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Moga TD, Nistor-Cseppento CD, Bungau SG, Tit DM, Sabau AM, Behl T, Nechifor AC, Bungau AF, Negrut N. The Effects of the 'Catabolic Crisis' on Patients' Prolonged Immobility after COVID-19 Infection. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060828. [PMID: 35744091 PMCID: PMC9231342 DOI: 10.3390/medicina58060828] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 12/16/2022]
Abstract
Background and Objectives: Quarantine, isolation and bed rest associated with COVID-19 infection favored the loss of muscle and bone mass, especially in elderly patients. The current study aims to compare the presence of sarcopenia and osteoporosis in patients with a recent (one month) history of SARS-CoV-2 infection versus the general population. Materials and Methods: A cross-sectional study was conducted in which 157 patients were enrolled, divided into two groups, comparable in structure. The COVID-19 group (group C) consisted of 86 patients who were diagnosed with SARS-CoV-2 respiratory infection within the last 30 days. The non-COVID-19 group (group NC) consists of 71 patients who had no clinical signs of respiratory infection and were not quarantined/hospitalized in the last 3 months. Muscle strength, incidence of sarcopenia (using SARC-F score) and osteoporosis (DEXA determination) and physical performance (SPPB score) in the two groups were assessed and compared. Results: No statistically significant differences were found between the SPPB scores of the C group versus the NC group. Statistically significant differences were found in the evaluation of three parameters included in the SARC-F score. Patients in the C group had difficulties in standing up from a chair (p = 0.009) and climbing stairs (p = 0.030) due to lower muscle strength (p = 0.002) compared with patients in the NC group. No correlation of the SARC F and SPPB scores with the T score values obtained by osteo-densitometry was found. Conclusions: The sudden and significant reduction in physical activity, through various measures taken in the general population during the pandemic, led to an increased incidence of sarcopenia, both in patients who did not have COVID-19 infection and among those quarantined/hospitalized for this condition.
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Affiliation(s)
- Titus David Moga
- Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Carmen Delia Nistor-Cseppento
- Department of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Correspondence: (C.D.N.-C.); (S.G.B.)
| | - Simona Gabriela Bungau
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania;
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
- Correspondence: (C.D.N.-C.); (S.G.B.)
| | - Delia Mirela Tit
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania;
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Anca Maria Sabau
- Department of Physical Education, Sport and Physical Therapy, Faculty of Geography, Tourism and Sport, University of Oradea, 410087 Oradea, Romania;
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India;
| | - Aurelia Cristina Nechifor
- Analytical Chemistry and Environmental Engineering Department, Polytechnic University of Bucharest, 011061 Bucharest, Romania;
| | - Alexa Florina Bungau
- Medicine Program of Study, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Nicoleta Negrut
- Department of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
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Qin HC, He Z, Luo ZW, Zhu YL. Management of hip fracture in COVID-19 infected patients. World J Orthop 2022; 13:544-554. [PMID: 35949705 PMCID: PMC9244961 DOI: 10.5312/wjo.v13.i6.544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/07/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Given that the global population of elderly individuals is expanding and the difficulty of recovery, hip fractures will be a huge challenge and a critical health issue for all of humanity. Although people have spent more time at home during the coronavirus disease 2019 (COVID-19) pandemic, hip fractures show no sign of abating. Extensive studies have shown that patients with hip fracture and COVID-19 have a multifold increase in mortality compared to those uninfected and a more complex clinical condition. At present, no detailed research has systematically analyzed the relationship between these two conditions and proposed a comprehensive solution. This article aims to systematically review the impact of COVID-19 on hip fracture and provide practical suggestions. We found that hip fracture patients with COVID-19 have higher mortality rates and more complicated clinical outcomes. Indirectly, COVID-19 prevents hip fracture patients from receiving regular medical treatment. With regard to the problems we encounter, we provide clinical recommendations based on existing research evidence and a clinical flowchart for the management of hip fracture patients who are COVID-19 positive. Our study will help clinicians adequately prepare in advance when dealing with such patients and optimize treatment decisions.
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Affiliation(s)
- Hao-Cheng Qin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhong He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu-Lian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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53
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Pires RE, Reis IGN, Waldolato GS, Pires DD, Bidolegui F, Giordano V. What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?: A Systematic Review. JBJS Rev 2022; 10:01874474-202206000-00001. [PMID: 35658089 DOI: 10.2106/jbjs.rvw.22.00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
» COVID-19 is a disease that is challenging science, health-care systems, and humanity. An astonishingly wide spectrum of manifestations of multi-organ damage, including musculoskeletal, can be associated with SARS-CoV-2. » In the acute phase of COVID-19, fatigue, myalgia, and arthralgia are the most common musculoskeletal symptoms. » Post-COVID-19 syndrome is a group of signs and symptoms that are present for >12 weeks. The associated musculoskeletal manifestations are fatigue, arthralgia, myalgia, new-onset back pain, muscle weakness, and poor physical performance. » Data on COVID-19 complications are growing due to large absolute numbers of cases and survivors in these 2 years of the pandemic. Additional musculoskeletal manifestations encountered are falls by the elderly, increased mortality after hip fracture, reduced bone mineral density and osteoporosis, acute sarcopenia, rhabdomyolysis, Guillain-Barré syndrome, muscle denervation atrophy, fibromyalgia, rheumatological disease triggering, septic arthritis, adhesive capsulitis, myositis, critical illness myopathy, onset of latent muscular dystrophy, osteonecrosis, soft-tissue abscess, urticarial vasculitis with musculoskeletal manifestations, and necrotizing autoimmune myositis. » A wide range of signs and symptoms involving the musculoskeletal system that affect quality of life and can result in a decrease in disability-adjusted life years. This powerful and unpredictable disease highlights the importance of multimodality imaging, continuing education, and multidisciplinary team care to support preventive measures, diagnosis, and treatment.
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Affiliation(s)
- Robinson E Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Hospital Felicio Rocho, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Instituto Orizonti, Belo Horizonte, Brazil
| | - Igor G N Reis
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo S Waldolato
- Serviço de Ortopedia e Traumatologia, Hospital Felicio Rocho, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Instituto Orizonti, Belo Horizonte, Brazil
| | - Diego D Pires
- Cedimagem Medicina Diagnóstica, Grupo Alliar, Juiz de Fora, Brazil
| | - Fernando Bidolegui
- Servicio de Ortopedia y Traumatologia, Hospital Sirio-Libanes, ECICARO, Buenos Aires, Argentin
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
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Hinkelmann JV, de Oliveira NA, Marcato DF, Costa ARRO, Ferreira AM, Tomaz M, Rodrigues TJ, Mendes AP. Nutritional support protocol for patients with COVID-19. Clin Nutr ESPEN 2022; 49:544-550. [PMID: 35623865 PMCID: PMC8915452 DOI: 10.1016/j.clnesp.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS COVID-19 is a hypercatabolic disease with possible pulmonary and gastrointestinal symptoms, and consequent deterioration of the nutritional status and the worst clinical prognosis. This study presents a protocol to guide the nutritional care of adult and elderly people non-critically and critically ill with COVID-19. METHODS A critical review of the literature was carried out in the databases PubMed, Scielo, Bireme, and Science Direct, in search of articles and guidelines that presented assessment criteria and nutritional conduct for COVID-19 and Severe Acute Respiratory Syndrome (SARS), as well as guidelines for managing the symptoms presented by patients. RESULTS The results are recommendations based on the literature and the professional experience of nutritionists who provide nutritional assistance to individuals hospitalized with COVID-19 since the beginning of the pandemic in Brazil. We present tools and suggestions for assessing the nutritional status, calculating nutritional needs, initiating nutritional therapy and monitoring tolerance to it, nutritional monitoring during hospitalization, and guidelines for hospital discharge. CONCLUSION Patients with COVID-19 are at nutritional risk. A complete nutritional assessment (anthropometric, dietary, and laboratory assessment) enables the establishment of an individualized nutritional approach in order to contribute to better clinical and nutritional prognoses.
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Affiliation(s)
| | | | | | | | | | - Marcilene Tomaz
- Santa Casa de Misericórdia de Juiz de Fora, Minas Gerais, Brazil
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Beneficial Effect of H 2S-Releasing Molecules in an In Vitro Model of Sarcopenia: Relevance of Glucoraphanin. Int J Mol Sci 2022; 23:ijms23115955. [PMID: 35682634 PMCID: PMC9180606 DOI: 10.3390/ijms23115955] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023] Open
Abstract
Sarcopenia is a gradual and generalized skeletal muscle (SKM) syndrome, characterized by the impairment of muscle components and functionality. Hydrogen sulfide (H2S), endogenously formed within the body from the activity of cystathionine-γ-lyase (CSE), cystathionine- β-synthase (CBS), and mercaptopyruvate sulfurtransferase, is involved in SKM function. Here, in an in vitro model of sarcopenia based on damage induced by dexamethasone (DEX, 1 μM, 48 h treatment) in C2C12-derived myotubes, we investigated the protective potential of exogenous and endogenous sources of H2S, i.e., glucoraphanin (30 μM), L-cysteine (150 μM), and 3-mercaptopyruvate (150 μM). DEX impaired the H2S signalling in terms of a reduction in CBS and CSE expression and H2S biosynthesis. Glucoraphanin and 3-mercaptopyruvate but not L-cysteine prevented the apoptotic process induced by DEX. In parallel, the H2S-releasing molecules reduced the oxidative unbalance evoked by DEX, reducing catalase activity, O2− levels, and protein carbonylation. Glucoraphanin, 3-mercaptopyruvate, and L-cysteine avoided the changes in myotubes morphology and morphometrics after DEX treatment. In conclusion, in an in vitro model of sarcopenia, an impairment in CBS/CSE/H2S signalling occurs, whereas glucoraphanin, a natural H2S-releasing molecule, appears more effective for preventing the SKM damage. Therefore, glucoraphanin supplementation could be an innovative therapeutic approach in the management of sarcopenia.
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Cordingley DM, Anderson JE, Cornish SM. Myokine Response to Blood-Flow Restricted Resistance Exercise in Younger and Older Males in an Untrained and Resistance-Trained State: A Pilot Study. JOURNAL OF SCIENCE IN SPORT AND EXERCISE 2022. [PMCID: PMC9099348 DOI: 10.1007/s42978-022-00164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose The purpose of this study was to examine the response of myokines to blood-flow restricted resistance-exercise (BFR-RE) in younger and older males before and after completing a 12-week resistance-training program. Methods There were 8 younger (24.8 ± 3.9 yrs) and 7 older (68.3 ± 5.0 yrs) untrained male participants completed this study. Anthropometric and maximal strength (1RM) measurements were collected before and after a 12-week, supervised, progressive full-body resistance-training program. As well, an acute bout of full-body BFR-RE was performed with venipuncture blood samples collected before and immediately following the BFR-RE, followed by sampling at 3, 6, 24 and 48 h. Results The 12-week training program stimulated a 32.2% increase in average strength and 30% increase in strength per kg of fat free mass. The response of particular myokines to the acute bout of BFR-RE was influenced training status (IL-4, untrained = 78.1 ± 133.2 pg/mL vs. trained = 59.8 ± 121.6 pg/mL, P = 0.019; IL-7, untrained = 3.46 ± 1.8 pg/mL vs. trained = 2.66 ± 1.3 pg/mL, P = 0.047) or both training and age (irisin, P = 0.04; leukemia inhibitory factor, P < 0.001). As well, changes in strength per kg of fat free mass were correlated with area under the curve for IL-4 (r = 0.537; P = 0.039), IL-6 (r = 0. 525; P = 0.044) and LIF (r = − 0.548; P = 0.035) in the untrained condition. Conclusion This study identified that both age and training status influence the myokine response to an acute bout of BFR-RE with the release of IL-4, IL-6 and LIF in the untrained state being associated with changes in strength per kg of fat free mass.
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Affiliation(s)
- Dean M. Cordingley
- Applied Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2 Canada
- Pan Am Clinic Foundation, 75 Poseidon Bay, Winnipeg, MB R3M 3E4 Canada
| | | | - Stephen M. Cornish
- Applied Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2 Canada
- Faculty of Kinesiology and Recreation Management, University of Manitoba, 110 Frank Kennedy Centre, Winnipeg, MB R3T 2N2 Canada
- Centre for Aging, University of Manitoba, Winnipeg, MB R3T 2N2 Canada
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Al Saedi A, Kirk B, Iuliano S, Zanker J, Vogrin S, Jayaram L, Thomas S, Golding C, Navarro-Perez D, Marusic P, Leng S, Nanan R, Duque G. Effects of 3 months of multi-nutrient supplementation on the immune system and muscle and respiratory function of older adults in aged care (The Pomerium Study): protocol for a randomised controlled trial. BMJ Open 2022; 12:e059075. [PMID: 35523505 PMCID: PMC9082724 DOI: 10.1136/bmjopen-2021-059075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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.
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Affiliation(s)
- Ahmed Al Saedi
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Ben Kirk
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sandra Iuliano
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Jesse Zanker
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sara Vogrin
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Lata Jayaram
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shane Thomas
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Christine Golding
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Diana Navarro-Perez
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Petra Marusic
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sean Leng
- Johns Hopkins Center on Aging and Immune Remodeling, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ralph Nanan
- Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Gustavo Duque
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
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De Lorenzo R, Palmisano A, Esposito A, Gnasso C, Nicoletti V, Leone R, Vignale D, Falbo E, Ferrante M, Cilla M, Magnaghi C, Martinenghi S, Vitali G, Molfino A, Rovere-Querini P, Muscaritoli M, Conte C. Myosteatosis Significantly Predicts Persistent Dyspnea and Mobility Problems in COVID-19 Survivors. Front Nutr 2022; 9:846901. [PMID: 35464004 PMCID: PMC9024358 DOI: 10.3389/fnut.2022.846901] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background Persistent symptoms including dyspnea and functional impairment are common in COVID-19 survivors. Poor muscle quality (myosteatosis) associates with poor short-term outcomes in COVID-19 patients. The aim of this observational study was to assess the relationship between myosteatosis diagnosed during acute COVID-19 and patient-reported outcomes at 6 months after discharge. Methods Myosteatosis was diagnosed based on CT-derived skeletal muscle radiation attenuation (SM-RA) measured during hospitalization in 97 COVID-19 survivors who had available anthropometric and clinical data upon admission and at the 6-month follow-up after discharge. Dyspnea in daily activities was assessed using the modified Medical Research Council (mMRC) scale for dyspnea. Health-related quality of life was measured using the European quality of life questionnaire three-level version (EQ-5D-3L). Results Characteristics of patients with (lowest sex- and age-specific tertile of SM-RA) or without myosteatosis during acute COVID-19 were similar. At 6 months, patients with myosteatosis had greater rates of obesity (48.4 vs. 27.7%, p = 0.046), abdominal obesity (80.0 vs. 47.6%, p = 0.003), dyspnea (32.3 vs. 12.5%, p = 0.021) and mobility problems (32.3 vs. 12.5%, p = 0.004). Myosteatosis diagnosed during acute COVID-19 was the only significant predictor of persistent dyspnea (OR 3.19 [95% C.I. 1.04; 9.87], p = 0.043) and mobility problems (OR 3.70 [95% C.I. 1.25; 10.95], p = 0.018) at 6 months at logistic regression adjusted for sex, age, and BMI. Conclusion Myosteatosis diagnosed during acute COVID-19 significantly predicts persistent dyspnea and mobility problems at 6 months after hospital discharge independent of age, sex, and body mass. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT04318366].
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Affiliation(s)
- Rebecca De Lorenzo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Palmisano
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Gnasso
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Nicoletti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Leone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Vignale
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Falbo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marica Ferrante
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Cilla
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristiano Magnaghi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabina Martinenghi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giordano Vitali
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Patrizia Rovere-Querini
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
- *Correspondence: Caterina Conte,
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Welch C, Greig C, Majid Z, Masud T, Moorey H, Pinkney T, Jackson T. The feasibility of conducting acute sarcopenia research in hospitalised older patients: a prospective cohort study. Eur Geriatr Med 2022; 13:463-473. [PMID: 34608617 PMCID: PMC8490139 DOI: 10.1007/s41999-021-00565-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/17/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To assess feasibility of conducting acute sarcopenia research in complex populations of hospitalised older adults. METHODS Patients ≥ 70 years old were recruited to three cohorts: elective colorectal surgery, emergency (abdominal) surgery, medical patients with infections. Participants were recruited to the elective cohort in preoperative assessment clinic, and acutely admitted participants from surgical and medical wards at the Queen Elizabeth Hospital Birmingham. Serial measures of muscle quantity (ultrasound quadriceps, bioelectrical impedance analysis), muscle function (hand grip strength, physical performance), and questionnaires (mini-nutritional assessment, physical function) were performed at baseline, within 7 (± 2) days of admission/surgery, and 13 (± 1) weeks post-admission/surgery. Feasibility outcomes were assessed across timepoints including recruitment and drop-out rates, and procedure completion rates. RESULTS Eighty-one participants were recruited (mean age 79, 38.3% females). Recruitment rates were higher in elective (75%, 24/32) compared to emergency surgery (37.2%, 16/43), and medical participants (45.1%, 41/91; p = 0.003). Drop-out rates varied from 8.3 to 19.5% at 7 days, and 12.5-43.9% at 13 weeks. Age and gender did not differ between patients assessed for eligibility, approached, or recruited. Completion rates were highest for ultrasound quadriceps (98.8%, 80/81 across all groups at baseline). Gait speed completion rates were lower in medical (70.7%, 29/41) compared to elective participants (100%, 24/24) at baseline. CONCLUSION Higher participation refusal and drop-out rates should be expected for research involving recruitment of participants from the acute setting. Assessment of muscle quantity/quality through ultrasound is recommended in early-stage trials in the acute setting, where completion rates of physical performance testing are expected to be lower.
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Affiliation(s)
- Carly Welch
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK.
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Nottingham, B152TT, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK.
| | - Carolyn Greig
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B152TT, UK
- Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Zeinab Majid
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Nottingham, B152TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
| | - Tahir Masud
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hannah Moorey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Thomas Pinkney
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
- Academic Department of Surgery, University of Birmingham, Birmingham, B152TT, UK
| | - Thomas Jackson
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Nottingham, B152TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
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Zamberlan P, Carlotti APDCP, Viani KHC, Rodriguez IS, Simas JDC, Silvério AB, Volpon LC, de Carvalho WB, Delgado AF. Increased nutrition risk at admission is associated with longer hospitalization in children and adolescents with COVID-19. Nutr Clin Pract 2022; 37:393-401. [PMID: 35226766 PMCID: PMC9088697 DOI: 10.1002/ncp.10846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We investigated the association of nutritional risk and inflammatory marker level with length of stay (LOS) in children and adolescents hospitalized for COVID-19 infection in two pediatric teaching hospitals in a developing country. METHODS This was a cross-sectional analytical retrospective study performed in two pediatric hospitals. We included the data from all children and adolescents who were hospitalized with a SARS-CoV-2 infection between March and December 2020. Demographic, anthropometric, clinical, and laboratory data were extracted from electronic medical records. Nutritional risk was assessed according to the STRONGkids tool within 24 hours of admission and was categorized into two levels: ≥4 (high risk) and <4 (moderate or low risk). Means or medians were compared between nutritional risk groups using the t test and Mann-Whitney U test, respectively. The association of nutritional risk and inflammatory markers with LOS was estimated using the Kaplan-Meier method and log-rank test. Cox proportional-hazard and linear regression models were performed, and adjusted for sex, age, and respiratory symptoms. RESULTS From a total of 73 patients, 20 (27.4%) had a STRONGkids score ≥4 at admission, which was associated with a longer LOS even after adjusting (β = 12.30; 1.74-22.9 95% CI; P = 0.023). The same association was observed between LOS and all laboratory markers except for D-dimer. CONCLUSION Among children and adolescents with COVID-19, a STRONGkids score ≥4 at admission, lower values of albumin, lymphocytes, and hemoglobin, and higher CRP values were associated with longer LOS.
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Affiliation(s)
- Patrícia Zamberlan
- Division of NutritionInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | | | - Karina Helena Canton Viani
- Division of NutritionInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | - Isadora Souza Rodriguez
- Pediatric Intensive Care UnitInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | - Josiane de Carvalho Simas
- Pediatric Intensive Care UnitInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | - Ariadne Beatriz Silvério
- Department of PediatricsFaculdade de Medicina de Ribeirão Preto, Universidade de São PauloSão PauloBrazil
| | - Leila Costa Volpon
- Department of PediatricsFaculdade de Medicina de Ribeirão Preto, Universidade de São PauloSão PauloBrazil
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Cantu N, Vyavahare S, Kumar S, Chen J, Kolhe R, Isales CM, Hamrick M, Fulzele S. Synergistic Effects of Multiple Factors Involved in COVID-19-dependent Muscle Loss. Aging Dis 2022; 13:344-352. [PMID: 35371610 PMCID: PMC8947833 DOI: 10.14336/ad.2021.0817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic caused by the novel SARS-CoV-2 coronavirus is an ongoing pandemic causing severe health crisis worldwide. Recovered COVID-19 patients go through several long-term side effects such as fatigue, headaches, dizziness, weight loss, and muscle loss among others. Our study sought to determine the molecular mechanisms behind muscle loss in COVID-19 patients. We hypothesized that multiple factors such as cytokine storm and therapeutic drugs (glucocorticoid and antiviral drugs) might be involved in muscle loss. Using the Gene Expression Omnibus database, we identified several studies that performed RNA sequencing on skeletal muscles with the treatment of cytokine, glucocorticoid, and antiviral drugs. Our study identified cytokines, such as IL-1b, and IL-6, associated with altered regulation of several genes involved in the myogenic processes, including Ttn, Cxxc5, Malat1, and Foxo1. We also observed that glucocorticoid altered the expression of Foxo1, Lcn2, Slc39a14, and Cdkn1a. Finally, we found out that the antiviral (RNA-dependent RNA polymerase inhibitor) drug regulates the expression of some of the muscle-related genes (Txnip, Ccnd1, Hdac9, and Fbxo32). Based on our findings, we hypothesize that the cytokine storm, glucocorticoids, and antiviral drugs might be synergistically involved in COVID-19-dependent muscle loss.
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Affiliation(s)
- Nicholas Cantu
- Department of Medicine, Augusta University, Augusta, GA, USA.
| | - Sagar Vyavahare
- Department of Cell biology and anatomy, Augusta University, Augusta, GA, USA.
| | - Sandeep Kumar
- Department of Cell biology and anatomy, Augusta University, Augusta, GA, USA.
| | - Jie Chen
- Division of Biostatistics & Data Sciences, DPHS, Augusta University, Augusta, GA, USA.
| | - Ravindra Kolhe
- Department of Pathology, Augusta University, Augusta, GA, USA.
| | - Carlos M Isales
- Department of Medicine, Augusta University, Augusta, GA, USA.
- Center for Healthy Aging, Augusta University, Augusta, GA, USA
| | - Mark Hamrick
- Department of Cell biology and anatomy, Augusta University, Augusta, GA, USA.
- Center for Healthy Aging, Augusta University, Augusta, GA, USA
| | - Sadanand Fulzele
- Department of Medicine, Augusta University, Augusta, GA, USA.
- Department of Cell biology and anatomy, Augusta University, Augusta, GA, USA.
- Center for Healthy Aging, Augusta University, Augusta, GA, USA
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Welch C, Greig C, Lewis D, Majid Z, Masud T, Moorey H, Pinkney T, Stanley B, Jackson T. Trajectories of muscle quantity, quality and function measurements in hospitalized older adults. Geriatr Gerontol Int 2022; 22:311-318. [PMID: 35246911 PMCID: PMC9313889 DOI: 10.1111/ggi.14366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 12/01/2022]
Abstract
AIM Acute sarcopenia is defined by the development of incident sarcopenia (low muscle quantity/quality and function) within 6 months of a stressor event. However, outcome measures for clinical trials have not been validated. This study aimed to characterize changes in muscle quantity, quality, strength, and physical function during and after hospitalization. METHODS Patients aged ≥70 years admitted for elective colorectal surgery, emergency abdominal surgery or acute infections were recruited from a single university hospital. Assessments were carried out at baseline, and within 7 ± 2 days and 13 ± 1 weeks postoperatively or post-admission. RESULTS A total of 79 participants (mean age 79 years, 39% female) were included. Physical function defined by the Patient-Reported Outcome Measures Information System T-score declined from baseline (42.3, 95% CI 40.2-44.3) to 7 days (36.6, 95% CI 34.5-38.8; P = 0.001), with improvement after 13 weeks (40.5, 95% CI 37.9-43.0). Changes in muscle quantity, quality and function measurements were overall heterogeneous, with few significant changes at the study population level. Change in rectus femoris echogenicity over 13 weeks correlated with changes in handgrip strength (r = 0.53; P < 0.001) and gait speed (r = 0.59; P = 0.003) over the same period. CONCLUSIONS Patient-Reported Outcome Measures Information System T-score provides a sensitive measure of change in physical function in hospitalized older patients. However, changes in muscle quantity, quality and function measurements were heterogeneous, and not significant at the study population level. Further research should assess for factors that might be predictive of changes within individuals to enable stratified interventions. Geriatr Gerontol Int 2022; 22: 311-318.
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Affiliation(s)
- Carly Welch
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Carolyn Greig
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- School of Sport, Exercise, and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
- Birmingham Biomedical Research CenterUniversity of Birmingham and University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Danielle Lewis
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Zeinab Majid
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Tahir Masud
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- Nottingham University Hospitals NHS TrustNottinghamUK
- University of NottinghamNottinghamUK
| | - Hannah Moorey
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Thomas Pinkney
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Academic Department of SurgeryUniversity of BirminghamBirminghamUK
| | - Benjamin Stanley
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Thomas Jackson
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
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Nagae M, Umegaki H, Yoshiko A, Fujita K, Komiya H, Watanabe K, Yamada Y, Sakai T, Kuzuya M. Muscle changes on muscle ultrasound and adverse outcomes in acute hospitalized older adults. Nutrition 2022; 102:111698. [DOI: 10.1016/j.nut.2022.111698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/02/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
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Brandi N, Ciccarese F, Rimondi MR, Balacchi C, Modolon C, Sportoletti C, Renzulli M, Coppola F, Golfieri R. An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review. Diagnostics (Basel) 2022; 12:846. [PMID: 35453894 PMCID: PMC9032937 DOI: 10.3390/diagnostics12040846] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
A significant proportion of patients with COVID-19 pneumonia could develop acute respiratory distress syndrome (ARDS), thus requiring mechanical ventilation, and resulting in a high rate of intensive care unit (ICU) admission. Several complications can arise during an ICU stay, from both COVID-19 infection and the respiratory supporting system, including barotraumas (pneumothorax and pneumomediastinum), superimposed pneumonia, coagulation disorders (pulmonary embolism, venous thromboembolism, hemorrhages and acute ischemic stroke), abdominal involvement (acute mesenteric ischemia, pancreatitis and acute kidney injury) and sarcopenia. Imaging plays a pivotal role in the detection and monitoring of ICU complications and is expanding even to prognosis prediction. The present pictorial review describes the clinicopathological and radiological findings of COVID-19 ARDS in ICU patients and discusses the imaging features of complications related to invasive ventilation support, as well as those of COVID-19 itself in this particularly fragile population. Radiologists need to be familiar with COVID-19's possible extra-pulmonary complications and, through reliable and constant monitoring, guide therapeutic decisions. Moreover, as more research is pursued and the pathophysiology of COVID-19 is increasingly understood, the role of imaging must evolve accordingly, expanding from the diagnosis and subsequent management of patients to prognosis prediction.
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Affiliation(s)
- Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Federica Ciccarese
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Maria Rita Rimondi
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Caterina Balacchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Cecilia Modolon
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Camilla Sportoletti
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Francesca Coppola
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122 Milano, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
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Montes-Ibarra M, Oliveira CL, Orsso CE, Landi F, Marzetti E, Prado CM. The Impact of Long COVID-19 on Muscle Health. Clin Geriatr Med 2022; 38:545-557. [PMID: 35868672 PMCID: PMC8934728 DOI: 10.1016/j.cger.2022.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rodriguez-Sanchez I, Rodriguez-Mañas L, Laosa O. Long COVID-19: The Need for an Interdisciplinary Approach. Clin Geriatr Med 2022; 38:533-544. [PMID: 35868671 PMCID: PMC8934714 DOI: 10.1016/j.cger.2022.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Isabel Rodriguez-Sanchez
- Geriatrics Department, Hospital Clínico San Carlos, c/ Profesor Martín Lagos s/n, 28040-Madrid, Spain
| | - Leocadio Rodriguez-Mañas
- Servicio de Geriatría, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.5, 28905-Getafe, Spain; Centro de Investigación Biomédica en Red "Fragilidad y Envejecimiento Saludable" (CIBERFES), Instituto de Salud Carlos III, c/ Sinesio Delgado, 10, 28029-Madrid, Spain.
| | - Olga Laosa
- Servicio de Geriatría, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.5, 28905-Getafe, Spain; Geriatric Research Group, Biomedical Research Foundation at Hospital Universitario de Getafe, Carretera de Toledo, Km 12.5, 28905-Getafe, Spain
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Palavras MJ, Faria C, Fernandes P, Lagarto A, Ponciano A, Alçada F, Banza MJ. The Impact of the Third Wave of the COVID-19 Pandemic on the Elderly and Very Elderly Population in a Tertiary Care Hospital in Portugal. Cureus 2022; 14:e22653. [PMID: 35371715 PMCID: PMC8963478 DOI: 10.7759/cureus.22653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background: COVID-19 poses a significantly more serious threat to adults aged 65 and above, with a higher mortality rate. This study aims to describe the outcome of COVID-19 patients in the elderly and very elderly population admitted to a tertiary care Portuguese hospital. The authors defined the elderly population (65 to 79 years) and the very elderly population (≥ 80 years). Methods: We conducted a retrospective observational single center study in the internal medicine ward of a tertiary hospital from November 1, 2020 to January 31, 2021. All COVID-19 patients aged over 65 years were enrolled. Results: Of the 824 patients with SARS-CoV-2 infection, 586 (71%) were aged above 65 years. Of them, 61.7% were very elderly and 32.9% were elderly. The hospital recorded 53 (27.5%) deaths in the elderly group and 182 (46.3%) in the over-80 group. In the elderly population, only 32 patients had critical illness compared to the 79 in the very elderly group. In addition to respiratory complications, acute kidney failure and liver dysfunction were noted. In both groups, mortality was higher when there was acute kidney injury (AKI). With respect to treatment, dexamethasone and azithromycin did not show a statistically significant difference between the groups. The need for oxygen therapy over 4L/min, high-flow therapy, and mechanical invasive ventilation was related to higher mortality in both groups. Conclusion: The very elderly group had a higher number of deaths compared to the elderly group due to multiple comorbidities. Respiratory failure was the most frequently occurring complication. Surprisingly, dexamethasone and azithromycin therapy did not show a statistically significant effect in both age groups despite their current widespread usage in COVID-19 treatment worldwide.
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Seixas MLGA, Mitre LP, Shams S, Lanzuolo GB, Bartolomeo CS, Silva EA, Prado CM, Ureshino R, Stilhano RS. Unraveling Muscle Impairment Associated With COVID-19 and the Role of 3D Culture in Its Investigation. Front Nutr 2022; 9:825629. [PMID: 35223956 PMCID: PMC8867096 DOI: 10.3389/fnut.2022.825629] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/18/2022] [Indexed: 12/12/2022] Open
Abstract
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been considered a public health emergency, extensively investigated by researchers. Accordingly, the respiratory tract has been the main research focus, with some other studies outlining the effects on the neurological, cardiovascular, and renal systems. However, concerning SARS-CoV-2 outcomes on skeletal muscle, scientific evidence is still not sufficiently strong to trace, treat and prevent possible muscle impairment due to the COVID-19. Simultaneously, there has been a considerable amount of studies reporting skeletal muscle damage in the context of COVID-19. Among the detrimental musculoskeletal conditions associated with the viral infection, the most commonly described are sarcopenia, cachexia, myalgia, myositis, rhabdomyolysis, atrophy, peripheral neuropathy, and Guillain-Barré Syndrome. Of note, the risk of developing sarcopenia during or after COVID-19 is relatively high, which poses special importance to the condition amid the SARS-CoV-2 infection. The yet uncovered mechanisms by which musculoskeletal injury takes place in COVID-19 and the lack of published methods tailored to study the correlation between COVID-19 and skeletal muscle hinder the ability of healthcare professionals to provide SARS-CoV-2 infected patients with an adequate treatment plan. The present review aims to minimize this burden by both thoroughly exploring the interaction between COVID-19 and the musculoskeletal system and examining the cutting-edge 3D cell culture techniques capable of revolutionizing the study of muscle dynamics.
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Affiliation(s)
- Maria Luiza G. A. Seixas
- Department of Physiological Sciences, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Lucas Pari Mitre
- Department of Physiological Sciences, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Shahin Shams
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, United States
| | - Gabriel Barbugian Lanzuolo
- Department of Physiological Sciences, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Cynthia Silva Bartolomeo
- Department of Physiological Sciences, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Department of Biosciences, Federal University of São Paulo, São Paulo, Brazil
| | - Eduardo A. Silva
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, United States
| | - Carla Maximo Prado
- Department of Biosciences, Federal University of São Paulo, São Paulo, Brazil
| | - Rodrigo Ureshino
- Department of Biological Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Roberta Sessa Stilhano
- Department of Physiological Sciences, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- *Correspondence: Roberta Sessa Stilhano
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Santos CAF, Amirato GR, Jacinto AF, Pedrosa AV, Caldo-Silva A, Sampaio AR, Pimenta N, Santos JMB, Pochini A, Bachi ALL. Vertical Jump Tests: A Safe Instrument to Improve the Accuracy of the Functional Capacity Assessment in Robust Older Women. Healthcare (Basel) 2022; 10:healthcare10020323. [PMID: 35206937 PMCID: PMC8872295 DOI: 10.3390/healthcare10020323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 01/27/2023] Open
Abstract
Age-related decreases in muscle function lead to disabilities and are associated with negative health outcomes in older people. Although several physical tests can be used to assess physical performance, muscle strength, and power, their interpretation can be hampered by the ceiling effect of some of them. The aim of this study was to assess whether vertical jump tests are safe in terms of physical integrity and whether they are useful in assessing physical performance in forty-one robust older women. The investigation entailed an assessment of anthropometric characteristics, physical functioning tests (Short Physical Performance Battery (SPPB), sit-to-up 5 times and sit-to-up 30 s, gait speed, time-up-to-go test (TUGT)), and tests evaluating muscle strength and power (handgrip, lower limb isokinetic tests, and vertical jumping tests). Significant negative correlations were found between vertical jumping tests and BMI, body fat percentage, sit-to-up 5 times and TUGT. In addition, significant positive correlations were observed between vertical jumping tests and SPPB, gait speed, handgrip, and concentric isokinetic tests of knee muscles. No adverse events in volunteers’ physical integrity were reported during and after the performance of all physical tests. Thus, the study results showed that vertical jumping tests are safe and accurate for assessing physical performance and are useful for monitoring age-related loss of muscle performance in robust older women.
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Affiliation(s)
- Carlos A. F. Santos
- Discipline of Geriatrics and Gerontology, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04020-050, Brazil;
- Postgraduate Program in Health Science Applied to Sports and Physical Activity, Paulista School of Medicine (EPM), Sao Paulo 04022-001, Brazil;
- Correspondence:
| | - Gislene R. Amirato
- Mane Garrincha Sports Education Center, Sports Department of the Municipality of Sao Paulo (SEME), Sao Paulo 04039-034, Brazil;
| | - Alessandro F. Jacinto
- Discipline of Geriatrics and Gerontology, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04020-050, Brazil;
- Postgraduate Program in Translational Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04039-002, Brazil
| | - Ana V. Pedrosa
- Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Science and Physical Education, (FCDEF-UC), University of Coimbra, 3040-248 Coimbra, Portugal; (A.V.P.); (A.C.-S.)
| | - Adriana Caldo-Silva
- Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Science and Physical Education, (FCDEF-UC), University of Coimbra, 3040-248 Coimbra, Portugal; (A.V.P.); (A.C.-S.)
| | - António R. Sampaio
- N2i, Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (A.R.S.); (N.P.)
| | - Nuno Pimenta
- N2i, Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (A.R.S.); (N.P.)
| | - Juliana M. B. Santos
- Post-Graduation Program in Science of Human Movement and Rehabilitation, Federal University of Sao Paulo (UNIFESP), Santos 11015-020, Brazil;
| | - Alberto Pochini
- Postgraduate Program in Health Science Applied to Sports and Physical Activity, Paulista School of Medicine (EPM), Sao Paulo 04022-001, Brazil;
| | - André L. L. Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), Sao Paulo 04829-300, Brazil;
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van Haastregt JCM, Everink IHJ, Schols JMGA, Grund S, Gordon AL, Poot EP, Martin FC, O'Neill D, Petrovic M, Bachmann S, van Balen R, van Dam van Isselt L, Dockery F, Holstege MS, Landi F, Pérez LM, Roquer E, Smalbrugge M, Achterberg WP. Management of post-acute COVID-19 patients in geriatric rehabilitation: EuGMS guidance. Eur Geriatr Med 2022; 13:291-304. [PMID: 34800286 PMCID: PMC8605452 DOI: 10.1007/s41999-021-00575-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation. METHODS The guidance is based on guidelines for post-acute COVID-19 geriatric rehabilitation developed in the Netherlands, updated with recent insights from literature, related guidance from other countries and disciplines, and combined with experiences from experts in countries participating in the Geriatric Rehabilitation Special Interest Group of the European Geriatric Medicine Society. RESULTS This guidance for post-acute COVID-19 rehabilitation is divided into a section addressing general recommendations for geriatric rehabilitation and a section addressing specific processes and procedures. The Sect. "General recommendations for geriatric rehabilitation" addresses: (1) general requirements for post-acute COVID-19 rehabilitation and (2) critical aspects for quality assurance during COVID-19 pandemic. The Sect. "Specific processes and procedures", addresses the following topics: (1) patient selection; (2) admission; (3) treatment; (4) discharge; and (5) follow-up and monitoring. CONCLUSION Providing tailored geriatric rehabilitation treatment to post-acute COVID-19 patients is a challenge for which the guidance is designed to provide support. There is a strong need for additional evidence on COVID-19 geriatric rehabilitation including developing an understanding of risk profiles of older patients living with frailty to develop individualised treatment regimes. The present guidance will be regularly updated based on additional evidence from practice and research.
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Affiliation(s)
- Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Irma H J Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Stefan Grund
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Derby, UK
| | - Else P Poot
- Verenso Dutch Association of Elderly Care Physicians, Utrecht, The Netherlands
| | - Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Desmond O'Neill
- Trinity College Dublin Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Stefan Bachmann
- Department of Rheumatology and Internal Medicine, Kliniken Valens, Valens, Switzerland
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Frances Dockery
- Department of Geriatrics and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Marije S Holstege
- Department of Research GRZPLUS, Omring and Zorgcirkel, Hoorn, The Netherlands
| | - Francesco Landi
- Geriatric Internal Medicine Department, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Laura M Pérez
- Clinical Head of Outpatient Clinic and Geriatric Home Care, Intermediate Care Hospital Parc Sanitari Pere Virgili, Barcelona, Spain
- Research Group on Aging, Frailty and Transitions in Barcelona (RE-FiT BCN), Vall d'Hebrón Institut de Recerca, Barcelona, Spain
| | - Esther Roquer
- Geriatric Service, University Hospital Sant Joan de Reus, Reus, Spain
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Chair of the Guidance Committee Post COVID-19 Geriatric Rehabilitation, Verenso Dutch Association of Elderly Care Physicians, Utrecht, The Netherlands
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71
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Kremer WM, Labenz C, Kuchen R, Sagoschen I, Bodenstein M, Schreiner O, Wörns MA, Sivanathan V, Weinmann A, Galle PR, Sprinzl MF. Sonographic assessment of low muscle quantity identifies mortality risk during COVID-19: a prospective single-centre study. J Cachexia Sarcopenia Muscle 2022; 13:169-179. [PMID: 34881516 PMCID: PMC8818698 DOI: 10.1002/jcsm.12862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Assessment of muscle quantity by sonographic muscle indices could help identify patients at risk for fatal outcome during coronavirus disease-2019 (COVID-19). The aim of this study was to explore sonographic muscle indices as predictors of COVID-19 outcome and to test the feasibility of sonographic muscle measurement in an isolation context. METHODS Muscle indices, derived from the psoas muscle or thigh muscles, were quantified by sonography in a cohort of patients without COVID-19 to obtain reference values for low muscle quantity. Gender-specific median of different muscle indices were defined as threshold value for low muscle quantity. The prognostic relevance of low muscle quantity, was prospectively explored in two cohorts of hospitalized COVID-19 patients. Optimal muscle index cutoff values predictive for 30 day mortality during COVID-19 were determined by receiver operating characteristic-area under the curve and Youden index calculation. Muscle quantity and known prognostic factors of COVID-19 were analysed by multivariable log-regression. RESULTS Compared with other muscle indices, the psoas muscle area index (PMAI) showed the most favourable characteristics to predict outcome of COVID-19 disease. Sonographic morphometry of patients without COVID-19 (n = 136) revealed a gender-specific median for PMAI (male: 291.1 mm2 /m2 , female 260.6 mm2 /m2 ) as threshold value of low muscle quantity. Subsequently, COVID-19 patients (Cohort I: n = 58; Cohort II: n = 55) were prospectively assessed by bedside sonography. The studied COVID-19 patients developed a critical course of disease in 22.4% (Cohort I: n = 13/58) and 34.5% (Cohort II: n = 20/55). Mortality rate reached 12.1% (Cohort I: n = 7/58) and 20.0% (Cohort I: n = 11/55) within 30 days of follow up. COVID-19 patients with a PMAI below the gender-specific median showed a higher 30 day mortality in both COVID-19 cohorts (log rank, P < 0.05). The optimal PMAI cutoff value (206 mm2 /m2 ) predicted 30 day mortality of hospitalized COVID-19 patients with a sensitivity of 72% and specificity of 78.5% (receiver operating characteristic-area under the curve: 0.793, 95% confidence interval 0.671-0.914, P = 0.008). Multivariable log-regression analysis of PMAI, age, gender, BMI and comorbidities confirmed an independent association of low PMAI with 30 day mortality of COVID-19 patients (P = 0.018). CONCLUSIONS Sonographic morphometry provides reliable muscle quantification under hygienic precautions and allows risk stratification of patients with COVID-19.
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Affiliation(s)
- Wolfgang M Kremer
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christian Labenz
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Robert Kuchen
- Institute of Medical Biometry, Epidemiology and Informatics of the Johannes Gutenberg-University, Mainz, Germany
| | - Ingo Sagoschen
- Center for Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Marc Bodenstein
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Oliver Schreiner
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Marcus A Wörns
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Visvakanth Sivanathan
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Clinical Registry Unit, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin F Sprinzl
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Clinical Registry Unit, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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72
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Stavrou VT, Vavougios GD, Boutlas S, Tourlakopoulos KN, Papayianni E, Astara K, Stavrou IT, Daniil Z, Gourgoulianis KI. Physical Fitness Differences, Amenable to Hypoxia-Driven and Sarcopenia Pathophysiology, between Sleep Apnea and COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:669. [PMID: 35055495 PMCID: PMC8775577 DOI: 10.3390/ijerph19020669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 12/26/2022]
Abstract
Handgrip strength is an indirect indicator of physical fitness that is used in medical rehabilitation for its potential prognostic value. An increasing number of studies indicate that COVID-19 survivors experience impaired physical fitness for months following hospitalization. The aim of our study was to assess physical fitness indicator differences with another prevalent and hypoxia-driven disease, Obstructive Sleep Apnea Syndrome (OSAS). Our findings showed differences between post-COVID-19 and OSAS groups in cardiovascular responses, with post-COVID-19 patients exhibiting higher values for heart rate and in mean arterial blood pressure. Oxygen saturation (SpO2) was lower in post-COVID-19 patients during a six-minute walking test (6MWT), whereas the ΔSpO2 (the difference between the baseline to end of the 6MWT) was higher compared to OSAS patients. In patients of both groups, statistically significant correlations were detected between handgrip strength and distance during the 6MWT, anthropometric characteristics, and body composition parameters. In our study, COVID-19 survivors demonstrated a long-term reduction in muscle strength compared to OSAS patients. Lower handgrip strength has been independently associated with a prior COVID-19 hospitalization. The differences in muscle strength and oxygenation could be attributed to the abrupt onset of the disorder, which does not allow compensatory mechanisms to act effectively. Targeted rehabilitation focusing on such residual impairments may thus be indispensable within the setting of post-COVID-19 syndrome.
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Affiliation(s)
- Vasileios T Stavrou
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - George D Vavougios
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Stylianos Boutlas
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Konstantinos N Tourlakopoulos
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Eirini Papayianni
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Kyriaki Astara
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Ilias T Stavrou
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Zoe Daniil
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Laboratory of Cardio-Pulmonary Testing and Pulmonary Rehabilitation, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 4100 Larissa, Greece
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73
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Terai H, Hori Y, Takahashi S, Tamai K, Iwamae M, Hoshino M, Ohyama S, Yabu A, Nakamura H. Impact of the COVID-19 pandemic on the development of locomotive syndrome. J Orthop Surg (Hong Kong) 2022; 29:23094990211060967. [PMID: 34894867 DOI: 10.1177/23094990211060967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has affected people in various ways, including restricting their mobility and depriving them of exercise opportunities. Such circumstances can trigger locomotor deterioration and impairment, which is known as locomotive syndrome. The purpose of this study was to investigate the incidence of locomotive syndrome in the pandemic and to identify its risk factors. Methods: This was a multicenter questionnaire survey performed between 1 November 2020 and 31 December 2020 in Japan. Patients who visited the orthopedics clinic were asked to answer a questionnaire about their symptoms, exercise habits, and locomotor function at two time points, namely, pre-pandemic and post-second wave (current). The incidence of locomotive syndrome in the COVID-19 pandemic was investigated. Additionally, multiple logistic regression analysis was used to identify the risk factors for developing locomotive syndrome during the pandemic. Results: A total of 2829 patients were enrolled in this study (average age: 61.1 ± 17.1 years; 1532 women). The prevalence of locomotive syndrome was 30% pre-pandemic, which increased significantly to 50% intra-pandemic. Among the patients with no symptoms of locomotive syndrome, 30% developed it in the wake of the pandemic. In the multinomial logistic regression analysis, older age, deteriorated or newly occurring symptoms of musculoskeletal disorders, complaints about the spine or hip/knee joints, and no or decreased exercise habits were independent risk factors for developing locomotive syndrome. Conclusions: The prevalence of locomotive syndrome in patients with musculoskeletal disorders has increased during the COVID-19 pandemic. In addition to age, locomotor symptoms, especially spine or hip/knee joint complaints, and exercise habits were associated with the development of locomotive syndrome. Although the control of infection is a priority, the treatment of musculoskeletal disorders and ensuring exercise habits are also essential issues to address during a pandemic such as COVID-19.
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Affiliation(s)
- Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masayoshi Iwamae
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shoichiro Ohyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akito Yabu
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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74
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Di Girolamo FG, Fiotti N, Sisto UG, Nunnari A, Colla S, Mearelli F, Vinci P, Schincariol P, Biolo G. Skeletal Muscle in Hypoxia and Inflammation: Insights on the COVID-19 Pandemic. Front Nutr 2022; 9:865402. [PMID: 35529457 PMCID: PMC9072827 DOI: 10.3389/fnut.2022.865402] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/09/2022] [Indexed: 12/23/2022] Open
Abstract
SARS-CoV-2 infection is often associated with severe inflammation, oxidative stress, hypoxia and impaired physical activity. These factors all together contribute to muscle wasting and fatigue. In addition, there is evidence of a direct SARS-CoV-2 viral infiltration into skeletal muscle. Aging is often characterized by sarcopenia or sarcopenic obesity These conditions are risk factors for severe acute COVID-19 and long-COVID-19 syndrome. From these observations we may predict a strong association between COVID-19 and decreased muscle mass and functions. While the relationship between physical inactivity, chronic inflammation, oxidative stress and muscle dysfunction is well-known, the effects on muscle mass of COVID-19-related hypoxemia are inadequately investigated. The aim of this review is to highlight metabolic, immunity-related and redox biomarkers potentially affected by reduced oxygen availability and/or muscle fatigue in order to shed light on the negative impact of COVID-19 on muscle mass and function. Possible countermeasures are also reviewed.
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Affiliation(s)
- Filippo G. Di Girolamo
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
- SC Assistenza Farmaceutica, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
- *Correspondence: Filippo G. Di Girolamo
| | - Nicola Fiotti
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Ugo G. Sisto
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Alessio Nunnari
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Stefano Colla
- SC Assistenza Farmaceutica, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Filippo Mearelli
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Pierandrea Vinci
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Paolo Schincariol
- SC Assistenza Farmaceutica, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Gianni Biolo
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
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75
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Sugiyama M, Kasai F, Kawate N. The Impact of Isolation on Elderly Patients with Mild to Moderate COVID-19. Prog Rehabil Med 2022; 7:20220032. [PMID: 35854684 PMCID: PMC9240098 DOI: 10.2490/prm.20220032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/14/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mizuki Sugiyama
- Department of Rehabilitation Medicine, Showa University School of Medicine, Yokohama, Japan
| | - Fumihito Kasai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Yokohama, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Showa University School of Medicine, Yokohama, Japan
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76
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Damanti S, Cilla M, Tuscano B, De Lorenzo R, Manganaro G, Merolla A, Pacioni G, Pomaranzi C, Tiraferri V, Martinenghi S, Vitali G, Bosi E, Conte C, Giustina A, Tresoldi M, Rovere Querini P. Evaluation of Muscle Mass and Stiffness with Limb Ultrasound in COVID-19 Survivors. Front Endocrinol (Lausanne) 2022; 13:801133. [PMID: 35250860 PMCID: PMC8892603 DOI: 10.3389/fendo.2022.801133] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND acute illnesses, like COVID-19, can act as a catabolic stimulus on muscles. So far, no study has evaluated muscle mass and quality through limb ultrasound in post-COVID-19 patients. METHODS cross sectional observational study, including patients seen one month after hospital discharge for SARS-CoV-2 pneumonia. The patients underwent a multidimensional evaluation. Moreover, we performed dominant medial gastrocnemius ultrasound (US) to characterize their muscle mass and quality. RESULTS two hundred fifty-nine individuals (median age 67, 59.8% males) were included in the study. COVID-19 survivors with reduced muscle strength had a lower muscle US thickness (1.6 versus 1.73 cm, p =0.02) and a higher muscle stiffness (87 versus 76.3, p = 0.004) compared to patients with normal muscle strength. Also, patients with reduced Short Physical Performance Battery (SPPB) scores had a lower muscle US thickness (1.3 versus 1.71 cm, p = 0.01) and a higher muscle stiffness (104.9 versus 81.07, p = 0.04) compared to individuals with normal SPPB scores. The finding of increased muscle stiffness was also confirmed in patients with a pathological value (≥ 4) at the sarcopenia screening tool SARC-F (103.0 versus 79.55, p < 0.001). Muscle stiffness emerged as a significant predictor of probable sarcopenia (adjusted OR 1.02, 95% C.I. 1.002 - 1.04, p = 0.03). The optimal ultrasound cut-offs for probable sarcopenia were 1.51 cm for muscle thickness (p= 0.017) and 73.95 for muscle stiffness (p = 0.004). DISCUSSION we described muscle ultrasound characteristics in post COVID-19 patients. Muscle ultrasound could be an innovative tool to assess muscle mass and quality in this population. Our preliminary findings need to be confirmed by future studies comparing muscle ultrasound with already validated techniques for measuring muscle mass and quality.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) San Raffaele Institute, Milan, Italy
- *Correspondence: Sarah Damanti,
| | - Marta Cilla
- Unit of General Medicine and Advanced Care, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) San Raffaele Institute, Milan, Italy
| | - Bruno Tuscano
- Unit of Radiology, IRCCS San Raffaele Institute, Milan, Italy
| | | | | | | | | | | | | | - Sabina Martinenghi
- San Raffaele Diabetes Research Institute, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Ospedale San Raffaele, Milan, Italy
| | - Giordano Vitali
- San Raffaele Diabetes Research Institute, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Ospedale San Raffaele, Milan, Italy
| | - Emanuele Bosi
- Vita-Salute San Raffaele University, Milan, Italy
- San Raffaele Diabetes Research Institute, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Ospedale San Raffaele, Milan, Italy
| | - Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) MultiMedica, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) San Raffaele Hospital, Ospedale San Raffaele, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) San Raffaele Institute, Milan, Italy
| | - Patrizia Rovere Querini
- Unit of Radiology, IRCCS San Raffaele Institute, Milan, Italy
- Department of Immunology, Transplantation and Infectious Diseases, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Ospedale San Raffaele, Milan, Italy
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77
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Jones S, Archer E, Ongan D, Morais C, Speer R, Tsagari A, Jager-Wittenaar H, Ruperto M. Nutritional interventions in older people with COVID-19: an overview of the evidence. Nurs Older People 2021; 34:e1368. [PMID: 34877834 DOI: 10.7748/nop.2021.e1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/09/2022]
Abstract
Older people are a high-risk group for coronavirus disease 2019 (COVID-19) because of a range of factors, including age-related changes in anatomical pulmonary and muscle function, decreased immunity and increased inflammation. These factors partly explain why older people with COVID-19 experience more severe symptoms and higher mortality than younger adults and are more likely to require nutritional support. Furthermore, there is an association between suboptimal nutritional status and poorer recovery from COVID-19. Therefore, nutritional interventions are an important aspect of care for older people with COVID-19. All members of the multidisciplinary team, including dietitians and nurses, need to assess, treat and prevent nutritional deficiencies in older people with COVID-19. This literature review provides an overview of the evidence regarding the role of nutritional interventions in the treatment of, and recovery from, COVID-19 in older people.
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Affiliation(s)
- Stacey Jones
- dietetics, Coventry University, Coventry, England
| | - Elizabeth Archer
- mental health services for older people, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, England
| | - Dilek Ongan
- department of nutrition and dietetics, Izmir Kâtip Çelebi University, Izmir, Turkey
| | - Cecilia Morais
- faculty of nutrition and food sciences, University of Porto, Porto, Portugal
| | - Robert Speer
- department of geriatrics, Paracelsus Medical University, Nuremberg, Germany
| | - Amalia Tsagari
- department of clinical nutrition, KAT Hospital, Athens, Greece
| | - Harriët Jager-Wittenaar
- research group healthy ageing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Mar Ruperto
- faculty of pharmacy and health sciences, CEU San Pablo University, Madrid, Spain. On behalf of the European Specialist Dietetic Network for Older Adults of the European Federation of the Associations of Dietitians
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78
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Gobbi M, Bezzoli E, Ismelli F, Trotti G, Cortellezzi S, Meneguzzo F, Arreghini M, Seitanidis I, Brunani A, Aspesi V, Cimolin V, Fanari P, Capodaglio P. Skeletal Muscle Mass, Sarcopenia and Rehabilitation Outcomes in Post-Acute COVID-19 Patients. J Clin Med 2021; 10:jcm10235623. [PMID: 34884325 PMCID: PMC8658326 DOI: 10.3390/jcm10235623] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/28/2022] Open
Abstract
The relationship between skeletal muscle mass at the beginning of the post-acute rehabilitation phase and rehabilitation outcomes has been scarcely investigated. The aim of this study was to investigate the impact of the existence of sarcopenia upon admission to a post-acute COVID-19 patient rehabilitation unit on body composition and functional and respiratory capacity at discharge. Thirty-four post-acute COVID-19 patients were referred to our Rehabilitation Unit from different COVID Hospitals in northern Italy. Body weight loss, body composition, handgrip strength, functional parameters, oxygen saturation and related perception of dyspnea in several positions were measured before and after a 28-day multidisciplinary rehabilitation program. Spirometry was performed only upon admission. The intervention included psychiatric support, cognitive behavioral therapy, nutritional therapy and physiotherapy, including aerobic and resistance training. Training volume was 45 min/session, 6 sessions/week. Upon admission, the prevalence of sarcopenia among our patients was 58%. In all of the 34 patients, we observed a trend of improvement in all of the respiratory, body composition, muscle strength and functional parameters considered. Monitoring muscle mass and strength in post-acute COVID-19 patients appears to be a key predictor of rehabilitation outcomes. Early diagnosis of sarcopenia therefore appears to be of paramount importance in the management of post-acute COVID-19 patients.
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Affiliation(s)
- Michele Gobbi
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
- Correspondence:
| | - Emanuela Bezzoli
- Respiratory Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (E.B.); (P.F.)
| | - Francesco Ismelli
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Giulia Trotti
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Stefano Cortellezzi
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Francesca Meneguzzo
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Marco Arreghini
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Ionathan Seitanidis
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Amelia Brunani
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Valentina Aspesi
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milano, Italy;
| | - Paolo Fanari
- Respiratory Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (E.B.); (P.F.)
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
- Department of Surgical Sciences, Physical Medicine and Rehabilitation, University of Torino, 10126 Torino, Italy
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Ashworth A. Sarcopenia and malnutrition: commonly occurring conditions in the older population. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S4-S10. [PMID: 34839683 DOI: 10.12968/bjon.2021.30.21.s4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This article reviews the prevalence of loss of muscle mass and function, (sarcopenia) alongside malnutrition in the older population (>65 years). It outlines what is meant by both sarcopenia and malnutrition and looks at how these conditions can interact to cause detrimental outcomes in both underweight and overweight older adults. It also details some of the potential consequences of loss of muscle mass on the effective functioning of the human body and clinical outcomes and includes tips for nurses on how they can incorporate simple strategies into everyday care to both identify and treat patients at risk of sarcopenia and malnutrition.
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Affiliation(s)
- Ann Ashworth
- Honorary Research Fellow, School of Health Professions, University of Plymouth, Panel Member, Managing Adult Malnutrition in the Community, and Member of the Malnutrition Action Group of BAPEN
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80
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Nutrient weight against sarcopenia: regulation of the IGF-1/PI3K/Akt/FOXO pathway in quinoa metabolites. Curr Opin Pharmacol 2021; 61:136-141. [PMID: 34801804 DOI: 10.1016/j.coph.2021.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 01/14/2023]
Abstract
Sarcopenia is characterized by the loss of muscle mass and strength, and one of its major molecular mechanisms is muscle protein turnover. Quinoa, the grain-like food crop, is a health nutrient used to treat diseases that predispose individuals to muscle wasting, including cardiovascular disorders, diabetes mellitus, and cancer. Quinoa secondary metabolites have recently been demonstrated to regulate protein turnover (including protein synthesis and degradation), a main biological process within muscle cells, through diverse signals (such as the p38 MAPK, TNF-α, and IGF-1/PI3K/Akt/FOXO pathways). Here, we describe how quinoa functions in the main pathway of protein synthesis and degradation, screen promising pharmacological components in nutritional applications, and provide guidance for the effects of quinoa products in sarcopenia.
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81
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Finsterer J, Chen L. Discrepancy between Mild Muscle Pathology and Severe Muscular Compromise in COVID-19 Suggests Nonviral Etiologies. J Neuropathol Exp Neurol 2021; 80:1088-1090. [PMID: 35288748 PMCID: PMC8690121 DOI: 10.1093/jnen/nlab068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Josef Finsterer
- From the Klinik Landstrasse, Messerli Institute, Vienna, Austria
| | - Liam Chen
- From the Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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82
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Kopanczyk R, Kumar N, Papadimos T. Post-Acute COVID-19 Syndrome for Anesthesiologists: A Narrative Review and a Pragmatic Approach to Clinical Care. J Cardiothorac Vasc Anesth 2021; 36:2727-2737. [PMID: 34688543 PMCID: PMC8487462 DOI: 10.1053/j.jvca.2021.09.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 02/07/2023]
Abstract
Post-acute coronavirus disease 2019 (COVID-19) syndrome is a novel, poorly understood clinical entity with life-impacting ramifications. Patients with this syndrome, also known as "COVID-19 long-haulers," often present with nonspecific ailments involving more than one body system. The most common complaints include dyspnea, fatigue, brain fog, and chest pain. There currently is no single agreed-upon definition for post-acute COVID-19 syndrome, but most agree that criterion for this syndrome is the persistence of mental and physical health consequences after initial infection. Given the millions of acute infections in the United States over the course of the pandemic, perioperative providers will encounter these patients in clinical practice in growing numbers. Symptoms of the COVID-19 long-haulers should not be minimized, as these patients are at higher risk for postoperative respiratory complications and perioperative mortality for up to seven weeks after initial illness. Instead, a cautious multidisciplinary preoperative evaluation should be performed. Perioperative care should be viewed through the prism of best practices already in use, such as avoidance of benzodiazepines in patients with cognitive impairment and use of lung-protective ventilation. Recommendations especially relevant to the COVID-19 long-haulers include assessment of critical care myopathies and neuropathies to determine suitable neuromuscular blocking agents and reversal, preoperative workup of insidious cardiac or pulmonary pathologies in previously healthy patients, and, thorough medication review, particularly of anticoagulation regimens and chronic steroid use. In this article, the authors define the syndrome, synthesize the available scientific evidence, and make pragmatic suggestions regarding the perioperative clinical care of COVID-19 long-haulers.
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Affiliation(s)
- Rafal Kopanczyk
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Nicolas Kumar
- The Ohio State University College of Medicine, Columbus, OH
| | - Thomas Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
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83
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Piotrowicz K, Gąsowski J, Michel JP, Veronese N. Post-COVID-19 acute sarcopenia: physiopathology and management. Aging Clin Exp Res 2021; 33:2887-2898. [PMID: 34328636 PMCID: PMC8323089 DOI: 10.1007/s40520-021-01942-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022]
Abstract
In this review, we discuss the pathophysiologic and management aspects of acute sarcopenia in relation to SARS-CoV-2 infection. COVID-19 is as a multi-organ infectious disease characterized by a severe inflammatory and highly catabolic status, influencing the deep changes in the body build, especially the amount, structure, and function of skeletal muscles which would amount to acutely developed sarcopenia. Acute sarcopenia may largely impact patients’ in-hospital prognosis as well as the vulnerability to the post-COVID-19 functional and physical deterioration. The individual outcome of the COVID-19 and the degree of muscle mass and functional loss may be influenced by multiple factors, including the patient’s general pre-infection medical and functional condition, especially in older adults. This paper gathers the information about how the SARS-CoV-2 hyper-inflammatory involvement exacerbates the immunosenescence process, enhances the endothelial damage, and due to mitochondrial dysfunction and autophagy, induces myofibrillar breakdown and muscle degradation. The aftermath of these acute and complex immunological SARS-CoV-2-related phenomena, augmented by anosmia, ageusia and altered microbiota may lead to decreased food intake and exacerbated catabolism. Moreover, the imposed physical inactivity, lock-down, quarantine or acute hospitalization with bedrest would intensify the acute sarcopenia process. All these deleterious mechanisms must be swiftly put to a check by a multidisciplinary approach including nutritional support, early physical as well cardio-pulmonary rehabilitation, and psychological support and cognitive training. The proposed holistic and early management of COVID-19 patients appears essential to minimize the disastrous functional outcomes of this disease and allow avoiding the long COVID-19 syndrome.
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Affiliation(s)
- Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego St., building I, 5th floor, 30-688, Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego St., building I, 5th floor, 30-688, Kraków, Poland.
| | | | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
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Abstract
BACKGROUND AND AIMS Post Covid-19 syndrome (PCS) is a major cause of morbidity. In this article we intend to review the association and consequences of PCS and diabetes. METHODS We reviewed all studies on "Long Covid", "Post COVID-19 Syndrome" and diabetes in PubMed and Google Scholar. RESULTS The symptoms of PCS can be due to organ dysfunction, effects of hospitalisation and drugs, or unrelated to these. Type 2 diabetes mellitus has a bidirectional relationship with COVID-19. Presence of diabetes also influences PCS via various pathophysiological mechanisms. COVID-19 can add to or exacerbate tachycardia, sarcopenia (and muscle fatigue), and microvascular dysfunction (and organ damage) in patients with diabetes. CONCLUSION PCS in patients with diabetes could be detrimental in multiple ways. Strict control of diabetes and other comorbidities, supervised rehabilitation and physical exercise, and optimal nutrition could help in reducing and managing PCS.
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Affiliation(s)
- A V Raveendran
- Specialist in Internal Medicine, Badr Al Samaa, Barka, Oman
| | - Anoop Misra
- National-Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, 110016, India; Diabetes Foundation (India), New Delhi 110016, India; Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B 16, Chirag Enclave, New Delhi, India.
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85
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Giraudo C, Librizzi G, Fichera G, Motta R, Balestro E, Calabrese F, Carretta G, Cattelan AM, Navalesi P, Pelloso M, Plebani M, Rea F, Vettor R, Vianello A, Stramare R. Reduced muscle mass as predictor of intensive care unit hospitalization in COVID-19 patients. PLoS One 2021; 16:e0253433. [PMID: 34138945 PMCID: PMC8211180 DOI: 10.1371/journal.pone.0253433] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose To evaluate if reduced muscle mass, assessed with Computed Tomography (CT), is a predictor of intensive care unit (ICU) hospitalization in COVID-19 patients. Methods In this Institution Review Board approved study, we retrospectively evaluated COVID-19 patients treated in our tertiary center from March to November 2020 who underwent an unenhanced chest CT scan within three weeks from hospitalization.We recorded the mean Hounsfield Unit (Hu) value of the right paravertebral muscle at the level of the 12th thoracic vertebra, the hospitalization unit (ICU and COVID-19 wards), clinical symptoms, Barthel Index, and laboratory findings.Logistic regression analysis was applied to assess if muscle loss (Hu<30) is a predictor of ICU admission and outcome.Fisher’s exact and Student’s tests were applied to evaluate if differences between patients with and without muscle loss occurred (p<0.05). Results One-hundred-fifty patients matched the inclusion criteria (46 females; mean age±SD 61.3±15 years-old), 36 treated in ICU. Patients in ICU showed significantly lower Hu values (29±24 vs 39.4±12, p = 0.001). Muscle loss was a predictor of ICU admission (p = 0.004).Patients with muscle loss were significantly older (73.4±10 vs 56.4±14 years), had lower Barthel Index scores (54.4±33 vs 85.1±26), red blood-cell count (3.9±1 vs 4.6±1×1012L−1), and Hb levels (11.5±2 vs 13.2±2g/l) as well as higher white blood-cell count (9.4±7 vs 7.2±4×109L−1), C-reactive protein (71.5±71 vs 44±48U/L), and lactate dehydrogenase levels (335±163 vs 265.8±116U/L) (p<0.05, each). Conclusions Muscle loss seems to be a predictor of ICU hospitalization in COVID-19 patients and radiologists reporting chest CT at admission should note this finding in their reports.
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Affiliation(s)
- Chiara Giraudo
- Department of Medicine–DIMED, University of Padova, Padova, Italy
- * E-mail:
| | | | - Giulia Fichera
- Department of Medicine–DIMED, University of Padova, Padova, Italy
| | - Raffaella Motta
- Department of Medicine–DIMED, University of Padova, Padova, Italy
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Fiorella Calabrese
- Pathological Anatomy Section, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giovanni Carretta
- Unità Locale Socio Sanitaria–ULSS 3 Serenissima, Veneto Region, Italy
| | - Anna Maria Cattelan
- Division of Infectious and Tropical Diseases, Padova University Hospital, Padova, Italy
| | - Paolo Navalesi
- Anesthesiology and Intensive Care Unit, Department of Medicine–DIMED, University of Padova, Padova, Italy
| | - Michela Pelloso
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Roberto Vettor
- Internal Medicine, Department of Medicine—DIMED, University of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Roberto Stramare
- Department of Medicine–DIMED, University of Padova, Padova, Italy
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86
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Del Brutto OH, Mera RM, Pérez P, Recalde BY, Costa AF, Sedler MJ. Hand grip strength before and after SARS-CoV-2 infection in community-dwelling older adults. J Am Geriatr Soc 2021; 69:2722-2731. [PMID: 34124775 PMCID: PMC8447376 DOI: 10.1111/jgs.17335] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 12/23/2022]
Abstract
Objective To assess the association between SARS‐CoV‐2 infection and decreased hand grip strength (HGS). Design Longitudinal population‐based study. Setting Community‐dwelling older adults (aged ≥60 years) living in a rural Ecuadorian village struck by the SARS‐CoV‐2 pandemic. Participants Of 282 enrolled individuals, 254 (90%) finished the study. Measurements HGS was measured 3 months before (January 2020) and 9 months after the introduction of the virus into the population (January 2021). SARS‐CoV‐2 antibody testing was performed in two rounds: in May–June (early) and September–November (late), 2020. An independent association between SARS‐CoV‐2 infection and HGS decline was assessed by fitting linear mixed models for longitudinal data. Changes in HGS scores in SARS‐CoV‐2 seropositive subjects, according to the time elapsed since seroconversion, were compared with those who remained seronegative. Results Overall, 149 (59%) individuals became seropositive for SARS‐CoV‐2. The mean HGS (in kg) was 25.3 ± 8.3 at baseline and 23.7 ± 8.1 at follow‐up (p = 0.028), with 140 individuals having >5% HGS decline between both measurements. The follow‐up HGS measurement decreased by 1.72 kg in seropositive individuals, and by 0.57 kg in their seronegative counterparts (p < 0.001). SARS‐CoV‐2 seropositive individuals were 2.27 times more likely (95% CI: 1.33–3.87) to have a lower HGS measurement at the time of follow‐up than those who remained seronegative. When compared with seronegative subjects, seropositive patients with early seroconversion were 3.41 times (95% CI: 1.73–6.74) more likely to have >5% HGS decline at the time of the follow‐up than those with later, i.e., more recent, infections. Conclusions This study shows an independent deleterious impact of SARS‐CoV‐2 on HGS that is more marked among individuals with infections that occurred more than 8 months before follow‐up HGS. Results suggest the possibility of chronic damage to skeletal muscles by SARS‐CoV‐2.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, California, USA
| | - Pedro Pérez
- Department of Psychiatry, Mount Sinai Morningside, New York, New York, USA
| | | | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, New York, USA
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87
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Holdoway A. Addressing nutrition in the road map of recovery for those with long COVID-19. Br J Community Nurs 2021; 26:218-222. [PMID: 33939462 DOI: 10.12968/bjcn.2021.26.5.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anne Holdoway
- Consultant Dietitian, Chair of the Malnutrition Pathway panel and Chair of the British Dietetic Association COVID-19 Clinical Guidance Group
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88
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Damanti S, Ramirez GA, Bozzolo EP, Rovere-Querini P, De Lorenzo R, Magnaghi C, Scotti R, Di Lucca G, Marinosci A, Strada S, Di Terlizzi G, Vitali G, Martinenghi S, Compagnone N, Landoni G, Tresoldi M. 6-Month Respiratory Outcomes and Exercise Capacity of COVID-19 Acute Respiratory Failure Patients Treated With CPAP. Intern Med J 2021; 51:1810-1815. [PMID: 33961728 PMCID: PMC8242499 DOI: 10.1111/imj.15345] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 01/08/2023]
Abstract
Background COVID‐19 long‐term sequelae are ill‐defined since only a few studies have explored the long‐term consequences of this disease so far. Aims To evaluate the 6‐month respiratory outcome and exercise capacity of COVID‐19 acute respiratory failure (ARF) patients treated with continuous positive airway pressure (CPAP) during the first wave of the ongoing COVID‐19 pandemic. Methods A retrospective observational study included COVID‐19 patients with ARF. Interventions included CPAP during hospitalisation and 6‐month follow up. Frailty assessment was carried out through frailty index (FI), pO2/FiO2 during hospitalisation and at follow up, respiratory parameters, 6‐min walking test (6MWT) and the modified British Medical Research Council (mMRC) and Borg scale at follow up. Results More than half of the patients had no dyspnoea according to the mMRC scale. Lower in‐hospital pO2/FiO2 correlated with higher Borg scale levels after 6MWT (ρ 0.27; P 0.04) at the follow‐up visit. FI was positively correlated with length of hospitalisation (ρ 0.3; P 0.03) and negatively with the 6MWT distance walked (ρ −0.36; P 0.004). Conclusions Robust and frail patients with COVID‐19 ARF treated with CPAP outside the intensive care unit setting had good respiratory parameters and exercise capacity at 6‐month follow up, although more severe patients had slightly poorer respiratory performance compared with patients with higher PaO2/FiO2 and lower FI.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica Paola Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Cristiano Magnaghi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Giuseppe Di Lucca
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Alessandro Marinosci
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Silvia Strada
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Gaetano Di Terlizzi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Giordano Vitali
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San, Raffaele, Mali
| | - Sabina Martinenghi
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San, Raffaele, Mali.,Diabetes Research Institute, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milan, Italy
| | | | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
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89
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Alsahab M, Beishon L, Brown B, Burn E, Burton JK, Cox N, Dani M, Elhadi M, Freshwater S, Gaunt V, Gordon A, Goujon M, Hale M, Hughes T, Jackson TA, Jelley B, Khan A, Khiroya H, Lal R, Madden K, Magill L, Masoli J, Masud T, McCluskey L, McNeela N, Mohammedseid-Nurhussien A, Moorey H, Lochlainn MN, Nirantharakumar K, Okoth K, Osuafor CN, Patterson K, Pearson GME, Perry R, Pettitt M, Pigott J, Pinkney T, Quinn T, Reynolds A, Richardson S, Sanyal N, Seed A, Sleeman I, Soo C, Steves C, Strain WD, Taylor J, Torsney K, Welch C, Wilson D, Witham M, Elazeem HASA, Abdelhafez MH, Abdelmalak A, Abdelwahab OA, Abdulhadi OMAS, Adewole O, Ahmad M, Ahmed EA, Ahmed H, Ahmed IA, Akcay M, Akdeniz Y, Akın E, Akladious C, Alessandri F, Ali A, Aljafari A, Aljafari A, Al-Sadawi M, Al-Sodani L, Altintoprak F, Amaratungaz G, Amer J, Amini S, Amir T, Anandarajah C, Anders R, Ansari MH, Appiah K, Atia J, Atkin C, Aujayeb A, Awad EM, Azab MA, Azam MT, Aziz S, Azzam AY, Babar L, Babb L, Badh M, Baguneid C, Bailey E, Baili E, Baldwin S, Baloyiannis I, Bannerjee M, Barnard A, Barra F, Bashir H, Bawor M, Bayhan Z, Beishon L, Belcher J, Belgamwar R, Bentley C, Birchenough A, Bo YNJ, Boden HR, Bouhuwaish A, Brachini G, Bremner L, Bridgwater H, Bryant C, Budd G, Budd S, Budzikoski A, Bulla R, Buondonno A, Buondonno A, Burden N, Burn E, Butt H, Capoglu R, Caracostea A, Cardoso R, Carr A, Carrasco-Prats M, Cattel C, Ceccarelli G, Cecere G, Charalabopoulos A, Charsley E, Cheney-Lowe H, Chevallier T, Choudhry AJ, Ciccarone F, Cicerchia PM, Cirillo B, Collins FD, Comerford V, Cordie A, Coulter S, Coulthard N, Cox C, Cox V, Crowe A, Cullen J, Cummings J, Cunningham N, Curley D, Currie H, Daly M, Darley J, Dattani N, Davakis S, Davies R, De Paola G, De Toma G, Del Valle-Ruiz S, Deldar B, Demir H, Desai A, Desai N, Devaney A, Dew L, Dhesi J, Dias M, Dick G, Doddamani P, Dogra G, Doll T, Dooley HC, Dost S, Dotchin C, Dowell H, Draghita IM, Dundas JM, Duranti G, Dusara H, Dwivedi R, Dyer AH, Eastaugh A, Edwards E, Elghazaly SM, Elmehrath AO, Elrick H, El-Shazly M, Emery A, Etchill EW, Evans S, Evison F, Fairhead C, Faulkner M, Felska A, Fernandez A, Fernández-Fernández PV, Ferraiolo A, Ferrero S, Fiori E, Firat N, Fisk G, Fleck A, Fonsi GB, Gabre-Kidan A, Gallo G, Gandhi R, Garner M, Georgiou N, Gerretsen H, Ghannam NAA, Ghobrial A, Ghobrial H, Ghufoor Z, Gibbon J, Gilbert GF, Giles M, Giménez-Francés C, Gonullu E, Gray A, Gray JH, Green D, Greene C, Griffin E, Griffith K, Grubb A, Guan Y, Guerero DN, Gupta A, Gustavino C, Guzman L, Hadreiez AKM, Hajiioannou J, Hanji D, Madhavan DH, Harmantepe T, Harrison P, Hart B, Haslam A, Haunton V, Haut ER, Heinsohn T, Hennah L, Hetta HF, Hickman A, Hobill A, Hogan PCP, Hogan V, Holmes E, Honney K, Hood K, Hopkinson K, Howells L, Hrouda N, Hunsley D, Hurst W, Hussein RA, Ibrahim MEAA, Ibtida I, Ibukunoluwakitan A, Ishlek I, Iyer R, Jackson K, Jackson R, James E, Jarvis H, Jeffs S, Jenko N, Jeyakumar S, Kabir S, Kainth H, Kalloo J, Kanzaria A, Karapanou A, Kardaman N, Karthikeyan S, Karunatilleke A, Kelly M, Kelly NI, Khalid H, Khan H, Khan MS, King M, Kneen T, Kok L, Kratochwila C, Kuzeva A, Lapolla P, Lau R, Law KY, Leadbetter A, Lee G, Lee H, Lee H, Levinson G, Lewis G, Liakakos T, Lim S, Lis D, Livesey E, López-Morales P, Lowes L, Lunt E, Lyon E, Madan S, Majid Z, Malapati H, Man J, Mandane B, Manning SH, Mantoglu B, Martínez-Sanz N, Marx W, Masood AEB, Maughan T, Mawhinney J, Maxfield D, Mayer J, Maynard H, McDonald C, McGovern A, Mclachlan S, Medina-Manuel E, Meneghini S, Metcalf M, Millwood-Hargrave J, Mingoli A, Miu K, Mohamed F, Mohamed SM, Hussein AARM, Mohammad A, Mohammed A, Momen AA, Moomo F, Mora-Guzmán I, Moriarty L, Morrin H, Morris C, Moss N, Moustafa MM, Mpoura M, Mubin M, Muhtaroglu A, Muir G, Mulhern S, Muller D, Murphy DC, Muzammil B, Nadkarni V, Nageh MA, NasrEldin YK, Nawaz W, Nguyen H, Cheallaigh CN, Noar A, North S, Nwolu F, O’Docherty A, Odutola O, O’Dwyer S, Ogochukwu O, O’Mahony C, Orlando L, Osterdahl M, Page C, Panayotidis I, Pancholi S, Parkin J, Passby LC, Pastor-Pérez P, Patel H, Patel S, Penfold R, Perinpanathan R, Perivoliotis K, Perra T, Pinkney M, Pinotti E, Porcu A, Price A, Pugliese F, Puri P, Pytraczyk S, Qaiser Y, Qurashi M, Radenkovic D, Rajeswaran T, Rapaport SF, Razzak T, Reilly L, Reynolds P, Richardson A, Roberts A, Roberts A, Roberts-Rhodes C, Robinson T, Rocca A, Ross-Skinner E, Ruiz-Marín M, Ryall R, Saad AM, Saad MM, Sadiq A, Sammarco G, Sampanis MA, Sanghvi H, Sapienza P, Sayers R, Scott L, Sen M, Shaban MAA, Shakespeare KT, Shaw E, Shaw H, Sheldrake J, Sim SY, Simonelli L, Sipsas NV, Sivam J, Sivarajan S, Smith J, Speranza F, Spice C, Stafford A, Stambollouian K, Stevens KA, Stewart J, Stratton E, Street H, Surtees M, Swinnerton E, Taher ASA, Tait C, Taylor A, Thake M, Thin K, Thould H, Thyn T, To B, Tobiss H, Toppley K, Townsend L, Tullo E, Tzovaras G, Umeadi A, Vaidya H, Valero-Soriano M, Varden R, Vergani V, Vervoort D, Vescio G, Vettasseri M, Virk M, Vyas V, Wagland J, Wallis S, Warner C, Watkins E, Watson H, Webb R, Welsh SH, West R, Whelan E, Whitney J, Whitsey M, Wilcock C, Wilkinson I, Williams D, Williamson M, Willott RH, Wimalasundera M, Win YL, Winter L, Worrall S, Wright R, Yeo N, Yeung E, Yigit M, Yildiz YA, Yusuf H, Zambon M, Zaw H, Elabedeen OZ, Welch C. Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study. Age Ageing 2021; 50:617-630. [PMID: 33543243 PMCID: PMC7929433 DOI: 10.1093/ageing/afab026] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/09/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Increased mortality has been demonstrated in older adults with coronavirus disease 2019 (COVID-19), but the effect of frailty has been unclear. METHODS This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS) and delirium on risk of increased care requirements on discharge, adjusting for the same variables. RESULTS Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, interquartile range [IQR] 54-83; 55.2% male). The risk of death increased independently with increasing age (>80 versus 18-49: hazard ratio [HR] 3.57, confidence interval [CI] 2.54-5.02), frailty (CFS 8 versus 1-3: HR 3.03, CI 2.29-4.00) inflammation, renal disease, cardiovascular disease and cancer, but not delirium. Age, frailty (CFS 7 versus 1-3: odds ratio 7.00, CI 5.27-9.32), delirium, dementia and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. CONCLUSION Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.
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90
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Mittal A, Dua A, Gupta S, Injeti E. A research update: Significance of cytokine storm and diaphragm in COVID-19. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100031. [PMID: 34870147 PMCID: PMC8086263 DOI: 10.1016/j.crphar.2021.100031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 12/23/2022] Open
Abstract
Emerging research on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) shows that it is spreading to multiple organs in addition to the respiratory system. Though the SARS-CoV2 enters the human body by binding to ACE2 receptors on pulmonary alveolar cells, recent studies indicate that it is spreading to the central nervous system, cardiac and skeletal muscles leading to various pathological conditions in these organs. In particular, the effects of SARS-CoV-2 on triggering the cytokine storm and its consequential effects on skeletal muscles has generated a lot of discussion. The effects of this virus on muscular function especially in susceptible elderly populations is still being explored. However, its effects on diaphragm, a respiratory muscle which plays an important role in determining lung capacity are not completely explored. Currently, as new evidence on using lung ultrasounds to confirm COVID-19 diagnosis is gaining traction, it is necessary to explore the role of diaphragm in treating COVID-19 patients. This article will review the effects of cytokine storm triggered by the SARS-CoV-2 and its resultant effects on skeletal muscle with a specific focus on the diaphragm in order to identify knowledge gaps in effectively treating COVID-19 patients, especially those who are on a mechanical ventilator.
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Affiliation(s)
- Ashwani Mittal
- Skeletal Muscle Laboratory, Institute of Integrated & Honors Studies, Kurukshetra University, Kurukshetra, Haryana, 136119, India
| | - Anita Dua
- Skeletal Muscle Laboratory, Institute of Integrated & Honors Studies, Kurukshetra University, Kurukshetra, Haryana, 136119, India
| | - Sanjeev Gupta
- Skeletal Muscle Laboratory, Institute of Integrated & Honors Studies, Kurukshetra University, Kurukshetra, Haryana, 136119, India
| | - Elisha Injeti
- Cedarville University School of Pharmacy, Cedarville, OH, 45314, USA
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Hasegawa Y, Takahashi F, Hashimoto Y, Munekawa C, Hosomi Y, Okamura T, Okada H, Senmaru T, Nakanishi N, Majima S, Ushigome E, Hamaguchi M, Yamazaki M, Fukui M. Effect of COVID-19 Pandemic on the Change in Skeletal Muscle Mass in Older Patients with Type 2 Diabetes: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084188. [PMID: 33920957 PMCID: PMC8071268 DOI: 10.3390/ijerph18084188] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023]
Abstract
Background: The aim of this study was to investigate the effect of the coronavirus disease (COVID-19) pandemic restrictions on the change in muscle mass in older patients with type 2 diabetes (T2D), who were not infected with COVID-19. Methods: In this retrospective cohort study, data were obtained from outpatients who underwent bioelectrical impedance analysis at least twice before April 2020 and at least once thereafter. Skeletal muscle mass index (SMI, kg/m2) was calculated as appendicular muscle mass (kg) divided by height squared (m2). Change in SMI (kg/m2/year) was calculated as (follow-up SMI-baseline SMI/follow-up period). The differences between the changes in SMI before and after the start of the COVID-19 pandemic were evaluated using paired t test. Results: This study recruited 56 patients, with a mean (SD) age of 75.2 (7.1) years. SMI changed from 6.7 (0.9) to 6.8 (0.9) kg/m2 before the COVID-19 pandemic, whereas SMI changed from 6.8 (0.9) to 6.6 (0.9) kg/m2 after the start of the COVID-19 pandemic. SMI decreased after the start of the COVID-19 pandemic compared with before the pandemic (-0.117 (0.240) vs. 0.005 (0.289) kg/m2/year, p = 0.049). This decrease was observed in men (-0.159 (0.257) vs. 0.031 (0.325) kg/m2/year, p = 0.038), patients with poor glycemic control (-0.170 (0.264) vs. 0.031 (0.285) kg/m2/year, p = 0.042), and those with a long diabetes duration (-0.153 (0.229) vs. 0.082 (0.291) kg/m2, p = 0.049). Conclusions: The COVID-19 pandemic restrictions caused muscle mass loss in older patents with T2D. Actions, including recommendation of exercise and adequate diet intake, are needed to prevent loss of muscle mass.
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Ali AM, Kunugi H. Skeletal Muscle Damage in COVID-19: A Call for Action. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:372. [PMID: 33921429 PMCID: PMC8069858 DOI: 10.3390/medicina57040372] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022]
Abstract
Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as well as the long-term consequences of muscle injury in disease survivors, are unclear. The current review briefly summarizes the literature for mechanisms, assessment measures, and interventions relevant to skeletal muscle insult in COVID-19 patients. Muscle injury is likely to be attributed to the cytokine storm, disease severity, malnutrition, prolonged physical inactivity during intensive care unit (ICU) stays, mechanical ventilation, and myotoxic drugs (e.g., dexamethasone). It has been assessed by imaging and non-imaging techniques (e.g., CT and electromyography), physical performance tests (e.g., six-minute walk test), anthropometric measures (e.g., calf circumference), and biomarkers of muscle dystrophy (e.g., creatine kinase). Interventions directed toward minimizing muscle loss among COVID-19 patients are lacking. However, limited evidence shows that respiratory rehabilitation improves respiratory function, muscle strength, quality of life, and anxiety symptoms in recovering older COVID-19 patients. Neuromuscular electrical stimulation may restore muscle condition in ICU-admitted patients, albeit empirical evidence is needed. Given the contribution of malnutrition to disease severity and muscle damage, providing proper nutritional management for emaciated patients may be one of the key issues to achieve a better prognosis and prevent the after-effects of the disease. Considerable attention to longer-term consequences of muscle injury in recovering COVID-19 patients is necessary.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 21527, Egypt
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
| | - Hiroshi Kunugi
- Department of Psychiatry, School of Medicine, Teikyo University, Tokyo 173-8605, Japan;
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
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93
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Abstract
BACKGROUND Vitamin D and its deficiency have recently been suspected to be involved in increased susceptibility and negative outcomes of COVID-19. This assumption was based on the well known immunomodulatory actions of vitamin D and on the consistent finding of low levels of 25 hydroxyvitamin D (25OHD) in hospitalized patients with COVID-19. Moreover, several studies reported a correlation between 25OHD levels and different clinical outcomes of the disease. AIM Aim of the current review was to approach the topic of vitamin D and COVID-19 from a different perspective summarizing the data which led to the evidence of the existence of an endocrine phenotype of COVID-19. CONCLUSIONS This review analyzed in the light of the current knowledge the possibility that several endocrine manifestations of COVID-19 could be holistically interpreted in the context of an inadequate vitamin D status.
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Affiliation(s)
- Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele, Vita-Salute University and IRCCS Hospital, Milan, Italy.
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94
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Walle-Hansen MM, Ranhoff AH, Mellingsæter M, Wang-Hansen MS, Myrstad M. Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalisation due to COVID-19. BMC Geriatr 2021; 21:199. [PMID: 33752614 PMCID: PMC7983098 DOI: 10.1186/s12877-021-02140-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
Background Older people are particularly vulnerable to severe COVID-19. Little is known about long-term consequences of COVID-19 on health-related quality of life (HR-QoL) and functional status in older people, and the impact of age in this context. We aimed to study age-related change in health-related quality of life, functional decline and mortality among older patients 6 months following hospitalisation due to COVID-19. Methods This was a cohort study including patients aged 60 years and older admitted to four general hospitals in South-Eastern Norway due to COVID-19, from March 1 up until July 1, 2020. Patients who were still alive were invited to attend a six-month follow-up. Change in HR-QoL and functional status compared to before the COVID-19 hospitalisation were assessed using the EuroQol 5-dimensional-5 levels questionnaire (EQ. 5D-5L). A change in visual analogue scale (VAS) score of 7 or more was considered clinically relevant. Results Out of 216 patients aged 60 years and older that were admitted to hospital due to COVID-19 during the study period, 171 were still alive 180 days after hospital admission, and 106 patients (62%) attended the six-month follow-up. Mean age was 74.3 years, 27 patients (26%) had experienced severe COVID-19. Fifty-seven participants (54%) reported a decrease in the EQ. 5D-5L VAS score after 6 months, with no significant difference between persons aged 75 years and older compared to younger. Seventy participants (66%) reported a negative change in any of the dimensions of the EQ. 5D-5L, with impaired ability to perform activities of daily life (35%), reduced mobility (33%) and having more pain or discomfort (33%) being the most commonly reported changes. Forty-six participants (43%) reported a negative change in cognitive function compared to before the COVID-19 hospitalisation. Six-month mortality was 21%, and increased with increasing age. Conclusions More than half of the patients reported a negative change in HR-QoL 6 months following hospitalisation due to COVID-19, and one out of three experienced a persistently impaired mobility and ability to carry out activities of daily living. The results suggest awareness of long-term functional decline in older COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02140-x.
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Affiliation(s)
- M M Walle-Hansen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, N-1346, Gjettum, Norway.
| | - A H Ranhoff
- Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - M Mellingsæter
- Department of Geriatric Medicine, Akershus University Hospital, Lørenskog, Norway
| | - M S Wang-Hansen
- Department of Geriatric Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - M Myrstad
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, N-1346, Gjettum, Norway.,Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, N-1346, Gjettum, Norway
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Imamura M, Mirisola AR, Ribeiro FDQ, De Pretto LR, Alfieri FM, Delgado VR, Battistella LR. Rehabilitation of patients after COVID-19 recovery: An experience at the Physical and Rehabilitation Medicine Institute and Lucy Montoro Rehabilitation Institute. Clinics (Sao Paulo) 2021; 76:e2804. [PMID: 34133481 PMCID: PMC8183312 DOI: 10.6061/clinics/2021/e2804] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/15/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES As patients recovering from the novel coronavirus disease 2019 (COVID-19) present with physical, respiratory, cognitive, nutritional, and swallowing-related impairments and mental health complications, their rehabilitation needs are complex. This study aimed to describe the demographic, clinical, and functional status after the discharge of COVID-19 survivors who underwent intensive multidisciplinary inpatient rehabilitation at the Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital and Lucy Montoro Rehabilitation Institute. We determined the most important factors related to the length of inpatient rehabilitation treatment and present the functional outcomes. METHODS This was a retrospective study based on electronic medical records. In addition to the severity of COVID-19 and length of hospital stay for the management of COVID-19 and comorbidities, we collected sociodemographic data including age, sex, height, and weight. Functional assessments were performed using the Functional Independence Measure (FIM); Short Physical Performance Battery; Montreal Cognitive Assessment; Depression, Anxiety and Stress Scale; Revised Impact of Events Scale; bioelectrical impedance; Functional Oral Intake Scale; oropharyngeal dysphagia classification; and nutritional assessment. RESULTS There was a significant improvement in FIM before and after inpatient rehabilitation treatment (p<0.0001). Muscle strength and walking capacity were significantly improved (p<0.01). The most important factors related to the length of inpatient rehabilitation treatment were improvement in FIM scores (Spearman's r=0.71) and gain in lean mass (Spearman's r=0.79). CONCLUSIONS Rehabilitation of patients after COVID-19 recovery improves their functional status and should be considered in the post-acute phase for selected patients with COVID-19.
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Affiliation(s)
- Marta Imamura
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Centro de Pesquisa Clinica, Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Aline Rossetti Mirisola
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fernando de Quadros Ribeiro
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Lucas Ramos De Pretto
- Centro de Pesquisa Clinica, Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Centro de Lasers e Aplicacoes, Instituto de Pesquisas Energeticas e Nucleares (IPEN-CNEN/SP), Sao Paulo, SP, BR
| | - Fábio Marcon Alfieri
- Centro de Pesquisa Clinica, Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Vinicius Ramos Delgado
- Centro de Pesquisa Clinica, Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Linamara Rizzo Battistella
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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