ABSTRACT
This article has as its central theme the legal regulation of the exercise of telemedicine, especially from the context created in the COV1D-19 pandemic. In this sense, the study addresses the legal mechanisms and guidelines given by the Federal Council of Medicine (CFM) for the adoption of the practice. As a result, several questions arise regarding the work situation of health professionals who use telemedicine as a work mechanism. The article, therefore, will explain the importance of adopting telemedicine, as well as the problems that arise through it. Copyright © 2023 Beatriz Sena Figueirêdo, Flávia de Paiva Medeiros de Oliveira.
ABSTRACT
BACKGROUND: COVID-19 has quickly become a worldwide threat to health, travel, and commerce. Studies adressing the clinical-functional presentation of viral infection and physiotherapy management in children are scarce. The purpose statement was to provide current perspectives on the physiotherapy interventions for managing children based on COVID-19 evidence. METHODS: In this review, databases were searched between January 1, and March 26, 2020. The following descriptors were considered in the electronic databases National Library of Medicine (PubMed/Medline), Scientific Electronic Library Online (SciELO) and Physiotherapy Evidence Database (PEDro): (novel Coronavirus), (novel corona virus), Coronavirus, (corona virus), 2019-nCoV, nCovor, COVID-19, SARS-CoV-2. The results were described through the International Classification of Functioning, Disability and Health. RESULTS: Sixteen papers were included in this review. COVID-19 seems to lead to restriction of participation and interfere in tasks, such as recreation and leisure activities, respiratory muscle function and exercise tolerance. Personal protective equipments and contact precautions are important part of treatment. Effective oxygen therapy should be given immediately in presence of hypoxia. Nasal high-flow oxygen therapy, noninvasive ventilation, lung-protective ventilation strategies and prone position, should be undertaken when necessary under appropriate conditions. Airway clearance techniques should be administered only strictly needed and early activities must be encouraged. CONCLUSIONS: Potential physiotherapy interventions for children with COVID-19/SARS-CoV-2 consist of ventilatory management, airway clearance techniques and early activities and mobilization.
ABSTRACT
Modern life-style is creating an indoor generation: human beings spend approximately 90% of their time indoors, almost 70% of which is at home – this trend is now exacerbated by the lockdowns/restrictions imposed due to the COVID-19 pandemic. That large amount of time spent indoors may have negative consequences on health and well-being. Indeed, poor indoor air quality is linked to a condition known as sick building syndrome. Therefore, breathing the freshest air possible is of outmost importance. Still, due to reduced ventilation rates, indoor air quality can be considerably worse than outdoor. Heating, ventilation, and air conditioning (HVAC), air filtration systems and a well-ventilated space are a partial answer. However, these approaches involve only a physical removal. The photocatalytic mineralization of pollutants into non-hazardous, or at least less dangerous compounds, is a more viable solution for their removal. Titanium dioxide, the archetype photocatalytic material, needs UVA light to be ‘activated’. However, modern household light emitting diode lamps irradiate only in the visible region of the solar spectrum. We show that the surface of titanium dioxide nanoparticles modified with copper oxide(s) and graphene has promise as a viable way to remove gaseous pollutants (benzene and nitrogen oxides) using a common light emitting diode bulb, mimicking real indoor lighting conditions. Titanium dioxide, modified with 1 mol% CuxO and 1 wt% graphene, proved to have a stable photocatalytic degradation rate, three times higher than that of unmodified titania. Materials produced in this research work are thus strong candidates for offering a safer indoor environment. © 2022 Elsevier Ltd
ABSTRACT
PURPOSE/HYPOTHESIS: Altered breathing patterns have been reported after SARS-CoV-2 infection, but it is unclear if they result from changes in chest wall kinematics, inspiratory muscle weakness, or both. Lung volumes can be estimated through chest wall motion via optoelectronic plethysmography (OEP). We hypothesized that poor inspiratory muscle performance would relate to impaired quiet breathing pattern as assessed by OEP in adults post COVID-19 infection. NUMBER OF SUBJECTS: 20. MATERIALS AND METHODS: A convenience sample of 20 subjects recovered from RT-PCR-confirmed COVID-19 (mean ± SD age = 52.45 ± 11.93 years and BMI = 30.89 ± 6.48 kg/m2) with no overt pulmonary disease underwent measures of maximal inspiratory pressure (MIP) using a digital manometer followed by OEP analysis to evaluate chest wall motion and its compartments during quiet breathing. All OEP data were collected with subjects in a seated position and with arms supported laterally. Eighty-nine reflective markers were distributed on the anterior surface, side and back of the participants' trunks, who were instructed to breathe normally for three minutes while the system was operated. The displacement of markers during the requested spontaneous quiet breathing was picked up by six synchronized cameras that recorded their coordinates, from which lung volumes were later estimated using algorithms. Statistical analyses included normality tests, descriptive statistics, Pearson's correlation and independent samples t-tests. RESULTS: The mean ± SD MIP and tidal volume (VT) of the sample were 82.15 ± 34.32 cmH2O and 369 ± 216.31 ml, respectively. 65% of the participants were below their predicted values for VT, and 70% had lower than predicted MIP values. MIP was significantly and positively associated with VT (r = 0.40, P=0.04), while a negative relationship was found between MIP and the percentage contribution of abdominal rib cage motion to VT (r=- 0.45, P=0.02). No further correlation was observed between MIP and other OEP variables. Additionally, subjects classified as having normal inspiratory muscle function (i.e. MIP > 80 cmH2O) had significantly greater VT when compared to those presenting with inspiratory muscle weakness (450.64 ± 262.57 versus 269.22 ± 67.67 ml, respectively;P = 0.04). CONCLUSIONS: The variability of post COVID-19 ventilatory impairment requires a complex screening process. In our sample, most subjects presented with lower than predicted VT and MIP. Moreover, a significant association existed between inspiratory muscle dysfunction and reduced tidal volume. Changes in abdominal rib cage motion were also observed and likely occurred to compensate for a less efficient diaphragm even during normal, regular breathing. CLINICAL RELEVANCE: Subjects recovering from COVID-19 may present with diaphragm myopathy and impairment, highlighting the need to screen for inspiratory muscle weakness which may help identify altered breathing patterns and guide management such as inspiratory muscle training to mitigate persistent symptoms related to abnormal ventilation.