Autonomic dysfunction in COVID-19 patients receiving mechanical ventilation: A cross-sectional study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can damage cardiac tissue by increasing troponin levels and inducing arrhythmias, myocarditis, and acute coronary syndrome. OBJECTIVES: To analyze the impact of COVID-19 on cardiac autonomic control in mechanically ventilated intensive care unit (ICU) patients. DESIGN AND SETTING: This cross-sectional analytical study of ICU patients of both sexes receiving mechanical ventilation was conducted in a tertiary hospital. METHODS: Patients were divided into COVID-19-positive (COVID(+)) and COVID-19-negative (COVID(-)) groups. Clinical data were collected and heart rate variability (HRV) records obtained using a heart rate monitor. RESULTS: The study sample comprised 82 subjects: 36 (44%) in the COVID(-) group (58.3% female; median age, 64.5 years) and 46 (56%) in the COVID(+) group (39.1% females; median age, 57.5 years). The HRV indices were lower than the reference values. An intergroup comparison identified no statistically significant differences in the mean normal-to-normal (NN) interval, standard deviation of the NN interval, or root mean square of successive differences in NN intervals. The COVID(+) group had an increased low frequency (P = 0.05), reduced high frequency (P = 0.045), and increased low frequency/high frequency (LF/HF) ratio (P = 0.048). There was a weak positive correlation between LF/HF and length of stay in the COVID(+) group. CONCLUSION: Patients who received mechanical ventilation had lower overall HRV indices. COVID(+) patients who received mechanical ventilation had lower vagal HRV components. These findings likely indicate clinical applicability, as autonomic control impairments are associated with a greater risk of cardiac death.

Autonomic dysfunction in COVID-19 patients receiving mechanical ventilation: A cross-sectional study

ABSTRACT BACKGROUND: Coronavirus disease 2019 (COVID-19) can damage cardiac tissue by increasing troponin levels and inducing arrhythmias, myocarditis, and acute coronary syndrome. OBJECTIVES: To analyze the impact of COVID-19 on cardiac autonomic control in mechanically ventilated intensive care unit (ICU) patients. DESIGN AND SETTING: This cross-sectional analytical study of ICU patients of both sexes receiving mechanical ventilation was conducted in a tertiary hospital. METHODS: Patients were divided into COVID-19-positive (COVID(+)) and COVID-19-negative (COVID(-)) groups. Clinical data were collected and heart rate variability (HRV) records obtained using a heart rate monitor. RESULTS: The study sample comprised 82 subjects: 36 (44%) in the COVID(-) group (58.3% female; median age, 64.5 years) and 46 (56%) in the COVID(+) group (39.1% females; median age, 57.5 years). The HRV indices were lower than the reference values. An intergroup comparison identified no statistically significant differences in the mean normal-to-normal (NN) interval, standard deviation of the NN interval, or root mean square of successive differences in NN intervals. The COVID(+) group had an increased low frequency (P = 0.05), reduced high frequency (P = 0.045), and increased low frequency/high frequency (LF/HF) ratio (P = 0.048). There was a weak positive correlation between LF/HF and length of stay in the COVID(+) group. CONCLUSION: Patients who received mechanical ventilation had lower overall HRV indices. COVID(+) patients who received mechanical ventilation had lower vagal HRV components. These findings likely indicate clinical applicability, as autonomic control impairments are associated with a greater risk of cardiac death.

Danos psicológicos relacionados ao trabalho em profissionais de uma unidade de terapia intensiva na pandemia de Covid-19 / Work-related psychological harm in intensive care unit professionals in the Covid-19 pandemic / Daño psicológico relacionado con el trabajo en profesionales de la unidad de cuidados intensivos en la pandemia de Covid-19

A pandemia de COVID-19 exacerbou o adoecimento mental dos profissionais de saúde devido ao estresse e a sobrecarga de trabalho. Objetivo: conhecer os danos de danos psicológicos relacionados às atividades laborais que acometem profissionais que atuam na linha de frente em Unidade de Terapia Intensiva-UTI durante o enfrentamento da pandemia do COVID-19. Métodos: Estudo transversal, exploratório. Foi enviado um questionário online sobre dados sociodemográficos, atividades de trabalho e os 10 itens sobre danos psicológicos da Escala de Avaliação dos Danos Relacionados ao Trabalho (EADRT). Resultados: Responderam aos questionários 91 indivíduos (81,25%), dos quais 72,5% foram do sexo feminino, 72,5% trabalhavam há até 5 anos em UTI e 81,3% possuíam mais de um vínculo empregatício. Os danos psicológicos mais prevalentes foram: irritação com tudo (26,4%), amargura (19,8%) e vontade de desistir de tudo (19,8%). A razão de prevalência entre danos psicológicos relacionados ao trabalho e fatores socio demográficos e de trabalho, pode observar que houve prevalência de 3,000(IC95%=1,560-5,770) vezes entre profissionais de nível superior em relação aos de nível médio.

The COVID-19 pandemic exacerbated mental illness of two health professionals due to stress and work overload. Objective: know the psychological damage related to the work activities undertaken by professionals who work on the front line in the Intensive Care Unit-ICU during the confrontation of the COVID-19 pandemic. Methods: Cross-sectional, exploratory study. An online questionnaire was sent on sociodemographic data, work activities and the 10 items on psychological damage from the Work-Related Damage Assessment Scale (EADRT). Results: 91 individuals (81.25%) responded to the questionnaires, of which 72.5% were female, 72.5% worked for 5 years in ICU and 81.3% had more than one employer. The most prevalent psychological damages were: irritation with everything (26.4%), bitterness (19.8%) and the desire to give up everything (19.8%). Based on the prevalence between work-related psychological harm and socio-demographic and work-related factors, it can be observed that there was a prevalence of 3,000 (CI=95%=1,560-5,770) times among higher-level professionals compared to middle-level professionals.

A pandemia de COVID-19 agravou as doenças psíquicas dos profissionais de saúde devido ao stress e à sobrecarga de trabalho. Objetivo: conocer el daño psicológico relacionado con las actividades laborales realizadas por profesionales que trabajan en primera línea en la Unidad de Cuidados Intensivos- UCI durante el afrontamiento de la pandemia de COVID-19. Métodos: Estudio transversal y exploratorio. Se envió un cuestionario online sobre datos sociodemográficos, actividades laborales y los 10 ítems sobre daño psicológico de la Escala de Evaluación del Daño Relacionado con el Trabajo (EADRT). Resultados: 91 individuos (81,25%) respondieron a los cuestionarios, de los cuales el 72,5% eran mujeres, el 72,5% trabajaban desde hacía 5 años en UCI y el 81,3% tenían más de un empleador. Los daños psicológicos más prevalentes fueron: irritación por todo (26,4%), amargura (19,8%) y deseo de dejarlo todo (19,8%). A partir de la prevalencia entre los daños psicológicos relacionados con el trabajo y los factores sociodemográficos y laborales, se observa que hubo una prevalencia de 3.000 (IC=95%=1.560-5.770) veces entre los profesionales de nivel superior en comparación con los profesionales de nivel medio.

Chest binding and respiratory complaints in transgender men / Uso de binder e queixas respiratórias em homens transexuais

Abstract Introduction: Chest binders are an important resource for building masculinity in transgender men without mastectomy, although they can cause respiratory and thoracic damage if misused. Objective: To analyze the association between chest binding and chest complaints in transgender men. Methods: This was a quantitative cross-sectional study conducted at the Trans Space of the Hospital das Clínicas de Pernambuco and the LGBTQI Patrícia Gomes outpatient clinic of the Lessa de Andrade polyclinic in Recife (Pernambuco State, northeastern Brazil). Sixty transgender men aged >18 years were included, and data on sociodemographics, general health, chest binding, and respiratory complaints in the thoracic region were collected. Descriptive analysis was performed, and prevalence ratios (PR) were estimated with a confidence interval (CI) of 95% to associate between binder use and complaints in the chest region. Results: The average was 27.25 years, of which 81.7% did not undergo mastectomy and 53.3% used chest binders. The use of chest binders was significantly associated with complaints in the chest region (PR = 2.73), difficulty breathing (PR = 2.27), and chest pain (PR = 1.82). Conclusion: This study demonstrated a higher prevalence of complaints in the chest and respiratory region in transgender men who use chest binders. This reinforces the need to broaden the view on the health of this population. Gender construction strategies are essential for the quality of life and mental health of transgender men, and binders are an important ally in this process.

Resumo Introdução: O uso de binder é um importante recurso para a construção da masculinidade nos homens transexuais não mastectomizados, contudo, pode acarretar danos respiratórios e torácicos se usado de forma inadequada. Objetivo: Analisar a associação entre o uso de binder e as queixas torácicas em homens transexuais. Métodos: Estudo transversal quantitativo realizado no Espaço Trans do Hospital das Clínicas de Pernambuco e no ambulatório LGBTQI Patrícia Gomes da Policlínica Lessa de Andrade, em Recife, PE. Foram incluídos 60 homens transexuais, com idade acima de 18 anos, e foram coletadas informações sociodemográficas, de saúde geral, uso de binder e queixas na região torácica. Foi realizada a análise descritiva e estimadas as razões de prevalência (RP) com intervalo de confiança (IC) de 95% para a associação entre o uso de binder e queixas na região do tórax. Resultados: A média foi de 27,25 anos; destes, 81,7% não realizaram mastectomia e 53,3% faziam uso de binder. O uso de binder teve associação significativa com queixas na região do tórax (RP = 2,73), dificuldade para respirar (RP = 2,27) e dor no tórax (RP = 1,82). Conclusão: Este estudo demonstrou que há prevalência maior de queixas na região do tórax e queixas respiratórias nos homens transexuais que fazem uso de binder. Isto reforça a necessidade de ampliar o olhar sobre a saúde dessa população. Estratégias de construção de gênero são essenciais para a qualidade de vida e saúde mental de homens transexuais, sendo o uso de binder um importante aliado neste processo.

Candidemia in a public hospital in Northeastern Brazil: epidemiological features and risk factors in critically ill patients / Candidemia en un hospital público del noreste de Brasil: aspectos epidemiológicos y factores de riesgo en los pacientes críticos

Background: Candidemia is a life-threatening fungal infection characterized by the presence of Candida in the blood. Aims: To describe the clinical-epidemiological features and main risk factors among patients with candidemia admitted to Intensive Care Unit. Methods: A cross-sectional, retrospective and observational study was performed between January 2015 and July 2016. Laboratory reports and medical records from ICU patients admitted to a public hospital in northeastern Brazil were analyzed. Results: There were 1573 admissions and 67 of them were positive for candidemia. The majority of patients were male (53.3%) and remained at the hospital for more than seven days (86.6%). Non-C. albicans Candida infections (60%) were predominant. Broad-spectrum antibiotic therapy was prescribed in 98.4% of the cases. The most frequent underlying diseases were sepsis (73.3%), presence of solid tumors (15%), respiratory condition (60%), urinary tract disease (56.6%) and gastrointestinal tract diseases (23.3%). Surgeries were carried out on 43% of the patients, consisting of 23.3% abdominal surgeries, with a mortality rate of 92.8%. Risk factors were venous central access (93.3%), mechanical ventilation (81.6%), nasoenteral tube (83.3%), nasogastric tube (25%), indwelling bladder catheter (88.3%), diabetes mellitus (55%) and tracheostomy (36.6%). Statistical analysis correlated the use of indwelling bladder catheter with a higher mortality rate (r=0.07412, p=0.0353). Conclusions: The current study reveals the high case fatality rates among critically ill patients suffering from candidemia admitted to ICU. Herein, we highlight the importance of identifying non-C. albicans Candida species and reinforce the idea of carrying out epidemiological surveillances and antifungal susceptibility tests

Antecedentes: La candidemia es una infección potencialmente fatal caracterizada por la presencia de Candida en la sangre. Objetivos: Describir las características clínico-epidemiológicas y los principales factores de riesgo en pacientes con candidemia ingresados en la unidad de cuidados intensivos (UCI). Métodos: Entre enero de 2015 y julio de 2016 se llevó a cabo un estudio transversal, retrospectivo y observacional en el que se analizaron los registros médicos e informes de laboratorio de pacientes de la UCI de un hospital público del noreste de Brasil. Resultados: Entre las 1.573 admisiones registradas hubo 67 diagnósticos de candidemia. La mayoría de los pacientes fueron del sexo masculino (53,3%) y la permanencia en el hospital fue superior a siete días (86,6%). Las infecciones por especies de Candida no-C. albicans fueron el 60% de los casos. En el 98,4% de los casos se prescribió antibioterapia de amplio espectro. Las enfermedades de base más frecuentes fueron la sepsis (73,3%), la presencia de tumores sólidos (15%), las enfermedades respiratorias (60%), la enfermedad del tracto urinario (56,6%) y las enfermedades del tracto gastrointestinal (23,3%). Se realizaron cirugías en el 43% de los pacientes, siendo el 23,3% cirugías abdominales, con una tasa de mortalidad del 92,8%. Los factores de riesgo fueron la existencia de un acceso venoso central (93,3%), ventilación mecánica (81,6%), sonda nasoenteral (83,3%), sonda nasogástrica (25%), catéter vesical permanente (88,3%), diabetes mellitus (55%) y traqueostomía (36,6%). Los análisis estadísticos correlacionaron el uso del catéter urinario permanente con una mayor mortalidad (r=0,07412; p=0,0353). Conclusiones: Este estudio muestra las elevadas tasas de letalidad asociadas a pacientes con candidemia ingresados en la UCI. Destacamos la creciente importancia de identificar las especies de Candida diferentes de C. albicans, y reforzamos la idea de llevar a cabo una vigilancia epidemiológica y de realizar pruebas de sensibilidad a los antifúngicos