scholarly journals Analgesic Effect of Intrathecal Fentanyl vs Dexmedetomidine as Adjuvants to Bupivacaine Following Abdominal Surgery for Cancer in Children, a Randomized Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2634-2641
Author(s):  
Khaled Mohamed Fares ◽  
Sahar Abdel-Baky Mohamed ◽  
Ahmad Mohammad Abd El-Rahman ◽  
Rania Mohammed AbdeLemam ◽  
Amira Mahmoud Mohamed Osman
Keyword(s):  
Informed Consent ◽  
Abdominal Surgery ◽  
Postoperative Analgesia ◽  
Pediatric Malignancy ◽  
Significant Difference ◽  
Abdominal Malignancy ◽  
The Mean ◽  
Group D ◽  
Cancer In Children ◽  
Written Informed Consent

Abstract Background Intrathecal fentanyl in spinal anesthesia improves intra- and postoperative analgesia. Dexmedetomidine is a fascinating adjuvant with regards to neuraxial anesthesia in children experiencing surgery for abdominal malignancy. Patients and Methods After endorsement by the institutional reviewing board (IRB) and guardians’ written informed consent, this research was carried out on 60 pediatric malignancy patients scheduled for major abdominal surgery. Children were randomly distributed into three groups (20 patients each): Group C: given 2 mL of bupivacaine 0.5% (0.4 mg/kg) intrathecally, injected gradually over 20 seconds. Group F: the same as group C, plus fentanyl 0.2 μg/kg. Group D: the same as group C, plus dexmedetomidine 0.2 μg/kg. Pain at zero, two, four, six, 12, 18, and 24 hours postoperatively was evaluated by Face, Legs, Activity, Crying, and Consolability (FLACC) score. First analgesic request and postoperative unfavorable effects were recorded for 24 hours postoperatively. Results A significant decrease was recognized in the mean FLACC score in groups D and F at six, eight, and 12 hours postoperatively, in contrast to group C (P ≤ 0.05). First analgesic request was significantly prolonged in group D (7.67 ± 0.57 hours), in contrast to groups F and C (5.40 ± 1.09 hours and 4.23 ± 3.27 hours, respectively, P < 0.04). Paracetamol utilization was significantly decreased in group D (316.67 ± 28.86 mg), in contrast to group C (391.00 ± 52.00 mg, P < 0.03), without a significant difference between group F (354.44 ± 46.67 mg) and groups D and C (P > 0.05). Conclusions Adding dexmedetomidine and fentanyl to intrathecal bupivacaine improved postoperative analgesia following abdominal surgery for cancer in children, with better overall analgesia of dexmedetomidine compared with fentanyl.

Comparing the Effect of Hand and Foot Reflexology Massages on the Severity of Nausea, Vomiting and Ileus in patients after Abdominal Surgery

2021 ◽  
Vol 15 (6) ◽  
pp. 1589-1593
Author(s):  
Elham Shahraki Moghadam ◽  
Zahrasadat Manzari ◽  
Hossein Rashki Ghalenow ◽  
Hajar Noori Sanchooli
Keyword(s):  
Abdominal Surgery ◽  
Repeated Measures ◽  
Abdominal Distension ◽  
Repeated Measure ◽  
Chi Square ◽  
Exact Test ◽  
Positive Effects ◽  
Significant Difference ◽  
The Mean ◽  
Hands And Feet

Background: Common clinical problems after surgery include nausea, vomiting and ileus that many patients complain of after their surgery. These complications can delay the patient's discharge from hospital. Nowadays, to reduce drug side effects, the use of complementary medicine, including reflexology, has received a great deal of attention. Aim: To compare the effect of hand and foot reflexology massages on the severity of nausea, vomiting and ileus in patients after abdominal surgery. Methods: This is a clinical trial study that was conducted between 2013 and 2015 in the emergency surgical departments of Imam Reza (AS) and Ghaem (AS) hospitals in Mashhad. The samples of this study included 90 women with cholecystitis and appendicitis who met the inclusion criteria. In this study, patients were randomly divided into 3 groups of hand reflexology massage, foot reflexology massage and control. To check the digestive status, gastrointestinal sounds were checked every hour using a clinical stethoscope. Also, information on gas and feces elimination was collected and recorded every hour. The intervention was performed 1 and 12 hours after the surgery. In both groups of hands and foot reflexology massages, after general massage of the hands and feet, the areas related to the abdominal distension and removal of the ileus were pressed. It should be noted that, the duration of massage for each person was 10 minutes (20 minutes in total). Data were analyzed by SPSS software version 16 using Chi-square, Fisher’s exact test, two-way ANOVA, Kruskal-Wallis test and repeated measures ANOVA. Results: There was no statistically significant difference in the mean score of severity of nausea before the intervention between the three groups (p = 0.90), but after the intervention a significant difference was observed in the mean score of severity of nausea between the three groups (p=0.002). Also, the result of ANOVA test with repeated measure showed a statistically significant difference in the mean score of nausea by group and stage (p<0.001). There was also no statistically significant difference in the frequency of vomiting severity between the three groups after the intervention. However, at 4 and 24 hours after the intervention, a statistically significant difference was observed between the three groups in that regard. Conclusion: The results showed that both types of hand and foot reflexology massage has positive effects on nausea and return of gastrointestinal movements, so nurses can use reflexology as a non-pharmacological and complementary method to reduce the severity of nausea and return gastrointestinal movements in postoperative patients. Since the reflexology had little or no effect on the severity of vomiting and the acceleration of gastrointestinal movements in patients, further studies in this area are recommended. Keywords: Reflexology, Pain, Nausea and vomiting, Ileus, Surgery

scholarly journals P160 Can the Lemann index at diagnosis predict the risk of early surgery in Crohn’s disease?

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S239-S239
Author(s):  
A Hassine ◽  
I Akkari ◽  
S Mrabet ◽  
E Ben Jazia
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Treatment Decision ◽  
Early Surgery ◽  
First Year ◽  
Rapid Disease Progression ◽  
Significant Difference ◽  
The Mean ◽  
Optimal Patient Management

Abstract Background Identifying patients with Crohn’s disease (CD) with rapid disease progression or at high risk for early surgery is a crucial pillar in the treatment decision to ensure optimal patient management. The objective of this study was to assess the correlation between the Lemann index at the time of diagnosis and abdominal surgery in the first year after diagnosis of Crohn’s disease and to find the risk factors for early surgery. Methods This is a retrospective study of all patients with CD followed in our center over a period of 4 years (January 2016- January 2020), and who were evaluated by endoscopy and MRI at baseline. The Lemann Index is a score that measures cumulative damage to digestive tissue from entero-MRI and endoscopy data. It was calculated by noting the previous surgery, the location and extension of the disease and any intestinal complications. The sociodemographic and clinical characteristics of the patients were studied. Hypothesis tests were applied to identify associations. Results 112 patients with CD were included in this study, of which 53.6% were female. The mean age at diagnosis was 33.29 years [15–63]. Active smoking was found in 34 patients (30.4%). Regarding the localization of CD, it was ileal (L1 according to the Montreal classification), colonic (L2), and ileocolonic (L3) in respectively 16.1%, 42.9% and 41%. The disease phenotype was inflammatory (B1) in 60.7%, stricturing (B2) in 21.42%, and penetrating (B3) in 17.85%. Anoperineal manifestations were noted in 24 patients. An upper digestive tract was present in 19.6% of patients. The initial flare was judged to be severe in 33.9% of cases, moderate in 55.4% of cases and mild in 10.7% of cases, with a mean CDAI of 305.21 [115–493]. During the first year after diagnosis of CD, 19.6% of patients (n = 22) required surgical treatment. The indications for surgery were: the presence of an intra-abdominal collection (27.3%), severe acute corticosteroid-resistant colitis (18.2%); ileocaecal stenosis resistant to medical treatment (27.3%) or acute bowel obstruction (27.3%). The LI at diagnosis was much higher in the early surgery group: 5.22 +/- 2.65 vs. 2.63 +/- 1.88; with a statistically significant difference (p = 0.01). A severe initial flare as well as a penetrating phenotype were predictors of early abdominal surgery (p = 0.022, p = 0.024, respectively). Conclusion According to our study, a high Lemann score at diagnosis correlates well with the risk of early surgery in Crohn’s disease. Further, larger-scale studies would be needed to establish the reliability of this test in predicting this risk.

scholarly journals A postmortem study - age related change of ovarian volume in Bangladeshi female

2013 ◽  
Vol 2 (2) ◽  
pp. 8-12
Author(s):  
Rubina Qasim ◽  
Humaira Naushaba ◽  
Md Enayet Ullah ◽  
Hasna Hena ◽  
Hosna Ara Perven
Keyword(s):  
Age Groups ◽  
Left Ovary ◽  
Female Population ◽  
Ovarian Volume ◽  
Significant Difference ◽  
Group A ◽  
Ovarian Diseases ◽  
The Mean ◽  
Group B ◽  
Group D

Background : Ovarian diseases and infertility are the very common health problems among the female population. Alteration in the volume of the ovary occurs throughout the reproductive life which may predispose to ovarian diseases such as cyst, polycystic ovary and ovarian carcinoma. Moreover, the reduction in ovarian volume leading to decrease the fertility of a women also. So the present study is designed to assess the volume of the ovary in Bangladeshi women in different age groups which will provide a complete and standarize the data in Bangladeshi population and also compare the data with other countries. It will provide resourcefull information which may further determine the ovarian reserve and reproductive age of female for improving the accurate diagnosis and management of ovarian diseases as well as infertility problems. Study design: Cross sectional and analytical type of study. Materials: The present study was performed on 65 cadaveric ovaries of both side in Bangladeshi female age ranging from 5 years to 65 years. Methods: The samples were divided into four different age groups. They were group A or prepubertal group (5-12years), group B or reproductive group (13-45 years), group C or perimenopausal group (46-51years) and group D or postmenopausal group (52-65years). Results: The mean (±SD) volumes were 2.84 + 0.22 milliliter and 2.83±0.24 milliliter in group A, 8.64 + 0.89 milliliter and 8.61± 0.89 milliliter in group B, 6.85 + 0.79 milliliter and 6.84±0.76 milliliter in group C and 2.62 + 0. 52 milliliter and 2.61± 0.50 milliliter in group D in the right & left ovaries respectively. The highest mean volume was observed in group B and lowest mean volume was in group D in both ovaries. Statistically highly significant difference (P<0.001) were found when group A was compared with group B & C, group B was compared with group C & D and group C was compared with group D. But when group A was compared with group D, it was not significant (P<0.50).The mean difference in volumes of right and left ovary between group A, group B, group C and group D were statistically not significant. Conclusion: In this study, volume of the ovary does not vary in between right and left ovary in any age group. DOI: http://dx.doi.org/10.3329/updcj.v2i2.15482 Update Dent. Coll. j: 2012; 2 (2): 08-12

scholarly journals Comparison of the Effect of Inhalation Aromatherapy with 10% and 30% Peppermint Essential Oils on the Severity of Nausea in Abdominal Surgery Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Yasin Ahmadi ◽  
Jahangir Rezaei ◽  
Mansour Rezaei ◽  
Alireza Khatony
Keyword(s):  
Abdominal Surgery ◽  
Essential Oils ◽  
Controlled Trial ◽  
Control Group ◽  
Green Food ◽  
Severity Scores ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
And Control

Background. One of the most common surgical complications is nausea. Regarding the contradictory findings on the effect of aromatherapy with peppermint on the severity of nausea, in the present study, we aimed at comparing the effect of aromatherapy with 10% and 30% peppermint essential oils on the severity of nausea in surgical patients. Methods. This single-blind randomized controlled trial was conducted at the surgical ward of Imam Reza Hospital in Kermanshah, Iran. A total of 120 patients undergoing abdominal surgery were randomly divided into three groups of 10% peppermint, 30% peppermint, and control (40 patients in each group) using a random number table. In each of the intervention groups, 0.2 ml of 10% and 30% peppermint essential oil was inhaled. In the control group, the same amount of distilled water colored with green food coloring was inhaled. The severity of nausea was measured by nausea visual analog scale (NVAS) before and 10 minutes after the intervention. Results. In the 10% peppermint group, the mean severity of nausea before the intervention was 52.3 ± 13.7 out of 100, which reduced to 40.5 ± 13.5 after the intervention (p<0.001). In the 30% peppermint group, the mean severity scores of nausea before and after the intervention were 60.2 ± 15.0 and 39.7 ± 12.4, respectively (p<0.001). In the control group, the mean severity scores of nausea before and after the intervention was not statistically significant. There was no significant difference between the two intervention groups in terms of the mean severity of nausea after the intervention. Conclusions. It can be concluded that 10% and 30% peppermint essential oils are equally effective on the severity of nausea.

TO STUDY AND COMPARE THE EFFECT OF DEXMEDETOMIDINE AND FENTANY AS AN ADJUVANT TO LEVOBUPIVACAINE IN INTERSCALENE BRACHIAL PLEXUS BLOCK FOR HUMERUS SURGERY: A PROSPECTIVE RANDOMIZED DOUBLE-BLIND CONTROLLED STUDY

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Kushal Jethani ◽  
Khushboo . ◽  
Anjali Bansal
Keyword(s):  
Brachial Plexus ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Controlled Study ◽  
Double Blind ◽  
Interscalene Brachial Plexus Block ◽  
The Mean ◽  
Plexus Block ◽  
Group D

Introduction: Interscalene brachial plexus block provides complete and reliable anaesthesia for surgery of humerus as well as analgesia for postoperative period. Many studies are being done for the search for an adjuvant which when added to a local anaesthetic, prolong the duration of postoperative analgesia. Therefore we compared the effect of fentanyl and dexmedetomidine on postoperative analgesia when added to levobupivacaine for Interscalene brachial plexus block. Material and Methods: In this prospective study, 90 patients were randomly allocated to 3 groups:  Group C (n=30) recieved 30 ml of 0.5% levobupivacaine, Group D (n=30) recieved 30 ml of 0.5% levobupivacaine + dexmedetomidine 1 μg/kg, Group F (n=30) recieved 30 ml of 0.5% levobupivacaine + fentanyl 1 μg/kg. The duration of blockade and analgesia were assessed for all the three groups. Observations: Demographic profile was comparable in all the groups. The onset of sensory and motor block and duration of analgesia and motor block were enhanced in Group D and Group F as compared to Group C. The mean pulse rate and mean arterial pressure were slightly lower in dexmedetomidine group than in other two groups. Results: Compared to the use of levobupivacaine alone for interscalene brachial plexus block, addition of 1 mcg/kg dexmedetomidine or 1 mcg/kg fentanyl to levobupivacaine enhanced the onset of blockade as well as increased the duration of blockade and post-operative analgesia. Also, the blockade characteristics were better improved with addition of dexmedetomidine to levobupivacaine than addition of fentanyl to levobupivacaine without increasing incidence of any unwanted side-effects. Keywords: Interscalene brachial plexus block, Levobupivacaine, Fentanyl, Dexmedetomidine.

scholarly journals Dexamethasone as a bupivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: a prospective randomized study

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Maha Abd el Fattah Metawie Badran ◽  
Ayman Mokhtar Kamaly ◽  
Hadil Magdy Abdel Hamid ◽  
Raham Hassan Mostafa
Keyword(s):  
Postoperative Analgesia ◽  
Randomized Study ◽  
Shoulder Surgery ◽  
Interscalene Block ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Vas Score ◽  
Arterial Blood ◽  
Significant Difference ◽  
Group D

Abstract Background Finding adjuvants to local anesthetic used in interscalene block that could efficiently extend the analgesia duration has recently been the focus of researchers. The aim of the work was to determine whether the addition of perineural dexamethasone to bupivacaine in-ultrasound guided interscalene block would prolong the duration of sensory analgesia in patients undergoing shoulder surgery. Results This prospective, randomized, double-blinded study comprised 50 patients. They were randomly subdivided into 2 groups: group C [control] and group D [dexamethasone]. We noted a significant difference regarding the timing for the first rescue analgesia being shorter in group C than in group D with a P value < 0.001. Regarding postoperative analgesia, higher Ketolac consumption was noticed in group C than in group D. Patients from both groups showed excellent analgesic effects with VAS score less than 2 points up to 6 h postoperative then patients in group C had a higher VAS score compared to group D, and the difference was statistically significant (P value < 0.05). We also noticed an increase in the heart rate and mean arterial blood pressure in group C than in group D at 12 h and 24 h postoperatively. Conclusion We concluded that the addition of 8 mg of perineural dexamethasone to 30 ml of 0.5% bupivacaine showed improvement in the postoperative analgesia in shoulder surgery without obvious complications.

scholarly journals On the nature of indoor airborne bioaerosols at a hospital in Iran

2021 ◽  
Author(s):  
Maryam Dashti ◽  
Abbas Norouzian Baghani ◽  
Armin Sorooshian ◽  
Mehdi Vosoughi ◽  
Seyed Ahmad Mokhtari ◽  
...  
Keyword(s):  
Group A Streptococcus ◽  
Airborne Fungi ◽  
Fungal Species ◽  
Care Workers ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group D ◽  
Mean Concentration ◽  
Total Concentrations

Introduction: Hospitals are sensitive places owing to the contagious nature of diseases transferred by patients to others such as health care workers and staff. Materials and methods: The aim of the present work is to evaluate the type and concentration of bacterial and fungal bio-aerosols in the indoor air of four operating rooms (ORs) and four wards in Khalkhal, Iran during 2019. A total of 192 bacterial and fungal samples were collected. Results: Mean total concentrations of airborne bacteria for ORs and wards were between 11±1.2 to 48±3.1 CFU/m3, respectively, while for airborne fungi values ranged from 95±5.6 to 51±1.2 CFU/m3, respectively. The predominant genera of airborne bacterial isolated (ORs vs. wards) were Staphylococcus epidermidis (72% vs. 58%), Group D Streptococcus (4% vs. 17%), Group A Streptococcus (13% vs. 3%), and Staphylococcus saprophyticus (6% vs. 4%). In addition, the main fungal species identified (ORs vs. wards) were Cladosporium sp. (37% vs. 38%), Penicillium sp. (28% vs. 22%), and Aspergillus Niger (21% vs. 12%). A statistically significant correlation was observed between the mean concentration of bio-aerosols and population density (p<0.05). Conclusion: Furthermore, a statistically significant difference was observed between the mean concentrations of bio-aerosols and the values recommended by WHO (p<0.05), linked presumably to inadequate disinfection, improper design and operation of standard central ventilation (SCV), and the high density of visitors and patients. Addressing such issues can help reduce airborne fungi and bacteria in hospital.

scholarly journals Protective Effects Of Tecomella Undulata Stem Bark Extract On Isoniazid Induced Hepatotoxicity: Based On Liver Enzymes And Histopathology In Rat Model

2019 ◽  
Vol 10 (1) ◽  
pp. 49-52
Author(s):  
Zubaida Umar Zehri ◽  
Shabih Zehra ◽  
Abdul Lateef Mahesar ◽  
M. Anwar ◽  
Syed Ijaz Hussain Zaidi ◽  
...  
Keyword(s):  
Liver Enzymes ◽  
Stem Bark ◽  
Bark Extract ◽  
Significant Difference ◽  
Function Test ◽  
Group A ◽  
Stem Bark Extract ◽  
The Mean ◽  
Group B ◽  
Group D

Objective: To evaluate the hepatoprotective effects of Tecomellaundulata stem bark extract on isoniazid induced hepatic damage based on liver enzymes and Liver function test in rat models. Study design and Setting: An experimental study conducted at Department of Pharmacology at Al-Tibri Medical College and Hospital, Isra University Karachi Campus and Dow University of Health Sciences, Karachi. Methodology: Total twenty-four rats were studied. The albino rats that were male, healthy, and weighing 200-250grams were included in this study. Rats were divided into four groups, each group having six rats and treated once daily orally for 30 days. Group A was control group and treated with normal animal diet and water; Group B was Isoniazid treated group and induced by oral administration of Isoniazid (INH) 50mg/kg. Group C was treated with Isoniazid 50mg/kg and Tecomellaundulata bark extract with low dose of 200mg/kg . Group D was treated with Isoniazid 50mg/kg and Tecomellaundulata bark extract with high dose of 400mg/kg . All the animals were weighed before commencement of the study. Liver enzymes were noted after the end of experiment. P value of <0.05 was taken as significant. Results: While comparing the mean values of AST,ALT, ALP and GGT in all four groups group; the statistical significant difference (p<0.001) was found. The mean levels in of total Bilirubin in group A was 0.69 ±0.01, group B 1.04 ±0.04, in group C was 1.15 ±0.39, and in group D was 1.04 ±0.44 with the significant difference (p=0.004). Conclusion: Tecomellaundulata has a protective effect on isoniazid induced toxicity on liver as evidenced by liver function test on rat models.

scholarly journals Sampling site for SARS-CoV-2 RT-PCR—An intrapatient four-site comparison from Tampere, Finland

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260184
Author(s):  
Dominik Kerimov ◽  
Pekka Tamminen ◽  
Hanna Viskari ◽  
Lauri Lehtimäki ◽  
Janne Aittoniemi
Keyword(s):  
Informed Consent ◽  
Study Design ◽  
Nasal Swab ◽  
Sampling Site ◽  
Threshold Values ◽  
Rt Pcr ◽  
Cycle Threshold ◽  
Significant Difference ◽  
Nasal Swabs ◽  
Written Informed Consent

Background SARS-CoV-2 diagnosis relies on the performance of nasopharyngeal swabs. Alternative sample sites have been assessed but the heterogeneity of the studies have made comparing different sites difficult. Objectives Our aim was to compare the performance of four different sampling sites for SARS-CoV-2 samples with nasopharynx being the benchmark. Study design COVID-19 positive patients were recruited prospectively, and samples were collected and analysed for SARS-CoV-2 with RT-PCR from all four anatomical sites in 43 patients, who provided written informed consent. Results All anterior nasal and saliva samples were positive, while two oropharyngeal samples were negative. There was no significant difference in the cycle threshold values of nasopharyngeal and anterior nasal samples while saliva and oropharynx had higher cycle threshold values. Conclusions Anterior nasal swab performs as good as nasopharynx swab with saliva also finding all the positives but with higher cycle threshold values. Thus, we can conclude that anterior nasal swabs can be used for SARS-CoV-2 detection instead of nasopharyngeal swabs if the situation would require so.

Correlation of Thorax Expansion with Heart Rate and Blood Pressure in School-Aged Children

2016 ◽  
Vol 5 (01) ◽  
pp. 22-28
Author(s):  
Pipit Wandini ◽  
Ellyana Sungkar ◽  
M. Rizki Akbar
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Junior High School ◽  
Cross Sectional ◽  
School Aged Children ◽  
Significant Difference ◽  
Questionnaire Form ◽  
The Mean ◽  
Method Factors ◽  
Written Informed Consent

Background: Thorax expansion used to measure respiratory function. Data of thorax expansion for healthychildren is still limited. Thorax expansion is caused by breathing. This influences cardiovascular functionbecause anatomically the heart is located within the thorax cavity. The aim of this study is to determine themeasurement of thorax expansion using the measurement tape method. Factors influencing thorax expansionare sex and age; and correlates with heart rate and blood pressure in school age children.Methods: Ninety-six children were included in this study both male and female and were aged 6 to 15years. They were in Elementary School and Junior High School in Jatinangor. The study were conductedfrom September-November 2013 by adopting a random selection cross sectional method. The examinationsperformed after written informed consent and questionnaire form from their parents.Results: The results showed that upper thorax has lower mean expansion than middle and lower thoraxexpansion respectively (2.96±0.64cm; 3.82±1.04cm; 5.01±1.15cm). There was significant difference betweengroups of age (p<0.05). This study also found that there was a correlation between the upper and middle thoraxexpansion with the heart rate (r=0.35; p=0.001, and r=0.32; p=0.002).Conclusions: The mean of thorax expansion at upper, middle and lower respectively (2.96±0.64cm;3.82±1.04cm; 5.01±1.15cm) are influenced by age and has correlation with heart rate.Keywords: blood pressure, heart rate, school-aged children, thorax expansion.

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