Factors Associated With Persistence of Dyspnea and Change in Health-Related Quality of Life in Patients With COVID-19 After Discharge.

Introduction Coronavirus disease 2019 (COVID-19) is a deadly virus affecting multiple organ systems, predominantly the respiratory system. Dyspnea along with the deterioration of health-related quality of life (HRQoL) is common in COVID-19 patients discharged from a dedicated Coronavirus disease (COVID) hospital. Very few studies in India used HRQoL for the assessment of COVID-19 patients after discharge. Our article aims to assess the factors associated with the persistence of dyspnea and HRQoL in discharged patients of COVID-19. Methods A total of 48 patients were included in this prospective observational study. Ethical approval from Institutional Ethics Committee was obtained before the enrolment of patients. Patients having dyspnea at exertion and during discharge were selected for this study. Modified Medical Research Council (mMRC) scale and modified Borg scale were used for assessing dyspnea on activity, and Saint George's Respiratory Questionnaire (SGRQ) was used to assess HRQoL. Data were collected on the day of discharge (D0) and after 60 days (D60) post-discharge. The significance of changes in parameters from D0 to D60 was evaluated by paired t-test. Results The mean mMRC, modified Borg, and SGRQ scores at D0 were 2.38±0.98, 3.15±2.12, and 45.36±27.32, respectively, which were improved to 0.94±0.86, 0.94±1.27, and 19.22±18.96 at D60. Age showed significant positive correlations with initial modified Borg (r=0.292, p=0.044) and SGRQ (r=0.332, p=0.021) scores. Body mass index showed significant positive correlations with initial mMRC (r=0.352, p=0.014) and SGRQ (r=0.419, p=0.003) scores. Conclusion Our study showed that on discharge, many COVID patients have impaired HRQoL. Many of them also have dyspnea on exertion. With the early institution of standard pulmonary rehabilitation protocol, symptoms and HRQoL improves rapidly in a month. Different influencing factors were identified. Long-term follow-up with a bigger sample size is needed to formulate a management strategy for these patients.

Exercise Capacity and Perceived Exertion on Treadmill Stress Test With vs Without Surgical Mask: a Randomized Clinical Trial in Healthy Adults.

Background: The graded exercise stress treadmill test (GXT) is among the most frequently performed tests in cardiology. The COVID-19 pandemic led many healthcare facilities to require patients to wear a mask. This study evaluated the effect of the surgical face mask on exercise capacity and perceived exertion. Methods: In this prospective, randomized crossover trial, 35 healthy adults performed a GXT using the Bruce protocol with a surgical mask, and without a mask. The primary outcome was exercise capacity in metabolic equivalents (METs), and the secondary outcome was exercise perception on the modified Borg scale (from 0 to 10). Effort duration, heart rate, oxygen saturation, and blood pressure were also analyzed. Results: Exercise capacity was reduced by 0.4 MET (95% confidence interval [CI] -0.7 - -0.2) during the GXT with a mask (11.8 ± 2.7 METs vs 12.3 ± 2.5 METs, p = 0.001), and the final perceived effort increased by 0.5 point (CI 0.2 - 0.8; 8.4 ± 1.3 vs 7.9 ± 1.6, p = 0.004). Effort duration was cut down by 24 seconds (CI -0:39 - -0:09; 10:03 ± 2:30 vs 10:27 ± 2:16, p = 0.003). Oxygen saturation was slightly lower at the end of the test with the mask. There was no significant difference in heart rate, or blood pressure during the test. Conclusion: Wearing a surgical mask causes a statistically significant decrease in exercise capacity and increase in perceived exertion. This small effect is not clinically significant for the interpretation of test results.

EFFICACY AND SAFETY OF ULTRA-LOW DOSE INHALED MELPHALAN IN THE TREATMENT OF HOSPITALIZED PATIENTS WITH COVID-19

Background. One of the most important components of COVID-19 therapy is the suppression of the hyperergic immune response. There is an urgent need ofcreating the optimaltactics ofefficientandsafe anti-inflammatory therapy. Anew methodoftreatment ofCOVID-19withinhalation ofultra-low (non-cytotoxic)doses of the alkylating drug melphalan is proposed, based on previous experimental, preclinical, and clinical data on its use in severe bronchial asthma. The aim. To evaluate the efficacy and safety of inhalation of ultra-low doses of melphalan in hospitalized patients with COVID-19-associated lung damage. Materials andmethods. A prospective, open, controlled, blindfor the centralexpert study was conducted. Sixty adult patients were included, 30 patients were consecutively admitted to the hospital and received nebulized inhalations of 0.1 mg of melphalan for 7 days. Thirty patients ofthe control group were selectedby an independentexpertretrospectively using the computer algorithm for selecting“close” patients based on the “case-control” principle. The primary endpoints were the dynamics on the WHO Clinical Improvement Scale and the dynamics of dyspnea according to the modified Borg scale, secondary – assessment of adverse events, dynamics of indicators of clinical, biochemical blood tests, lungs computed tomography data from the beginning ofinhalations in the melphalan group andfrom the corresponding day in the control group. Results. Inhalations of melphalan led to a significant improvement in the clinical condition ofpatients according to the WHOscale, decrease in the intensity ofdyspnea on day 7 of treatment and by the time of discharge, a significant anti-inflammatory effect. Adverse events and dynamics of laboratory parameters did not differ from the control group. Conclusion. The method of treatment of COVID-19 by inhalation of ultra-low doses of the alkylating drug melphalan is safe and leads to a significant clinical improvement of hospitalized patients with COVID-19-associated lung damage. © 2022 by the Author(s).

Impact of digital boards on hand and neck muscle activity during online teaching process.

Academicians across the globe due to Covid 19 shifted to online teaching as a mainstream method by replacing the chalk and talk method. The main objective of this study is to find the impact of different sizes of digital boards used for online teaching on muscle activity and muscle fatigue, and then results are compared with conventional writing. Initially, a questionnaire survey is conducted among 100 college professors about the issue they faced while using online teaching methods. Experimental analysis are then conducted using electromyography sensor (sEMG) among ten college professors and their muscle activity on the dominant hand and neck while writing on two commercially available digital boards namely Type 1 (small writing area) and Type 2 (large writing area). Four muscles namely Flexor carpi radialis, Extensor carpi radialis, Biceps brachii, and Sternocleidomastoid (SCM) are chosen for the study. The results are then compared with muscle activity while writing on conventional A4 sheets. Normalized root mean square (RMS) is used to assess the muscle activity and the trend line of MPF value is utilized to assess the muscle fatigue. The results show that SCM muscle has more muscle activation compared to other selected muscles followed by flexor carpi radialis. Subjective analysis is carried out using the Borg scale, which has reported that Type 2 digital board having larger working area was preferred by the participants as it reduces muscle fatigue.

Analysis of Physiological Parameters and Workload during Working Tasks in COVID-19 Pandemic Conditions

Social distancing and wearing of the face masks are mandatory in all the workplaces since the COVID-19 pandemic outbreak. To guarantee workers' safety, it could be useful to analyze the influence of the face mask use on physiological parameters during working activities. This paper aims at collecting and comparing both objective and subjective measurements during lifting and moving a light load (3 kg) in two working conditions: with and without a N95 face mask. The recorded physiological measures are the cardiac and respiratory activity, the skin temperature and the muscular activation. They are synchronously collected via an integrated wearable and unobtrusive sensory system. Moreover, the Borg scale is used to estimate the perceived exertion of the participants during the execution of the working activity. The analysis carried out in this work pointed out some statistically significant differences in the physiological measures due to an increased physical workload experimented by the volunteers when wearing the face mask. In addition, the correlation between the Borg scale and the monitored physiological measurements does not change significantly in the two experimented conditions. Moreover, the strong correlation between perceived exertion and physiological parameters demonstrates that the Borg scale remains an excellent method for estimating the level of perceived strain. Finally, even though some physiological differences can occur when wearing a face mask, its usefulness as personal protective equipment remains undisputed.

Efficacy of early prone or lateral positioning in patients with severe COVID-19: a single-center prospective cohort.

Background: Position intervention has been shown to improve oxygenation, but its role in non-invasively ventilated patients with severe COVID-19 has not been assessed. The objective of this study was to investigate the efficacy of early position intervention on non-invasively ventilated patients with severe COVID-19. Methods: This was a single-center, prospective observational study in consecutive patients with severe COVID-19 managed in a provisional ICU at Renmin Hospital of Wuhan University from 31 January to 15 February 2020. Patients with chest CT showing exudation or consolidation in bilateral peripheral and posterior parts of the lungs were included. Early position intervention (prone or lateral) was commenced for > 4 hours daily for 10 days in these patients, while others received standard care. Results: The baseline parameters were comparable between the position intervention group (n = 17) and the standard care group (n = 35). Position intervention was well-tolerated and increased cumulative adjusted mean difference of SpO2/FiO2 (409, 95% CI 86 to 733) and ROX index (26, 95% CI 9 to 43) with decreased Borg scale (-9, 95% CI -15 to -3) during the first 7 days. It also facilitated absorption of lung lesions and reduced the proportion of patients with high National Early Warning Score 2 (≥ 7) on days 7 and 14, with a trend toward faster clinical improvement. Virus shedding and length of hospital stay were comparable between the two groups. Conclusions: This study provides the first evidence for improved oxygenation and lung lesion absorption using early position intervention in non-invasively ventilated patients with severe COVID-19, and warrants further randomized trials.