RESUMO
In December of 2019, there was an outbreak of a severe acute respiratory syndrome caused by the coronavirus 2 (SARS-CoV-2 or COVID-19) in China. The virus rapidly spread into the whole world causing an unprecedented pandemic and forcing governments to impose a global quarantine, entering an extreme unknown situation. The organizational consequences of quarantine/isolation are absence of organized training and competition, lack of communication among athletes and coaches, inability to move freely, lack of adequate sunlight exposure, and inappropriate training conditions. The reduction of mobility imposed to contain the advance of the SARS-Cov-2 pandemic can negatively affect the physical condition and health of individuals leading to muscle atrophy, progressive loss of muscle strength, and reductions in neuromuscular and mechanical capacities. Resistance training (RT) might be an effective tool to counteract these adverse consequences. RT is considered an essential part of an exercise program due to its numerous health and athletic benefits. However, in the face of the SARS-Cov-2 outbreak, many people might be concerned with safety issues regarding its practice, especially in indoor exercise facilities, such as gyms and fitness centers. These concerns might be associated with RT impact in the immune system, respiratory changes, and contamination due to equipment sharing and agglomeration. In this current opinion article, we provide insights to address these issues to facilitate the return of RT practices under the new logistical and health challenges. We understand that RT can be adapted to allow its performance with measures adopted to control coronavirus outbreak such that the benefits would largely overcome the potential risks. The article provides some practical information to help on its implementation.
Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Treinamento Resistido/efeitos adversos , Treinamento Resistido/métodos , Betacoronavirus , COVID-19 , China/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/transmissão , Desinfecção/métodos , Humanos , Sistema Imunitário/fisiopatologia , Pandemias/prevenção & controle , Pneumonia Viral/fisiopatologia , Pneumonia Viral/transmissão , Treinamento Resistido/instrumentação , Sistema Respiratório/fisiopatologia , Fatores de Risco , SARS-CoV-2 , SegurançaRESUMO
Resumen Objetivo: Analizar la evidencia sobre la relación entre la contaminación del aire y un riesgo mayor de morbimortalidad por Covid-19. Material y métodos: Se utilizó una adaptación de la metodología de revisiones rápidas de Cochrane. La búsqueda se realizó en PubMed y MedRxiv y se limitó hasta el 28 y 26 de abril, respectivamente. Los títulos y resúmenes fueron revisados por cinco investigadores que, a su vez, revisaron los textos completos de la selección final. Resultados: Se encontraron 450 manuscritos, 15 cumplieron los criterios de inclusión. La evidencia encontrada reporta que la incidencia y el riesgo de morbilidad y mortalidad por Covid-19 se incrementan con la exposición crónica y aguda a la contaminación del aire, particularmente a material particulado (PM2.5, PM10) y dióxido de nitrógeno. Conclusiones: Se requieren más estudios especialmente en ciudades latinoamericanas. Es necesario fortalecer las recomendaciones en las ciudades con mayores niveles de contaminantes y reducir sus emisiones.
Abstract Objective: To analyze the evidence on the relationship between air pollution and an increased risk of morbidity and mortality from Covid-19. Materials and methods: An adaptation of the Cochrane rapid review methodology was used. The search was performed in PubMed and MedRxiv and was limited until April 28 and 26, respectively. The titles and abstracts were reviewed by five researchers who, in turn, reviewed the full texts of the final selection. Results: 450 manuscripts were found, 15 met the inclusion criteria. The evidence reports that the incidence and risk of morbidity and mortality from Covid-19 increase with chronic and acute exposure to air pollution, particularly to particulate matter (PM2.5, PM10) and nitrogen dioxide. Conclusions: More studies are required especially in Latin American cities. It is necessary to strengthen the recommendations in cities with higher levels of pollutants and to reduce their emissions.
Assuntos
Humanos , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Poluição do Ar/efeitos adversos , Pandemias , Betacoronavirus , Pneumonia Viral/etiologia , Sistema Respiratório/fisiopatologia , Sistema Respiratório/virologia , Monitoramento Ambiental , Saúde da População Urbana , Incidência , Cidades , Infecções por Coronavirus/etiologia , Síndrome Respiratória Aguda Grave/etiologia , Síndrome Respiratória Aguda Grave/mortalidade , Poluentes Atmosféricos/efeitos adversos , Suscetibilidade a Doenças , Exposição Ambiental , Material Particulado/efeitos adversos , SARS-CoV-2 , COVID-19 , América Latina/epidemiologia , Conceitos MeteorológicosRESUMO
OBJECTIVE: To analyze the evidence on the relationship between air pollution and an increased risk of morbidity and mortality from Covid-19. MATERIALS AND METHODS: An adaptation of the Cochrane rapid review methodology was used. The search was performed in PubMed and MedRxiv and was limited until April 28 and 26, respectively. The titles and abstracts were reviewed by five researchers who, in turn, reviewed the full texts of the final selection. RESULTS: 450 manuscripts were found, 15 met the inclusion criteria. The evidence reports that the incidence and risk of morbidity and mortality from Covid-19 increase with chronic and acute exposure to air pollution, particularly to particulate matter (PM2.5, P M10) and nitrogen dioxide. CONCLUSIONS: More studies are required especially in Latin American cities. It is necessary to strengthen the recommendations in cities with higher levels of pollutants and to reduce their emissions.
OBJETIVO: Analizar la evidencia sobre la relación entre la contaminación del aire y un riesgo mayor de morbimor-talidad por Covid-19. MATERIAL Y MÉTODOS: Se utilizó una adaptación de la metodología de revisiones rápidas de Cochrane. La búsqueda se realizó en PubMed y MedRxiv y se limitó hasta el 28 y 26 de abril, respectivamente. Los títu-los y resúmenes fueron revisados por cinco investigadores que, a su vez, revisaron los textos completos de la selección final. RESULTADOS: Se encontraron 450 manuscritos, 15 cumplieron los criterios de inclusión. La evidencia encon-trada reporta que la incidencia y el riesgo de morbilidad y mortalidad por Covid-19 se incrementan con la exposición crónica y aguda a la contaminación del aire, particularmente a material particulado (PM2.5, P M10) y dióxido de nitrógeno. CONCLUSIONES: Se requieren más estudios especialmente en ciudades latinoamericanas. Es necesario fortalecer las recomendaciones en las ciudades con mayores niveles de contaminantes y reducir sus emisiones.
Assuntos
Poluição do Ar/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Poluentes Atmosféricos/efeitos adversos , COVID-19 , Cidades , Infecções por Coronavirus/etiologia , Suscetibilidade a Doenças , Exposição Ambiental , Monitoramento Ambiental , Humanos , Incidência , América Latina/epidemiologia , Conceitos Meteorológicos , Material Particulado/efeitos adversos , Pneumonia Viral/etiologia , Sistema Respiratório/fisiopatologia , Sistema Respiratório/virologia , SARS-CoV-2 , Síndrome Respiratória Aguda Grave/etiologia , Síndrome Respiratória Aguda Grave/mortalidade , Saúde da População UrbanaRESUMO
NEW FINDINGS: What is the central question of this study? What are the alterations in respiratory motor activity that may underlie ventilatory dysfunctions in juvenile and adult animals exposed to postnatal chronic intermittent hypoxia? What is the main finding and its importance? Postnatal chronic intermittent hypoxia modifies the motor activity to pumping and upper airway respiratory muscles in rats, mediated by epigenetic DNA hypermethylation, enhancing resting pulmonary ventilation and predisposing to collapse of the upper airways in juvenile and adult life. ABSTRACT: Periods of apnoea, commonly observed in prematures and newborns, are an important risk factor for the development of cardiorespiratory diseases in adulthood. In the present study, we evaluated changes in pulmonary ventilation and respiratory motor pattern in juvenile and adult rats exposed to postnatal chronic intermittent hypoxia (pCIH). Newborn male Holtzman rats (P1) were submitted to pCIH (6% O2 for 30 s, every 9 min, 8 h a day (09.30-17.30 h)) during their first 10 days of life, while control animals were maintained under normoxic conditions (20.8% O2 ). Thereafter, animals of both groups were maintained under normoxia until the experiments. Unanaesthetized juvenile pCIH rats (n = 27) exhibited elevated tidal volume and respiratory irregularities (P < 0.05) compared to control rats (n = 7). Decerebrate, arterially perfused in situ preparations of juvenile pCIH rats (n = 11) displayed augmented phrenic nerve (PN) burst amplitude and reduced central vagus nerve activity in comparison to controls (n = 10). At adulthood, pCIH rats (n = 5) showed enhanced tidal volume (P < 0.05) and increased respiratory variability compared to the control group (n = 5). The pCIH-induced changes in ventilation and respiratory motor outputs were prevented by treatment with the DNA methyltransferase inhibitor decitabine (1 mg kg-1 , i.p.) during the exposure to pCIH. Our data demonstrate that pCIH in rats impacts, in a persistent way, control of the respiratory pattern, increasing PN activity to the diaphragm and reducing the vagal-related activity to laryngeal muscles, which, respectively, may contribute to improve resting pulmonary ventilation and predispose to collapse of the upper airways during quiet breathing.
Assuntos
Epigênese Genética , Hipóxia/fisiopatologia , Nervo Frênico/fisiopatologia , Músculos Respiratórios/fisiopatologia , Sistema Respiratório/fisiopatologia , Nervo Vago/fisiopatologia , Envelhecimento , Animais , Animais Recém-Nascidos , Metilação de DNA/efeitos dos fármacos , Decitabina/farmacologia , Diafragma/fisiopatologia , Masculino , Ventilação Pulmonar , Ratos , Ratos Sprague-DawleyRESUMO
The diagnosis of primary ciliary dyskinesia (PCD) is complex and requires high clinical suspicion. The findings in the diagnostic images are nonspecific and can be seen in other conditions of the airway. In this review, we will describe the findings of PCD in chest radiography and computed tomography, with emphasis on some of the characteristics that differentiate it from cystic fibrosis and we will review the role of CT in the monitoring of changes of the PCD, since the CT findings correlate very well with the structural changes that occur in the course of PCD, especially bronchiectasis. However, using serial CTs should be decided on a case-by-case basis to avoid unnecessary radiation because they are pediatric patients.
El diagnóstico de la Discinesia ciliar primaria (DCP) es complejo y requiere alta sospecha clínica. Los hallazgos en la imágenes diagnósticas son inespecíficos y se pueden ver en otras afecciones de la vía aérea. En esta revisión describiremos los hallazgos de la DCP en Radiología simple y en Tomografía computada (TC), con énfasis en algunas de las características que permiten diferenciarla de la Fibrosis quística (FQ) y revisaremos el rol de la TC en la monitorización de la DCP ya que los hallazgos en la TC se correlacionan muy bien con los cambios estructurales que ocurren en el curso de la DCP, en especial las bronquiectasias. Sin embargo usar TC seriadas se debe decidir caso por caso para evitar la radiación innecesaria por ser pacientes pediátricos.
Assuntos
Humanos , Criança , Sistema Respiratório/metabolismo , Síndrome de Kartagener/fisiopatologia , Pulmão/diagnóstico por imagem , Sistema Respiratório/fisiopatologia , Sistema Respiratório/patologia , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X/métodos , Síndrome de Kartagener/metabolismo , Síndrome de Kartagener/microbiologia , Pulmão/metabolismo , Pulmão/patologiaRESUMO
Abstract Introduction: Although the nose and lungs are separate organs, numerous studies have reported that the entire respiratory system can be considered as a single anatomical and functional unit. The upper and lower airways affect each other either directly or through reflex mechanisms. Objective: In this study, we aimed to evaluate the effects of the radiofrequency ablation of persistent inferior turbinate hypertrophy on nasal and pulmonary function. Methods: Twenty-seven patients with bilateral persistent inferior turbinate hypertrophy without septal deviation were included in this study. All of the patients were evaluated using anterior rhinoscopy, nasal endoscopy, acoustic rhinometry, a visual analogue scale, and flow-sensitive spirometry on the day before and 4 months after the radiofrequency ablation procedure. Results: The post-ablation measurements revealed that the inferior turbinate ablation caused an increase in the mean cross-sectional area and volume of the nose, as well as in the forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow of the patients. These differences between the pre- and post-ablation results were statistically significant. The post-ablation visual analogue scale scores were lower when compared with the pre-ablation scores, and this difference was also statistically significant. Conclusion: This study demonstrated that the widening of the nasal passage after the reduction of the inferior turbinate size had a favorable effect on the pulmonary function tests.
Resumo Introdução: Embora o nariz e os pulmões sejam órgãos separados, numerosos estudos relataram que todo o sistema respiratório pode ser considerado como uma única unidade anatômica e funcional. As vias aéreas superiores e inferiores afetam uma à outra diretamente ou através de mecanismos reflexos. Objetivo: Avaliar os efeitos da ablação por radiofrequência em conchas nasais inferiores com hipertrofia persistente sobre a função nasal e pulmonar. Método: Foram incluídos neste estudo 27 pacientes com hipertrofia persistente bilateral de conchas inferiores sem desvio septal. Todos os pacientes foram avaliados com rinoscopia anterior, endoscopia nasal, rinometria acústica, escala visual analógica e espirometria sensível ao fluxo no dia anterior e quatro meses após o procedimento de ablação por radiofrequência. Resultados: As medidas pós-ablação demonstraram que a ablação das conchas nasais inferiores resultou em um aumento da área transversal média e do volume do nariz, bem como do volume expiratório forçado em um segundo, da capacidade vital forçada e do fluxo expiratório máximo dos pacientes. Essas diferenças entre os resultados pré e pós-ablação foram estatisticamente significantes. Os escores da escala visual analógica pós-ablação foram menores quando comparados com os escores pré-ablação e essa diferença também foi estatisticamente significante. Conclusão: O alargamento da passagem nasal após a redução do tamanho das conchas nasais inferiores teve efeito favorável nos testes de função pulmonar.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Sistema Respiratório/fisiopatologia , Conchas Nasais/fisiopatologia , Hiperostose/cirurgia , Obstrução Nasal/cirurgia , Obstrução Nasal/fisiopatologia , Ablação por Radiofrequência/métodos , Tamanho do Órgão , Período Pós-Operatório , Valores de Referência , Conchas Nasais/cirurgia , Conchas Nasais/patologia , Conchas Nasais/diagnóstico por imagem , Hiperostose/fisiopatologia , Obstrução Nasal/diagnóstico por imagem , Pico do Fluxo Expiratório , Capacidade Vital , Volume Expiratório Forçado , Estudos Prospectivos , Resultado do Tratamento , Estatísticas não Paramétricas , Rinometria Acústica , Endoscopia/métodos , Escala Visual AnalógicaRESUMO
INTRODUCTION: Although the nose and lungs are separate organs, numerous studies have reported that the entire respiratory system can be considered as a single anatomical and functional unit. The upper and lower airways affect each other either directly or through reflex mechanisms. OBJECTIVE: In this study, we aimed to evaluate the effects of the radiofrequency ablation of persistent inferior turbinate hypertrophy on nasal and pulmonary function. METHODS: Twenty-seven patients with bilateral persistent inferior turbinate hypertrophy without septal deviation were included in this study. All of the patients were evaluated using anterior rhinoscopy, nasal endoscopy, acoustic rhinometry, a visual analogue scale, and flow-sensitive spirometry on the day before and 4 months after the radiofrequency ablation procedure. RESULTS: The post-ablation measurements revealed that the inferior turbinate ablation caused an increase in the mean cross-sectional area and volume of the nose, as well as in the forced expiratory volume in 1s, forced vital capacity, and peak expiratory flow of the patients. These differences between the pre- and post-ablation results were statistically significant. The post-ablation visual analogue scale scores were lower when compared with the pre-ablation scores, and this difference was also statistically significant. CONCLUSION: This study demonstrated that the widening of the nasal passage after the reduction of the inferior turbinate size had a favorable effect on the pulmonary function tests.
Assuntos
Hiperostose/cirurgia , Obstrução Nasal/fisiopatologia , Obstrução Nasal/cirurgia , Ablação por Radiofrequência/métodos , Sistema Respiratório/fisiopatologia , Conchas Nasais/fisiopatologia , Conchas Nasais/cirurgia , Adulto , Endoscopia/métodos , Feminino , Volume Expiratório Forçado , Humanos , Hiperostose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico por imagem , Tamanho do Órgão , Pico do Fluxo Expiratório , Período Pós-Operatório , Estudos Prospectivos , Valores de Referência , Rinometria Acústica , Estatísticas não Paramétricas , Resultado do Tratamento , Conchas Nasais/diagnóstico por imagem , Conchas Nasais/patologia , Escala Visual Analógica , Capacidade Vital , Adulto JovemRESUMO
Abstract Background: In recent decades, obesity has become a public health problem in many countries. The objective of this study was to evaluate the main joint and extra-articular manifestations related to spondyloarthritis (SpA) after bariatric surgery (BS) in a retrospective cohort. Methods: Demographic, clinical, laboratory and imaging data from nine patients whose SpA symptoms started after a BS have been described. Modified New York (mNY) criteria for ankylosing spondylitis (AS) and the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial (ax-SpA) and peripheral (p-SpA) spondyloarthritis were applied. Results: The mean weight reduction after BS was 49.3 ±21.9 kg. The BS techniques were Roux-en-Y gastric bypass (n =8; 88.9%) and biliopancreatic diversion with duodenal switch (n = 1; 11.1%). Four (44.4%) patients had no axial or peripheral pain complaints before BS, while the other four (44.4%) had sporadic non-inflammatory back pain that had been attributed to obesity. One patient (11.1%) had persistent chronic back pain. In all nine cases, patients reported back pain onset or pattern (intensity or night pain) change after BS (mean time 14.7 ± 18 months). In addition, 8 of them (88.9%) were human leukocyte antigen (HLA)-B27 positive. All nine patients could be classified according to ASAS criteria as ax-SpA and five (55.6%) patients were classified as AS, according to the mNY criteria. Conclusion: Our data highlight a temporal link between SpA onset symptoms and the BS, suggesting a possible causal plausibility between the two events.