Improvement In Respiratory Function Research Articles

Editorial to “Improvement in respiratory function and exercise tolerance following video‐assisted thoracoscopic diaphragm plication for symptomatic iatrogenic persistent diaphragm paralysis after radiofrequency catheter ablation”—An essential respiratory physiology every electrophysiologist should know‐

Editorial to “Improvement in respiratory function and exercise tolerance following video‐assisted thoracoscopic diaphragm plication for symptomatic iatrogenic persistent diaphragm paralysis after radiofrequency catheter ablation”—An essential <scp>respiratory physiology</scp> every <scp>electrophysiologist</scp> should know‐

Improvement in respiratory function and exercise tolerance following video‐assisted thoracoscopic diaphragm plication for symptomatic iatrogenic persistent diaphragm paralysis after radiofrequency catheter ablation

Improvement in respiratory function and exercise tolerance following video‐assisted thoracoscopic diaphragm plication for symptomatic iatrogenic persistent diaphragm paralysis after radiofrequency catheter ablation

Fisioterapia precoce na Síndrome de Freeman-Sheldon: relato de caso

Freeman-Sheldonn Syndrome (FSS) is a rare condition that presents as autosomal dominant due to mutations in the embryonic myosin heavy chain (MYH3). Individuals with FSS develop contractures that lead to motor and respiratory impairments and difficulties in eating. Physiotherapy can act in the prevention of skeletal deformities, muscle rebalance and in the improvement of respiratory function, thus aiming to promote more functionality for the patient. This study aimed to report a case of physiotherapy in the FSS. This is the first case report of an infant with FSS seen at a teaching clinic twice a week, lasting 1 hour each session, for a period of two consecutive months. The care protocol was built based on the assessment of the infant's primary and secondary disabilities, from which the functional goals (short, medium and long term) were pre-established and the activities developed aimed at functional improvement. The performance of physiotherapy in the FSS over a period of two months had a positive effect on improving cervical extension in prone posture and improving cervical alignment in supine posture. Physiotherapy plays an important role in the prevention and maintenance of functional aspects, improving the patient's health condition, from increasing functionality and reducing disabilities.

Effect of early pulmonary rehabilitation training on the prognosis of patients with acute respiratory distress syndrome after weaning of invasive mechanical ventilation in the intensive care unit

To investigate the effect of early pulmonary rehabilitation (PR) training on the improvement of respiratory function in patients with acute respiratory distress syndrome (ARDS) after weaning of invasive mechanical ventilation in the intensive care unit (ICU). The retrospective cohort research method was used. The clinical information of adult patients with ARDS receiving invasive mechanical ventilation admitted to the ICU of Qingdao Municipal Hospital from January 2019 to March 2023 was collected. The patients were divided into a control group and an observation group according to off-line training program. The control group received traditional training after weaning, and the observation group received the early PR training after weaning. Other treatments and nursing were implemented according to the routine of the ICU. The scores of the short physical performance battery (SPPB) on day 3-day 6 of the weaning training, respiratory muscle strength, level of interleukin-6 (IL-6), number of aspirations of sputum after weaning, length of stay after weaning, rehospitalization rate within 6 months after discharge, and pulmonary function indicators at discharge and 3 months after discharge [peak expiratory flow (PEF), forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC), and vital capacity (VC)] of the two groups of patients were compared. The Kaplan-Meier survival curve was drawn to analyze the cumulative survival rate of patients 6 months after discharge. A total of 50 of which 25 cases received the traditional training after weaning, 25 cases received the early PR training after weaning. There was no significant difference in gender, age, acute physiology and chronic health evaluation II (APACHE II), oxygenation index upon admission, etiological diagnosis of ARDS upon admission, time of invasive ventilation, mode of invasive mechanical ventilation, pulmonary function indicators at discharge, and other baseline data of the two groups. The SPPB questionnaire scores and respiratory muscle strength in both groups were increased gradually with the extended offline training time, the serum level of IL-6 in both groups were descend gradually with the extended offline training time, especially in the observation group [SPPB questionnaire score in the observation group were 7.81±0.33, 8.72±0.53, 9.44±0.31, 10.57±0.50, while in the control group were 7.74±0.68, 8.73±0.37, 8.72±0.40, 9.33±0.26, effect of time: F = 192.532, P = 0.000, effect of intervention: F = 88.561, P = 0.000, interaction effect between intervention and time: F = 24.724, P = 0.000; respiratory muscle strength (mmHg, 1 mmHg≈0.133 kPa) in the observation group were 123.20±24.84, 137.00±26.47, 149.00±24.70, 155.40±29.37, while in the control group were 129.00±20.34, 126.00±24.01, 132.20±25.15, 138.60±36.67, effect of time: F = 5.926, P = 0.001, effect of intervention: F = 5.248, P = 0.031, interaction effect between intervention and time: F = 3.033, P = 0.043; serum level of IL-6 in the observation group were 80.05±6.81, 74.76±9.33, 63.66±10.19, 56.95±4.72, while in the control group were 80.18±7.21, 77.23±9.78, 71.79±10.40, 66.51±6.49, effect of time: F = 53.485, P = 0.000, effect of intervention: F = 22.942, P = 0.000, interaction effect between intervention and time: F = 3.266, P = 0.026]. Compared with the control group, the number of aspirations of sputum after weaning of patients in the observation group significantly decreased (number: 22.46±1.76 vs. 27.31±0.90), the length of ICU stay after weaning significantly became shorter (days: 6.93±0.95 vs. 8.52±2.21), and the rehospitalization rate within 6 months after discharge significantly decreased [20.00% (5/25) vs. 48.00% (12/25)]. There were significant differences. The pulmonary function indicators 3 months after discharge of two groups of patients significantly increased compared with those at discharge and those of the observation group were significantly higher than those of the control group [PEF (L/min): 430.20±95.18 vs. 370.00±108.44, FEV1/FVC ratio: 0.88±0.04 vs. 0.82±0.05, VC (L): 3.22±0.72 vs. 2.74±0.37, all P < 0.05]. The Kaplan-Meier survival curve showed that the cumulative survival rate of patients 6 months after discharge of patients in the observation group was significantly higher than that of patients in the control group [76.9% vs. 45.5%, hazard ratio (HR) = 0.344, P = 0.017]. Early PR training can significantly improve the respiratory function of patients with ARDS after weaning of invasive mechanical ventilation. Continuous active respiratory training after discharge can improve the respiratory function of patients and effectively decrease mortality.

The Effect of Respiratory Care on the Treatment of Asthma Patients

Objective: To analyze the intervention effect of respiratory care on asthma patients. Methods: 49 asthma patients admitted to the hospital between December 1, 2018 and November 30, 2022 were selected for this study. The patients were divided into Group A (25 cases) and Group B (24 cases). The patients in Group A received respiratory care, while the patients in Group B received routine care, and the nursing effects of both groups were compared. Results: Group A demonstrated a better nursing effect compared to Group B; the patients in Group A were generally more satisfied with the care given compared to those of Group B. Furthermore, Group A showed better improvements in respiratory function compared to Group B (P &lt; 0.05). Before care, there was no difference in quality-of-life scores between the two groups (P&gt; 0.05). After care, Group A’s quality of life score was lower than Group B’s (P &lt; 0.05). Conclusion: Respiratory care for asthma patients can improve the quality of care and patient satisfaction. Besides, it also leads to a better improvement in respiratory function and the quality of life of the patients.

Real-Life Effects of Omalizumab on Chronic Rhinosinusitis with Nasal Polyposis.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the nasal and sinus mucosa. This inflammatory process is supported by a multitude of cytokines, including IL-4, IL-5, and IL-13 produced by Th2 cells, as well as by IgE produced by B lymphocytes in response to a stimulus. Omalizumab is an anti-IgE monoclonal antibody with well-recognized roles in allergic asthma and chronic spontaneous urticaria. The aim of this study was to evaluate the clinical efficacy of omalizumab in a cohort of 13 patients suffering from chronic rhinosinusitis with CRSwNP. The inclusion criteria considered were as follows: 18 years of age, with a diagnosis of chronic rhinosinusitis with severe nasal polyposis expressed by an NPS greater than or equal to 5 and/or a SNOT-22 greater than or equal to 50. In addition, in the enrolled patients, the classic treatment with corticosteroids had to have been suspended due to recurrence after surgery or lack of response. Our results highlighted that omalizumab treatment for 16 weeks improved the parameters analyzed: SNOT-22, NPS, NRS, and NCS. The clinical efficacy of omalizumab was further strengthened by a significant improvement in respiratory function as well as reductions in the nasal polyps' size and in the associated symptoms.

Effects of Chest Mobilization and Breathing Exercises on Respiratory Function, Trunk Stability, and Endurance in Chronic Stroke Patients after Coronavirus Disease.

Background and objectives: This study investigates the effects of chest mobilization and breathing exercises on respiratory function, trunk stability, and endurance in chronic stroke patients who have contracted coronavirus disease (COVID-19). Materials and Methods: Thirty inpatients of a tertiary hospital in South Korea, who had a history of COVID-19 and were diagnosed with stroke within the last 6 months, were randomly assigned to either chest mobilization exercise with breathing exercise (CMEBE) or conservative physical therapy with breathing exercise (CPTBE) groups. The respiratory function, trunk stability, and endurance were measured at baseline and 6 weeks after the interventions. Results: Both CMEBE and CPTBE groups showed improvements in respiratory function, trunk stability, and endurance after the intervention (p < 0.05). However, the CMEBE group showed significantly greater improvements in forced expiratory volume in 1 s (p < 0.05), trunk stability (p < 0.05), and endurance (p < 0.05) than the CPTBE group. No significant intergroup difference was observed in forced vital capacity and peak expiratory flow. Conclusions: The combination of chest mobilization and breathing exercises improved respiratory muscle mobility and endurance, stabilized the trunk, and enhanced balance and the transfer of weight. The findings suggest that this intervention could be beneficial in improving respiratory function and endurance in stroke patients.

Regional anesthesia and sickle cell crisis in pediatric patients: An educational-focused review.

Sickle cell disease (SCD) is the most common inherited hemoglobinopathy, affecting approximately 100 000 patients in United States and millions worldwide. Although the mainstay of pain management for VOC remains systemic opioids, given the potential for adverse effects including respiratory depression and hypoxemia, there remains interest in the use of regional anesthetic techniques (neuraxial or peripheral nerve blockade). A systematic search of pubMed, Scopus, and Google Scholar was conducted using the terms sickle cell disease, sickle cell crisis, pain crisis, vaso-occlusive crisis, regional anesthesia, peripheral nerve blockade, and neuraxial anesthesia. We identified 7 publications, all of which were retrospective case series or single case reports, outlining the use of neuraxial anesthesia in a total of 26 patients with SCD. Additionally, we identified 4 publications, including one retrospective case series and 3 single case reports, entailing the use of peripheral blockade in patients with VOC and SCD. The available literature, albeit all retrospective or anecdotal, suggests the potential utility of regional anesthesia to treat pain in patients with SCD. Additional benefits have included avoidance of the potential deleterious physiologic effects of systemic opioids and in one case series, an improvement in respiratory function as judged by pulse oximetry. The anecdotal and retrospective nature of the available reports with an absence of prospective trials limits the evidence based medicine available from which to develop to guidlines for the optimal local anesthetic agent to use, its concentration, the rate of infusion, and the choice of adjunctive agents.

Effectiveness of Pursed Lip Breathing and Alternate-Nostril Breathing in Patients with Respiratory Dysfunction

Respiratory dysfunctions are the diseases or disorders like Asthma, emphysema, bronchitis, lung cancer, pulmonary hypertension, COPD and tuberculosis. Among respiratory dysfunctions, COPD is the most common and may be fatal. Objective: To observe the effectiveness of pursed lip breathing and alternate-nostril breathing in patients of respiratory dysfunction. Methods: This study is aimed to see the effects of PLB and ANB on respiratory outcomes in COPD patients. Qausi Experimental study was completed on 100 participants of age between 24-60 years. Purposive sampling is used to select the population. The participants were selected on the basis of inclusion criteria. Informed consent was taken before the start of exercise. Pulse oximeter was used to assess oxygen saturation values, numeric pain rating scale rating pain from 1-10 , was used to check pain level and Samn-perelli fatigue scale rating fatigue from 1-7 from fully alert till completely exhausted was used respectively. SPSS (version 23) was used for statistical analysis. Findings show that there is marked improvement in respiratory functions including oxygen saturation, pain and fatigue. Results: Outcomes after 4-6 weeks of performing pursed lip breathing shows improvement in oxygen saturation and alternate nostril decreases fatigue and pain with the p-value 0.05 which is highly significant. According to statistics, all respiratory variables are highly significant with the p-value&lt;0.05. Conclusions: It is concluded that pursed lip breathing and alternate nostril breathing is an effective in improving oxygen saturation and respiratory rate. It is an inexpensive, non-pharmacological and easy method and helped in improving respiratory outcomes.

Respiratory benefit in preterm lambs is progressively lost when the concentration of fetal plasma betamethasone is titrated below two nanograms per milliliter.

Antenatal steroid therapy is the standard of care for women at imminent risk of preterm delivery. Current dosing regimens use suprapharmacological doses to achieve extended fetal steroid exposures. We aimed to determine the lowest fetal plasma betamethasone concentration sufficient to achieve functional preterm lung maturation. Ewes with single fetuses underwent surgery to install a fetal jugular catheter. Adopting a stepwise design, ewes were randomized to either a saline-only group (negative control group; n = 9) or one of four betamethasone treatment groups. Each betamethasone group fetus received a fetal intravenous infusion to target a constant plasma betamethasone level of either 1) 2 ng/mL (2 ng/mL positive control group, n = 9); 2) 1 ng/mL, (1 ng/mL group, n = 10); 3) 0.5 ng/mL (0.5 ng/mL group, n = 10); or 4) 0.25 ng/mL (0.25 ng/mL group, n = 10). Fetuses were infused for 48 h, delivered, and ventilated. The positive control group, negative control group, and mid-point 0.5 ng/mL group animals were tested first. An interim analysis informed the final betamethasone group tested. Positive control group animals had large, statistically significant improvements in respiratory function. Based on an interim analysis, the 1.0 ng/mL group was studied in favor of the 0.25 ng/mL group. Treatment efficacy was progressively lost at plasma betamethasone concentrations lower than 2 ng/mL. We demonstrated that the acute respiratory benefit conveyed by antenatal steroid exposure in the fetal sheep is progressively lost when constant fetal plasma betamethasone concentrations are reduced below a targeted value of 2 ng/mL.NEW & NOTEWORTHY Lung maturation benefits in preterm lambs were progressively lost when fetal plasma betamethasone concentrations fell below 2 ng/mL. The effective floor threshold for a robust, lung-maturing exposure likely lies between 1 and 2 ng betamethasone per milliliter of plasma. Hypothalamic pituitary adrenal axis signaling and immunocyte populations remained materially disrupted at subtherapeutic steroid concentrations. These data demonstrate the potential to improve antenatal steroid therapy using reduced dose regimens informed by glucocorticoid pharmacokinetics and pharmacodynamics.

Something to consider: rapid palatal expansion for treatment of obstructive sleep apnea in pediatric patients.

This review examines the potential of rapid palatal expansion (RPE) as a treatment for pediatric obstructive sleep apnea (OSA). The focus is on recent findings related to its efficacy, safety, patient selection, timing, appliance options, cost considerations, and long-term outcomes. Recent studies indicate that RPE can lead to significant improvements in pediatric OSA, with a 70% reduction in the Apnea Hypopnea Index (AHI) and increased oxygen saturation levels. It has been particularly effective in children with small or absent tonsils and has been found to reduce adenoid and tonsil size. Long-term follow-up studies suggest the need for ongoing monitoring, as some patients may experience relapse over time. RPE shows promise as an additional treatment for pediatric obstructive sleep apnea. It offers improvements in respiratory function and reduced symptoms in certain patients. However, long-term efficacy and safety require further investigation. Comparative studies and patient-reported outcomes are necessary to optimize treatment approaches. Collaboration between orthodontists, sleep specialists, and ear-nose-throat (ENT) specialists may be essential for optimal outcomes in pediatric OSA patients treated with RPE.

Suitability of the Respicheck questionnaire and Epworth sleepiness scale for therapy monitoring in myotonic dystrophy type 1

Myotonic dystrophy type 1 (DM1) is an autosomal dominant trinucleotide disorder that often leads to respiratory dysfunction resulting in hypoventilation symptoms, reduced quality of life and causing premature death if untreated. To early identify symptoms of hypoventilation, the Respicheck questionnaire was developed as a screening tool. Symptomatic therapies like inspiratory muscle training (IMT) are recommended to strengthen respiratory muscles and reduce or even prevent hypoventilation symptoms.Our study aimed to evaluate the Respicheck questionnaire's suitablility to monitor the efficacy of IMT. Patients with genetically confirmed DM1 were randomly assigned to either IMT – endurance or strength training, or control group. At baseline, end of study and four interim visits, pulmonary function tests, Respicheck questionnaire and Epworth sleepiness scale were assessed. While patients in training groups achieved a substantial improvement after nine months of regular IMT in pulmonary function tests, the Respicheck score did not improve likewise. Similarly, the ESS score did not change significantly in both training and control groups. Consequently, we conclude that either improvement of respiratory function is not necessarily associated with clinical improvement, or respiratory muscle weakness was not the only reason for hypoventilation syndrome, or both questionnaires are not sensitive enough to detect slight clinical changes.

Defining Meaningful Outcomes for Patients with Spinal Muscular Atrophy in the Era of Gene Therapy

Spinal muscular atrophy (SMA) occurs due to a mutation in the SMN1 gene. It most typically has an onset in early childhood and presents as impairment in motor, bulbar, and respiratory function. In a symposium at the European Paediatric Neurology Society’s (EPNS) 2023 congress, three leading experts in SMA discussed the findings of real-world evidence (RWE) studies of the first gene therapy approved in NMD, in 2019 in the USA, and 2020 in Europe. Onasemnogene abeparvovec combines an adeno-associated virus (AAV9) vector with a functional copy of SMN complementary DNA, and is delivered in a single infusion. While clinical trials of onasemnogene abeparvovec show its efficacy and safety in populations with SMA who are symptomatic and pre-symptomatic, RWE studies have expanded the understanding of this therapy to wider SMA patient groups in the real-world clinical practice setting. Combined, such studies show how administration of onasemnogene abeparvovec in patients with symptomatic SMA can lead to motor and respiratory function improvement or stabilisation and achievement of motor milestones in naïve or pre-treated patients, while in patients who are pre-symptomatic, administration may lead to a normal development. The experts also discussed how understanding the benefit/risk profile of this gene therapy can help with decision-making over its use in patients with SMA. They highlighted how onasemnogene abeparvovec efficacy and safety can be affected by clinical status, disease severity, weight, age, and previous treatment at the time of infusion. Recently published RWE points to improvements being best predicted by baseline Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) score and age at treatment initiation, and in regard to safety and tolerability profile, liver enzyme elevation is the most predominant treatment-emergent adverse event (TEAE) with onasemnogene abeparvovec; hence, a prednisolone (or equivalent) dosing regimen is administered prior to, during, and for at least 3 months following infusion. The experts discussed how careful monitoring and adequate multidisciplinary team discussion, including colleagues from other specialities, such as hepatologists and paediatric immunologists, is advised in all cases of SMA receiving an onasemnogene abeparvovec infusion.

Promising Markers of Inflammatory and Gut Dysbiosis in Patients with Post-COVID-19 Syndrome.

Post-COVID-19 syndrome is a complex of different symptoms, which results in a multisystemic impairment after the suffering from COVID-19 infection. The aim of the study was to reveal the clinical, laboratory, and gut disorders in patients with post-COVID-19 syndrome (n = 39) before and after taking part in the 14-day complex program of rehabilitation. A complete blood count, coagulation test, blood chemistry, biomarkers, and metabolites in serum samples, and gut dysbiosis were revealed in patients on the day of admission and after 14-day rehabilitation, in comparison with the variables of healthy volunteers (n = 48) or with reference ranges. On the day of discharge, patients noted an improvement in respiratory function, general well-being, and mood. At the same time, the levels of some metabolic (4-hydroxybenzoic, succinic, fumaric acids) and inflammatory (interleukin-6) variables, which were increased on admission, did not reach the level of healthy people during the rehabilitation program. Taxonomy disbalance was observed in patients' feces, namely, a high level of total bacterial mass, a decrease in the number of Lactobacillus spp., and an increase in pro-inflammatory microorganisms. The authors suggest that the post-COVID-19 rehabilitation program should be personalized, considering the patient's state together with not only the baseline levels of biomarkers, but also with the individual taxonomy of the gut microbiota.

Effects of inspiratory muscle training on respiratory muscle strength, respiratory function and functional capacity in adolescents with idiopathic scoliosis : Arandomized, controlled trial.

Adolescent Idiopathic Scoliosis (AIS) may impair respiratory dynamics and affect the performance of inspiratory and expiratory muscles. The benefit of inspiratory muscle training (IMT) is not well investigated in AIS. We aimed to investigate the effects of IMT on respiratory muscle strength, respiratory function and functional capacity in adolescents with mild to moderate AIS. Thirty-six adolescents were randomized into control or IMT groups. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) were measured by spirometry; respiratory muscle strength by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP); and functional capacity by 6-min walk test (6MWT) before and after the 8-week-long home-based exercise program. Both groups received conventional exercise program including diaphragmatic breathing exercises, resistive local expansion exercise on the collapsed areas in concave sides of scoliosis, spinal stabilization, strengthening of interscapular muscles and stretching exercises. IMT group also trained with Threshold IMT device for 15 minutes, twice a day for 8 weeks at the intensity of 30% of initial MIP value in addition to conventional exercise program. FEV1, PEF, MIP, MEP and 6MWT distance significantly improved in both groups. IMT group also showed significant improvement in FVC. The increases in FVC, MIP, MEP and 6MWT distance of IMT group were significantly higher compared to control group. IMT is found to be beneficial for patients with AIS for achieving further improvements in respiratory function, respiratory muscle strength and functional capacity compared to conventional exercise program alone.

Transthoracic robotic plication for diaphragmatic elevation.

This study aims to evaluate the feasibility, safety, and efficacy of transthoracic robot-assisted surgery for diaphragmatic plication and to describe our surgical approach in detail. Between January 2014 and January 2020, a total of 13 patients (11 males, 2 females; median age: 55 years; range, 24 to 70 years) who underwent diaphragmatic plication with the robotic system were retrospectively analyzed. The changes in the Medical Research Council dyspnea scale, forced expiratory volume in 1 sec, body mass index, and quality of life scale scores of the patients before the operation and at the first year of follow-up were examined. Twelve of the operations were performed on the left side. The median pre- and postoperative Medical Research Council dyspnea scores were 2 (range, 1 to 4) and 1 (range, 1 to 4), respectively, indicating a statistically significant improvement (p=0.008). A significant improvement was detected in the forced expiratory volume in 1 sec of the patients in the first year after surgery (p=0.036). In terms of quality of life parameters, only, in the physical health subscale, the scores were statistically significantly different in the pre- and postoperative first-year follow-up (p=0.002). Median time to chest tube removal was 1 (range 1-5, IQR=0,5) days. Median total length of hospital stay was 2 (range 2-18, IQR=3) days. Owing to its technical dexterity, the robot enables the plication to be performed easily and safely. Late improvement in respiratory functions is reflected in quality of life.

Impact of Vitamin D in the improvement of respiratory function in sickle cell disease adult patients

Abstract The study aimed to discover the role of vitamin D in improving the respiratory function in sickle cell disease patients. In this prospective study, 188 adults were enrolled, drawn from the out-patients unit of Thalassemia Cente The collected data were categorized into three groups: group 1 included the data of 100 healthy individuals of age range of 18-50 years as control; group 2 included the data of 88 (40 males and 48 females) sickle cell disease patients in steady state before supplementation of vitamin D; group 3 represented the data of the same 88 sickle cell disease patients as measured and recorded after 6 weeks of vitamin D supplementation. Laboratory measurements including pulmonary function tests and hematological parameters, while vitamin D levels were estimated for all groups to compare the data before and after supplementation of vitamin We found significant differences in the pulmonary function tests when comparing groups. Mean value of FEV1 revealed significant differences between group 1 and 2 (p &gt;0.05), while vitamin D supplement created a significant difference between group 2 and 3 (p &gt;0.05). The improvement in FEV1 did not reach to that of healthy (group 1), as referred by the significant variation between group 1 and group 3 (p&gt;0.05). The same findings were indicative within most pulmonary function tests, and the percentages of combined cases (restrictive and obstructive) were also deceased in group 3. Conclusion: supplement of vitamin D in SCD patients could result in relative improvement in lung function.

Predictive factors inhibiting recovery of the respiratory function after anatomical pulmonary resection.

Some patients have worse actual observed postoperative (apo) respiratory function values than predicted postoperative (ppo) values. The present study therefore clarified the predictive factors that hinder the recovery of the postoperative respiratory function. This study enrolled 255 patients who underwent anatomical pulmonary resection for lung cancer. A pulmonary function test (PFT) was carried out before surgery and at one, three, and six months after surgery. In each surgical procedures, the forced expiratory volume in 1s (FEV1) ratio was calculated as the apo value divided by the ppo value. In addition, we investigated the predictive factors that inhibited postoperative respiratory function improvement in patients with an FEV1 ratio < 1.0 at 6months after surgery. The FEV1 ratio gradually improved over time in all surgical procedures. However, 49 of 196 patients who underwent a PFT at 6months after surgery had an FEV1 ratio < 1.0. In a multivariate analysis, right side, upper lobe, segmentectomy and pleurodesis for prolonged air leakage were independent significant predictors of a decreased FEV1 ratio (p = 0.003, 0.006, 0.001, and 0.009, respectively). Pleurodesis was the only controllable factor that might help preserve the postoperative respiratory function. Thus, the intraoperative management of air leakage is important.

Clinical effectiveness of medical ozone therapy in COVID-19: the evidence and gaps map.

Ozone therapy (OT), a medical procedure, has been showing good results during the coronavirus disease (COVID-19). We aimed to build an evidence and gaps map (EGM) of OT in the COVID-19 ranking the articles found according to levels of evidence and outcomes. The EGM brings bubbles of different sizes and different colors according to the articles. The OT intervention used was major or minor autohemotherapy, rectal insufflation and ozonized saline solution. EGM was based on 13 clinical studies using OT for COVID-19 involving a total of 271 patients. We found 30 outcomes related to OT in COVID-19. Our EGM divided the outcomes into six groups: 1-clinical improvement; 2-hospitalization; 3-inflammatory, thromboembolic, infectious, or metabolic markers; 4-radiological aspects, 5-viral infection and 6-adverse events. Major autohemotherapy was present in 19 outcomes, followed by rectal insufflation. Improvement in clinical symptoms of COVID-19, improvement of respiratory function, improvement of oxygen saturation, reduction in hospital internment, decrease in C-reactive protein, decrease in ferritin, decrease in lactate dehydrogenase, decrease in interleukin 6, decrease in D-dimer, radiological improvement of lung lesions and absence of reported adverse events were related in the papers. The most commonly used concentrations of OT in major autohemotherapy and in rectal insufflation were 40 μg/mL and 35 μg/mL, respectively. Here, we bring the first EGM showing the efficacy and safety of OT in the treatment of COVID-19. OT can be used as integrative medical therapy in COVID-19 at a low cost and improve the health conditions of the patients.

Physical Therapy Management of a COVID-19 Patient on Extracorporeal Membrane Oxygenation: A Case Report

Coronavirus Disease-2019 (COVID-19) can be classified as a respiratory disease that ranges from pneumonia to critically ill cases. Extracorporeal Membrane Oxygenation (ECMO) is a therapeutic procedure that can treat severe cases of respiratory failure. Hereby, the authors present, a 28-year-old case of Acute Respiratory Distress Syndrome (ARDS) young patient with COVID-19 on ECMO therapy, presenting with complaints of weakness, decreased mobility and function, and depression. The patient has received physical therapy interventions during the hospitalisation period. Respiratory, mobility, activity level, and psychological assessments were done before and after treatment using blood gases, the Intensive Care Unit (ICU) Mobility Scale, the University of Michigan scale, and the Hamilton Anxiety and Depression Rating Scale, respectively. There was an improvement in respiratory function, mobility (scores increased from 0 to 1), activity level (scores increased from 0 to 3), and psychological well-being (depression scores decreased from 18 to 15, and anxiety scores decreased from 20 to 14) after physical therapy. The treatment resulted in better recovery and prevented the worsening of the COVID-19 disease scenario.