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1.
J Int Med Res ; 49(11): 3000605211056783, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1533180

ABSTRACT

The ongoing global administration of vaccines for coronavirus disease 2019 (COVID-19) means that increasing numbers of patients are likely to present with post-vaccination complications. We describe the first reported case of neuralgic amyotrophy (NA) involving the lumbosacral plexus occurring after AstraZeneca COVID-19 vaccination. The patient presented with acute-onset leg paralysis following administration of the vaccine. Based on the clinical, electrodiagnostic, and radiologic findings, the patient was diagnosed with post-vaccination NA. We speculate that the COVID-19 vaccine elicited an immune-mediated inflammatory response to the injected antigen due to inflammatory immunity in a patient with predisposed susceptibility to NA.


Subject(s)
Brachial Plexus Neuritis , COVID-19 , Brachial Plexus Neuritis/chemically induced , Brachial Plexus Neuritis/diagnosis , COVID-19 Vaccines , Humans , Leg , Lumbosacral Plexus , Paraplegia , SARS-CoV-2 , Vaccination/adverse effects
3.
Surg Radiol Anat ; 43(12): 2071-2076, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1371354

ABSTRACT

PURPOSE: An antegrade approach is frequently used in catheter-directed thrombolysis to remove deep-vein thrombosis. However, the antegrade approach is difficult when accessing veins with small diameters; therefore, understanding the variation of deep calf vein is important. METHODS: This study measured the diameters and surface areas of the proximal and distal posterior tibial vein, peroneal vein, and anterior tibial vein to determine which are preferable for venous access. This study dissected 132 legs from Korean and Thai cadavers. The proximal and distal posterior tibial vein, peroneal vein, and anterior tibial vein were scanned and measured. RESULTS: The mean diameter and surface area were largest for the proximal tibial vein, at 6.34 mm and 0.312 cm2, respectively, followed by the anterior tibial vein (5.22 mm and 0.213 cm2), distal posterior tibial vein (3.29 mm and 0.091 cm2), and peroneal vein (3.43 mm and 0.081 cm2). The proximal posterior tibial vein and anterior tibial vein have large diameters and surface areas, which make them ideal for applying an antegrade approach in catheter-directed thrombolysis. CONCLUSIONS: The distal posterior tibial vein and peroneal vein are not recommended due to their smaller surface areas and also the anatomical variations therein.


Subject(s)
Leg/anatomy & histology , Leg/blood supply , Thrombolytic Therapy/methods , Adult , Aged , Aged, 80 and over , Cadaver , Catheters , Female , Humans , Male , Middle Aged , Thrombolytic Therapy/instrumentation , Veins/anatomy & histology
5.
Biomolecules ; 11(7)2021 07 20.
Article in English | MEDLINE | ID: covidwho-1323104

ABSTRACT

We report the case of a 77-year-old woman affected by coronavirus disease-19 (COVID-19) who developed an occlusive arterial disease of the lower limb requiring a left leg amputation. We studied the mechanisms of vascular damage by SARS-CoV-2 by means of a comprehensive multi-technique in situ analysis on the diseased popliteal arterial district, including immunohistochemistry (IHC), transmission electron microscopy (TEM) and miRNA analysis. At histological analyses, we observed a lymphocytic inflammatory infiltrate, oedema and endothelialitis of adventitial vasa vasorum while the media was normal and the intima had only minor changes. The vasa vasorum expressed the ACE2 receptor and factor VIII; compared with the controls, VEGFR2 staining was reduced. TEM analyses showed endothelial injury and numerous Weibel-Palade bodies in the cytoplasm. No coronavirus particle was seen. IL-6 protein and mRNA, together with miR-155-5p and miRs-27a-5p, which can target IL-6, were significantly increased compared with that in the controls. Our case report suggests an involvement of adventitial artery microcirculation by inflammation in the course of COVID-19. Without evident signs of current infection by SARS-CoV-2, endothelial cells show a spectrum of structural and functional alterations that can fuel the cardiovascular complications observed in people infected with SARS-CoV-2.


Subject(s)
Arterial Occlusive Diseases/etiology , COVID-19/complications , Inflammation/etiology , Aged , Arterial Occlusive Diseases/pathology , COVID-19/pathology , Female , Humans , Inflammation/pathology , Leg/blood supply , Leg/pathology , MicroRNAs/analysis , Microcirculation , SARS-CoV-2/isolation & purification
6.
Respir Med ; 186: 106530, 2021 09.
Article in English | MEDLINE | ID: covidwho-1316624

ABSTRACT

BACKGROUND: Surgical (SM) or cloth facemasks (CM) has become mandatory in many public spaces during the COVID-19 pandemic. They may interfere with the participation in physical activities. OBJECTIVE: To evaluate how these masks influence dyspnoea (primary outcome), exercise performance and cardiorespiratory response during a 1-min sit-to-stand test (1STST), and to assess masks discomfort sensations. METHODS: A randomized crossover trial was conducted in healthy adults. They performed 3 1STST (with either no mask (NM), a SM, or a CM) separated from each other by 24-72 h. The number of 1STST repetitions and leg rate of perceived exertion (RPE) were measured. Dyspnoea (Borg scale), hearth rate, respiratory rate and SpO2 were recorded before and at the end of 1STST, as well as after a short resting period. Several domains of subjective discomfort perceptions with masks were assessed. RESULTS: Twenty adults aged 22 ± 2y (11 males) were recruited. Wearing the CM generated significantly higher dyspnoea than NM at all time points, but it only became clinically relevant after the 1STST (median difference, 1 [95%CI 0 to 1]). The SM generated a small but significant higher leg RPE than NM (median difference, 1 [95%CI 0 to 1]). The masks had no impact on 1STST performance nor cardiorespiratory parameters. Both masks were rated similarly for discomfort perceptions except for breathing resistance where CM was rated higher. CONCLUSIONS: In healthy adults, the CM and SM had minimal to no impact on dyspnoea, cardiorespiratory parameters, and exercise performance during a short submaximal exercise test.


Subject(s)
COVID-19 , Dyspnea/etiology , Exercise Test , Exercise/physiology , Healthy Volunteers , Leg/physiology , Masks/adverse effects , Physical Exertion/physiology , Sensation/physiology , Cross-Over Studies , Female , Heart Rate/physiology , Humans , Male , Respiration , Young Adult
7.
Obesity (Silver Spring) ; 29(7): 1146-1154, 2021 07.
Article in English | MEDLINE | ID: covidwho-1293295

ABSTRACT

OBJECTIVE: Studies have shown that fidgeting augments metabolic demand and increases blood flow to the moving limbs, whereas prolonged sitting suppresses these factors and exacerbates postprandial glucose excursions. Therefore, the hypothesis of this study was that leg fidgeting during prolonged sitting would improve postprandial glycemic control. METHODS: Adults with obesity (n = 20) participated in a randomized crossover trial in which blood glucose and insulin concentrations were measured during a 3-hour sitting period following the ingestion of a glucose load (75 g). During sitting, participants either remained stationary or intermittently fidgeted both legs (2.5 minutes off and 2.5 minutes on). Accelerometer counts, oxygen consumption, and popliteal-artery blood flow were also measured during the sitting period. RESULTS: As expected, fidgeting increased accelerometer counts (P < 0.01), oxygen consumption (P < 0.01), and blood flow through the popliteal artery (P < 0.05). Notably, fidgeting lowered both glucose (P < 0.01) and insulin (P < 0.05) total area under the curve (AUC) and glucose incremental AUC (P < 0.05). Additionally, there was a strong negative correlation between fidgeting-induced increases in blood flow and reduced postprandial glucose AUC within the first hour (r = -0.569, P < 0.01). CONCLUSIONS: Leg fidgeting is a simple, light-intensity physical activity that enhances limb blood flow and can be incorporated during prolonged sitting to improve postprandial glycemic control in people with obesity.


Subject(s)
Leg , Sitting Position , Adult , Blood Glucose , Cross-Over Studies , Glycemic Control , Humans , Insulin , Obesity , Postprandial Period , Sedentary Behavior
9.
BMJ Case Rep ; 14(3)2021 Mar 16.
Article in English | MEDLINE | ID: covidwho-1138311

ABSTRACT

We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our Emergency Department with left-sided back pain followed by acute left leg swelling. Blood tests showed significantly raised C-Reactive Protein and D-Dimer. CT-Abdomen-Pelvis demonstrated a large mass in the region of the right ovary with suspicious heterogeneous filling defects in the left external iliac vein, confirmed as a left-sided deep-vein thrombosis on ultrasound Doppler. MRI revealed the lesion to be cystic and the deep venous thrombosis was treated with twice-daily Clexane. Prior to removal of the cyst, an Inferior Vena Cava Filter was placed to reduce thromboembolic risk. The cyst was resected without complication and the postoperative period was uneventful. This case occurred while face-to-face services were limited by COVID-19 and illustrates the need for robust systemic measures to safeguard patients against the emergency sequelae of insidious gynaecological pathology.


Subject(s)
Back Pain/etiology , Diagnostic Imaging/methods , Ovarian Cysts/complications , Ovarian Cysts/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/etiology , Adult , Diagnosis, Differential , Enoxaparin/therapeutic use , Female , Fibrinolytic Agents/therapeutic use , Humans , Leg , Magnetic Resonance Imaging , Ovarian Cysts/surgery , Ovary/diagnostic imaging , Ovary/surgery , Tomography, X-Ray Computed , Ultrasonography, Doppler , Venous Thrombosis/drug therapy , Young Adult
10.
BMC Anesthesiol ; 21(1): 64, 2021 03 02.
Article in English | MEDLINE | ID: covidwho-1115216

ABSTRACT

BACKGROUND: Few studies have evaluated muscle strength in COVID-19 ICU survivors. We aimed to report the incidence of limb and respiratory muscle weakness in COVID-19 ICU survivors. METHOD: We performed a cross sectional study in two ICU tertiary Hospital Settings. COVID-19 ICU survivors were screened and respiratory and limb muscle strength were measured at the time of extubation. An ICU mobility scale was performed at ICU discharge and walking capacity was self-evaluated by patients 30 days after weaning from mechanical ventilation. RESULTS: Twenty-three patients were included. Sixteen (69%) had limb muscle weakness and 6 (26%) had overlap limb and respiratory muscle weakness. Amount of physiotherapy was not associated with muscle strength. 44% of patients with limb weakness were unable to walk 100 m 30 days after weaning. CONCLUSION: The large majority of COVID-19 ICU survivors developed ICU acquired limb muscle weakness. 44% of patients with limb weakness still had severely limited function one-month post weaning.


Subject(s)
COVID-19/complications , Muscle Weakness/etiology , Aged , Arm/physiopathology , COVID-19/physiopathology , Cross-Sectional Studies , Female , Follow-Up Studies , France , Humans , Leg/physiopathology , Lung/physiopathology , Male , Middle Aged , Muscle Weakness/physiopathology , Retrospective Studies , SARS-CoV-2
11.
BMJ Case Rep ; 14(3)2021 Mar 02.
Article in English | MEDLINE | ID: covidwho-1115108

ABSTRACT

We present a 71-year-old man who developed left calf pain after an elective laparoscopic assisted anterior resection. A clinical picture with a raised creatine kinase and negative Doppler ultrasound was suggestive of compartment syndrome. Successful surgical management was performed with two incisional fasciotomies to release all four compartments of the left leg. The patient recovered well postoperatively. The lateral incision was closed primarily while the medial incision required vacuum-assisted closure dressings and healed by secondary intention. Neither wound required skin grafts. The patient recovered well but had an extended hospital stay due to extensive physiotherapy requirements and mild foot drop. This report is intended as a guide for clinicians when considering differentials in calf pain following surgery and to keep in mind the small risk of developing compartment syndrome after pelvic surgery.


Subject(s)
Colorectal Surgery , Compartment Syndromes , Laparoscopy , Aged , Compartment Syndromes/etiology , Compartment Syndromes/surgery , Fasciotomy , Humans , Laparoscopy/adverse effects , Leg , Male
13.
Clin Imaging ; 75: 1-4, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1039316

ABSTRACT

We describe a 40-year-old man with severe COVID-19 requiring mechanical ventilation who developed aorto-bi-iliac arterial, right lower extremity arterial, intracardiac, pulmonary arterial and ilio-caval venous thromboses and required right lower extremity amputation for acute limb ischemia. This unique case illustrates COVID-19-associated thrombotic complications occurring at multiple, different sites in the cardiovascular system of a single infected patient.


Subject(s)
COVID-19 , Hypertension, Pulmonary , Thrombosis , Venous Thrombosis , Adult , Amputation , Humans , Leg/diagnostic imaging , Leg/surgery , Lower Extremity/diagnostic imaging , Lower Extremity/surgery , Male , SARS-CoV-2 , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/surgery , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/surgery
14.
Ann Vasc Surg ; 72: 205-208, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-973859

ABSTRACT

The novel coronavirus pandemic is associated with coagulopathy and an increased risk of thromboembolic events. A case of an extensive arterial thrombus in the left leg of a patient that occurred after discharge from Covid-19 pneumonia is described. Some patients may be under continued risk of thromboembolism after discharge and the value of extended thromboprophylaxis should be investigated.


Subject(s)
COVID-19/complications , Leg/blood supply , Venous Thromboembolism/etiology , Anticoagulants/therapeutic use , Humans , Iliac Artery , Male , Middle Aged , Pandemics , Patient Discharge , SARS-CoV-2 , Thrombectomy , Venous Thromboembolism/diagnostic imaging , Venous Thromboembolism/therapy
15.
IEEE Trans Neural Syst Rehabil Eng ; 28(12): 2837-2848, 2020 12.
Article in English | MEDLINE | ID: covidwho-936597

ABSTRACT

Motor disorder is a typical symptom of Parkinson's disease (PD). Neurologists assess the severity of PD motor symptoms using the clinical rating scale, i.e., MDS-UPDRS. However, this assessment method is time-consuming and easily affected by the perception difference of assessors. In the recent outbreak of coronavirus disease 2019, telemedicine for PD has become extremely urgent for clinical practice. To solve these problems, we developed an automated and objective assessment method of the leg agility task in the MDS-UPDRS using videos and a graph neural network. In this study, a sparse adaptive graph convolutional network (SA-GCN) was proposed to achieve fine-grained quantitative assessment of skeleton sequences extracted from videos. Specifically, the sparse adaptive graph convolutional unit with a prior knowledge constraint was proposed to perform adaptive spatial modeling of physical and logical dependency for skeleton sequences, thus achieving the sparse modeling of the discriminative spatial relationships. Subsequently, a temporal context module was introduced to construct the remote context dependency in the temporal dimension, hence determining the global changes of the task. A multi-domain attention learning module was also developed to integrate the static spatial features and dynamic temporal features, and then to emphasize the salient feature selection in the channel domain, thereby capturing the multi-domain fine-grained information. Finally, the evaluation results using a dataset with 148 patients and 870 samples confirmed the effectiveness and reliability of our scheme, and the method outperformed other related state-of-the-art methods. Our contactless method provides a new potential tool for automated PD assessment and telemedicine.


Subject(s)
Leg/physiopathology , Parkinson Disease/diagnosis , Parkinson Disease/physiopathology , Aged , Algorithms , Automation , COVID-19 , Databases, Factual , Female , Humans , Machine Learning , Male , Middle Aged , Movement Disorders/diagnosis , Movement Disorders/etiology , Movement Disorders/physiopathology , Neural Networks, Computer , Parkinson Disease/complications , Psychomotor Performance , Reproducibility of Results , Telemedicine/methods , Video Recording
16.
Can J Neurol Sci ; 47(5): 697-699, 2020 09.
Article in English | MEDLINE | ID: covidwho-922194

ABSTRACT

Ischemic monomelic neuropathy (IMN) is a little-known, painful axonal neuropathy, secondary to vascular occlusion or steal phenomenon. It typically occurs after vascular bypass, hemodialysis fistulization, or diabetic microvascular disease in the absence of significant clinical features of ischemia. There is limited literature to assist in the characterization and diagnosis of this condition. We describe three patients with IMN with no surgical or peripheral vascular disease history who exhibited spontaneous, persistent foot pain, edema numbness, and weakness with denervation on needle electromyogram in a distal lower leg peripheral nerve distribution. Occlusive disease was found in all patients on angiogram, requiring vascular bypass surgery.


Subject(s)
Peripheral Nervous System Diseases , Humans , Ischemia/complications , Leg , Peripheral Nerves , Peripheral Nervous System Diseases/complications , Renal Dialysis
17.
Ann Vasc Surg ; 71: 103-111, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-898488

ABSTRACT

A 49-year-old man was admitted to his local hospital with left leg pain and breathing difficulties. He had negative nasopharyngeal polymerase chain reaction tests for severe acute respiratory syndrome coronavirus 2. Chest X-ray and Computed tomography pulmonary angiogram displayed typical coronavirus disease 2019 (COVID-19) radiological features as ground-glass opacities and bronchovascular thickening. His respiratory symptoms resolved after four days of supportive treatment, whereas his left leg became more painful and discolored. He was referred to our center with acute left leg ischemia. computed tomography angiogram revealed eccentric mural thrombus at the aortic bifurcation, extending into left common iliac and an abrupt occlusion of left popliteal, tibioperoneal, and posterior tibial arteries. He was treated with catheter-directed thrombolysis for 48-hours that achieved successful revascularization of the ischemic limb with no intervention-related complications. At six-week follow-up, he showed full recovery. Our case demonstrates that catheter-directed thrombolysis is a successful and safe treatment option in a COVID-19 patient with acute arterial occlusion.


Subject(s)
COVID-19/complications , Ischemia/diagnostic imaging , Ischemia/drug therapy , Leg/blood supply , Peripheral Vascular Diseases/diagnostic imaging , Peripheral Vascular Diseases/drug therapy , Thrombolytic Therapy/methods , Humans , Male , Middle Aged , SARS-CoV-2
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