The effect of a high-intensity interval training program on combat soldiers fitness

Running helps maintain aerobic and anaerobic fitness and normal body weight in combat fighters. However, alternative training methods are necessary to maintain combat fitness when conditions do not allow running, be it service-related or, recently, coronavirus 2019 (COVID-19) pandemic-related limitations. This prospective interventional, unblinded, nonrandomized controlled study aimed to evaluate the effectiveness of a high-intensity interval training program that excluded prolonged running in maintaining physical fitness and bodyweight. The study included 60 compulsory service male soldiers, aged 20.45 ± 0.48 years, divided into equal matched intervention and control groups. The three weekly workouts in the control group comprised 5–8 km running. The intervention group underwent three weekly workouts that included agility and strength training at short, intense intervals with brief recovery times between sets. The groups were compared before and after six weeks of training. At the start and end of the six-week program, the groups were similar at a significance level of P < 0.05 for bodyweight, body fat and muscle percent, background characteristics, Army Fitness Test (3-km running, pull-ups, squats, dips), agility, and maximal oxygen consumption. Our findings showed that the intervention training program was as effective as the standard running program in maintaining the participants aerobic and anaerobic fitness and normal bodyweight. The suggested high-intensity interval training program could be a viable fitness strategy when running is not possible in combat soldiers and civilians alike. (English) [ FROM AUTHOR]

Characterization of Inhaled Nitric Oxide (iNO) for the treatment of Viral Community Acquired Pneumonia (CAP)

Background. Nitric Oxide (NO) has been previously demonstrated to have antimicrobial, anti-inflammatory, and vasodilator properties. Extensive work has been done in the clinical setting to explore these properties with iNO administered intermittently at high concentrations of 150-250 ppm. While viral CAP has gained major attention with the emergence of COVID-19, treatment methods remain limited and are challenging to develop. The purpose of this study is to assess iNO treatment administered to hospitalized adults with viral CAP. Methods. This is a randomized, open label multi-center ongoing study. Study population includes subjects aged 18-80, hospitalized for vCAP including COVID-19. Following enrollment, subjects were randomized 1:1 to either iNO [150ppm for 40 minutes, 4 times daily, up to 7 days in addition to standard supportive treatment (SST)], or control [SST alone]. iNO was delivered by LungFitTM, an innovative NO generator under development (Beyond Air, NY, USA). Follow up period is 180 days. Study endpoints include safety and the time to reach a stable saturation of >=93%. In addition, different other clinical parameters are collected to profile the effect of iNO in this population. Results. Analyzing the Intent To Treat (ITT) population (n=35, [16 iNO and 19 control]), safety profile of iNO treatment observed so far, was found to be favorable with no treatment related Adverse Events (AEs). Faster clinical improvement was noted in the iNO treatment group, paralleling CRP improvement between baseline to end of treatment (mean 2.7 mg/dl comparing treatment group [n=8] to control group [n=7], data not final). Conclusion. These data suggest that intermittent treatment with 150ppm iNO is safe and well tolerated and may contribute to faster clinical improvement in viral CAP. Different laboratory parameters may shed some light and help to characterize this observed effect, supporting the further exploration of iNO for the treatment of viral lower respiratory tract infection, including COVID-19.

The effect of a high-intensity interval training program on combat soldiers fitness

Summary Introduction Running helps maintain aerobic and anaerobic fitness and normal body weight in combat fighters. However, alternative training methods are necessary to maintain combat fitness when conditions do not allow running, be it service-related or, recently, coronavirus 2019 (COVID-19) pandemic-related limitations. This prospective interventional, unblinded, nonrandomized controlled study aimed to evaluate the effectiveness of a high-intensity interval training program that excluded prolonged running in maintaining physical fitness and bodyweight. Summary of facts and results The study included 60 compulsory service male soldiers, aged 20.45±0.48 years, divided into equal matched intervention and control groups. The three weekly workouts in the control group comprised 5–8km running. The intervention group underwent three weekly workouts that included agility and strength training at short, intense intervals with brief recovery times between sets. The groups were compared before and after six weeks of training. At the start and end of the six-week program, the groups were similar at a significance level of P<0.05 for bodyweight, body fat and muscle percent, background characteristics, Army Fitness Test (3-km running, pull-ups, squats, dips), agility, and maximal oxygen consumption. Conclusion Our findings showed that the intervention training program was as effective as the standard running program in maintaining the participants aerobic and anaerobic fitness and normal bodyweight. The suggested high-intensity interval training program could be a viable fitness strategy when running is not possible in combat soldiers and civilians alike. Résumé Introduction La course à pied aide à maintenir la forme aérobie et anaérobie et un poids corporel normal chez les combattants. Cependant, des méthodes d’entraînement alternatives sont nécessaires pour maintenir l’aptitude au combat lorsque les conditions ne permettent pas de courir, que ce soit des limitations liées au service ou, récemment, liées à la pandémie de coronavirus 2019 (COVID-19). Cette étude prospective interventionnelle, sans insu et non randomisée visait à évaluer l’efficacité d’un programme d’entraînement par intervalles à haute intensité qui exclurait la course prolongée pour maintenir la forme physique et le poids corporel. Résumé des faits et des résultats L’étude a été portée sur 60 soldats (Homme) en service obligatoire, âgés de 20,45±0,48 ans, répartis en groupes recherche et de contrôle appariés égaux. Les trois entraînements hebdomadaires du groupe témoin comprenaient 5 à 8km de course. Le groupe recherche a également subi trois séances d’entraînement hebdomadaires comprenant de l’agilité et de la musculation à intervalles courts et intenses avec de brefs temps de récupération entre les séries. Les groupes ont été comparés avant et après six semaines d’entraînement. Au début et à la fin du programme de six semaines, les groupes étaient similaires à un niveau de signification de p<0,05 pour le poids corporel, le pourcentage de graisse corporelle et de muscle, les caractéristiques de base, le test de condition physique de l’armée (course de 3km, tractions, squats, dips), agilité et consommation maximale d’oxygène. Conclusion Nos résultats ont montré que le programme d’entraînement utilisé était aussi efficace que le programme de course standard pour maintenir la forme aérobie et anaérobie des participants et un poids corporel normal. Le programme d’entraînement par intervalles à haute intensité suggéré pourrait être une stratégie de remise en forme viable lorsque la course n’est pas possible chez les soldats de combat et les civils.

IMPROVING INFLUENZA VACCINATION IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: A QUALITY IMPROVEMENT INITIATIVE

Background: Vaccination rates remain low among patients with inflammatory bowel disease (IBD) despite guideline recommendations and evidence-based publications. Reported barriers include perceived lack of benefit, fear of side effects, and inconvenience. At our IBD center we follow approximately 1700 patients. During the 2019-2020 influenza season, our vaccination rate for the entire IBD population was 40.3% and 45.5% for those receiving biologic therapies at our infusion center (n=772). We developed a quality improvement initiative to evaluate vaccination practices and to determine effective strategies to increase vaccine uptake. As a first-step, we targeted our most vulnerable and accessible population: patients receiving biologic infusions. Methods: Our initiative began in August 2020. Plan-do-study-act cycles included creation of a multi-disciplinary team to review vaccination barriers and distribution of a survey to caregivers or IBD patients >=18 years to explore vaccination decision making process, awareness of recommendations, and impact of vaccine availability in the infusion center on uptake. The next phase was optimizing access among patients receiving biologic therapies at our infusion center. The strategies we implemented included educational sessions with the division providers and infusion center nurses, creation of an Epic EMR order set, active phone screening of our population prior to infusion visits, at which point unvaccinated patients were offered the vaccine during the appointment. Chi squared analysis compared survey responses between caregivers and patients. Two proportion sample test identified differences in vaccination rates between the two influenza seasons. Results: The survey was answered by 14.4% (n=269 caregivers and n=60 patients), with 71.3% on either anti-TNF alpha (infliximab, adalimumab) or vedolizumab. Of respondents, 13.4% were unvaccinated in 2019-2020. Top reasons for non-vaccination included “unsure of safety” (31.8%), “unsure of benefit” (29.5%), and “forgot to schedule” (13.6%). Patients and caregivers had similar vaccine impressions, with no statistically significant differences (Figure 1). For the 2020-2021 season, 88.75% plan to get vaccinated and 51.7% expressed interest in receiving the vaccine during their infusion appointment. Since implementing our initiative, the vaccination rate has already increased to 59.2% compared to 45.5% (p=0.001). Conclusions: Our initiative increased vaccination rates in patients receiving biologic infusions by 13.7% thus far. Particularly during the COVID-19 pandemic, the influenza vaccine is essential to protect this vulnerable population and decrease the burden on the healthcare system. We have identified pre-screening prior to appointments and providing access in conjunction to scheduled appointments as the most effective strategies to optimize vaccination uptake.(figure presented)

Update on regional stroke activation trends during COVID-19 mitigation

Background: The University of Cincinnati Stroke Team provides acute stroke care to the southwest Ohio, northern Kentucky, and southeast Indiana catchment area of ∼2 million people and 30 healthcare facilities. We previously published a significant decline in stroke activations and reperfusion treatment (IV thrombolysis and EVT) rates following state announcements of COVID-19 mitigation measures. Here, we update these trends after state reopening guidelines. Methods: We compared Stroke Team activations and reperfusion treatments logged in a prospectively collected database, comparing the same period in 2020 versus 2019. Kentucky and Ohio announced school and restaurant closures on March 12 and 13, respectively, followed by Indiana. A stepwise reopening of our tristate area started on May 1, 2020. We also compared trends in activations and treatment rates before (Weeks 1-10), during (Weeks 11-17), and after (Weeks 18- 26) the lifting of COVID-19 mitigation efforts using the Poisson test, and graphically with segmented regression analysis. Results: Compared to 2019, stroke team activations declined by 12% in 2020 (95% CI 7 - 16%;p<0.01). During 2020, an initial decline in stroke activations following COVID-19 mitigation announcements was followed by a 28% increase in activations after reopening (Weeks 18-26: 95% CI 15 - 42%;p<0.01). In contrast, compared to 2019, treatment rates were unchanged (0%, 95% CI -15 - 18%;p=1.00), including specifically IV thrombolysis and thrombectomy rates. Similarly, an initial decline in reperfusion treatments was followed by a 24% nonsignificant increase after reopening (95% CI -10 - 71%;p=0.19) in 2020. Conclusion: The initial decline in stroke team activations during COVID-19 mitigation efforts was followed by an increase in activations after reopening. Hospital capacity and 911 services remained fully intact, suggesting that the reduction in activations were related to reduced presentation by patients for emergent stroke care.(Figure Presented).

Renin-angiotensin system inhibitors in management of hypertension during the COVID-19 pandemic.

COVID-19, which is caused by the single-stranded RNA severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has introduced significant therapeutic dilemmas in several areas. One of these is concern regarding the use of renin-angiotensin system (RAS) inhibitors. Dysfunction of the RAS has been observed in COVID-19 patients, but whether RAS inhibitors, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type-1 receptor blockers (ARBs), are associated with improved or worse clinical outcomes, remains unclear. RAS inhibitors are currently widely used in the treatment of hypertension. Emerging data suggest an increased association and a heightened mortality in patients of COVID-19 with co-morbidities such as hypertension, coronary heart disease, and diabetes mellitus, particularly in the elderly. Therefore, several recently published research papers have focused on the management of hypertension during the COVID-19 pandemic, as this co-morbidity was found to be the most common in patients with coronavirus infections. SARS-CoV-2 viral surface protein is known to attach angiotensin converting enzyme-2 (ACE-2) on the cell membrane to facilitate viral entry into the cytoplasm. While the SARS-CoV-2 viral load remains the highest in upper respiratory tract of COVID-19 patients, it has also been reported in multiple sites in COVID-19, and patients not infrequently require the Intensive Care Units (ICU) admission. However, despite the theoretical concerns of possible increased ACE2 expression by RAS blockade, there is no evidence that RAS inhibitors are harmful during COVID-19 infection, and indeed they have been shown to be beneficial in some animal studies. In this review we summarise the pathophysiology of the interaction between RAS, ACEIs/ARBs inhibitors and COVID-19, and conclude, on the basis of current data, that RAS blockade should be maintained during the current coronavirus pandemic.