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1.
Med J Aust ; 215(6): 280-285, 2021 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-34382211

RESUMO

Endoscopic lung volume reduction (ELVR) is recognised in both national and international expert guidelines as one of the few additive treatments to benefit patients with advanced chronic obstructive pulmonary disease (COPD) who are otherwise receiving optimal medical and supportive care. Despite these recommendations and a growing evidence base, these procedures are not widely offered across Australia and New Zealand, and general practitioner and physician awareness of this therapy can be improved. ELVR aims to mitigate the impact of hyperinflation and gas trapping on dyspnoea and exercise intolerance in COPD. Effective ELVR is of proven benefit in improving symptoms, quality of life, lung function and survival. Several endoscopic techniques to achieve ELVR have been developed, with endobronchial valve placement to collapse a single lobe being the most widely studied and commonly practised. This review describes the physiological rationale underpinning lung volume reduction, highlights the challenges of patient selection, and provides an overview of the evidence for current and investigational endoscopic interventions for COPD.


Assuntos
Broncoscopia/métodos , Dispneia/fisiopatologia , Pneumonectomia/instrumentação , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/cirurgia , Austrália/epidemiologia , Conscientização , Broncoscopia/normas , Humanos , Nova Zelândia/epidemiologia , Seleção de Pacientes/ética , Pneumonectomia/métodos , Pneumonectomia/mortalidade , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Volume Residual/fisiologia , Instrumentos Cirúrgicos/efeitos adversos , Sobrevida , Capacidade Pulmonar Total/fisiologia
2.
Respir Res ; 22(1): 222, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362372

RESUMO

The COVID-19 pandemic has resulted in significant acute morbidity and mortality worldwide. There is now a growing recognition of the longer-term sequelae of this infection, termed "long COVID". However, little is known about this condition. Here, we describe a distinct phenotype seen in a subset of patients with long COVID who have reduced exercise tolerance as measured by the 6 min walk test. They are associated with significant exertional dyspnea, reduced health-related quality of life and poor functional status. However, surprisingly, they do not appear to have any major pulmonary function abnormalities or increased burden of neurologic, musculoskeletal or fatigue symptoms.


Assuntos
COVID-19/complicações , Dispneia/fisiopatologia , Tolerância ao Exercício/fisiologia , Pulmão/fisiologia , Fenótipo , Esforço Físico/fisiologia , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/fisiopatologia , Dispneia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Teste de Caminhada/métodos
3.
Medicine (Baltimore) ; 100(33): e26976, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414971

RESUMO

BACKGROUND: We sought to synthesize the evidence about aerobic exercise intervention during pulmonary rehabilitation, and to further explore the difference in rehabilitation effects between water and land-based aerobic exercise. This review's purpose is to provide a basis by which practitioners and therapists can select and create appropriate therapeutic programs. METHODS: Data of randomized and quasi-randomized controlled trials comparing training group (TG, aerobic exercise in water or land) and control group (CG, usual care) in chronic obstructive pulmonary disease (COPD) patients (January 1, 2000-December 28, 2019) were obtained from the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases. Two researchers independently reviewed the literature, extracted the data, and evaluated the quality of the literature. Review Manager software (Rev Man 5.3; Cochrane, London, UK) was used for meta-analysis. The rehabilitation effect of water- or land based aerobic exercise was evaluated by subgroup analysis. The proposed systematic review details were registered in PROSPERO (CRD 42020168331). RESULTS: Eighteen studies (1311 cases of COPD) were included. Meta-analysis results show that compared with the control group, the dyspnea level and functional and endurance exercise capacity in COPD patients were significantly improved after aerobic exercise (P < .05), but there was no significant change in lung function (P > .05). Compared with land-based aerobic exercise, water-based aerobic exercise significantly improved the endurance exercise capacity in COPD patients (mean difference [MD]: 270.18, 95% CI: 74.61-465.75). CONCLUSION: Medium to high-quality evidence shows that aerobic exercise can effectively improve dyspnea and exercise capacity in COPD patients. Compared with land-based aerobic exercise, water-based aerobic exercise had a significant additional effect in improving the endurance exercise capacity of COPD patients.


Assuntos
Dispneia/etiologia , Tolerância ao Exercício , Exercício Físico , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Doença Pulmonar Obstrutiva Crônica/terapia , Dispneia/fisiopatologia , Dispneia/reabilitação , Dispneia/terapia , Exercício Físico/fisiologia , Tolerância ao Exercício/fisiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Água
4.
BMC Pregnancy Childbirth ; 21(1): 505, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253173

RESUMO

BACKGROUND: Evidence on the outcome of SARS-CoV-2 infection in pregnancy is generally reassuring but yet not definitive. METHODS: To specifically assess the impact of SARS-CoV-2 infection in late pregnancy, we prospectively recruited 315 consecutive women delivering in a referral hospital located in Lombardy, Italy in the early phase of the epidemic. Restriction of the recruitment to this peculiar historical time period allowed to exclude infections occurring early in pregnancy and to limit the recall bias. All recruited subjects underwent a nasopharyngeal swab to assess the presence of Sars-Cov-2 using Real-time PCR. In addition, two different types of antibodies for the virus were evaluated in peripheral blood, those against the spike proteins S1 and S2 of the envelope and those against the nucleoprotein of the nucleocapsid. Women were considered to have had SARS-CoV-2 infection in pregnancy if at least one of the three assessments was positive. RESULTS: Overall, 28 women had a diagnosis of SARS-CoV-2 infection in pregnancy (8.9%). Women diagnosed with the infection were more likely to report one or more episodes of symptoms suggestive for Covid-19 (n = 11, 39.3%) compared to unaffected women (n = 39, 13.6%). The corresponding OR was 4.11 (95%CI: 1.79-9.44). Symptoms significantly associated with Covid-19 in pregnancy included fever, cough, dyspnea and anosmia. Only one woman necessitated intensive care. Pregnancy outcome in women with and without SARS-CoV-2 infection did not also differ. CONCLUSIONS: SARS-CoV-2 infection is asymptomatic in three out of five women in late pregnancy and is rarely severe. In addition, pregnancy outcome may not be markedly affected.


Assuntos
COVID-19/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Anosmia/fisiopatologia , Infecções Assintomáticas , COVID-19/fisiopatologia , Teste de Ácido Nucleico para COVID-19 , Teste Sorológico para COVID-19 , Tosse/fisiopatologia , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Humanos , Itália/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Prevalência , SARS-CoV-2 , Adulto Jovem
5.
PLoS One ; 16(7): e0255141, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297774

RESUMO

The natural history of COVID-19 and predictors of mortality in older adults need to be investigated to inform clinical operations and healthcare policy planning. A retrospective study took place in 80 long-term nursing homes in Catalonia, Spain collecting data from March 1st to May 31st, 2020. Demographic and clinical data from 2,092 RT-PCR confirmed cases of SARS-CoV-2 infection were registered, including structural characteristics of the facilities. Descriptive statistics to describe the demographic, clinical, and molecular characteristics of our sample were prepared, both overall and by their symptomatology was performed and an analysis of statistically significant bivariate differences and constructions of a logistic regression model were carried out to assess the relationship between variables. The incidence of the infection was 28%. 71% of the residents showed symptoms. Five major symptoms included: fever, dyspnea, dry cough, asthenia and diarrhea. Fever and dyspnea were by far the most frequent (50% and 28%, respectively). The presentation was predominantly acute and symptomatology persisted from days to weeks (mean 9.1 days, SD = 10,9). 16% of residents had confirmed pneumonia and 22% required hospitalization. The accumulated mortality rate was 21.75% (86% concentrated during the first 28 days at onset). A multivariate logistic regression analysis showed a positive predictive value for mortality for some variables such as age, pneumonia, fever, dyspnea, stupor refusal to oral intake and dementia (p<0.01 for all variables). Results suggest that density in the nursing homes did not account for differences in the incidence of the infection within the facilities. This study provides insights into the natural history of the disease in older adults with high dependency living in long-term nursing homes during the first pandemic wave of March-May 2020 in the region of Catalonia, and suggests that some comorbidities and symptoms have a strong predictive value for mortality.


Assuntos
COVID-19 , Dispneia , Febre , Casas de Saúde , SARS-CoV-2 , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , COVID-19/patologia , COVID-19/fisiopatologia , Comorbidade , Dispneia/mortalidade , Dispneia/patologia , Dispneia/fisiopatologia , Feminino , Febre/mortalidade , Febre/patologia , Febre/fisiopatologia , Humanos , Incidência , Masculino , Estudos Retrospectivos , Espanha/epidemiologia
6.
Am Heart J ; 241: 83-86, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34302751

RESUMO

SARS-CoV-2 infection has been associated with cardiovascular disease in children, but which children need cardiac evaluation is unclear. We describe our experience evaluating 206 children for cardiac disease following SARS-CoV-2 infection (one of whom had ventricular ectopy) and propose a new guideline for management of these children. Routine cardiac screening after SARS-CoV-2 infection in children without any cardiac signs or symptoms does not appear to be high yield.


Assuntos
Assistência ao Convalescente , COVID-19/fisiopatologia , Cardiopatias/diagnóstico , Encaminhamento e Consulta , Adolescente , Assistência Ambulatorial , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bradicardia/diagnóstico , Bradicardia/etiologia , Bradicardia/fisiopatologia , COVID-19/complicações , Cardiologia , Dor no Peito/fisiopatologia , Criança , Pré-Escolar , Dispneia/fisiopatologia , Ecocardiografia , Eletrocardiografia , Fadiga/fisiopatologia , Feminino , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Hipertrofia Ventricular Direita/diagnóstico , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/fisiopatologia , Ciência da Implementação , Masculino , Pediatria , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Índice de Gravidade de Doença , Síncope/fisiopatologia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/fisiopatologia , Adulto Jovem
7.
Am J Surg Pathol ; 45(12): 1587-1596, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34081035

RESUMO

After deployment to Southwest Asia, some soldiers develop persistent respiratory symptoms, including exercise intolerance and exertional dyspnea. We identified 50 soldiers with a history of deployment to Southwest Asia who presented with unexplained dyspnea and underwent an unrevealing clinical evaluation followed by surgical lung biopsy. Lung tissue specimens from 17 age-matched, nonsmoking subjects were used as controls. Quantitative histomorphometry was performed for evaluation of inflammation and pathologic remodeling of small airways, pulmonary vasculature, alveolar tissue and visceral pleura. Compared with control subjects, lung biopsies from affected soldiers revealed a variety of pathologic changes involving their distal lungs, particularly related to bronchovascular bundles. Bronchioles from soldiers had increased thickness of the lamina propria, smooth muscle hypertrophy, and increased collagen content. In adjacent arteries, smooth muscle hypertrophy and adventitial thickening resulted in increased wall-to-lumen ratio in affected soldiers. Infiltration of CD4 and CD8 T lymphocytes was noted within airway walls, along with increased formation of lymphoid follicles. In alveolar parenchyma, collagen and elastin content were increased and capillary density was reduced in interalveolar septa from soldiers compared to control subjects. In addition, pleural involvement with inflammation and/or fibrosis was present in the majority (92%) of soldiers. Clinical follow-up of 29 soldiers (ranging from 1 to 15 y) showed persistence of exertional dyspnea in all individuals and a decline in total lung capacity. Susceptible soldiers develop a postdeployment respiratory syndrome that includes exertional dyspnea and complex pathologic changes affecting small airways, pulmonary vasculature, alveolar tissue, and visceral pleura.


Assuntos
Bronquiolite Obliterante/patologia , Dispneia/etiologia , Pulmão/patologia , Adulto , Ásia , Biópsia , Bronquiolite Obliterante/complicações , Bronquiolite Obliterante/imunologia , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Doença Crônica , Dispneia/diagnóstico , Dispneia/fisiopatologia , Feminino , Humanos , Pulmão/imunologia , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medicina Militar , Militares , Esforço Físico , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
9.
Sci Rep ; 11(1): 12459, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127700

RESUMO

This study aimed to investigate the walking economy and possible factors influencing self-selected walking speed (SSWS) in patients with fibrotic interstitial lung disease (ILD) compared to controls. In this study, 10 patients with ILD (mean age: 63.8 ± 9.2 years, forced expiratory volume in the first second: 56 ± 7% of predicted) and 10 healthy controls underwent resting pulmonary function tests, cardiopulmonary exercise, and submaximal treadmill walking tests at different speeds. The walking economy was assessed by calculating the cost-of-transport (CoT). Dynamic stability was assessed by stride-to-stride fluctuations using video recordings. Patients with ILD showed reduced peak oxygen uptake with a tachypneic breathing pattern and significant oxygen desaturation during exercise. The CoT did not differ between the groups (p = 0.680), but dyspnea and SpO2 were higher and lower, respectively, in patients with ILD at the same relative speeds. SSWS was reduced in ILD patients (2.6 ± 0.9 vs. 4.2 ± 0.4 km h-1 p = 0.001) and did not correspond to the energetically optimal walking speed. Dynamic stability was significantly lower in patients with ILD than in healthy controls, mainly at lower speeds. Patients with ILD presented a similar cost of transport compared to healthy controls; however, they chose lower SSWS despite higher walking energy expenditure. Although walking stability and dyspnea were negatively affected, these factors were not associated with the slower walking speed chosen by individuals with ILD.


Assuntos
Dispneia/fisiopatologia , Metabolismo Energético/fisiologia , Doenças Pulmonares Intersticiais/complicações , Velocidade de Caminhada/fisiologia , Idoso , Estudos de Casos e Controles , Dispneia/etiologia , Teste de Esforço , Voluntários Saudáveis , Humanos , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Testes de Função Respiratória
10.
Radiology ; 301(1): E353-E360, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34032513

RESUMO

Background SARS-CoV-2 targets angiotensin-converting enzyme 2-expressing cells in the respiratory tract. There are reports of breathlessness in patients many months after infection. Purpose To determine whether hyperpolarized xenon 129 MRI (XeMRI) imaging could be used to identify the possible cause of breathlessness in patients at 3 months after hospital discharge following COVID-19 infection. Materials and Methods This prospective study was undertaken between August and December of 2020, with patients and healthy control volunteers being enrolled. All patients underwent lung function tests; ventilation and dissolved-phase XeMRI, with the mean red blood cell (RBC) to tissue or plasma (TP) ratio being calculated; and a low-dose chest CT, with scans being scored for the degree of abnormalities after COVID-19. Healthy control volunteers underwent XeMRI. The intraclass correlation coefficient was calculated for volunteer and patient scans to assess repeatability. A Wilcoxon rank sum test and Cohen effect size calculation were performed to assess differences in the RBC/TP ratio between patients and control volunteers. Results Nine patients (mean age, 57 years ± 7 [standard deviation]; six male patients) and five volunteers (mean age, 29 years ± 3; five female volunteers) were enrolled. The mean time from hospital discharge for patients was 169 days (range, 116-254 days). There was a difference in the RBC/TP ratio between patients and control volunteers (0.3 ± 0.1 vs 0.5 ± 0.1, respectively; P = .001; effect size, 1.36). There was significant difference between the RBC and gas phase spectral full width at half maximum between volunteers and patients (median ± range, 567 ± 1 vs 507 ± 81 [P = .002] and 104 ± 2 vs 122 ± 17 [P = .004], respectively). Results were reproducible, with intraclass correlation coefficients of 0.82 and 0.88 being demonstrated for patients and volunteers, respectively. Participants had normal or nearly normal CT scans (mean, seven of 25; range, zero of 25 to 10 of 25). Conclusion Hyperpolarized xenon 129 MRI results showed alveolar capillary diffusion limitation in all nine patients after COVID-19 pneumonia, despite normal or nearly normal results at CT. © RSNA, 2021 See also the editorial by Dietrich in this issue.


Assuntos
COVID-19/fisiopatologia , Dispneia/fisiopatologia , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Isótopos de Xenônio , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , SARS-CoV-2
12.
Am J Emerg Med ; 49: 29-34, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34051399

RESUMO

AIM OF STUDY: Cardiac output (CO) responses to acute changes in body position and Valsalva maneuver (VM) were proposed to assess cardiac contractile reserve. We investigated the value of sitting position (SP), leg raising (LR), and VM for identifying heart failure (HF) in patients with undifferentiated dyspnea. MATERIALS AND METHODS: It is a prospective study including patients over 18 years old admitted to the emergency department (ED) for dyspnea. Bioimpedance CO was measured at baseline, under SP, LR, and VM. HF diagnosis was based on clinical assessment, serum levels of brain natriuretic peptide (BNP) and echocardiography findings. Study population was divided into patients with heart failure (HF group) and patients without HF (HF- group). Diagnostic performance of CO change under the three maneuvers was calculated by sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve. RESULTS: 290 patients were enrolled in the study. The final diagnosis was dyspnea due to congestive heart failure in 147 patients (50.7%). CO change with VM was the most accurate exam in identifying congestive heart failure as the cause of dyspnea with a sensitivity, specificity, positive and negative likelihood ratios of 79%, 60%, 1.97, and 0.36 respectively. Area under ROC curve was 0.62(95% CI, 0.55-0.69), 0.63(95% CI, 0.56-0.69), and 0.70(95% CI, 0.64-0.76) respectively for SP, LR, and VM. In a multivariate analysis, CO change with VM, but not with SP or LR, carried independent diagnostic value (p < 0.001). CONCLUSION: the diagnosis of HF can be aided with use of analyzing the effect of VM on non-invasively measured CO among patients admitted to the ED with undifferentiated dyspnea. Diagnostic yield of SP and LR was poor.


Assuntos
Débito Cardíaco/fisiologia , Impedância Elétrica , Insuficiência Cardíaca/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Dispneia/etiologia , Dispneia/fisiopatologia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC
13.
Chest ; 159(4): e257-e260, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-34022029

RESUMO

CASE PRESENTATION: A 26-year-old woman with no significant medical history was referred for 5 months of dry cough, dyspnea, presyncope and chest pressure, and nausea with exertion. The family history was notable for thromboembolic disease in the setting of malignancy and autoimmune disease. She was not on any medications. She is a never smoker and did not use recreational drugs. She had no work-related exposures. Her BP was 95/67 mm Hg; her heart rate was 93 beats per minute, and oxygen saturation was 98% on room air. Lung fields were clear to auscultation. She had a prominent P2 heart sound. There was no jugular venous distension or edema. There was no clubbing, rash, or synovitis.


Assuntos
Dispneia/etiologia , Pulmão/diagnóstico por imagem , Esforço Físico , Pneumopatia Veno-Oclusiva/complicações , Adulto , Biópsia , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/fisiopatologia , Feminino , Humanos , Pneumopatia Veno-Oclusiva/diagnóstico , Tomografia Computadorizada por Raios X
14.
Am J Cardiol ; 150: 55-59, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34006373

RESUMO

Coronary artery bypass grafting (CABG) often causes physiological changes in patients. Although functional changes, such as lung function and exercise capacity changes, are observed in patients, there are no detailed studies examining this. The aim was to compare preoperative and postoperative pulmonary function and exercise capacity in patients undergoing on-pump CABG with a multidimensional index (BODE index). Demographic and surgical characteristics of patients were recorded. Pulmonary function test, six-minute walk test (6MWT), and modified Medical Research Council (mMRC) dyspnea score were assessed and BODE index were calculated in preoperative and at six months postoperatively. A total of 75 patients were included with a mean ± standard deviation age of 59.8±10.0 years. The male to female ratio was 57/18. There was a statistically significant decrease in the forced expiratory flow at 25-75% (FEF25-75%) value after CABG. Other pulmonary function test values were also lower in the postoperative period compared to the preoperative period, but these changes were not significant. The mean distance achieved in the 6MWT (p=0.02) and the mMRC dyspnea score (p=0.001) were significantly better postoperatively. The BODE index, which combines these parameters, had increased in the postoperative period. Age (OR 1.09; 95% CI: 1.008-1.181) and postoperative FEF25-75% (OR -0.96; 95% CI: 0.938-0.988) were the independent predictors of BODE score ≥3 in multivariate analysis. Despite the decrease in pulmonary function in patients undergoing CABG, there was an improvement in exercise capacity and dyspnea score.


Assuntos
Ponte de Artéria Coronária/métodos , Doença das Coronárias/fisiopatologia , Doença das Coronárias/cirurgia , Tolerância ao Exercício/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Dispneia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Testes de Função Respiratória , Índice de Gravidade de Doença , Teste de Caminhada
15.
Chron Respir Dis ; 18: 14799731211015691, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33957805

RESUMO

Individuals with lasting symptoms of COVID-19 should be offered a comprehensive recovery programme. 30 individuals (mean[SD] age 58[16]) that completed a 6 week, twice supervised rehabilitation programme demonstrated statistically significant improvements in exercise capacity, respiratory symptoms, fatigue and cognition. Participants improved by 112 m on the Incremental Shuttle Walking Test and 544 seconds on the Endurance Shuttle Walking Test. There were no serious adverse events recorded, and there were no dropouts related to symptom worsening. COVID-19 rehabilitation appears feasible and significantly improves clinical outcomes.


Assuntos
COVID-19/reabilitação , Dispneia/reabilitação , Terapia por Exercício/métodos , Tolerância ao Exercício/fisiologia , Fadiga/reabilitação , Caminhada/fisiologia , COVID-19/complicações , COVID-19/epidemiologia , Dispneia/etiologia , Dispneia/fisiopatologia , Fadiga/etiologia , Fadiga/fisiopatologia , Seguimentos , Humanos , Pandemias , Qualidade de Vida , SARS-CoV-2 , Inquéritos e Questionários
16.
Saudi Med J ; 42(4): 391-398, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33795494

RESUMO

OBJECTIVES: To determine the demographic and clinical characteristics, underlying comorbidities, and outcomes of children with coronavirus disease 2019 (COVID-19) infection. METHODS: In this retrospective study, we reported 62 pediatric patients (age <14 years) with confirmed COVID-19 between March 2 and July 1, 2020, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. RESULTS: Comorbid conditions, including cardiac, neurological, respiratory, and malignant disorders, were reported in 9 patients (14.5%). The most prominent presenting complaints were fever (80.6%) and cough (48.4%). Most of our patients (80.6%) had mild disease, 11.3% had moderate disease, and 8.1% exhibited severe and critical illness. Twenty-one patients (33.9%) were hospitalized, with 4 patients (6.5%) admitted to the pediatric intensive care unit, and 3 (4.8%) patients died. CONCLUSION: All pediatric age groups are susceptible to COVID-19, with no gender difference. COVID-19 infection may result in critical illness and even mortality in subsets of pediatric patients.


Assuntos
COVID-19/fisiopatologia , Dor Abdominal/fisiopatologia , Adolescente , Asma/epidemiologia , Atrofia , Encéfalo/patologia , Bronquiolite Obliterante/epidemiologia , COVID-19/sangue , COVID-19/epidemiologia , COVID-19/terapia , Criança , Pré-Escolar , Comorbidade , Tosse/fisiopatologia , Diarreia/fisiopatologia , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Cardiopatias Congênitas/epidemiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Hidrocefalia/epidemiologia , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Faringite/fisiopatologia , Respiração Artificial , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Rinorreia/fisiopatologia , SARS-CoV-2 , Arábia Saudita/epidemiologia , Índice de Gravidade de Doença , Vômito/fisiopatologia
17.
BMC Pulm Med ; 21(1): 126, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33874930

RESUMO

BACKGROUND: Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnoea (platypnea) and arterial desaturation in the upright position resolved in the supine position (orthodeoxia). Intracardiac shunt, pulmonary ventilation-perfusion mismatch and others intrapulmonary abnormalities are involved. CASE PRESENTATION: We report a case of POS associated with two pathophysiological issues: one, cardiac POS caused by a patent foramen ovale (PFO) and second, pulmonary POS due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interstitial pneumonia. POS has resolved after recovery of coronavirus disease 2019 (COVID-19) pneumonia. CONCLUSIONS: Right-to-left interatrial shunt and intrapulmonary shunt caused by SARS-CoV-2 pneumonia contributed to refractory hypoxemia and POS. Therefore, in case of COVID-19 patient with unexplained POS, the existence of PFO must be investigated.


Assuntos
COVID-19 , Dispneia , Forame Oval Patente , Hipóxia , Pulmão/diagnóstico por imagem , Pneumonia Viral , COVID-19/diagnóstico , COVID-19/fisiopatologia , Dispneia/diagnóstico , Dispneia/etiologia , Dispneia/fisiopatologia , Ecocardiografia/métodos , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico , Forame Oval Patente/fisiopatologia , Hemodinâmica , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Hipóxia/fisiopatologia , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/fisiopatologia , Doenças Pulmonares Intersticiais/virologia , Masculino , Pessoa de Meia-Idade , Oxigênio/análise , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Postura/fisiologia , SARS-CoV-2/isolamento & purificação , Síndrome , Resultado do Tratamento
18.
Respir Res ; 22(1): 116, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882928

RESUMO

BACKGROUND: Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients in Japan is mainly based on the registration order. Hence, scientific evidence for risk stratification regarding waitlist mortality is urgently needed. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation. METHODS: We analyzed factors related to waitlist mortality using data of 203 patients who were registered as candidates for lung transplantation from deceased donors. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale, and the health status was determined with St. George's Respiratory Questionnaire (SGRQ). RESULTS: Among 197 patients who met the inclusion criteria, the main underlying disease was interstitial lung disease (99 patients). During the median follow-up period of 572 days, 72 patients died and 96 received lung transplantation (69 from deceased donors). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total score were significantly associated with waitlist mortality (p = 0.003 and p < 0.001, respectively) as well as age, interstitial lung disease, arterial partial pressure of carbon dioxide, and forced vital capacity. Multivariable competing risk analyses revealed that the mMRC and SGRQ score were associated with waitlist mortality in addition to age and interstitial lung disease. CONCLUSIONS: Both mMRC dyspnea and SGRQ score were significantly associated with waitlist mortality, in addition to other clinical variables such as patients' background, underlying disease, and pulmonary function. Patient-reported dyspnea and health may be measured through multi-dimensional analysis (including subjective perceptions) and for risk stratification regarding waitlist mortality.


Assuntos
Dispneia/mortalidade , Pneumopatias/mortalidade , Transplante de Pulmão , Pulmão/fisiopatologia , Inquéritos e Questionários , Listas de Espera/mortalidade , Adulto , Dispneia/diagnóstico , Dispneia/fisiopatologia , Dispneia/cirurgia , Feminino , Nível de Saúde , Humanos , Japão , Pulmão/cirurgia , Pneumopatias/diagnóstico , Pneumopatias/fisiopatologia , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
19.
BMC Pregnancy Childbirth ; 21(1): 326, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902483

RESUMO

BACKGROUND: Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation. METHODS: Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020-31/07/2020 were included. Epidemiological, clinical, and analytical data was collected. RESULTS: A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8-37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473-11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578-0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340-22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840-31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery. CONCLUSIONS: Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.


Assuntos
COVID-19/epidemiologia , Portador Sadio/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , COVID-19/fisiopatologia , COVID-19/terapia , Teste de Ácido Nucleico para COVID-19 , Cesárea/estatística & dados numéricos , Estudos de Coortes , Comorbidade , Tosse/fisiopatologia , Diabetes Gestacional/epidemiologia , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Idade Gestacional , Humanos , Hipertensão/epidemiologia , Hipotireoidismo/epidemiologia , Fatores Imunológicos/uso terapêutico , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Unidades de Terapia Intensiva/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Masculino , Obesidade Materna/epidemiologia , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Radiografia Torácica , Respiração Artificial , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Espanha/epidemiologia
20.
Epidemiol Infect ; 149: e92, 2021 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-33814027

RESUMO

Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.


Assuntos
Assistência Ambulatorial , Teste para COVID-19/métodos , COVID-19/diagnóstico , Dor Abdominal/fisiopatologia , Adolescente , Adulto , COVID-19/fisiopatologia , Estudos de Casos e Controles , Regras de Decisão Clínica , Tosse/fisiopatologia , Diarreia/fisiopatologia , Progressão da Doença , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Cefaleia/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Mialgia/fisiopatologia , Razão de Chances , Seleção de Pacientes , Faringite/fisiopatologia , Rinorreia/fisiopatologia , SARS-CoV-2 , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Adulto Jovem
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