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Background: Peripheral muscle weakness has been observed in the post-acute phase of Covid-19 patients. However, it is unknown whether Covid-19 is associated with structural changes in skeletal muscles, like atrophy, inflammation or fibrosis. Aim(s): To examine whether peripheral muscle weakness in post-Covid-19 patients is associated with changes in muscle echogenicity and thickness. Method(s): Post-Covid-19 patients with objectified muscle weakness (isometric quadriceps maximal voluntary contraction (MVC) <lower limit of normal) at ~6 months after infection were cross-sectionally studied. Vastus lateralis (VL), rectus femoris (RF), tibialis anterior (TA) and gastrocnemius (GCM) were examined unilaterally using quantitative muscle ultrasound. Standardized scores (z-scores) of 2 were defined as limits of normal. Result(s): Fourteen post-Covid-19 patients were included (age 47+/-15y, 64% male, BMI 26+/-3 kg/m2). Median z-scores were determined for muscle thickness and echogenicity of VL (-1.0 [-1.3- -0.2], 0 [-0.2-1.1]), RF (-0.2 [-1.4-0.1], -0.2 [-1.3-0.6]), TA (0.1 [-0.8-0.6], 0.5 [-0.4-1.0]), and GCM (0.8 [0.1-1.0], -0.7 [-1.3- -0.1]), respectively. Thirteen patients had values within the limits of normal. One patient showed increased echogenicity of VL, but normal values for other muscles. There were significant moderate-to-strong correlations between MVC and muscle thickness of VL (r=0.670), RF (r=0.812), TA (r=0.593) and GCM (r=0.579), and between MVC and echogenicity of GCM (r=-0.588). Conclusion(s): In a cohort of post-Covid-19 patients with peripheral muscle weakness, standardized muscle ultrasound investigations did not show any evidence for structural abnormalities.
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Objective: To compare body fat-muscle and visceral obesity indices that can be measured with thorax computed tomography (CT) between reverse transcriptase-polymerase chain reaction (RT-PCR) positive and negative patients. Material(s) and Method(s): This ret-rospective, comparative study included 141 PCR (+) and 150 PCR (-) patients who applied to our hospital with flu-like symptoms without having the comorbid diseases and undergone thoracic CT between April 1, 2020-July 1, 2020. For the each patient, the ratio of thoracic subcutaneous adipose tissue thickness to pectoralis major muscle thickness (TSAT/PMJ), epicardial adipose tissue thickness (EAT), liver density (LD), abdominal subcutaneous adipose tissue thickness to psoas major muscle thickness ratio (ASAT/ PSM), subcutaneous abdominal adipose tissue thickness to erector spinae muscle thickness ratio (ASAT/ESM) was measured. The comparison was made between the subgroups in terms of age, gender, and measured parameters. Result(s): Statistically significant difference was found between PCR (+) and (-) individuals in terms of EAT mean (p<0.05). TSAT/PMJ, ASAT/PSM and ASAT/ESM ratios were higher in women (p <0.05). The mean EAT in men was increased in the PCR (+) group (p<0.05). In PCR (+) group, LD decreased, EAT increased with increasing age (p<0.05). PCR (+) and PCR (-) groups didn't show significant difference (p>0.05) in terms of TSAT/PMJ, ASAT/PSM, LD, ASAT/ESM. Conclusion(s): Higher EAT values can increase the risk of getting coronavirus disease-2019 (COVID-19) infection. Peripheral fat-muscle indices don't increase the risk of contracting COVID-19 infection.Copyright © 2023 by Turkiye Klinikleri.
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Background: Fatigue and muscle weakness are common complaints in COVID-19 survivors. However, little is still known about the skeletal muscle qualitative and quantitative characteristics after hospitalization due to moderate and severe COVID-19. Objectives: To assess rectus femoris and vastus intermedius muscle thickness (MT) and rectus femoris echo intensity (EI) and to establish its association with demographic, clinical, functional, and inflammatory parameters in long COVID patients after hospital discharge. Methods: Cross-sectional study with 312 COVID-19 patients (53.53% male; age: 54.59 ± 13.50 years), with a laboratory-confirmed diagnosis of COVID-19. Patients were assessed 3-11 months after hospital discharge. We evaluated MT of the right rectus femoris and vastus intermedius and EI of the right rectus femoris using a portable ultrasound system, 6-13 MHz, broadband linear transducer. We corrected EI using the subcutaneous fat thickness. Ultrasonographic parameters were tested in association with demographic (sex and age); functional (Handgrip strength measurement, Timed Up and Go, 1 min Sit-to-Stand test, EuroQoL-5 Dimensions-5 Levels, World Health Organization Disability Assessment Schedule (WHODAS 2.0), Post-COVID-19 Functional Status, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT), Medical Research Council (MRC) sum score, Borg Dyspnea Scale, MRC Dyspnea score, Visual Analogue Scale (VAS), Epworth Sleepiness Scale, Insomnia Severity Index, Functional Independence Measurement (FIM), and Functional Oral Intake Scale); clinical (length of hospital stay, intubation, and presence of comorbidities such as systemic hypertension, diabetes, obesity, chronic obstructive pulmonary disease, asthma), and inflammatory data assessed by the C-reactive protein and D-dimer serum concentrations. Results: Rectus femoris MT was associated with age, handgrip strength, Epworth Sleepiness Scale, and subcutaneous fat thickness (r2 = 27.51%; p < 0.0001). Vastus intermedius MT was associated with age, pain intensity, handgrip strength, Epworth Sleepiness scale, FIM, and time since hospital discharge (r2 = 21.12%; p < 0.0001). Rectus femoris EI was significantly associated with the male sex, TUG, Epworth Sleepiness Scale, and C-Reactive Protein levels (r2 = 44.39%; p < 0.0001). Mean MT of rectus femoris and vastus intermedius are significantly different (p < 0.001). Conclusion: After hospital discharge, long COVID patients present qualitative and quantitative skeletal muscle characteristics associated with a combination of demographic, clinical, and functional parameters.
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COVID-19 is associated with musculoskeletal disorders. Ultrasound is a tool to assess muscle architecture and tendon measurements, offering an idea of the proportion of the consequences of the disease, since significant changes directly reflect the reduction in the ability to produce force and, consequently, in the functionality of the patient; however, its application in post-COVID-19 infection needs to be determined. We aimed to assess the intra- and inter-rater reliability of ultrasound measures of the architecture of the vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM), gastrocnemius lateralis (GL), gastrocnemius medialis (GM), soleus (SO), and tibialis anterior (TA) muscles, as well as the patellar tendon (PT) cross-sectional area (CSA) in post-COVID-19 patients. An observational, prospective study with repeated measures was designed to evaluate 20 post-COVID-19 patients, who were measured for the pennation angle (θp), fascicular length (Lf), thickness, echogenicity of muscles, CSA and echogenicity of the PT. The intra-class correlation coefficient (ICC) and 95% limits of agreement were used. The intra-rater reliability presented high or very high correlations (ICC = 0.71-1.0) for most measures, except the θp of the TA, which was classified as moderate (ICC = 0.69). Observing the inter-rater reliability, all the evaluations of the PT, thickness and echogenicity of the muscles presented high or very high correlations. For the Lf, only the RF showed as low (ICC = 0.43), for the θp, RF (ICC = 0.68), GL (ICC = 0.70) and TA (ICC = 0.71) moderate and the SO (ICC = 0.40) low. The ultrasound reliability was acceptable for the muscle architecture, muscle and tendon echogenicity, and PT CSA, despite the low reliability for the Lf and θp of the RF and SO, respectively.
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Background: Doing a job with functional activity may aggravate chronic neck pain(CNP). Thickness, PCSA of the neck muscles can be improved with exercise. During the Covid-19 pandemic, people has caused an increase in home workload, the frequency of performing functional activities related to performance has increased. The distance between physiotherapists and the patient should be at least 2 meters in clinics due to the risk of transmission. As a result, the importance of telerehabilitation has increased. Objectives: Our aim is to investigate the effect of remotely spinal stabilization exercises(SSE) with telerehabilitation on clinical variables, the functional activities, exercise adherence and muscle architecture patients with CNP. Methods: The demographic characteristics were recorded. Pain intensity with Visual Analog Scale (VAS), disability level with Neck Disability Index (NDI), neck awareness with Fremantle Neck Awareness Questionnaire (FreNAQ), the functional capacity levels with neck function capacity evaluation test, the difficulty of functional activities with VAS were assessed. Muscle thickness of M. Sterno-cleideomastoideus, M. Upper Trapezius, PCSA of M. Longus Colli, M. Cervical Multifdus was evaluated in the resting with 3.5-10 MHz ultrasound. The exercise adherence with Exercise Adherence Rating Scale and exercise program satisfaction with VAS were evaluated. The telerehabilitation group (TG) used exercises videos and video conferences, control group (CG) did SSE in the clinic. To study the effects of the interventions, the outcome measures were compared time-by-group interaction effects, one the within-groups factor (time) and one the between-groups factor (group) by repeated-measures two-way ANOVA. The Mann Whitney-U test was performed to compare two groups for non-parametric data. Results: Twenty-eight patients were randomly allocated to the TG and the CG. The VAS, NDI, FreNAQ, the functional capacity levels, muscle architecture showed similar changes over time in both groups. Results showed no signifcant time-by-group interaction effects of VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture (p>0.05);a signifcant effect for time in the VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture (p<0.001). There was no difference between the groups in terms of VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture. Results showed no signifcant effect for the group in the VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture (p>0.05). Both groups adapted well to the exercise program and were highly satisfed with the SSE (p<0.05). Conclusion: The VAS, NDI, difficulty of functional activities decreased;FreNAQ, functional capacity levels, architecture of neck muscles increased in both groups after 8 weeks SSE. It was determined that telerehabilitation with remotely SSE was benefcial as face-to-face SSE.
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Background and aims: Sarcopenia is a promising tool for prognostication of cirrhosis.EWGSOP2 guidelines define sarcopenia based on muscle strength, muscle quantity or quality and physical performance. Many previous studies didn’t use a standardized definition of sarcopenia and was based on skeletal muscle measurement by CT or MRI.Ultrasound guided thigh muscle thickness (TMT) measurement is a validated, cost effective and easy method for assessment of muscle quantity.There is paucity of Indian studies analysing prognostic role of sarcopenia in cirrhosis. To study the predictive role of sarcopenia on mortality and complications in cirrhosis patients. Method: This was a prospective cohort study with 120 consecutive patients each in sarcopenia and no sarcopenia groups. Sarcopeniawas diagnosed based on EWGSOP2 guidelines using ultrasound guided measurement of TMT.They were followed up for 6 months.Kaplan- Meier analysis with LogRank test was used to compare survival and Cox proportional hazards modelwas used for multivariate analysis to determine risk factors of mortality. Results: Cirrhosis patients with sarcopenia[N1 = 120, M:F = 80:40, Median age-58yrs (51–64)] and without sarcopenia[N2 = 120, M:F = 93:27, Median age-54yrs (46.25–60)] were enrolled.Six month cumulative survival was 56.7% and 76.7% in sarcopenia and no sarcopenia groups respectively (p = 0.001).Six month cumulative survival in severe and non-severe sarcopenia was 23.9% and 70% respectively (p = 0.001).Age, sex, nutritional status, sarcopenia status, CTP score, MELD score, Bilirubin, Albumin, INR and Sodium were significantly associated with survival.A multivariate analysis showed sarcopenia (HR = 1.283, 95%CI 1.092–2.130, p = 0.031), female sex (HR = 1.851, 95%CI 1.106–3.097, p = 0.019), CTP class C (HR = 1.447, 95%CI 1.252–1.794, p = 0.002) and MELD score>15 (HR = 1.116, 95%CI 1.056– 2.203, p = 0.05) as independent predictors of mortality. Development of complications like ascites, HE, Covid infection and UGI bleed were significantly higher in sarcopenia group, while SBP, AKI, cellulitis, UTI, HCC and ACLF were not statistically significant between two groups.(Figure Presented) Figure 1. Survival curves in both groups (Log rank p = 0.001) Conclusion: Sarcopenia is an independent prognostic marker of mortality in cirrhosis and is associated with increased risk of complications like ascites, HE, Covid infection and UGI bleed. Severe sarcopenia has even poorer outcome. It appears that addition of sarcopenia to existing scoring systems of cirrhosis will improve prognostication of patients
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Objectives: To study the predictive role of sarcopenia on mortality and complications in cirrhosis patients. Sarcopenia is a promising tool for prognostication of cirrhosis.EWGSOP2 guidelines define sarcopenia based on muscle strength,muscle quantity or quality and physical performance.Many previous studies didn't use a standardized definition of sarcopenia and was based on skeletal muscle measurement by CT or MRI.Ultrasound guided thigh muscle thickness (TMT) measurement is a validated,cost effective and easy method for assessment of muscle quantity.There is paucity of Indian studies analysing prognostic role of sarcopenia in cirrhosis.This study was aimed at the same. Materials and Methods: This was a prospective cohort study with 120 consecutive patients each in 'sarcopenia' and 'no sarcopenia groups'.Sarcopenia was diagnosed based on EWGSOP2 guidelines using ultrasound guided measurement of TMT.They were followed up for 6 months.Kaplan-Meier analysis with LogRank test was used to compare survival and Cox proportional-hazards model was used for multivariate analysis to determine risk factors of mortality. Results: Cirrhosis patients with sarcopenia[N1 = 120,M:F = 80:40,Median age-58yrs (51-64)] and without sarcopenia[N2 = 120,M:F = 93:27,Median age-54yrs (46.25-60)] were enrolled.Six month cumulative survival was 56.7% and 76.7% in sarcopenia and no sarcopenia groups respectively (p = 0.001).Six month cumulative survival in severe and non severe sarcopenia was 23.9% and 70% respectively (p = 0.001).Age,sex,nutritional status, sarcopenia status, CTP score, MELD score, Bilirubin, Albumin, INR and Sodium were significantly associated with survival.A multivariate analysis showed sarcopenia (HR = 1.283,95%CI 1.092-2.130,p = 0.031),female sex (HR = 1.851,95%CI 1.106-3.097,p = 0.019), CTP class C (HR = 1.447,95%CI 1.252-1.794,p = 0.002) and MELD score>15 (HR = 1.116,95%CI 1.056-2.203,p = 0.05) as independent predictors of mortality. Development of complications like ascites,HE,Covid infection and UGI bleed were significantly higher in sarcopenia group, while SBP,AKI,cellulitis,UTI,HCC and ACLF were not statistically significant between two groups. Conclusion: Sarcopenia is an independent prognostic marker of mortality in cirrhosis and is associated with increased risk of complications like ascites, HE, Covid infection and UGI bleed. Severe sarcopenia has even poorer outcome. It appears that addition of sarcopenia to existing scoring systems of cirrhosis will improve prognostication of patients. (Figure Presented).
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PURPOSE: Neuromuscular electrical stimulation (NMES) has been considered as a promising approach for the early rehabilitation of patients during and/or after intensive care unit (ICU) stay. The overall objective of this study is to evaluate the NMES effectiveness to counteract the post-ICU impairment in physical function of COVID-19 patients. The specific aim of this manuscript is to describe the study design, protocol, content of interventions, primary and secondary outcomes and to discuss the clinical rehabilitation impact of the expected experimental results. METHODS: This prospective, randomized, controlled, parallel-group, single-blind trial will include 80 patients who had undergone mechanical or non-invasive ventilation following pneumonia-induced respiratory failure. Patients are randomized to a control group (routine physical therapy for 3 weeks) or a NMES group (routine physical therapy plus NMES of quadriceps and gastrocnemius muscles for 3 weeks). The primary outcome is physical performance assessed through the Short Physical Performance Battery (SPPB). Secondary outcomes include independence level, perceived fatigue, muscle strength, rectus femoris thickness, and walking performance. The SPBB and walking performance are assessed once (after the intervention), while all other outcomes are assessed twice (before and after the intervention). CONCLUSION: NMES is a simple and non-invasive technique for muscle strengthening that is usually well tolerated, does not produce adverse effects, requires no or little cooperation from patients and is quite inexpensive. Therefore, proving the effectiveness of NMES therapy for physical and muscle function in COVID-19 patients could support its systematic incorporation in post-ICU rehabilitation protocols of patients presenting with post-intensive care syndrome.