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BACKGROUND: The clinical picture of coronavirus disease 2019 (COVID-19)-associated sepsis is similar to that of sepsis of other aetiologies. The present study aims to analyse the role of syndecan-1 (SDC-1) as a potential predictor of septic shock in critically ill patients with COVID-19. METHODS: This is a prospective study of 86 critically ill patients due to COVID-19 infection. Patients were followed until day 28 of hospitalization. Vascular biomarkers, such as vascular cell adhesion protein-1, SDC-1, angiopoietin-1 and angiopoietin-2, were quantified upon admission and associated with the need for vasopressors in the first 7 d of hospitalization. RESULTS: A total of 86 patients with COVID-19 (mean age 60±16 y; 51 men [59%]) were evaluated. Thirty-six (42%) patients died during hospitalization and 50 (58%) survived. The group receiving vasopressors had higher levels of D-dimer (2.46 ng/ml [interquartile range {IQR} 0.6-6.1] vs 1.01 ng/ml [IQR 0.62-2.6], p=0.019) and lactate dehydrogenase (929±382 U/l vs 766±312 U/l, p=0.048). The frequency of deaths during hospitalization was higher in the group that received vasoactive amines in the first 24 h in the intensive care unit (70% vs 30%, p=0.002). SDC-1 levels were independently associated with the need for vasoactive amines, and admission values >269 ng/ml (95% CI 0.524 to 0.758, p=0.024) were able to predict the need for vasopressors during the 7 d following admission. CONCLUSIONS: Syndecan-1 levels predict septic shock in critically ill patients with COVID-19.
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COVID-19 , Sepse , Choque Séptico , Masculino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Sindecana-1 , Estado Terminal , COVID-19/complicações , AminasRESUMO
Melatonin (MLT), the main product of the pineal gland, is involved in muscle tissue repair and regeneration, besides several other important physiologic functions. In COPD, MLT administration can improve lung oxidative stress and sleep quality, but its potential effects on the outcomes of pulmonary rehabilitation (PR) have not been previously investigated. A randomized controlled trial was undertaken to test the hypothesis that a combined approach of rehabilitative exercise training and MLT supplementation could maximize functional performance, health status and quality of life in patients with COPD. Thirty-nine individuals with COPD referred to a supervised PR program at the Federal University of Ceara, Brazil, were randomized to receive MLT (3 mg/day; n = 18) or placebo (n = 21). Exercise capacity (6-min walk test - 6MWT), health status (COPD assessment test), and quality of life (airways questionnaire 20) were investigated as primary outcomes. No differences were observed at baseline in demographic, anthropometric and clinical characteristics between MLT and placebo groups. At the end of PR, superiority of the MLT group was demonstrated in improvement in the distance covered in the 6MWT (71 ± 26 vs. 25 ± 36 m; p < 0.01), health status (-11 ± 6 vs. -3 ± 5; p < 0.01), and quality of life (-6.9 ± 3.0 vs. -1.9 ± 2.4; p < 0.01), compared to the placebo group. In conclusion, MLT supplementation during the course of 12 weeks of PR can improve functional capacity, health status and quality of life in patients with COPD. These findings may have significant implications for the management of this condition.
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Melatonina , Doença Pulmonar Obstrutiva Crônica , Humanos , Melatonina/uso terapêutico , Melatonina/farmacologia , Qualidade de Vida , Pulmão , Resultado do Tratamento , Tolerância ao Exercício , Suplementos NutricionaisRESUMO
Objective: This study aims to evaluate the impact of morning-evening preference in pregnancy outcomes in gestational diabetes mellitus (GDM). Methods: This is a prospective cohort study of 2nd-3rd trimester GDM outpatient care in Fortaleza, Brazil (2018-2020). Eveningness was defined by the Horne-Östberg Morningness-Eveningness-Questionnaire (MEQ ≤ 41). Furthermore, we obtained a 7-day actigraphic register. Subjective sleep quality, daytime somnolence, insomnia, fatigue and depressive symptoms were also evaluated. Associations with pregnancy outcomes were investigated. Results: Among 305 patients with GDM, evening preference was found in 21 (6.9%). Patients with evening preference had worse sleep quality (p < 0.01), greater severity of insomnia (p < 0.005), fatigue (p < 0.005) and depressive symptoms (<0.009). Evening chronotype was associated with preeclampsia [p = 0.01; OR = 0.27; CI 0.09-0.79] and a greater need for admission to a neonatal intensive care unit (NICU) [p = 0.02; OR = 0.23; CI .0.06-0.80]. A lower MEQ score confirmed an association with preeclampsia [p = 0.002; OR = 0.94; CI 0.90-0.97] and this was maintained after controlling for age, arterial hypertension, sleep quality, fatigue and depressive symptoms [p < 005; OR = 0.91; CI 0.87-0.95]. Conclusion: In GDM, patients with evening preference had worse sleep quality, more insomnia, fatigue, and depressive symptoms. Furthermore, eveningness was independently associated with preeclampsia. These results indicate the important role of eveningness in adverse pregnancy outcomes.
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Diabetes Gestacional , Pré-Eclâmpsia , Distúrbios do Início e da Manutenção do Sono , Feminino , Recém-Nascido , Gravidez , Humanos , Sono , Ritmo Circadiano , Distúrbios do Início e da Manutenção do Sono/etiologia , Estudos Prospectivos , Fadiga , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To investigate the associations between sleep quality, fatigue, disease activity and depressive symptoms in women with rheumatoid arthritis (RA). METHODS: Female patients with previous diagnosis of RA from a Rheumatology Outpatient Clinic at a tertiary referral centre, in Fortaleza, Brazil, were consecutively recruited into the study. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI); fatigue by the Fatigue Severity Scale (FSS); daytime sleepiness by the Epworth Sleepiness Scale (ESS); and depressive symptoms by the Beck Depression Inventory II (BDI-II). RA activity was measured by the disease activity score (DAS28). RESULTS: One hundred ten women (mean age ± SD = 51.1 ± 13.0 y) were included in the study. On average, patients with depressive symptoms (BDI-II > 13), as compared to those without, showed poorer sleep quality (PSQI: 10.09 ± 4.1 vs 7.33 ± 3.55; p = 0.001 respectively), more fatigue (FSS: 4.69 ± 1.89 vs 3.34 ± 1.8; p = 0.001) and higher disease activity level (DAS28: 4.36 ± 1.53 vs 3.7 ± 1.39; p = 0,047). The logistic regression analysis showed that sleep quality is an independent predictor of depressive symptom severity. CONCLUSION: Depressive symptoms, impaired sleep and fatigue are common in women with RA. Poor sleep is associated with greater frequency and severity of depressive symptoms in these patients, suggesting that screening for sleep and mood problems may be relevant both in clinical research and routine patient care. Future studies investigating the impact of measures to promote healthy sleep on depressive symptom control in this patient population are warranted.
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Artrite Reumatoide , Depressão , Fadiga , Transtornos do Sono-Vigília , Artrite Reumatoide/fisiopatologia , Depressão/epidemiologia , Fadiga/epidemiologia , Feminino , Humanos , Qualidade do Sono , Transtornos do Sono-Vigília/epidemiologiaRESUMO
INTRODUCTION: Night Eating Syndrome (NES) is characterized by a delay in the circadian rhythm of food intake and affects 1.5% of the general population, occurring more frequently in obese people. The Night Eating Questionnaire (NEQ) was originally developed for the American adult population. It is a self-administered instrument widely used in the identification and follow-up of individuals with NES. Although the NEQ has been translated and validated for Brazilian adults, there are no reports of its adaptation for use in Brazilian adolescents. The present study aimed to adapt and evaluate reliability and reproducibility of the NEQ for Brazilian adolescents. MATERIAL AND METHODS: Initially, a semantic adaptation of the Portuguese version of the NEQ was performed by 3 professionals with experience with adolescents. The suggested text was analyzed and consolidated item by item by the researchers and then presented to 21 adolescents from an intermediate school in Fortaleza. The questions with low level of understanding (<90%) were modified and the questionnaire was re-applied to 23 adolescents, obtaining satisfactory understanding. RESULTS: The version of the NEQ for Brazilian adolescents, compared to the adult version, contains changes in items 3, 5, 6, 7 and 13. The questionnaire was administered to 463 students aged 11 to 17 years (mean ± SD = 13.7 ± 1.2), from 3 schools. The internal consistency, measured by the Cronbach's alpha coefficient, was 0.73. The reproducibility that was measured after one week in 27 adolescents was 0.92 (95% CI 0.82-0.96). CONCLUSION: The new version of the NEQ for Brazilian adolescents presents excellent reproducibility and good internal consistency and is a simple and useful instrument to evaluate nocturnal eating symptoms in this age group.
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OBJECTIVE: To investigate the prevalence and main factors associated with short and long sleep duration and excessive daytime sleepiness in Brazilian adolescents. METHODS: This was a cross-sectional study of 11.525 students of both genders, aged 14-17 years, from the public high-school system. Sleep duration was assessed by self-report and <8 h of sleep per day was considered short sleep and >10 h, long sleep. Socio-demographic and behavioral factors were investigated through a purpose-built questionnaire and daytime somnolence was assessed by the Epworth sleepiness scale (ESS). RESULTS: The overall prevalence of short and long sleep was 54.7% and 3.3%, respectively. Frequency of short sleep was lowest in the afternoon shift (38.2%) and highest in the morning shift (62.9%) and full-day students (70.0%). Insufficient sleep was more frequent in working (63.0%) than non-working adolescents (53.1%; p = 0.001) and among those who used their cell phone before bedtime (56.3%) compared to non-users (49.7%, p = 0.001). On average, ESS score was higher in subjects with short and long sleep (respectively, 9.7 ± 4.4 and 10.0 ± 4.5) compared to those with normal sleep duration (8.9 ± 4.2; p = 0.001). CONCLUSION: Insufficient sleep and excessive daytime sleepiness are very common among urban high-school Brazilian adolescents. Full day and morning school shifts are associated with short sleep and daytime somnolence, suggesting later start times may have a role in reducing sleep loss in these subjects. Older age, work activity, and cell phone use before bedtime, are also risk factors for of short sleep in adolescents. Although less common, long sleep can also be associated with excessive daytime sleepiness.
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Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Instituições Acadêmicas , Transtornos do Sono-Vigília/epidemiologia , Estudantes/estatística & dados numéricos , Adolescente , Fatores Etários , Brasil/epidemiologia , Estudos Transversais , Emprego/estatística & dados numéricos , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Autorrelato , Inquéritos e Questionários , Fatores de TempoRESUMO
PURPOSE: Although it is generally recognized that poor sleep is common in the intensive care unit (ICU), it is still unclear which interventions can effectively improve sleep in this setting. In this review, we critically analyze the various pharmacological and non-pharmacological measures that have been proposed to tackle this problem. METHODS: A search of MEDLINE/PubMed, SciELO, and the Brazilian Virtual Library in Health (LILACS and BNDEF) databases was performed. Results were reviewed and 41 articles on pharmacological and non-pharmacological interventions to promote sleep in ICU were analyzed. RESULTS: Non-pharmacological interventions including eye mask and earplugs, bundles to reduce noise and lighting, and organization of patient care were shown to improve subjective and objective sleep quality, although the level of evidence was considered low. Assist-control ventilation was associated with a greater objective sleep quality than spontaneous modes, such as pressure support ventilation and proportional assist ventilation. Among pharmacological interventions, a moderate level of evidence was found for oral melatonin, with increases in both objective and subjective sleep quality. Continuous nocturnal infusion of dexmedetomidine was reported to increase sleep efficiency and favorably modify the sleep pattern, although evidence level was moderate to low. CONCLUSIONS: Several non-pharmacological and pharmacological measures can be helpful to improve sleep in critical patients. Further high-quality studies are needed to strengthen the evidence base.
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Unidades de Terapia Intensiva , Ventilação Líquida , Medicamentos Indutores do Sono/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/terapia , Dexmedetomidina/uso terapêutico , Humanos , Infusões Intravenosas , Medicamentos Indutores do Sono/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Wake-up stroke (WUS) are strokes that are noted upon awakening in patients previously going to bed in a normal state of health. The role of sleep abnormalities in WUS is uncertain. The objective was to determine clinical characteristics, respiratory abnormalities during sleep and outcomes in patients with WUS versus non-WUS. METHODS: At baseline, patients with ischemic stroke were examined clinically and with a portable sleep recorder. Apnea-Hypopnea Index greater than or equal to 20 defined a cut-off severity index. At follow-up (3 and 12-months), patients were re-evaluated clinically and with questionnaires: Epworth Sleepiness Scale, Modified Rankin (MR) and Modified Barthel Index Results: Among all (Nâ¯=â¯102, 64% male), hypertension (73%), Type 2 diabetes (29.4), heart disease (16.7%), physical inactivity (69.6%), smoking (32.4%) and alcohol consumption (17.6) were found. Apnea-Hypopnea Index (AHI) greater than 5 (92.9%), AHI greater than 15 (44.7%), AHI greater than or equal to 20 (35.3%) and AHI greater than 30 (11.8%) were registered. Cases with and without WUS did not differ regarding polygraphic findings. Long apneas (apnea duration > 20 s) was equally found in patients with WUS (23.1%) and non-WUS (23.7%). Type 2 diabetes mellitus (T2D) was independently associated with WUS (ORâ¯=â¯2.76; CI: 1.10-6.05; Pâ¯=â¯.03). Prospectively, symptom severity was not different between WUS and non-WUS. Overall, patients with OSA (IAH≥20) evolved with worse functional performance (MR, Pâ¯=â¯.02). CONCLUSIONS: Wake-up stroke occurred in approximately 1 of 3 of cases. Irrespective of WUS, half of the patients had moderate to severe sleep apnea; those with OSA (AHI≥ 20) evolved with worse functional performance after 1 year. WUS was associated with TDM reinforcing a relationship with cerebral small vessel disease.
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Isquemia Encefálica/fisiopatologia , Pulmão/fisiopatologia , Respiração , Apneia Obstrutiva do Sono/fisiopatologia , Sono , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Brasil/epidemiologia , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Avaliação da Deficiência , Feminino , Nível de Saúde , Humanos , Estilo de Vida , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de TempoRESUMO
INTRODUCTION: Exercise is an adjuvant therapy indicated for various psychiatric disorders. However, prospective studies in patients with bipolar disorder (BD) are scarce and with uncertain conclusions. This study aims to evaluate physical activity as a prognostic factor for BD, analyzing relationship with levels of anxiety, functionality, sleep, mood episodes and hospitalizations. METHODS: Three psychiatrists interviewed 80 BD outpatients in euthymia, referred from four different institutions in Brazil. In this moment, they evaluated the intensity of physical activities using the International Physical Activity Questionnaire (IPAQ) - short form. They reevaluated patients and reviewed medical records monthly for 18 months to identify mood episodes and psychiatric hospitalizations. RESULTS: Thirty-eight patients (47.5%) were physically inactive (or sedentary) and 42 (52.5%) active. Physically active patients had lower Body Mass Index (pâ¯=â¯0.006), waist circumference (pâ¯=â¯0.002), lower levels of anxiety (pâ¯=â¯0.032) and less insomnia (pâ¯=â¯0.001). Sedentary individuals revealed poorer global functioning (p < 0.001) and in all domains: autonomy (p < 0.001), occupational functioning (pâ¯=â¯0.008), cognitive functioning (pâ¯=â¯0.013), capacity of managing the finances (pâ¯=â¯0.012), interpersonal relationships (pâ¯=â¯0.011) and leisure time (pâ¯=â¯0.001). Less activity was associated with more mood episodes (pâ¯=â¯0.042) and psychiatric hospitalizations (pâ¯=â¯0.043) over 18 months. CONCLUSION: This study suggested physical activity as a good prognostic factor for BD during euthymia. This reinforces the need to encourage this practice in clinical settings. Future prospective surveys with longer duration using objective instruments are proposed.