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Avalia??o n?o invasiva da taxa m?xima de relaxamento dos m?sculos inspirat?rios na distrofia miot?nicaEvangelista, Morgana de Ara?jo 17 June 2015 (has links)
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Previous issue date: 2015-06-17 / INTRODU??O: A Distrofia Miotonica ? caracterizada por atrofia, fraqueza presen?a de miotonia nos m?sculos esquel?ticos. A presen?a de miotonia nos musculos respirat?rios ? duvidosa assim como as t?cnicas para avalia-l?s. OBJETIVOS: Avaliar a sensibilidade /especificidade da taxa m?xima de relaxamento dos m?sculos inspirat?rios (MRR), a eletromiografia de superf?cie (EMGs) dos m?sculos esternocleidomast?ideo (SCM), escaleno (ESC), paraesternal (2EIC), reto abdominal (RA) e a fun??o pulmonar/muscular respiratoria em pacientes com DM1 e sujeitos saudaveis. M?TODOS: Foram convidados a participar do estudo, 71 indiv?duos, 44 pacientes com DM1 e 27 controles. Foram inclu?dos no estudo 28 sujeitos, (18 DM1 e 10 controles). Ap?s exlcus?es a amostra final foi de 25 sujeitos, 16 pacientes com DM1 e 9 sujeitos saud?veis. Todos foram avaliados em rela??o MRR dos m?sculos inspirat?rios, (dP/dt)/Psniff*100(%10ms), a EMGs dos m?sculos respirat?rios, ? fun??o muscular e pulmonar. RESULTADOS: A MRR foi menor nos pacientes com DM1 vs. controle (p=0,003) e foi considerada sens?vel e espec?fica para identificar a doen?a na DM1 e descart?-la no grupo controle, ?rea de ROC 0,87 (95%IC, 0,729 a 1,01, p=0,003). Foi observado valores reduzidos de PIm?x (p=0,0029), PEm?x (p=0,0007) e SNIP (p=0,0030), CVF%pred. (p=0,0014) e VEF1%pred. (p=0,0003) e maior atividade da EMGs em repouso nos m?sculos SCM (p=0,004), ESC (p=0,009) e RA (p=0,045) e no m?sculo SCM (p=0,001) durante o sniff teste. CONCLUS?ES: A MRR ? sensivel e especifica para identificar atraso no relaxamento dos musculos respirat?rios e a fun??o muscular respirat?ria encontra-se alterada nos pacientes com DM1. / INTRODUCTION: Myotonic dystrophy (DM) is a neuromuscular disease characterized by unstable expansion of CTG triplet on chromosome 19. It has two forms: type 1 (DM1 or Steinert's disease); and type 2 (DM2), being the former the most frequent and showing systemic manifestations, such as myotonia (muscle relaxation difficulty), cataracts, arrhythmias, muscle weakness and atrophy, among others, respiratory failure being one of the main factors predictive of mortality and a leading cause of death. OBJECTIVES: To evaluate the sensitivity / specificity of the maximum relaxation rate of the inspiratory muscles (MRR), the surface electromyography (sEMG) of the sternocleidomastoid (SCM), scalene (SCA), parasternal (2ICS), rectus abdominis (RA) and lung function/respiratory muscle strength in patients with DM1 and healthy subjects. METHODS: We invited 74 subjects to participate in the study, 44 patients with DM1 and 30 controls. The study included 31 subjects (18 DM1 and 13 controls). After exclusions, the final sample was of 27 subjects, 16 patients with DM1 and 11 healthy subjects. All of them were assessed for MRR of inspiratory muscles, for sEMG of the respiratory muscles, muscle and lung function. RESULTS: The MRR was lower in patients with DM1 vs. control (p = 0.001) and was considered sensitive and specific to identify the disease in DM1 and discard it in the control group, ROC area of 0.87 (95% CI, 0.74 to 1.01, p=0.001). DM1 group showed lower PImax (p=0.0006), PEmax (p=0.0002), SNIP (p=0.0014), CVF%pred (p=0.0018) and FEV1%pred. (p=0.0004) and higher sEMG activity of the SCM (p=0.0022) and ESC muscles (p=0.004) at rest; of 2EIC (p=0.003) during PEmax and of SCM (p=0.02) and ESC muscles (p= 0.03) during the sniff test. CONCLUSIONS: The MRR is sensitive and specific to identify delayed relaxation of the respiratory muscles and respiratory muscle function is altered in patients with DM1.
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Avalia??o muscular respirat?ria: adapta??o do mano vacu?metro nacional para a avalia??o da press?o inspirat?ria nasal e n?vel de intensidade da ventila??o volunt?ria m?xima em sujeitos saud?veisSeverino, Fernanda Gadelha 18 May 2010 (has links)
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Previous issue date: 2010-05-18 / The clinical importance of evaluating the respiratory muscles with a variety of tests
has been proposed by several studies, once that the combination of several tests
would allow a better diagnosis and therefore, a better clinical follow of disorders of
the respiratory muscles. This study aimed to evaluate the feasibility of adapting a
national electronic manovacuometer to measure the nasal inspiratory pressure (study
1) and analyze the level of load intensity of maximum voluntary ventilation, as well as
the variables that may influence this maneuver in healthy subjects (study 2). We
studied 20 healthy subjects by a random evaluation of two measures of SNIP in
different equipments: a national and an imported. In study 2 it was analyzed the
intensity of the load of MVV test, change in pressure developed during the maneuver,
the possible differences between genders, and the correlations between the flow
developed in the test and the result of MVV. In study 1 it was found the average for
both measures of nasal inspiratory pressures: 125 ? 42.4 cmH2O for the imported
equipment and 131.7 ? 28.7 cmH2O for the national one. Pearson analysis showed a
significant correlation between the average, with a coefficient r = 0.63. The average
values showed no significant differences evaluated by paired t test (p> 0.05). In the
Bland-Altman analysis it was found a BIAS = 7 cmH2O, SD 32.9 and a confidence
interval of - 57.5 cmH2O up to 71.5 cmH2O. In the second study it was found
significant differences between the genders in the air volume moved, being higher in
males 150.9 ? 13.1 l / min vs 118.5 ? 15.7 L / min for (p = 0.0002, 95% CI 44.85 to
20:05). Regarding the inspiratory and expiratory loading, they were significantly
higher in men than in women, peak inspiratory pressure (34.7 ? 5.3 cmH2O vs 19.5 ?
4.2 cmH2O, 95% CI - 18.0 to -12.3, p <0.0001), peak expiratory (33.8 vs. 23.1 ? 5.9
cmH2O ? 5.4 cmH2O, 95% CI -17.1 to - 4.6, p <0.0001), and the delta pressure (59.7
? 10 cmH2O vs 36.8 ? 8.3 cmH2O, 95% CI 14.5 to 31.2, p <0.0002). The Pearson
correlation showed that the flow generated by the maneuver is strongly correlated
with the delta-expiratory pressure / inspiratory (r2= 0.83,R = 0.91, 95%IC 0.72 a 0.97
e p< 0.0001).Through these results we suggest that the national electronic
manovacuometer is feasible and safe to perform the sniff test in healthy subjects. For
the MVV, there are differences between the genders in the intensity of pressure
developed during the maneuver. We found a load intensity considered low during the
MVV, and found a strong correlation between the flow generated in the test and the
delta pressure expiratory / inspiratory / A import?ncia clinica de avaliar os m?sculos respirat?rios com uma variedade de
testes vem sendo proposta por diversos trabalhos, pois a combina??o de v?rios
testes possibilitaria um melhor diagn?stico e consequentemente um melhor
seguimento cl?nico das disfun??es dos m?sculos respirat?rios. Este trabalho teve
como objetivo avaliar a viabilidade da adapta??o do manovacu?metro nacional
eletr?nico para a realiza??o da medida de press?o inspirat?ria nasal (estudo 1) e
analisar o n?vel de intensidade de carga da ventila??o volunt?ria m?xima, assim
como as vari?veis que possam influenciar a manobra em sujeitos saud?veis (estudo
2). Foram estudados 20 sujeitos saud?veis atrav?s da avalia??o aleat?ria de duas
medidas de SNIP em equipamentos diferentes: um nacional e outro importado. No
estudo 2 foi analisado a intensidade da carga do teste da ventila??o volunt?ria
m?xima(VVM), a varia??o de press?o desenvolvida durante manobra, as poss?veis
diferen?as entre g?neros, e as correla??es entre o fluxo desenvolvido no teste e o
resultado da VVM. No estudo 1 as m?dias encontradas durante as duas medidas
das press?es nasais foram de 125 ? 42,4 cmH2O para o aparelho importado e de
131,7 ? 28,7 cmH2O para o nacional. A an?lise de Pearson demonstrou uma
correla??o significativa entre as m?dias com um coeficiente r=0.63. Os valores
m?dios n?o apresentaram diferen?as significativas avaliadas pelo teste t pareado
(p>0,05).Na an?lise de Bland-Altman foi encontrado um BIAS igual a 7 cmH2O,
desvio padr?o 32,9 e um intervalo de confian?a de - 57,5cmH2O at? 71,5 cmH2O.
No estudo 2 foi encontrada diferen?a significativa entre os g?neros para o volume
de ar deslocado maior em homens 150.9 ? 13.1 l/mim vs 118.5 ? 15.7 L/mim para
(p= 0.0002, IC95% 20.05 ? 44.85). Em rela??o carga inspirat?ria e expirat?ria foram
significativamente maiores em homens que nas mulheres: pico inspirat?rio (34.7 ?
5.3 cmH2O vs 19.5 ? 4.2 cmH2O, IC95% - 18.0 a -12.3, p< 0.0001), pico expirat?rio
(33.8 ? 5.9 cmH2O vs 23.1 ? 5.4 cmH2O, IC95% -17.1 a - 4.6, p< 0.0001), assim
como o delta de press?o (59.7 ? 10 cmH2O vs 36.8 ? 8.3 cmH2O, IC95% 14.5 a 31.2
, p< 0.0002). A correla??o de Pearson mostrou que o fluxo gerado pela manobra
est? fortemente correlacionado com o delta de press?o expirat?ria/inspirat?ria (r2=
0.83,R = 0.91, (95%IC 0.72 a 0.97 e p< 0.0001). Atrav?s dos resultados
encontrados podemos sugerir que o manovacu?metro eletr?nico nacional ? vi?vel e
seguro para realiza??o do sniff teste em sujeitos saud?veis. Em rela??o a VVM,
existem diferen?as entre os g?neros na intensidade de press?o desenvolvida
durante a VVM, a uma intensidade de carga durante a VVM foi considerada baixa
assim como foi encontrada uma forte correla??o entre o fluxo gerado no teste e o
delta de press?o expirat?rio/inspirat?rio
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