Respiratory Muscle Strength in Patients after Covid-19

Respiratory muscles (RM) are a very important part of the respiratory system that enables pulmonary ventilation. This study aimed to assess the post-COVID-19 strength of RM by estimating maximum static inspiratory (MIP or PImax) and expiratory (MEP or PEmax) pressures and to identify the relationship between MIP and MEP and the parameters of lung function. We analyzed the data of 36 patients (72% male;median age 47 years) who underwent spirometry, and body plethysmography, diffusion test for carbon monoxide (DLCO) and measurement of MIP and MEF. The median time between the examinations and onset of COVID-19 was 142 days. The patients were divided into two subgroups. In subgroup 1, as registered with computed tomography, the median of the maximum lung tissue damage volume in the acute period was 27%, in subgroup 2 it reached 76%. The most common functional impairment was decreased DLCO, detected in 20 (55%) patients. Decreased MIP and MEP were observed in 5 and 11 patients, respectively. The subgroups did not differ significantly in MIP and MEP values, but decreased MIP was registered in the second subgroup more often (18%). There were identified no significant dependencies between MIP/MEP and the parameters of ventilation and pulmonary gas exchange. Thus, in patients after COVID-19, MIP and MEP were reduced in 14 and 31% of cases, respectively. It is reasonable to add RM tests to the COVID-19 patient examination plan in order to check them for dysfunction and carry out medical rehabilitation.Copyright © 2022 Obstetrics, Gynecology and Reproduction. All rights reserved.

The inspiratory activity of respiratory center and respiratory muscles strength after COVID-19.

The respiratory pump that provides pulmonary ventilation includes the respiratory center, peripheral nervous system, chest and respiratory muscles. The aim of this study was to evaluate the activity of the respiratory center and the respiratory muscles strength after COVID-19 (COronaVIrus Disease 2019). Methods. The observational retrospective cross-sectional study included 74 post-COVID-19 patients (56 (76%) men, median age - 48 years). Spirometry, body plethysmography, measurement of lung diffusing capacity (DLCO), maximal inspiratory and expiratory pressures (MIP and MEP), and airway occlusion pressure after 0.1 sec (P0.1) were performed. In addition, dyspnea was assessed in 31 patients using the mMRC scale and muscle strength was assessed in 27 of those patients using MRC Weakness scale. Results. The median time from the COVID-19 onset to pulmonary function tests (PFTs) was 120 days. The total sample was divided into 2 subgroups: 1 - P0.1 <= 0.15 kPa (norm), 2 - > 0.15 kPa. The lung volumes, airway resistance, MIP, and MEP were within normal values in most patients, whereas DLCO was reduced in 59% of cases in both the total sample and the subgroups. Mild dyspnea and a slight decrease in muscle strength were also detected. Statistically significant differences between the subgroups were found in the lung volumes (lower) and airway resistance (higher) in subgroup 2. Correlation analysis revealed moderate negative correlations between P0.1 and ventilation parameters. Conclusion. Measurement of P0.1 is a simple and non-invasive method for assessing pulmonary function. In our study, an increase in P0.1 was detected in 45% of post-COVID-19 cases, possibly due to impaired pulmonary mechanics despite the preserved pulmonary ventilation as well as normal MIP and MEP values.Copyright © Savushkina O.I. et al., 2023.

Role of the Inspiratory Muscles on Functional Performance from Critical Care to Hospital Discharge and beyond in Patients with COVID-19.

OBJECTIVE: The role of inspiratory muscle performance in functional performance in patients with COVID-19 is poorly understood. The purpose of this study was to perform a longitudinal examination of inspiratory and functional performance from intensive care unit (ICU) discharge (ICUD) to hospital discharge (HD) and symptoms at HD and 1 month after HD in patients with COVID-19. METHODS: Thirty patients (19 men, 11 women) with COVID-19 were included. Examination of inspiratory muscle performance at ICUD and HD was performed with an electronic manometer which provided the maximal inspiratory pressure (MIP) and several other inspiratory measures. Examination of dyspnea and functional performance was performed at ICUD and HD with the Modified Borg Dyspnea Scale and the 1-minute sit-to-stand test (1MSST), respectively. RESULTS: The mean age was 71 (SD = 11) years, the mean length of ICU stay was 9 (SD = 6) days, and the mean length of hospital stay was 26 (SD = 16) days. Most of the patients were diagnosed with severe COVID-19 (76.7%) and had a mean Charlson Comorbidity Index of 4.4 (SD = 1.9), reflecting high comorbidity. The mean MIP of the entire cohort increased minimally from ICUD to HD (from 36 [SD = 21] to 40 [SD = 20] cm H2O), reflecting predicted values for men and women at ICUD and HD of 46 (25%) to 51 (23%) and 37 (24%) to 37 (20%), respectively. The 1MSTS score increased significantly from ICUD to HD (9.9 [SD = 7.1] versus 17.7 [SD = 11.1]) for the entire cohort but remained far below population-based reference values (2.5th percentile) for the majority of patients at ICUD and HD. At ICUD, MIP was found to be a significant predictor of a favorable change in 1MSTS performance (ß = 0.308; odds ratio = 1.36) at HD. CONCLUSIONS: A significant reduction in inspiratory and functional performance exists in patients with COVID-19 at both ICUD and HD, with a greater MIP at ICUD being a significant predictor of a greater 1MSTS score at HD. IMPACT: This study shows that inspiratory muscle training may be an important adjunct after COVID-19.

Dying together: A convergence analysis of fatalities during COVID-19.

Governments implemented countermeasures to mitigate the spread of the COVID-19 virus. This had a severe effect on the economy. We examine convergence patterns in the evolution of COVID-19 deaths across countries. We aim to investigate whether countries that implemented different measures managed to limit the number of COVID-19 deaths. We extend the most recent macro-growth convergence methodology to examine convergence of COVID-19 deaths. We combine a long memory stationarity framework with the maximal clique algorithm. This provides a rich and flexible club formation strategy that goes beyond the stationary/non stationary approach adopted in the previous literature. Our results suggest that strict measures (even belated) or an aggressive vaccination scheme can confine the spread of the disease while maintaining the strictness of the measures steady can lead to a burst of the virus. Finally, we observe that fiscal measures did not have an effect on the containment of the virus.

Autoimmune pulmonary alveolar proteinosis in an adolescent girl with rapidly progressive dyspnea

Autoimmune pulmonary alveolar proteinosis (PAP) is a rare disease, especially in pediatrics, but important to consider, as it may avoid unnecessary and/or invasive investigations and delayed diagnosis. This case report highlights an adolescent girl with rapid onset dyspnea but an unremarkable physical exam and initial testing. However, due to a high index of suspicion, a chest computed tomography (CT) scan was done, revealing a "crazy paving" pattern, which then prompted expedited assessment. This finding, however, is not as specific as often discussed and has a broad differential diagnosis, which will be reviewed in detail as part of this case. Furthermore, this report demonstrates a diagnostic approach for PAP that avoids lung biopsy, previously considered to be required for diagnosis of PAP, but is increasingly becoming unnecessary with more advanced blood tests and understanding of their sensitivity and specificity. Additionally, management strategies for PAP will be briefly discussed.Copyright © 2022 Canadian Thoracic Society.

A temporal examination of inspiratory muscle strength and endurance in hospitalized COVID-19 patients.

BACKGROUND: The two most common symptoms associated with COVID-19 are dyspnea and fatigue. One possible cause of such symptoms may be inspiratory muscle weakness. OBJECTIVES: The purpose of this study was to examine inspiratory muscle performance (IMP) from intensive care unit discharge (ICUD) to hospital discharge (HD) in patients with COVID-19 hypothesizing that IMP would be markedly depressed at both ICUD and HD. METHODS: IMP was examined at ICUD and HD via the PrO2 device (PrO2 Health, Smithfield, RI) which provided the maximal inspiratory pressure (MIP), sustained MIP (SMIP), inspiratory duration (ID), and fatigue index test (FIT). Patient symptoms were assessed at ICUD, HD, and 1-month post-HD. RESULTS: 30 patients (19 men, 11 women) with COVID-19 were included. The mean±SD age, BMI, and length of ICU and hospital stay was 71±11 yrs, 27.9 ± 6.3 kg/m, 9 ± 6 days, and 26±16 days, respectively. The mean±SD MIP, SMIP, ID, and FIT of the entire cohort at ICUD vs HD were 36±21 vs 40±20 cm H2O, 231±157 vs 297±182 PTU, 8.8 ± 4.2 vs 9.5 ± 4.6 s, and 9.0 ± 9.4 vs 13.1 ± 12.3, respectively, with only SMIP and FIT significantly greater at HD (p=.006 and 0.03, respectively). SMIP at HD was significantly related to resting dyspnea at HD (r=-0.40; p=.02). The SMIP and FIT of men were found to increase significantly from ICUD to HD, but no measure of IMP in the women increased significantly from ICUD to HD. At least one COVID-19-related symptom was present 1 month after HD with the most persistent symptoms being fatigue, cough, and dyspnea in 47%, 40%, and 37% of the patients, respectively. CONCLUSIONS: A significant reduction in IMP exists in patients with COVID-19 at both ICUD and HD and no measure of IMP in women was observed to increase significantly from ICUD to HD. Impaired inspiratory muscle endurance rather than strength was associated with greater dyspnea at HD.

Abstracts from the 6th International Symposium of Advanced Topics in Exercise Physiology: Interval Training as an Efficient Strategy to Overcome the 21st Century Diseases with Emphasis in the Mental Brain Diseases

The proceedings contain 14 papers. The topics discussed include: lifestyles and their relationship with the psychological status of postgraduate students in the area of physical activity;impact of a remote supervised moderate interval training on cognitive functions in Mexican older adults. a preliminary study;bone diameters and their association with causes of health risk in college athletes;an online home exercise program changes lower body strength, nutritional status but not depression scores during the COVID-19 in Mexican elderly;anxiety symptoms in older adults during the COVID-19 pandemic. Intervention of physical exercise through social networks;leger test as a specific protocol to estimate the maximum oxygen consumption in the urban search and rescue division of the fire department of Tijuana, Mexico;effect of physical exercise on natural killer cells;effects of a 16-session high intensity interval training program on body composition in sedentary subjects;and resistance training using time under tension improves the muscle quality and muscle mass in healthy-young women. a preliminary study.

Pulmonary function and functional capacity at 3, 6 and 12 months in COVID-19 patients and effect of physical activity on recovery

BACKGROUND: Long-term sequelae due to Coronavirus disease 2019 (COVID-19) are now under investigation. Aim of this study was to evaluate the one-year clinical impact of COVID-19 on respiratory function and relation with physical activity. METHOD(S): One hundred four patients were evaluated 3, 6 and 12 months after SARS-CoV-2 diagnosis. Clinical conditions, symptomatology, 6-minute walking test (6MWT), pulmonary function test with spirometry and diffusing capacity of carbon monoxide (DLCO) were analyzed. RESULT(S): Eighty-six (82.7%) patients referred at least one symptom at 3 months, 46 (44.2%) at 6 months and 24 (23.1%) at 12 months. At the 3-months visit, patients with moderate COVID showed a slight decrease of distance at the 6MWT, with an improvement at 12 months (P=0.04). Patients with severe COVID-19 showed a recovery of SpO2 at rest (P<0.001), DLCO (P=0.001), DLCO/VA (P=0.002), forced vital capacity (P=0.01) and 6MWT distance (P=0.002) at 6 and 12 months. Patients with critical COVID-19 showed a remarkable reduction of DLCO at 3 months (65+/-21%). Then a subsequent gradual improvement of DLCO was recorded (78+/-18% at 6 months, 85+/-16% at 12 months, P=0.01). Patients with DLCO<80% of predicted at 12 months were older (P=0.02), with higher prevalence of cardio-vascular disease (P=0.006), diabetes (P=0.01) and critical COVID-19 (P=0.003). The improvement of 6MWT distance and DLCO during the three visits did not correlate with physical activity. CONCLUSION(S): Patients with COVID-19 lung involvement showed a progressive improvement in respiratory function and physical performance at 6 and 12 months after acute disease.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Comparing the Effects of Endurance and Resistance Training Programs on some Pulmonary, Functional, and Quality of Life Indicators in Patients with COVID-19 Discharged from Hospital.

Background and purpose: The present study investigated the effect of six weeks of endurance and resistance training on pulmonary indices, physical performance, and quality of life in COVID-19 patients after discharge from hospital. Materials and methods: Thirty six patients with COVID-19 (mean age: 38.76±0.98 years, mean weight: 81.86±2.88 kg) were selected. At the beginning and end of the study, pulmonary (FEV1, FVC, FEV1/FVC, and MVV), physical (6-minute walk test), quality of life (SF-36), and anthropometry tests were performed. The patients were divided into three groups: Endurance training (45 minutes at 60-75% estimated HR), Resistance training (45 minutes at 40-70% of I-RM), and controls. The intervention was conducted for 6 weeks (3 sessions). One-way ANOVA test was used for statistical analysis. Results: Findings indicated a significant increase in FEV1 (P=0.029), FVC (P=0.047), FEV1/FVC (P=0.043) in the endurance training group compared to the control group, while difference was observed in MVV (P=0.041) and FEV1/FVC (P=0.022) between endurance training and resistance training groups. The 6-minute test distance increased in the endurance training (P=0.0001) and resistance training (P=0.001) groups compared to the control group, but no difference was observed between the training groups (P=0.48). Endurance and resistance training programs induced significant improvements in physical performance (P=0.024 and P=0.09, respectively) and general health (P=0.022 and P=0.015, respectively) dimensions compared to the control group. Conclusion: Moderate-intensity endurance training can improve pulmonary function, physical performance, and quality of life in patients with COVID-19 after discharge from hospital and can be used in rehabilitation programs of these patients. [ FROM AUTHOR] Copyright of Journal of Mazandaran University of Medical Sciences (JMUMS) is the property of Mazandaran University of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Superhighways and roads of multivariate time series shock transmission: Application to cryptocurrency, carbon emission and energy prices

Inferring the heterogeneous connection pattern of a networked system of multivariate time series observations is a key issue. In finance, the topological structure of financial connectedness in a network of assets can be a central tool for risk measurement. Against this, we propose a topological framework for variance decomposition analysis of multivariate time series in time and frequency domains. We build on the network representation of time–frequency generalized forecast error variance decomposition (GFEVD), and design a method to partition its maximal spanning tree into two components: (a) superhighways, i.e. the infinite incipient percolation cluster, for which nodes with high centrality dominate;(b) roads, for which low centrality nodes dominate. We apply our method to study the topology of shock transmission networks across cryptocurrency, carbon emission and energy prices. Results show that the topologies of short and long run shock transmission networks are starkly different, and that superhighways and roads considerably vary over time. We further document increased spillovers across the markets in the aftermath of the COVID-19 outbreak, as well as the absence of strong direct linkages between cryptocurrency and carbon markets. © 2023 Elsevier B.V.

Comparing the Effects of Endurance and Resistance Training Programs on some Pulmonary, Functional, and Quality of Life Indicators in Patients with COVID-19 Discharged from Hospital.

Background and purpose: The present study investigated the effect of six weeks of endurance and resistance training on pulmonary indices, physical performance, and quality of life in COVID-19 patients after discharge from hospital. Material(s) and Method(s): Thirty six patients with COVID-19 (mean age: 38.76+/-0.98 years, mean weight: 81.86+/-2.88 kg) were selected. At the beginning and end of the study, pulmonary (FEV1, FVC, FEV1/FVC, and MVV), physical (6-minute walk test), quality of life (SF-36), and anthropometry tests were performed. The patients were divided into three groups: Endurance training (45 minutes at 60-75% estimated HR), Resistance training (45 minutes at 40-70% of I-RM), and controls. The intervention was conducted for 6 weeks (3 sessions). One-way ANOVA test was used for statistical analysis. Result(s): Findings indicated a significant increase in FEV1 (P=0.029), FVC (P=0.047), FEV1/FVC (P=0.043) in the endurance training group compared to the control group, while difference was observed in MVV (P=0.041) and FEV1/FVC (P=0.022) between endurance training and resistance training groups. The 6-minute test distance increased in the endurance training (P=0.0001) and resistance training (P=0.001) groups compared to the control group, but no difference was observed between the training groups (P=0.48). Endurance and resistance training programs induced significant improvements in physical performance (P=0.024 and P=0.09, respectively) and general health (P=0.022 and P=0.015, respectively) dimensions compared to the control group. Conclusion(s): Moderate-intensity endurance training can improve pulmonary function, physical performance, and quality of life in patients with COVID-19 after discharge from hospital and can be used in rehabilitation programs of these patients.Copyright © 2023, Mazandaran University of Medical Sciences. All rights reserved.

Comparing the Effects of Endurance and Resistance Training Programs on some Pulmonary, Functional, and Quality of Life Indicators in Patients with COVID-19 Discharged from Hospital.

Background and purpose: The present study investigated the effect of six weeks of endurance and resistance training on pulmonary indices, physical performance, and quality of life in COVID-19 patients after discharge from hospital. Material(s) and Method(s): Thirty six patients with COVID-19 (mean age: 38.76+/-0.98 years, mean weight: 81.86+/-2.88 kg) were selected. At the beginning and end of the study, pulmonary (FEV1, FVC, FEV1/FVC, and MVV), physical (6-minute walk test), quality of life (SF-36), and anthropometry tests were performed. The patients were divided into three groups: Endurance training (45 minutes at 60-75% estimated HR), Resistance training (45 minutes at 40-70% of I-RM), and controls. The intervention was conducted for 6 weeks (3 sessions). One-way ANOVA test was used for statistical analysis. Result(s): Findings indicated a significant increase in FEV1 (P=0.029), FVC (P=0.047), FEV1/FVC (P=0.043) in the endurance training group compared to the control group, while difference was observed in MVV (P=0.041) and FEV1/FVC (P=0.022) between endurance training and resistance training groups. The 6-minute test distance increased in the endurance training (P=0.0001) and resistance training (P=0.001) groups compared to the control group, but no difference was observed between the training groups (P=0.48). Endurance and resistance training programs induced significant improvements in physical performance (P=0.024 and P=0.09, respectively) and general health (P=0.022 and P=0.015, respectively) dimensions compared to the control group. Conclusion(s): Moderate-intensity endurance training can improve pulmonary function, physical performance, and quality of life in patients with COVID-19 after discharge from hospital and can be used in rehabilitation programs of these patients.Copyright © 2023, Mazandaran University of Medical Sciences. All rights reserved.

Pulmonary rehabilitation outcome in patients recovering from COVID-19 disease

In patients who have recovered from COVID-19, the functional impairment and prolonged symptoms of dyspnea, cough, weakness and fatigue can persist for a long period. The aim of this study was to evaluate functional capacity, respiratory muscle and hangrip strenght, pulmonary function tests and pulmonary rehabilitation outcome in patients recovering from COVID-19 disease. Study included patients recovering from COVID-19 diasese who attended standard in-person pulmonary rehabilitation program (PRP) five days a week, for three weeks. Patients were recruited during six months period, mainly treated on an outpatient basis for acute COVID-19 disease without previously recorded lung disease, and the reason for referral to PRP was dyspnea and exercise intolerance. Pulmonary function testing (spirometry, diffusing lung capacity for carbon monoxide, body pletysmography), maximum static inspiratory pressure (Pi max), maximum static expiratory pressure (Pe max), 6-minute walking test (6MWT) and handgrip musle strength were performed. There where 87 patients (40 male and 47 female), with mean age of 52,3 years. Average results of pulmonary function tests and Pe max prior to PRP showed no limitations, with reduced Pi max (73 cmH2O, 68%) and 6MWT distance (435m, 77%). There were statistically significant difference in 6MWT distance, Pi max and Pe max, hand grip muscle strength prior and after PRP (p<0.05). Patients in our study had exercise intolerance and decreased inspiratory muscle strength prior PRP with significant improvement after PRP. Our study shows that pulmonary rehabilitation is effective and important in patients recovering from COVID-19 disease.

Respiratory muscle strength in patients post infection by COVID-19

The persistence of symptoms in post-COVID patients, such as dyspnea and fatigue, has been common. Our objective was to determine the prevalence of respiratory and palmar muscles weakness in patients post-COVID-19 infection and compare with those without weakness. Method(s): A prospective study carried out with individuals of post-COVID-19 outpatient clinic of the Pulmonology Department of Hospital Sao Paulo/Brazil. Assessment of maximal respiratory pressures and maximal handgrip strength (HGS) were performed in the first assessment after hospital discharge (60+/-20 days after the onset of symptoms). Individuals with maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) lower than 80% of predicted were considered respiratory muscle weakness. Result(s): 269 patients were evaluated, most were male (55%), 55+/-14 years, BMI 30+/-7 Kg/m , average length of stay for hospital 14+/-10 days, of which 138 (51%) were referred to the ICU (11+/-9 days) and 49 (87%) required invasive mechanical ventilation. Inspiratory and expiratory muscle weakness was verified in 85 (32%) and 72 (27%) patients, respectively. Patients with inspiratory muscle weakness had MIP of 67+/-22 vs 110+/-26 cmH2O (p<0.001), MIP 2 %predicted 65+/-13 vs 108+/-18 cmH2O (p<0.001), sustained MIP of 60+/-21 vs 110+/-26 cmH2O (p<0.001), MEP of 73+/-32 vs 104+/-34 cmH2O (p<0.001), MEP%predicted of 72+/-23 vs 94+/-25 cmH2O (p<0.001). The HGS of patients with inspiratory muscle weakness was 17+/-10 vs 22+/-12 KgF (p<0.05). Conclusion(s): After hospital discharge for COVID-19, 32% of patients had inspiratory muscle weakness and 27% had expiratory muscle weakness. Patients with inspiratory muscle weakness had lower maximal HGS when compared to patients without inspiratory muscle weakness.

The clinical effectiveness and validity of home spirometry in children with cystic fibrosis

Introduction: During the COVID-19 pandemic, home spirometry became essential for continued monitoring of cystic fibrosis patients, however, the clinical effectiveness was unknown. Aim(s): The aims of this study were to assess the success rate of testing patients at home and to compare the home spirometry and lab spirometry results Methods: 147 home spirometry devices (Air Next, NuvoAir, USA) were given out to cystic fibrosis patients (M:F 67:80;mean age 11.8 [4.7 - 17.3]) who had previous experience of spirometry and deemed to be competent to perform spirometry at home. Patients were asked to perform 4 tests in the first month, then 1 test per month unless clinically requested. When Lab spirometry resumed, 28 (M:F 12:16;mean age 13.1 [8.0-17.0]) patients tested on NuvoAir within 5 days (mean 0.7 days (1.0)) of Lab spirometry (Vyntus Spiro, Vyaire Medical, USA). Correlation between spirometry indices were analysed using linear regression. Result(s): 142 patients (96.6%) successfully onboarded onto the NuvoAir platform. Between July 2020 and Jan 2022, 1854 tests were performed, with 1711 (92.3%) tests over-read to be valid. 54 patients (36.7%) performed >=15 tests requested. FEV1 (R2 = 0.93, p = <0.00), FVC (R2 = 0.91, p = <0.00), MMEF (R2 = 0.87, p = <0.00) and PEF (R2 = 0.88, p = <0.00) all showed significant correlation between Lab spirometry and Home spirometry. Conclusion(s): Our results show that home spirometry is well adopted by cystic fibrosis patients and they are able to perform valid loops on this device. Continual encouragement may be required to achieve good trend data. There is also close agreements between this home spirometry device and the gold standard of laboratory spirometry.

Post-COVID-19 Exercise Stress Test

Objectives: Atypical chest pain, fatigue, and palpitations can be seen in post-coronavirus disease-2019 (COVID-19) period. With the hypothesis of explaining these complaints, we evaluated the exercise stress test (EST) parameters in COVID-19 patients with mild disease. Material(s) and Method(s): Between the ages of 30-50 years, who had mild COVID-19 in the last 3-9 months, were taken as the COVID-19 group [n=80, male/female (M/F): 40/40]. A total of 160 patients were included, of which age and gender matched 80 patients (M/F: 40/40) without COVID-19 were the control group. During the EST, baseline heart rate HR1(beats/min), baseline systolic, diastolic blood pressure (mmHg) (SBP1, DBP1), maximum blood pressures (SBPmax, DBPmax), and blood pressure changes (DELTASBP, DELTADBP) were recorded. As EST parameters, Duke score, exercise time (min), ST change (mm), exercise capacity (METs), maximum reached HR (% beats/min), distance walked (m), maximum oxygen consumption amount (VO2max mL/kg/min), rate pressure product (RPP mmHg/min/1000), and heart HR recovery 1 (HRR1 beats/min) was used. Result(s): In the COVID-19 group, baseline HR1, SBP1, DBP1, SBPmax, DBPmax, DELTASBP, DELTADBP, VO2max, and RPP were higher, while distance walked and HRR1 were less. There was no difference between the two groups in terms of Duke score, exercise duration, ST change and exercise capacity. Conclusion(s): The fact that the exercise capacities in the COVID-19 group were similar to those in the control group, but there was a difference in the changes in heart rate and blood pressure, RPP, HRR1 suggested that the autonomic system might be affected.Copyright © 2022 by Heart and Health Foundation of Turkey.

Nocturnal hypoventilation and respiratory muscle/cough weakness in COVID-19 ICU survivors

Background: The impact of severe COVID-19 in nocturnal hypoventilation and respiratory muscles/cough strength is unknown. Aim(s): Characterize respiratory function in post-ICU COVID-19 patients and correlate these findings with COVID-19 associated outcomes. Method(s): Retrospective study with 55 post-ICU COVID-19 patients admitted to a rehabilitation center (RC). Clinical data were collected and patients performed arterial blood gas analysis, nocturnal oxy-capnography, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and peak cough flow (PCF) at admission. Result(s): Mean age was 64.4+/-10.2 years, 39 (70.9%) were male. Co-morbidities were present in 50 (90.9%): 39 (70.9%) hypertension;20 (36.4%) diabetes;3 (5.5%) OSA;1 (1.8%) COPD. None had neuromuscular disorders. Median of ICU length was 25.5 (min 5;max 190) days. Fifty-three (96.4%) needed mechanical and invasive ventilation, 6 (10.9%) ECMO and 22 (40%) tracheostomy (all decannulated before admission to our RC). Eighteen (32.7%) had criteria of nocturnal hypoventilation, 17 (30.9%) inspiratory, 16 (29.1%) expiratory and 17 (30.9%) cough weakness. Sepsis correlated with increased length of ICU stay (p=0.007) and with lower PCF values (p=0.048). Neurologic disfunction was associated with lower minimum SpO2 and more time of SpO2<88% (p=0.032;p=0.035). Renal disfunction was associated with higher values of mean and maximum TcCO2 (p=0.003;p=0.011). Patients with previously diagnosed OSA had higher values of MIP and PCF (p=0.006;p<0.001) at evaluation. Conclusion(s): In COVID-19 ICU survivors, nocturnal hypoventilation, inspiratory/expiratory muscle and cough weakness are common and may have an impact in rehabilitation outcomes.

It Takes Two to Make a Thing Go Wrong

Seventy-three-year-old diabetic male was a high-risk transfer from Alaska for respiratory decompensation in the setting of progressive bulbar and proximal weakness. He was diagnosed with COVID-19 two months prior and viral mononucleosis 1 month prior to presentation. While the patient had a fall 3 months prior to presentation, and decreased mobility at home, there was abrupt onset of progressive upper/lower extremity weakness, dysphagia, and difficulties managing secretions 2 weeks prior to presentation. Initial exam was notable for MRC 3-4/5 proximal upper/lower extremity weakness, areflexia, and negative inspiratory force of 224 to 230 cm H20. A subtle periorbital heliotrope rash was documented. Lumbar puncture demonstrated albumino-cytologic dissociation (protein 142 mg/dL, 6 WBCs) and CK remained elevated (1930 U/L) despite intravenous hydration. Outside electrodiagnostic testing demonstrated a sensorimotor axonal neuropathy with questionable myopathic features on needle electromyography. Given concern for an inflammatory neuropathy and concomitant inflammatory myopathy, intravenous immunoglobulin 2G/kg and IV methylprednisolone 1G/day over 5 days was started. He was transferred for further diagnostic workup and supportive care 6 days after presentation and required intubation within 24 hours of admission. Exam showed progressive proximal and distal weakness of the extremities and general areflexia/hyporeflexia. Repeat electromyography confirmed a severe sensorimotor axonal polyneuropathy without acquired demyelinating features and normal repetitive nerve stimulation. While the patient could no longer activate muscles voluntarily, proximal muscles had increased spontaneous activity with predominant myotonia. Neuroaxis imaging was notable only for enhancement of the lumbar nerve roots. Combined vastus lateralis muscle biopsy and serologic testing confirmed a second pathologic process contributing to the patient's weakness. This case highlights the cooccurrence of 2 distinct neuropathological entities, with potential relation to a prior viral infection, and the importance of ancillary testing to guide treatment for acute causes of neuromuscular respiratory failure.

Fatigue And Dyspnea In Young Adults Recovered From COVID-19

Background: Fatigue and dyspnea are the most common long-COVID symptoms in people who recovered from COVID-19. It is important to understand related factors with fatigue and dyspnea in young adults for early detection of the existing or future chronic disease risk and secondary prevention. Objective(s): To investigate the relationship between fatigue, dyspnea, respiratory functions, functional exercise capacity, physical activity, and anxiety in young adults who recovered from COVID-19. Method(s): Twenty-seven individuals (4 male, 23 female) aged 18-25/years (mean age=21.4+/-1.8/years), diagnosed with COVID-19 and at least 12 weeks passed after diagnosis (mean 231.84+/-118.1/days) were included in the study. Dyspnea-12 and Fatigue Severity Scale (FSS) were used to evaluate dyspnea and fatigue. Respiratory functions and respiratory muscle strength (maximal inspiratory pressure-MIP, maximal expiratory pressure-MEP) were assessed using spirometry and intraoral pressure gauge. Functional exercise capacity was evaluated with the "6-minute walking test (6MWT)". International Physical Activity Questionnaire-Short Form (IPAQ-SF) and Coronavirus Anxiety Scale (CAS) were used to evaluate physical activity and anxiety Results: Of the subjects, %63 reported fatigue and 37% reported dyspnea. None of the subjects were treated at the hospital during the disease. There were significant moderate negative correlations between Dyspnea-12 and %peak expiratory flow-PEF (p=0.020), and FSS and MEP (p=0.009). Time after PCR, age, 6MWT, IPAQ-SF, and CAS were not correlated with FSS or Dyspnea-12. Conclusion(s): Our results showed that fatigue and dyspnea are related with expiratory muscle strength and PEF in young adults who recovered from COVID-19.

Pulmonary function, muscular strength and quality of life according to mechanical ventilation use in post-Covid patients

Introduction: Mechanical ventilation (MV) is a known risk to impact in respiratory and functional capacity postCOVID-19 infection. Objective(s): Assess pulmonary function, muscular strength and quality of life in post-COVID-19 patients submitted or not to MV. Method(s): During March of 2020 and July 2021 we had 983 hospitalized COVID-19 patients and 527 patients were discharged and invited to be followed at the multidisciplinary assistance. From the total, 116 patients [57% male, 59(52-67) years] were evaluated 60 days after first symptoms appearance through pulmonary function testing, manovacuometry, handgrip test and Saint George's Respiratory Questionnaire (SGRQ). There were no vaccinated subjects. Result(s): 34% of the patients needed intensive care (n=39), of which, 51% needed MV (n=20). MV group showed statistically significant weaker handgrip strength [27(18-35) kgf vs 35(26-45) kgf;p=0,025] and maximum inspiratory pressure predicted percentile reduction (86+/-23,5% vs 101+/-27,6%;p=0,043) when compared to non-MV group. We did not observe SGRQ differences between the groups. However, females showed statistically significant higher impact in quality of life in all SGRQ domains compared to males. There were no differences in pulmonary function. Conclusion(s): MV submitted patients presented worsened respiratory and peripheral muscular strengths without difference in pulmonary function and quality of life. Women showed higher impact in quality of life regardless of MV use.