Prevalence and factors associated with long COVID in adults from Southern Brazil: findings from the PAMPA cohort.

Most COVID-19 survivors have reported experiencing persistent symptoms after the infection - these types of cases are known as long COVID. Since Brazil was an epicenter of the COVID-19 pandemic, a high burden of long COVID is expected. This study aimed to identify the prevalence and factors associated with long COVID in adults in Southern Brazil, analyzing data from the PAMPA cohort. Participants filled out a self-reported online questionnaire in June 2022. This study only included subjects who tested positive for COVID-19. Long COVID was defined by any symptoms that persisted for at least three months after the SARS-CoV-2 infection. Poisson's regression models with robust variance were used to identify factors associated with long COVID; and results were reported as prevalence ratios (PR) and respective 95% confidence intervals (95%CI). A total of 1,001 participants (77.4% women, mean age [SD] = 38.3 [11.9] years) were analyzed. The prevalence of long COVID among these patients was 77.4% (95%CI: 74.7; 79.9). The likelihood of long COVID was higher in unvaccinated participants (PR = 1.23, 95%CI: 1.06; 1.42), in those with chronic conditions (PR = 1.13, 95%CI: 1.04; 1.24), and in those who were hospitalized due to the COVID-19 infection (PR = 1.24, 95%CI: 1.16; 1.32). This prevalence was also higher in women (PR = 1.21, 95%CI: 1.09; 1.33) than in men. Physical activity was associated with a reduced likelihood of fatigue, neurological complications, coughing, and headaches as persistent symptoms after a COVID-19 infection. It was found that three out of four adults in Southern Brazil experienced long COVID. Public policies aiming to reduce the burden of long COVID must be prioritized, especially in groups that are at higher risk of developing this harmful condition.

Kilohertz Frequency Alternating Current Induces Less Evoked Torque and Less Neuromuscular Efficiency Than Pulsed Current in Healthy People: A Randomized Crossover Trial.

CONTEXT: Pulsed current and kilohertz frequency alternating current are 2 types of neuromuscular electrical stimulation (NMES) currents often used by clinicians during rehabilitation. However, the low methodological quality and the different NMES parameters and protocols used in several studies might explain their inconclusive results in terms of their effects in the evoked torque and the discomfort level. In addition, the neuromuscular efficiency (ie, the NMES current type that evokes the highest torque with the lowest current intensity) has not been established yet. Therefore, our objective was to compare the evoked torque, current intensity, neuromuscular efficiency (evoked torque/current intensity ratio), and discomfort between pulsed current and kilohertz frequency alternating current in healthy people. DESIGN: A double-blind, randomized crossover trial. METHODS: Thirty healthy men (23.2 [4.5] y) participated in the study. Each participant was randomized to 4 current settings: 2 kilohertz frequency alternating currents with 2.5 kHz of carrier frequency and similar pulse duration (0.4 ms) and burst frequency (100 Hz) but with different burst duty cycles (20% and 50%) and burst durations (2 and 5 ms); and 2 pulsed currents with similar pulse frequency (100 Hz) and different pulse duration (2 and 0.4 ms). The evoked torque, current intensity at the maximal tolerated intensity, neuromuscular efficiency, and discomfort level were evaluated. RESULTS: Both pulsed currents generated higher evoked torque than the kilohertz frequency alternating currents, despite the similar between-currents discomfort levels. The 2 ms pulsed current showed lower current intensity and higher neuromuscular efficiency compared with both alternated currents and with the 0.4 ms pulsed current. CONCLUSIONS: The higher evoked torque, higher neuromuscular efficiency, and similar discomfort of the 2 ms pulsed current compared with 2.5-kHz frequency alternating current suggests this current as the best choice for clinicians to use in NMES-based protocols.

Prevalence and factors associated with long COVID in adults from Southern Brazil: findings from the PAMPA cohort / Prevalência e fatores associados à COVID longa em adultos do Sul do Brasil: achados da coorte PAMPA / Prevalencia y factores asociados con el COVID largo en adultos del Sur de Brasil: hallazgos de la cohorte PAMPA

Abstract: Most COVID-19 survivors have reported experiencing persistent symptoms after the infection - these types of cases are known as long COVID. Since Brazil was an epicenter of the COVID-19 pandemic, a high burden of long COVID is expected. This study aimed to identify the prevalence and factors associated with long COVID in adults in Southern Brazil, analyzing data from the PAMPA cohort. Participants filled out a self-reported online questionnaire in June 2022. This study only included subjects who tested positive for COVID-19. Long COVID was defined by any symptoms that persisted for at least three months after the SARS-CoV-2 infection. Poisson's regression models with robust variance were used to identify factors associated with long COVID; and results were reported as prevalence ratios (PR) and respective 95% confidence intervals (95%CI). A total of 1,001 participants (77.4% women, mean age [SD] = 38.3 [11.9] years) were analyzed. The prevalence of long COVID among these patients was 77.4% (95%CI: 74.7; 79.9). The likelihood of long COVID was higher in unvaccinated participants (PR = 1.23, 95%CI: 1.06; 1.42), in those with chronic conditions (PR = 1.13, 95%CI: 1.04; 1.24), and in those who were hospitalized due to the COVID-19 infection (PR = 1.24, 95%CI: 1.16; 1.32). This prevalence was also higher in women (PR = 1.21, 95%CI: 1.09; 1.33) than in men. Physical activity was associated with a reduced likelihood of fatigue, neurological complications, coughing, and headaches as persistent symptoms after a COVID-19 infection. It was found that three out of four adults in Southern Brazil experienced long COVID. Public policies aiming to reduce the burden of long COVID must be prioritized, especially in groups that are at higher risk of developing this harmful condition.

Resumo: A maior parte dos sobreviventes da COVID-19 relatou sintomas persistentes após a infecção, também conhecida como COVID longa. O Brasil foi um epicentro da pandemia de COVID-19, logo, espera-se uma alta carga de COVID longa. Este estudo teve como objetivo identificar a prevalência e os fatores associados à COVID longa em adultos no Sul do Brasil. Foram analisados dados da coorte PAMPA. Os participantes preencheram um questionário online autoaplicável em junho de 2022. Foram incluídos apenas os participantes que testaram positivo para COVID-19. A COVID longa foi definida como qualquer sintoma que persistiu por pelo menos três meses após a infecção do SARS-CoV-2. Os modelos de regressão de Poisson com variância robusta foram usados para identificar fatores associados à COVID longa; os resultados foram relatados como razão de prevalência (RP) e seus respectivos intervalos de 95% de confiança (IC95%). Ao todo, 1.001 participantes (77,4% mulheres, idade média [DP] = 38,3 [11,9] anos) foram analisados. A prevalência da COVID longa foi de 77,4% (IC95%: 74,7; 79,9). A probabilidade da COVID longa foi maior em participantes não vacinados (RP = 1,23, IC95%: 1,06; 1,42), pessoas com condições crônicas (RP = 1,13, IC95%: 1,04; 1,24), e pacientes hospitalizados devido à infecção por COVID-19 (RP = 1,24, IC95%: 1,16; 1,32) em comparação com as contrapartes. A prevalência foi maior em mulheres (RP = 1,21, IC95%: 1,09; 1,33) do que em homens. A atividade física foi associada à probabilidade reduzida de fadiga, complicações neurológicas, tosse e dor de cabeça como sintomas persistentes após a infecção por COVID-19. Três em cada quatro adultos no Sul do Brasil tiveram COVID longa. Políticas públicas que visem reduzir a carga da covid longa devem ser priorizadas, especialmente nos grupos de maior risco desta condição.

Resumen: La mayoría de los supervivientes de la COVID-19 relató síntomas persistentes tras la infección, también conocida como COVID largo. Brasil fue un epicentro de la pandemia de COVID-19, así, se espera una alta carga de COVID largo. El objetivo de este estudio fue identificar la prevalencia y los factores asociados con la COVID largo en adultos en el Sur de Brasil. Se analizaron datos de la cohorte PAMPA. Los participantes rellenaron un cuestionario en línea autoadministrado en junio de 2022. Solo se incluyeron los participantes que dieron positivo para COVID-19. La COVID largo fue definida como cualquier síntoma que persistió durante al menos tres meses tras la infección del SARS-CoV-2. Se utilizaron los modelos de regresión de Poisson con varianza robusta para identificar factores asociados con el COVID largo; se relataron los resultados como razón de prevalencia (RP) y sus respectivos intervalos de 95% confianza de 95% (IC95%). En total, se analizaron 1.001 participantes (el 77,4% mujeres, edad media [DP] = 38,3 [11,9] años). La prevalencia del COVID largo fue del 77,4% (IC95%: 74,7; 79,9). La probabilidad del COVID largo fue más alta en participantes no vacunados (RP = 1,23, IC95%: 1,06; 1,42), personas con condiciones crónicas (RP = 1,13, IC95%: 1,04; 1,24) y pacientes hospitalizados debido a la infección por COVID-19 (RP = 1,24, IC95%: 1,16; 1,32) en comparación con sus contrapartes. La prevalencia fue más alta en mujeres (RP = 1,21, IC95%: 1,09; 1,33) que en hombres. La actividad física se asoció con la probabilidad reducida de fatiga, complicaciones neurológicas, tos y dolor de cabeza como síntomas persistentes tras la infección por COVID-19. Tres de cada cuatro adultos en el Sur de Brasil han tenido COVID largo. Se deben priorizar las políticas públicas destinadas a reducir la carga del COVID largo, sobre todo en los grupos de mayor riesgo para esta condición.

Alternating Current Is More Fatigable Than Pulsed Current in People Who Are Healthy: A Double-Blind, Randomized Crossover Trial.

OBJECTIVE: Tolerance level and rapid fatigue onset are limitations in the use of neuromuscular electrical stimulation (NMES) as an electrotherapeutic resource in rehabilitation and training protocols; however, it is unclear if pulsed current (PC) and alternating current (AC) produce different fatigue levels when applied at submaximal contraction level. The purpose of this study was to compare fatigue and discomfort levels between PC and AC during a submaximal contraction protocol in people who are healthy. METHODS: In this double-blind, randomized crossover trial conducted in a laboratory setting, 30 male volunteers [23.23 years of age (SD = 4.59)] performed 2 submaximal fatigue protocols (with a 7-day interval) in a randomized order: PC (pulse duration = 2 milliseconds, pulse frequency = 100 Hz) and AC (2.5 kHz, pulse duration = 0.4 milliseconds, burst frequency = 100 Hz). NMES currents were applied to the knee extensor motor point of the dominant limb. The NMES protocol consisted of 80 evoked contractions (time on:off = 5:10 seconds) and lasted 20 minutes. The current was maintained at a constant intensity throughout the NMES protocol. The primary outcome measures were maximal voluntary isometric contraction, fatigue index (evoked torque decline), fatigability (number of contractions for a 50% drop in evoked-torque from the protocol start), total evoked torque-time integral (TTI), decline in TTI, and discomfort level. RESULTS: AC at 2.5 kHz demonstrated higher maximal voluntary isometric contraction decline post-fatigue, higher fatigue index, higher fatigability (ie, fewer contractions to reach the 50% evoked torque decline from the protocol start), smaller total TTI, and higher TTI decline compared with PC. No between-currents difference was observed in discomfort level. CONCLUSION: PC is less fatigable than AC at 2.5 kHz. IMPACT: Based on this study, PC is the preferred current choice when the NMES goal is to generate higher muscle work, higher mechanical load, and smaller fatigability during training both for athletes who are healthy and for rehabilitation programs for people with disease or injury.

Terapia complexa descongestiva no tratamento intensivo do linfedema: revisão sistemática / Terapia compleja descongestiva en el tratamiento intensivo del linfedema: revisión de literatura / Complex Decongestive Therapy in the intensive care of lymphedema: systematic review

RESUMO O linfedema caracteriza-se por acúmulo de proteínas e fluídos no interstício, com alterações físicas e psicológicas. Entre as técnicas fisioterapêuticas utilizadas para redução do linfedema está a terapia complexa descongestiva. O objetivo desta revisão é identificar evidências para a prática da terapia complexa descongestiva no tratamento intensivo do linfedema. Realizou-se uma busca nas bases de dados PubMed, EMBASE e PEDro. Os artigos selecionados foram estudos randomizados e de coorte, os quais foram avaliados e selecionados de forma independente por dois revisores, que avaliaram a qualidade metodológica dos estudos com a escala PEDro. As buscas resultaram em 414 estudos, depois foram reduzidos a sete estudos elegíveis para análise de qualidade, classificados pela escala PEDro como qualidade alta e eficácia moderada. Os artigos analisados apresentaram boa qualidade metodológica, e seus resultados evidenciaram a efetividade da terapia complexa descongestiva na redução do volume do linfedema no tratamento intensivo.

RESUMEN El linfedema es producido debido a la acumulación de proteínas y fluidos en el intersticio, causando alteraciones físicas y psicológicas. Entre las técnicas fisioterapéuticas empleadas para reducirlo se encuentra la terapia compleja descongestiva. El propósito de este estudio es identificar la práctica de la terapia compleja descongestiva en el tratamiento intensivo del linfedema. Para ello, se hizo una búsqueda en las bases de datos PubMed, EMBASE y PEDro. Los estudios elegidos fueron de tipo aleatorio y de cohorte, en los cuales se hizo una evaluación y elección de forma independiente por dos revisores, quienes trataron de evaluar la calidad metodología en los estudios con la escala PEDro. Se encontraron 414 estudios, después fueron reducidos a siete, elegidos para el análisis de calidad y clasificados en la escala PEDro como de alta calidad y eficacia moderada. Los estudios evaluados presentaron alta calidad metodológica, y sus resultados mostraron la eficacia de la terapia compleja descongestiva para el tratamiento intensivo de reducir el volumen del linfedema.

ABSTRACT Lymphedema is characterized by accumulation of proteins and fluids in the interstice, with physical and psychological changes. Among the physiotherapeutic techniques used to reduce lymphedema we have the complex decongestive therapy. The objective of this review is to identify evidence for the practice of complex decongestive therapy for intensive care of lymphedema. A search was carried out in the PubMed, EMBASE and PEDro databases. The articles chosen were randomized and cohort studies, which have been evaluated and selected independently by two reviewers who evaluated the methodological quality of the studies within the PEDro Scale. The search resulted in 414 studies, reduced to seven eligible studies for quality analysis, classified by PEDro scale as high quality and moderate effectiveness studies. The analyzed articles showed good methodological quality and their results showed the effectiveness of complex decongestive therapy in reducing the volume of lymphedema in intensive care.