A comparative study of virus nucleic acid re-positive and non-re-positive patients infected with SARS-CoV-2 Delta variant strain in the Ningxia Hui Autonomous Region.

Objective: This study aimed to provide a basis for epidemic prevention and control measures as well as the management of re-positive personnel by analyzing and summarizing the characteristics of re-positive patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant infections discharged from a hospital in the Ningxia Hui Autonomous Region in 2021. Methods: This case-control study included a total of 45 patients with Delta variant infections diagnosed in the Fourth People's Hospital of the Ningxia Hui Autonomous Region between October 17 and November 28, 2021. Based on the nucleic acid test results post-discharge, the patients were dichotomized into re-positive and non-re-positive groups. Based on the time of the first re-positive test, the re-positive group was further divided into <7 and ≥7 days groups to compare their clinical characteristics and explore the possible influencing factors of this re-positivity. Results: Of the 45 total patients, 16 were re-positive (re-positivity rate: 35.6%), including four patients who were re-positive after 2 weeks (re-positivity rate: 8.8%). The median time of the first re-positive after discharge was 7 days (IQR: 14-3). The re-positive group was younger than the non-re-positive group (35 vs. 53, P < 0.05), had a higher proportion of patients who were not receiving antiviral therapy (56.2 vs. 17.2%, P < 0.05). The median CT value of nucleic acid in the re-positive group was considerably greater than that at admission (36.7 vs. 22.6 P < 0.05). The findings demonstrated that neutralizing antibody treatment significantly raised the average IgG antibody level in patients, particularly in those who had not received COVID-19 vaccine (P < 0.05). The median lowest nucleic acid CT value of the ≥7 days group during the re-positive period and the immunoglobulin G (IgG) antibody level at discharge were lower than those in the <7 days group (P < 0.05). When compared to the non-positive group, patients in the ≥7 days group had a higher median virus nucleic acid CT value (27.1 vs. 19.2, P < 0.05) and absolute number of lymphocytes at admission (1,360 vs. 952, P < 0.05), and a lower IgG antibody level at discharge (P < 0.05). Conclusions: In conclusion, this study found that: (1) The re-positivity rate of SARS-CoV-2 Delta variant infection in this group was 35.6%, while the re-positivity rate was the same as that of the original strain 2 weeks after discharge (8.0%). (2) Young people, patients who did not use antiviral therapy or had low IgG antibody levels at discharge were more likely to have re-positive. And the CT value of nucleic acid at the time of initial infection was higher in re-positive group. We speculated that the higher the CT value of nucleic acid at the time of initial infection, the longer the intermittent shedding time of the virus. (3) Re-positive patients were asymptomatic. The median CT value of nucleic acid was > 35 at the re-positive time, and the close contacts were not detected as positive. The overall transmission risk of re-positive patients is low.

Effects of a nutrition plus exercise programme on physical function in sarcopenic obese elderly people: study protocol for a randomised controlled trial.

INTRODUCTION: With a rapidly ageing population, sarcopenic obesity, defined as decreased muscle mass and function combined with increased body fat, is a complex health problem. Although sarcopenic obesity contributes to a decline in physical function and exacerbates frailty in older adults, evidence from clinical trials about the effect of exercise and nutrition on this complex syndrome in Chinese older adults is lacking. METHODS AND ANALYSIS: We devised a study protocol for a single-blind randomised controlled trial. Sarcopenia is described as age-related decline in muscle mass plus low muscle strength and/or low physical performance. Obesity is defined as a percentage of body fat above the 60th centile. Ninety-two eligible participants will be randomly assigned to a control group, nutrition group, exercise group and nutrition plus exercise group to receive an 8-week intervention and 12-week follow-up. The primary outcomes will be the change in short physical performance battery scores, grip strength and 6 m usual gait speed. The secondary outcomes will include basic activities of daily living scores, instrumental activity daily living scores, body composition and body anthropometric indexes. For all main analyses, the principle of intention-to-treat will be used. ETHICS AND DISSEMINATION: This study was approved by the medical ethics committee of Zhejiang Hospital on 25 November 2015. The study will present data targeting the clinical effects of nutrition and exercise on physical function and body composition in a Chinese older population with sarcopenic obesity. The results will help to provide important clinical evidence of the role of complex non-pharmaceutical interventions for sarcopenic obese older people. The findings of this study will be submitted to peer-reviewed medical journals for publication and presented at relevant academic conferences. TRIAL REGISTRATION NUMBER: ChiCTR-IOR-15007501; Pre-results.

Relationship of serum vitamin D level on geriatric syndromes and physical performance impairment in elderly hypertensive patients.

OBJECTIVE: To investigate the relationship among serum vitamin D levels, physical performance impairment, and geriatric syndromes in elders with hypertension. METHODS: According to the concentration of vitamin D levels, a total of 143 elderly patients with hypertension were classified into vitamin D deficient group (vitamin D ≤ 20 ng/mL, n = 94) and vitamin D appropriate group (vitamin D > 20 ng/mL, n = 49). Geriatric syndromes and physical performance were assessed by using comprehensive geriatric assessment (CGA). Correlation among vitamin D levels, geriatric syndromes and physical performance was analyzed. RESULTS: No statistical differences were found in various aspects of geriatric syndromes between the two groups (P > 0.05). While correlation analysis indicated that vitamin D levels had a positive association with ADL score (r = 0.235, P < 0.01) and a negative association with Morse fall scale score (r = -0.238, P < 0.01). Patients with deficient vitamin D level had longer time both in the Five Time Sit to Stand Test (5tSTS), (15.765 ± 5.593) and the four-meter walk test [7.440 (5.620, 9.200)], a weaker hand-grip in the grip strength test (28.049 ± 9.522), and a lower Tinetti performance-oriented mobility assessment (Tinetti POMA) [26 (22, 27)] and Balance subscale of the Tinetti performance-oriented mobility assessment (B-POMA) score [14 (12, 16)], compared with appropriate vitamin D level [(13.275 ± 3.692); 5.810 (4.728, 7.325)]; (31.989 ± 10.217); [26.5 (25, 28)]; [15 (14, 16), respectively, all P < 0.05]. Furthermore, results of logistic regression indicated that vitamin D was significantly associated with 5tSTS (OR = 1.2, 95% CI = 1.050-1.331, P < 0.01), Tinetti POMA (OR = 3.7, 95% CI:1.284-10.830, P < 0.05) and B-POMA (OR = 0.8, 95% CI:0.643-0.973, P < 0.05). CONCLUSIONS: In elderly hypertensive patients, serum vitamin D deficient level is associated with physical performance impairment. However, no statistical significance was found between vitamin D and geriatric syndromes. Further study is required to investigate possible mechanisms for the association between vitamin D and physical performance.

A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension: a cross-sectional study.

BACKGROUND: Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. METHODS: A total of 342 elderly hypertension patients (age 79.5 ± 6.7 years, male 63.8%) were recruited to the study. Comprehensive geriatric assessment (CGA), including measurements about activity of daily living (ADL), nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti performance oriented mobility assessment (POMA) and history of fall in the recent year. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. RESULTS: Participants with higher CGA score were likely to be older, had a lower body mass index (BMI), and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease (COPD), cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile (P < 0.01 T3 vs. T1, P < 0.01 T3 vs. T2). Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale (P < 0.001), as well as CGA and POMA (P < 0.001). Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL impairment (OR: 2.748, 95%CI: 1.598-4.725), (OR: 3.310, 95%CI: 1.893-5.788). Decreased Tinetti POMA score was associated with Mini-Mental State Examination (MMSE) (OR: 4.035, 95%CI: 2.100-7.751), ADL (OR: 2.380, 95%CI: 1.357-4.175) and shortened MNA form (MNA-SF) impairment (OR: 2.692, 95%CI: 1.147-6.319). CONCLUSIONS: In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effective interventions.