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Mancilla-Galindo J, Kammar-García A, Mendoza-Gertrudis MDL, García Acosta JM, Nava Serrano YS, Santiago O, Torres Vásquez MB, Martínez Martínez D, Fernández-Urrutia LA, Robledo Pascual JC, Narváez Morales ID, Velasco-Medina AA, Mancilla-Ramírez J, Figueroa-Damián R, Galindo-Sevilla N. Regional moderate hyperthermia for mild-to-moderate COVID-19 (TherMoCoV study): a randomized controlled trial. Front Med (Lausanne) 2023; 10:1256197. [PMID: 38188344 PMCID: PMC10766786 DOI: 10.3389/fmed.2023.1256197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
BackgroundTo prevent COVID-19 progression, low-cost alternatives that are available to all patients are needed. Diverse forms of thermotherapy have been proposed to prevent progression to severe/critical COVID-19.ObjectiveThe aim of this study is to evaluate the efficacy and safety of local thermotherapy to prevent disease progression in hospitalized adult patients with mild-to-moderate COVID-19.MethodsA multicenter, open-label, parallel-group, randomized, adaptive trial is used to evaluate the efficacy and safety of local thermotherapy to prevent disease progression in hospitalized adult patients with mild-to-moderate COVID-19. Eligible hospitalized adult patients with symptoms of COVID-19 with ≤5 days from symptom onset, meeting criteria for mild or moderate COVID-19, were randomly assigned to the intervention consisting of local thermotherapy via an electric heat pad in the thorax (target temperature range 39.5–42°C) continuously for 90 min, twice daily, for 5 days, or standard care. The main outcome was the proportion of patients who progressed to severe-to-critical COVID-19 or death. Patients were randomized in a 1:1 ratio through a centralized computer-generated sequence of minimization with a random component of 20%. Participants and medical staff were not blinded to the intervention.ResultsOne-hundred and five participants (thermotherapy n = 54, control n = 51) with a median age of 53 (IQR: 41–64) years were included for analysis after the early cessation of recruitment due to the closure of all temporal COVID-19 units (target sample size = 274). The primary outcome of disease progression occurred in 31.4% (16/51) of patients in the control group vs. 25.9% (14/54) of those receiving thermotherapy (risk difference = 5.5%; 95%CI: −11.8–22.7, p = 0.54). Thermotherapy was well tolerated with a median total duration of thermotherapy of 900 (IQR: 877.5–900) min. Seven (13.7%) patients in the control group and seven (12.9%) in the thermotherapy group had at least one AE (p = 0.9), none of which were causally attributed to the intervention. No statistically significant differences in serum cytokines (IL-1β, IL-6, IL-8, IL-10, IL-17, and IFN-γ) were observed between day 5 and baseline among groups.ConclusionLocal thermotherapy was safe and well-tolerated. A non-statistically significant lower proportion of patients who experienced disease progression was found in the thermotherapy group compared to standard care. Local thermotherapy could be further studied as a strategy to prevent disease progression in ambulatory settings.Clinical Trial registration: www.clinicaltrials.gov, identifier: NCT04363541.
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Affiliation(s)
- Javier Mancilla-Galindo
- División de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ashuin Kammar-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
| | - María de Lourdes Mendoza-Gertrudis
- Servicio de Alergia e Inmunología Clínica, Hospital General de México, Mexico City, Mexico
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | | | - Yanira Saralee Nava Serrano
- Unidad Temporal COVID-19 Autónomo Hermanos Rodríguez, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Oscar Santiago
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Miriam Berenice Torres Vásquez
- División de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Daniela Martínez Martínez
- División de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Liliana Aline Fernández-Urrutia
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Mexico City, Mexico
- St. Luke Medical School of Alliant International University, Mexico City, Mexico
| | | | | | - Andrea Aida Velasco-Medina
- Servicio de Alergia e Inmunología Clínica, Hospital General de México, Mexico City, Mexico
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Javier Mancilla-Ramírez
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
- Hospital de la Mujer, Secretaría de Salud, Mexico City, Mexico
| | - Ricardo Figueroa-Damián
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Norma Galindo-Sevilla
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Mexico City, Mexico
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Pérez-Padilla R. Letter from Mexico: A 2023 post-COVID update. Respirology 2023; 28:1084-1085. [PMID: 37593966 DOI: 10.1111/resp.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023]
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Núñez I, Gillard J, Fragoso-Saavedra S, Feyaerts D, Islas-Weinstein L, Gallegos-Guzmán AA, Valente-García U, Meyerowitz J, Kelly JD, Chen H, Ganio E, Benkendorff A, Flores-Gouyonnet J, Dammann-Beltrán P, Heredia-González JF, Rangel-Gutiérrez GA, Blish CA, Nadeau KC, Nolan G, Crispín JC, McIlwain DR, Gaudillière B, Valdés-Ferrer SI. Longitudinal clinical phenotyping of post COVID condition in Mexican adults recovering from severe COVID-19: a prospective cohort study. Front Med (Lausanne) 2023; 10:1236702. [PMID: 37727759 PMCID: PMC10505811 DOI: 10.3389/fmed.2023.1236702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction Few studies have evaluated the presence of Post COVID-19 conditions (PCC) in people from Latin America, a region that has been heavily afflicted by the COVID-19 pandemic. In this study, we describe the frequency, co-occurrence, predictors, and duration of 23 symptoms in a cohort of Mexican patients with PCC. Methods We prospectively enrolled and followed adult patients hospitalized for severe COVID-19 at a tertiary care centre in Mexico City. The incidence of PCC symptoms was determined using questionnaires. Unsupervised clustering of PCC symptom co-occurrence and Kaplan-Meier analyses of symptom persistence were performed. The effect of baseline clinical characteristics was evaluated using Cox regression models and reported with hazard ratios (HR). Results We found that amongst 192 patients with PCC, respiratory problems were the most prevalent and commonly co-occurred with functional activity impairment. 56% had ≥5 persistent symptoms. Symptom persistence probability at 360 days 0.78. Prior SARS-CoV-2 vaccination and infection during the Delta variant wave were associated with a shorter duration of PCC. Male sex was associated with a shorter duration of functional activity impairment and respiratory symptoms. Hypertension and diabetes were associated with a longer duration of functional impairment. Previous vaccination accelerated PCC recovery. Discussion In our cohort, PCC symptoms were frequent (particularly respiratory and neurocognitive ones) and persistent. Importantly, prior SARS-CoV-2 vaccination resulted in a shorter duration of PCC.
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Affiliation(s)
- Isaac Núñez
- Department of Medical Education, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Division of Postrgraduate Studies, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Joshua Gillard
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
- Center for Molecular and Biomolecular Informatics, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Sergio Fragoso-Saavedra
- Department of Medical Education, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Division of Postrgraduate Studies, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Combined Study Plan in Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Dorien Feyaerts
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - León Islas-Weinstein
- Department of Neurology & Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Angel A. Gallegos-Guzmán
- Department of Neurology & Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Uriel Valente-García
- Department of Neurology & Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Justin Meyerowitz
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - J. Daniel Kelly
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, United States
- Institute for Global Health Sciences, UCSF, San Francisco, CA, United States
- F.IProctor Foundation, UCSF, San Francisco, CA, United States
| | - Han Chen
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Edward Ganio
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexander Benkendorff
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jaime Flores-Gouyonnet
- Department of Neurology & Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Pedro Dammann-Beltrán
- Department of Neurology & Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Gabriela A. Rangel-Gutiérrez
- Combined Study Plan in Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Catherine A. Blish
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, United States
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
- Chan Zuckerberg Biohub, San Francisco, CA, United States
- Division of Infectious Diseases, Stanford University, Stanford, CA, United States
| | - Kari C. Nadeau
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, United States
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA, United States
- Institute for Immunity, Transplantation, and Infectious Diseases, Stanford University, Stanford, CA, United States
| | - Garry Nolan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Jose C. Crispín
- School of Medicine and Health Sciencies, Tecnologico de Monterrey, Mexico City, Mexico
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - David R. McIlwain
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Brice Gaudillière
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Sergio I. Valdés-Ferrer
- Department of Neurology & Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Center for Biomedical Science, Feinstein Institutes for Medical Research, New York, NY, United States
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Shapiro I, Stein J, MacRae C, O'Reilly M. Pulse oximetry values from 33,080 participants in the Apple Heart & Movement Study. NPJ Digit Med 2023; 6:134. [PMID: 37500721 PMCID: PMC10374661 DOI: 10.1038/s41746-023-00851-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 05/24/2023] [Indexed: 07/29/2023] Open
Abstract
Wearable devices that include pulse oximetry (SpO2) sensing afford the opportunity to capture oxygen saturation measurements from large cohorts under naturalistic conditions. We report here a cross-sectional analysis of 72 million SpO2 values collected from 33,080 individual participants in the Apple Heart and Movement Study, stratified by age, sex, body mass index (BMI), home altitude, and other demographic variables. Measurements aggregated by hour of day into 24-h SpO2 profiles exhibit similar circadian patterns for all demographic groups, being approximately sinusoidal with nadir near midnight local time, zenith near noon local time, and mean 0.8% lower saturation during overnight hours. Using SpO2 measurements averaged for each subject into mean nocturnal and daytime SpO2 values, we employ multivariate ordinary least squares regression to quantify population-level trends according to demographic factors. For the full cohort, regression coefficients obtained from models fit to daytime SpO2 are in close quantitative agreement with the corresponding values from published reference models for awake arterial oxygen saturation measured under controlled laboratory conditions. Regression models stratified by sex reveal significantly different age- and BMI-dependent SpO2 trends for females compared with males, although constant terms and regression coefficients for altitude do not differ between sexes. Incorporating categorical variables encoding self-reported race/ethnicity into the full-cohort regression models identifies small but statistically significant differences in daytime SpO2 (largest coefficient corresponding to 0.13% lower SpO2, for Hispanic study participants compared to White participants), but no significant differences between groups for nocturnal SpO2. Additional stratified analysis comparing regression models fit independently to subjects in each race/ethnicity group is suggestive of small differences in age- and sex-dependent trends, but indicates no significant difference in constant terms between any race/ethnicity groups for either daytime or nocturnal SpO2. The large diverse study population and study design employing automated background SpO2 measurements spanning the full 24-h circadian cycle enables the establishment of healthy population reference trends outside of clinical settings.
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Affiliation(s)
| | | | - Calum MacRae
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Madrid-Mejía W, Gochicoa-Rangel L, Padilla JRP, Salles-Rojas A, González-Molina A, Salas-Escamilla I, Durán-Cuellar A, Silva-Cerón M, Guzmán-Valderrábano C, Lozano-Martínez L. Improvement in Walking Distance Lags Raise in Lung Function in Post-COVID Patients. Arch Bronconeumol 2021; 58:261-263. [PMID: 34054195 PMCID: PMC8150358 DOI: 10.1016/j.arbres.2021.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022]
Key Words
- 6-MWD, 6-minute walk distance
- 6-MWT, 6-minute walk test
- COVID-19, coronavirus disease-2019
- DLCO, diffusing lung capacity for carbon monoxide
- FEV1, forced expiratory volume in the first second
- FT, pulmonary function tests
- FVC, forced vital capacity
- HHR, heart rate recovery
- IMV, invasive mechanical ventilation
- LLN, lower limit of normal
- MEP, maximal expiratory pressure
- MERS, Middle East respiratory syndrome
- MIP, maximal inspiratory pressure
- SARS, severe acute respiratory syndrome
- SpO2, oxygen blood saturation measured by pulse oximeter
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Affiliation(s)
- Wilmer Madrid-Mejía
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - José Rogelio Pérez Padilla
- COPD and Tobacco Research Department. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Antonio Salles-Rojas
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Amaury González-Molina
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Isabel Salas-Escamilla
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Adela Durán-Cuellar
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Mónica Silva-Cerón
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Carlos Guzmán-Valderrábano
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Luis Lozano-Martínez
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
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Fernández-Plata R, Thirion-Romero I, Nava-Quiroz KJ, Pérez-Rubio G, Rodríguez-Llamazares S, Pérez-Kawabe M, Rodríguez-Reyes Y, Guerrero-Zuñiga S, Orea-Tejeda A, Falfán-Valencia R, Pérez-Padilla R, On Behalf Of The Mexican Translational Research Hypoxemia Working Group. Clinical Markers of Chronic Hypoxemia in Respiratory Patients Residing at Moderate Altitude. Life (Basel) 2021; 11:428. [PMID: 34068590 DOI: 10.3390/life11050428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/12/2022] Open
Abstract
Supplemental oxygen (SO) increases survival in hypoxemic patients. In hypoxia, mammals respond by modulating O2-sensitive transducers that stabilize the transcription factor hypoxia-inducible factor-1-alpha (HIF-1α), which transactivates the genes that govern angiogenesis and metabolic pathways. Residing at high altitudes exposes millions of people to hypoxemia with potential adverse consequences on their health. We aimed to identify markers of hypoxemia that can be used in the evaluation of patients in addition to pulse oximetry and arterial blood gases, especially those that could respond after 1 month of oxygen use. We performed a prospective pilot study at 2240 m above sea level, with repeated measurements before and after (b/a) 1-month home oxygen therapy in 70 patients with lung diseases, of which 24/20 have COPD, 41/39 obstructive sleep apnea (OSA), and 5/2 with interstitial lung diseases (ILD), all of them having chronic hypoxemia, as well as 70 healthy subjects as controls. Proteins evaluated included HIF-1α, vascular endothelial growth factor (VEGF), and erythropoietin (EPO). Among the main results, we found that hypoxemic patients had normal levels of HIF-1α but increased EPO compared with healthy controls. VEGF levels were heterogeneous in the sample studied, similar to the control group in COPD, slightly increased in OSA, and decreased in fibrosis. With oxygen treatment, the HIF-1α and EPO decreased in COPD and OSA but not in fibrosis, and VEGF remained constant over time. In conclusion, erythropoietin and HIF-1α identified hypoxemia initially and responded to oxygen. In pulmonary fibrosis, HIF-1α, EPO, and VEGF increased with oxygen therapy, which is likely linked to the disease's pathogenesis and clinical course rather than hypoxemia.
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Bok T, Hysi E, Kolios MC. In vivo photoacoustic assessment of the oxygen saturation changes in the human radial artery: a preliminary study associated with age. J Biomed Opt 2021; 26:JBO-200377R. [PMID: 33754541 PMCID: PMC7984962 DOI: 10.1117/1.jbo.26.3.036006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/02/2021] [Indexed: 05/08/2023]
Abstract
SIGNIFICANCE We demonstrate the potential of probing the sO2 change under blood flow in vivo using photoacoustic (PA) imaging and sheds light on the complex relationship between RBC aggregation and oxygen delivery. AIM To conduct in vivo assessments of the sO2 in the radial artery of healthy volunteers and simultaneously probe the relation between the sO2 and hemodynamic behavior such as red blood cell (RBC) aggregation. APPROACH The effects of PA-based measurements of blood hemodynamics were studied as a function of the subjects' age (20s, 30s, and 40s). The pulsatile blood flow in the human radial artery of 12 healthy subjects was imaged in the 700 to 900 nm optical wavelength range using a linear array-based PA system. RESULTS The PA power when blood velocity is minimum (Pamax) was larger than the one attained at maximum blood velocity (Pamin), consistent with predictions based on the cyclical variation of RBC aggregation during pulsatile flow. The difference between Pamin and Pamax at 800 nm (ΔPa800) increased with age (1.7, 2.2, and 2.6 dB for age group of 20s, 30s, and 40s, respectively). The sO2 computed from Pamax was larger than the one from Pamin. CONCLUSIONS The ΔPa800 increased with participant age. The ΔPa800 metric could be a surrogate of noninvasively monitoring the age-induced changes in RBC aggregation. The sO2 change during a cycle of pulsatile blood flow also increased with age, demonstrating that RBC aggregation can affect the sO2 change.
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Affiliation(s)
- Taehoon Bok
- Ryerson University, Faculty of Science, Department of Physics, Toronto, Canada
- Institute for Biomedical Engineering, Science and Technology, Toronto, Canada
- St. Michael’s Hospital, Keenan Research Centre for Biomedical Science, Division of Nephrology, Toronto, Canada
| | - Eno Hysi
- St. Michael’s Hospital, Keenan Research Centre for Biomedical Science, Division of Nephrology, Toronto, Canada
| | - Michael C. Kolios
- Ryerson University, Faculty of Science, Department of Physics, Toronto, Canada
- Institute for Biomedical Engineering, Science and Technology, Toronto, Canada
- St. Michael’s Hospital, Keenan Research Centre for Biomedical Science, Division of Nephrology, Toronto, Canada
- Address all correspondence to Michael C. Kolios,
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Arima H, Nakano M, Koirala S, Ito H, Pandey BD, Pandey K, Wada T, Yamamoto T. Unique hemoglobin dynamics in female Tibetan highlanders. Trop Med Health 2021; 49:2. [PMID: 33397517 PMCID: PMC7780399 DOI: 10.1186/s41182-020-00289-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tibetan highlanders have adapted to hypoxic environments through the development of unique mechanisms that suppress an increase in hemoglobin (Hb) concentration even in high-altitude areas. Hb concentrations generally decrease with increasing age. However, in the highlands, chronic altitude sickness is known to occur in the elderly population. To investigate how aging in a hypoxic environment affects Hb levels in Tibetan highlanders, we focused on the Mustang people, who live above 3500 m. We tried to clarify the pure relationship between aging and Hb levels in a hypoxic environment. RESULTS We found that the Hb concentration increased with increasing age in females but not in males. Multivariate analysis showed that age, pulse pressure, the poverty index, and vascular diameter were strongly correlated with the Hb concentration. CONCLUSIONS We found unique Hb dynamics among female Tibetan highlanders. As seen in these Hb dynamics, there may be sex-based differences in the adaptive mechanism in Tibetan highlanders.
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Affiliation(s)
- Hiroaki Arima
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masayuki Nakano
- Department of Nutrition, Faculty of Health Sciences, Kochi Gakuen University, Kochi, Japan
| | | | - Hiromu Ito
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Basu Dev Pandey
- Everest International Clinic and Research Center, Kathmandu, Nepal.,Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal
| | - Kishor Pandey
- Everest International Clinic and Research Center, Kathmandu, Nepal.,Nepal Academy of Science and Technology, Lalitpur, Nepal
| | - Takayuki Wada
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Graduate School of Human Life Science, Osaka City University, Osaka, Japan
| | - Taro Yamamoto
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan. .,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan. .,Leading Program, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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Acero Colmenares R, Lombo Moreno CE. SaO 2 as a predictor of exercise-induced hypoxemia in chronic obstructive pulmonary disease at moderate altitude. Int J Chron Obstruct Pulmon Dis 2019; 14:1951-1958. [PMID: 31695353 PMCID: PMC6718247 DOI: 10.2147/copd.s207467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/22/2019] [Indexed: 11/29/2022] Open
Abstract
Background Given the high prevalence of chronic obstructive pulmonary disease (COPD) in Bogota (2630 m above the sea), screening methods are required for COPD patients who develop exercise-induced hypoxemia (EIH). Objective The objective was to measure the productive capacity of basal oxygen saturation for the detection of EIH during the 6-min walking test (6MWT) in patients diagnosed with COPD in a hospital in Bogotá. Design This was a cross-sectional, retrospective study. Population Patients diagnosed with COPD with SaO2≥88% who attended the Pneumology Section of the FSFB for a 6MWT between 2013 and 2017 were included in the study. Measurements Age, sex, anthropometric data, SaO2, SaO2 during 6MWT, and spirometry were evaluated. Results Ninety-two patients with EIH and 32 patients without EIH were studied. Statistically significant differences were found in SaO2, minimum SaO2 during 6MWT, and BMI (90.8% vs 93%, 80.3% vs 88.9%, and 26.7 kg/m2 vs 23.8 kg/m2, respectively). FEV1 was without statistically significant differences (74.1% vs 78.6%). The ROC curve showed a better cut-off point for detecting EIH with basal SaO2≤92% (sensitivity 76.1%, specificity 62.5%, NPV 47.6%, and PPV 85.4%) and SaO2≤94% as the best sensitivity point (sensitivity 94.6%, specificity 15.6%, NPV 76.3%, and PPV 50%). Conclusion SaO2 is not a good screening test for EIH in COPD patients at moderate altitude.
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Abstract
The PLATINO and PREPOCOL population-based studies documented the prevalence of chronic obstructive pulmonary disease (COPD) in several Latin American (Mexico City, Sao Paulo, Montevideo, Santiago and Caracas) and Colombian (Medellin, Bogota, Barranquilla, Bucaramanga and Cali) cities. COPD ranged between 6.2 and 19.6% in individuals ≥40 years of age, with substantial rates of underdiagnosis (up to 89%) but also overdiagnosis, mostly due to the lack of spirometric confirmation. The main risk factor was tobacco smoking, but male gender and age were also associated with COPD. COPD in never smokers represented about one third of the cases and was associated with previous history of tuberculosis or a diagnosis of asthma. COPD associated with biomass smoke exposure was a common clinical phenotype in Latin America, found as a risk factor in PREPOCOL and other observational studies in the region. Smoking has been decreasing in Latin America and efforts have been made to implement cleaner biomass stoves. Unfortunately, treatment of COPD in Latin America remains highly variable with low rates of smoking cessation counselling, low use of inhaled bronchodilators and influenza vaccination. A primary-care approach to COPD, particularly in the form of integrated programs is lacking but would be critical to improving rates of diagnosis and treatment of COPD.
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Montero D, Diaz-Cañestro C, Flammer A, Lundby C. Unexplained Anemia in the Elderly: Potential Role of Arterial Stiffness. Front Physiol 2016; 7:485. [PMID: 27826252 PMCID: PMC5078728 DOI: 10.3389/fphys.2016.00485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 12/02/2022] Open
Affiliation(s)
- David Montero
- Department of Cardiology, University Heart Center, University Hospital Zurich Zurich, Switzerland
| | | | - Andreas Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich Zurich, Switzerland
| | - Carsten Lundby
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich Zurich, Switzerland
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Feng B, Xu WH, Gao YQ, Liu FY, Li P, Zheng SJ, Gai LY, Zhang G. Intermittent Oxygen Inhalation with Proper Frequency Improves Overall Health Conditions and Alleviates Symptoms in a Population at High Risk of Chronic Mountain Sickness with Severe Symptoms. Chin Med J (Engl) 2016; 129:1322-9. [PMID: 27231170 PMCID: PMC4894043 DOI: 10.4103/0366-6999.182831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Oxygen inhalation therapy is essential for the treatment of patients with chronic mountain sickness (CMS), but the efficacy of oxygen inhalation for populations at high risk of CMS remains unknown. This research investigated whether oxygen inhalation therapy benefits populations at high risk of CMS. Methods: A total of 296 local residents living at an altitude of 3658 m were included; of which these were 25 diagnosed cases of CMS, 8 cases dropped out of the study, and 263 cases were included in the analysis. The subjects were divided into high-risk (180 ≤ hemoglobin (Hb) <210 g/L, n = 161) and low-risk (Hb <180 g/L, n = 102) groups, and the cases in each group were divided into severe symptom (CMS score ≥6) and mild symptom (CMS score 0-5) subgroups. Severe symptomatic population of either high- or low-risk CMS was randomly assigned to no oxygen intake group (A group) or oxygen intake 7 times/week group (D group); mild symptomatic population of either high- or low-risk CMS was randomly assigned to no oxygen intake group (A group), oxygen intake 2 times/week group (B group), and 4 times/week group (C group). The courses for oxygen intake were all 30 days. The CMS symptoms, sleep quality, physiological biomarkers, biochemical markers, etc., were recorded on the day before oxygen intake, on the 15th and 30th days of oxygen intake, and on the 15th day after terminating oxygen intake therapy. Results: A total of 263 residents were finally included in the analysis. Among these high-altitude residents, CMS symptom scores decreased for oxygen inhalation methods B, C, and D at 15 and 30 days after oxygen intake and 15 days after termination, including dyspnea, palpitation, and headache index, compared to those before oxygen intake (B group: Z = 5.604, 5.092, 5.741; C group: Z = 4.155, 4.068, 4.809; D group: Z = 6.021, 6.196, 5.331, at the 3 time points respectively; all P < 0.05/3 vs. before intake). However, dyspnea/palpitation (A group: Z = 5.003, 5.428, 5.493, both P < 0.05/3 vs. before intake) and headache (A group: Z = 4.263, 3.890, 4.040, both P < 0.05/3 vs. before intake) index decreased significantly also for oxygen inhalation method A at all the 3 time points. Cyanosis index decreased significantly 30 days after oxygen intake only in the group of participants administered the D method (Z = 2.701, P = 0.007). Tinnitus index decreased significantly in group A and D at 15 days (A group: Z = 3.377, P = 0.001, D group: Z = 3.150, P = 0.002), 30 days after oxygen intake (A group: Z = 2.836, P = 0.005, D group: Z = 5.963, P < 0.0001) and 15 days after termination (A group: Z = 2.734, P = 0.006, D group: Z = 4.049, P = 0.0001), and decreased significantly in the group B and C at 15 days after termination (B group: Z = 2.611, P = 0.009; C group: Z = 3.302, P = 0.001). In the population at high risk of CMS with severe symptoms, oxygen intake 7 times/week significantly improved total symptom scores of severe symptoms at 15 days (4 [2, 5] vs. 5.5 [4, 7], Z = 2.890, P = 0.005) and 30 days (3 [1, 5] vs. 5.5 [2, 7], Z = 3.270, P = 0.001) after oxygen intake compared to no oxygen intake. In the population at high risk of CMS with mild symptoms, compared to no oxygen intake, oxygen intake 2 or 4 times/week did not improve the total symptom scores at 15 days (2 [1, 3], 3 [1, 4] vs. 3 [1.5, 5]; χ2= 2.490, P = 0.288), and at 30 days (2 [0, 4], 2 [1, 4.5] vs. 3 [2, 5]; χ2= 3.730, P = 0.155) after oxygen intake. In the population at low risk of CMS, oxygen intake did not significantly change the white cell count and red cell count compared to no oxygen intake, neither in the severe symptomatic population nor in the mild symptomatic population. Conclusions: Intermittent oxygen inhalation with proper frequency might alleviate symptoms in residents at high altitude by improving their overall health conditions. Administration of oxygen inhalation therapy 2–4 times/week might not benefit populations at high risk of CMS with mild CMS symptoms while administration of therapy 7 times/week might benefit those with severe symptoms. Oxygen inhalation therapy is not recommended for low-risk CMS populations.
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Affiliation(s)
- Bin Feng
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Wei-Hao Xu
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yu-Qi Gao
- Department of High Altitude Military Hygiene, College of High Altitude Military Medicine, Third Military Medical University, Chongqing 400030, China
| | - Fu-Yu Liu
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Third Military Medical University, Chongqing 400030, China
| | - Peng Li
- Department of High Altitude Military Hygiene, College of High Altitude Military Medicine, Third Military Medical University, Chongqing 400030, China
| | - Shan-Jun Zheng
- Department of High Altitude Military Hygiene, College of High Altitude Military Medicine, Third Military Medical University, Chongqing 400030, China
| | - Lu-Yue Gai
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Gang Zhang
- Department of High Altitude Military Hygiene, College of High Altitude Military Medicine, Third Military Medical University, Chongqing 400030, China
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Affiliation(s)
| | - Rafael Stelmach
- Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | - Alvaro Augusto Cruz
- Center of Excellence in Asthma, Federal University of Bahia, Salvador, Brazil
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Laniado-Laborin R, Rendón A, Batiz F, Alcantar-Schramm JM, Bauerle O. High altitude and chronic obstructive pulmonary disease prevalence: a casual or causal correlation? Arch Bronconeumol 2012; 48:156-60. [PMID: 22341912 DOI: 10.1016/j.arbres.2011.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 12/01/2011] [Accepted: 12/11/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Studies on the relationship of chronic obstructive pulmonary disease (COPD) prevalence and altitude have reported contrasting results. The aim of this COPD case-finding study was to include a larger number of geographical sites to determine if there is an association between altitude and COPD prevalence. PATIENTS AND METHODS Individuals aged 40 or older with known COPD risk factors, whether symptomatic or not, were referred by primary-care physicians. After obtaining written informed consent, they were invited to answer a questionnaire and undergo pre- and post-bronchodilator spirometry. RESULTS Subjects were recruited in 27 Mexican cities, within an altitude range from 1 to 2,680 m above sea level. We found a weak (-0.31; P<.0001) although significant negative correlation between altitude and COPD prevalence. The COPD rate for cities located ≤1,000 m was 32.7% vs 16.4% for cities located >1,000 m (P<.0001); the rate for cities located at ≤2,000 m was 22.7% vs 15.6% for those >2,000 m; in the multiple logistic regression analysis, older age, male sex, tobacco habit, pack-years of smoking, years of exposure to biomass smoke and city altitude over sea level were significantly associated with COPD prevalence. CONCLUSIONS Our data shows a significant inverse correlation between prevalence/severity of COPD and altitude.
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Affiliation(s)
- Rafael Laniado-Laborin
- Facultad de Medicina, Universidad Autónoma de Baja California, Tijuana, Baja California, México.
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de León AC, Pérez MDCR, González DA, Díaz BB, Coello SD, Hernández AG, Aguirre-Jaime A. Hemodynamics and metabolism at low versus moderate altitudes. High Alt Med Biol 2012; 12:179-86. [PMID: 21718166 DOI: 10.1089/ham.2010.1078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite the higher prevalence of diabetes and hypertension in populations residing at moderate altitudes, mortality in these populations is lower than in populations residing at low altitudes. To examine whether metabolic and hemodynamic differences can explain this apparent paradox, we performed a cross-sectional study of a general population sample recruited in the Canary Islands, Spain (n=6729). We recorded altitude of residence, age, heart rate, blood pressure, body mass index, social class, physical activity, energy intake, alcohol intake, smoking habit, prevalence of type 2 diabetes mellitus and hypertension. In a subsample (n=903), we recorded serum concentration of cholesterol, triglycerides, glucose, C peptide, leptin, soluble leptin receptor (sObR), C-reactive protein, resistin, soluble CD40 ligand (sCD40L), and paraoxonase activity (PON), and we estimated insulin resistance and free leptin index. We found an inverse association between altitude and heart rate (p<0.001), leptin (p<0.001), free leptin index (p<0.001), resistin (p<0.001), and sCD40L (p<0.05) and a direct association between altitude and hypertension (odds ratio=1.29 for altitude >600 m; 95% confidence interval=1.03-1.62), glycemia (p<0.05), C peptide (p<0.001), insulin resistance (p<0.001), sObR (p<0.05), and PON (p<0.05). When social class was included in the multivariate model, the association with PON was no longer significant. In conclusion, individuals residing at moderate altitudes have a lower heart rate and lower serum concentration of total leptin, free leptin, and sCD40L. These differences may partially explain the lower mortality in these populations.
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Affiliation(s)
- Antonio Cabrera de León
- Unidad de Investigación del Hospital Universitario, Nuestra Señora de Candelaria y de Atención Primaria, Tenerife, Spain.
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Pérez-Padilla R, Vargas-Domínguez C, Torre-Bouscoulet L. [Scientific studies are required to validate the indications for long-term oxygen therapy at high altitudes]. Arch Bronconeumol 2011; 47:613-4. [PMID: 22075402 DOI: 10.1016/j.arbres.2011.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 08/31/2011] [Indexed: 10/15/2022]
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