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Backhaus SJ, Schulz A, Lange T, Schmidt-Schweda LS, Hellenkamp K, Evertz R, Kowallick JT, Kutty S, Hasenfuß G, Schuster A. Prognostic and diagnostic implications of impaired rest and exercise-stress left atrial compliance in heart failure with preserved ejection fraction: Insights from the HFpEF stress trial. Int J Cardiol 2024; 404:131949. [PMID: 38471649 DOI: 10.1016/j.ijcard.2024.131949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/24/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND With emerging therapies, early diagnosis of heart failure with preserved ejection fraction (HFpEF) comes to the fore. Whilst the reference standard of exercise-stress right heart catheterisation is well established, the clinical routine struggles between feasibility of exercise-stress and diagnostic accuracy of available tests. METHODS The HFpEF Stress Trial (DZHK-17) prospectively enrolled 75 patients with exertional dyspnoea and echocardiographic signs of diastolic dysfunction (E/e' > 8) who underwent simultaneous rest and exercise-stress echocardiography and right heart catheterisation (RHC). HFpEF was defined according to pulmonary capillary wedge pressure (HFpEF: PCWP rest: ≥15 mmHg stress: ≥25 mmHg). Patients were classified as non-cardiac dyspnoea (NCD) in the absence of HFpEF and cardiovascular disease. LA compliance was defined as reservoir strain (Es)/(E/e'). Follow-up was conducted after 4 years to evaluate cardiovascular hospitalisation (CVH). RESULTS The final study population included 68 patients (HFpEF n = 34 and NCD n = 34) of which 23 reached the clinical endpoint, 1 patient was lost to follow-up. Patients with HFpEF according to the HFA-PEFF score (≥5 points) had significantly lower LA compliance at rest (p < 0.001) compared to patients with a score ≤ 4. LA compliance at rest outperformed E/e' (AUC 0.78 vs 0.87, p = 0.024) and showed a statistical trend to outperform Es (AUC 0.79 vs 0.87, p = 0.090) for the diagnosis of HFpEF. LA compliance at rest predicted CVH (HR 2.83, 95% CI 1.70-4.74, p < 0.001) irrespective of concomitant atrial fibrillation. CONCLUSIONS LA compliance at rest can be obtained from clinical routine imaging and bears strong diagnostic and prognostic accuracy. Addition of LA compliance can improve the role of echocardiography as the primary test and gatekeeper.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Alexander Schulz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Lennart S Schmidt-Schweda
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
| | - Kristian Hellenkamp
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
| | - Ruben Evertz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany; University Medical Center Göttingen (UMG), Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - Shelby Kutty
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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Gaines AG, Cagle JG. Associations Between Certificate of Need Policies and Hospice Quality Outcomes. Am J Hosp Palliat Care 2024; 41:471-478. [PMID: 37256687 DOI: 10.1177/10499091231180613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Certificate of need (CON) laws are state-based regulations requiring approval of new healthcare entities and capital expenditures. Varying by state, these regulations impact hospices in 14 states and DC, with several states re-examining provisions. AIM This cross-sectional study examined the association of CON status on hospice quality outcomes using the hospice item set metric (HIS). DESIGN Data from the February 2022 Medicare Hospice Provider and General Information reports of 4870 US hospices were used to compare group means of the 8 HIS measures across CON status. Multiple regression analysis was used to predict HIS outcomes by CON status while controlling for ownership and size. RESULTS Approximately 86% of hospices are in states without a hospice CON provision. The unadjusted mean HIS scores for all measures were higher in CON states (M range 94.40-99.59) than Non-CON (M range 90.50-99.53) with significant differences in all except treatment preferences. In the adjusted model, linear regression analyses showed hospice CON states had significantly higher HIS ratings than those from Non-CON states for beliefs and values addressed (β = .05, P = .009), pain assessment (β = .05, P = .009), dyspnea treatment (β = .08, P < .001) and the composite measure (β = .09, P < .001). Treatment preferences, pain screening, dyspnea screening, and opioid bowel treatment were not statistically significant (P > .05). CONCLUSION The study suggests that CON regulations may have a modest, but beneficial impact on hospice-reported quality outcomes, particularly for small and medium-sized hospices. Further research is needed to explore other factors that contribute to HIS outcomes.
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Affiliation(s)
- Arlen G Gaines
- Doctoral Program in Palliative Care, Department of Pharmacy Practice and Science, University of Maryland, Baltimore, MD, USA
| | - John G Cagle
- Department of Social Work, University of Maryland, Baltimore, MD, USA
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Watson S, Dixon G, Savill A, Gibbons MA, Barratt SL, Rodrigues JCL. Complications of fibrotic interstitial lung disease for the general radiologist. Clin Radiol 2024; 79:323-329. [PMID: 38429136 DOI: 10.1016/j.crad.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/01/2023] [Accepted: 01/16/2024] [Indexed: 03/03/2024]
Abstract
Interstitial lung diseases (ILDs) are a heterogeneous group of conditions characterised by non-infective inflammation and scarring of the lung parenchyma. They are not infrequently encountered by the general radiologist in both acute and outpatient reporting settings who may even be the first to make the diagnosis. In the acute setting, patients with ILD can present with respiratory deterioration due to a number of causes and in addition to the common causes of dyspnoea, an acute exacerbation of ILD needs to be considered. An exacerbation can be initiated by common triggers such as infection, pulmonary embolism (PE), and heart failure, and it can also be initiated by an insult to the lung or occur due to an unknown cause. Particular care needs to be taken when interpreting computed tomography (CT) examinations in these patients as the findings of an acute exacerbation are non-specific and patient and technical factors can cause spurious appearances including dependent changes, breathing artefact and contrast medium opacification. In the non-acute setting, patients with ILD are at increased risk of lung cancer and pulmonary hypertension (PH), with lung cancer being a particularly important consideration as treatments carry the risk of triggering an acute exacerbation or deterioration in lung function. Overall, this review aims to provide an overview for the general radiologist of additional factors to consider when interpreting scans in patients with ILD and how the presence of ILD impacts the differential diagnoses and complications that can occur in these patients in both acute and non-acute settings.
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Affiliation(s)
- S Watson
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - G Dixon
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK; South West Peninsula ILD Network, UK; Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Department of Clinical & Biomedical Sciences, University of Exeter, Exeter, UK
| | - A Savill
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - M A Gibbons
- South West Peninsula ILD Network, UK; Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - S L Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK; Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, UK
| | - J C L Rodrigues
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK; Department of Health, University of Bath, Bath, UK.
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Liu YY, Lu HB, Li YJ, Wang ZY, Liu YH, Qiao S, Xie J. Effects of mindful breathing training combined with diary-based rehabilitation guidance in lung cancer patients undergoing surgery: A randomized controlled trial. Complement Ther Clin Pract 2024; 55:101849. [PMID: 38522328 DOI: 10.1016/j.ctcp.2024.101849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND PURPOSE Lung cancer surgery patients experience severe physical and mental symptoms, which seriously affect their quality of life and prognosis. Mindful breathing training is a promising strategy to improve their symptoms, but its effectiveness is affected by training compliance, and diary-based rehabilitation instruction has been shown to help improve training compliance. Therefore, the aim of this study was to evaluate the effects of mindful breathing training combined with diary-based rehabilitation guidance on improving perioperative outcomes in lung cancer surgery patients. MATERIALS AND METHODS This single-center, assessor-blinded, prospective, three-arm randomized controlled trial was conducted from November 1, 2021 to November 1, 2022. Patients diagnosed with primary non-small cell lung cancer and scheduled for thoracoscopic surgery were randomly allocated to the combined intervention group, the mindful breathing group or the control group, with 34 patients in each group. The control group received routine care, while the mindful breathing group received mindful breathing training and routine care. The combined intervention group received both mindful breathing training and diary-based rehabilitation guidance, along with routine care. RESULTS The per-protocol analysis revealed that patients in the mindful breathing group experienced statistically significant improvements in dyspnea, fatigue and anxiety. Patients in the combined intervention group had statistically significant improvements in dyspnea, fatigue, anxiety, depression, exercise self-efficacy and training compliance. CONCLUSION This study provides evidence that mindful breathing training combined with diary-based rehabilitation guidance can be effective in improving perioperative outcomes in lung cancer patients. It can be applied in clinical practice in the future.
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Affiliation(s)
- Yan-Yan Liu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China.
| | - Han-Bing Lu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China.
| | - Ya-Jie Li
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China.
| | - Zi-Yu Wang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China.
| | - Yu-Han Liu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China.
| | - Shuai Qiao
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China.
| | - Jiao Xie
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China.
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Juwara L, Cressatti M, Galindez JM, Drammeh PS, Velly AM, Schipper HM. Development and internal validation of a prognostic model for loss of balance and falls in mid- to late-stage Parkinson's disease. Neurol Sci 2024; 45:2027-2033. [PMID: 38060035 DOI: 10.1007/s10072-023-07220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Mid- to late-stage Parkinson's disease (PD) is often linked with worsened and significant impairment of motor activities, but existing prognostic markers do not adequately capture the risk of loss of balance in PD patients. This study aims to develop a risk prognostic model for mid- to late-stage PD and identify prognostic factors that are indicative of impending loss of balance and falls. METHODS The study included 307 participants of which 75 were diagnosed with idiopathic PD and 232 were neurological or non-neurological controls. Among the PD group, 46 were early-stage (Hoehn and Yahr [H&Y] = 1,2) with no significant loss of balance while 29 were mid- to late-stage (H&Y = 3,4,5) which is characterized by loss of balance and falls. Multivariable logistic regression (MLR) was used to develop a prognostic model for mid- to late-stage PD. Model discrimination was assessed by ROC curves. The model was internally validated through bootstrapping and calibration plots. RESULTS The relevant factors identified and included in the final MLR model were shortness of breath, age, swollen joints, heme oxygenase-1 (HO-1) protein, and total salivary protein. The model had an AUC of 0.82 (95% CI = 0.71-0.92) and was well calibrated (calibration slope = 0.77, intercept = 0.03). The likelihood of shortness of breath (OR = 7.91, 95% CI = 1.63-45.12) was significantly higher among mid- to late-stage PD than early-stage. Age and total salivary protein were also significantly higher among mid- to late-stage PD. CONCLUSION The MLR prognostic model for mid- to late-stage PD may assist physicians in identifying patients at high risk for loss of balance and falls.
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Affiliation(s)
- Lamin Juwara
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Quantitative Life Sciences, McGill University, Montreal, Quebec, Canada
| | - Marisa Cressatti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Julia M Galindez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Pa Sallah Drammeh
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Ana M Velly
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Dentistry, Jewish General Hospital, Montreal, Quebec, Canada
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Hyman M Schipper
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada.
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Belvederi Murri M, Triolo F, Coni A, Nerozzi E, Maietta Latessa P, Fantozzi S, Padula N, Escelsior A, Assirelli B, Ermini G, Bagnoli L, Zocchi D, Cabassi A, Tedeschi S, Toni G, Chattat R, Tripi F, Neviani F, Bertolotti M, Cremonini A, Bertakis KD, Amore M, Chiari L, Zanetidou S. The body of evidence of late-life depression: the complex relationship between depressive symptoms, movement, dyspnea and cognition. Exp Aging Res 2024; 50:296-311. [PMID: 37035934 DOI: 10.1080/0361073x.2023.2196504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Physical symptoms play an important role in late-life depression and may contribute to residual symptomatology after antidepressant treatment. In this exploratory study, we examined the role of specific bodily dimensions including movement, respiratory functions, fear of falling, cognition, and physical weakness in older people with depression. METHODS Clinically stable older patients with major depression within a Psychiatric Consultation-Liaison program for Primary Care underwent comprehensive assessment of depressive symptoms, instrumental movement analysis, dyspnea, weakness, activity limitations, cognitive function, and fear of falling. Network analysis was performed to explore the unique adjusted associations between clinical dimensions. RESULTS Sadness was associated with worse turning and walking ability and movement transitions from walking to sitting, as well as with worse general cognitive abilities. Sadness was also connected with dyspnea, while neurovegetative depressive burden was connected with activity limitations. DISCUSSION Limitations of motor and cognitive function, dyspnea, and weakness may contribute to the persistence of residual symptoms of late-life depression.
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Affiliation(s)
| | - Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Alice Coni
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Erika Nerozzi
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | | | - Silvia Fantozzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Nicola Padula
- Association for Research on Mental and Physical Health of the Elderly (ARISMA), Bologna, Italy
| | - Andrea Escelsior
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Barbara Assirelli
- Department of Primary Care, Azienda Unita' Locale Sanita', Bologna, Italy
| | - Giuliano Ermini
- Department of Primary Care, Azienda Unita' Locale Sanita', Bologna, Italy
| | - Luigi Bagnoli
- Department of Primary Care, Azienda Unita' Locale Sanita', Bologna, Italy
| | - Donato Zocchi
- Department of Primary Care, Azienda Unita' Locale Sanita', Bologna, Italy
| | - Aderville Cabassi
- Cardiorenal and Hypertension Research Unit, Physiopathology Unit, Clinica Medica Generale e Terapia Medica, Department of Medicine and Surgery (DIMEC), University of Parma, Parma, Italy
| | - Stefano Tedeschi
- Cardiorenal and Hypertension Research Unit, Physiopathology Unit, Clinica Medica Generale e Terapia Medica, Department of Medicine and Surgery (DIMEC), University of Parma, Parma, Italy
| | - Giulio Toni
- Association for Research on Mental and Physical Health of the Elderly (ARISMA), Bologna, Italy
| | - Rabih Chattat
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Ferdinando Tripi
- Association for Research on Mental and Physical Health of the Elderly (ARISMA), Bologna, Italy
| | - Francesca Neviani
- Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy
| | - Marco Bertolotti
- Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy
| | - Alessandro Cremonini
- Association for Research on Mental and Physical Health of the Elderly (ARISMA), Bologna, Italy
| | - Klea D Bertakis
- Department of Family and Community Medicine, University of California, Davis, California, United States
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Stamatula Zanetidou
- Association for Research on Mental and Physical Health of the Elderly (ARISMA), Bologna, Italy
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Halpin DMG, Mahler DA. Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD. BMJ Open Respir Res 2024; 11:e002211. [PMID: 38626929 PMCID: PMC11029336 DOI: 10.1136/bmjresp-2023-002211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/05/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Errors using inhaled delivery systems for COPD are common and it is assumed that these lead to worse clinical outcomes. Previous systematic reviews have included patients with both asthma and COPD and much of the evidence related to asthma. More studies in COPD have now been published. Through systematic review, the relationship between errors using inhalers and clinical outcomes in COPD, including the importance of specific errors, was assessed.MethodsElectronic databases were searched on 27 October 2023 to identify cohort, case-control or randomised controlled studies, which included patients with COPD, an objective assessment of inhaler errors and data on at least one outcome of interest (forced expiratory volume in 1 s, (FEV1), dyspnoea, health status and exacerbations). Study quality was assessed using the Newcastle and Ottawa scales. A narrative synthesis of the results was performed as there was insufficient detail in the publications to allow quantitative synthesis. There was no funding for the review. RESULTS 19 publications were included (7 cohort and 12 case-control) reporting outcomes on 6487 patients. 15 were considered low quality, and most were confounded by the absence of adherence data. There was weak evidence that lower error rates are associated with better FEV1, symptoms and health status and fewer exacerbations. Only one considered the effects of individual errors and found that only some were related to worse outcomes. CONCLUSION Evidence about the importance of specific errors using inhalers and outcomes would optimise the education and training of patients with COPD. Prospective studies, including objective monitoring of inhalation technique and adherence, are needed. PROSPERO REGISTRATION NUMBER CRD42023393120.
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Affiliation(s)
- David M G Halpin
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Donald A Mahler
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Valley Regional Hospital, Claremont, New Hampshire, USA
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Jenkins AR, Burtin C, Camp PG, Lindenauer P, Carlin B, Alison JA, Rochester C, Holland AE. Do pulmonary rehabilitation programmes improve outcomes in patients with COPD posthospital discharge for exacerbation: a systematic review and meta-analysis. Thorax 2024; 79:438-447. [PMID: 38350731 DOI: 10.1136/thorax-2023-220333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Previous systematic reviews have provided heterogeneous and differing estimates for the efficacy of pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this review was to examine the efficacy of pulmonary rehabilitation programmes initiated within 3 weeks of hospital discharge following an exacerbation of COPD. METHODS An update of a previous Cochrane review was undertaken using the Cochrane Airways Review Group Specialised Register. Searches were conducted from October 2015 to August 2023 for studies that initiated pulmonary rehabilitation within 3 weeks of hospital discharge. Studies assessing the impact of solely inpatient pulmonary rehabilitation were excluded. Forest plots were generated using a generic inverse variance random effects method. RESULTS Seventeen studies were included. Posthospital discharge pulmonary rehabilitation reduced hospital re-admissions (OR 0.48, 95% CI 0.30 to 0.77, I2=67%), improved exercise capacity (6 min walk test, mean difference (MD) 57 m, 95% CI 29 to 86, I2=89%; incremental shuttle walk test, MD 43 m, 95% CI 6 to 79, I2=81%), health-related quality of life (St. George's Respiratory Questionnaire, MD -8.7 points, 95% CI -12.5 to -4.9, I2=59%; Chronic Respiratory Disease Questionnaire (CRQ)-emotion, MD 1.0 points, 95% CI 0.4 to 1.6, I2=74%; CRQ-fatigue, MD 0.9 points, 95% CI 0.1 to 1.6, I2=91%), and dyspnoea (CRQ-dyspnoea, MD 1.0 points, 95% CI 0.3 to 1.7, I2=87%; modified Medical Research Council Dyspnoea Scale, MD -0.3 points, 95% CI -0.5 to -0.1, I2=60%). Significant effects were not observed for CRQ-mastery, COPD assessment test, EuroQol-5 Dimension-5 Level and mortality. No intervention-related adverse events were reported. DISCUSSION Pulmonary rehabilitation delivered posthospital discharge for exacerbation of COPD results in a reduction in hospital re-admissions and improvements in exercise capacity, health-related quality of life and dyspnoea in the absence of any intervention-related adverse events. TRIAL REGISTRATION NUMBER CRD42023406397.
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Affiliation(s)
- Alex R Jenkins
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montreal, QC, Canada
| | - Chris Burtin
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- BIOMED-Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Pat G Camp
- Centre for Heart Lung Innovation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA
| | - Brian Carlin
- Sleep Medicine and Lung Health Consultants, Pittsburgh, Pennsylvania, USA
| | - Jennifer A Alison
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Allied Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Carolyn Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
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Charrin L, Romain-Scelle N, Di-Filippo C, Mercier E, Balen F, Tazarourte K, Benhamed A. Impact of delayed mobile medical team dispatch for respiratory distress calls: a propensity score matched study from a French emergency communication center. Scand J Trauma Resusc Emerg Med 2024; 32:27. [PMID: 38609957 PMCID: PMC11010329 DOI: 10.1186/s13049-024-01201-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Shortness of breath is a common complaint among individuals contacting emergency communication center (EMCCs). In some prehospital system, emergency medical services include an advanced life support (ALS)-capable team. Whether such team should be dispatched during the phone call or delayed until the BLS-capable paramedic team reports from the scene is unclear. We aimed to evaluate the impact of delayed MMT dispatch until receiving the paramedic review compared to immediate dispatch at the time of the call on patient outcomes. METHODS A cross-sectional study conducted in Lyon, France, using data obtained from the departmental EMCC during the period from January to December 2019. We included consecutive calls related to adult patients experiencing acute respiratory distress. Patients from the two groups (immediate mobile medical team (MMT) dispatch or delayed MMT dispatch) were matched on a propensity score, and a conditional weighted logistic regression assessed the adjusted odds ratios (ORs) for each outcome (mortality on days 0, 7 and 30). RESULTS A total of 870 calls (median age 72 [57-84], male 466 53.6%) were sought for analysis [614 (70.6%) "immediate MMT dispatch" and 256 (29.4%) "delayed MMT" groups]. The median time before MMT dispatch was 25.1 min longer in the delayed MMT group (30.7 [26.4-36.1] vs. 5.6 [3.9-8.8] min, p < 0.001). Patients subjected to a delayed MMT intervention were older (median age 78 [66-87] vs. 69 [53-83], p < 0.001) and more frequently highly dependent (16.3% vs. 8.6%, p < 0.001). A higher proportion of patients in the delayed MMT group required bag valve mask ventilation (47.3% vs. 39.1%, p = 0.03), noninvasive ventilation (24.6% vs. 20.0%, p = 0.13), endotracheal intubation (7.0% vs. 4.1%, p = 0.07) and catecholamine infusion (3.9% vs. 1.3%, p = 0.01). After propensity score matching, mortality at day 0 was higher in the delayed MMT group (9.8% vs. 4.2%, p = 0.002). Immediate MMT dispatch at the call was associated with a lower risk of mortality on day 0 (0.60 [0.38;0.82], p < 0.001) day 7 (0.50 [0.27;0.72], p < 0.001) and day 30 (0.56 [0.35;0.78], p < 0.001) CONCLUSIONS: This study suggests that the deployment of an MMT at call in patients in acute respiratory distress may result in decreased short to medium-term mortality compared to a delayed MMT following initial first aid assessment.
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Affiliation(s)
- Léo Charrin
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Université Claude Bernard Lyon 1, 5 Place d'Arsonval, 69437, Lyon, France
| | - Nicolas Romain-Scelle
- Department of Biostatistics and Public Health, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Christian Di-Filippo
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Université Claude Bernard Lyon 1, 5 Place d'Arsonval, 69437, Lyon, France
| | - Eric Mercier
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada
| | - Frederic Balen
- Emergency Department, University Hospital of Toulouse, 31059, Toulouse, France
| | - Karim Tazarourte
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Université Claude Bernard Lyon 1, 5 Place d'Arsonval, 69437, Lyon, France
| | - Axel Benhamed
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Université Claude Bernard Lyon 1, 5 Place d'Arsonval, 69437, Lyon, France.
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada.
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10
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Shi XY, Ren Y, Gu XM, Jia YR, Wang X. Impact of pulmonary rehabilitation on patients with different chronic respiratory diseases during hospitalization. Medicine (Baltimore) 2024; 103:e37778. [PMID: 38608115 PMCID: PMC11018183 DOI: 10.1097/md.0000000000037778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/12/2024] [Indexed: 04/14/2024] Open
Abstract
The impact of pulmonary rehabilitation (PR) on patients with different chronic respiratory diseases (CRDs) during hospitalization has not been thoroughly evaluated before. The objectives of the current research were to assess the effect of comprehensive PR management on inpatients' self-management skills, exercise capacity, nutrition assessment and mental health issues and explore whether impacts of PR vary in different CRDs. This retrospective study analyzed the clinical data from 272 inpatients with CRDs receiving PR management during hospitalization between October 2020 and March 2022 in Beijing Chao-Yang Hospital. Significant improvements were found in the patients' ability of daily living (ADL), dyspnea (assessed by modified medical research council dyspnea scale (MMRC)), handgrip strength, maximal inspiratory and expiratory pressure, anxiety (using the 7-item generalized anxiety disorder scale (GAD-7)) and depression (the 9-item patient health questionnaire score (PHQ-9)). There was no significant change in nutrition assessment pre-post PR management during hospitalization. The subgroup analyses were conducted on hospitalized patients with chronic obstructive pulmonary disease (COPD), bronchiectasis, asthma, interstitial lung diseases (ILDs) and other CRDs (e.g., lung cancer, diaphragm hemiparesis, obesity, etc.). The results showed that ADL, MMRC score, MIP, MEP, PHQ-9 score improved in all subgroups with CRDs. Handgrip strength of left hand was increased in COPD inpatients and anxiety was improved in all subgroups except for ILDs. Comprehensive PR management was necessary and beneficial for patients with different CRDs during hospitalization.
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Affiliation(s)
- Xin-Yu Shi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yi Ren
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Meng Gu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan-Rui Jia
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xue Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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11
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Hakimi A, Bergoin C, De Jesus A, Hermand E, Fabre C, Mucci P. Impairment of lung volume perception and breathing control in hypermobile Ehlers-Danlos syndrome. Sci Rep 2024; 14:8119. [PMID: 38582758 PMCID: PMC10998874 DOI: 10.1038/s41598-024-58890-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/04/2024] [Indexed: 04/08/2024] Open
Abstract
Breathing difficulties and exertional dyspnea are frequently reported in hypermobile Ehlers-Danlos syndrome (hEDS); however, they are not clearly explained. An impaired proprioception or the addition of a cognitive task could influence ventilatory control. How can the perception of lung volume be measured? Is lung volume perception impaired in hEDS patients? Is the breathing control impaired during a cognitive task in hEDS patients? A device was developed to assess the accuracy of lung volume perception in patients with hEDS and matched control subjects. In the second step, ventilation was recorded in both groups with and without a cognitive task. Two groups of 19 subjects were included. The accuracy of lung volume perception was significantly (P < 0.01) lower at 30% of inspired vital capacity in patients with hEDS in comparison to the control group, and they showed erratic ventilation (based on spatial and temporal criteria) when performing a cognitive task. These data support the influence of the proprioceptive deficit on ventilatory control in hEDS patients. These elements may help to understand the respiratory manifestations found in hEDS. Future research should focus on this relationship between lung volume perception and ventilation, and could contribute to our understanding of other pathologies or exercise physiology.Trial registration number: ClinicalTrials.gov, NCT05000151.
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Affiliation(s)
- Adrien Hakimi
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France.
- Clinique de la Mitterie, Lomme, France.
- URePSSS, Eurasport, 413, Avenue Eugène Avinée, 59120, Loos, France.
| | - Cyrille Bergoin
- Clinique de la Mitterie, Lomme, France
- Cabinet de Pneumologie, Tourcoing, France
| | - Anna De Jesus
- Clinique de la Mitterie, Lomme, France
- Cabinet de Pneumologie, Tourcoing, France
| | - Eric Hermand
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France
- Université Sorbonne Paris Nord, UMR INSERM U1272 Hypoxie & Poumon, Bobigny, France
| | - Claudine Fabre
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France
| | - Patrick Mucci
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France
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12
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Huang HL, Chen PJ, Mori M, Suh SY, Wu CY, Peng JK, Shih CY, Yao CA, Tsai JS, Chiu TY, Hiratsuka Y, Kim SH, Morita T, Yamaguchi T, Tsuneto S, Hui D, Cheng SY. Improved Symptom Change Enhances Quality of Dying in Patients With Advanced Cancer: An East Asian Cross-Cultural Study. Oncologist 2024; 29:e553-e560. [PMID: 37758042 PMCID: PMC10994251 DOI: 10.1093/oncolo/oyad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/20/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Symptom burdens tend to increase for patients with cancer and their families over the disease trajectory. There is still a lack of evidence on the associations between symptom changes and the quality of dying and death. In this context, this research investigated how symptom changes influence the quality of dying and death. METHODS This international prospective cohort study (the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED), 2017-2019) included 22, 11, and 4 palliative care units across Japan, South Korea, and Taiwan. Eligible participants were adults (Japan and Korea, ≥18 years; Taiwan, ≥20 years) with locally advanced or metastatic cancer. Physical and psychological symptoms were assessed by physicians upon admission and within 3 days before death. Death quality was assessed using the Good Death Scale (GDS), developed in Taiwan. Univariate and multivariate regression analyses were used to identify correlations between symptom severity changes and GDS scores. RESULTS Among 998 patients (542 [54.3%] men and 456 [45.7%] women; mean [SD] age = 70.1 [± 12.5] years), persistent dyspnea was associated with lower GDS scores when compared to stable dyspnea (β = -0.427, 95% CI = -0.783 to -0.071). Worsened (-1.381, -1.932 to -0.831) and persistent (-1.680, -2.701 to -0.659) delirium were also significantly associated with lower GDS scores. CONCLUSIONS Better quality of dying and death was associated with improved symptom control, especially for dyspnea and delirium. Integrating an outcome measurement for the quality of dying and death is important in the management of symptoms across the disease trajectory in a goal-concordant manner.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Ping-Jen Chen
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Republic of China
- Department of Family Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Republic of China
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea
| | - Chien-Yi Wu
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Republic of China
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Republic of China
| | - Jen-Kuei Peng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Chih-Yuan Shih
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Jaw-Shiun Tsai
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi Prefecture, Japan
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, USA
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
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13
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Gomes Dos Santos EG, Vieira da Costa K, Cordeiro de Souza IT, Victor Dos Santos Felix J, Furtado Brandão CB, Michelle de Souza Fernandes V, Lugon Favero AB, Lucrécia de Aquino Gouveia M, Tavares de Lima D, Heriston de Morais Lima J, Pedrosa R, Alves de Oliveira VM, da Cruz Santos A, Gama TO, Guedes de Brito GE, Tenório de França EE. Effects of a cardiopulmonary rehabilitation protocol on functional capacity, dyspnea, fatigue, and body composition in individuals with post-COVID-19 syndrome: A randomized controlled trial. Physiother Res Int 2024; 29:e2086. [PMID: 38572991 DOI: 10.1002/pri.2086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 01/31/2024] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Reduced functional capacity, dyspnea, fatigue, and changes in body composition are common in patients with post-COVID-19 syndrome (PCS), and cardiopulmonary rehabilitation may improve these parameters. Thus, the present study verified the effects of cardiopulmonary rehabilitation (respiratory, aerobic, and resistance muscle training) on submaximal exercise tolerance, dyspnea, fatigue, and body composition. METHODS This controlled and randomized clinical trial applied a six-week outpatient intervention protocol in individuals over 18 years old (n = 33) with a diagnosis of COVID-19 confirmed by polymerase chain reaction. These individuals were allocated to cardiopulmonary rehabilitation (n = 17) or control groups (i.e., educational lectures; n = 16). The cardiopulmonary rehabilitation group performed respiratory, aerobic, and resistance muscle training. Submaximal exercise tolerance, dyspnea, fatigue, and body composition were assessed before and after the protocol. RESULTS After 6 weeks, the cardiopulmonary rehabilitation group increased the tolerance to submaximal exercise, with a difference of 100.46 m (95% confidence interval [CI]: 7.40-193 m) in the distance walked on the six-minute walk test, reduced dyspnea (-1.45, 95% CI: -1.98--0.92) in the modified Medical Research Council, and increased 0.63 kg (95% CI: 0.09-1.18 kg) of muscle mass in the upper limbs compared with the control group. CONCLUSION The six-week cardiopulmonary rehabilitation protocol improved functional capacity, reduced dyspnea, and increased muscle mass in the upper limbs in individuals with PCS. Thus, these results supported the protocol use in this population and encourage further studies to assess its effectiveness in a large sample.
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Affiliation(s)
| | - Karina Vieira da Costa
- Postgraduate Program in Physiotherapy, Federal University of Paraíba, Joao Pessoa, Brazil
| | | | | | | | | | | | | | - Dyego Tavares de Lima
- Intensive Care Unit, University Hospital Lauro Wanderley, Paraíba, Joao Pessoa, Brazil
| | | | - Rafaela Pedrosa
- Physiotherapy Departament, Federal University of Paraíba, Joao Pessoa, Brazil
| | | | | | - Tatiana Onofre Gama
- Physiotherapy Departament, Federal University of Paraíba, Joao Pessoa, Brazil
| | - Geraldo Eduardo Guedes de Brito
- Postgraduate Program in Physiotherapy, Federal University of Paraíba, Joao Pessoa, Brazil
- Physiotherapy Departament, Federal University of Paraíba, Joao Pessoa, Brazil
| | - Eduardo Eriko Tenório de França
- Postgraduate Program in Physiotherapy, Federal University of Paraíba, Joao Pessoa, Brazil
- Physiotherapy Departament, Federal University of Paraíba, Joao Pessoa, Brazil
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14
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Shah NM, Apps C, Kaltsakas G, Madden-Scott S, Suh ES, D'Cruz RF, Arbane G, Patout M, Lhuillier E, Hart N, Murphy PB. The Effect of Pressure Changes During Mechanical Insufflation-Exsufflation on Respiratory and Airway Physiology. Chest 2024; 165:929-941. [PMID: 37844796 DOI: 10.1016/j.chest.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Respiratory muscle weakness can impair cough function, leading to lower respiratory tract infections. These infections are an important contributor to morbidity and mortality in patients with neuromuscular disease. Mechanical insufflation-exsufflation (MIE) is used to augment cough function in these patients. Although MIE is widely used, there are few data to advise on the optimal technique. Since the introduction of MIE, the recommended pressures to be delivered have increased. There are concerns regarding the use of higher pressures and their potential to cause lung derecruitment and upper airway closure. RESEARCH QUESTION What is the impact of high-pressure MIE (HP-MIE) on lung recruitment, respiratory drive, upper airway flow, and patient comfort, compared with low-pressure MIE (LP-MIE), in patients with respiratory muscle weakness? STUDY DESIGN AND METHODS Clinically stable patients using domiciliary MIE with respiratory muscle weakness secondary to Duchenne muscle dystrophy, spinal cord injury, or long-term tracheostomy ventilation received LP-MIE (30/-30 cm H2O) and HP-MIE (60/-60 cm H2O) in a random sequence. Lung recruitment, neural respiratory drive, and cough peak expiratory flow were measured throughout, and patients reported comfort and breathlessness following each intervention. RESULTS A total of 29 patients (10 with Duchenne muscle dystrophy, eight with spinal cord injury, and 11 with long-term tracheostomy ventilation) were included in this study. HP-MIE augmented cough peak expiratory flow compared with LP-MIE (mean cough peak expiratory flow HP-MIE 228 ± 81 L/min vs LP-MIE 179 ± 67 L/min; P = .0001) without any significant change in lung recruitment, neural respiratory drive, or patient-reported breathlessness. However, in patients with more pronounced respiratory muscle weakness, HP-MIE resulted in an increased rate of upper airway closure and patient discomfort that may have an impact on clinical efficacy. INTERPRETATION HP-MIE did not lead to lung derecruitment or breathlessness compared with LP-MIE. However, it was poorly tolerated in individuals with advanced respiratory muscle weakness. HP-MIE generates more upper airway closure than LP-MIE, which may be missed if cough peak expiratory flow is used as the sole titration target. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT02753959; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom.
| | - Chloe Apps
- Critical Care, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; GKT School of Medical Education, King's College London, London, United Kingdom
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom
| | - Sophie Madden-Scott
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Critical Care, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Eui-Sik Suh
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom
| | - Rebecca F D'Cruz
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom
| | - Gill Arbane
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Maxime Patout
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | | | - Nicholas Hart
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom
| | - Patrick B Murphy
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom
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15
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Aguilar-Zafra S, Fabero-Garrido R, Del Corral T, López-de-Uralde-Villanueva I. Reliability and Minimal Detectable Change for Respiratory Muscle Strength Measures in Individuals With Multiple Sclerosis. J Neurol Phys Ther 2024; 48:94-101. [PMID: 38015070 DOI: 10.1097/npt.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE The test-retest reliability and minimal detectable changes (MDCs) for respiratory muscle strength measures have not been determined in individuals with multiple sclerosis (MS). This study determined the test-retest reliability and MDCs for specific respiratory muscle strength measures, as well as their associations with health-related quality of life (HRQoL), disability, dyspnea, and physical activity level measures in this population. In addition, the study examined differences in respiratory muscle strength between different degrees of disability. METHODS Sixty-one individuals with MS attended 2 appointments separated by 7 to 10 days. Respiratory muscle strength was evaluated by maximal inspiratory and expiratory pressures (MIP/MEP), HRQoL by EuroQol-5D-5L (index and visual analog scale [EQ-VAS]), disability by the Expanded Disability Status Scale, dyspnea by the Medical Research Council scale, and physical activity levels by the International Physical Activity Questionnaire. RESULTS Respiratory muscle strength measures had excellent test-retest reliability (ICC ≥ 0.92). The MDC for MIP is 15.42 cmH 2 O and for MEP is 17.84 cmH 2 O. Participants with higher respiratory muscle strength (MIP/MEP cmH 2 O and percentage of predicted values) had higher HRQoL ( r = 0.54-0.62, P < 0.01, EQ-5D-5L index; r = 0.30-0.42, P < 0.05, EQ-VAS); those with higher expiratory muscle strength (cmH 2 O and percentage of predicted values) had lower levels of disability ( r ≤ -0.66) and dyspnea ( r ≤ -0.61). There were differences in respiratory muscle strength between different degrees of disability ( P < 0.01; d ≥ 0.73). DISCUSSION AND CONCLUSION Respiratory muscle strength measures provide excellent test-retest reliability in individuals with MS. MDCs can be interpreted and applied in the clinical setting. Low respiratory muscle strength can contribute to a poor HRQoL; specifically, expiratory muscle strength appears to have the strongest influence on disability status and dyspnea.
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Affiliation(s)
- Sandra Aguilar-Zafra
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain, and Téxum S.L. Physiotherapy Center, Coslada, Madrid, Spain (S.A.Z.); Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain (R.F.G.); and Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, IdISSC, Madrid, Spain (T.d.C., I.L.d.U.V.)
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16
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Martínez-Pozas O, Meléndez-Oliva E, Rolando LM, Rico JAQ, Corbellini C, Sánchez Romero EA. The pulmonary rehabilitation effect on long covid-19 syndrome: A systematic review and meta-analysis. Physiother Res Int 2024; 29:e2077. [PMID: 38389299 DOI: 10.1002/pri.2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/18/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES This systematic review and meta-analysis aims to evaluate the efficacy of pulmonary rehabilitation (PR) in improving dyspnea, fatigue, physical activity, quality of life, anxiety and depression in patients with Long COVID-19 (LC). The impact of PR on LC and a comparison of face-to-face and telerehabilitation approaches was explored. METHODS This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO. A literature search included PubMed, Web of Science, and Cochrane Library until January 2023. No language filters were applied. Randomized controlled trials, non-randomized controlled trials, and observational studies were included. The risk of bias was assessed using appropriate tools. Descriptive analysis and meta-analysis were performed. Forest plots presented results. Statistical analyses were conducted using the Metafor Package in R v.3.4.2. RESULTS/FINDINGS This systematic review and meta-analysis included 16 studies on PR in LC patients. A total of 1027 adults were included. The studies varied in design, with seven observational studies, three quasi-experimental studies, and six randomized controlled trials. Dyspnea, physical function, quality of life, psychological state, and fatigue were assessed as outcomes. The review found that pulmonary rehabilitation had a significant positive effect on dyspnea, physical function, quality of life (both global and physical domain), anxiety, and depression. However, the effect on fatigue was not significant. Heterogeneity was observed in some analyses, and publication bias was found in certain outcomes. Age and study design were identified as potential moderators. Both face-to-face and telerehabilitation interventions improved the studied outcomes, with only differences in the physical domain of quality of life favoring the face-to-face group. IMPLICATIONS ON PHYSIOTHERAPY PRACTICE PR improved dyspnea, physical function, quality of life, and psychological state in LC patients, but not fatigue. Face-to-face and telerehabilitation have similar effects, except for physical quality of life.
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Affiliation(s)
- Oliver Martínez-Pozas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Spain
- Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), Madrid, Spain
| | - Erika Meléndez-Oliva
- Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Valencia, Valencia, Spain
| | | | - José Antonio Quesada Rico
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Camilo Corbellini
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.S.B.L., Differdange, Luxembourg
| | - Eleuterio A Sánchez Romero
- Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
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17
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Liang C, Feng L, Shunlin G. A rare case of massive myxoma. Asian J Surg 2024; 47:1785-1786. [PMID: 38160155 DOI: 10.1016/j.asjsur.2023.12.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Cao Liang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Liu Feng
- The First Clinical Medical College, Lanzhou University, Lanzhou, 730000, China
| | - Guo Shunlin
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
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18
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Matsunaga M, Sato Y, Nagao M, Ikeda M, Motomura C, Kameda M, Yoshida Y, Terada A, Miyairi I, Fujisawa T. Development and validation of a new asthma questionnaire to help achieve a high level of control in school-age children and adolescents. Allergol Int 2024; 73:224-230. [PMID: 38065704 DOI: 10.1016/j.alit.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/17/2023] [Accepted: 11/01/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Maintaining good asthma control minimizes the risk of exacerbations and lung function decline and is a primary goal of asthma management. The Japanese Pediatric Asthma Guidelines (JPGL) employs different classification criteria for control status from other guidelines, stressing a higher level of control. Based on JPGL, we previously developed a caregiver-completed questionnaire for assessing and achieving best asthma control in preschoolers. In this study, we aimed to develop a questionnaire for school-age children and adolescents. METHODS A working questionnaire comprising 14 items for patients and 34 items for caregivers was administered to 362 asthma patients aged 6-15 years and their caregivers. Separately, physicians filled out a questionnaire to determine JPGL-defined control. Logistic regression analysis was performed to construct a model to predict control levels using data from a randomly selected set of completed questionnaires from two-thirds of the subjects. Validation was performed using the remaining questionnaires. RESULTS A set of 7 questions, encompassing self-assessed control status at the time of the visit and in the past month, and nocturnal/early morning asthma symptoms for patients and frequency of asthma symptoms, dyspnea, rescue beta-agonist use, and asthma hospitalization for caregivers, were selected and the 7-item model showed a good statistical fit with AIC of 110.5. The model has been named the Best Asthma Control Test for School Children and Adolescents (Best ACT-S). Best ACT-S scores differed significantly in the hypothetical direction among the groups of different JPGL-defined control levels, step-up/down treatment decisions, and presence/non-presence of exacerbations in the previous year. CONCLUSIONS The Best ACT-S is a valid questionnaire for children/adolescents aiming for best asthma control.
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Affiliation(s)
- Mayumi Matsunaga
- Allergy Center, National Hospital Organization Mie National Hospital, Mie, Japan; Department of Pediatrics, Hamamatsu University Graduate School of Medicine, Hamamatsu, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Mizuho Nagao
- Allergy Center, National Hospital Organization Mie National Hospital, Mie, Japan
| | - Masanori Ikeda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Chikako Motomura
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Makoto Kameda
- Department of Pediatrics, Osaka Habikino Medical Center, Osaka, Japan
| | - Yukinori Yoshida
- Department of Pediatrics, Osaka Habikino Medical Center, Osaka, Japan
| | | | - Isao Miyairi
- Department of Pediatrics, Hamamatsu University Graduate School of Medicine, Hamamatsu, Japan
| | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, Mie, Japan.
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Carvalho D, Rei Pacheco A, Carvalho S, Ferreira R, Briosa Neves A. Trepopnea as a diagnostic clue for malignant disease. Rev Port Cardiol 2024; 43:213-215. [PMID: 37481237 DOI: 10.1016/j.repc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/09/2023] [Accepted: 06/04/2023] [Indexed: 07/24/2023] Open
Affiliation(s)
- Diana Carvalho
- Department of Cardiology, Centro Hospitalar Baixo Vouga, Aveiro, Portugal.
| | | | - Simão Carvalho
- Department of Cardiology, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Raquel Ferreira
- Department of Cardiology, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Ana Briosa Neves
- Department of Cardiology, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
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20
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de Miguel-Díez J, Núñez Villota J, Santos Pérez S, Manito Lorite N, Alcázar Navarrete B, Delgado Jiménez JF, Soler-Cataluña JJ, Pascual Figal D, Sobradillo Ecenarro P, Gómez Doblas JJ. Multidisciplinary Management of Patients With Chronic Obstructive Pulmonary Disease and Cardiovascular Disease. Arch Bronconeumol 2024; 60:226-237. [PMID: 38383272 DOI: 10.1016/j.arbres.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/23/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently coexist, increasing the prevalence of both entities and impacting on symptoms and prognosis. CVD should be suspected in patients with COPD who have high/very high risk scores on validated scales, frequent exacerbations, precordial pain, disproportionate dyspnea, or palpitations. They should be referred to cardiology if they have palpitations of unknown cause or angina pain. COPD should be suspected in patients with CVD if they have recurrent bronchitis, cough and expectoration, or disproportionate dyspnea. They should be referred to a pulmonologist if they have rhonchi or wheezing, air trapping, emphysema, or signs of chronic bronchitis. Treatment of COPD in cardiovascular patients should include long-acting muscarinic receptor antagonists (LAMA) or long-acting beta-agonists (LABA) in low-risk or high-risk non-exacerbators, and LAMA/LABA/inhaled corticosteroids in exacerbators who are not controlled with bronchodilators. Cardioselective beta-blockers should be favored in patients with CVD, the long-term need for amiodarone should be assessed, and antiplatelet drugs should be maintained if indicated.
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Affiliation(s)
- Javier de Miguel-Díez
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain.
| | - Julio Núñez Villota
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Salud Santos Pérez
- Servicio de Neumología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nicolás Manito Lorite
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Juan Francisco Delgado Jiménez
- Servicio de Cardiología e Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Medicina, UCM, CIBERCV, Madrid, Spain
| | - Juan José Soler-Cataluña
- Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Valencia, Spain; Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Domingo Pascual Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
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Rischard F, Altman N, Szmuszkovicz J, Sciurba F, Berman-Rosenzweig E, Lee S, Krishnan S, Truong N, Wood J, Finn AV. Long-Term Effects of COVID-19 on the Cardiopulmonary System in Adults and Children: Current Status and Questions to be Resolved by the National Institutes of Health Researching COVID to Enhance Recovery Initiative. Chest 2024; 165:978-989. [PMID: 38185377 PMCID: PMC11026169 DOI: 10.1016/j.chest.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024] Open
Abstract
TOPIC IMPORTANCE Long COVID may occur in at least 10% of patients recovering from SARS-CoV-2 infection and often is associated with debilitating symptoms. Among the organ systems that might be involved in its pathogenesis, the respiratory and cardiovascular systems may be central to common symptoms seen in survivors of COVID-19, including fatigue, dyspnea, chest pain, cough, and exercise intolerance. Understand the exact symptomatology, causes, and effects of long COVID on the heart and lungs may help us to discover new therapies. To that end, the National Institutes of Health is sponsoring a national study population of diverse volunteers to support large-scale studies on the long-term effects of COVID-19. REVIEW FINDINGS The National Institutes of Health Researching COVID to Enhance Recovery (RECOVER) initiative currently is recruiting participants in the United States to answer critical questions about long COVID. The study comprises adult and pediatric cohorts as well as an electronic health record cohort. Based on symptoms, individuals undergo prespecified medical testing to understand whether abnormalities can be detected and are followed up longitudinally. Herein, we outline current understanding of the clinical symptoms and pathophysiologic features of long COVID with respect to the cardiopulmonary system in adults and children and then determine how the clinical, electronic health record, and autopsy cohorts of the RECOVER initiative will attempt to answer the most pressing questions surrounding the long-term effects of COVID-19. SUMMARY Data generated from the RECOVER initiative will provide guidance about missing gaps in our knowledge about long COVID and how they might be filled by data gathered through the RECOVER initiative.
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Affiliation(s)
- Franz Rischard
- Department of Medicine, University of Arizona, Tucson, AZ
| | - Natasha Altman
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jacqueline Szmuszkovicz
- Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Division of Cardiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Frank Sciurba
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Simon Lee
- Heart Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Sankaran Krishnan
- Boston Children's Health Physicians, New York Medical College, Valhalla, NY
| | - Ngan Truong
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - John Wood
- Department of Pediatrics and Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Aloke V Finn
- CVPath Institute, Gaithersburg, University of Maryland School of Medicine, Baltimore, MD; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
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22
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Andrew LM, Sandler CB, Long CA, Bauman NM, Mudd PA. Exploring Mental Health in a Pediatric Paradoxical Vocal Fold Motion Sample Using Patient-Reported Outcomes. Otolaryngol Head Neck Surg 2024; 170:1167-1172. [PMID: 38193359 DOI: 10.1002/ohn.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Paradoxical vocal fold motion (PVFM) is characterized by inappropriate adduction of vocal folds during inspiration causing dyspnea. While anxiety is suspected to be a predisposing factor, incidence has been understudied. STUDY DESIGNS Retrospective review. SETTING Multidisciplinary PVFM hospital clinic. METHODS We used patient-reported outcome measures to examine anxiety and depression in consecutive patients aged 10 to 17 years using Pediatric SFv1.1 Anxiety 8b and Level 2-Depression inventories (parents completed proxy forms). T-scores were classified as normal (none to slight <55) or elevated (mild 55-59.9, moderate 60-69.9, severe >70). RESULTS Twenty-three pediatric patients and 20 parents completed surveys. Mean age was 13.74 years. For anxiety, 69.6% of patients and 40% of parents identified elevated levels. For depression, 30.4% of patients and 15% of parents identified elevated levels. Therapy need for the sample was 65.2% (34.8% active in services and 30.4% referred). Child anxiety scores were significantly higher in the therapy need group, U = 17, P = .004. CONCLUSION This study of adolescents with PVFM confirmed elevated anxiety and depression scores in 2/3 of the participants. Anxiety likely precedes diagnosis and is a predisposing factor. Referral for individualized intervention targeting anxiety and depression is indicated.
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Affiliation(s)
- Lilia Mucka Andrew
- Psychology, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Claire B Sandler
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Courtney A Long
- Hearing and Speech, Children's National Hospital, Washington, DC, USA
| | - Nancy M Bauman
- Otolaryngology, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Pamela A Mudd
- Otolaryngology, Children's National Hospital, George Washington University, Washington, DC, USA
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23
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Jiang Z, Yang D, Ainiwaer M, Li Q, Mo W, Liu F. Congenital trans-sellar trans-sphenoidal encephalocele: a systematic review of diagnosis, treatment, and prognosis. Eur Arch Otorhinolaryngol 2024; 281:1659-1670. [PMID: 38189965 PMCID: PMC10943159 DOI: 10.1007/s00405-023-08355-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/13/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Clinical presentations encompass respiratory, feeding issues, nasopharyngeal mass, meningitis, CSF leakage, craniofacial anomalies, and endocrine problems. Surgery is the primary treatment, transitioning from frontal craniotomy to endoscopic methods, offering improved outcomes. Yet, more studies are needed. A comprehensive review on trans-sellar trans-sphenoidal encephalocele (TSTSE) is missing. Our study aims to fill this gap, offering a comprehensive perspective for physicians. METHODS This review adhered to the PRISMA guideline. Eligible studies focused on human subjects, specifically trans-sellar encephaloceles, and provided comprehensive treatment details. English language articles published up to April 11th, 2023, were considered. Two trained researchers conducted article screening using consistent criteria. Data extraction covered various aspects, including clinical presentation, surgical methods, and outcomes, with results presented descriptively in two tables. Due to the rarity of this congenital anomaly, meta-analysis and publication bias assessment were not feasible. Data extraction was independently conducted by two reviewers, with subsequent cross-verification. RESULTS A total of 36 patients were identified from 14 studies, the most frequently observed clinical presentation was dyspnea (41.67%) and the most frequently observed accompanying anomaly was cleft lip/palate (55.56%). CT and MRI were adopted in nearly all the cases, and trans-nasal approach was the most often used surgical approach (57.14%) with the 'soft material combination' the most commonly used method for cranial base repairment (35.71%). A total of two deaths occurred and diabetes insipidus was the most common perioperative complication which occurred in six surgery patients (21.43%). CONCLUSION TSTSE predominantly affects males and presents with dyspnea, visual deficits, pituitary insufficiency, and cranial base-related symptoms. Early diagnosis is critical, with advanced imaging playing a key role. Endocrine assessment is vital for hormone management. Surgery offers symptom relief but entails risks, including reported fatalities and complications. The choice between surgery and conservative management requires careful deliberation. The trans-nasal approach is favored for its reduced trauma, yet further research is necessary to validate this preference.
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Affiliation(s)
- Zheng Jiang
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Deming Yang
- Department of Otolaryngology, Zhaotong Second People's Hospital, Zhaotong, 657099, China
| | - Mailudan Ainiwaer
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Qiong Li
- Department of Otolaryngology, The People's Hospital of Jianyang City, Chengdu, 641499, China
| | - Wei Mo
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Feng Liu
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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24
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Mills JF, Monaghan NP, Nguyen SA, O'Rourke AK, Halstead LA, Meyer TA. Adult Laryngomalacia: A Scoping Review. Otolaryngol Head Neck Surg 2024; 170:1020-1031. [PMID: 38219735 DOI: 10.1002/ohn.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE This review sought to determine the characteristics of adults diagnosed with new onset laryngomalacia including airway symptoms, laryngoscopic findings, treatments, and outcomes. Moreover, we wanted to highlight suspected limitations in the literature. DATA SOURCES Studies were identified through CINAHL, Cochrane Review, PubMed, and Scopus published between 1966 and 2023. REVIEW METHODS The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews checklist by 2 independent investigators. A meta-analysis of proportions and continuous measures was conducted. RESULTS Of the 1121 abstracts identified, 33 articles pertaining to laryngomalacia in the adult population were included. The most common presenting symptoms were stridor at rest (78.3%, 65.1-88.3) and dyspnea with exertion (83.8%, 64.8-96.3). The most suspected etiology was exercise-induced (86.0%, 69.4-95.5), and the most common description of laryngomalacia on visualization was collapse of supraglottic structures during exercise (93.3%, 79.0-99.1). Nonsurgical options were attempted in 87.0% (54.0-99.1), which included oral appliances, respiratory retraining, breathing techniques, and working with a speech pathologist. Surgical options were ultimately performed in 84.2% (75.0-91.0). Complete resolution of symptoms following therapy was seen in 61.9% (48.0-74.6). CONCLUSION Adult onset laryngomalacia is difficult to characterize. It typically presents in patients during exercise, with neurological injury, or idiopathically. Surgical management can lead to improvement or complete resolution of symptoms. The need for a universal nomenclature is highlighted in this review, as it is inconsistently classified.
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Affiliation(s)
- John F Mills
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical College, Albany, New York, USA
| | - Neil P Monaghan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lucinda A Halstead
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Ghadery AH, Abbasian L, Jafari F, Yazdi NA, Ahmadinejad Z. Correlation of clinical, laboratory, and short-term outcomes of immunocompromised and immunocompetent COVID-19 patients with semi-quantitative chest CT score findings: A case-control study. Immun Inflamm Dis 2024; 12:e1239. [PMID: 38577996 PMCID: PMC10996371 DOI: 10.1002/iid3.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND As the effects of immunosuppression are not still clear on COVID-19 patients, we conducted this study to identify clinical and laboratory findings associated with pulmonary involvement in both immunocompromised and immunocompetent patients. METHODS A case-control of 107 immunocompromised and 107 immunocompetent COVID-19 patients matched for age and sex with either positive RT-PCR or clinical-radiological findings suggestive of COVID-19 enrolled in the study. Their initial clinical features, laboratory findings, chest CT scans, and short-term outcomes (hospitalization time and intensive care unit [ICU] admission) were recorded. In addition, pulmonary involvement was assessed with the semi-quantitative scoring system (0-25). RESULTS Pulmonary involvement was significantly lower in immunocompromised patients in contrast to immunocompetent patients, especially in RLL (p = 0.001), LUL (p = 0.023), and both central and peripheral (p = 0.002), and peribronchovascular (p = 0.004) sites of lungs. Patchy (p < 0.001), wedged (p = 0.002), confluent (p = 0.002) lesions, and ground glass with consolidation pattern (p < 0.001) were significantly higher among immunocompetent patients. Initial signs and symptoms of immunocompromised patients including dyspnea (p = 0.008) and hemoptysis (p = 0.036), respiratory rate of over 25 (p < 0.001), and spo2 of below 93% (p = 0.01) were associated with higher pulmonary involvement. Total chest CT score was also associated with longer hospitalization (p = 0.016) and ICU admission (p = 0.04) among immunocompromised patients. CONCLUSIONS Pulmonary involvement score was not significantly different among immunocompromised and immunocompetent patients. Initial clinical findings (dyspnea, hemoptysis, higher RR, and lower Spo2) of immunocompromised patients could better predict pulmonary involvement than laboratory findings.
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Affiliation(s)
- Abdolkarim Haji Ghadery
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center(ADIR)Tehran University of Medical SciencesTehranIran
| | - Ladan Abbasian
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Department of Infectious Diseases, Imam Khomeini Hospital Complex, School of MedicineTehran University of Medical SciencesTehranIran
| | - Fatemeh Jafari
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Department of Infectious Diseases, Imam Khomeini Hospital Complex, School of MedicineTehran University of Medical SciencesTehranIran
| | - Niloofar Ayoobi Yazdi
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR)Tehran University of Medical SciencesTehranIran
| | - Zahra Ahmadinejad
- Department of Infectious Diseases, Liver Transplantation Research Center, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
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Puzzolo E, Fleeman N, Lorenzetti F, Rubinstein F, Li Y, Xing R, Shen G, Nix E, Maden M, Bresnahan R, Duarte R, Abebe L, Lewis J, Williams KN, Adahir-Rohani H, Pope D. Estimated health effects from domestic use of gaseous fuels for cooking and heating in high-income, middle-income, and low-income countries: a systematic review and meta-analyses. Lancet Respir Med 2024; 12:281-293. [PMID: 38310914 DOI: 10.1016/s2213-2600(23)00427-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Exposure to household air pollution from polluting domestic fuel (solid fuel and kerosene) represents a substantial global public health burden and there is an urgent need for rapid transition to clean domestic fuels. Gas for cooking and heating might possibly affect child asthma, wheezing, and respiratory health. The aim of this review was to synthesise the evidence on the health effects of gaseous fuels to inform policies for scalable clean household energy. METHODS In this systematic review and meta-analysis, we summarised the health effects from cooking or heating with gas compared with polluting fuels (eg, wood or charcoal) and clean energy (eg, electricity and solar energy). We searched PubMed, Scopus, Web of Science, MEDLINE, Cochrane Library (CENTRAL), Environment Complete, GreenFile, Google Scholar, Wanfang DATA, and CNKI for articles published between Dec 16, 2020, and Feb 6, 2021. Studies eligible for inclusion had to compare gas for cooking or heating with polluting fuels (eg, wood or charcoal) or clean energy (eg, electricity or solar energy) and present data for health outcomes in general populations. Studies that reported health outcomes that were exacerbations of existing underlying conditions were excluded. Several of our reviewers were involved in screening studies, data extraction, and quality assessment (including risk of bias) of included studies; 20% of studies were independently screened, extracted and quality assessed by another reviewer. Disagreements were reconciled through discussion with the wider review team. Included studies were appraised for quality using the Liverpool Quality Assessment Tools. Key health outcomes were grouped for meta-analysis and analysed using Cochrane's RevMan software. Primary outcomes were health effects (eg, acute lower respiratory infections) and secondary outcomes were health symptoms (eg, respiratory symptoms such as wheeze, cough, or breathlessness). This study is registered with PROSPERO, CRD42021227092. FINDINGS 116 studies were included in the meta-analysis (two [2%] randomised controlled trials, 13 [11%] case-control studies, 23 [20%] cohort studies, and 78 [67%] cross-sectional studies), contributing 215 effect estimates for five grouped health outcomes. Compared with polluting fuels, use of gas significantly lowered the risk of pneumonia (OR 0·54, 95% CI 0·38-0·77; p=0·00080), wheeze (OR 0·42, 0·30-0·59; p<0·0001), cough (OR 0·44, 0·32-0·62; p<0·0001), breathlessness (OR 0·40, 0·21-0·76; p=0·0052), chronic obstructive pulmonary disease (OR 0·37, 0·23-0·60; p<0·0001), bronchitis (OR 0·60, 0·43-0·82; p=0·0015), pulmonary function deficit (OR 0·27, 0·17-0·44; p<0·0001), severe respiratory illness or death (OR 0·27, 0·11-0·63; p=0·0024), preterm birth (OR 0·66, 0·45-0·97; p=0·033), and low birth weight (OR 0·70, 0·53-0·93; p=0·015). Non-statistically significant effects were observed for asthma in children (OR 1·04, 0·70-1·55; p=0·84), asthma in adults (OR 0·65, 0·43-1·00; p=0·052), and small for gestational age (OR 1·04, 0·89-1·21; p=0·62). Compared with electricity, use of gas significantly increased risk of pneumonia (OR 1·26, 1·03-1·53; p=0·025) and chronic obstructive pulmonary disease (OR 1·15, 1·06-1·25; p=0·0011), although smaller non-significant effects were observed for higher-quality studies. In addition, a small increased risk of asthma in children was not significant (OR 1·09, 0·99-1·19; p=0·071) and no significant associations were found for adult asthma, wheeze, cough, and breathlessness (p>0·05). A significant decreased risk of bronchitis was observed (OR 0·87, 0·81-0·93; p<0·0001). INTERPRETATION Switching from polluting fuels to gaseous household fuels could lower health risk and associated morbidity and mortality in resource-poor countries where reliance on polluting fuels is greatest. Although gas fuel use was associated with a slightly higher risk for some health outcomes compared with electricity, gas is an important transitional option for health in countries where access to reliable electricity supply for cooking or heating is not feasible in the near term. FUNDING WHO.
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Affiliation(s)
- Elisa Puzzolo
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK.
| | - Nigel Fleeman
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Federico Lorenzetti
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Fernando Rubinstein
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Yaojie Li
- College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Ran Xing
- College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Guofeng Shen
- College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Emily Nix
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Rebecca Bresnahan
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Rui Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Lydia Abebe
- Public Health, Environmental and Social Determinants of Health, WHO, Geneva, Switzerland
| | - Jessica Lewis
- Public Health, Environmental and Social Determinants of Health, WHO, Geneva, Switzerland
| | - Kendra N Williams
- Public Health, Environmental and Social Determinants of Health, WHO, Geneva, Switzerland
| | - Heather Adahir-Rohani
- Public Health, Environmental and Social Determinants of Health, WHO, Geneva, Switzerland
| | - Daniel Pope
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
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Wen X, Huang A, Zhang A, Xu M, Song Y, Cui L, Geng J, Shi J. [Analysis of 141 cases with benign upper airway occupying in infant]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 38:334-338. [PMID: 38563179 DOI: 10.13201/j.issn.2096-7993.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Indexed: 04/04/2024]
Abstract
Objective:To analyze and summarize the clinical characteristics, diagnosis, treatment and prognosis of benign upper airway space occupancy in infants. Methods:The clinical data of 141 cases with begin upper airway space from January 2012 to January 2022 were analyzed. Among them, 101 were male and 68 were female, the age is 0-3 years old. In which there were 24 newborns. The clinical characteristics, auxiliary examination and treatment results were summarized and analyzed. Results:The main clinical manifestations of 141 infants were dyspnea and/or laryngeal wheezing, including 116 cases of congenital cyst of tongue, 15 cases of hair polyps, 4 cases of nasopharyngeal second pharyngeal fissure cysts, 2 cases of congenital laryngeal cysts, 2 cases of pharyngeal bronchial cyst, 1 case of nasopharyngeal teratoma and 1 case of myofibroma. All the infants had completed the corresponding examination and treatment. The diagnosis was clear, and there was no missed diagnosis or misdiagnosis. Among them, 19 infants with congenital cyst of tongue were given cyst puncture to relieve dyspnea. 2 cases of congenital cyst of tongue recurred half a year after operaion, and then they underwent reoperation. The prognosis of the remaining infants were good. Conclusion:The most common occupying of benign upper airway space occupancy is cyst, and low-temperature plasma resection under endoscope is the main treatment method. Timely puncture therapy is also a safe and effective treatment for infants who are dyspnea and life threatening.
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Affiliation(s)
- Xin Wen
- Department of Otolaryngology,Hebei Children' s Hospital,Shijiazhuang,050031,China
| | - Aiping Huang
- Department of Otolaryngology,Hebei Children' s Hospital,Shijiazhuang,050031,China
| | - Aiying Zhang
- Department of Otolaryngology,Hebei Children' s Hospital,Shijiazhuang,050031,China
| | - Min Xu
- Department of Otolaryngology,Hebei Children' s Hospital,Shijiazhuang,050031,China
| | - Yingluan Song
- Department of Otolaryngology,Hebei Children' s Hospital,Shijiazhuang,050031,China
| | - Li Cui
- Department of Otolaryngology,Hebei Children' s Hospital,Shijiazhuang,050031,China
| | - Jiangqiao Geng
- Department of Otolaryngology,Hebei Children' s Hospital,Shijiazhuang,050031,China
| | - Jing Shi
- Department of Anesthesiology,Hebei Children's Hospital
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Barboza M, Oliveira C, Mont'Alverne D, Morano M, Lima V, Velloso M. Cardiopulmonary responses during unsupported upper limb exercise tests and limitations in activities of daily living in individuals with chronic obstructive pulmonary disease. Physiother Theory Pract 2024; 40:695-703. [PMID: 36528786 DOI: 10.1080/09593985.2022.2157688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Cardiopulmonary responses during unsupported upper limb function assessment may vary in chronic obstructive pulmonary disease (COPD). OBJECTIVE To compare the cardiopulmonary responses during the function assessment with the Six-Minute Pegboard and Ring Test (6PBRT) and the incremental Unsupported Upper Limb Exercise (UULEX) test in COPD and to investigate the correlations with muscle strength and the limitations on activity of daily living (ADLs). METHODS This was a cross-sectional study. Cardiopulmonary variables were recorded during tests using a breath-by-breath analyzer. Muscle strength was assessed using a hand-held dynamometer. Self-reported ADL was evaluated using the modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M). Paired t-test, Wilcoxon signed rank test, and Spearman correlation coefficients were used. RESULTS Fifteen individuals with moderate-to-severe COPD participated (66 ± 9 years old, forced expiratory volume in the first second [FEV1]: 48%±14% of predicted). The UULEX induced higher oxygen consumption (0.54 ± 0.20 vs. 0.44 ± 0.09 L/min, p = .01) and dyspnea (4.0 [2.6 to 6.9] vs. 0.5 [0.9 to 5.1], p < .01) than 6PBRT. The performance in both tests was correlated with self-reported ADL limitations on PFSDQ-M (6PBRT: r = -0.69, p < .01; UULEX: r = -0.62, p = .01). CONCLUSION The UULEX promoted greater cardiopulmonary responses than 6PBRT, and performance in 6PBRT and UULEX was correlated with ADL limitations in individuals with COPD.
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Affiliation(s)
- Michelli Barboza
- Physical Therapy Course, University of Fortaleza, Fortaleza, Brazil
- Postgraduate Research Program on Rehabilitation Sciences, Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cristino Oliveira
- Postgraduate Research Program on Rehabilitation Sciences, Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Postgraduate Research Program on Rehabilitation Sciences and Physical Functional Performance, Faculty of Physical Therapy, Federal University of Juiz de For a, Juiz de Fora, Brazil
| | - Daniela Mont'Alverne
- Masters Program in Physical Therapy and Functioning, Department of Physical Therapy, Federal University of Ceará, Fortaleza, Brazil
| | - Maria Morano
- Physical Therapy Course, University of Fortaleza, Fortaleza, Brazil
- Pulmonary Rehabilitation division, Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | - Vanessa Lima
- Postgraduate Research Program on Rehabilitation and Functional Performance, Department of Physical Therapy, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, Brazil
| | - Marcelo Velloso
- Postgraduate Research Program on Rehabilitation Sciences, Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Lladós G, Massanella M, Coll-Fernández R, Rodríguez R, Hernández E, Lucente G, López C, Loste C, Santos JR, España-Cueto S, Nevot M, Muñoz-López F, Silva-Arrieta S, Brander C, Durà MJ, Cuadras P, Bechini J, Tenesa M, Martinez-Piñeiro A, Herrero C, Chamorro A, Garcia A, Grau E, Clotet B, Paredes R, Mateu L. Vagus nerve dysfunction in the post-COVID-19 condition: a pilot cross-sectional study. Clin Microbiol Infect 2024; 30:515-521. [PMID: 37984511 DOI: 10.1016/j.cmi.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES The post-COVID-19 condition (PCC) is a disabling syndrome affecting at least 5%-10% of subjects who survive COVID-19. SARS-CoV-2 mediated vagus nerve dysfunction could explain some PCC symptoms, such as dysphonia, dysphagia, dyspnea, dizziness, tachycardia, orthostatic hypotension, gastrointestinal disturbances, or neurocognitive complaints. METHODS We performed a cross-sectional pilot study in subjects with PCC with symptoms suggesting vagus nerve dysfunction (n = 30) and compared them with subjects fully recovered from acute COVID-19 (n = 14) and with individuals never infected (n = 16). We evaluated the structure and function of the vagus nerve and respiratory muscles. RESULTS Participants were mostly women (24 of 30, 80%), and the median age was 44 years (interquartile range [IQR] 35-51 years). Their most prevalent symptoms were cognitive dysfunction 25 of 30 (83%), dyspnea 24 of 30 (80%), and tachycardia 24 of 30 (80%). Compared with COVID-19-recovered and uninfected controls, respectively, subjects with PCC were more likely to show thickening and hyperechogenic vagus nerve in neck ultrasounds (cross-sectional area [CSA] [mean ± standard deviation]: 2.4 ± 0.97mm2 vs. 2 ± 0.52mm2 vs. 1.9 ± 0.73 mm2; p 0.08), reduced esophageal-gastric-intestinal peristalsis (34% vs. 0% vs. 21%; p 0.02), gastroesophageal reflux (34% vs. 19% vs. 7%; p 0.13), and hiatal hernia (25% vs. 0% vs. 7%; p 0.05). Subjects with PCC showed flattening hemidiaphragms (47% vs. 6% vs. 14%; p 0.007), and reductions in maximum inspiratory pressure (62% vs. 6% vs. 17%; p ≤ 0.001), indicating respiratory muscle weakness. The latter findings suggest additional involvement of the phrenic nerve. DISCUSSION Vagus and phrenic nerve dysfunction contribute to the complex and multifactorial pathophysiology of PCC.
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Affiliation(s)
- Gemma Lladós
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Marta Massanella
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, Madrid, Spain
| | - Roser Coll-Fernández
- Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; Department of Rehabilitation, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Raúl Rodríguez
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Electra Hernández
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Giuseppe Lucente
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Cristina López
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain
| | - Cora Loste
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain
| | - José Ramón Santos
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain
| | - Sergio España-Cueto
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Maria Nevot
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Francisco Muñoz-López
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Sandra Silva-Arrieta
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Christian Brander
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Maria José Durà
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Department of Rehabilitation, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Patricia Cuadras
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Jordi Bechini
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Montserrat Tenesa
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Alicia Martinez-Piñeiro
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Cristina Herrero
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Anna Chamorro
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Anna Garcia
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Eulalia Grau
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain
| | - Bonaventura Clotet
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain
| | - Roger Paredes
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, Madrid, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain; Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lourdes Mateu
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain.
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Xu R, Zhang J, Zheng J, Wu Q. Allergic bronchopulmonary mycosis due to Schizophyllum commune in a patient with chronic hepatitis B. J Infect Dev Ctries 2024; 18:488-494. [PMID: 38635609 DOI: 10.3855/jidc.18024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/11/2023] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Schizophyllum commune (S. commune) is an opportunistic pathogenic fungus and can cause infection of the respiratory system in immunocompromised hosts. Allergic bronchopulmonary mycosis (ABPM) is the major disease caused by S. commune. However, identification of S. commune using routine mycological diagnostic methods is difficult. It is easy to make mistakes in diagnosis and treatment, resulting in deterioration of the disease. We report the first case of ABPM due to S. commune in a Chinese patient with chronic hepatitis B. CASE PRESENTATION The patient presented cough, sputum and dyspnea for six months. The pathogen was missed during routine laboratory workup. We performed bronchoscopy examination and bronchoalveolar lavage. S. commune was identified by metagenomic next-generation sequencing (mNGS) of bronchial alveolar lavage fluid (BALF). Hence, the patient was immediately treated with 200 mg voriconazole twice daily (intravenous infusion) and 20 mg prednisone once a day (oral therapy), along with oral entecavir for hepatitis B. There was no recurrence of infection after the medication was discontinued. CONCLUSIONS S. commune infection should be considered in the diagnosis of patients with refractory cough, sputum and dyspnea, especially in immunocompromised individuals. The mNGS technique is an effective supplementary technique for the diagnosis of S. commune infection, enabling precise clinical decision-making and appropriate treatment. Most patients have good prognosis with a combination of proper antifungal therapy and hormonal therapy.
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Affiliation(s)
- Rui Xu
- Department of Respiratory and Critical Care Medicine, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou Ninth People's Hospital, Suzhou 215200, China
| | - Jianfeng Zhang
- Department of Respiratory and Critical Care Medicine, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou Ninth People's Hospital, Suzhou 215200, China
| | - Jiangnan Zheng
- Department of Respiratory and Critical Care Medicine, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou Ninth People's Hospital, Suzhou 215200, China
| | - Qiaozhen Wu
- Department of Respiratory and Critical Care Medicine, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou Ninth People's Hospital, Suzhou 215200, China
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Gholinataj Jelodar M, Nadershahbaz M, Mirzaei S, Montazerolhodjah M, Saghafi F. Clinical and imaging features of patients with COVID-19 in a double-center cohort study. J Infect Dev Ctries 2024; 18:337-349. [PMID: 38635611 DOI: 10.3855/jidc.17817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/18/2023] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION There is extensive published data on coronavirus disease 2019 (COVID-19). However, information on the effective factors that improve the pulmonary involvement of COVID-19 patients, and long-term clinical and imaging follow-up of these patients is limited. METHODOLOGY This is a prospective cohort study on patients with COVID-19 who were hospitalized in two major academic hospitals in Yazd, Iran. The correlation between the baseline demographic and clinical/para-clinical data with the imaging resolution status at day 60 was assessed. RESULTS 122 patients, including 65 males, with an average age of 53.43 years participated in this study. Age, gender, baseline oxygen saturation (O2Sat), and the percentage of lung involvement were the main prognostic factors. Our results suggest that with every year increase in age, the probability of complete imaging resolution decreases by 6.4%. In addition, women are 2.07 times more likely to recover completely. Moreover, each percent increase of baseline O2Sat makes the patients 15.4% more likely to fully recover. As the patients' shortness of breath increases, the probability of recovery decreases by 9.8%.;56.7% of patients who did not recover after 60 days had persistent shortness of breath, while only 21% of those who recovered had symptoms of dyspnea after day 60. CONCLUSIONS Age, gender, baseline O2Sat, percentage of lung involvement, and shortness of breath were identified as the main risk factors in the recovery of patients with COVID-19. Long-term follow-up of patients with COVID-19, especially patients with high-risk factors, is necessary.
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Affiliation(s)
- Mohsen Gholinataj Jelodar
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahshid Nadershahbaz
- Pharmaceutical Sciences Research Center, School of Pharmacy, Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Samaneh Mirzaei
- Department of Health in Emergencies and Disasters, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Fatemeh Saghafi
- Department of Clinical Pharmacy, School of Pharmacy and Pharmaceutical Sciences Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Sung S, Kim Y, Kim SH, Jung H. Identification of Predictors for Clinical Deterioration in Patients With COVID-19 via Electronic Nursing Records: Retrospective Observational Study. J Med Internet Res 2024; 26:e53343. [PMID: 38414056 PMCID: PMC10984341 DOI: 10.2196/53343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/26/2023] [Accepted: 02/27/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Few studies have used standardized nursing records with Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) to identify predictors of clinical deterioration. OBJECTIVE This study aims to standardize the nursing documentation records of patients with COVID-19 using SNOMED CT and identify predictive factors of clinical deterioration in patients with COVID-19 via standardized nursing records. METHODS In this study, 57,558 nursing statements from 226 patients with COVID-19 were analyzed. Among these, 45,852 statements were from 207 patients in the stable (control) group and 11,706 from 19 patients in the exacerbated (case) group who were transferred to the intensive care unit within 7 days. The data were collected between December 2019 and June 2022. These nursing statements were standardized using the SNOMED CT International Edition released on November 30, 2022. The 260 unique nursing statements that accounted for the top 90% of 57,558 statements were selected as the mapping source and mapped into SNOMED CT concepts based on their meaning by 2 experts with more than 5 years of SNOMED CT mapping experience. To identify the main features of nursing statements associated with the exacerbation of patient condition, random forest algorithms were used, and optimal hyperparameters were selected for nursing problems or outcomes and nursing procedure-related statements. Additionally, logistic regression analysis was conducted to identify features that determine clinical deterioration in patients with COVID-19. RESULTS All nursing statements were semantically mapped to SNOMED CT concepts for "clinical finding," "situation with explicit context," and "procedure" hierarchies. The interrater reliability of the mapping results was 87.7%. The most important features calculated by random forest were "oxygen saturation below reference range," "dyspnea," "tachypnea," and "cough" in "clinical finding," and "oxygen therapy," "pulse oximetry monitoring," "temperature taking," "notification of physician," and "education about isolation for infection control" in "procedure." Among these, "dyspnea" and "inadequate food diet" in "clinical finding" increased clinical deterioration risk (dyspnea: odds ratio [OR] 5.99, 95% CI 2.25-20.29; inadequate food diet: OR 10.0, 95% CI 2.71-40.84), and "oxygen therapy" and "notification of physician" in "procedure" also increased the risk of clinical deterioration in patients with COVID-19 (oxygen therapy: OR 1.89, 95% CI 1.25-3.05; notification of physician: OR 1.72, 95% CI 1.02-2.97). CONCLUSIONS The study used SNOMED CT to express and standardize nursing statements. Further, it revealed the importance of standardized nursing records as predictive variables for clinical deterioration in patients.
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Affiliation(s)
- Sumi Sung
- Department of Nursing Science, Research Institute of Nursing Science, Chungbuk National University, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Youlim Kim
- Department of Radiation Oncology, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Su Hwan Kim
- Department of Information Statistics, Gyeongsang National University, Jinju, Gyeongsangnam-do, Republic of Korea
| | - Hyesil Jung
- Department of Nursing, College of Medicine, Inha University, Incheon, Republic of Korea
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Shin J, Miaskowski C, Wong ML, Yates P, Olshen AB, Roy R, Dokiparthi V, Cooper B, Paul S, Conley YP, Levine JD, Hammer MJ, Kober K. Perturbations in inflammatory pathways are associated with shortness of breath profiles in oncology patients receiving chemotherapy. Support Care Cancer 2024; 32:250. [PMID: 38532105 DOI: 10.1007/s00520-024-08446-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE One plausible mechanistic hypothesis is the potential contribution of inflammatory mechanisms to shortness of breath. This study was aimed to evaluate for associations between the occurrence of shortness of breath and perturbations in inflammatory pathways. METHODS Patients with cancer reported the occurrence of shortness of breath six times over two cycles of chemotherapy. Latent class analysis was used to identify subgroups of patients with distinct shortness of breath occurrence profiles (i.e., none (70.5%), decreasing (8.2%), increasing (7.8%), high (13.5%)). Using an extreme phenotype approach, whole transcriptome differential gene expression and pathway impact analyses were performed to evaluate for perturbed signaling pathways associated with shortness of breath between the none and high classes. Two independent samples (RNA-sequencing (n = 293) and microarray (n = 295) methodologies) were evaluated. Fisher's combined probability method was used to combine these results to obtain a global test of the null hypothesis. In addition, an unweighted knowledge network was created using the specific pathway maps to evaluate for interconnections among these pathways. RESULTS Twenty-nine Kyoto Encyclopedia of Genes and Genomes inflammatory signaling pathways were perturbed. The mitogen-activated protein kinase signaling pathway node had the highest closeness, betweenness, and degree scores. In addition, five common respiratory disease-related pathways, that may share mechanisms with cancer-related shortness of breath, were perturbed. CONCLUSIONS Findings provide preliminary support for the hypothesis that inflammation contribute to the occurrence of shortness of breath in patients with cancer. In addition, the mechanisms that underlie shortness of breath in oncology patients may be similar to other respiratory diseases.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
- School of Medicine, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Melisa L Wong
- School of Medicine, University of California, San Francisco, CA, USA
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Adam B Olshen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Ritu Roy
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Vasuda Dokiparthi
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Bruce Cooper
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Steven Paul
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Yvette P Conley
- School of Nursing, Univeristy of Pittsburgh, 3500 Victoria St, Pittsburgh, 15213, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Kord Kober
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
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Kim KH, Han JY, Park J, Cho JS. The First Korean Case with Cardiac, Facial, and Digital Anomalies with Developmental Delay Caused by De Novo TRAF7 p.Arg655Gln Variant. Int J Mol Sci 2024; 25:3701. [PMID: 38612512 PMCID: PMC11011995 DOI: 10.3390/ijms25073701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
TRAF7-related disorders represent some of the rarest inherited disorders, exhibiting clinical features that overlap with cardiac, facial, and digital anomalies with developmental delay (CAFDADD) syndrome, as well as blepharophimosis-mental retardation syndrome (BMRS). A 36-year-old male, presenting with total blindness, blepharophimosis, and intellectual disability, was admitted for the assessment of resting dyspnea several months previously. He had a history of being diagnosed with obstructive sleep apnea (OSA). Transesophageal and transthoracic echocardiography unveiled right ventricular dilatation without significant pulmonary hypertension, bicuspid aortic valve with aortic root aneurysm, and aortic regurgitation in the proband. Sanger sequencing identified a de novo TRAF7 variant (c.1964G>A; p.Arg655Gln). Subsequently, aortic root replacement using the Bentall procedure was performed. However, despite the surgery, he continued to experience dyspnea. Upon re-evaluating OSA with polysomnography, it was discovered that continuous positive airway pressure support alleviated his symptoms. The underlying cause of his symptoms was attributed to OSA, likely exacerbated by the vertebral anomaly and short neck associated with CAFDADD syndrome. Clinicians should be attentive to the symptoms associated with OSA as it is a potentially serious medical condition in patients with TRAF7 variants.
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Affiliation(s)
- Kyung Hee Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Ji Yoon Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Joonhong Park
- Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Republic of Korea;
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Jung Sun Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Meng L, Xiao J, Wang L, Huang Z. Acute exacerbation of idiopathic pulmonary fibrosis disease: a diagnosis model in China. Eur J Med Res 2024; 29:198. [PMID: 38528574 DOI: 10.1186/s40001-024-01791-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To develop and validate a diagnosis model to inform risk stratified decisions for idiopathic pulmonary fibrosis patients experiencing acute exacerbations (AE-IPF). METHODS In this retrospective cohort study performed from 1 January 2016 to 31 December 2022, we used data from the West China Hospital of Sichuan University for model development and validation. Blood test results and the underlying diseases of patients were collected through the HIS system and LIS system. An algorithm for filtering candidate variables based on least absolute shrinkage and selection operator (LASSO) regression. Logistic regression was performed to develop the risk model. Multiple imputation handled missing predictor data. Model performance was assessed through calibration and diagnostic odds ratio. RESULTS 311 and 133 participants were included in the development and validation cohorts, respectively. 3 candidate predictors (29 parameters) were included. A logistic regression analysis revealed that dyspnea, percentage of CD4+ T-lymphocytes, and percentage of monocytes are independent risk factors for AE-IPF. Nomographic model was constructed using these independent risk factors, and the C-index was 0.69. For internal validation, the C-index was 0.69, and that indicated good accuracy. Diagnostic odds ratio was 5.40. Meanwhile, in mild, moderate, and severe subgroups, AE positivity rates were 0.37, 0.47, and 0.81, respectively. The diagnostic model can classify patients with AE-IPF into different risk classes based on dyspnea, percentage of CD4+ T-lymphocytes, and percentage of monocytes. CONCLUSION A diagnosis model was developed and validated that used information collected from HIS system and LIS system and may be used to risk stratify idiopathic pulmonary fibrosis patients experiencing acute exacerbations.
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Affiliation(s)
- Liye Meng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jun Xiao
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Li Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhuochun Huang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Abuyousef S, Alnaimi S, Omar NE, Elajez R, Elmekaty E, Abdelfattah-Arafa E, Barazi R, Ghasoub R, Rahhal A, Hamou F, Al-Amri M, Karawia A, Ajaj F, Alkhawaja R, Kardousha A, Awaisu A, Abou-Ali A, Khatib M, Aboukamar M, Al-Hail M. Early predictors of intensive care unit admission among COVID-19 patients in Qatar. Front Public Health 2024; 12:1278046. [PMID: 38572008 PMCID: PMC10987715 DOI: 10.3389/fpubh.2024.1278046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/19/2024] [Indexed: 04/05/2024] Open
Abstract
Background COVID-19 is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission among patients with COVID-19. Methods This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29-May 29, 2020. For each case enrolled, one control was matched by age and gender. Results A total of 1,560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (adjusted odds ratio (aOR) = 1.64, 95% confidence interval (CI): 1.16-2.32, p = 0.005), diabetes (aOR = 1.52, 95% CI: 1.08-2.13, p = 0.016), obesity (aOR = 1.46, 95% CI: 1.03-2.08, p = 0.034), lymphopenia (aOR = 2.69, 95% CI: 1.80-4.02, p < 0.001), high AST (aOR = 2.59, 95% CI: 1.53-4.36, p < 0.001), high ferritin (aOR = 1.96, 95% CI: 1.40-2.74, p < 0.001), high CRP (aOR = 4.09, 95% CI: 2.81-5.96, p < 0.001), and dyspnea (aOR = 2.50, 95% CI: 1.77-3.54, p < 0.001). Conclusion Having cardiovascular disease, diabetes, obesity, lymphopenia, dyspnea, and increased AST, ferritin, and CRP were independent predictors for ICU admission in patients with COVID-19.
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Affiliation(s)
- Safae Abuyousef
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shaikha Alnaimi
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | - Nabil E. Omar
- Department of Pharmacy, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
- Health Sciences Program, Clinical and Population Health Research, College of Pharmacy, Qatar University, Doha, Qatar
| | - Reem Elajez
- Department of Pharmacy, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Eman Elmekaty
- Department of Pharmacy, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Raja Barazi
- Department of Pharmacy, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rola Ghasoub
- Department of Pharmacy, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ala Rahhal
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fatima Hamou
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maha Al-Amri
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Karawia
- Department of Pharmacy, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fatima Ajaj
- Department of Pharmacy, Home Health Care, Hamad Medical Corporation, Doha, Qatar
| | - Raja Alkhawaja
- Department of Pharmacy, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Kardousha
- Department of Pharmacy, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Adel Abou-Ali
- Astellas Pharma Global Development, Inc., Northbrook, IL, United States
| | - Mohamad Khatib
- Department of Critical Care, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Aboukamar
- Department of Infectious Disease, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Moza Al-Hail
- Department of Pharmacy, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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Ruiyin W, Qi J, Tingting W, Yuqin Y, Yan J, Kun P. Long COVID outcomes following omicron wave in non-hospital population. Front Public Health 2024; 12:1377866. [PMID: 38560433 PMCID: PMC10978792 DOI: 10.3389/fpubh.2024.1377866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Background The persistence of symptoms or the development of new symptoms following a diagnosis of SARS-CoV-2 has given rise to a multifaceted clinical condition referred to as "long COVID" (LC). The understanding of LC among China's non-hospitalized population continues to be insufficient. This investigation was designed to evaluate the protracted consequences amongst this demographic, as well as to identify the associated risk factors. Methods This research constitutes a prospective cohort study focusing on non-hospitalized individuals, aged between 18 and 59, who have been positively diagnosed with COVID-19. Each participant was subjected to a sequence of questionnaire-based surveys, designed to evaluate symptoms as well as the status of depression and anxiety. A logistic regression model, adjusted for multiple variables, was employed to scrutinize the correlation between demographic elements, lifestyle attributes, and health-related risk factors in relation to conditions and symptoms post COVID-19 infection. Results A total of 706 individuals participated in the 3 months follow-up, with 620 continuing on to the 6 months follow-up. The median age was 35 (28, 43) years, and 597 (85%) are female. Upon follow-up, Compared with patients without LC, patients with LC have a higher proportion of females (420 (87%) vs. 177 (79%); p = 0.010), were older (35 (29, 44) years vs. 33 (27, 41) years; p = 0.010) and have more comorbidities. Out of all participants, 483 (68.4%) reported experiencing at least one symptom at the 3 months mark, while 49.7% reported symptoms persisting at the 6 months mark. At the 3 months follow-up, the most prevalent persistent symptoms were cough (46%), fatigue (38%), and shortness of breath (34%). By the 6 months follow-up, fatigue (25%), shortness of breath (22%), and sleep disorders (16%) were the most commonly reported symptoms. Anxiety and depression were consistently reported as prevalent symptoms throughout the follow-up period. Most patient symptoms fade over time, with the quickest decreases observed in cough (from 46 to 9%), expectoration (from 26 to 6.3%), smell disorder (from 16 to 3.9%), and taste disorder (from 18 to 3.5%). Male and those possessing advanced educational qualifications exhibit a decreased susceptibility to the sustained incidence of coughing. Conversely, older age and the presence of comorbidities were identified as risk factors for persistent fatigue and shortness of breath. Conclusion In the after of COVID-19, it has been observed that the majority of patient symptoms tend to decrease over time. The primary residual symptoms noticed after a 6 month follow-up were fatigue, dyspnea, and sleep disturbances. However, it's noteworthy that the risk factors associated with these symptoms exhibit subtle variations. Furthermore, psychological sequelae, namely depression and anxiety, are frequently reported among COVID-19 survivors.
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Affiliation(s)
- Wang Ruiyin
- Department of Respiratory, Beijing Longfu Hospital, Beijing, China
| | - Jia Qi
- Department of Respiratory, Beijing Longfu Hospital, Beijing, China
| | - Wang Tingting
- Department of Respiratory, Beijing Longfu Hospital, Beijing, China
| | - Yan Yuqin
- Department of Respiratory, Beijing Longfu Hospital, Beijing, China
| | - Jia Yan
- Department of Respiratory, Beijing Longfu Hospital, Beijing, China
| | - Peng Kun
- Department of Office of the Hospital, Beijing Longfu Hospital, Beijing, China
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Kitsios GD, Blacka S, Jacobs JJ, Mirza T, Naqvi A, Gentry H, Murray C, Wang X, Golubykh K, Qurashi H, Dodia A, Risbano M, Benigno M, Emir B, Weinstein E, Bramson C, Jiang L, Dai F, Szigethy E, Mellors JW, Methe B, Sciurba FC, Nouraie SM, Morris A. Subphenotypes of self-reported symptoms and outcomes in long COVID: a prospective cohort study with latent class analysis. BMJ Open 2024; 14:e077869. [PMID: 38485476 PMCID: PMC10941166 DOI: 10.1136/bmjopen-2023-077869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To characterise subphenotypes of self-reported symptoms and outcomes (SRSOs) in postacute sequelae of COVID-19 (PASC). DESIGN Prospective, observational cohort study of subjects with PASC. SETTING Academic tertiary centre from five clinical referral sources. PARTICIPANTS Adults with COVID-19 ≥20 days before enrolment and presence of any new self-reported symptoms following COVID-19. EXPOSURES We collected data on clinical variables and SRSOs via structured telephone interviews and performed standardised assessments with validated clinical numerical scales to capture psychological symptoms, neurocognitive functioning and cardiopulmonary function. We collected saliva and stool samples for quantification of SARS-CoV-2 RNA via quantitative PCR. OUTCOMES MEASURES Description of PASC SRSOs burden and duration, derivation of distinct PASC subphenotypes via latent class analysis (LCA) and relationship with viral load. RESULTS We analysed baseline data for 214 individuals with a study visit at a median of 197.5 days after COVID-19 diagnosis. Participants reported ever having a median of 9/16 symptoms (IQR 6-11) after acute COVID-19, with muscle-aches, dyspnoea and headache being the most common. Fatigue, cognitive impairment and dyspnoea were experienced for a longer time. Participants had a lower burden of active symptoms (median 3 (1-6)) than those ever experienced (p<0.001). Unsupervised LCA of symptoms revealed three clinically active PASC subphenotypes: a high burden constitutional symptoms (21.9%), a persistent loss/change of smell and taste (20.6%) and a minimal residual symptoms subphenotype (57.5%). Subphenotype assignments were strongly associated with self-assessments of global health, recovery and PASC impact on employment (p<0.001) as well as referral source for enrolment. Viral persistence (5.6% saliva and 1% stool samples positive) did not explain SRSOs or subphenotypes. CONCLUSIONS We identified three distinct PASC subphenotypes. We highlight that although most symptoms progressively resolve, specific PASC subpopulations are impacted by either high burden of constitutional symptoms or persistent olfactory/gustatory dysfunction, requiring prospective identification and targeted preventive or therapeutic interventions.
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Affiliation(s)
- Georgios D Kitsios
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawna Blacka
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jana J Jacobs
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Taaha Mirza
- Internal Medicine Residency Program, UPMC in Central Pa, Harrisburg, Pennsylvania, USA
| | - Asma Naqvi
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Heather Gentry
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cathy Murray
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xiaohong Wang
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Konstantin Golubykh
- Internal Medicine Residency Program, UPMC in Central Pa, Harrisburg, Pennsylvania, USA
| | - Hafiz Qurashi
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Akash Dodia
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Risbano
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | - Feng Dai
- Pfizer Inc, New York, New York, USA
| | - Eva Szigethy
- Department of Psychiatry and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John W Mellors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Barbara Methe
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Emphysema Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Seyed Mehdi Nouraie
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alison Morris
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zhu J, Yin W, Xiao Y, Yuan ML, Ni F, Hu Y. [Application of interventional respiratory techniques in the treatment of pulmonary bullae:an update]. Zhonghua Jie He He Hu Xi Za Zhi 2024; 47:259-264. [PMID: 38448179 DOI: 10.3760/cma.j.cn112147-20230902-00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Pulmonary bullae is a common complication of chronic obstructive pulmonary disease(COPD), causing the deterioration in lung function, leading to aggravated dyspnea and poor quality of life for patients. The traditional therapeutic approach for pulmonary bullae is bullectomy using surgical thoracoscopy. The disadvantage of this approach is the postoperative complications and high risk of recurrence in many patients. In addition, for some patients, due to the patient's physical conditions, such as poor lung function and other diseases, bullectomy could not be used. Therefore, new alternative approaches were urgently needed. In recent years, interventional respiratory technology has been trialed to treat pulmonary bulla all around the world and has achieved great success. In this paper, we reviewed the relevant clinical research progress of interventional respiratory medicine techniques in the treatment of pulmonary bullae.
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Affiliation(s)
- J Zhu
- Department of Pulmonary and Critical Care Medicine, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology & Wuhan Clinical Research Center for Interventional Diagnosis and Treatment of Respiratory Diseases, Wuhan 430014,China
| | - W Yin
- Department of Pulmonary and Critical Care Medicine, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology & Wuhan Clinical Research Center for Interventional Diagnosis and Treatment of Respiratory Diseases, Wuhan 430014,China
| | - Y Xiao
- Department of Pulmonary and Critical Care Medicine, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology & Wuhan Clinical Research Center for Interventional Diagnosis and Treatment of Respiratory Diseases, Wuhan 430014,China
| | - M L Yuan
- Department of Pulmonary and Critical Care Medicine, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology & Wuhan Clinical Research Center for Interventional Diagnosis and Treatment of Respiratory Diseases, Wuhan 430014,China
| | - F Ni
- Department of Pulmonary and Critical Care Medicine, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology & Wuhan Clinical Research Center for Interventional Diagnosis and Treatment of Respiratory Diseases, Wuhan 430014,China
| | - Y Hu
- Department of Pulmonary and Critical Care Medicine, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology & Wuhan Clinical Research Center for Interventional Diagnosis and Treatment of Respiratory Diseases, Wuhan 430014,China
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Chen RX, Mai YL, Shen KN, Zhang T, Shi JH, Yang YL. [A case of follicular lymphoma with recurrent fever and pulmonary infiltrates]. Zhonghua Jie He He Hu Xi Za Zhi 2024; 47:222-227. [PMID: 38448171 DOI: 10.3760/cma.j.cn112147-20230829-00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
We reported a case of a 65-year-old male who had been treated with obinutuzumab and chemotherapy for follicular lymphoma. He was infected with SARS-CoV-2 after the second course of therapy. He developed fever, cough and bilateral pulmonary infiltrates. His nasopharyngeal swab became negative only temporarily after repeated courses of antiviral therapy, and the symptoms and pulmonary infiltrates waxed and waned. He presented to our hospital with exertional dyspnea and hypoxemia after his nasopharyngeal swab was positive for SARS-CoV-2 for the fourth time. He had an elevated serum lactate dehydrogenase and a positive 1, 3-β-D-glucan test. The PCR test for Pneumocystis jirovecii in the sputum was positive. The patient was diagnosed with persistent COVID-19 and Pneumocystis jirovecii pneumonia. He responded well to the combination treatment of antiviral medication, convalescent plasma, trimethoprim-sulfamethoxazole and corticosteroids.
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Affiliation(s)
- R X Chen
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y L Mai
- Department of Infectious Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - K N Shen
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - T Zhang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J H Shi
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y L Yang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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King JP, Chung JR, Donahue JG, Martin ET, Leis AM, Monto AS, Gaglani M, Dunnigan K, Raiyani C, Saydah S, Flannery B, Belongia EA. Post-recovery health domain scores among outpatients by SARS-CoV-2 testing status during the pre-Delta period. BMC Infect Dis 2024; 24:300. [PMID: 38454352 PMCID: PMC10921777 DOI: 10.1186/s12879-024-09108-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Symptoms of COVID-19 including fatigue and dyspnea, may persist for weeks to months after SARS-CoV-2 infection. This study compared self-reported disability among SARS-CoV-2-positive and negative persons with mild to moderate COVID-19-like illness who presented for outpatient care before widespread COVID-19 vaccination. METHODS Unvaccinated adults with COVID-19-like illness enrolled within 10 days of illness onset at three US Flu Vaccine Effectiveness Network sites were tested for SARS-CoV-2 by molecular assay. Enrollees completed an enrollment questionnaire and two follow-up surveys (7-24 days and 2-7 months after illness onset) online or by phone to assess illness characteristics and health status. The second follow-up survey included questions measuring global health, physical function, fatigue, and dyspnea. Scores in the four domains were compared by participants' SARS-CoV-2 test results in univariate analysis and multivariable Gamma regression. RESULTS During September 22, 2020 - February 13, 2021, 2712 eligible adults were enrolled, 1541 completed the first follow-up survey, and 650 completed the second follow-up survey. SARS-CoV-2-positive participants were more likely to report fever at acute illness but were otherwise comparable to SARS-CoV-2-negative participants. At first follow-up, SARS-CoV-2-positive participants were less likely to have reported fully or mostly recovered from their illness compared to SARS-CoV-2-negative participants. At second follow-up, no differences by SARS-CoV-2 test results were detected in the four domains in the multivariable model. CONCLUSION Self-reported disability was similar among outpatient SARS-CoV-2-positive and -negative adults 2-7 months after illness onset.
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Affiliation(s)
- Jennifer P King
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue ML2, Marshfield, WI, 54449, USA.
| | - Jessie R Chung
- Influenza Division, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop H24-7, Atlanta, GA, 30329, USA.
| | - James G Donahue
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue ML2, Marshfield, WI, 54449, USA
| | - Emily T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Aleda M Leis
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, TX, USA
- Texas A&M University College of Medicine, Temple, TX, USA
| | - Kayan Dunnigan
- Baylor Scott & White Research Institute, Temple, TX, USA
| | | | - Sharon Saydah
- Coronavirus and Other Respiratory Viruses Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brendan Flannery
- Influenza Division, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop H24-7, Atlanta, GA, 30329, USA
| | - Edward A Belongia
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue ML2, Marshfield, WI, 54449, USA
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Butler MJ, Chiuzan C, Ahn H, Gao M, D’Angelo S, Yeh J, Davidson K. Before and after COVID-19: Changes in symptoms and diagnoses in 13,033 adults. PLoS One 2024; 19:e0286371. [PMID: 38457409 PMCID: PMC10923490 DOI: 10.1371/journal.pone.0286371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/15/2023] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Most patients with COVID-19 report experiencing one or more symptoms after acute infection subsides, known as post-acute sequelae of SARS-CoV-2 infection (PASC). Though research has examined PASC after acute COVID-19, few studies have examined PASC over a longer follow-up duration or accounted for rates of symptoms and diagnoses before COVID-19 infection, and included those not actively seeking treatment for PASC. To determine what symptoms and diagnoses are occurring at higher rates after acute COVID-19 infection from a more inclusive sample, we extracted electronic hospital records (EHR) data from 13,033 adults with previously known diagnoses and symptoms. METHODS The sample was comprised of patients who had a positive PCR test for SARS-CoV-2 between March 1, 2020, and December 31, 2020, and follow-up was conducted through November 29, 2021. All patients in the sample had medical appointments ≥4 weeks before and ≥4 weeks after their positive PCR test. At these appointments, all ICD-10 codes recorded in the EHR were classified into 21 categories based on the literature and expert review. Conditional logistic regression models were used to quantify the odds of these symptoms and diagnostic categories following COVID-19 infection relative to visits occurring before infection. The sample was comprised of 28.0% adults over 65 and was 57.0% female. After the positive PCR test, the most recorded diagnoses and symptoms were dyspnea and respiratory failure, myositis, musculoskeletal pain/stiffness, anxiety, and depression. RESULTS Results from regression analyses showed increased odds of diagnosis for 15 of the 21 categories following positive PCR. Relative to pre-COVID, the diagnoses and symptoms with the greatest odds after a positive PCR test were loss of smell or taste [OR (95% CI) = 6.20 (3.18-12.09)], pulmonary fibrosis [3.50 (1.59-7.68)], and dyspnea/respiratory failure [2.14 (1.92-2.40)]. Stratification of these analyses by age, gender, race, and ethnicity showed similar results. CONCLUSION The increased symptoms and diagnoses detected in the current study match prior analyses of PASC diagnosis and treatment-seeking patients. The current research expands upon the literature by showing that these symptoms are more frequently detected following acute COVID-19 than before COVID-19. Further, our analyses provide a broad snapshot of the population as we were able to describe PASC among all patients who tested positive for COVID-19.
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Affiliation(s)
- Mark J. Butler
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America
| | - Codruta Chiuzan
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America
| | - Heejoon Ahn
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America
| | - Michael Gao
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America
| | - Stefani D’Angelo
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America
| | - Jackson Yeh
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America
| | - Karina Davidson
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, United States of America
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Ruan W, Xu J, Yang F, Wu X, Ying K. Tropheryma whipplei infection in the lung of a patient with long COVID: a case report. BMC Infect Dis 2024; 24:292. [PMID: 38448808 PMCID: PMC10916207 DOI: 10.1186/s12879-024-09183-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Immune dysregulation in individuals with long COVID has been detected. Differential diagnosis of diffuse infiltration on chest CT in long COVID is challenging. CASE PRESENTATION A 62-year-old man presented with a 10-month history of dyspnea after COVID-19 infection. Dyspnea became worse in the one month preceding presentation. The chest CT showed multifocal, subpleural, bilateral opacities due to long-COVID, and infiltration around the bronchovascular bundle in the bilateral lower lung field. The pathology for the transbronchial cryobiopsy (TBCB) first reported chronic inflammation (mainly interstitial pneumonia). The patient had positive results on tests for the antibody, RO-52+, EJ+. The presumptive diagnosis of connective tissue disease-interstitial lung disease was made. Prednisone and cyclophosphamide were given. At follow-up one month later, the chest CT showed new diffuse ground-glass infiltration. The previous TBCB specimen was re-evaluated. Foamy macrophages were found in the alveolar air space. Periodic acid-Schiff (PAS) staining was performed. Numerous intracytoplasmic organisms were detected, with morphologic features consistent with those of Tropheryma whipplei. The patient recovered after intravenous ceftriaxone and oral trimethoprim-sulfamethoxazole. The final diagnosis was lung T. whipplei infection and long COVID-19. CONCLUSION This is the first case report of Tropheryma whipplei infection in the lung of a patient with long COVID-19. T. whipplei should be considered as a potential pathogen for diffuse lung infiltration in the post-COVID-19 era.
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Affiliation(s)
- Wenjing Ruan
- Regional Medical Center for the National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, 310016, Hangzhou, China.
| | - Jing Xu
- Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fan Yang
- Regional Medical Center for the National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, 310016, Hangzhou, China
| | - Xiaohong Wu
- Regional Medical Center for the National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, 310016, Hangzhou, China
| | - Kejing Ying
- Regional Medical Center for the National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, 310016, Hangzhou, China
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Cruickshank M, Brazzelli M, Manson P, Torrance N, Grant A. What is the impact of long-term COVID-19 on workers in healthcare settings? A rapid systematic review of current evidence. PLoS One 2024; 19:e0299743. [PMID: 38442116 PMCID: PMC10914278 DOI: 10.1371/journal.pone.0299743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Long COVID is a devastating, long-term, debilitating illness which disproportionately affects healthcare workers, due to the nature of their work. There is currently limited evidence specific to healthcare workers about the experience of living with Long COVID, or its prevalence, pattern of recovery or impact on healthcare. OBJECTIVE Our objective was to assess the effects of Long COVID among healthcare workers and its impact on health status, working lives, personal circumstances, and use of health service resources. METHODS We conducted a systematic rapid review according to current methodological standards and reported it in adherence to the PRISMA 2020 and ENTREQ statements. RESULTS We searched relevant electronic databases and identified 3770 articles of which two studies providing qualitative evidence and 28 survey studies providing quantitative evidence were eligible. Thematic analysis of the two qualitative studies identified five themes: uncertainty about symptoms, difficulty accessing services, importance of being listened to and supported, patient versus professional identity and suggestions to improve communication and services for people with Long COVID. Common long-term symptoms in the survey studies included fatigue, headache, loss of taste and/or smell, breathlessness, dyspnoea, difficulty concentrating, depression and anxiety. CONCLUSION Healthcare workers struggled with their dual identity (patient/doctor) and felt dismissed or not taken seriously by their doctors. Our findings are in line with those in the literature showing that there are barriers to healthcare professionals accessing healthcare and highlighting the challenges of receiving care due to their professional role. A more representative approach in Long COVID research is needed to reflect the diverse nature of healthcare staff and their occupations. This rapid review was conducted using robust methods with the codicil that the pace of research into Long COVID may mean relevant evidence was not identified.
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Affiliation(s)
- Moira Cruickshank
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Paul Manson
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Nicola Torrance
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, United Kingdom
| | - Aileen Grant
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, United Kingdom
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Iversen A, Blomberg B, Haug K, Kittang B, Özgümüs T, Cox RJ, Langeland N. Symptom trajectories of post-COVID sequelae in patients with acute Delta or Omicron infection in Bergen, Norway. Front Public Health 2024; 12:1320059. [PMID: 38504678 PMCID: PMC10948556 DOI: 10.3389/fpubh.2024.1320059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction A substantial proportion of the over 700 million COVID-19 cases world-wide experience long-term symptoms. The objectives of this study were to compare symptom trajectories and risk factors for post-COVID-19 condition after Delta and Omicron infection. Methods This study consecutively recruited patients with SARS-CoV-2 infection from November 2021 to March 2022. We recorded demographics, comorbidities, vaccination status, sick leave, and 18 symptoms during acute infection and after 4 months. The primary outcome measures were symptoms during acute infection and after 4 months. Secondary outcome measures were work and school absenteeism. Results We followed a cohort of 1,374 non-hospitalized COVID-19 patients in Bergen, Norway, at three time points. The median age was 39.8 years and 11% were children <16 years. Common acute upper respiratory symptoms waned during follow-up. Fatigue remained common from acute infection (40%) until after 4 months (37%). Four months post-infection, patients reported increased frequencies of dyspnea (from 15% during acute illness to 25% at 4 months, p < 0.001), cognitive symptoms (from 9 to 32%, p < 0.001) and depression (from 1 to 17%, p < 0.001). Patients infected with Omicron reported less dyspnea (22% versus 27%, p = 0.046) and smell/taste problems (5% versus 19%, p < 0.001) at 4 months follow-up than those with Delta infection. Comorbidities and female sex were risk factors for persistent dyspnea and cognitive symptoms. Ten percent reported sick leave after acute illness, and vaccination reduced the risk of absenteeism (adjusted risk ratio: 0.36, 95% confidence interval: 0.15, 0.72, p = 0.008). Conclusion At 4 months, home-isolated patients infected with Omicron reported overall comparable symptom burden, but less dyspnea and smell/taste problems than Delta infected patients. Several acute symptoms waned during follow-up. It is worrying that dyspnea, neurocognitive symptoms, and particularly depression, increased significantly during the first 4 months after acute infection. Previous vaccination was protective against prolonged sick leave.
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Affiliation(s)
- Arild Iversen
- Chief Municipal Doctor’s Office, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Blomberg
- Department of Clinical Science, University of Bergen, Bergen, Norway
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kjell Haug
- Chief Municipal Doctor’s Office, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bård Kittang
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Nursing Home Medicine, Bergen Municipality, Bergen, Norway
| | - Türküler Özgümüs
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rebecca Jane Cox
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Fockens MM, van der Scheer FA, Eerenstein SEJ. [Implications of total laryngectomy]. Ned Tijdschr Geneeskd 2024; 168:D7676. [PMID: 38512235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
This clinical lesson describes three patients with problems after a total laryngectomy. Patient A suffered from acute tracheitis and narrowing of the tracheostoma. Patient B experienced acute dyspnea due to thick mucus plugs. Patient C had progressive symptoms of deteriorating speech and dysphagia, which resolved after dilatation of a pharyngeal stenosis. A total laryngectomy leads to definitive changes in anatomy and physiology. In case of respiratory symptoms, it is important to recognize the tracheostoma is the only entrance to the airway. Speech is generally well rehabilitated with a speech valve in a tracheoesophageal fistula.
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Affiliation(s)
- M M Fockens
- Amsterdam UMC, locatie VUmc, afd. Keel-, Neus-, Oorheelkunde en Hoofd-halschirurgie, Amsterdam
- Contact:
| | | | - Simone E J Eerenstein
- Amsterdam UMC, locatie VUmc, afd. Keel-, Neus-, Oorheelkunde en Hoofd-halschirurgie, Amsterdam
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Hill R, Vigliotti AA, Chaves-Gnecco DG, Williams AE. Respiratory Distress and Hypocalcemia in a 2-Week-Old Boy. Clin Pediatr (Phila) 2024; 63:405-407. [PMID: 38284368 DOI: 10.1177/00099228231179455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Rachel Hill
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Alyssa A Vigliotti
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Diego G Chaves-Gnecco
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Division of General Academic Pediatrics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allison E Williams
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
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Pancera S, Lopomo NF, Porta R, Sanniti A, Buraschi R, Bianchi LNC. Effects of Combined Endurance and Resistance Eccentric Training on Muscle Function and Functional Performance in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:470-479. [PMID: 37716519 DOI: 10.1016/j.apmr.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/03/2023] [Accepted: 09/01/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To evaluate the adherence to treatment and efficacy of an eccentric-based training (ECC) program on peripheral muscle function and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD). DESIGN Prospective, assessor-blinded, randomized controlled trial. SETTING The cardiopulmonary rehabilitation unit of a tertiary subacute referral center. PARTICIPANTS Thirty (N=30) stable inpatients (mean age 68±8 years; FEV1 44±18% of predicted) with COPD were included in the study. INTERVENTIONS Inpatients were randomly assigned to 4 weeks of a combined endurance and resistance ECC (n=15) or conventional training (CON; n=15). MAIN OUTCOME MEASURES Quadriceps peak torque (PT) was the primary outcome measure for muscle function. Rate of force development (RFD), muscle activation and quality (quadriceps PT/leg lean mass), 6-min walk distance (6MWD), 4-meter gait speed (4mGS), 10-meter gait speed, 5-repetition sit-to-stand (5STS), dyspnea rate, and mortality risk were the secondary outcomes. Evaluations were performed at baseline and repeated after 4 weeks and 3 months of follow-up. RESULTS Quadriceps PT, RFD, and muscle quality improved by 17±23% (P<.001), 19±24%, and 16±20% (both P<.05) within the ECC group. Besides, a significant between-group difference for RFD (56±94 Nm/s, P=.038) was found after training. Both groups showed clinically relevant improvements in 6MWD, 4mGS, dyspnea rate, and mortality risk, with no significant differences between groups. CONCLUSION Combined endurance and resistance ECC improved lower limbs muscle function compared with CON in inpatients with COPD. In contrast, ECC did not further improve functional performance, dyspnea, and mortality risk. ECC may be of particular benefit to effect on skeletal muscle function in patients with COPD.
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Affiliation(s)
| | - Nicola F Lopomo
- Department of Information Engineering, University of Brescia, Brescia, Italy
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Backhaus SJ, Schulz A, Lange T, Schmidt-Schweda LS, Evertz R, Kowallick J, Hasenfuß G, Schuster A. Real-time cardiovascular magnetic resonance imaging for non-invasive characterisation of heart failure with preserved ejection fraction: final outcomes of the HFpEF stress trial. Clin Res Cardiol 2024; 113:496-508. [PMID: 38170248 PMCID: PMC10881625 DOI: 10.1007/s00392-023-02363-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. Recently, the HFpEF Stress Trial demonstrated feasibility and accuracy of non-invasive cardiovascular magnetic resonance (CMR) real-time (RT) exercise-stress atrial function imaging for early identification of HFpEF. However, no outcome data have yet been presented. METHODS The HFpEF Stress Trial (DZHK-17) prospectively recruited 75 patients with dyspnea on exertion and echocardiographic preserved EF and signs of diastolic dysfunction (E/e' > 8). 68 patients entered the final study cohort and were characterized as HFpEF (n = 34) or non-cardiac dyspnea (n = 34) according to pulmonary capillary wedge pressure (HFpEF: PCWP rest: ≥ 15 mmHg stress: ≥ 25 mmHg). These patients were contacted by telephone and hospital charts were reviewed. The clinical endpoint was cardiovascular events (CVE). RESULTS Follow-up was performed after 48 months; 1 patient was lost to follow-up. HFpEF patients were more frequently compared to non-cardiac dyspnea (15 vs. 8, p = 0.059). Hospitalised patients during follow-up had higher H2FPEF scores (5 vs. 3, p < 0.001), and impaired left atrial (LA) function at rest (p ≤ 0.002) and stress (p ≤ 0.006). Impairment of CMR-derived atrial function parameters at rest and during exercise-stress (p ≤ 0.003) was associated with increased likelihood for CVE. CMR-Feature Tracking LA Es/Ee (p = 0.016/0.017) and RT-CMR derived LA long axis strain (p = 0.003) were predictors of CVE independent of the presence of atrial fibrillation. CONCLUSIONS Left atrial function emerged as the strongest predictor for 4-year outcome in the HFpEF Stress Trial. A combination of rest and exercise-stress LA function quantification allows accurate diagnostic and prognostic stratification in HFpEF. CLINICALTRIALS gov: NCT03260621.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Lennart S Schmidt-Schweda
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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Cai Y, Ren X, Wang J, Ma B, Chen O. Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: A Network Meta-analysis. Arch Phys Med Rehabil 2024; 105:558-570. [PMID: 37150427 DOI: 10.1016/j.apmr.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE A network meta-analysis of randomized controlled trials (RCTs) was conducted to compare and rank the effectiveness of various breathing exercises for patients with chronic obstructive pulmonary disease (COPD). DATA SOURCES We searched PubMed, Web of Science, Embase, and the Cochrane Library databases to determine the articles. STUDY SELECTION Publications investigating the effect of breathing exercises on exercise capacity (six-minute walk test [6MWT]), pulmonary function (the ratio of the first second forced expiratory volume of forced vital capacity [FEV1/FVC]), quality of life (St George's Respiratory Questionnaire [SGRQ]), inspiratory muscle pressure (maximum inspiratory pressure [PImax]), and dyspnea (Borg scale) were searched. DATA EXTRACTION Data extracted by 2 researchers were entered into predesigned tables for data extraction. The quality of the literature was assessed using the Cochrane Collaboration's tool. DATA SYNTHESIS A total of 43 RCTs involving 1977 participants were analyzed. To boost exercise capacity, the top 2 exercises were inspiratory muscle training (75%), Chinese traditional fitness exercises (13%); To improve pulmonary function, the top 2 exercises were Chinese traditional fitness exercises (32%), diaphragm breathing (30%); To raise patients' quality of life, the top 2 exercises were yoga (52%), diaphragm breathing (28%); To increase inspiratory muscle pressure, the top 2 exercises were pursed-lip breathing (47%), Chinese traditional fitness exercises (25%); To improve dyspnea, the top 2 exercises were yoga (44%), inspiratory muscle training (22%). CONCLUSIONS Various breathing exercises for COPD patients confer benefits that manifest in diverse ways. Pulmonary rehabilitation specialists could administer personalized breathing exercises tailored to each patient's condition to attain optimal therapeutic outcomes.
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Affiliation(s)
- Yingying Cai
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaohe Ren
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingyi Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bin Ma
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ou Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China.
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