Effects of upper limbs' neuromuscular electrical stimulation (NMES) superimposed to voluntary contraction added to a protocol of intradialytic leg cycle ergometer exercise, in muscle strength, functional capacity and quality of life of adult patients with CKD: a randomized clinical trial protocol.

OBJECTIVE: To investigate the effects of unilateral upper limbs' (ULM) neuromuscular electrical stimulation (NMES) superimposed on a voluntary contraction added to a protocol of intradialytic leg cycle ergometer exercise on muscle strength, functional capacity and quality of life of adult patients with chronic kidney disease (CKD). METHODS: This randomized controlled clinical trial will be carried out at a Brazilian University Hospital. The patients will be evaluated and randomly allocated to an intervention group (i.e., unilateral NMES on the upper limb without hemodialysis fistula for 20 min and leg cycle ergometer for 30 min) or a control group (i.e., unilateral NMES-Sham on the upper limb without hemodialysis fistula for 20 min and leg cycle ergometer for 30 min). The patients will be treated for 8 weeks, with three weekly treatment sessions totaling 24 sessions. MEASUREMENTS: ULM muscle strength, functional capacity, quality of life and also the feasibility, safety and patient adherence to the exercise protocol. All physical measurements will be collected by trained researchers before treatment (week 0) and at the end of treatment (week 9), always in the second hemodialysis session of the week. It will be used in an intention-to-treat analysis. RESULTS/CONCLUSIONS: The outcomes of this clinical trial protocol may help to know the possible benefits of unilateral ULM' NMES superimposed on a voluntary contraction added to a protocol of leg cycle ergometer for patients with CKD and to aid clinical decisions about future implementation or not of this technique (NMES) in intradialytic physical training programs.

Brazilian physiotherapist anxiety and depression during the COVID-19 pandemic: a cross-sectional survey.

This study investigated the prevalence and the potential risk factors for anxiety and depression among physiotherapists during the pandemic. Physiotherapists answered a web-based questionnaire including 1) sociodemographic, professional and clinical information; 2) psychosocial demands; and 3) two validated questionnaires to measure anxiety and depression. Binary logistic regression identified the risk factors by means of odds ratio (OR) and 95% confidence interval (CI). In 417 participants, there was a high prevalence of anxiety (48.2%) and depression (53.0%). The risk factors for anxiety were female sex (OR 2.07; 95%CI 1.01-4.24), worsening in sleep patterns (OR 3.78; 95%CI 1.92-7.44), moderate (OR 2.24; 95%CI 1.00-5.00) and extreme concern about financial issues (OR 3.47; 95%CI 1.57-7.65), and extreme loneliness (OR 3.47; 95%CI 1.71-7.07). The risk factors for depression were female sex (OR 2.16; 95%CI 1.03-4.55), low family income (OR 2.43; 95%CI 1.21-4.89), worsening in sleep patterns (OR 5.97; 95%CI 3.02-11.82), extreme concern about financial issues (OR 2.61; 95%CI 1.15-5.94), and extreme loneliness (OR 4.38; 95%CI 2.00-9.63). This study found a high prevalence of anxiety and depression in the studied population and identified risk factors for both.

Brazilian physiotherapist anxiety and depression during the COVID-19 pandemic: a cross-sectional survey / Ansiedade e depressão em fisioterapeutas brasileiros durante a pandemia de COVID-19: um estudo transversal

Abstract This study investigated the prevalence and the potential risk factors for anxiety and depression among physiotherapists during the pandemic. Physiotherapists answered a web-based questionnaire including 1) sociodemographic, professional and clinical information; 2) psychosocial demands; and 3) two validated questionnaires to measure anxiety and depression. Binary logistic regression identified the risk factors by means of odds ratio (OR) and 95% confidence interval (CI). In 417 participants, there was a high prevalence of anxiety (48.2%) and depression (53.0%). The risk factors for anxiety were female sex (OR 2.07; 95%CI 1.01-4.24), worsening in sleep patterns (OR 3.78; 95%CI 1.92-7.44), moderate (OR 2.24; 95%CI 1.00-5.00) and extreme concern about financial issues (OR 3.47; 95%CI 1.57-7.65), and extreme loneliness (OR 3.47; 95%CI 1.71-7.07). The risk factors for depression were female sex (OR 2.16; 95%CI 1.03-4.55), low family income (OR 2.43; 95%CI 1.21-4.89), worsening in sleep patterns (OR 5.97; 95%CI 3.02-11.82), extreme concern about financial issues (OR 2.61; 95%CI 1.15-5.94), and extreme loneliness (OR 4.38; 95%CI 2.00-9.63). This study found a high prevalence of anxiety and depression in the studied population and identified risk factors for both.

Resumo Este estudo investigou a prevalência e potenciais fatores de risco para ansiedade e depressão em fisioterapeutas durante a pandemia. Fisioterapeutas responderam a um questionário na web, incluindo: dados sociodemográficos, profissionais e clínicos; demandas psicossociais; e dois questionários validados para medir ansiedade e depressão. Regressão logística binária identificou fatores de risco para ansiedade e depressão por meio de odds ratio (OR) e intervalo de confiança de 95% (IC). Em 417 participantes houve alta prevalência de ansiedade (48,2%) e depressão (53%). Os fatores de risco para ansiedade foram: sexo feminino (OR 2,07; IC95% 1,01-4,24), piora nos padrões de sono (OR 3,78; IC95% 1,92-7,44), moderada (OR 2,24; IC95% 1,00-5,00) e extrema preocupação financeira (OR 3,47; IC95% 1,57-7,65) e extrema solidão (OR 3,47; IC95% 1,71-7,07). Os fatores de risco para depressão foram: sexo feminino (OR 2,16; IC95% 1,03-4,55), baixa renda familiar (OR 2,43; IC95% 1,21-4,89), piora nos padrões de sono (OR 5,97; IC95% 3,02-11,82), extrema preocupação financeira (OR 2,61; IC95% 1,15-5,94) e extrema solidão (OR 4,38; IC95% 2,00-9,63). Este estudo mostrou alta prevalência de ansiedade e depressão na população estudada e identificou fatores de risco para ambos.

Comparison of different methods of obtaining the rapid shallow breathing index

Abstract Objective: To compare the Rapid Shallow Breathing Index (RSBI) obtained by the ventilometer and from mechanical ventilation parameters. Methods: Randomized crossover trial, including 33 intubated patients, on mechanical ventilation for at least 24 hours, undergoing spontaneous breathing test. Patients were submitted to the measurement of RSBI by four methods: disconnected from the ventilator through the ventilometer; in Pressure Support Ventilation (PSV) mode at a pressure of 7 cm H2O; in Continuous Positive Airway Pressure (CPAP) mode at a pressure of 5 cmH2O with flow trigger; in CPAP mode at a pressure of 5 cmH2O with pressure trigger. Results: No significant difference was detected between the RSBI obtained by the ventilometer and in the CPAP mode with flow and pressure triggers, however, in the PSV mode, the values were lower than in the other measurements (p < 0.001). By selecting patients from the sample with higher RSBI (≥ 80 cycles.min−1.L−1), the value of the index obtained by the ventilometer was higher than that obtained in the three options of ventilation methods. Conclusion: The RSBI obtained in the CPAP mode at a pressure of 5 cmH2O, in both triggers types, did not differ from that measured by the ventilometer; it is, therefore, an alternative when obtaining it from mechanical ventilation parameters is necessary. However, in the presence of borderline values, the RSBI measured by ventilometer is recommended, as in this method the values are significantly higher than in the three ventilation modalities investigated.

Factors associated with Brazilian physical therapists' perception of stress during the COVID-19 pandemic: a cross-sectional survey.

This study aimed to evaluate the stress perception among Brazilian physical therapists (PTs) during COVID-19 pandemic and to identify which psychosocial demands, sociodemographic, professional and clinical factors do associate with the PTs' stress perception. This cross-sectional survey was based on a convenience sample of PTs, who answered a questionnaire about: 1) sociodemographic and professional characteristics, 2) clinical characteristics and information related to COVID-19, 3) psychosocial demands, and 4) 10-item Perceived Stress Scale (PSS-10). Full responses were obtained from 417 PTs. The average PSS-10 score was 19.2 (95% CI 18.5 to 19.9), which was higher than in other Brazilians before COVID-19 and figured among the highest one observed in healthcare workers from different countries during COVID-19 pandemic. After multivariate analysis, PTs' perceived stress remained associated with female sex, younger age, previous diagnosis of depressive or anxiety disorder, worsening in sleep patterns, large reduction in family income, housework, relationship with the partner, concern about close people/family members being infected by SARS-CoV-2, and loneliness.

Early mobilization and physical exercise in patients with COVID-19: A narrative literature review.

BACKGROUND: Currently, little is known about early mobilization and exercise in individuals with COVID-19. OBJECTIVE: To describe the indication and safety of early mobilization and exercises in mild to severe COVID-19 patients and to investigate the use of telerehabilitation to deliver exercise programs to these patients. METHODS: This narrative literature review was conducted performing a comprehensive search of databases. RESULTS: 32 articles met the established criteria and the main findings were summarized and described, including indication, contraindication and recommendation for early rehabilitation and exercises prescription. CONCLUSIONS: The literature suggests that early mobilization and physical exercise are beneficial for individuals with COVID-19. However, much of what has been published is based on expert opinion due to a lack of randomized trials, which are needed.

RESPIRATORY AND SYMPTOMATIC IMPACT OF ASCITES RELIEF BY PARACENTESIS IN PATIENTS WITH HEPATIC CIRRHOSIS.

BACKGROUND: Liver cirrhosis is a highly prevalent disease that, at an advanced stage, usually causes ascites and associated respiratory changes. However, there are few studies evaluating and quantifying the impact of ascites and its relief through paracentesis on lung function and symptoms such as fatigue and dyspnea in cirrhotic patients. OBJECTIVE: To assess and quantify the impact of acute reduction of ascitic volume on respiratory parameters, fatigue and dyspnea symptoms in patients with hepatic cirrhosis, as well as to investigate possible correlations between these parameters. METHODS: Thirty patients with hepatic cirrhosis and ascites who underwent the following pre and post paracentesis evaluations: vital signs, respiratory pattern, thoracoabdominal mobility (cirtometry), pulmonary function (ventilometry), degree of dyspnea (numerical scale) and fatigue level (visual analog scale). RESULTS: There was a higher prevalence of patients classified as CHILD B and the mean MELD score was 14.73±5.75. The comparison of pre and post paracentesis parameters evidenced after paracentesis: increase of predominantly abdominal breathing pattern, improvement of ventilatory variables, increase of the differences obtained in axillary and abdominal cirtometry, reduction of dyspnea and fatigue level, blood pressure reduction and increased peripheral oxygen saturation. Positive correlations found: xiphoid with axillary cirtometry, degree of dyspnea with fatigue level, tidal volume with minute volume, Child "C" with higher MELD score, volume drained in paracentesis with higher MELD score and with Child "C". We also observed a negative correlation between tidal volume and respiratory rate. CONCLUSION: Since ascites drainage in patients with liver cirrhosis improves pulmonary volumes and thoracic expansion as well as reduces symptoms such as fatigue and dyspnea, we can conclude that ascites have a negative respiratory and symptomatological impact in these patients.

Impacto respiratório e sintomatológico do alívio da ascite através da paracentese em pacientes com cirrose hepática / Respiratory and symptomatic impact of ascites relief by paracentesis in patients with hepatic cirrhosis

ABSTRACT BACKGROUND: Liver cirrhosis is a highly prevalent disease that, at an advanced stage, usually causes ascites and associated respiratory changes. However, there are few studies evaluating and quantifying the impact of ascites and its relief through paracentesis on lung function and symptoms such as fatigue and dyspnea in cirrhotic patients. OBJECTIVE: To assess and quantify the impact of acute reduction of ascitic volume on respiratory parameters, fatigue and dyspnea symptoms in patients with hepatic cirrhosis, as well as to investigate possible correlations between these parameters. METHODS: Thirty patients with hepatic cirrhosis and ascites who underwent the following pre and post paracentesis evaluations: vital signs, respiratory pattern, thoracoabdominal mobility (cirtometry), pulmonary function (ventilometry), degree of dyspnea (numerical scale) and fatigue level (visual analog scale). RESULTS: There was a higher prevalence of patients classified as CHILD B and the mean MELD score was 14.73±5.75. The comparison of pre and post paracentesis parameters evidenced after paracentesis: increase of predominantly abdominal breathing pattern, improvement of ventilatory variables, increase of the differences obtained in axillary and abdominal cirtometry, reduction of dyspnea and fatigue level, blood pressure reduction and increased peripheral oxygen saturation. Positive correlations found: xiphoid with axillary cirtometry, degree of dyspnea with fatigue level, tidal volume with minute volume, Child "C" with higher MELD score, volume drained in paracentesis with higher MELD score and with Child "C". We also observed a negative correlation between tidal volume and respiratory rate. CONCLUSION: Since ascites drainage in patients with liver cirrhosis improves pulmonary volumes and thoracic expansion as well as reduces symptoms such as fatigue and dyspnea, we can conclude that ascites have a negative respiratory and symptomatological impact in these patients.

RESUMO CONTEXTO: A cirrose hepática é uma doença altamente prevalente que, em estágio avançado, geralmente causa ascite e alterações respiratórias associadas. No entanto, existem poucos estudos avaliando e quantificando o impacto da ascite e do seu alívio através da paracentese na função pulmonar e em sintomas como fadiga e dispneia em pacientes cirróticos. OBJETIVO: Avaliar e quantificar o impacto da redução aguda do volume ascítico nos parâmetros respiratórios, sintomas de fadiga e dispneia em pacientes com cirrose hepática, bem como investigar possíveis correlações entre esses parâmetros. MÉTODOS: Trinta pacientes com cirrose hepática e ascite foram submetidos às seguintes avaliações pré e pós-paracentese: sinais vitais, padrão respiratório, mobilidade toracoabdominal (cirtometria), função pulmonar (ventilometria), grau de dispneia (escala numérica) e nível de fadiga (escala visual analógica). RESULTADOS: Houve maior prevalência de pacientes classificados como CHILD B e o escore MELD médio foi de 14,73±5,75. A comparação dos parâmetros pré e pós paracentese evidenciou após a paracentese: aumento do padrão respiratório predominantemente abdominal, melhora das variáveis ventilatórias, aumento das diferenças obtidas na cirtometria axilar e abdominal, redução do nível de dispneia e fadiga, redução da pressão arterial e aumento da saturação periférica de oxigênio. Correlações positivas encontradas: cirtometria xifoide com axilar, grau de dispneia com nível de fadiga, volume corrente com volume minuto, CHILD "C" com maior escore MELD, volume drenado na paracentese com maior escore MELD e com CHILD "C". Também observamos uma correlação negativa entre volume corrente e a frequência respiratória. CONCLUSÃO: Uma vez que a drenagem da ascite em pacientes com cirrose hepática melhora os volumes pulmonares e a expansão torácica, além de reduzir sintomas como fadiga e dispneia, podemos concluir que a ascite tem um impacto respiratório e sintomatológico negativo nesses pacientes.

Associação entre pico de fluxo da tosse, colonização bacteriana e estado nutricional em crianças e adolescentes com fibrose cí­stica / Association of cough peak flow with chronic bacterial colonization and nutritional status in children and adolescents with cystic fibrosis

Introdução: Este estudo teve como objetivo avaliar a associação entre pico de fluxo da tosse (PFT), colonização bacteriana crônica e estado nutricional em crianças e adolescentes com Fibrose Cí­stica. Métodos: Estudo transversal, com amostra por conveniência composta por indiví­duos com FC (7-18 anos), cadastrados em um hospital de referência estadual. Foi avaliado o PFT por um medidor portátil de pico de fluxo expiratório. Dados clí­nicos, antropométricos e sobre colonização bacteriana foram colhidos nos prontuários. O estado nutricional foi classificado pelo percentil do í­ndice de massa corporal para a idade. Para a análise estatí­stica foram usados os testes: Shapiro-Wilk, Exato de Fisher, Teste T Student independente, Mann-Whitney e Correlação de Spearman. Foi considerado significante p<0,05. Resultados: Na caracterização da amostra, houve predomí­nio das seguintes caracterí­sticas: redução do PFT (82,35%), risco nutricional (70,6%), colonização bacteriana crônica (82,4%). Indiví­duos colonizados por Pseudomonas aeruginosa apresentaram maior percentual de redução do PFT (p=0,045). Conclusão: O pico de fluxo da tosse apresentou-se reduzido nas crianças e adolescentes com FC da amostra estudada, sendo essa redução mais acentuada nos indiví­duos colonizados por Pseudomonas aeruginosa do que naqueles colonizados por Staphylococcus aureus. A maioria dos indiví­duos apresentava-se em risco nutricional, mas não foi observada correlação entre estado nutricional e pico de fluxo da tosse. (AU)

Introduction: The aim of this study was to evaluate the association among cough peak flow (CPF), chronic bacterial colonization and nutritional status in children and adolescents diagnosed with cystic fibrosis. Methods: A cross-sectional study with a convenience sample of individuals diagnosed with CF (7-18 years old) enrolled in a referral hospital of a Brazilian State. The CPF was evaluated by a portable expiratory peak flow meter. Clinical, anthropometric and bacterial colonization data were collected in the medical records. Nutritional status was classified according to the percentile of the body mass index for age. Statistical analysis was performed using the following tests: Shapiro Wilk, Fisher's Exact, Student's t, Mann-Whitney and Spearman's Correlations, being considered significant p<0.05. Results: The following characteristics predominated: CPF reduction (82.35%), nutritional risk (70.6%), chronic bacterial colonization (82.4%). Individuals colonized by Pseudomonas aeruginosa had a higher percentage of CPF reduction (p=0.045). Conclusion: The cough peak flow was reduced in the children and adolescents with cystic fibrosis in the studied sample, and this reduction was more pronounced in individuals colonized by Pseudomonas aeruginosa than in those colonized by Staphylococcus aureus. Most individuals were at nutritional risk, but no correlation was observed between nutritional status and cough peak flow. (AU)

Prevalence of musculoskeletal symptoms in obese patients candidates for bariatric surgery and its impact on health related quality of life

ABSTRACT Objective This study was designed to identify the major musculoskeletal symptoms of individuals with obesity, to assess their health-related quality of life, and to evaluate the correlation between the musculoskeletal symptoms and the individuals' health-related quality of life. Materials and methods Cross-sectional study. Instruments used "Nordic Musculoskeletal Questionnaire" and "The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)". Results In total, 41 subjects were evaluated, of which 90.15% were female. The mean age of the subjects was 40.78 ± 9.85 years and their mean body-mass index was 46.87 ± 8.08. All subjects reported musculoskeletal pain in at least one anatomical region and 80.49% had pain in three or more regions. The activity limitations due to pain were reported by 75.61% of them. The most affected regions by pain were the ankles and/or feet, lower back, knees and wrists/hands/fingers. The most associated regions with activity limitations due to pain were the ankles and/or feet, knees and lower back. The presence of pain showed a negative correlation with the domains physical functioning (PF), role-physical (RP) and body pain (BP). The activity limitations showed a negative correlation with the domains PF, BP, social functioning (SF) and role-emotional (RE). Conclusion Our data showed a high prevalence of musculoskeletal pain and limitation in activities due to pain in obese subjects. The musculoskeletal symptoms had negative correlations with physical and mental components of the health-related quality of life, highlighting the importance of ensuring that patients with obesity have access to interdisciplinary care, for the prevention and rehabilitation of musculoskeletal disorders.

Prevalence of musculoskeletal symptoms in obese patients candidates for bariatric surgery and its impact on health related quality of life.

OBJECTIVE: This study was designed to identify the major musculoskeletal symptoms of individuals with obesity, to assess their health-related quality of life, and to evaluate the correlation between the musculoskeletal symptoms and the individuals' health-related quality of life. MATERIALS AND METHODS: Cross-sectional study. INSTRUMENTS USED: "Nordic Musculoskeletal Questionnaire" and "The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)". RESULTS: In total, 41 subjects were evaluated, of which 90.15% were female. The mean age of the subjects was 40.78 ± 9.85 years and their mean body-mass index was 46.87 ± 8.08. All subjects reported musculoskeletal pain in at least one anatomical region and 80.49% had pain in three or more regions. The activity limitations due to pain were reported by 75.61% of them. The most affected regions by pain were the ankles and/or feet, lower back, knees and wrists/hands/fingers. The most associated regions with activity limitations due to pain were the ankles and/or feet, knees and lower back. The presence of pain showed a negative correlation with the domains physical functioning (PF), role-physical (RP) and body pain (BP). The activity limitations showed a negative correlation with the domains PF, BP, social functioning (SF) and role-emotional (RE). CONCLUSION: Our data showed a high prevalence of musculoskeletal pain and limitation in activities due to pain in obese subjects. The musculoskeletal symptoms had negative correlations with physical and mental components of the health-related quality of life, highlighting the importance of ensuring that patients with obesity have access to interdisciplinary care, for the prevention and rehabilitation of musculoskeletal disorders.

Effects of captopril on cardiovascular reflexes and respiratory mechanisms in rats submitted to monocrotaline-induced pulmonary arterial hypertension.

BACKGROUND: Pulmonary Arterial Hypertension (PAH) is a disease associated with increased arteriolar resistance in the lungs. Due to hypoxemia, some physiological mechanisms can be posteriorly affected, including respiratory and cardiovascular reflexes, but this has not yet been fully investigated. This study aimed to evaluate how these mechanisms were affected by monocrotaline (MCT)-induced PAH and the possible therapeutic role of angiotensin converting enzyme inhibitor (ACEi), captopril, in reversing this remodeling process. METHODS AND RESULTS: Groups of Wistar rats received MCT injections (60 mg kg(-1)). Three weeks later, they received captopril (CPT, 100 mg kg(-1)) in their drinking water (MCT + CPT) or water alone (MCT) for 2 weeks. As control, saline-treated animals received captopril in their drinking water (CPT) or water alone (CON), also for 2 weeks. Results showed that PAH was fully induced in the MCT group, evidenced by a high pulmonary index. Gasometrical and respiratory analyses showed hypoxemia and compensatory hyperventilation. CPT treatment brought these parameters to similar values to those observed in the CON group. We observed that autonomic dysfunction in the MCT group was suppressed by CPT. Finally, cardiovascular reflexes analysis showed increased chemoreflex responses in the MCT group, while baroreflex sensibility was decreased. Surprisingly, CPT normalized these reflex responses to values similar to the CON group. CONCLUSIONS: The present study demonstrates that MCT-induced PAH induces compensatory respiratory responses, dysautonomia, and baroreflex dysfunction and increases chemoreflex responses. The data also indicate that CPT was effective in reversing these cardio-respiratory disorders, suggesting that ACEi could be a potential therapeutic target for PAH.