEsc com EV, variando 2,5±1,4 no teste sem estímulo e 3,0±1,8 pontos no com estímulo (p<0,05). O estímulo verbal melhora o desempenho no TEsc e leva à maior sensação de esforço.

Comparison between actual and predicted postoperative stair-climbing test, walk test and spirometric values in patients undergoing lung resection

OBJETIVO: Verificar se os testes: Volume Expiratório Forçado no 1º segundo (VEF1), Teste de Caminhada de 6 minutos (TC6) e Teste de Escada (TE) se alteram proporcionalmente ao pulmão funcionante ressecado. MÉTODOS: Foram incluídos pacientes candidatos a toracotomia para ressecção pulmonar. No pré-operatório (pré) e no mínimo três meses após a cirurgia (pós), realizaram espirometria, TC6 e TE. O TE foi realizado em escada com 12,16m de altura. O tempo para subir todos os degraus o mais rápido possível foi chamado tempo de escada (tTE). Os cálculos dos valores dos testes preditos para o pós-operatório (ppo) foram realizados conforme o número de segmentos funcionantes perdidos. Os valores pré, ppo e pós foram comparados entre si para cada teste. Estatística: foi utilizada a análise de variância para medidas repetidas (ANOVA), com significância de 5%. RESULTADOS: Foram estudados 40 pacientes. A ressecção pulmonar variou desde o ganho de dois segmentos funcionantes até a perda de 9. Os valores pré, ppo e pós foram respectivamente: VEF1 -pré = 2,6±0,8L, ppo = 2,3±0,8L, pós = 2,3±0,8L (VEF1pré > VEF1ppo = VEF1pós), TC6-pré = 604±63m, ppo = 529±103m, pós = 599±74m (TC6pré = TC6pós > TC6ppo), tTE-pré = 32,9±7,6s, ppo = 37,8±12,1s, pós = 33,7±8,5s (tTEpré = tTEpós < tTEppo). CONCLUSÃO: Nas ressecções pulmonares, este grupo de pacientes perdeu função pulmonar medida através da espirometria, mas não perdeu a capacidade de exercício, medida através dos testes de escada e caminhada.

Paracoccidioidomicose: estudo radiológico e pulmonar de 58 casos

Spirometric and haemogasimetric tests were performed in 52 patients with unifocal and multifocal progressive Paracoccidioidomycosis pulmonary diseases, in 5 patients with juvenile and 1 female internal genital forms. The age ranged from 20 to 74 years old and the duration of disease from 3 to 25 years. Dyspnea, cough, tegumentary and lymphatic manifestations were the most predominant signs observed. Fourteen of them was developed Cor pulmonale. Impaired renal function was recorded in 19 patients, cardiac symptoms were described in 7 and hyporeactor adrenal activity was showed in 13 patients. Radiological studies demonstrated mild in 16, moderate in 24 and severe pulmonary lesions types in 18 patients. The pulmonary function revealed: normal spyrographic findings in 17, pure obstructive type in 32 and mixed form in 9 of them. Hyperventilation was described in 54 individuals and all of them showed an increasing of the alveolo-arterial difference. PaO2 less than 80 mm/Hg observed in 36 of them. Statistical analysis demonstrated significative association between clinical evolution and radiological interpretation. Similar data were obtained in radiology evaluations, clinical evolutive studies and pulmonary functions described in these patients. The granulomatous reaction due to Paracoccidioidomycosis, in heavy smokers patients, gave origin to the alterations in small airways predisposing the interalveolar dissemination an impaired alveolo-arterial diffusion.

Assessment of vitamin A status in chronic obstructive pulmonary disease patients and healthy smokers

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Acurácia do teste de escada utilizando o consumo máximo de oxigênio como padrão-ouro

Objective: To determine the accuracy of the variables related to the fixed-height stair-climbing test (SCT) using maximal oxygen uptake (V̇O 2 max) as the gold standard. Methods: The SCT was performed on a staircase consisting of 6 flights (72 steps; 12.16 m total height), with verbal encouragement, in 51 patients. Stair-climbing time was measured, the variables 'work' and 'power' also being calculated. The V̇O2 max was measured using ergospirometry according to the Balke protocol. We calculated the Pearson linear correlation (r), as well as the values of p, between the SCT variables and V̇O2 max. To determine accuracy, the V̇O 2 max cut-off point was set at 25 mL/kg/min, and individuals were classified as normal or altered. The cut-off points for the SCT variables were determined using the receiver operating characteristic curve. The Kappa statistic (k) was used in order to assess concordance. Results: The following values were obtained for the variable 'time': cut-off point = 40 s; mean = 41 ± 15.5 s; r = -0.707; p < 0.005; specificity = 89%; sensibility = 83%; accuracy = 86%; and k = 0.724. For 'power', the values obtained were as follows: cut-off point = 200 w; mean = 222.3 ± 95.2 w; r = 0.515; p < 0.005; specificity = 67%; sensibility= 75%; accuracy = 71%; and k = 0.414. Since the correlation between the variable 'work' and V̇O2 max was not significant, that variable was discarded. Conclusion: Of the SCT variables tested, using V̇O2 max as the gold standard, the variable 'time' was the most accurate.

Effects of active smoking on airway and systemic inflammation profiles in patients with chronic obstructive pulmonary disease

Background: The markers that characterize local and systemic inflammation in chronic obstructive pulmonary disease (COPD) remain unclear, as do their correlations with smoking status and presence of disease. The aim of this study was to assess markers of inflammation in the peripheral blood and airways of current smokers without COPD, of current smokers with COPD and of ex-smokers with COPD. METHODS: In this study, 17 current smokers with COPD (mean age: 58.2 ± 9.6 years; mean forced expiratory volume in 1 second [FEV1]: 56.1 ± 15.9%), 35 ex-smokers with COPD (mean age: 66.3 ± 7.3 years; mean FEV1: 47.9 ± 17.2%) and 20 current smokers without COPD (mean age: 49.1 ± 6.2 years; mean FEV1: 106.5 ± 15.8%) were evaluated. Spirometry findings, body composition and serum/induced sputum concentrations of tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-8 and IL-10, together with serum C-reactive protein (CRP) levels, were assessed. RESULTS: Serum TNF-α concentration was higher in all current smokers than in ex-smokers with COPD. In current smokers without COPD, serum CRP level was lower than in ex-smokers with COPD and significantly lower than in current smokers with COPD. Sputum TNF-α concentration was higher in current and ex-smokers with COPD than in current smokers without COPD. Multiple regression analyses showed that serum TNF-α was associated with active smoking, and serum CRP and sputum TNF-α were associated with COPD diagnosis. CONCLUSIONS: Smoking is associated with higher systemic inflammation in patients with COPD. Current findings also support the hypothesis that smoking and COPD have different effects on the regulation of airway and systemic inflammatory processes. © 2013 Lippincott Williams and Wilkins.

Correlação entre os resultados pré-operatórios de testes cardiopulmonares e a evolução pós-operatória em cirurgia bariátrica

Pós-graduação em Bases Gerais da Cirurgia - FMB

Respiratory chemoreceptor function in vertebrates - Comparative and evolutionary aspects

The sensing of blood gas tensions and/or pH is an evolutionarily conserved, homeostatic mechanism, observable in almost all species studied from invertebrates to man. In vertebrates, a shift from the peripheral O2-oriented sensing in fish, to the central CO2/pH sensing in most tetrapods reflects the specific behavioral requirements of these two groups whereby, in teleost fish, a highly O2-oriented control of breathing matches the ever-changing and low oxygen levels in water, whilst the transition to air-breathing increased the importance of acid-base regulation and O2-related drive, although retained, became relatively less important. The South American lungfish and tetrapods are probably sister groups, a conclusion backed up by many similar features of respiratory control. For example, the relative roles of peripheral and central chemoreceptors are present both in the lungfish and in land vertebrates. In both groups, the central CO2/pH receptors dominate the ventilatory response to hypercarbia (60-80), while the peripheral CO2/pH receptors account for 20-30. Some basic components of respiratory control have changed little during evolution. This review presents studies that reflect the current trends in the field of chemoreceptor function, and several laboratories are involved. An exhaustive review on the previous literature, however, is beyond the intended scope of the article. Rather, we present examples of current trends in respiratory function in vertebrates, ranging from fish to humans, and focus on both O2 sensing and CO2 sensing. As well, we consider the impact of chronic levels of hypoxia - a physiological condition in fish and in land vertebrates resident at high elevations or suffering from one of the many cardiorespiratory disease states that predispose an animal to impaired ventilation or cardiac output. This provides a basis for a comparative physiology that is informative about the evolution of respiratory functions in vertebrates and about human disease. Currently, most detail is known for mammals, for which molecular biology and respiratory physiology have combined in the discovery of the mechanisms underlying the responses of respiratory chemoreceptors. Our review includes new data on nonmammalian vertebrates, which stresses that some chemoreceptor sites are of ancient origin.

Respiratory pressures and expiratory peak flow rate of patients undergoing coronary artery bypass graft surgery

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo das alterações funcionais respiratórias em pacientes submetidos à colecistectomia videolaparoscópica

Pós-graduação em Bases Gerais da Cirurgia - FMB

Estudo das alterações funcionais respiratórias em pacientes dubmetidos à cirurgia videolaparoscópica de válvula anti-refluxo

Pós-graduação em Bases Gerais da Cirurgia - FMB

Estudo da alterações funcionais cardiorrespiratórias em pacientes submetidos a simpatectomia toráxica videoassistida

Pós-graduação em Bases Gerais da Cirurgia - FMB

Cardiorespiratory evaluation in pre and post operative moments of laparoscopic cholecystectomy

PURPOSE: To analyze the changes in both respiratory function and cardiopulmonary exercise tests results in patients subjected to laparoscopic cholecystectomy. METHODS: Fifty patients were evaluated (76% women) and the average age was 47.8±14.2 years. All individuals underwent the measurement of spirometry, manovacuometry, 6-minute walk test (6MWT) and stair-climbing test (SCT). All tests were performed at the first (PO1), fifth (PO5) and thirtieth (PO30) postoperative days. RESULTS: BMI average was 28.8±4.8 kg/m2. Sample comprised 68% non-smokers, 20% current smokers, and 12% former smokers. There was no incidence of postoperative complication whatsoever. There was a significant decrease in spirometric values at PO1, but values were similar to the ones of PRE at PO30. Manovacuometry showed alterations at PO1 displaying values that were similar to the ones of PRE at PO30. 6MWT was significantly shorter at until PO5, but at PO30 values were similar to ones of PRE. As for SCT, values were significantly compromised at PO5 and PO30 since they were similar to the ones of PRE. CONCLUSION: Patients submitted to laparoscopic cholecystectomy present a decrease in cardiorespiratory function on the first postoperative moments but there is a rapid return to preoperative conditions.

Control of respiratory and cardiovascular functions by leptin

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Natação Adaptada: análise da função pulmonar de pessoas com deficiência

The research discusses the pulmonary function of the students of SORRI that are part of the Project for the extension of the Department of Physical Education in Bauru Swimming for People with Disabilities during the aquatic activities, noting the changes in efficiency class of breathing with the practice of aquatic activity, by the analysis of the volume and respiratory capacity. The respiratory control is essential in the process of adaptation to the liquid medium, because a student who fails to immerse the face in the water will not be able to adopt a horizontal position sufficiently stable. The practice of aquatic activities requires a great effort of breathing. Therefore, the practice of aquatic activities influence favorably the breathing, because the movements performed in the water tone the diaphragm, which is the essential muscle of the breathing, allowing an improvement in pulmonary ventilation. For the purposes of this study, the sample was composed of 10 students of the SORRI of the city of Bauru forming part of the project Swimming for People with Disabilities, practicing swimming once a week for 1 hour. For the collection of lung volumes and capacities was used a transducer of air flow and a unit of data collection, model MP36, both of the brand Biopac connected to a computer, where the data were collected and recorded for later analysis. Two tests were carried out in a day with each participant in the project of swimming, and a test at the beginning of the lesson, at rest, and another after a series of 10 breaths carried out within the swimming pool. These tests were performed in the months of March and April. The analysis of the data was through the medium of the figures and also individually, noting the changes in respiratory function of students practicing aquatic activities, without which there would be no comparison between the participants. The measurements of the scores on the pre- and post-exercise show that the...