Fatigue in patients with COPD participating in a pulmonary rehabilitation program

Cindy J Wong1, Donna Goodridge1, Darcy D Marciniuk2, Donna Rennie1,31College of Nursing, 2College of Medicine, 3Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, CanadaBackground: Fatigue is a distressing, complex, multidimensional sensation common in individuals with chronic obstructive pulmonary disease (COPD). While fatigue negatively impacts functional performance and quality of life, there has been little study of the fatigue that affects participants in pulmonary rehabilitation programs. The purpose of this study was to examine the emotional, behavioral, cognitive, and physical dimensions of fatigue and their relationships to dyspnea, mental health, sleep, and physiologic factors.Patients and methods: A convenience sample of 42 pulmonary rehabilitation participants with COPD completed self-report questionnaires which measured dimensions of fatigue using the Multidimensional Fatigue Inventory, anxiety and depression using the Hospital Anxiety and Depression Scale, and sleep quality using the Pittsburgh Sleep Quality Index. Data on other clinical variables were abstracted from pulmonary rehabilitation program health records.Results: Almost all (95.3%) participants experienced high levels of physical fatigue. High levels of fatigue were also reported for the dimensions of reduced activity (88.1%), reduced motivation (83.3%), mental fatigue (69.9%), and general fatigue (54.5%). Close to half (42.9%) of participants reported symptoms of anxiety, while almost one quarter (21.4%) reported depressive symptoms. Age was related to the fatigue dimensions of reduced activity (ρ = 0.43, P < 0.01) and reduced motivation (ρ = 0.31, P < 0.05). Anxiety was related to reduced motivation (ρ = -0.47, P < 0.01). Fatigue was not associated with symptoms of depression, sleep quality, gender, supplemental oxygen use, smoking status, or Medical Research Council dyspnea scores.Conclusions: Fatigue (particularly the physical and reduced motivation dimensions of fatigue) was experienced by almost all participants with COPD attending this pulmonary rehabilitation program. Fatigue affected greater proportions of participants than either anxiety or depression. The high prevalence of fatigue may impact on enrolment, participation, and attrition in pulmonary rehabilitation programs. Further investigation of the nature, correlates, and impact of fatigue in this population is required.Keywords: COPD, fatigue, pulmonary rehabilitation, anxiety, depression, sleep qualit

Test-Retest Reliability and Physiological Responses Associated with the Steep Ramp Anaerobic Test in Patients with COPD

The Steep Ramp Anaerobic Test (SRAT) was developed as a clinical test of anaerobic leg muscle function for use in determining anaerobic power and in prescribing high-intensity interval exercise in patients with chronic heart failure and Chronic Obstructive Pulmonary Disease (COPD); however, neither the test-retest reliability nor the physiological qualities of this test have been reported. We therefore, assessed test-retest reliability of the SRAT and the physiological characteristics associated with the test in patients with COPD. 11 COPD patients (mean FEV1 43% predicted) performed a cardiopulmonary exercise test (CPET) on Day 1, and an SRAT and a 30-second Wingate anaerobic test (WAT) on each of Days 2 and 3. The SRAT showed a high degree of test-retest reliability (ICC = 0.99; CV = 3.8%, and bias 4.5 W, error −15.3–24.4 W). Power output on the SRAT was 157 W compared to 66 W on the CPET and 231 W on the WAT. Despite the differences in workload, patients exhibited similar metabolic and ventilatory responses between the three tests. Measures of ventilatory constraint correlated more strongly with the CPET than the WAT; however, physiological variables correlated more strongly with the WAT. The SRAT is a highly reliable test that better reflects physiological performance on a WAT power test despite a similar level of ventilatory constraint compared to CPET

Anatomy of ovary and ovule in dandelions (Taraxacum, Asteraceae)

The genus Taraxacum Wigg. (Asteraceae) forms a polyploid complex within which there are strong links between the ploidy level and the mode of reproduction. Diploids are obligate sexual, whereas polyploids are usually apomictic. The paper reports on a comparative study of the ovary and especially the ovule anatomy in the diploid dandelion T. linearisquameum and the triploid T. gentile. Observations with light and electron microscopy revealed no essential differences in the anatomy of both the ovary and ovule in the examined species. Dandelion ovules are anatropous, unitegmic and tenuinucellate. In both sexual and apomictic species, a zonal differentiation of the integument is characteristic of the ovule. In the integumentary layers situated next to the endothelium, the cell walls are extremely thick and PAS positive. Data obtained from TEM indicate that these special walls have an open spongy structure and their cytoplasm shows evidence of gradual degeneration. Increased deposition of wall material in the integumentary cells surrounding the endothelium takes place especially around the chalazal pole of the embryo sac as well as around the central cell. In contrast, the integumentary cells surrounding the micropylar region have thin walls and exhibit a high metabolic activity. The role of the thick-walled integumentary layers in the dandelion ovule is discussed. We also consider whether this may be a feature of taxonomic importance

Three-month recovery from common negative physical, functional, and psychosocial effects among individuals infected with COVID-19: a single observational group repeated measure study

Purpose: We examined three-month recovery from common negative effects of COVID-19 infection on select physical, functional, and psychosocial parameters among infected individuals and their implications for rehabilitation programs. Methods: Twenty-one subjects participated in this study. Four standardized questionnaires were used to assess dyspnea, physical, and psychosocial variables in this study. The post-test survey was conducted 90 days following the pre-test survey. Wilcoxon-Signed Rank test and paired t-test were used to compare the variables data between pre- and post-testing time points. Results: Dyspnea scores decreased from (pre: 2 vs post:1, Z=-3.276, p=0.001, r=.50). Work performance scores increased from (pre: 42 ±25 vs post: 57 ±21, t(20) =-2.868, p=0.010, r=.62). Social functioning increased from (pre: 44 ±27 vs post: 60 ±24, t(20) =-3.525, p=0.002, r=.76) and pain scores from (pre: 42 ±30 vs post: 53 ±25, t(20) =-2.134, p=0.045, r=.46) also increased across the 90 days. Conclusions: Long-term symptoms after COVID-19 infection include ongoing physical, functional, and psychosocial deficits. While dyspnea decreased and work performance and social functioning increased, we observed a concomitant increase in pain scores over the 90-day measurement period. Long-term multidisciplinary rehabilitation programs should be designed to address the ongoing deficits among this population

PHOTOCATALYTIC ACTIVITY OF GRAPHENE OXIDE/ZnO COMPOSITES FOR DYE DEGRADATION

This work was supported by the Araucária Foundation, a Research Founding Agency from Paraná State - Brazi

Four patients with a history of acute exacerbations of COPD: implementing the CHEST/Canadian Thoracic Society guidelines for preventing exacerbations

This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/ by/4.0

Synergids and filiform apparatus in the sexual and apomictic dandelions from section Palustria (Taraxacum, Asteraceae)

An evolutionary trend to reduce “unnecessary costs” associated with the sexual reproduction of their amphimictic ancestors, which may result in greater reproductive success, has been observed among the obligatory apomicts. However, in the case of the female gametophyte, knowledge about this trend in apomicts is not sufficient because most of the ultrastructural studies of the female gametophyte have dealt with amphimictic angiosperms. In this paper, we tested the hypothesis that, in contrast to amphimictic plants, synergids in apomictic embryo sacs do not form a filiform apparatus. We compared the synergid structure in two dandelions from sect. Palustria: the amphimictic diploid Taraxacum tenuifolium and the apomictic tetraploid, male-sterile Taraxacum brandenburgicum. Synergids in both species possessed a filiform apparatus. In T. brandenburgicum, both synergids persisted for a long time without any degeneration, in spite of the presence of an embryo and endosperm. We propose that the persistent synergids in apomicts may play a role in the transport of nutrients to the embryo

The role and performance of chest X-ray for the diagnosis of tuberculosis: A cost-effectiveness analysis in Nairobi, Kenya

BACKGROUND: The objective of this study was to establish 1) the performance of chest X-ray (CXR) in all suspects of tuberculosis (TB), as well as smear-negative TB suspects and 2) to compare the cost-effectiveness of the routine diagnostic pathway using Ziehl-Neelsen (ZN) sputum microscopy followed by CXR if case of negative sputum result (ZN followed by CXR) with an alternative pathway using CXR as a screening tool (CXR followed by ZN). METHODS: From TB suspects attending a chest clinic in Nairobi, Kenya, three sputum specimens were examined for ZN and culture (Lowenstein Jensen). Culture was used as gold standard. From each suspect a CXR was made using a four point scoring system: i: no pathology, ii: pathology not consistent for TB, iii: pathology consistent for TB and iv: pathology highly consistent for TB. The combined score i + ii was labeled as "no TB" and the combined score iii + iv was labeled as "TB". Films were re-read by a reference radiologist. HIV test was performed on those who consented. Laboratory and CXR costs were used to compare for cost-effectiveness. RESULTS: Of the 1,389 suspects enrolled, for 998 (72%) data on smear, culture and CXR was complete. 714 films were re-read, showing a 89% agreement (kappa value = 0.75 s.e.0.037) for the combined scores "TB" or "no-TB". The sensitivity/specificity of the CXR score "TB" among smear-negative suspects was 80%/67%. Using chest CXR as a screening tool in all suspects, sensitivity/specificity of the score "any pathology" was 92%, respectively 63%. The cost per correctly diagnosed case was for the routine process $8.72, compared to$9.27 using CXR as screening tool. When costs of treatment were included, CXR followed by ZN became more cost-effective. CONCLUSION: The diagnostic pathway ZN followed by CXR was more cost-effective as compared to CXR followed by ZN. When cost of treatment was also considered CXR followed by ZN became more cost-effective. The low specificity of chest X-ray remains a subject of concern. Depending whether CXR was performed on all suspects or on smear-negative suspects only, 22%–45% of patients labeled as "TB" had a negative culture. The introduction of a well-defined scoring system, clinical conferences and a system of CXR quality control can contribute to improved diagnostic performance

Synthesis, Characterization and Comparison of New Ionic Liquids Derived from Imidazole

The authors would like to thank the Brazilian Agency Funding: CNPq, CAPES and Fundaçăo Araucária