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1.
Front Health Serv Manage ; 38(4): 33-38, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1878831

ABSTRACT

SUMMARY: Addressing ethics issues in healthcare is essential to living out an organization's mission, vision, and values. In addition to exacerbating existing ethical dilemmas, the COVID-19 pandemic raised many new and complex questions for leaders and their organizations. Ethical issues related to the workforce require a deliberate and comprehensive consideration of values. The case study scenarios presented here demonstrate examples of common ethical staffing challenges that healthcare leaders have faced, notably the allocation of care providers among COVID-19 patients and the balancing of care quality with staff and patient safety. With access to expert resources and a decision-making framework, leaders can build the moral muscle to meet these challenges and reach ethically justifiable resolutions. These staffing issues highlight the need for increased access to ethics resources for organizational leaders, including moral development support and assistance from experts to resolve complex ethical matters.


Subject(s)
COVID-19 , Pandemics , COVID-19/therapy , Humans , Morals , Muscles , Workforce
2.
BMJ Open ; 12(5): e059075, 2022 05 06.
Article in English | MEDLINE | ID: covidwho-1832463

ABSTRACT

INTRODUCTION: Immunosenescence leads to increased morbidity and mortality associated with viral infections and weaker vaccine responses. This has been well documented for seasonal influenza and the current pandemic with SARS-CoV-2 (COVID-19), which disproportionately impact older adults, particularly those in residential aged care facilities. Inadequate nutrient intakes associated with impaired immunity, respiratory and muscle function are likely to augment the effects of immunosenescence. In this study, we test whether the impact of inadequate nutrition can be reversed using multi-nutrient supplementation, consequently enhancing vaccine responses, reducing the risk of viral infections and improving respiratory and muscle function. METHODS AND ANALYSIS: The Pomerium Study is a 3-month, single-blind, randomised, controlled trial testing the effects of two daily servings of an oral multi-nutrient supplement (330 kcal, 20 g protein, 1.5 g calcium 3-hydroxy-3-methylbutyrate monohydrate (CaHMB), 449 mg calcium, 500 IU vitamin D3 and 25 vitamins and minerals) on the immune system and muscle and respiratory function of older adults in aged care in Melbourne, Australia. 160 older adults (≥75 years old) will be recruited from aged care facilities and randomised to treatment (multi-nutrient supplement) or control (usual care). The primary outcome is a change in T-cell subsets CD8 + and CD28null counts at months 1 and 3. Secondary outcomes measured at baseline and month 3 are multiple markers of immunosenescence (also at 1 month), body composition (bioimpedance), handgrip strength (dynamometer), physical function (short physical performance battery), respiratory function (spirometry) and quality of life (EQ-5D-5L). Incidence and complications of COVID-19 and/or viral infections (ie, hospitalisation, complications or death) will be recorded throughout the trial, including 3 months after supplementation is ceased. ETHICS AND DISSEMINATION: This study was approved by Melbourne Health Human Research Ethics Committee (Ref No. HREC/73985/MH-2021, ERM Ref No. RMH73985, Melbourne Health Site Ref No. 2021.115). Written informed consent will be obtained from participants. Results will be published in peer-reviewed journals and made available to key aged care stakeholders, including providers, residents, and government bodies. TRIAL REGISTRATION NUMBER: ACTRN12621000420842.


Subject(s)
COVID-19 , SARS-CoV-2 , Aged , Calcium , Dietary Supplements , Hand Strength , Humans , Immune System , Muscles , Nutrients , Quality of Life , Randomized Controlled Trials as Topic , Single-Blind Method , Treatment Outcome
3.
Viruses ; 14(5)2022 04 22.
Article in English | MEDLINE | ID: covidwho-1822447

ABSTRACT

BACKGROUND: This study aimed to investigate the early and longitudinal humoral response in Healthcare Workers (HCWs) after two doses of the BNT162b2 vaccine and to assess the association between metabolic and anthropometric parameters and the humoral response after vaccination. METHODS: The study included 243 fully vaccinated HCWs: 25.50% previously infected with SARS-CoV-2 (with prior history of COVID-19-PH) and 74.40%-uninfected, seronegative before the first vaccination (with no prior history of COVID-19-NPH). IgG antibodies were measured, and sera were collected: prior to the vaccination, 21 days after the first dose, and 14 days and 8 months after the second dose. RESULTS: 21 days after the first dose, 90.95% of individuals were seropositive; 14 days after the second dose, persistent immunity was observed in 99.18% HCWs, 8 months after complete vaccination-in 61.73%. Statistical analysis revealed that HCWs with PH had a greater chance of maintaining a humoral response beyond eight months after vaccination. Increased muscle mass, decreased fat mass, and younger age may positively affect long-term immunity. Smokers have a reduced chance of developing immunity compared to non-smokers. CONCLUSIONS: Fully vaccinated HCWs with PH are more likely to be seropositive than fully inoculated volunteers with NPH.


Subject(s)
COVID-19 , Muscular Diseases , Vaccines , Adipose Tissue , Body Mass Index , COVID-19/prevention & control , COVID-19 Vaccines , Health Personnel , Humans , Muscles , RNA, Messenger , SARS-CoV-2
4.
Exp Gerontol ; 163: 111774, 2022 06 15.
Article in English | MEDLINE | ID: covidwho-1814413

ABSTRACT

OBJECTIVES: Measurement of skeletal muscle wasting using computed tomography (CT) is widely known to be useful in predicting prognosis. Although some reports have been found in patients with coronavirus disease 2019 (COVID-19), few reports have focused on the ability to perform activities of daily living (ADLs). This study retrospectively investigated the relationship between the erector spinae muscle area measured from CT images and ADL at the time of hospital discharge in patients with COVID-19. METHODS: Among patients aged 40 years or older, 271 patients (median age, 65 years; 180/271 male patients) who had CT cross-sectional images of the 12th thoracic vertebral level on admission were included. The Katz index was used to assess ADLs, and patients who were not completely independent were defined as dependent. Multivariable logistic and Poisson regression analyses were applied to examine the relationship between the cross-sectional area of the erector spinae muscles and the onset of ADL dependence at discharge. RESULTS: A total of 75 (27.7%) patients became dependent on ADL at the time of hospital discharge. Decreased erector spinae muscle area was significantly related to dependent ADL at discharge (adjusted odds ratio: 0.886, 95% confidence interval: 0.805-0.975). In addition, the erector spinae muscle area was significantly related to the number of ADL items for which independence was not achieved (adjusted incidence rate ratio: 0.959, P < 0.001). CONCLUSIONS: The cross-sectional area of the erector spinae muscles from the thoracic CT image was associated with the ability to perform basic ADL at hospital discharge.


Subject(s)
Activities of Daily Living , COVID-19 , Aged , Female , Humans , Male , Middle Aged , Muscles , Patient Discharge , Retrospective Studies
5.
Cardiovasc Diabetol ; 21(1): 40, 2022 03 15.
Article in English | MEDLINE | ID: covidwho-1759752

ABSTRACT

BACKGROUND: Distinguishable sex differences exist in fat mass and muscle mass. High fat mass and low muscle mass are independently associated with cardiovascular disease (CVD) risk factors in people living with type 2 diabetes; however, it is unknown if the association between fat mass and CVD risk is modified by muscle mass, or vice versa. This study examined the sex-specific interplay between fat mass and muscle mass on CVD risk factors in adults with type 2 diabetes living with overweight and obesity. METHODS: Dual-energy X-ray absorptiometry (DXA) measures were used to compute fat mass index (FMI) and appendicular muscle mass index (ASMI), and participants were separated into high-fat mass vs. low-fat mass and high-muscle mass vs. low-muscle mass. A two-way analysis of covariance (ANCOVA: high-FMI vs. low-FMI by high-ASMI vs. low-ASMI) was performed on CVD risk factors (i.e., hemoglobin A1C [A1C]; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; triglycerides; systolic and diastolic blood pressure; cardiorespiratory fitness, depression and health related-quality of life [HR-QoL]) at baseline and following a 1-year intensive lifestyle intervention (ILI) for females and males separately, with a primary focus on the fat mass by muscle mass interaction effects. RESULTS: Data from 1,369 participants (62.7% females) who completed baseline DXA were analyzed. In females, there was a fat mass by muscle mass interaction effect on A1C (p = 0.016) at baseline. Post-hoc analysis showed that, in the low-FMI group, A1C was significantly higher in low-ASMI when compared to high-ASMI (60.3 ± 14.1 vs. 55.5 ± 13.5 mmol/mol, p = 0.023). In the high-FMI group, there was no difference between high-ASMI and low-ASMI (56.4 ± 12.5 vs. 56.5 ± 12.8 mmol/mol, p = 0.610). In males, only high-FMI was associated with higher A1C when compared to low-FMI (57.1 ± 14.4 vs. 54.2 ± 12.0 mmol/mol, p = 0.008) at baseline. Following ILI, there were significant fat mass by muscle mass interaction effects on changes in the mental component of HR-QoL in males. CONCLUSION: Considering that A1C predicts future CVD, strategies to lower A1C may be especially important in females with low fat and low muscle mass living with type 2 diabetes. Our results highlight the complicated and sex-specific contribution of fat mass and muscle mass to CVD risk factors.


Subject(s)
Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Adult , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cholesterol, LDL , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Female , Glycated Hemoglobin A , Heart Disease Risk Factors , Humans , Male , Muscles , Obesity/complications , Obesity/diagnosis , Obesity/epidemiology , Overweight/complications , Overweight/diagnosis , Overweight/epidemiology , Quality of Life
6.
Expert Rev Clin Immunol ; 18(4): 413-423, 2022 04.
Article in English | MEDLINE | ID: covidwho-1758481

ABSTRACT

INTRODUCTION: The inflammatory myopathies (IM) have now evolved into distinct subsets requiring clarification about their immunopathogenesis to guide applications of targeted therapies. AREAS COVERED: Immunohistopathologic criteria of IM with a focus on complement, anti-complement therapeutics, and other biologic immunotherapies. The COVID19-triggered muscle autoimmunity along with the correct interpretation of muscle amyloid deposits is discussed. EXPERT OPINION: The IM, unjustifiably referred as idiopathic, comprise Dermatomyositis (DM), Necrotizing Autoimmune Myositis (NAM), Anti-synthetase syndrome-overlap myositis (Anti-SS-OM), and Inclusion-Body-Myositis (IBM). In DM, complement activation with MAC-mediated endomysial microvascular destruction and perifascicular atrophy is the fundamental process, while innate immunity activation factors, INF1 and MxA, sense and secondarily enhance inflammation. Complement participates in muscle fiber necrosis from any cause and may facilitate muscle-fiber necrosis in NAM but seems unlikely that myositis-associated antibodies participate in complement-fixing. Accordingly, anti-complement therapeutics should be prioritized for DM. SARS-CoV-2 can potentially trigger muscle autoimmunity, but systematic studies are needed as the reported autopsy findings are not clinically relevant. In IBM, tiny amyloid deposits within muscle fibers are enhanced by inflammatory mediators contributing to myodegeneration; in contrast, spotty amyloid deposits in the endomysial connective tissue do not represent 'amyloid myopathy' but only have diagnostic value for amyloidosis due to any cause.


Subject(s)
COVID-19 , Dermatomyositis , Myositis , Dermatomyositis/diagnosis , Humans , Muscles/pathology , Myositis/diagnosis , Plaque, Amyloid , SARS-CoV-2
7.
J Cachexia Sarcopenia Muscle ; 13(3): 1653-1672, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1750384

ABSTRACT

General muscle health declines with age, and in particular, sarcopenia-defined as progressive loss of muscle mass and strength/physical performance-is a growing issue in Asia with a rising population of community-dwelling older adults. Several guidelines have addressed early identification of sarcopenia and management, and although nutrition is central to treatment of sarcopenia, there are currently few guidelines that have examined this specifically in the Asian population. Therefore, the Asian Working Group for Sarcopenia established a special interest group (SIG) comprising seven experts across Asia and one from Australia, to develop an evidence-based expert consensus. A systematic literature search was conducted using MEDLINE on the topic of muscle health, from 2016 (inclusive) to July 2021, in Asia or with relevance to healthy, Asian community-dwelling older adults (≥60 years old). Several key topics were identified: (1) nutritional status: malnutrition and screening; (2) diet and dietary factors; (3) nutritional supplementation; (4) lifestyle interventions plus nutrition; and (5) outcomes and assessment. Clinical questions were developed around these topics, leading to 14 consensus statements. Consensus was achieved using the modified Delphi method with two rounds of voting. Moreover, the consensus addressed the impacts of COVID-19 on nutrition, muscle health, and sarcopenia in Asia. These statements encompass clinical expertise and knowledge across Asia and are aligned with findings in the current literature, to provide a practical framework for addressing muscle health in the community, with the overall aim to encourage and facilitate broader access to equitable care for this target population.


Subject(s)
COVID-19 , Sarcopenia , Aged , Humans , Independent Living , Middle Aged , Muscles , Nutritional Status , Sarcopenia/diagnosis , Sarcopenia/epidemiology , Sarcopenia/therapy
8.
J Sports Med Phys Fitness ; 62(3): 356-360, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1716368

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the influence that COVID-19 lockdown had on the epidemiology of soccer musculoskeletal injuries during 2019/2020 Italian First Football League Serie A in professional football players. METHODS: In this retrospective study we analyzed records from media-based platform (Trasfermarkt, https://www.transfermarkt.com), describing the epidemiology of muscle injuries before and after the first COVID-19 lockdown phases in Italian professional football players. We also classified the severity of the injury as the number of missing days from participation. RESULTS: We assessed a lower prevalence of post-lockdown injuries, albeit showing a similar injury rate at 1000 game-hours (prelockdown: 16.9 [13.0-20.7], post-lockdown: 15.5 [9.9-21.1]; RR=0.92 [0.46-1.8]). All risk ratios for injury rate were not significantly different (P>0.05) between pre- and post-lockdown. CONCLUSIONS: The incidence of muscle injuries has not significantly changed after the first COVID-19 lockdown in Italian professional soccer players. Recognizing injury rates might be crucial for physician to evaluate adequate preventive measures.


Subject(s)
Athletic Injuries , COVID-19 , Football , Soccer , Athletic Injuries/epidemiology , Communicable Disease Control , Humans , Incidence , Italy/epidemiology , Muscles , Retrospective Studies , SARS-CoV-2
9.
Urol Oncol ; 40(6): 274.e1-274.e6, 2022 06.
Article in English | MEDLINE | ID: covidwho-1704754

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has raised concerns about delaying treatment for localized cancer and its impact on long-term outcomes. OBJECTIVE: We aimed to investigate the impact of time to chemoradiation (CRT) on recurrence and survival outcomes for patients with muscle-invasive bladder cancer (MIBC). METHODS: In the national Veterans Affairs' database, we identified patients with urothelial histology, MIBC (T2-4a/N0-3/M0) diagnosed between 2000 to 2018 and treated with definitive CRT. Time to treatment was defined as the number of days between date of diagnosis and start date of CRT. The cohort was stratified into < 90 (early) or ≥ 90 days (delayed) groups. Endpoints of locoregional failure (LRF), distant failure (DF), overall survival (OS), and bladder cancer-specific survival (BCS) were evaluated in multivariable Cox and Fine-Gray models. RESULTS: 305 patients with MIBC underwent CRT - 190 (62.3%) received early CRT, 115 (37.7%) received delayed CRT. Multivariable analysis (including success of transurethral resection of bladder tumor and type of chemotherapy) revealed no difference in recurrence between groups - LRF HR 1.12 (95%CI 0.76-1.67, P = 0.56) and DF HR 1.03 (95%CI 0.70-1.53, P = 0.88). Similarly, there were no differences in survival outcomes. The lack of association was maintained at both earlier and later time cutoffs (60-120 days). CONCLUSIONS: Our findings suggest that a short-term delay in definitive therapy may not affect long-term outcomes for patients with MIBC undergoing CRT. This study does not endorse delays in therapy, but rather provides information to aid patients and clinicians navigate the unique challenges of MIBC care in both pandemic and non-pandemic times.


Subject(s)
COVID-19 , Urinary Bladder Neoplasms , Cystectomy , Female , Humans , Male , Muscles/pathology , Neoplasm Invasiveness , Treatment Outcome , Urinary Bladder Neoplasms/pathology
10.
Viruses ; 14(2)2022 01 27.
Article in English | MEDLINE | ID: covidwho-1667342

ABSTRACT

The hepatitis E virus (HEV) is a major global health problem, leading to large outbreaks in the developing world and chronic infections in the developed world. HEV is a non-enveloped virus, which circulates in the blood in a quasi-enveloped form. The quasi-envelope protects HEV particles from neutralising anti-capsid antibodies in the serum; however, most vaccine approaches are designed to induce an immune response against the HEV capsid. In this study, we explored systemic in vivo administration of a novel synthetic and myotropic Adeno-associated virus vector (AAVMYO3) to express the small HEV phosphoprotein ORF3 (found on quasi-enveloped HEV) in the musculature of mice, resulting in the robust and dose-dependent formation of anti-ORF3 antibodies. Neutralisation assays using the serum of ORF3 AAV-transduced mice showed a modest inhibitory effect on the infection of quasi-enveloped HEV in vivo, comparable to previously characterised anti-ORF3 antibodies used as a control. The novel AAVMYO3 capsid used in this study can serve as a versatile platform for the continued development of vector-based vaccines against HEV and other infectious agents, which could complement traditional vaccines akin to the current positive experience with SARS-CoV-2.


Subject(s)
Dependovirus/genetics , Genetic Vectors , Hepatitis Antibodies/blood , Hepatitis E virus/immunology , Muscles/virology , Viral Proteins/immunology , Absorption, Physiological , Animals , Dependovirus/immunology , Female , Hepatitis Antibodies/immunology , Hepatitis E virus/genetics , Mice , Mice, Inbred BALB C , Viral Proteins/administration & dosage , Viral Proteins/genetics
11.
J Sports Sci ; 40(8): 899-907, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1642109

ABSTRACT

This study examined adolescent muscle-strengthening exercise (MSE) participation at home and associated socioecological correlates during Australia's initial COVID-19 lockdown restrictions. Adolescents (N = 731, Mage = 16.3, SD = 1.2 years, 73% female) self-reported their MSE participation in February 2020 (pre-lockdown; at a gym or at home) and April/May (during lockdown; at home only as gyms were closed). They also reported a range of potential individual, family, and home environment correlates. Remoteness and area-level socioeconomic disadvantage were also considered. Logistic regression models examined potential correlates of participation in any MSE and MSE engagement ≥3 times/week during April/May. Fewer adolescents participated in MSE during April/May (48%) than February (54%), however, the proportions that engaged in MSE ≥3 times/week were the same (30%). Prioritising being active every day (OR = 2.43, 95% CI = 1.52, 3.90), being active with sibling/s ≥ 5 days/week (OR = 2.24, 95% CI = 1.00, 5.00) and access to weights at home (OR = 2.98, 95% CI = 1.94, 4.57) were associated with higher odds of any MSE participation at home during April/May. These variables were also positively associated with MSE participation at home ≥3 times/week. Understanding how to support adolescents to prioritise being active, engage in MSE with siblings, and provide equipment may assist adolescents to engage in home-based MSE.


Subject(s)
COVID-19 , Adolescent , Communicable Disease Control , Exercise , Female , Humans , Male , Muscles , Self Report
12.
Int J Environ Res Public Health ; 19(2)2022 01 09.
Article in English | MEDLINE | ID: covidwho-1633758

ABSTRACT

The available data from electroneurography (ENG) studies on the transmission of neural impulses in the motor fibers of upper and lower extremity nerves following neuromuscular functional electrical stimulation (NMFES) combined with kinesiotherapy in post-stroke patients during sixty-day observation do not provide convincing results. This study aims to compare the effectiveness of an NMFES of antagonistic muscle groups at the wrist and ankle and kinesiotherapy based mainly on proprioceptive neuromuscular facilitation (PNF). An ENG was performed once in a group of 60 healthy volunteers and three times in 120 patients after stroke (T0, up to 7 days after the incident; T1, after 21 days of treatment; and T2, after 60 days of treatment); 60 subjects received personalized NMFES and PNF treatment (NMFES+K), while the other 60 received only PNF (K). An ENG studied peripheral (M-wave recordings), C8 and L5 ventral root (F-wave recordings) neural impulse transmission in the peroneal and the ulnar nerves on the hemiparetic side. Both groups statistically differed in their amplitudes of M-wave recording parameters after peroneal nerve stimulation performed at T0 and T2 compared with the control group. After 60 days of treatment, only the patients from the NMFES+K group showed significant improvement in M-wave recordings. The application of the proposed NMFES electrostimulation algorithm combined with PNF improved the peripheral neural transmission in peroneal but not ulnar motor nerve fibers in patients after ischemic stroke. Combined kinesiotherapy and safe, personalized, controlled electrotherapy after stroke give better results than kinesiotherapy alone.


Subject(s)
Electric Stimulation Therapy , Ischemic Stroke , Stroke Rehabilitation , Ankle , Electric Stimulation , Electric Stimulation Therapy/methods , Follow-Up Studies , Humans , Lower Extremity , Muscles , Stroke Rehabilitation/methods , Synaptic Transmission , Treatment Outcome , Wrist
13.
Elife ; 112022 01 17.
Article in English | MEDLINE | ID: covidwho-1626761

ABSTRACT

Insulin resistance (IR) contributes to the pathophysiology of diabetes, dementia, viral infection, and cardiovascular disease. Drug repurposing (DR) may identify treatments for IR; however, barriers include uncertainty whether in vitro transcriptomic assays yield quantitative pharmacological data, or how to optimise assay design to best reflect in vivo human disease. We developed a clinical-based human tissue IR signature by combining lifestyle-mediated treatment responses (>500 human adipose and muscle biopsies) with biomarkers of disease status (fasting IR from >1200 biopsies). The assay identified a chemically diverse set of >130 positively acting compounds, highly enriched in true positives, that targeted 73 proteins regulating IR pathways. Our multi-gene RNA assay score reflected the quantitative pharmacological properties of a set of epidermal growth factor receptor-related tyrosine kinase inhibitors, providing insight into drug target specificity; an observation supported by deep learning-based genome-wide predicted pharmacology. Several drugs identified are suitable for evaluation in patients, particularly those with either acute or severe chronic IR.


Developing a new drug that is both safe and effective is a complex and expensive endeavor. An alternative approach is to 'repurpose' existing, safe compounds ­ that is, to establish if they could treat conditions others than the ones they were initially designed for. To achieve this, methods that can predict the activity of thousands of established drugs are necessary. These approaches are particularly important for conditions for which it is hard to find promising treatment. This includes, for instance, heart failure, dementia and other diseases that are linked to the activity of the hormone insulin becoming modified throughout the body, a defect called insulin resistance. Unfortunately, it is difficult to model the complex actions of insulin using cells in the lab, because they involve intricate networks of proteins, tissues and metabolites. Timmons et al. set out to develop a way to better assess whether a drug could be repurposed to treat insulin resistance. The aim was to build a biological signature of the disease in multiple human tissues, as this would help to make the findings more relevant to the clinic. This involved examining which genes were switched on or off in thousands of tissue samples from patients with different degrees of insulin resistance. Importantly, some of the patients had their condition reversed through lifestyle changes, while others did not respond well to treatment. These 'non-responders' provided crucial new clues to screen for active drugs. Carefully piecing the data together revealed the molecules and pathways most related to the severity of insulin resistance. Cross-referencing these results with the way existing drugs act on gene activity, highlighted 138 compounds that directly bind 73 proteins responsible for regulating insulin resistance pathways. Some of the drugs identified are suitable for short-term clinical studies, and it may even be possible to rank similar compounds based on their chemical activity. Beyond giving a glimpse into the complex molecular mechanisms of insulin resistance in humans, Timmons et al. provide a fresh approach to how drugs could be repurposed, which could be adapted to other conditions.


Subject(s)
Drug Repositioning , Metabolic Diseases/drug therapy , Adipose Tissue/metabolism , Biomarkers/metabolism , Humans , Insulin Resistance , Metabolic Diseases/genetics , Muscles/metabolism , Transcriptome
14.
J Appl Physiol (1985) ; 132(3): 581-592, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1622106

ABSTRACT

The long-term sequelae of the coronavirus disease 2019 (COVID-19) are multifaceted and, besides the lungs, impact other organs and tissues, even in cases of mild infection. Along with commonly reported symptoms such as fatigue and dyspnea, a significant proportion of those with prior COVID-19 infection also exhibit signs of cardiac damage, muscle weakness, and ultimately, poor exercise tolerance. This review provides an overview of evidence indicating cardiac impairments and persistent endothelial dysfunction in the peripheral vasculature of those previously infected with COVID-19, irrespective of the severity of the acute phase of illness. In addition, V̇o2peak appears to be lower in convalescent patients, which may stem, in part, from alterations in O2 transport such as impaired diffusional O2 conductance. Together, the persistent multi-organ dysfunction induced by COVID-19 may set previously healthy individuals on a trajectory towards frailty and disease. Given the large proportion of individuals recovering from COVID-19, it is critically important to better understand the physical sequelae of COVID-19, the underlying biological mechanisms contributing to these outcomes, and the long-term effects on future disease risk. This review highlights relevant literature on the pathophysiology post-COVID-19 infection, gaps in the literature, and emphasizes the need for the development of evidence-based rehabilitation guidelines.


Subject(s)
COVID-19 , Dyspnea , Fatigue , Humans , Muscles , SARS-CoV-2
15.
Eur J Neurol ; 28(10): 3411-3417, 2021 10.
Article in English | MEDLINE | ID: covidwho-1607226

ABSTRACT

BACKGROUND AND PURPOSE: Since the outbreak of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, several reports indicated neurological involvement in COVID-19 disease. Muscle involvement has also been reported as evidenced by creatine kinase (CK) elevations and reports of myalgia. METHODS: Creatine kinase, markers of inflammation, pre-existing diseases and statin use were extracted from records of Austrian hospitalised COVID-19 patients. Disease severity was classified as severe in case of intensive care unit (ICU) admission or mortality. COVID-19 patients were additionally compared to an historical group of hospitalised influenza patients. RESULTS: Three hundred fifty-one patients with SARS-CoV-2 and 258 with influenza were included in the final analysis. CK was elevated in 27% of COVID-19 and in 28% of influenza patients. CK was higher in severe COVID-19 as were markers of inflammation. CK correlated significantly with inflammation markers, which had an independent impact on CK when adjusted for demographic variables and disease severity. Compared to influenza patients, COVID-19 patients were older, more frequently male, had more comorbidities, and more frequently had a severe disease course. Nevertheless, influenza patients had higher baseline CK than COVID-19, and 35.7% of intensive care unit (ICU)-admitted patients had CK levels >1,000 U/L compared to only 4.7% of ICU-admitted COVID-19 patients. CONCLUSIONS: HyperCKemia occurs in a similar frequency in COVID-19 and influenza infection. CK levels were lower in COVID-19 than in influenza in mild and severe disease. CK levels strongly correlate with disease severity and markers of inflammation. To date, it remains unclear whether hyperCKemia is due to a virus-triggered inflammatory response or direct muscle toxicity.


Subject(s)
COVID-19 , Influenza, Human , Humans , Influenza, Human/complications , Influenza, Human/epidemiology , Male , Muscles , Pandemics , SARS-CoV-2
16.
Intern Med ; 60(21): 3503-3506, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1572222

ABSTRACT

In hospitalized coronavirus disease 2019 (COVID-19) patients, anticoagulation therapy is administered to prevent thrombosis. However, anticoagulation sometimes causes bleeding complications. We herein report two Japanese cases of severe COVID-19 in which spontaneous muscle hematomas (SMH) developed under therapeutic anticoagulation with unfractionated heparin. Although the activated partial prothrombin time was within the optimal range, contrast-enhanced computed tomography (CECT) revealed SMH in the bilateral iliopsoas muscles in both cases, which required emergent transcatheter embolization. Close monitoring of the coagulation system and the early diagnosis of bleeding complications through CECT are needed in severe COVID-19 patients treated with anticoagulants.


Subject(s)
COVID-19 , Heparin , Anticoagulants/adverse effects , Hematoma/chemically induced , Hematoma/diagnostic imaging , Heparin/adverse effects , Humans , Japan , Muscles , SARS-CoV-2
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2021: 1588-1592, 2021 11.
Article in English | MEDLINE | ID: covidwho-1566241

ABSTRACT

Previous works have shown the efficacy of mechanical stimulation by applying pressure and vibration on muscle rehabilitation. Additionally, a temperature increase can improve both muscle performance and blood circulation during therapies. These modalities of treatment are commonly applied separately in patients with moderate disuse-induced muscle atrophy. In this paper, we propose the design of a novel medical device that synergistically integrates the function of i) elastomeric pneumatic actuators to apply focused orthogonal pressure, ii) vibratory motors to generate localized vibration and iii) carbon fibre heaters for a temperature increase. In particular, computational simulations were performed to characterize the mechanical behaviour of different pneumatic actuator geometries and their predicted advantages in comparison to previous designs. The integration of the three functionalities of the device and preliminary simulations results showcase its potential for improving therapy efficacy, while also being compact, lightweight, and comfortable, which would ease its implementation in rehabilitation programs.Clinical relevance- Disuse-induced muscle atrophy and related cardiovascular problems can lead to physical impairment and significantly affect patient independence. The surge in the number of hospitalized and bedridden patients related to the coronavirus disease (COVID-19) brings about a predicted increase in the incidence of myopathies and muscle weakness. To attend the growing demand, technological aids for more efficient physical therapies will need to be developed.


Subject(s)
COVID-19 , Medicine , Robotics , Humans , Muscles , SARS-CoV-2
18.
JAMA Neurol ; 79(1): 92-93, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1527399
19.
JAMA Neurol ; 79(1): 92, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1527398
20.
Nutr Rev ; 80(3): 561-578, 2022 02 10.
Article in English | MEDLINE | ID: covidwho-1522274

ABSTRACT

This comprehensive review establishes the role of vitamin B12 as adjunct therapy for viral infections in the treatment and persistent symptoms of COVID-19, focusing on symptoms related to the muscle-gut-brain axis. Vitamin B12 can help balance immune responses to better fight viral infections. Furthermore, data from randomized clinical trials and meta-analysis indicate that vitamin B12 in the forms of methylcobalamin and cyanocobalamin may increase serum vitamin B12 levels, and resulted in decreased serum methylmalonic acid and homocysteine concentrations, and decreased pain intensity, memory loss, and impaired concentration. Among studies, there is much variation in vitamin B12 doses, chemical forms, supplementation time, and administration routes. Larger randomized clinical trials of vitamin B12 supplementation and analysis of markers such as total vitamin B12, holotranscobalamin, total homocysteine and methylmalonic acid, total folic acid, and, if possible, polymorphisms and methylation of genes need to be conducted with people with and without COVID-19 or who have had COVID-19 to facilitate the proper vitamin B12 form to be administered in individual treatment.


Subject(s)
COVID-19 , Vitamin B 12 Deficiency , Dietary Supplements , Folic Acid , Homocysteine , Humans , Muscles , SARS-CoV-2 , Vitamin B 12 , Vitamin B 12 Deficiency/drug therapy
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