Nível de Dispneia, Atividades de Vida Diária e Autocuidado na Doença Pulmonar Obstrutiva Crónica: Estudo descritivo

Introduction: Dyspnea is one of the most characteristic symptoms of Chronic Obstructive Pulmonary Disease and is directly related to the reduction in a person's capacity for exercise, performance of daily life activities, and self-care. The purpose of this study was to understand the level of dyspnea, the ability to perform daily life activities, and the dependence level on self-care in individuals with Chronic Obstructive Pulmonary Disease. Methodology: Exploratory, descriptive and cross-sectional study, with a quantitative approach. Results: The sample was formed by 52 participants, predominantly male, with an average age of 72 years. Regarding the degree of dyspnea, assessed by the modified Medical Research Council dyspnea scale, 76.9% of the participants reported dyspnea ? 2. The London Chest Activity of Daily Living scale revealed that 55.8% of participants had limitations in performing daily life activities. According to the Barthel Index, 67.3% of the sample were independent in self-care. Conclusion: Participants in the study revealed a high level of dyspnea and limitations in performing daily life activities, but when assessing the degree of autonomy in self-care, the majority of participants are independent. Therefore, the Specialist Nurse in Rehabilitation interventions should aim to optimize the capabilities of individuals with Chronic Obstructive Pulmonary Disease, promote their autonomy and quality of life, as well as empower them for disease self-management.Introducción: La disnea es uno de los síntomas más característicos de la Enfermedad Pulmonar Obstructiva Crónica y está directamente relacionada con la disminución de la capacidad de ejercicio, la realización de actividades de la vida diaria y el autocuidado en la persona. El presente estudio tuvo como objetivo profundizar en el conocimiento sobre el nivel de disnea, la capacidad para llevar a cabo actividades de la vida diaria y la dependencia en el autocuidado en personas con Enfermedad Pulmonar Obstructiva Crónica. Metodología: Estudio exploratorio, de naturaleza descriptiva, transversal, con un enfoque cuantitativo. Resultados: La muestra estuvo compuesta por 52 participantes, predominantemente de sexo masculino, con una edad promedio de 72 años. En cuanto al grado de disnea, evaluado mediante la escala modificada del Medical Research Council, el 76,9% de los participantes informó de una disnea ? 2. La Escala de Actividades de la Vida Diaria London Chest mostró que el 55,8% de los participantes presentaban limitaciones en la realización de actividades de la vida diaria. Según la evaluación del Índice de Barthel, el 67,3% de la muestra era independiente en el autocuidado. Conclusión: Los participantes en el estudio presentan un alto nivel de disnea y limitaciones en la realización de actividades de la vida diaria, pero cuando se evalúa el grado de autonomía en el autocuidado, la mayoría de los participantes son independientes. Por lo tanto, las intervenciones del Enfermero Especialista en Enfermería de Rehabilitación deberían tener como objetivos la optimización de las capacidades de las personas con Enfermedad Pulmonar Obstructiva Crónica, la promoción de su autonomía y calidad de vida, así como la capacitación para la autogestión de la enfermedad.Introdução: A dispneia é um dos sintomas mais característicos da Doença Pulmonar Obstrutiva Crónica e está diretamente relacionada com a diminuição, na pessoa, da capacidade para o exercício, realização das atividades de vida diária e autocuidado. O presente estudo teve como finalidade aprofundar o conhecimento sobre o nível de dispneia, a capacidade para realização das atividades de vida diária e dependência no autocuidado na pessoa com Doença Pulmonar Obstrutiva Crónica. Metodologia: Estudo exploratório, de natureza descritiva, transversal, com uma abordagem do tipo quantitativo. Resultados: A amostra foi constituída por 52 participantes, predominantemente do sexo masculino, com uma média de idade de 72 anos. Quanto ao grau de dispneia, avaliada pela escala da dispneia modificada do Medical Research Council, 76,9% dos participantes referem uma dispneia ? 2. A escala London Chest Activity of Daily Living revela que 55,8% dos participantes apresentam limitações na realização das atividades de vida diária. Pela avaliação do Índice de Barthel, 67,3% da amostra é independente no autocuidado. Conclusão: Os participantes no estudo apresentam alto nível de dispneia e limitação na realização das atividades de vida diária, porém quando avaliado o grau de autonomia para o autocuidado, a maioria dos participantes é independente. Assim, as intervenções do Enfermeiro Especialista em Enfermagem de Reabilitação deverão ter como objetivos a otimização das capacidades da pessoa com Doença Pulmonar Obstrutiva Crónica, a promoção da sua autonomia e a qualidade de vida, bem como a capacitação para a autogestão da doença

Western outcomes of circumferential endoscopic submucosal dissection for early esophageal squamous cell carcinoma

Background and aims: Circumferential endoscopic submucosal dissection (cESD) in the esophagus has been reported to be feasible in small Eastern case series. We assessed the outcomes of cESD in the treatment of early esophageal squamous cell carcinoma (ESCC) in Western countries. Methods: We conducted an international study at 25 referral centers in Europe and Australia using prospective databases. We included all patients with ESCC treated with cESD before November 2022. Our main outcomes were curative resection according to European guidelines and adverse events. Results: A total of 171 cESDs were performed on 165 patients. En bloc and R0 resections rates were 98.2% (95% CI 95.0%-99.4%) and 69.6% (95% CI 62.3%-76.0%), respectively. Curative resection was achieved in 49.1% (95% CI 41.7%-56.6%) of the lesions. The most common reason for non-curative resection was deep submucosal invasion (21.6%). The risk of stricture requiring six or more dilations or additional techniques (incisional therapy/stent) was high (71%), despite the use of prophylactic measures in 93% of the procedures. The rates of intraprocedural perforation, delayed bleeding and adverse cardiorespiratory events were 4.1%, 0.6% and 4.7%, respectively. Two patients died (1.2%) from a cESD-related adverse event. Overall and disease-free survival rates at 2 years were 91% and 79%. Conclusions: In Western referral centers, cESD for ESCC is curative in approximately half of the lesions. It can be considered a feasible treatment in selected patients. Our results suggest the need to improve patient selection and to develop more effective therapies to prevent esophageal strictures

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use