ABSTRACT
To assess malnutrition contribution to the functional status and health related quality of life after hospitalization due to COVID-19 pneumonia, 66 selected adults referred for physical rehabilitation accepted to participate in the study; none of them required oxygen supply or had history of lung/musculoskeletal/neurological/immune/rheumatic disease or trauma, or contraindication for respiratory-function tests. At three evaluations, with 3 months in-between, assessments included: self-report of functional status, the St. George's Respiratory Questionnaire, spirometry, the 6-min-walk-test, the MRC-scale, the 30-s sit-to-stand-test, the timed-up-and-go-test, nutritional status, and ultrasound imaging (vastus medialis and diaphragm). At referral, patients had nutritional deficits with protein deficiency, which gradually improved; while muscle thickness (of both vastus medialis and diaphragm) increased, along with muscle strength and mobility (ANOVA, p < 0.05). Contrarywise, the distance covered during the 6-min-walk-test decreased (ANOVA, p < 0.05), with a negative influence from excess body mass. During rehabilitation, health-related quality of life and functional status improved, with negative influence from a history of tobacco use and referral delay, respectively. After hospitalization due to COVID-19, early diagnosis of both protein deficiency and decrease of skeletal muscle thickness could be relevant for rehabilitation, while pondering the negative impact of excess body mass on submaximal exercise performance.
Subject(s)
COVID-19 , Functional Status , Malnutrition , Nutritional Status , Quality of Life , Humans , COVID-19/psychology , COVID-19/epidemiology , COVID-19/physiopathology , Male , Female , Middle Aged , Aged , Follow-Up Studies , SARS-CoV-2/isolation & purification , Adult , Hospitalization , Muscle Strength/physiology , Surveys and QuestionnairesABSTRACT
A follow-up study was designed to assess correlations among physical signs, quality of sleep, common mental symptoms, and health-related quality of life after moderate to severe COVID-19 pneumonia. Daily changes in dyspnoea and pulse oximetry were recorded (200 days), and four evaluations (in >2 years) were performed on quality of sleep, mental symptoms, cognitive performance, and health-related quality of life. In a single center, 72 adults participated in the study (52.5 ± 13.7 years old), with no psychiatry/neurology/chronic lung/infectious diseases, chronic use of corticosteroids/immunosuppressive therapy, or pregnancy. Daily agendas showed delayed decreases in dyspnoea scores compared to pulse oximetry and heart rate recordings; however, changes in pulse oximetry were minimal. Slight changes in cognitive performance were related to the general characteristics of the participants (obesity and tobacco use) and with the severity of acute disease (MANCOVA, p < 0.001). Health-related quality of life gradually improved (MANCOVA, p < 0.004). During recovery, bad quality of sleep and mental symptoms (mainly attention/concentration) contributed to the subscores on health perception and vitality in the health-related quality of life assessment. Early mental support services including sleep hygiene could be beneficial during rehabilitation after acute COVID-19.
ABSTRACT
The aim of this study was to assess the shear wave velocity by LUS elastography (SWE2D) for the evaluation of superficial lung stiffness after COVID-19 pneumonia, according to "fibrosis-like" signs found by Computed Tomography (CT), considering the respiratory function. Seventy-nine adults participated in the study 42 to 353 days from symptom onset. Paired evaluations (SWE2D and CT) were performed along with the assessment of arterial blood gases and spirometry, three times with 100 days in between. During the follow-up and within each evaluation, the SWE2D velocity changed over time (MANOVA, p < 0.05) according to the extent of "fibrosis-like" CT signs by lung lobe (ANOVA, p < 0.05). The variability of the SWE2D velocity was consistently related to the first-second forced expiratory volume and the forced vital capacity (MANCOVA, p < 0.05), which changed over time with no change in blood gases. Covariance was also observed with age and patients' body mass index, the time from symptom onset until hospital admission, and the history of diabetes in those who required intensive care during the acute phase (MANCOVA, p < 0.05). After COVID-19 pneumonia, SWE2D velocity can be related to the extent and regression of "fibrotic-like" involvement of the lung lobes, and it could be a complementary tool in the follow-up after COVID-19 pneumonia.
ABSTRACT
Science, through scientific research, is an activity that generates new ideas. However, for the construction of new knowledge it is necessary to confront ideas with peers in the scientific world; which is exercised through scientific communication.
La ciencia, a través de la investigación científica, es una actividad generadora de nuevas ideas. Sin embargo, para la construcción del nuevo conocimiento es necesario confrontar las ideas con los pares en el mundo científico; lo cual se ejerce a través de la comunicación científica.
Subject(s)
COVID-19 , Humans , Thorax/diagnostic imaging , Radiography , UltrasonographyABSTRACT
In addition to the sanitary constrains implemented due to the pandemic, frontline physicians have faced increased workloads with insufficient resources, and the responsibility to make extraordinary clinical decisions. In 108 physicians who were at the forefront of care of patients with COVID-19 during the first two years of the pandemic, mental health, moral distress, and moral injury were assessed twice, in between two late waves of COVID-19 contagions, according to their adverse psychological reactions, in-hospital experience, sick leave due to COVID-19, quality of sleep, moral sensitivity, clinical empathy, resilience, and sense of coherence. Three months after the wave of contagions, the adverse emotional reactions and moral distress decreased, while moral injury persisted. Moral distress was related to clinical empathy, with influence from burnout and sick leave due to COVID-19, and moral injury was related to the sense of coherence, while recovery from moral distress was related to resilience. The results suggest that measures to prevent physician infection, as well as strengthening resilience and a sense of coherence, may be helpful to prevent persistent mental damage after exposure to a sanitary crisis.
Subject(s)
COVID-19 , Physicians , Humans , Mental Health , Morals , Burnout, PsychologicalABSTRACT
Background: During the COVID-19 pandemic, portable chest radiography (portable CRx) and lung ultrasonography (LUS) have been widely used to follow up hospitalized patients. Yet, it is scarce the information about the relation between the signs observed by means of each method in patients with COVID-19. Objective: To assess the correlation between concurrent images acquired by LUS and portable CRx during the follow-up of hospitalized patients with COVID-19. Material and methods: We performed 113 LUS and 113 corresponding CRx during the follow-up of 44 patients (30 men/14 women, 30-85 years old) with COVID-19 (RT-qPCR). Images were stored in a picture communication system and were revised by two specialists of each imaging method independently. Statistical analysis was performed using Gamma correlation and t test (significance level of 0.05). Results: The most frequent LUS sign was confluent B lines, and it was related to the most frequent portable CRx signs (ground-glass opacities and consolidations). An inverse relationship was observed between A lines (gas in the lungs) and B7 lines (suggestive of interstitial edema). Confluent B lines also showed a strong inverse correlation with A lines (more frequent confluent B lines were related to low frequent A lines), a moderate inverse correlation with B7 lines, and a mild inverse correlation with B3 lines. Conclusion: During the follow-up of hospitalized patients with COVID-19, LUS and portable CRx may complement each other to provide information about lung damage.
Introducción: durante la pandemia por COVID-19, la radiografía portátil de tórax y la ultrasonografía se han usado ampliamente para el seguimiento de pacientes hospitalizados. Sin embargo, es escasa la información sobre la relación entre los signos que se observan mediante cada método en pacientes con COVID-19. Objetivo: estimar la correlación entre imágenes concurrentes obtenidas por ultrasonografía de pulmón y por radiografía portátil de tórax durante el seguimiento de pacientes hospitalizados por COVID-19. Material y métodos: se realizaron 113 estudios de ultrasonografía y los correspondientes 113 de radiografía portátil de tórax durante el seguimiento de 44 pacientes (30 hombres/14 mujeres, edad 30-85 años) con COVID-19 (RT-qPCR). Las imágenes se resguardaron en un sistema de comunicación para su evaluación independiente por dos especialistas en cada método. El análisis se hizo con correlación gamma y prueba t (significancia de 0.05). Resultados: el signo por ultrasonido más frecuente fue el de líneas B-confluentes en correlación con los signos radiológicos de imagen en vidrio deslustrado y consolidación. Se observó correlación inversa entre líneas A (pulmón aireado) y líneas B7 (sugerentes de edema intersticial); las líneas B-confluentes mostraron correlación inversa y fuerte con líneas A (a mayor frecuencia de líneas B-confluentes, menor frecuencia de líneas A), correlación inversa moderada con líneas B7 y correlación inversa débil con líneas B3. Conclusión: en el seguimiento de pacientes hospitalizados por COVID-19, los signos por ultrasonografía pulmonar y por radiografía portátil de tórax pueden ser complementarios para identificar las características del daño pulmonar.
Subject(s)
COVID-19 , Adult , Aged , Aged, 80 and over , COVID-19/diagnostic imaging , Female , Humans , Male , Middle Aged , Pandemics , Radiography , SARS-CoV-2 , Thorax , UltrasonographyABSTRACT
Introducción: durante la pandemia por COVID-19, la radiografía portátil de tórax y la ultrasonografía se han usado ampliamente para el seguimiento de pacientes hospitalizados. Sin embargo, es escasa la información sobre la relación entre los signos que se observan mediante cada método en pacientes con COVID-19. Objetivo: estimar la correlación entre imágenes concurrentes obtenidas por ultrasonografía de pulmón y por radiografía portátil de tórax durante el seguimiento de pacientes hospitalizados por COVID-19. Material y métodos: se realizaron 113 estudios de ultrasonografía y los correspondientes 113 de radiografía portátil de tórax durante el seguimiento de 44 pacientes (30 hombres/14 mujeres, edad 30-85 años) con COVID-19 (RT-qPCR). Las imágenes se resguardaron en un sistema de comunicación para su evaluación independiente por dos especialistas en cada método. El análisis se hizo con correlación gamma y prueba t (significancia de 0.05). Resultados: el signo por ultrasonido más frecuente fue el de líneas B-confluentes en correlación con los signos radiológicos de imagen en vidrio deslustrado y consolidación. Se observó correlación inversa entre líneas A (pulmón aireado) y líneas B7 (sugerentes de edema intersticial); las líneas B-confluentes mostraron correlación inversa y fuerte con líneas A (a mayor frecuencia de líneas B-confluentes, menor frecuencia de líneas A), correlación inversa moderada con líneas B7 y correlación inversa débil con líneas B3. Conclusión: en el seguimiento de pacientes hospitalizados por COVID-19, los signos por ultrasonografía pulmonar y por radiografía portátil de tórax pueden ser complementarios para identificar las características del daño pulmonar
Background: During the COVID-19 pandemic, portable chest radiography (portable CRx) and lung ultrasonography (LUS) have been widely used to follow up hospitalized patients. Yet, it is scarce the information about the relation between the signs observed by means of each method in patients with COVID-19. Objective: To assess the correlation between concurrent images acquired by LUS and portable CRx during the follow-up of hospitalized patients with COVID-19. Material and methods: We performed 113 LUS and 113 corresponding CRx during the follow-up of 44 patients (30 men/14 women, 30-85 years old) with COVID-19 (RT-qPCR). Images were stored in a picture communication system and were revised by two specialists of each imaging method independently. Statistical analysis was performed using Gamma correlation and t test (significance level of 0.05). Results: The most frequent LUS sign was confluent B lines, and it was related to the most frequent portable CRx signs (ground-glass opacities and consolidations). An inverse relationship was observed between A lines (gas in the lungs) and B7 lines (suggestive of interstitial edema). Confluent B lines also showed a strong inverse correlation with A lines (more frequent confluent B lines were related to low frequent A lines), a moderate inverse correlation with B7 lines, and a mild inverse correlation with B3 lines. Conclusion: During the follow-up of hospitalized patients with COVID-19, LUS and portable CRx may complement each other to provide information about lung damage
Subject(s)
Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Diagnostic Imaging , COVID-19 , Radiography , Ultrasonography , MexicoABSTRACT
INTRODUCTION: We designed a follow-up study of frontline health workers at COVID-19 patient care, within the same working conditions, to assess the influence of their general characteristics and pre-existing anxiety/depression/dissociative symptoms and resilience on the development of symptoms of post-traumatic stress disorder (PTSD), while monitoring their quality of sleep, depersonalization/derealization symptoms, acute stress, state anxiety, and burnout. METHODS: In a Hospital reconfigured to address the surge of patients with COVID-19, 204 frontline health workers accepted to participate. They completed validated questionnaires to assess mental health: before, during, and after the peak of inpatient admissions. After each evaluation, a psychiatrist reviewed the questionnaires, using the accepted criteria for each instrument. Correlations were assessed using multivariable and multivariate analyses, with a significance level of .05. RESULTS: Compared to men, women reporting pre-existing anxiety were more prone to acute stress; and younger age was related to both pre-existent common psychological symptoms and less resilience. Overall the evaluations, sleep quality was bad on the majority of participants, with an increase during the epidemic crisis, while persistent burnout had influence on state anxiety, acute stress, and symptoms of depersonalization/derealization. PTSD symptoms were related to pre-existent anxiety/depression and dissociative symptoms, as well as to acute stress and acute anxiety, and negatively related to resilience. CONCLUSIONS: Pre-existent anxiety/depression, dissociative symptoms, and coexisting acute anxiety and acute stress contribute to PTSD symptoms. During an infectious outbreak, psychological screening could provide valuable information to prevent or mitigate against adverse psychological reactions by frontline healthcare workers caring for patients.