Subacute Thyroiditis Following Vaccination with COVID-19 mRNA Vaccine

Introduction: Subacute thyroiditis is a self-limiting post-viral inflammatory disorder occurring in 3 phases (hyper-, hypo-, and euthyroidism) Post-vaccine thyroiditis has also been reported, but is rare. Case Description: A 36-year-old Emirati female presented to our clinic with generalized fatigue, mild to moderate vague neck pain, intermittent palpitations, and loss of appetite 2 weeks after receiving her first dose of Pfizer-BioNTech mRNA vaccine against COVID-19. Clinical examination findings and laboratory test results were consistent with subacute thyroiditis. Patient is a mother of 5 healthy children, youngest is breast-fed infant (11 months old). There was no history suggestive of postpartum thyroiditis and no family history of thyroid dysfunction. Physical examination at initial visit showed mild tachycardia, and a normal blood pressure. She weighed 66 kg. Thyroid function tests revealed a suppressed TSH of 0.011 muIU/mL, high Free T4 of >100 pmol/l), and Free T3 FT3 of 29.6 pmol/L. Both TSH receptor antibodies, and Thyroid antibodies (TPO) were negative. Thyroid scintigraphy showed decreased uptake in both lobes. Thyroid ultrasound showed hypoechoic heterogeneous echotexture of the thyroid gland with vascular conglomerate and micro-calcification, along with normal sized reactive lymph nodes at sternal angle. Symptoms aggravated through the next week;patient dropped 3kg of her body weight and her palpitations increased, with a recorded resting heart rate between 120-130 beats/min. TSH decreased to 0.001muIU/mL while FT4 remained high, with an improvement to 90 pmol/L. Subsequently, the patient started to regain weight. Palpitations improved within a month. She developed a biochemically hypothyroid picture followed by clinical and biochemical euthyroidism after one more month. Second dose of the vaccine was uneventful. Last evaluation was 10 months later;TSH, FT3 and FT4 were all in normal range, acute-phase reactants were completely normal and in complete remission. Discussion(s): The exact mechanism for post-vaccination subacute thyroiditis remains unknown, vaccine adjuvants may induce diverse autoimmune and inflammatory reaction. Subacute thyroiditis has rarely been reported with other COVID-19 vaccines contains no Polyethylene glycol (PEG). A possible cross-reactivity between thyroid cell antigens and spike protein of the coronavirus produced by mRNA vaccines might be responsible. Further research is needed to investigate the incidence of subacute thyroiditis in COVID-19 pandemic days.Copyright © 2023

Cystic fibrosis fitness during inpatient treatment

Background: Physical activity has been shown to have a positive impact on cystic fibrosis (CF) symptoms and slows decline in lung function. Additionally, moderate-intensity activities have been shown to improve sputum expectoration and oxygen saturation in children with CF, improving symptoms [1]. This study assessed whether using fitness trackers and providing a daily step goal would increase physical activity in hospitalized children with CF. Method(s): This pre-post pilot study included participants aged 6 to 21 who were admitted to the hospital for a pulmonary exacerbation of CF between October 2020 and November 2021. Garmin vivosmart 4 wrist-based activity trackers were issued, and baseline datawere tracked and analyzed for the first 2 study days. Pre-goal number of steps was defined as average number of steps taken on those 2 days. On study day 3, a step goal and menu of activities designed to increase physical activity were shared with the participants. Steps after goal settingwere defined as average number of steps taken on study day 3 and beyond while hospitalized, excluding day of discharge. Data collected from the medical record and the activity tracker web-based profile included daily oxygen requirement, daily step count, sleep duration, overnight pulse oximetry levels, resting heart rate, calories expended, and intensity minutes. The primary outcome of change in daily steps and attainment of step goals was analyzed using descriptive statistical testing, means, and standard deviations. Outpatient data were collected for 3 months to observe adherence to goals after discharge. Result(s): Eight participants aged 6 to 18 completed the study. Hospital length of stay ranged from 4 to 14 days. Participants took an average of 1508 +/- 1078 steps before goal setting, which increased to an average of 3704 +/- 1555 steps after the intervention. Step goals were met 56% of the time, although these data were highly variable. During the first week after hospital discharge, participants took an average of 6303 +/- 1786 steps per day (Figure 1).(Figure Presented) Figure 1. During the intervention, patients met their step goal 56% of the time, although this was highly variable. Two patients met their goal 100% of the time (9- year-old boy, 7-year-old girl), two met it 0% of the time (18-year-old boy, 17-year-old girl), one met it 44% of the time (6-year-old boy), and the remaining three met it 67% of the time (10-year-old girl, 17-year-old girl, 14-year-old boy). Conclusion(s): This intervention shows promise, with daily number of steps doubling from baseline during the intervention period. There was great variability among participants, suggesting that the approach helps some more than others. Enrollment was initially planned for 20 patients, but the SARS-CoV-2 pandemic and changes to CF therapy reduced hospitalizations during the study period. Outpatient data were analyzed for only the first week after discharge because of poor adherence to wearing the device. Although our results showa positive impact, further research is needed to determine the effect such an intervention would have on a larger scale. Future directions of research include determining potential clinical benefit from increased activity during hospitalization and prolonged follow-up to assess long-term benefits of intervention.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Effects of Covid-19 pneumonia on submaximal exercise tolerance

Introduction: After Covid-19 pneumonia, regular respiratory function assessment is necessary for the subsequent management of patients, including resting respiratory function tests and assessment of submaximal exercise tolerance by six-minute walk (6MW) test. Method(s): Six-minute walk test was undergone for 326 patients about 3 months after Covid-19 pneumonia. Physiological cost of walking (PCW) defined as the difference between maximum heart rate reached at the 6MWT and resting heart rate divided by walking speed was calculated. Result(s): Median age and BMI were respectively 61 [18-95] years-old and 30,4 [18,5-65,2] kg/m2 with a sex-ratio at 1.26. Smoking was reported in 52.8% of cases (12,45 PY). Median 6MW distance was 528 meters [48-832], corresponding of 80% [7-113] of theoric. Median PCW was 0,379 beats/meter [-1.38-5.38]. Low 6MW distance and low saturation during the test were found respectively in 33.1% and 15.2% of cases and were both correlated with DLCO (r=-0.258;p<10-3 and r=-0.423;p<10-3). Chronotropic insufficiency and chronotropic intolerance were found in 13.8% and 7% of cases. PCW was correlated with BMI (r=0.463;p<10-3), FEV1 (r=-0.175;p=0.001), FVC (r=-0.167;p=0.002) and DLCO (r=-0.161;p=0.004). Conclusion(s): Six-minute walk test is an inexpensive, easy and reliable tool that tells us about the global response to submaximal exercise, especially after Covid-19 pneumonia. It is an interesting alternative for patients follow-up, especially when rehabilitation is considered.

Physical condition and heart rate rest of yogyakarta rugby pon team players during the COVID-19 pandemic

Aim: To identify the correlation between different fitness indicators of rugby players in training conditions during quarantine related to Covid-19. Material and methods. The study involved athletes from PON Rugby DIY (n = 28, including 15 male athletes and 13 female athletes). To assess the level of physical fitness, the following tests were used: to assess the level of strength, push ups for 1 minute (number) and squats for one minute (number) were used;the yo-yo test was used to assess the level of endurance;speed was assessed using a 40 meter running test (s);agility by performing an Illinois agility test;power (speed-strength abilities) was assessed by the value of the vertical jump (cm);and for the heart rate was determined by the athlete independently within 60 seconds after waking up. The data collection method in this study is test and questionnaire. Data analysis was performed using Pearson correlation analysis using SPSS V 25 software. Results. It was shown that endurance has a strong correlation with power with r value (0.651) and significant p = 0.000. Speed ?also has a strong correlation with strength, as evidenced by the r (0.538) value with a significant p = 0.003. Strength has a strong correlation with power, as evidenced by the value of r (0.561) with a significant value of p = 0.002. Speed ?has a very strong correlation with agility, as evidenced by the value (0.935) with a significant p = 0.000. Conclusions. It was found that endurance does not correlate with resting heart rate, and endurance does not correlate with strength, because the load of the training program was not optimally implemented by athletes in the Covid-19 quarantine. © Antonius Tri Wibowo, 2020.

PCovNet+: A CNN-VAE anomaly detection framework with LSTM embeddings for smartwatch-based COVID-19 detection.

The world is slowly recovering from the Coronavirus disease 2019 (COVID-19) pandemic; however, humanity has experienced one of its According to work by Mishra et al. (2020), the study's first phase included a cohort of 5,262 subjects, with 3,325 Fitbit users constituting the majority. However, among this large cohort of 5,262 subjects, most significant trials in modern times only to learn about its lack of preparedness in the face of a highly contagious pathogen. To better prepare the world for any new mutation of the same pathogen or the newer ones, technological development in the healthcare system is a must. Hence, in this work, PCovNet+, a deep learning framework, was proposed for smartwatches and fitness trackers to monitor the user's Resting Heart Rate (RHR) for the infection-induced anomaly. A convolutional neural network (CNN)-based variational autoencoder (VAE) architecture was used as the primary model along with a long short-term memory (LSTM) network to create latent space embeddings for the VAE. Moreover, the framework employed pre-training using normal data from healthy subjects to circumvent the data shortage problem in the personalized models. This framework was validated on a dataset of 68 COVID-19-infected subjects, resulting in anomalous RHR detection with precision, recall, F-beta, and F-1 score of 0.993, 0.534, 0.9849, and 0.6932, respectively, which is a significant improvement compared to the literature. Furthermore, the PCovNet+ framework successfully detected COVID-19 infection for 74% of the subjects (47% presymptomatic and 27% post-symptomatic detection). The results prove the usability of such a system as a secondary diagnostic tool enabling continuous health monitoring and contact tracing.

Effects of Yoga on the Cardio-Respiratory System: Socio-Technical Effect to Reduce the Impact of the Pandemic on Indian Employees

This research paper is an initiative to provide insight associated with the physiological health of employees by examining the interventions of yogic exercise on physiological health. The investigation was done to study the impact of Yoga and Pranayama on functioning of lungs (vital capacity) and functioning of heart (resting heart rate) as an ancient therapy. The study found the effect of aerobic exercise and yogic practices on resting pulse rate and vital capacity among employees of a private organization engaged in production of technical equipment for Indian railway and metro trains and other related industries. After taking due consent from the promoter and founder of PPS International, the researchers randomly selected 120 subjects, all males of age group 25-35 years. Yoga helps to improve the lives of all age groups irrespective of gender. It can be adopted at any stage of life or started at any age;yoga has shown excellent results on the physiological health-related variable of stressed working professionals. Copyright © 2022, IGI Global.

Effect of Minimal Lifestyle Modification on Resting Heart Rate in Corporate Employees

Lack of physical activity along with improper diet, stress, sleep deprivation and habits like smoking negatively affects a corporate employee's long-term well-being. With repeated waves of COVID-19 pandemic happening, the proportion of those working from home in this group is rapidly increasing. It makes them more prone to a sedentary lifestyle thus raising the risk of future cardiovascular issues. Resting Heart Rate (RHR) is an established indicator of cardiac fitness. The aim of this study is to evaluate the effect of minimal lifestyle modification on RHR and thus the cardiac health of corporate employees. The study was conducted on 10 previously sedentary corporate employees who shifted to work from home mode post the pandemic. Participants incorporated a minimum of 30 minutes of moderate to vigorous intensity physical activity into their daily lifestyle according to the recommendations of the World Health Organisation (WHO). In addition, they were also advised to implement other lifestyle modifications such as dietary alteration, sleep regularity, etc. Measurement of the RHR of each participant was done regularly for a period of three months and an overall analysis was done at the end of the study. A total of 90 data sets were analysed. It was found that RHR decreased in all the participants by the end of the study duration. In addition, it was seen that endurance training combined with other lifestyle modifications gives a greater reduction in RHR in comparison with other modes of exercise. This study concluded that incorporating the WHO recommended physical activity in daily routine greatly helped in improving the cardiac health of previously sedentary work from home corporate employees. © 2022 IEEE.

WAS COVID A “BLESSING IN DISGUISE?” MAY-THURNER SYNDROME COMPLICATES COVID

CASE: A 30-year-old previously healthy male presented with three weeks of progressively worsening pain, erythema, swelling in his left thigh, inability to bear weight and associated fatigue, fever, and dyspnea on exertion. Four weeks prior, he experienced 1 week of anosmia, fatigue, and “even worse” dyspnea on exertion with a resting heart rate in excess of 110 bpm and felt he most likely had had COVID. He self-treated for symptoms, rested, isolated and felt he had improved from COVID. The pain and swelling in the left leg increased over the prior three weeks and he sought care. On exam the left thigh was warm to touch, erythematous, and painful. Ultrasound imaging revealed left lower extremity deep venous thrombosis (DVT) extending from his upper thigh to lower leg. Abdominal/thoracic CT w/ contrast noted diffuse pulmonary emboli and May-Thurner Syndrome (MTS). Treatment was started with IV heparin followed by thrombolytic therapy with higher dose heparin and alteplase for 3 days. Shortly after this therapy was initiated, he developed significant hypoxia and was transferred to the ICU. He was stabilized and on the final day of thrombolytic therapy, a left common iliac vein stent was placed and he was discharged two days later on Apixaban and aspirin. IMPACT/DISCUSSION: May-Thurner syndrome (MTS), is an anatomical variant that may lead to venous outflow obstruction due to extrinsic compression by the iliac arterial system against bony structures in the iliocaval venous territory. Most common in the left leg, MTS is present in about 20% of the population and is more commonly found in women. It can result in venous hypertension and venous thromboembolisms (VTE). In serious and untreated cases, these VTEs can progress to pulmonary embolisms with resultant serious injury, hospitalization, and death. In this case, a recent COVID infection unearthed an MTS anomaly. The activated proinflammatory state induced by COVID is known to result in blood clots in hospitalized patients and appears to be related to a cytokine storm. This inflammatory state induces endothelial damage, microvascular thrombosis, and possibly pro-thrombotic antiphospholipid antibodies. In hospitalized patients with more severe disease VTE is commonly diagnosed, however the risk of COVID related coagulopathy in the outpatient setting is unknown. It appears that when blood clots do develop in outpatients, 1/5 have had a recent COVID infection which indicates an association between inflammation from infection contributes to VTE. In this case, the COVID complication helped to uncover a May-Thurner anomaly. CONCLUSION: - Delayed presentation can exacerbate COVID-related complications, even after acute symptoms have diminished - more should be done to educate patients on the dangers of post COVID thromboembolic disease. - Despite its prevalence in females, May-Thurners Syndrome should be in the differential for males with DVT.

PCovNet: A presymptomatic COVID-19 detection framework using deep learning model using wearables data.

While the advanced diagnostic tools and healthcare management protocols have been struggling to contain the COVID-19 pandemic, the spread of the contagious viral pathogen before the symptom onset acted as the Achilles' heel. Although reverse transcription-polymerase chain reaction (RT-PCR) has been widely used for COVID-19 diagnosis, they are hardly administered before any visible symptom, which provokes rapid transmission. This study proposes PCovNet, a Long Short-term Memory Variational Autoencoder (LSTM-VAE)-based anomaly detection framework, to detect COVID-19 infection in the presymptomatic stage from the Resting Heart Rate (RHR) derived from the wearable devices, i.e., smartwatch or fitness tracker. The framework was trained and evaluated in two configurations on a publicly available wearable device dataset consisting of 25 COVID-positive individuals in the span of four months including their COVID-19 infection phase. The first configuration of the framework detected RHR abnormality with average Precision, Recall, and F-beta scores of 0.946, 0.234, and 0.918, respectively. However, the second configuration detected aberrant RHR in 100% of the subjects (25 out of 25) during the infectious period. Moreover, 80% of the subjects (20 out of 25) were detected during the presymptomatic stage. These findings prove the feasibility of using wearable devices with such a deep learning framework as a secondary diagnosis tool to circumvent the presymptomatic COVID-19 detection problem.

THE FEATURE OF ATRIAL FIBRILLATION OCCURRENCE AND PROGRESSION IN PATIENTS WITH ARTERIAL HYPERTENSION, WHO HAVE UNDERGONE COVID-19

Objective: COVID-19 pandemic has a rather negative effect on patients with cardiovascular pathology. AH is one of the main reasons for the remodeling process in AF patients and makes a significant contribution to the development of heart structural changes. The aim of this study is to identify the feature of AF occurrence and progression in patients with AH, who have undergone COVID-19. Design and method: In this study where enrolled 91 patients with AH and nonvalvular paroxysmal/persistent AF, who have undergone COVID-19 (first group). As a control group 109 patients with AH and AF, but without have undergone COVID- 19 were also examined (second group). The database consisting of indices that characterize the clinical, hemodynamic and structural-functional state of the heart, were analyzed by SPSS 13. Results: The obtained results showed that in the first group patients were signifi- cantly older than in the second group (mean age 71.6 ± 7.4 vs. 61.6 ± 6.4 years, p < 0.001). Resting heart rate was significantly higher in patients from first group in comparison with second group (86.6 ± 6.2 vs. 76.9 ± 7.8 beat/min, p < 0.01). In first group body mass index of patients was significantly more than in second group (33.9 ± 1.5 vs. 31.6 ± 1.8 kg/m2, p < 0.05). In the first group the prevalence of patients with uncontrolled AH were statistically significantly higher, than in the second group (54% vs. 23%, p < 0.001). In those patients the doses of antihypertensive medications taken were either increased or the antihypertensive treatment were revised. Moreover, in the first group the frequency of hypertensive crises was nearly twofold higher (31% vs. 17%, p < 0.001). It was revealed that the left atrium diameter in patients of the first group was significantly greater than in the second (44.3 ± 1.4 vs.41.2 ± 1.1 mm, p < 0.05);but systolic and diastolic dysfunction did not significantly differ in both groups. Conclusions: The obtained results indicate that in patients with AH who have undergone COVID-19, the onset of AF has some features, namely;uncontrolled AH, frequent hypertensive crises, tachycardia, overweight and older age. As well as left atrium more large dilation compared with second group that did not undergo a viral infection.

ELEVATED RESTING HEART RATE AS INDEPENDENT IN-HOSPITAL PROGNOSTIC MARKER IN COVID-19

Objective: SARS-CoV-2 infection could be complicated by serious autonomic imbalance caused directly by the virus or through secondary release of inflammatory cytokines. Some studies suggested that elevated resting heart rate (HR) and resting tachycardia, being markers of an increased adrenergic cardiac drive, are associated with poor prognosis in COVID-19 syndrome. Design and method: We performed a retrospective analysis in an inpatient cohort of 389 subjects diagnosed with SARS-CoV-2 infection to investigate the prognostic relevance of HR in predicting the maximum care intensity needed during hospitalization according to the following four severity outcome classes: I) no need for oxygen support/ need for low flow oxygen therapy;II) need for high flow oxygen therapy/continuous positive airway pressure;III) transfer to the Intensive Care Unit;IV) death. HR assessments were recorded on admission and during the first 3 and 7 days of hospitalization. Results: For each class increase in maximum care intensity we observed a corresponding significant increase in HR, considering both data collected on admission (average HR value: 90.1 ± 17 beats/minute, p-value trend = 0.0397), and during the first 3 days (p-value trend < 0.0006) or 7 days (p-value trend < 0.0001) of hospitalization. The significant trend was maintained after adjustment for age, sex, comorbidities and fever and in the subpopulation of patients (n = 118) not receiving drugs potentially active on HR both before and during hospitalization. Kaplan- Meier curves for survival based on HR displayed a significant decreased survival in patients with higher HR. Conclusions: The assessment of HR during hospitalization provides information on the clinical outcome of patients affected by SARS-CoV-2 infection independently of other confounders. HR as an in-hospital prognostic marker can be obtained both through a first assessment at the admission or mean values over the course of hospitalization with an increase of its accuracy by a 7-days longitudinal evaluation. Further studies might elucidate the association between SARS-CoV-2 infection with multiple autonomic abnormalities.

VR content for Non contact job training and experience

This paper proposes virtual reality content for non-face-to-face job education and job experience With the development of digital devices and communication technology, online communities are emerging, and people's lifestyles are also changing. Recently, due to COVID-19, telecommuting and online classes through video conferencing programs have been conducted, and they have also begun to be used for interviews. However, job training and hands-on activities other than classes after employment were mainly conducted offline, and virtual reality content was devised for non-face-to-face job education and job experience First, it was developed for the purpose of job experience, and content was produced under the theme of horticulture artists who are not well recognized as jobs but perform familiar tasks. It was configured similarly to the natural environment with the aim of rapid adaptation of users. In addition, heart rate data through heart rate sensors were used to induce intensive participation in the content of users and to elicit emotional stability.

Effect of home-based smartphone-supported high-intensity interval training on cardiorespiratory fitness in breast cancer survivors: A randomized controlled trial of the habit-B program

Background: A strategy for maintaining and/or improving cardiorespiratory fitness (CRF) in the growing population of cancer survivors is of major clinical importance in the COVID-19 era. With the aim of increasing CRF, recent studies have focused on the use of high-intensity interval training (HIIT) in supervised experimental settings, which appeared to be more beneficial than usual care in cancer survivors at all stages of treatment and aftercare. However, the effect of unsupervised HIIT on increasing CRF in breast cancer survivors is not known. Purpose: To determine whether the newly developed habit-B program, which involves home-based smartphone-supported HIIT using body-weight exercises, improves CRF in early-stage breast cancer survivors. We hypothesized that the habit-B program would improve VO2peak compared with a control group. Methods: This single-center, 12-week, parallel-group, single-blind, randomized controlled trial involved 50 women with stage I-IIa breast cancer, aged 20 to 59 years, who had completed initial treatment except for hormone therapy. Participants wore a smartwatch and were randomized to either the exercise or control group from May 27, 2019 through November 30, 2020. The planned sample size was 60 Spatients to detect the increase of 2.0 ml/kg/min change in VO2peak with a standard deviation of 2.6 ml/kg/min, one-sided significance level of 2.5% and 80% power. The exercise group underwent home-based HIIT using a smartphone and a Fitbit Versa thrice weekly for 12 weeks (three times per week). The primary outcome was the 12-week change in peak oxygen uptake (VO2peak;mL/kg/min) between the groups. Other outcomes included muscle strength, 6-min walk test, resting heart rate, physical activity, fatigue, safety, and quality of life. Results: Of the 50 participants, 44 (exercise group, n=23;control group, n=21) completed the CRF assessment and 6 did not because of issues related to the COVID-19 pandemic. The change in VO2peak increased significantly in the exercise group (0.9 [95%CI, 0.1 to 1.7]) compared with the control group (-0.8 [95%CI,-1.5 to-0.1]) (mean difference, 1.7 [95% CI, 0.7 to 2.7], p <.01). Leg strength also increased significantly in the exercise group compared with the control group (mean difference, 13.5 [95% CI, 2.9 to 24.1], p <.01). Changes in other outcomes were not significantly different between the groups. Conclusion: A home-based HIIT intervention can lead to improved cardiorespiratory fitness and muscle strength in early-stage breast cancer survivors;however, a multicenter pragmatic clinical trial is required to confirm the benefits of the habit-B program.

The benefits of home based telemonitored cardiac rehabilitation exercise program among patients with reduced ejection fraction heart failure: Its significance on covid-19 pandemic

Objectives: This study is a randomized clinical trial aimed to investigate the effects of a home-based cardiac rehabilitation exercise program with social media-based supervision on NT-proBNP level and functional capacity of heart failure with reduced ejection fraction patients. Methods: We randomly recruited 25 subjects with left ventricle ejection fraction <40%, early after heart failure hospitalisation, resting heart rate <100 bpm, NYHA class I and II, and 6MWT entry test >100 m. Subjects were allocated into combination of hospital and home group (Control Group/CG) (n=12) and the home group under supervision of videocall telemonitor using WhatsApp (Intervention Group/IG) (n=13). Both groups got an exercise program 5 times / week, moderate intensity, 30 minutes per session for 4 weeks. The endpoint is a change in NTproBNP level and 6 minute walk distance (6MWD) at week 4 as a marker of increased functional capacity. Results: The groups have similar baseline characteristics. There was a significant decrease in NT-proBNP levels in IG and CG (2834±1546.39 pg/ mL and 3340±853.18 pg/mL, p=0.001 vs 0.041). Comparative analysis of changes in NT-proBNP level between the two groups did not show a significant difference (p=0.979). Post-intervention NT-proBNP levels in the IG group were 2553±778.86 pg/mL and CG group 2448.90±701.84 pg/mL, p=0.852. The 6MWT distance increased significantly in both groups (IG and CG 29.92±30.95 m vs 69.75±75.68 m, p=0.005 vs 0.009, respectively), mean increase in CG was higher than IG, but not significant (p=0.225). Postintervention 6MWD result of the IG was 340.92±109.38 m, and CG 378.42± 142.69 m, p=0.401. Conclusion: Home-based telemonitored cardiac rehabilitation with social media supervision (using WhatsApp) programs has comparable effectiveness as the combined cardiac rehabilitation program. In current COVID-19 pandemic, home-based telemonitored cardiac rehabilitation program can be implemented with similar benefit as conventional program.

Cystic fibrosis fitness during inpatient treatment

Purpose of Study Cystic Fibrosis (CF) is a progressive, genetic disease that affects over 30,000 individuals across the nation and results in decreased functionality of the lungs. Physical activity has a positive impact on the symptoms of CF and works to slow the decline in lung function. Additionally, activities with moderate intensity have been shown to improve sputum expectoration and oxygen saturation in children with CF. This study assessed whether using fitness trackers and providing a daily step goal would increase physical activity in hospitalized children and young adults with CF. Methods Used This prospective study included participants 6- 21 years of age who were admitted to the hospital for a pulmonary exacerbation of CF between October 2020-May 2021. Study enrollment occurred no more than 48 hours after hospital admission. Garmin vivosmart® 4 wrist-based activity trackers were issued and baseline data were tracked and analyzed for the first 2 study days. Pre-goal steps were defined as the average of steps taken on those 2 days. On study day 3, a step goal and menu of activities designed to increase physical activity were shared with the participant. Steps after goal setting were defined as the average of steps taken on study day 3 and beyond, excluding day of discharge. Data were collected from the electronic medical record and the activity tracker web-based profile and included the following: daily oxygen requirement, daily step count, sleep duration, overnight pulse oximetry levels, resting heart rate, calories expended, and intensity minutes. The primary outcome of change in daily steps and attainment of step goals was analyzed using descriptive statistical testing, means and standard deviations. Summary of Results Six patients, aged 6-18 years, completed the study. Mean baseline FEV1for study participants was 66% predicted (range 38 to 92%). Hospital length of stay ranged from 4-14 days. Participants took an average of 1772 ± 1011 steps before goal setting. This increased to an average of 3741 ± 1780 steps after goal setting. Overall, step goals were met 52% (Range 0-100%) of the time. Conclusions This intervention shows promise, as daily steps doubled from baseline during the intervention period. There was great variability among the participants, suggesting the device may help some people much more than others. Enrollment was initially planned for 20 patients;however, the SARS-CoV-2 pandemic and consequent changes to CF therapy drastically reduced hospitalizations during the study period. Though our results show a positive impact of increased physical activity following goal implementation, further research is needed to determine the effect such an intervention would have on a larger scale. Future directions of research include having a larger sample size, conducting a multi-center study to increase population diversity, and implementing a longer follow- up period to better assess long term benefits of intervention.

Elevated resting heart rates are a risk factor for mortality among patients with coronavirus disease 2019 in Wuhan, China.

BACKGROUND: We evaluated the association between higher resting heart rates (RHRs) and adverse events in COVID-19 patients. METHODS: One hundred and thirty-six patients with laboratory-confirmed COVID-19 were admitted. Outcomes of patients with different RHRs were compared. RESULTS: Twenty-nine patients had RHRs of <80 bpm (beat per min), 85 had 80-99 bpm and 22 had ≥100 bpm as tachycardia. Those with higher RHRs had lower pulse oxygen saturation (SpO2) and higher temperatures, and there was a higher proportion of men upon admission (all P < 0.05). Patients with higher RHRs showed higher white blood cell counts and D-dimer, cardiac troponin I (TnI), N-terminal pro-B-type natriuretic peptide and hypersensitive C-reactive protein levels, but lower albumin levels (all P < 0.05) after admission. During follow-up, 26 patients died (mortality rate, 19.1%). The mortality rate was significantly higher among patients with tachycardia than among the moderate and low RHR groups (all P < 0.001). Kaplan-Meier survival curves showed that the risks of death and ventilation use increased for patients with tachycardia (P < 0.001). Elevated RHR as a continuous variable and a mean RHR as tachycardia were independent risk factors for mortality and ventilator use (all P < 0.05) in the multivariable adjusted Cox proportional hazards regression model. CONCLUSIONS: Elevated average RHRs during the first 3 days of hospitalisation were associated with adverse outcomes in COVID-19 patients. Average RHRs as tachycardia can independently predict all-cause mortality.

P.0518 Effects of COVID-19 lockdowns on well-being in subgroups of the population

Introduction: The unprecedented restrictions imposed due to the COVID-19 pandemic, including movement control orders and lockdowns, altered our daily habits, and severely affected our well-being and physiology. Aims: The studies described in this work were designed to explore the effects of COVID-19 related lockdowns on well-being indicators in different population groups in Israel. Methods: We studied the effects of lockdown in three cohorts: (1) 169 individuals from the general population;(2) 91 undergraduate students and (3) 39 women within fertility age. We used wearable devices (FitBit® smartwatches and TempDrop® sensor), a smartphone app, sleep logs (for up to 5 weeks) and online (Qualtrics®) questionnaires to evaluate multiple well-being indicators before, during and after lockdown in Israel. We used a mixed ANOVA model to study the interplay between different factors on well-being before and after lockdowns. Results: Studies demonstrate effects on sleep latency and/or patterns during lockdown. Moreover studies indicate changes in mood, activity levels, social encounters, resting heart rate (RHR) and menstrual cycle length related to lockdown. In cohort (1) lockdown resulted in decreased mood (p<0.001), increased sleep duration (p<0.001) delayed midsleep point during workdays (p=0.07) and weekends (p=0.02), reduced social encounters (p<0.001), and reduced RHR (p=0.05). Moreover, the data suggest differential effects of lockdown in sub-groups with lower mood (p=0.05) and lower activity (p=0.01) in younger individuals, increased stress (p=0.01), reduced social encounters (p=0.03) and reduced RHR (p=0.06) in females. The strongest reduction in mood was shown in young individuals with early chronotype (p=0.02) while largest change in sleep duration was shown in young people with late chronotype (p=0.04) and older subjects with early chronotype (p=0.04). In cohort (2), There were effects of lockdown (p=0.02) and chronotype (p=0.05) on sleep duration. Increased sleep during lockdown and in early chronotypes. Females slept more during lockdown (p=0.01) and students who work slept less (p=0.02). Midsleep point free days (MSF) was delayed during lockdown (p=0.001) with MSF of late chronotypes later than MSF of early chronotypes (p<0.001). For cohort (3) changes in menstrual cycle length where heterogeneous showing increase, decrease or no change due to lockdown. Interestingly, length of the cycle normalized to pre-lockdown conditions when lockdown was over with women who had increase from pre-lockdown to lockdown had decrease from lockdown to post-lockdown and vice versa. Statistical analysis (mixed ANOVA) of cycle length across time with direction of change as main factor shows no main effects but a highly significant interaction (p<0.001) indicating a different pattern of change across time for each of the groups. Additional findings from this cohort show delay of MSF during lockdown (p=0.002) and an interesting correlation between MSF and menstrual cycle length (p=0.04). Conclusions: COVID-19 lockdowns in Israel had significant effects on the wellbeing of the population with possibly more severe effects in specific subgroups including younger people and females with involvement of additional factors including work status and chronotypes. Hopefully, these lockdown-induced adverse changes can naturally normalize after lockdown ends as shown with the length of the menstrual cycle in cohort (3). No conflict of interest

Early detection of exacerbation of the severe acute respiratory syndrome coronavirus 2 infection using Fitbit (DEXTERITY pilot study)

Some patients with coronavirus disease 2019 (COVID-19) experienced sudden death because of sudden symptom deterioration. Thus, an alarm system that could detect early signs of COVID-19 exacerbation beforehand, to prevent serious illness or death of patients while receiving outpatient treatment at home or in hotels is necessary. Here, we tested whether estimated oxygen variations (EOV), a relative physiological scale that represents users' blood oxygen saturation level during sleep measured by Fitbit, predicted COVID-19 symptom exacerbation. Study period was from August to November 2020. We enrolled 23 COVID-19 patients diagnosed by SARS-CoV-2 polymerase chain reaction-positive (mean age ± standard deviation, 50.9±20 years;70% female), let each patient wore the Fitbit for 30 days;COVID-19 symptoms were exacerbated in 6 (26%). High EOV signal (a patient's oxygen level exhibits significant dip and recovery within the index period) had 80% sensitivity before symptom exacerbations, whereas resting heart rate signal only had 50% sensitivity. Coincidental obstructive sleep apnea syndrome confirmed by polysomnography was detected in a patient by consistently high EOV signals. This pilot study successfully detected early COVID-19 symptoms exacerbation by measuring EOV and may help to identify early signs of COVID-19 exacerbation.

Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection

During the pandemic, several studies were carried out on the short-term effects of acute SARS-CoV-2 infection in athletes. As some cases of young athletes with serious complications like myocarditis or thromboembolism and even sudden death were reported, strict recommendations for return to sport were published. However, we have less data about athletes who have already returned to high-intensity trainings after a SARS-CoV-2 infection. Athletes underwent cardiology screening (personal history, physical examination, 12-lead resting ECG, laboratory tests with necroenzyme levels and echocardiography) 2 to 3 weeks after suffering a SARS-CoV-2 infection. In case of negative results, they were advised to start low intensity trainings and increase training intensity regularly until achieving maximal intensity a minimum of 3 weeks later. A second step of cardiology screening was also carried out after returning to maximal intensity trainings. The above mentioned screening protocol was repeated and was completed with vita maxima cardiopulmonary exercise testing (CPET) on running treadmill. If the previous examinations indicated, 24h Holter ECG recording, 24h ambulatory blood pressure monitoring or cardiac MR imaging were also carried out. Data are presented as mean±SD. Two-step screening after SARS-CoV-2 infection was carried out in 111 athletes (male:74, age:22.4±7.4y, elite athlete:90%, training hours:14.8±5.8 h/w, ice hockey players:31.5%, water polo players:22.5%, wrestlers:18.9%, basketball players:18.0%). Second screenings were carried out 94.5±31.5 days after the first symptoms of the infection. A 5% of the athletes was still complaining of tiredness and decreased exercise capacity. Resting heart rate was 70.3±13.0 b.p.m., During CPET examinations, athletes achieved a maximal heart rate of 187.3±11.6 b.p.m., maximal relative aerobic capacity of 49.2±5.5 ml/kg/min, and maximal ventilation of 138.6±31.2 l/min. The athletes reached their anaerobic threshold at 87.8±6.3% of their maximal aerobic capacity, with a heart rate of 93.3±3.7% of their maximal values. Heart rate recovery was 29.9±9.2/min. During the CPET examinations, short supraventricular runs, repetititve ventricular premature beats + ventricular quadrigeminy and inferior ST depression were found in 1-1 cases. Slightly higher pulmonary pressure was measured on the echocardiography in 4 cases. Hypertension requiring drug treatment was found in 5.4% of the cases. Laboratory examinations revealed decreased vitamin D3 levels in 26 cases, decreased iron storage levels in 18 athletes. No SARS-CoV-2 infection related CMR changes were revealed in our athlete population. Three months after SARS-CoV-2 infection, most of the athletes examined had satisfactory fitness levels. However, some cases of decreased exercise capacity, decreased vitamin D3 or iron storage levels, arrhythmias, hypertension and elevated pulmonary pressure requiring further examinations, treatment or follow-up were revealed.

Bhramari Pranayama - A simple lifestyle intervention to reduce heart rate, enhance the lung function and immunity.

Individuals with chronic diseases have a higher risk of infection and show lung function impairment. Poor lifestyle choices such as physical inactivity, poor diet, stress, excess tobacco, and alcohol, and sleep disruption increase the risk of chronic inflammation and immune impairment but the evidence does not quantify the specific risk factor(s) and their correlation with the immune system impairment. COVID-19 related uncertainty has created a more urgent need to understand the need to identify interventions that could help in managing the risk factors, especially for healthy individuals who are at a higher risk of infection and/or immune system impairment. The role of three parameters, the Resting Heart Rate (HR), increased Heart Rate Variability (HRV), and lung function is considered as risk factors for systemic inflammation and chronic diseases. The evidence on Bhramari Pranayama is presented for possible lifestyle interventions to reduce the risk of infection, increase lung function, enhance autonomic function, and improve sleep quality in healthy individuals.