Obesity-hypoventilation syndrome (OHS) is a leading cause of hypercapnic respiratory failure, with the need to implement home-mechanical ventilation (HMV). Symptom burden reduction and control of therapy side effects are fundamental for HMV success. The S3-NIV is a validated questionnaire to assess respiratory and sleep-related symptoms and therapy side-effects in patients with HMV. We conducted a cross-sectional study with OHS patients followed in a HMV outpatient clinic, between September 2019 and March 2020. The S3-NIV questionnaire is a short, valid and easy tool to use in routine clinical practice to assess disease and treatment impact. The highest score (10) corresponds to the lowest impact of disease and treatment, while the lowest score (0) relates to the highest impact. We included 64 (28% male) patients. Results are summarized in figure 1. Mean age was 68.6 ± 12.9 years. The median duration of HMV was 27.50 [14.00; 67.50] months. The total median score of the patients was 7.61 [6.59 – 8.63]. The sub-scores were similar to the total score: respiratory symptoms sub-score, 7.50 [6.00 – 8.50]; sleep & side effects sub-score, 7.50 [6.67 – 9.17]. Despite of the severity of the underlying disease, patients recognize a low impact of disease and treatment. The S3-NIV questionnaire is a simple tool to use in clinical practice.
Non-invasive ventilation is indicated in patients with chronic severe respiratory insufficiency of different causes. Not only the underlying disease, but also the intervention can have a deep impact on the patients' quality of life. We analyzed the quality of life 93 stable patients with both the Severe Respiratory Insufficiency (SRI) and SF-36 questionnaires. Disease distribution and composite questionnaire scales are described in the table. This study found that quality of life is significantly impaired in home mechanically ventilated patients. The mean score of the SRI-SS (56.6) was approximately in the middle of the questionnaire's scaling range. When comparing to other SRI studies, we observed that our mean SRI-SS score was very similar to the Spanish 57.8 (SD=18.5) and English 55.9 (SD=18.9) validation study groups. Comparing our SF-36 results with the general Portuguese population we observed that our patients have significantly lower mean scores, with approximately 20 points less in almost each subscale. Questionnaire's subscales and disease comparisons will be presented.
Body and brain undergo several changes with aging. One of the domains in which these changes are more remarkable relates with cognitive performance. In the present work, electroencephalogram (EEG) markers (power spectral density and spectral coherence) of age-related cognitive decline were sought whilst the subjects performed the Wisconsin Card Sorting Test (WCST). Considering the expected age-related cognitive deficits, WCST was applied to young, mid-age and elderly participants, and the theta and alpha frequency bands were analyzed. From the results herein presented, higher theta and alpha power were found to be associated with a good performance in the WCST of younger subjects. Additionally, higher theta and alpha coherence were also associated with good performance and were shown to decline with age and a decrease in alpha peak frequency seems to be associated with aging. Additionally, inter-hemispheric long-range coherences and parietal theta power were identified as age-independent EEG correlates of cognitive performance. In summary, these data reveals age-dependent as well as age-independent EEG correlates of cognitive performance that contribute to the understanding of brain aging and related cognitive deficits.
Abstract Funding Acknowledgements Type of funding sources: None. Background Advanced heart failure is associated with a high rate of hospitalization due to clinical decompensating. Adding Levosimendan (LVS), an inodilatador which metabolite has long-lasting effect, to intravenous diuretic therapy (standard therapy) is a therapeutic option in these patients, although the magnitude of the short and long-term benefit still remains controversial. Objective The aim of this study was to determine whether combination of LVS with standard therapy in patients with decompensated advanced heart failure (DAHF) increases time out-of-hospital compared to standard therapy alone. The secondary endpoint was duration of hospital stay for each type of hospitalization. Methods and Results Retrospective analysis of patients with advanced heart failure who met the following criteria: at least one hospitalization with standard therapy and at least one hospitalization with standard therapy plus LVS, separated less than 6 months from each other. From a total of 71 patients who took LVS in our cardiac care unit, 7 patients met the inclusion criteria. All these patients were male, mean age was 64,1 ± 10,6 years, mean left ventricular ejection fraction was 24,57 ± 7,3% and 71,4% had ischemic cardiomyopathy. A total of 22 hospitalizations were analysed (12 with standard therapy plus LVS and 10 with standard therapy), with 4 patients having more than two hospitalizations. The administration of LVS increased the time out-of-hospital until readmission compared to standard therapy alone (70.5 days vs 34.7 days, p = 0.023) (figure 1). The length of stay during LVS administration was longer (12.1 days vs 6.0 days, p <0.001). In 75% of cases after LVS infusion patients stay out-of-hospital more than 2 months while after standard therapy this event occurred only once (10%) (figure 2). 1-year mortality was 71,4%. Conclusion Use of Levosimendan increases time out-of-hospital in patients with DAHF. This is an opportunity to improve quality of life in patients with severe disease and recurrent hospitalizations.
The aim of the present work is to propose and validate an evidence-based Wheelchair Handball Classification System, that allows its widespread use and the standardization of the classification system in different Wheelchair Handball competitions. The study involved 98 Wheelchair Handball athletes of both sex (87 males, 11 females), aged between 14 and 76 years old (M=40.32; SD= 11.73) with physical impairments. All wheelchair handball players that had participated in the last 3 national championships were invited to participate. We applied the assessment protocol to the participants and athletes’ classification process had three phases: Medical and Physiological functional assessment; Technical assessment (evaluation of specific movements with wheelchair manipulation and Handball skills) and observation in a game situation (with videorecorder). We used a Classification Points Form to permit the assessment of muscle strength and range of movement of upper limbs, trunk, lower limbs, wheelchair manipulation and Handball skills. The manipulation of wheelchair was measured considering the symmetrical movement, acceleration, braking and change direction, using the Sprint 20m – speed test and a Slalom test. The handball skills were assessed, using dribbling, reception, catching the ball from the floor, shoulder and shopped pass and 9m to the goal shot. Data Analysis was done using descriptive statistics and an Ordinal Linear Regression. The dependent variable was the classification class and we considered five independent variables (mean of upper limbs, trunk, lower limbs, wheelchair manipulation and Handball skills). Data Analysis was done using IBM SPSS Statistics. The results showed that the proposed model presents a high degree of adjustment and permitted identify determinant variables of performance in that sport and indicates key tasks to optimize classification process. There was consistency in the specific parameters to assign a class to the athlete, according to their functional capacity, associated with the specific neuromotor alterations of each clinical condition.
Abstract Funding Acknowledgements Type of funding sources: None. Background Acute heart failure (AHF) is a complex clinical condition associated with high morbidity and mortality. Treatment of AHF remains a therapeutic challenge, with inotropic agents playing an important role. Levosimendan (LVS) is distinguished from other catecholaminergic inotropic by its three mechanisms of action - inotropic, vasodilator and cardioprotection - and by the presence of a long-acting metabolite. Objective We aimed to characterize the predictors of mortality and readmission rate following AHF hospitalizations treated with LVS. Methods and Results This is a retrospective analysis of all 69 patients treated with LVS in a Cardiology Department at a Tertiary Center (84% male, mean age 65 ± 13 years and mean left ventricular ejection fraction 27 ± 12%). 30-day and 6-month mortality was 23.2% and 36.2%, respectively. Risk factors for 30-day mortality (p <0.05) were: obesity (41% vs 17%), absence of valvular heart disease (48% vs 13%) and plasma creatinine (pCr) variation after LVS infusion (+0.05 mg/dL vs -0.24 mg/dL). Patients with ischemic heart disease have higher mortality at 6 months (68% vs 25%, p=0.001). Risk factors for both 30-day and 6-month mortality (p<0.05) were: chronic kidney disease stage ≥3 (40% vs 10%; 63% vs 15%), pCr before LSV (1.97 vs 1.43mg/dL; 1.83 vs 1.48mg/dL) and pCr after LVS (1.82 vs 1.23mg/dL; 1.71 vs 1.22mg/dL). The readmission rate at 30 days and 6 months was 7.4% and 36.0%, respectively. We did not find any significant predictors for 30-day readmission. Factors associated with higher readmission rate at 6 months (p <0.05) were: pre-infusion NYHA IV class (71% vs 30%), decompensated chronic HF (44% vs 9%) and atrial fibrillation or atrial flutter rhythm (56% vs 26%). In 27 cases, pre and post treatment NT-proBNP values were available. LVS therapy significantly reduced NT-proBNP from 10467 ± 8984 ng/L to 8237 ± 9500 ng/L (p=0.012) and improvement was observed in 93% of patients. Survival at 30 days and 6 months can be predicted by percentage of NT-proBNP improvement (-84.4% vs -28.4%, p=0.047; -92.3% vs -16.3%; p=0.012). Conclusion AHF patients requiring inotropic therapy have high mortality and readmission rates. Several clinical features and analytical responses to LVS perfusion are predictors of these events. LVS significantly reduces NT-proBNP. The magnitude of this reduction is a predictor of short- and long-term mortality.
Body and brain undergo several changes with aging. One of these changes is the loss of neuroplasticity, which leads to the decrease of cognitive abilities. Hence the necessity of stopping or reversing these changes is of utmost importance to contemporary society. In the present work, electroencephalogram (EEG) markers of cognitive decline are sought whilst the subjects perform the Wisconsin Card Sorting Test (WCST). Considering the expected age-related cognitive deficits, WCST was applied to young and elder participants. The results suggest that coherence on theta and alpha EEG rhythms decrease with aging and increase with performance. Additionally, theta phase coherence seems more sensitive to performance, while alpha synchronization appears as a potential ageing marker.
The COVID-19 pandemic brought the outpatient management to the spotlight, especially in what home mechanical ventilation (HMV) is regarded. Our goal was to assess the main complaints/problems and the adjustments made in the appointment. We performed a transversal retrospective analysis of patients on HMV for at least a month, followed in the outpatient clinic of a tertiary hospital, in 2019’s 2nd semester. The HMV outpatient clinic consists of a pulmonologist, a nurse and a technician from the home respiratory care company (provider of HMV in Portugal). In a day-hospital regimen, patients are monitored on HMV with their equipment for at least 30 minutes with blood gas analysis and/or capnography. Ventilator data is observed in real time and also collected from the previous 3 months. A total of 301 patients were analyzed. No changes were made in 138 cases (45.8%). A total of 212 changes were made in the remainder 163 patients. Most detected problems were found in HMV software data (33.5%), such as usage, leakage and volumes. HMV parameters suffered the most adjustments (36.3%). Only 5 problems (2.4%) lead to stop HMV. All results are shown in this table: Almost half of the patients needed no changes. On the other hand, our results show how an outpatient approach to HMV follow-up allows clinicians to detect a diverse amount of patients’ complaints or problems regarding the treatment itself and, at the same time, address changes to try to fix them.
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