Post-COVID-19 optoelectronic plethysmography findings: Inspiratory muscle weakness linked to impaired breathing pattern

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.

Acute severe SARS COVID-19 patients produce pro-resolving lipids mediators and eicosanoids.

OBJECTIVE: This study aimed to evaluate the eicosanoid and pro resolutive parameters in SARS COVID-19 patients with the severe acute respiratory syndrome. PATIENTS AND METHODS: Fourteen male patients with an acute respiratory syndrome caused by SARS COVID-19 and four healthy controls were evaluated by measuring the following parameters in plasma: Polyunsaturated fatty acids: EPA, DHA, ARA, and DPA. Specialized Pro-resolving mediators (SPMs) (including monohydroxy-containing precursors 17-HDHA, 18-HEPE, 14-HDHA) resolvins, maresins, protectins, and lipoxins. The eicosanoids group included prostaglandins, thromboxanes, and leukotrienes. RESULTS: Plasma from COVID-19 patients presented higher amounts of pro-inflammatory and pro-thrombotic lipid mediators as compared to healthy subjects (65.7 pg/ml vs. 10.2 pg/ml), including thromboxane (2142.6 pg/ml vs. 10.4 pg/ml), and the ratio between total plasma pro-inflammatory mediators versus total SPM's was 13.2 to 0,4, respectively. CONCLUSIONS: A clear disbalance favoring the pro-inflammatory axis is described, showing the need to perform future clinical interventions in these patients using SPM's or monohydroxylated lipid mediators derivates from fatty acids.

Impact of COVID-19 on Oral Healthcare for Oncopediatric Patients: The Setting in a Reference Hospital in Northeast Brazil

Objective: To describe the impact of the COVID-19 pandemic on dental care provided to pediatric cancer patients assisted in a referral hospital. Material and Methods: This is an observational, retrospective study based on secondary data extracted from worksheets of dental procedures for patients aged between 0 and 19 years assisted in the pediatric oncology sector of a hospital in João Pessoa, PB, Brazil. Dental procedures performed by the interdisciplinary team of researchers from August 2018 to February 2020 (19 months prior to the pandemic) and from April 2020 to October 2021 (19 months during the pandemic) were totaled and compared. A descriptive analysis of the data was performed. Results: There was a reduction of 80.2% in dental interventions implemented in the sector during the pandemic, with the number of procedures decreasing from 6,210 (the period before the pandemic) to 1,229 (during the pandemic). Most procedures in both periods were performed for patients assisted in beds, for whom there was a reduction of care provided for 81.2% from 5,275 to 994 procedures. Dental procedures in the outpatient clinic decreased by 74.9%, from 935 to 235. Conclusion: The COVID-19 pandemic negatively impacted dental care provided to pediatric oncology patients by restricting dental procedures to emergency demands, compromising performance prevention and health promotion actions.