Modified Borg Scale Research Articles

Efficacy and safety of ultra-low dose inhaled melphalan in the treatment of hospitalized patients with COVID-19

Background. One of the most important components of COVID-19 therapy is the suppression of the hyperergic immune response. There is an urgent need of creating the optimal tactics of efficient and safe anti-inflammatory therapy. A new method of treatment of COVID-19 with inhalation of ultra-low (non-cytotoxic) doses of the alkylating drug melphalan is proposed, based on previous experimental, preclinical, and clinical data on its use in severe bronchial asthma.The aim. To evaluate the efficacy and safety of inhalation of ultra-low doses of melphalan in hospitalized patients with COVID-19-associated lung damage.Materials and methods. A prospective, open, controlled, blind for the central expert study was conducted. Sixty adult patients were included, 30 patients were consecutively admitted to the hospital and received nebulized inhalations of 0.1 mg of melphalan for 7 days. Thirty patients of the control group were selected by an independent expert retrospectively using the computer algorithm for selecting «close» patients based on the «case-control» principle. The primary endpoints were the dynamics on the WHO Clinical Improvement Scale and the dynamics of dyspnea according to the modified Borg scale, secondary – assessment of adverse events, dynamics of indicators of clinical, biochemical blood tests, lungs computed tomography data from the beginning of inhalations in the melphalan group and from the corresponding day in the control group.Results. Inhalations of melphalan led to a significant improvement in the clinical condition of patients according to the WHO scale, decrease in the intensity of dyspnea on day 7 of treatment and by the time of discharge, a significant anti-inflammatory effect. Adverse events and dynamics of laboratory parameters did not differ from the control group.Conclusion. The method of treatment of COVID-19 by inhalation of ultra-low doses of the alkylating drug melphalan is safe and leads to a significant clinical improvement of hospitalized patients with COVID-19-associated lung damage.

Effort perception and hemodynamic responses to the 3/7 vs. 3X9 methods in heart failure and in coronary artery disease patients: a randomized-cross-over study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Fonds Erasme pour la recherche médicale Background/Introduction The hemodynamic response to strength training depends on the intensity, the time of rest between exercise sets and the duration of the exercise (1-3). A new method (the ‘3/7 method’), which consist of 5 successive sets of exercise with an increasing number of repetitions (3 to 7) separated by brief inter-set rest intervals (15 s), achieved a greater and faster strength gain after 12 weeks of training in young healthy subjects (4-5) (Fig 1). Further characterization of the tolerability of 3/7 method, as well as rise in blood pressure (BP) and heart rate (HR) it may induce, is needed in a patient population before this methodology can be applied in cardiac rehabilitation centers (6). These parameters were compared to those induced by 3 series of 9 repetitions (‘3X9 method’) with a longer inter-set rest interval (1min), using a randomized and cross-over study design. Purpose This study investigated the Borg scale and hemodynamic response of the 3/7 vs. 3X9 strength training methods in heart failure patients with reduced ejection fraction (HFrEF, Left ventricular ejection fraction (LVEF) < 40%) and patients with coronary artery disease (LVEF> 40%, CAD). Method 23 HFrEF (58±9 y, 13% female) and 22 CAD (64±10 y, 14% female) participated in the study. CAD underwent revascularization between 1 and 6 months prior to the study. Patients with decompensated heart failure, atrial fibrillation, major orthopedics disabilities were not included in the study. The strength training consisted in leg extension against a load of ~ 70% of 1 repetition maximal (1RM). Perceived exertion was also assessed at the end of the last set by using the modified Borg Scale (0-10). HR and BP were assessed noninvasively beat by beat (Task Force Monitor). We compared baseline and peak exercise values in each group. All participants signed an agreement form approved by the local Ethic Review Board. Result Baseline BP and HR and effort perception at the end of exercise did not differ between the 3/7 and 3X9 groups (Borg scale: HFrEF 3/7 method: 5,4±2,6 vs. 3X9 method: 5,8±2,5; CAD 3/7 method: 6,2±1,3 vs. 3X9 method: 6,1±1,5; p= NS) (Fig 2). HR became faster with the 3/7 method as compared to the 3X9 method in the HFrEF (85±11 vs. 83±12 bpm, p=0.014, respectively) and CAD (90±13 vs. 87±14 bpm, p=0.03, respectively) patients. In the CAD group, systolic BP increased more with the 3/7 method than with the 3X9 method (143±22 vs. 133±20 mm Hg, p<0.001). Other parameters did not differ. Conclusion The 3/7 and 3X9 strength training protocols elicit comparable effort perception and similar hemodynamic responses in HFrEF and CAD. The 3/7 method increases transiently HR by a few more beats in both groups and raises systolic BP by 10 additional mmHg in CAD patients. Taken together, this study suggests the 3/7 method is safe in patients with HFrEF and CAD, and warrants further investigation of the usefulness of the 3/7 method in cardiac rehabilitation units.

129Xe MRI ventilation defects in ever-hospitalised and never-hospitalised people with post-acute COVID-19 syndrome

BackgroundPatients often report persistent symptoms beyond the acute infectious phase of COVID-19. Hyperpolarised 129Xe MRI provides a way to directly measure airway functional abnormalities; the clinical relevance of 129Xe MRI...

Effectiveness of upper limb endurance and resistance exercises on reducing dyspnoea and improving activities of daily living (ADL) in patients with COPD

Introduction and Aim: Chronic Obstructive Pulmonary Disease (COPD) is preventable and treatable disease, presenting permanent airflow limitation accompanying an augmented chronic inflammatory response in the airway and the lungs to harmful elements or gases. Chronic bronchitis and emphysema are the two most common conditions that contribute to COPD, individuals with COPD often experience difficulty with performing upper limb exercise due to dyspnoea and arm fatigue. Consequently, upper limb exercise training is habitually included in lung rehabilitation programmes to advance upper limb exercise tolerance; yet the effects of this exercise on dyspnoea and activities of daily living remain unclear. The aim of this analysis is to determine the effects of upper limb endurance and resistance exercises on reducing dyspnoea and improving activities of daily living (ADL) in patients with COPD. Methodology: This is an experimental study design and was conducted in a clinical set-up of Physiotherapy Department with a total number of 10 samples selected based on the Inclusion and Exclusion criteria. All the participants underwent endurance and resistance exercises to the upper limb for 20 Minutes session for 3 days per week for 4weeks. Pre- and post-treatment assessments were done using the outcome measures Modified Borg Scale and London Chest Activity of Daily Living Scale. Results: The findings of the study revealed improved clinical outcomes in the study group. Calculation of mean and median values and then performing a paired t test of within group between pre-test and post-test values, it shows highly significant difference with a p value of p < 0.001. Conclusion: This study shows that there is a significant improvement in the COPD patients after the treatment implying that Upper Limb Endurance and Resistance Exercises were beneficial in improving ADL and reducing dyspnoea in COPD patients. Future research suggests recommendation of early COPD treatment in both genders.

Сlinical Efficacy of Individually Dosed Intermittent Hypoxia-Hyperoxic Therapy in Osteoarthritis Patients with Post-Covid Syndrome

Aim. To evaluate the clinical efficiency of the individually dosed interval hypoxia-hyperoxic therapy in the medical rehabilitation of patients with osteoarthritis (OA), having post-COVID syndrome. Material and methods. 50 patients with OA (84% females, age of 43 to 68 years) where included in the randomized placebo-controlled study. Coronavirus infection COVID-19 were diagnosed from 12 to 26 weeks before the study. Patients had at least 6 symptoms of post-COVID syndrome. All patients were randomized into 3 groups. 18 patients of the study group received 10 hypoxia-hyperoxic therapy procedures, 15 comparison group patients – 10 placebo procedures, 14 control group patients – only standard rehabilitation. The study group patients were breathing hypoxic (FiO2 13–15%) and hyperoxic (FiO2 up to 40%) gas mixture through the mask in the interval mode using device ReOxy. The duration of 1–4 procedures was 30 min, 5–10 procedures – 40 min. The placebo procedures were performed using the mask with the atmospheric air hole. The standard rehabilitation program in all groups for 2 weeks included: 10 group sessions of physical exercises with elements of breathing exercises, 10 procedures of magnetic therapy for joints, 10 sodium chloride baths. Joint pain and general health on 100-mm visual analog scale, Lequesne and WOMAC indexes, Spielberger-Khanin reactive anxiety test, Beck depression inventory and breathlessness on Modified Borg scale were evaluated at baseline (control point T0) and at 2 weeks (control point T1). Results and discussion. After 2 weeks (T1) in the study group, pain decreased by 51.4% (p < 0.01), Lequesne index – by 34.8% (p < 0.05), WOMAC – by 44.7% (p < 0.05), reactive anxiety level – by 23.7% (p < 0.05), depression symptoms – by 52.9% (p < 0.01), breathlessness – by 71.2% (p < 0.01), general health improved by 52.1% (р < 0.01). In the study group, there were statistically significant differences from the control group in all parameters (р < 0.05) and from the comparison group in most indicators (р < 0.05), excluding the Lequesne index. These results are consistent with the data of modern studies of efficiency of hypoxic conditioning. Conclusion. 2-week rehabilitation program, including interval hypoxia-hyperoxic therapy, reduces pain, breathlessness, depression and reactive anxiety symptoms, improves general health and functional status in patients with OA, having post-COVID syndrome.

Optimising the Dyspnoea Challenge: exertional dyspnoea responses to changing treadmill gradients

BackgroundThe Dyspnoea Challenge is a two-minute treadmill walk designed to measure exertional dyspnoea(ED). To efficiently individualise workload, we aimed to assess; 1) whether the Dyspnoea Challenge is responsive to 1% changes in treadmill gradient and 2) the minimum gradient variation necessary to generate a clinically meaningful change in ED (≥1 modified Borg scale). MethodsThirty individuals with COPD(GOLD II-IV) (age: 69.2 ± 9.2 years; FEV1: 49.3 ± 19.1%) completed six Dyspnoea Challenges at a fixed treadmill speed of 3 km·h−1 and at a gradient of between 3% and 8%, performed in random order. ED intensity and leg fatigue were measured using the 0–10 modified Borg scale. Heart rate(HR) and oxygen saturation(SpO2) were monitored continuously. A multidimensional dyspnoea profile(MDP) was used to quantify the discomfort, physical, e.g., work/effort and breathing frequency, and emotional components of ED. ResultsHigher treadmill gradients generated stronger intensities of ED (3%:2.6 ± 1.8; 4%:2.8 ± 2.2; 5%:3.2 ± 2.2; 6%:3.4 ± 2.2; 7%:3.7 ± 1.8; 8%:4.0 ± 2.1units). Statistical changes were observed in ED(e.g.,3 vs. 5%: P = .03) and the MDP discomfort data(e.g.,4 vs. 6%: P = .04) at ≥ a 2% variation in treadmill gradient. Linear regression found a 4% variation in treadmill gradient corresponded to a rise in ED ≥ 1unit. Increases in ED intensity corresponded to heightened sensations of work/effort(P < .01) and breathing frequency(P < .01). There were no changes in emotional constructs(P = .27). While there was an increase in HR with increasing gradient(P < .01), no differences were observed in end-exercise SpO2(P = .79) or leg fatigue(P = .06). ConclusionTo significantly change ED, the treadmill gradient must be manipulated by ≥ 2%, with a ≥ 4% change in gradient required to induce a clinically meaningful change in ED.

Impact of surgical mask on performance and cardiorespiratory responses to submaximal exercise in COVID-19 patients near hospital discharge: A randomized crossover trial

Background Wearing a surgical mask in hospitalized patients has become recommended during care, including rehabilitation, to mitigate coronavirus disease 2019 (COVID-19) transmission. However, the mask may increase dyspnoea and raise concerns in promoting rehabilitation activities in post-acute COVID-19 patients. Objective To evaluate the impact of the surgical mask on dyspnoea, exercise performance and cardiorespiratory response during a 1-min sit-to-stand test in hospitalized COVID-19 patients close to discharge. Methods COVID-19 patients whose hospital discharge has been planned the following day performed in randomized order two sit-to-stand tests with or without a surgical mask. Outcome measures were recorded before, at the end, and after two minutes of recovery of each test. Dyspnoea (modified Borg scale), cardiorespiratory parameters and sit-to-stand repetitions were measured. Results Twenty-eight patients aged 52 ± 10 years were recruited. Compared to unmasked condition, dyspnoea was significantly higher with the mask before and at the end of the sit-to-stand test (mean difference[95%CI]: 1.0 [0.6, 1.4] and 1.7 [0.8, 2.6], respectively). The difference was not significant after the recovery period. The mask had no impact on cardiorespiratory parameters nor the number of sit-to-stand repetitions. Conclusion In post-acute COVID-19 patients near hospital discharge, the surgical mask increased dyspnoea at rest and during a submaximal exercise test but had no impact on cardiorespiratory response or exercise performance. Patients recovering from COVID-19 should be reassured that wearing a surgical facemask during physical or rehabilitation activities is safe. These data may also mitigate fears to refer these patients in rehabilitation centres where mask-wearing has become mandatory.

Comparison of Ratings of Perceived Exertion and Target Heart Rate-Based Exercise Prescription in Cardiac Rehabilitation: A RANDOMIZED CONTROLLED PILOT STUDY.

Although ratings of perceived exertion (RPE) are widely used to guide exercise intensity in cardiac rehabilitation (CR), it is unclear whether target heart rate ranges (THRRs) can be implemented in CR programs that predominantly use RPE and what impact this has on changes in exercise capacity. We conducted a three-group pilot randomized control trial (#NCT03925493) comparing RPE of 3-4 on the 10-point modified Borg scale, 60-80% of heart rate reserve (HRR) with heart rate (HR) monitored by telemetry, or 60-80% of HRR with a personal HR monitor (HRM) for high-fidelity adherence to THRR. Primary outcomes were protocol fidelity and feasibility. Secondary outcomes included exercise HR, RPE, and changes in functional exercise capacity. Of 48 participants randomized, four patients dropped out, 20 stopped prematurely (COVID-19 pandemic), and 24 completed the protocol. Adherence to THRR was high regardless of HRM, and patients attended a median (IQR) of 33 (23, 36) sessions with no difference between groups. After randomization, HR increased by 1 ± 6, 6 ± 5, and 10 ± 9 bpm ( P = .02); RPE (average score 3.0 ± 0.05) was unchanged, and functional exercise capacity increased by 1.0 ± 1.0, 1.9 ± 1.5, 2.0 ± 1.3 workload METs (effect size between groups, ηp2 = 0.11, P = .20) for the RPE, THRR, and THRR + HRM groups, respectively. We successfully implemented THRR in an all-RPE CR program without needing an HRM. Patients randomized to THRR had higher exercise HR but similar RPE ratings. The THRR may be preferable to RPE in CR populations for cardiorespiratory fitness gains, but this needs confirmation in an adequately powered trial.

Effects of Cardiac Telerehabilitation During COVID-19 on Cardiorespiratory Capacities in Patients With Coronary Artery Disease.

BackgroundThe COVID-19 pandemic led to the closure of most cardiac therapy centers. One of the solutions was to adapt the existing cardiac rehabilitation (CR) program in an institute to a remote approach offered by home-based telerehabilitation. The aim of this study was to measure the cardiorespiratory effects of telerehabilitation compared to conventional center-based CR.MethodsPatients were assigned to two 3-week CR programs: telerehabilitation and conventional center-based CR. The telerehabilitation group wore a connected watch to monitor heart rate (HR) and gave their perception of effort according to a modified Borg scale. The exercise training (four sessions/week) consisted of 1-h aerobic endurance and strength training session at the target HR zone determined by results based on cardiopulmonary exercise test (CPET) and perception of effort, respectively. The exercise protocol was the same for conventional CR participants except the duration of session that lasted 2 h instead of one. The week before and after the training program, peak oxygen uptake (VO2 peak), oxygen uptake at first ventilatory threshold (VO2 at VT1), peak workload, percent of predicted maximum HR, and the absolute differences in HR and systolic blood pressure between maximum and recovery at 1 and 3 min were measured using a CPET. A two-way ANOVA with one repeated measure and one independent factor was performed.ResultsFifty-four patients (mean age: 61.5 ± 8.6 years, 10 women) equally split in the two groups were included in this experiment. A significant increase was observed in both groups on VO2 peak (telerehabilitation: 8.1 ± 7.8% vs. conventional: 10.1 ± 9.7%, p < 0.001), VO2 at VT1 (telerehabilitation: 8.8 ± 4.4% vs. conventional: 7.3 ± 19.0%, p = 0.02) and peak workload (telerehabilitation: 16.6 ± 18.9% vs. conventional: 17.2 ± 7.0%, p < 0.001) after the 3-week telerehabilitation and conventional CR, respectively. No significant difference was noticed between both groups.ConclusionA 3-week exercise program improved patients’ cardiorespiratory fitness. Telerehabilitation was as effective and represents a safe alternative CR program during the COVID-19 period. In the future, this approach could facilitate the continuity of care for patients unable to participate in center-based CR.

Effects of surgical facemasks on perceived exertion during submaximal exercise test in healthy children.

Only a few data associated to wearability of facemask during exercise are available in children. The aim of the study was to evaluate the effect of wearing a facemask on perceived exertion (primary aim), dyspnea, physical performance, and cardiorespiratory response during a submaximal exercise test in children aged between 8 and 12 years. This study was performed in 2021 in healthy volunteer children from 8 to 12 years. They performed prospectively two 1-min sit-to-stand tests (STST), with or without a surgical facemask. The perceived exertion (modified Borg scale), dyspnea (Dalhousie scale), heart rate, and pulsed oxygen saturation were recorded before and after STST. The STST measured the submaximal performance. Thirty-eight healthy children were recruited (8–9 years: n = 19 and 10–11 years: n = 19). After the STST, the perceived exertion increased with or without a facemask (8–9 years group: + 1 [0.6; 1.4] and + 1.6 [1.0; 2.1] — 10–11 years group: + 1.3 [0.7; 1.8] and + 1.9 [1.3; 2.6]) and it was higher with the facemask. The difference between the two conditions in perceived exertion was not clinically relevant in any group (mBorgf: 0.56 pts and 0.68 pts, respectively). The different domains of dyspnea assessed with Dalhousie scale were not influenced by the facemask. The submaximal performance measured by the STST was not changed by the mask whatever the age group. The cardio-respiratory demand was not clinically modified.Conclusion: The surgical facemask had no impact on dyspnea, cardiorespiratory parameters, and exercise performance during a short submaximal exercise in healthy children. What is Known: • The use of facemask has been associated with breathing difficulties during physical activities in adults.• Before the COVID-19 pandemic, the facemasks were not recommended during exercise in children and the consequences have been poorly investigated. What is New: • The different domains of dyspnea assessed with Dalhousie scale, the cardiac demand, and the submaximal performance measured by the STST were not changed by the facemask whatever the age group in children.

The effect of ultrasound-guided transversus abdominis plane block on pulmonary function in patients undergoing laparoscopic cholecystectomy: a prospective randomized study.

Transversus abdominis plane block (TAPB) is commonly used for postoperative pain control after laparoscopic cholecystectomy. However, few studies have analyzed its effect on pulmonary function. The goal of this study was to elucidate the effect of ultrasound-guided bilateral TAPB on pulmonary function preservation and analgesia after laparoscopic cholecystectomy. We enrolled 58 patients who underwent laparoscopic cholecystectomy. Among them, 53 were randomized to group T (n = 27) and group C (n = 26). Group T and group C received ultrasound-guided bilateral TAPB with 40ml of 0.375% ropivacaine and 40ml of 0.9% normal saline, respectively. Visual analog scale (VAS) scores, patient-controlled analgesia (PCA) consumption, forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), FEV1/FVC, peak expiratory flow rate (PEF), and modified Borg scale scores were measured until 24h post-surgery. The VAS scores were significantly lower in group T than in group C at 1 and 8h after the surgery. PCA consumption was significantly lower in group T than in group C at all postoperative time points. FEV1, PEF, and FEV1/FVC were more preserved in group T than in group C at 1h. Group T had significantly lower modified Borg scale scores than did group C at 1 and 8h. Ultrasound-guided TAPB is effective in pulmonary function preservation and pain control after laparoscopic cholecystectomy. Therefore, it could be a great option for multimodal analgesia, preservation of pulmonary function, prevention of pulmonary complications including atelectasis, and promotion of postoperative recovery after laparoscopic cholecystectomy. This study was enrolled in the Clinical Research Information Service (Clinical Research Information Service, KCT0004435, Hwa Yong Shin, 2019-08-19).

Respiratory Muscles Training in the Complex Treatment of Patients with Acute Decompensated Heart Failure

The aim: to evaluate the efficacy of respiratory muscles training in the complex treatment of patients with acute decompensated heart failure. Material and methods. A prospective randomized study included 120 patients (71 men and 49 women, mean age 73,6±5,8 years) hospitalized with acute decompensated heart failure. The main exclusion criteria were: requirement for treatment in intensive care unit; hemodynamic instability; severe pulmonary and other concomitant pathology. After initial procedures all patients were randomized to breathing exercises performed in addition to standard therapy (main group, n=60) or to standard therapy only (control group, n=60). Patients of the main group were trained in the technique of complete yogic breathing, which consists of three successive phases: abdominal, thoracic and clavicular. The participants practiced full breathing daily at least 3 times a day for 10 minutes under the supervision of instructor. The primary endpoint of the study was the change in dyspnea according to the modified Borg scale (modified by V.Yu. Mareev) on the 7th day of treatment. Results. During treatment the severity of dyspnea decreased in both groups, more significantly in the main group (from 6 (5; 6) to 3 (2; 3) points) compared to control (from 6 (5; 6) to 4 (3; 4) points, p &lt;0,05). Significant differences between the groups were also obtained for the secondary variables of efficacy: six-minute walk distance, heart rate and breathing rate at rest, blood oxygen saturation (p &gt;&lt;0,05). In patients who performed breathing exercises, body weight decreased faster (0,72±0,06 kg/day versus 0,53±0,06 kg/day, p &gt;&lt;0,001), although the volumes of excreted fluid did not differ between the groups. In the main group moist rales in the lungs were stopped by the sixth day of hospitalization (interquartile range of 5-7 days), and in the control group — by the eighth (interquartile range of 7-9 days), p=0,024. The duration of active diuretic phase and the average daily doses of diuretics were lower in main group compared to control (p &gt;&lt;0,05). During hospitalization quality of life improved in both groups, more significantly in respiratory muscles training group (p &gt;&lt;0,01). In-hospital mortality and the rate of transfers to the intensive care unit did not differ between groups. The average hospital stay in surviving patients was significantly shorter in main group than in control (14,2±2,5 versus 17,3±2,9 days, p &gt;&lt;0,001). &gt;Conclusion. Respiratory muscles training with full yogic breathing in addition to standard medical therapy for patients with acute decompensated heart failure leads to a more significant reduction in the severity dyspnea, increased exercise tolerance, improved blood oxygen saturation, and reduced need for diuretics. The use of full breathing is associated with significant improvement in the quality of life and decrease in the length of hospital stay, but does not lead to improvement in hospital outcomes.

Biomechanical analysis of force distribution in one-handed and two-handed child chest compression- a randomized crossover observational study

BackgroundEven force distribution would generate efficient external chest compression (ECC). Little research has been done to compare force distribution between one-hand (OH) and two-handed (TH) during child ECC. Therefore, this study was to investigate force distribution, rescuer perceived fatigue and discomfort/pain when applying OH and TH ECC in children.MethodsCrossover manikin study. Thirty-five emergency department registered nurses performed lone rescuer ECC using TH and OH techniques, each for 2 min at a rate of at least 100 compressions/min. A Resusci Junior Basic manikin equipped with a MatScan pressure measurement system was used to collect data. The perceived exertion scale (modified Borg scale) and numerical rating scale (NRS) was applied to evaluate the fatigue and physical pain of delivering chest compressions.ResultsThe maximum compression force (kg) delivered was 56.58 ± 13.67 for TH and 45.12 ± 7.90 for OH ECC (p < 0.001). The maximum-minimum force difference force delivered by TH and OH ECC was 52.24 ± 13.43 and 41.36 ± 7.57, respectively (p < 0.001). The mean caudal force delivered by TH and OH ECC was 29.45 ± 16.70 and 34.03 ± 12.01, respectively (p = 0.198). The mean cranial force delivered by TH and OH ECC was 27.13 ± 11.30 and 11.09 ± 9.72, respectively (p < 0.001). The caudal–cranial pressure difference delivered by TH and OH ECC was 19.14 ± 15.96 and 26.94 ± 14.48, respectively (p = 0.016). The perceived exertion and NRS for OH ECC was higher than that of the TH method (p < 0.001, p = 0.004, respectively).ConclusionsThe TH method produced greater compression force, had more efficient compression, and delivered a more even force distribution, and produced less fatigue and physical pain in the rescuer than the OH method.Trial registrationThe Cheng Kung University Institutional Review Board A-ER-103-387. http://nckuhirb.med.ncku.edu.tw/sitemap.php

Characteristics of the deventilation syndrome in COPD patients treated with non-invasive ventilation: an explorative study

BackgroundNon-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.MethodsA prospective, controlled, non-blinded study was conducted. After a night with established NIV therapy, the patients underwent spirometry, blood gas analyses and 6-min walking tests (6MWT) directly, at 2 and 4 h 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.ResultsEleven 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 2 h (4.8 ± 2.6; p = 0.003). Initially, mean inspiratory vital capacity was significantly reduced (VCmax: 46 ± 16%) compared to 2 h 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).ConclusionsThe deventilation syndrome is a serious side effect of NIV in COPD patients, characterized by increase of dyspnea. It is associated with decrease in vital capacity, exercise tolerance after mask removal and lower HRQoL. 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) on 09 April 2019.

What Are the Most Effective Factors in Determining Future Exacerbations, Morbidity Weight, and Mortality in Patients with COPD Attack?

Background and Objectives: This study aimed to investigate the important factors that affect COPD prognosis. Materials and Methods: We included 160 hospitalized patients with COPD exacerbation in the study. The hemoglobin (HB), hematocrit (HCT), leukocytes, red cell distribution width (RDW), mean platelet volume, platelet distribution width, plateletcrits, platelets, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, eosinophils, uric acid, albumin, C-reactive protein (CRP), procalcitonin, arterial blood gases (PO2 and PCO2), pulmonary function test (FEV1 and FVC), echocardiography (ejection fraction-EF), Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Modified Medical Research Council (mMRC) and Borg scales, Charlson comorbidity index, body mass index (BMI), and the length of hospital stay were examined on the first day of hospitalization. Admission to the hospital with a new attack, hospitalization in the intensive care unit (ICU), and mortality during the six months after discharge were evaluated. Results: High CRP and procalcitonin levels were observed in the group with a long hospital stay. In the mortality group, the HB, HCT, BMI, and PO2 values were significantly lower than in the group without mortality, while the age and GOLD stage were higher. The age, Borg and mMRC scores, number of exacerbations experienced in the previous year, RDW, eosinophil count, and PCO2 were significantly higher in the ICU group than that without an ICU stay. The HCT and EF values were lower in the ICU group than that without an ICU stay. The FEV1 and FVC values were significantly lower in the follow-up attack group than those without a follow-up attack. The duration of COPD and the number of attacks that were experienced in the previous year were high. Conclusion: Scoring combining selected biomarkers and other factors is a strong determinant of the prognosis.

Translation and Validation of the Modified Borg Scale (CR-10) in Hindi Language in Healthy Indian Adults

Translation and Validation of the Modified Borg Scale (CR-10) in Hindi Language in Healthy Indian Adults

The Effect of Cycling and Arm Ergometer Exercises on Physical and Psychosocial Functions: Application in Patients Undergoing Coronary Artery Bypass Surgery

Aim: The aim of this study was to compare the effects of bicycle and arm ergometer exercises on physical and psychosocial functions in patients who underwent Coronary Artery Bypass Surgery. Methods: A total of 107 cases (64 males, 43 females) were included in the study, with 23 participants aged between 52 and 65 using bicycle ergometers and a group of 58 people who performed arm ergometers opposite. After the demographic data were recorded, physical functions of all individuals participating in the study were evaluated with a 6-minute walk test, bioimpedance analysis, HDL, LDL, Triglyceride and Total cholesterol values, and psychosocial functions were evaluated with the Beck depression scale, modified borg scale and SF 36 questionnaires before and after the training. All participants were given bicycle or arm ergometer exercises for 6 weeks, 5 sessions per week, for a total of 30 sessions. Result: When the results were examined, it was observed that there was a statistically significant increase in walking distance of the people in the bicycle ergometer group compared to the arm ergometer group (p general health parameter, which is one of the sub-parameters of SF 36, in the arm ergometer group compared to the bicycle ergometer group (p Conclusion: When we look at the results of this study, it is important in terms of revealing that bicycle and arm ergometer exercises similarly improve the physical and psychosocial functions of patients who have undergone Coronary Artery Bypass Surgery. However, it has been shown that cycling exercises are much more advantageous in improving functional capacity. Summary Statement: What is already known about this topic? 1) Walking and arm exercises are good for heart diseases. What this paper adds? 2) Demonstrated that cycling and arm ergometer exercises have curative aspects for patients undergoing Coronary Artery Bypass Surgery. As a result of our study, it has emerged that leg and arm ergometry techniques are good imagers in individuals who have undergone coronary artery bypass surgery.

Ergonomics of anatomical bra models for breastfeeding: a contribution of nursing.

to analyze the ergonomics of two models of breastfeeding bras. descriptive study carried out with 152 infants in a Brazilian university hospital. The prototypes were separated into two groups (A and B). To compare the two bra models, the Odds Ratio (OR) was used as a measure of the strength of the association. In subjective perceptions, the Modified Borg Scale, and the chi-square test of independence (χ2) were used. To compare the two prototypes, the Z test and logistic regression analysis were performed. A significance level of 5% was considered. the bra in group B was more suitable for ergonomics of physical and psycho-aesthetic comfort than the bra in group A (p < 0.0001), according to the logistic regression tests. modeling B was ergonomically adequate, with usability and evaluation criteria centered on breastfeeding women.

Tailor-made Pulmonary Rehabilitation Program Aiding Return to Preinfection Fitness in Massive Cavitatory Lung Abscess: A Case Report

Lung abscess is a form of liquefactive necrosis of the lung tissue that causes the formation of cavities (greater than 2 cm) which are filled with necrotic debris and fluid because of microbial infection. Aspiration, which may happen while the patient is not conscious and end in a pus-filled cavity. It is very rare to find out lung abscess with a complicated infection of Streptococcus pneumoniae stereotype 6B. A 42-year-old male patient was referred to a tertiary care hospital with chief complaints of breathlessness of grade II on the Modified Borg Scale, cough with expectoration, and right-sided chest pain. Chest X-ray and High Resolution Computed Tomography (HRCT) High Resolution Computed Tomography (HRCT) scan of the thorax were done and the patient was diagnosed with right lower lobe lung abscess caused by Streptococcus pneumoniae. The patient was managed by bronchoscopy and bronchoalveolar lavage (washing). A complete plan of rehabilitation was designed to meet the patient's objectives, and it was executed and followed for 1 month. The patient showed considerable functional improvement in terms of aerobic capacity, endurance, and exercise tolerance ability. It was concluded that medical care combined with pulmonary rehabilitation, together as a multidisciplinary approach result in improved outcomes related to the quality of life of the patients.

Comparison of two questionnaires measuring the health-related quality of life in patients with idiopathic interstitial pulmonary fibrosis

Objectives To compare two questionnaires that measure health-related quality of life (HRQL) in idiopathic pulmonary fibrosis (IPF) patients. Background IPF is a disease with a progressive course as it is associated with high rates of mortality and a median survival rate of 3–4 years, so it severely affects the patient’s quality of life. General and disease-specific questionnaires are available to assess HRQL. Patients and methods HRQL was measured in 30 previously diagnosed IPF patients using a general questionnaire [short form 36 and specific questionnaires − St George’s Respiratory Questionnaire (SGRQ)]. Pulmonary function tests and 6-min walking distance test (6MWDT) were used to assess the patients’ functional status. Dyspnea at rest was evaluated by baseline dyspnea index and after exercise by the modified Borg scale. Results Pulmonary function tests showed a restrictive pattern, a decline in the exercise capacity of the patient (6MWDT), and higher scores of dyspnea at rest and following exercise. Both questionnaires showed a good correlation with some of patients’ functional parameters but all of the SGRQ domains showed a strong correlation with all functional status parameters. Also, a good correlation with HRQL was presented by 6MWDT and baseline dyspnea index. Conclusion Specific SGRQ is a more suitable instrument for HRQL assessment in IPF patients than the general questionnaire (short form 36).