Resumo: Apresentamos o caso de um paciente de 31 anos de idade que trabalha em um moinho de grãos há 12 anos e desenvolveu asma ocupacional. O objetivo do artigo é apresentar a justificativa da origem ocupacional da asma adquirida. Descrevemos as tarefas realizadas, os materiais e os meios de trabalho utilizados. Analisamos especialmente a exposição ocupacional à poeira orgânica e sua conexão temporal com a sintomatologia respiratória. Essas informações nos permitem entender a importância das condições em que o trabalho é realizado e a exposição a um fator de risco, a poeira orgânica, para o desenvolvimento da patologia respiratória ocupacional. As medições do volume pulmonar expiratório máximo foram realizadas com a técnica de pico de fluxo durante e fora da jornada de trabalho. Observamos variações no fluxo expiratório superiores a 20%, tanto durante quanto fora do horário de trabalho, com um padrão sintomático semelhante ao relatado pelo trabalhador. Concluímos que há evidências de um nexo causal entre asma e trabalho e, portanto, propomos o diagnóstico de asma ocupacional. Destacamos a importância de avaliar os riscos ocupacionais em cada atividade para implementar planos de vigilância da saúde tanto do trabalhador quanto do ambiente de trabalho, a fim de evitar o surgimento e a evolução dessa ou de outras patologias que, em muitos casos, geram incapacidade para a tarefa e deterioração da qualidade de vida dos trabalhadores.

Resumen: Se presenta el caso de un trabajador de 31 años que desempeña tareas en un molino de granos desde hace 12 años y que ha desarrollado asma ocupacional. El objetivo del artículo es presentar los fundamentos utilizados para sostener el origen profesional del asma adquirido. Se describen las tareas laborales que desarrolla, materiales y medios de trabajo que utiliza. Se analiza en particular la exposición laboral a polvo orgánico y su vinculación temporal con la sintomatología respiratoria. Esta información permite comprender la importancia de las condiciones en las que realiza el trabajo y la exposición a un factor de riesgo, el polvo orgánico, para el desarrollo de la patología respiratoria laboral. Se realizaron mediciones de volumen máximo espiratorio pulmonar, con técnica de pico flujo, durante la jornada laboral y fuera de ésta. Se observaron variaciones del flujo espiratorio mayores a 20%, tanto durante la jornada laboral como fuera de ella, con similar patrón sintomático, según relata el trabajador. Se concluyó que existe evidencia del nexo causal entre el asma y el trabajo, por lo que se plantea el diagnóstico de asma ocupacional. Se destaca la importancia de evaluar los riesgos laborales en cada actividad para implementar planes de vigilancia de la salud, tanto del operario como del ambiente de trabajo, para prevenir la aparición como la evolución de esta u otras patologías que en muchos casos generan incapacidad para la tarea y deterioro de la calidad de vida de los trabajadores.

Abstract: We present the case of a 31-year-old worker who has been working in a grain mill for 12 years and has developed work-related asthma. The objective of this article is to present the foundations used to support the occupational origin of the acquired asthma. The study describe the work tasks performed, the materials used, and the working methods. The work-related exposure to organic dust and its temporal relationship with respiratory symptoms is particularly analyzed. This information allows us to understand the importance of working conditions and exposure to organic dust, a risk factor, for the development of this work-related respiratory pathology. Measurements of maximum expiratory lung volume were made using the peak flow technique during and outside of the workday. Expiratory flow variations greater than 20% were observed, both during and outside of the workday, which followed a similar symptomatic pattern as reported by the worker. The study concluded that there is evidence of a causal link between asthma and work, thus suggesting the diagnosis of work-related asthma. The importance of assessing occupational risks in each activity to implement health surveillance plans for both workers and the work environment is highlighted, aiming to prevent the onset and progression of this and other pathologies that often result in work incapacity and deterioration of workers’ quality of life.

ABSTRACT Objectives: To describe persistent symptoms and lung function in mild cases of COVID-19 six months after infection. Methods: Data collection was performed through a semi-structured questionnaire containing information on the participants’ demographic and anthropometric data, the disease in the acute phase, and persistent symptoms six months after COVID-19 using spirometry and manovacuometry. Results: A total of 136 participants were evaluated, of whom 64% were male, with a mean age of 38.17 ± 14.08 years and a body mass index (BMI) of 29.71 ± 17.48 kg/m2. The main persistent symptoms reported were dyspnea on exertion (39.7%), memory loss (38.2%), and anxiety (48.5%). Considering lung function, the participants reached 88.87 ± 17.20% of the predicted forced vital capacity (FVC), 86.03 ± 22.01% of the forced expiratory volume in one second (FEV1), and 62.71 ± 25.04% of peak expiratory flow (PEF). Upon manovacuometry, 97.41 ± 34.67% of the predicted inspiratory force (Pimax) and 66.86 ± 22.97% of the predicted expiratory force (Pemax) were observed. Conclusions: Six months after COVID-19 infection, a reduction in PEF and MEP was observed. Among the most commonly reported persistent symptoms were fatigue, tiredness with the slightest exertion, anxiety and depression, memory loss, and deficits in concentration. Objectives COVID19 COVID 19 COVID-1 infection Methods semistructured semi structured data phase manovacuometry Results 13 evaluated 64 male 3817 38 17 38.1 1408 14 08 14.0 BMI (BMI 2971 29 71 29.7 1748 48 17.4 kgm2 kgm kg m2 m kg/m2 39.7%, 397 39.7% , 39 7 (39.7%) 38.2%, 382 38.2% 2 (38.2%) 48.5%. 485 48.5% . 5 (48.5%) 8887 88 87 88.8 1720 20 17.20 FVC, FVC (FVC) 8603 86 03 86.0 2201 22 01 22.01 FEV1, FEV1 FEV (FEV1) 6271 62 62.7 2504 25 04 25.04 PEF. (PEF) 9741 97 41 97.4 3467 34 67 34.67 Pimax (Pimax 6686 66 66.8 2297 22.97 Pemax (Pemax observed Conclusions fatigue depression concentration COVID1 1 COVID- 6 381 3 38. 140 0 14. 297 29. 174 4 17. kg/m 39.7 (39.7% 38.2 (38.2% 48.5 (48.5% 888 8 88. 172 17.2 (FVC 860 86. 220 22.0 (FEV1 627 62. 250 25.0 (PEF 974 9 97. 346 34.6 668 66. 229 22.9 39. (39.7 (38.2 48. (48.5 22. (FEV 25. 34. (39. (38. (48. (39 (38 (48 (3 (4 (

RESUMO Objetivos: Descrever os sintomas persistentes e a função pulmonar em casos leves de COVID-19 seis meses após a infecção. Métodos: A coleta de dados foi realizada por meio de um questionário semiestruturado contendo informações sobre dados demográficos e antropométricos dos participantes, a doença na fase aguda e os sintomas persistentes seis meses após a COVID-19, utilizando espirometria e manovacuometria. Resultados: Um total de 136 participantes foram avaliados, dos quais 64% eram do sexo masculino, com uma idade média de 38,17 ± 14,08 anos e índice de massa corporal (IMC) de 29,71 ± 17,48 kg/m2. Os principais sintomas persistentes relatados foram dispneia ao esforço (39,7%), perda de memória (38,2%) e ansiedade (48,5%). Considerando a função pulmonar, os participantes atingiram 88,87 ± 17,20% da capacidade vital forçada (CVF) prevista, 86,03 ± 22,01% do volume expiratório forçado no primeiro segundo (VEF1) e 62,71 ± 25,04% do pico de fluxo expiratório (PFE). Na manovacuometria, observou-se 97,41 ± 34,67% da força inspiratória prevista (Pimáx) e 66,86 ± 22,97% da força expiratória prevista (Pemáx). Conclusões: Seis meses após a infecção por COVID-19, observou-se uma redução no PFE e na PEM. Dentre os sintomas persistentes mais comumente relatados estavam fadiga, cansaço com o mínimo esforço, ansiedade e depressão, perda de memória e déficits de concentração. Objetivos COVID19 COVID 19 COVID-1 Métodos COVID19, 19, manovacuometria Resultados 13 avaliados 64 masculino 3817 38 17 38,1 1408 14 08 14,0 IMC (IMC 2971 29 71 29,7 1748 48 17,4 kgm2 kgm kg m2 m kg/m2 39,7%, 397 39,7% , 39 7 (39,7%) 38,2% 382 2 (38,2% 48,5%. 485 48,5% . 5 (48,5%) 8887 88 87 88,8 1720 20 17,20 CVF (CVF 8603 86 03 86,0 2201 22 01 22,01 VEF1 VEF (VEF1 6271 62 62,7 2504 25 04 25,04 PFE. (PFE) observouse observou se 9741 97 41 97,4 3467 34 67 34,67 Pimáx (Pimáx 6686 66 66,8 2297 22,97 Pemáx. Pemáx (Pemáx) Conclusões PEM fadiga depressão concentração COVID1 1 COVID- 6 381 3 38, 140 0 14, 297 29, 174 4 17, kg/m 39,7 (39,7% 38,2 (38,2 48,5 (48,5% 888 8 88, 172 17,2 860 86, 220 22,0 (VEF 627 62, 250 25,0 (PFE 974 9 97, 346 34,6 668 66, 229 22,9 (Pemáx 39, (39,7 (38, 48, (48,5 22, 25, 34, (39, (38 (48, (39 (3 (48 ( (4

ABSTRACT Introduction: This study aimed to evaluate the efficacy of respiratory muscle training during the immediate postoperative period of cardiac surgery on respiratory muscle strength, pulmonary function, functional capacity, and length of hospital stay. Methods: This is a systematic review and meta-analysis. A comprehensive search on PubMed®, Excerpta Medica Database (or Embase), Cumulative Index of Nursing and Allied Health Literature (or CINAHL), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Cochrane Central Register of Controlled Trials databases was performed. A combination of free-text words and indexed terms referring to cardiac surgery, coronary artery bypass grafting, respiratory muscle training, and clinical trials was used. A total of 792 studies were identified; after careful selection, six studies were evaluated. Results: The studies found significant improvement after inspiratory muscle training (IMT) (n = 165, 95% confidence interval [CI] 9.68, 21.99) and expiratory muscle training (EMT) (n = 135, 95% CI 8.59, 27.07) of maximal inspiratory pressure and maximal expiratory pressure, respectively. Also, IMT increased significantly (95% CI 19.59, 349.82, n = 85) the tidal volume. However, no differences were found in the peak expiratory flow, functional capacity, and length of hospital stay after EMT and IMT. Conclusion: IMT and EMT demonstrated efficacy in improving respiratory muscle strength during the immediate postoperative period of cardiac surgery. There was no evidence indicating the efficacy of IMT for pulmonary function and length of hospital stay and the efficacy of EMT for functional capacity. Introduction capacity Methods metaanalysis. metaanalysis meta analysis. analysis meta-analysis PubMed PubMed® or Embase, Embase , Embase) CINAHL, CINAHL CINAHL) LILACS, LILACS LILACS) SciELO, SciELO SciELO) PEDro, PEDro PEDro) performed freetext free text grafting used 79 identified selection evaluated Results (IMT 165 95 [CI 968 9 68 9.68 21.99 2199 21 99 (EMT 135 859 8 59 8.59 27.07 2707 27 07 respectively Also (95 1959 19 19.59 34982 349 82 349.82 85 volume However flow Conclusion 7 16 96 6 9.6 21.9 219 2 13 5 8.5 27.0 270 0 (9 195 1 19.5 3498 34 349.8 9. 21. 8. 27. ( 19. 3 349.

BACKGROUND. There is a dearth of information on the relationship between indoor air pollution and lung function, especially among sub-Saharan African children. OBJECTIVE. To assess the relationship between indoor particulate matter (PM) and lung function in children living in the Eastern Cape Province of South Africa (SA). METHODS. This cross-sectional study included 540 children aged 10 - 14 years and was conducted between May and September 2016. PM from 23 classrooms was measured with a handheld particle counter and lung function was assessed with a handheld spirometer. RESULTS. Mean (standard deviation) PM5 levels were higher (109.96 (75.39) μg/m³) than PM10 (84.84 (63.28) μg/m³) and PM25 (39.45 (26.38) μg/m³). PM25, PM5 and PM10 correlated negatively (p<0.05) with forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV25-75 , as well as peak expiratory flow (PEF) but correlated positively (p<0.001) with the FEV1/FVC ratio. CONCLUSION. PM in classrooms showed a negative relationship with lung function in the study population.

Abstract Objective: This study aims to evaluate the respiratory function of children and adolescents with osteogenesis imperfecta (OI) followed up at a referral center. Methods: A cross-sectional study was conducted with a non-probabilistic sample. Manovacuometry was performed with the measurement of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), and in addition, peak expiratory flow (PEF) and ventilometry were performed to measure forced vital capacity (FVC). Results: In total, 23 individuals were evaluated, with a mean age of 11.6±3.4 years, 56.5% of whom were females. Regarding the classification of OI, 56.5% of the sample belonged to type IV, 30.5% to type III, and 13% to type I. The mean MIP was 64.4% of the predicted, and the mean MEP was 56.2% of the predicted. Overall, the mean PEF was 213.9 L/min, but only 140.6 L/min in the OI type III group. Median FVC was 1.9 L, corresponding to 110% of the predicted. Conclusions: Respiratory function of the study subjects was altered, with respiratory muscle strength values lower than expected in the whole sample, and peak expiratory flow was significantly reduced in the OI type III group. Objective (OI center Methods crosssectional cross sectional nonprobabilistic non probabilistic (MIP MEP, , (MEP) addition (PEF FVC. . (FVC) Results total 2 evaluated 11634 11 6 3 4 11.6±3. years 565 56 5 56.5 females IV 305 30 30.5 13 I 644 64 64.4 predicted 562 56.2 Overall 2139 213 9 213. Lmin L min 1406 140 140. group 19 1 1. 110 Conclusions altered (MEP (FVC 1163 11.6±3 56. 30. 64. 21 14 116 11.6± 11.6 11.

RESUMO Objetivo: Avaliar a função respiratória de crianças e adolescentes com osteogênese imperfeita (OI) acompanhados em um centro de referência. Métodos: Realizou-se um estudo de corte transversal, com amostragem não probabilística. Foi realizada manovacuometria com mensuração da pressão inspiratória máxima (PIM) e pressão expiratória máxima (PEM), além do pico de fluxo expiratório (PFE) e da ventilometria para a medida da capacidade vital forçada (CVF). Resultados: Foram avaliados 23 indivíduos, com média de idade de 11,6±3,4 anos, sendo 56,5% do sexo feminino. Com relação à classificação da OI, 56,5% da amostra pertencia ao tipo IV, 30,5% ao tipo III e 13% ao tipo I. A média de PIM foi de 64,4% do previsto, e a PEM foi de 56,2% do previsto. A média de PFE foi de 213,9 L/min, sendo 140,6 L/min no grupo de OI tipo III. A mediana da CVF foi de 1,9 L, correspondendo a 110% do previsto. Conclusões: A função respiratória dos indivíduos estudados encontrava-se alterada, com valores abaixo do esperado em toda a amostra para força muscular respiratória, além do PFE reduzido no grupo OI tipo III. Objetivo (OI referência Métodos Realizouse Realizou se transversal probabilística (PIM PEM, , (PEM) (PFE CVF. . (CVF) Resultados 2 11634 11 6 3 4 11,6±3, anos 565 56 5 56,5 feminino IV 305 30 30,5 13 I 644 64 64,4 previsto 562 56,2 2139 213 9 213, Lmin L min 1406 140 140, 19 1 1, 110 Conclusões encontravase encontrava alterada (PEM (CVF 1163 11,6±3 56, 30, 64, 21 14 116 11,6± 11,6 11,

Abstract Introduction Coronary artery bypass grafting (CABG) surgery is associated with a decline in ventilatory muscle strength and lung function. Inspiratory muscle training (IMT) based on anaerobic threshold (AT) has been used to minimize the impact of CABG on these parameters, but the long-term impact is unknown. Objective To test the hypothesis that AT-based IMT improves inspiratory muscle strength and lung function even six months after CABG. Methods This is a randomized controlled clinical trial. In the preoperative period, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), vital capacity (VC) and peak expiratory flow (PEF) rate were assessed. On the first postoperative day, patients were randomized into two groups: AT-based IMT (IMT-AT) (n=21) where the load was prescribed based on glycemic threshold and conventional IMT (IMT-C) (n=21), with load of 40% of MIP. Patients were trained during hospitalization until the day of discharge and were assessed at discharge and six months later. For within-group comparison, paired Student's t-test or Wilcoxon test was used, and independent Student's t-test or the Mann-Whitney test was used to analyze the different time points. A p<0.05 was considered significant. Results At six months after CABG surgery, statistical difference was found between the IMT-AT and the IMT-C groups in MIP (difference between the means of -5cmH2; 95% CI=- 8.21to-1.79) and VC (difference between the means of -2ml/kg;95%CI=-3.87to-0.13). No difference was found between groups in the other variables analyzed. Conclusion IMT-AT promoted greater recovery of inspiratory muscle strength and VC after six months of CABG when compared to conventional training. (CABG (IMT AT (AT parameters longterm long term unknown ATbased trial period MIP, , (MIP) MEP, MEP (MEP) (VC PEF (PEF IMTAT (IMT-AT n=21 n21 n 21 (n=21 IMTC C (IMT-C n=21, 40 later withingroup within group comparison Students Student s ttest t MannWhitney Mann Whitney points p005 p 0 05 p<0.0 significant 5cmH2 cmH -5cmH2 95 CI= CI 8.21to1.79 821to179 8.21to 1.79 8 21to 1 79 8.21to-1.79 2ml/kg95%CI=3.87to0.13. 2mlkg95CI387to013 mlkgCIto 2ml/kg 95%CI= 3.87to 0.13 . 2ml kg 3 87to 13 ml -2ml/kg;95%CI=-3.87to-0.13) analyzed (MIP (MEP n=2 n2 2 (n=2 4 p00 p<0. 5cmH -5cmH 9 21to1 8.21to1.7 821to17 821to 179 1.7 7 8.21to-1.7 kg95 87to0 2ml/kg95%CI=3.87to0.13 mlkg 2mlkg95CI387to01 2mlkg 95CI 95%CI 387to 013 0.1 -2ml/kg;95%CI=-3.87to-0.13 n= (n= p0 p<0 8.21to1. 821to1 17 1. 8.21to-1. kg9 2ml/kg95%CI=3.87to0.1 2mlkg95CI387to0 01 0. -2ml/kg;95%CI=-3.87to-0.1 (n p< 8.21to1 8.21to-1 2ml/kg95%CI=3.87to0. 2mlkg95CI387to -2ml/kg;95%CI=-3.87to-0. 8.21to- 2ml/kg95%CI=3.87to0 -2ml/kg;95%CI=-3.87to-0 2ml/kg95%CI=3.87to -2ml/kg;95%CI=-3.87to- -2ml/kg;95%CI=-3.87to

Abstract Objective To analyze the effects of hospital cardiorespiratory physical therapy protocol on the functional capacity and quality of life of patients submitted to hematopoietic stem cell transplantation (HSCT). Methods From January to December 2019, bilateral dynamometry, Manovacuometry and Ventilometry, peak expiratory flow "Peak Flow", 6-min walk test (6MWT), SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS) were applied in patients who have undergone an allogeneic or autologous hematopoietic stem cell transplantation (HSCT), pre-conditioning (initial evaluation) and pre-discharge (final evaluation). The patients were submitted to an intervention protocol, consisting of aerobic training, muscle strengthening and respiratory muscle training, between the two assessments. Results 29 patients were enrolled in the study and 24 (83%) completed all procedure. Myeloablative and reduced intensity conditioning were performed in 89.6% and 10.4%, respectively; 17 (58%) patients have undergone an autologous HSCT; 10 (35%) identical related allogeneic HSCT, and 2 (7%) haploidentical allogeneic HSCT. The median number of interventions per patient was 3 (1-9). A decreasing in the right and left dynamometry (p ≤ 0.0001 and 0.002, respectively) and, also in the distance covered in the 6MWT (p = 0.004), was observed after HSCT. There was no significant difference in respiratory muscle strength, quality of life and fatigue sensation. Conclusion Cardiorespiratory rehabilitation can preserve functional capacity and quality of life. HSCT . (HSCT) 2019 Ventilometry Peak Flow, Flow , Flow" 6min min 6 6MWT, MWT (6MWT) SF36 SF 36 SF-3 VAS (VAS preconditioning pre initial evaluation predischarge discharge final evaluation. training assessments 83% 83 (83% procedure 896 89 89.6 104 4 10.4% respectively 1 58% 58 (58% 35% 35 (35% 7% 7 (7% 19. 19 9 (1-9) p 00001 0 0001 0.000 0002 002 0.002 0.004, 0004 0.004 004 0.004) strength sensation (HSCT 201 (6MWT SF3 SF- 8 (83 89. 10.4 5 (58 (35 (7 (1-9 0000 000 0.00 00 20 (8 10. (5 (3 ( (1- 0.0 (1 0.

Abstract Background Neuromuscular diseases are acquired or inherited diseases that affect the function of the muscles in our body, including respiratory muscles. Objective We aimed to discover more cost-effective and practical tools to predict respiratory function status, which causes serious problems with patients with neuromuscular disease. Methods The Vignos and Brooke Upper Extremity Functional Scales were used to evaluate functional status for patient recruitment. The handgrip strength and dexterity of patients were measured using a dynamometer and nine-hole peg test. Respiratory function parameters: forced vital capacity, forced expiratory volume in one second, and peak expiratory flow were evaluated using spirometry. Results The mean age of the 30 patients was 11.5 ± 3.79 years old. Significant relationships were found between nine-hole-peg-test scores and respiratory function parameters on both sides. Significant correlations were found between both handgrip strength and respiratory function parameters (p< 0.05). In the linear regression analysis, it was seen that the forced expiratory volume in 1 second, and peak expiratory flow values could be explained in different percentages (p< 0.05). Conclusions Handgrip strength and dexterity measurements can be used as indicators for estimating respiratory function parameters in terms of cost and accessibility, although it is known that they will not replace respiratory function tests. body costeffective effective disease recruitment ninehole nine hole test capacity second spirometry 3 115 11 5 11. 379 79 3.7 old nineholepegtest sides p< p (p 0.05. 005 0.05 . 0 05 0.05) analysis accessibility tests 37 7 3. 00 0.0 0.

Resumo Antecedentes As doenças neuromusculares são doenças adquiridas ou hereditárias que afetam a função dos músculos do nosso corpo, incluindo os músculos respiratórios. Objetivo Nosso objetivo foi descobrir ferramentas mais práticas e econômicas para prever o estado da função respiratória, que causa sérios problemas em pacientes com doença neuromuscular. Métodos As Escalas Funcionais da Extremidade Superior de Vignos e Brooke foram utilizadas para avaliar o estado funcional para recrutamento de pacientes. A força de preensão manual e a destreza dos pacientes foram medidas por meio de um dinamômetro e do teste de nove buracos. Os parâmetros da função respiratória: capacidade vital forçada, volume expiratório forçado no primeiro segundo e pico de fluxo expiratório foram avaliados por meio da espirometria. Resultados A média de idade dos 30 pacientes foi de 11,5 ± 3,79 anos. Relações significativas foram encontradas entre as pontuações do teste de nove buracos e os parâmetros da função respiratória em ambos os lados. Correlações significativas foram encontradas entre a força de preensão manual e os parâmetros da função respiratória (p< 0,05). Na análise de regressão linear, observou-se que o volume expiratório forçado no primeiro segundo e os valores de pico de fluxo expiratório puderam ser explicados em diferentes percentuais (p< 0,05). Conclusões As medidas de força de preensão manual e destreza podem ser utilizadas como indicadores para estimar parâmetros da função respiratória em termos de custo e acessibilidade, embora se saiba que não substituirão os testes de função respiratória. corpo respiratórios neuromuscular forçada espirometria 3 115 11 5 11, 379 79 3,7 anos lados p< p (p 0,05. 005 0,05 . 0 05 0,05) linear observouse observou acessibilidade 1 37 7 3, 00 0,0 0,

Abstract Background: Cardiac resynchronization therapy (CRT) is an effective treatment for patients with heart failure. Objective: To evaluate the response of CRT in maximal inspiratory pressure (MIP), peak expiratory flow (PEF), and exercise tolerance as determined by the six-minute walk test (6MWT) in patients with HF. Methods: This study used the 6MWT and Manovacuometer to assess functional capacity in relation to activities of daily living, in which fatigue and dyspnea are common. Results: After six months of CRT, this study identified improvements in the 6MWT, p<0.05; MIP, p=0.01; and PEF, p=0.03. Conclusion: After CRT, this study showed a significant improvement in MIP, PEF, and exercise tolerance. However, further studies are warranted to demonstrate the relevance of these findings.

ABSTRACT BACKGROUND: Use of inhaled corticosteroids for managing acute asthma exacerbations has been tested since the 1990s. OBJECTIVE: To compare high doses of inhaled ciclesonide with systemic hydrocortisone for managing acute asthma exacerbations in the emergency department. DESIGN AND SETTING: Double-blind, randomized clinical trial in the public healthcare system of the city of São Paulo. METHODS: Fifty-eight patients with moderate or severe asthma with peak flow < 50% of predicted were randomized into two groups. Over the course of four hours, one group received 1440 mcg of inhaled ciclesonide plus hydrocortisone-identical placebo (ciclesonide + placebo), while the other received 500 mg of intravenous hydrocortisone plus ciclesonide-identical placebo (hydrocortisone + placebo). Both groups received short-acting bronchodilators (fenoterol hydrobromide and ipratropium bromide). The research protocol included spirometry, clinical evaluation, vital signs and electrocardiogram monitoring. Data were obtained at 30 (baseline), 60, 90, 120, 180, and 240 minutes. We compared data from baseline to hour 4, between and within groups. RESULTS: Overall, 31 patients received ciclesonide + placebo and 27 received hydrocortisone + placebo. Inhaled ciclesonide was as effective as intravenous hydrocortisone for improving clinical parameters (Borg-scored dyspnea, P = 0.95; sternocleidomastoid muscle use, P = 0.55; wheezing, P = 0.55; respiratory effort, P = 0.95); and spirometric parameters (forced vital capacity, P = 0.50; forced expiratory volume in the first second, P = 0.83; peak expiratory flow, P = 0.51). CONCLUSIONS: Inhaled ciclesonide was not inferior to systemic hydrocortisone for managing acute asthma exacerbations, and it improved both clinical and spirometric parameters. TRIAL REGISTRATION: RBR-6XWC26 - Registro Brasileiro de Ensaios Clínicos (http://www.ensaiosclinicos.gov.br/rg/RBR-6xwc26/).

Resumen Hay pocos datos relativos a la evaluación combinada del estado nutricional y respiratorio de sujetos con enfermedades neuromusculares. El objetivo fue establecer correlaciones entre las variables nutricionales compartimentales y las variables respiratorias para identificar los determinantes de la debilidad de los músculos respiratorios de los pacientes con esclerosis lateral amiotrófica (ELA) y distrofia muscular de Duchenne (DMD). Estudio transversal con pacientes con ELA y DMD incluidos en el Registro Institucional de Enfermedades Neuromusculares. El estado nutricional se evaluó mediante el índice de masa corporal (IMC), el peso esperado para masa muscular cero (ZMM%) y el índice de creatinina-talla (CHI%). Los índices respiratorios evaluados fueron espirometría, presiones inspiratorias y espiratorias estáticas máximas en la boca (MIP y MEP) y flujo espiratorio pico tosido (PCF). Se incluyeron un total de 36 pacientes con ELA y 34 con DMD. Ambos grupos mostraron una disminución de la masa muscular corporal y un exceso de grasa corporal (p <0.001). Solo en el grupo ELA hubo una débil correlación positiva entre el IMC y las variables respiratorias. En ambos grupos, el índice ZMM% no se correlacionó con ninguna variable respiratoria. El CHI% mostró la relación lineal positiva más fuerte (r > 0.700) con FVC%, MIP%, MEP% y PCF% tanto en pacientes con ELA como con DMD (p < 0.001). El IMC no reflejó con precisión la composición corporal y subestimó el exceso de grasa. Este estudio pone en perspectiva la relevancia de la evaluación compartimental para evaluar la función de la musculatura respiratoria y establece que la masa muscular corporal es el parámetro nutricional más relevante en relación a la fuerza de la musculatura respiratoria.

Abstract There are few data devoted to the combined assessment of the nutritional and respiratory status of subjects with neuromuscular diseases. The objective was to establish correlations between com partmental nutritional variables and respiratory variables to identify respiratory muscle weakness determinants of patients with amyotrophic lateral sclerosis (ALS) and Duchenne muscular dystrophy (DMD). Cross-sectional study with ALS and DMD patients included in an Institutional Registry of Neuromuscular diseases. Nutritional status was assessed through body mass index (BMI), expected weight for zero muscle mass (ZMM%) and creatinine-height index (CHI%). Respiratory indices evaluated were spirometry, maximal static inspiratory and expiratory pressures at the mouth (MIP and MEP), and peak cough flow (PCF). A total of 36 ALS and 34 DMD patients were included. Both groups showed a decrease in the body muscle mass and an excess in body fat (p < 0.001). Only in the ALS group was there a weak uphill relationship between body mass index (BMI) and the respiratory variables. In both groups, the ZMM% index did not correlate with any respiratory variable. The CHI% showed the strongest (r > 0.700) positive linear relationship with FVC%, MIP%, MEP%, and PCF% in both ALS and DMD patients (p < 0.001).In this study our patients, BMI did not accurately reflect body composition and underestimated excess fat. This study puts into perspective the relevance of compartmental evaluation to assess respiratory muscle function and establishes that body muscle mass is the most relevant nutritional parameter in relation to respiratory muscle strength.

Abstract Introduction: Coronary artery bypass grafting (CABG) is a procedure associated with a decline in pulmonary function. Among the main causes is the presence of the drain that is usually positioned in the intercostal or subxiphoid region. Objective: To measure the interference of drains positioning on pulmonary function in patients undergoing CABG. Methods: Observational study that assessed preoperative pulmonary function through vital capacity (VC), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak expiratory flow (PEF). These variables were evaluated in three different moments: in the presence of two drains, when removing one, and after removing all drains. Results: We evaluated 45 patients with a mean age of 62 ± 7 years with male prevalence of 29 (64%) individuals. The insertion of drains caused a decline in pulmonary function after surgery by reducing MIP by 48%, MEP by 11%, VC by 39%, and PEF by 6%. Conclusion: This study has demonstrated that drains positioning after CABG surgery may produce weakness of the respiratory muscles, change ventilatory mechanics, and impair normal pulmonary function postoperatively.

Resumo Introdução: O câncer de mama é a segunda neoplasia maligna mais encontrada entre as mulheres, sendo a intervenção cirúrgica um dos tratamentos preconizados, o que pode acarretar sequelas físicas e sensoriais importantes. Objetivo: Analisar as funções musculoes-queléticas, cardiorrespiratórias, antropométricas e sensoriais de mulheres submetidas ao procedimento cirúrgico para neoplasia mamária. Métodos: Estudo observacional e transversal com mulheres que realizaram procedimento cirúrgico para ressecção de neoplasia mamária assistidas no interior paulista, Jaú/SP. Foram realizadas três avaliações: pré-cirurgia (AV1), um dia (AV2) e 15 dias após a cirurgia (AV3). Foram coletadas informações sociodemográficas e ginecológicas e realizadas avaliações antropométrica, cardiovascular, sensibilidade dérmica, amplitude de movimento (ADM) dos membros superiores, saturação periférica de oxigênio (SpO2), força muscular inspiratória (PImax), pico de fluxo expiratório (PFE) e mobilidade toracoabdominal. Os dados foram avaliados pelo teste estatístico ANOVA de medidas repetidas e Wilcoxon com correção de Bonferroni (p < 0,05). Resultados: Dezoito mulheres, de 57,44 ± 9,35 anos, tiveram o lado esquerdo mais acometido (61,1%) e a linfonodectomia foi realizada em 50% dos casos. Houve diferenças nas variáveis pressão arterial sistólica e diastólica, PFE e SpO2, índice de amplitude axilar (AV1>AV2), PImax (AV3>AV2), perimetria (AV2>AV3), ADM em todos os eixos de movimento do ombro e em flexão de punho (AV2<AV1) e alteração de sensibilidade próxima à cicatriz (AV3>AV2 e AV1). Conclusão: A cirurgia para exerese de neoplasia mamária acarretou alterações principalmente hemodinâmicas e respiratórias, sobremaneira no primeiro dia após a cirurgia, retornando aos valores basais aproxi-madamente 15 dias após o procedimento.

Abstract Introduction: Breast cancer is the second most common malignant neoplasm in women. Surgical intervention is one of the recommended treatments, which can lead to significant physical and sensorial sequelae. Objective: To analyze the musculoskeletal, cardiorespiratory, anthropometric and sensorial functions of women who underwent breast cancer surgery. Methods: An observational, cross-sectional study with women who underwent surgical resection of breast tumors at Amaral Carvalho, a reference hospital in the countryside of the São Paulo State, Jaú/SP, Brazil. Three assessments were obtained: pre-surgery (Ass1), one day after the surgery (Ass2) and 15 days after surgery (Ass3). Sociodemographic and gynecological data were collected, and anthropometric, cardiovascular, dermal sensitivity, range of motion (ROM) of the upper limbs, peripheral oxygen saturation (SpO2), inspiratory muscle strength (PImax), peak expiratory flow (PEF) and thoraco-abdominal mobility assessments were performed. Data were evaluated by repeated measures ANOVA and Wilcoxon statistical test with a Bonferroni correction (p < 0.05). Results: Eighteen women, with a mean age of 57.44 ± 9.35 years, mainly with the left side affected (61.1%) and lymphadenectomy performed in 50% of the cases. Differences were found in systolic and diastolic blood pressure, PEF and SpO2, axillary ROM index (Ass1>Ass2), PImax (Ass3>Ass2), perimetry (Ass2>Ass3), ROM in all axes of shoulder motion and wrist flexion (Ass2<Ass1), and sensitivity alteration close to the surgical wound (Ass3>Ass2 and Ass1). Conclusion: The surgery for breast cancer excision resulted in hemodynamic and respiratory changes, especially on the first day after the procedure, returning to baseline values approximately 15 days later.

ABSTRACT Manual hyperinflation is used in neonatal and pediatric intensive care units to promote expiratory flow bias, but there is no consensus on the benefits of the technique. Thus, a review that presents supporting evidence is necessary. This study aims to review the literature on the manual hyperinflation maneuver in neonatal and pediatric intensive care units to analyze the evidence for this technique in terms of the forms of application (associated with other techniques or not), its safety, the performance of manual resuscitators and the influence of the physical therapist’s experience, in addition to evaluating the methodological quality of the identified articles. A search was performed in the following databases: Web of Science, ScienceDirect, PubMedⓇ, Scopus, CINAHL and SciELO. Two researchers independently selected the articles. Duplicate studies were assessed, evaluated by title and abstract and then read in full. The quality of the articles was analyzed using the PEDro scale. Six articles were included, two of which had high methodological quality. The main results provided information on the contribution of the positive end-expiratory pressure valve to increasing lung volumes and the use of chest compressions to optimize expiratory flow bias, the negative influence of operator experience on the increase in peak inspiratory flow, the performance of different manual resuscitators when used with the technique and the safety of application in terms of maintaining hemodynamic stability and increasing peripheral oxygen saturation. The available studies point to a positive effect of the manual hyperinflation maneuver in children who are admitted to intensive care units. Registration PROSPERO: CRD42018108056. bias Thus necessary associated not, not , not) therapists therapist s databases Science ScienceDirect PubMed PubMedⓇ Scopus SciELO assessed full scale included endexpiratory end saturation PROSPERO CRD42018108056 CRD CRD4201810805 CRD420181080 CRD42018108 CRD4201810 CRD420181 CRD42018 CRD4201 CRD420 CRD42 CRD4

RESUMO A hiperinsuflação manual é utilizada em unidades de terapia intensiva neonatal e pediátrica para promover um flow bias expiratório, porém não há consenso sobre os benefícios da técnica. Assim faz-se necessária uma revisão que apresente suas evidências. Este estudo objetiva revisar a literatura sobre a manobra de hiperinsuflação manual em unidades de terapia intensiva neonatal e pediátrica, para analisar as evidências dessa técnica em relação às formas de aplicação (associadas ou não a outras técnicas), sua segurança, o desempenho dos ressuscitadores manuais e a influência da experiência do fisioterapeuta, além de avaliar a qualidade metodológica dos artigos encontrados. Realizou-se uma busca nas bases de dados: Web of Science, ScienceDirect, PubMedⓇ, Scopus, CINAHL e SciELO. Dois pesquisadores selecionaram os artigos de forma independente. Verificaram-se os estudos duplicados, avaliados por títulos, resumos e, então, leitura na íntegra. Analisou-se a qualidade dos artigos pela escala PEDro. Foram incluídos seis artigos, sendo dois com alta qualidade metodológica. Os principais resultados trouxeram informações sobre a contribuição da válvula de pressão positiva expiratória final no aumento dos volumes pulmonares e a utilização das compressões torácicas para otimizar o flow bias expiratório, a influência negativa da experiência do operador no aumento do pico de fluxo inspiratório, o desempenho de diferentes ressuscitadores manuais durante a realização da técnica e a segurança na aplicação, com manutenção da estabilidade hemodinâmica e aumento da saturação periférica de oxigênio. Os estudos disponíveis apontam para um efeito positivo da manobra de hiperinsuflação manual realizada em crianças internadas em unidades de terapia intensiva. Registro PROSPERO: CRD42018108056. expiratório fazse faz se associadas técnicas, técnicas , técnicas) fisioterapeuta encontrados Realizouse Realizou dados Science ScienceDirect PubMed PubMedⓇ Scopus SciELO independente Verificaramse Verificaram duplicados títulos então íntegra Analisouse Analisou PEDro inspiratório oxigênio PROSPERO CRD42018108056 CRD CRD4201810805 CRD420181080 CRD42018108 CRD4201810 CRD420181 CRD42018 CRD4201 CRD420 CRD42 CRD4

RESUMO Objetivo: Relatar a independência funcional e o grau de comprometimento pulmonar em pacientes adultos 3 meses após a alta da unidade de terapia intensiva. Métodos: Este foi um estudo de coorte retrospectiva conduzido em uma unidade de terapia intensiva multiprofissional para pacientes adultos em um único centro. Incluíram-se pacientes admitidos à unidade de terapia intensiva entre janeiro de 2012 e dezembro de 2013 que, 3 meses mais tarde, foram submetidos à espirometria e responderam ao questionário Medida de Independência Funcional. Resultados: Os pacientes foram divididos em grupos segundo sua classificação de independência funcional e espirometria. O estudo incluiu 197 pacientes, que foram divididos entre os grupos maior dependência (n = 4), menor dependência (n = 12) e independente (n = 181). Na comparação dos três grupos com relação à classificação pela Medida de Independência Funcional, pacientes com maior dependência tinham escores Acute Physiology and Chronic Health Evaluation II e Sequential Organ Failure Assessment mais altos quando da admissão à unidade de terapia intensiva, idade mais avançada, mais dias sob ventilação mecânica e tempo mais longo de permanência na unidade de terapia intensiva e no hospital. A maioria dos pacientes apresentava comprometimento pulmonar, sendo o padrão obstrutivo o mais frequentemente observado. Na comparação da independência funcional com a função pulmonar, observou-se que, quanto pior a condição funcional, pior a função pulmonar, observando-se diferenças significantes em relação ao pico de fluxo expiratório (p = 0,030). Conclusão: Em sua maioria, os pacientes que retornaram ao ambulatório 3 meses após a alta tinham boa condição funcional, porém apresentavam comprometimento pulmonar relacionado com o grau de dependência funcional.

ABSTRACT Objective: To relate functional independence to the degree of pulmonary impairment in adult patients 3 months after discharge from the intensive care unit. Methods: This was a retrospective cohort study conducted in one adult intensive care unit and a multi-professional post-intensive care unit outpatient clinic of a single center. Patients admitted to the intensive care unit from January 2012 to December 2013 who underwent (3 months later) spirometry and answered the Functional Independence Measure Questionnaire were included. Results: Patients were divided into groups according to the classification of functional independence and spirometry. The study included 197 patients who were divided into greater dependence (n = 4), lower dependence (n = 12) and independent (n = 181) groups. Comparing the three groups, regarding the classification of the Functional Independence Measure, patients with greater dependence had higher Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment values at intensive care unit admission with more advanced age, more days on mechanical ventilation, and longer stay in the intensive care unit and hospital. The majority of patients presented with pulmonary impairment, which was the obstructive pattern observed most frequently. When comparing functional independence with pulmonary function, it was observed that the lower the functional status, the worse the pulmonary function, with a significant difference being observed in peak expiratory flow (p = 0.030). Conclusion: The majority of patients who returned to the outpatient clinic 3 months after discharge had good functional status but did present with pulmonary impairment, which is related to the degree of functional dependence.