RESUMEN
BACKGROUND: Abdominal surgeries are performed for the treatment and diagnosis of many diseases. Smokers undergoing abdominal surgery, are high risk population, having underlying pathological changes in lung parenchyma due to inflammatory effect of smoking. Site of incision and history of smoking may significantly affect pulmonary function such as FVC and FEV1. Respiratory muscle training pre-operatively has shown significant improvement of pulmonary function compare to only conventional therapy and has led to reduction of PPCs, length of hospital stay and cost. This study aims to find effectiveness of IMT in chronic smokers undergoing abdominal surgery and its significance in reduction of PPC and in pulmonary function and functional capacity as compared to non-smokers. METHODOLOGY: This study protocol is observational cohort study comparing smoker and non-smoker participants undergoing abdominal surgery. The participants will be assessed for pulmonary function test and functional capacity (6MWD); pre-operatively and post-operatively day 1 till the day of discharge. Both the groups will receive IMT and conventional chest Physiotherapy from POD1 and increment of IMT will be done by assessing MIP each day. DISSEMINATION: We plan to publish this review in a peer-reviewed journal. We may also present this review at local and/or national conferences.
RESUMEN
BACKGROUND: Cystic fibrosis lung disease is characterized by chronic bacterial infections in the setting of mucus abnormalities. Patients experience periodic exacerbations that manifest with increased respiratory symptoms that require intensification of therapy with enhanced airway clearance and intravenous (IV) antibiotics. OBJECTIVES: In an observational study we tested if the profile of metabolites in serum distinguished the pre-from post-exacerbation state and which systemically measurable pathways were affected during the process to recovery. METHODS: Serum collected within 48â¯h of start and completion, respectively of IV antibiotics was collected from people with CF ages 6-30 years. Three day food records were collected prior to each sample. To reduce variation between subjects only subjects who had pancreatic insufficiency, had similar CF mutations, and did not have CF liver disease or diabetes were included. Metabolomic profiling was conducted by Ultrahigh Performance Liquid Chromatography-Tandem Mass Spectroscopy with metabolites being identified based on retention time/index, mass to charge ratio and comparison to known compounds. Biostatistical analyses used paired t-test with correction for multiple comparisons and orthogonal partial least square discriminant analysis. RESULTS: Thirty subjects (20 male) with a mean⯱â¯SEM age of 15.3⯱â¯1.2 years participated, 17 of whom had matched food-records. Lung function was significantly improved post-therapy compared to pre-therapy, (mean⯱â¯SEM) 75⯱â¯4% vs. 68⯱â¯4% predicted (nâ¯=â¯26). Serum metabonomics showed distinction of the pre-vs. post-therapy groups with 123 compounds contributing to the differentiation pre-versus post-antibiotics by multiple biostatistical analyses. Compounds and pathways affected included bile acids and microbial derived amino acid metabolites, increases in lipid classes of the glycerophospholipid, glycerolipids, cholesterol, phopsholipids, and most pronounced, the class of sphingolipids. Changes in n6/n3 fatty acids, decreased polyamines but increased metabolites in the nitric oxide pathway, and changes in the tryptophan-kynurenine pathway indicated decreased inflammation at resolution of exacerbation. CONCLUSIONS: Changes in serum metabolites that distinguished CF pulmonary exacerbation vs. resolution of symptoms showed evidence of decreased inflammation and improvement from a catabolic state.