A meta-analysis suggested with low confidence that symptomatic long COVID was associated with decreased exercise capacity on cardiopulmonary exercise testing up to 3 months after initial SARS-COV-2 infection.
Underlying mechanisms may include but are not limited to deconditioning, peripheral mechanisms, hyperventilation, chronotropic incompetence, preload failure and autonomic and endothelial dysfunction, according to a study published in JAMA Network Open.
“In our meta-analysis of symptomatic vs. recovered individuals more than 3 months after SARS-CoV-2 infection, we found a modest but consistent effect suggesting that exercise capacity was reduced among individuals with long COVID, with very low certainty in the magnitude of the effect size by [the Grading of Recommendations, Assessment, Development, and Evaluations framework],” Matthew S. Durstenfeld, MD, MAS, assistant professor of medicine at the University of California, San Francisco, and noninvasive general cardiologist and physician-scientist clinical researcher at Zuckerberg San Francisco General Hospital, and colleagues wrote. “Despite the large number of participants included, the overall quality of the evidence is poor, owing to the small sample size of most studies, selection bias, variability in symptom ascertainment and cardiopulmonary exercise testing interpretation, inadequate methods to address confounding, and lack of appropriate statistical methods.”
For this meta-analysis, researchers identified 38 studies in which cardiopulmonary exercise testing was performed in individuals 3 to 18 months after SARS-CoV-2 infection.
Cardiopulmonary exercise testing involved measurement of baseline resting cardiopulmonary parameters, exercise on a cycle ergometer or a treadmill with measures of peak oxygen consumption (VO2) and cardiopulmonary monitoring.
The primary outcome was change in exercise capacity defined as difference in peak VO2 more than 3 months after initial SARS-CoV-2 infection among participants with and without symptoms of long COVID.
Among the 2,160 individuals included in this analysis, 1,228 had symptoms consistent with long COVID.
An analysis of nine studies including patients with and without symptoms of long COVID showed a mean change in peak VO2 of 4.9 mL/kg/minute at 3 months among participants with long COVID symptoms (95% CI, 6.4 to 3.4; P < .001); however, moderate heterogeneity was observed.
Common symptoms included dyspnea, fatigue or exertional intolerance at the time of testing.
Using data from the cardiopulmonary exercise tests, the researchers concluded that mechanisms such as deconditioning, which may occur to some degree after any illness; peripheral mechanisms related to oxygen delivery and/or extraction; dysfunctional breathing or hyperventilation unexplained by baseline pulmonary tests; chronotropic incompetence; preload failure despite normal resting cardiac function; autonomic dysfunction; and endothelial dysfunction may be attributable to reduced exercise capacity in this population.
“Further research should include longitudinal assessments to understand the trajectory of exercise capacity,” the researchers wrote. “Interventional trials of potential therapies are urgently needed, including studies of rehabilitation to address deconditioning, as well as further mechanistic investigation into dysfunctional breathing, autonomic dysfunction, chronotropic incompetence, impaired oxygen uptake or utilization, and preload failure to identify treatments for long COVID.”
HIV/AIDS progress in Brazil
December 1 is World AIDS Day, a time to raise awareness and show support for those living with AIDS or HIV, the virus that causes AIDS.
Treatment of HIV/AIDS has come a long way since the first cases became public in the 1980s.
And Brazil is one country that led the way; its pioneering programs to identify and treat patients recognized the world over.
In recent years, however, the country’s progress has shown to be slipping.
Early RSV season primarily impacts infants
Dear Doctors: What can I do to protect my baby from RSV? What are the symptoms? People are talking about a “tripledemic,” and it has my husband and me worried. We’re both vaccinated for the flu and COVID-19, and we are being super careful when we’re out and about. What else can we do?
Dear Reader: RSV is short for respiratory syncytial virus. It’s a common winter virus that can affect people of any age. In most cases, RSV infection causes mild symptoms similar to the common cold. However, infants and children younger than 2, whose immune systems are still developing, are at increased risk of becoming seriously ill.
RSV is the most common cause of pneumonia in infants and young children in the United States. It is also the leading cause of bronchiolitis in that age group. That’s a lung infection in which the smallest airways become inflamed and swollen, and an increase in mucus production impedes air flow into and out of the lungs.
This year, as with the flu, RSV season has arrived early. Hospitals throughout the U.S. are reporting a surge of serious infections among infants and younger children.
The virus enters the body through the airways and the mucous membranes. It can remain viable on hard surfaces — such as a doorknob, night table or dinnerware — for several hours. It can also persist on softer surfaces, such as a tissue or the skin. Someone can become infected by breathing in the viral particles that remain airborne following a cough or a sneeze, or by touching their mouth, nose or eyes after direct contact with contaminated droplets.
Someone who is sick with RSV typically remains contagious for between four and eight days. However, due to their still-developing immune systems, it’s possible for infants to continue to spread the virus for several weeks, even after symptoms of the disease have abated. There is no vaccine for this virus, and no targeted treatments. Prevention relies on the same precautions you use to avoid any respiratory illness. That is, keep your baby away from people who are ill, avoid close contact with people outside your home and be vigilant about hand hygiene.
Symptoms of RSV arise between three and six days after infection. They can include a runny nose, sneezing and coughing, fever, a decrease in appetite and lung congestion that can cause wheezing. These symptoms tend to be progressive, arriving in stages as the body mounts its attack against the virus. But in very young patients, the first, and sometimes only noticeable, symptoms of RSV can be increased fussiness, a decrease in activity and difficulty breathing.
Treatment for RSV consists of managing symptoms. The specific avenue of care depends on a child’s age, general health and symptoms. In infants, treating RSV includes a focus on adequate hydration and remaining alert for any signs of problems with breathing. The majority of RSV infections run their course in a week to 10 days. Parents of younger infants should check with their pediatricians for guidance on treatment, particularly medications. If your child has difficulty breathing, isn’t drinking enough fluids or has worsening symptoms, call your health care provider right away.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to firstname.lastname@example.org, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.
AIDS Memorial Quilt comes to Palm Beach County
PALM BEACH COUNTY, Fla. — The largest piece of community folk art in the world, a tribute to victims of AIDS, is on display in Palm Beach County.
Now through Dec. 15, three different panels of the NAMES Project AIDS Memorial Quilt, often known as the AIDS Quilt, will be on display at three different Palm Beach County Public Library locations.
The quilt is a giant tribute to the lives of people who have died due to AIDS or AIDS-related causes.
The quilt weighs around 54 tons and was started in the 1980s during the early years of the AIDS pandemic.
The AIDS Memorial Quilt is comprised of nearly 50,000 panels containing 91,000 names of the men, women and children who lost their lives to the immune system disease.
The blocks, which make up the panels, are stitched by individuals in communities across the nation, including one librarian right in Palm Beach County.
Katrina Brockway, a librarian at the Hagen Ranch Road Branch Library, said she feels it brings tragedy a bit closer to home.
“It becomes so much more personal when you see these quilt panels and all of these people who were loved and didn’t have the same opportunity to escape this,” Brockway said. “So you can remember them, what they went through, and what their loved ones have gone through.”
Visitors can see the quilt panels during normal library hours at the library’s main branch on Summit Boulevard at the Jupiter branch and at the west Boca Raton branch.
Click here for the library’s hours and more information on upcoming AIDS events at the library.
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