Made available in DSpace on 2015-07-22T20:50:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-01-01 / Objetivo: avaliar os efeitos do treinamento muscular inspiratório (TMI), e da associação do TMI ao anabolizante oxandrolona (Ox), na função pulmonar de indivíduos com doenças neuromusculares (DNM). Métodos: Foram avaliados 14 indivíduos (9 homens e 5 mulheres; idade: 36±17 anos) com as seguintes doenças: distrofia muscular cintura membros (n=9), distrofia muscular de Becker (n=1), distrofia muscular facio-escápulo-umeral (n=1) e atrofia muscular espinhal tipo III (n=3). Os indivíduos realizaram as seguintes avaliações respiratórias: pressões respiratórias estáticas máximas (PImáx e PEmáx), ventilação voluntária máxima (VVM), teste de resistência muscular respiratória (RMR) e espirometria. O estudo consistiu de quatro etapas: avaliação inicial, avaliação após 30 dias de TMI (40% da PImáx inicial), avaliação após 30 dias de destreinamento e avaliação após 30 dias de TMI (40% da PImax)+ Ox (0,1mg/Kg/dia). Resultados: O TMI aumentou a PImáx e a PEmáx (p<0,05). O tempo de destreinamento foi suficiente para a perda desses efeitos (p<0,05). A associação de TMI+Ox potencializou o aumento da PImáx e da PEmáx (p<0,05) e melhorou a RMR (p<0,05). Entretanto, ocorreu queda de algumas variáveis analisadas na espirometria (p<0,05), quando associamos a Ox ao TMI (CVF, VEF1 e FEF25-75%). Conclusões: A associação da oxandrolona potencializou os efeitos do TMI, entretanto, apesar de ter ocorrido queda em algumas variáveis analisadas na espirometria, não observamos alteração no diagnóstico funcional ventilatório, em todos os pacientes estudados. / Purpose: to evaluate the effects of inspiratory muscle training (IMT) associated to anabolic steroid oxandrolone in pulmonary function of patients with neuromuscular diseases. Methods: Fourteen subjects (9 male, 5 female, mean age 36±17 years) with the following diseases: limb-girdle muscular dystrophy (n=9), Becker muscular dystrophy (n=1), facioescapulohumeral muscular dystrophy (n=1) and spinal muscular atrophy (n=3), performed the following assessments: maximal static inspiratory and expiratory pressures (respectively, MIP and MEP), maximal voluntary ventilation in 12 seconds (MVV), respiratory muscle resistance (RMR) and spirometry. The research included four evaluations: baseline, after 30 days of IMT at 40% of baseline MIP, after 30 days of washout and after 30 days of IMT (at 40% of MIP) associated with oxandrolone (0.1 mg/kg/day). Results: MIP and MEP increased after IMT (p<0,05), and after washout they returned to baseline levels. MIP, MEP and RMR were higher after oxandrolone was associated to IMT (p<0,05), but a reduction in dynamic pulmonary volumes (FVC, FEV1 and FEF25-75%) was found in this condition (p<0,05). Conclusion: The association of oxandrolone increased the effect of the IMT, however, although to have occurred fall in some variables analyzed in the spirometry, we do not observe alteration in the ventilatory functional diagnosis, in all the studied patients. / TEDE

Objective: Severe burn injuries are associated with a rapid escalating hypermetabolic state and catabolism of muscle mass. To ameliorate this process a standardized approach using pharmacological and non-pharmacological interventions was implemented within a single burns center. Whilst individual components of this standardized package are well documented in the literature, their collective or bundled effect has not as yet been assessed. The aim of this study was to evaluate the efficacy of this standardized bundle of metabolic modulators and assess the safety of including the anabolic steroid oxandrolone within it. Methods: This retrospective observational study constituted all patients in whom the metabolic bundle including oxandrolone therapy was applied. The other elements of the metabolic bundle consisted of early surgical burn excision within seven days to completion, early active mobilization, increased ambient room temperature, expediated carbohydrate and protein rich enteral feeding with glutamine and trace element supplements (such as copper and zinc). Finally, administration of propranolol as a non-selective beta-blocker. Data collection was through review of the patient data management system focusing on the outcome criteria and hepatic blood values. Results: The study looked at fifty consecutive patients meeting the inclusion criteria. Median patient age and burned total body surface area (TBSA) were 62 years [51.75; 73] and 33.75 % [24.75; 51] respectively with an abbreviated burn severity index (ABSI) of 10 [9; 10.25]. Definitive surgical burn wound excision was completed in 44 patients [88 %] within 7 days. 39 patients (78 %) received propranolol over a therapeutic period of 29 days [19; 44]. Glutamine was supplemented in 45 patients (90 %), while zinc and copper were applied to 42 (84 %) and 31 (62 %) respectively. Significant low zinc values were noted at therapeutic onset (6.5 mmol/ l [4.7; 7.9]) requiring sustained substitution over 37.5 days [22; 46.75]). In respect of the inclusion criteria, all patients received oxandrolone at 20mg/day [20; 20]. This was commenced on day 6.5 [4; 14] post burn injury and continued over 26 days [19; 31]. Despite a transitory elevation of hepatic enzyme values (ALT, GGT), these were only clinically relevant (>10µmol/l*S) in 2.4 % and 4.6 % of all measurements respectively. None were sufficiently of concern to merit cessation of treatment. Conclusion: The application of a standardised bundle of metabolic treatment options of severe burns injured patients is reliable, repeatable and safe. Potential concerns of oxandrolone treatment regarding hepatic compromise remain unfounded.:Introduction Epidemiology of severe burns injuries in the Federal Republic of Germany The hypermetabolic and catabolic state Therapeutic approach Non-pharmacological therapy Early surgical intervention Ambient temperature Enteral feeding in burns patients Occupational and physiotherapy in burns patients Pharmacological therapy Insulin Propranolol Oxandrolone Oxandrolone in the Federal Republic of Germany Metabolic bundle Materials and Methods Subjects and study design Ethical approval Burn care protocol Oxandrolone and the metabolic bundle Data collection Statistical analysis Objective of study Publication Summary References Appendix Declaration of independent scientific contribution, conception and execution of publication Declaration of independent scientific contribution towards dissertation Curriculum vitae Acknowledgements and thanks