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1.
Ulus Travma Acil Cerrahi Derg ; 28(11): 1655-1658, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2111172

ABSTRACT

The pulmonary symptoms secondary to severe acute respiratory syndrome in coronavirus (COVID-19) infections are the most common presentation for the disease; however, it is now known that in a small portion of patients, severe hemorrhagic complications can also be seen. In this report, three cases of elderly women with known COVID-19 infection, developing spontaneous rectus sheath hematoma on anticoagulation therapy, are presented. Three cases presented above emphasize the need to perform a computed tomography examination after a sudden hemodynamic deterioration and a decrease in hemoglobin count in COVID-19 patients in intensive care units (ICUs). Since this clinical deterioration can be caused by spontaneous rectus sheath hematomas (RSH), it must be taken into consideration while examination. If these RSHs rupture into the abdominal cavity, the outcome may be fatal in few hours as represented in two of our cases. Major spontaneous hemorrhage in COVID-19 patients is quite uncommon; therefore, it may cause serious complications as it is rarely taken into consideration. Failure to acknowledge such a risk could significantly worsen the prognosis of the patients especially in ERs and ICUs.


Subject(s)
COVID-19 , Muscular Diseases , Humans , Female , Aged , Rectus Abdominis/diagnostic imaging , COVID-19/complications , Hematoma/etiology , Hematoma/complications , Muscular Diseases/complications , Muscular Diseases/therapy , Tomography, X-Ray Computed , Anticoagulants/adverse effects
2.
J Clin Neurophysiol ; 39(7): 583-591, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2107709

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 patients hospitalized in intensive care units develop neuromuscular manifestations. However, to our knowledge, a study describing the neurophysiological findings in these patients has not been reported. The objective of this study was to diagnose the cause of neuromuscular deficit in severe coronavirus disease 2019 patients, through neurophysiological examination. METHODS: This is a retrospective, observational case series. Data were collected from April 13, 2020, to May 31, 2020. Twenty-two coronavirus disease 2019 patients with generalized neuromuscular deficit during intensive care unit hospitalization were studied. Neurophysiological examinations included motor and sensory peripheral nerve conductions, needle electromyography, F waves, and repetitive nerve stimulation. RESULTS: The subjects were 14 men (63.6%) and eight women, ranged from 35 to 74 years old (58.0, interquartile ranges 50.7-66.2). Intensive care unit hospitalization time ranged from 14 to 82 days (median 37.5, interquartile ranges 22.7-55.0). Through neurophysiological examination, myopathy was diagnosed in 17 patients (77.3%) and polyneuropathy in four (18.2%). Focal neuropathies were diagnosed in 12 patients (54.6%), with a total of 19 affected nerves. Common peroneal nerve lesions at the fibular head (68.4%) and ulnar nerve lesions at the elbow level (21.1%) were the most frequent locations. No significant differences were established between neurophysiological findings and clinical or analytical data. CONCLUSIONS: In critical coronavirus disease 2019 patients with neuromuscular complaints, neurophysiological examination provides an accurate diagnosis-useful to select treatment measures and establish the prognosis of recovery. Neurophysiological findings are similar to those described for critical illness neuromuscular disease, with myopathy being the most frequent diagnosis.


Subject(s)
COVID-19 , Muscular Diseases , Neuromuscular Diseases , Male , Humans , Female , Adult , Middle Aged , Aged , COVID-19/diagnosis , Neuromuscular Diseases/etiology , Electromyography/adverse effects , Critical Illness , Peroneal Nerve
3.
Ulus Travma Acil Cerrahi Derg ; 28(10): 1468-1474, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2081059

ABSTRACT

BACKGROUND: There has been an increased incidence of rectus sheath hematoma (RSH) due to chronic cough attacks and anti-coagulant therapy due to the COVID-19 pandemic. The present study aims to determine, in which parameters differ before and during the diagnosis of RSH in COVID-19 patients and what may be expected during diagnosis and follow-up. METHODS: Thirty-five patients diagnosed with RSH were evaluated retrospectively between March 2016 and March 2021. The COVID-19 group comprised 11 patients. Various information including patient history and time of discharge/death were retrieved and compared between the experimental groups. RESULTS: The rates of hypotension on admission (p=0.011) and the rates of defense and rebound (p=0.030) were higher in the patients with COVID-19 than in those without. Although there was no difference in terms of bleeding width, there was a greater decrease in the hemoglobin levels (p=0.009) in the COVID-19 patients and the need for erythrocyte suspension (p=0.040) increased significantly in that group. CONCLUSION: The present study constitutes the first evaluation of RSH in COVID-19 patients. The clinical situation is serious due to high rates of hypotension, defense or rebound, and decreases in hemoglobin levels in COVID-19 patients. This makes the clinical management of RSH more difficult, resulting in longer hospitalization. Despite these difficulties, COVID-19 infection does not increase morbidity or mortality.


Subject(s)
COVID-19 , Hypotension , Muscular Diseases , Anticoagulants/therapeutic use , COVID-19 Testing , Follow-Up Studies , Gastrointestinal Hemorrhage , Hematoma/diagnosis , Hematoma/etiology , Hematoma/therapy , Hemoglobins , Humans , Hypotension/complications , Hypotension/drug therapy , Muscular Diseases/complications , Muscular Diseases/drug therapy , Pandemics , Rectus Abdominis , Retrospective Studies
4.
biorxiv; 2022.
Preprint in English | bioRxiv | ID: ppzbmed-10.1101.2022.10.07.511313

ABSTRACT

ABSTRACT Chronic lung disease is often accompanied by disabling extrapulmonary symptoms, notably skeletal muscle dysfunction and atrophy. Moreover, the severity of respiratory symptoms correlates with decreased muscle mass and in turn lowered physical activity and survival rates. Previous models of muscle atrophy in chronic lung disease often modeled COPD and relied on cigarette smoke exposure and LPS-stimulation, but these conditions independently affect skeletal muscle even without accompanying lung disease. Moreover, there is an emerging and pressing need to understand the extrapulmonary manifestations of long-term post-viral lung disease (PVLD) as found in Covid-19. Here, we examine the development of skeletal muscle dysfunction in the setting of chronic pulmonary disease using a mouse model of PVLD caused by infection due to the natural pathogen Sendai virus. We identify a significant decrease in myofiber size when PVLD is maximal at 49 d after infection. We find no change in the relative types of myofibers, but the greatest decrease in fiber size is localized to fast-twitch type IIB myofibers based on myosin heavy chain immunostaining. Remarkably, all biomarkers of myocyte protein synthesis and degradation (total RNA, ribosomal abundance, and ubiquitin-proteasome expression) were stable throughout the acute infectious illness and chronic post-viral disease process. Together, the results demonstrate a distinct pattern of skeletal muscle dysfunction in a mouse model of long-term PVLD. The findings thereby provide new insight into prolonged limitations in exercise capacity in patients with chronic lung disease after viral infections and perhaps other types of lung injury.


Subject(s)
Chronic Disease , Muscular Atrophy , Muscular Diseases , COVID-19 , Lung Diseases , Lung Injury , Atrophy , Pulmonary Disease, Chronic Obstructive
5.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.10.03.22280646

ABSTRACT

Background COVID-19 and associated controls may be particularly problematic in the context of chronic conditions. This study investigated health management, well-being, and pandemic-related perspectives in these patients in the context of stringent measures, and associated correlates. Methods A self-report survey was administered via Wenjuanxing in Simplified Chinese between March-June 2022 during the Omicron wave lockdown in Shanghai, China. Items from the Somatic Symptom Scale (SSS) and Symptom Checklist-90 (SCL-90) were administered, as well as pandemic-related items created by a working group of the Chinese Preventive Medical Association. Chronic disease patients in this cross-sectional study were recruited through an associated community family physician group. Results Overall, 1775 patients, mostly married females with hypertension, participated. Mean SSS scores were 36.1±10.5/80, with 41.5% scoring in the elevated range (i.e., above 36). In an adjusted model, female, diagnosis of coronary artery disease and arrhythmia, perceived impact of pandemic on life, duration can tolerate control measures, perception of future & control measures, impact of pandemic on health condition and change to exercise routine due to pandemic were significantly associated with greater distress. Approximately one-quarter (24.5%) perceived the pandemic had a permanent impact on their life, and 44.1% perceived at least a minor impact on their health. One-third (33.5%) discontinued exercise due to the pandemic. While 47.6% stocked up on their medications before the lockdown, their remaining supply was mostly only enough for a couple of weeks and 17.5% of participants discontinued use. Chief among their fears were inability to access healthcare (83.2%), and what they stated they most needed to manage their condition was medication access (65.6%). Conclusions Since 2020 when we assessed a similar cohort, distress and perceived impact of the pandemic has worsened. Greater access to cardiac rehabilitation in China could address these issues.


Subject(s)
Chronic Disease , Coronary Artery Disease , Muscular Diseases , COVID-19 , Arrhythmias, Cardiac , Hypertension
6.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-1901764.v1

ABSTRACT

Background: Monitoring of SARS-COV-2 vaccine hesitancy is important for epidemic control. We measured vaccine hesitancy among healthy adults and adults with chronic diseases after they had been offered the first dose of the vaccine in Mexico City. Methods. An observational cross-sectional study was undertaken among 185 healthy adults and 175 adults living with chronic diseases. Differences in means of variables for confidence, complacency, and convenience were analyzed. Aggregate indicators were constructed and their association to socioeconomic and demographic conditions and to vaccination acceptance were analyzed using multivariate analysis of variance and multivariate logistic analysis. Results. Up to 16.8% of healthy adults and 10.3% of sick adults report not having received the SARS-COV-2 vaccine. Healthy adults are more complacent about COVID-19 risks than adults with chronic diseases, while no differences were reported across the two groups regarding other hesitancy aggregate indicators. Among adults with chronic diseases, those with more education and enrolled with a social insurance institution are less complacent of COVID-19, while education is positively associated to convenience across both groups. Less complacency with COVID-19 and more confidence on the vaccine are associated to higher vaccine acceptance across both groups. Among adults living with chronic diseases the odds ratios of vaccine acceptance are higher for less complacency (OR=2.4, p=0.007) than for confidence (OR=2.0, p=0.001). Odds ratios of vaccine acceptance in these two hesitancy indicators are similar among healthy adults (OR=3.3, p=<0.005), and higher than for adults with comorbidities. Conclusions. Confidence in the vaccine and complacency regarding COVID-19 risks play an important role for vaccine acceptance in Mexico City, particularly among healthy adults. The perception of risk regarding COVID-19 is more important than confidence in vaccine safety and effectiveness. Promotion of COVID-19 vaccines needs to focus on decreasing complacency with COVID-19 and increasing vaccine confidence, particularly among healthy adults.


Subject(s)
Muscular Diseases , COVID-19 , Chronic Disease
7.
Medicina (Kaunas) ; 58(9)2022 Sep 01.
Article in English | MEDLINE | ID: covidwho-2010208

ABSTRACT

Background and Objectives: Consequences due to infection with SARS-CoV-2 virus can have a direct impact on skeletal muscle, due to the fact that both cardiac and skeletal muscle tissue show robust ACE2(angiotensin-converting enzyme 2) expression, suggesting a potential susceptibility to SARS-CoV-2 infection in both types of tissues. From the articles analyzed we concluded that the musculoskeletal damage is firstly produced by the inflammatory effects, cytokine storm and muscle catabolism. However, myopathy, polyneuropathy and therapies such as corticoids were also considered important factors in muscle fatigue and functional incapacity. Pulmonary rehabilitation programs and early mobilization had a highly contribution during the acute phase and post-illness recovery process and helped patients to reduce dyspnea, increase the capacity of physical effort, overcome psychological disorders and improved the quality of their life. Materials and Methods: We have included in this review 33 articles that contain data on muscle damage following SARS-CoV-2 infection. We used the following keywords to search for articles: SARS-CoV-2, COVID-19, muscle weakness, muscle disease, muscle fatigue, neurological disorders. As a search strategy we used PubMed, Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects and Health Technology Assessment Database to collect the information. We also have chosen the most recent articles published in the last 5 years. Conclusions: Muscular damage, as well as the decrease in the quality of life, are often a consequence of severe SARS-CoV-2 infection through: systemic inflammation, corticotherapy, prolonged bed rest and other unknown factors. Pulmonary rehabilitation programs and early mobilization had a highly contribution during the acute phase and post-illness recovery process and helped patients to reduce dyspnea, increase the capacity of physical effort, overcome psychological disorders and improve the quality of their life.


Subject(s)
COVID-19 , Muscular Diseases , Angiotensin-Converting Enzyme 2 , Dyspnea , Humans , Muscle Fatigue , Muscle, Skeletal/metabolism , Muscular Diseases/complications , Quality of Life , SARS-CoV-2 , Systematic Reviews as Topic
8.
biorxiv; 2022.
Preprint in English | bioRxiv | ID: ppzbmed-10.1101.2022.09.13.507829

ABSTRACT

When viruses like SARS-CoV-2 infect cells, they reprogram the repertoire of cellular and viral transcripts that are being translated to optimize their strategy of replication, often targeting host translation initiation factors, particularly eIF4F complex consisting of eIF4E, eIF4G and eIF4A. A proteomic analysis of SARS-CoV-2/human proteins interaction revealed viral Nsp2 and initiation factor eIF4E2, but a role of Nsp2 in regulating translation is unknown. HEK293T cells stably expressing Nsp2 were tested for protein synthesis rates of synthetic and endogenous mRNAs known to be translated via cap- or IRES-dependent mechanism under normal and hypoxic conditions. Both cap- and IRES-dependent translation were increased in Nsp2-expressing cells under normal and hypoxic conditions, especially mRNAs that require high levels of eIF4F. This could be exploited by the virus to maintain high translation rates of both viral and cellular proteins, particularly in hypoxic conditions as may arise in SARS-CoV-2 patients with poor lung functioning.


Subject(s)
Muscular Diseases
9.
J Clin Neuromuscul Dis ; 24(1): 38-48, 2022 Sep 01.
Article in English | MEDLINE | ID: covidwho-2005014

ABSTRACT

ABSTRACT: We cover intensive care unit-acquired neuromuscular disorders associated with coronavirus disease 2019. Outcomes may be worse than expected in these patients, and there is some evidence that coronavirus disease 2019 causes myopathy directly. Corticosteroid regimens in Duchenne muscular dystrophy are addressed including outcomes in pulmonary and cardiac function. A recent article notes a continued diagnostic delay in Duchenne muscular dystrophy. An interesting report of a Canary Islands cohort of patients with oculopharyngeal muscular dystrophy is discussed. Features and clinical pearls related to a series of patients with limb-girdle muscle dystrophy R12 (anoctaminopathy) and a misdiagnosis of idiopathic inflammatory myopathy are provided. The last section on autoimmune myopathy includes articles on clinical and pathologic features associated with myositis-specific antibodies and dermatomyositis, the epidemiology of immune-mediated necrotizing myopathies (IMNMs) in Olmsted County, Minnesota, and features of a German cohort of hydroxy-3-methylglutaryl coenzyme A reductase-associated IMNM. A recent article proposes the benefit of early intravenous immunoglobulin use for adults with IMNM. We also highlight a report of 2 unusual cases of antisignal recognition particle myopathy presenting with asymmetric distal weakness.


Subject(s)
Autoimmune Diseases , COVID-19 , Muscular Diseases , Muscular Dystrophy, Duchenne , Myositis , Autoantibodies , COVID-19/complications , Delayed Diagnosis , Humans , Muscle, Skeletal/pathology , Muscular Diseases/pathology , Myositis/diagnosis , Necrosis/pathology
10.
Cells ; 11(15)2022 07 25.
Article in English | MEDLINE | ID: covidwho-1993936

ABSTRACT

Skeletal muscle is a pivotal organ in humans that maintains locomotion and homeostasis. Muscle atrophy caused by sarcopenia and cachexia, which results in reduced muscle mass and impaired skeletal muscle function, is a serious health condition that decreases life longevity in humans. Recent studies have revealed the molecular mechanisms by which long non-coding RNAs (lncRNAs) regulate skeletal muscle mass and function through transcriptional regulation, fiber-type switching, and skeletal muscle cell proliferation. In addition, lncRNAs function as natural inhibitors of microRNAs and induce muscle hypertrophy or atrophy. Intriguingly, muscle atrophy modifies the expression of thousands of lncRNAs. Therefore, although their exact functions have not yet been fully elucidated, various novel lncRNAs associated with muscle atrophy have been identified. Here, we comprehensively review recent knowledge on the regulatory roles of lncRNAs in skeletal muscle atrophy. In addition, we discuss the issues and possibilities of targeting lncRNAs as a treatment for skeletal muscle atrophy and muscle wasting disorders in humans.


Subject(s)
Muscular Diseases , RNA, Long Noncoding , Humans , Muscle Development/genetics , Muscle, Skeletal/metabolism , Muscular Atrophy/genetics , Muscular Atrophy/metabolism , Muscular Diseases/genetics , RNA, Long Noncoding/genetics , RNA, Long Noncoding/metabolism
11.
Eur J Neurol ; 29(12): 3752-3753, 2022 12.
Article in English | MEDLINE | ID: covidwho-1992780
12.
Eur J Neurol ; 29(12): 3750-3751, 2022 12.
Article in English | MEDLINE | ID: covidwho-1992779
13.
Curr Opin Neurol ; 35(5): 622-628, 2022 10 01.
Article in English | MEDLINE | ID: covidwho-1992449

ABSTRACT

PURPOSE OF REVIEW: The global spread of severe acute respiratory syndrome coronavirus 2 resulted in many cases of acute and postacute muscular symptoms. In this review, we try to decipher the potential underlying pathomechanisms and summarize the potential links between viral infection and muscle affection. RECENT FINDINGS: Disregarding single case studies that do not allow safe conclusions due to the high number of infections, histopathological evidence of myositis has only been reported in deceased individuals with severe COVID-19. Postacute myalgia and weakness seem to occur in a subset of patients up to one year after initial infection, reminiscent of postinfectious syndromes (PIS) described in prior epidemics and pandemics of the past. SUMMARY: COVID-19 associated myopathy likely comprises different entities with heterogeneous pathomechanisms. Individual factors such as disease severity and duration, age, sex, constitutional susceptibilities, and preexisting conditions are important to consider when formulating a diagnosis. Persisting symptoms show overlapping features with PIS or postintensive care syndrome. In lack of strong evidence for a direct infection of myocytes, inflammatory myopathies associated with COVID-19 are presumably immune-mediated. Differential diagnosis of rheumatological and nonmuscular neurological origin coinciding with the infection need to be considered, due to the extremely high numbers of newly occurring infections the last 2 years.


Subject(s)
COVID-19 , Muscular Diseases , Virus Diseases , COVID-19/complications , Humans , Muscular Diseases/epidemiology , Muscular Diseases/etiology , Pandemics , SARS-CoV-2
14.
biorxiv; 2022.
Preprint in English | bioRxiv | ID: ppzbmed-10.1101.2022.08.30.505854

ABSTRACT

Cellular and tissue-level edema is a common feature of acute viral infections such as covid-19, and of many hyponatremic hypoosmolar disorders. However, there is little understanding of the effects of cellular edema on antiviral effector mechanisms. We previously discovered that cytoplasmic human MxA, a major antiviral effector of Type I and III interferons against several RNA- and DNA-containing viruses, existed in the cytoplasm in phase-separated membraneless biomolecular condensates of varying sizes and shapes. In this study we investigated how hypoosmolar conditions, mimicking cellular edema, might affect the structure and antiviral function of MxA condensates. Cytoplasmic condensates of both IFN-α-induced endogenous MxA and of exogenously expressed GFP-MxA in human A549 lung and Huh7 hepatoma cells rapidly disassembled within 1-2 min when cells were exposed to hypotonic buffer (~ 40-50 mOsm), and rapidly reassembled into new structures within 1-2 min of shifting of cells to isotonic culture medium (~ 330 mOsm). MxA condensates in cells continuously exposed to culture medium of moderate hypotonicity (in the range one-fourth, one-third or one-half isotonicity; range 90-175 mOsm) first rapidly disassembled within 1-3 min, and then, in most cells, spontaneously reassembled 7-15 min later into new structures. Condensate reassembly, whether induced by isotonic medium or occurring spontaneously under continued moderate hypotonicity, was preceded by crowding of the cytosolic space by large vacuole-like dilations (VLDs) derived from internalized plasma membrane. Remarkably, the antiviral activity of GFP-MxA against vesicular stomatitis virus survived hypoosmolar disassembly. Overall, the data highlight the exquisite sensitivity of MxA condensates to rapid reversible osmoregulation.


Subject(s)
Mucolipidoses , Muscle Hypotonia , Muscular Diseases , COVID-19 , Vesicular Stomatitis , Carcinoma, Hepatocellular , Genetic Diseases, Inborn
15.
Int J Rheum Dis ; 25(11): 1246-1253, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1968048

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome (SARS-CoV-2), caused by the Coronavirus 2019 (COVID-19), has become a life-threatening epidemic, affecting multiple organs, including the nervous system. Recent studies have documented that COVID-19-associated peripheral neuropathy is a common and frequent problem, with central and peripheral nervous system complications. OBJECTIVE: This work aims to evaluate the peripheral nerves and muscle involvement after COVID-19 infection, in addition to studying the prevalence rate and risk factors of their affection. METHODS: The study involved 400 patients, divided into 2 groups, with a history of COVID-19 infection with or without symptoms of neuromuscular affection, and 30 gender- and age-matched healthy volunteers were involved as controls. They were referred to the Department of Rheumatology and Rehabilitation for electro-diagnosis. All participants performed complete clinical examination and laboratory measures with an electrophysiological study. RESULTS: The prevalence of peripheral neuropathy and myopathy in post-COVID-19 patients was 56.3% among all patients. A significant difference was detected among patients of both groups regarding serum creatine phosphokinase level, clinical signs, and electrophysiologic findings of neuropathy and myopathy compared to the control group, with more prominent features among the symptomatic group. Histories of hospitalization, severe and long-lasting respiratory symptoms were risk factors for developing neuromuscular complications. CONCLUSIONS: The present study could indicate that muscle involvement and peripheral nerve affection are common problems even among asymptomatic patients after COVID-19 infection, especially in the presence of any risk factors.


Subject(s)
COVID-19 , Muscular Diseases , Peripheral Nervous System Diseases , Humans , SARS-CoV-2 , Prevalence , Peripheral Nervous System Diseases/etiology
16.
Immunol Res ; 70(4): 419-431, 2022 08.
Article in English | MEDLINE | ID: covidwho-1956007

ABSTRACT

Ehlers-Danlos syndrome (EDS) is a group of related connective tissue disorders consisting of 13 subtypes, each with its own unique phenotypic and genetic variation. The overlap of symptoms and multitude of EDS variations makes it difficult for patients to achieve a diagnosis early in the course of their disease. The most common form, hypermobile type EDS (hEDS) and its variant, hypermobile spectrum disorder (HSD), are correlated with rheumatologic and inflammatory conditions. Evidence is still needed to determine the pathophysiology of hEDS; however, the association among these conditions and their prevalence in hEDS/HSD may be explained through consideration of persistent chronic inflammation contributing to a disruption of the connective tissue. Aberrant mast cell activation has been shown to play a role in disruption of connective tissue integrity through activity of its mediators including histamine and tryptase which affects multiple organ systems resulting in mast cell activation disorders (MCAD). The overlap of findings associated with MCAD and the immune-mediated and rheumatologic conditions in patients with hEDS/HSD may provide an explanation for the relationship among these conditions and the presence of chronic inflammatory processes in these patients. It is clear that a multidisciplinary approach is required for the treatment of patients with EDS. However, it is also important for clinicians to consider the summarized symptoms and MCAD-associated characteristics in patients with multiple complaints as possible manifestations of connective tissue disorders, in order to potentially aid in establishing an early diagnosis of EDS.


Subject(s)
Arthritis, Rheumatoid , Ehlers-Danlos Syndrome , Joint Instability , Muscular Diseases , Ehlers-Danlos Syndrome/diagnosis , Ehlers-Danlos Syndrome/epidemiology , Ehlers-Danlos Syndrome/genetics , Humans , Joint Instability/diagnosis , Mast Cells , Syndrome
17.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-1821544.v1

ABSTRACT

Background: Muscle Tension Dysphonia (MTD) is responsible for up to 40% of patients presenting with voice and throat complaints. It is due to inefficient or ineffective voice production resulting from an imbalance in the control of the breathing mechanism, and uncontrolled constriction of the muscles in the larynx (voice box) or vocal tract (throat space above the vocal cords). Standard treatment is Voice Therapy delivered by a specialist Speech Therapist (SLT-V) often using a video link (telepractice aka telehealth). However, voice therapy has been portrayed as a “black box” and many recognised treatment regimens overlap in their treatment aims and therapeutic goals and have a poor-quality evidence base. The Complete Vocal Technique (CVT) is widely used in Europe by singers and vocal coaches. Practitioners (CVT-Ps) undergo a three-year accredited training programme, and the systematic and structured approach helps healthy singers and other performers optimise the function of the voice to produce any sound required. It also rapidly effective in performers with vocal problems, which are also mainly due to uncontrolled throat constrictions. Although there is a growing evidence base and understanding of how CVT can help singers, there is no evidence that, it can be of benefit to patients with MTD or is different from standard SLT techniques. This proof-of-concept study is designed to evaluate whether CVT can be used to help MTD patients using a multidimensional approach for assessment. Methods: /design: A proof of concept study, will recruit 10 people with a clinical diagnosis of primary muscle tension dysphonia (Type I-III) with a VHI score­ > 30, who meet the inclusion/exclusion criteria. Participants will have a multidimensional assessment using a range of validated and non-validated disease-specific questionnaires, statistical analysis of voice and electroglottographic (EGG) recordings and auditory-perceptual evaluations of the voice by Speech Therapy experts in Voice Disorders (SLT-V). They will then receive up to 6 video sessions of CVT-VT delivered using a video link by a CVT-P. The participants will then be reviewed back in clinic at 8 weeks and be reassessed, using further questionnaires and voice recordings. The assessors will be blinded to the testing order of the outcome measures and patients will act as their own controls. In addition, qualitative analysis of the therapy sessions will be made by direct observation of some of the CVT therapy sessions by an experienced SLT-V and review of the Therapist’s treatment log.The main objectives of this Proof-of Concept study are 1) to determine whether CVT-VT is beneficial in the treatment of patients with primary MTD; 2) to determine if and how CVT-VT differs from traditional SLT-VT methods and therefore if it could be a useful additional tool for SLT-VTs in the management of MTD; 3) whether delivery of CVT-VT via a video link is satisfactory to both patients and the CVT-P? Discussion: This study will involve a detailed assessment of the approach to therapy by the CVT-P to determine whether it leads to improvement in the presenting symptoms and voice production, whether it differs from traditional SLT-VT approaches, whether it is acceptable to patients as part of the evaluation as to whether a non-inferiority randomised controlled trial is feasible. Trial registration: The Protocol has been registered on the Clinicaltrials.gov website (NCT05365126 Unique Protocol ID: 19ET004). Registered 06 May 2022, https://beta.clinicaltrials.gov/study/NCT05365126?patient=Muscle%20Tension%20Dysphonia&locStr=Nottingham,%20UK&lat=52.9540223&lng=-1.1549892&distance=50


Subject(s)
Dysphonia , Voice Disorders , Muscular Diseases
18.
Ulus Travma Acil Cerrahi Derg ; 28(7): 920-926, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1934719

ABSTRACT

BACKGROUND: The COVID-19 pandemic started to affect Turkey in March 2020. In this study, we retrospectively investigated spontaneous rectus sheath hematoma (S-RSH) in patients with COVID-19 presenting with acute abdominal pain during the ongoing pandemic. METHODS: The demographic characteristics, laboratory findings, length of hospital stay, and treatment processes of COVID-19 cases with S-RSH detected between March and December 2020 were recorded. The rectus sheath hematoma diagnosis of the patients was made using abdominal computed tomography, and the patients were followed up. Low-molecular-weight heparin treatment, which was initiated upon admission, was continued during the follow-up. RESULTS: S-RSH was detected in 13 out of 220 patients with COVID-19 who were referred to general surgery for consultation due to acute abdominal pain. The mean age of these patients was 78±13 years, and the female-to-male ratio was 1.6. Mechanical ven-tilation support was applied to three patients, all of whom were followed up in the intensive care unit. Two patients died for reasons independent of rectus sheath hematoma during their treatment. Among the laboratory findings, the activated partial thromboplastin time (aPTT) values did not deviate from the normal range. While there was no correlation between the international normalized ratio (INR) and aPTT (p>0.01), a significant correlation was found between INR and interleukin-6 (IL-6) (p<0.002). None of the patients required surgical or endovascular interventional radiology procedures. CONCLUSION: In the literature, the incidence of S-RSH in patients presenting with acute abdominal pain is 1.8%. However, in our series, this rate was approximately 3 times higher. Our patients' normal INR and aPTT values suggest that coagulopathy was mostly secondary to endothelial damage. In addition, the significantly higher IL-6 values (p<0.002) indicate the development of vasculitis along with the acute inflammatory process. S-RSH can be more commonly explained the high severity of vasculitis and endothelial damage due to viral infection.


Subject(s)
Abdomen, Acute , COVID-19 , Muscular Diseases , Vasculitis , Abdomen, Acute/epidemiology , Abdominal Pain/etiology , Aged , Aged, 80 and over , Female , Hematoma/diagnostic imaging , Hematoma/epidemiology , Hematoma/etiology , Humans , Incidence , Interleukin-6 , Male , Muscular Diseases/diagnosis , Muscular Diseases/epidemiology , Muscular Diseases/etiology , Pandemics , Rectus Abdominis/diagnostic imaging , Retrospective Studies , Vasculitis/complications , Vasculitis/epidemiology
19.
Eur J Neurol ; 29(9): 2832-2841, 2022 09.
Article in English | MEDLINE | ID: covidwho-1879026

ABSTRACT

BACKGROUND AND PURPOSE: Among post-COVID-19 symptoms, fatigue is reported as one of the most common, even after mild acute infection, and as the cause of fatigue, myopathy diagnosed by electromyography has been proposed in previous reports. This study aimed to explore the histopathological changes in patients with post-COVID-19 fatigue. METHODS: Sixteen patients (mean age = 46 years) with post-COVID-19 complaints of fatigue, myalgia, or weakness persisting for up to 14 months were included. In all patients, quantitative electromyography and muscle biopsies analyzed with light and electron microscopy were taken. RESULTS: Muscle weakness was present in 50% and myopathic electromyography in 75%, and in all patients there were histological changes. Muscle fiber atrophy was found in 38%, and 56% showed indications of fiber regeneration. Mitochondrial changes, comprising loss of cytochrome c oxidase activity, subsarcollemmal accumulation, and/or abnormal cristae, were present in 62%. Inflammation was found in 62%, seen as T lymphocytes and/or muscle fiber human leukocyte antigen ABC expression. In 75%, capillaries were affected, involving basal lamina and cells. In two patients, uncommon amounts of basal lamina were found, not only surrounding muscle fibers but also around nerves and capillaries. CONCLUSIONS: The wide variety of histological changes in this study suggests that skeletal muscles may be a major target of SARS-CoV-2, causing muscular post-COVID-19 symptoms. The mitochondrial changes, inflammation, and capillary injury in muscle biopsies can cause fatigue in part due to reduced energy supply. Because most patients had mild-moderate acute affection, the new variants that might cause less severe acute disease could still have the ability to cause long-term myopathy.


Subject(s)
COVID-19 , Muscular Diseases , COVID-19/complications , Fatigue/complications , Humans , Inflammation/pathology , Middle Aged , Muscle, Skeletal/pathology , Muscular Diseases/diagnosis , SARS-CoV-2
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