Exercise intolerance in post-coronavirus disease 2019 survivors after hospitalisation

Rationale Post-coronavirus disease 2019 (COVID-19) survivors frequently have dyspnoea that can lead to exercise intolerance and lower quality of life. Despite recent advances, the pathophysiological mechanisms of exercise intolerance in the post-COVID-19 patients remain incompletely characterised. The objectives of the present study were to clarify the mechanisms of exercise intolerance in post-COVID-19 survivors after hospitalisation. Methods This prospective study evaluated consecutive patients previously hospitalised due to moderate-to-severe/critical COVID-19. Within mean±sd 90±10 days of onset of acute COVID-19 symptoms, patients underwent a comprehensive cardiopulmonary assessment, including cardiopulmonary exercise testing with earlobe arterialised capillary blood gas analysis. Measurements and main results 87 patients were evaluated; mean±sd peak oxygen consumption was 19.5±5.0 mL·kg−1·min−1, and the tertiles were ≤17.0, 17.1–22.2 and ≥22.3 mL·kg−1·min−1. Hospitalisation severity was similar among the three groups; however, at the follow-up visit, patients with peak oxygen consumption ≤17.0 mL·kg−1·min−1 reported a greater sensation of dyspnoea, along with indices of impaired pulmonary function, and abnormal ventilatory, gas-exchange and metabolic responses during exercise compared to patients with peak oxygen consumption >17 mL·kg−1·min−1. By multivariate logistic regression analysis (receiver operating characteristic curve analysis) adjusted for age, sex and prior pulmonary embolism, a peak dead space fraction of tidal volume ≥29 and a resting forced vital capacity ≤80% predicted were independent predictors of reduced peak oxygen consumption. Conclusions Exercise intolerance in the post-COVID-19 survivors was related to a high dead space fraction of tidal volume at peak exercise and a decreased resting forced vital capacity, suggesting that both pulmonary microcirculation injury and ventilatory impairment could influence aerobic capacity in this patient population

Psicanálise modernista no Brasil: um recorte histórico Modernist psychoanalysis in Brazil: a historical approach

O presente artigo partiu do pressuposto de que o discurso psicanalítico é sempre apropriado por um intérprete que se filia a uma tradição histórica e cultural. Nesta perspectiva, a produção de subjetividade, que tem lugar na clínica psicanalítica, será marcada por essa tradição privilegiada pelo analista. Assim, julgou-se de grande relevância a investigação das vias discursivas de entrada da psicanálise no Brasil, indicando os pontos de ancoragem da mesma na cultura e na história locais. Com este intuito, traçou-se o processo de urbanização e modernização do Brasil no início do século XX e a entrada da psicanálise em um campo de forças divergentes. Encontrou-se um embate pela hegemonia discursiva entre duas leituras que se constituíram como antagônicas e inconciliáveis, e que levaram a dois modos distintos de uso instrumental da psicanálise: de um lado, o discurso psiquiátrico-higienista, com sua leitura reformista e universalizante da psicanálise; de outro, o discurso da vanguarda modernista, com a leitura da subversão dos códigos estabelecidos e da busca de singularidade. Ambos se constituíram no rastro da busca de forjar o brasileiro que se desejava. Este trabalho percorre o viés da psicanálise modernista, com sua utilização singular para a análise da cultura e das subjetividades, bem como sua função de construção de novos mundos.<br>The current article's basic premise is that psychoanalytic discourse is always appropriated by an interpreter thereof who belongs to a historical and cultural tradition. From this perspective, the production of subjectivity in psychoanalytic practice is marked by the analyst's prime tradition. Thus the major relevance of investigating the discursive routes by which psychoanalysis entered Brazil, identifying its anchoring points in local culture and history. The article thus outlines the urbanization and modernization process in early 20th-century Brazil, together with the entry of psychoanalysis in a field of divergent forces. What occurred was a struggle for discursive hegemony between two antagonistic and irreconcilable readings: on the one hand, psychiatric-hygienist discourse with its reformist and universalizing reading of psychoanalysis; on the other, that of the modernist vanguard, with a reading that subverted established codes in the pursuit of singularity. Both were constituted in the wake of a quest to forge what was viewed as the desired Brazilian. This study covers the modernist psychoanalytic bias, with its unique utilization in the analysis of culture and subjectivities, as well as its role in the construction of new worlds