Cardiorespiratory Status Research Articles

The prediction model of academic achievement based on cardiorespiratory fitness and BMI status for ninth-grade students

The purpose of this study was to predict an academic achievement model based on cardiorespiratory fitness (CRF) and body mass index (BMI) in ninth-graders. The study sample included 6 530 adolescents from 341 public schools in Slovakia. Criterion-referenced competency tests measuring academic performance in mathematics and mother language (Slovak), CRF, and BMI were assessed in the academic year 2022–2023. The results from the Random Forest Regression (RFR) machine learning algorithm suggest that adolescents who meet the international CRF and BMI criterion-referenced standards have a higher probability of getting a higher academic achievement score than unfit students with overweight or obesity. The chances of achieving the highest level of academic performance rose by 165% in mathematics and by 484% in mother language for boys who were fit and of normal weight compared to unfit boys with obesity. Unfit boys with obesity and unfit overweight girls had significantly lower odds of having the highest level of academic achievement compared to fit and normal-weight adolescents in mathematics (OR = 0.38; 95% CI, 0.20–0.71; p = 0.003; OR = 0.32; 95% CI, 0.18–0.55; p < 0.001) and mother language, respectively (OR = 0.17; 95% CI, 0.09–0.34; p < 0.001; OR = 0.17; 95% CI, 0.08–0.38; p < 0.001). Our results suggest that CRF is a significant predictor, with fit and normal-weight boys showing higher odds of better academic performance, but the model’s modest predictive power suggests other factors also play a role.

The impact of gasping versus apnea on initial heart rate and response to positive pressure ventilation in the delivery room following interruption of placental blood flow.

The impact and/or significance of gasping or apnea on cardio-respiratory status at birth remains unclear. The study objectives were to determine in infants presenting with gasping or apnea in the delivery room, initial heart rate (HR), responses to positive pressure ventilation (PPV), time to onset of spontaneous respirations, and the relationship of these responses to 24-hour outcome (death/survival) METHODS: Observation study undertaken in a rural setting involving late preterm and term newborns who gasped (n=126) or were apneic (n=105) at birth and received PPV had HR and respiratory parameters continuously measured and were video recorded. Apneic (12.3 %) versus gasping infants (5.7 %) were 7.2-fold more likely to die in the first 24 h (p = 0.01) and 2.8-fold more likely to die (p = 0.047) by 7 days. Initial HR was higher in gasping versus apneic infants (122 vs 105 bpm) (p = 0.01). Time to initiate breathing after starting PPV was significantly shorter in gasping versus apneic infants. No differences in applied peak inflation pressure, tidal volume, end tidal CO2, or resuscitation duration were noted. Of infants who died versus survivors, a HR < 100 bpm was observed more often in both gasping and apneic infants (p = 0.01) CONCLUSIONS: Infants who present with gasping versus apnea are less likely to die; apneic infants are more likely to die within the initial 24 h. Gasping versus apneic infants had a higher initial HR, were less likely to have a HR < 100 bmp and initiated spontaneous respiratory effort sooner after PPV. These findings are consistent with experimental and adult observations that suggest gasping appears critical to survival if PPV is initiated in a timely manner.

Performing High-Quality Sublobar Resections: Key Differences Between Wedge Resection and Segmentectomy.

Lung cancer remains the leading cause of cancer-related deaths worldwide. The introduction of targeted treatments and immunotherapy in lung cancer has transformed patient care by offering "precision medicine" focused on the characteristics of the disease. The same concept has emerged in lung cancer surgery. This "precision surgery" aims to determine the best surgical approach based on the characteristics of the cancer, the patient's cardiorespiratory status, and technological advances in thoracic surgery. While lobectomy continues to be the gold standard for managing early-stage lung cancer, the implementation of screening programs has enabled the earlier detection of smaller tumors. In this context, sublobar resections, particularly segmentectomy, have emerged as valuable options in the treatment of early-stage lung cancer. Recent studies suggest that sublobar resections, including segmentectomy and wedge resection, provide a viable alternative to lobectomy. This review explores the various resection strategies available, tailored to patient and tumor characteristics, and highlights modern preoperative techniques aimed at advancing precision surgery.

Cardiorespiratory Stability in Critically Ill Preterm Infants following Dexmedetomidine Initiation.

This study aimed to evaluate cardiorespiratory status in preterm infants receiving dexmedetomidine using high-resolution physiologic data. We analyzed preterm infants with continuous heart rate (HR) and oxygen saturation (SpO2) data for 24 hours preceding and 48 hours following dexmedetomidine initiation. Invasive arterial blood pressure (ABP), when available, was analyzed. In 100 infants with a mean gestational age of 28 weeks and high baseline illness severity, mean HR decreased from 152 to 141 beats per minute while mean SpO2 increased from 91 to 93% in the 48 hours after dexmedetomidine initiation (p < 0.01). In 57 infants with continuous ABP monitoring, mean ABP increased from 40 to 42 mm Hg (p = 0.01). Vasoactive-inotropic support increased before and after initiation. We observed cardiorespiratory changes in critically ill preterm infants following dexmedetomidine initiation; mean HR decreased and mean SpO2 increased in the 48 hours after initiation. In a subset, mean ABP increased along with vasoactive-inotropic support. · Limited evidence exists on the acute cardiorespiratory effects of dexmedetomidine in preterm infants.. · Evaluation of continuous HR, blood pressure, and oxygenation from two centers provides useful data.. · Dexmedetomidine consistently decreased the HR of preterm infants.. · Dexmedetomidine initiation during critical illness complicated the interpretation of physiologic effects.. · Oxygenation stabilized after initiation during invasive mechanical ventilation..

The effect of swimmer position during prone ventilation on the onset of brachial plexus injury in the intensive care unit: A multiprofessional clinical study protocol.

Prone positioning improves oxygenation in adults with acute respiratory distress syndrome (ARDS) and has been extensively applied in intensive care units (ICU) during the COVID-19 pandemic. Although some complications due to the manoeuvre are well known, brachial plexus injury after prone positioning is reported as a rare complication and the phenomenon could be either very rare or underestimated. This study aimed to evaluate the effect of swimmer position during prone ventilation on the onset of brachial plexus injury in patients admitted to ICU for ARDS. The study will also evaluate the safety of prolonged prone positioning collecting data on any adverse events occurred. A prospective, observational cohort study will be conducted in a tertiary level ICU in the metropolitan area of Milano (Italy) specialized in advanced treatment of patients with ARDS. This observational study will report clinical data on the electromyography (EMG) and the muscle strength assessment, including comorbidities and cardio-respiratory status. A baseline EMG will be performed within 2 h from the first pronation manoeuvre and immediately at the end of each pronation cycle. The functional assessment of patients will be also performed at the end of ICU stay and at hospital discharge. The primary outcome is to estimate the prevalence of brachial plexus injury in patients with ARDS placed in the swimmer position during prone ventilation. Secondary outcomes will also include the safety of the manoeuvre by evaluation of all adverse events classified as skin or ocular damage, loss of tube and vascular access and new pressure ulcers. The findings of this study will contribute to understand the possible benefits/harms of prone ventilation performed using swimmer position. Eventually, this will call for the development of specific and tailored rehabilitation programs for patients with upper limb injuries during ICU stay, including also timely follow-up upon ICU-discharge.

Comparison of functionality, physical activity, cardiac and respiratory parameters between patients with mood disorders and healthy controls

Background The cardiorespiratory effect in mental illnesses has recently received much attention. However, the cardiovascular and pulmonary effects of mood disorders have not been clearly demonstrated. Aims This study aims to compare individuals with mood disorders and healthy people in terms of exercise capacity, functionality, respiratory muscle strength, pulmonary function, dyspnoea and physical activity level. Method This cross-sectional study involved 30 patients with mood disorders and 35 age- and gender-matched healthy individuals. Exercise capacity (6-Minute Walk Test (6MWT), 3-Minute Step Test (3MST)), functionality (vertical jump test, functional reach test), respiratory parameters (respiratory muscle strength, pulmonary function test), dyspnoea (Modified Medical Research Council Dyspnoea Scale) and physical activity level (Short-Form International Physical Activity Questionnaire (IPAQ)) were evaluated. Results 6MWT results (P &lt; 0.001) and functional test scores (vertical jump test, P = 0.006; functional reach test, P &lt; 0.001) were significantly lower, and heart rate recovery after 3MST (P &lt; 0.001) was higher in mood disorder patients. Although patients' respiratory parameters were lower than healthy individuals, only measured and predicted respiratory muscle strength (P &lt; 0.001), peak expiratory flow rate litres (P &lt; 0.001), forced vital capacity predicted (P = 0.010) and forced expiratory volume in 1 s predicted (P = 0.002) values were statistically significantly different. Dyspnoea with activities was higher in patients (P &lt; 0.001). Patients spent more time sitting (IPAQ, P &lt; 0.001), but overall physical activity levels were similar between the two groups (P &gt; 0.05). Conclusions Patients with mood disorders had decreased exercise capacity and pulmonary function, lower functionality scores and respiratory muscle strength, and increased dyspnoea. Exercise-based rehabilitation protocols are recommended for the management of risk factors affecting the mood disorder patients' cardiorespiratory status.

Exercise and training in sickle cell disease: Safety, potential benefits, and recommendations.

Sickle cell disease (SCD) is a genetic disorder characterized by complex pathophysiological mechanisms leading to vaso-occlusive crisis, chronic pain, chronic hemolytic anemia, and vascular complications, which require considerations for exercise and physical activity. This review aims to elucidate the safety, potential benefits, and recommendations regarding exercise and training in individuals with SCD. SCD patients are characterized by decreased exercise capacity and tolerance. Acute intense exercise may be accompanied by biological changes (acidosis, increased oxidative stress, and dehydration) that could increase the risk of red blood cell sickling and acute clinical complications. However, recent findings suggest that controlled exercise training is safe and well tolerated by SCD patients and could confer benefits in disease management. Regular endurance exercises of submaximal intensity or exercise interventions incorporating resistance training have been shown to improve cardiorespiratory and muscle function in SCD, which may improve quality of life. Recommendations for exercise prescription in SCD should be based on accurate clinical and functional evaluations, taking into account disease phenotype and cardiorespiratory status at rest and in response to exercise. Exercise programs should include gradual progression, incorporating adequate warm-up, cool-down, and hydration strategies. Exercise training represents promising therapeutic strategy in the management of SCD. It is now time to move through the investigation of long-term biological, physiological, and clinical effects of regular physical activity in SCD patients.

Elevated pulmonary capillary wedge pressure, higher blood pressure, and lower cardiac index in infants with bronchopulmonary dysplasia

BackgroundLeft ventricular diastolic dysfunction indicated by elevated pulmonary capillary wedge pressure (ePCWP) may worsen cardiorespiratory status in bronchopulmonary dysplasia (BPD), but the scope of ePCWP by cardiac catheterization is not well described. MethodsThis single-center retrospective cohort study included infants with BPD without congenital heart disease, significant intracardiac shunts, or pulmonary vein stenosis who underwent cardiac catheterization from 2010 to 2021. ePCWP was defined as >10 mmHg. Quantitative measures of ventricular systolic and diastolic function were performed on existing echocardiograms. Patients with and without ePCWP were compared using the Chi-squared or Wilcoxon rank-sum tests. Associations between catheterization hemodynamics and echocardiographic parameters were assessed by simple linear regression. ResultsSeventy-one infants (93% Grade 2 or 3 BPD) met inclusion criteria, and 30 (42%) had ePCWP. Patients with ePCWP were older at catheterization (6.7 vs. 4.5 months, p < 0.001), more commonly underwent tracheostomy (66.7% vs. 29.3%, p = 0.003), and had higher mean systemic blood pressure [64.5 (56.0, 75.0) vs. 47.0 (43.0, 55.0) mm Hg, p < 0.001], higher systemic vascular resistance [11.9 (10.4, 15.6) vs. 8.7 (6.7, 11.2) WU*m2, p < 0.001), and lower cardiac index [3.9 (3.8, 4.9) vs. 4.7 (4.0, 6.3) L/min/m2, p = 0.03] at catheterization. Mean pulmonary artery pressure, pulmonary vascular resistance, and mortality were similar between the groups. Echocardiographic indices of left ventricular diastolic dysfunction did not correlate with PCWP. ConclusionsePCWP was common in infants with severe BPD who underwent cardiac catheterization in this cohort. The association between ePCWP and higher systemic blood pressure supports further study of afterload reduction in this population.

IMPACT OF SARS-COV-2 INFECTION IN NEUROCOGNITIVE AND CARDIOPULMONARY FUNCTIONALITY OF HYPERTENSIVE PATIENTS

Objective: Few data have been published regarding the holistic approach of post-Covid patients with a history of hypertension, examining both physical and mental health. The purpose of our prospective study was to follow up cardiorespiratory status, and mental and psychological health of hypertensive patients 3 months after the first day of infection. Design and method: All patients with a history of Sars-Cov-2 infection and good functional status were assessed using cardiorespiratory test, transthoracic echocardiogram, and standardized questionnaires by a comprehensive team of experts (cardiologists, psychiatrists, and psychologists). The population was divided into two groups according to hypertension status. Results: Out of total population of 198 patients (51±15 years, 44.4% males, 6.6% history of coronary heart disease) with COVID-19 infection were assessed. Hypertensives had higher BMI (p&lt;0.001) and BSA (p&lt;0.001) and they were hospitalized in higher percentage (p&lt;0.01). Out of echocardiographic parameters, diastolic dysfunction parameters including left atrial diameter (p&lt;0.001) and E/A ratio (p&lt;0.001) differed significantly between the two groups. LVEF (%) was significantly impaired (56±10% vs. 58±9%, p:0.04) in hypertensives that was depicted in lower values of oxygen consumption (VO2 (ml/kg/min)) both maximum (p&lt;0.001) and during the 1st minute of recovery (p&lt;0.006), metabolic equivalents (METS) at peak, (p&lt;0.001) and HR1st minute recovery (p&lt; 0.001) comparing to normotensives. Systolic blood pressure (mmHg) at rest (p: 0.002), at peak (p: 0.01), and during the 1st minute of recovery (p: 0.001) as well as Borg scale score for dyspnea (p:0.02) were higher while the exercise duration was significantly lower (p&lt;0.001) in hypertensives comparing to normotensives. Similarly, their psychometric tests (DASI METS (p:0.008), Functionality (p:0.036)) were also affected. Finally, using linear regression analysis adjusted for age, gender, hypertension status, and hospitalization, age (p: 0.001) proved to be an independent predictive factor for VO2, VO2_AT, and VO21st minute of recovery in hypertensive patients. Conclusions: To conclude, the current study highlighted the reduced ability to exercise and fragility of patients with a history of hypertension. Age proved to be an independent negative predictor of functionality. Therefore, the need for a more comprehensive approach to the rehabilitation of post-covid patients is mandatory.

Functional status of the human cardiorespiratory system during a one-year expedition at Vostok station in central Antarctica as a model of a long-term lunar base

Investigation of the cardiorespiratory system status in the conditions of yearlong wintering at Vostok station provided new data on the development of long-term adaptation of the human body under the influence of combined factors of the extreme environment of Central Antarctica, where this climatic zone was considered as a model of the extreme environment of the lunar base. During the 64th Russian Antarctic Expedition (2019), extended studies, including a dynamic assessment of the state of the cardiovascular and respiratory systems of polar expeditioners were carried out at Vostok station. New information was obtained regarding the peculiarities of the functioning of the cardiorespiratory system under the conditions of hypobaric hypoxia depending on age during the annual adaptation to the extreme climatic conditions of Central Antarctica.

Trivial Complaint in an Eisenmenger Syndrome Patient: A Case Report

Acute pulmonary embolism (PE) is a life-threatening cardiorespiratory condition. Shortness of breath and cyanosis in an active daily living patient with Eisenmenger Syndrome (ES) obscuring the early diagnosis of acute PE. We reported a case of a 41-year-old lady with underlying Eisenmenger syndrome presented to Emergency Department with sudden onset of palpitation. Otherwise, she did not complain of any worsening shortness of breath or reduced effort tolerance. Compensation of the heart causing normalization of the blood pressure in ES may mask the features of massive PE and make it more challenging in managing this kind of patient. However, with the complaint of acute onset palpitation trigger the managing team to think about PE. Computed Tomography Pulmonary Angiography (CTPA) had done, and there were significant blood clots in the right main pulmonary artery. Luckily, she survived after thrombolytic therapy, warded a few days, and discharge well with a life-long oral anticoagulant.

The effect of exercise training intervention for patients with abdominal aortic aneurysm on cardiovascular and cardiorespiratory variables: an updated meta-analysis of randomized controlled trials

ObjectiveThe purpose of this meta-analysis was to evaluate the effect of exercise training intervention in patients with abdominal aortic aneurysm (AAA).MethodsEight randomized controlled trials (RCTs) that recruited 588 AAA patients were extracted using 4 databases (PubMed, Embase, Wanfang Data, and Cochrane Library). Physiological and biochemistry parameters that included in this study are high-sensitivity C-reactive protein (hs-CRP), respiratory peak oxygen uptake rate (VO2peak), triglyceride (TG), total cholesterol (TC), anaerobic threshold (AT), the diameter of AAA, high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), and matrix metalloproteinase-9 (MMP-9). Standard mean difference (SMD) was used to assess the between group effect.ResultsThis meta-analysis was synthesized with findings from RCTs and found that hs-CRP (SMD, − 0.56 mg/dL; 95% CI: − 0.90 to 0.22; P = 0.001), VO2peak (SMD, 0.4 mL/kg/min; 95% CI, 0.21 to 0.60; P < 0.001), TG (SMD, − 0.39 mg/dL; 95% CI: − 0.02 to 0.77; P = 0.04), and AT (SMD, 0.75 mL/kg/min; 95% CI, 0.54 to 0.96; P < 0.001) were significantly improved in the exercise groups, while the size of AAA (SMD, − 0.15; 95% CI: − 0.36 to 0.06; P = 0.15), TC (SMD, 0.16 mg/dL; 95% CI: − 0.10 to 0.42; P = 0.23), HDL/LDL ratio (SMD, − 0.06; 95% CI: − 0.32 to 0.20; P = 0.64), HDL (SMD, − 0.09; 95% CI: − 0.39 to 0.20; P = 0.54), LDL (SMD, 0.08; 95% CI: − 0.21 to 0.38; P = 0.59), and MMP-9 (SMD, − 0.23 mg/dL; 95% CI: − 0.53 to 0.06; P = 0.12) did not differ in the exercise groups compared with the controls.ConclusionExercise intervention improved some of the CVD risk factors but not all, hs-CRP, VO2peak and AT were significantly improved after exercise intervention, while, changes of MMP-9, the size of AAA, and the overall lipids profile were not. Exercise intervention provides an additional solution for improving cardiorespiratory capacity and health status among AAA patients, and might lead to a delay of AAA progression.

Signal Quality Assessment of Photoplethysmogram Signals Using Hybrid Rule- and Learning-Based Models

Photoplethysmography signals are crucial for a wide range of applications and, therefore, high-quality PPG signals are crucial to describe the cardiorespiratory status accurately. Motion artifacts can impair PPG-based applications, especially when these signals are recorded via wearable devices. Taking that in consideration, some researchers had proposed few methods for assessing the quality of these signals. Some rule- and learning-based approaches for PPG signal are available to determine the quality of the signal. In this paper, we propose a tradeoff between these two approaches by introducing a hybrid model that employs both learning and decision rules to determine the quality of the signal.

Role of exercise physiologists in talent identification, training and monitoring performance in sports

Exercise Physiology is the branch of 'Sports Science', which involves the study of adaptation to exercise. Exercise physiologists monitor thephysical and physiological variables of the sports persons, which are used for talent identification, training, and evaluation of performance.Sports talent may be identified from young children when they show interest in sports. Proper nutrition and training during the growthand development phase of life help improve the athletes' performance. Training has to be formulated according to the principles ofperiodization to achieve the best possible performance. Long-term training and participating in competitions brought changes withinthe sports persons. Regular monitoring of athletes' anthropometric, physical fitness and physiological variables provides valuableinformation about their fitness, health, metabolic and cardio-respiratory status. This would enable the coaches to assess the currentstatus of the athletes and the degree of training adaptability and provide an opportunity to modify the training schedule accordinglyto achieve the desired performance. Exercise physiologists suggest optimal training strategies to enhance athletic performance. Thedemand for an athlete's success and fitness awareness within society increases the responsibility of exercise physiologists to optimizeathletes' sports performance, health, and safety.

PHYSIOLOGICAL STUDIES ON THE CARDIOPULMONARY INDEX CHANGES IN ADAPTATION TO PROGRESSIVE PHYSICAL LOADS

Objective. The main purpose of the research was to develop a coefficient of cardiorespiratory system status, which will take into account both frequency and power characteristics of external respiration and hemodynamics activity. Compare an informativeness of this coefficient with a universally accepted Hildebrandt one.&#x0D; Materials and Methods. 154 apparently healthy young people of both sexes were examined. On a bicycle ergometer with a pedaling rhythm of 40 per minute, five standard stages of short-term physical exercise load ranging from negligible to moderate were provided. Spirography, tonometry and pulsometry were carried out before loading, at its peak and after it. The parameters specified were recorded for each subject simultaneously. Systolic volume was calculated using Starr formula with subsequent defining cardiac minute output.&#x0D; Statistical analysis was performed using Statistica ® 7.0 package (StatSoft Inc., USA). Assessment of results’ significance was calculated using Student's t-test and sign test.&#x0D; Results. In the case of low short-term physical exercises pulmonary ventilation is increased due to greater reactivity of external breathing amplitude and to a lesser extent due to change in the frequency of respiratory movements. This type of reactions of the respiratory component in cardiorespiratory interaction is more efficient. In the given conditions, body’s adaptation is ensured by breathing component dominance, while responses of systemic arterial pressure and pulse turn out to be less pronounced, less stabile. Taking into account greater adaptive importance in power characteristics changes of respiratory and cardiovascular activity, a coefficient of cardiorespiratory system status is proposed – MBV/RMV (ratio of minute blood flow volume to respiratory minute volume). The given factor is demonstrated to have significantly greater informative value and sensitivity to generally recognized Hildebrandt coefficient.

Cytokine Storm Syndrome Triggered by Extracorporeal Membrane Oxygenation in Pediatric Patients.

Cytokine storm syndrome (CSS) is a serious and potentially life-threatening condition caused by severe systemic inflammation, immune activation, and a positive feedback loop of cytokine release. Typically triggered by systemic infection, malignancy, monogenic or rheumatic disease, similar patterns of hyper-inflammation have been seen in patients undergoing cardiopulmonary bypass (CPB) and in patients treated with extracorporeal membrane oxygenation (ECMO). Typical treatments used for the prevention and treatment of CPB/ECMO-induced hyper-inflammation have not been shown to be substantially effective. Two patients suffering from ECMO-related CSS were identified by their severe hyper-inflammatory profile and life-threatening sequelae of vasodilatory shock and respiratory failure. Anakinra, an interleukin-1 receptor antagonist, was employed as specific cytokine-directed therapy for the treatment of CSS in these two patients to good effect, with significant improvement in hyper-inflammation and cardiorespiratory status. The use of cytokine-directed therapies in CPB/ECMO-related CSS has great potential to improve the treatment and outcomes of this serious condition.

Reflex regulation and the functional assessment possibility of the cardiorespiratory system in pregnancy: a systematic review

INTRODUCTION: Anesthesia planning for cesarean section requires knowledge of physiological and functional features a pregnant patient has in her gestational age. Proper planning reduced the perioperative critical incidents risk. OBJECTIVE: Search for data on the methods and results of assessing the cardiorespiratory status of pregnant women using methods that involve such key mechanisms of arterial baroreflex (ABR) and peripheral chemoreflex (PCR) mechanisms. MATERIAL AND METHODS: We performed a systematic review of the literature in accordance with the PRISMA guidelines. The bibliographic search was performed in December 2022 in the Medline (Pubmed), RSCI (eLibrary.ru) and Cochrane Library databases. The search keywords were: “pregnancy breath holding test”, “pregnancy chemoreflex”, “pregnancy baroreflex”, “Valsalva test pregnancy”. RESULTS: 110 documents were found, after deleting 68 papers for various reasons 42 full-text sources were analyzed, including a detailed comparative analysis of 8 sources that met totally the inclusion criteria. The design, objectives, methods, data availability, and outcomes of the studies were heterogeneous, so a meta-analysis was not performed. Were extracted and summarized data on functional changes in the work of cardiorespiratory system during pregnancy and changes in the sensitivity of the baroreflex and chemoreflex. CONCLUSIONS: The sensitivity of PCR in pregnant women can be assessed by inhalation of hyperoxic, hypercapnic and isooxic-hypercapnic gas mixtures (rebreathing test). The sensitivity of ABR in pregnant can be assessed by phenylephrine test, Valsalva test, orthostatic test, and spectral analysis of the sequences of blood pressure values and the R-R interval. The sensitivity of PCR in full-term pregnancy increases. The sensitivity of ABR in pregnant progressively decreases from the beginning of pregnancy to the end of the second trimester and increases in the postpartum period to initial level; in the third trimester of pregnancy, changes in ABR sensitivity are individual and do not have a single trend.

Preoperative Stress Testing before Non-Cardiac Surgery.

The current guidelines from various medical societies provide a good summary of data regarding various preoperative exercise tests in patients prior to non-cardiac surgical interventions. However, there is no consensus among experts on the appropriateness of these methods for identifying risk groups for potential perioperative complications. A large volume of published studies describes the role of preoperative exercise stress testing impact in improving the prediction of potential cardiovascular (CV) risk in patients after non-cardiac surgery. Numerous stress tests are available in clinical practice, and the methods used and the best choice depends on the purpose of the study and the availability of equipment in the hospital. Traditionally, the value of exercise electrocardiography (ECG), or ECG stress test, has been based on the belief that it is beneficial for perioperative cardiac risk prediction. However, in the past two decades, the key role of this method has lost its importance due to the growing trend toward the use of imaging techniques. Moreover, in light of current trends, the six-minute walk test (6MWT) is a helpful tool in preoperative assessment and plays an important role in postoperative rehabilitation. Interestingly, the recent finding showed how 6MWT affects the risk of postoperative complications. Cardiopulmonary testing, as a dynamic clinical tool, determines the cardiorespiratory status of a patient. Various clinical indications for cardiopulmonary exercise testing include evaluation of therapy, stratification of risk factors, diagnosis of disease, and control of physical activity. Stress testing is one of the most practical ways of predicting perioperative risk and managing patients. This test is based on ischemia provoked by pharmacological agents or exercise. There is no established evidence of a significant advantage of pharmacological stress over exercise stress imaging in subjects who are capable enough to be physically active. All of these studies examined a stress test for induced myocardial ischemia. Currently, there are no data on the use of ischaemic stress tests, especially diastolic stress tests, in the assessment of perioperative risk before non-cardiac surgical interventions. We consider it promising and essential to continue research in this direction in patients with coronary heart disease and other categories of cardiac patients, in particular, comorbid and low-symptomatic individuals, before elective high-risk surgical interventions.

Validity and sensitivity of field tests' heart-rate recovery assessment in recreational football players.

We aimed at examining the criterion validity and sensitivity of heart-rate recovery (HRRec) in profiling cardiorespiratory fitness in male recreational football players in the untrained and trained status, using endurance field-tests. Thirty-two male untrained subjects (age 40 ± 6 years, VO2max 41.7 ± 5.7 ml·kg-1·min-1, body mass 82.7 ± 9.8 kg, stature 173.3 ± 7.4 cm) participated in a 12-week (2‒3 sessions per week) recreational football intervention and were tested pre- and post-intervention (i.e. untrained and trained status). The participants performed three intermittent field tests for aerobic performance assessment, namely Yo-Yo intermittent endurance level 1 (YYIE1) and level 2 (YYIE2) tests, and Yo-Yo intermittent recovery level 1 (YYIR1) test. VO2max was assessed by performing a progressive maximal treadmill test (TT) and maximal HR (HRmax) determined as the maximal value across the testing conditions (i.e., Yo-Yo intermittent tests or TT). HRRec was calculated as the difference between Yo-Yo tests' HRpeak or HRmax and HR at 30 s (HR30), 60 s (HR60) and 120 s (HR120) and considered as beats·min-1 (absolute) and as % of tests' HRpeak or HRmax values. Significant post-intervention improvements (p<0.0001) were shown in VO2max (8.6%) and Yo-Yo tests performance (23-35%). Trivial to small (p>0.05) associations were found between VO2max and HRRec (r = -0.05-0.27, p>0.05) across the Yo-Yo tests, and training status either expressed as percentage of HRpeak or HRmax. The results of this study do not support the use of field-test derived HRRec to track cardiorespiratory fitness and training status in adult male recreational football players.

Development of Pneumothorax Concurrent with Pleural Effusion in a Critically Ill Patient of Ruptured Ectopic Pregnancy with Covid-19 Pneumonia: A Case Report

Development of pneumothorax in COVID-19 pneumonia is a rare occurrence, incidence approximately 1%, while the incidence of pleural effusion varies between 2%-11%. A young patient with COVID-19 pneumonia and unstable hemodynamics was referred to our hospital. She had undergone an emergency laparotomy two days back for ruptured ectopic pregnancy during which she suffered hemorrhagic shock followed by episodes of pulseless ventricular tachycardia and was resuscitated. On her third day of intensive care stay at our centre, she remained critical and developed pleural effusion with concurrent pneumothorax with the complete collapse of the left lung. Here we present a rare complication in COVID-19 pneumonia, pleural effusion and concurrent pneumothorax leading to complete collapse of hemi-lung and its implications on the cardiorespiratory status of our critically ill patient.