Persistence of symptoms and lung function in mild cases of COVID-19 six months after infection: a cross-sectional study.

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.

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.

Correlation between functional capacity and oxidative stress and inflammation in hemodialysis patients.

INTRODUCTION: Patients with chronic kidney disease (CKD) may present impaired functional capacity due to peripheral muscle involvement. Oxidative stress and inflammation are probably involved in this pathophysiology. This study aimed to evaluate the association between functional capacity and biomarkers of oxidative stress as well as biomarkers of inflammation in patients under chronic hemodialysis therapy. METHOD: Cross-sectional study including 41 patients from a single hemodialysis center. Functional capacity was assessed through the 6-min walk test (6MWT). The assessed blood biomarkers were: malondialdehyde (MDA) (oxidative stress, TBARS method) and angiopoietin-2 (Ang-2) (inflammation, ELISA). The influence of gender on impairment of functional capacity was further explored. RESULTS: There was an inversely proportional correlation between the 6MWD and MDA (r = -,322 and p = 0.040) and Ang-2 (r = -, 376 and p = 0.016) values. 6MWD was 370.9 ± 101.2 m and 391.4 ± 108.2 m in women and men, respectively (p < 0.001), which means 29.3% and 34.3% reduction of the expected values for healthy individuals from the same age range. CONCLUSION: Patients with CKD under hemodialysis, regardless of gender, presented impaired performance in 6MWT and this impairment was associated with oxidative stress and inflammation.

Perfil demográfico e clínico de pacientes com diagnóstico de COVID-19 em um hospital público de referência na cidade de Fortaleza-Ceará / Demographic and clinical profile of patients diagnosed with COVID-19 in a public reference hospital in the city of Fortaleza - Ceará

Objetivo: caracterizar o perfil demográfico e clínico de pacientes com diagnóstico de COVID-19 em um hospital público de referência na cidade de Fortaleza-Ceará. Métodos: estudo do tipo transversal e documental, realizado no período de março a junho de 2020. A amostra contemplou os prontuários dos pacientes com diagnóstico da doença e com idade igual ou superior a 18 anos. As variáveis foram gênero, idade, comorbidades, indicação de ventilação mecânica invasiva (VMI), uso de hidroxicloroquina, dias de internação e desfecho clínico. Resultados: foram analisados 127 prontuários. A maioria dos pacientes era do gênero masculino, pertencentes à faixa etária de 36 a 60 anos, que apresentaram alguma condição de doença prévia e que permaneceram internados, em ambiente hospitalar, de 1 a 10 dias. A obesidade isolada e a tríade hipertensão arterial, diabetes mellitus e obesidade foram as comorbidades mais contempladas. A hidroxicloroquina foi utilizada em mais da metade dos pacientes, e a VMI foi administrada em menos de 50%. Quanto à alta ou ao óbito, perceberam-se valores próximos entre ambos os desfechos. Conclusão: foi evidenciado que, quanto ao gênero dos pacientes, à faixa etária e ao uso ou não do fármaco em relação ao desfecho final, não foram encontradas diferenças estatisticamente significantes entre eles; em contrapartida, quando observada a alta ou o óbito com as comorbidades, foi constatada uma diferença estatisticamente significante.

Objective: To characterize the demographic and clinical profile of patients diagnosed with COVID-19 in a public reference hospital in the city of Fortaleza-Ceará. Methods: Cross-sectional and documentary study conducted from March to June 2020. The sample included the medical records of patients diagnosed with the disease and aged 18 years or older. The variables were gender, age, comorbidities, indication of invasive mechanical ventilation (IMV), use of hydroxychloroquine, days of hospitalization and clinical outcome. Results: A total of 127 medical records were analyzed. Most of the patients were male, from 36 to 60 years of age, who presented some previous disease condition and remained hospitalized, in the hospital environment, from 1 to 10 days. Isolated obesity and the hypertension triad, diabetes mellitus and obesity were the most contemplated comorbidities. Hydroxychloroquine was used in more than half of the patients, and IMV was administered in less than 50%. Regarding discharge or death, close values between both outcomes were observed. Conclusion: It was evidenced that the patients' gender, age group and the use or not of the drug in relation to the final outcome, no statistically significant differences were found between them; in contrast, when a discharge or death with comorbidities was observed, a statistically significant difference was found.

Alterações pulmonares causadas pelo novo Coronavírus (COVID-19) e o uso da ventilação mecânica invasiva / Pulmonary repercussions caused by the new Coronavírus (COVID-19) and the use of invasive mechanical ventilation

Introdução: o novo coronavírus é semelhante a outras pneumonias coronavirais e também pode levar à síndrome do desconforto respiratório agudo. Métodos: comunicação breve sobre as repercussões pulmonares causadas pela doença e uso da ventilação mecânica invasiva. Resultados: a ventilção mecânica invasiva é a forma de tratamento adequada para pacientes com saturação abaixo de 92%, pressão arterial de O2 abaixo de 65 mm/Hg com ou sem hipercapnia, frequência respiratória > 30 ipm e piora clínica. Conclusão: o uso da ventilação não invasiva ou de oxigenoterapia nasal de alto fluxo não é recomendado na rotina.(AU)

Introduction: the novel coronavirus is similar to other coronaviral pneumonias, and can also lead to acute respiratory distress syndrome. Methods: brief communication about the pulmonary repercussions caused by the disease and the use of invasive mechanical ventilation. Results: Invasive mechanical ventilation is the appropriate form of treatment for patients with saturation below 92%, oxygen arterial pressure below 65 mm /hg with or without hypercapnia, respiratory rate> 30 ipm and clinical worsening. Conclusion: the use of non-invasive ventilation or high-flow nasal oxygen therapy is not recommended in routine.

Immediate effects of diaphragmatic myofascial release on the physical and functional outcomes in sedentary women: A randomized placebo-controlled trial.

BACKGROUND: Although diaphragmatic myofascial release techniques are widely used in clinical practice, few studies have evaluated the simultaneous acute effects of these techniques on the respiratory and musculoskeletal systems. OBJECTIVE: To evaluate the immediate effects of diaphragmatic myofascial release in sedentary women on the posterior chain muscle flexibility; lumbar spine range of motion; respiratory muscle strength; and chest wall mobility. DESIGN: A randomized placebo-controlled trial with concealed allocation, intention-to-treat analysis, and blinding of assessors and participants. PARTICIPANTS: Seventy-five sedentary women aged between 18 and 35 years. INTERVENTION: The sample was randomly allocated into one of two groups; the experimental group received two diaphragmatic myofascial release techniques in a single session, and the control group received two placebo techniques following the same regimen. OUTCOMES MEASURES: The primary outcome was chest wall mobility, which was analyzed using cirtometry. The secondary outcomes were flexibility, lumbar spine range of motion, and respiratory muscle strength. Outcomes were measured before and immediately after treatment. RESULTS: The manual diaphragm release techniques significantly improved chest wall mobility immediately after intervention, with a between-group difference of 0.61 cm (95% CI, 0.12-1.1) for the axillary region, 0.49 cm (95% CI, 0.03-0.94) for the xiphoid region, and 1.44 (95% CI, 0.88-2.00) for the basal region. The techniques also significantly improved the posterior chain muscle flexibility, with a between-group difference of 5.80 cm (95% CI, 1.69-9.90). All movements except flexion of the lumbar spine significantly increased. The effects on respiratory muscle strength were non-significant. CONCLUSION: The diaphragmatic myofascial release techniques improve chest wall mobility, posterior chain muscle flexibility, and some movements of the lumbar spine in sedentary women. These techniques could be considered in the management of people with reduced chest wall and lumbar mobility. TRIAL REGISTRATION: NCT03065283.

Effects of respiratory muscle training on endothelium and oxidative stress biomarkers in hemodialysis patients: A randomized clinical trial.

INTRODUCTION: Hemodialysis (HD) patients have altered pulmonary function and this is associated with impaired endothelial function and cardiovascular events. Respiratory muscle training (RMT) has the potential to improve cardiovascular outcomes in patients undergoing maintenance HD. Here, we evaluated the effects of RMT on endothelium/glycocalyx, oxidative stress biomarkers and pulmonary function test in HD patients. METHODS: This is a randomized controlled clinical trial including 41 patients undergoing thrice-weekly maintenance HD. Patients were randomly assigned at a 2:1 ratio to receive or not RMT during HD sessions for 8 weeks. Main outcomes were changes in levels of the biomarkers related to endothelium activation (vascular cell adhesion molecule 1, VCAM-1, and intercellular adhesion molecule 1, ICAM-1), glycocalyx derangement (syndecan-1), aberrant angiogenesis (angiopoietin-2) and oxidative stress (malondialdehyde) compared to baseline. Also, maximal inspiratory/expiratory pressure (MIP, MEP), Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) were evaluated. Other outcomes included changes in functional capacity and pulmonary function test. We also performed a post-hoc analysis of plasma endothelin-1 levels. RESULTS: Of 56 randomly assigned patients, 41 were included in the primary final analyses. RMT increased all pulmonary function parameters evaluated and significantly reduced plasma syndecan-1 levels at 8 weeks compared to placebo (between-group difference: -84.5; 95% CI, -148.1 to -20.9). Also, there was a reduction in plasma levels of angiopoietin-2 (between-group difference: -0.48; 95% CI, -1.03 to -0.097). Moreover, there was a significant reduction in mean blood pressure at rest (between-group difference: -12.2; 95%CI, -17.8 to -6.6) associated with a reduction in endothelin-1 levels (between-group difference: -0.164; 95% CI, -0.293 to -0.034). There was no difference regarding biomarkers of endothelial activation or oxidative stress. CONCLUSION: A short-term RMT program ameliorate FVC, FEV1 and reduces syndecan-1 and angiopoietin-2 biomarker levels. Finally, better blood pressure control was attained during training and it was associated with a reduction in endothelin-1 levels.

Atuação da fisioterapia em pacientes transplantados de medula óssea: revisão sistemática de literatura / Physiotherapy performance in bone marrow transplant recipients: Systematic review of the literature

Introdução: O Transplante de medula óssea (TMO) é um procedimento terapêutico que consiste na infusão de sangue da medula óssea, em receptor adequadamente compatível. Devido ao longo período de isolamento protetor e à toxicidade dos agentes quimioterápicos utilizados no regime de condicionamento pré-transplante, ocorre uma restrição das atividades físicas do paciente e potencializa os efeitos deletérios para o sistema cardiopulmonar. Objetivo: Realizar uma revisão sistemática sobre a atuação da fisioterapia no cuidado a pacientes submetidos ao transplante de medula óssea. Materiais e Métodos: Estudo seccional e documental realizado por meio de revisão sistemática da literatura disponível nas bibliotecas virtuais de saúde: BIREME, PEDro, PubMed e Scielo. Resultados: Sete artigos foram selecionados e discutidos com outros trabalhos. Os estudos mostraram que a Fisioterapia pode auxiliar no tratamento dos pacientes submetidos ao TMO, melhorando a função motora global ou auxiliando no tratamento dos sintomas apresentados, além de se mostrar eficiente nas repercussões pulmonares, melhorando a força dos músculos respiratórios e a ventilação pulmonar, além de poder atuar na avaliação da qualidade de vida desses pacientes utilizando questionário específico. Conclusão: A Fisioterapia tem papel importante no tratamento desses indivíduos, visando à melhoria da funcionalidade e da qualidade de vida, por meio de exercícios físicos e respiratórios, alongamentos e recursos respiratórios fisioterapêuticos. Porém, a atuação da Fisioterapia nesse contexto ainda não está bem descrita na literatura, pois os artigos não detalham os protocolos de reabilitação utilizados na intervenção dos pacientes pós-tratamentos de medula óssea, apenas citam a Fisioterapia em sua realização e sua importância para uma melhor recuperação desses pacientes. É necessário o incentivo à pesquisa nesta área. (AU)

Introduction: Bone marrow transplantation (BMT) is a therapeutic procedure consisting in the infusion of bone marrow blood, obtained from previously selected donors into properly compatible patients. Due to the long period of protective isolation and toxicity of chemotherapeutic agents used in pretransplant conditioning, a restriction of physical activity of the patient occurs what enhances the deleterious effects on the cardiopulmonary system. Objective: To carry out a systematic review on the performance of Physiotherapy in the care of patients submitted to bone marrow transplantation. Methods: Cross-sectional documentary study by performing a systematic review of the available literature on virtual health libraries: BIREME, PEDro, PubMed and SciELO. Results: Seven articles were selected and discussed with other authors. Studies have shown that physical therapy can aid in the treatment of patients undergoing BMT, improving overall motor function or assisting in treating the symptoms, besides showing itself efficient in reducing pulmonary complications, improving the strength of respiratory muscles and lung ventilation. Another study showed that physical therapy can act in assessing the quality of life of patients by using a specific questionnaire. Thus, the motor and respiratory therapy plays an important role in the quality of life improvement. Conclusion: Physiotherapy plays an important role in the treatment of these individuals in order to improve the functionality and quality of life through physical and breathing exercises, stretches and breathing physiotherapy resources. However, the role of physiotherapy in this context is not well described in the literature, because the articles do not detail the protocols used in the rehabilitation of post-intervention treatments for bone marrow patients; they only cite Physiotherapy in its realization and its importance for a better recovery of these patients. Encouraging research in this area is needed. (AU)