Effect of a home-based inspiratory muscle training programme on functional capacity in postdischarged patients with long COVID: the InsCOVID trial.

BACKGROUND: Fatigue and exercise intolerance are the most common symptoms in patients with long COVID. AIMS: This study aimed to evaluate whether a home-based inspiratory muscle training (IMT) programme improves maximal functional capacity in patients' long COVID after a previous admission due to SARS-CoV-2 pneumonia. METHODS: This study was a single-centre, blinded assessor, randomised controlled trial. Twenty-six patients with long COVID and a previous admission due to SARS-CoV-2 pneumonia were randomly assigned to receive either a 12-week IMT or usual care alone (NCT05279430). The physiotherapist and participants were not blinded. Patients allocated to the IMT arm were instructed to train at home twice daily using a threshold inspiratory muscle trainer and to maintain diaphragmatic breathing during the training session. The usual care arm received no intervention.The primary endpoint was the change in peak oxygen consumption (peakVO2). Secondary endpoints were changes in quality of life (QoL), ventilatory efficiency and chronotropic response during exercise (evaluated by chronotropic index-CIx- formula). We used linear mixed regression analysis for evaluating changes in primary and secondary endpoints. RESULTS: The mean age of the sample and time to first visit after discharge were 50.4±12.2 years and 362±105 days, respectively. A total of 11 (42.3%) were female. At baseline, the mean of peakVO2, ventilatory efficiency and CIx were 18.9±5 mL/kg/min, 29.4±5.2 and 0.64±0.19, respectively. The IMT arm improved their peakVO2 significantly compared with usual care (+Δ 4.46 mL/kg/min, 95% CI 3.10 to 5.81; p<0.001). Similar positive findings were found when evaluating changes for CIx and some QoL dimensions. We did not find significant changes in ventilatory efficiency. CONCLUSION: In long COVID patients with a previous admission due to SARS-CoV-2 pneumonia, IMT was associated with marked improvement in exercise capacity and QoL. TRIAL REGISTRATION NUMBER: NCT05279430.

Evaluation Using Polar Coordinate of the Representation of Movement in the Drawings of Children Aged 5 to 8 Years.

The progressive complexity of mental representation is the basis for changes in human cognitive development. Evaluation of its external manifestations as graphic representation in drawings could be an instrument to understand changes in cognitive development and representational complexity. The aim of this study is to evaluate the appearance and role of the indicators used by children to represent moving figures in their drawings. This allows us to know the continuum from its non-manifestation to full expression through the vectorial interrelationships of the graphic indicators in each of the ages studied. Participants were n = 240 children from 5 to 8 years old; their drawings of two moving figures were analyzed, applying the polar coordinate technique. Results show a map of interrelations among the graphical movement indicators and changes in the drawing elements in an increasing continuum of complexity and the roles conferred to figures sketched. The conclusion is that changes evaluated in drawings can interactively reflect mental representation, and they could promote its transformation. The applied transfer of the results to education is discussed, in order to optimize the representational complexity and cognitive development.

Factores predictivos de mortalidad y de riesgo de ingreso en cuidados intensivos de los pacientes hospitalizados infectados por Sars-cov-2 en el área sanitaria Galicia sur / Predictive factors of mortality and risk of admission in a critical care unit of hospitalized patients infected by Sars-cov-2 in the sanitary area Galicia sur

Objetivo: Determinar factores de riesgo de gravedad y mortalidad en pacientes ingresados por COVID 19 en la población de Ourense. Método: Estudio prospectivo en 342 pacientes hospitalizados en el Hospital Universitario de Ourense por COVID 19 entre el 8 de marzo y 15 de mayo del 2020, periodo correspondiente a la primera ola de contagios. Se recogieron variables demográficas, patologías y tratamientos previos, analítica y tratamientos durante el ingreso. Se relacionaron con el riesgo de ingreso en cuidados intensivos y con mortalidad. Se llevó a cabo un análisis univariante y uno multivariante de regresión logísitca. Para la comparación de variables cualitativas se utilizó la prueba Chi-cuadrado. Para la comparación de las variables cuantitativas, se analizó la normalidad de la distribución de los datos en cada uno de los grupos muestrales y se aplicó el test t-Student o Mann-Whitney. El nivel de significación aceptado para todos los contrastes de hipótesis fue de 0,05. Resultados y Conclusiones: Edad>75, linfocitos<0.9, Dímero D>2500 se correlacionaron positivamente con la mortalidad. Obesidad, linfocitos<0.8, Dímero D>2500, LDH>500 y ferritina>800 se correlacionaron positivamente con el riesgo de ingreso en cuidados intensivos. Tratamiento con Lopinavir/Ritonavir, Hidroxicloroquina, corticoides y anticoagulantes, actuaron como factores protectores frente a la mortalidad. (AU)

Objective: To determine severity and mortality risk factors in patients admitted to hospital for COVID 19 in the population of Ourense. Method: Prospective study in 342 patients hospitalized at the University Hospital of Ourense for COVID 19 between March 8 and May 15, 2020, the period corresponding to the first wave of infections. Demographic variables, pathologies and previous treatments, laboratory tests and treatments during admission were collected and were related to the risk of admission to critical patients and mortality. A univariate analysis and a multivariate logistic regression analysis were carried out. For the comparison of qualitative variables, the Chi-square test was used. For the comparison of the quantitative variables, the normality of the distribution of the data in each of the sample groups was analyzed and the t-Student or Mann-Whitney test was applied. The accepted level of significance for all hypothesis tests was 0.05. Results and Conclusions: Age> 75, lymphocytes <0.9, D-dimer> 2500 were positively correlated with mortality. Obesity, lymphocytes <0.8, Ddimer> 2500, LDH> 500 and ferritin> 800 were positively correlated with the risk of admission to critical patients. Treatment with Lopinavir/ Ritonavir, Hydroxychloroquine, corticosteroids, and anticoagulants acted as protective factors against mortality (AU)

Kinesioterapia en varón con tétano generalizado / Kinesitherapy in men with generalized tetanus

Introducción: El Tétanos es una enfermedad causada por la bacteria Clostridium tetani, siendo el tétanos generalizado la forma más común de la infección, caracterizándose por espasmos generalizados de la musculatura, que involucra a los músculos del tronco más que a los de las extremidades y, manifiesta síntomas de hiperactividad autonómica. Descripción del caso: Se presenta el caso de un varón de 48 años internado en el Hospital de Clínicas, traqueostomizado, con diagnóstico de tétanos generalizado. En el día 30 de su enfermedad recibió kinesioterapia respiratoria y motora, con 15 sesiones realizadas. La kinesioterapia aplicada al paciente consistió en facilitar la eliminación de secreciones bronquiales, mejorar la expansión pulmonar, reeducar la deglución, mejorar la fuerza muscular y amplitud articular, inhibir la secuelas de la hipertonía muscular. Resultados: Se logró mejorar la mecánica respiratoria, el retiro de la cánula de traqueostomía y sonda nasogástrica, mejoró la fuerza muscular y amplitud articular, pudiendo el paciente realizar la sedestación sin apoyo y la bipedestación con asistencia. Discusión: Con el tratamiento relajante, traqueostomía y respiración asistida aparecen nuevos problemas, aspectos que fueron abordados kinésicamente en el presente caso clínico, observándose un menor tiempo de hospitalización y mayor independencia física en comparación con otros casos publicados. Conclusión: Para la aplicación de kinesioterapia en pacientes con tétanos generalizado, es necesario conocer la enfermedad, su evolución y manejo clínico. El trabajo interdisciplinario, es muy importante, específicamente en lo que respecta a la medicación y control del dolor, para que el avance de las técnicas kinésicas alcance su objetivo.

Introduction: Tetanus is a disease caused by the bacterium Clostridium tetani, with tetanus being the most common form of infection, characterized by generalized spasms of the musculature, which involves the muscles of the trunk rather than those of the limbs and, manifests symptoms of autonomic hyperactivity. Case description: The case of a 48-year-old male admitted to the Tracheostomized Clinic Hospital with a generalized tetanus diagnosis is presented. On the 30th day of his illness he received respiratory and motor kinesiotherapy, with 15 sessions performed. The kinesitherapy applied to the patient consisted of facilitating the elimination of bronchial secretions, improving lung expansion, re-educating swallowing, improving muscle strength and joint amplitude, inhibiting the sequelae of muscular hypertonia. Results: It was possible to improve the respiratory mechanics, the removal of the tracheostomy cannula and nasogastric tube, improved muscle strength and joint amplitude, being able to perform unsupported sitting and standing with assistance. Discussion: With the relaxing treatment, tracheostomy and assisted breathing, new problems appear, aspects that were addressed kinésicamente in the present clinical case, observing a shorter hospitalization time and greater physical independence compared to other published cases. Conclusion: For the application of kinesitherapy in patients with generalized tetanus, it is necessary to know the disease, its evolution and clinical management. Interdisciplinary work is very important, specifically with regard to medication and pain control, so that the advancement of kinesic techniques reaches its goal.

Evaluation of satisfaction in an extracurricular enrichment program for high-intellectual ability participants.

BACKGROUND: The objective of this study was to evaluate the satisfaction of an extracurricular enrichment program of the cognitive and personal management of participants with high intellectual ability. METHOD: At the first time point, the sample consisted of n= 38 participants, and n= 20 parents; n= 48 participants at the second time point; and n= 60 participants at the third time point. The Satisfaction Questionnaire (CSA in Spanish), both for students (CSA-S) and for parents (CSA-P), was constructed. RESULTS: The CSA-S scores showed adequate psychometric properties. Exploratory factor analysis yielded a unidimensional structure. Cronbach’s alpha ranged between 85 and .86. Test-retest reliability was 0.45 (p<.05). The generalizability coefficient was .98. A high percentage of the sample was satisfied with the program, perceived improvements in cognitive and emotional management, motivation and interest in learning, and in the frequency and quality of their interpersonal relationships. CONCLUSIONS: The evaluation of educational programs is necessary in order to determine the efficacy and the effects of their implementation on the participants’ personal and intellectual management.

Evaluation of satisfaction in an extracurricular enrichment program for high-intellectual ability participants / Evaluación de la satisfacción de un programa de enriquecimiento extracurricular en participantes de alta capacidad intelectual

BACKGROUND: The objective of this study was to evaluate the satisfaction of an extracurricular enrichment program of the cognitive and personal management of participants with high intellectual ability. METHOD: At the first time point, the sample consisted of n= 38 participants, and n= 20 parents; n= 48 participants at the second time point; and n= 60 participants at the third time point. The Satisfaction Questionnaire (CSA in Spanish), both for students (CSA-S) and for parents (CSA-P), was constructed. RESULTS: The CSA-S scores showed adequate psychometric properties. Exploratory factor analysis yielded a unidimensional structure. Cronbach's alpha ranged between 85 and .86. Test-retest reliability was 0.45 (p<.05). The generalizability coefficient was .98. A high percentage of the sample was satisfied with the program, perceived improvements in cognitive and emotional management, motivation and interest in learning, and in the frequency and quality of their interpersonal relationships. CONCLUSIONS: The evaluation of educational programs is necessary in order to determine the efficacy and the effects of their implementation on the participants' personal and intellectual management

ANTECEDENTES: el objetivo de este estudio fue evaluar la satisfacción de un programa de enriquecimiento extracurricular para el desarrollo cognitivo y la gestión de recursos de los participantes de alta capacidad intelectual. MÉTODO: en el primer punto del tiempo la muestra fue de n= 38 participantes y n= 20 padres; n= 48 participantes en el segundo punto de tiempo; y n= 60 participantes en el tercer momento temporal. Se construyó el Cuestionario de Satisfacción (CSA), con una versión para el alumno (CSA-A) y otra para los padres (CSA-P). RESULTADOS: las puntuaciones CSA-A mostraron propiedades psicométricas adecuadas. Una estructura esencialmente dimensional fue encontrada cuando se llevó a cabo el análisis factorial exploratorio. El alfa de Cronbach osciló entre 0,85 y 0,86. La fiabilidad test-retest fue 0,45 (p < 0,05). El coeficiente de generalizabilidad fue de 0,98. Un alto porcentaje de la muestra se mostró satisfecho con el programa y percibió mejoras en gestión cognitiva y emocional, en la motivación y el interés hacia el aprendizaje, y en la frecuencia y calidad de sus relaciones interpersonales. CONCLUSIONES: la evaluación de los programas extracurriculares es necesaria con el fin de determinar la eficacia y los efectos de su aplicación en la gestión personal e intelectual de los participantes

Preserved endothelial function in human obesity in the absence of insulin resistance.

BACKGROUND: Insulin resistance (IR) is frequently associated with endothelial dysfunction and has been proposed to play a major role in cardiovascular disease (CVD). On the other hand, obesity has long been related to IR and increased CVD. However it is not known if IR is a necessary condition for endothelial dysfunction in human obesity, allowing for preserved endothelial function in obese people when absent. Therefore, the purpose of the study was to assess the relationship between IR and endothelial dysfunction in human obesity and the mechanisms involved. METHODS: Twenty non-insulin resistant morbid obese (NIR-MO), 32 insulin resistant morbid obese (IR-MO), and 12 healthy subjects were included. Serum concentrations of glucose, insulin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), resistin and adiponectin were determined. IR was evaluated by HOMA-index. Endothelium-dependent relaxation to bradykinin (BK) in mesenteric microvessels was assessed in wire myograph. RESULTS: Serum IL-6, and TNF-α levels were elevated only in IR-MO patients while resistin was elevated and adiponectin reduced in all MO individuals. Mesenteric arteries from IR-MO, but not from NIR-MO subjects displayed blunted relaxation to BK. Vasodilatation was improved in IR-MO arteries by the superoxide scavenger, superoxide dismutase (SOD) or the mitochondrial-targeted SOD mimetic, mito-TEMPO. NADPH oxidase inhibitors (apocynin and VAS2870) and the nitric oxide synthase (NOS) cofactor, tetrahydrobiopterin failed to modify BK-induced vasodilatations. Superoxide generation was higher in vessels from IR-MO subjects and reduced by mito-TEMPO. Blockade of TNF-α with infliximab, but not inhibition of inducible NOS or cyclooxygenase, improved endothelial relaxation and decreased superoxide formation. CONCLUSIONS: Endothelial dysfunction is observed in human morbid obesity only when insulin resistance is present. Mechanisms involved include augmented mitochondrial superoxide generation, and increased systemic inflammation mediated by TNF-α. These findings may explain the different vascular risk of healthy vs unhealthy obesity.

[The costs of altruism in organ donation case analysis]. / Los costos del altruismo en donación de órganos análisis de casos.

Three main assumptions were considered for the structure of donation programs during the decade of the sixties: the first states that people, through altruism, would feel committed with the affected and therefore incentivized to donate. The second one states that the human body can not be valued in mercantile terms; therefore organ donation should not be done free of any charges. The last one states donation does not represent any type of harm or damage for the donor. Today, more tan four decades away from their instauration, these three assumptions have been violated and modified due to the way in which they were socialized through the donation protocols. Altruism did not seem to be as generalized as expected, and organ commerce has already gone beyond the legislative frameworks that intended to prevent it; one example is the case of India. In this paper we analyze--through two objectives--the repercussions and impact that took effect in four cases registered in the National Institute of Cardiology (Instituto Nacional de Cardiología) "Ignacio Chávez" in Mexico City. First objective: to describe the economical costs that the altruism-based donation protocol caused on the participant families. Second objective: to reflect on other costs that affected donators due to organ donation. It was found on the reviewed cases that repercussions can go beyond the economical issues; labor related, emotional and ethical repercussions were found too due to a undeniable sensation of reification that donors experience in view of the mechanization of the study protocol they undergo, specially when results are not the optimum. We circumscribe this paper's analysis to living donors.