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1.
Maturitas ; 149: 8-15, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34134889

RESUMO

OBJECTIVES: Physiological and psychological changes, including sleep disturbance and mood changes, frequently occur in post-menopausal women. We explored associations between sleep duration/quality and arterial stiffness, as well as the moderating role of depressive symptoms, in post-menopausal women. STUDY DESIGN: This cross-sectional study utilized data obtained from 1687 post-menopausal women in the Cardiovascular and Metabolic Diseases Etiology Research Center cohort study. MAIN OUTCOME MEASURES: Self-reported sleep was classified into short (<6 h/day), normal, and long (≥ 8 h/day) sleep durations. Poor sleep quality was operationally defined using the fatigue-related Berlin questionnaire. Depressive symptoms were assessed using the Beck Depression Index-II (BDI-II). Arterial stiffness was evaluated using the augmentation index (AI) and the HEM-9000AI system. The associations between sleep and AI were examined using generalized linear models, followed by a path model to investigate whether depressive symptoms act as an effect modifier. RESULTS: AI (%) values for participants with poor sleep quality were higher than those for participants with normal sleep quality (ß=1.53, standard error [SE]=0.59, p = 0.009). Although overall sleep duration was not associated with AI values, the severity of depressive symptoms altered the association (p-for interaction=0.021). The magnitude of the positive association between sleep duration and AI was amplified in participants with higher BDI-II scores. In participants with severe depressive symptoms (BDI-II ≥20), a long sleep duration was significantly associated with elevated AI values (ß=4.80, SE=1.56, p = 0.003) compared with those with a normal sleep duration. CONCLUSION: In post-menopausal women, poor sleep quality appears to result in an increase in arterial stiffness, and depressive symptoms seem to modify the association between sleep duration and AI. This modifying role for mental health should be considered in the association between sleep and cardiovascular health in post-menopausal women.


Assuntos
Depressão/epidemiologia , Fadiga/fisiopatologia , Pós-Menopausa , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Adulto , Estudos de Coortes , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Inquéritos e Questionários , Fatores de Tempo
2.
Life Sci ; 280: 119701, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34119538

RESUMO

AIMS: Post-exertional malaise (PEM) is poorly understood in Gulf War Illness (GWI). Exercise challenges have emerged as stimuli to study PEM; however, little attention has been paid to unique cardiorespiratory and perceptual responses during exercise. This study tested whether select exercise parameters explained variability in PEM responses. MAIN METHODS: Visual analog scale (0-100) versions of the Kansas questionnaire were used for daily symptom measurements one week before and one week after 30-min of cycling at 70% heart rate reserve in 43 Veterans with GWI and 31 Veteran controls (CON). Cardiopulmonary exercise testing (CPET) methods were used to measure oxygen (VO2), carbon dioxide (VCO2), ventilation (VE), heart rate, work rate, and leg muscle pain. Symptom changes and CPET parameters were compared between groups with independent samples t-tests. Linear regression (GLM) with VE/VCO2, cumulative work, leg muscle pain, and self-reported physical function treated as independent variables and peak symptom response as the dependent variable tested whether exercise responses predicted PEM. KEY FINDINGS: Compared to CON, Veterans with GWI had greater ventilatory equivalent for oxygen (VE/VO2), peak leg muscle pain, fatigue, and lower VCO2, VO2, power, and cumulative work during exercise (p < 0.05), and greater peak symptom responses (GWI = 38.90 ± 29.06, CON = 17.84 ± 28.26, g = 0.70, p < 0.01). The final GLM did not explain significant variance in PEM (Pooled R2 = 0.15, Adjusted R2 = 0.03, p = 0.34). SIGNIFICANCE: The PEM response was not related to the selected combination of cardiorespiratory and perceptual responses to exercise.


Assuntos
Exercício Físico , Síndrome do Golfo Pérsico/fisiopatologia , Idoso , Teste de Esforço , Fadiga/complicações , Fadiga/fisiopatologia , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Mialgia/complicações , Mialgia/fisiopatologia , Síndrome do Golfo Pérsico/complicações
3.
Life Sci ; 280: 119702, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34111462

RESUMO

AIMS: Nearly a third of U.S. veterans who deployed in support of the 1990-1991 Persian Gulf War are affected by Gulf War illness (GWI). Here we aimed to characterize whether subjective sleep complaints in GWI veterans are associated with objective sleep EEG disturbances relative to healthy veterans and controls; and whether Gulf War veterans show alterations in neural activity during sleep that differentiate them from healthy subjects. MAIN METHODS: We used high-density EEG (HDEEG) to assess regional patterns of rapid eye movement (REM) sleep and non-REM (NREM) sleep between three groups: Gulf War male veterans with fatigue and GWI, Gulf War male veterans without fatigue or GWI, and control males. The groups were matched relative to age, sex and obstructive sleep apnea. Topographic comparisons of nocturnal NREM and REM sleep were made between groups for all frequency bands. KEY FINDINGS: Topographic analysis revealed a broadband reduction in EEG power in a circumscribed region overlying the frontal lobe in both groups of Gulf War veterans, regardless of GWI and fatigue. This frontal reduction in neural activity was present, to some extent, across all frequency bands in NREM and REM sleep. SIGNIFICANCE: Given that our findings were observed in all Gulf War veterans, it appears unlikely that frontal sleep HDEEG power reductions prove wholly responsible for fatigue symptoms. These results provide avenues for research which may someday contribute to improved clinical care of formerly deployed veterans of the Persian Gulf War.


Assuntos
Lobo Frontal/fisiopatologia , Síndrome do Golfo Pérsico/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Sono , Adulto , Estudos de Casos e Controles , Eletroencefalografia , Fadiga/etiologia , Fadiga/fisiopatologia , Guerra do Golfo , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Golfo Pérsico/complicações , Polissonografia , Estudos Prospectivos , Apneia Obstrutiva do Sono/etiologia
4.
J Clin Psychiatry ; 82(3)2021 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-34004095

RESUMO

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has led to an increased risk of psychiatric symptoms among frontline health care workers (FHCWs). In the current study, a novel "symptomics" approach was employed to examine the association between acute transdiagnostic symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) and burnout and work and relationship difficulties in FHCWs at an urban tertiary care hospital in New York City. METHODS: Symptoms of COVID-19-related PTSD (4-item PTSD Checklist-5), MDD (Patient Health Questionnaire-8), GAD (Generalized Anxiety Disorder-7), burnout (Single-Item Mini-Z Burnout Assessment), and functional difficulties (Brief Inventory of Psychosocial Functioning) were assessed. Relative importance analyses were conducted to identify PTSD, MDD, and GAD symptoms associated with burnout and functional difficulties. RESULTS: The total number of eligible participants included 6,026 presumed FHCWs, of which 3,360 (55.8%) completed the survey and 2,579 (76.8%) of whom endorsed directly treating patients with COVID-19 and provided sufficient responses to our outcome variables for analysis. Feeling tired/having little energy, being easily annoyed or irritable, and feeling nervous, anxious, or on edge were most strongly associated with burnout; feeling tired/having little energy accounted for the greatest amount of explained variance (> 15%). Negative expectations of oneself or the world, trouble concentrating, and feeling easily annoyed or irritable were most strongly associated with work difficulties; negative expectations of oneself or the world accounted for the greatest amount of explained variance (> 9%). Feeling easily annoyed or irritable, negative expectations about oneself or the world, and feeling bad about oneself were most strongly associated with relationship difficulties; feeling easily annoyed or irritable accounted for the greatest amount of explained variance (> 10%). CONCLUSIONS: Results of this study underscore the importance of a transdiagnostic, symptom-based approach when examining associations between acute psychopathology and burnout and functional difficulties in FHCWs. Further work is needed to determine if early interventions aimed at ameliorating specific psychiatric symptoms may help mitigate risk for peri- and posttraumatic burnout and functional difficulties in this population.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Esgotamento Profissional/fisiopatologia , COVID-19/terapia , Transtorno Depressivo Maior/fisiopatologia , Fadiga/fisiopatologia , Humor Irritável/fisiologia , Recursos Humanos em Hospital , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Feminino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Centros de Atenção Terciária
5.
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
6.
Clin Neurophysiol ; 132(8): 1974-1981, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34020890

RESUMO

OBJECTIVE: To investigate the peripheral nerve and muscle function electrophysiologically in patients with persistent neuromuscular symptoms following Coronavirus disease 2019 (COVID-19). METHODS: Twenty consecutive patients from a Long-term COVID-19 Clinic referred to electrophysiological examination with the suspicion of mono- or polyneuropathy were included. Examinations were performed from 77 to 255 (median: 216) days after acute COVID-19. None of the patients had received treatment at the intensive care unit. Of these, 10 patients were not even hospitalized. Conventional nerve conduction studies (NCS) and quantitative electromyography (qEMG) findings from three muscles were compared with 20 age- and sex-matched healthy controls. RESULTS: qEMG showed myopathic changes in one or more muscles in 11 patients (55%). Motor unit potential duration was shorter in patients compared to healthy controls in biceps brachii (10.02 ± 0.28 vs 11.75 ± 0.21), vastus medialis (10.86 ± 0.37 vs 12.52 ± 0.19) and anterior tibial (11.76 ± 0.31 vs 13.26 ± 0.21) muscles. All patients with myopathic qEMG reported about physical fatigue and 8 patients about myalgia while 3 patients without myopathic changes complained about physical fatigue. CONCLUSIONS: Long-term COVID-19 does not cause large fibre neuropathy, but myopathic changes are seen. SIGNIFICANCE: Myopathy may be an important cause of physical fatigue in long-term COVID-19 even in non-hospitalized patients.


Assuntos
COVID-19/complicações , COVID-19/fisiopatologia , Fadiga/etiologia , Fadiga/fisiopatologia , Doenças Musculares/etiologia , Doenças Musculares/fisiopatologia , Adulto , Idoso , COVID-19/diagnóstico , Eletromiografia/tendências , Fadiga/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculares/diagnóstico , Condução Nervosa/fisiologia , Sistema de Registros , Fatores de Tempo
7.
Medicine (Baltimore) ; 100(16): e25425, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879672

RESUMO

BACKGROUND: The American Heart Association guidelines recommend switching chest compression providers at least every 2 min depending on their fatigue during cardiopulmonary resuscitation (CPR). Although the provider's heart rate is widely used as an objective indicator for detecting fatigue, the accuracy of this measure is debatable. OBJECTIVES: This study was designed to determine whether real-time heart rate is a measure of fatigue in compression providers. STUDY DESIGN: A simulation-based prospective interventional study including 110 participants. METHODS: Participants performed chest compressions in pairs for four cycles using advanced cardiovascular life support simulation. Each participant's heart rate was measured using wearable healthcare devices, and qualitative variables regarding individual compressions were obtained from computerized devices. The primary outcome was correct depth of chest compressions. The main exposure was the change in heart rate, defined as the difference between the participant's heart rate during individual compressions and that before the simulation was initiated. RESULTS: With a constant compression duration for one cycle, the overall accuracy of compression depth significantly decreased with increasing heart rate. Female participants displayed significantly decreased accuracy of compression depth with increasing heart rate (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95-0.98; P < .001). Conversely, male participants displayed significantly improved accuracy with increasing heart rate (OR: 1.03; 95% CI: 1.02-1.04; P < .001). CONCLUSION: Increasing heart rate could reflect fatigue in providers performing chest compressions with a constant duration for one cycle. Thus, provider rotation should be considered according to objectively measured fatigue during CPR.


Assuntos
Reanimação Cardiopulmonar/métodos , Auxiliares de Emergência/estatística & dados numéricos , Fadiga/fisiopatologia , Frequência Cardíaca/fisiologia , Doenças Profissionais/fisiopatologia , Adulto , Reanimação Cardiopulmonar/educação , Auxiliares de Emergência/educação , Fadiga/diagnóstico , Feminino , Humanos , Masculino , Manequins , Doenças Profissionais/diagnóstico , Estudos Prospectivos , Treinamento por Simulação , Trabalho/fisiologia , Adulto Jovem
8.
Biofactors ; 47(2): 232-241, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33847020

RESUMO

COVID-19 leads to severe respiratory problems, but also to long-COVID syndrome associated primarily with cognitive dysfunction and fatigue. Long-COVID syndrome symptoms, especially brain fog, are similar to those experienced by patients undertaking or following chemotherapy for cancer (chemofog or chemobrain), as well in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or mast cell activation syndrome (MCAS). The pathogenesis of brain fog in these illnesses is presently unknown but may involve neuroinflammation via mast cells stimulated by pathogenic and stress stimuli to release mediators that activate microglia and lead to inflammation in the hypothalamus. These processes could be mitigated by phytosomal formulation (in olive pomace oil) of the natural flavonoid luteolin.


Assuntos
COVID-19/tratamento farmacológico , Disfunção Cognitiva/tratamento farmacológico , Fadiga/tratamento farmacológico , Luteolina/uso terapêutico , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Encéfalo/virologia , COVID-19/complicações , COVID-19/fisiopatologia , COVID-19/virologia , Disfunção Cognitiva/complicações , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/virologia , Citocinas/genética , Fadiga/complicações , Fadiga/fisiopatologia , Fadiga/virologia , Humanos , Mastócitos/efeitos dos fármacos , Mastócitos/virologia , SARS-CoV-2/patogenicidade
9.
Rev. neurol. (Ed. impr.) ; 72(5): 157-167, 1 mar., 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-202075

RESUMO

INTRODUCCIÓN: La esclerosis múltiple (EM) es una enfermedad inflamatoria desmielinizante del sistema nervioso central. Se ha propuesto la imagen motora (IM) como tratamiento para mejorar la marcha, la fatiga y la calidad de vida en esta patología. OBJETIVO: Evaluar la eficacia del abordaje mediante IM, terapia de observación de acciones (AOT) o terapia en espejo, en comparación con una modalidad diferente de rehabilitación o la no intervención en la EM. DESARROLLO: Se realizó una revisión sistemática de ensayos controlados aleatorizados. Se incluyeron estudios de los últimos 10 años que comparasen la IM frente a otras intervenciones o la no intervención en pacientes con EM. Se utilizó la escala PEDro para evaluar la calidad metodológica de los estudios incluidos. Ocho estudios cumplieron los criterios de elegibilidad. Para la fatiga, la IM y su combinación con la relajación parecen ser superiores en comparación con otros tratamientos o la no intervención. La IM combinada con música también mostró mejoras significativas en la marcha y en la calidad de vida. CONCLUSIONES: La IM combinada con ejercicios de relajación ha demostrado eficacia en el tratamiento de la fatiga, la marcha, el equilibrio, la depresión y la calidad de vida en personas con EM. La AOT resulta útil en la rehabilitación del miembro superior y en la mejora de la atención, el control ejecutivo y la activación de las redes sensoriomotoras. Son necesarios estudios de mayor calidad metodológica que respalden estos resultados y valoren su efectividad a largo plazo


INTRODUCTION: Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. Motor imagery (MI) has been proposed as a treatment to improve gait, fatigue and quality of life in these dysfunctions. AIM: To assess the effectiveness of MI, action observation therapy or mirror therapy approaches compared to other rehabilitation modality or no intervention, in MS. DEVELOPMENT: A systematic review of randomized controlled trials was conducted. Studies published in the last ten years investigating MI versus other interventions or no intervention in patients with MS were included. PEDro scale was used to assess methodological quality of included studies. Eight studies met the eligibility criteria. For fatigue, the MI and its combination with relaxation seem to be superior compared with other types of interventions or no intervention. The MI combined with music also showed significant improvements in gait and quality of life (QoL). CONCLUSIONS: MI and its combination with relaxation exercises have been shown to be effective in the treatment of fatigue, gait, balance, depression and QoL in patients with MS. The action observation therapy is useful in upper limb rehabilitation and improvement in attention, executive control and activation of sensorimotor networks. Further research with high methodological quality is needed to support these findings and to evaluate their effectiveness in long term


Assuntos
Esclerose Múltipla/reabilitação , Imagens, Psicoterapia/métodos , Modalidades de Fisioterapia , Qualidade de Vida , Marcha/fisiologia , Fadiga/fisiopatologia , Equilíbrio Postural/fisiologia
10.
Enferm. intensiva (Ed. impr.) ; 32(1): 48-53, ene.-mar. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-202301

RESUMO

INTRODUCCIÓN: La enfermedad de McArdle o glucogenosis tipo V es una enfermedad rara debida al déficit de miofosforilasa muscular, lo que produce incapacidad para degradar el glucógeno a este nivel. Los pacientes presentan fatiga, dolor y calambres de forma habitual. Además, tras un ejercicio intenso o situación estresante, están expuestos a lisis celular. Esto se puede manifestar en forma de mioglobinuria y rabdomiólisis, síndrome clínico potencialmente grave si no se trata con rapidez. VALORACIÓN: Se presenta el caso de un varón de 38 años con enfermedad de McArdle y rabdomiólisis secundaria a la realización de ejercicio, que precisó atención en el Servicio de Urgencias durante 24 horas, así como su posterior ingreso en Unidad de Hospitalización. Se realizó una valoración enfermera siguiendo el modelo de cuidados de Virginia Henderson. DIAGNÓSTICO: Se priorizaron los diagnósticos enfermeros: (00016) deterioro de la eliminación urinaria, (00092) intolerancia a la actividad, (00093) fatiga y (00132) dolor agudo; y la complicación potencial: riesgo de fallo renal agudo. PLANIFICACIÓN: Se elabora Plan de Cuidados siguiendo la metodología NANDA-NIC-NOC, con especial atención a las alteraciones en la eliminación y en el sistema musculoesquelético. Se realiza monitorización de la diuresis. Se realiza reposición de líquidos y se administra medicación analgésica. DISCUSIÓN: Existe escasa literatura sobre los cuidados enfermeros de pacientes con enfermedad de McArdle, lo que ha limitado la comparación de nuestros resultados con los de otros autores, sin embargo, dada la buena respuesta del sujeto mediante reposición de líquidos, un óptimo control del dolor y el reposo demostraron una rápida recuperación del paciente


INTRODUCTION: McArdle's disease or glycogenosis type V is a rare disease due to deficiency of muscle myophosphorylase leading to inability to degrade glycogen at this level. Patients have fatigue, pain, and cramps on a regular basis. In addition, after intense exercise or stressful situation, they are exposed to cellular lysis. This can occur in the form of rhabdomyolysis and myoglobinuria, a potentially serious clinical syndrome if not treated quickly. CASE EVALUATION: We present the care plan of a 38-year-old man with McArdle's disease and secondary rhabdomyolysis on physical exercise, which required attention in the Emergency Department for 24 hours, as well as his subsequent admission to the ward. A nursing evaluation was performed following the care model of Virginia Henderson. DIAGNOSIS: Priority was given to nurse diagnoses: (00016) deterioration of urinary elimination, (00092) activity intolerance, (00093) fatigue and (00132) acute pain; and potential complication: risk of acute renal failure. PLANNING: The Care Plan is developed following the NANDA-NIC-NOC methodology, with special attention to alterations in the elimination and musculoskeletal system. The diuresis is monitored. Fluid replenishment is performed, and analgesic medication is given. DISCUSSION: There is little literature on the nursing care of patients with McArdle's disease, which has limited the comparison of our results with those of other authors. However, given the good response of the subject through fluid replacement, optimal pain control and rest, they made a rapid recovery


Assuntos
Humanos , Masculino , Adulto , Doença de Depósito de Glicogênio Tipo V/complicações , Rabdomiólise/enfermagem , Insuficiência Renal/prevenção & controle , Doenças Raras/enfermagem , Tolerância ao Exercício , Fadiga/fisiopatologia
11.
BMJ Open Respir Res ; 8(1)2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33731329

RESUMO

BACKGROUND: Descriptions of clinical characteristics of patients hospitalised withCOVID-19, their clinical course and short-term inpatient and outpatient outcomes in deprived urban populations in the UK are still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequelae of patients admitted to two large District General Hospitals across a large East London National Health Service Trust during the first wave of the pandemic. METHODS: A retrospective analysis was carried out on a cohort of 1946 patients with a clinical or laboratory diagnosis of COVID-19, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three respiratory units in the trust. RESULTS: Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow-up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 70% of survivors, with 39% of patients unable to return to work due to ongoing symptoms. CONCLUSIONS: Understanding the acute clinical features, course of illness and outcomes of COVID-19 will be crucial in understanding the effect of differences in risk, as well as the effectiveness of new interventions and vaccination between the successive waves of the pandemic.


Assuntos
COVID-19/complicações , COVID-19/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alopecia/fisiopatologia , COVID-19/mortalidade , COVID-19/fisiopatologia , COVID-19/terapia , Estudos de Coortes , Tosse/fisiopatologia , Dispneia/fisiopatologia , Grupos Étnicos , Fadiga/fisiopatologia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Londres/epidemiologia , Masculino , Transtornos da Memória/fisiopatologia , Pessoa de Meia-Idade , Análise Multivariada , Ventilação não Invasiva/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Retorno ao Trabalho , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Fatores Sexuais
12.
Chron Respir Dis ; 18: 14799731211002240, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729021

RESUMO

Knowledge on the sequelae of Coronavirus Disease 2019 (COVID-19) remains limited due to the relatively recent onset of this pathology. However, the literature on other types of coronavirus infections prior to COVID-19 reports that patients may experience persistent symptoms after discharge. To determine the prevalence of respiratory symptoms in survivors of hospital admission after COVID-19 infection. A living systematic review of five databases was performed in order to identify studies which reported the persistence of respiratory symptoms in COVID-19 patients after discharge. Two independent researchers reviewed and analysed the available literature, and then extracted and assessed the quality of those articles. Of the 1,154 reports returned by the initial search nine articles were found, in which 1,816 patients were included in the data synthesis. In the pooled analysis, we found a prevalence of 0.52 (CI 0.38-0.66, p < 0.01, I 2 = 97%), 0.37 (CI 0.28-0.48, p < 0.01, I 2 = 93%), 0.16 (CI 0.10-0.23, p < 0.01, I 2 = 90%) and 0.14 (CI 0.06-0.24, p < 0.01, I 2 = 96%) for fatigue, dyspnoea, chest pain, and cough, respectively. Fatigue, dyspnoea, chest pain, and cough were the most prevalent respiratory symptoms found in 52%, 37%, 16% and 14% of patients between 3 weeks and 3 months, after discharge in survivors of hospital admission by COVID-19, respectively.


Assuntos
COVID-19/complicações , COVID-19/fisiopatologia , Dor no Peito/epidemiologia , Tosse/epidemiologia , Dispneia/epidemiologia , Fadiga/epidemiologia , COVID-19/epidemiologia , Dor no Peito/fisiopatologia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Humanos , Prevalência , SARS-CoV-2 , Sobreviventes
13.
Respir Physiol Neurobiol ; 288: 103644, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33647535

RESUMO

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.


Assuntos
COVID-19/complicações , Dispneia/fisiopatologia , Tolerância ao Exercício , Fadiga/fisiopatologia , Troca Gasosa Pulmonar , Espirometria , Adulto , Idoso , COVID-19/fisiopatologia , Doença Crônica , Dispneia/sangue , Feminino , Volume Expiratório Forçado , Estado Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Testes de Função Respiratória , SARS-CoV-2 , Índice de Gravidade de Doença , Sobreviventes , Capacidade Vital , Teste de Caminhada
14.
J Med Case Rep ; 15(1): 108, 2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33653380

RESUMO

BACKGROUND: Hypothyroidism is diagnosed on the basis of laboratory tests because of the lack of specificity of the typical clinical manifestations. There is conflicting evidence on screening for hypothyroidism. CASE PRESENTATION: We report a case of an apparently healthy 19-year-old Kuwaiti woman referred to our clinic with an incidental finding of extremely high thyroid-stimulating hormone (TSH), tested at the patient's insistence as she had a strong family history of hypothyroidism. Despite no stated complaints, the patient presented typical symptoms and signs of hypothyroidism on evaluation. Thyroid function testing was repeated by using different assays, with similar results; ultrasound imaging of the thyroid showed a typical picture of thyroiditis. Treatment with levothyroxine alleviated symptoms and the patient later became biochemically euthyroid on treatment. CONCLUSION: There is controversy regarding screening asymptomatic individuals for hypothyroidism; therefore, it is important to maintain a high index of suspicion when presented with mild signs and symptoms of hypothyroidism especially with certain ethnic groups, as they may be free of the classical symptoms of disease.


Assuntos
Hipotireoidismo/diagnóstico , Tireoidite Autoimune/diagnóstico , Alopecia/fisiopatologia , Apetite , Autoanticorpos/imunologia , Constipação Intestinal/fisiopatologia , Depressão/fisiopatologia , Fadiga/fisiopatologia , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/fisiopatologia , Achados Incidentais , Iodeto Peroxidase/imunologia , Menorragia/fisiopatologia , Índice de Gravidade de Doença , Glândula Tireoide/diagnóstico por imagem , Tireoidite Autoimune/sangue , Tireoidite Autoimune/imunologia , Tireoidite Autoimune/fisiopatologia , Tireotropina/sangue , Tiroxina/sangue , Tiroxina/uso terapêutico , Ultrassonografia , Ganho de Peso , Adulto Jovem
15.
Clin Neurophysiol ; 132(5): 1138-1143, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33774378

RESUMO

OBJECTIVE: A high proportion of patients experience fatigue and impairment of cognitive functions after coronavirus disease 2019 (COVID-19). Here we applied transcranial magnetic stimulation (TMS) to explore the activity of the main inhibitory intracortical circuits within the primary motor cortex (M1) in a sample of patients complaining of fatigue and presenting executive dysfunction after resolution of COVID-19 with neurological manifestations. METHODS: Twelve patients who recovered from typical COVID-19 pneumonia with neurological complications and complained of profound physical and mental fatigue underwent, 9 to 13 weeks from disease onset, a psychometric evaluation including a self-reported fatigue numeric-rating scale (FRS, Fatigue Rating Scale) and the Frontal Assessment Battery (FAB). Intracortical activity was evaluated by means of well-established TMS protocols including short-interval intracortical inhibition (SICI), reflecting GABAA-mediated inhibition, long-interval intracortical inhibition (LICI), a marker of GABAB receptor activity, and short-latency afferent inhibition (SAI) that indexes central cholinergic transmission. TMS data were compared to those obtained in a control group of ten healthy subjects (HS) matched by age, sex and education level. RESULTS: Post-COVID-19 patients reported marked fatigue according to FRS score (8.1 ± 1.7) and presented pathological scores at the FAB based on Italian normative data (12.2 ± 0.7). TMS revealed marked reduction of SICI, and disruption of LICI as compared to HS. SAI was also slightly diminished. CONCLUSIONS: The present study documents for the first time reduced GABAergic inhibition in the M1 in patients who recovered from COVID-19 with neurological complications and manifested fatigue and dysexecutive syndrome. SIGNIFICANCE: TMS may serve as diagnostic tool in cognitive disturbances and fatigue in post-COVID-19 patients.


Assuntos
COVID-19/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Fadiga/fisiopatologia , Neurônios GABAérgicos/fisiologia , Córtex Motor/fisiopatologia , Estimulação Magnética Transcraniana/métodos , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , COVID-19/terapia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/terapia , Fadiga/etiologia , Fadiga/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
J Nutr Health Aging ; 25(4): 410-415, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33786555

RESUMO

OBJECTIVE: Frailty is known to be influenced by genetics, however, little evidence on the association of Apolipoprotein E (ApoE) genotype and frailty exists which we aim to investigate. DESIGN: This study is a cross-sectional analysis from a prospective longitudinal study cohort. SETTING AND PARTICIPANTS: Community-dwelling individuals aged 55 years and older from Beijing region in China. MEASUREMENTS: A total of 3,569 older adults with a mean age of 75.06(±6.79) years were included. We investigated the association between ApoE polymorphism and frailty syndrome using the frailty index (FI) and frailty phenotype (including association with individual components of the frailty phenotype). Logistic regressions were performed to investigate the relation between ApoE variants and frailty. RESULTS: There was no significant association between ApoE variants and frailty as assessed by the FI. In the age and sex-adjusted model, compared to the ApoE e3/e3 carriers ApoE e4 carriers had almost 1.5 times higher odds of being frail as assessed by the frailty phenotype. However, the significance was lost on the model with adjustment for cognitive impairment. Compared to the ApoE e3/e3 carriers ApoE e4 carriers had almost two times higher odds of fatigue. ApoE e4 heterozygotes had higher odds of fatigue compared to ApoE e4 non-carriers. No significant association was found between ApoE variants and other components of frailty phenotype. CONCLUSIONS: Our findings do not support an association between ApoE genotype and frailty irrespective of the frailty assessment tools. Fatigue in older adults is the only component of frailty phenotype influenced by ApoE genotype.


Assuntos
Apolipoproteínas E/genética , Fadiga/genética , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/genética , Polimorfismo Genético/genética , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Fadiga/fisiopatologia , Feminino , Humanos , Vida Independente , Estudos Longitudinais , Masculino , Estudos Prospectivos
17.
Phys Ther ; 101(6)2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33735374

RESUMO

OBJECTIVE: The aim of this pilot study was to assess physical fitness and its relationship with functional dyspnea in survivors of COVID-19 6 months after their discharge from the hospital. METHODS: Data collected routinely from people referred for cardiopulmonary exercise testing (CPET) following hospitalization for COVID-19 were retrospectively analyzed. Persistent dyspnea was assessed using the modified Medical Research Council dyspnea scale. RESULTS: Twenty-three people with persistent symptoms were referred for CPET. Mean modified Medical Research Council dyspnea score was 1 (SD = 1) and was significantly associated with peak oxygen uptake (VO2peak; %) (rho = -0.49). At 6 months, those hospitalized in the general ward had a relatively preserved VO2peak (87% [SD = 20]), whereas those who had been in the intensive care unit had a moderately reduced VO2peak (77% [SD = 15]). Of note, the results of the CPET revealed that, in all individuals, respiratory equivalents were high, power-to-weight ratios were low, and those who had been in the intensive care unit had a relatively low ventilatory efficiency (mean VE/VCO2 slope = 34 [SD = 5]). Analysis of each individual showed that none had a breathing reserve <15% or 11 L/min, all had a normal exercise electrocardiogram, and 4 had a heart rate >90%. CONCLUSION: At 6 months, persistent dyspnea was associated with reduced physical fitness. This study offers initial insights into the mid-term physical fitness of people who required hospitalization for COVID-19. It also provides novel pathophysiological clues about the underlaying mechanism of the physical limitations associated with persistent dyspnea. Those with persistent dyspnea should be offered a tailored rehabilitation intervention, which should probably include muscle reconditioning, breathing retraining, and perhaps respiratory muscle training. IMPACT: This study is the first, to our knowledge, to show that a persistent breathing disorder (in addition to muscle deconditioning) can explain persistent symptoms 6 months after hospitalization for COVID-19 infection and suggests that a specific rehabilitation intervention is warranted.


Assuntos
COVID-19/complicações , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Consumo de Oxigênio/fisiologia , Aptidão Física/fisiologia , Dispneia/virologia , Teste de Esforço , Fadiga/virologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Projetos Piloto , Recuperação de Função Fisiológica , Estudos Retrospectivos , SARS-CoV-2
18.
Artif Intell Med ; 112: 102018, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33581830

RESUMO

BACKGROUND AND OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) is considered a pandemic by the World Health Organization (WHO). As of April 3, 2020, there were 1,009,625 reported confirmed cases, and 51,737 reported deaths. Doctors have been faced with a myriad of patients who present with many different symptoms. This raises two important questions. What are the common symptoms, and what are their relative importance? METHODS: A non-structured and incomplete COVID-19 dataset of 14,251 confirmed cases was preprocessed. This produced a complete and organized COVID-19 dataset of 738 confirmed cases. Six different feature selection algorithms were then applied to this new dataset. Five of these algorithms have been proposed earlier in the literature. The sixth is a novel algorithm being proposed by the authors, called Variance Based Feature Weighting (VBFW), which not only ranks the symptoms (based on their importance) but also assigns a quantitative importance measure to each symptom. RESULTS: For our COVID-19 dataset, the five different feature selection algorithms provided different rankings for the most important top-five symptoms. They even selected different symptoms for inclusion within the top five. This is because each of the five algorithms ranks the symptoms based on different data characteristics. Each of these algorithms has advantages and disadvantages. However, when all these five rankings were aggregated (using two different aggregating methods) they produced two identical rankings of the five most important COVID-19 symptoms. Starting from the most important to least important, they were: Fever/Cough, Fatigue, Sore Throat, and Shortness of Breath. (Fever and cough were ranked equally in both aggregations.) Meanwhile, the sixth novel Variance Based Feature Weighting algorithm, chose the same top five symptoms, but ranked fever much higher than cough, based on its quantitative importance measures for each of those symptoms (Fever - 75 %, Cough - 39.8 %, Fatigue - 16.5 %, Sore Throat - 10.8 %, and Shortness of Breath - 6.6 %). Moreover, the proposed VBFW method achieved an accuracy of 92.1 % when used to build a one-class SVM model, and an NDCG@5 of 100 %. CONCLUSIONS: Based on the dataset, and the feature selection algorithms employed here, symptoms of Fever, Cough, Fatigue, Sore Throat and Shortness of Breath are important symptoms of COVID-19. The VBFW algorithm also indicates that Fever and Cough symptoms were especially indicative of COVID-19, for the confirmed cases that are documented in our database.


Assuntos
COVID-19/fisiopatologia , Biologia Computacional/métodos , Algoritmos , COVID-19/epidemiologia , COVID-19/virologia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Febre/fisiopatologia , Humanos , Pandemias , Faringite/fisiopatologia , SARS-CoV-2/isolamento & purificação
19.
J Nurs Adm ; 51(3): 128-134, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33570369

RESUMO

OBJECTIVE: The aims of this study were to explore nurses' fatigue levels and sleep measures during two 12-hour consecutive day shifts and examine the relationships between nurses' fatigue levels within shifts and their previous-night sleep characteristics. BACKGROUND: Monitoring changes in fatigue and sleep is important to enable effective fatigue management. METHODS: This was a descriptive, repeated-measures study. Data were collected using surveys and actigraphy 4 times during each consecutive shift (7:00 am-7:30 pm). RESULTS: General fatigue levels started trending up 4 hours after the start of work; highest levels were reported at 7:30 pm. Fatigue levels accumulated across consecutive shifts. Subjective sleep quality was higher the night before the 2nd shift than the night before the 1st shift. Nurses' poor sleep the night before a shift was related to increased fatigue levels during the next shift. CONCLUSION: It is important to consider when fatigue management interventions will be most effective and to consider previous-night's sleep when monitoring fatigue.


Assuntos
Fadiga/fisiopatologia , Fadiga/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Privação do Sono/fisiopatologia , Privação do Sono/psicologia , Tolerância ao Trabalho Programado/fisiologia , Tolerância ao Trabalho Programado/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Doenças Profissionais/fisiopatologia , Doenças Profissionais/psicologia , Inquéritos e Questionários
20.
Can Respir J ; 2021: 6692409, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33628349

RESUMO

We aimed to investigate changes in pulmonary function and computed tomography (CT) findings in patients with coronavirus disease 2019 (COVID-19) during the recovery period. COVID-19 patients underwent symptom assessment, pulmonary function tests, and high-resolution chest CT 6 months after discharge from the hospital. Of the 54 patients enrolled, 31 and 23 were in the moderate and severe group, respectively. The main symptoms 6 months after discharge were fatigue and exertional dyspnea, experienced by 24.1% and 18.5% of patients, respectively, followed by smell and taste dysfunction (9.3%) and cough (5.6%). One patient dropped out of the pulmonary function tests. Of the remaining 54 patients, 41.5% had pulmonary dysfunction. Specifically, 7.5% presented with restrictive ventilatory dysfunction (forced vital capacity <80% of the predicted value), 18.9% presented with small airway dysfunction, and 32.1% presented with pulmonary diffusion impairment (diffusing capacity for carbon monoxide <80% of the predicted value). Of the 54 patients enrolled, six patients dropped out of the chest CT tests. Eleven of the remaining 48 patients presented with abnormal lung CT findings 6 months after discharge. Patients with residual lung lesions were more common in the severe group (52.6%) than in the moderate group (3.4%); a higher proportion of patients had involvement of both lungs (42.1% vs. 3.4%) in the severe group. The residual lung lesions were mainly ground-glass opacities (20.8%) and linear opacities (14.6%). Semiquantitative visual scoring of the CT findings revealed significantly higher scores in the left, right, and both lungs in the severe group than in the moderate group. COVID-19 patients 6 months after discharge mostly presented with fatigue and exertional dyspnea, and their pulmonary dysfunction was mostly characterized by pulmonary diffusion impairment. As revealed by chest CT, the severe group had a higher prevalence of residual lesions than the moderate group, and the residual lesions mostly manifested as ground-glass opacities and linear opacities.


Assuntos
COVID-19/fisiopatologia , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Pulmão/fisiopatologia , Adulto , Idoso , COVID-19/diagnóstico por imagem , Tosse/fisiopatologia , Feminino , Seguimentos , Volume Expiratório Forçado , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/fisiopatologia , Pico do Fluxo Expiratório , Capacidade de Difusão Pulmonar , Recuperação de Função Fisiológica , Testes de Função Respiratória , SARS-CoV-2 , Índice de Gravidade de Doença , Distúrbios do Paladar/fisiopatologia , Tomografia Computadorizada por Raios X , Capacidade Vital
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