Impaired pulmonary and muscle function during moderate exercise in female patients recovered from SARS-CoV-2.

This study aimed to assess pulmonary and muscle dysfunction by analyzing the slow component of oxygen uptake (VO2SC), and mechanical and ventilatory efficiency in adult women recovered from the severe acute respiratory syndrome coronavirus type II (SARS-CoV-2) during a constant load test. 32 women (N = 17 patients with SARS-CoV-2; N = 15 control group) performed two cardiopulmonary exercise tests (CPX) on a cycle ergometer. In the first test, the participants performed incremental CPX until extenuation. In the second test the participants performed a 10-min CPX at a constant load intensity (watts) corresponding to the first ventilatory threshold. There was a 48-72 h rest period between the two tests. There was a significant increase in the VO2SC in the patients recovered from SARS-CoV-2 (160.4 ± 60 mL min-1) in comparison with the healthy participants (59.6 ± 65 mL min-1) (P < 0.001). Mechanical efficiency significantly decreased in patients recovered from SARS-CoV-2 compared to the control group (P = 0.04). Ventilatory inefficiency significantly increased in the patients recovered from SARS-CoV-2 compared with the control group (P < 0.001). Adult women recovered from SARS-CoV-2 infection have important pulmonary and muscular dysfunction and fatigue which contributes to increasing the VO2SC and reducing mechanical and ventilatory efficiency during mild-moderate exercise at a constant load.

Severe loss of mechanical efficiency in COVID-19 patients.

BACKGROUND: There is limited information about the impact of coronavirus disease (COVID-19) on the muscular dysfunction, despite the generalized weakness and fatigue that patients report after overcoming the acute phase of the infection. This study aimed to detect impaired muscle efficiency by evaluating delta efficiency (DE) in patients with COVID-19 compared with subjects with chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), and control group (CG). METHODS: A total of 60 participants were assigned to four experimental groups: COVID-19, COPD, IHD, and CG (n = 15 each group). Incremental exercise tests in a cycle ergometer were performed to obtain peak oxygen uptake (VO2 peak). DE was obtained from the end of the first workload to the power output where the respiratory exchange ratio was 1. RESULTS: A lower DE was detected in patients with COVID-19 and COPD compared with those in CG (P ≤ 0.033). However, no significant differences were observed among the experimental groups with diseases (P > 0.05). Lower VO2 peak, peak ventilation, peak power output, and total exercise time were observed in the groups with diseases than in the CG (P < 0.05). A higher VO2 , ventilation, and power output were detected in the CG compared with those in the groups with diseases at the first and second ventilatory threshold (P < 0.05). A higher power output was detected in the IHD group compared with those in the COVID-19 and COPD groups (P < 0.05) at the first and second ventilatory thresholds and when the respiratory exchange ratio was 1. A significant correlation (P < 0.001) was found between the VO2 peak and DE and between the peak power output and DE (P < 0.001). CONCLUSIONS: Patients with COVID-19 showed marked mechanical inefficiency similar to that observed in COPD and IHD patients. Patients with COVID-19 and COPD showed a significant decrease in power output compared to IHD during pedalling despite having similar response in VO2 at each intensity. Resistance training should be considered during the early phase of rehabilitation.

Serum levels of immunoglobulins and severity of community-acquired pneumonia.

INSTRUCTION: There is evidence of a relationship between severity of infection and inflammatory response of the immune system. The objective is to assess serum levels of immunoglobulins and to establish its relationship with severity of community-acquired pneumonia (CAP) and clinical outcome. METHODS: This was an observational and cross-sectional study in which 3 groups of patients diagnosed with CAP were compared: patients treated in the outpatient setting (n=54), patients requiring in-patient care (hospital ward) (n=173), and patients requiring admission to the intensive care unit (ICU) (n=191). RESULTS: Serum total IgG (and IgG subclasses IgG1, IgG2, IgG3, IgG4), IgA and IgM were measured at the first clinical visit. Normal cutpoints were defined as the lowest value obtained in controls (≤680, ≤323, ≤154, ≤10, ≤5, ≤30 and ≤50 mg/dL for total IgG, IgG1, IgG2, IgG3, IgG4, IgM and IgA, respectively). Serum immunoglobulin levels decreased in relation to severity of CAP. Low serum levels of total IgG, IgG1 and IgG2 showed a relationship with ICU admission. Low serum level of total IgG was independently associated with ICU admission (OR=2.45, 95% CI 1.4 to 4.2, p=0.002), adjusted by the CURB-65 severity score and comorbidities (chronic respiratory and heart diseases). Low levels of total IgG, IgG1 and IgG2 were significantly associated with 30-day mortality. CONCLUSIONS: Patients with severe CAP admitted to the ICU showed lower levels of immunoglobulins than non-ICU patients and this increased mortality.

IgG2 as an independent risk factor for mortality in patients with community-acquired pneumonia.

BACKGROUND: Mortality in patients with community-acquired pneumonia (CAP) remains high despite improvements in treatment. OBJECTIVE: To determine immunoglobulin levels in patients with CAP and impact on disease severity and mortality. METHODOLOGY: Observational study. Hospitalized patients with CAP were followed up for 30 days. Levels of immunoglobulin G (IgG) and subclasses, immunoglobulin A (IgA) and immunoglobulin M (IgM) were measured in serum within 24 hours of CAP diagnosis. RESULTS: Three hundred sixty-two patients with CAP were enrolled -172 ward-treated and 190 intensive care unit-treated. Intensive care unit-treated patients had significantly lower values of IgG1, IgG2, IgG3 subclasses, and IgA than ward-treated patients. Thirty-eight patients died before 30 days. Levels of IgG2 were significantly lower in non-survivors than survivors (P=.004) and IgG2 <301 mg/dL was associated with poorer survival according to both the bivariate (hazard ratio 4.47; P<.001) and multivariate (HR 3.48; P=.003) analyses. CONCLUSIONS: Patients with CAP with IgG2 levels <301 mg/dL had a poorer prognosis and a higher risk of death. Our study suggests the usefulness of IgG2 to predict CAP evolution and to provide support measures or additional treatment.

Serum immunoglobulins in the infected and convalescent phases in community-acquired pneumonia.

BACKGROUND: A population-based case-control study was designed to assess changes of serum levels of immunoglobulins and IgG subclasses between infected and convalescent phase in community-acquired pneumonia (CAP). METHODS: Over a 2-year period, all subjects who were >14 years of age living in the Maresme region (Barcelona, Spain) diagnosed of CAP were registered. Controls were healthy subjects selected from the municipal census. Prognostic factors were assessed and serum levels of total IgG, IgA, IgM, and IgG subclasses were measured at diagnosis and 1 month later (cases). RESULTS: We studied 171 patients with CAP and 90 controls. All immunoglobulins were significantly lower in cases than in controls. At diagnosis, 42.7% of cases showed low levels of some immunologic parameter, mainly total IgG and IgG2. Low immunoglobulin levels at diagnosis were more frequent in patients requiring in-patient care and in those with pneumonia of other etiology than Streptococcus pneumoniae. In the convalescent phase, 26 (23.6%) patients normalized immunological levels. In 27 (24.5%) cases, some parameter with low levels persisted especially in patients with etiology of CAP other than S. pneumoniae. CONCLUSIONS: Low serum levels of immunoglobulins particularly total IgG and IgG2 were a common finding in patients with CAP compared to healthy controls. Low immunoglobulin levels may be related to CAP prognosis and persisted in the convalescent phase in one-fourth of cases.

Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial.

OBJECTIVE: We examined the effect on survival of prone positioning as an early and continuous treatment in ARDS patients already treated with protective ventilation. DESIGN AND SETTING: Open randomized controlled trial in 17 medical-surgical ICUs. PATIENTS: Forty mechanically ventilated patients with early and refractory ARDS despite protective ventilation in the supine position. INTERVENTIONS: Patients were randomized to remain supine or be moved to early (within 48[Symbol: see text]h) and continuous (> or = 20 h/day) prone position until recovery or death. The trial was prematurely stopped due to a low patient recruitment rate. MEASUREMENTS AND RESULTS: Clinical characteristics, oxygenation, lung pressures, and hemodynamics were monitored. Need for sedation, complications, length of MV, ICU, and hospital stays, and outcome were recorded. PaO(2)/FIO(2) tended to be higher in prone than in supine patients after 6[Symbol: see text]h (202 +/-78 vs. 165+/-70 mmHg); this difference reached statistical significance on day 3 (234+/-85 vs. 159+/-78). Prone-related side effects were minimal and reversible. Sixty-day survival reached the targeted 15% absolute increase in prone patients (62% vs. 47%) but failed to reach significance due to the small sample. CONCLUSIONS: Our study adds data that reinforce the suggestion of a beneficial effect of early continuous prone positioning on survival in ARDS patients.

[Knowledge of the disease and the advance directives in patients with HIV infection]. / Conocimiento de la enfermedad y de los documentos de voluntades anticipadas en el paciente seropositivo para el VIH.

BACKGROUND AND OBJECTIVE: Advanced directives documents (ADD), allow respect and know patient's intentions in health matters, when they are not able by themselves, for decision making. The aim of this study is making a valoration of the knowledgment of this documents in human immunodeficiency virus (HIV) infected patients, as well as their own knowledgment about this patology and possible complications. PATIENTS AND METHOD: HIV infected patients controlled in 2 centers (Hospital de Mataró and Hospital de Granollers). Plained interview as a questinonary, that permits evaluate: own knowledge of the patology, received medical information level of satisfaction, patient s medical decision making involving desire, aptitudes in front of different hypothetical health status, and ADD knowledge. Factors associated to both knowledges (patology and ADD) are also evaluated. RESULTS: 74.3% of the interviewed patients, showed a good patology knowledge. This result was associated with: youth, less functional level according to Karnofsky's scale, subjective perception on severity, previous admission at an intensive care unit, chronic hepatopathy, and previous parenteral drugs addiction. In the same way was associated with the negative to depend of mechanical ventilation or another people, and not being uncomfortable talking about this subjects. ADD's knowledge was relationated with the fact of being female (42.0% vs 26.8%; p = 0.024), higher academic formation (55.1% vs 25.5%; p < 0.001) and belief that medical decision making must be done by themselves (78.3% vs 53.6%; p = 0.002). CONCLUSIONS: Patology understanding and its complications, may be considered optimal in HIV population. One third of this group, has a good knowledge of ADDs, and is directly relationated with female sex, academic level, and clinical decisions making implication by the patients.

Conocimiento de la enfermedad y de los documentos de voluntades anticipadas en el paciente seropositivo para el VIH / Knowledge of the disease and the advance directives in patients with HIV infection

Fundamento y objetivo: Los documentos de voluntades anticipadas (DVA) permiten conocer y respetar los deseos del enfermo en materia de salud cuando éste no es competente para decidir. El estudio pretende valorar el conocimiento de estos documentos en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) y el conocimiento de la propia enfermedad y de sus complicaciones. Pacientes y método: Pacientes con infección por el VIH controlados en el Hospital de Mataró y en el Hospital de Granollers, a los que se les administró una entrevista estructurada como un cuestionario que valora el conocimiento de la propia enfermedad, la satisfacción con la información médica recibida, los deseos de participar en la toma de decisiones médicas, la disposición a tolerar diferentes estados hipotéticos de salud y el conocimiento de los DVA. Se valoran los factores asociados al conocimiento de la enfermedad y al conocimiento de los DVA. Resultados: El 74,3% de los entrevistados mostró un buen conocimiento de la enfermedad, circunstancia que se relacionó con el hecho de ser joven, presentar un peor nivel funcional según la escala de Karnofsky, percepción subjetiva de mayor gravedad, no haber ingresado en la unidad de cuidados intensivos, tener hepatopatía crónica y haber sido adicto a drogas por vía parenteral. Asimismo se relacionó con no estar dispuesto a vivir conectado a un respirador ni dependiendo de otra persona y no sentirse incómodo hablando de estos temas. El conocimiento de los DVA fue del 31,1%, y se relacionó con ser mujer (el 42,0 frente al 26,8%; p = 0,024), con mayor nivel de estudios (el 55,1 frente al 25,5%; p < 0,0001) y con creer que las decisiones médicas deben tomarlas ellos mismos (el 78,3 frente al 53,6%; p = 0,002). Conclusiones: El conocimiento de la enfermedad y sus complicaciones puede considerarse aceptable en la población infectada por el VIH. Una tercera parte de esta población conoce los DVA, circunstancia que se relaciona con el hecho de ser mujer, tener mayor nivel de estudios y desear implicarse en las decisiones médicas

Background and objective: Advanced directives documents (ADD), allow respect and know patient's intentions in health matters, when they are not able by themselves, for decision making. The aim of this study is making a valoration of the knowledgment of this documents in human inmunodeffinecy virus (HIV) infected patients, as well as their own knowledgment about this patology and possible complications. Patients and method: HIV infected patients controlled in 2 centers (Hospital de Mataró and Hospital de Granollers). Plained interview as a cuestinonary, that permits evaluate: own knowledge of the patology, received medical information level of satisfaction, patient´s medical decision making involving desire, aptitudes in front of different hipotetical health status, and ADD knowledge. Factors associated to both knowledges (patology and ADD) are also evaluated. Results: 74.3% of the interviewed patients, showed a good patology knowledge. This result was associated with: youth, less functional level acording to Karnofsky's scale, subjective perception on severity, previous admission at an intensive care unit, cronic hepatopathy, and previous parenteral drugs addiction. In the same way was associated with the negative to depend of mechanical ventilation or another people, and not being uncomfortable talking about this subjects. ADD's knowledge was relationated with the fact of being female (42.0% vs 26.8%; p = 0.024), higher academic formation (55.1% vs 25.5%; p < 0.001) and belief that medical decision making must be done by themselves (78.3% vs 53.6%; p = 0.002). Conclusions: Patology understanding and its complications, may be considered optimal in HIV population. One third of this group, has a good knowledge of ADDs, and is directly relationated with female sex, academic level, and clinical decisions making implication by the patients