BACKGROUND: Neuromuscular diseases (NMDs) lead to different weakness patterns, and most patients with NMDs develop respiratory failure. Inspiratory and expiratory muscle strength can be measured by maximum static inspiratory pressure (P _Imax ) and maximum static expiratory pressure (P _Emax ), and the relationship between them has not been well described in healthy subjects and subjects with NMDs. Our aim was to assess expiratory/inspiratory muscle strength in NMDs and healthy subjects and calculate P _Emax /P _Imax ratio for these groups. METHODS: Seventy (35 males) subjects with NMDs (amyotrophic lateral sclerosis, myasthenia gravis, and myotonic dystrophy), and 93 (47 males) healthy individuals 20–80 y of age were evaluated for anthropometry, pulmonary function, P _Imax , and P _Emax , respectively. RESULTS: Healthy individuals showed greater values for P _Imax and P _Emax when compared with subjects with NMDs. P _Emax /P _Imax ratio for healthy subjects was 1.31 ± 0.26, and P _Emax %/P _Imax % was 1.04 ± 0.05; for subjects with NMDs, P _Emax /P _Imax ratio was 1.45 ± 0.65, and P _Emax %/P _Imax % ratio was 1.42 ± 0.67. We found that P _Emax %/P _Imax % for myotonic dystrophy was 0.93 ± 0.24, for myasthenia gravis 1.94 ± 0.6, and for amyotrophic lateral sclerosis 1.33 ± 0.62 when we analyzed them separately. All healthy individuals showed higher P _Emax compared with P _Imax . For subjects with NMDs, the impairment of P _Emax and P _Imax is different among the 3 pathologies studied ( P < .001). CONCLUSIONS: Healthy individuals and subjects with NMDs showed higher P _Emax in comparison to P _Imax regarding the P _Emax /P _Imax ratio. Based on the ratio, it is possible to state that NMDs show different patterns of respiratory muscle strength loss. P _Emax /P _Imax ratio is a useful parameter to assess the impairment of respiratory muscles in a patient and to customize rehabilitation and treatment.

Background: Diabetes mellitus (DM) is an important public health problem worldwide. In addition to the impairment in functionality, the large number of complications which lead to hospitalizations results in high treatment costs. The aim of this study was to analyze the incidence of hospitalizations, mortality rate and hospital costs, as well as to observe the temporal trend of hospitalizations and length of hospital stay due to DM between 2008 and 2019 in Brazil. Methods: This is a longitudinal descriptive study in which all data regarding hospital admissions registered in the Brazilian system of Hospital Information of “Sistema Único de Saúde” (SIH/SUS; http://datasus.saude.gov.br) due to DM (ICD-10) were included. Comparisons among the groups were performed by an unpaired Student’s t-test, two-way ANOVA with a Tukey post hoc test (p < 0.05). Results: An increased hospitalization of 1.83% due to DM was observed between 2008 and 2019 in Brazil. The Southeastern region had the highest incidence (34.6%) and mortality rate when compared to the other regions (p < 0.05). We also found that females were more likely to be hospitalized in comparison to males, without a statistically significant difference. Finally, a progressive increase of hospitalizations and mortality rate were observed according to age groups, as well as increased spending due to DM hospitalizations over the years. Conclusion: Hospitalizations due to DM in Brazil showed an expressive increase over the last 12 years, and there is a need for primary healthcare interventions to help reduce this situation.

The expansion of the rib cage and abdomen occurs in a synchronic way during a coordinated contraction of the diaphragm and the abdominal and intercostal muscles under normal conditions and healthy. The presence of restrictive respiratory disease may lead to uncoordinated action of the respiratory muscles which affects breathing pattern and chest wall volumes. The aim of this study was to evaluate chest wall volumes, chest wall asynchrony and inspiratory paradoxical movement of breathing, as well as the influence of the time of disease diagnosis in subjects with Parkinson’s disease and post-Stroke in comparison to healthy individuals. Total and compartmental chest wall volumes, chest wall asynchrony and paradoxical movement were measured at rest in a seated position by Optoelectronic Plethysmography in 76 individuals (29 healthy individuals, 20 post-Stroke and 27 Parkinson’s disease subjects). Post-stroke and Parkinson’s disease subjects were also grouped according to the length of diagnosis. In both groups with restrictive respiratory disease we observed that pulmonary rib cage compartment (V_RCp) volume is reduced when compared to healthy subjects (p <0.05). This same pattern was observed when analyzing post-stroke subjects with more than three years of diagnosis and Parkinson’s subjects with less than three years of diagnosis (p<0.05). Furthermore, post-stroke subjects with inspiratory paradoxical movement showed decreased total and compartmental chest wall volumes (p<0.05), while individuals with Parkinson’s disease with inspiratory paradoxical movement only presented a decrease in pulmonary rib cage compartment volume (p<0.05). Our study presents new findings for better understanding of chest wall volumes and chest wall asynchrony in post-stroke and Parkinson’s disease individuals. Half of the subjects with post-Stroke and Parkinson’s disease presented inspiratory paradox movement, but changes in breathing pattern was especially observed in post-stroke subjects with more than three years of diagnosis.

To evaluate sensitivity/specificity of the maximum relaxation rate (MRR) of inspiratory muscles, amplitude of electromyographic activity of the sternocleidomastoid (SCM), scalene (SCA), parasternal (2^ndIS) and rectus abdominis (RA) muscles; lung function and respiratory muscle strength in subjects with Myotonic dystrophy type 1 (DM₁) compared with healthy subjects. Quasi-experimental observational study with control group. MRR of inspiratory muscles, lung function and amplitude of the electromyographic activity of SCM, SCA, 2^ndIS and RA muscles during maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and sniff nasal inspiratory pressure (SNIP) tests were assessed in eighteen DM₁ subjects and eleven healthy. MRR was lower in DM₁ group compared to healthy (P = 0.001) and was considered sensitive and specific to identify disease in DM₁ and discard it in controls, as well as SNIP% (P = 0.0026), PImax% (P = 0.0077) and PEmax% (P = 0.0002). Contraction time of SCM and SCA was higher in DM₁ compared to controls, respectively, during PImax (P = 0.023 and P = 0.017) and SNIP (P = 0.015 and P = .0004). The DM₁ group showed lower PImax (P = .0006), PEmax (P = 0.0002), SNIP (P = 0.0014), and higher electromyographic activity of the SCM (P = 0.002) and SCA (P = 0.004) at rest; of 2^ndIS (P = 0.003) during PEmax and of SCM (P = 0.02) and SCA (P = 0.03) during SNIP test. MD₁ subjects presented restrictive pattern, reduced respiratory muscle strength, muscular electrical activity and MRR when compared to higher compared to controls. In addition, the lower MRR found in MD₁ subjects showed to be reliable to sensitivity and specificity in identifying the delayed relaxation of respiratory muscles.

OM-85 is an immunostimulant bacterial lysate, which has been proven effective in reducing the number of lower airways infections. We investigated the efficacy of the bacterial lysate OM-85 in the primary prevention of a murine model of asthma. In the first phase of our study the animals received doses of 0.5μg, 5μg and 50μg of OM-85 through gavage for five days (days -10 to -6 of the protocol), 10 days prior to starting the sensitisation with ovalbumin (OVA), in order to evaluate the results of dose-response protocols. A single dose (5μg) was then chosen in order to verify in detail the effect of OM-85 on the pulmonary allergic response. Total/differential cells count and cytokine levels (IL-4, IL-5, IL-13 and IFN-γ) from bronchoalveolar lavage fluid (BALF), OVA-specific IgE levels from serum, lung function and lung histopathological analysis were evaluated. OM-85 did not reduce pulmonary eosinophilic response, regardless of the dose used. In the phase protocol using 5μg/animal of OM-85, no difference was shown among the groups studied, including total cell and eosinophil counts in BALF, serum OVA-specific IgE, lung histopathologic findings and lung resistance. However, OM-85 decreased IL-5 and IL-13 levels in BALF. OM-85, administered in early life in mice in human-equivalent doses, does not inhibit the development of allergic pulmonary response in mice.