COVID19-associated new-onset movement disorders: a follow-up study.

BACKGROUND: Neurological symptoms are common manifestation in acute COVID-19. This includes hyper- and hypokinetic movement disorders. Data on their outcome, however, is limited. METHODS: Cases with new-onset COVID-19-associated movement disorders were identified by searching the literature. Authors were contacted for outcome data which were reviewed and analyzed. RESULTS: Movement disorders began 12.6 days on average after the initial onset of COVID-19. 92% of patients required hospital admission (mean duration 23 days). In a fraction of patients (6 of 27; 22%; 4 males/2 females, mean age 66.8 years) the movement disorder (ataxia, myoclonus, tremor, parkinsonism) was still present after a follow-up period of 7.5 ± 3 weeks. Severe COVID-19 in general and development of encephalopathy were risk factors, albeit not strong predictors, for the persistence. CONCLUSIONS: The prognosis of new-onset COVID-19-associated movement disorder appears to be generally good. The majority recovered without residual symptoms within several weeks or months. Permanent cases may be due to unmasking of a previous subclinical movement disorder or due to vascular/demyelinating damage. Given the relatively low response rate of one third only and the heterogeneity of mechanisms firm conclusions on the (long-term) outome cannot, however, be drawn.

Functional Brain Connectivity Prior to the COVID-19 Outbreak Moderates the Effects of Coping and Perceived Stress on Mental Health Changes: A First Year of COVID-19 Pandemic Follow-up Study.

BACKGROUND: The COVID-19 pandemic provides a unique opportunity to investigate the psychological impact of a global major adverse situation. Our aim was to examine, in a longitudinal prospective study, the demographic, psychological, and neurobiological factors associated with interindividual differences in resilience to the mental health impact of the pandemic. METHODS: We included 2023 healthy participants (age: 54.32 ± 7.18 years, 65.69% female) from the Barcelona Brain Health Initiative cohort. A linear mixed model was used to characterize the change in anxiety and depression symptoms based on data collected both pre-pandemic and during the pandemic. During the pandemic, psychological variables assessing individual differences in perceived stress and coping strategies were obtained. In addition, in a subsample (n = 433, age 53.02 ± 7.04 years, 46.88% female) with pre-pandemic resting-state functional magnetic resonance imaging available, the system segregation of networks was calculated. Multivariate linear models were fitted to test associations between COVID-19-related changes in mental health and demographics, psychological features, and brain network status. RESULTS: The whole sample showed a general increase in anxiety and depressive symptoms after the pandemic onset, and both age and sex were independent predictors. Coping strategies attenuated the impact of perceived stress on mental health. The system segregation of the frontoparietal control and default mode networks were found to modulate the impact of perceived stress on mental health. CONCLUSIONS: Preventive strategies targeting the promotion of mental health at the individual level during similar adverse events in the future should consider intervening on sociodemographic and psychological factors as well as their interplay with neurobiological substrates.

Free triiodothyronine levels and age influences the metabolic profile and COVID-19 severity parameters in euthyroid and levothyroxine-treated patients

Metabolic reprogramming is required to fight infections and thyroid hormones are key regulators of metabolism. We have analyzed in hospitalized COVID-19 patients: 40 euthyroid and 39 levothyroxine (LT4)-treated patients in the ward and 29 euthyroid and 9 LT4-treated patients in the intensive care unit (ICU), the baseline characteristics, laboratory data, thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), the FT3/FT4 ratio, 11 antiviral cytokines and 74 metabolomic parameters. No evidence for significant differences between euthyroid and LT4-treated patients were found in the biochemical, metabolomic and cytokines parameters analyzed. Only TSH (p=0.009) and ferritin (p=0.031) showed significant differences between euthyroid and LT4-treated patients in the ward, and TSH (p=0.044) and FT4 (p=0.012) in the ICU. Accordingly, severity and mortality were similar in euthyroid and LT4-treated patients. On the other hand, FT3 was negatively related to age (p=0.012), independently of sex and body mass index in hospitalized COVID-19 patients. Patients with low FT3 and older age showed a worse prognosis and higher levels of the COVID-19 severity markers IL-6 and IL-10 than patients with high FT3. IL-6 negatively correlated with FT3 (p=0.023) independently of age, body mass index and sex, whereas IL-10 positively associated with age (p=0.035) independently of FT3, body mass index and sex. A metabolomic cluster of 6 parameters defined low FT3 ward patients. Two parameters, esterified cholesterol (p=4.1x10-4) and small HDL particles (p=6.0x10-5) correlated with FT3 independently of age, body mass index and sex, whereas 3-hydroxybutyrate (p=0.010), acetone (p=0.076), creatinine (p=0.017) and high-density-lipoprotein (HDL) diameter (p=8.3x10-3) were associated to FT3 and also to age, with p-values of 0.030, 0.026, 0.017 and 8.3x10-3, respectively. In conclusion, no significant differences in FT3, cytokines, and metabolomic profile, or in severity and outcome of COVID-19, were found during hospitalization between euthyroid patients and hypothyroid patients treated with LT4. In addition, FT3 and age negatively correlate in COVID-19 patients and parameters that predict poor prognosis were associated with low FT3, and/or with age. A metabolomic cluster indicative of a high ketogenic profile defines non-critical hospitalized patients with low FT3 levels.

Corrigendum to "Prefrontal reactivity to TMS perturbation as a toy model of mental health outcomes during the COVID-19 pandemic"[Heliyon 8 (8), (August 2022) Article e10208].

[This corrects the article DOI: 10.1016/j.heliyon.2022.e10208.].

Severe diabetic foot infections without systemic inflammatory response syndrome: Prospective validation of a new category.

We aimed to validate the prognostic value of subclassifying moderate diabetic foot infections into two categories: moderate and moderate/severe. We conducted a prospective study of a cohort of 200 patients with moderate and severe infections. Moderate infections were subclassified after applying a previously published score. Variables associated with prognosis were: need for any amputation, major amputation, need for hospitalisation, length of hospitalisation, length of antibiotic therapy, reinfection rate and infection-related mortality. Infections were moderate in 111 cases (55.5%) and severe in 89 (44.5%). Osteomyelitis (OM) was diagnosed in 114 cases (57%), 73 moderate (36.5%) and 41 severe (20.5%). Patients with severe OM had a higher rate of amputations, major amputations, hospitalisations and need for antibiotic therapy, and a longer duration of antibiotics when compared with moderate OM. After applying the score, moderate infections were subclassified into 73 moderate cases (65.7%) and 38 moderate/severe cases (34.3%). Moderate/severe had a higher rate of amputations, major amputations, hospitalisations and need for antibiotics than moderate ones. No differences regarding prognosis were found between moderate/severe and severe infections with systemic inflammatory response syndrome. Moderate/severe diabetic foot infections, which could also be known as severe infections without systemic inflammatory response syndrome, should be recognised as a new subgroup. We propose to merge severe diabetic foot infections with and without systemic inflammatory response syndrome into a unique category due to its prognostic value. Furthermore, OM should be added to both moderate and severe new categories of diabetic foot infections.

Prefrontal reactivity to TMS perturbation as a toy model of mental health outcomes during the COVID-19 pandemic.

Psychosocial hardships associated with the COVID-19 pandemic led many individuals to suffer adverse mental health consequences, however, others show no negative effects. We hypothesized that the electroencephalographic (EEG) response to transcranial magnetic stimulation (TMS) could serve as a toy-model of an individual's capacity to resist psychological stress, in this case linked to the COVID-19 pandemic. We analyzed data from 74 participants who underwent mental health monitoring and concurrent electroencephalography with transcranial magnetic stimulation of the left dorsolateral prefrontal cortex (L-DLPFC) and left inferior parietal lobule (L-IPL). Within the following 19 months, mental health was reassessed at three timepoints during lock-down confinement and different phases of de-escalation in Spain. Compared with participants who remained stable, those who experienced increased mental distress showed, months earlier, significantly larger late EEG responses locally after L-DLPFC stimulation (but not globally nor after L-IPL stimulation). This response, together with years of formal education, was significantly predictive of mental health status during the pandemic. These findings reveal that the effect of TMS perturbation offers a predictive toy model of psychosocial stress response, as exemplified by the COVID-19 pandemic.

Impact of COVID-19 on Respiratory Admissions in a Tertiary Pediatric Intensive Care Unit.

Background Pediatric inpatient admissions for viral respiratory infections decreased worldwide during the early part of the coronavirus disease 2019 (COVID-19) pandemic. This was likely due to social distancing measures and mask mandates leading to a decreased spread of viruses. We question if there was an increase in respiratory admissions during the winter of 2020-2021 due to the overlap of seasonal respiratory viruses and COVID-19 and the severity of those admissions. Methods We performed a single-center retrospective chart review of all respiratory admissions to our pediatric intensive care unit (PICU) from October to April during the years 2018-2019, 2019-2020, and 2020-2021. We compared the total number of respiratory admissions from different viruses and respiratory admissions by diagnoses among those time periods. Second, we compared the PICU length of stay and duration of mechanical ventilation (both invasive and non-invasive) for these respiratory admissions during those years. Results We saw a drastic decrease in the total respiratory admissions to the PICU in 2020-2021 compared to the same period of time in the last two years. The greatest contributor to this decrease was admissions secondary to bronchiolitis. We noticed a statistically significant decrease in both asthma (p<0.001) and chronic respiratory failure admissions (p=0.0029) during the pandemic winter compared to previous winters. Although, the total number of all respiratory viral admissions is not significant, admissions specific to the respiratory syncytial virus (RSV) (p<0.0001), rhino-enterovirus (p<0.0001), and multi-virus (p=0.0016), achieved statistical significance. There was no statistical difference between the PICU length of stay and duration of mechanical ventilation during the three years. Conclusion Despite a decrease in pediatric respiratory admissions during the COVID-19 pandemic, the severity of illness based on length of stay in the PICU and length of time on respiratory support remains unchanged compared to the previous two years.

Evaluation of Cost-Benefit and Measures During the COVID-19 Pandemic for Incoming Travelers Through Tests in Origin in Spain.

Background: The World Health Organization has promoted preventive measures for reducing the impact of the pandemic. One of these measures was tests in origin for travelers. Testing strategies for COVID-19 facilitate the overall public health response to the pandemic and contributes to minimize the infection among the population COVID-19. Goal: In this work, we assess the efficiency of diagnostic testing of incoming travelers in the Canary Islands, Spain, during a period of 4 months, with a focus on the economic impact for the regional government. We study the cost-benefit of this measure as well as the potential influence on the number of positive cases in the population. Methods: We processed the real data in the Canary Islands of pre-flight PCR and antigen tests that were required to the residents when traveling back to the Canaries from anywhere in Spain in a period of 4 months, from 14 December, 2020 to 4 April, 2021. As a result, we calculated the economic impact of doing those tests and compare them with the estimated costs of passengers under the hypothesis of entering the islands without testing. The cost-benefit was obtained for different scenarios, where the incoming passengers generated hospitalization and intensive care unit (ICU) costs directly and via transmissions. Results: The incoming testing funded by the government, if applied during the bad evolution of the pandemic with 1.2 ratio of transmission, clearly saved money to the public health system. In addition to the economic impact of this measure, we estimated the potential influence on the number of positive cases in the population according to different scenarios of the propagation of the pandemic. At the beginning of February 2021, the savings were about €130.551,47, with a 95% confidence interval (CI) of €24.677,94-236.425,00. By the end of April 2021, the savings were above €2,000,000 (€2.284.788,50 on average and 95% CI of €2.092.914,84-2.476.662,16) and the savings increased as the pandemic evolved. At the end of the period, the savings were twice the expenses. Conclusions: Testing in origin has proved to be a good measure that helped to mitigate COVID-19 spread among regions. Our results confirm that the free PCR or rapid antigen tests produce relevant savings to the public budget. We studied 61.990 reported data during 2020 and 2021 from the travelers from national flights, against 346.449 of total incoming travelers to the Canary Islands in this period. The measure pursued by the Government of the Canary Islands of providing free tests for residents showed a clear benefit for both, limiting the propagation of COVID-19 and reducing the costs of the hospitalizations and ICU admissions. It should be noted that the free testing measure in this period was before starting the vaccination campaigns. As measure of public health in the airports, testing helped to control and make the mobility of travelers secure.

Seizures and COVID-19: Results from the Spanish Society of Neurology's COVID-19 registry.

We describea series of patients with COVID-19 who presented with seizures, reported in the Spanish Society of Neurology's COVID-19 Registry. This observational, descriptive,multicentre, registry-based study includes patients with confirmed COVID-19 who experienced seizures during active infection.Wedescribe theclinicalpresentation of COVID-19,seizures,and resultsof complementary tests.Wealsodescribe the suspectedaetiologyof the seizures. Of 232 reported cases, 26 (11.2%) presented with seizures;7 of these patients (26.9%) had prior history of epilepsy, whereas the remaining 19 (73.1%) had no history of seizures.In most cases, seizures presented on days 0 and 7 after onset of COVID-19. By seizure type, 8 patients (30.7%) presentedgeneralised tonic-clonic seizures, 7 (26.9%) status epilepticus, 8 (30.7%) focal impaired-awareness seizures, and 4 (11.7%) secondary generalised seizures.Six patients (23.1%) also presented other neurological symptoms, includingaltered mental status and decreased level of consciousness. Predisposing factors for seizures (eg, dementia, tumour, cerebrovascular disease) were observed in 10 of the 19 patients with no prior history of epilepsy (52.6%). Patients with COVID-19 may present with seizures over the course of the disease,either alone or in the context of encephalopathy.Seizures may present in patients with no prior history of epilepsy; however, most of these patients present predisposing factors.

Fenómeno de la COVID-19: retrospectiva de las estrategias informativas y persuasivas en pandemia

Understanding media's response to epidemics. Public Health Reports, 116 (2), pp. 87. https://doi.org/10.1016/S00333549(04)50149-8 Glik, D. (2007). Risk communication for public health emergencies. Annual Review of Public Health, 28, pp. 33-54. https://doi.org/10.1146/ annurev.publhealth.28.021406.144123 Singh, L., Bansal, S., Bode, L., Budak, C., Chi, G., Kawintiranon, K., Padden, C., Vanarsdall

New-Onset Type 1 Diabetes in Children With SARS-CoV-2 Infection.

There has been a worldwide increase in cases of diabetic ketoacidosis in both adults and children with diabetes during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This can be multifactorial: delayed care due to reduced medical services, fear of approaching hospitals, or SARS-CoV-2 infection itself. It is well-known that infection is an important trigger for diabetic ketoacidosis in children with type 1 or type 2 diabetes mellitus, but little is known whether SARS-CoV-2 infection can trigger diabetic ketoacidosis and new-onset diabetes mellitus in a child with no previous history of diabetes mellitus. The association of SARS-CoV-2 as a trigger for new-onset diabetes requires further investigation, as the incidence of diabetes is steadily rising in the pediatric population during the pandemic. This case report explores two cases where children present in diabetic ketoacidosis with concurrent SARS-CoV-2 infection and no known history of type 1 diabetes mellitus.

MLLP-VRAIN Spanish ASR Systems for the Albayzín-RTVE 2020 Speech-to-Text Challenge: Extension

Featured ApplicationThis work has direct application in live automatic captioning of audiovisual material, which is fundamental in accessibility.This paper describes the automatic speech recognition (ASR) systems built by the MLLP-VRAIN research group of Universitat Politècnica de València for the Albayzín-RTVE 2020 Speech-to-Text Challenge, and includes an extension of the work consisting of building and evaluating equivalent systems under the closed data conditions from the 2018 challenge. The primary system (p-streaming_1500ms_nlt) was a hybrid ASR system using streaming one-pass decoding with a context window of 1.5 seconds. This system achieved 16.0% WER on the test-2020 set. We also submitted three contrastive systems. From these, we highlight the system c2-streaming_600ms_t which, following a similar configuration as the primary system with a smaller context window of 0.6 s, scored 16.9% WER points on the same test set, with a measured empirical latency of 0.81 ± 0.09 s (mean ± stdev). That is, we obtained state-of-the-art latencies for high-quality automatic live captioning with a small WER degradation of 6% relative. As an extension, the equivalent closed-condition systems obtained 23.3% WER and 23.5% WER, respectively. When evaluated with an unconstrained language model, we obtained 19.9% WER and 20.4% WER;i.e., not far behind the top-performing systems with only 5% of the full acoustic data and with the extra ability of being streaming-capable. Indeed, all of these streaming systems could be put into production environments for automatic captioning of live media streams.

Prevalence, Management, and Outcome of Atrial Fibrillation and Other Supraventricular Arrhythmias in COVID-19 Patients.

COVID-19 mainly affects the respiratory system but has been correlated with cardiovascular manifestations such as myocarditis, heart failure, acute coronary syndromes, and arrhythmias. Cardiac arrhythmias are the second most frequent complication affecting about 30% of patients. Several mechanisms may lead to an increased risk of cardiac arrhythmias during COVID-19 infection, ranging from direct myocardial damage to extracardiac involvement. The aim of this review is to describe the role of COVID-19 in the pathogenesis of cardiac arrhythmias and provide a comprehensive guidance for their monitoring and management.

Neurological complications of COVID-19 in hospitalized patients: The registry of a neurology department in the first wave of the pandemic.

OBJECTIVE: To describe the spectrum of neurological complications observed in a hospital-based cohort of COVID-19 patients who required a neurological assessment. METHODS: We conducted an observational, monocentric, prospective study of patients with a COVID-19 diagnosis hospitalized during the 3-month period of the first wave of the COVID-19 pandemic in a tertiary hospital in Madrid (Spain). We describe the neurological diagnoses that arose after the onset of COVID-19 symptoms. These diagnoses could be divided into different groups. RESULTS: Only 71 (2.6%) of 2750 hospitalized patients suffered at least one neurological complication (77 different neurological diagnoses in total) during the timeframe of the study. The most common diagnoses were neuromuscular disorders (33.7%), cerebrovascular diseases (CVDs) (27.3%), acute encephalopathy (19.4%), seizures (7.8%), and miscellanea (11.6%) comprising hiccups, myoclonic tremor, Horner syndrome and transverse myelitis. CVDs and encephalopathy were common in the early phase of the COVID-19 pandemic compared to neuromuscular disorders, which usually appeared later on (p = 0.005). Cerebrospinal fluid severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction was negative in 15/15 samples. The mortality was higher in the CVD group (38.1% vs. 8.9%; p = 0.05). CONCLUSIONS: The prevalence of neurological complications is low in patients hospitalized for COVID-19. Different mechanisms appear to be involved in these complications, and there was no evidence of direct invasion of the nervous system in our cohort. Some of the neurological complications can be classified into early and late neurological complications of COVID-19, as they occurred at different times following the onset of COVID-19 symptoms.

Impact of COVID-19 lockdown on match activity and physical performance in professional football referees.

To investigate the effect of COVID-19 lockdown on match-play metrics in professional football referees during official matches of the Spanish professional leagues. Forty-two professional football referees from the First (n = 20) and Second Division (n = 22) were monitored during 564 official games using Global Positioning System (GPS) technology. Data of matches before lockdown were compared to matches after resumption of the competition. Compared to pre-lockdown, in the referees of the First Division there was a decrease in the total running distance and the distance covered at all speed thresholds > 6 km · h-1 after lockdown (P < .05). In the Second Division referees, the post-lockdown measurement only showed a decrease in the running distance at 21-24 km · h-1 (P < .05), with no changes in the other speed thresholds. The post-lockdown measurement showed an increased distance covered at < 6 km · h-1 and the number of accelerations for both First and Second Division referees (P < .05). Referees' match activity was reduced due to the COVID-19 lockdown, while the effect on running parameters was more pronounced in First Division referees.

TMS-induced EEG perturbation as a marker of psychological resilience to deleterious mental health effects during the COVID-19 pandemic

Background Social, economic and psychological hardships associated with the COVID-19 pandemic are expected to result in a global burden on mental health outcomes. However, while some individuals suffer from increasing distress and reduced quality of life, others will show no negative effects. A better understanding of brain mechanisms subtending resilience would be helpful in informing future recommendations to individuals and societies facing the present pandemic and future similar events. Here, we compared neurophysiological brain markers between individuals who exhibited resilience or vulnerability to pandemic associated psychological stress. Method 23 participants from the longitudinal study cohort of the Barcelona Brain Health Initiative (Cattaneo et al., Front. Aging Neurosci. 2018;10:321) who underwent concurrent transcranial magnetic stimulation with electroencephalography (TMS-EEG), were classified as either resilient (n=16) or non-resilient (n=7), based on their scoring in the PHQ-4 questionnaire (Kroenke et al., Psychosomatics 2009;50(6):613?21) along four timepoints;one before COVID-19 outbreak and three spanning 2.5 months during the pandemic. Individuals maintaining a score below 3 across all timepoints were deemed resilient, while those scoring below 3 before pandemic but higher than 2 at any pandemic timepoint were considered non-resilient. TMS-EEG data was collected by delivering 120 single TMS pulses to the dorsolateral prefrontal cortex (DLPFC) and inferior parietal lobule (IPL). TMS evoked global mean field amplitude and local response at the stimulation site were computed. Result Figure 1 depicts time-series for DLPFC and IPL responses for both groups of subjects. Overall, non-resilient individuals exhibited a larger global response to TMS perturbation during DLPFC stimulation, as well as larger local current density estimates during IPL stimulation. Conclusion These preliminary results revealed that non-resilient individuals were more susceptible to TMS perturbation, shown by global DLPFC and local IPL reactivity. Notably, these targets are nodes of the default mode and cognitive control networks affected by stress (van Oort et al., Neurosci. Biobehav. Rev. 2017;83:281?97), and the left frontal cortex has been proposed as a cognitive resilience hub (Franzmeier et al., J. Alzheimer?s Dis. 2017;59(4):1381?92.). Future studies should investigate and confirm the possibility that these nodes constitute a shared neurophysiological substrate for psychological and cognitive resilience.

Acute Myopericarditis after COVID-19 Vaccine in Teenagers.

BACKGROUND: There have been an increasing number of reports of myocarditis and pericarditis in adolescents and young adults after coronavirus disease 19 vaccinations. The pathophysiology of myocarditis after this vaccination is indeterminate currently. The problem is a relatively new phenomenon, and so there are no current guidelines on how to manage these cases of myopericarditis. We intend to describe our management in these two cases so that it can help guide pediatricians, intensivists, and cardiologists taking care of similar cases. Case Summaries. The first case is a young adolescent who presented with chest pain after receiving his second dose of coronavirus disease 19 vaccination with no other symptoms. His troponin was found to be 40 ng/mL. He had a normal echocardiogram and chest CT angiogram. His troponins trended down with symptomatic pain management after 3 days. The second case is another adolescent who presented with fever, fatigue, headache, and chest pain 3 days after receiving his second dose of coronavirus vaccine. His troponin was elevated to 5 ng/mL, electrocardiogram with ST segment elevations, and mildly decreased systolic function on echocardiogram. His troponins and electrocardiogram were normalized in 3 days at the time of his discharge. CONCLUSION: The clinical course of vaccine-associated myocarditis appears favorable as both our patients have responded well to medications and rest with prompt improvement in symptoms with full recovery. The experience remains limited at this time regarding the investigations, management, and follow-up of this novel clinical entity. It is vital for all the health care providers taking care of adolescents to have knowledge about this phenomenon and make correct diagnosis in those presenting with chest pain after COVID-19 vaccine and in preventing unnecessary invasive procedures such as coronary angiogram to rule out acute coronary syndromes.

Eccentric Hamstring Muscle Strength during Home Confinement Due to the COVID-19 Pandemic, and Football Competition Resumption in Professional Football Referees: A Prospective Observational Study.

The COVID-19 pandemic has produced a major disruption for professional football leagues that has affected the physical preparation of both football players and referees. In Spain, health authorities decreed home confinement for eight weeks, supressing the normal training routines of professional referees. After home confinement, referees had four weeks to retrain as the national football league was set to resume matches to complete the 11 games remaining. The aim of the present investigation was to assess changes in eccentric hamstring muscle strength during football competition suspension/resumption due to the COVID-19 pandemic in 21 professional football referees (mean ± SD, age: 33.4 ± 5.1 years; height: 182.4 ± 5.0 cm; body mass: 75.1 ± 4.4 kg). Eccentric hamstring muscle strength was measured with the Nordic hamstring exercise at four time points. During home confinement, referees presented the lowest value of bilateral eccentric muscle strength (300 ± 14 N). Eccentric muscle strength increased by 13.2 ± 3.7% one week after the end of home confinement (339 ± 16 N; p = 0.001, effect size (ES) = 2.8) and remained stable before the first match (343 ± 17 N; p = 0.001, ES = 3.1) and after the end of the national league (328 ± 13 N; p = 0.001, ES = 2.0). In summary, home confinement produced detraining effects in professional football referees associated with hamstring muscle weakness. In this regard, strength-based activities with body loads may be insufficient to avoid muscle weakness and other means (e.g., weights) may be necessary to maintain muscle strength. However, the 4-weeks retraining period was sufficient to resolve hamstring muscle weakness induced by the restrictions of home confinement. This information may be helpful in the case of future sport competition suspension or home quarantine due to new waves of COVID-19 pandemic.