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1.
Medicina (Kaunas) ; 57(3)2021 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-33803690

RESUMEN

The COVID-19 pandemic dramatically changed medical care. Healthcare professionals are faced with new issues. Patients who survived COVID-19 have plenty of different continuing symptoms, of which the most common are fatigue and breathlessness. It is not well known how to care for patients with persistent or worsening respiratory symptoms and changes on chest X-ray following COVID-19 pneumonia. In this article, we talk about a subgroup of patients with organizing pneumonia following COVID-19 pneumonia that could be effectively treated with systemic glucocorticoids. It is important that patients with COVID-19 pneumonia be followed-up at least three weeks after diagnosis, in order to recognize early lung damage. We are providing a management algorithm for early diagnosis of lung diseases after COVID-19 pneumonia.


Asunto(s)
/complicaciones , Enfermedades Pulmonares Intersticiales/diagnóstico , Algoritmos , Biopsia , /tratamiento farmacológico , Angiografía por Tomografía Computarizada , Manejo de la Enfermedad , Diagnóstico Precoz , Glucocorticoides/uso terapéutico , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/fisiopatología , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Enfermedades Pulmonares Intersticiales/etiología , Enfermedades Pulmonares Intersticiales/fisiopatología , Capacidad de Difusión Pulmonar , Espirometría , Tomografía Computarizada por Rayos X , Prueba de Paso
2.
Artículo en Inglés | MEDLINE | ID: mdl-33800094

RESUMEN

BACKGROUND: Severe COVID-19 infection often leads to impairments requiring pulmonary rehabilitation (PR) following the acute phase. Little is known about the efficacy of PR in these patients. We therefore compared post-COVID-19 patients (PG) referred to PR patients with other lung diseases (LG). METHODS: 99 PG were admitted to PR. In a prospective design, the results of PG were collected and compared to the results of LG of 2019 (n = 419) according to Functional Independence Measurement (FIM), Cumulative Illness Rating Scale (CIRS), 6-min walk test (6-MWT), duration of PR, and Feeling Thermometer (FT). RESULTS: According to age, sex, and CIRS, both groups showed no significant differences. The improvements in the 6-MWT in the pre to post comparison were on average 180 (±101) meters for PG and 102 (±89) meters for LG (p < 0.001). FT showed a significant enhancement for PG of 21 (±14) points and for LG of 17 (±16) points (p < 0.039), while FIM significantly increased by 11 (±10) points in PG and 7 (±8) points in LG (p < 0.001). CONCLUSIONS: Comprehensive PR in PG is very effective according to the results in FIM, 6-MWT and FT. Therefore, we recommend PR following severe post-COVID-19 infections.


Asunto(s)
Enfermedades Pulmonares , Humanos , Estudios Prospectivos , Resultado del Tratamiento , Prueba de Paso
3.
Sensors (Basel) ; 21(6)2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33809581

RESUMEN

Step counts and oxygen consumption have yet to be reported during the 2-min walk test (2MWT) test in persons with lower-limb amputations (LLA). The purpose of this study was to determine step counts and oxygen consumption during the 2MWT in LLA. Thirty-five men and women walked for two minutes as quickly as possible while wearing activity monitors (ActiGraph Link on the wrist (LW) and ankle (LA), Garmin vivofit®3 on the wrist (VW) and ankle (VA), and a modus StepWatch on the ankle (SA), and a portable oxygen analyzer. The StepWatch on the ankle (SA) and the vivofit3 on the wrist (VW) had the least error and best accuracy of the activity monitors studied. While there were no significant differences in distance walked, oxygen consumption (VO2) or heart rate (HR) between sexes or level of amputation (p > 0.05), females took significantly more steps than males (p = 0.034), and those with unilateral transfemoral amputations took significantly fewer steps than those with unilateral transtibial amputations (p = 0.023). The VW and SA provided the most accurate step counts among the activity monitors and were not significantly different than hand counts. Oxygen consumption for all participants during the 2MWT was 8.9 ± 2.9 mL/kg/min, which is lower than moderate-intensity activity. While some may argue that steady-state activity has not yet been reached in the 2MWT, it may also be possible participants are not walking as fast as they can, thereby misclassifying their performance to a lower standard.


Asunto(s)
Amputación , Caminata , Femenino , Humanos , Extremidad Inferior/cirugía , Masculino , Consumo de Oxígeno , Tecnología , Prueba de Paso
4.
JAMA ; 325(13): 1266-1276, 2021 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-33821898

RESUMEN

Importance: Supervised high-intensity walking exercise that induces ischemic leg symptoms is the first-line therapy for people with lower-extremity peripheral artery disease (PAD), but adherence is poor. Objective: To determine whether low-intensity home-based walking exercise at a comfortable pace significantly improves walking ability in people with PAD vs high-intensity home-based walking exercise that induces ischemic leg symptoms and vs a nonexercise control. Design, Setting, and Participants: Multicenter randomized clinical trial conducted at 4 US centers and including 305 participants. Enrollment occurred between September 25, 2015, and December 11, 2019; final follow-up was October 7, 2020. Interventions: Participants with PAD were randomized to low-intensity walking exercise (n = 116), high-intensity walking exercise (n = 124), or nonexercise control (n = 65) for 12 months. Both exercise groups were asked to walk for exercise in an unsupervised setting 5 times per week for up to 50 minutes per session wearing an accelerometer to document exercise intensity and time. The low-intensity group walked at a pace without ischemic leg symptoms. The high-intensity group walked at a pace eliciting moderate to severe ischemic leg symptoms. Accelerometer data were viewable to a coach who telephoned participants weekly for 12 months and helped them adhere to their prescribed exercise. The nonexercise control group received weekly educational telephone calls for 12 months. Main Outcomes and Measures: The primary outcome was mean change in 6-minute walk distance at 12 months (minimum clinically important difference, 8-20 m). Results: Among 305 randomized patients (mean age, 69.3 [SD, 9.5] years, 146 [47.9%] women, 181 [59.3%] Black patients), 250 (82%) completed 12-month follow-up. The 6-minute walk distance changed from 332.1 m at baseline to 327.5 m at 12-month follow-up in the low-intensity exercise group (within-group mean change, -6.4 m [95% CI, -21.5 to 8.8 m]; P = .34) and from 338.1 m to 371.2 m in the high-intensity exercise group (within-group mean change, 34.5 m [95% CI, 20.1 to 48.9 m]; P < .001) and the mean change for the between-group comparison was -40.9 m (97.5% CI, -61.7 to -20.0 m; P < .001). The 6-minute walk distance changed from 328.1 m at baseline to 317.5 m at 12-month follow-up in the nonexercise control group (within-group mean change, -15.1 m [95% CI, -35.8 to 5.7 m]; P = .10), which was not significantly different from the change in the low-intensity exercise group (between-group mean change, 8.7 m [97.5% CI, -17.0 to 34.4 m]; P = .44). Of 184 serious adverse events, the event rate per participant was 0.64 in the low-intensity group, 0.65 in the high-intensity group, and 0.46 in the nonexercise control group. One serious adverse event in each exercise group was related to study participation. Conclusions and Relevance: Among patients with PAD, low-intensity home-based exercise was significantly less effective than high-intensity home-based exercise and was not significantly different from the nonexercise control for improving 6-minute walk distance. These results do not support the use of low-intensity home-based walking exercise for improving objectively measured walking performance in patients with PAD. Trial Registration: ClinicalTrials.gov Identifier: NCT02538900.


Asunto(s)
Terapia por Ejercicio/métodos , Enfermedad Arterial Periférica/terapia , Caminata , Anciano , Biopsia , Femenino , Humanos , Isquemia/terapia , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/patología , Masculino , Músculo Esquelético/patología , Enfermedad Arterial Periférica/patología , Enfermedad Arterial Periférica/fisiopatología , Prueba de Paso
5.
Artículo en Inglés | MEDLINE | ID: mdl-33802300

RESUMEN

Cardiorespiratory fitness (CRF) provides oxygen to the exercising muscles and is related to body adiposity, with cardiometabolic variables. The aim was to develop reference values and a predictive model of CRF in Chilean adolescents. A total of 741 adolescents of both genders (15.7 years old) participated in a basic anthropometry, performance in the six-minute walk test (SMWT), and in Course Navette was measured. Percentiles were determined for the SMWT, for the V̇O2max, and an equation was developed to estimate it. The validity of the equation was checked using distribution assumptions and the Bland-Altman diagram. The STATA v.14 program was used (p < 0.05). The 50th percentile values for males and females in the SMWT and in the V̇O2max of Course Navette were, respectively, from 607 to 690 and from 630 to 641 m, and from 43.9 to 45 and from 37.5 to 31.5 mlO2·kg·min-1, for the range of 13 to 17 years. For its part, the model to predict V̇O2max incorporated gender, heart rate, height, waist-to-height ratio (WHR), and distance in the SMWT (R2 = 0.62; estimation error = 0.38 LO2·min-1; p <0.001). Reference values can guide physical fitness in Chilean adolescents, and V̇O2max was possible to predict from morphofunctional variables.


Asunto(s)
Capacidad Cardiovascular , Adolescente , Chile , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Consumo de Oxígeno , Aptitud Física , Prueba de Paso
6.
Artículo en Inglés | MEDLINE | ID: mdl-33807611

RESUMEN

The six-minute walk test (6MWT) is a widely used test for the indirect measurement of cardiorespiratory fitness in various cancer populations. Although the 6MWT is a simple test, there are no normative values for breast cancer survivors (BCS) or comparisons of results with healthy counterparts. A systematic review with a meta-analysis was carried out, which included studies from 2007 to 2020. Ninety-one studies were found, 21 of which were included in the quantitative synthesis. Among them were 9 randomized controlled trials (RCT), 8 prospective cohort studies and 4 cross-sectional studies. A total of 1084 BCS were included. Our results revealed that healthy subjects (n = 878) covered a significantly greater distance than BCS during the 6MWT (589.9 m vs. 477.4 m, p < 0.001), and the results of the meta-regression analysis showed that the 6MWD was predicted by the participants' BMI (p < 0.001), but not by their age (p = 0.070). After adjustment for BMI, the healthy subjects also covered greater distances than the BCS (103 m; p < 0.001). The normative values of 6MWT were presented for BCS. Besides, 6MWT distances distinguish between their healthy counterparts, therefore, the 6MWT distance is a relevant parameter for the assessment and monitoring of cardiorespiratory fitness in medical and exercise interventions for BCS.


Asunto(s)
Neoplasias de la Mama , Supervivientes de Cáncer , Capacidad Cardiovascular , Prueba de Esfuerzo , Humanos , Sobrevivientes , Prueba de Paso , Caminata
7.
Medicine (Baltimore) ; 100(15): e23736, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847606

RESUMEN

BACKGROUND: Shenfu Injection (SFI) is a promising alternative treatment for heart failure (HF) in China. Many complete clinical trials have examined the efficacy of SFI combined use with conventional treatment (CT) vs CT alone. This study is to conduct a systematic review and meta-analysis of randomized clinical trials to evaluate the benefits and risks of using SFI in addition to CT for the treatment of HF. METHOD: All the trials will be searched through 4 English databases (MEDLINE via PubMed, the Cochrane Library, EMBASE, Web of Science) and 4 Chinese databases (the China Science and Technology Journal Database, Chinese Biomedical Literature Database, Wan-fang Database, the China National Knowledge Infrastructure.) from October 2005 to June 2019. Conference articles or articles with incomplete data will be removed. The primary outcome was the New York Heart Association, 6-minute walk test, hospitalization or rehospitalization. Left ventricular ejection fraction percentage, left ventricular end-diastolic dimension, Cardiac index, heart rate, N-terminal pronatriuretic peptide and other indicators were also assessed. RevMan V.5.3 Software and Stata 13.0 Statistics Software were used to calculate the data synthesis and conduct meta-analysis according to the guideline of Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols 2015. RESULTS: Mortality, New York Heart Association function classification, heart rate, 6-minute walk test, hospitalization or rehospitalization, Heart rate, systolic blood pressure, DBP, Cardiac minute volume, left ventricular ejection fractions percentage, left ventricular end-diastolic dimension (mm), N-terminal pronatriuretic peptide, etc. and adverse effects will be comprehensively assessed to evaluate the adjunctive effect of SFI through different aspects. We will perform a meta-analysis of each outcome with subgroup analysis based on the type of HF, treatment methods, and course of disease. Sensitivity analysis will be conducted with clinical factors, treatment methods, methodological characteristics, and statistical heterogeneity (if applicable). CONCLUSION: This study will assess the adjunctive effect of SFI and its safety on HF with clinical evidence. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020151856.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Gasto Cardíaco , Terapia Combinada , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/efectos adversos , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Hospitalización/estadística & datos numéricos , Humanos , Inyecciones , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Índice de Severidad de la Enfermedad , Prueba de Paso
8.
Rev Bras Ter Intensiva ; 33(1): 167-171, 2021.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33886866

RESUMEN

The natural history of the disease, and the treatment of post-COVID-19 patients, are still being built. Symptoms are persistent, even in mild cases, and the infection consequences include fatigue, dyspnea, tachycardia, muscle loss, and reduced functional capacity. Regarding cardiopulmonary rehabilitation, there seems to be an improvement in functional capacity, quality of life, and prognosis with the 6-Minute Walk Test used as a prognostic and therapeutic evaluator. Therefore, this case series report aims to present our experience with four cases of different severity levels, involved in a post-COVID-19 cardiopulmonary rehabilitation program. These patients were assessed with the 6-Minute Walk Test, peripheral muscle strength, and double product at rest, to assess the results after a three-month rehabilitation protocol of at least 300 minutes per week. The four patients had their distance covered during the walk test increased between 16% and 94%. Peripheral muscle strength was improved by 20% to six times the baseline values, and double product at rest was reduced by 8% to 42%. The cardiopulmonary rehabilitation program had a positive impact on these cases, improving functional capacity despite the different severity levels in these post-COVID-19 cases.


Asunto(s)
/rehabilitación , Rehabilitación Cardiaca/métodos , Disnea/rehabilitación , Fatiga/rehabilitación , Fuerza Muscular , Prueba de Paso , Adulto , Anciano , Ejercicios Respiratorios/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Respiratoria/métodos
9.
Medicine (Baltimore) ; 100(16): e25655, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33879749

RESUMEN

OBJECTIVE: It remains unclear whether Tai Chi is effective for walking function and posture control improvements in aged populations with knee osteoarthritis. The aim of this study was to systematically evaluate the effects of Tai Chi on improving walking function and posture control in elderly patients with knee osteoarthritis by updating the latest trial evidence. METHODS: Web of Science, PubMed/Medline, Embase, Scopus, PEDro, and Cochrane library were searched up to October 1, 2020 to identify RCTs evaluating Tai Chi for improving walking function and posture control in older adults with knee osteoarthritis. The primary outcomes were walking function and posture control. Meta-analysis was performed with RevMan Version 5.3 software. RESULTS: A total of 603 participants with knee osteoarthritis in the 11 trials were included. The results of meta-analysis showed that: The Tai Chi group was associated with better performance in 6-minute walk test (6 MWT), time up and go test (TUG) and "Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index" Physical Function Score than the control group ([MD: 46.67, 95% CI 36.91-56.43, P < .001]), ([MD: -0.89, 95% CI -1.16 to -0.61, P < .001]), ([MD: -11.28, 95% CI -13.33 to -9.24, P < .001]). CONCLUSION: This meta-analysis provided evidence from 11 RCTs that Tai Chi could be an excellent physical training strategy for improving walking function and posture control in older adults with knee osteoarthritis. Assuming that Tai Chi is at least effective and safe in most areas, it can be used as an adjuvant and reliable physical training strategy for walking function upgrading and balance control improvements for older patients with knee osteoarthritis.


Asunto(s)
Osteoartritis de la Rodilla/rehabilitación , Equilibrio Postural , Tai Ji/métodos , Caminata , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Rendimiento Físico Funcional , Índice de Severidad de la Enfermedad , Estudios de Tiempo y Movimiento , Resultado del Tratamiento , Prueba de Paso
10.
Sensors (Basel) ; 21(9)2021 Apr 28.
Artículo en Inglés | MEDLINE | ID: mdl-33925075

RESUMEN

BACKGROUND: Walking disorders represent the most disabling condition in persons with Multiple Sclerosis (PwMS). Several studies showed good reliability of the 6-min walk test (6MWT) (i.e., especially distance traveled), but little is known about the reliability of the Spatio-temporal (ST) variables in the 6MWT. OBJECTIVE: To evaluate the test-retest reliability of ST variables and perceived exertion during the 6MWT in PwMS and comparable healthy persons. METHODS: We explored three 1-min intervals (initial: 0'-1', middle: 2'30″-3'30″, end: 5'-6') of the 6MWT. Six ST variables and perceived exertion were measured (respectively, using the GAITRite system and the Borg Scale). These measurements were performed twice, 1 week apart. The test-retest effects were assessed using the intraclass correlation coefficient (ICC) or the weighted kappa. RESULTS: Forty-five PwMS and 24 healthy persons were included. The test-retest reliability of ST variables values was good-to-excellent for PwMS (ICC range: 0.858-0.919) and moderate-to-excellent for healthy persons (ICC range: 0.569-0.946). The test-retest reliability values of perceived exertion were fair for PwMS (weighted kappa range: 0.279-0.376) and substantial for healthy persons (weighted kappa range: 0.734-0.788). CONCLUSION: The measurement of ST variables during these 6MWT intervals is reliable and applicable in clinical practice and research to adapt rehabilitation care in PwMS.


Asunto(s)
Personas con Discapacidad , Esclerosis Múltiple , Prueba de Esfuerzo , Humanos , Esclerosis Múltiple/diagnóstico , Reproducibilidad de los Resultados , Prueba de Paso , Caminata
11.
BMC Pulm Med ; 21(1): 136, 2021 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-33902513

RESUMEN

BACKGROUND: All over the world, SARS-CoV-2 pneumonia is causing a significant short-term morbidity and mortality, but the medium-term impact on lung function and quality of life of affected patients are still unknown. METHODS: In this prospective observational study, 39 patients with SARS-CoV-2 pneumonia were recruited from a single COVID-19 hospital in Southern Switzerland. At three months patients underwent radiological and functional follow-up through CT scan, lung function tests, and 6 min walking test. Furthermore, quality of life was assessed through self-reported questionnaires. RESULTS: Among 39 patients with SARS-CoV-2 pneumonia, 32 (82% of all participants) presented abnormalities in CT scan and 25 (64.1%) had lung function tests impairment at three months. Moreover, 31 patients (79.5%) reported a perception of poor health due to respiratory symptoms and all 39 patients showed an overall decreased quality of life. CONCLUSIONS: Medium-term follow up at three months of patients diagnosed with SARS-CoV-2 pneumonia shows the persistence of abnormalities in CT scans, a significant functional impairment assessed by lung function tests and a decreased quality of life in affected patients. Further studies evaluating the long-term impact are warranted to guarantee an appropriate follow-up to patients recovering from SARS-CoV-2 pneumonia.


Asunto(s)
/fisiopatología , Pulmón/fisiopatología , Calidad de Vida , Anciano , Convalecencia , Femenino , Volumen Espiratorio Forzado , Estado de Salud , Humanos , Tiempo de Internación , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Capacidad de Difusión Pulmonar , Recuperación de la Función , Pruebas de Función Respiratoria , Suiza , Tomografía Computarizada por Rayos X , Capacidad Vital , Prueba de Paso
12.
Cochrane Database Syst Rev ; 3: CD004434, 2021 03 26.
Artículo en Inglés | MEDLINE | ID: mdl-33765691

RESUMEN

BACKGROUND: Pulmonary arterial hypertension is a devastating disease that leads to right heart failure and premature death. Endothelin receptor antagonists have shown efficacy in the treatment of pulmonary arterial hypertension. OBJECTIVES: To evaluate the efficacy of endothelin receptor antagonists (ERAs) in pulmonary arterial hypertension. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and the reference sections of retrieved articles. The searches are current as of 4 November 2020. SELECTION CRITERIA: We included randomised trials and quasi-randomised trials involving participants with pulmonary arterial hypertension. DATA COLLECTION AND ANALYSIS: Two of five review authors selected studies, extracted data and assessed study quality according to established criteria. We used standard methods expected by Cochrane. The primary outcomes were exercise capacity (six-minute walk distance, 6MWD), World Health Organization (WHO) or New York Heart Association (NYHA) functional class, Borg dyspnoea scores and dyspnoea-fatigue ratings, and mortality. MAIN RESULTS: We included 17 randomised controlled trials involving a total of 3322 participants. Most trials were of relatively short duration (12 weeks to six months). Sixteen trials were placebo-controlled, and of these nine investigated a non-selective ERA and seven a selective ERA.   We evaluated two comparisons in the review: ERA versus placebo and ERA versus phosphodiesterase type 5 (PDE5) inhibitor. The abstract focuses on the placebo-controlled trials only and presents the pooled results of selective and non-selective ERAs. After treatment, participants receiving ERAs could probably walk on average 25.06 m (95% confidence interval (CI) 17.13 to 32.99 m; 2739 participants; 14 studies; I2 = 34%, moderate-certainty evidence) further than those receiving placebo in a 6MWD. Endothelin receptor antagonists probably improved more participants' WHO functional class (odds ratio (OR) 1.41, 95% CI 1.16 to 1.70; participants = 3060; studies = 15; I2 = 5%, moderate-certainty evidence) and probably lowered the odds of functional class deterioration (OR 0.43, 95% CI 0.26 to 0.72; participants = 2347; studies = 13; I2 = 40%, moderate-certainty evidence) compared with placebo. There may be a reduction in mortality with ERAs (OR 0.78, 95% CI 0.58, 1.07; 2889 participants; 12 studies; I2 = 0%, low-certainty evidence), and pooled data suggest that ERAs probably improve cardiopulmonary haemodynamics and may reduce Borg dyspnoea score in symptomatic patients. Hepatic toxicity was not common, but may be increased by ERA treatment from 37 to 67 (95% CI 34 to 130) per 1000 over 25 weeks of treatment (OR 1.88, 95% CI 0.91 to 3.90; moderate-certainty evidence). Although ERAs were well tolerated in this population, several cases of irreversible liver failure caused by sitaxsentan have been reported, which led the licence holder for sitaxsentan to withdraw the product from all markets worldwide.  As planned, we performed subgroup analyses comparing selective and non-selective ERAs, and with the exception of mean pulmonary artery pressure, did not detect any clear subgroup differences for any outcome. AUTHORS' CONCLUSIONS: For people with pulmonary arterial hypertension with WHO functional class II and III, endothelin receptor antagonists probably increase exercise capacity, improve WHO functional class, prevent WHO functional class deterioration, result in favourable changes in cardiopulmonary haemodynamic variables compared with placebo. However, they are less effective in reducing dyspnoea and mortality. The efficacy data were strongest in those with idiopathic pulmonary hypertension. The irreversible liver failure caused by sitaxsentan and its withdrawal from global markets emphasise the importance of hepatic monitoring in people treated with ERAs. The question of the effects of ERAs on pulmonary arterial hypertension has now likely been answered.. The combined use of ERAs and phosphodiesterase inhibitors may provide more benefit in pulmonary arterial hypertension; however, this needs to be confirmed in future studies.


Asunto(s)
Antihipertensivos/uso terapéutico , Antagonistas de los Receptores de Endotelina/uso terapéutico , Hipertensión Pulmonar/tratamiento farmacológico , Sesgo , Humanos , Hipertensión Pulmonar/mortalidad , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Prueba de Paso
13.
Artículo en Inglés | MEDLINE | ID: mdl-33668304

RESUMEN

This study investigated an alternative home-based cardiac telerehabilitation model in consideration of the recommendations for the COVID-19 quarantine of people diagnosed with coronary heart disease (CHD). We hypothesized that using a 200 m fast walking test (200 mFWT) and telerehabilitation would create an effective alternative cardiac rehabilitation (CR) intervention that could improve cardiorespiratory fitness. Participants (n = 19, mean age 60.4 ± 9.6) of the 8-week intervention performed regular physical exercise at the target heart rate zone determined by calculations based on the 200 mFWT results. In our study, the participants were supervised using telerehabilitation. A total of 84% of participants completed the 8-week intervention. No adverse events were reported during telerehabilitation. The study participants noted a significant improvement (p < 0.001) in cardiorespiratory fitness expressed by an 8% reduction in the walking test time (Δ 8.8 ± 5.9 s). Home-based telerehabilitation based on 200 mFWT effectively increased the cardiorespiratory fitness in people with CHD with a low to moderate cardiovascular risk. This was a novel approach in CR during the COVID-19 pandemic. As research in this area is justified, this paper may serve as an alternative method of providing healthcare during the COVID-19 pandemic and as a basis for further upcoming randomized controlled trials.


Asunto(s)
Rehabilitación Cardiaca , Capacidad Cardiovascular , Enfermedad Coronaria/rehabilitación , Telerrehabilitación , Anciano , Terapia por Ejercicio , Humanos , Persona de Mediana Edad , Pandemias , Prueba de Paso
14.
N Engl J Med ; 384(13): 1204-1215, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33789009

RESUMEN

BACKGROUND: Pulmonary arterial hypertension is characterized by pulmonary vascular remodeling, cellular proliferation, and poor long-term outcomes. Dysfunctional bone morphogenetic protein pathway signaling is associated with both hereditary and idiopathic subtypes. Sotatercept, a novel fusion protein, binds activins and growth differentiation factors in the attempt to restore balance between growth-promoting and growth-inhibiting signaling pathways. METHODS: In this 24-week multicenter trial, we randomly assigned 106 adults who were receiving background therapy for pulmonary arterial hypertension to receive subcutaneous sotatercept at a dose of 0.3 mg per kilogram of body weight every 3 weeks or 0.7 mg per kilogram every 3 weeks or placebo. The primary end point was the change from baseline to week 24 in pulmonary vascular resistance. RESULTS: Baseline characteristics were similar among the three groups. The least-squares mean difference between the sotatercept 0.3-mg group and the placebo group in the change from baseline to week 24 in pulmonary vascular resistance was -145.8 dyn · sec · cm-5 (95% confidence interval [CI], -241.0 to -50.6; P = 0.003). The least-squares mean difference between the sotatercept 0.7-mg group and the placebo group was -239.5 dyn · sec · cm-5 (95% CI, -329.3 to -149.7; P<0.001). At 24 weeks, the least-squares mean difference between the sotatercept 0.3-mg group and the placebo group in the change from baseline in 6-minute walk distance was 29.4 m (95% CI, 3.8 to 55.0). The least-squares mean difference between the sotatercept 0.7-mg group and the placebo group was 21.4 m (95% CI, -2.8 to 45.7). Sotatercept was also associated with a decrease in N-terminal pro-B-type natriuretic peptide levels. Thrombocytopenia and an increased hemoglobin level were the most common hematologic adverse events. One patient in the sotatercept 0.7-mg group died from cardiac arrest. CONCLUSIONS: Treatment with sotatercept resulted in a reduction in pulmonary vascular resistance in patients receiving background therapy for pulmonary arterial hypertension. (Funded by Acceleron Pharma; PULSAR ClinicalTrials.gov number, NCT03496207.).


Asunto(s)
Hipertensión Arterial Pulmonar/tratamiento farmacológico , Proteínas Recombinantes de Fusión/uso terapéutico , Factor de Crecimiento Transformador beta/antagonistas & inhibidores , Resistencia Vascular/efectos de los fármacos , Adulto , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Tolerancia al Ejercicio/efectos de los fármacos , Femenino , Humanos , Inyecciones Subcutáneas , Análisis de los Mínimos Cuadrados , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Hipertensión Arterial Pulmonar/sangre , Hipertensión Arterial Pulmonar/fisiopatología , Proteínas Recombinantes de Fusión/efectos adversos , Proteínas Recombinantes de Fusión/farmacología , Trombocitopenia/inducido químicamente , Prueba de Paso
15.
Respir Physiol Neurobiol ; 288: 103644, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33647535

RESUMEN

The purpose of this study was to examine the physiological mechanisms of persistent dyspnoea in COVID-19 survivors. Non-critical patients (n = 186) with varying degrees of COVID-19 severity reported persistent symptoms using a standardized questionnaire and underwent pulmonary function and 6-minute walk testing between 30 and 90 days following the onset of acute COVID-19 symptoms. Patients were divided into those with (n = 70) and without (n = 116) persistent dyspnoea. Patients with persistent dyspnoea had significantly lower FVC (p = 0.03), FEV1 (p = 0.04), DLCO (p = 0.01), 6-minute walk distance (% predicted, p = 0.03), and end-exercise oxygen saturation (p < 0.001), and higher Borg 0-10 ratings of dyspnoea and fatigue (both p < 0.001) compared to patients without persistent dyspnoea. We have shown that dyspnoea is a common persistent symptom across varying degrees of initial COVID-19 severity. Patients with persistent dyspnoea had greater restriction on spirometry, lower DLCO, reduced functional capacity, and increased exertional desaturation and symptoms. This suggests that there is a true physiological mechanism that may explain persistent dyspnoea after COVID-19.


Asunto(s)
/complicaciones , Disnea/fisiopatología , Tolerancia al Ejercicio , Fatiga/fisiopatología , Intercambio Gaseoso Pulmonar , Espirometría , Adulto , Anciano , Enfermedad Crónica , Disnea/sangre , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad , Sobrevivientes , Capacidad Vital , Prueba de Paso
16.
Respir Physiol Neurobiol ; 287: 103639, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33588090

RESUMEN

INTRODUCTION: Some COVID-19 patients develop respiratory failure requiring admission to intensive care unit (ICU). We aim to evaluate the effects of pulmonary rehabilitation (PR) post-ICU in COVID-19 patients. METHODS: Twenty-one COVID-19 patients were evaluated pre- and post-PR and compared retrospectively to a non-COVID-19 group of 21 patients rehabilitated after ICU admission due to respiratory failure. RESULTS: PR induced greater 6-min walking distance improvement in COVID-19 patients (+205 ± 121 m) than in other respiratory failure patients post-ICU (+93 ± 66 m). The sooner PR was performed post-ICU, the better patients recovered. CONCLUSIONS: PR induced large functional improvements in COVID-19 patients post-ICU although significant physical and psychosocial impairments remained post-PR.


Asunto(s)
Ejercicios Respiratorios , /rehabilitación , Terapia por Ejercicio , Recuperación de la Función , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/rehabilitación , Anciano , Anciano de 80 o más Años , Cuidados Críticos , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Prueba de Paso
17.
Neurology ; 96(12): e1595-e1607, 2021 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-33597289

RESUMEN

OBJECTIVE: To assess long-term (2 years) effects of bimagrumab in participants with sporadic inclusion body myositis (sIBM). METHODS: Participants (aged 36-85 years) who completed the core study (RESILIENT [Efficacy and Safety of Bimagrumab/BYM338 at 52 Weeks on Physical Function, Muscle Strength, Mobility in sIBM Patients]) were invited to join an extension study. Individuals continued on the same treatment as in the core study (10 mg/kg, 3 mg/kg, 1 mg/kg bimagrumab or matching placebo administered as IV infusions every 4 weeks). The co-primary outcome measures were 6-minute walk distance (6MWD) and safety. RESULTS: Between November 2015 and February 2017, 211 participants entered double-blind placebo-controlled period of the extension study. Mean change in 6MWD from baseline was highly variable across treatment groups, but indicated progressive deterioration from weeks 24-104 in all treatment groups. Overall, 91.0% (n = 142) of participants in the pooled bimagrumab group and 89.1% (n = 49) in the placebo group had ≥1 treatment-emergent adverse event (AE). Falls were slightly higher in the bimagrumab 3 mg/kg group vs 10 mg/kg, 1 mg/kg, and placebo groups (69.2% [n = 36 of 52] vs 56.6% [n = 30 of 53], 58.8% [n = 30 of 51], and 61.8% [n = 34 of 55], respectively). The most frequently reported AEs in the pooled bimagrumab group were diarrhea 14.7% (n = 23), involuntary muscle contractions 9.6% (n = 15), and rash 5.1% (n = 8). Incidence of serious AEs was comparable between the pooled bimagrumab and the placebo group (18.6% [n = 29] vs 14.5% [n = 8], respectively). CONCLUSION: Extended treatment with bimagrumab up to 2 years produced a good safety profile and was well-tolerated, but did not provide clinical benefits in terms of improvement in mobility. The extension study was terminated early due to core study not meeting its primary endpoint. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02573467. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with sIBM, long-term treatment with bimagrumab was safe, well-tolerated, and did not provide meaningful functional benefit. The study is rated Class IV because of the open-label design of extension treatment period 2.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Miositis por Cuerpos de Inclusión/tratamiento farmacológico , Accidentes por Caídas , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular/efectos de los fármacos , Miositis por Cuerpos de Inclusión/complicaciones , Tiempo , Resultado del Tratamiento , Prueba de Paso
18.
Medicine (Baltimore) ; 100(5): e23188, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592818

RESUMEN

ABSTRACT: To explore the short-term effect of high-dose spironolactone (80 mg/d) on chronic congestive heart failure (CHF).The general clinical data of 211 patients with CHF from February 2016 to August 2019 were collected and analyzed. Patients were divided into Low-dose group (taking 40 mg/d spironolactone) and High-dose group (taking 80 mg/d spironolactone) according to the patient's previous dose of spironolactone. The changes of B-type brain natriuretic peptide (BNP), NT-pro BNP (N terminal pro B type natriuretic peptide), echocardiography, 6-minute walking test (6MWT), and comprehensive cardiac function assessment data were collected for analysis.Compared with before treatment, the blood potassium of the two groups increased significantly (P < .05), but the blood potassium did not exceed the normal range. Compared with before treatment, BNP, NT-pro BNP, LVEDD, LVEDV and NYHA grading were significantly decreased (P < .05), LVEF and 6-MWT were significantly increased (P < .05). Compared with the Low-dose group, the high-dose group BNP (117.49 ±â€Š50.32 vs 195.76 ±â€Š64.62, P < .05), NT-pro BNP (312.47 ±â€Š86.28 vs 578.47 ±â€Š76.73, P < .05), LVEDD (45.57 ±â€Š5.69 vs 51.96 ±â€Š5.41, P <.05), LVEDV (141.63 ±â€Š51.14 vs 189.85 ±â€Š62.49, P < .05) and NYHA grading (1.29 ±â€Š0.41 vs 1.57 ±â€Š0.49, P < .05) were significantly reduced, but, 6-MWT (386.57 ±â€Š69.72 vs 341.73 ±â€Š78.62, P < .05), LVEF (41.62 ±â€Š2.76 vs 36.02 ±â€Š2.18, P < .05) and total effective rate (92.68% vs 81.39%, P < .05) increased significantly.Compared with 40 mg spironolactone, 80 mg spironolactone can rapidly reduce BNP and NT-pro BNP concentration, enhance exercise tolerance, improve clinical signs and cardiac function classification, and has better efficacy.


Asunto(s)
Insuficiencia Cardíaca/tratamiento farmacológico , Espironolactona/uso terapéutico , Anciano , Relación Dosis-Respuesta a Droga , Ecocardiografía , Femenino , Pruebas de Función Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Potasio/sangre , Estudios Retrospectivos , Espironolactona/administración & dosificación , Prueba de Paso
19.
Am J Cardiol ; 144: 26-32, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33385348

RESUMEN

Extracorporeal shockwave myocardial revascularization (ESMR) is a therapy for refractory angina pectoris. Our aim was to assess the efficacy and safety of ESMR in the management of patients with stable coronary artery disease (CAD) and heart failure as well as its effects on inflammation and angiogenesis. In this single-arm prospective trial, we included 48 patients with CAD, myocardial ischemia assessed by radionuclide imaging, echocardiographic evidence of left ventricular systolic dysfunction and without revascularization options. Changes in angina grading score, myocardial perfusion, left ventricular ejection fraction, and six-minute walk test after ESMR therapy were used for efficacy assessment. Changes of inflammation and angiogenesis biomarkers were also evaluated. ESMR therapy was performed using a commercially available cardiac shockwave generator system (Cardiospec; Medispec). After 9 weeks of ESMR therapy, a significant improvement was found regarding the initial angina class, severity of ischemia, left ventricular ejection fraction, and six-minute walk test in most patients. No deleterious side effects after treatment were detected. Regarding biomarkers, endothelial progenitor cells and angiopoietin-3 were significantly increased whereas IL-18 and TGF-ß were significantly decreased after ESMR in the total group. Notably, VEGF, IL-1ß, and lipoxin A4 levels were significantly increased only in patients with myocardial ischemia improvement. In conclusion, ESMR therapy is safe and effective in most but not all patients with CAD and heart failure. ESMR is associated with increased markers of angiogenesis and decreased markers of inflammation. Myocardial ischemia improvement after ESMR is associated with increased markers of angiogenesis and pro-resolving mediators.


Asunto(s)
Angina de Pecho/terapia , Enfermedad de la Arteria Coronaria/terapia , Tratamiento con Ondas de Choque Extracorpóreas/métodos , Insuficiencia Cardíaca/fisiopatología , Revascularización Miocárdica/métodos , Disfunción Ventricular Izquierda/fisiopatología , Anciano , Angina de Pecho/complicaciones , Angina de Pecho/diagnóstico por imagen , Angina de Pecho/metabolismo , Proteínas Similares a la Angiopoyetina/metabolismo , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/metabolismo , Citocinas/metabolismo , Células Progenitoras Endoteliales , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/metabolismo , Humanos , Interleucina-18/metabolismo , Interleucina-1beta/metabolismo , Lipoxinas/metabolismo , Masculino , Persona de Mediana Edad , Imagen de Perfusión Miocárdica , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Volumen Sistólico , Factor de Crecimiento Transformador beta/metabolismo , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/metabolismo , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/metabolismo , Prueba de Paso
20.
Can J Anaesth ; 68(4): 514-529, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33442834

RESUMEN

PURPOSE: The six-minute walk test (6MWT) is a simple and valid test for assessing cardiopulmonary fitness. Nevertheless, the relationship between preoperative 6MWT distance and postoperative complications is uncertain. We conducted a secondary analysis of the 6MWT nested cohort substudy of the Measurement of Exercise Tolerance before Surgery study to determine if 6MWT distance predicts postoperative complications or death. METHODS: This analysis included 545 adults (≥ 40 yr) who were at elevated cardiac risk and had elective inpatient non-cardiac surgery at 15 hospitals in Canada, Australia, and New Zealand. Each participant performed a preoperative 6MWT and was followed for 30 days after surgery. The primary outcome was moderate or severe in-hospital complications. The secondary outcome was 30-day death or myocardial injury. Multivariable logistic regression modelling was used to characterize the adjusted association of 6MWT distance with these outcomes. RESULTS: Seven participants (1%) terminated their 6MWT sessions early because of lower limb pain, dyspnea, or dizziness. Eighty-one (15%) participants experienced moderate or severe complications and 69 (13%) experienced 30-day myocardial injury or death. Decreased 6MWT distance was associated with increased odds of moderate or severe complications (adjusted odds ratio, 1.32 per 100 m decrease; 95% confidence interval, 1.01 to 1.73; P = 0.045). There was no association of 6MWT distance with myocardial injury or 30-day death (non-linear association; P = 0.49). CONCLUSION: Preoperative 6MWT distance had a modest association with moderate or severe complications after inpatient non-cardiac surgery. Further studies are needed to determine the optimal role of the 6MWT as an objective exercise test for informing preoperative risk stratification.


Asunto(s)
Prueba de Esfuerzo , Complicaciones Posoperatorias , Adulto , Australia , Canadá , Estudios de Cohortes , Humanos , Nueva Zelanda , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Prueba de Paso
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