Clinical Variables Related to Functional Capacity and Exertional Desaturation in Patients with COVID-19.

Impaired functional capacity is one of the most commonly reported consequences among post-COVID-19 patients. This study aimed to analyse the clinical variables related to functional capacity and exertional desaturation in post-COVID-19 patients at the time of hospital discharge. A cross-sectional study was conducted on patients recovering from COVID-19 pneumonia. The main outcomes measures were functional capacity, assessed using the 1 min sit-to-stand test (1 min STST), and exertional desaturation, defined as a drop of ≥4% in the arterial oxygen saturation. Factors used to characterise the participant outcomes included the use of a high-flow nasal cannula (HFNC), prolonged hospitalisation, occurrence of pulmonary embolism during hospitalisation, and underlying comorbidities. A total of 381 participants (mean age = 53.7 ± 13.2 years, 65.6% men) were included. Participants completed a mean of 16.9 ± 6.2 repetitions in the 1 min STST. Exertional desaturation was observed in 51% of the patients. Higher odds of exertional desaturation were found in the participants who used a HFNC (OR = 3.6; 95%CI: 1.6 to 7.8), were admitted in the hospital >10 days (OR = 4.2; 95%CI: 2.6 to 6.8), and had a pulmonary embolism (OR = 3.5; 95%CI: 2.2. to 5.3). Use of a HFNC (ß = -3.4; 95%CI: -5.3 to -1.44), a hospital stay >10 days (ß = -2.2; 95%CI: -3.4 to -0.9), and a history of pulmonary embolism (ß = -1.4; 95%CI: -2.6 to -0.2) were also negatively associated with the 1 min STST. Most post-COVID-19 patients exhibited reduced functional capacity at the time of hospital discharge, and approximately half had exertional desaturation after the 1 min STST. The use of a HFNC, prolonged hospitalisation and pulmonary embolism were the main clinical variables associated with worse a 1 min STST performance and a higher likelihood of exertional desaturation.

Exercise Capacity in Children and Adolescents With Congenital Heart Disease: A Systematic Review and Meta-Analysis.

Background: Congenital heart disease (CHD) entails structural defects in the morphogenesis of the heart or its main vessels. Analyzing exercise capacity of children and adolescents with CHD is important to improve their functional condition and quality of life, since it can allow timely intervention on poor prognostic factors associated with higher risk of morbidity and mortality. Objective: To describe exercise capacity in children and adolescents with CHD compared with healthy controls. Methods: A systematic review was carried out. Randomized clinical trials and observational studies were included assessing exercise capacity through direct and indirect methods in children and adolescents between 5 and 17 years-old. A sensitive analysis was performed including studies with CHD repaired participants. Additionally, it was sub-analyzed by age range (< and ≥ 12 years old). Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of the evidence. Results: 5619 articles were found and 21 were considered for the review. Eighteen articles used the direct exercise capacity measurement method by cardiopulmonary exercise test (CPET). The CHD group showed significant differences in peak oxygen consumption (VO2peak) with a value of -7.9 ml/Kg/min (95% CI: -9.9, -5.9, p = 0.00001), maximum workload (Wmax) -41.5 (95% CI: -57.9, -25.1 watts, p = 0.00001), ventilatory equivalent (VE/VCO2 ) slope 2.6 (95% CI: 0.3, 4.8), oxygen pulse (O2 pulse)-2.4 ml/beat (95% CI: -3.7, -1.1, p = 0.0003), and maximum heart rate (HRmax) -15 bpm (95% CI: -18, -12 bpm, p = 0.00001), compared with healthy controls. Adolescents (≥ 12 yrs) with CHD had a greater reduction in VO2peak (-10.0 ml/Kg/min (95% CI: -12.0, -5.3), p < 0.00001), Wmax (-45.5 watts (95% CI: -54.4, -36.7), p < 0.00001) and HRmax (-21 bpm (95% CI: -28, -14), p<0.00001). Conclusion: Suffering CHD in childhood and adolescence is associated with lower exercise capacity as shown by worse VO2peak, Wmax, VE/VCO2 slope, O2 pulse, and HRmax compared with matched healthy controls. The reduction in exercise capacity was greater in adolescents. Systematic Review Registration: www.crd.york.ac.uk/prospero/display_record.php?RecordID=208963, identifier: CRD42020208963.

Performance of a Point of Care Test for Detecting IgM and IgG Antibodies Against SARS-CoV-2 and Seroprevalence in Blood Donors and Health Care Workers in Panama.

Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has reached 28 million cases worldwide in 1 year. The serological detection of antibodies against the virus will play a pivotal role in complementing molecular tests to improve diagnostic accuracy, contact tracing, vaccine efficacy testing, and seroprevalence surveillance. Here, we aimed first to evaluate a lateral flow assay's ability to identify specific IgM and IgG antibodies against SARS-CoV-2 and second, to report the seroprevalence estimates of these antibodies among health care workers and healthy volunteer blood donors in Panama. We recruited study participants between April 30th and July 7th, 2020. For the test validation and performance evaluation, we analyzed serum samples from participants with clinical symptoms and confirmed positive RT-PCR for SARS-CoV-2, and a set of pre-pandemic serum samples. We used two by two table analysis to determine the test positive and negative percentage agreement as well as the Kappa agreement value with a 95% confidence interval. Then, we used the lateral flow assay to determine seroprevalence among serum samples from COVID-19 patients, potentially exposed health care workers, and healthy volunteer donors. Our results show this assay reached a positive percent agreement of 97.2% (95% CI 84.2-100.0%) for detecting both IgM and IgG. The assay showed a Kappa of 0.898 (95%CI 0.811-0.985) and 0.918 (95% CI 0.839-0.997) for IgM and IgG, respectively. The evaluation of serum samples from hospitalized COVID-19 patients indicates a correlation between test sensitivity and the number of days since symptom onset; the highest positive percent agreement [87% (95% CI 67.0-96.3%)] was observed at ≥15 days post-symptom onset (PSO). We found an overall antibody seroprevalence of 11.6% (95% CI 8.5-15.8%) among both health care workers and healthy blood donors. Our findings suggest this lateral flow assay could contribute significantly to implementing seroprevalence testing in locations with active community transmission of SARS-CoV-2.

Medical and surgical management for chronic thromboembolic pulmonary hypertension: a single center experience.

INTRODUCTION: Pulmonary endarterectomy (PE) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to analyze our experience in the medical and surgical management of CTEPH. METHODS: We included 80 patients diagnosed with CTEPH between January 2000 and July 2012. Thirty two patients underwent PE and 48 received medical treatment (MT). We analyzed functional class (FC), six-minute walking distance (6MWD) and pulmonary hemodynamics. Mortality in both groups and periods were analyzed. RESULTS: Patients who underwent PE were younger, mostly men, and had longer 6MWD. No differences were observed in pulmonary hemodynamics or FC at diagnosis. One year after treatment, all PE patients versus 41% in MT group were at FCI-II. At follow-up, the PE group showed greater increase in 6MWD, and greater reduction in mean pulmonary arterial pressure and pulmonary vascular resistance than the MT group (P<.05). Overall survival in the MT group at 1 and 5years was 83% and 69%, respectively. Conditional survival in patients alive 100days post-PE at 1 and 5years was 95% and 88%, respectively. Surgical mortality in operated patients in the first period (2000-2006) was 31,3%, and 6,3% in the second (2007-2012). CONCLUSIONS: PE provides good clinical results, and improves pulmonary hemodynamics in patients who successfully overcome the immediate postoperative period. After a learning period, the current operatory mortality in our center is similar to international standards.

Capacitación sobre reanimación cardiopulmonar básica a personal de enfermería por criterios de conocimiento, aptitud y actitud / Training on basic cardiopulmonary resuscitation for nursing staff by knowledge, aptitude and attitude

Introducción: El paro cardiorespiratorio (PCR) es la interrupción repentina y simultánea de la respiración y funcionamiento del corazón. El apoyo vital básico permite evitarla insuficiencia circulatoria y respiratoria. En promedio los pacientes que sobreviven al PCR son aquellos en que la reanimación se inicia durante los primeros cuatro minutos. Objetivo: Evaluar el conocimiento, aptitud y actitud del personal de enfermería en reanimación cardiopulmonar básica antes y después de un proceso educativo. Metodología: Durante un periodo de 5 meses se impartió un curso-taller a 40 enfermeras del área de hospitalización, con una evaluación al inicio y al final del proceso educativo. La variable fue capacitación con 3 criterios: conocimiento con valor de 20 puntos, habilidad 30 y actitudes 40. El tipo de muestreo fue estratificado, los instrumentos fueron validados a través de ronda de expertos y calificados por el propio investigador. Se consideró capacitada, a la persona que logró aprobar los 3 criterios. Resultados: En la evaluación inicial ninguna enfermera logró calificar como capacitada y en la evaluación final 85%. Conclusión: El resultado del proceso educativo se consideró de bueno a excelente, los resultados finales muestran alto porcentaje de enfermeras capacitadas.

Training on basic cardiopulmonary resuscitation for nursing staff by knowledge, aptitude and attitude Introduction: Cardiac arrest is the sudden and simultaneous interruption of the breathing and function of the heart. Basic vital support allows avoiding the circulatory and respiratory deficiency. In average the patients who survive a cardiac arrest are those in which the resuscitation begins during the first 4 minutes. Objective: To evaluate the knowledge, aptitude and attitude from the nursing staff in Basic CPR before and after an Educational Process. Methodology: During June 11th, through October 22nd, 2001, it was implemented a workshop to 40 nurses from hospitalization services, evaluating their performance at the beginning and the end of the educational process. The variable was training with 3 criteria: knowledge with a score of 20 points, ability 30 and attitudes 40. The sample was stratified, and the instruments were validated through round of experts and qualified by the researcher. People who approved the 3 criteria was considered skilled. Results: In the initial evaluation any nurse reached the score to be considered as skilled but in the final evaluation 85% achieved the score. Conclusion: The result of the educational process was considered from good to excellent, the final results show a high percentage of skilled nurses.