Clinical and anthropometric evolution of individuals with cystic fibrosis during COVID-19 pandemic: A 24-month cohort study

OBJECTIVES

To analyze the evolution of clinical and anthropometric characteristics of children and adolescents with cystic fibrosis (CF) over 24 months, including the period of the COVID-19 pandemic.

METHODS

A longitudinal study with data collection from May 2018 to November 2020 in physical and electronic records from a pediatric reference center, including individuals with CF aged up to 18 years.

RESULTS

The sample encompassed 72 individuals. Weight (p < 0.01), height (p < 0.01), and body mass index (BMI) (p = 0.043) were higher in 2020 than in 2018. There were no significant changes in BMI-Z (p = 0.977) and in percentiles of weight (p = 0.540), height (p = 0.458), and BMI percentile (p = 0.454) between both periods. Pancreatic insufficiency was observed in 91.7% of patients in 2020, and there were twice as many confirmed cases of diabetes compared to 2018. There was a 9.7% increase in individuals colonized by the oxacillin-sensitive Staphylococcus aureus (OSSA) (p = 0.039) and an 11.1% reduction in non-colonized individuals (p = 0.008).

CONCLUSION

Although there was an increase in weight, height, and BMI from 2018 to 2020, there were no significant changes in BMI-Z and in percentiles of weight, height, and BMI percentile, suggesting that the anthropometric aspects of nutritional status did not change in this period of 2 years. Moreover, there was an increase in the prevalence of individuals colonized by OSSA and a reduction in the prevalence of individuals non-colonized with any bacteria.

Massage, laser and shockwave therapy improve pain and scar pruritus after burns: a systematic review

QUESTIONS

In adults with a burn injury, do non-invasive therapies improve pain and burn scar pruritus, elasticity and vascularisation? Are any effects maintained beyond the intervention period?

DESIGN

Systematic review of randomised trials with meta-analyses.

PARTICIPANTS

Adults with burn scars.

INTERVENTION

The experimental intervention was a non-invasive (ie, non-surgical or non-pharmacological) therapy applied to the burn scar.

OUTCOME MEASURES

Pain intensity, pruritus intensity, elasticity and vascularisation.

RESULTS

Fifteen trials involving 780 participants were included. The results indicated a beneficial effect on pain intensity on a 0-to-10 scale after massage (MD -1.5, 95% CI -1.8 to -1.1), shockwave therapy (MD -0.8, 95% CI -1.2 to -0.4) and laser (MD -4.0, 95% CI -6.0 to -2.0). The results indicated a beneficial effect on pruritus intensity on a 0-to-10 scale after massage (MD -0.4, 95% CI -0.7 to -0.2), shockwave therapy (MD -1.3, 95% CI -2.3 to -0.3) and laser (MD -4.8, 95% CI -6.1 to -3.5). Massage, shockwave therapy and silicone produced negligible or unclear benefits on scar elasticity and vascularisation. The quality of evidence varied from low to moderate.

CONCLUSION

Among all commonly used non-invasive therapies for the treatment of burn scars, low-to-moderate quality evidence indicated that massage, laser and shockwave therapy reduce pain and the intensity of scar pruritus. Low-to-moderate quality evidence suggested that massage, shockwave therapy and silicone have negligible or unclear effects for improving scar elasticity and vascularisation.

REVIEW REGISTRATION

PROSPERO (CRD42021258336).

Evidence of validity of internal structure of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12) in Brazilian adolescents with chronic health conditions

This study explored the evidence of validity of internal structure of the 12-item Functional Assessment of Chronic Illness Therapy—Spiritual Wellbeing Scale (FACIT-Sp-12) in Brazilian adolescents with chronic health conditions. The study involved 301 Brazilian adolescents with cancer, type 1 diabetes mellitus, or cystic fibrosis. Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and Item Response Theory (IRT) were used to test the internal structure. Reliability was determined with Cronbach’s Alpha and McDonald’s Omega. The EFA suggested a one-dimensional scale structure in contrast to the original 2-factor model or the 3-factor model which were not reproduced in the current CFA. All quality indicators for the EFA one-factor exceeded the required criteria (FDI = 0.97, EAP = 0.97, SR = 3.96 and EPTD = 0.96, latent GH = 0.90. and the observed GH = 0.85). The FACIT-Sp-12 for adolescents yielded strong evidence for a 1-factor model and with good reliability.

Perfil clínico e sociodemográfico de indivíduos com disfunção temporomandibular atendidos no projeto Alívio

Introdução A Disfunção Temporomandibular (DTM) compõe um coletivo de afecções cujos sintomas incluem dores na face e cefaleia. Objetivos Definir o perfil clínico e sociodemográfico dos pacientes com DTM atendidos no projeto Alívio da UFES. Material E Métodos Trata-se de um estudo descritivo. Colheu-se dos prontuários: idade, sexo, estado civil, número de filhos, tempo e intensidade da dor (EVN), consultas prévias ao projeto, diagnóstico clínico pelo DC/TMD, dados de questionários de incapacidade cervical (NDI) e limitação de função mandibular (MFIQ). Resultados Entre novembro/2020 e agosto/2021 foram atendidos 19 pacientes. 83,3% eram do sexo feminino, com média de idade de 38.06 (±14.3) anos, 50% solteiros, 44,4% casados e 5,6% divorciados e média de 0,61 filhos. Consultaram-se anteriormente ao projeto em média com 2 profissionais, sendo eles 83,3% dentistas, 33,3% médicos e 27,8% fisioterapeutas. Todos apresentavam dor crônica (>3 meses) e a dor média foi de 4,32 (±2,6). O diagnóstico de DTM pelo DC/TMD revelou que 88,9% tinham mialgia e 77,8% artralgia; 88,9% mialgia e artralgia. 38,9% dos pacientes tiveram diagnóstico de cefaleia atribuída à DTM, 61,1% deslocamento de disco articular, 44.4% doença articular degenerativa e 11,1% subluxação. O NDI evidenciou os respectivos percentuais de incapacidade cervical: 27,8% nenhuma, 33,3% leve, 16,7% moderada e 16,7% severa. O MFIQ revelou o mesmo percentual de incapacidade mandibular (38,9%) para escores baixo e moderado e 22,2% escore severo.A literatura evidencia a prevalência do gênero feminino com DTM, maior frequência de DTM do tipo mista ou mialgia, sendo a tensão cervical um dos fatores desencadeantes/perpetuantes de dor e cefaleia, resultando em algum grau de incapacidade, tanto mandibular quanto nas atividades de vida diária. Conclusão Apesar da pequena amostra, este estudo revelou o perfil dos pacientes com DTM, permitindo assim criar estratégias de manejo em consonância com esta população.

Perfil psicossocial de indivíduos com disfunção temporomandibular (DTM) atendidos no projeto de extensão alívio

Introdução  As disfunções temporomandibulares (DTM) são condições que frequentemente evoluem para cronicidade e o perfil psicossocial do indivíduo pode contribuir para o seu prognóstico.  Objetivos Traçar o perfil psicossocial de pacientes com DTM atendidos no Projeto Multiprofissional de Dor Orofacial da Universidade Federal do Espírito Santo (Alívio).  Material E Métodos Trata-se de um estudo descritivo retrospectivo, aprovado no Comitê de Ética em Pesquisa (CAAE: 48433621.1.0000.5060). Foram analisados dados dos pacientes no período de novembro de 2020 a agosto de 2021.  Para análise do perfil psicossocial tivemos como base: Índice de Qualidade do sono de Pittsburgh (PSQI); Cinesiofobia (TAMPA); Hábitos orais (OBC); Hipervigilância (PVAQ); Catastrofização (PCS), a prática e o tipo de atividade física realizada. Os resultados foram analisados através de média, desvio padrão e frequência. Resultados Compuseram a amostra 18 indivíduos dos quais 66,7% apresentaram distúrbio do sono (PSQI); 66,7% apresentavam baixa cinesiofobia (TAMPA), 83,3% demonstraram hábitos orais que representam alto risco em desenvolver DTM (OBC); hipervigilância (PVAQ) com média de pontuação 56,78 (16,3) de um total de 80 pontos; 38,9% foram classificados com baixo nível catastrofização (PCS); 55,6% praticavam atividade física, destes, 33,6% tinham como hábito a prática de caminhada. A análise psicossocial de pacientes com DTM considera aspectos psicológicos e sociais no início e prognóstico desse transtorno. Logo, faz-se necessária uma abordagem psicossocial e multidisciplinar para entender e abordar fatores além dos físicos que repercutem no prognóstico da condição.  Conclusão O presente estudo observou que existe uma relação que pacientes com  DTM dispõe de uma predominância de distúrbio do sono, baixa cinesiofobia, hábitos orais relacionados a alto risco de desenvolver DTM, hipervigilância com pontuação média, baixo nível de catastrofização e a prática de atividade física é moderada.

Association of sleep disorders with heart rate variability in children and adolescents with cystic fibrosis

Objective:

To assess the association of sleep disorders with the findings of heart rate variability (HRV) in children and adolescents with cystic fibrosis (CF).

Methods:

Cross-sectional study including children and adolescents aged six to 18 years with a clinical diagnosis of CF. Sociodemographic and clinical data were collected. Sleep disorders were evaluated using baseline nocturnal polysomnography. The autonomic nervous system (ANS) was evaluated through resting HRV.

Results:

A total of 30 individuals (11.2 years) with a mean forced expiratory volume in the first second (FEV₁) of 62.7% were included. The respiratory disturbance index presented a median of 2.6 and obstructive sleep apnea syndrome (OSAS) was identified in 30%. In the HRV analysis, a mean standard deviation of all inter-beat (RR) intervals (SDNN) of 60.8±45.9ms was found. There was a significant correlation between the HRV low-frequency/high-frequency (LF/HF) global modulation index and the minimum SpO₂ during sleep in patients with FEV₁<60% (r=0.71; p=0.02). The prevalence of sleep disorders and HRV abnormalities was higher in individuals with lesser pulmonary function (FEV₁<60%).

Conclusions:

The results indicate a weak correlation of sleep disorders (minimum SpO₂) with HRV parameters (LH/HF) in children and adolescents with CF. When pulmonary function was reduced, a stronger correlation was found, highlighting the influence of disease severity. A high prevalence of ANS disorders, nocturnal hypoxemia, and presence of OSAS was also found.

Heart rate variability, exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate cystic fibrosis

Background: Autonomic nervous system balance is altered in cystic fibrosis (CF), although its influence on physical fitness has been poorly explored.

Objective: This study aimed to evaluate the association of heart rate variability (HRV) with exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate CF.

Methods: A cross-sectional study including individuals with CF aged 6–18 years, not under CFTR modulator therapy, was performed. Sociodemographic (age, sex) and clinical information (airway colonization, pancreatic insufficiency, and genotyping) were collected. In addition, exercise capacity (modified shuttle test — MST), lung function (spirometry), body composition (bioimpedance), levels of daily physical activity (5-day accelerometer), and HRV (both at rest and during the MST) were evaluated.

Results: 30 individuals (20 females) aged [Formula: see text] years, mean FEV[Formula: see text]%, were included. A sympathovagal balance (LF/HF) increase ([Formula: see text]) during the MST was shown, indicating a predominance of sympathetic modulation. The standard deviation of all RR intervals (SDNN) and the high frequency (HF) index during exercise correlated significantly with FEV1 ([Formula: see text], [Formula: see text] and [Formula: see text], [Formula: see text]; respectively). MST distance also correlated positively and significantly with SDNN ([Formula: see text], [Formula: see text]), square root of the mean of the sums of squares of frequencies between RR intervals greater than 50[Formula: see text]ms — RMSSD ([Formula: see text], [Formula: see text]), low frequency — LF ([Formula: see text], [Formula: see text]), HF ([Formula: see text], [Formula: see text]), dispersion of points perpendicular to the short-term identity line — SD1 ([Formula: see text], [Formula: see text]) and negatively with LF/HF ([Formula: see text], [Formula: see text]). Regarding daily physical activity, SDNN at rest ([Formula: see text], [Formula: see text]) and exercise ([Formula: see text], [Formula: see text]) showed positive correlations with time in moderate-to-vigorous activities. When normalizing the SDNN and classifying individuals as normal or altered, those presenting altered SDNN showed poorest FEV1 ([Formula: see text]) and lower exercise capacity ([Formula: see text]).

Conclusion: HRV correlates with lung function, exercise capacity and levels of daily physical activity in children and adolescents with CF. The study highlights the influence of CF on autonomic function and suggests HRV measurement as an easy tool to be used in clinical settings as an alternative marker to monitor CF individuals.

Capacidade de exercício e nível de atividade física diária de crianças e adolescentes com fibrose cística: associação com estado nutricional, função pulmonar, hospitalização e uso de antibióticos

RESUMO O objetivo deste trabalho é avaliar a capacidade de exercício e nível de atividade física diária de crianças e adolescentes com fibrose cística e associar com estado nutricional, função pulmonar, tempo de hospitalização e uso de antibióticos. Trata-se de estudo transversal em indivíduos com fibrose cística entre 6 e 18 anos, registrando-se informações sobre perfil clínico, histórico de hospitalizações e uso de antibióticos. Os participantes foram submetidos à espirometria, bioimpedância, avaliação da capacidade de exercício com teste de Shuttle modificado (MST), o nível da atividade física foi medido por meio do questionário internacional de atividade física (IPAQ) e usando acelerômetro por 5 dias. Participaram 30 indivíduos com idade de 11,2 ± 3,6 anos e volume expirado forçado (VEF1) de 68,0 ± 24,8%. A mediana da distância percorrida no MST foi de 820 metros (66,3%) e demonstrou associação com a função pulmonar (r = 0,78), estado nutricional (r = 0,38), tempo de hospitalização (r = -0,42) e uso de antibióticos (r = -0,46). De acordo com o questionário, 20 pacientes (64,6%) foram classificados como sedentários, o acelerômetro revelou que os indivíduos passam 354,2 minutos em atividades sedentárias e apenas 14,9 minutos em atividades moderadas a vigorosas por dia. Quanto maior a porcentagem de tempo em atividade física moderada a vigorosa, maior o índice de massa corpórea (IMC) e menor o tempo de hospitalização. Assim, a capacidade de exercício e nível de atividade física em crianças e adolescentes com fibrose cística apresentou-se reduzida e associada com menores valores de IMC e aumento do tempo de hospitalização.

Adherence and barriers to general and respiratory exercises in cystic fibrosis

OBJECTIVES

To investigate the adherence and the self-reported barriers to general and respiratory exercises reported by individuals with cystic fibrosis (CF).

STUDY DESIGN

An exploratory, experimental study.

METHODS

Community-dwelling individuals aged 16 years and over, diagnosed with CF, who were accompanied in referral centers were included. Information regarding adherence to exercises was obtained by a questionnaire and reported as a ratio between prescribed exercises and self-reported adherence. The weekly frequency was used to verify adherence to exercise initiation, and the amount of session duration concluded was used to verify adherence to exercise duration. Values above 0.70 were considered as high adherence. Eight demographic and clinical factors were examined to explore their relationships with adherence, and the barriers to exercises were also collected by questionnaire.

RESULTS

Thirty-four participants met the inclusion criteria. Overall, adherence to exercise initiation was 0.40 (standard deviation [SD] = 0.3) for general exercises and 0.63 (SD = 0.4) for respiratory exercises. Adherence to exercise duration was 0.76 (SD = 0.4) for general exercises and 0.73 (SD = 0.4) for respiratory exercises. Forced vital capacity (r = 0.39; P = .02) was associated with adherence to the duration of general exercises, and body mass index (r = -0.33; P = .05) was associated with adherence to the duration of respiratory exercises. The main reported barriers were lack of interest, motivation and time, tiredness, noncommitment, and do not recognize the benefits of exercises.

CONCLUSIONS

Individuals with CF minded completing the sessions of prescribed exercises once they have initiated it, but most of the days they did not practice general or respiratory exercises.

Sleep-disordered breathing and markers of morbidity in children and adolescents with cystic fibrosis

BACKGROUND

Studies have shown that sleep disorders occur in cystic fibrosis (CF) patients and may be present before daytime clinical manifestations.

OBJECTIVES

To evaluate the presence of sleep disorders among children and adolescents with CF, attempting to identify associations with pulmonary function, nutritional status, days in hospital, and days taking antibiotics.

METHODS

Individuals with a diagnosis of CF aged between 6 and 18 years were included. Information on sociodemographic, clinical profile, history of hospitalizations, and use of antibiotics in the last year were collected. Spirometry, bioimpedance, and polysomnography were performed. The presence of nocturnal hypoxemia and obstructive sleep apnea syndrome (OSAS) were evaluated and participants divided according to their presence.

RESULTS

Thirty-one patients were included. The prevalence of OSAS was 32.3% and nocturnal hypoxemia was 29.0%. Average nocturnal peripheral oxyhemoglobin saturation (SpO₂ ) correlated (P < .001) with forced vital capacity (r = .55) and forced expiratory volume in the first second (r = .62). The higher the percentage of total sleep time (TST) with SpO₂ less than 90%, the lower the pulmonary function. Individuals with OSAS and nocturnal hypoxemia had lower spirometric values compared to patients without these disorders, but the nocturnal hypoxemia group also had lower Shwachman-Kulczycki score, longer hospitalization time and antibiotic use. TST with SpO₂ less than 90% was associated with length of hospitalization (r²  = .53).

CONCLUSION

Children and adolescents with CF have sleep disorders, including OSAS (32.3%) and nocturnal hypoxemia (29%). Individuals with nocturnal hypoxemia presented lower lung function, worse clinical score, and higher morbidity. TST with SpO₂ less than 90% was associated with length of hospitalization.