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Journal of Rehabilitation Medicine Jun 2024To assess the clinical effects of incentive spirometry (IS) and diaphragmatic breathing (DB) in patients with post COVID-19 condition and diaphragmatic dysfunction as... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To assess the clinical effects of incentive spirometry (IS) and diaphragmatic breathing (DB) in patients with post COVID-19 condition and diaphragmatic dysfunction as compared with the standard care alone.
METHODS
The present longitudinal randomized study included 60 patients with post COVID-19 condition and diaphragmatic dysfunction. Patients were equally randomized to receive standard care plus IS (G1), standard care plus DB (G2) or standard care alone (G3) for 8 weeks. The primary outcome is clinical improvement as evaluated by the modified Medical Research Council (mMRC) dyspnoea scale.
RESULTS
Comparison between the studied groups revealed significant improvement in G1 and G2 in all parameters at the end of follow-up. However, no significant improvement was found in G3. At the end of follow-up, 15 patients (75.0%) in G1, 11 patients (55.0%) in G2, and 3 patients (15.0%) in G3 showed improvement on the mMRC dyspnoea scale. Multivariate logistic regression analysis identified mild acute COVID-19 infection (p = 0.009), use of IS (p < 0.001), and use of DB (p = 0.023) as significant predictors of improvement on the mMRC dyspnoea scale.
CONCLUSIONS
IS or DB training in addition to the standard care in post COVID-19 condition was associated with better clinical improvement as compared with the standard care alone.
Topics: Humans; COVID-19; Male; Female; Middle Aged; Breathing Exercises; Diaphragm; Dyspnea; Adult; Post-Acute COVID-19 Syndrome; SARS-CoV-2; Spirometry; Longitudinal Studies; Treatment Outcome; Aged
PubMed: 38860716
DOI: 10.2340/jrm.v56.25491 -
History of Psychiatry Jun 2024is ubiquitous in ancient medicine and philosophy. Galen mentions the disease innumerable times, Patristic authors take it as a favourite allegory of human flaws, and no...
is ubiquitous in ancient medicine and philosophy. Galen mentions the disease innumerable times, Patristic authors take it as a favourite allegory of human flaws, and no ancient doctor fails to diagnose it and attempt its cure. Yet the nature of this once famous disease has not been properly understood by scholars. My book provides the first full history of . In doing so, it surveys ancient ideas about the interactions between body and soul, both in health and in disease. It also addresses ancient ideas about bodily health, mental soundness and moral 'goodness', and their heritage in contemporary psychiatry, offering a chance to reflect critically on contemporary ideas about what it means to be 'insane'.
PubMed: 38859599
DOI: 10.1177/0957154X241254927 -
Optics Express Jun 2024A fiber Bragg grating (FBG) accelerometer based on cross-type diaphragm was proposed and designed, in which the cross-beam acts as a spring element. To balance the...
A fiber Bragg grating (FBG) accelerometer based on cross-type diaphragm was proposed and designed, in which the cross-beam acts as a spring element. To balance the sensitivity and stability, the accelerometer structure was optimized. The experimental results show that the designed device has a resonant frequency of 556 Hz with a considerable wide frequency bandwidth of up to 200 Hz, which is consistent with the simulation. The sensitivity of the device is 12.35 pm/g@100 Hz with a linear correlation coefficient of 0.99936. The proposed FBG accelerometer has simple structure and strong anti-interference capability with a maximal cross-error less than 3.26%, which can be used for mechanical structural health monitoring.
PubMed: 38859498
DOI: 10.1364/OE.523300 -
Optics Express Apr 2024Miniature acoustic sensors with high sensitivity are highly desired for applications in medical photoacoustic imaging, acoustic communications and industrial...
Miniature acoustic sensors with high sensitivity are highly desired for applications in medical photoacoustic imaging, acoustic communications and industrial nondestructive testing. However, conventional acoustic sensors based on piezoelectric, piezoresistive and capacitive detectors usually require a large element size on a millimeter to centimeter scale to achieve a high sensitivity, greatly limiting their spatial resolution and the application in space-confined sensing scenarios. Herein, by using single-crystal two-dimensional gold flakes (2DGFs) as the sensing diaphragm of an extrinsic Fabry-Perot interferometer on a fiber tip, we demonstrate a miniature optical acoustic sensor with high sensitivity. Benefiting from the ultrathin thickness (∼8 nm) and high reflectivity of the 2DGF, the fiber-tip acoustic sensor gives an acoustic pressure sensitivity of ∼300 mV/Pa in the frequency range from 100 Hz to 20 kHz. The noise-equivalent pressure of the fiber-tip acoustic sensor at the frequency of 13 kHz is as low as 62.8 µPa/Hz, which is one or two orders of magnitude lower than that of reported optical acoustic sensors with the same size.
PubMed: 38859405
DOI: 10.1364/OE.519624 -
Optics Express May 2024We propose and demonstrate a new method of direct writing large-area fiber Bragg grating by femtosecond laser through the coating. By adding an adjustable diaphragm...
We propose and demonstrate a new method of direct writing large-area fiber Bragg grating by femtosecond laser through the coating. By adding an adjustable diaphragm before the focusing objective, we can precisely control the length of the refractive index modulation line along the femtosecond laser incident direction up to 29.1 µm. In combination with femtosecond laser scanning fabrication technology, a uniform refractive index modulation plane can be inscribed in the fiber in a single scanning. Based on the plane-by-plane inscription method, we have fabricated a high-quality high-reflectivity fiber Bragg grating and a chirped fiber Bragg grating on 20/400 double-clad fiber core. The reflectivity of both gratings is greater than 99%, and the insertion loss is as low as 0.165 dB and 0.162 dB, respectively. The thermal slope of chirped fiber Bragg grating without any refrigeration is 0.088 °C/W and there is no obvious temperature increase when using the water cooling. Therefore, the fabrication method of large-area fiber Bragg grating based on diaphragm shaping can efficiently fabricate high-quality fiber Bragg grating in the large core diameter fiber, which has an important application prospect in high-power all-fiber oscillators, especially all-fiber oscillators in special wavebands.
PubMed: 38859011
DOI: 10.1364/OE.521554 -
Acta Neurochirurgica Jun 2024During pituitary surgery, CSF leaks are often treated by intrasellar packing, using muscle or fat grafts. However, this strategy may interfere with the interpretation of...
BACKGROUND
During pituitary surgery, CSF leaks are often treated by intrasellar packing, using muscle or fat grafts. However, this strategy may interfere with the interpretation of postoperative MRI and may impact the quality of resection in cases of second surgery, due to the existence of additional fibrous tissue. We present an alternative technique, using a diaphragm reconstruction with a heterologous sponge combining fibrinogen and thrombin (TachoSil), applied in selected patients with low-flow CSF leaks. This study investigates the surgical outcome of patients treated with this strategy.
METHODS
From a cohort of 2231 patients treated from June 2011 to June 2023 by endoscopic endonasal approach for pituitary surgery, the surgical technique of diaphragm repair with TachoSil patch performed in 55 patients (2.6%) was detailed, and the rate of closure failure was analyzed at 6 months postoperatively. No intrasellar packing was used and sellar floor reconstruction was performed whenever possible. The rate of postoperative CSF leak was compared with that reported in three previous publications that also used the TachoSil patch technique.
RESULTS
Patients were mostly women (F/M ratio: 1.2) with a median age of 53.6 years. Surgery was indicated for non-functioning adenomas, Cushing's disease, acromegaly, and Rathke's cleft cysts in 38/55 (69.1%), 6/55 (10.9%), 5/55 (9.1%) and 6/55 (10.9%) patients respectively. The rate of postoperative CSF leak was 1.8% (n = 1/55), which was not significantly different from that reported in the three cohorts from the literature (2.8%, p > 0.05). No postoperative meningitis was recorded.
CONCLUSIONS
In highly selected patients with low-flow CSF leaks related to small focal diaphragm defects, diaphragm reconstruction using a TachoSil patch can be a safe and valuable alternative to intrasellar packing.
Topics: Humans; Female; Middle Aged; Thrombin; Male; Fibrinogen; Adult; Cerebrospinal Fluid Leak; Drug Combinations; Aged; Plastic Surgery Procedures; Cohort Studies; Diaphragm; Postoperative Complications; Pituitary Neoplasms; Treatment Outcome; Cerebrospinal Fluid Rhinorrhea; Pituitary Gland; Surgical Sponges
PubMed: 38853198
DOI: 10.1007/s00701-024-06152-5 -
Critical Care (London, England) Jun 2024Respiratory effort should be closely monitored in mechanically ventilated ICU patients to avoid both overassistance and underassistance. Surface electromyography of the...
Advanced waveform analysis of diaphragm surface EMG allows for continuous non-invasive assessment of respiratory effort in critically ill patients at different PEEP levels.
BACKGROUND
Respiratory effort should be closely monitored in mechanically ventilated ICU patients to avoid both overassistance and underassistance. Surface electromyography of the diaphragm (sEMGdi) offers a continuous and non-invasive modality to assess respiratory effort based on neuromuscular coupling (NMCdi). The sEMGdi derived electrical activity of the diaphragm (sEAdi) is prone to distortion by crosstalk from other muscles including the heart, hindering its widespread use in clinical practice. We developed an advanced analysis as well as quality criteria for sEAdi waveforms and investigated the effects of clinically relevant levels of PEEP on non-invasive NMCdi.
METHODS
NMCdi was derived by dividing end-expiratory occlusion pressure (Pocc) by sEAdi, based on three consecutive Pocc manoeuvres at four incremental (+ 2 cmH2O/step) PEEP levels in stable ICU patients on pressure support ventilation. Pocc and sEAdi quality was assessed by applying a novel, automated advanced signal analysis, based on tolerant and strict cut-off criteria, and excluding inadequate waveforms. The coefficient of variations (CoV) of NMCdi after basic manual and automated advanced quality assessment were evaluated, as well as the effect of an incremental PEEP trial on NMCdi.
RESULTS
593 manoeuvres were obtained from 42 PEEP trials in 17 ICU patients. Waveform exclusion was primarily based on low sEAdi signal-to-noise ratio (N = 155, 37%, N = 241, 51% waveforms excluded), irregular or abrupt cessation of Pocc (N = 145, 35%, N = 145, 31%), and high sEAdi area under the baseline (N = 94, 23%, N = 79, 17%). Strict automated assessment allowed to reduce CoV of NMCdi to 15% from 37% for basic quality assessment. As PEEP was increased, NMCdi decreased significantly by 4.9 percentage point per cmHO.
CONCLUSION
Advanced signal analysis of both Pocc and sEAdi greatly facilitates automated and well-defined identification of high-quality waveforms. In the critically ill, this approach allowed to demonstrate a dynamic NMCdi (Pocc/sEAdi) decrease upon PEEP increments, emphasising that sEAdi-based assessment of respiratory effort should be related to PEEP dependent diaphragm function. This novel, non-invasive methodology forms an important methodological foundation for more robust, continuous, and comprehensive assessment of respiratory effort at the bedside.
Topics: Humans; Male; Critical Illness; Diaphragm; Female; Electromyography; Middle Aged; Positive-Pressure Respiration; Aged; Intensive Care Units
PubMed: 38851709
DOI: 10.1186/s13054-024-04978-0 -
Parasitology Research Jun 2024The genus Sarcocystis includes protozoan parasites with an indirect life cycle. Sarcocystis spp. can infect various animal species and humans, causing sarcocystosis, a...
The genus Sarcocystis includes protozoan parasites with an indirect life cycle. Sarcocystis spp. can infect various animal species and humans, causing sarcocystosis, a parasitosis of economic importance and zoonotic concern. Wild boars can act as intermediate hosts for Sarcocystis miescheriana and the zoonotic Sarcocystis suihominis that infects humans by consumption of raw or undercooked infected swine meat. In the present study, the diaphragmatic muscle tissue of 123 wild boars hunted in Greece was examined to determine the frequency of Sarcocystis spp. The samples were examined by tissue compression and molecular techniques. Under light microscopy, 34 out of 123 (27.6%) wild boars tested positive for Sarcocystis spp., while a higher infection prevalence (75%) was revealed by multiplex PCR performed in 100 of the samples. The partial mtDNA cox1 gene (~ 1100 bp) of 20 samples tested positive for S. miescheriana by multiplex PCR was amplified and sequenced. Sarcocystis miescheriana was identified as the only species involved in these infections. This is the first study on the prevalence of Sarcocystis spp. in wild animals in Greece. Further, large-scale surveys are needed to assess the prevalence and species of this parasite in Greece and to design efficient control and preventive measures in a One Health perspective.
Topics: Animals; Sarcocystis; Sarcocystosis; Greece; Sus scrofa; Swine Diseases; Swine; DNA, Protozoan; Microscopy; Prevalence; Sequence Analysis, DNA; DNA, Mitochondrial; Multiplex Polymerase Chain Reaction; Electron Transport Complex IV; Diaphragm
PubMed: 38850432
DOI: 10.1007/s00436-024-08254-6 -
Journal of Women's Health (2002) Jun 2024Choosing a contraceptive method is a pivotal decision for patients, whereas health care professionals (HCPs) face challenges in providing suitable recommendations.... (Review)
Review
Choosing a contraceptive method is a pivotal decision for patients, whereas health care professionals (HCPs) face challenges in providing suitable recommendations. Adverse sexual effects often lead to dissatisfaction and discontinuation of contraceptives, underscoring the importance of thorough counseling and shared decision making between HCPs and patients. This article aims to investigate the relationship between contraceptive methods and female sexual function through a comprehensive review of available literature, emphasizing the importance of considering sexual health in contraceptive prescription and management. A systematic analysis of existing literature, incorporating studies utilizing validated sexual health questionnaires, was conducted to elucidate the intricate interplay between contraceptives and female sexual function. The review encompasses various contraceptive methods, including combined hormonal contraceptives, progestin-only pills, depot medroxyprogesterone acetate, subdermal contraceptive implants, hormonal intrauterine devices, permanent sterilization, and barrier methods. Insights gleaned from the analysis shed light on the impact of these methods on female sexual health. Comprehensive understanding of the effects of contraceptives on female sexual function is crucial for both HCPs and patients. By integrating sexual health considerations into contraceptive surveillance, compliance can be improved, contraceptive efficacy optimized, and the risk of unwanted pregnancies minimized. This review underscores the significance of tailored counseling and shared decision making in contraceptive management, particularly for cisgender women.
PubMed: 38848279
DOI: 10.1089/jwh.2023.0625 -
JAMA Health Forum Jun 2024Improving access to the choice of postpartum contraceptive methods is a national public health priority, and the need is particularly acute within the Medicaid...
IMPORTANCE
Improving access to the choice of postpartum contraceptive methods is a national public health priority, and the need is particularly acute within the Medicaid population. One strategy to ensure individuals have access to the full range of contraceptive methods is the provision of a method prior to hospital discharge following a birth episode. Beginning in 2016, some states changed their Medicaid billing policy, allowing separate reimbursement for intrauterine devices and contraceptive implants to increase the provision of long-acting reversible contraceptive (LARC) methods immediately postpartum (IPP).
OBJECTIVE
To assess the association of a change in Medicaid billing policy with use of IPP LARC.
DESIGN, SETTING, AND PARTICIPANTS
The cohort study of postpartum Medicaid recipients in 9 treatment and 6 comparison states was conducted from January 2016 to October 2019. Data were analyzed from August 2023 to January 2024.
MAIN OUTCOMES AND MEASURES
The primary outcome was use of IPP LARC.
RESULTS
The final sample included 1 378 885 delivery encounters for 1 197 287 Medicaid enrollees occurring in 15 states. Mean age of beneficiaries at delivery was 27 years. The IPP LARC billing policy was associated with a mean increase of 0.74 percentage points (95% CI, 0.30-1.18 percentage points) in the immediate receipt of IPP LARC, with a prepolicy baseline rate of 0.54%. The IPP LARC billing policy was also associated with an overall increase of 1.48 percentage points (95% CI, 0.43-2.73 percentage points) in LARC use by 60 days post partum.
CONCLUSIONS AND RELEVANCE
In this cohort study, changing Medicaid billing policy to allow for separate reimbursement of LARC devices from the global fee was associated with increased use of IPP LARC, suggesting that this may be a strategy to improve access to the full range of postpartum contraceptive methods.
Topics: Humans; Medicaid; Female; United States; Long-Acting Reversible Contraception; Adult; Postpartum Period; Cohort Studies; Health Policy; Young Adult
PubMed: 38848089
DOI: 10.1001/jamahealthforum.2024.1359