Can We Use the Maximum Phonation Time as a Screening of Pulmonary Forced Vital Capacity in Post-COVID-19 Syndrome Patients?

OBJECTIVE: To verify the accuracy of the maximum phonation time of the vowel /a/ (MPT/a/), fricative /s/ (MPT/s/), number counting (MPTC), and number reached in this count (CN) to estimate forced vital capacity (FVC) in patients with post-COVID-19 syndrome. METHOD: Cross-sectional study involving adult patients, who were admitted to the intensive care unit and referred to the Post-COVID-19 Rehabilitation Outpatient Clinic. Voice function was assessed using a Vocal Handicap Index (VHI) self-assessment questionnaire and MPT tests. To perform the phonatory tests, the patients remained in a standing posture and were instructed to inhale as much air as possible and, during a single exhalation, at usual pitch and loudness, sustain the emission of /a/ and /s/; and in another breath, to perform the ascending numerical count, starting from the number one up to the highest number they could reach. Pulmonary function was assessed by spirometry. The receiver operating characteristic (ROC) curve was plotted, and FVC values lower than the normal limit by Z-score (fifth percentile) were classified as impaired lung function. The predictive values and likelihood ratios were calculated. RESULTS: A total of 70 patients participated, with 20-30% having a high VHI. Approximately 24% had an FVC impairment and significantly low values of MPT/a/, MPT/s/, MPTC, and CN. The test results showed overall accuracy of 70% and the cutoff points of 9.69, 6.78, 10.60, and 13, respectively, with high sensitivity, predictive negative value and low specificity, predictive positive value, and positive likelihood ratio. CONCLUSIONS: Our results suggest that the MPT has moderate discriminatory power for FVC impairment, indicating that it is not a reliable indicator of pulmonary function in the population studied. Therefore, in patients with an MPT of less than 10.60 seconds, or a CN lower than 13, other criteria should be added to improve the diagnostic accuracy and support the decision to perform more complex investigations.

Predictors of Post-COVID-19 Functional Status Scale in Hospitalized Patients Recovering From SARS-CoV-2 Infection.

OBJECTIVE: The study aimed to investigate whether peripheral and inspiratory muscle strength and architecture, functional capacity, functional mobility, fatigue, and health-related quality of life are predictors of the Post-COVID-19 Functional Status Scale score in patients with post-COVID-19 syndrome who were hospitalized. DESIGN: A cross-sectional study included 69 patients (53.3 ± 13.2 yrs, 36 men) with post-COVID-19 syndrome. The following outcomes were assessed: peripheral (dynamometry) and inspiratory (manovacuometry) muscle strength, muscle architecture (ultrasound), functional capacity (six-minute walk test), functional mobility (Timed Up and Go), fatigue (Functional Assessment of Chronic Illness Therapy), health-related quality of life (36-item Short-Form Health Survey), and functional status (Post-COVID-19 Functional Status scale). RESULTS: Functional mobility (ß = 0.573, P < 0.001), vastus intermedius echogenicity (ß = -0.491, P = 0.001), length of stay (ß = 0.349, P = 0.007), and female sex (ß = 0.415, P = 0.003) influenced the Post-COVID-19 Functional Status Scale. CONCLUSIONS: Functional mobility, muscle quality of the vastus intermedius, length of stay, and female sex influence the Post-COVID-19 Functional Status Scale score in this population. It is noteworthy that functional mobility is an independent predictor of Post-COVID-19 Functional Status Scale.

Maximum Phonation Times as Biomarkers of Lung Function.

PURPOSE: To verify whether measurements of maximal phonation times are biomarkers of forced vital capacity in patients with chronic obstructive pulmonary disease, and to characterize the vocal aspects of these patients, taking into account variables, such as age, body mass index, use of bronchodilators, presence of symptoms, and quality of life related to voice. METHODS: Complete records of 25 subjects with chronic obstructive pulmonary disease, both sexes, aged 31 to 85 years, evaluated by forced vital capacity, maximum phonation times of /a/, and numerical count and number reached at this count, Vocal Symptom Scale, Voice Quality of Life. Data were presented descriptively and statistically analyzed using Student's t test for independent samples and Mann-Whitney U test. A significance level of 5% was accepted. The receiver operating characteristic curve was plotted and the standardized value of forced vital capacity <80% was considered as an indicator of pulmonary dysfunction. RESULTS: Patients exhibited reduced maximum phonation times for /a/, numeric counting, and reached digits in counting; discrepancies in Vocal Signs and Symptoms and Voice Quality of Life Scale scores. Numeric counting times of up to 12.5 seconds indicated that forced vital capacity may be impaired. CONCLUSION: The patients with chronic obstructive pulmonary disease examined in this study exhibited vocal deviations as evidenced by reduced maximum phonation times of /a/, numeric counting, and the digit reached during counting, as well as deviations in vocal self-assessment. Maximum phonation time in numerical counting was considered a biomarker of pulmonary function impairment.

Influence of handgrip strength on pharyngeal transit time in individuals with chronic obstructive pulmonary disease.

OBJECTIVE: To investigate the relationship between Handgrip Strength (HGS), dysphagia classification, nutritional aspects, and Pharyngeal Transit Time (PTT) in subjects with Chronic Obstructive Pulmonary Disease (COPD). METHODS: Study based on the analysis of secondary data from a database. The sample comprised 15 COPD patients of both sexes and a mean age of 65.7 years. We collected information on HGS, videofluoroscopic swallowing study, Volume-Viscosity Swallow Test (V-VST), and Body Mass Index (BMI). We applied correlation, effect size, and logistic regression tests at the 5% significance level. RESULTS: Most individuals had severe COPD (66.7%), mean dominant HGS of 28.2, and non-dominant HGS of 25.3. Five subjects were malnourished, five were well-nourished, and five were obese. Most of them had normal swallowing (40%), normal V-VST results (60%), and PTT of 0.89 s (liquid) and 0.81 s (pudding-thick). There was no significant correlation between the swallowing classification and the other variables. We obtained a significant correlation (p = 0.015), though weak (r = -0.611), between non-dominant HGS and PTT. Regarding the binary logistic regression, HGS variables and HGS asymmetry were not enough to be considered a risk to clinically abnormal swallowing (V-VST). CONCLUSION: Subjects with COPD in this study had a longer PTT than reported in the literature for normal subjects and a weak correlation between PTT and non-dominant HGS. The variables related to muscle condition were not considered predictors for abnormal swallowing.

Effects of multimodal exercise program on postural balance in patients with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial.

BACKGROUND: Evidence has shown that patients with chronic obstructive pulmonary disease present significant deficits in the control of postural balance when compared to healthy subjects. In view of this, it is pertinent to investigate the effects of different therapeutic strategies used alone or in association with pulmonary rehabilitation with the potential to improve postural balance and other outcomes with clinical significance in patients with chronic obstructive pulmonary disease. This study will investigate the effects of an 8-week (short-term) multimodal exercise program [inspiratory muscle training (IMT) plus neuromuscular electrical stimulation (NMES)] on postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program compared to individualized addition of IMT or NMES to pulmonary rehabilitation or standard pulmonary rehabilitation. METHODS: This is a randomized, single-blind, 4-parallel-group trial. Forty patients with chronic obstructive pulmonary disease will be included prospectively to this study during a pulmonary rehabilitation program. Patients will be randomly assigned to one of four groups: multimodal exercise program (IMT + NMES + pulmonary rehabilitation group) or (IMT + pulmonary rehabilitation group) or (NMES + pulmonary rehabilitation group) or standard pulmonary rehabilitation group. Patients will receive two sessions per week for 8 weeks. The primary outcome will be static postural balance and secondary outcomes will include as follows: static and dynamic postural balance, fear of falling, muscle strength and endurance (peripheral and respiratory), functional capacity, health-related quality of life, muscle architecture (quadriceps femoris and diaphragm), and laboratory biomarkers. DISCUSSION: This randomized clinical trial will investigate the effects of adding of short-term multimodal exercise program, in addition to pulmonary rehabilitation program, in postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation. Furthermore, this randomized control trial will enable important directions regarding the effectiveness of short-term intervention as part of the need to expand the focus of pulmonary rehabilitation to include balance management in chronic obstructive pulmonary disease patients which will be generated. TRIAL REGISTRATION: ClinicalTrials.gov NCT04387318. Registered on May 13, 2020.

Quality of Life Predictors in Voice of Individuals With Chronic Obstructive Pulmonary Disease.

OBJECTIVE: To investigate whether there is a relationship between voice-related quality of life, pulmonary function, risk of dysphagia, symptoms of dyspnea, and the different degrees of Chronic Obstructive Pulmonary Disease, and to verify which factors may be associated to voice-related quality of life. METHODS: Complete records of 37 individuals diagnosed with Chronic Obstructive Pulmonary Disease, of both sexes, aged between 35 and 89, assessed using the Voice-Related Quality of Life Questionnaire, Questionnaire for Dysphagia Screening, Modified Medical Research Council, Index of Body Mass, Peak Expiratory Flow, COPD Assessment Test and Global Initiative for Chronic Obstructive Lung Disease classification. RESULTS: There was a significant, moderate, and negative correlation between the total scores and the physical domain scores of the Voice-Related Quality of Life as a COPD Assessment Test. In the multivariate linear regression analysis, the coefficient of determination explained 51.1% of the relationship between the total Voice-Related Quality of Life score and the independent variables: Peak Expiratory Flow and Questionnaire for Dysphagia Screening. CONCLUSION: In the analyzed group, voice-related quality of life was negatively influenced by Chronic Obstructive Pulmonary Disease, risk of dysphagia, and changes in Peak Expiratory Flow.

Outcomes of manual therapy on the biomechanics of swallowing in individuals with COPD. / Desfechos da terapia manual sobre a biomecânica da deglutição em indivíduos com DPOC.

PURPOSE: Several swallowing disorders have been reported in chronic obstructive pulmonary disease (COPD) patients due to the mechanical disadvantage of the respiratory muscles caused by hyperinflation. To date, no reports have been found in the literature among the therapeutic strategies on the use of manual therapy (MT) to manage swallowing disorders in COPD. The aim of the study was to verify the outcomes of a TM program on the biomechanics of swallowing of individuals with COPD. METHODS: 18 individuals with a mean age of 66.06 ± 8.86 years, 61.1% (11) men, and a FEV1% mean of 40.28 ± 16.73 were evaluated before and after TM. The measures analyzed were: oral transit time, pharyngeal transit time (PTT), number of swallows, vallecular (VL) residue and pyriform sinuses, penetration/aspiration and hyolaryngeal excursion in liquid and pasty consistencies. RESULTS: A significant difference was found in PTT (p=0.04), VL residue (p=0.03), maximal hyoid elevation (p=0.003), and displacement of hyoid (p=0.02) in the pasty consistency. In the liquid consistency, we found a decrease in VL residue (p=0.001). CONCLUSION: The MT program influenced the swallowing biomechanics of COPD patients demonstrated by a reduction in PTT and VL residue and increased hyoid elevation and displacement in the pasty consistency. In the liquid consistency, a decrease in VL residue was found.

OBJETIVO: Diversos comprometimentos da deglutição têm sido relatados em indivíduos com doença pulmonar obstrutiva crônica (DPOC), tendo como causa a desvantagem mecânica da musculatura respiratória devido à hiperinsuflação. Dentre as estratégias terapêuticas, até o momento, não foram encontrados relatos na literatura sobre o uso da terapia manual (TM) no manejo dos transtornos da deglutição nesta população. O objetivo do estudo foi verificar os desfechos de um programa de TM sobre a biomecânica da deglutição de indivíduos com DPOC. MÉTODO: Foram avaliados 18 indivíduos com idade média 66,06±8,86 anos, 61,1% (11) homens e VEF1%médio 40,28±16,73 antes e após-programa de TM. As medidas analisadas foram: tempo de trânsito oral, tempo de trânsito faríngeo (TTF), número de deglutições, resíduos em valéculas (VL) e seios piriformes, penetração/aspiração e excursão hiolaríngea na deglutição das consistências líquida e pastosa. RESULTADOS: Houve diferença significativa no TTF (p=0,04), resíduos em VL (p=0,03), elevação máxima do hioide (p=0,003) e deslocamento do hioide (p=0,02) na deglutição da consistência pastosa. Na consistência líquida apenas redução de resíduos em VL (p=0,001). CONCLUSÃO: O programa de TM interferiu na biomecânica da deglutição de indivíduos DPOC demonstrada pela redução do TTF, resíduos em VL e maior elevação e deslocamento do hioide na consistência pastosa. Na consistência líquida houve redução de resíduos em VL.

Relationship of pharyngeal transition time and presence of residue with dyspnea and lung function in chronic obstructive pulmonary disease. / Relação do tempo de trânsito faríngeo e presença de resíduo com dispneia e função pulmonar na doença pulmonar obstrutiva crônica.

PURPOSE: To relate pharyngeal transit time and the presence of residues with dyspnea and lung function in individuals with Chronic Obstructive Pulmonary Disease COPD. METHODS: Study conducted with 19 adults (11 men, 8 women) with a clinical and spirometric diagnosis of COPD and a mean age of 63.8 years (SD = 9.3). Data collection was performed using the COPD Assessment Test (CAT) questionnaire, the modified Medical Research Council scale (mMRC) and a digital manovacuometer, to characterize the impact of the disease on the individual, dyspnea and lung function. The data related to pharyngeal transit time and pharyngeal residue were collected through the analysis of videofluoroscopic images performed by three blinded judges. RESULTS: No significant relationship was found between pharyngeal transit time (PTT) with lung function (r = -0.71), pharyngeal residue and dyspnea (r = -0.06). PTT, when compared to normality, was increased. CONCLUSION: Individuals with COPD, regardless of the severity of the disease, showed no association between PTT and pharyngeal residue and dyspnea and lung function.

OBJETIVO: Relacionar o tempo de trânsito faríngeo e a presença de resíduos com a dispneia e a função pulmonar em indivíduos com Doença Pulmonar Obstrutiva Crônica DPOC. MÉTODO: Estudo realizado com 19 adultos (11 homens e 8 mulheres) com diagnóstico clínico e espirométrico de DPOC e idade média de 63,8 (±9,3) anos. A coleta de dados foi realizada utilizando o questionário COPD Assessment Test (CAT, Teste de Avaliação da DPOC) a escala de dispneia do Medical Research Council modificada (mMRC) e um manovacuômetro digital, para caracterizar o impacto da doença no indivíduo, a dispneia e a função pulmonar. Os dados referentes ao tempo de trânsito faríngeo e resíduo faríngeo foram coletados por meio de análise das imagens videofluoroscópicas realizada por três juízes cegados. RESULTADOS: Não foram encontradas relações significativas entre tempo de trânsito faríngeo (TTF) com função pulmonar (r = -0,71), e entre presença de resíduo faríngeo com a dispneia (r= -0,06). O TTF, quando comparado com a normalidade, apresentou-se aumentado. CONCLUSÃO: Os indivíduos com DPOC, independente da gravidade da doença, não manifestaram associação entre alterações no TTF e resíduo faríngeo e dispneia e função pulmonar.

Oral and Oropharyngeal Sensory Function in Adults With Chronic Obstructive Pulmonary Disease.

Introduction The oral cavity and pharynx have a rich sensory system composed of specialized receptors. The integrity of oropharyngeal sensation is thought to be fundamental for safe and efficient swallowing. Chronic obstructive pulmonary disease (COPD) patients are at risk for oropharyngeal sensory impairment due to frequent use of inhaled medications and comorbidities including gastroesophageal reflux disease. Objective This study aimed to describe and compare oral and oropharyngeal sensory function measured using noninstrumental clinical methods in adults with COPD and healthy controls. Method Participants included 27 adults (18 men, nine women) with a diagnosis of COPD and a mean age of 66.56 years (SD = 8.68). The control group comprised 11 healthy adults (five men, six women) with a mean age of 60.09 years (SD = 11.57). Spirometry measures confirmed reduced functional expiratory volumes (% predicted) in the COPD patients compared to the control participants. All participants completed a case history interview and underwent clinical evaluation of oral and oropharyngeal sensation by a speech-language pathologist. The sensory evaluation explored the detection of tactile and temperature stimuli delivered by cotton swab to six locations in the oral cavity and two in the oropharynx as well as identification of the taste of stimuli administered in 5-ml boluses to the mouth. Analyses explored the frequencies of accurate responses regarding stimulus location, temperature and taste between groups, and between age groups ("≤ 65 years" and "> 65 years") within the COPD cohort. Results We found significantly higher frequencies of reported use of inhaled medications (p < .001) and xerostomia (p = .003) in the COPD cohort. Oral cavity thermal sensation (p = .009) was reduced in the COPD participants, and a significant age-related decline in gustatory sensation was found in the COPD group (p = .018). Conclusion This study found that most of the measures of oral and oropharyngeal sensation remained intact in the COPD group. Oral thermal sensation was impaired in individuals with COPD, and reduced gustatory sensation was observed in the older COPD participants. Possible links between these results and the use of inhaled medication by individuals with COPD are discussed.

Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Chronic Obstructive Pulmonary Disease.

Purpose Dysphagia is a serious extra pulmonary manifestation of chronic obstructive pulmonary disease (COPD). However, the nature of abnormalities in swallowing physiology in COPD has yet to be clearly established. We explored the frequency of swallowing measures outside the healthy reference range in adults with COPD. Method Participants were 28 adults aged 41-79 years (18 men, 20 women) with stable COPD. Disease severity was classified as GOLD (Global Initiative For Chronic Obstructive Lung Disease) Stages 1 (4%), 2 (25%), 3 (53%), and 4 (18%). Participants underwent a videofluoroscopy and swallowed 20% w/v thin barium in, followed by 20% w/v mildly, moderately, and extremely thick barium prepared with a xanthan gum thickener. Blinded duplicate ratings of swallowing safety, efficiency, kinematics, and timing were performed according to the ASPEKT method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). Comparison data for healthy adults aged < 60 years were extracted from an existing data set. Chi-square and Fisher's exact tests compared the frequencies of measures falling < 1 SD/ > 1 SD from mean reference values (or < the first or > the third quartile for skewed parameters). Results Participants with COPD did not display greater frequencies of penetration-aspiration, but they were significantly more likely (p < .05) to display incomplete laryngeal vestibule closure (LVC), longer time-to-LVC, and shorter LVC duration. They also displayed significantly higher frequencies of short upper esophageal sphincter opening, reduced pharyngeal constriction, and pharyngeal residue. Conclusion This analysis reveals differences in swallowing physiology in patients with stable COPD characterized by impaired safety related to the mechanism, timing, and duration of LVC and by impaired swallowing efficiency with increased pharyngeal residue related to poor pharyngeal constriction.

Relationship between dysphagia risk and health status in patients with chronic obstructive pulmonary disease. / Relação entre o risco de disfagia e o estado de saúde de indivíduos com a doença pulmonar obstrutiva crônica.

PURPOSE: To verify the relationship between the risk of dysphagia and health status in patients with Chronic Obstructive Pulmonary Disease (COPD). METHOD: Cross-sectional study with convenience sample. Twenty-three individuals with a diagnosis of COPD according to GOLD 2019 criteria. The individuals participated in a pulmonary rehabilitation program, clinically stable (without exacerbations of at least 30 days) and in optimized drug treatment were included. The study analyzed anthropometric measures (BMI), peak expiratory flow (PEF), mental status (MEEM), eating assessment tool (EAT-10), and health status (COPD Assessment Test -CAT). The mean age was 60.39 ± 9.90 years, 11 individuals were female and eutrophic. RESULTS: We observed a positive and moderate association (r = 0.57, p = 0.004) between the CAT and EAT-10 scores in the sample studied. CONCLUSION: The results demonstrated relationship between the risk of dysphagia and the health status in individuals with COPD.

Oropharyngeal deglutition, nutrition, and quality of life in individuals with chronic pulmonary disease. / Deglutição orofaríngea, nutrição e qualidade de vida no indivíduo com doença pulmonar crônica.

PURPOSE: Describe efficacy and safety of deglutition, nutritional risk, and quality of life in deglutition, and associate nutritional risk with quality of life in individuals with chronic pulmonary disease. METHODS: The participants were 17 individuals with chronic pulmonary disease evaluated using the following instruments: Volume-Viscosity Swallow Test (V-VST), Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire, Mini Nutritional Assessment (MNA), and body mass index (BMI). RESULTS: Changes in efficacy were observed in nine (52.94%) individuals and impairments in efficacy and safety were found in two (11.77%) individuals. All individuals were considered eutrophic by the nutritional assessment. Correlation was observed between nutritional risk and domains 3 (r=-0.803; p=0.05) and 5 (r=0.636; p=0.026) of the SWAL-QOL questionnaire. CONCLUSION: Changes in efficacy and safety of deglutition were observed; however, no nutritional risk was evidenced in the sample evaluated. Correlation between nutritional risk and quality of life in deglutition was also observed.

OBJETIVO: descrever a eficácia e segurança da deglutição, o risco nutricional e a qualidade de vida em deglutição e relacionar o risco nutricional com a qualidade de vida dos indivíduos com doença pulmonar crônica. MÉTODO: 17 indivíduos com diagnóstico de doença pulmonar crônica foram avaliados por meio do Volume-Viscosity Swallow Test (V-VST), Quality of Life in Swallowing Disorders (SWAL-QOL), Mini Nutritional Assessment (MNA) e índice de massa corpórea. RESULTADOS: foi encontrada alteração de eficácia da deglutição em nove (52,94%) dos indivíduos e eficácia+segurança em dois (11,77%). Todos os indivíduos estavam eutróficos na avaliação nutricional. Houve relação entre o risco nutricional com os domínios 3 (r=-0,803; p=0,05) e 5 (r=0,636; p=0,026) do SWAL-QOL. CONCLUSÃO: houve alteração de eficácia e segurança da deglutição, no entanto não foi encontrado risco nutricional evidente na amostra avaliada. Ainda, houve relação entre o risco nutricional com a qualidade de vida em deglutição.

Influence of handgrip strength on pharyngeal transit time in individuals with chronic obstructive pulmonary disease

Abstract Objective: To investigate the relationship between Handgrip Strength (HGS), dysphagia classification, nutritional aspects, and Pharyngeal Transit Time (PTT) in subjects with Chronic Obstructive Pulmonary Disease (COPD). Methods: Study based on the analysis of secondary data from a database. The sample comprised 15 COPD patients of both sexes and a mean age of 65.7 years. We collected information on HGS, videofluoroscopic swallowing study, Volume-Viscosity Swallow Test (V-VST), and Body Mass Index (BMI). We applied correlation, effect size, and logistic regression tests at the 5% significance level. Results: Most individuals had severe COPD (66.7%), mean dominant HGS of 28.2, and non-dominant HGS of 25.3. Five subjects were malnourished, five were well-nourished, and five were obese. Most of them had normal swallowing (40%), normal V-VST results (60%), and PTT of 0.89 s (liquid) and 0.81 s (pudding-thick). There was no significant correlation between the swallowing classification and the other variables. We obtained a significant correlation (p = 0.015), though weak (r = -0.611), between non-dominant HGS and PTT. Regarding the binary logistic regression, HGS variables and HGS asymmetry were not enough to be considered a risk to clinically abnormal swallowing (V-VST). Conclusion: Subjects with COPD in this study had a longer PTT than reported in the literature for normal subjects and a weak correlation between PTT and non-dominant HGS. The variables related to muscle condition were not considered predictors for abnormal swallowing. Level of evidence: 3.

Genital self-image, sexual function and pelvic floor discomfort in COVID-19 pandemic scenario / Autoimagem genital, função sexual e desconforto do assoalho pélvico no cenário pandêmico de COVID-19

Abstract Introduction: Sexual health is an important area of women's health, comprising aspects that can be affected by stressors, such as in the COVID-19 pandemic scenario. Objective: To investigate genital self-image, sexual function and pelvic floor discomfort in young female university students during the COVID-19 pandemic, comparing these factors with their sexual activity. Methods: This study is a quantitative and cross-sectional survey of young female university students during the COVID-19 pandemic period, carried out through an online form. To assess the variables, the Female Sexual Function Index, Pelvic Floor Distress Inventory, and Female Genital Self-Image Scale were used. Results: 182 women participated in the study, and the general mean age was 22.06 ± 2.75 years. Sexually active women (n = 128) had significantly better genital self-image compared to inactive women (22.87 ± 2.92 vs. 20.85 ± 4.41; p = 0.004). Likewise, better genital self-image was also observed in women without sexual dysfunction (23.36 ± 2.72 vs. 21.11 ± 2.96; p < 0.001) and in those who reported fewer symptoms of pelvic floor discomfort (p = 0.014). Conclusion: A positive genital self-image was associated with fewer sexual dysfunctions, better sexual function, and fewer symptoms of pelvic floor discomfort. Furthermore, sexual activity is associated with a better genital self-image.

Resumo Introdução: A saúde sexual é uma área importante da saúde da mulher, compreendendo aspectos que podem ser afetados por estressores, como no cenário de pandemia da COVID-19. Objetivo: Investigar a autoimagem genital, função sexual e desconforto do assoalho pélvico em jovens universitárias durante a pandemia de COVID-19, comparando esses fatores com sua atividade sexual. Métodos: Este estudo é uma pesquisa quantitativa e transversal com jovens universitárias durante o período da pandemia de COVID-19, realizada por meio de formulário online. Para avaliar as variáveis, foram utilizados o Índice de Função Sexual Feminina, Inventário de Desconforto do Assoalho Pélvico e Escala de Autoimagem Genital Feminina. Resultados: Participaram do estudo 182 mulheres, com média de idade de 22,06 ± 2,75 anos. Mulheres sexualmente ativas (n = 128) apresentaram autoimagem genital significativamente melhor em comparação às mulheres inativas (22,87 ± 2,92 vs. 20,85 ± 4,41; p = 0,004). Da mesma forma, melhor autoimagem genital também foi observada em mulheres sem disfunção sexual (23,36 ± 2,72 vs. 21,11 ± 2,96; p < 0,001) e naquelas que relataram menos sintomas de desconforto do assoalho pélvico (p = 0,014). Conclusão: Uma autoimagem genital positiva foi associada a menos disfunções sexuais, melhor função sexual e menos sintomas de desconforto do assoalho pélvico. Além disso, a atividade sexual está associada a uma melhor autoimagem genital.

Patients with Post-Covid-19 Syndrome are at risk of malnutrition and obesity: findings of outpatient follow-up / Pacientes com Síndrome Pós-Covid-19 apresentam risco de desnutrição e obesidade: achados de um ambulatório de seguimento

ABSTRACT Objective To evaluate the nutritional and functional status, swallowing disorders, and musculoskeletal manifestations of patients with Post-Covid-19 Syndrome, stratified by the Appendicular Skeletal Muscle Mass Index. Methods This is a cross-sectional study with patients diagnosed with Post-Covid-19 Syndrome after discharge from the intensive care unit of a university hospital. The evaluated outcomes were: nutritional status (Mini Nutritional Assessment, bioimpedance and anthropometry), swallowing disorders (Dysphagia Risk Evaluation Protocol), functional status (Post-Covid-19 Functional Status Scale), and musculoskeletal manifestations. According to the Appendicular Skeletal Muscle Mass Index, patients were stratified in terms of loss or not loss of muscle mass. Results Thirty-eight patients were included in the study, 20 stratified into the no loss of muscle mass group (17 females; 49.45±12.67 years) and 18 into the loss of muscle mass group (18 males; 61.89±12.49 years). Both groups were at risk of malnutrition (Mini Nutritional Assessment scores between 17-23.5 points; No Loss of Muscle Mass Group: 21.82±3.93; Loss of Muscle Mass Group: 23.33±3.41) and obesity (No Loss of Muscle Mass Group: 33.76±6.34; Loss of Muscle Mass Group: 30.23±3.66). The groups differed in terms of bioimpedance parameters (except fat mass) and age. However, there were no differences in swallowing alterations, functional status, and musculoskeletal manifestations. Conclusion Patients with Post-Covid-19 Syndrome, stratified according to the Appendicular Skeletal Muscle Mass Index, were at risk of malnutrition and obesity. The persistence of fatigue, weakness, myalgia and arthralgia at 6 months after hospital discharge is noteworthy. These findings emphasize the importance of comprehensive care for patients with Post-Covid-19 Syndrome.

RESUMO Objetivo Avaliar o estado nutricional, status funcional, alterações de deglutição e manifestações musculoesqueléticas de pacientes com Síndrome Pós-Covid-19, estratificados pelo Índice de Massa Muscular Esquelética Apendicular. Métodos Estudo transversal composto por pacientes diagnosticados com a Síndrome Pós-Covid-19 que estiveram internados na Unidade de Terapia Intensiva de um hospital universitário. Os desfechos avaliados foram: estado nutricional (Mini Avaliação Nutricional; bioimpedância e antropometria), alterações de deglutição (Protocolo Fonoaudiológico de Avaliação do Risco de Disfagia), status funcional (Post-Covid-19 Functional Status Scale) e manifestações musculoesqueléticas. Os pacientes foram classificados, quanto à perda de massa muscular conforme o Índice de Massa Muscular Esquelética Apendicular, em grupo sem e com perda de massa muscular. Resultados Foram inseridos no estudo 38 pacientes, 20 no grupo sem perda de massa muscular (17 deles do sexo feminino; 49,45±12,67 anos) e 18 no grupo com perda de massa muscular (todos do sexo masculino; 61,89±12,49 anos). Os pacientes de ambos os grupos apresentaram risco de desnutrição (escores Mini Avaliação Nutricional entre 17-23.5 pontos; Grupo Sem Perda de Massa Muscular: 21,82±3,93; Grupo Com Perda de Massa Muscular: 23,33±3,41) e obesidade (Grupo Sem Perda de Massa Muscular: 33,76±6,34; Grupo Com Perda de Massa Muscular: 30,23±3,66). Os grupos diferiram quanto aos parâmetros da bioimpedância (exceto massa gorda) e idade. Entretanto, não foram observadas diferenças na deglutição, status funcional e manifestações musculoesqueléticas. Conclusão Os pacientes com Síndrome Pós-Covid-19, estratificados conforme o Índice de Massa Muscular Esquelética Apendicular, apresentaram risco de desnutrição e obesidade. Destaca-se a persistência de fadiga, fraqueza, mialgia e artralgia após seis meses da alta hospitalar. Esses achados ressaltam a importância do cuidado integral ao paciente com a Síndrome Pós-Covid-19.

Desfechos da terapia manual sobre a biomecânica da deglutição em indivíduos com DPOC / Outcomes of manual therapy on the biomechanics of swallowing in individuals with COPD

RESUMO Objetivo Diversos comprometimentos da deglutição têm sido relatados em indivíduos com doença pulmonar obstrutiva crônica (DPOC), tendo como causa a desvantagem mecânica da musculatura respiratória devido à hiperinsuflação. Dentre as estratégias terapêuticas, até o momento, não foram encontrados relatos na literatura sobre o uso da terapia manual (TM) no manejo dos transtornos da deglutição nesta população. O objetivo do estudo foi verificar os desfechos de um programa de TM sobre a biomecânica da deglutição de indivíduos com DPOC. Método Foram avaliados 18 indivíduos com idade média 66,06±8,86 anos, 61,1% (11) homens e VEF1%médio 40,28±16,73 antes e após-programa de TM. As medidas analisadas foram: tempo de trânsito oral, tempo de trânsito faríngeo (TTF), número de deglutições, resíduos em valéculas (VL) e seios piriformes, penetração/aspiração e excursão hiolaríngea na deglutição das consistências líquida e pastosa. Resultados Houve diferença significativa no TTF (p=0,04), resíduos em VL (p=0,03), elevação máxima do hioide (p=0,003) e deslocamento do hioide (p=0,02) na deglutição da consistência pastosa. Na consistência líquida apenas redução de resíduos em VL (p=0,001). Conclusão O programa de TM interferiu na biomecânica da deglutição de indivíduos DPOC demonstrada pela redução do TTF, resíduos em VL e maior elevação e deslocamento do hioide na consistência pastosa. Na consistência líquida houve redução de resíduos em VL.

ABSTRACT Purpose Several swallowing disorders have been reported in chronic obstructive pulmonary disease (COPD) patients due to the mechanical disadvantage of the respiratory muscles caused by hyperinflation. To date, no reports have been found in the literature among the therapeutic strategies on the use of manual therapy (MT) to manage swallowing disorders in COPD. The aim of the study was to verify the outcomes of a TM program on the biomechanics of swallowing of individuals with COPD. Methods 18 individuals with a mean age of 66.06 ± 8.86 years, 61.1% (11) men, and a FEV1% mean of 40.28 ± 16.73 were evaluated before and after TM. The measures analyzed were: oral transit time, pharyngeal transit time (PTT), number of swallows, vallecular (VL) residue and pyriform sinuses, penetration/aspiration and hyolaryngeal excursion in liquid and pasty consistencies. Results A significant difference was found in PTT (p=0.04), VL residue (p=0.03), maximal hyoid elevation (p=0.003), and displacement of hyoid (p=0.02) in the pasty consistency. In the liquid consistency, we found a decrease in VL residue (p=0.001). Conclusion The MT program influenced the swallowing biomechanics of COPD patients demonstrated by a reduction in PTT and VL residue and increased hyoid elevation and displacement in the pasty consistency. In the liquid consistency, a decrease in VL residue was found.

Relação do tempo de trânsito faríngeo e presença de resíduo com dispneia e função pulmonar na doença pulmonar obstrutiva crônica / Relationship of pharyngeal transition time and presence of residue with dyspnea and lung function in chronic obstructive pulmonary disease

RESUMO Objetivo Relacionar o tempo de trânsito faríngeo e a presença de resíduos com a dispneia e a função pulmonar em indivíduos com Doença Pulmonar Obstrutiva Crônica DPOC. Método Estudo realizado com 19 adultos (11 homens e 8 mulheres) com diagnóstico clínico e espirométrico de DPOC e idade média de 63,8 (±9,3) anos. A coleta de dados foi realizada utilizando o questionário COPD Assessment Test (CAT, Teste de Avaliação da DPOC) a escala de dispneia do Medical Research Council modificada (mMRC) e um manovacuômetro digital, para caracterizar o impacto da doença no indivíduo, a dispneia e a função pulmonar. Os dados referentes ao tempo de trânsito faríngeo e resíduo faríngeo foram coletados por meio de análise das imagens videofluoroscópicas realizada por três juízes cegados. Resultados Não foram encontradas relações significativas entre tempo de trânsito faríngeo (TTF) com função pulmonar (r = -0,71), e entre presença de resíduo faríngeo com a dispneia (r= -0,06). O TTF, quando comparado com a normalidade, apresentou-se aumentado. Conclusão Os indivíduos com DPOC, independente da gravidade da doença, não manifestaram associação entre alterações no TTF e resíduo faríngeo e dispneia e função pulmonar.

ABSTRACT Purpose To relate pharyngeal transit time and the presence of residues with dyspnea and lung function in individuals with Chronic Obstructive Pulmonary Disease COPD. Methods Study conducted with 19 adults (11 men, 8 women) with a clinical and spirometric diagnosis of COPD and a mean age of 63.8 years (SD = 9.3). Data collection was performed using the COPD Assessment Test (CAT) questionnaire, the modified Medical Research Council scale (mMRC) and a digital manovacuometer, to characterize the impact of the disease on the individual, dyspnea and lung function. The data related to pharyngeal transit time and pharyngeal residue were collected through the analysis of videofluoroscopic images performed by three blinded judges. Results No significant relationship was found between pharyngeal transit time (PTT) with lung function (r = -0.71), pharyngeal residue and dyspnea (r = -0.06). PTT, when compared to normality, was increased. Conclusion Individuals with COPD, regardless of the severity of the disease, showed no association between PTT and pharyngeal residue and dyspnea and lung function.

Relação entre o risco de disfagia e o estado de saúde de indivíduos com a doença pulmonar obstrutiva crônica / Relationship between dysphagia risk and health status in patients with chronic obstructive pulmonary disease

RESUMO Objetivo: Verificar a relação entre o risco de disfagia e o estado de saúde de indivíduos com Doença Pulmonar Obstrutiva Crônica (DPOC). Método: Estudo transversal, com amostra de conveniência. Foram incluídos 23 indivíduos com diagnóstico de DPOC, de acordo com os critérios de GOLD (2019). São participantes de um programa de reabilitação pulmonar, clinicamente estáveis (sem exacerbações dos sintomas, no mínimo, de 30 dias) e em tratamento medicamentoso otimizado. Foram avaliadas as medidas antropométricas (IMC), o pico de fluxo expiratório (PFE), o estado mental (MEEM), o risco de disfagia (Eating Assessment Tool -EAT-10) e o estado de saúde (COPD Assessment Test -CAT). A média de idade dos participantes foi de 60,39 ± 9,90 anos, dos quais 11 eram do sexo feminino e eutróficos. Resultados: Foram encontradas associações positiva e moderada (r=0,57; p=0,004) entre o escore obtido pelo CAT e EAT-10 de indivíduos com DPOC. Conclusão: Os resultados demonstraram relação entre o risco de disfagia e o estado de saúde nos indivíduos com DPOC.

ABSTRACT Purpose: To verify the relationship between the risk of dysphagia and health status in patients with Chronic Obstructive Pulmonary Disease (COPD). Method: Cross-sectional study with convenience sample. Twenty-three individuals with a diagnosis of COPD according to GOLD 2019 criteria. The individuals participated in a pulmonary rehabilitation program, clinically stable (without exacerbations of at least 30 days) and in optimized drug treatment were included. The study analyzed anthropometric measures (BMI), peak expiratory flow (PEF), mental status (MEEM), eating assessment tool (EAT-10), and health status (COPD Assessment Test -CAT). The mean age was 60.39 ± 9.90 years, 11 individuals were female and eutrophic. Results: We observed a positive and moderate association (r = 0.57, p = 0.004) between the CAT and EAT-10 scores in the sample studied. Conclusion: The results demonstrated relationship between the risk of dysphagia and the health status in individuals with COPD.

Características de neonatos com síndrome do desconforto respiratório considerando a via de parto em uma unidade de terapia intensiva da região central do RS / Characteristics of neonates with respiratory distress syndrome admitted to an intensive care unit of the central region of RS

Objetivo: Analisar as características dos neonatos com Síndro-me do Desconforto Respiratório (SDR), considerando a via de parto, admitidos em uma Unidade de Terapia Intensiva de um hospital universitário da região central do Rio Grande do Sul. Materiais e métodos: Estudo retrospectivo, realizado no período de abril a maio de 2017, através da análise de prontuários de neonatos com idade gestacional acima de 37 semanas, ambos os sexos, internados no ano de 2016 na Unidade de Terapia Intensiva Neonatal (UTIN) do Hospital Universitário de Santa Maria com CID 10 P22 ­ Desconforto (angústia) respiratório(a) do recém-nascido. Resultados: A amostra foi constituída por 40 registros de nascimentos (25 do sexo masculino), divididos em parto vaginal (n=11) e cesárea (n=29), representando 27,5% e 72,5%, respectivamente, das internações totais. A média de idade materna foi de 27±7 anos, com uma média de 7±5 con-sultas pré-natais. Durante o período de internação 65%(n=26) dos 40 neonatos necessitaram de oxigenoterapia. Conclusão:A partir dos resultados obtidos no presente estudo, observamos que a SDR representa 11% das internações ocorridas na UTIN, no ano de 2016. A prevalência, quanto ao tipo de parto, foi de neonatos nascidos de cesariana, sem a presença do trabalho de parto e com idade gestacional de 38 semanas. (AU)

Objective: To analyze the characteristics of newborns with Respiratory Distress Syndrome (RDS), considering the route of delivery, admitted to an Intensive Care Unit of a university hospital in the central region of Rio Grande do Sul, Brazil. Materials and methods: A retrospective study, conducted from April to May 2017, through the analysis of records of neonates with gestational age above 37 weeks, both sexes, hospitalized in 2016 at the Neonatal Intensive Care Unit (NICU) of the Uni-versity Hospital of Santa Maria, with ICD 10 P22 - Respiratory distress syndrome of newborn. Results: The sample consisted of 40 birth records (25 males), divided into vaginal (n = 11) and caesarean (n = 29), representing 27.5% and 72.5%, respective-ly, of total hospitalization. The mean maternal age was 27 ± 7 years, with a mean of 7 ± 5 prenatal consultations. During the hospitalization period, 65% (n = 26) of the 40 neonates required oxygen therapy. Conclusion: Based on the results obtained in the present study, we observed that the RDS represents 11% of the hospitalizations that occurred in the NICU in 2016. The prevalence, in terms of route delivery, was of neonates born caesarean, without the presence of labor and gestational age of 38 weeks. (AU)

Deglutição orofaríngea, nutrição e qualidade de vida no indivíduo com doença pulmonar crônica / Oropharyngeal deglutition, nutrition, and quality of life in individuals with chronic pulmonary disease

RESUMO Objetivo descrever a eficácia e segurança da deglutição, o risco nutricional e a qualidade de vida em deglutição e relacionar o risco nutricional com a qualidade de vida dos indivíduos com doença pulmonar crônica. Método 17 indivíduos com diagnóstico de doença pulmonar crônica foram avaliados por meio do Volume-Viscosity Swallow Test (V-VST), Quality of Life in Swallowing Disorders (SWAL-QOL), Mini Nutritional Assessment (MNA) e índice de massa corpórea. Resultados foi encontrada alteração de eficácia da deglutição em nove (52,94%) dos indivíduos e eficácia+segurança em dois (11,77%). Todos os indivíduos estavam eutróficos na avaliação nutricional. Houve relação entre o risco nutricional com os domínios 3 (r=-0,803; p=0,05) e 5 (r=0,636; p=0,026) do SWAL-QOL. Conclusão houve alteração de eficácia e segurança da deglutição, no entanto não foi encontrado risco nutricional evidente na amostra avaliada. Ainda, houve relação entre o risco nutricional com a qualidade de vida em deglutição.

ABSTRACT Purpose Describe efficacy and safety of deglutition, nutritional risk, and quality of life in deglutition, and associate nutritional risk with quality of life in individuals with chronic pulmonary disease. Methods The participants were 17 individuals with chronic pulmonary disease evaluated using the following instruments: Volume-Viscosity Swallow Test (V-VST), Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire, Mini Nutritional Assessment (MNA), and body mass index (BMI). Results Changes in efficacy were observed in nine (52.94%) individuals and impairments in efficacy and safety were found in two (11.77%) individuals. All individuals were considered eutrophic by the nutritional assessment. Correlation was observed between nutritional risk and domains 3 (r=-0.803; p=0.05) and 5 (r=0.636; p=0.026) of the SWAL-QOL questionnaire. Conclusion Changes in efficacy and safety of deglutition were observed; however, no nutritional risk was evidenced in the sample evaluated. Correlation between nutritional risk and quality of life in deglutition was also observed.