Low handgrip strength is associated with worse functional outcomes in long COVID

The diagnosis of long COVID is troublesome, even when functional limitations are present. Dynapenia is the loss of muscle strength and power production that is not caused by neurologic or muscular diseases, being mostly associated with changes in neurologic function and/or the intrinsic force-generating properties of skeletal muscle, which altogether, may partially explain the limitations seen in long COVID. This study aimed to identify the distribution and possible associations of dynapenia with functional assessments in patients with long COVID. A total of 113 patients with COVID-19 were evaluated by functional assessment 120 days post-acute severe disease. Body composition, respiratory muscle strength, spirometry, six-minute walk test (6MWT, meters), and hand-grip strength (HGS, Kilogram-force) were assessed. Dynapenia was defined as HGS < 30 Kgf (men), and < 20 Kgf (women). Twenty-five (22%) participants were dynapenic, presenting lower muscle mass (p < 0.001), worse forced expiratory volume in the first second (FEV1) (p = 0.0001), lower forced vital capacity (p < 0.001), and inspiratory (p = 0.007) and expiratory (p = 0.002) peek pressures, as well as worse 6MWT performance (p < 0.001). Dynapenia, independently of age, was associated with worse FEV1, maximal expiratory pressure (MEP), and 6MWT, (p < 0.001) outcomes. Patients with dynapenia had higher intensive care unit (ICU) admission rates (p = 0.01) and need for invasive mechanical ventilation (p = 0.007) during hospitalization. The HGS is a simple, reliable, and low-cost measurement that can be performed in outpatient clinics in low- and middle-income countries. Thus, HGS may be used as a proxy indicator of functional impairment in this population.

[Epidemiological pattern of lymphatic filariasis in children living in endemic areas]

OBJECTIVE

Lymphatic filariasis still represents a major public health problem in the city of Recife. In spite of the fact that previous surveys had already shown high frequency of microfilaraemia in pediatric population, the prevalence of filarial disease and the microfilaraemic pattern of this group were unknown. This paper describes the clinical-epidemiological pattern of filariasis in children and adolescents living in two highly endemic areas of Recife.

METHODS

The parasitological survey was done through a census carried out between December 1990 and July 1991. Thick drop technique (45 micro l) was performed on a total of 1,464 children and adolescents between the ages of 5 and 14, of whom 967 were submitted to clinical examination. Positive cases had their blood recollected (60 micro l) to measure the microfilaraemic density.

RESULTS

The microfilaraemia prevalence was 6.4 %. In the age groups of 5 to 9 and 10 to 14 a microfilaraemia prevalence of respectively 4.6% and 8.3% was observed. The microfilaraemic density varied from 3 to 864 microfilariae per 60 microl of blood, there having been no statistically significant difference between the sexes and age groups (p<0.05). 6 cases (0.6 %) of acute filarial disease and 11 of chronic filarial disease (1.1%) were identified, hydrocele being the principal manifestation found. Lymphadenopathy was found in 22% of the children, statistical association with microfilaraemia being observed (p<0.001).

CONCLUSIONS

The results of the parasitological survey show the strong presence of children in the contingent of microfilaraemic individuals, indicating an early and intense exposure to filariasis in the population studied.

[Catheter ablation of atrial flutter. Electrophysiological characterization of posterior and septal isthmus block]

PURPOSE

Evaluate the different types of conduction blocks obtained between inferior vena cava-tricuspid annulus (posterior isthmus) and between tricuspid annulus-coronary sinus ostium (septal isthmus) after radiofrequency (RF) catheter ablation of atrial flutter (AFL).

METHODS

In 16 procedures, 14 patients (pts), 9 male, with type I AFL underwent RF ablation. Atrial activation around tricuspid annulus was performed with a 10-bipole "Halo" catheter (H1-2; H19-20). In sinus rhythm, isthmus conduction was evaluated during proximal coronary sinus (PCS) and low lateral right atrium (H1-2) pacing, before and after linear ablation. According to the wave front of impulse propagation we assessed absence of block (bidirectional conduction); incomplete block (bidirectional conduction with delay in one front of impulse propagation) and complete block (absence of conduction). The PCS/H1-2 interval was measured before and after ablation.

RESULTS

Complete isthmus block was achieved in 7 (44%) and incomplete block in 4 (25%) procedures. Conduction block was not achieved in 5 procedures. At a mean follow-up of 12 months, there were no recurrences in the pts with complete block, whereas AFL recurred in the 6 pts with incomplete or no conduction block (p < 0.001). Pts with complete block had delta PCS/H1-2 interval (74.0 +/- 26.0 ms) greater than incomplete (30.5 +/- 7.5 ms) or absent block (p < 0.05).

CONCLUSION

The verification of complete isthmus conduction block with atrial multipolar mapping is an effective strategy to assess electrophysiological success and absence of late recurrence in common atrial flutter ablation.

Pulmonary Rehabilitation Associated with Noninvasive Ventilation on Physical Capacity and Quality of Life in Post-COVID-19: A Randomized Controlled Double-Blinded Clinical Trial Protocol

Background

The coronavirus disease-2019 (COVID-19) pulmonary rehabilitation (PR) seems to be a better choice to improve physical and functional capacity after acute infection. However, there is a lack of evidence regarding the effects of different strategies to optimize post-acute phase rehabilitation and reduce long COVID-19 physical deteriorations.

Objective

To compare the use of a noninvasive ventilation (NIV) plus aerobic exercise strategy during PR program with to a standard PR (without NIV) on physical capacity and quality of life outcomes in post-COVID-19.

Methods

Double-blinded randomized controlled clinical trial. A total of 100 individuals discharged from hospital in a post-acute phase of severe COVID-19 will be randomized into two groups: PR + NIV (Group 1) and PR (Group 2). Inclusion criteria include participants who present symptomatic dyspnea II and III by the modified Medical Research Council, aged 18 years or older. Both groups will receive aerobic and resistance exercise, and inspiratory muscle training. However, group 1 will perform aerobic training with bilevel NIV. Cardiopulmonary exercise test will assess the O2 peak uptake, 6-minute walk test will assess the walking distance and short-form 36 will assess the quality of life before and after 8 weeks (after 24 PR sessions). Moreover, patients will be contacted by telephone every 3 months for one year to record possible adverse events, hospitalizations, and death. All data will be registered in RedCap, and analyses will be performed in the STATA v13 software.

Clinical Trial Registration

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Impact of Respiratory Support During Hospitalization on Functional Outcomes in Long COVID: A Post-Hoc Analysis of a Prospective Cohort Study

Post-acute COVID-19 syndrome (PACS) is characterized by the persistence of one or more symptoms after the acute phase, leading to physical disabilities. This study aims to investigate whether the functional capacity and respiratory function 120 days post-COVID-19 differed according to the level of respiratory support needed during hospitalization in acute COVID-19 in the pre-vaccine rollout period. We followed up with 118 COVID-19 hospitalized patients in the acute phase until 120 days post-acute disease, with patients split into a Non-Invasive Oxygen Therapy Group (OTG, n = 72), Invasive Mechanical Ventilation Group (IMV, n = 12), and Room Air Group (RAG, n = 34), assessing the body composition, respiratory muscle strength, pulmonary function, functional capacity, and muscle strength at the follow-up visit. In total, 54 individuals (45.8%) were female, with a median age of 48 years old (IQR: 41-58). We found that the group with IMV was older (p < 0.001), had more admissions to the ICU (p < 0.001), and had longer hospital stays (p < 0.001). There were no statistically significant differences between groups (OTG, IMV, and RAG) for the spirometry function (p = 0.31), DASI score (p = 0.77), manovacuometry (MIP p = 0.74; MEP p = 0.23), 6MWT (p = 0.43), and handgrip (p = 0.19) outcomes. At D120, the IMV group had an important loss of body muscle mass (BMM) and a higher BMM than RAG (p = 0.02). Reduction in MIP (p = 0.01) and MEP (p = 0.02) in the IMV group and OTG group when compared to the RAG was also observed. Functional outcomes at 120 days from COVID-19 hospitalization were not found to be associated with the levels of oxygen supplementation during acute disease in this group of participants.

Assistance time and peripheral oxygen saturation in prehospital emergency data as predictors of COVID19 hospital outcomes

To verify if data obtained in the prehospital evaluation of patients with severe acute respiratory syndrome (SARS) during the initial response to the COVID-19 pandemic is associated with clinical outcomes: mechanical ventilation, hospital discharge, and death. This is a retrospective analysis involving secondary data from the Emergency Medical Service (EMS) records and the Health Surveillance Information System of patients assisted by the EMS in Manaus, from January to June 2020, the period of the first peak of COVID-19 cases. The combination of the two databases yielded a total of 1.190 patients, who received a first EMS response and were later admitted to hospital with SARS and had data on clinical outcomes of interest available. Patients were predominantly male (754, 63.4%), with a median age of 66 (IQR: 54.0-78.0) years. SARS illness before medical assistance was associated to need for invasive mechanical ventilation (IMV, p < 0.001). Lower pre-hospital SpO2 was associated to death (p = 0.025). Death was more common among patients with respiratory support needs, especially in the invasive ventilation group (262/287; 91.3%) (p < 0.001). In addition, IMV was more common among elderly individuals (p < 0.001). Patients admitted to ICU had a greater chance of dying when compared to non-ICU admitted patients (p < 0.001), and closely related to IMV (p < 0.001). Patients in ICU were also older (p = 0.003) and had longer hospital stay (p < 0.001). Mortality was associated with mechanical ventilation (p < 0.001), ICU admission (p < 0.001), and older age (p < 0.001). Patients who died had a shorter length of both ICU and total hospital stay (p < 0.001). Prehospital EMS may provide feasible and early recognition of critical patients with SARS in strained healthcare systems, such as in low-resource settings and pandemics.

Exploring Prehospital Data for Pandemic Preparedness: A Western Brazilian Amazon Case Study on COVID-19

BACKGROUND

The timely management of rapidly evolving epidemiological scenarios caused by disease outbreaks is crucial to prevent devastating consequences. However, delayed laboratory diagnostics can hamper swift health policy and epidemic response, especially in remote regions such as the western Brazilian Amazon. The aim of the article is to analyze the impact of the COVID-19 pandemic on the volume and characteristics of emergency medical services (EMS) in Manaus, focusing on how the pandemic affected sensitive indicators such as response time and the use of advanced life support ambulances. Additionally, the study seeks to understand how changes in prehospital EMS patterns, triggered by the pandemic, could be utilized as health surveillance tools, enabling a more rapid response in epidemic scenarios.

METHODS

This retrospective, descriptive study included data from the SAMU (Serviço de Atendimento Móvel de Urgência) medical records between January and June 2020.

RESULTS

A total of 45,581 calls resulted in mobile units being dispatched during this period. These patients were predominantly male (28,227, 61.9%), with a median age of 47 years (IQR 30-67). The median response time significantly increased during the pandemic, reaching a median of 45.9 min (IQR 30.6-67.7) (p < 0.001). EMS calls were reduced for trauma patients and increased for other medical emergencies, especially respiratory conditions, concomitantly to an escalation in the number of deaths caused by SARS and COVID-19 (p < 0.001). The employment of advanced life support ambulances was higher during the pandemic phase (p = 0.0007).

CONCLUSION

The COVID-19 pandemic resulted in a temporary disorder in the volume and reason for EMS calls in Manaus. Consequently, sensitive indicators like the response time and the employment of advanced life support ambulances were negatively affected. Sudden prehospital EMS pattern changes could play an important role in health surveillance systems, allowing for earlier establishment of countermeasures in epidemics. The impact of the COVID-19 pandemic on prehospital EMS and its role in health surveillance should be further explored.