Browsing by Author "Neves, Djamila"
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- Association of acute COVID-19 severity and long COVID fatigue and quality of life: prospective cohort multicenter observational studyPublication . Pires, Ligia; Marreiros, Ana; Saraiva, Cátia; Reis, Cláudia; Neves, Djamila; Guerreiro, Cláudia; Tomé, José Boleo; Luz, Maria Inês; Pereira, Margarida Isabel; Barroso, Ana Sofia; Ferreira, Jorge; Gonzalez, Lucía Méndez; Moniri, Armin; Drummond, Marta; Berger-Estilita, JoanaLong COVID, or post-COVID-19 condition, is characterized by symptoms persisting beyond 12 weeks after severe acute respiratory syndrome coronavirus 2 infection, affecting individuals regardless of acute disease severity. Fatigue – often linked with depression and anxiety – is among its most debilitating manifestations. However, the associations between fatigue subtypes (physical vs mental), mental health symptoms, and acute disease severity on long-term health-related quality of life (HRQoL) remain unclear. This study examines the relationships between long COVID fatigue, depression, anxiety, acute disease severity, and HRQoL in a post-COVID-19 cohort. This prospective observational cohort study was conducted across 5 Portuguese hospitals between November 2020 and June 2022. Adults (≥18 years) with confirmed severe acute respiratory syndrome coronavirus 2 infection ≥6 months prior and fulfilling World Health Organization criteria for long COVID were included. Acute Coronavirus disease 2019 (COVID-19) severity was classified per World Health Organization definitions. The sampling strategy included patients across the severity spectrum. At 3 months postinfection (T1), patients received physician-led clinical assessments. At 6 months (T2), they attended in-person follow-up visits, completing standardized forms and validated questionnaires assessing post-acute sequelae. Fatigue was reported both binarily (yes/no) and via the chalder fatigue scale (11-item version). Anxiety and depression were assessed using the hospital anxiety and depression scale; post-traumatic stress disorder symptoms with the 14-item post-traumatic stress scale; and HRQoL with the EuroQol-5 dimensions. Descriptive statistics, analysis of variance, chi-square, and correlation analyses (Pearson’s or Spearman’s) were used to evaluate associations. Analyses were performed using SPSS (v27; IBM Corp., Amonk). Among 208 patients, fatigue was significantly associated with anxiety and depression (P < .001). Physical fatigue correlated more strongly with depression (r = 0.65, P < .001) and anxiety (r = 0.58, P < .001) than mental fatigue (r = 0.50 and R = 0.48, respectively; P < .001). Surprisingly, severe acute COVID-19 cases reported lower fatigue (CFQ: 13.3 ± 8.4) than mild (17.7 ± 7.2) or moderate (17.4 ± 8.0) cases (P < .005), and higher HRQoL (EuroQol visual analog scale: 74.3 ± 20.3, P = .002). Anxiety symptoms were more common in mild cases (P < .001); post-traumatic stress disorder symptoms did not differ by severity. Long COVID fatigue – especially physical – is strongly linked to depression and anxiety. Mild/moderate acute COVID-19 cases show greater fatigue and lower HRQoL than severe cases, highlighting the need for tailored long-term care regardless of initial severity.
- Mortality predictive factors in subjects with COPD after a pulmonary rehabilitation program: A 3-year studyPublication . Saraiva, Catia; Abreu, Tiago; Neves, Djamila; Rodrigues, FatimaBACKGROUND: COPD is a high-mortality disease and projected to become the third leading cause of death worldwide by 2030. Our aim was to evaluate predictors of 3-y mortality and factors associated with early (1 y) and late (second and third year) mortality in subjects with severe COPD who completed a pulmonary rehabilitation program. METHODS: A historical cohort study was performed with subjects with COPD who were admitted to a day-hospital for chronic respiratory failure for a pulmonary rehabilitation program, from January 2008 to December 2010. The population was characterized based on sociodemographic factors, body mass index, smoking habits, lung function tests, respiratory failure, comorbidities, bacterial colonization, Modified Medical Research Council dyspnea index, 6-min walk test, mechanical ventilation, noninvasive ventilation, long-term oxygen therapy, hospital admissions, and mortality. RESULTS: From 183 patients who completed a pulmonary rehabilitation program, 93 had COPD. Our cohort had 78 male and 15 female subjects. The mean age +/- SD was 68.6 +/- 8.9 y, ranging from 43 to 85 y. After the pulmonary rehabilitation program, there were fewer, although not statistically significantly different hospital admissions (2.1 vs 1.7, P =.17). Three years after the pulmonary rehabilitation program, 34 subjects died (36.6%). Hypercapnic respiratory failure (P = .02), noninvasive ventilation (P = .002), lung cancer (P = .001), shorter 6-min walk distance (P = .03), and higher number of previous hospital admissions (P <.001) were associated with a higher mortality rate. CONCLUSION: There is a high mortality rate in late-stage patients with COPD. The most relevant factors associated with mortality were lung cancer, respiratory failure and noninvasive ventilation, severe exacerbations with hospitalization, and lower functional exercise capacity.
- Ventilação não invasiva (VNI) no pré-hospitalar em tempos de covid-19.Publication . Marques, Tânia Sales; Neves, DjamilaNos últimos anos a ventilação mecânica não invasiva (VMNI) têm sido imprescindível no tratamento da insuficiência respiratória aguda (IRA),em particular no edema agudo do pulmão (EAP) e na doença pulmonar obstrutiva crónica (DPOC)2,3. Mais recentemente, estas técnicas têm ganho especial relevo no tratamento dos doentes com manifestações mais graves da infeção por SARS-COV-2. O recurso a este tipo de ventilação em contexto pré-hospitalar está a aumentar, levando a uma diminuição da taxa de intubação e a uma reduçãoda taxa de mortalidade3. Ao tratar a IRA os profissionais de saúde devem questionar-se sobre qual a forma de ventilação que irá proporcionar mais benefícios e, simultaneamente, menor risco para o doente. Não há dúvida de que a ventilação mecânica invasiva é frequentemente uma medida indispensável para salvar vidas, mas está também associada a riscos importantes de infeção e outras complicações que aumentam a mortalidade. A VMNI também acarreta riscos, sendo necessário saber quando e a quem instituir. Selecionar os dispositivos e interfaces, saber manipular e obter uma boa sincronia entre doente e ventilador são os principais aspetos para aumentar a eficácia terapêutica, maximizando o conforto e a estabilidade do doente.Para além disso, na Era atual da pandemia COVID-19, é imprescindível saber adaptar toda a prática clínica para garantir a segurança dos profissionais de saúde sem colocar em causa a saúde dos doentes. A VMNI é uma técnica que leva à dispersão de aerossóis, pelo que a sua instituição deverá ser reajustada para minimizar o risco 12,13.