Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials.

OBJECTIVE: This systematic review and meta-analysis aimed to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness. DESIGN: Systematic review and meta-analysis of RCTs. DATA SOURCES: We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to January 2023) for RCTs that evaluated the effects of physical rehabilitation interventions following hospital discharge for recovery from critical illness. REVIEW METHODS: Study quality was evaluated using the PEDro Scale. Mean differences (MDs), standard MDs (SMD), and 95% confidence intervals (CIs) were calculated. RESULTS: Fourteen studies met the study criteria, including 1259 patients. Exercise interventions improved aerobic capacity SMD 0.2 (95% CI: 0.03-0.3, I2 = 0% N = 880, nine studies, high-quality evidence), and physical component score of health-related quality of life MD 3.3 (95% CI: 1.0-5.6, I2 = 57%, six studies N = 669, moderate-quality evidence). In addition, a significant reduction in depression was observed MD -1.4 (95% CI: -2.7 to -0.1, I2 = 0% N = 148, three studies, moderate-quality evidence). No serious adverse events were reported. CONCLUSION: Exercise intervention was associated with improvement of aerobic capacity, depression, and physical component score of health-related quality of life after hospital discharge for survivors of critical illness.

Development, reliability, and validity of the mobility assessment scale in hospitalized patients (HMob).

BACKGROUND: Existing mobility scales for hospitalized patients do not include assessment of tasks for the right and left side, ability to transfer from sitting to lying and from standing to sitting, ability to climbing steps and pick up an object from the floor in the same instrument. OBJECTIVE: Evaluate the reliability and validity of the hospital mobility assessment scale (HMob) according to the Consensus-based standards for the selection of health measurement instruments (COSMIN). METHODS: Study conducted in three inpatient units (cardiology, neurology, and gastrohepatology) and one adult intensive care unit in a hospital. Patients of both sexes were included; age >18 years; collaborative and who obeyed commands, with different medical diagnoses and clinical release to leave their bed (provided by the doctor). Special populations such as those with burns and orthopedics were excluded. RESULTS: The sample consisted of 130 patients; 20 from the pilot study and 110 to assess the clinimetric properties of the HMob. Cronbach alpha coefficient was 0.949. Relative intra- (A1-A2) and inter-rater (A1-B; A2-B) reliability was excellent (A1-A2: ICC = 0.982, p-value < 0.0001; A1-B: ICC = 0.993, p-value < 0.0001; A2-B: ICC = 0.986, p-value < 0.0001.) The convergent criterion validity of HMob in relation to the ICU Functional Status Score was 0.967 (p-value < 0.0001) and for Functional Independence measure (MIF) was 0.926 (p-value < 0.0001). CONCLUSION: The HMob scale showed excellent internal consistency, intra- and inter-rater reliability, and concurrent validity in the motor domain, which suggests that it can be used in daily practice to measure mobility in hospitalized patients.

NR3C1 and NR3C2 Genes Increase the Risk of Suicide Attempt in Psychiatric Disorder Patients with History of Childhood Trauma.

Background: Hypothalamic-pituitary-adrenal axis gene variants and childhood trauma (CT) are considered risk factors for suicide attempt (SA). The aim of the present study was analyzed gene x environment (GxE) interaction of NR3C1, NR3C2, and CT, and NR3C1 and NR3C2 gene expression in the development of SA with CT. Participants and Methods: A total of 516 psychiatric Mexican patients from Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. Among them, 274 had SA at least once and 242 had not SA. Genetic variants of NR3C1 and NR3C2 were genotyped in all the patients, of which were obtained the CT information from medical records. Additionally, the gene expression of NR3C1 and NR3C2 was also analyzed for a subsample of 96 patients, obtaining the TC information from Childhood Trauma Questionnaire (CTQ). Results: The analysis showed a GxE interaction of NR3C1, NR3C2, and CT (OR=2.8, 95% CI [1.9-3.9], p<0.0001). Interactions were also observed with neglect (OR=2.1, 95% CI [1.4-3.1], p<0.0001), emotional abuse (OR=2.1, 95% CI [1.5-3], p<0.0001), and sexual abuse (OR=2.4, 95% CI [1.4-2.9], p<0.0001) in the prediction of SA. The analysis of gene expression identified an overexpression of NR3C1 in SA patients with high scores for physical and sexual abuse (p<0.0001; p<0.0006, respectively) and emotional neglect (p=0.014). An underexpression was observed of NR3C2, associated with high scores of trauma subtypes (p<0.0001) except physical neglect. Additionally, we observed an overexpression of NR3C1 gene in patients with SA carriers of A allele of rs6191 (p=0.0015). Also, overexpression of NR3C1 gene in carriers of G allele of rs6198 and underexpression of NR3C2 gene in carriers of G allele of rs5522 (p<0.0001). Conclusion: Our findings suggest that genetic variants of NR3C1 and NR3C2 differentially affect expression levels, increasing the susceptibility to SA in psychiatric patients with a history of CT.

Toll-Like Receptor (TLR) 1, 2, and 6 Gene Polymorphisms Support Evidence of Innate Immune Factors in Schizophrenia.

Introduction: Schizophrenia is a complex psychiatric disorder with an important genetic contribution. Immunological abnormalities have been reported in schizophrenia. Toll-like receptor (TLR) genes play an important role in the activation of the innate immune response, which may help to explain the presence of inflammation in people with this disorder. The aim of this study was to analyze the association of TLR1, TLR2, and TLR6 gene polymorphisms in the etiology of schizophrenia. Methods: We included 582 patients with schizophrenia and 525 healthy controls. Genetic analysis was performed using allelic discrimination with TaqMan probes. Results: We observed significant differences between patients and controls in the genotype and allele frequencies of TLR1/rs4833093 (χ2 = 17.3, p = 0.0002; χ2 = 15.9, p = 0.0001, respectively) and TLR2/rs5743709 (χ2 = 29.5, p = 0.00001; χ2 = 7.785, p = 0.0053, respectively), and in the allele frequencies of TLR6/rs3775073 (χ2 = 31.1, p = 0.00001). Finally, we found an interaction between the TLR1/rs4833093 and TLR2/rs5743709 genes, which increased the risk of developing schizophrenia (OR = 2.29, 95% CI [1.75, 3.01]). Discussion: Our findings add to the evidence suggesting that the activation of innate immune response might play an important role in the development of schizophrenia.

Comparison of High-Intensity Interval Training to Moderate-Intensity Continuous Training for Functioning and Quality of Life in Survivors of COVID-19 (COVIDEX): Protocol for a Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to compare high-intensity interval training (HIIT) with moderate-intensity continuous training (MICT) for feasibility, safety, adherence, and short- and long-term efficacy in improving functioning and health-related quality of life in survivors of coronavirus disease 2019 (COVID-19). METHODS: COVIDEX is a two-pronged, parallel-group, randomized controlled trial with an 8-week training intervention. The study participants will be 94 patients aged >18 years, admitted to a specialized post-COVID center. Participants will be randomized to HIIT (4 × 4 minutes of high-intensity work periods at 85% to 90% of peak heart rate) and MICT (47 minutes at 70% to 75% peak heart rate) groups for biweekly sessions for 8 weeks. The participants will undergo 2 phases of supervised training (phases 1 and 2) of 4 weeks each, in a public, specialized, post-COVID center. In phase 1, we will assess and compare the feasibility, acceptability, and short-term efficacy of HIIT and MICT intervention. In phase 2, the long-term efficacy of HIIT and MICT will be assessed and compared regarding function and health-related quality of life. To prevent any expectation bias, all study participants and assessors will be blinded to the study hypotheses. Group allocation will be masked during the analysis. All statistical analyses will be conducted following intention-to-treat principles. IMPACT: This study is the first randomized controlled trial that will compare the feasibility, safety, adherence, and efficacy of the HIIT and MICT intervention programs in this population. The findings will potentially provide important information and assist in clinical decision making on exercise to optimize the benefits of clinical health care in survivors of COVID-19.

Early biochemical analysis of COVID-19 patients helps severity prediction.

COVID-19 pandemic has put the protocols and the capacity of our Hospitals to the test. The management of severe patients admitted to the Intensive Care Units has been a challenge for all health systems. To assist in this challenge, various models have been proposed to predict mortality and severity, however, there is no clear consensus for their use. In this work, we took advantage of data obtained from routine blood tests performed on all individuals on the first day of hospitalization. These data has been obtained by standardized cost-effective technique available in all the hospitals. We have analyzed the results of 1082 patients with COVID19 and using artificial intelligence we have generated a predictive model based on data from the first days of admission that predicts the risk of developing severe disease with an AUC = 0.78 and an F1-score = 0.69. Our results show the importance of immature granulocytes and their ratio with Lymphocytes in the disease and present an algorithm based on 5 parameters to identify a severe course. This work highlights the importance of studying routine analytical variables in the early stages of hospital admission and the benefits of applying AI to identify patients who may develop severe disease.

Study of the Rv1417 and Rv2617c Membrane Proteins and Their Interactions with Nicotine Derivatives as Potential Inhibitors of Erp Virulence-Associated Factor in Mycobacterium tuberculosis: An In Silico Approach.

The increasing emergence of Mycobacterium tuberculosis (Mtb) strains resistant to traditional anti-tuberculosis drugs has alarmed health services worldwide. The search for new therapeutic targets and effective drugs that counteract the virulence and multiplication of Mtb represents a challenge for the scientific community. Several studies have considered the erp gene a possible therapeutic target in the last two decades, since its disruption negatively impacts Mtb multiplication. This gene encodes the exported repetitive protein (Erp), which is located in the cell wall of Mtb. In vitro studies have shown that the Erp protein interacts with two putative membrane proteins, Rv1417 and Rv2617c, and the impairment of their interactions can decrease Mtb replication. In this study, we present five nicotine analogs that can inhibit the formation of heterodimers and trimers between these proteins. Through DFT calculations, molecular dynamics, docking, and other advanced in silico techniques, we have analyzed the molecular complexes, and show the effect these compounds have on protein interactions. The results show that four of these analogs can be possible candidates to counteract the pathogenicity of Mtb. This study aims to combine research on the Erp protein as a therapeutic target in the search for new drugs that serve to create new therapies against tuberculosis disease.

Effects of ventilator hyperinflation on pulmonary function and secretion clearance in adults receiving mechanical ventilation: A systematic review with meta-analysis.

INTRODUCTION: It is important to clarify the effect of ventilator hyperinflation(VHI) on pulmonary function and secretion clearance in adults receiving mechanical ventilation(MV). There is no published meta-analysis on the effects VHI on pulmonary function and secretion clearance in adults receiving MV. Objective Analyze the published randomized clinical trials(RCTs) that investigated the effects of VHI on pulmonary function and secretion clearance in adults receiving MV, comparing VHI with isolated aspiration, VHI with manual hyperinflation(MHI), VHI +vibrocompression(VB) versus VB and VHI+VB versus isolated aspiration. METHODS: The following databases PubMed, LILACS, EMBASE, SciELO, PEDro database and Cochrane Central Register of Controlled Trials (CENTRAL) were consulted up to December 2021. Secretion clearance, static and dynamic compliance of the respiratory system(Cstat and Cdyn), airway resistance(Raw) and oxygenation outcomes were evaluated. RESULTS: Thirteen studies met the study criteria, but only 12 studies were included on meta-analysis. There was no difference between VHI versus isolated aspiration for amount of secretions removed(0.41 SMD; 95% CI: -0.08 to 0.89; n=270), VHI versus MHI(0.51 grams; 95% CI: -0.08 to 1.11; n=256), VHI+VB versus VB(0.31 grams; 95% CI: -0.42 to 1.05; n=130) and VHI+VB versus isolated aspiration(0.54 grams; 95% CI: -0.06 to 1.14; n=132). There was difference for VHI versus isolated aspiration to Cstat (4.77 ml/cm H2O; 95% CI: 2.41 to 7.14; n= 136). CONCLUSION: Taking into account all studies included in meta-analysis, no evidences was found that VHI was effective in increasing the amount of secretions removed, Cdyn and oxygenation, but VHI seems to show a slight improvement in Cstat when compared to isolated aspiration. No evidence was found that VHI was effective in increasing the amount of secretions removed, Cdyn and oxygenation, but VHI seems to show a slight improvement in Cstat when compared to isolated aspiration.

Effects of neuromuscular electrical stimulation on exercise capacity, muscle strength and quality of life in COPD patients: A Systematic Review with Meta-Analysis.

OBJECTIVE: To determine the effects of neuromuscular electrical stimulation on disabilities and activity limitation of individuals affected by chronic obstructive pulmonary disease. DATA SOURCES: MEDLINE, PEDro database, Cochrane Controlled Trials Register, and SciELO, were searched from inception until October 2021. REVIEW METHODS: Inclusion criteria were patients with COPD, randomized controlled trials comparing neuromuscular electrical stimulation alone or combined conventional pulmonary rehabilitation and neuromuscular electrical stimulation versus control or sham or pulmonary rehabilitation in disabilities and activity limitation in COPD. There were no mandatory language or publication date restrictions. Two reviewers selected studies independently. Weighted mean differences and 95% confidence intervals were calculated. Results 32 studies met the study criteria, including 1.269 participants. Neuromuscular electrical stimulation improved exercise capacity (MD 1.10, 95% CI: 0.33, 1.86, N = 147), and muscle strength (0.53, 95% CI: 0.20, 0.87, N = 147) compared to sham group. Combined neuromuscular electrical stimulation and conventional rehabilitation improved exercise capacity (MD 34.28 meters, 95% CI: 6.84, 61.73, N = 262) compared to conventional rehabilitation alone. No adverse events were reported. CONCLUSIONS: Neuromuscular electrical stimulation resulted in small improvement in disabilities and activity limitation (below the MCID) in COPD. Thus, the inclusion of neuromuscular electrical stimulation in rehabilitation programs must consider the cost Because of inadequate methodological conduction and reporting of methods, some studies were of low quality.

Avaliação da independência funcional e da qualidade de vida após a alta da unidade de terapia intensiva: um estudo do coorte prospectivo / Evaluation of functional independence and quality of life after discharge of intensive care unit: a prospective cohort study

INTRODUÇÃO: Os pacientes criticamente doentes podem sofrer alterações funcionais, sociais e mentais, incluindo deficiência de conhecimento, memória e concentração após a admissão na unidade de terapia intensiva (UTI) e alta hospitalar. Apesar do conhecimento sobre o impacto da internação hospitalar na funcionalidade e qualidade de vida, ainda há pouco reconhecimento na literatura sobre este impacto a longo prazo. OBJETIVO: Verificar a independência funcional e a qualidade de vida (QOL) em pacientes acima de 1 ano após a alta da Unidade de Tratamento Intensivo (UTI). MÉTODOS: Este é um estudo de coorte prospectivo, foram admitidos na UTI e sob ventilação mecânica por mais de 48 horas, até 24 horas após a alta da UTI, acima de 18 anos de idade, de ambos os sexos e que concordaram em participar do estudo. Foram excluídos aqueles com sequelas neurológicas e traumas recorrentes que impossibilitavam a avaliação funcional. As variáveis independência funcional (Medida de Independência Funcional - FIM) e QOL foram medidas utilizando o questionário do formulário curto 36 (SF-36) no momento da alta da UTI (período I), 30 dias (período II), e 1 ano após (período III). RESULTADOS: 33 pacientes foram incluídos no estudo com uma idade média de 49,13±16,3 anos, e a principal causa de hospitalização foi distúrbios neurológicos, dos quais 5(14,70%) morreram, e dois não completaram as avaliações, resultando em um total de 26 pacientes avaliados 1 ano após a alta. A duração da internação na UTI (dias) foi de 16 (7 - 22) e o tempo de ventilação mecânica (dias) foi de 8,5 (2 - 13). Dez pacientes lá foram diagnosticados com sepse. Foram encontrados os seguintes valores nesses três momentos para as variáveis IF (I-51 [47-64,5]; II-80[59,5-108]; III104[82,8-123]) e QOL(I-67,4[57,3-81,1]; II-80,2[70,1-99,2]; III-93,5[88,5-96,5]). A independência funcional e QOL aumentou significativamente entre os momentos II e III, em comparação com os momentos I (p <0,05), sem diferença na comparação do período II em relação ao III. CONCLUSÃO: Os pacientes recuperam sua funcionalidade e qualidade de vida após trinta dias de alta da UTI. Entretanto, a funcionalidade e a qualidade de vida deste paciente não mudam após 1 ano de alta da UTI em relação ao período de 30 dias após a alta da UTI.

INTRODUCTION: Critically ill patients may experience functional, social, and mental changes, including impaired cognition, memory, and concentration after admission to the intensive care unit (ICU) and hospital discharge. Despite the knowledge about the impact of the hospital stay on functionality and quality of life, there is still little recognition in the literature of this impact in the long term. OBJECTIVE: To verify functional independence and quality of life (QOL) in patients over 1 year after discharge from the Intensive Care Unit (ICU). METHODS: This is a prospective cohort study, were admitted to the ICU and under mechanical ventilation for more than 48 hours, up to 24 hours after discharge from the ICU, over 18 years of age, of both sexes and who agreed to participate in the study. Those with neurological sequelae and recurrent trauma that made functional assessment impossible were excluded. Functional independence (Functional Independence Measure-FIM) and QOL variables were measured using the Short Form 36 questionnaire (SF-36) at the time of discharge from the ICU (period I), 30 days (period II), and 1 year after (period III). RESULTS: 33 patients were included in the study with a mean age of 49.13±16.3, and the main cause of hospitalization was neurological disorders, of which 5 (14.70%) died, and two did not complete the evaluations, resulting in a total of 26 patients evaluated 1 year after discharge. The length of ICU stay (days) was 16 (7 - 22) and the Mechanical Ventilation time (days) was 8,5 (2 - 13). Ten patients there were diagnosed with sepsis. The following values over these three moments were found for the variables IF (I-51 [47­64.5]; II-80[59.5­108]; III-104[82.8-123]) and QOL(I­67.4[57.3­81.1]; II-80.2[70.1­99.2]; III­93.5[88.5­ 96.5]). Functional independence and QOL increased significantly between moments II and III compared to moments I (p <0.05), with no difference, when comparing period II in relation to III. CONCLUSION: Patients recover their functionality and quality of life after thirty days of discharge from the ICU. However, this patient's functionality and quality of life do not change after 1 year of discharge from the ICU in relation to the period of 30 days after discharge from the ICU.

Initial study of anaemia profile for primary care centres with automated laboratory algorithms reduces the demand for ferritin, iron, transferrin, vitamin B12 and folate tests.

AIM: To evaluate the influence of an algorithm designed to incorporate reflex testing according to haemogram results for analytical tests ordered to investigate anaemia. METHODS: In 2020, a new request for 'initial study of anaemia' was created in three primary care pilot centres for suspected anaemia or new anaemias. A haemogram was ordered and the remainder of the tests were created in a reflex manner according to an algorithm integrated in the laboratory information system that also generates a comment that is completed and validated by a haematologist. The demand for tests was evaluated over three time periods. RESULTS: Of 396 requests, anaemia was detected in 80 (20.2%), with 26 microcytic anaemias (6.57%), 20 iron deficiency anaemias, 41 (10.3%) normocytic anaemias and 13 macrocytic anaemias (3.28%); 4 with folate deficiency; and 1 haemolytic anaemia. No haematological diseases were detected. Twenty-four (6.06%) cases exhibited microcytosis/hypochromia without anaemia, 12 of which exhibited iron deficiency. Four young women exhibiting within-limit haemoglobin levels had iron deficiency. There were 56 (14.1%) cases of macrocytosis without anaemia.With the new profile of 'initial study of anaemia', the demand for tests was reduced and was significantly lower than in the remainder of primary centres for iron, transferrin, ferritin, vitamin B12 and folate. CONCLUSIONS: A new profile of 'initial study of anaemia' in the request form with algorithms integrated in the laboratory information system enabled submission of orders and decreased the demand for unnecessary iron, transferrin, ferritin, vitamin B12 and folate tests.

Avaliação da segurança e viabilidade do protocolo de sentar-levantar observando os efeitos hemodinâmicos agudos em idosos hospitalizados / Assessment of the safety and feasibility of the sit-up protocol observing acute hemodynamic effects in hospitalized elderly

Introdução: o processo de envelhecimento associado à hospitalização prolongada gera diminuição de massa e de força muscular dos membros inferiores, sendo necessárias intervenções para minimizar esses efeitos deletérios, como o treinamento de sentar-levantar. Este treinamento utiliza o peso do próprio corpo e é um movimento essencial para a manutenção da independência funcional. As respostas cardiovasculares agudas estão relacionadas com a segurança desta atividade, por isso é imprescindível a monitorização constante. Objetivo: avaliar a segurança e a viabilidade da realização do protocolo de sentar-levantar, observando os efeitos hemodinâmicos agudos em idosos hospitalizados. Metodologia: em uma amostra composta de idosos com estabilidade clínica, realizou-se um protocolo de sentar-levantar progressivo, com oito níveis em apenas uma sessão. Avaliaram-se variáveis hemodinâmicas, como pressão arterial sistólica e diastólica, pressão arterial média, frequência cardíaca e duplo produto, em repouso e após 1 min, 10 min e 30 min, sendo analisados e comparados médias e desvio-padrão. Resultados: observou-se um leve aumento nas variáveis pressão arterial sistólica, na frequência cardíaca e duplo produto, com normalização nos minutos seguintes ao protocolo. A pressão arterial diastólica e a arterial média apresentaram uma discreta diminuição no decorrer das mensurações. Observaram-se poucos eventos adversos na amostra, os quais foram solucionados após o repouso. Houve significância estatística entre a maior parte das variáveis, porém não houve significância clínica. Conclusão: o protocolo de sentarlevantar é viável e seguro em idosos hospitalizados, desde que seja realizado de acordo com os critérios de elegibilidade e monitorados.

Introduction: the aging process associated with prolonged hospitalization generates a decrease in muscle mass and strength in the lower limbs, requiring interventions to minimize these harmful effects, such as sit-to-stand training. This training uses the body's own weight and is an essential movement for the maintenance of functional independence. Acute cardiovascular responses are related to the safety of this activity, so constant monitoring is essential. Objective: evaluate the safety and feasibility of performing the sit-to-stand protocol, observing the acute hemodynamic effects in hospitalized elderly. Methods: in a sample composed of elderly people with clinical stability, a progressive sit-to-stand protocol was performed, with eight levels in just one session. Hemodynamic variables were evaluated, such as systolic and diastolic blood pressure, mean arterial pressure, heart rate and double product, at rest and after 1 min, 10 min and 30 min, and means and standard deviations were analyzed and compared. Results: there was a slight increase in the variables systolic blood pressure, heart rate and double product, with normalization in the minutes following the protocol. Diastolic blood pressure and mean arterial pressure showed a slight decrease during the measurements. Few adverse events were observed in the sample, which were resolved after rest. There was statistical significance among most of the variables, but there was no clinical significance. Conclusion: the sit-to-stand protocol is feasible and safe in hospitalized elderly, as long as it is performed according to eligibility criteria and monitored.

Ultrasound Protocols to Assess Skeletal and Diaphragmatic Muscle in People Who Are Critically Ill: A Systematic Review.

This study aims to review published studies that use protocols and ultrasound measurements to evaluate skeletal and diaphragmatic muscles in patients who are critically ill. We searched for references on databases through September 2020 and included in our systematic review studies that used muscular ultrasound to assess skeletal or diaphragm muscles in patients who are critically ill. Seventy-six studies were included, 32 (1720 patients) using skeletal-muscle ultrasound and 44 (2946 patients) using diaphragmatic-muscle ultrasound, with a total of 4666 patients. The population is predominantly adult men. As for designs, most studies (n = 62) were cohort studies. B-mode B was dominant in the evaluations. Medium-to-high frequency bands were used in the analysis of peripheral muscles and medium-to-low frequency bands for diaphragmatic muscles. Evaluation of the echogenicity, muscle thickness and pennation angle of the muscle was also reported. These variables are important in the composition of the diagnosis of muscle loss. Studies demonstrate great variability in their protocols, and sparse description of the important variables that can directly interfere with the quality and validity of these measures. Therefore, a document is needed that standardizes these parameters for ultrasound assessment in patients who are critically ill.

Autonomia em procedimentos ventilatórios por fisioterapeutas que atuam em fisioterapia intensiva no estado da Bahia: um estudo transversal / Autonomy in ventilatory procedures by physiotherapists working in the intensive care in the state of Bahia: a cross-sectional study

| INTRODUÇÃO: A Unidade de Terapia Intensiva (UTI) é um local destinado ao suporte adequado para pacientes que requerem monitorização e cuidado constante. Neste ambiente o fisioterapeuta auxilia na manutenção de funções vitais e colabora para a redução de complicações clínicas e do índice de mortalidade. Além disso, dentro das suas áreas de domínio, o fisioterapeuta compartilha a responsabilidade do manejo de procedimentos ventilatórios que substituem a ventilação espontânea. OBJETIVO: Descrever a autonomia em procedimentos ventilatórios pelos fisioterapeutas que atuam em UTI no estado da Bahia. METODOLOGIA: Trata-se de um estudo transversal com fisioterapeutas que atuam em UTI no estado da Bahia, inscritos no Conselho Regional de Fisioterapia e Terapia Ocupacional da 7ª Região (CREFITO-7), utilizando um questionário eletrônico desenvolvido pelos pesquisadores. Os dados foram submetidos à análise estatística descritiva e multivariada. O nível de significância adotado foi de p < 0,05. O tratamento estatístico foi realizado utilizando-se o Statistical Package for the Social Sciences, versão 21.0 (SPSS Inc., Chicago, IL, EUA). RESULTADOS: Foram avaliados 265 fisioterapeutas que atuam em terapia intensiva no estado da Bahia, com média de idade de 32,4 ±5,4 anos, sendo 61,9% do sexo feminino. Em relação a autonomia profissional, 94,3% declararam que a tomada de decisão (sobre os procedimentos fisioterapêuticos na UTI em que atuam) é de responsabilidade do fisioterapeuta. O maior nível de autonomia sobre os procedimentos ventilatórios foi observado para a aplicação de Ventilação Mecânica Não Invasiva VNI (97,7%), seguido do desmame (97,4%), indicação (97%) e manutenção (96,2%). CONCLUSÃO: Através do presente estudo foi possível concluir que os fisioterapeutas que atuam em UTI no Estado da Bahia declaram possuir autonomia profissional em relação a procedimentos ventilatórios, sobretudo para os não invasivos.

INTRODUCTION: The Intensive Care Unit (ICU) is a ward intended to the specialized support to critically ill patients or after undergoing a highly complex procedure, who need constant monitoring and care. In this environment, the physiotherapist works to maintain vital functions and helps reduce clinical complications and mortality rates. Furthermore, within their domains, the physiotherapist shares the responsibility for managing methods that replace spontaneous breaths. OBJECTIVE: To describe the autonomy in ventilatory procedures by physiotherapists working in ICUs in the state of Bahia. METHODOLOGY: This is a cross-sectional study with physiotherapists working in ICUs in the state of Bahia, registered at the Regional Council of Physiotherapy and Occupational Therapy of the 7th Region (CREFITO-7). In data, collect was used an electronic questionnaire was developed by the researchers. The data collected was analyzed through descriptive and multivariate statistics. A p-value < 0.05 was set as statistically significant. Statistical analysis was performed with Statistical Package for the Social Sciences, 21.0 version (SPSS Inc., Chicago, IL, EUA). RESULTS: Were evaluated a total of two hundred and sixty-five (265) physiotherapists who work at an Intensive Care Unit in the state of Bahia, with a mean age of 32.4 ±5.4 years, being 61.9% female. Regarding professional autonomy, 94.3% declared that decision-making about physical therapy procedures in the ICU where they work is the responsibility of the physiotherapists. The highest level of autonomy over ventilatory procedures was observed for the application of non-invasive ventilation (97.7%), followed by weaning from mechanical ventilation (97.4%), indication (97%), and maintenance (96.2%). CONCLUSION: Through this study, it was possible to conclude that physiotherapists working in ICUs in the State of Bahia claim to have professional autonomy in relation to ventilatory procedures, especially for the non-invasive ones.

Atualização: Sarcopenia / Update: Sarcopenia

OBJETIVO: Fazer uma atualização da revisão de literatura sobre sarcopenia publicada em 2014 nesta revista. De acordo com o Consenso do Working Group on Sarcopenia in Older People (EWGSOP2), a sarcopenia foi redefinida como uma doença muscular, caracterizada pela redução da força muscular, associada à diminuição da qualidade/quantidade muscular e/ou desempenho físico, sendo classificada como primária, secundária, aguda e crônica. Além de consequências físicas como aumento da ocorrência de quedas e limitação para atividades cotidianas, pode promover alterações sistêmicas pelo desequilíbrio entre síntese e degradação proteica. A prevalência aumenta com a idade, sendo mais alta a partir de 60 anos. Estudos em seis países encontraram prevalência entre 4,6% e 22,1%, havendo oscilação de valores conforme definições utilizadas, métodos diagnósticos e os pontos de corte para índice de massa muscular (IMM). Como estratégia para refinar a detecção do risco da sarcopenia, o EWGSOP2 sugere aplicação do questionário SARC-F. Para mensuração da variável massa muscular, os métodos recomendados são Ressonância Magnética, Tomografia Computadorizada, Absorciometria de Raio-X de Dupla Energia, Bioimpedância Elétrica e Antropometria, existindo acurácias e custos variáveis entre eles. Na aferição da força muscular, a principal forma de mensuração é a força de preensão palmar. Já o desempenho físico pode ser quantificado através do teste de velocidade de marcha de quatro metros. As formas de tratamento são treino de exercícios de resistência progressiva e aeróbicos, além de uma nutrição adequada. O estilo de vida sedentário, obesidade e fragilidade são fatores desencadeantes de perda de massa e função muscular no ambiente clínico.

OBJECTIVES: To update on a sarcopenia literature review published in 2014 in this journal. According to the Working Group on Sarcopenia in Older People Consensus (EWGSOP2), sarcopenia was redefined as a muscular disease, characterized by muscular strength reduction, associated with a diminished muscular quantity and /or quality and /or low physical performance, being stratified as primary, secondary acute and chronic. Beyond physical consequences as a fall risk and daily activities, sarcopenia can promote a dysbalance between protein synthesis and degradation. Sarcopenia prevalence is higher with increasing age, especially after 60 years. Studies in six countries had found sarcopenia prevalence between 4.6% and 22.1%, but differences between definitions, diagnostic methods, and cutoff points to evaluate muscle mass and function are found. To improve sarcopenia risk detection, EWGSOP2 suggests the use of the SARC-F questionnaire. Muscle mass measurement recommended methods are Magnet Resonance Imaging, Computed Tomography, Double Energy X-Ray Absorptiometry, Electric Bioimpedance, and Anthropometry with variable accuracy and costs between these methods. To evaluate muscle strength, the handgrip strength test is the main method recommended. In addition, four Meter Gait speed is recommended to evaluate physical performance. Treatment options are progressive exercise, endurance training, and aerobic exercises, together with nutritional interventions. Sedentary lifestyle, obesity, and frailty are the main risks factors associated with muscle mass and function losses in the clinical setting

Avaliação da diferença na força muscular periférica entre admissão e alta em idosos hospitalizados / Evaluation of peripheral muscle strength alterations of elderlies admitted at an ICU

The measurement of peripheral muscle strength in the hospital environment directs rehabilitation and contributes to predicting mortality in the elderly. Objective: To evaluate the variation of muscle strength during hospitalization in hospitalized elderly. Methods: This is a retrospective longitudinal study with stable elderly admitted at an ICU of a large public hospital in Salvador, Bahia State, Brazil. Three measurements of handgrip strength (HGS) were performed, and the highest value was considered for analysis. Other variables collected were cognitive function (MMSE) and Charlson's comorbidity index (CCI). Student T-test was used to test the variation of HGS between admission and discharge. Results: The sample consisted of 80 elderlies with an average age of 68.1 ± 5.8 years, mostly male (77.5%) and with surgical profiles (92.5%). In the comparison between HGS at admission and discharge, no significant differences were found (29.8 ± 7.5 kgf; 30.0 ± 7.8 kgf; p-value= 0.698). However, different forms of variation were observed 36.2% of participants had an increase in HGS (27.8 ± 9.3 kgf to 32.3 ± 9.6 kgf), whereas 38, 7% had a loss of HGS (30.9 ± 6.7 kgf to 26.8 ± 6.9 kgf) between admission and discharge. Conclusion: There are different trajectories in HGS from admission to discharge in hospitalized elderly, and understanding the factors that favor these variations is important for the rehabilitation process.

A mensuração da força muscular periférica (FMP) no ambiente hospitalar direciona a reabilitação e contribui para predição da mortalidade dos idosos. Objetivo: Avaliar a variação da força muscular ao longo da internação em idosos hospitalizados. Métodos: Trata-se de um estudo longitudinal prospectivo, com idosos estáveis das enfermarias e UTI´s de um hospital de grande porte da rede pública estadual, em Salvador-BA. Foram realizadas 3 medidas de dinamometria de preensão palmar, sendo considerado para análise o maior valor. Outras variáveis coletadas foram a função cognitiva (MEEM) e índice de comorbidades de Charlson (ICC). Para comparação da variação da FPP entre a admissão e alta realizado o teste T de Student. Resultados: A amostra foi composta por 80 idosos com média de idade 68,1 ± 5,8 anos, majoritariamente do sexo masculino (77.5%) e com perfil cirúrgico (92,5%). Na comparação entre a FPP na admissão e alta não foram encontradas diferenças significativas (29,8±7,5 kgf; 30,0±7,8 kgf; valor de p= 0,698). Entretanto, observou-se formas distintas de variação ao longo da internação, sendo que 36,2% dos pacientes apresentaram aumento da FPP(27,8 ± 9,3 kgf para 32,3 ± 9,6 kgf), enquanto que 38,7% tiveram perda da FPP(30,9 ± 6,7 kgf para 26,8 ± 6,9 kgf) entre a admissão e a alta. Conclusão: Existem diferentes trajetórias da FMP desde admissão até a alta em idosos hospitalizados. Compreender quais são os fatores que favorecem essas variações é algo importante para o processo de reabilitação.

O group is a protective factor for COVID19 in Basque population.

ABO blood groups have recently been related to COVID19 infection. In the present work, we performed this analysis using data from 412 COVID19 patients and 17796 blood donors, all of them from Gipuzkoa, a region in Northern Spain. The results obtained confirmed this relation, in addition to showing a clear importance of group O as a protective factor in COVID19 disease, with an OR = 0.59 (CI95% 0.481-0.7177, p<0.0001) while A, B and AB are risk factors. ABO blood groups are slightly differently distributed in the populations and therefore these results should be replicated in the specific areas with a proper control population.

Effects of Exercise Interventions on Aerobic Capacity and Health-Related Quality of Life in People Living With HIV/AIDS: Systematic Review and Network Meta-Analysis.

OBJECTIVE: Exercise is a recommended component of care for people living with HIV/AIDS; however, it is unclear which type of exercise is most effective. The purpose of this study was to investigate the relative effects of different types of exercise interventions on aerobic capacity measured by peak oxygen consumption (peak VO2) and health-related quality of life (HRQoL) in this population. METHODS: For this systematic review and indirect-comparisons meta-analysis (network meta-analysis), different electronic databases were searched up to February 2020 for randomized controlled trials that evaluated the effects of different types of exercise interventions on peak VO2 and HRQoL of people living with HIV/AIDS. Mean differences, standardized mean difference (SMD), and 95% CI were calculated. Fixed- and random-effects Bayesian network meta-analysis were used to compare the relative effectiveness of the different exercise interventions. RESULTS: Forty studies met the study criteria, reporting on a total of 1518 patients. When comparing the exercise interventions with usual care (control group) for the peak VO2 outcome, combined aerobic and resistance exercise was the highest ranked exercise intervention with an SMD of 4.2 (95% CI = 2.5 to 5.9), followed by aerobic exercise (SMD = 3.1; 95% CI = 1.4 to 5.1). Compared with aerobic exercise, resistance training, and yoga, combined aerobic and resistance exercise was the best exercise intervention to promote improvement on physical function, general health, mental health, and energy/vitality domains HRQoL. CONCLUSION: The combined aerobic and resistance exercise was the highest ranked exercise intervention to improve peak VO2 and HRQoL. Combined aerobic and resistance exercise should be considered as a component of care for people living with HIV/AIDS.

Segurança e aplicação da plataforma vibratória em pacientes hospitalizados: uma revisão sistemática / Safety and application of the vibratory platform in hospitalized patients: a systematic review

Um curto período de hospitalização, se acompanhado de imobilidade, pode ser capaz de promover declínio das funções musculoesqueléticas, gerando impacto negativo na funcionalidade e qualidade de vida. Com isso, tem-se tornado cada vez mais comum a adoção de estratégias terapêuticas como o uso da plataforma vibratória (PV). OBJETIVO: Sistematizar evidências sobre a funcionalidade e a segurança da aplicação da PV em pacientes adultos hospitalizados. MÉTODOS: Revisão sistemática, registrada na PROSPERO com código CRD42019119672. Desenvolvida nas bases: LILACS, SciELO, MedLine/PubMed, EBSCOhost e PEDro. Descritores e palavras-chave: "Whole body vibration", "Intensive Care Units", "hospitalization", "muscle strenght", e "functional capacity". Incluídos estudos que analisaram os efeitos e a segurança da aplicação da PV em pacientes adultos hospitalizados. A qualidade metodológica foi avaliada através da escala Downs and Black. RESULTADOS: Incluídos 2 estudos, um ensaio clínico randomizado e outro estudo de intervenção controlado. A amostra variou entre 24 e 40 sujeitos, de ambos os sexos, média de idade 52±4 anos, com diagnóstico de DPOC e condições variadas. Houve uma melhora na distância percorrida no teste de caminhada de seis minutos e diminuição no tempo do teste de sentar e levantar, aumento dos níveis de irisina e melhora na qualidade de vida, em relação aos parâmetros dos sinais vitais não teve alterações significativas. O escore metodológico foi em média 16. CONCLUSÃO: Os resultados indicam que a PV parece ser viável e segura, podendo trazer efeitos favoráveis na funcionalidade para o tratamento em pacientes adultos hospitalizados, sendo uma alternativa para a reabilitação de forma precoce.

A short period of hospitalization, if accompanied by immobility, may be able to promote a decline in musculoskeletal functions, generating a negative impact on functionality and quality of life. As a result, the adoption of therapeutic strategies such as the use of the vibrating platform (PV) has become increasingly common. OBJECTIVE: To systematize evidence on the functionality and safety of the application of PV in hospitalized adult patients. METHODS: Systematic review, registered at PROSPERO with code CRD42019119672. Developed in the bases: LILACS, SciELO, MedLine / PubMed, EBSCOhost and PEDro. Keywords and keywords: "Whole body vibration", "Intensive Care Units", "hospitalization", "muscle strength", and "functional capacity". Included studies that analyzed the effects and safety of the application of PV in hospitalized adult patients. Methodological quality was assessed using the Downs and Black scale. RESULTS: Included 2 studies, a randomized clinical trial and another controlled intervention study. The sample varied between 24 and 40 subjects, of both sexes, mean age 52 ± 4 years, with a diagnosis of COPD and varied conditions. There was an improvement in the distance covered in the six-minute walk test and a decrease in the time of the sit and stand test, an increase in irisin levels and an improvement in quality of life, in relation to the vital signs parameters, there was no significant change. The methodological score was on average 16. CONCLUSION: The results indicate that PV seems to be viable and safe, and may have favorable effects on functionality for treatment in hospitalized adult patients, being an alternative for early rehabilitation.