ABSTRACT
Introduction: More than 12% of COVID-19 hospitalized patients develop Generalized Anxiety Disorder (GAD) after discharged. High frequency band percentage of heart rate variability (hfHRV) is a reliable indicator of efficient functional coupling between autonomic branches across high-demanding adaptive situations. Objective(s): To compare hfHRV among post-hospitalized COVID-19 survivors by level of GAD. Method(s): We conducted an observational study with 211 post-COVID-19 participants (63.7% males;47.6y +/-14.3), 3 months after discharged. We registered their hfHRV with a computerized biofeedback equipment throughout four conditions: open-eyes (C1);closed-eyes (C2);closed-eyes+natural-relaxation (C3);and closed-eyes+deep-breathing (C4) (2.5 minutes per condition). Participants were classified into 3 categories using General Anxiety Disorder Scale (GAD-7): low anxiety (n=174, 67.5%, 47.2 yo +/-13.4;G1);moderate anxiety (n=24, 66.5%, 47.3 yo +/-15.3;G2) and severe anxiety (n=13, 60.5%, 46.1 yo +/-9;G3). Statistical analysis were performed with SPSS v28. Result(s): hfHRV percentage is higher at C3 in G1 (G1: 29.5 +/-21.1, G2: 21.1 +/-17.1, G3: 20.0 +/-20.4;p = 0.01). G3 display a 30% decrease in hfHRV during this condition in contrast with G1 (p = 0.006). Percentage of hfHRV in G1 (C1: 31 +/-22.6, C2: 29.2 +/-23.6, C4: 24.3 +/-20.7), and G3 (C1: 29.7 +/-22.8;C2: 27.9 +/-17.6;C4: 20 +/-20) didn't show any significant differences. Conclusion(s): C3 involve an adaptive challenge that demands an effective sympathetic-parasympathetic regulation. An increase in hfHRV during C3 in G1, indicates that the group with low anxiety exhibit a more effective psychophysiological adaptive feature than G2 and G3: a potential protective factor from GAD.
ABSTRACT
Background and/or Objectives: To determine the feasibility of utilizing M-Mode (motion-mode) for ultrasound imaging and data collection of the diaphragm. Design(s): A review of data collected during a prospective, randomized controlled trial. Setting(s): Research hospital Participants: 12 adults (mean age = 39 years) with lab-confirmed SARS-CoV2 infection and persistent exercise intolerance affecting function. Musculoskeletal M-Mode imaging of the left and right diaphragm were acquired using a Samsung RS85 Prestige Ultrasound System and a PA1-5A transducer. Data were cataloged for 3 different breathing conditions: quiet breathing, deep breathing, and sniffing. Intervention(s): not applicable Main Outcome Measure(s): Images were scored independently by three researchers on a three-point scale. Disagreements were resolved by a senior researcher. Main outcome measures included: percentage of viable images acquired for patients with a range of BMI scores, comparison of image viability between the three breathing conditions, percentage of compromised images for the right and left diaphragm. Result(s): BMI did not impact image quality (range: 19.8-37.7). The sniff test yielded the lowest percentage of unusable images (13%) compared to quiet breathing (17%) and deep breathing (21%). Moreover, the left diaphragm yielded a higher number of unmeasurable (92% percent of imaging errors were on the left side). No statistical significance was found in image usability scores between the 3 breathing conditions on either the right or left diaphragm. Conclusion(s): M-Mode imaging of the diaphragm is feasible;however, it is accompanied by user-, machine-, and patient-dependent challenges that appear to create more obstacles when imaging the left hemidiaphragm. A sniff test performed during M-mode US imaging is more likely to provide usable measurements of diaphragmatic function than other breathing conditions.
ABSTRACT
SESSION TITLE: Late Breaking Investigations From Pulmonary and Critical Care SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Although spirometry is the standard lung functional test, it requires the patient to perform a series of maneuvers correctly, which is difficult for elderly, children, and patients with severe lung impairments. Furthermore, spirometry lacks regional assessment for detecting and monitoring subtle changes in lung diseases, e.g., chronic obstructive pulmonary disease (COPD) and potentially COVID-19. We aim to establish a home-based imaging system, portable electrical impedance tomography (EIT), that can detect lung function deterioration and monitor its recovery through a close-to-effortless breathing paradigm. METHODS: We developed a palm-sized EIT system and a novel guided breathing paradigm that consists of a periodic inhalation and exhalation at 12 breaths per minute. We validated them on healthy subjects (n=23) performing different breathing efforts (deep vs shallow), then on patients with ILD (n=2), COPD (n=8), asthma (n=4) and bronchiectasis (n=4) against healthy (n=8) cross-sectionally, and last monitored a COVID-19 discharged subject with two age- and gender-matched healthy controls longitudinally. We further applied machine learning to distinguish between healthy and patients, and calculated its sensitivity and specificity. RESULTS: We detected higher amplitude during deep breathing compared to shallow (p < 0.001) in healthy subjects, with right lung having more activated voxels and higher total amplitude than the left lung (p < 0.001), likely due to the position of the heart. Cross-sectionally, we observed lower amplitude in patients compared to healthy (p < 0.01), while coefficient of variation (CV) of the amplitude in the lungs is higher in patients (p < 0.05). Note that CV is a parameter reflecting inhomogeneity which is indicative of lung function deterioration. Longitudinally, the COVID-19 discharged subject had higher CV in the left lung (p < 0.001) which decreased across time (p < 0.01), suggesting a functional deterioration at the beginning followed by a recovery. Regional analysis further pin-pointed the potential deterioration and recovery was in the anterior left lung. Separately, despite the small sample size, the sensitivity and specificity for detecting patients using a machine learning classifier were 76% and 62%, respectively, and will likely increase with a larger sample. CONCLUSIONS: Home-based portable EIT with close-to-effortless guided breathing paradigm can map global and regional lung function deterioration and recovery cross-sectionally and longitudinally. More importantly, it can potentially be deployed as a screening tool for various lung diseases through the application of machine learning. CLINICAL IMPLICATIONS: Portable EIT with guided breathing paradigm enables lung function diagnostic screening and treatment monitoring at home, advancing telemedicine and lowering hospital burden. DISCLOSURES: no disclosure on file for Peng Cao;Owner/Founder relationship with Gense Technologies Ltd Please note: Since 2017 Added 06/06/2022 by Russell Chan, value=Ownership interest No relevant relationships by Wang Chun Kwok No relevant relationships by Wei-Ning Lee No relevant relationships by Terence Tam Employee relationship with Gense Technologies Please note: Setpember 2021 - Now Added 06/07/2022 by Adrien Touboul, value=Salary contractor relationship with Gense Technologies Ltd Please note: since Apr 2021 Added 06/06/2022 by Eddie Wong, value=Consulting fee Employee relationship with Gense Technologies Please note: since 2020 Added 06/06/2022 by Fedi Zouari, value=Royalty
ABSTRACT
SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Post COVID pulmonary complications can be attributed to severe inflammatory response that can result in pulmonary fibrosis. It is somewhat predictable in patients with severe illness, advanced age and comorbidities. However, a little is known about pulmonary complications in younger patients with mild illness followed up at outpatient clinics. We aim to shed light on post COVID pulmonary complications in patients who did not require hospitalization but had significant outpatient visits. METHODS: This study is based upon a retrospective chart review of patients who presented to Pulmonology Clinic at Cayuga Medical Associates with respiratory symptoms associated with COVID-19 disease. Mild illness was defined as symptoms of dyspnea on exertion or fatigue or shortness of breath that have not required oxygen and lasted for less than or equal to two months. Moderate illness was defined as symptoms of mild illness lasting for more than two months without oxygen supplementation. Severe illness was defined as hypoxia requiring home oxygen. We have excluded the patients who were hospitalized for COVID pneumonia. RESULTS: Of 23 patients (56.52% female) with COVID illness seen at Pulmonology Clinic in one-year duration, 13.04% had COPD, 26.09% had asthma and 21.74% had OSA. Median age was 33 with mean BMI 27.61.13.04% were current smokers. 39.13% required a PFT among which 77.78% had normal results. 21.74% of the total patients who never had OSA as an underlying diagnosis, required sleep study, among which 60% had mild OSA and 20% had severe OSA. 13.04% were already on oral steroids for other diseases. Majority of the patients had normal chest x-ray findings. 39.13% had CT chest, majority of which showed normal findings and few with diffuse ground glass opacities. 8.70% developed palpitations along with respiratory symptoms. At six months follow up, 43.48% had mild illness who were managed with conservative management such as incentive spirometry, deep breathing techniques, prone positioning and as needed short acting bronchodilator treatments. 43.48% had moderate illness who were treated with short course of oral steroids in addition to conservative management. 13.04% had severe illness who required home oxygen up to 2 L for two months maximum. Most common pulmonary complaint was dyspnea on exertion, seen in 43.48%. 17.39% had fatigue. 21.74% had sleep apnea symptoms. Median duration of symptoms was two months. CONCLUSIONS: Our study outlines the incidence of post COVID pulmonary complications in patient group where these complications are least expected. CLINICAL IMPLICATIONS: Post COVID pulmonary complications appear to be of significant concern in patients visiting outpatient clinics. The heterogeneity in management of those complications needs a serious attention. The feasibility and implementation strategy of post COVID-19-care-clinic with proper management guidelines should be brought to streamline practice. DISCLOSURES: No relevant relationships by Sameer Acharya No relevant relationships by Ali AKRAM No relevant relationships by Samjhauta Bhattarai No relevant relationships by Lavanya Kodali
ABSTRACT
SESSION TITLE: Variety in Risk Factors and Treatment of VTE SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: The year of 2020 will be a year never forgotten when the COVID-19 pandemic began. The healthcare system is going into a crisis facing a disease that is unknown and overwhelming. Companies were frantic to find a solution to help prevent so many unnecessary deaths. Pfizer mRNA COVID-19 vaccine was granted emergency use by the FDA after proving efficacy in early trials. Many side effects were unknown and discovered as time went on. Unprovoked isolated pulmonary embolisms are rare. CASE PRESENTATION: A 24 year old male with no significant past medical history presented to the emergency department due to shortness of breath, hemoptysis and chest pain. He denied any family history or personal history of clotting disorders. He received the mRNA COVID-19 Pfizer vaccine 5 days prior to symptom onset. He describes it as constant sharp pain with varying intensity that he rates a 6/10 and can reach a 10/10 pain exacerbated with lying flat and deep breathing. He also states he has been coughing up a teaspoon amount of blood with this chest pain. Physical examination revealed reduced breath sounds in the left lower lobe. Patient was hemodynamically stable. Labs were stable and hemoglobin was stable throughout the hospital course. Fibrinogen was elevated and hypercoagulable work-up was negative. CTA of chest was performed and revealed left-sided pulmonary emboli involving the left lower lobe with pulmonary infarction. Therefore, he was managed by Eliquis. DISCUSSION: Pfizer released a safety and efficacy report of the BNT162b2 mRNA Covid-19 Vaccine. Many of the common side effects reported were pain at the injection site, fatigue, headache, and fever [1]. Adverse events that were reported were shoulder injury, right axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and right leg paresthesia [1]. Isolated PE in a young healthy patient was never reported as an adverse event from the Pfizer safety and efficacy report. Severe acute respiratory syndrome-coronavirus-2 has been proven to increase the risk of venous thromboembolism because it is a prothrombotic virus [2]. Vaccination reports of pulmonary embolism are increasing, however, isolated PE without a DVT is still very underreported and rare. The literature states that a lot of patients that are having PE after mRNA vaccine also have associated thrombocytopenia, however, this is not what this patient demonstrates [3]. A total of 43, 548 participants were observed for the safety and efficacy report of the Pfizer COVID-19 report and not a single patient demonstrated an isolated pulmonary embolism event [1]. CONCLUSIONS: This case is a demonstration of a rare occurrence of isolated PE with no evidence of DVT in such close proximity to receiving the mRNA COVID-19 Pfizer vaccination.There are few reports of pulmonary embolism in healthy patients with no history of clotting disorders and further data are needed to support this association. Reference #1: Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27):2603-2615. doi:10.1056/NEJMoa2034577 Reference #2: Hesam-Shariati S, Fatehi P, Abouzaripour M, Fathi F, Hesam-Shariati N, Hesam Shariati MB. Increased pulmonary embolism in patients with COVID-19: a case series and literature review. Trop Dis Travel Med Vaccines. 2021;7(1):16. Published 2021 Jun 12. doi:10.1186/s40794-021-00145-3 Reference #3: Muster V, Gary T, Raggam RB, Wölfler A, Brodmann M. Pulmonary embolism and thrombocytopenia following ChAdOx1 vaccination. Lancet. 2021;397(10287):1842. doi:10.1016/S0140-6736(21)00871-0 DISCLOSURES: No relevant relationships by Muhammad Azaz Cheema No relevant relationships by Morcos Fahmy No relevant relationships by Christina Gearges No relevant relationships by Asma Iftikhar
ABSTRACT
SETTING AND PARTICIPANTS: Medicine subspecialty fellows at Washington University School of Medicine in St. Louis, Missouri DESCRIPTION: Multiple studies show that the wellness of trainees has been negatively affected by the COVID-19 pandemic. Trainees often lack necessary resources and skills to intentionally work on their wellness. In addition, wellness initiatives for trainees are often limited by time, space, and financial barriers. Studies have shown that slow intentional breathing techniques have psycho-physiological benefits like increased comfort, relaxation, and alertness, as well as reduced anxiety, anger, depression, and confusion. Hence, a 3-step Pranayama (deep breathing) technique was selected as a potentially effective tool to improve the wellness of fellows at our institution. The goal of the session was to introduce fellows to beginner level Pranayama, augmenting relaxation and a sense of well-being. Fellows from various subspecialties (n = 11) participated in the pilot session, which lasted 12 minutes and included cognitive, affective and psychomotor learning activities. The large group facilitated session explored participants' attitudes, perceptions, and experience with breathing exercises. The fellows then watched a video about Pranayama, followed by a demonstration of the technique by the facilitator and a knowledge check activity. Subsequently, all fellows performed Pranayama with guidance first, then independently. Due to the success of the pilot, a second iteration of the activity was incorporated into a wellness intervention for the Division of Infectious Diseases fellows (n = 7) as part of “Wellness Week”. EVALUATION: This is a mixed-methods study. The cumulative survey response rate from both sessions was 72% (13/18). Qualitative feedback included “Great, relaxed. Definitely going to try to remember to use this!”, “more relaxed than prior”, “relaxed, like I am on a beach in Australia”, “loved the applicability and digestibility”, and “overall I thought this was great! Super practical for us to incorporate easily into our busy lives”. Using a Likert scale, 61.5% (8/13) and 38.4% (5/13) reported “definitely” and “probably” learned something new, respectively;38.4% (5/13) reported being “extremely comfortable” and 53.4% (7/13) “somewhat comfortable” performing Pranayama after this session. On a multiple-choice quiz, 60% of respondents correctly identified the hand gesture used for Pranayama. DISCUSSION / REFLECTION / LESSONS LEARNED: Breathing exercises are quick, easy to learn and perform. In particular, Pranayama is an effective, efficient way for trainees to relax when resources and time are limited. The pilot session assessed trainee attitudes and perceptions at Kirkpatrick level 1. The knowledge check during the intervention served as a Kirkpatrick level 2 assessment. Longitudinal follow up surveys are required to determine if participants continued to use Pranayama and to assess long term impact on wellness.
ABSTRACT
Objective: To analyze the characteristics of commercially available sleep-exclusive apps using the Mobile Health Index and Navigation (MIND) apps database published by the Division of Digital Psychiatry at BIDMC for app review. Background: Over 70 million Americans endure a chronic sleep disorder during their lifetime. Due to the COVID-19 pandemic, mobile app benefits have been postulated as a means of expanding patient access to scientifically-based interventions in aiding their sleep disorders. With the increasing adoption of mobile health apps, it is critical that information regarding these mobile apps are sufficiently analyzed. Design/Methods: Using pre-specified criteria, we identified 106 sleep related mobile apps in the iOS and Google Playstores, and rated them using a 105 question review that is part of the MIND database. Questions focused on: Accessibility, Privacy & Security, Clinical Foundation, Engagement Style, and Interoperability. The features of the 106 apps were compared to a control group of non-sleep apps to evaluate the features and limitations sleep apps bear relative to the remainder of the marketplace. Results: The most common features of sleep apps were mindfulness (68.9%), deep breathing (54.7%), and psychoeducation (30.2%). Regarding functionality, 39.6% of apps have accessibility features and 49.1% can be used offline. However, sleep apps lack sleep trackers (22.6%), exportability features (21.7%), and opportunities to collaborate with one's provider (7.6%). Only 10.4% of sleep apps have an efficacy study. Conclusions: Sleep apps in the marketplace are primarily used to help the user fall and stay asleep. In its current state, sleep apps can assist only the user as a self-help tool. The lack of sleep tracking, support, exportability, the inability to collaborate with one's provider and efficacy studies limit the potential of implementing sleep apps for clinical use.
ABSTRACT
Objective: A substantial number of COVID long-haulers have developed POTS, which warrants further investigation. This study is intended as a first look at a new and growing patient population that is bringing greater attention to the prevalent autonomic disease of POTS. Background: POTS (Postural Orthostatic Tachycardia Syndrome) is a disorder of autonomic dysregulation involving overactive compensation for postural blood pressure changes. This debilitating syndrome can be associated with small fiber neuropathy and a broad spectrum of autonomic symptoms including palpitations, changes in sweating, and gastrointestinal problems like constipation. Respiratory and gastrointestinal viruses have been known to cause onset of POTS pathophysiology. In approximately 10% of COVID cases, patients experience long-term health effects after the conclusion of their COVID infection. These patients are called COVID “long-haulers.” Design/Methods: We conducted a chart review of 25 Cleveland Clinic post-COVID POTS patients who are mostly female (84%) to learn about this patient population's distribution of top symptoms, comorbidities, autonomic testing, and autonomic questionnaire scores. Top three symptoms were determined based on the physician's note from the patients' initial visit to the Cleveland Clinic Neurology Department. Results: Our chart review revealed a high occurrence of excitatory comorbidities such as chronic migraine (44%) and irritable bowel syndrome (24%). In addition, when assessing patients' top three POTS symptoms, we found that palpitations, fatigue, and dyspnea were affecting patients most. As with POTS in general, autonomic testing outside of tilt table testing (85.7%) shows variable results with QSART (50%), skin punch biopsy (37.5%), deep breathing (14.3%), and Valsalva testing (0%) all showing positivity rates of 50% or less for our patient sample. Conclusions: Post-COVID POTS could be an excitatory process with hyperadrenergic signaling based on the symptoms and comorbidities. We hope that this chart review will be the launching point for future studies aimed at achieving greater understanding of the post-COVID POTS phenomenon.
ABSTRACT
Although misophonia is not yet included in the primary diagnostic manuals used by psychologists or psychiatrists, proposed criteria suggest that this condition is characterized by a strong negative reaction to and avoidance of certain trigger sounds. Misophonic trigger sounds are largely human-made (e.g., chewing and slurping) and evoke responses such as disgust, irritation, and/or anger that are out of proportion to the situation and cause distress and/or impairment. Currently, there is no gold standard evidence-based treatment for misophonia. As the misophonia treatment literature grows, several important questions are arising: (1) should exposure to aversive sound triggers be included in treatment for misophonia and (2) how can clinicians best assess misophonia symptoms. This case offers one example of misophonia being successfully treated with a cognitive-behavioral approach to treatment (including exposures) in an adolescent girl. This case also offers an example of how clinicians may conduct a comprehensive assessment of misophonia symptoms. Theoretically and empirically derived recommendations for including exposure in misophonia treatment are presented. Information from this case may be helpful in informing future research, as there is a paucity of evidence-based assessment and treatment protocols for misophonia.
ABSTRACT
The sports world has certainly been one of the most affected by the SARS-CoV-2 pandemic. In addition to the closure of clubs and gyms, the introduction of personal protective equipment and face masks has raised many doubts about the safety of their use during physical activity. This is due to the possible onset of symptoms related to the physical barrier standing in front of the airways, resulting in greater resistance to airways flow and a bigger respiratory work. The aim of this article was to analyze the data available so far in the literature to try to answer the question: can sport and masks get along? (Cite this article as: Lodi E, Scavone A, Dias Rodrigues G, D'Antonio L, Pergreffi M, Modena MG. Can sport and face masks get along? Med Sport 2021;74:731-9. DOI: 10.23736/S0025-7826.21.03962-4)