Efficacy of pulmonary telerehabilitation on exercise tolerance, fatigue, perceived exertion, depression, and quality of life in COVID-19 survivors / Eficácia da telereabilitação pulmonar na tolerância ao exercício, fadiga, percepção de esforço, depressão e qualidade de vida em sobreviventes de COVID-19

INTRODUCTION: Telerehabilitation advanced significantly with the emergence of COVID-19 and the recommendation of limiting physiotherapist-patient contact time whenever practicable. The effectiveness of telerehabilitation on those who had a longer stay in hospital and on oxygen support following discharge is still under question. OBJECTIVES: To evaluate the effects after six weeks of pulmonary telerehabilitation on exercise tolerance, fatigue level, perceived exertion, symptoms of depression and quality of life in patients surviving COVID-19. MATERIALS AND METHODS: A quasi-experimental study was conducted on 25 post-COVID-19 patients following discharge in a home environment setting. The participants were advised to prepare equipment such as oxygen concentrator, B-type oxygen cylinder (backup), lengthy oxygen tubes, finger pulse oximeter, mini static pedal exerciser, incentive spirometry, weight cuffs or water bottles and sandbags. After six weeks of telerehabilitation, the patients underwent assessments including initial oxygen saturation (SPO2), heart rate, peak oxygen demand during exercise to maintain baseline SPO2, peak heart rate, maximum drop in SPO2, recovery time to baseline SPO2 measured with a pulse oximeter and stopwatch, peak perceived exertion using the Borg Dyspnea Scale, peak fatigue score using the visual analog scale (VASF), quality of life assessed with the SF-36 questionnaire, and mental health status evaluated with the Hamilton Depression Scale (HAMD). One-way repeated measure ANOVA and paired t-test were used. RESULTS: Significant improvements following the intervention on the initial SPO2 (F (2.12, 23.13) = 21.0, p< 0.05) and quality of life also showed significant improvement (mean difference =29.92, p< 0.05). CONCLUSION: Six weeks of comprehensive pulmonary telerehabilitation with simple equipment improved tolerance to exercise, fatigue, perceived exertion, symptoms of depression and quality of life for post-COVID-19 patients.

INTRODUÇÃO: A telereabilitação avançou significativamente com o surgimento da COVID-19 e a recomendação de limitar o tempo de contato entre fisioterapeutas e pacientes sempre que possível. A eficácia da telereabilitação em pacientes que permaneceram mais tempo no hospital e necessitaram de suporte de oxigênio após a alta ainda está em questão. OBJETIVO: Para avaliar os efeitos após seis semanas de telereabilitação pulmonar na tolerância ao exercício, nível de fadiga, percepção de esforço, sintomas de depressão e qualidade de vida em pacientes sobreviventes de COVID-19. MATERIAIS E MÉTODOS: Foi realizado um estudo quase-experimental com dezesseis pacientes pós-COVID-19 selecionados de um hospital multispecializado. Os participantes foram orientados a preparar equipamentos como concentrador de oxigênio, cilindro de oxigênio tipo B (reserva), tubos de oxigênio longos, oxímetro de pulso, exercitador de pedal estático, espirômetro incentivador, pesos de tornozelo ou garrafas d'água e sacos de areia. Após seis semanas de telereabilitação, os pacientes foram submetidos a avaliações, incluindo saturação inicial de oxigênio (SPO2), frequência cardíaca, demanda máxima de oxigênio durante o exercício para manter a SPO2 basal, frequência cardíaca máxima, queda máxima na SPO2, tempo de recuperação para SPO2 basal medido com um oxímetro de pulso e cronômetro, esforço percebido máximo usando a Escala de Dispneia de Borg, pontuação máxima de fadiga usando a escala analógica visual (VASF), qualidade de vida avaliada com o questionário SF-36 e estado de saúde mental avaliado com a Escala de Depressão de Hamilton (HAMD). RESULTADOS: Melhorias significativas após a intervenção foram observadas na SPO2 inicial (F (2,12, 23,13) = 21,0, p <0,05) e na frequência cardíaca (F (1,839, 20,23) = 43,73, p <0,05), demanda máxima de oxigênio durante o exercício para manter a SPO2 basal (F (1,487, 16,36) = 8,96, p <0,05), esforço percebido máximo (F (5, 55) = 112,51, p <0,05), pontuação máxima de fadiga (F (1,755, 19,30) = 67,44, p <0,05), frequência cardíaca máxima (F (1,798, 19,78) = 50,99, p <0,05), queda máxima na SPO2 (F (2,467, 27,14) = 41,46, p <0,05) e tempo máximo de recuperação para alcançar a SPO2 basal (F (5, 55) = 78,89, p <0,05). A análise de seis semanas pós-intervenção nos sintomas depressivos (diferença média = 11,25, p <0,05) e na qualidade de vida também mostrou melhoria significativa (diferença média = 29,92, p <0,05). CONCLUSÃO: Seis semanas de telereabilitação pulmonar abrangente com equipamentos simples melhoraram a tolerância ao exercício, a fadiga, a percepção de esforço, os sintomas de depressão e a qualidade de vida em pacientes pós-COVID-19.

High-flow Nasal Cannula Oxygen Therapy in a Palliative Care Unit: Three Cases of Cancer Patients Suffering from Severe Dyspnea with Respiratory Failure

High-flow nasal cannula oxygen therapy (HFNC) in palliative care is mentioned in several guidelines, however, the indication for this procedure has not been established yet. At our department, HFNC has increasingly been adopted for end-stage cancer patients when their dyspnea needs to be alleviated. This is a case report on three patients treated with this procedure at our department. Although they had severe dyspnea with respiratory failure, their daily activities, such as enjoying meals and conversation with their families, were improved with HFNC. It can be a treatment of choice to maintain and improve patients’ quality of life (QOL) in palliative setting, where benefits and risks should be considered for each patient.

Persistence of symptoms and lung function in mild cases of COVID-19 six months after infection: a cross-sectional study / Persistência de sintomas e função pulmonar em casos leves de COVID-19 seis meses após a infecção: um estudo transversal

ABSTRACT Objectives: To describe persistent symptoms and lung function in mild cases of COVID-19 six months after infection. Methods: Data collection was performed through a semi-structured questionnaire containing information on the participants' demographic and anthropometric data, the disease in the acute phase, and persistent symptoms six months after COVID-19 using spirometry and manovacuometry. Results: A total of 136 participants were evaluated, of whom 64% were male, with a mean age of 38.17 ± 14.08 years and a body mass index (BMI) of 29.71 ± 17.48 kg/m2. The main persistent symptoms reported were dyspnea on exertion (39.7%), memory loss (38.2%), and anxiety (48.5%). Considering lung function, the participants reached 88.87 ± 17.20% of the predicted forced vital capacity (FVC), 86.03 ± 22.01% of the forced expiratory volume in one second (FEV1), and 62.71 ± 25.04% of peak expiratory flow (PEF). Upon manovacuometry, 97.41 ± 34.67% of the predicted inspiratory force (Pimax) and 66.86 ± 22.97% of the predicted expiratory force (Pemax) were observed. Conclusions: Six months after COVID-19 infection, a reduction in PEF and MEP was observed. Among the most commonly reported persistent symptoms were fatigue, tiredness with the slightest exertion, anxiety and depression, memory loss, and deficits in concentration.

RESUMO Objetivos: Descrever os sintomas persistentes e a função pulmonar em casos leves de COVID-19 seis meses após a infecção. Métodos: A coleta de dados foi realizada por meio de um questionário semiestruturado contendo informações sobre dados demográficos e antropométricos dos participantes, a doença na fase aguda e os sintomas persistentes seis meses após a COVID-19, utilizando espirometria e manovacuometria. Resultados: Um total de 136 participantes foram avaliados, dos quais 64% eram do sexo masculino, com uma idade média de 38,17 ± 14,08 anos e índice de massa corporal (IMC) de 29,71 ± 17,48 kg/m2. Os principais sintomas persistentes relatados foram dispneia ao esforço (39,7%), perda de memória (38,2%) e ansiedade (48,5%). Considerando a função pulmonar, os participantes atingiram 88,87 ± 17,20% da capacidade vital forçada (CVF) prevista, 86,03 ± 22,01% do volume expiratório forçado no primeiro segundo (VEF1) e 62,71 ± 25,04% do pico de fluxo expiratório (PFE). Na manovacuometria, observou-se 97,41 ± 34,67% da força inspiratória prevista (Pimáx) e 66,86 ± 22,97% da força expiratória prevista (Pemáx). Conclusões: Seis meses após a infecção por COVID-19, observou-se uma redução no PFE e na PEM. Dentre os sintomas persistentes mais comumente relatados estavam fadiga, cansaço com o mínimo esforço, ansiedade e depressão, perda de memória e déficits de concentração.

Analysis of pulmonary function in post-Covid-19 patients at a university hospital / Análise da função pulmonar de pacientes com síndrome pós-covid-19 em um hospital universitário

Objective: Evaluate the spirometry pattern of patients who persisted with respiratory symptoms after infection with SARS-Cov-2. Methods: Cross-sectional, observational, retrospective study in a single center, approved by the local Ethics Committee (registration number: 5,120,720). Patients who underwent spirometry due to Post-Covid Syndrome were evaluated to analyze the spirometric pattern presented. The following were collected: exam identification data, sex, age, symptom time, the need for mechanical ventilation, and quality of spirometry, in addition to the following exam parameters: FVC, FEV1, FEV1/FVC, FEV 25-75/FVC, and FEV 75, evaluating the Lower Limit of Normality, pre-bronchodilator and post-bronchodilator values. Results: Data from 72 patients were collected. Of these, 55.5% of patients had spirometry results within normal limits. The most frequent respiratory alteration was obstructive respiratory disorder, present in 29.2% of the patients. Conclusions: The presence of dyspnea in patients with normal spirometry may indicate further evaluation of lung function and other etiologies for dyspnea (AU).

Objetivo: Avaliar o padrão de espirometria de pacientes que persistiram com sintomas respiratórios após a infecção pelo SARS-CoV-2. Métodos: Estudo transversal, observacional e retrospectivo realizado em um único centro, aprovado pelo Comitê de Ética local (número do parecer: 5.120.720). Foram avaliados pacientes submetidos a espirometria devido à Síndrome Pós-Covid, a fim de analisar o padrão espirométrico apresentado. Os seguintes dados foram coletados: identificação do exame, sexo, idade, tempo de sintomas, necessidade de ventilação mecânica, qualidade da espirometria, além dos seguintes parâmetros do exame: CVF, VEF1, VEF1/CVF, VEF 25-75/CVF e VEF 75, avaliando o Limite Inferior da Normalidade, valores pré-broncodilatador e pós-broncodilatador. Resultados: Foram coletados dados de 72 pacientes. Destes, 55,5% apresentaram resultados espirométricos dentro dos limites normais. A alteração respiratória mais frequente foi o distúrbio ventilatório obstrutivo, presente em 29,2% dos pa-cientes. Conclusões: A presença de dispneia em pacientes com espirometria dentro da normalidade pode indicar uma avaliação adicional da função pulmonar, assim como outras etiologias para a dispneia (AU).

Enfermedad de Pompe y compromiso respiratorio / Pompe Disease and Respiratory Impairment

Introducción: El compromiso respiratorio en la enfermedad de Pompe es una de sus manifestaciones más frecuentes, tiene un impacto negativo en la calidad de vida y facilita la aparición de múltiples complicaciones. Se puede presentar como parte evolutiva de la enfermedad o incluso ser el síntoma inicial de la patología. Contenidos: La presentación clínica del compromiso respiratorio en la enfermedad de Pompe se caracteriza por disnea, ortopnea, cefalea y tos, y sus cambios paraclínicos incluyen hipercapnia, policitemia, elevación del índice de apnea/hipopnea, así como disminución de la capacidad vital y de las presiones inspiratoria y espiratorias máximas. El compromiso respiratorio es causado principalmente por disfunción muscular (especialmente el diafragma) y alteración de la regulación del sistema nervioso central. Conclusiones: Es fundamental la valoración acuciosa inicial de los patrones respiratorios y por supuesto su seguimiento, el cual dependerá del tipo de progresión de la disfunción respiratoria (rápida o lenta) o del requerimiento específico para cada paciente (ventilación no invasiva o invasiva).

Introduction: Respiratory compromise in Pompe disease is one of the most frequent manifestations, which has a negative impact on quality of life and leads to multiple complications. This can occur as an evolutionary part of the disease, or even be the initial symptom of the pathology. Contents: Its clinical presentation is characterized by dyspnea, orthopnea, headache, and cough, and its paraclinical changes include hypercapnia, polycythemia, elevated apnea/hypopnea index, decreased vital capacity, and decreased maximum inspiratory and expiratory pressures. Respiratory compromise is caused mainly by muscular dysfunction (especially the diaphragm) and alteration of regulation of the central nervous system. Conclusions: An initial careful assessment of respiratory patterns is essential, and of course their follow-up, that will depend of the type of progression of respiratory dysfunction (rapid or slow) or the specific requirement for each patient (non-invasive or invasive ventilation).

Female sexual dysfunction in chronic obstructive pulmonary disease

Background: Sexual life of women with chronic obstructive pulmonary disease (COPD) can be affected by breathing difficulties, a decrease in functional status, depressive mood and fatigue. Objetive: To evaluate the sexual dysfunction in female COPD patients and the possible explanatory mechanisms or correlations between these conditions. Methods: The study included 70 female patients with COPD aged between 36-65 and 70 age-matched controls. All the subjects completed questionnaires for the Female Sexual Functional Index (FSFI), BECK depression inventory and, spirometry. Results: Statistically significant sexual dysfunction was noted in COPD patients compared to the non-COPD group (p0.005). In linear regression analysis determining depression, no statistically significant factor was found among age, number of comorbidities, and FEV1/ forced vital capacity (FVC) % predicted (p>0.05). In multivariable analysis, only fatigue during intercourse was found to be a statistically significant factor in predicting sexual dysfunction among factors like age, presence of comorbidities, duration of the disease, smoking status, FEV1%, m MRCpoints, 6-minutes walk test, BECK depression scores (p=0.008). Conclusion: Sexual dysfunction is reported in many COPD females and seems to be related not to spirometric measures or exercise capacity but to fatigue. Depression is also a common comorbidity, of which both disorders are often neglected.

Antecedentes: La vida sexual en mujeres con enfermedad pulmonar obstructiva crónica (EPOC) es afectada por dificultades respiratorias, disminución del estado funcional, estado de ánimo depresivo y fatiga. Objetive: Evaluar la disfunción sexual en mujeres con EPOC y posibles mecanismos explicativos de esas dos condiciones Métodos: Participaron 70 pacientes mujeres con EPOC, rango edad 36-65 años y 70 controles emparejados por edad. Todos los sujetos respondieron un cuestionario para el índice funcional sexual femenino e inventario de depresión de BECK, mas una espirometría. Resultados: Se observó disfunción sexual significativa en las pacientes con EPOC comparado con el grupo sin EPOC. Las puntuaciones del inventario de depresión BECK fueron significativamente inferiores a las del grupo control. No hubo correlación entre las puntuaciones del FSFI y la depresión BECK con las características de las "mujeres" (r=-0.055). No se encontraron diferencias significativas en edad, FEV1% y antecedentes de exacerbación del año anterior según la gravedad de la depresión. En la regresión lineal para determinar la depresión, no hubo ningún factor estadísticamente significativo entre edad, número de comorbilidades y FEV1/FVC% predicho. En el multivariado, sólo la fatiga durante el coito resultó ser un factor significativo para predecir la disfunción sexual entre factores como edad, presencia de comorbilidades, duración de la enfermedad, hábito tabáquico, FEV1%, m MRCpoints, prueba de la marcha de 6 minutos y puntuaciones de depresión de BECK. Conclusiones: La disfunción sexual parece no estar relacionada con las medidas espirométricas o la capacidad de ejercicio, pero si con la fatiga. La depresión es una comorbilidad frecuente, de la que a menudo se descuidan ambos trastornos.

Quiste Vallecular: Caso clínico de estridor agudo / Vallecular cyst: clinical case of acute stridor

El enfrentamiento de estridor en el Servicio de Urgencias puede ser un desafío para el clínico. La mayoría de los pacientes responderán a medidas estándar de anafilaxia, no obstante, ante pacientes refractarios a tratamiento se deben sospechar otras patologías. Presentamos el caso clínico de una paciente refractaria a manejo de anafilaxia. Se realiza videolaringoscopía que identifica quiste de vallécula y se maneja mediante protección de vía aérea con intubación orotraqueal. Se decide escisión quirúrgica, en la cual se identifica estenosis subglótica que requiere instalación de traqueostomía. La paciente evoluciona favorablemente y es dada de alta.

Coping with stridor in the Emergency Department can challenge the clinician. Most patients respond to standard anaphylaxis measures. The clinician should suspect other differential diagnoses when patients are refractory to treatment. We present the clinical case of a patient refractory to standard anaphylaxis management. A video laryngoscopy was performed, identifying a vallecula cyst. We secured the airway through orotracheal intubation. The surgical team of our hospital performed a surgical excision of the cyst and identified subglottic stenosis, which required the installation of a tracheostomy. The patient evolved favorably in the postoperative period and was discharged.

Infección del miocardio por Mycobacterium tuberculosis: una localización infrecuente de una infección antigua

La tuberculosis miocárdica es una localización infrecuente que, en general, se caracteriza por cuadros clínicos silentes. Su diagnóstico se basa en la alta sospecha clínica y hallazgos inespecíficos en las imágenes cardíacas, pero la histopatología continúa siendo el estándar de oro para establecer el diagnóstico. La terapia antituberculosa ha sido exitosa, presentando mejoría radiológica y clínica en la mayoría de los casos. Presentamos el caso de una infección miocárdica por Mycobacterium tuberculosis en un hombre de 34 años que consultó por un cuadro de disnea de varias semanas de evolución. Se pesquisó un derrame pleural derecho y pericárdico grave, sin signos de taponamiento cardíaco. La RPC para M. tuberculosis en líquido pleural resultó positiva. El estudio histológico de pericardio y miocardio evidenció una pericarditis crónica y una inflamación granulomatosa, no necrosante, con células gigantes multinucleadas en el tejido miocárdico. Se estableció el diagnóstico de tuberculosis pleural, pericárdica y miocárdica y se inició tratamiento antituberculoso, presentando una mejoría clínica significativa.

Myocardial tuberculosis is a rare location that is generally characterized by silent clinical pictures. Diagnosis is based on high clinical suspicion and some nonspecific findings on cardiac imaging, but histological findings remain the gold standard. Treatment with standard antitubercular drugs llave been successful, presenting radiological and clinical improvement in most cases. We report a case of myocardial infection by Mycobacterium tuberculosis in a 34-year-old man, who presented with several weeks of dyspnea and evidence of right pleural effusion and severe pericardial effusion, without signs of cardiac tamponade. PCR for M. tuberculosis was positive in pleural fluid. The histologic study of pericardium and myocardium showed myocardial fibers with non-necrotizing granulomatous inflammation with multinucleated giant cells. Due to all the above, a diagnosis of pleural and myocardial tuberculosis was made, and tuberculosis treatment was started with significant clinical improvement.

Cuidados paliativos em idosos com dispneia: estudo de validação / Cuidados paliativos en el adulto mayor con disnea: estudio de validación / Palliative care in elderly people with dyspnea: A validation study

Objetivo: validar o conteúdo do cenário de simulação clínica sobre assistência ao paciente idoso hospitalizado em cuidados paliativos com dispneia, como ferramenta de ensino para estudantes de graduação em enfermagem. Materiais e método: estudo metodológico desenvolvido em três fases: revisão integrativa da literatura; entrevista com enfermeiros da área de gerontologia e cuidados paliativos; e validação do conteúdo do cenário de simulação. A validação contou com cinco juízes especialistas na área de simulação, gerontologia e cuidados paliativos entre abril e maio de 2022. O cenário criado foi baseado no pressuposto da Fabri: objetivos, material de estudo prévio, preparação, desenvolvimento, debriefing e avaliação. Utilizaram-se estatística descritiva e índice de validade de conteúdo. Resultados: foi identificado que os itens "duração do cenário", "características do paciente", "descrição do caso clínico", "caracterização do ator", "prebriefing" e "avaliação" obtiveram 0,80. O cenário de simulação obteve um valor geral de 0,91. Foram realizados ajustes no cenário referente à clareza da redação, às funcionalidades e à pertinência segundo as sugestões dos juízes. Conclusões: o cenário validado é uma ferramenta que auxilia no ensino da graduação em enfermagem, proporcionando uma formação nas áreas de gerontologia e de cuidados paliativos com um olhar diferenciado, o que pode levar a uma assistência humanizada e de qualidade.

Objetivo: validar el escenario de simulación clínica sobre la asistencia al adulto mayor hospitalizado en cuidados paliativos con disnea como herramienta de enseñanza para estudiantes de pregrado en enfermería. Materiales y método: estudio metodológico desarrollado en tres fases: revisión integrativa de la literatura; entrevista con profesionales de enfermería en el área de gerontología y cuidados paliativos; y validación del escenario de simulación. La validación contó con la participación de cinco jueces expertos en el área de simulación, gerontología y cuidados paliativos, y se llevó a cabo entre abril y mayo de 2022. El escenario creado se basó en el referencial de Fabri: objetivos, material de estudio previo, preparación, desarrollo, debriefing y evaluación. Esta investigación acudió al uso de estadística descriptiva y el índice de validez de contenido. Resultados: se identificó que los ítems "duración del escenario", "características del paciente", "descripción del caso clínico", "caracterización del actor", "prebriefing" y "evaluación" obtuvieron un valor de 0,80. El escenario de simulación obtuvo un valor general de 0,91. Se incorporaron algunos ajustes al escenario con respecto a la claridad de la escritura, las funcionalidades y su relevancia, de acuerdo con las sugerencias de los jueces. Conclusiones: el escenario validado se constituye en una herramienta que contribuirá al proceso de enseñanza del estudiante de enfermería, particularmente a la formación en las áreas de gerontología y cuidados paliativos, proporcionando una mirada diferente que redundará en cuidados de calidad y humanizados.

Objective: To validate the content of a clinical simulation scenario on the care provided to elderly patients with dyspnea hospitalized in palliative care as a teaching tool for undergraduate nursing students. Materials and method: Methodological study developed in three phases, namely: integrative literature review; interviews with nurses in the gerontology and palliative care area; and validation of the simulation scenario content. The validation phased engaged five specialist judges in the area of simulation, gerontology, and palliative care, and was conducted between April and May 2022. The scenario created was based on Fabri's assumption: objectives, previous study material, preparation, development, debriefing, and evaluation. Descriptive statistics and the content validity index were used. Results: The items "duration of the scenario", "patient characteristics", "description of the clinical case", "characterization of the actors", "prebriefing" and "evaluation" obtained a score of 0.80. The simulation scenario obtained an overall value of 0.91. Adjustments on the clarity in writing, functionalities, and the relevance of the scenario were incorporated, according to the judges' suggestions. Conclusions: The validated scenario could become a tool in the training process of undergraduate nursing courses, providing a different perspective for gerontology and palliative care training and fostering humanized and quality care.

Application of cardiopulmonary ultrasound in adult acute dyspnea: construction of differential diagnosis model between cardiogenic pulmonary edema and pneumonia / 中华超声影像学杂志

Objective:To analyze the cardio-pulmonary ultrasound features of cardiogenic pulmonary edema (CPE) and pneumonia in adults with acute dyspnea, and to construct a differential diagnosis model.Methods:Seven hundred and forty-three patients with sudden acute dyspnea admitted to Hebei General Hospital from November 2018 to May 2022 were retropectively included. Ultrasonographer A performed lung ultrasound with 12 zone method, and interpreted and recorded the ultrasonic signs (including A-lines area, B-lines area, consolidation area and pleural effusion area) together with ultrasonographer B. According to the ultrasonic characteristics of the whole lung, it was divided into A-profile and B-profile. According to the continuity and symmetry of the distribution of B-lines in bilateral lung fields, it could be divided into bilateral lung continuous and discontinuous B-profile, bilateral lung symmetric and asymmetric B-profile. Left ventricular ejection fraction (LVEF), left ventricular filling pressure (E/e′), right ventricular dilatation, tricuspid annular systolic displacement (TAPSE) and inferior vena cava diameter (IVCD) were evaluated by echocardiography, and all the indexes were transformed into binary variables. According to the final clinical diagnosis and treatment results, the disease was divided into CPE group and pneumonia group. Binary Logistic regression model was used to screen independent influencing factors, and partial regression coefficient β value was used as a weight to assign a score, and a differential diagnosis model was established based on the total score. The predictive value of the model was evaluated by the receiver operating characteristic curve (ROC) and area under curve (AUC). After the model was built, 30 patients with CPE or pneumonia were independently collected by ultrasonographer C as external validation data, which were included in the model to draw ROC curve and evaluate the differential diagnosis efficiency of the model. The consistencies between ultrasonographer A and B, A and C in observing lung ultrasound were explored.Results:A total of 743 patients from 43 clinical departments were included, including 246 cases in CPE group and 497 cases in pneumonia group. Multivariate logistic regression analysis showed that bilateral lung continuous B-profile, bilateral lung symmetric B-profile, ≥1 pleural effusion area, LVEF<50%, E/e′>14 were the risk factors for CPE (all OR>1, P<0.05), and ≥1 consolidation area and ≥1 pleural sliding disappearance area were the protective factors for CPE (all OR>1, P<0.05). The sensitivity, specificity and AUC of combined cardio-pulmonary ultrasound index β value weight score in the differential diagnosis of CPE and pneumonia were 0.939, 0.956 and 0.986, respectively. The AUC of external validation data was 0.904. Ultrasonographer A and B, A and C had good consistency in the interpretation of lung ultrasound signs ( P<0.05). Conclusions:The differential diagnosis model based on combined cardio-pulmonary ultrasound indexes has high differential diagnosis efficiency for CPE and pneumonia, and can be used in bedside cardio-pulmonary ultrasound practice.

Two Cases of Cesarean Sections Performed with Combined Spinal-Epidural Anesthesia with Perioperative Asthma Attacks / 日本東洋医学雑誌

Asthma attack difficulty breathing rapidly worsens the condition over time. Especially when the condition worsens before surgery, general anesthesia (GA) may be indicated depending on the type of surgery. In Japan, there is a tendency to avoid GA in cesarean section (C/S) due to the risk of difficult intubation, adverse effects on the fetus, and concerns about resuscitation of the newborn. This time, foreign body sensation in the throat (baikakuki) was found in a case of asthma-like attack accompanied by difficulty breathing caused by disturbance symptoms on the day of C/S and in a case of difficulty breathing due to preoperative antibiotic intravenous drip. After oral administration of hangekobokuto to the patients, dyspnea disappeared in either case, and I was able to avoid GA and perform C/S with combined spinal-epidural anesthesia. Considering asthma in Kampo medicine, it is thought that psychoactive predispositions such as anxiety and impatience are the triggers that cause qi counter flow and qi stagnation, which causes phlegm to condense, resulting in baikakuki and symptoms. Therefore, it was thought that hangekobokuto, which remove phlegm, was adapted.

Factors Requiring Midazolam in Addition to Systemic Opioids to Control Dyspnea in Cancer Patients at the End of Life

Background: Factors requiring midazolam in addition to systemic opioids to control dyspnea in cancer patients have yet to be evaluated. Methods: We retrospectively analyzed data for cancer patients who received systemic opioids to relieve dyspnea from April 2019 to July 2021 in Wakayama Medical University Hospital, Japan. Patients were divided into an opioid-alone group and an opioid plus midazolam group, according to the treatment of dyspnea. Results: The total of 107 patients included 85 patients (79.4%) in the opioid alone group and 22 patients (20.6%) in the opioid plus midazolam group. Age<60 years (p=0.004) and male sex (p=0.034) was significantly associated with the addition of midazolam. Multivariate analysis found age <60 years (OR=5.34, 95%CI: 1.66–17.21; p=0.005) was associated with the addition of midazolam. Conclusion: Age <60 years is factor requiring midazolam in addition to systemic opioids to control dyspnea in cancer patients.

The Effect of High-flow Nasal Cannula Oxygen for Dyspnea in Patients with Advanced Disease: Systematic Review

Objective: To evaluate the efficacy of high-flow nasal cannula oxygen (HFNC) for dyspnea in patients with advanced disease. Methods: A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Ichu-shi Web. Inclusion criteria were: 1) randomized controlled trials evaluating the effect of HFNC on dyspnea; 2) aged 18 years or older with advanced disease with hypoxemia; 3) control group was conventional oxygen therapy or noninvasive positive pressure ventilation. Exclusion criteria were: 1) patients in intensive care unit, 2) weaning from ventilator. Results: Six studies (4 from database searches, and 2 from hand searches) were included. In the 2 studies evaluating short-term intervention, one showed HFNC was more efficacious, and the other conventional oxygen was more efficacious. In the 2 studies evaluating long-term interventions: one showed HFNC was more efficacious, and the other showed no significant difference. In the 2 studies evaluating the intervention during exercise, one showed HFNC was more efficacious, and the other showed no significant difference. Conclusion: HFNC may be effective for dyspnea in patients with advanced disease associated with hypoxemia.

Series en disnea. Parte 3. Mecanismos, copia eferente o descarga corolaria / Series on Dyspnea. Part 3. Mechanisms, efferent copy or corollary discharge

RESUMEN Todas las teorías sobre los mecanismos de generación de disnea tuvieron defensores y detractores e, interesantemente, con el desarrollo de sofisticadas técnicas neurofisio lógicas y de imágenes funcionales ha sido posible jerarquizar cada uno de ellos. Todas han sobrevivido al paso del tiempo y ninguna puede explicar por sí sola la disnea en todas las situaciones clínicas, lo cual habla de la naturaleza compleja y multifactorial del fenómeno. El concepto de inadecuación tensión y longitud halló en las últimas décadas un sustento con nuevas evidencias a su favor. En particular, con el hallazgo de las vías involucradas y con la aplicación de conocimientos neurofisiológicos, la teoría de la inadecuación tensión y longitud se vería refinada con la descarga corolaria o copia eferente. Esta descarga corolaria o copia eferente es un atributo básico del sistema nervioso, que se encuentra en el reino animal, desde los invertebrados a los primates y en la especie humana. Este artículo está dedicado a la historia de la copia eferente y su incorporación como hipótesis para explicar la disnea, la más aceptada en la actualidad.

ABSTRACT All the theories about the mechanisms of generation of dyspnea had defenders and detractors and, interestingly, with the development of sophisticated neurophysiological techniques and functional imaging, it has been possible to rank each one of them. All have survived the passage of time and none can singularly explain dyspnea in all clini cal situations, showing the complex and multifactorial nature of the phenomenon. The concept of length-tension inappropriateness has found support in recent decades with new evidence in its favor. Specially with the discovery of the pathways involved and with the application of neurophysiological knowledge, the length-tension inappropriate ness theory would be refined with the corollary discharge or efferent copy. This corol lary discharge or efferent copy is a basic attribute of the nervous system found in the animal kingdom, from invertebrates to primates and in the human species. This article is dedicated to the history of the efferent copy and its incorporation as a hypothesis to explain dyspnea, which is currently the most accepted one.

Mobile application-based oximetry: a potential toolfor appropriate referral of patients with respiratory symptoms examined via telemedicine

ABSTRACT Objective To calculate the positive likelihood ratio to determine whether telemedicine is able to optimize referral to the emergency department. Methods Unicenter study with 182 consecutive patients admitted to Hospital Israelita Albert Einstein due to respiratory symptoms. All patients were submitted to oxygen saturation measurement using the standard method Welch Allyn finger device vital sign monitor and a 2-minute evaluation (Binah.ai mobile application). The reproducibility of oxygen saturation measurements made with both methods was investigated using interclass correlation coefficients and analysis of dispersion. Bland-Altman plots were constructed and kappa concordance coefficients used to examine data normality. Accuracy was also estimated. Results Oxygen saturation measurement differences between methods were ≤2% in more than 85% of cases. The mean difference (bias) between methods was near zero (0.835; Bland-Altman analysis). Oxygen saturation measurements made using the Binah.ai mobile application had an average ability to detect patients with altered oxygen saturation levels compared to the conventional method (ROC analysis). The positive likelihood ratio of the mobile application was 6.23. Conclusion Mobile applications for oxygen saturation measurement are accessible user-friendly tools with moderate impact on clinical telemedicine evaluation of patients with respiratory symptoms, and may optimize referral to the emergency department.

Inspiratory muscle training in people with chronic obstructive pulmonary disease (COPD): a systematic review / Entrenamiento de los músculos inspiratorios en personas con enfermedad pulmonar obstructiva crónica (EPOC): una revisión sistemática / Treinamento muscular inspiratório em pessoas com doença pulmonar obstrutiva crônica (DPOC): uma revisão sistemática

ABSTRACT This systematic review aimed to demonstrate the effectiveness of inspiratory muscle training (IMT) in people with chronic obstructive pulmonary disease (COPD), analyzing the effects of IMT on inspiratory muscle strength and endurance, exercise tolerance and reduction of dyspnea. A systematic search was carried out in the PubMed, Cochrane and Lilacs databases, from August 2021 to February 2023, searching for studies published from 2016. The descriptors used for the search followed the description of the MeSH/DeCS terms, namely: "Pulmonary Disease, Chronic Obstructive," "Breathing Exercises," "Exercise Tolerance," "Dyspnea," and "Muscle strength," with the languages: English and Portuguese, using the Boolean operators "AND" and "OR." Ten studies met the inclusion criteria, including 733 patients. In all examined studies, there was a significant increase in inspiratory muscle strength and endurance compared to the control group; of the ten studies analyzed, four showed advances in reducing dyspnea and exercise tolerance. Notably, inspiratory muscle training is effective in improving dyspnea, exercise tolerance, and in increasing inspiratory muscle strength and endurance in people with moderate to severe COPD.

RESUMEN El objetivo de esta revisión sistemática fue evaluar la efectividad del entrenamiento muscular inspiratorio (EMI) en personas con enfermedad pulmonar obstructiva crónica (EPOC), analizando los efectos del EMI en la fuerza y resistencia muscular inspiratoria, en la tolerancia al ejercicio y en la reducción de la disnea. Se realizó una búsqueda sistemática en las bases de datos PubMed, Cochrane y LILACS, en el período de agosto de 2021 a febrero de 2023, en los estudios publicados desde 2016. Los descriptores utilizados en la búsqueda siguieron la descripción de los Medical Subject Headings (MeSH)/Descriptores en Ciencias de la Salud (DeCS), a saber: "pulmonary disease, chronic obstructive", "breathing exercises", "exercise tolerance", "dyspnea" y "muscle strength", en los idiomas inglés y portugués, y con los operadores booleanos "AND" y "OR". Diez estudios cumplieron los criterios de inclusión, en los cuales participaron 733 pacientes. En todos los estudios en análisis, se observó un significativo incremento de la fuerza muscular inspiratoria y de la resistencia en comparación con el grupo control. De los 10 estudios analizados, cuatro mostraron progreso en la reducción de la disnea y en la tolerancia al ejercicio. Cabe destacar que el entrenamiento muscular inspiratorio mostró ser eficaz en la mejora de la disnea, en la tolerancia al ejercicio y en el aumento de la fuerza y la resistencia muscular inspiratoria en personas con EPOC de moderada a grave.

RESUMO O objetivo desta revisão sistemática foi evidenciar a eficácia do treinamento muscular inspiratório (TMI) em pessoas com doença pulmonar obstrutiva crônica (DPOC), analisando os efeitos do TMI na força e resistência muscular inspiratória; na tolerância ao exercício; e na redução da dispneia. Realizou-se uma busca de forma sistemática nas bases de dados PubMed, Cochrane e LILACS, no período de agosto de 2021 a fevereiro 2023, por estudos publicados a partir de 2016. Os descritores utilizados para a busca seguiram a descrição dos Medical Subject Headings (MeSH)/Descritores em Ciências da Saúde (DeCS), sendo eles: "pulmonary disease, chronic obstructive", "breathing exercises", "exercise tolerance", "dyspnea" e "muscle strength", com o filtro dos idiomas inglês e português e os operadores booleanos "AND" e "OR". Dez estudos cumpriram os critérios de inclusão, envolvendo 733 pacientes. Em todos os estudos examinados, houve um aumento expressivo da força e da resistência muscular inspiratória em comparação ao grupo-controle. Ainda, dos 10 estudos analisados, quatro apresentaram progressos na diminuição da dispneia e na tolerância ao exercício. Ressalta-se que o treinamento muscular inspiratório é eficaz na melhora da dispneia, da tolerância ao exercício e do aumento da força e da resistência muscular inspiratória em pessoas com DPOC em estágios moderado a grave.

Effects of a home-based pulmonary rehabilitation program with and without telecoaching on health-related outcomes in COVID-19 survivors: a randomized controlled clinical study / Efeitos de um programa de reabilitação pulmonar domiciliar com e sem telecoaching nos desfechos relacionados à saúde em sobreviventes da COVID-19: estudo clínico controlado randomizado

ABSTRACT Objective: To compare the effects of a home-based pulmonary rehabilitation (PR) program with and without telecoaching on health-related outcomes in COVID-19 survivors. Methods: A total of 42 COVID-19 patients who completed medical treatment were randomly divided into two groups: the study (telecoaching) group (n = 21) and the control (no telecoaching) group (n = 21). Both groups participated in an 8-week home-based PR program including education, breathing exercises, strength training, and regular walking. The study group received phone calls from a physiotherapist once a week. Both groups of patients were assessed before and after the program by means of the following: pulmonary function tests; the modified Medical Research Council dyspnea scale; the six-minute walk test; extremity muscle strength measurement; the Saint George's Respiratory Questionnaire (to assess disease-related quality of life); the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36, to assess overall quality of life); and the Hospital Anxiety and Depression Scale. Results: In both groups, there were significant improvements in the following: FVC; the six-minute walk distance; right and left deltoid muscle strength; Saint George's Respiratory Questionnaire activity domain, impact domain, and total scores; and SF-36 social functioning, role-physical, role-emotional, and bodily pain domain scores (p < 0.05). Decreases in daily-life dyspnea, exertional dyspnea, and exertional fatigue were significant in the study group (p < 0.05), and the improvement in SF-36 social functioning domain scores was greater in the study group (p < 0.05). Conclusions: A home-based PR program with telecoaching increases social functioning and decreases daily-life dyspnea, exertional dyspnea, and exertional fatigue in COVID-19 survivors in comparison with a home-based PR program without telecoaching.

RESUMO Objetivo: Comparar os efeitos de um programa de reabilitação pulmonar (RP) domiciliar com e sem coaching por telefone (telecoaching) nos desfechos relacionados à saúde em sobreviventes da COVID-19. Métodos: Um total de 42 pacientes com COVID-19 que completaram o tratamento médico foram aleatoriamente divididos em dois grupos: o grupo com telecoaching (grupo de estudo; n = 21) e o grupo sem telecoaching (grupo controle; n = 21). Ambos os grupos participaram de um programa de RP domiciliar que teve 8 semanas de duração e incluiu educação, exercícios respiratórios, treinamento de força e caminhada regular. O grupo de estudo recebeu telefonemas de um fisioterapeuta uma vez por semana. Ambos os grupos foram avaliados antes e depois do programa por meio de testes de função pulmonar, escala modificada de dispneia do Medical Research Council, teste de caminhada de seis minutos, mensuração da força muscular dos membros superiores e inferiores, Saint George's Respiratory Questionnaire (para avaliar a qualidade de vida relacionada à doença), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36, para avaliar a qualidade de vida global) e Hospital Anxiety and Depression Scale. Resultados: Em ambos os grupos, houve melhoria significativa da CVF; da distância percorrida no teste de caminhada de seis minutos; da força dos músculos deltoides direito e esquerdo; da pontuação obtida nos domínios "atividade" e "impacto" do Saint George's Respiratory Questionnaire, bem como da pontuação total no questionário; e da pontuação obtida nos domínios "aspectos sociais", "função física", "função emocional" e "dor corporal" do SF-36 (p < 0,05). A redução da dispneia na vida diária, da dispneia aos esforços e da fadiga aos esforços foi significativa no grupo de estudo (p < 0,05), e a melhoria da pontuação obtida no domínio "aspectos sociais" do SF-36 foi maior no grupo de estudo (p < 0,05). Conclusões: Um programa de RP domiciliar com telecoaching melhora os aspectos sociais e diminui a dispneia na vida diária, a dispneia aos esforços e a fadiga aos esforços em sobreviventes da COVID-19 em comparação com um programa de RP domiciliar sem telecoaching.

Dyspnée récidivante révélatrice d'un syndrome de Kartagener: à propos d'un cas / Recurrent dyspnea revealing a Kartagener Syndrome: About one case

La triade bronchectasies, sinusites et situs inversus caractérisent le syndrome de Kartagener. Sa transmission est autosomique récessive. Le cas de cette jeune fille de 19 ans que nous rapportons permet de déterminer la place de l'imagerie dans la démarche diagnostique de cette pathologie. La patiente présentait un syndrome clinique respiratoire récidivant depuis sa naissance. Le diagnostic a été posé par l'examen scannographique. L'évolution de la maladie dépend de la précocité du diagnostic.

Reeducación al esfuerzo en pacientes con neumonía por COVID-19 / Effort reeducation in patients with COVID-19 pneumonia / Reeducação de esforço em pacientes com pneumonia por COVID-19

Los pacientes con neumonía por COVID-19, presentan secuelas como disnea, fatiga, problemas cognitivos, disminución de la capacidad aeróbica y funcional. La reeducación al esfuerzo requiere de ejercicios de bajo impacto, que exigen un trabajo progresivo de fuerza máxima en un tiempo límite para enseñarles a resistir la fatiga. El objetivo general de este trabajo es demostrar los beneficios del Programa de reeducación al esfuerzo en pacientes con neumonía por COVID-19 atendidos en el Hospital General IESS Milagro. Estudio de enfoque cuantitativo, alcance explicativo, diseño experimental e instrumentos de evaluación como: Historia clínica y escalas de mMRC, IBF, MRC Modificado, PCFS, Sit to stand y Mini mental, la muestra fue de 50 pacientes en edades entre los 20 a 70 años. Después de realizar el Programa de Reeducación al esfuerzo el 100% de los pacientes presentaron fatiga leve (IBF), el 100% no presentó deterioro cognitivo (Mini-mental); el 44% no manifestó disnea y el 56% disnea leve (mMRC). El 100% aumentaron su fuerza muscular (MRC) y el 40% realiza sus actividades de la vida diaria a pesar de presentar pocos síntomas (PCFS). El 100% mejoró en la capacidad aeróbica (Sit to Stand). Se concluye que los ejercicios de reeducación al esfuerzo coadyuvan de forma positiva a mejorar la calidad de vida de los pacientes con neumonía por COVID-19, mediante la utilización de diversas técnicas que les permita el regreso progresivo a la actividad física y los deportes, lo cual fue demostrado en los resultados.

Patients with COVID-19 pneumonia present sequelae such as dyspnea, fatigue, cognitive problems, decreased aerobic and functional capacity. The re-education to effort requires low impact exercises, which require a progressive work of maximal strength in a time limit to teach them to resist fatigue. The general objective of this work is to demonstrate the benefits of the stress reeducation program in patients with COVID-19 pneumonia treated at the General Hospital IESS Milagro. A quantitative approach study, explanatory scope, experimental design and evaluation instruments such as: Clinical history and mMRC scales, IBF, Modified MRC, PCFS, sit to stand and Mini mental, the sample consisted of 50 patients aged between 20 and 70 years. After the Exertion Re-education Program, 100% of the patients presented mild fatigue (IBF), 100% did not present cognitive deterioration (Mini-mental); 44% did not manifest dyspnea and 56% mild dyspnea (mMRC). 100% increased their muscle strength (MRC) and 40% performed their activities of daily living despite presenting few symptoms (PCFS). 100% improved in aerobic capacity (Sit to Stand). It is concluded that exertional re-education exercises contribute positively to improve the quality of life of patients with COVID-19 pneumonia, through the use of various techniques that allow them to progressively return to physical activity and sports, which was demonstrated in the results.

Os pacientes com pneumonia COVID-19 têm seqüelas como dispneia, fadiga, problemas cognitivos, diminuição da capacidade aeróbica e funcional. A reeducação do exercício requer exercícios de baixo impacto, que requerem um trabalho progressivo de máxima força em um limite de tempo para ensiná-los a resistir à fadiga. O objetivo geral deste estudo é demonstrar os benefícios do Programa de Reeducação do Exercício em pacientes com pneumonia COVID-19 tratados no Hospital Geral IESS Milagro. Um estudo de abordagem quantitativa, escopo explicativo, desenho experimental e instrumentos de avaliação tais como: história clínica e escalas mMRC, IBF, MRC modificado, PCFS, sit to stand e Mini mental, a amostra consistiu de 50 pacientes com idade entre 20 e 70 anos. Após o Programa de Reeducação do Exercício, 100% dos pacientes apresentaram fadiga leve (IBF), 100% não apresentaram deterioração cognitiva (Mini-mental); 44% não manifestaram dispneia e 56% dispneia leve (mMRC). 100% aumentaram sua força muscular (MRC) e 40% realizaram suas atividades de vida diária apesar de terem poucos sintomas (PCFS). 100% melhorada em capacidade aeróbica (Sente-se para ficar de pé). Conclui-se que os exercícios de reeducação por esforço contribuem positivamente para melhorar a qualidade de vida dos pacientes com pneumonia COVID-19, através do uso de várias técnicas que lhes permitem retornar progressivamente à atividade física e ao esporte, o que foi demonstrado nos resultados.

Principales secuelas respiratorias del Covid-19: una revisión exploratoria / oria Main respiratory sequelae of Covid-19: an exploratory review

La Covid-19 es una enfermedad infecciosa que ha causado importantes tasas de morbi-mortalidad en la población mundial, la evidencia científica ha procurado describir la fisiopatogenia del SARS-CoV-2. En fase inicial, se produce un proceso inflamatorio agudo que empieza acentuándose en el tracto respiratorio y que afecta primera y principalmente al pulmón; lo que, posteriormente, puede desencadenar disfunciones respiratorias que perduran aún después del alta médico, lo que se considera como un síntoma persistente. De acuerdo con la metodología de la revisión sistemática exploratoria, se realizó esta investigación cuyo propósito se centró en encontrar referencias bibliográficas que sustente e identifiquen las principales secuelas respiratorias del Covid-19; para ello, se realizó una búsqueda de la literatura a través de las bases de datos PubMed, Scielo, Medline, Web of Science y Scopus. La indagación bibliográfica se llevó a cabo en enero de 2022, se dectectaron 70 documentos, los cuales fueron sometidos a evaluación de calidad. Se incluyeron 38 estudios observaionales, 3 artículos de revisión y 1 metaanálisis. Hasta la fecha no se ha llegado a un consenso respecto a la secuela más importante en el campo respiratorio post Covid, fundamentalmente destacan: fatiga, disnea, dolor torácico y la tos. Además, un porcentaje considerable de pacientes persisten con anomalías residuales de la función pulmonar, sugerentes fibrosis pulmonar, requiriendo asistencia médica aun despúes del alta hospitalario. Se recomienda continuar con investigaciones orientadas la valoración de las secuelas por Covid-19, para obtener basamentos claros relacionados con la capacidad funcional respiratoria post infección(AU)

Covid-19 is an infectious disease that has caused significant rates of morbidity and mortality in the world population, scientific evidence has sought to describe the pathophysiology of SARS-CoV-2. In the initial phase, an acute inflammatory process occurs that begins to be accentuated in the respiratory tract and affects the lungs first and foremost; which, subsequently, can trigger respiratory dysfunctions that persist even after medical discharge, which is considered a persistent symptom. In accordance with the methodology of the exploratory systematic review, this research was carried out whose purpose was focused on finding bibliographic references that support and identify the main respiratory sequelae of Covid-19; For this, a search of the literature was carried out through the PubMed, Scielo, Medline, Web of Science and Scopus databases. The bibliographic investigation was carried out in January 2022, 70 documents were detected, which were subjected to quality evaluation. 38 observational studies, 3 review articles and 1 meta-analysis were included. So far, no consensus has been reached regarding the most important sequela in the post-COVID respiratory field, fundamentally the following stand out: fatigue, dyspnea, chest pain and cough. In addition, a considerable percentage of patients persist with residual pulmonary function abnormalities, suggestive of pulmonary fibrosis, requiring medical assistance even after hospital discharge. It is recommended to continue with research aimed at assessing the sequelae of Covid-19, to obtain clear foundations related to post-infection respiratory functional capacity(AU)