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Pulmonary function tests in obese people candidate to bariatric surgery
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Guimarães, M.V. Martins, J. Moutinho dos Santos" "autores" => array:3 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Guimarães" "email" => array:1 [ 0 => "catarina.guimaraes@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.V." "apellidos" => "Martins" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Moutinho dos Santos" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Serviço de Pneumologia, Centro Hospitalar de Coimbra-EPE, Coimbra, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Medicina do Sono, Centro Hospitalar de Coimbra-EPE, Coimbra, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1208 "Ancho" => 1632 "Tamanyo" => 67587 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation between BMI and FRC.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. Obesity has reached epidemic proportions globally; once associated with high-income countries, obesity is now also prevalent in low- and middle-income countries.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A person with a BMI of 30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> or more is generally considered obese.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Excessive body weight may cause impaired pulmonary function and can lead to a restrictive or occasionally an obstructive pulmonary disorder. The obese subject presents damage to the respiratory mechanics causing adverse effects on the pulmonary function such as increase of the respiratory work and reduction of pulmonary volumes.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Several mechanisms have been suggested as possible effects of obesity on lung function. It is known that morbid obesity can lead to a restrictive syndrome by abdominal and thoracic adipose tissue decreasing lung volume, the expiratory reserve volume (ERV) and FRC, due to reduced chest wall and lung volumes and increased respiratory resistance. It also promotes abnormalities in ventilation/perfusion balance causing hypoxemia at rest and supine position probably due to the closure of small airways. Obesity involves increased resistance to the passage of air in and out of the lungs due to narrowing of the airways.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–10</span></a> It is believed that the volume of blood in the lung leads to congestion, resulting in thickening of the airway wall, thereby decreasing the size of the airways.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand, it is expected that after surgery and weight loss, an improvement or even a resolution in pulmonary function may be seen.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Due to the need for more effective intervention in the clinical management of morbidly obese, indications for bariatric surgery have increased.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Objective</span><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study was to test if morbid obesity causes pulmonary function changes and if post-bariatric surgery weight loss had an effect on pulmonary function.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a comparative and retrospective study including a cohort of patients undergoing bariatric surgery, from 1998 to 2008, who were sent for preoperative lung function assessment. In addition to a clinical evaluation and chest X-ray examination they did the following: spirometry, using a SensorMedics<span class="elsevierStyleSup">®</span> spirometer; lung volumes measured by body plethysmography, a Jaeger<span class="elsevierStyleSup">®</span> plethysmograph; diffusing capacity of the lung for carbon monoxide (DLCO) assessed by the single breath technique; maximal respiratory pressures, using a Sibelmed<span class="elsevierStyleSup">®</span> manometer; and arterial blood gases. The tests were performed according to the <span class="elsevierStyleItalic">American Thoracic Society</span> and <span class="elsevierStyleItalic">European Respiratory Society</span> standardization of lung function testing. After surgery and following 3 months with no weight changes, patients were re-evaluated and again submitted to respiratory function tests. We included patients with morbid obesity (BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>) that had failed to lose weight with standard clinical treatment, as diet and exercise, and excluded patients with respiratory complications after surgery and those with previous pulmonary disease.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Results are expressed as percentages of predicted values.</p><p id="par0040" class="elsevierStylePara elsevierViewall">SPSS 17.0 was used for the statistic analysis.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">We studied 36 patients undergoing bariatric surgery, their mean age was 40.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.2; 24–60 (<span class="elsevierStyleItalic">x</span><span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD; min–max) years of which 23 (64%) were female. Their mean BMI before surgery was 49.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.2; 40–69<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, 21 had a BMI from 40.0 to 49.9, 8 from 50.0 to 59.9 and 7 a BMI of 60 or more. Before weight loss only 2 patients had normal pulmonary function and 6 had a restrictive pattern with a total lung capacity (TLC) average of 71.3% of the predicted. The decrease in FRC, in 34 patients, was the most frequent change in lung function with an average of 56.5% of the predicted value. Arterial blood gas analysis showed simultaneously a low oxygen arterial tension (PaO<span class="elsevierStyleInf">2</span>) and a high arterial carbon dioxide tension (PaCO<span class="elsevierStyleInf">2</span>) in 5 patients, with a mean PaO<span class="elsevierStyleInf">2</span> of 67.3 and PaCO<span class="elsevierStyleInf">2</span> of 47.7<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg in these obese people. Before surgery we found a statistically significant correlation between BMI and FRC (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.525, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001), FRC and PaCO<span class="elsevierStyleInf">2</span> (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.346, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.039), and TLC with PaO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span> (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.386, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.020 and <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.524, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001, respectively). No additional correlation among respiratory function parameters, arterial blood gases analyses and BMI was found. In obese patients who had restrictive pattern there were no differences regarding age or BMI with those without the restrictive pattern.</p><p id="par0050" class="elsevierStylePara elsevierViewall">All patients lost weight, with a post-surgery BMI of 34<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.4; 23–51<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>; corresponding to a mean difference of 15.7<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), equivalent to a weight loss of 31.6%. The duodenal switch procedure was performed in 15 obese patients, gastric bypass in 10, gastric sleeve in 8 and adjustable gastric band in 3. After surgery and stabilization of weight loss there was a significant difference in the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), TLC, FRC, PaO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span>, and no significant difference in residual volume (RV), DLCO, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). There was an average improvement of 13.4% in FVC, 14.8% in FEV1, 11.1% in TLC and 35.5% in FRC. Regarding FRC we demonstrated that its decrease and subsequent increase from 56.5% to 87.3% were mainly due to ERV as the RV did not change before and after surgery. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> represents the capacity and lung volumes differences before and after surgery compared with predicted values. After surgery and weight loss lung function did not become normal in all patients. Despite the resolution of the restrictive pattern the decrease in FRC has remained in 13 patients which corresponds to patients that had a higher initial BMI and a smaller difference in weight loss (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). There was also a significant improvement in arterial blood gases analyses with a resolution of hypoxemia and hypercapnia in 4 patients. The main changes in dynamic and static lung volumes and arterial gases are described in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Statistical analysis found a negative correlation between reduction of BMI and increase in FRC (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.371, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.028; <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), the lower the weight loss the smaller the change in FRC. There was no correlation between loss of weight excess and the remaining PFT variables such as FEV1, FVC, TLC or arterial blood gases analyses.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">In our study there was a marked predominance of female gender, an almost universal finding regarding the prevalence of morbid obesity.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Mean BMI was significantly reduced from 49.7 to 34<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>. This reduction after surgery (32% on average) was slightly higher than reported in the literature (25.89%).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Several studies have shown an association between obesity and impaired lung function.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–10</span></a> There are no published studies about lung function tests and arterial blood gases analyses before and after surgery in Portuguese population. Rubinstein et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> supported this statement in a study on 293 patients divided into two groups (103 obese and 190 non-obese subjects) which revealed a significant reduction of FRC, TLC and ERV in the obese group and normal values in most of the non-obese subjects.</p><p id="par0075" class="elsevierStylePara elsevierViewall">This study assessed a population of morbidly obese patients and it became clear that this degree of obesity influenced lung volumes and capacities in particular with the decrease of FEV1, FVC, TLC and FRC mainly due to ERV. In almost all of them there was a decrease in FRC, however a restrictive pattern (TLC<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>80%) was only found in 6 patients. As these patients did not have a higher BMI than patients without restrictive pattern, and there was no other respiratory disease, these results are probably due to a different fat distribution and the consequent difference in respiratory muscle function.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The reduction of ERV and FRC in morbidly obese patients is a result of the mechanical changes caused by the increased abdominal adiposity and by the weight on the chest wall, a fact that contributes to reduced pulmonary compliance, increased work of breathing and resistance resulting in weakening of the respiratory muscles. Gas exchange deficits are also evident in our study with the decrease of PaO<span class="elsevierStyleInf">2</span> and the increase of PaCO<span class="elsevierStyleInf">2</span>. This may be due to a combination of ventilation-perfusion mismatch and hypoventilation. Causes of ventilation-perfusion mismatch include hypoventilation of well perfused lower lung regions, due to atelectasis, which occurs in obesity.</p><p id="par0085" class="elsevierStylePara elsevierViewall">There was an improvement in PFT parameters after surgery as well as gas exchange with a significant increase in FRC, TLC, FEV1, FVC and PaO<span class="elsevierStyleInf">2</span> and a significant decrease in PaCO<span class="elsevierStyleInf">2</span>. Mean FRC was 56.5% during the preoperative period and 87.3% during the postoperative period, confirming a significant improvement of this variable after weight loss.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The improvement in FRC observed here was correlated with the decrease of BMI, further supporting the fact that obese patients, and morbidly obese ones in particular, have important changes in the respiratory volumes and that the loss of weight excess results in a clear improvement of pulmonary function.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Our results are similar to other studies, such as Thomas et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and Xavier et al.,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> although the sample size was smaller, 29 and 20 patients, respectively, who also found a significant improvement in PFR and arterial blood gases before and after bariatric surgery</p><p id="par0100" class="elsevierStylePara elsevierViewall">Since none of the 36 patients studied here had previous pulmonary disease, the pulmonary volumes and arterial gas parameters changes are due exclusively to obesity.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The limitations of this study are those inherent to retrospective studies; if the type of obesity that leads to a different fat distribution had been included it would have been an important factor in characterizing the PFT in these obese patients.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">These results point to the fact that morbid obesity may lead to pulmonary function impairment and particularly the decrease in FRC, which may be associated or not to a restrictive pattern.</p><p id="par0115" class="elsevierStylePara elsevierViewall">There was a significant weight loss which led to a significant improvement in lung function and gas exchange. We found a negative correlation between FRC and BMI, but there was no correlation between other pulmonary function variables and BMI. These results confirm the impaired lung function associated with obesity, as well as the positive impact of bariatric surgery on the lung function.</p><p id="par0120" class="elsevierStylePara elsevierViewall">This should encourage morbidly obese patients to lose weight; in addition to the possible health benefits related to other associated diseases it will also improve respiratory function.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Knowing the difficulty in achieving significant weight loss with conservative attitudes in patients with morbid obesity, the significant improvement in respiratory function found in this study after bariatric surgery, strengthens its indication in cases of morbid obesity.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres173662" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec161959" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres173663" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec161958" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objective" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Materials and methods" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-10-23" "fechaAceptado" => "2012-01-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec161959" "palabras" => array:4 [ 0 => "Obesity" 1 => "Bariatric surgery" 2 => "Pulmonary function test" 3 => "Body mass index" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec161958" "palabras" => array:4 [ 0 => "Obesidade" 1 => "Cirurgia bariátrica" 2 => "Provas funcionais respiratórias" 3 => "Índice de massa corporal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Obesity is considered one of the most serious public health problems of the modern world. Because it alters the relationship between the lungs, chest wall and diaphragm, it is to be expected that it impacts on the respiratory function. In Portugal, there is not much data about the relationship between obesity and pulmonary function.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to characterize respiratory function in morbidly obese patients and to evaluate whether weight loss in patients submitted to bariatric surgery affects pulmonary function tests (PFT).</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We conducted a retrospective study with 36 morbidly obese patients submitted to bariatric surgery, with a mean age of 40.6 years, 64% female and with a mean body mass index (BMI) of 49.7<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>. All patients were clinical and functionally evaluated before surgery and after their weight had stabilized following surgery. They underwent a complete pulmonary function testing with spirometry, lung volumes, carbon monoxide diffusing capacity (DLCO), maximum respiratory pressures and arterial blood gases analysis. Prior to surgery almost all the patients had functional respiratory changes, 34 had a decrease in functional residual capacity (FRC) 6 of whom a restrictive syndrome. Only 2 patients did not show any functional or arterial blood gas change. After bariatric surgery, BMI decreased to 34<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> and there was a significant improvement in almost all functional parameters with resolution of restrictive disorders. Nevertheless, in 13 patients the FRC remained decreased.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">After weight loss, the only correlation found was between reduction of BMI and increased FRC (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.371; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.028). This study suggests a relationship between obesity and pulmonary restriction and a positive impact of bariatric surgery in PFT.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A obesidade é considerada um problema de saúde pública da atualidade. Devido ao facto de alterar a relação entre pulmões, parede torácica e diafragma, a obesidade tem sido relacionada com alterações da função pulmonar. Em Portugal, existem dados muito limitados entre a relação da obesidade com a função pulmonar.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O objetivo deste estudo foi avaliar as alterações da função respiratória nos doentes obesos mórbidos e o comportamento dos parâmetros obtidos nas provas funcionais respiratórias (PFR) no pré e pós cirurgia bariátrica.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Realizamos um estudo retrospectivo pré e pós cirurgia bariátrica em 36 doentes obesos mórbidos, com uma média de idades de 40,6 anos sendo 64% do sexo feminino e com um índice de massa corporal (IMC) médio de 49,7<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>. Todos os doentes foram avaliados clínica e funcionalmente antes da cirurgia bariátrica e após estabilização do peso na sequência deste procedimento tendo-se realizado espirometria, volumes pulmonares, difusão do monóxido de carbono (DLCO), pressões máximas respiratórias e gasometria arterial. Previamente à cirurgia a maioria mostrava alterações nas PFR, 34 doentes apresentavam uma diminuição da capacidade residual funcional (CRF) dos quais 6 tinham síndrome restritiva. Apenas 2 doentes não expressavam qualquer alteração funcional ou gasométrica. Após a cirurgia bariátrica o IMC médio reduziu para 34<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> e verificou-se uma melhoria significativa de quase todos os parâmetros funcionais havendo resolução dos padrões restritivos, mantendo, contudo, ainda 13 doentes a CRF diminuída.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Foi apenas encontrada correlação com significado estatístico entre a redução do IMC e o aumento da CRF (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0,371; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,028).</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Este estudo sugere uma relação entre obesidade e restrição pulmonar e aponta para um impacto positivo da cirurgia bariátrica nas PFR.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Guimarães C, et al. Função pulmonar em doente obesos submetidos a cirurgia bariátrica. Rev Port Pneumol. 2012, <span class="elsevierStyleInterRef" href="doi:10.1016/j.rppneu.2012.01.005">doi:10.1016/j.rppneu.2012.01.005</span></p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 812 "Ancho" => 1625 "Tamanyo" => 88846 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Lung volumes and capacities distribution.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1208 "Ancho" => 1632 "Tamanyo" => 67587 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation between BMI and FRC.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Postoperative FRC <75% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Postoperative FRC ≥75% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">t</span>-Student \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial BMI, kg/m<span class="elsevierStyleSup">2</span> (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI mean difference, kg/m<span class="elsevierStyleSup">2</span> (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab266656.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">FRC after surgery.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD preoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD postoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">t</span>-Student \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FVC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">110.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEV1 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">108.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEV1/FVC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TLC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FRC (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>25.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RV (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DLCO/VA (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MIP (cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MEP (cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PaO<span class="elsevierStyleInf">2</span> (mm<span class="elsevierStyleHsp" style=""></span>Hg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PaCO<span class="elsevierStyleInf">2</span> (mm<span class="elsevierStyleHsp" style=""></span>Hg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 8 | 18 |
| 2024 October | 62 | 38 | 100 |
| 2024 September | 89 | 32 | 121 |
| 2024 August | 108 | 44 | 152 |
| 2024 July | 75 | 33 | 108 |
| 2024 June | 55 | 41 | 96 |
| 2024 May | 61 | 50 | 111 |
| 2024 April | 45 | 32 | 77 |
| 2024 March | 58 | 37 | 95 |
| 2024 February | 64 | 23 | 87 |
| 2024 January | 58 | 36 | 94 |
| 2023 December | 25 | 33 | 58 |
| 2023 November | 48 | 38 | 86 |
| 2023 October | 54 | 49 | 103 |
| 2023 September | 56 | 41 | 97 |
| 2023 August | 44 | 37 | 81 |
| 2023 July | 45 | 32 | 77 |
| 2023 June | 44 | 34 | 78 |
| 2023 May | 59 | 46 | 105 |
| 2023 April | 49 | 12 | 61 |
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