Need for Testing and Supplementation of Vitamin D3 After Release of COVID-19 Lockdown in Patients with Increased Musculoskeletal Pain

Vitamin D insufficiency is high in Malaysia: A systematic review and meta-analysis of studies on vitamin D status in Malaysia

PURPOSE

To estimate the vitamin D status of participants residing in Malaysia.

METHODS

PubMed, Scopus, Web of Science, and MyJurnal were searched up to June 2022 without language restrictions. Studies that reported the 25-hydroxyvitamin D [25(OH)D] concentrations and defined their cut-off for deficiency or insufficiency from healthy participants residing in Malaysia were included. The random effects model was used to pool vitamin D status using established cut-offs of <30, <50, and <75 nmol/L according to age group.

RESULTS

From 299 studies screened, 32 studies were included in the meta-analysis. The pooled proportion for <30 nmol/L was 21% (95% CI 9-36, n = 2,438 from 10 studies), while the pooled proportion <50 nmol/L was 64% (95% CI 56-72, n = 13,977 from 30 studies), and <75 nmol/L was 85% (95% CI 61-100, n = 1,376 from five studies). Heterogeneity was high (I2 ranged from 98-99%). Higher proportions of vitamin D insufficiency (defined as <50 nmol/L) were found in participants living in the urban areas (compared to rural areas), in females (compared to males), and in Malays and Malaysian Indians (compared to Malaysian Chinese) ethnicities.

CONCLUSION

More than half of Malaysians have insufficient vitamin D levels, despite being a country that is close to the equator. We strongly urge prompt public health measures to improve the vitamin D status in Malaysia.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021260259].

The relationship between COVID-19 and fibromyalgia syndrome: prevalence, pandemic effects, symptom mechanisms, and COVID-19 vaccines

On March 11, 2020, the World Health Organization, realizing the level of spread worldwide and the severity of the condition, accepted coronavirus disease 19 (COVID-19) as a pandemic. Subsequently, quarantine conditions were implemented around the world, and these triggered particular results. Like all other individuals, fibromyalgia syndrome (FMS) patients were affected by these conditions. The stress load in pandemic conditions, difficulties in accessing healthcare services, changes in exercise compliance, variations in physiotherapy programs, and remote work conditions all had an impact on FMS patients. Although general expectations were negative, some FMS patients were able to manage the pandemic conditions and even turn them in their favor. This is thought to be due to this patient group having established strategies to cope with stress in the pre-pandemic period, and they had sufficient ability to adapt to changing situations. FMS-related symptoms occur in a subset of individuals following COVID-19. One of the factors is the increased psychological burden after COVID-19. There is evidence that neuroinflammatory pathways affect neuroplasticity in the central nervous system and trigger the onset of FMS-related symptoms. Among the probable mechanisms are alterations in inflammatory and anti-inflammatory pathways. Changes in the autonomic nervous system with the effect of SARS-CoV-2 may induce the emergence of FMS-related symptoms. FMS and COVID-19 can coexist, and FMS may create a tendency to vaccine hesitancy. Future studies should focus on elucidating FMS-related symptoms occurring post-COVID-19. There is a need to determine distinctions between the FMS clinical status that emerged following COVID-19 and the regular patient group in terms of diagnosis, treatment, and follow-up.

Fibromialgia en la nueva era de la infección por SARS-CoV-2 y el síndrome post-COVID-19: una revisión exploratoria

Introducción

La fibromialgia es un síndrome caracterizado por dolor crónico generalizado, rigidez articular, trastornos del sueño, fatiga, ansiedad y episodios depresivos, cuyas manifestaciones clínicas comienzan después de un trauma físico o emocional. Pese a ello, son escasas las publicaciones que describen el impacto clínico de la COVID-19 en los síntomas de fibromialgia.

Objetivo

Mapear la evidencia médica disponible sobre el impacto de la COVID-19 y el síndrome post-COVID en pacientes con y sin diagnóstico de fibromialgia previo a la infección.

Materiales y métodos

Revisión sistemática exploratoria en PubMed y Scopus, considerando artículos en inglés y en español, con datos sobre la fibromialgia en población sobreviviente a la infección por SARS-CoV-2. Se revisaron los registros de ensayos clínicos de las bases de datos de la Organización Mundial de la Salud.

Resultados

Se incluyeron 12 artículos publicados: estudios retrospectivos (n = 4), transversales (n = 2), casos y controles (n = 2), estudios cualitativos (n = 2), cohorte prospectiva (n = 1) y corte longitudinal (n = 1). La población total fue de 3.060 pacientes. Además, se incluyeron registros de un ensayo clínico controlado aleatorizado, un estudio observacional tipo transversal y uno de casos y controles. La suma total de la población estudiada fue de 173 participantes.

Conclusión

Los pacientes sobrevivientes a la COVID-19 con o sin diagnóstico previo de fibromialgia pueden presentar un aumento del dolor crónico, insomnio, rigidez articular y deterioro en la calidad de vida. La población con antecedente de fibromialgia puede verse más afectada por estrés psicológico, lesión tisular a estructuras neuromusculares e inflamación por la infección por SARS-CoV-2.

COVID-Pain: Acute and Late-Onset Painful Clinical Manifestations in COVID-19 - Molecular Mechanisms and Research Perspectives

Although the respiratory manifestations of COVID-19 are predominant, signs and symptoms of an extra-pulmonary involvement are usually encompassed among the clinical picture of the disease. Several painful manifestations can occur during the acute phase but also as short- or long-term complications. Myalgia, joint pain, sore throat, abdominal pain, chest pain, and headache usually accompany respiratory symptoms, but they can also occur as isolated clinical findings or can be expressed regardless of the severity of COVID-19. On these premises, given the vast spectrum of clinical manifestations and the complexity of their pathogenesis, it would be more appropriate to refer to "COVID-pain", an umbrella term useful for encompassing all these clinical manifestations in a separate chapter of the disease. In this scenario, we addressed the topic from a molecular perspective, trying to provide explanations for the underlying pathophysiological processes. Consequently, this narrative review is aimed at dissecting the mechanisms of acute and chronic painful manifestations, summarizing fundamental concepts on the matter, controversies, current research gaps, and potential developments in this field.