Biomedical subjects

Carlos G Tun

Publications and source records attributed to Carlos G Tun.

5 recordsLinked to original sources

PubMed2006

Determinants of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC in chronic spinal cord injury.

OBJECTIVE: To assess factors that influence pulmonary function, because respiratory system dysfunction is common in chronic spinal cord injury (SCI). DESIGN: Cross-sectional cohort study. SETTING: Veterans Affairs Boston SCI service and the community. PARTICIPANTS: Between 1994 and 2003, 339 white men with chronic SCI completed a respiratory questionnaire and underwent spirometry. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), and FEV(1)/FVC. RESULTS: Adjusting for SCI level and completeness, FEV(1) (-21.0 mL/y; 95% confidence interval [CI], -26.3 to -15.7 mL/y) and FVC (-17.2 mL/y; 95% CI, -23.7 to -10.8 mL/y) declined with age. Lifetime cigarette use was also associated with a decrease in FEV(1) (-3.8 mL/pack-year; 95% CI, -6.5 to -1.1 mL/pack-year), and persistent wheeze and elevated body mass index were associated with a lower FEV(1)/FVC. A greater maximal inspiratory pressure (MIP) was associated with a greater FEV(1) and FVC. FEV(1) significantly decreased with injury duration (-6.1 mL/y; 95% CI, -11.7 to -0.6 mL/y), with the greatest decrement in the most neurologically impaired. The most neurologically impaired also had a greater FEV(1)/FVC, and their FEV(1) and FVC were less affected by age and smoking. CONCLUSIONS: Smoking, persistent wheeze, obesity, and MIP, in addition to SCI level and completeness, were significant determinants of pulmonary function. In SCI, FEV(1), FVC, and FEV(1)/FVC may be less sensitive to factors associated with change in airway size and not reliably detect the severity of airflow obstruction.

Adult↗

PubMed2005

Dyspnea during daily activities in chronic spinal cord injury.

OBJECTIVE: To assess factors associated with breathlessness in chronic spinal cord injury (SCI) during daily activities. DESIGN: Cross-sectional survey. SETTINGS: Veterans Affairs SCI service and the community. PARTICIPANTS: Four hundred forty-one participants 1 or more years post-SCI, and without acute illness, were recruited between 1994 and 2003 and were categorized according to their ability to walk unassisted, walk with an aid, or to move about by either hand-propelled wheelchair or motorized wheelchair (MWC). INTERVENTIONS: Assessment of injury extent, respiratory symptoms, cigarette smoking, comorbid medical conditions, and spirometry. MAIN OUTCOME MEASURES: Breathlessness during talking, eating, or dressing. RESULTS: Breathlessness was more common in MWC users (20/85 users, 24%) than in nonusers (20/356, 6%). The main activity associated with breathlessness in 15 MWC users was talking (18%). In MWC users, the risk of breathlessness was related to lifetime cigarette smoking (odds ratio [OR]=1.02; 95% confidence interval [CI], 1.00-1.03 per pack year), and reports of chronic cough (OR=7.8; 95% CI, 2.0-32.7), and wheeze (OR=3.5; 95% CI, 1.04-13.6). SCI level, percentage of predicted forced vital capacity and forced expiratory volume in 1 second, and maximal inspiratory pressures were not related to breathlessness. CONCLUSIONS: Breathlessness during selected daily activities (most commonly talking) was greatest in SCI participants who were most impaired with regard to mobility and was associated with reports of coughing, wheezing, and cigarette smoking.

Activities of Daily Living↗

PubMed2004

Alcohol use associated with cervical spinal cord injury.

OBJECTIVES: To determine whether alcohol use at time of spinal cord injury (SCI) is more common with cervical injury than with lower levels of spinal injury. METHODS: Veterans and nonveterans with SCI were assessed at a Veteran's Affairs Medical Center from 1994 through 2002 and completed a health questionnaire that included information on alcohol use at time of traumatic injury. RESULTS: Of 362 men, 45% had neurologically complete or incomplete cervical injuries. Participants with cervical injury were more likely to have used alcohol when injured (62/162, 38%) compared with participants without cervical injury (45/200, 23%). Adjusting for age at injury and accident type, participants with cervical SCI had an increased relative odds of having used alcohol at injury compared with participants without cervical SCI (2.06, 95% confidence interval = 1.24-3.43). CONCLUSION: Alcohol use at time of SCI is a risk factor for cervical injury. This finding is of public health concern and should be included in alcohol educational programs.

Adolescent↗

PubMed2003

Preservation of cognitive function after long-term tetraplegia.

The claim of a significant relationship between pulmonary peak expiratory flow rate and cognitive decline in normal aging is bound to raise the question of whether accelerated cognitive decline would be an automatic consequence of long-term tetraplegia, with its significant effects on normal respiratory function. We present a case series of three persons with long-term tetraplegia (11, 15, and 21 yr) comparing their cognitive test results (short-term and working memory, the ability to inhibit interference, and cognitive processing speed) with scores for age-matched noninjured adults. Results showed that long-term tetraplegia, even with compromised respiration, does not inevitably lead to decline in fundamental cognitive functions relative to age-matched noninjured controls.

Adult↗

PubMed2003

Spirometry testing standards in spinal cord injury.

STUDY OBJECTIVES: Because muscle paralysis makes it uncertain whether subjects with spinal cord injury (SCI) can perform spirometry in accordance with American Thoracic Society (ATS) standards, determinants of test failure were examined. DESIGN: Cross-sectional study. SETTING: Veterans Affairs (VA) medical center. PARTICIPANTS: Veterans with SCI at VA Boston Healthcare System and nonveterans recruited by mail and advertisement. MEASUREMENTS AND RESULTS: Two hundred thirty of 278 subjects (83%) were able to produce three expiratory efforts lasting > or = 6 s and without excessive back-extrapolated volume (EBEV). In 217 of 230 subjects (94%), FVC and FEV(1) were each reproducible in accordance with 1994 ATS standards. In the remaining 48 subjects, efforts with smooth and continuous volume-time tracings and acceptable flow-volume loops were identified. These subjects had a lower percentage of predicted FVC, FEV(1), and maximum expiratory and inspiratory pressures compared to the others, and a greater proportion had neurologically complete cervical injury (42% compared to 16%). In 19 subjects (40%), some expiratory efforts were not sustained maximally for > or = 6 s but had at least a 0.5-s plateau at residual volume (short efforts). In eight subjects (17%), some efforts were not short but had EBEV. In the remaining 21 subjects (44%), some efforts were short, some had EBEV, and some had both. If these efforts were not rejected, 262 of 278 subjects (94%) would have produced three acceptable efforts, and in 257 subjects (92%), the efforts were reproducible. CONCLUSIONS: Subjects with SCI with the most impaired respiratory muscles and abnormal pulmonary function are able to perform spirometry reproducibly despite not meeting usual ATS acceptability standards. Exclusion of these subjects would lead to bias in studies of respiratory function in SCI. The modification of spirometry testing standards to include efforts with EBEV and with a 0.5-s plateau if < 6 s would reduce the potential for bias.

Adult↗