Changes in respiratory function and physical performance in middle-aged and old inpatients recovering from COVID-19 after a rehabilitation program

Степень изменений дыхательной функции и физической подготовленности у пациентов, выздоравливающих после COVID-19, представляет интерес для реабилитационных мер. 56 пациентов (67 % - женщины), средний возраст - 64±11 лет, перенесшие COVID-19, прошли курс комплексной реабилитации (16,9±3,8 дня). После курса реабилитации пациенты показали улучшение дыхательной функции: проба Штанге - на 19 % (p=0,006), проба Генчи - на 25 % (p=0,026), улучшение самочувствия по результатам КТ легких (p<0,001); повышение физической подготовленности: скорость привычной ходьбы - на 80 % (р=0,025); толерантности к физической нагрузке: пройденное расстояние до первых признаков утомления - на 227 % (р<0,001), ЧСС в покое - на 1 % (р=0,011). Темпы изменений дыхательной функции и физической подготовленности были значительными и превышали подобные изменения, приводимые в литературе для относительно здоровых пожилых людей, которые приступают к физическим занятиям. Однако абсолютные показатели функции дыхания и физической подготовленности после реабилитационной программы были ниже нормированных значений для данного возраста. Данные результаты могут быть полезны для клиницистов при составлении программы реабилитации пациентов, перенёсших COVID-19. Changes in respiratory and physical performance in geriatric inpatients recovering from COVID-19 are of interest for rehabilitation interventions. 56 inpatients (67 % women), average age 64±11 years recovering from COVID-19 underwent a comprehensive rehabilitation program (16,9±3,8 days). After the rehabilitation program, the patients showed an improvement in respiratory function: voluntary breath-holding after inhalation - by 19 % (p=0,006), breath-holding after exhalation - by 25 % (p=0,026), lungs computed tomography (p<0,001); physical performance: handgrip strength - by 14 % (p=0,083), preferred walking speed - by 80 % (p=0,025); exercise tolerance: distance walked until the first signs of fatigue - by 227 % (p<0,001), resting heart rate - by 1 % (p=0,011). The interaction of rehabilitation time and patient sex was statically nonsignificant across all variables of interest. The rates of changes in respiratory function and physical performance were significant and exceeded similar changes recorded in healthy old people who begin an exercise program. However, in absolute values, respiratory function and physical performance values after the rehabilitation were lower than reference values for this age group. These results can be valuable for clinicians when designing a rehabilitation program for geriatric patients recovering from COVID-19.

Retinal axial motion analysis and implications for real-time correction in human retinal imaging

High-resolution ophthalmic imaging devices including spectral-domain and full-field optical coherence tomography (SDOCT and FFOCT) are adversely affected by the presence of continuous involuntary retinal axial motion. Here, we thoroughly quantify and characterize retinal axial motion with both high temporal resolution (200,000 A-scans/s) and high axial resolution (4.5 um), recorded over a typical data acquisition duration of 3 s with an SDOCT device over 14 subjects. We demonstrate that although breath-holding can help decrease large-and-slow drifts, it increases small-and-fast fluctuations, which is not ideal when motion compensation is desired. Finally, by simulating the action of an axial motion stabilization control loop, we show that a loop rate of 1.2 kHz is ideal to achieve 100% robust clinical in-vivo retinal imaging.

Measurement of Adult Human Brain Responses to Breath-Holding by Multi-Distance Hyperspectral Near-Infrared Spectroscopy

A major limitation of near-infrared spectroscopy (NIRS) is its high sensitivity to the scalp and low sensitivity to the brain of adult humans. In the present work we used multi-distance hyperspectral NIRS (hNIRS) to investigate the optimal source-detector distances, wavelength ranges, and analysis techniques to separate cerebral responses to 30 s breath-holds (BHs) from the responses in the superficial tissue layer in healthy adult humans. We observed significant responses to BHs in the scalp hemodynamics. Cerebral responses to BHs were detected in the cytochrome C oxidase redox (rCCO) at 4 cm without using data from the short-distance channel. Using the data from the 1 cm channel in the two-layer regression algorithm showed that cerebral hemodynamic and rCCO responses also occurred at 3 cm. We found that the waveband 700–900 nm was optimal for the detection of cerebral responses to BHs in adults.

Practice and Perception of Radiographers on the Positioning Techniques of Erect Lateral Cervical Spine Radiography in Non-trauma Adult Patients

Background: The visualization of the lower cervical spine (C-spine), including the C7-T1 junction on lateral radiograph is a challenge due to the overlapping of the shoulder girdle. Therefore, the radiographers have adapted different positioning strategies to overcome this challenge. This study explores the current practice and perception of radiographers on positioning techniques of erect lateral cervical spine radiography in non-trauma adult patients. Methods: This prospective study was conducted with a self-administered, structured questionnaire distributed among 50 radiographers working in four selected hospitals in Sri Lanka. Results: The radiographers used weight-bearing and non-weight-bearing positioning techniques for the erect lateral C-spine radiography. Most of them employed the standing breath-holding technique for image acquisition with or without exertion. While 54% of the radiographers utilized two water-filled cans during the weight-bearing technique, 82% used holding arms back with the shoulders down and pulling as low as possible in the non-weight-bearing technique. In addition, 88% of the radiographers believed that the weight-bearing position could increase the visibility of the C-spine. Almost all the radiographers (100%) stated that correct positioning instruction could improve the visibility of the C-spine. Conclusion: Radiographers have mainly used two positioning techniques of weight-bearing and non-weight-bearing for erect lateral C-spine radiography for non-trauma adult patients. In addition, most radiographers had a positive attitude toward the weight-bearing technique in the evaluation of lateral C-spine. These results highlight the importance of conducting studies to evaluate the effectiveness of the weight-bearing technique in erect lateral C-spine radiography.

Functional status of COVID-19 patients at discharge from acute care

<p class="abstract">Coronavirus disease 2019 (COVID-19) is a multisystem illness that can affect a person's mental and physical health exhibiting various physiological and behavioural symptoms. The long-term consequence of COVID -19 affects the quality of life of these patients. The quality of life depends on the status of the physical function. Hence the need to focus on post-COVID rehabilitation in addition to already existing acute care Physiotherapy. This case series, describes functional status of 5 patients at the time of discharge from the Tertiary Care Hospital. The evaluation is done on the day of discharge of each patient using six outcomes, namely Breath Holding Time, 1 Minute Sit to Stand Test, 6 Minute Walk test, Heel Raise Test, 4 Meter Gait Speed Test and muscle strength, to study the functional status. All the patients showed impairment in musculoskeletal capacity (one MSTS, manual muscle test, Heel raise test), functional capacity (6 MWT), lung capacity (BHT) and gait speed as compared to their normal values.This case series brings out the reduced functional status of COVID-19 patients in all domains of fitness at discharge. Thus, there is a dire need for Physiotherapy based holistic pulmonary rehabilitation even after discharge to prevent or delay the possible late manifestation of the disease.</p>

Estimation of Breath Holding Time (BHT) among Dental Students

Background: Breath holding time is the time taken by an individual to hold his/her breath as long as they can. During voluntary breath holding, tissues continue to utilize oxygen and liberate carbon dioxide. Therefore, during breath holding arterial pO2 falls and pCO2 rises. Normal Breath holding time (BHT) is 45-55 seconds which is estimated at 2014. The main aim of this study is to assess the breath holding time among healthy dental students. Materials and Methods: A minimal number of sample sizes have been taken into account with regards to their BMI. The sample size was divided into two groups as gender comparison. Students were detail explained about the procedure and breath holding time has been measured. The statistical analysis was done by ANOVA test in SPSS Software-23 and an independent t-test was calculated. Results: BHT was found to be significantly low among females compared to males. A statistically significant negative correlation was observed when BHT is correlated with gender because BHT differs in both the gender. Conclusion: The present study revealed that breath holding time is less in females compared to males. Therefore, males are healthier than females.

Prognosis in patients with coronary heart disease and breath-holding limitations: a free-breathing cardiac magnetic resonance protocol at 3.0 T

Background and purpose Conventional cardiac magnetic resonance (CCMR) imaging is usually performed with breath-holding (BH), which is adverse in patients with BH limitations. We explored the ability of a free-breathing CMR (fCMR) protocol to prognosticate in patients with coronary heart diseases (CHD) and limited BH ability. Methods Sixty-seven patients with CHD and limited BH abilities were prospectively enrolled in this study. All patients underwent comprehensive fCMR imaging at 3.0 T. The fCMR protocols included compressed sensing (CS) single-shot cine acceleration imaging, and motion-corrected (MOCO), single-shot late gadolinium enhancement (LGE) imaging. Image quality (IQ) of the cine and LGE images was evaluated based on the 5-point Likert scale. The value of fMRI in providing a prognosis in patients with CHD was assessed. Statistical methods included the T test, Mann–Whitney test, Kappa test, Kaplan–Meier curve, Log-rank test, Cox proportional hazard regression analysis, and receiver operating characteristic curves. Results All IQ scores of the short axis CS-cine and both the short and long axes MOCO LGE images were ≥ 3 points. Over a median follow-up of 31 months (range 3.8–38.2), 25 major adverse cardiovascular events (MACE) occurred. In the univariate analysis, infarction size (IS), left ventricular ejection fraction (LVEF), 3D-Global peak longitudinal strain (3D-GPLS), heart failure classification were significantly associated with MACE. When the significantly univariate MACE predictors, added to the multivariate analysis, which showed IS (HR 1.02; 95% CI 1.00–1.05; p = 0.048) and heart failure with preserved EF (HR 0.20; 95% CI 0.04–0.98; p = 0.048) correlated positively with MACE. The optimal cutoff value for LVEF, 3D-GPLS, and IS in predicting MACE was 34.2%, − 5.7%, and 26.1% respectively, with a sensitivity of 90.5%, 64%, and 96.0% and specificity of 72%, 95.2%, and 85.7% respectively. Conclusions The fCMR protocol can be used to make prognostic assessments in patients with CHD and BH limitations by calculating IS and LVEF.

Free-breathing contrast-enhanced multiphase MRI of the liver in patients with a high risk of breath-holding failure: comparison of compressed sensing-accelerated radial and Cartesian acquisition techniques

Background Knowing the advantages and disadvantages of each magnetic resonance (MR) technique, would allow us to choose a sequence better suited in patients with a high risk of breath-holding failure. Purpose To compare the image quality of free-breathing contrast-enhanced multiphase MR imaging (MRI) using incoherent Cartesian k-space sampling combined with a motion-resolved compressed sensing reconstruction (XD-VIBE) and Golden-Angle Radial Sparse Parallel MRI (GRASP). Material and Methods A total of 67 patients were included. Overall image quality, motion artifacts, and liver edge sharpness on arterial and portal-venous phase were evaluated by two radiologists. We evaluated the signal intensity ratio between liver in the late arterial phase to aorta at peak enhancement and the detection rate of hypervascular lesions. Results Overall image quality, artifact, and liver edge sharpness scores of XD-VIBE and GRASP were not significantly different ( P = 0.070–0.397). Four (reviewer 1, 12.1%) and seven patients (reviewer 2, 21.2%) received non-diagnostic quality in the XD-VIBE group whereas one patient (reviewer 2, 2.9%) received non-diagnostic quality in the GRASP group. The ratio between the aorta and liver signal for GRASP was significantly higher than that of XD-VIBE (0.32 ± 0.10 vs. 0.47 ± 0.13; P < 0.001). The hypervascular lesion detection rate of XD-VIBE (86.7%) was higher than that of GRASP (57.1%) in the arterial phase without a statistically significant difference ( P = 0.081). Conclusion Overall image quality of XD-VIBE and GRASP were not significantly different. More XD-VIBE examinations were rated non-diagnostic. On the other hand, the relative liver parenchymal enhancement to the aorta in the late arterial phase of GRASP was higher than that of XD-VIBE, which potentially leads to lower detectability of hypervascular lesions on arterial phase images.

The Implications of the Diving Response in Reducing Panic Symptoms

Increased CO2 sensitivity is common in panic disorder (PD) patients. Free divers who are known for their exceptional breathing control have lower CO2 sensitivity due to training effects. This study aimed to investigate the immediate effects of cold facial immersion (CFI), breath holding and CO2 challenges on panic symptoms. Healthy participants and patients with PD were subjected to four experimental conditions in a randomly assigned order. The four conditions were (a) breath-holding (BH), (b) CFI for 30 s, (c) CO2 challenge, and (d) CO2 challenge followed by CFI. Participants completed a battery of psychological measures, and physiological data (heart rate and respiration rate) were collected following each experimental condition. Participants with PD were unable to hold their breath for as long as normal controls; however, this finding was not significant, potentially due to a small sample size. Significant reductions in both physiological and cognitive symptoms of panic were noted in the clinical group following the CFI task. As hypothesized, the CFI task exerted demonstrable anxiolytic effects in the clinical group in this study by reducing heart rate significantly and lessening self-reported symptoms of anxiety and panic. This outcome demonstrates the promise of the CFI task for clinical applications.