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1.
PLoS One ; 16(2): e0246123, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33577565

RESUMO

BACKGROUND: Nasal High Flow (NHF) therapy delivers flows of heated humidified gases up to 60 LPM (litres per minute) via a nasal cannula. Particles of oral/nasal fluid released by patients undergoing NHF therapy may pose a cross-infection risk, which is a potential concern for treating COVID-19 patients. METHODS: Liquid particles within the exhaled breath of healthy participants were measured with two protocols: (1) high speed camera imaging and counting exhaled particles under high magnification (6 participants) and (2) measuring the deposition of a chemical marker (riboflavin-5-monophosphate) at a distance of 100 and 500 mm on filter papers through which air was drawn (10 participants). The filter papers were assayed with HPLC. Breathing conditions tested included quiet (resting) breathing and vigorous breathing (which here means nasal snorting, voluntary coughing and voluntary sneezing). Unsupported (natural) breathing and NHF at 30 and 60 LPM were compared. RESULTS: Imaging: During quiet breathing, no particles were recorded with unsupported breathing or 30 LPM NHF (detection limit for single particles 33 µm). Particles were detected from 2 of 6 participants at 60 LPM quiet breathing at approximately 10% of the rate caused by unsupported vigorous breathing. Unsupported vigorous breathing released the greatest numbers of particles. Vigorous breathing with NHF at 60 LPM, released half the number of particles compared to vigorous breathing without NHF.Chemical marker tests: No oral/nasal fluid was detected in quiet breathing without NHF (detection limit 0.28 µL/m3). In quiet breathing with NHF at 60 LPM, small quantities were detected in 4 out of 29 quiet breathing tests, not exceeding 17 µL/m3. Vigorous breathing released 200-1000 times more fluid than the quiet breathing with NHF. The quantities detected in vigorous breathing were similar whether using NHF or not. CONCLUSION: During quiet breathing, 60 LPM NHF therapy may cause oral/nasal fluid to be released as particles, at levels of tens of µL per cubic metre of air. Vigorous breathing (snort, cough or sneeze) releases 200 to 1000 times more oral/nasal fluid than quiet breathing (p < 0.001 with both imaging and chemical marker methods). During vigorous breathing, 60 LPM NHF therapy caused no statistically significant difference in the quantity of oral/nasal fluid released compared to unsupported breathing. NHF use does not increase the risk of dispersing infectious aerosols above the risk of unsupported vigorous breathing. Standard infection prevention and control measures should apply when dealing with a patient who has an acute respiratory infection, independent of which, if any, respiratory support is being used. CLINICAL TRIAL REGISTRATION: ACTRN12614000924651.


Assuntos
Expiração , Oxigenoterapia/efeitos adversos , Oxigenoterapia/métodos , Adulto , Testes Respiratórios/métodos , Cânula , Feminino , Humanos , Masculino , Microscopia de Vídeo , Nariz/química , Respiração , Taxa Respiratória
2.
Medicine (Baltimore) ; 100(2): e23982, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466140

RESUMO

ABSTRACT: Acute respiratory distress syndrome (ARDS) is very common in patients with severe acute pancreatitis (SAP), the early interventions are essential to the prognosis of SAP patients. We aimed to evaluate the risk factors for ARDS in SAP patients, to provide insights into the management of SAP.SAP patients treated in our hospital from June 1, 2018 to May 31, 2020 were included. The characteristics and lab test results were collected and compared, and we conducted the logistic regression analyses were conducted to identify the potential risk factors for ARDS in patients with SAP.A total of 281 SAP patients were included finally, the incidence of ARDS in patients with SAP was 30.60%. There were significant differences on the respiratory rate, heart rate, APACHE II and Ranson score between 2 groups (all P < .05). And there were significant differences on the polymorphonuclear, procalcitonin, C-reactive protein, serum creatinine, albumin and PO2/FiO2 between 2 groups (all P < .05), and no significant differences on the K+, Na+, Ca+, white blood cell, neutrophils, urine and blood amylase, trypsin, lipase, alanine aminotransferase, aspartate aminotransferase, total bilirubin, triglyceride, total cholesterol, total bilirubin, fasting blood glucose, and pH were found (all P > .05). Respiratory rate >30/min (odds ratio [OR]: 2.405, 95% confidence interval[CI]: 1.163-4.642), APACHE II score >11 (OR: 1.639, 95% CI: 1.078-2.454), Ranson score >5 (OR: 1.473, 95% CI: 1.145-2.359), polymorphonuclear >14 × 109/L (OR: 1.316, 95% CI: 1.073-2.328), C-reactive protein >150 mg/L (OR: 1.127, 95% CI: 1.002-1.534), albumin ≤30 g/L (OR: 1.113, 95% CI: 1.005-1.489) were the independent risk factors for ARDS in patients with SAP (all P < .05).The incidence of ARDS in SAP patients is relatively high, and it is necessary to carry out targeted early prevention and treatment for the above risk factors.


Assuntos
Pancreatite/epidemiologia , /epidemiologia , APACHE , Adulto , Biomarcadores , Feminino , Frequência Cardíaca , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pancreatite/sangue , Taxa Respiratória , Estudos Retrospectivos , Fatores de Risco
3.
BMC Infect Dis ; 21(1): 66, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441088

RESUMO

BACKGROUND: Early detection and treatment of Gram-negative bacteria (GNB), major causative pathogens of sepsis (a potentially fatal condition caused by the body's response to an infection), may benefit a patient's outcome, since the mortality rate increases by 5-10% for each hour of delayed therapy. Unfortunately, GNB diagnosis is based on bacterial culture, which is time consuming. Therefore, an economic and effective GNB (defined as a positive blood, sputum, or urine culture) infection detection tool in the emergency department (ED) is warranted. METHODS: We conducted a retrospective cohort study in the ED of a university-affiliated medical center between January 01, 2014 and December 31, 2017. The inclusion criteria were as follows: (1) age ≥ 18; (2) clinical suspicion of bacterial infection; (3) bacterial culture from blood, sputum, or urine ordered and obtained in the ED. Descriptive statistics was performed on patient demographic characteristics, vital signs, laboratory data, infection sites, cultured microorganisms, and clinical outcomes. The accuracy of vital signs to predict GNB infection was identified via univariate logistic regression and receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 797 patients were included in this study; the mean age was 71.8 years and 51.3% were male. The odds ratios of patients with body temperature ≥ 38.5 °C, heart rate ≥ 110 beats per minute, respiratory rate ≥ 20 breaths per minute, and Glasgow coma scale (GCS) < 14, in predicting GNB infection were found to be 2.3, 1.4, 1.9, and 1.6, respectively. The area under the curve values for ROC analysis of these measures were 0.70, 0.68, 0.69, and 0.67, respectively. CONCLUSION: The four physiological parameters were rapid and reliable independent predictors for detection of GNB infection.


Assuntos
Temperatura Corporal , Serviço Hospitalar de Emergência , Escala de Coma de Glasgow , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Frequência Cardíaca , Taxa Respiratória , Idoso , Idoso de 80 Anos ou mais , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/microbiologia
4.
Mymensingh Med J ; 30(1): 208-213, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33397876

RESUMO

Slow deep breathing is known to modulate cardiovascular control and is a used in many ancient breath control practices like pranayama. The changes in Heart Rate Variability (HRV) during a less known form of Slow Deep Breathing (SDB) with equal counts of inhalation, holding and exhalation are not well documented. This study analyses the changes during such a slow deep breathing pattern with less than 4 breaths per minute on HRV. The cross sectional descriptive type of observational study was done at AIIMS, Bhopal on 30 regular Kriya yogi volunteers who are practicing for last 10-20 years. SDB involves slow and deep inhalation through the nose, usually to a count of 15, holding for an equal count of 15, followed by slow and complete exhalation for a similar count of 15. The process was repeated for five minutes. The recording ECG for HRV analysis was taken by heart rate variability (Dinamika HRV - Advanced Heart Rate Variability Test System, Moscow, Russia). The resting and during readings of heart rate variability parameters were compared and analysed using a paired t-test. Time domain parameters: Standard Deviation Normal to Normal (SDNN) and Root Mean Square of Successive Differences (RMSSD) were increased at a high level of statistical significance during the manoeuvre. Frequency Domain parameters: Low Frequency (LF), High Frequency (HF), LF/HF ratio increased significantly. Parasympathetic activity is represented by LF when respiration rate is lower than 7 breaths per minute or during taking a deep breath. Thus, when the subject is in the state of relaxation with a slow and even breathing, the LF values can be very high indicating an increase in parasympathetic activity rather than an increase in sympathetic regulation. Practice of pranayama naturally slows the breathing, which in turn makes the heart calmer and calmer as demonstrated by a statistically significant decrease in heart rate after five minutes of SDB. Transient and rapid excitation of cardiovascular system during SDB suggests that the multiple regulatory mechanism at play like mechanical coupling, baroreflex and central mechanisms. Slow yogic breathing (pranayama) may serve as a physiologic method to draw upon cardio-vagal reserve and regular practice of these manoeuvres may beneficially affect cardiovascular autonomic regulation in health and in various cardiovascular diseases.


Assuntos
Doenças Cardiovasculares , Taxa Respiratória , Sistema Nervoso Autônomo , Estudos Transversais , Frequência Cardíaca , Humanos
5.
Enferm. clín. (Ed. impr.) ; 30(6): 377-385, nov.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197667

RESUMO

OBJETIVO: Identificar las medidas de precisión de las características definitorias del diagnóstico de enfermería termorregulación ineficaz en los recién nacidos. MÉTODO: Estudio de precisión diagnóstica de diseño transversal realizado en unidades de maternidad de medio y alto riesgo, localizada en la ciudad de Fortaleza-CE. Se evaluaron 216 recién nacidos para la identificación de las características definitorias del diagnóstico en estudio. Las medidas de precisión de las características definitorias se obtuvieron a partir de un modelo de 2 clases latentes con efectos aleatorios para el cálculo de los valores de sensibilidad y especificidad. RESULTADOS: Las características de frecuencia respiratoria aumentada y piel caliente al tacto presentaron valores de sensibilidad más altos (99,9%) y de especificidades menores (79 y 75%) y las características fluctuaciones de la temperatura corporal por encima y por debajo de los parámetros normales e hipertensión fueron las de mayor especificidad (80,4%) y sensibilidad (100%), respectivamente. CONCLUSIÓN: La característica fluctuación de la temperatura corporal por encima y por debajo de los parámetros normales puede ser más adecuadas para confirmar la presencia del diagnóstico, por haber presentado un mayor valor de especificidad


OBJECTIVE: To identify the measures of accuracy for defining characteristics of the nursing diagnosis: Ineffective thermoregulation in newborns. METHOD: Diagnostic accuracy study with cross-sectional design performed in medium and high-risk maternity units, located in Fortaleza city/Brazil. A total of 216 newborns were evaluated to identify the defining characteristics of the diagnosis under study. The measures of accuracy for defining characteristics were obtained from a latent class model with random effects for the calculation of sensitivity and specificity values. RESULTS: The characteristics of increased respiratory rate and warm skin to the touch had higher sensitivity values (99.9%) and lower specificity (79 and 75%) and the characteristics of body temperature fluctuations above and below the normal parameters and hypertension had the highest specificity (80.4 and 100%, respectively). CONCLUSION: The characteristic fluctuation of the body temperature above and below the normal parameters may be better to confirm the diagnosis, having presented a higher specificity value


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Diagnóstico de Enfermagem/métodos , Regulação da Temperatura Corporal/fisiologia , Taxa Respiratória , Febre/complicações , Diagnóstico de Enfermagem/normas , Estudos Transversais , Sensibilidade e Especificidade , Encefalopatias/prevenção & controle , Razão de Chances , Febre/diagnóstico , Febre/enfermagem
6.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(6): 487-490, 2020 Dec 08.
Artigo em Chinês | MEDLINE | ID: mdl-33314854

RESUMO

This paper designs a bluetooth-based low-power multi-parameter monitoring system. The system is mainly composed of ECG signal acquisition, respiratory signal acquisition, body temperature acquisition, bluetooth 4.0 transmission module and Android mobile phone APP display. The system collects the corresponding physiological signals through various collection parts, and can realize the monitoring of three physiological signals of electrocardiogram, respiration and body temperature. The Android mobile APP can display ECG, respiratory waveform and temperature data in real time. The system is small in size and low in power consumption, and has a good application prospect in portable and wearable medical applications.


Assuntos
Telefone Celular , Eletrocardiografia , Aplicativos Móveis , Monitorização Fisiológica/instrumentação , Temperatura Corporal , Humanos , Taxa Respiratória
7.
PLoS One ; 15(12): e0243939, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370375

RESUMO

BACKGROUND: Current cardiorespiratory monitoring equipment can cause injuries and infections in neonates with fragile skin. Impulse-radio ultra-wideband (IR-UWB) radar was recently demonstrated to be an effective contactless vital sign monitor in adults. The purpose of this study was to assess heart rates (HRs) and respiratory rates (RRs) in the neonatal intensive care unit (NICU) using IR-UWB radar and to evaluate its accuracy and reliability compared to conventional electrocardiography (ECG)/impedance pneumography (IPG). METHODS: The HR and RR were recorded in 34 neonates between 3 and 72 days of age during minimal movement (51 measurements in total) using IR-UWB radar (HRRd, RRRd) and ECG/IPG (HRECG, RRIPG) simultaneously. The radar signals were processed in real time using algorithms for neonates. Radar and ECG/IPG measurements were compared using concordance correlation coefficients (CCCs) and Bland-Altman plots. RESULTS: From the 34 neonates, 12,530 HR samples and 3,504 RR samples were measured. Both the HR and RR measured using the two methods were highly concordant when the neonates had minimal movements (CCC = 0.95 between the RRRd and RRIPG, CCC = 0.97 between the HRRd and HRECG). In the Bland-Altman plot, the mean biases were 0.17 breaths/min (95% limit of agreement [LOA] -7.0-7.3) between the RRRd and RRIPG and -0.23 bpm (95% LOA -5.3-4.8) between the HRRd and HRECG. Moreover, the agreement for the HR and RR measurements between the two modalities was consistently high regardless of neonate weight. CONCLUSIONS: A cardiorespiratory monitor using IR-UWB radar may provide accurate non-contact HR and RR estimates without wires and electrodes for neonates in the NICU.


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Frequência Cardíaca/fisiologia , Monitorização Fisiológica , Taxa Respiratória/fisiologia , Eletrocardiografia/métodos , Estudos de Viabilidade , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Radar , Processamento de Sinais Assistido por Computador/instrumentação
8.
PLoS One ; 15(12): e0244963, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378363

RESUMO

The COVID-19 pandemic disrupted the world in 2020 by spreading at unprecedented rates and causing tens of thousands of fatalities within a few months. The number of deaths dramatically increased in regions where the number of patients in need of hospital care exceeded the availability of care. Many COVID-19 patients experience Acute Respiratory Distress Syndrome (ARDS), a condition that can be treated with mechanical ventilation. In response to the need for mechanical ventilators, designed and tested an emergency ventilator (EV) that can control a patient's peak inspiratory pressure (PIP) and breathing rate, while keeping a positive end expiratory pressure (PEEP). This article describes the rapid design, prototyping, and testing of the EV. The development process was enabled by rapid design iterations using additive manufacturing (AM). In the initial design phase, iterations between design, AM, and testing enabled a working prototype within one week. The designs of the 16 different components of the ventilator were locked by additively manufacturing and testing a total of 283 parts having parametrically varied dimensions. In the second stage, AM was used to produce 75 functional prototypes to support engineering evaluation and animal testing. The devices were tested over more than two million cycles. We also developed an electronic monitoring system and with automatic alarm to provide for safe operation, along with training materials and user guides. The final designs are available online under a free license. The designs have been transferred to more than 70 organizations in 15 countries. This project demonstrates the potential for ultra-fast product design, engineering, and testing of medical devices needed for COVID-19 emergency response.


Assuntos
/terapia , Desenho de Equipamento/métodos , Respiração Artificial/instrumentação , Ventiladores Mecânicos/efeitos adversos , Animais , Humanos , Respiração Artificial/métodos , Mecânica Respiratória/fisiologia , Taxa Respiratória/fisiologia , Suínos
9.
BMC Pulm Med ; 20(1): 324, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33357219

RESUMO

BACKGROUND: It had been shown that High-flow nasal cannula (HFNC) is an effective initial support strategy for patients with acute respiratory failure. However, the efficacy of HFNC for patients with COVID-19 has not been established. This study was performed to assess the efficacy of HFNC for patients with COVID-19 and describe early predictors of HFNC treatment success in order to develop a prediction tool that accurately identifies the need for upgrade respiratory support therapy. METHODS: We retrospectively reviewed the medical records of patients with COVID-19 treated by HFNC in respiratory wards of 2 hospitals in Wuhan between 1 January and 1 March 2020. Overall clinical outcomes, the success rate of HFNC strategy and related respiratory variables were evaluated. RESULTS: A total of 105 patients were analyzed. Of these, 65 patients (61.9%) showed improved oxygenation and were successfully withdrawn from HFNC. The PaO2/FiO2 ratio, SpO2/FiO2 ratio and ROX index (SpO2/FiO2*RR) at 6h, 12h and 24h of HFNC initiation were closely related to the prognosis. The ROX index after 6h of HFNC initiation (AUROC, 0.798) had good predictive capacity for outcomes of HFNC. In the multivariate logistic regression analysis, young age, gender of female, and lower SOFA score all have predictive value, while a ROX index greater than 5.55 at 6 h after initiation was significantly associated with HFNC success (OR, 17.821; 95% CI, 3.741-84.903 p<0.001). CONCLUSIONS: Our study indicated that HFNC was an effective way of respiratory support in the treatment of COVID-19 patients. The ROX index after 6h after initiating HFNC had good predictive capacity for HFNC outcomes.


Assuntos
/terapia , Hipóxia/terapia , Oxigenoterapia/métodos , Oxigênio/administração & dosagem , Oxigênio/sangue , Idoso , /fisiopatologia , Cânula , Feminino , Humanos , Hipóxia/fisiopatologia , Hipóxia/virologia , Masculino , Pessoa de Meia-Idade , Pressão Parcial , Taxa Respiratória , Estudos Retrospectivos , Resultado do Tratamento
10.
PLoS One ; 15(12): e0244051, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33326502

RESUMO

BACKGROUND: During the COVID-19 pandemic, risk stratification has been used to decide patient eligibility for inpatient, critical and domiciliary care. Here, we sought to validate the MSL-COVID-19 score, originally developed to predict COVID-19 mortality in Mexicans. Also, an adaptation of the formula is proposed for the prediction of COVID-19 severity in a triage setting (Nutri-CoV). METHODS: We included patients evaluated from March 16th to August 17th, 2020 at the Instituto Nacional de Ciencias Médicas y Nutrición, defining severe COVID-19 as a composite of death, ICU admission or requirement for intubation (n = 3,007). We validated MSL-COVID-19 for prediction of mortality and severe disease. Using Elastic Net Cox regression, we trained (n = 1,831) and validated (n = 1,176) a model for prediction of severe COVID-19 using MSL-COVID-19 along with clinical assessments obtained at a triage setting. RESULTS: The variables included in MSL-COVID-19 are: pneumonia, early onset type 2 diabetes, age > 65 years, chronic kidney disease, any form of immunosuppression, COPD, obesity, diabetes, and age <40 years. MSL-COVID-19 had good performance to predict COVID-19 mortality (c-statistic = 0.722, 95%CI 0.690-0.753) and severity (c-statistic = 0.777, 95%CI 0.753-0.801). The Nutri-CoV score includes the MSL-COVID-19 plus respiratory rate, and pulse oximetry. This tool had better performance in both training (c-statistic = 0.797, 95%CI 0.765-0.826) and validation cohorts (c-statistic = 0.772, 95%CI 0.0.745-0.800) compared to other severity scores. CONCLUSIONS: MSL-COVID-19 predicts inpatient COVID-19 lethality. The Nutri-CoV score is an adaptation of MSL-COVID-19 to be used in a triage environment. Both scores have been deployed as web-based tools for clinical use in a triage setting.


Assuntos
/patologia , Índice de Gravidade de Doença , Adulto , Idoso , Área Sob a Curva , Índice de Massa Corporal , /virologia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Curva ROC , Taxa Respiratória , Medição de Risco , Triagem
11.
BMC Infect Dis ; 20(1): 841, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33187475

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an emerging viral disease. Here, we report the clinical features, management, and short-term outcomes of COVID-19 patients in Wenzhou, China, an area outside Wuhan. METHODS: Patients admitted to the Infectious Diseases Department of Ruian People's Hospital in Wenzhou, from January 21 to February 7, 2020, were recruited. Medical data on epidemiological history, demographics, clinical characteristics, laboratory tests, chest computerized tomography (CT) examination, treatment, and short-term outcomes were retrospectively reviewed. Blood biochemistry and routine tests were examined using standard methods and automatic machines. CT examination was performed several times during hospitalization as necessary. RESULTS: A total of 67 confirmed COVID-19 cases were diagnosed; 64 (95.4%) were common cases and three (4.5%) were severe cases. The most common symptoms at admission were fever (86.6%), cough (77.6%), productive cough (52.2%), chest distress (17.9%), and sore throat (11.9%), followed by diarrhea (7.4%), headache (7.4%), shortness of breath (6.0%), dizziness (4.5%), muscular soreness (4.5%), and running nose (4.5%). Thirty patients (47.8%) had increased C-reactive protein levels. The CT radiographs at admission showed abnormal findings in 54 (80.6%) patients. The patients were treated mainly by oxygen therapy and antiviral drugs. By March 3, 2020, all 67 patients completely recovered and had negative nucleic acid tests. The patients were discharged from the hospital and transferred to a medical observation isolation center for further observation. CONCLUSION: Cases of COVID-19 in Wenzhou are milder and have a better prognosis, compared to those in Wuhan. Timely and appropriate screening, diagnosis, and treatment are the key to achieve good outcomes.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Adolescente , Adulto , Idoso , Antivirais/uso terapêutico , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Criança , Pré-Escolar , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Tosse/virologia , Diarreia/virologia , Feminino , Febre/virologia , Hospitalização , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Alta do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Gravidez , Taxa Respiratória , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Viagem , Resultado do Tratamento , Adulto Jovem
12.
PLoS One ; 15(11): e0241407, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33141845

RESUMO

OBJECTIVES: The purpose is to assess the ability of low-dose CT (LDCT) to determine lung involvement in SARS-CoV-2 pneumonia and to describe a COVID19-LDCT severity score. MATERIALS AND METHODS: Patients with SARS-CoV-2 infection confirmed by RT-PCR were retrospectively analysed. Clinical data, the National Early Warning Score (NEWS) and imaging features were recorded. Lung features included ground-glass opacities (GGO), areas of consolidation and crazy paving patterns. The COVID19-LDCT score was calculated by summing the score of each segment from 0 (no involvement) to 10 (severe impairment). Univariate analysis was performed to explore predictive factor of high COVID19-LDCT score. The nonparametric Mann-Whitney test was used to compare groups and a Spearman correlation used with p<0.05 for significance. RESULTS: Eighty patients with positive RT-PCR were analysed. The mean age was 55 years ± 16, with 42 males (53%). The most frequent symptoms were fever (60/80, 75%) and cough (59/80, 74%), the mean NEWS was 1.7±2.3. All LDCT could be analysed and 23/80 (28%) were normal. The major imaging finding was GGOs in 56 cases (67%). The COVID19-LDCT score (mean value = 19±29) was correlated with NEWS (r = 0.48, p<0.0001). No symptoms were risk factor to have pulmonary involvement. Univariate analysis shown that dyspnea, high respiratory rate, hypertension and diabetes are associated to a COVID19-LDCT score superior to 50. CONCLUSIONS: COVID19-LDCT score did correlate with NEWS. It was significantly different in the clinical low-risk and high-risk groups. Further work is needed to validate the COVID19-LDCT score against patient prognosis.


Assuntos
Infecções por Coronavirus/diagnóstico , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Tosse/etiologia , Feminino , Febre/etiologia , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Taxa Respiratória , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
Medicine (Baltimore) ; 99(42): e22433, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080676

RESUMO

The chest computed tomography (CT) characteristics of coronavirus disease 2019 (COVID-19) are important for diagnostic and prognostic purposes. The aim of this study was to investigate chest CT findings in COVID-19 patients in order to determine the optimal cut-off value of a CT severity score that can be considered a potential prognostic indicator of a severe/critical outcome.The CT findings were evaluated by means of a severity score that included the extent (0-4 grading scale) and nature (0-4 grading scale) of CT abnormalities. The images were evaluated at 3 levels bilaterally. A receiver operating characteristics (ROC) curve was used to identify the optimal score (Youden's index) predicting severe/critical COVID-19.The study involved 165 COVID-19 patients (131 men [79.4%] and 34 women [20.6%] with a mean age of 61.5 ±â€Š12.5 years), of whom 30 (18.2%) had severe/critical disease and 135 (81.8%) mild/typical disease. The most frequent CT finding was bilateral predominantly subpleural and basilar airspace changes, with more extensive ground-glass opacities than consolidation. CT findings of consolidation, a crazy-paving pattern, linear opacities, air bronchogram, and extrapulmonary lesions correlated with severe/critical COVID-19. The mean CT severity score was 63.95 in the severe/critical group, and 35.62 in the mild/typical group (P < .001). ROC curve analysis showed that a CT severity score of 38 predicted the development of severe/critical symptoms.A CT severity score can help the risk stratification of COVID-19 patients.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/patologia , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/patologia , Tomografia Computadorizada por Raios X/normas , Adulto , Idoso , Betacoronavirus , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pandemias , Prognóstico , Curva ROC , Taxa Respiratória , Tomografia Computadorizada por Raios X/métodos
14.
Chem Biol Interact ; 331: 109272, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33010220

RESUMO

A cellular model of cardiomyocytes (H9c2 cell line) and mitochondria isolated from mouse liver were used to understand the drug action of BPDZ490 and BPDZ711, two benzopyran analogues of the reference potassium channel opener cromakalim, on mitochondrial respiratory parameters and swelling, by comparing their effects with those of the parent compound cromakalim. For these three compounds, the oxygen consumption rate (OCR) was determined by high-resolution respirometry (HRR) and their impact on adenosine triphosphate (ATP) production and calcium-induced mitochondrial swelling was investigated. Cromakalim did not modify neither the OCR of H9c2 cells and the ATP production nor the Ca-induced swelling. By contrast, the cromakalim analogue BPDZ490 (1) induced a strong increase of OCR, while the other benzopyran analogue BPDZ711 (2) caused a marked slowdown. For both compounds, 1 displayed a biphasic behavior while 2 still showed an inhibitory effect. Both compounds 1 and 2 were also found to decrease the ATP synthesis, with pronounced effect for 2, while cromakalim remained without effect. Overall, these results indicate that cromakalim, as parent molecule, does not induce per se any direct effect on mitochondrial respiratory function neither on whole cells nor on isolated mitochondria whereas both benzopyran analogues 1 and 2 display totally opposite behavior profiles, suggesting that compound 1, by increasing the maximal respiration capacity, might behave as a mild uncoupling agent and compound 2 is taken as an inhibitor of the mitochondrial electron-transfer chain.


Assuntos
Cromakalim/análogos & derivados , Mitocôndrias/metabolismo , Trifosfato de Adenosina/metabolismo , Animais , Cálcio/farmacologia , Linhagem Celular , Cromakalim/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Mitocôndrias/efeitos dos fármacos , Consumo de Oxigênio/efeitos dos fármacos , Canais de Potássio/agonistas , Canais de Potássio/metabolismo , Taxa Respiratória/efeitos dos fármacos
15.
J Clin Sleep Med ; 16(10): 1811-1813, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33063660

RESUMO

None: A middle-aged man with obstructive sleep apnea who had been treated with continuous positive airway pressure developed COVID-19. An analysis of airflow records from the continuous positive airway pressure machine revealed a rise in his respiratory rate on the night before the onset of COVID-19-related symptoms, while his nocturnal respiratory rate had been stable during the 18-month period prior to the presently reported episode. The present case suggests that a rise in respiratory rate detected using continuous positive airway pressure machine data could be an important sign of impending acute illness, such as COVID-19. Studies to elucidate the usefulness of this method are warranted.


Assuntos
Betacoronavirus , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Taxa Respiratória/fisiologia , Apneia Obstrutiva do Sono/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Polissonografia/métodos
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2581-2584, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018534

RESUMO

The objective of this study was to determine potential effects of Respiratory-gated Auricular Vagal Afferent Nerve Stimulation (RAVANS) on cardiac autonomic activity in hypertensive patients.20 hypertensive subjects (57.3±6.2 years; 11 females, 9 males) were randomized to receive either active RAVANS at 25 Hz or sham stimulation for 5 consecutive days and were assessed 5 and 10 days later. Continuous electrocardiogram, pulse rate, and blood pressure signals were collected during 10-minute baseline, 30-minute stimulation, and 10-minute recovery periods for each session. LabChart was used to acquire and process heart rate variability and blood pressure indices. Percent changes of mean values during the recovery period were calculated comparing the final stimulation session and follow-up sessions to the first stimulation session. General linear models were applied to assess the effects of RAVANS on the variables evaluated, considering baseline values and sex as covariates in the models.We found that RAVANS increased high frequency (HF-HRV) power during recovery of the final stimulation session and both follow-up sessions in comparison to sham. RAVANS also lowered heart rate and increased average RR and root mean square of successive RR interval differences (RMSSD) during recovery on the final day of stimulation. No significant effects on blood pressure values were observed during these periods.These results suggest that RAVANS effectively stimulates cardiovagal activity in hypertension, with effects lasting up to 10 days. Future research incorporating larger sample sizes is needed to replicate the effects of RAVANS.Clinical Relevance- This research has implications for potential therapeutic effects of respiratory-gated tVNS on cardiovagal modulation in hypertensive patients.


Assuntos
Hipertensão , Estimulação do Nervo Vago , Pressão Sanguínea , Feminino , Frequência Cardíaca , Humanos , Hipertensão/terapia , Masculino , Taxa Respiratória
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2622-2625, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018544

RESUMO

Respiratory rate (RR), which is an essential observation for prediagnosis, can be obtained indirectly from the electrocardiogram (ECG), the so-called ECG-derived respiration (EDR). In this paper, we compared embroidered electrodes with gel electrodes on their performance in capturing EDR signals and analysed which frequency feature best estimates RR. Data were collected from 9 healthy subjects. Results reveal that (1) embroidered electrodes performed similarly to gel electrodes (P = 0.077), (2) using the median frequency of the obtained EDR signals is significantly better (P = 0.01) than the counting methods in the time domain. The obtained results are relevant for the future development of textile-based sensors.


Assuntos
Eletrocardiografia , Taxa Respiratória , Eletrodos , Respiração , Têxteis
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2650-2653, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018551

RESUMO

Respiration rate can be assessed by analyzing respiratory changes of the electrocardiogram (ECG). Several methods can be applied to derive the respiratory signal from the ECG (EDR signal). In this study, four EDR estimation methods based on QRS features were analyzed. A database with 44 healthy subjects (16 females) in supine and sitting positions was analyzed. Respiratory flow and ECG recordings on leads I, II, III and a Chest lead was studied. A QR slope-based method, an RS slope-based method, an QRS angle-based method and an QRS area-based method were applied. Their performance was evaluated by the correlation coefficient with the reference respiratory volume signal. Significantly higher correlation coefficients in the range r = 0.77 - 0.86 were obtained with the Chest lead for all methods. The EDR estimation method based on the QRS angle provided the highest similarity with the volume signal for all recording leads and subject positions. We found no statistically significant differences according to gender or subject position.Clinical Relevance- This work analyzes the EDR signal from four electrocardiographic leads to obtain the respiratory signal and contributes to a simplified analysis of respiratory activity.


Assuntos
Eletrocardiografia , Respiração , Feminino , Voluntários Saudáveis , Humanos , Taxa Respiratória
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2667-2670, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018555

RESUMO

This paper reports an interesting phenomenon that the amplitude of the QRS complex reduces during inhalation and increases during exhalation and the variation can exceed even 100% during very slow breathing rates (BR). The phenomenon has been consistent in all the nine normal male subjects we have studied with age ranging from 23 to 61 years. Further, at very low respiration rates which included breath holds both after inhalation and exhalation, there are highly significant second and third harmonics of the respiration frequency in the heart rate variability spectrum. On the other hand, the R-wave amplitude changes do not have any noticeable higher harmonics of the BR. Thus, the observed changes in the R-wave amplitude are neither connected to the movement of the heart nor changes in its relative position with respect to the recording electrodes nor the fluctuations in the stroke volume.


Assuntos
Suspensão da Respiração , Taxa Respiratória , Expiração , Frequência Cardíaca , Humanos , Masculino , Respiração
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2732-2735, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018571

RESUMO

Demand of portable health monitoring has been growing due to increasing cardiovascular and respiratory diseases. While both cardiovascular monitoring and respiratory monitoring have been developed independently, there lacks a simple integrated solution to monitor both simultaneously. Seismocardiography (SCG), a method of recording cardiac vibrations with an accelerometer can also be used to extract respiratory information via low frequency chest oscillations. This study used an inertial measurement unit which pairs a 3-axis accelerometer and a 3-axis gyroscope to monitor respiration while maintaining optimum placement protocol for recording SCG. Additionally, the connection between inertial measurement and both respiratory rate and volume were explored based on their correlation with a Spirometer. Respiratory volume was shown to have moderate correlation with chest motion with an average best-case correlation coefficient of 0.679 across acceleration and gyration. The techniques described will assist the design of future SCG algorithms by understanding the sources behind their modulation from respiration. This paper shows that a simplified processing technique can be added to SCG algorithms for respiration monitoring.


Assuntos
Respiração , Processamento de Sinais Assistido por Computador , Humanos , Monitorização Fisiológica , Taxa Respiratória , Tórax
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