Body composition and cardiorespiratory fitness of overweight COVID-19 survivors in different severity degrees: a cohort study.

COVID-19 sequelae are varied, and whether they are temporary or permanent is still unknown. Identifying these sequelae may guide therapeutic strategies to improve these individuals' recovery. This prospective cohort aimed to assess body composition, cardiopulmonary fitness, and long-term symptoms of overweight individuals affected by COVID-19. Participants (n = 90) were divided into three groups according to the severity of acute COVID-19: mild (no hospitalization), moderate (hospitalization, without oxygen support), and severe/critical cases (hospitalized in Intensive Care Unit). We assessed body composition with a tetrapolar multifrequency bioimpedance, hemodynamic variables (heart rate, blood pressure, and peripheral oxygen saturation-SpO2) at rest, and the Bruce test with direct gas exchange. Two assessments with a one-year interval were performed. The most prevalent long-term symptoms were memory deficit (66.7%), lack of concentration (51.7%), fatigue (65.6%), and dyspnea (40%). Bruce test presented a time effect with an increase in the distance walked after 1 year just for severe/critical group (p < 0.05). SpO2 was significantly lower in the severe/critical group up to 5 min after the Bruce test when compared to the mild group, and diastolic blood pressure at the end of the Bruce test was significantly higher in the severe/critical group when compared to mild group (p < 0.05; for all comparisons). A time effect was observed for body composition, with increased lean mass, skeletal muscle mass, fat-free mass, and lean mass just for the severe/critical group after 1 year (p < 0.05). Cardiopulmonary fitness parameters did not differ among the groups, except for respiratory quotient with higher values for the severe/critical group when compared to itself after 1 year. All COVID-19 patients might present long-term sequelae, regardless of the acute disease severity. Reassessing and identifying the most prevalent long-term sequelae are essential to perform more precise health promotion interventions.

Effects of a multi-professional intervention on body composition, physical fitness and biochemical markers in overweight COVID-19 survivors: a clinical trial.

Introduction: The sequelae post-COVID can affect different systems. In this sense, considering the multi-factorial etiology of COVID-19, multi-professional interventions could be a relevant strategy for recovery health indicators. Objective: This study aimed to investigate the effects of multi-professional intervention on body composition, physical fitness, and biomarkers in overweight COVID-19 survivors with different symptomatology. Methodology: A non-randomized parallel group intervention included 69 volunteers (BMI ≥25 kg/m2), divided into three groups according to SARS CoV-2 symptomatology, but only 35 finished the longitudinal protocol [control group (n = 11); moderate group (n = 17) and severe group (n = 7)]. The groups were submitted to a multi-professional program (nutritional intervention, psychoeducation, and physical exercise intervention) for 8 weeks, and the volunteers underwent body composition assessments (primary outcome) and physical and biochemical tests (secondary outcome) in pre- and post-intervention. This study was registered on the Clinical Trials Registration Platform number: RBR-4mxg57b and with the local research ethics committee protocol under number: 4,546,726/2021. Results: After the 8-week multi-professional intervention, the following results were observed for the moderate COVID-19 group: improved dynamic strength of lower- and (p = 0.003), upper-limbs (p = 0.008), maximal isometric lumbar-traction strength (p = 0.04), flexibility (p = 0.0006), and albumin (p = 0.0005), as well as a reduction in the C reactive protein (CRP) (p = 0.003) and fasting glucose (p = 0.001); for the severe COVID-19 group: an improvement in dynamic lower-body strength (p = 0.001), higher values of albumin (p = 0.005) and HDL-c (p = 0.002), and lower values of CRP (p = 0.05), and for the control group: an improvement in sit-up repetitions (p = 0.008), and a reduction of CRP (p = 0.01), fasting glucose (p = 0.001) and total cholesterol (p = 0.04) were identified. All experimental groups reduced triglycerides after intervention (p < 0.05). Conclusion: Finally, 8 weeks of multiprofessional intervention can be an efficient tool for reversing the inflammatory process and promoting improvements in daily activities and quality of life, although it is believed that the severe COVID-19 group needs longer interventions to improve different health indicators. Clinical Trial Registration: https://ensaiosclinicos.gov.br/, identifier: RBR-4mxg57b.

Body composition and cardiorespiratory fitness in overweight or obese people post COVID-19: A comparative study.

The present study aimed to evaluate the body composition and cardiorespiratory fitness of overweight or obese people after COVID-19. 171 volunteers of both sexes (men, n = 93 and women, n = 78) between 19 and 65 years old were allocated into three groups according to the severity of their symptoms of COVID-19: non-hospitalized people/mild symptoms (n = 61), hospitalized (n = 58), and hospitalized in an intensive care unit-ICU (n = 52). Two laboratory visits were carried out 24 h apart. First, a medical consultation was carried out, with subsequent measurement of body weight and height (calculation of body mass index) and body composition assessment via electrical bioimpedance. After 24 h, a cardiorespiratory test was performed using the Bruce protocol, with a direct gas exchange analysis. Hospitalized individuals had significantly higher values for fat mass and body fat percentage than non-hospitalized individuals (p < 0.05). Significantly higher values were found for heart rate (HR) and peak oxygen consumption (VO2peak) for individuals who were not hospitalized when compared to those hospitalized in the ICU (p < 0.05). Significantly higher values for distance, ventilation, and the relationship between respiratory quotient were found for non-hospitalized individuals compared to hospitalized individuals and those in the ICU (p < 0.05). After the cardiorespiratory test, higher values for peripheral oxygen saturation (SpO2) were observed for non-hospitalized individuals than for all hospitalized individuals (p < 0.05). Diastolic blood pressure was significantly higher at the tenth and fifteenth minute post-Bruce test in hospitalized than in non-hospitalized participants (p < 0.05). Based on these results, proposals for cardiopulmonary rehabilitation are indispensable for hospitalized groups considering the responses of blood pressure. Monitoring HR, SpO2, and blood pressure are necessary during rehabilitation to avoid possible physical complications. Volume and intensity of exercise prescription should respect the physiologic adaptation. Given lower physical conditioning among all the groups, proposals for recovering from health conditions are urgent and indispensable for COVID-19 survivors.

Air Medical Transportation Provided by Norte Novo Regional Urgency Mobile Service: What Is the Current Scenario?

OBJECTIVE: The aim of this study was to investigate, describe, and analyze the Norte Novo regional air medical service provided by the Brazilian Emergency Medical Rescue Service. METHODS: This was a retrospective and descriptive study with a quantitative approach of the incidents registered from November 2016 to December 2019. For general patient classification, descriptive statistics of the following variables were performed: sex, age/age group, type of diagnosis, city where the incident took place, city of destination, length of patient care, ventilatory support, use of sedation, and use of vasoactive drugs. All analyses were performed using the XLSTAT program (Version 19.4; Addinsoft, New York, NY), considering a significance level of 5%. RESULTS: There were 1,677 responses divided into clinical (60.8%), traumatic (37.8%), organ transport (1.2%), and interhospital transference (0.2%). The most frequent diagnoses were acute myocardial infarction and stroke (clinical care) and polytrauma (trauma care). The average waiting time until the helicopter arrived at the scene was 25 minutes. CONCLUSION: This study shows the importance and relevance of this air medical service for the area it covers. Further research is needed to address the profile of this service in our country, which will allow us to elucidate scenarios and develop strategies to assist the population and, thus, design training and simulation exercises for emergency service teams based on local realities.

Resection of Pulmonary Endometriosis by Video-Assisted Thoracoscopic Surgery Using Bronchoscopy as a Preoperative Strategy.

The presence of parenchymal or intrabronchial endometrial tissue is rare and has been reported in <6% of women of childbearing age with thoracic endometriosis. Hemoptysis during the menstrual cycle is the most common clinical presentation. We report a case of pulmonary endometriosis, treated concurrently with the patient's menstrual period, with wedge resection by video-assisted thoracoscopic surgery. Bronchoscopy, immediately before the start of the surgical procedure, allowed us to identify the pulmonary segment that had active bleeding, which made the surgical procedure feasible.

Laringotraqueoscopia flexível na decanulação de pacientes traqueostomizados: otimização de segurança para o paciente / Flexible laringotracheoscopy in de-cannulation of tracheostomized patients: safety improvements for the patient

Avaliar a decanulação utilizando a laringotraqueoscopia flexível visando o reconhecimento das lesões laringotraqueais não diagnosticadas quando utilizados somente critérios clínicos. Participaram do estudo 100 pacientes, com idade entre 18 e 80 anos, traqueostomizados, com indicação de decanulação que foram submetidos à oclusão da cânula por 03 minutos para avaliar fonação e ventilação seguido da realização do exame. Foi comparada a indicação de decanulação por critérios clínicos com o diagnóstico de lesões laringotraqueais reconhecidas após o término da laringotraqueoscopia flexível. Os critérios de Myer-Cotton foram utilizados como referencial para classificação de doença laringotraqueal. Resultados: 62 (62%) pacientes apresentaram critérios clínicos para decanulação, porém, com doença laringotraqueal identificada pela laringotraqueoscopia flexível. Dentre estes, oito (8%) considerados aptos à decanulação baseados nos critérios clínicos apresentaram contraindicação à retirada da cânula. Apenas 26 (26%) pacientes não apresentaram doença laringotraqueal; 11 (11%) não foram decanulados por não preencherem critérios clínicos e endoscópicos. A laringotraqueoscopia flexível reconheceu doença laringotraqueal nos pacientes que preenchiam critérios clínicos para retirada da cânula traqueal. Este exame como rotina na avaliação de pacientes preenchendo critérios de decanulação mostrou-se útil e seguro.

To evaluate de-cannulation by flexible laringeotracheoscopy for laringeotracheal lesions which are not diagnosed by clinical criteria. One hundred tracheostomized patients, aged between 18 and 80 years old, with indication of de-cannulation submitted to occlusion of the cannula during three minutes to evaluate fonation and ventilation, followed by tests. De-cannulation by clinical criteria was compared with diagnosis of larigeotracheal lesions after the end of flexible laringeotracheoscopy. Myer-Cotton criteria were employed, a referential for the classification of laringeotracheal diseases. Sixty-two (62%) patients had clinical criteria for de-cannulation but with laringeotracheal disease identified by flexible largineotracheoscopy. Eight (8%) could be de-cannulated, based on clinical criteria which counterindicated the removal of the cannula. Only twenty-six (26%) did not present a laringeotracheal disease. Eleven (11%) were not de-cannulated since they did not comply with clinical and endoscopy criteria. Flexible laringeotracheoscopy acknowledged the laringeotracheal disease in patients who complied with clinical criteria for the removal of tracheal cannula. The test, as a routine in patients´ evaluation complying with de-cannulation criteria, was useful and safe.

Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room / Avaliação do atendimento às vítimas de acidentes de trânsito por plantonista clínico e cirurgião na sala de emergência hospitalar

ABSTRACT Objective: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. Methods: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of ​​Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. Results: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (n​=187), the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values ​​was performed in greater numbers when compared with cases led by surgeons (n=501). There was a statistically significant relationship (p<0.01) between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28) in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments. Conclusion: in the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.

RESUMO Objetivo: avaliar o atendimento às vítimas de acidentes de trânsito por médicos plantonistas cirurgiões e/ou clínicos na sala de emergência hospitalar. Métodos: estudo retrospectivo, descritivo e exploratório do atendimento às vítimas de acidentes de trânsito da área urbana de Maringá-PR, entre julho de 2013 e julho de 2014, em hospitais referenciados. Questionário aplicado aos médicos plantonistas avaliou dados demográficos e a formação profissional. Resultados: dos 688 prontuários avaliados, 99% apresentavam Revised Trauma Score pré-hospitalar de 12. Análise estatística mostrou que nos atendimentos feitos por Clínicos (n=187), a anotação dos escores da Escala de Coma de Glasgow e a realização de procedimentos cirúrgicos foram feitas em menor número e, em contrapartida, a anotação dos valores de pressão arterial sistêmica foi realizada em maior número quando comparados com atendimentos feitos por Cirurgiões (n=501). Houve relação estatisticamente significativa (p<0,01) entre o tempo de permanência hospitalar e a especialidade cirúrgica, com maior chance (OR bruta=28) observada no período de uma a seis horas para o grupo atendido pelos Clínicos. A maioria dos plantonistas que participaram do estudo eram jovens, com tempo de atividade em sala de emergência hospitalar de um a dois anos e com capacitação no curso do ATLS. Entre os que participaram do curso do ATLS, 60% o fizeram nos últimos quatro anos. Cirurgiões realizaram 73% dos atendimentos hospitalares. Conclusão: nos atendimentos às vítimas de trânsito com lesões leves, a Escala de Coma de Glasgow, os níveis de pressão arterial sistêmica, o tipo de tratamento na sala de emergência e o tempo de internação hospitalar tiveram abordagens diferentes entre Clínicos e Cirurgiões.

Institutional protocol to standardize the chest drainage system management, from surgery to nursing care, at a regional hospital in northern Paraná / Protocolo institucional para padronizar cuidados com o dreno de tórax, desde a intervenção cirúrgica até os cuidados de enfermagem, em hospital regional do norte do Paraná

The purpose of chest drainage is to allow lung re-expansion and the reestablishment of the subatmospheric pressure in the pleural space. Properly managing the drainage system minimizes procedure -related complications. This prospective observational study evaluated adult patients undergoing water-seal chest drainage, admitted to our hospital and accompanied by residents and tutors, aiming to check their care. One hundred chest drainages were monitored. The average age was 38.8 years old. The average drainage time was 6.7 days. Trauma was the prevalent cause (72%) for the indication of pleural drainage. The obstruction of the system occurred in 6% of the cases; 5% subcutaneous emphysema, 1% infection around the drain; 5% accidental dislodgement of the drain, and in 5% of the patients, there were some complications when removing the drain. Failures in chest drainage technique and management were present, and reflected in some complications that are inherent to the procedure, although it is known that there are intrinsic complications. This study aimed to assess the management of closed chest drainage systems and standardize the care provided in such procedure.

O objetivo da drenagem torácica é possibilitar a reexpansão pulmonar e o restabelecimento da pressão subatmosférica no espaço pleural. O manejo adequado do sistema de drenagem minimiza as complicações relacionadas ao procedimento. O presente estudo observacional prospectivo avaliou pacientes adultos submetidos à drenagem torácica em selo d'água, internados em nosso hospital e acompanhados por médicos residentes e preceptores, com o objetivo de verificar o manejo com eles. Foram observadas 100 drenagens torácicas. A faixa etária média foi de 38,8 anos. O tempo médio de drenagem foi de 6,7 dias. Houve predomínio da causa traumática (72%) na indicação de drenagem pleural. A obstrução do sistema esteve presente em 6% dos casos; em 5%, houve enfisema subcutâneo; em 1%, infecção peridreno; em 5%, deslocamento acidental do dreno e, em 5% dos pacientes, houve complicação na retirada do dreno. Falhas na técnica e no manejo de drenagem torácica estão presentes em nosso serviço, refletidas em algumas complicações inerentes ao procedimento, embora saibamos que haja complicações que lhe são intrínsecas. O objetivo do estudo foi avaliar o manejo dos sistemas de drenagem torácica fechada e padronizar o protocolo para os cuidados com esse procedimento.

Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room.

OBJECTIVE: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. METHODS: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of ​​Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. RESULTS: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (n​=187), the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values ​​was performed in greater numbers when compared with cases led by surgeons (n=501). There was a statistically significant relationship (p<0.01) between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28) in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments. CONCLUSION: in the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.