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Frontiers in Pediatrics 2024The study aims to analyze the clinical characteristics of acute phase of SARS-CoV-2 infection in children aged 0-17 years with the Omicron variant, and summarize the...
OBJECTIVE
The study aims to analyze the clinical characteristics of acute phase of SARS-CoV-2 infection in children aged 0-17 years with the Omicron variant, and summarize the persistent symptoms or new-onset clinical manifestations from 4 to 12 weeks after acute COVID. Explore the association between the vaccination status and SARS-CoV-2 neutralizing antibody levels post infection among preschool-aged children. The comprehensive study systematically describes the clinical characteristics of children infected with SARS-CoV-2, providing a foundation for diagnosis and evaluating long-term COVID in pediatric populations.
METHODS
The study enrolled children who were referred to the Children's Hospital, Capital Institute of Pediatrics, (Beijing, China) from January 10, 2023 to March 31, 2023. Participants were classified as infant and toddlers, preschool, school-age, and adolescent groups. Children or their legal guardians completed survey questionnaires to provide information of previous SARS-CoV-2 infection history, as well as clinical presentation during the acute phase and long-term symptoms from 4 to 12 weeks following infection. Furthermore, serum samples were collected from children with confirmed history of SARS-CoV-2 infection for serological testing of neutralizing antibodies.
RESULTS
The study recruited a total of 2,001 children aged 0-17 years who had previously tested positive for SARS-CoV-2 through nucleic acid or antigen testing. Fever emerged as the predominant clinical manifestation in 1,902 (95.1%) individuals with body temperature ranging from 37.3 to 40.0°C. Respiratory symptoms were identified as secondary clinical manifestations, with cough being the most common symptom in 777 (38.8%) children, followed by sore throat (22.1%), nasal congestion (17.8%), and runnning nose (17.2%). Fatigue (21.6%), headache (19.8%) and muscle-joint pain (13.5%) were frequently reported systemic symptoms in children. The proportion of children with symptoms of SARS-CoV-2 infection varied across age groups. 1,100 (55.0%) children experienced persistent symptoms from 4 to 12 weeks post the acute phase of infection. Trouble concentrating (22.1%), cough (22.1%), and fatigue (12.1%) were frequently reported across age groups in the extended period. A limited number of children exhibited cardiovascular symptoms with chest tightness, tachycardia, and chest pain reported by 3.5%, 2.5%, and 1.8% of children, respectively. Among 472 children aged 3-5 years, 208 children had received two doses of SARS-CoV-2 vaccine at least 6 months prior to infection, and no association was found between the incidence of long-term COVID and pre-infection vaccination statuses among the 3-5 years age groups ( = 1.136, = 0.286).
CONCLUSIONS
In children aged 0-17 years infected with SARS-CoV-2 Omicron variant, fever was the primary clinical manifestation in the acute phase, followed by respiratory symptoms, systemic non-specific and digestive presentations. In particular, respiratory and digestive system symptoms were more frequent in children aged above 6 years. Regarding the long-term symptoms from 4 to 12 weeks post-infection, the most common presentations were concentrating difficulty, cough, and fatigue. The incidence of persistent symptoms of SARS-CoV-2 did not exhibit a significant correlation with vaccination status, which was attributed to the waning efficacy of the vaccine-induced humoral immune response after 6 months.
PubMed: 38813546
DOI: 10.3389/fped.2024.1332020 -
Sports Medicine International Open 2024Mean propulsive velocity (MPV) has been associated with neuromuscular fatigue; however, its suitability for strength training in Paralympic powerlifting (PP) remains...
Mean propulsive velocity (MPV) has been associated with neuromuscular fatigue; however, its suitability for strength training in Paralympic powerlifting (PP) remains uncertain. The objective of this work was to evaluate the MPV in two training methods (traditional-TRAD and eccentric-ECC). Eleven PP athletes were evaluated pre, during the intervention and post intervention at a load of 80% of the 1RM for TRAD and 110%-80% of 1 RM for ECC. The results demonstrated that there was no significant neuromuscular fatigue for the TRAD (~5% performance loss), as well as no significant decline in MPV during the intervention. For the ECC, there is a significant reduction in MPV before and after training (~12% loss of performance). A difference between TRAD and ECC after the intervention was also identified (0.87 m/s±0.22, 95% CI 0.72-1.02 vs. 0.72±0.20, 95% CI 0.59-0.86 p=0.042, F(3.30)=10.190, η2p=0.505 - very high effect). During the intervention for ECC, no significant decline in MPV was observed. The results of this study suggest that the mechanical indices of MPV do not seem to be effective indicators of neuromuscular fatigue in the sample studied or in the context of this specific training regime, being more indicated as a control of training volume.
PubMed: 38812958
DOI: 10.1055/a-2207-7922 -
Turkish Journal of Medical Sciences 2024Although high muscle strength worsens the sense of force, it is unknown whether there is a relationship between this deterioration and the underlying molecular...
BACKGROUND/AIM
Although high muscle strength worsens the sense of force, it is unknown whether there is a relationship between this deterioration and the underlying molecular mechanisms. This study examined the relationship between decreased force sense (FS) acuity and strength-related gene expressions.
MATERIALS AND METHODS
Maximal voluntary isometric contraction (MVIC) and FS (50% MVIC) tests were performed on the knee joints of twenty-two subjects. The expression analyses were evaluated by qRT-PCR in blood samples taken before, after MVIC, after 50% MVIC, and 15 min after the test.
RESULTS
MVIC and FS error values were significantly correlated with each other (r = .659, p = .001). The qRT-PCR analyses demonstrated that the expressed mRNAs of the interleukin 6 (IL-6), alpha-actinin 3 (ACTN3), angiotensin-converting enzyme (ACE), brain-derived neurotrophic factor (BDNF), and ciliary neurotrophic factor receptor (CNTFR) genes dramatically increased until 50% MVIC and subsequently decreased 15 min after the exercise (p < .05). The muscle-specific creatine kinase (CKMM), myosin light chain kinase (MLCK), and G-protein β3 subunit (GNB3) genes reached their peak expression levels 30 min after MVIC (p < .05). ACE and ACTN3 gene expression increased significantly in parallel with the increased FS error (p < .05). These gene expression fluctuations observed at 50% MVIC and after the rest could be related to changes in cellular metabolism leading to fatigue.
CONCLUSION
The time points of gene expression levels during exercise need to be considered. The force acuity of those whose maximal force develops too much may deteriorate.
Topics: Humans; Male; Muscle Strength; Isometric Contraction; Adult; Young Adult; Gene Expression; Muscle, Skeletal; Interleukin-6; Female; Brain-Derived Neurotrophic Factor; Peptidyl-Dipeptidase A; Actinin; Knee Joint
PubMed: 38812641
DOI: 10.55730/1300-0144.5775 -
BMC Nephrology May 2024Pathological changes were observed in the diaphragm due to abnormal renal function in chronic kidney disease (CKD). Inspiratory muscle training (IMT) has been suggested... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of different inspiratory muscle training protocols on functional exercise capacity and respiratory and peripheral muscle strength in patients with chronic kidney disease: a randomized study.
BACKGROUND
Pathological changes were observed in the diaphragm due to abnormal renal function in chronic kidney disease (CKD). Inspiratory muscle training (IMT) has been suggested for patients with CKD; however, the most appropriate intensity for IMT has not been determined. Therefore, this study aimed to investigate the effects of different IMT protocols on respiratory muscle strength, quadriceps femoris muscle strength (QMS), handgrip muscle strength (HGS), functional exercise capacity, quality of life (QoL), pulmonary function, dyspnoea, fatigue, balance, and physical activity (PA) levels in patients with CKD.
METHODS
This randomized, controlled, single-blind study included 47 patients and they were divided into three groups: Group 1 (n = 15, IMT with 10% maximal inspiratory pressure (MIP)), Group 2 (n = 16, IMT with 30% MIP), and Group 3(n = 16; IMT with 60% MIP). MIP, maximal expiratory pressure (MEP), 6-min walking test (6-MWT), QMS, HGS, QoL, pulmonary function, dyspnoea, fatigue, balance, and PA levels were assessed before and after eight weeks of IMT.
RESULTS
Increases in MIP, %MIP, 6-MWT distance, and %6-MWT were significantly higher in Groups 2 and 3 than in Group 1 after IMT (p < 0.05). MEP, %MEP, FEF QMS, HGS, and QoL significantly increased; dyspnoea and fatigue decreased in all groups (p < 0.05). FVC, PEF, and PA improved only in Group 2, and balance improved in Groups 1 and 2 (p < 0.05).
CONCLUSIONS
IMT with 30% and 60% MIP similarly improves inspiratory muscle strength and functional exercise capacity. IMT with 30% is more effective in increasing PA. IMT is a beneficial method to enhance peripheral and expiratory muscle strength, respiratory function, QoL and balance, and reduce dyspnoea and fatigue. IMT with %30 could be an option for patients with CKD who do not tolerate higher intensities.
TRIAL REGISTRATION
This study was retrospectively registered (NCT06401135, 06/05/2024).
Topics: Humans; Male; Female; Muscle Strength; Renal Insufficiency, Chronic; Exercise Tolerance; Middle Aged; Single-Blind Method; Respiratory Muscles; Breathing Exercises; Quality of Life; Adult; Hand Strength; Dyspnea; Aged
PubMed: 38811888
DOI: 10.1186/s12882-024-03610-1 -
PloS One 2024Biomechanical analysis of human movement plays an essential role in understanding functional changes in people with Amyotrophic Lateral Sclerosis (ALS), providing...
Biomechanical analysis of human movement plays an essential role in understanding functional changes in people with Amyotrophic Lateral Sclerosis (ALS), providing information on muscle impairment. Studies suggest that surface electromyography (sEMG) may be able to quantify muscle activity, identify levels of fatigue, assess muscle strength, and monitor variation in limb movement. In this article, a systematic review protocol will analyze the psychometric properties of the sEMG regarding the clinical data on the skeletal muscles of people with ALS. This protocol uses the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodological tool. A specific field structure was defined to reach each phase. Nine scientific databases (PubMed, Web of Science, Embase, Elsevier, IEEE, Google Scholar, SciELO, PEDro, LILACS E CENTRAL) were searched. The framework developed will extract data (i.e. study information, sample information, sEMG information, intervention, and outcomes) from the selected studies using a rigorous approach. The data will be described quantitatively using frequency and trend analysis methods, and heterogeneity between the included studies will be assessed using the I2 test. The risk of bias will be summarized using the most recent prediction model risk of bias assessment tool. Be sure to include relevant statistics here, such as sample sizes, response rates, P values or Confidence Intervals. Be specific (by stating the value) rather than general (eg, "there were differences between the groups"). This protocol will map out the construction of a systematic review that will identify and synthesize the advances in movement analysis of people with ALS through sEMG, using data extracted from articles.
Topics: Amyotrophic Lateral Sclerosis; Humans; Electromyography; Systematic Reviews as Topic; Muscle, Skeletal; Movement; Biomechanical Phenomena
PubMed: 38805448
DOI: 10.1371/journal.pone.0302479 -
Cureus Apr 2024Myasthenia gravis (MG) is an autoimmune illness characterized by autoantibodies against the acetylcholine receptor (AChR), muscle-specific tyrosine kinase (MuSK), and an... (Review)
Review
Myasthenia gravis (MG) is an autoimmune illness characterized by autoantibodies against the acetylcholine receptor (AChR), muscle-specific tyrosine kinase (MuSK), and an increasing number of extra postsynaptic proteins. Pathogenic autoantibodies reduce the number of functional AChRs in the neuromuscular junction's (NMJ) muscle end plate. The cause of the autoimmune response is unknown, but thymic abnormalities and immune regulatory deficiencies are significant. The disease's incidence is likely influenced by genetic predisposition, with sex hormones and exercise playing a role. MG can affect any age, race, or gender and can be caused by any stressor, with infections being the most frequent cause. Treatment focuses on airway support and the triggering incident. MG is a rare autoimmune disease causing fatigue-inducing weakness in the axial, respiratory, leg, and bulbar muscles. Initially affecting the eyes, most MG patients experience at least one worsening symptom during their illness. The disease is mainly caused by antibodies against the AChR, dependence on the immune system within cells, and engagement of the complement system. The complement system plays a significant role in MG, and complement inhibition can both prevent the onset and slow its development. Ocular MG affects around 15% of people, with most patients having blocking antibodies against the cholinergic receptor. There may be correlations between thymoma and other autoimmune conditions, especially thyroid illness. Treatment and management for MG involve removing autoantibodies from circulation or blocking effector mechanisms using techniques such as complement inhibition, plasmapheresis, and B-cell elimination.
PubMed: 38803727
DOI: 10.7759/cureus.59104 -
Kidney & Blood Pressure Research May 2024Physical inactivity is common in patients with chronic kidney disease (CKD) and is an important modifiable risk factor for mortality, morbidity, and reduced quality of...
BACKGROUND/AIMS
Physical inactivity is common in patients with chronic kidney disease (CKD) and is an important modifiable risk factor for mortality, morbidity, and reduced quality of life. The present single-centre pilot study evaluated the possibility of performing structured physical exercise using a specific walking model, Fitwalking, in a population of patients with CKD and, according to the American College of Rheumatology guidelines, also in a population with immuno-rheumatological disease.
METHODS
Patients were recruited from the nephrology, haemodialysis, peritoneal dialysis, transplantation, and immuno-rheumatology outpatient clinics. After general and functional clinical evaluation and exercise prescription at the Department of Sports Medicine, we performed scientifically proven tests on CKD (Six-minute walk test and Sit to stand test), before and after the Fitwalking technique training course, and again after 6 and 12 months, to evaluate its effectiveness and identify any critical issues.
RESULTS
We enrolled 80 patients, (41 males, 51.2%), mean age 53±12 years; the clinical data showed statistically significant improvements in systolic, average, and differential blood pressure, average speed, and physical strength. Participants also adapted to muscle fatigue, experienced a reduction in BMI with stable lean mass and reduced fat mass, and reported improved perceptions of physical and mental health, and quality of life.
CONCLUSION
All enrolled patients successfully completed the process. A specific prescription was used that provided health education and allowed for the implementation of structured physical activity that could be performed safely and independently even after the training period. The activity was sustainable thanks to the training of in-house medical and nursing staff, demonstrating that it is possible to overcome this type of barrier to physical activity in CKD and in immuno-rheumatological patients.
PubMed: 38801816
DOI: 10.1159/000539525 -
Journal of Robotic Surgery May 2024There is a high prevalence of upper limb musculoskeletal pain among robotic surgeons. Poor upper limb ergonomic positioning during robotic surgery occurs when the... (Review)
Review
There is a high prevalence of upper limb musculoskeletal pain among robotic surgeons. Poor upper limb ergonomic positioning during robotic surgery occurs when the shoulders are abducted, and the elbows are lifted off the console armrest. The validated rapid upper limb assessment can quantify ergonomic efficacy. Surface electromyography and hand dynamometer assessment of strength are the most common methods to assess muscle fatigue. A literature review was performed to find evidence of ergonomic interventions which reduce upper limb musculoskeletal pain during robotic surgery. There is a paucity of studies which have reported on this topic. In other occupations, there is strong evidence for the use of resistance training to prevent upper extremity pain. Use of forearm compression sleeves, stretching, and massage may help reduce forearm fatigue. Microbreaks with targeted stretching, active ergonomic training, improved use of armrest, and optimal hand controller design have been shown to reduce upper limb musculoskeletal pain. Future studies should assess which interventions are beneficial in reducing surgeon upper limb pain during robotic surgery.
Topics: Humans; Ergonomics; Robotic Surgical Procedures; Musculoskeletal Pain; Upper Extremity; Muscle Fatigue; Occupational Diseases; Electromyography; Resistance Training; Surgeons; Massage
PubMed: 38801617
DOI: 10.1007/s11701-024-01992-w -
AACE Clinical Case Reports 2024Ectopic cosecretion of corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) in silent (ie, non-catecholamine-secreting) pheochromocytoma is a...
BACKGROUND/OBJECTIVE
Ectopic cosecretion of corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) in silent (ie, non-catecholamine-secreting) pheochromocytoma is a rare cause of Cushing syndrome.
CASE REPORT
A 57-year-old woman rapidly developed hypercortisolism, clinically manifesting as fatigue, muscle weakness, weight gain, and worsening hypertension and biochemically characterized by hypokalemia and marked increases in the serum cortisol and plasma ACTH levels. This acute presentation suggested a diagnosis of ectopic ACTH syndrome (EAS). Imaging studies revealed a right adrenal mass that enhanced after administration of the radioisotope gallium-68-DOTATATE. Plasma metanephrines were normal in 2 separate measurements. The possibility of a silent pheochromocytoma was considered. After controlling her hypercortisolism with metyrapone and surgical preparation with alpha blockade, the patient underwent elective right adrenalectomy. Pathology revealed a pheochromocytoma that stained focally for ACTH and CRH. Postoperatively, the cortisol levels normalized, the hypothalamic-pituitary-adrenal axis was not suppressed, and clinical symptoms from hypercortisolism abated.
DISCUSSION
Patients who exhibit a rapid progression of ACTH-dependent hypercortisolism should be screened for EAS. The use of functional imaging radioisotopes (eg, gallium DOTA-peptides) improves the detection of ACTH-secreting tumors. Preoperative treatment with steroidogenesis inhibitors helps control clinical and metabolic derangements associated with severe hypercortisolemia, whereas alpha blockade prevents the onset of an adrenergic crisis.
CONCLUSION
We present a rare case of EAS due to a silent pheochromocytoma that cosecreted ACTH and CRH. Pheochromocytoma should be considered in patients with EAS who have an adrenal mass even in the absence of excessive catecholamine secretion.
PubMed: 38799040
DOI: 10.1016/j.aace.2024.01.007 -
Narra J Apr 2024Fish transport workers in Indonesia lift loads more than the specified limits, both in weight and frequency. This could cause lactic acid accumulation, fatigue and...
Fish transport workers in Indonesia lift loads more than the specified limits, both in weight and frequency. This could cause lactic acid accumulation, fatigue and reduced physical performance. The aim of this study was to assess the effect of stretching intervention on muscle tension, fatigue, strength, and lactic acid level in fish transport workers in Indonesia. A pre-experimental study design with one group (pre- and post-test) design was conducted among male fish transport workers at the Tawang fish auction, Weleri, Central Java, Indonesia, in June 2022 for two weeks. We created a 1.5-minute stretching exercise video based on the University of New Castle's Manual Handling guideline, involving hand, feet, and shoulder movements. Participants performed these exercises independently before and during work every two hours, guided by the video. Data on lactic acid, muscle tension, fatigue, and strength were collected before and after the 2-week intervention. Data analysis was performed using Wilcoxon and paired Student t-tests to compare the outcome between post- and pre-intervention. A total of 18 fish transport workers were included in the study. The results showed a statistically significant increase in lactic acid levels following the intervention (=0.016). However, the increase in muscle tension was not statistically significant (=0.292). There was a significant increase in fatigue levels after the intervention (=0.000). This could suggest that the stretching intervention may have had an unintended effect of increasing fatigue among the participants. On the other hand, there was a statistically significant decrease in muscle strength after the intervention (=0.003). In conclusion, this study suggests that while stretching exercises can affect lactic acid accumulation, fatigue, and muscle strength, they do not influence muscle tension. Therefore, it is advised for workers to incorporate stretching exercises into their daily routine to mitigate potential injury risks.
Topics: Humans; Male; Lactic Acid; Indonesia; Adult; Muscle Stretching Exercises; Fatigue; Muscle Strength; Muscle Tonus; Muscle Fatigue
PubMed: 38798855
DOI: 10.52225/narra.v4i1.627