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.

Initiating Home Parenteral Nutrition Therapy in a Patient at High Risk of Refeeding Syndrome After COVID-19 Infection

Background: An emerging finding about COVID-19 is its effect on nutrition and weight loss. The COVID-19 symptoms of fatigue, altered taste or smell, and lack of appetite are well known. But COVID-19 may have a more profound effect on clinical nutrition status. Two recent studies have identified that approximately one-third of ambulatory COVID-19 patients are at risk of experiencing weight loss >= 5% (Anker, et al;di Filippo, et al). The case study presented here discusses home start total parenteral nutrition (TPN) in a patient recently diagnosed with COVID-19 at high risk for refeeding syndrome. Method(s): N/A Results: Case Study: A 92-year-old patient was diagnosed with COVID-19 on June 8, 2022. Over the next week, she was hospitalized twice to manage symptoms of acute mental status changes, lethargy, aphasia, hypotension, and loss of appetite. The patient received nirmatrelvir/ritonavir, remdesivir, and bebtelovimab to treat COVID-19 at different times between June 9, 2022, and June 18, 2022. She remained COVID positive and continued to deteriorate clinically. On June 20, 2022, the patient began receiving 24/7 homecare, including intravenous (IV) fluids of dextrose 5% in normal saline (D5NS) 1000 mL daily for three days. She continued to experience loss of appetite and had no bowel movement for 3 days. On June 23, 2022, she was referred to this specialty infusion provider to initiate TPN therapy in the home setting. The patient's BMI was 18.2 kg/m2. Lab results revealed potassium 3.0 mmol/L, phosphate 1.6 mg/dL, and magnesium 1.6 mg/dL. High risk of refeeding syndrome was identified by the level of hypophosphatemia and hypokalemia. The specialty infusion provider's registered dietitian recommended to discontinue D5NS and begin NS with added potassium, phosphate, and magnesium. Thiamine 200mg daily was added to prevent Wernicke's encephalopathy. The patient's clinical status and lab values were monitored closely each day until her electrolyte levels stabilized (Table 1). Home TPN therapy was initiated on June 28, 2022, with <10% dextrose and 50% calorie requirement with 85% protein and 1.0 g/kg lipids. Three-day calorie count and nutrition education were performed four days post TPN initiation. Oral intake met only 25% of estimated needs. Over several days, theTPN formula was gradually increased to goal calories and the infusion cycle was slowly decreased. The following week, the patient's oral intake improved to 60%-75% of estimated needs. Her constipation resolved, and she showed improvement in functional status and mobility. Her appetite drastically improved when the TPN was cycled. Another three-day calorie count was performed when TPN calories reached goals. Oral intake demonstrated 100% estimated calorie and protein needs. TPN therapy was ultimately discontinued on July 14, 2022. As of September 30, 2022, the patient has stabilized at her pre-COVID weight of 45 kg with full recovery of appetite, function, and cognition. Discussion(s): The ASPEN Consensus Recommendations for Refeeding Syndrome (da Silva, et al) describe the repletion of electrolyte levels before introducing calories to prevent end-organ damage associated with refeeding syndrome (respiratory muscle dysfunction, decreased cardiac contractility, cardiac arrhythmias, and encephalopathy). Conclusion(s): This case study highlights the successful initiation of home TPN therapy in a patient at high risk of refeeding syndrome post COVID-19 infection. Although home start TPN and the risk of refeeding syndrome are not new concepts, they must be considered in the setting of COVID-19. Given the effects COVID-19 has on taste, smell, and appetite and the recent finding that one-third of patients with COVID infection may experience weight loss of >= 5%, nutrition support and patient education are vital components of overall patient care. (Figure Presented).

A Case of Ocular Myasthenia Gravis Seen by Rheumatology as Suspected Mononeuritis Multiplex in an Adult Male Shortly after Pfizerbiontech Sars-Cov-2 Vaccination

Background/Aims Myasthenia gravis (MG) is an antibody-mediated autoimmune disease targeting proteins at the postsynaptic membrane of the neuromuscular junction. MG is thought to occur in genetically susceptible individuals following an environmental trigger. SARS-CoV-2 infection has been associated with new-onset autoimmune disease, new-onset MG, and exacerbations of pre-existing MG, with molecular mimicry between SARS-CoV-2 epitopes and autoantigen-induced autoreactivity thought to be part of the underlying mechanism. We report a case of newonset ocular MG following first dose Pfizer-BioNTech BNT162b2 SARS-COV2 vaccination which was referred to rheumatology as suspected mononeuritis multiplex. Methods A 53-year-old man of East Asian ethnicity presented to the emergency department (ED) with sudden onset diplopia and left lateral gaze restriction 7 days after receiving his first dose of the Pfizer-BioNTech BNT162b2 SARS-COV2 vaccination. He had longstanding myopia and dry eyes but no other medical history, no regular medications or significant family history. He was a current smoker, with a 50-pack year history. He did not drink alcohol or use any recreational drugs. He was found to have an isolated left VI cranial nerve (CN) palsy with an otherwise normal ocular and physical examination. Blood tests were unremarkable apart from raised cholesterol, and he was discharged with a suspected self-limiting microvascular CN lesion. Three weeks later he presented to ED with worsening diplopia, increasingly restricted eye movements, headache, nausea, vomiting and blurred vision. Ophthalmology assessment noted new right sided CN III and VI palsy, persistent left CN VI palsy, and vertical diplopia in all fields of gaze. Neurological and physical examination were normal. Bloods including an autoimmune screen were unremarkable. SARS-CoV-2 Spike antibodies were positive consistent with SARS-CoV-2 vaccination but not infection. Intracranial and thoracic imaging were unremarkable. He was referred to and seen by both rheumatology and neurology as a case of suspected mononeuritis multiplex. Results A diagnosis of ocular MG was confirmed with positive serum acetylcholine receptor antibodies, and he was started on prednisolone, and pyridostigmine to good effect. Daily forced vital capacity (FVC) showed no respiratory muscle involvement, and nerve conduction studies and electromyography were normal, excluding secondary generalisation. Conclusion A review of the literature found 14 reported cases of new-onset MG all within 4 weeks following SARS-CoV-2 vaccine. Whilst these cases provide interesting insights into the pathogenesis of autoimmune conditions such as MG, they are not epidemiological studies to inform vaccine safety. Ultimately, current evidence suggests that the risks of SARS-COV-2 infection outweigh the risk of vaccine-related adverse events, therefore we suggest clinicians should be aware of potential new-onset autoimmune conditions, but support the safety of SARSCOV2 vaccination. Further, research into possible immunological mechanisms behind this phenomenon, including identifying potential epitopes inducing molecular mimicry, could help establish the likelihood of a causative link.

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.

Year 2022 in review - Respiratory failure and lung support therapy.

The use of ECMO methods has experienced a significant boom in recent years, mainly due to the SARS-CoV-2 pandemic. Many workplaces that had little or no experience with ECMO currently possess the relevant technology and can use this method in real clinical practice. The prone position (PP) has changed from the original position of rescue intervention to the leading position among the methods that should be considered standard in patients with a severe form of acute respiratory failure. Thus, the combination of pronation and ECMO support has received considerable attention in recent years. This text, although a year in the 2022 review, briefly discusses available evidence-based medicine publications over the past few years devoted to this topic. The use of PP in clinical conditions other than mechanical ventilation (MV), e.g. in conscious patients on non-invasive ventilatory support, is described in the next section of this text. Another topic is the correct setting of MV while using PP and the effect of PP in pregnant patients with COVID-19. Inhalational anesthetics and their use for sedation of patients on UPV are currently among the frequently discussed topics within the optimization of intensive care. Conversely, ventilator-induced dysfunction of the main respiratory muscles, especially the diaphragm, has been a serious topic in critical care for a long time. Next, critically ill patients are at risk of hyperoxemia both as part of MV and ECMO support. The negative impact of this condition is the final topic of the article.Copyright © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.

Physical therapy follow-up before and during COVID-19 pandemic of patients with amyotrophic lateral sclerosis

Introduction: Amyotrophic lateral sclerosis (ALS) is marked by a gradual decline in functional capacity and increased morbidity from respiratory infections due to progressive loss of muscle strength. The regular monitoring by a multidisciplinary team, adjustments in ventilatory parameters, and maintenance of NIV are essential for disease management. This study aimed to monitor functional progression of patients with ALS during COVID-19 pandemic using telemedicine. Method(s): This is longitudinal case series with patients with ALS. Five assessments were performed, being two occurred in-person and three were performed remotely during the COVID-19 pandemic. First assessments included pulmonary function, respiratory muscle strength, functionality (ALSFRS-R), rate of disease progression, and disease staging. The further assessments included a clinical evaluation form, use and parameters of NIV. Result(s): We followed 11 patients for 30 months. Most patients had spinal onset ALS (72.7%), were male (72.7%), had a median age of 51 years. Total ALSFRS-R (P < 0.01) and motor domain (P < 0.01) scores reduced during the pandemic. However, total and domain scores were not different between patients with spinal and bulbar onset. According to ALSFRS-R, 90.9% of patients presented a slow disease progression. Most patients used NIV at night and during a half-day shift. Conclusion(s): The telemedicine facilitates monitoring clinical and seems to influence functional progression of patients with ALS during COVID-19 pandemic. Patients with ALS have a slow rate of disease progression and a functional decrease during 14 months follow-up period.

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.

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.

Single breath counting as a respiratory muscle function assessment test

Background: Spirometry may be used as a surrogate marker of respiratory muscle strength in patients with neuromuscular disorders. However, it is an aerosol-generating procedure, not readily conducted during remote consultation, and its use has been limited by infection control guidance during the COVID-19 pandemic. Single breath counting (SBC) has been reported to predict vital capacity (VC). We aimed to evaluate the utility of SBC in our clinic. Method(s): We conducted an evaluation to compare SBC and VC measurements in healthy volunteers and patients with respiratory muscle weakness. To perform SBC, individuals were asked to maximally inhale and then count every second in time with a metronome from 1 to the highest number they could manage in a single breath. SBC was repeated 3 times and the mean and maximum results were recorded. Individuals performed spirometry for slow VC in accordance with ERS guidelines. Results were compared using Spearman's rank correlation coefficient. Result(s): 31 healthy controls and 18 cases were included. The correlation between VC and SBC were rho=0.697 (p<0.001) and rho=0.694 (p<0.001) for mean and maximal efforts respectively (Figure). Conclusion(s): Primary findings highlight the potential usefulness of SBC for respiratory muscle function assessment. This promising technique is simple and feasible with current infection control guidelines and may be useful in remotely conducted appointments.

Pulmonary Rehabilitation in Post-COVID-19 Patients Improves Lung Function and Mechanics and Skeletal Muscle, and Immune Response

COVID-19 let sequelae beyond the respiratory system, including in skeletal muscle and in immune response. We evaluated the effects of 12 weeks of pulmonary rehabilitation (PR), 3x/week, constituted by aerobic and resistance training on 28 moderate and severe post-COVID-19 patients. The results demonstrated that PR improved lung function, FVC (p<0.02), FEV1 (p<0.02), FEV1/FVC (p<0.01), MEF25% (p<0.006), MEF50% (p<0.03), and MEF75% (p<0.02). PR improved lung mechanics, respiratory impedance (Z5hz, p<0.03);respiratory reactance (X5Hz, p<0.01), resistance of the whole respiratory systems (R5Hz, p<0.03), central airway resistance (RCentral, p<0.03), and peripheral airway resistance (RPeripheral, p<0.02). PR improved peripheral muscle strength, increasing right (p<0.02) and left (p<0.01) hand grip strength and respiratory muscle strength, increasing maximum inspiratory (p<0.02) and expiratory (p<0.03) pressure. Of note, PR reduced pulmonary inflammation (breath condensate), reducing the levels of pro-inflammatory cytokine IL-1beta (p<0.0001) and IL-6 (p<0.0001), while increased the levels of anti-inflammatory cytokine IL-1RA (p<0.0004) and IL-10 (p<0.003), beyond to increase the levels of IFN-gamma (p<0.0002) and IFN-beta (p<0.008). PR reduced the serum levels of pro-inflammatory IL-1beta (p<0.006) and IL-6 (p<0.01), while increased the levels of anti-inflammatory cytokine IL-1RA (p<0.0001) and IL-10 (p<0.0001), increasing the levels of IFN-gamma (p<0.02) and IFN-beta (p<0.001). PR reveals to be beneficial for post-COVID-19 patients, mitigating the sequelae observed in the respiratory system, skeletal muscle and in the immune response.

Similar pulmonary functional outcomes at 3 months in critical COVID-19 survivors of the first, second and third pandemic waves

Introduction: We don't known whether pharmacological treatments and adaptation of ventilatory support has changed the outcomes of intensive care unit (ICU) COVID-19 survivors during the consecutive waves (W) of the pandemics. Aims and objectives: To assess pulmonary functional outcomes, radiologic pattern and quality of life (QoL) in ICU COVID-19 survivors at 3 months, according to W of pandemics. Method(s): Patients admitted to ICU for COVID-19 acute respiratory distress syndrome (ARDS) in 2 university hospitals were prospectively included, and assessed 3 months post discharge by a chest CT Scan, pulmonary function test (PFT), 6-minute walking distance test (6MWDT), respiratory muscle strength (RMS), and Short Form 36 (SF-36) questionnaire. Result(s): 84 ARDS COVID -19 survivors were included. Hospital length of stay was shorter during W3 vs W1 (23.4 +/- 14.2 vs 34.7 +/- 20.8, p= 0.03). Less patients required mechanical ventilation (MV) during W2 vs W1 (33.3 % vs 63.9%, p=0.0038). Three months after discharge, PFT, 6MWDT and RMS were similar, regardless the W (p>0.05). QoL (SF-36) was worse for patients of W1 vs W3 (64.7+/- 16.3 vs 49.2 +/- 23.2, p= 0.0169). On multivariate analysis, MV was associated with decreased total lung capacity (TLC), forced expiratory volume in 1 sec (FEV1), diffusing capacity of CO (DLCO) and RMS (w1,2,3, p<0.05). Low SF-36 score was correlated with low 6MWDT (w3, p= 0.01). Glucocorticoids use was associated with better PFT and chest CT recovery (p=0.00001), and tocilizumab with higher TLC (w1, p=0.03). Remdesevir improved MV duration in w2 (p=0.008). Conclusions At 3 months, PFT remains similar in ICU survivors, regardless pandemic w.

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.

The effects of COVID-19 infection on respiratory muscle strength and trunk muscle endurance in healthy individuals

The study aims to evaluate the relationship between the endurance of the trunk muscles and the strength of the respiratory muscles among Novel Coronavirus Disease (COVID-19) survivors. The study included 20 participants divided into Experimental Group (10 COVID-19 survivors) and Control Group (10 healthy volunteers). Respiratory muscle strength, functional exercise capacity, core endurance, quality of life were assessed with The Micro Medikal Micro Respiratory Pressure Meter, Six-Minute Walking Test, McGill Core Endurance Test, and Short Form-36, respectively. Experimental Group had statistically lower scores in respiratory muscle strength, functional exercise capacity, core endurance and quality of life (p<0.05). In the light of current study, the physiotherapy and rehabilitation programs may include respiratory muscle training, aerobic exercises, and core training for COVID-19 survivors.

Pulmonary rehabilitation interventions in COVID-19 patients

Introduction: Owing to post-Covid 19 pulmonary sequelae, there are a considerable number of COVID-19 survivors requiring respiratory rehabilitation. We aim to reveal the impact of pulmonary rehabilitation as an effective intervention in these patients. Method(s): Prospective study of hospitalized patients with COVID-19 in pneumology department D of Abderahman Mami hospital. We evaluated symptoms and pulmonary function tests assessments in patients (N = 28) who participated in the pulmonary rehabilitation program,including respiratory muscle training and breathing exercises (twice a week for 6 weeks) at one month after discharge and 6 weeks after training. Result(s): The average age was 58.7 years. A severe lung involvement (>50%) was revealed in 25% (n=7). The most common comorbidities were hypertension (n=11) and diabetes (n=6). Common persistent symptoms post COVID 19pneumonia were: breathlessness (19cases with mean mMRC scale 1.82), fatigue (n=19) and cough (n=12). This study showed a significant decrease of persistent symptoms after 6 weeks: 2 cases of persistent dyspnea (mMRC scale 1 vs 1.82, p=0.03), 1 case of cough and 1 case of fatigue. Pulmonary function revealed statistically significant improvement after this program: TLC (73.2% vs 86.1%, p<0.01), FEV1 (93.4% vs 98.6%, p<0.01), FVC (89.4% vs 95.8%, p<0.01) and DLCO (63.9% vs 75.3%, p<0.01). A significant increase in distance traveled after the six-minute walk test was found (473 vs 517 meter, p<0.01). Respiratory muscle training improved maximum inspiratory pressure (PImax 70.5cmH20 vs 81.3, p<0.01) and maximum expiratory pressure (PEmax 80.4 cmH20 vs 87, p<0.01) Conclusion(s): Respiratory rehabilitation improve symptoms and pulmonary function after COVID-19 pneumonia.

Personalized rehabilitation of patients after COVID-19: the experience of the Republic of Mari El

Two years after the onset of the COVID-19 pandemic, not only the diagnosis and treatment, but also rehabilitation of patients at different times after the disease became relevant. The aim. To develop and analyze the efficiency of personalized hospital-based rehabilitation programs for COVID-19 patients. Methods. Retrospective analysis of medical records of 109 patients with COVID-19 admitted to the rehabilitation department. A team of physiotherapist, pulmonologist and psychiatrist used simulators (bicycle ergometer, treadmill, motomed, and stepper), physiotherapeutic exercises, training of respiratory muscles with Threshold IMT (Philips, Netherlands) simulators, psychotherapy, and physiotherapy. Results. A total of 109 patients, 59 (54%) men and 50 (46%) women, aged 56.54 +/- 11.73 years suffered from moderate (41%), severe (40%) and very severe (19%) COVID-19. 25% of the patients had concomitant diabetes mellitus, 65% - arterial hypertension, and 22% - ischemic heart disease. Patients with 5 rehabilitation points (5RP) on Rehabilitation Routing Scale walked a median distance of 110 [40;248] m in the 6-minute walk test (6MWT), 4RP - 300 [240;350] m in 6MWT, 3RP - 400 [360;431] m in 6MWT. The difference in 6MWT distance was significant only between 4RP and 3RP groups (p < 0.001). By the end of rehabilitation program, 6MWT increased by 90 m in 5RP group, by 120 m - in 4RP group, and by 89 m in patients with 3RP (p = 0.036 between RPs and 4RP groups;p = 0.007 between 3RP and 5RP groups, respectively). SpO2 was over 95% in all patients by the end of rehabilitation. Conclusion. Comorbid patients after severe COVID-19 demonstrated better rehabilitation potential seen as improvement of exercise tolerance and respiratory status. The original personalized rehabilitation programs improve significantly impaired body functions early on after severe COVID-19. Copyright © 2022 Medical Education. All rights reserved.

Model for Home-Based Physical Activity Program Utilizing Telemedicine for Fontan Patients

Introduction: Fontan patients have decreased exercise capacity. The COVID-19 pandemic exacerbated the variable adherence to hospital-based physical activity programs, which improve exercise capacity and attenuate the expected decline in aging Fontan patients. A positive pediatric exercise capacity trajectory has been reported to predict better adult Fontan outcomes. We designed and implemented a reimbursable 12-month, home-based, individualized physical activity program for Fontan patients utilizing a telemedicine model. Method(s): Eligible participants must be able to complete a cardiopulmonary exercise test (CPET) and demonstrate ability to adhere to a 12-month exercise prescription. Assent and consent are obtained. CPET and informal surveys of physical activity self-efficacy are completed at enrollment and graduation. An individualized exercise prescription is provided, with focus on skeletal and respiratory muscle strength training and aerobic activities. Participants receive a Garmin © device to monitor adherence. A cardiologist, nurse coordinator, and exercise physiologists comprise the team and regularly communicate with participants, starting with weekly check-ins that gradually space out to monthly as participants gain confidence. Result(s): Since program initiation, 9 participants have completed the program and 3 remain active. For the 9 graduates, all scheduled in-person and telehealth visits were completed. At completion of the 12-month program compared to baseline, there was no difference in maximal or submaximal oxygen consumption (VO2), peak heart rate, or oxygen saturation, but there was a significant increase in systolic blood pressure (144 +/- 16 vs 162 +/- 15, p-value 0.004) and minute ventilation (68.8 +/- 19.3 vs 76.8 +/- 22.1, p-value 0.012) at peak exercise. Per subjective report, all graduates had increased confidence related to exercise. There were no adverse events in any participant. Conclusion(s): A novel, home-based, 12-month individualized physical activity program using telemedicine was successfully implemented, with no adverse events. A larger study is needed to better assess change in VO2 and other qualitative and quantitative parameters, although the lack of decline in exercise capacity is encouraging.

Correlation Between Respiratory Muscles Power, Hand Grip Strength and Their Impact on Quality of Life in Post COVID-19 Patients

Background:After being released from the hospital, COVID-19 cases frequently report experiencing tiredness, dyspnea, muscle weakness, and mental agony. Method(s): The study involved 100 participants (both sexes, 30 to 50 years old) who had been COVID-19 for three to six months ago. A respiratory pressure meter was used to measure the highest possible inspiratory and expiratory pressures. A hand dynamometer was used to measure hand grip strength, while the Medical Outcomes Study Questionnaire Short Form 36 Health Survey was used to measure the quality of life (SF-36). Result(s): The results of Pearson correlation coefficients in post-Covid-19 cases showed a strong correlation between respiratory muscle strength and hand grip muscles. Additionally, respiratory muscle strength and hand grip strength had a significant impact on the quality of life of post-Covid-19 cases. (p <0.05). Conclusion(s): There was a correlation between the gripping power of the hands and the respiratory muscle strength in individuals who had undergone COVID-19 that in turn had effect on quality of life. This might aid in the efficient recovery of these patients. Copyright © 2022, Anka Publishers. All rights reserved.

A mortal Covid-19 case with SARS-CoV-2 variant VOC-202012/01 after two doses of CoronaVac vaccination, case report

Many countries have started their vaccination program against the ongoing COVID-19 pandemic. One of these countries, the Republic of Turkey began to use the CoronaVac vaccine and a large number of people in the country have been vaccinated so far. The efficacy rate of CoronaVac vaccine 14 days after two doses was reported as 83% for cases requiring medical treatment and 100% for hospitalization or severe-mortal cases. In addition, in a recent study, it was reported that Coronavac vaccine prevented 86.5% death due to covid-19 in the population over 60 years old, 14 days after receiving two doses of CoronaVac. The effectiveness of the vaccine in subgroups such as patients exposed to SARS-CoV-2 virus in less than 14 days, advanced age, comorbidity, and immunosuppression is not yet known. In addition, its effectiveness against different variants of the SARS-CoV-2 virus is not clear. An 85-year-old female patient with a positive SARS-CoV-2 Variant VOC-202012/01 Polymerase Chain Reaction test was admitted to the emergency department with dyspnea. The patient, whose tachycardia, tachypnea and auxiliary respiratory muscle use continued despite 60 L / min of 100% oxygen therapy with a high flow nasal cannula and whose PaO2 / fiO2 ratio was 63, was intubated. Bilateral widespread multifocal ground glass densities consistent with COVID-19 were observed in the thorax computed tomography. The patient, who was followed up in the intensive care unit, died on the 11th day of her follow-up. There are no cases of severe COVID-19 disease reported in the literature yet after the CoronaVac vaccine. In this case report, we present a severe COVID-19 patient with a positive PCR test for SARS-CoV-2 Variant VOC-202012/01 11 days after the second dose of CoronaVac administration. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.

Association or Causation? Rehabilitation of a Patient with Concurrent Covid-19 Pneumonia and Guillain Barre Syndrome: A Case Report

Case Diagnosis: Covid-19 Pneumonia with Guillain Barre Syndrome. Case Description or Program Description: A 53-year-old female with history of tobacco use presented to the ED after a week of bilateral leg weakness, ascending to the arms, and difficulty swallowing. Covid test was incidentally positive. She had 1+ upper extremity and absent lower extremity reflexes, and was admitted with clinical diagnosis of Guillain Barre Syndrome (GBS). Patient was pre-medicated with lorazepam and diphenhydramine prior to initiation of IVIG. Ten minutes into the infusion, she became acutely and persistently hypoxemic, requiring transfer to ICU with intubation and proning. CT Chest showed bilateral aspiration with collapse of posterior lobes. Thus, respiratory failure attributed to bulbar weakness. GBS was later confirmed by LP, EMG, and MRI Spine. Setting(s): Tertiary to inpatient rehabilitation hospital. Assessment/Results: Patient completed 5 day course of IVIG, and empiric treatment with Dexamethasone and Remdesivir. Her course was complicated by two bacterial pneumoniae and failed extubation requiring tracheostomy. At time of transfer to inpatient rehab, she received her first Covid vaccine and experienced only commonly reported side effects. She was successfully decannulated. Patient made excellent progress with PT and OT, progressing from Moderate Assistance to Independent levels. She had residual right plantarflexion weakness that benefited from a posterior leaf spring (PLS) brace. She ultimately discharged home with family. Discussion (relevance): Development of GBS with a Covid-19 infection or post-vaccination has been described in the literature, but as this case demonstrates, temporal association does not imply causation. Furthermore in this case, decreased mental status due to sedating medications in the setting of dysphagia led to massive aspiration, leading to a prolonged hospital course. Conclusion(s): In Covid patients with concurrent GBS, heightened vigilance is required for rapidly weakening swallowing and respiratory muscle dysfunction, compromising Covid-infected lungs. Special attention is necessary for the medical care and rehabilitation of these dual diagnosis patients.