Measured and perceived exercise intensity during the performance of single-task, cognitive-motor dual-task and exergame training: a transversal study (Preprint)

UNSTRUCTURED The physical and cognitive loads during exergaming may differ from more conventional cognitive-motor dual-task trainings. The aim of this pilot transversal study was to compare exercise intensity during exergame, cognitive-motor dual-task and single-task training sessions. We recruited healthy young adults who carried out one session of each t type of training: exergaming, cognitive-motor dual-tasking and single-tasking. We used a custom-made exergame as support. The sessions lasted 30 minutes, were spaced at least 24 hours, and took place in random order for each group of 4 participants. We used heart rates to assess exercise intensity, and the modified Borg scale to assess their perception of intensity. Sixteen healthy young participants carried out all sessions. There was no difference between the different types of training in mean heart rates (p = 0.3), peak heart rates (p = 0.5) or Borg scale scores (p = 0.4). Our custom-made exergames measured and perceived physical load did not differ between cognitive-motor dual-task and single-task training. As a result, our exergame can be considered as intense as more traditional physical training. Future studies should be conducted in seniors with or without cognitive impairments and should incorporate an assessment of cognitive performance.

Efficacy and safety of intrapleural streptokinase in tubercular empyema thoracis – old wine in new wineskin

Tubercular empyema thoracis continues to be one of the leading causes of morbidity in low-income countries. Despite antitubercular therapy (ATT) and thoracostomy, empyema drainage is hampered by multiple septations, loculations, debris, and blood clots leading to complications. In a comparative experimental study to estimate the efficacy and safety of intrapleural streptokinase (IPSTK) in tubercular empyema, 30 cases of chronic multiloculated tubercular empyema were compared by radiological improvement by chest radiography, duration and volume of fluid drained, and degree of dyspnoea according to the modified Borg scale, depending on whether streptokinase was used or not. The former scored on all counts; we therefore conclude that intrapleural streptokinase is a safe, efficacious intervention in tubercular empyema. It decreases morbidity and reduces the need for surgery.

Silent Hypoxia in COVID-19: A Case Series

<b><i>Background:</i></b> The coronavirus disease 2019 (COVID-19) pandemic is an ongoing global crisis challenging the worldwide healthcare systems. Many patients present with a mismatch of profound hypoxemia and few signs of respiratory distress (i.e., silent hypoxemia). This particular clinical presentation is often cited, but data are limited. <b><i>Main Body:</i></b> We describe dyspnea sensation as assessed by using the BORG scale in pulmonary patients admitted to the emergency room during a 4-week period and transferred to the respiratory department of Siloah Hospital, Hannover, Germany. From October 1 to November 1, 2020, 82 patients with hypoxemia defined as oxygen demand to achieve an oxygen saturation (SpO₂) ≥92% were included. In 45/82 (55%) patients, SARS-CoV-2 was detected by PCR on admission. Among non-COVID patients, exacerbation of COPD was the main diagnosis (15/37, 41%). All subjects rated their perceived dyspnea using the modified Borg CR10 scale. Patients in the non-COVID group suffered from more dyspnea on the modified Borg CR10 scale (median 1, IQR: 0–2 vs. median 5, IQR: 3–6, <i>p</i> &#x3c; 0.001). In multivariate analysis, “silent hypoxemia” as defined by the dyspnea Borg CR10 scale ≥5 was independently associated with COVID-19 and presence of severe hypocapnia with an odds ratio of 0.221 (95% confidence interval 0.054, 0.907, <i>p</i> 0.036). <b><i>Conclusion:</i></b> Among pulmonary patients with acute hypoxemia defined as oxygen demand, patients suffering from COVID-19 experience less dyspnea compared to non-COVID patients. “Silent” hypoxemia was more common in COVID-19 patients.

Breathing exercises versus strength exercises through telerehabilitation in coronavirus disease 2019 patients in the acute phase: A randomized controlled trial

Objective To compare the effectiveness of two different exercise-based programs through telerehabilitation in patients with coronavirus disease 2019. Design Randomized, controlled, parallel, double-blinded, three-arm clinical trial. Setting Patients’ homes through telerehabilitation devices. Subjects Subjects with coronavirus disease 2019 in the acute phase. Interventions Subjects were divided into three groups: breathing exercises group, strength exercises group or no treatment/control group. Main measures We analysed visual analogue scale for fatigue, 6-minute walking test, 30-seconds sit-to-stand test, multidimensional dyspnoea-12 questionnaire and Borg scale at baseline and 14 days later. Results From 93 subjects recruited, 88 were enrolled, and 77 patients (mean [SD] age 39.40 [11.71]) completed the 14-days intervention and were included in the analysis: 26 in strength exercises group, 29 in breathing exercises group and 22 in control group. The intergroup analysis shows significant differences between the study groups and control group in all variables ( p < 0.05); Borg scale, multidimensional dyspnoea-12 questionnaire (pre–post intervention score: strength exercises group: 7.85 [6.82] – 4.54[4.82], breathing exercises group: 11.04 [6.49] – 5.32 [3.63], control group: 10.27 [6.49] – 10.59[6.58]), visual analogue scale for fatigue, 6-minute walking test and 30-seconds sit-to-stand test (pre–post intervention score: strength exercises group: 12.19 [4.42] – 13.58 [5.37], breathing exercises group: 11.18 [3.42] – 12.79 [4.00], control group: 10.45 [2.15] – 9.86[1.88]). The greatest effect sizes were found in the variables Borg Scale ( R2 = 0.548) and multidimensional dyspnoea-12 questionnaire ( R2 = 0.475). Conclusions Strength exercises group and breathing exercises group obtained significant improvements in fatigue, dyspnoea, perceived effort, and physical state, compared to control group, although the greatest benefits were found for dyspnoea and aerobic capacity in breathing exercises group.

A Case Report on Sojaganggi-tang Treatment for a Patient with Asthma

Objectives: This study aimed to describe the effects of traditional Korean medical treatment on a patient with asthma.Methods: The patient (female, 88) was treated with herbal medicine (Sojaganggi-tang), acupuncture, and moxibustion. The effects of these treatments were evaluated using the Modified Borg Scale (MBS) and Quality of Life Questionnaire for Adult Korean Asthmatics (QLQAKA).Results: Following treatment, the MBS score decreased from 7 to 4, and the QLQAKA score increased from 45 to 57.Conclusion: The results suggest that traditional Korean medicine can effectively treat patients with asthma.

Effect of the Active Cycle of Breathing Technique on Perioperative Outcome in Individuals With Esophagectomy: A Quasi-Experimental Study

Background: The effect of active cycle of breathing technique (ACBT) on EC patients has not been well elucidated. In this research, we aim to explore the effect of ACBT on the perioperative outcomes in patients with esophageal carcinoma who underwent esophagectomy.Methods: Patients who underwent esophagectomy in an academic institution from December 2017 to July 2019 were included in this study. In a quasi-experimental study, participants were randomly divided into an experimental group (active cycle of breathing technique, n = 107) and an observational group (n = 106) by drawing lots. The chi-squared test, Cochran–Mantel–Haenszel test, Logistic regression analysis, and Kruskal–Wallis test were used to analyze data. A two-sided P value &lt;0.05 was considered statistically significant. The primary observational endpoint was the mean weight of the sputum. Other outcomes included the six-min-walk test (6MWT), Borg scale, anastomotic leakage, and the length of hospital stay.Results: 95 patients underwent minimally invasive surgery, and 118 patients received open surgery. There were 16 patients with anastomotic leakage in the present study, and we found that patients in the observational group had higher odds of anastomotic leakage. The results showed that the mean weight of the sputum in the observation group was lighter than that of the experimental group. After esophagectomy, the experimental group had better outcomes than the observation group (Borg scale: 2.448 vs. 1.547; 6-MWT: 372.811 vs. 425.355m, all P &lt; 0.05). The mean length of hospital stay was longer in the observation group (17.953 days) than that in the experimental group (12.037 days, P = 0.01). We also found that the observational group had a higher discharge ratio over 2 weeks in all cohort (adjusted OR 2.487, 95% confidence intervals 1.147–5.392, P = 0.021).Conclusion: Active cycle of breathing technique may improve the perioperative outcomes and decrease the length of hospital stay after surgery in patients with esophageal cancer. However, we need more researches to validate these findings.

THE USE OF INDICATORS OF THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING TO ASSESS THE CONDITION OF PATIENTS WITH HYPERTENSION WITH COMPLICATED HYPERTENSIVE CRISES

The International Classification of Functioning, Disability and Health (ICF) is gaining a special role. Using a set of clear definitions of functions, structure, activities and participation and environmental factors, the attending (family) doctor and rehabilitation doctor will be able to objectively assess the abilities and limitations of daily life and activities, consistently determining the factors influencing human functioning. The aim of the study: to assess the functionality, activity and participation of patients with arterial hypertension (AH) stage III, 2-3 degrees, severe risk according to the criteria of the ICF. Materials and methods: examined 53 patients with hypertension, 15 of whom had hypertensive crisis it was complicated by STEMI myocardial infarction (MI) with a rehabilitation diagnosis according to ICF s4100.378, b4200.8, 20 patients with hypertensive crisis complicated by ischemic stroke (rehabilitation diagnosis according to ICF - s110.878, b4200.8) and 18 patients with atrial fibrillation due to hypertensive crisis and a diagnosis of ICF - s4100.878, b4101.8. To assess the structural changes of the heart echocardiography. To assess activity and participation for all patients included in the study were offered and performed the Tinetti test (1986) with a separate assessment of balance and gait, using the Rivermead mobility index, a 6-minute walk test, and a modified Borg load perception scale. All obtained indicators were statistically processed. Results. Studies of myocardial structure show that its the largest mass was in patients with AH and atrial fibrillation and slightly lower, although insignificantly, in patients who developed a MI on the background of hypertensive crisis and significantly (p<0.05) less in the subjects, where hypertensive crisis was complicated by ischemic stroke. At the same time MMLV of all the patients significantly (p1,2,3<0,05) exceeded the similar indicator at healthy. The same nature of changes is characteristic of IMMLV in patients examined by us. The Tinnetti test for balance was the lowest (6.7±0.6 points) in patients with AH and hypertensive crisis complicated by ischemic stroke and 1.8 and 1.98 times higher (p1.3 <0.05) in patients with AH in whom the hypertensive crisis was complicated by MI and atrial fibrillation. The overall mobility of the subjects also depended on the nature of the complications of the hypertensive crisis and was most severely impaired in patients with ischemic stroke (6.3±0.5 points) and decreased 1.4 times (p<0.05) compared with patients with MI and 1.7 times in cases of complications of hypertensive crisis with cardiac arrhythmia. While performing the test with a 6-minute walk, it was found that patients with AH complicated by ischemic stroke, walked 133.3 m (p<0.01) shorter distance than those examined with AH complicated by MI. The Borg scale in patients with AH and hypertensive crisis, complicated by MI and ischemic stroke was almost the same and slightly exceeded its average degree. In cases of development after a hypertensive crisis of cardiac arrhythmias (atrial fibrillation), the Borg scale showed a slight fatigue. Thus, apart the biological model that takes into account the localization of the pathological process and its complications, a biosocial model is very important, which includes activity, participation, adaptation to everyday life and the environment, which has diverse changes and must be evaluated for rehabilitation planning in such patients.

Characteristics of the deventilation syndrome in COPD patients treated with non-invasive ventilation: a prospective, controlled, non-blinded study

Background Non-invasive ventilation (NIV) is a recommended treatment for COPD patients suffering from chronic hypercapnic respiratory failure. Prolonged dyspnea after mask removal in the morning, often referred to as deventilation syndrome, is a common side effect but has been poorly characterized yet. This study aimed to explore the pathomechanism, identify risk factors and possible treatment strategies for the deventilation syndrome. Methods A prospective, controlled, non-blinded study was conducted. After a night with established NIV therapy, the patients underwent spirometry, blood gas analyses and 6-minute walking tests (6MWT) directly, at two and four hours after mask removal. Dyspnea was measured by the modified Borg scale. Bodyplethysmography and health-related quality of life (HRQoL) questionnaires were used. Patients suffering from deventilation syndrome (defined as dyspnea of at least three points on the Borg scale after mask removal) were treated with non-invasive pursed lip breathing ventilation (PLBV) during the second night of the study. Results Eleven of 31 patients included (35%) met the given criteria for a deventilation syndrome. They reported significantly more dyspnea on the Borg scale directly after mask removal (mean: 7.2 ± 1.0) compared to measurement after two hours (4.8 ± 2.6; p = 0.003). Initially, mean inspiratory vital capacity was significantly reduced (VCmax: 46 ± 16%) compared to two hours later (54 ± 15%; p = 0.002), while no changes in pulse oximetry or blood gas analysis were observed. Patients who suffered from a deventilation syndrome had a significantly higher mean airway resistance (Reff: 320 ± 88.5%) than the patients in the control group (253 ± 147%; p = 0.021). They also scored significantly lower on the Severe Respiratory Insufficiency Questionnaire (SRI; mean: 37.6 ± 10.1 vs 50.6 ± 16.7, p = 0.027). After one night of ventilation in PLBV mode, mean morning dyspnea decreased significantly to 5.6 ± 2.0 compared to 7.2 ± 1.0 after established treatment (p = 0.019) and mean inspiratory vital capacity increased from 44 ± 16.0% to 48 ± 16.3 (p = 0.040). Conclusions The deventilation syndrome is a serious side effect of NIV in COPD patients, associated with lower HRQoL. Our data suggests that it is most likely caused by dynamic hyperinflation. Patients with high airway resistance are at greater risk of suffering from morning dyspnea. Ventilation in PLBV mode may prevent or improve the deventilation syndrome. Trial registration The study was registered in the German Clinical Trials Register (DRKS00016941) at 04 April 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS

Muscle Activation and Subjectively Perceived Effort in Typical Violin Positions

Violinists display a high incidence of task-specific musculoskeletal problems. Sources pertaining to violin playing and teaching traditions as well as musicians’ medicine research offer only imprecise and contradictory recommendations regarding suitable instrument positions. The aim of this study was to add to a growing scientific base for teaching and medical counseling regarding violin positioning. The study evaluated muscle activation (EMG) and subjectively perceived effort (Borg scale) in four standardized typical violin positions, as well as the violinists’ normally used one. The hypothesis, the smaller the angle between the instrument’s longitudinal axis (LoAx) and the player’s central sagittal plane (CSP) and the angle between its lateral axis (LatAx) and the player’s horizontal plane (HP), the more muscle activation and perceived effort in the violinist’s left arm, was confirmed: Decreasing the LoAx-CSP angle from 50° to 20° and the LatAx-HP angle from 50° to 20° resulted in a highly significant and independent increase of EMG and Borg scale self-ratings mean values. Results may allow for a first step in decision-making on violin positioning for ergonomic adaptations in teaching as well as prevention and therapy of playing-related health problems at all levels of proficiency.