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PubMed2006

The effect of tiotropium on exacerbations and airflow in patients with COPD.

This randomised, double-blind, parallel-group, 1-yr study compared the effect of tiotropium 18 microg once daily (n=500) and placebo (n=510) on exacerbations, associated health resource use (HRU) and airflow limitation in chronic obstructive pulmonary disease (COPD) patients. The mean+/-sd number of exacerbations during the past year was 2.14+/-1.40, the mean weekly morning peak expiratory flow (PEF) was 259.6+/-96.1 L.min-1 and the mean forced expiratory volume in one second (FEV1) was 1.37+/-0.45 L. Tiotropium significantly delayed the time to first exacerbation by approximately 100 days, reduced the proportion of patients experiencing more than one exacerbation by 17%, and decreased the number of exacerbations by 35% and exacerbation days by 37% versus placebo. Tiotropium also decreased HRU versus placebo, as indicated by the significant reductions in the use of concomitant respiratory medications, antibiotics and oral steroids, and the number of unscheduled physician contacts. Mean weekly morning PEF improved significantly with tiotropium versus placebo from week 1 until the end of the study. At the end of the study, tiotropium significantly improved trough (pre-dose) FEV1, forced vital capacity, slow vital capacity and inspiratory capacity versus placebo. In conclusion, tiotropium reduced exacerbations and associated health resource use, and improved airflow over 1 yr in chronic obstructive pulmonary disease patients.

Aged↗
PubMedDate not supplied

The effects of daily pulmonary rehabilitation program at home on childhood asthma.

OBJECTIVE: the aim of this study is to investigate the efficacy of pulmonary rehabilitation program in children with asthma. PATIENTS AND METHOD: twenty eight children with mild persistent or moderate asthma were included into a double blind, randomised study. Sixteen children (9 girls, 7 boys) with the mean age of 10.8 +/- 2.3 were assigned to receive pulmonary rehabilitation program with their parents for 30 days (group I). Control group included 12 children (6 girls, 6 boys ) with the mean age of 10.2 +/- 2.4 (group II). Symptom and medication scores quality of life index and pulmonary function tests were evaluated in rehabilitation and control group in the beginning of the study and after the one month period. RESULTS: the groups did not differ on all parameters before the study (p > 0. 05). Statistically significant decrease were found in symptom and medication scores in rehabilitation group (p < 0.05) and quality of life index was increased significantly in the same group (p < 0.05). Pulmonary function measures also significantly improved including vital capacity, forced vital capacity, FEV1, PEF and FEF25-75 in the rehabilitation group (p < 0.05). The best improvement were seen in FEF25-75 (10.09% increase) and PEF (7.81% increase) values. In control group no statistically significant differences were found in all parameters. CONCLUSION: in this study it was shown that daily pulmonary rehabilitation at home could improve quality of life and pulmonary functions. So pulmonary rehabilitation should be placed as a component of management in childhood asthma.

Anti-Asthmatic Agents↗
PubMed1992

[The effect of epidural analgesia on respiratory muscles].

The effect of epidural analgesia on respiratory functions and muscular power was studied in patients. The subjects had no abnormality of cardiopulmonary system, and were classified into two groups; the adult group whose ages were 21 to 59, and the aged group, 60 to 72. Either 1% or 2% mepivacaine for epidural anesthesia was used to obtain the analgesic level up to Th4 and Th7 in adult group, and Th4 in aged group. The analgesic level was assessed by the pin-prick method. Vital capacity, forced vital capacity, forced expiratory volume 1 second, peak expiratory flow rate, maximal mid-expiratory flow rato, maximal inspiratory pressure and maximal expiratory pressure decreased significantly after epidural anesthesia in all patients whose analgesic levels were up to Th4. In all patients, the change of maximal expiratory pressure was larger than that of maximal inspiratory pressure after epidural analgesia. The patients whose analgesic levels were up to Th7 by 1% mepivacaine in adult group, showed a significant increase of maximal inspiratory pressure. It is concluded that epidural anesthesia diminishes respiratory functions and respiratory muscular power associated with a higher level of analgesia.

Adult↗
PubMed2005

Body structure and respiratory efficiency among high altitude Himalayan populations.

To understand the morphological and physiological variations among the temporary and permanent residents of high altitude, this study was undertaken at Leh, Ladakh. It is situated at 3500 m (11500 feet) above sea level, the mean barometric pressure was 500 tors and air temperature varied from 2 degrees C to 20 degrees C. The highland Tibetans showed broadest chest and most developed musculature closely followed by Ladakhi Bods. These high altude natives also displayed significantly higher value of vital capacity, forced vital capacity, and inspiratory capacity. The better respiratory efficiency observed among high altitude residents indicates higher degree of adaptation to high altitude hypoxia. Temporary residents were observed to be tallest and fattest with lower trunk fat predominance of all the four groups and showed narrowest chest and lower respiratory efficiency as compared to high altitude natives. The duration of stay at high altitude has clearly brought about a perceptible difference in body dimensions and respiratory functions of various groups of adult males studied at same altitude.

Adaptation, Physiological↗
PubMed2006

Effects of a multimodal exercise program for people with ankylosing spondylitis.

BACKGROUND AND PURPOSE: Few randomized controlled studies have examined the effects of exercise in patients with ankylosing spondylitis (AS). This study investigated the effects of a 12-week, multimodal exercise program in patients with AS. SUBJECTS: A convenience sample of 30 patients with AS (18 male, 12 female), with a mean age of 34.9 years (SD=6.28), participated in the study. Twenty-six subjects were classified as having stage I AS and 4 subjects were classified as having stage II AS according to the modified New York Criteria. METHODS: This study was a randomized controlled trial. Subjects were assigned to either a group that received an exercise program or to a control group. The exercise program consisted of 50 minutes of multimodal exercise, including aerobic, stretching, and pulmonary exercises, 3 times a week for 3 months. Subjects in both groups received medical treatment for AS, but the exercise group received the exercise program in addition to the medical treatment. All subjects received a physical examination at baseline and at 12 weeks. The examinations were conducted under the supervision of a physician who specialized in physical medicine and rehabilitation and included the assessment of spinal mobility using 2 methods: clinical measurements (chin-to-chest distance, Modified Schober Flexion Test, occiput-to-wall distance, finger-to-floor distance, and chest expansion) and inclinometer measurements (gross hip flexion, gross lumbar flexion, and gross thoracic flexion). In addition, vital capacity was measured by a physiologist, and physical work capacity was evaluated by a doctorally prepared exercise instructor. RESULTS: The measurements of the exercise group for chest expansion, chin-to-chest distance, Modified Schober Flexion Test, and occiput-to-wall distance were significantly better than those of the control group after the 3-month exercise period. The spinal movements of the exercise group improved significantly at the end of exercise program, but those of the control group showed no significant change. In addition, the results showed that the posttraining value of gross thoracic flexion of the exercise group was significantly higher than that of the control group. Physical work capacity and vital capacity values improved in the exercise group but decreased in the control group. DISCUSSION AND CONCLUSION: In this study, a multimodal exercise program including aerobic, stretching, and pulmonary exercises provided in conjunction with routine medical management yielded greater improvements in spinal mobility, work capacity, and chest expansion.

Adult↗
PubMed1980

[Assessment of lung function in asthmatic children during a stay on the North Sea coast (author's transl)].

In a group of 40 asthmatic children, the following lung function parameters were measured during symptom free period: functional residual capacity (FRC); vital capacity (VC); total lung capacity (TLC); total pulmonary flow resistance (R1) and dynamic lung compliance (C1dyn). All the children were examined during their stay on Norderney (an island in the North Sea). The mean values of all measured lung volumes were significantly larger than the predicted values (p < 0.001), the mean value of R1 corresponded to the predicted one whereas the mean value of C1dyn was significantly smaller (p < 0.001), most of the individual values being within the normal range. After inhalation of Orciprenaline the mean value of R1 was significantly smaller than the initial value (about 15%; p < 0.001), whereas the lung volumes as well as C1 dyn were still unchanged. The influence of Orciprenaline on R1 and was only temporary and was reproducible 24 h later. Ther low mean value of C1 cyn was independent of the length of stay on Norderney. The reasons for this phenomena are discussed: obstructions and/or occlusions in the smallest airways seem to be the most important factor, uninfluenced by beta-2-mimetic drugs.

Adolescent↗
PubMedDate not supplied

Prediction of some ventilatory 'norms' in healthy Indian males 21-69 years age.

This paper presents regression equations for predicting some ventilatory 'norms' (viz. vital capacity, forced vital capacity, forced expiratory volume for one second, expiratory reserve volume, inspiratory capacity and maximum voluntary ventilation) from physical characteristics of healthy Indian males. These equations have been constructed on the basis of multivariate regression analysis of the data of ventilatory 'norms' and physical characteristics collected on 171 healthy Indian males of age ranging from 21-69 years. Applications of these regression equations will be of practiced importance to biomedical scientists interested in the indirect assessment of ventilatory 'norms for a wider age range (21-69 years) which has not been covered by earlier studies carried out in this direction.

Adult↗
PubMed1993

[Effect of aminophylline on respiratory function in patients with chronic renal failure treated by peritoneal dialysis].

In 8 patients with chronic renal failure aminophylline influence was studied on respiratory function. No changes were seen in lung volumes after 30 minutes of intravenous aminophylline infusion. After 2 weeks of intraperitoneal infusion of aminophylline, maximal ventilation, vital capacity, forced vital capacity and inspiratory residual volume rose significantly. Residual volume and the ratio residual volume/total lung capacity, decreased. This changes may indicate an improved contractility of the respiratory muscles. A rise in the concentration of oxypurines after peritoneal dialysis and a significant improvement in the arterial oxygen tension indicate that aminophylline influences the respiratory function by bronchodilatation and by contractility improvement of the respiratory muscles.

Aminophylline↗
PubMed1997

Lung function parameters of Bangladeshi male subjects in different living conditions.

The "standard" values of pulmonary function tests obtained from Western populations do not agree with that of people of Bangladesh. The present survey was conducted with a view to determining the values of three lung functions parameters, viz., vital capacity, forced vital capacity, and forced expiratory volume in healthy Bangladeshi male population. 250 non-smoker male subjects of age 20-40 years were selected for the study. Of these 150 were university students and employees and 100 were low income group slum dwellers. All three values correlated positively with height and weight and negatively with age. There was a definite effect of aging on the lung function showing a declining trend from age 35 years onwards. The slum dwellers showed lower values (-12.5% in young adults) of lung functions than the university students and employees. The difference decreased with age. Prediction equations were set up using height, weight, and age as parameters. In general the lung function values were found to be 80% of the European Standards.

Adult↗
PubMed2006

Does reduction mammaplasty improve lung function test in women with macromastia? Results of a randomized controlled trial.

BACKGROUND: To determine the effects of reduction mammaplasty on lung function in women with mammary hypertrophy (macromastia), a prospective, randomized, controlled trial was conducted at the Academic Surgery and Plastic Surgery Units, Castle Hill Hospital, Cottingham, United Kingdom. METHODS: Seventy-three women who were referred for consideration of bilateral breast reduction surgery were randomized into either an early intervention group (surgery within 6 weeks) or a control group (surgery 6 months after recruitment). Each group had two sets of lung function tests: the intervention group had one before and one 3 months after surgery and the control arm had one test initially and a second test 4 months after randomization and before surgery. The main outcome measure was the lung function test. RESULTS: Sixty-five patients completed the study. The mean age was 39 years (SD, 12 years); both groups were equally matched for age, smoking status, social class, and educational status. By independent t test, there was no significant difference in lung function in the two groups. Subgroup analysis of the intervention group demonstrated a positive correlation between specimen weight and forced expiratory volume/vital capacity, forced expiratory volume/forced vital capacity, peak expiratory flow rate, and forced vital capacity. A paired sample t test revealed a significant improvement in the percentage of forced vital capacity performed/forced vital capacity predicted. CONCLUSION: The improvement in pulmonary function following reduction mammaplasty correlates with specimen weight resected.

Adolescent↗
PubMed1992

Theophylline and salbutamol improve pulmonary function in patients with irreversible chronic obstructive pulmonary disease.

To investigate the efficacy of bronchodilators in patients with irreversible chronic obstructive pulmonary disease (COPD), we conducted a double-blind, randomized, four-phase, crossover comparison between placebo, oral theophylline, inhaled salbutamol, and a combination of both drugs in 12 patients with stable COPD (mean age, 63 years) whose increase in forced expiratory volume in 1 s (FEV1) was less than or equal to 15 percent following 200 micrograms of inhaled salbutamol. Patients received two weeks of therapy with each of the test regimens. Both theophylline and salbutamol resulted in statistically significant improvement in FEV1, forced vital capacity (FVC), slow vital capacity (SVC), residual volume (RV), airway resistance (Raw), and maximum expiratory flow rate at 50 percent of vital capacity (V50). In most instances, there were no significant differences between theophylline and salbutamol. Combination therapy produced significantly greater improvement in FEV1, FVC, V50, Raw, and RV than either agent alone. The two drugs interacted in an additive fashion. Neither of the drugs, used singly, significantly reduced the severity or incidence of symptoms. The reduction in dyspnea and wheeze during combination therapy approached statistical significance (p = 0.06) and patient preference was significantly in favor of the combination regimen. None of the active treatments produced significantly more side effects than placebo. We conclude that theophylline and inhaled salbutamol produce significant, and approximately equal, improvement in pulmonary function in patients traditionally classified as suffering from "irreversible" COPD. The combination of theophylline and inhaled salbutamol generally results in additional improvement over that obtained with either drug used alone and this improvement is reflected by reduced symptomatology and treatment preference.

Administration, Inhalation↗
PubMedDate not supplied

Pulmonary function studies in healthy non-smoking women of Calcutta.

Pulmonary function measurements were made in 230 healthy non-smoking women from Calcutta with an age range of 20-59 years. The tests consisted of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory volume in one second as a percentage of forced vital capacity (FEV1%), forced expiratory time (FET), maximum voluntary ventilation, uncontrolled frequency (MVVF), forced expiratory flow (FEF200-1200ml), forced mid-expiratory flow (FEF25-75%), forced end-expiratory flow (FEF75-80%) and peak expiratory flow rate (PEFR). Except for PEFR, all the measurements were made with the help of two 9-litre closed-circuit-type expirographs using standard spirometric techniques. PEFR was recorded with the help of two Wright peak flow meters. Prediction formulae were derived on the basis of physical characteristics. Age and height were found to be the significant predictor variables for VC, FVC and FEV1, while only age was significant for FEV1%. The FVC and FEV1 values of the subjects, standardized for age and height, are much lower than those of Americans, Europeans and Jordanians. On comparison with data reported from other parts of India, it was revealed that the VC and FEV1 values of the current study, after adjustment for age and height, were much higher than those of Southern Indians but comparable with those of North-Western Indians.

Adult↗
PubMed2005

Idiopathic pulmonary fibrosis in patients younger than 50 years.

OBJECTIVE: To assess clinical, radiological, histopathologic, and prognostic differences in younger patients with idiopathic pulmonary fibrosis (IPF). PATIENTS AND METHODS: This study consisted of patients younger than 50 years with IPF who were seen at the Mayo Clinic in Rochester, Minn, from January 1, 1994, to December 31, 2000. Clinical, radiological, and histopathologic data were abstracted from clinical records. Total lung capacity using plethysmography, vital capacity, diffusing capacity for carbon monoxide using the single-breath method, and alveolar volume using single-breath neon wash-in were measured. RESULTS: Our study population was composed of 16 men and 6 women with a median age of 45 years (range, 28-49 years). Median survival was 2.1 years, with 1- and 2-year survival rates of 68% and 53%, respectively. Of the 22 patients, 2 were current smokers, 14 were former smokers, and 6 had never smoked. Three patients had familial pulmonary fibrosis, 21 had bibasilar inspiratory crackles, and 10 had digital clubbing. Median total lung capacity was 56.2%, vital capacity was 51.0%, diffusing capacity was 45.5%, and alveolar volume was 65.0%. CONCLUSION: Although previous studies have suggested that younger age is a favorable prognostic factor in patients with IPF, we found that younger patients have the same poor prognosis as do older patients with this disorder. We observed no distinguishing differences in the clinical, radiological, and histopathologic features compared with those in older patients in whom the disorder is more common. Lung transplantation should be considered early in the treatment of younger patients with IPF.

Adult↗
PubMed1993

Lung size matching for double lung transplantation based on the submammary thoracic perimeter. Accuracy and functional results. The Joint Marseille-Montreal Lung Transplant Program.

The present study evaluates the accuracy of submammary thoracic perimeter for lung size matching between donor and recipient and analyzes the influence of donor lung size discrepancies on functional outcome after double lung transplantation. The population is composed of 18 double lung graft recipients, 16 of whom had cystic fibrosis. The lung size match was assessed by comparison of predicted total lung capacity of donor and recipient: five patients were matched in a 10% confidence interval; four received smaller lungs, and nine received larger ones. The functional outcome was assessed with the spirometric values measured at 3 and 6 months after transplantation. The final functional result was not influenced by the lung size (r = 0.142 for total lung capacity; r = 0.372 for vital capacity; r = 0.378 for forced expiratory volume in 1 second). For larger lungs the final result tended to the recipient's predicted, whereas for smaller lungs, spirometry tended to the donor's predicted (r = 0.906 for total lung capacity; r = 0.875 for vital capacity; r = 0.874 for forced expiratory volume in 1 second). The thoracotomy effect, that is, restrictive syndrome at 3 months that resolves at 6 months, was not correlated with the lung size (r = 0.07 for total lung capacity; r = 0.436 for vital capacity). It is concluded that respiratory functional result is not affected by larger lungs; despite the wide range of error, the submammary thoracic perimeter appeared to be a satisfactory selection parameter in this group of patients.

Adolescent↗
PubMed2002

Lung function under high thoracic segmental epidural anesthesia with ropivacaine or bupivacaine in patients with severe obstructive pulmonary disease undergoing breast surgery.

BACKGROUND: Because general anesthesia with tracheal intubation can elicit life-threatening bronchospasm in patients with bronchial hyperreactivity, epidural anesthesia is often preferred. However, segmental high thoracic epidural anesthesia (sTEA) causes pulmonary sympathetic and respiratory motor blockade. Whether it can be safely used for chest wall surgery as a primary anesthetic technique in patients with chronic obstructive pulmonary disease or asthma is unclear. Furthermore, ropivacaine supposedly evokes less motor blockade than bupivacaine and might minimize side effects. To test the feasibility of the technique and the hypotheses that (1) sTEA with ropivacaine or bupivacaine does not change lung function and (2) there is no difference between sTEA with ropivacaine or bupivacaine, the authors studied 20 patients with severe chronic obstructive pulmonary disease (forced expiratory volume in 1 s [FEV1] = 52.1 +/- 17.3% of predicted [mean +/- SD]) or asthma who were undergoing breast surgery. METHODS: In a double-blind, randomized fashion, sTEA was performed with 6.6 +/- 0.5 ml of either ropivacaine, 0.75% (n = 10), or bupivacaine, 0.75% (n = 10). FEV1, vital capacity, FEV1 over vital capacity, spread of analgesia (pin prick), hand and foot skin temperatures, mean arterial pressure, heart rate, and local anesthetic plasma concentrations were measured with patients in the sitting and supine positions before and during sTEA. RESULTS: Segmental high thoracic epidural anesthesia (segmental spread C4-T8 [bupivacaine] and C5-T9 [ropivacaine]) significantly decreased FEV1 from 1.22 +/- 0.54 l (supine) to 1.09 +/- 0.56 l (ropivacaine) and from 1.23 +/- 0.49 l to 1.12 +/- 0.46 l (bupivacaine). In contrast, FEV1 over vital capacity increased from 64.6 +/- 13.5 to 68.2 +/- 14.5% (ropivacaine) and from 62.8 +/- 12.4 to 66.5 +/- 13.6% (bupivacaine). There was no difference between ropivacaine and bupivacaine. Skin temperatures increased significantly, whereas arterial pressure and heart rate significantly decreased indicating widespread sympathetic blockade. All 20 patients tolerated surgery well. CONCLUSIONS: Despite sympathetic blockade, sTEA does not increase airway obstruction and evokes only a small decrease in FEV1 as a sign of mild respiratory motor blockade with no difference between ropivacaine and bupivacaine. Therefore, sTEA can be used in patients with severe chronic obstructive pulmonary disease and asthma undergoing chest wall surgery as an alternative technique to general anesthesia.

Adult↗
PubMed1986

Assessment of ventilatory performance of athletes using the maximal expiratory flow-volume curve.

We carried out a maximum expiratory flow-volume curve (MEFV) and a spirometric recording with 67 athletes of different ages (15-27 years) and disciplines (rowers, kayakists, cyclists, swimmers) and with 20 adult and 13 adolescent nonathletic controls of matching ages. These recordings were repeated, with athletes only, after 6-10 months of training. Significant differences between the groups of adult athletes and the controls were observed for some parameters, the most discriminating of which were, in order, the peak expiratory flow (PEF), the forced expiratory volume in the first second (FEV1), and the flow at 75% of the vital capacity (V75). The vital capacity (VC) itself was only higher in the rowers group. The adult athletes, when grouped together (n = 47), produced a higher flow at 50% of their VC (V50) than the control group (+15%, P less than 0.05) with no difference in the flow at 25% of VC (V25) nor in the VC. A study of the effects of training showed no evolution among high level athletes while increases of 14% of the PEF, 5% of the V75, and 7% of the FEV1 were found after 7-10 months of training in adolescents; the VC increased during that time by only 2.7%. The reproducibility of these ventilatory parameters after 6-8 months was studied with adult athletes. The upper limit of the variation (95% CLl) was 12% for the FEV1 and forced vital capacity (FVC), 18% for PEF, 21% for V75 and V50, and 40% for V25.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

[Analysis of breathing function in Parkinson's disease].

We studied 40 parkinsonian patients (P), mean age 50-80 years, with Hoehn and Yahr stages I-III and 40 no parkinsonian patients (NP), with similar characteristics. The results of the thoracic amplitude was 1,8+/-0,8cm of P that showed a reduction to 4,3+/-1,0 cm of NP (p=0,00001), the vital capacity and forced vital capacity, 66,8+/-20,3% and 69,6+/-22,2% of P was decreased that 82,3+/-15,7% and 82,7+/-16,6% of NP (p=0,00001 and p=0,0023). There was not difference among the maximal inspiratory and expiratory mouth pressures, 33,5+/-12,7 cmH2O and 36,3+/-17,8 cmH2O of P and 37,0+/-12,2 cmH2O and 43,1+/-16,6 cmH2O of NP (p=0,1753 and p=0,0398), the forced expiratory volume in 1 second, 71,3+/-25,6% of P and 80,6+/-23,6% of NP (p=0,0899), and the forced expiratory volume in 1 second/ forced vital capacity, 104,5+/-19,9% of P and 97,4+/-22,8% of NP (p=0,1234). The parkinsonian patients present restrictive pulmonary dysfunction, low chest wall compliance and the respiratory muscle strength do not decreased.

Aged↗
PubMed2003

Peak expiratory flow in children and adolescents with idiopathic scoliosis.

Spirometric and plethysmographic examinations were performed in two groups of children with idiopathic scoliosis and healthy children. Group I, 23--children with scoliosis 1 degree by Cobb, spinal curvature 17.2 degree, 12 girls and 11 boys at the age 8-15 years (the mean age was 11.4 +/- 2.4 yr). In Group II were 35 children, 28 girls and 7 boys at the age 12-19 years (the mean age was 14.67 +/- 1.47 yr) with mean angle of curvature 63.35 degree, which is grade II and III scoliosis according to Cobb. The Control Group were 20 children, 13 girls and 7 boys at the age of 8-16 years (the mean age was 13.77 +/- 1.72 yr). The measurements were done using Body--plethysmography with pneumotachograph Jaeger. All subjects had respiratory function examination performed, which included: total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in 1 sec. (FEV1), residual volume (RV) and intrathoracic gas volume (ITGV). At the same time peak expiratory flow--PEF were determined. In children with scoliosis at initial stage, Group I, were found slightly decreased total lung capacity--TLC and statistically significantly decreased intrathoracic gas volume--ITGV as well as residual volume--RV in comparison to the control group. Forced vital capacity--FVC and forced expiratory volume in 1 sec.--FEV1 were normal. But statistically significantly decreased PEF values were found in comparison to the control group (p < 0.05). It means that restrictive and obstructive disturbances of lungs progressing in grade II and III scoliosis were shown manifested by reduced values of TLC, FVC, ITGV and RV. A statistically significant decrease of peak expiratory flow together with the growth of spinal curvature angle was shown in grade II and III scoliosis in comparison with both the control group and the studied Group I (p < 0.001, p < 0.05).

Adolescent↗