Functional Limitations and Exercise Intolerance in Patients With Post-COVID Condition: A Randomized Crossover Clinical Trial.

Importance: Many patients with post-COVID condition (PCC) experience persistent fatigue, muscle pain, and cognitive problems that worsen after exertion (referred to as postexertional malaise). Recommendations currently advise against exercise in this population to prevent symptom worsening; however, prolonged inactivity is associated with risk of long-term health deterioration. Objective: To assess postexertional symptoms in patients with PCC after exercise compared with control participants and to comprehensively investigate the physiologic mechanisms underlying PCC. Design, Setting, and Participants: In this randomized crossover clinical trial, nonhospitalized patients without concomitant diseases and with persistent (≥3 months) symptoms, including postexertional malaise, after SARS-CoV-2 infection were recruited in Sweden from September 2022 to July 2023. Age- and sex-matched control participants were also recruited. Interventions: After comprehensive physiologic characterization, participants completed 3 exercise trials (high-intensity interval training [HIIT], moderate-intensity continuous training [MICT], and strength training [ST]) in a randomized order. Symptoms were reported at baseline, immediately after exercise, and 48 hours after exercise. Main Outcomes and Measures: The primary outcome was between-group differences in changes in fatigue symptoms from baseline to 48 hours after exercise, assessed via the visual analog scale (VAS). Questionnaires, cardiopulmonary exercise testing, inflammatory markers, and physiologic characterization provided information on the physiologic function of patients with PCC. Results: Thirty-one patients with PCC (mean [SD] age, 46.6 [10.0] years; 24 [77%] women) and 31 healthy control participants (mean [SD] age, 47.3 [8.9] years; 23 [74%] women) were included. Patients with PCC reported more symptoms than controls at all time points. However, there was no difference between the groups in the worsening of fatigue in response to the different exercises (mean [SD] VAS ranks for HIIT: PCC, 29.3 [19.5]; controls, 28.7 [11.4]; P = .08; MICT: PCC, 31.2 [17.0]; controls, 24.6 [11.7]; P = .09; ST: PCC, 31.0 [19.7]; controls, 28.1 [12.2]; P = .49). Patients with PCC had greater exacerbation of muscle pain after HIIT (mean [SD] VAS ranks, 33.4 [17.7] vs 25.0 [11.3]; P = .04) and reported more concentration difficulties after MICT (mean [SD] VAS ranks, 33.0 [17.1] vs 23.3 [10.6]; P = .03) compared with controls. At baseline, patients with PCC showed preserved lung and heart function but had a 21% lower peak volume of oxygen consumption (mean difference: -6.8 mL/kg/min; 95% CI, -10.7 to -2.9 mL/kg/min; P < .001) and less isometric knee extension muscle strength (mean difference: -37 Nm; 95% CI, -67 to -7 Nm; P = .02) compared with controls. Patients with PCC spent 43% less time on moderate to vigorous physical activity (mean difference, -26.5 minutes/d; 95% CI, -42.0 to -11.1 minutes/d; P = .001). Of note, 4 patients with PCC (13%) had postural orthostatic tachycardia, and 18 of 29 (62%) showed signs of myopathy as determined by neurophysiologic testing. Conclusions and Relevance: In this study, nonhospitalized patients with PCC generally tolerated exercise with preserved cardiovascular function but showed lower aerobic capacity and less muscle strength than the control group. They also showed signs of postural orthostatic tachycardia and myopathy. The findings suggest cautious exercise adoption could be recommended to prevent further skeletal muscle deconditioning and health impairment in patients with PCC. Trial Registration: ClinicalTrials.gov Identifier: NCT05445830.

Effects of far-infrared radiation lamp therapy on recovery from a simulated soccer-match in elite female soccer players.

We investigated the effects of far-infrared radiation (FIR) lamp therapy on changes in muscle damage and performance parameters following six sets of 15-min Loughborough intermittent shuttle test (LIST), a simulated soccer match. Twenty-four elite female soccer players (20-24 y) were assigned into FIR or sham treatment group (n = 12/group). The participants received a 60-min FIR or sham treatment (30 min per muscle) over knee extensors (KE) and flexors (KF) at 2, 25, 49, 73, and 97 h post-LIST. Maximal voluntary isometric contraction (MVC) torque and muscle soreness of the KE and KF, plasma creatine kinase (CK) activity as muscle damage markers, and several performance parameters including countermovement jump (CMJ) and Yo-Yo intermittent recovery test level 1 (YYIR1) were measured before and 1, 24, 48, 72, 96, and 120 h post-LIST. Changes in the measures were compared between groups by a mixed-design two-way ANOVA. The running distance covered during LIST and changes in the measures at 1-h post-LIST (before the treatment) were similar (p = 0.118-0.371) between groups. Changes in muscle damage markers at 24-120 h post-LIST were smaller (p < 0.05, η2 = 0.208-0.467) for the FIR (e.g., MVC-KE torque decrease at 48-h post-LIST: -1 ± 2%, peak KE soreness: 16 ± 10 mm, peak CK: 172 ± 42 IU/L) than sham group (-11 ± 9%, 33 ± 7 mm, 466 ± 220 IU/L, respectively). Performance parameters recovered faster (p < 0.05, η2 = 0.142-0.308) to baseline for the FIR (e.g., decreases at 48-h post-LIST; CMJ: 0 ± 1%, YYIR1: 0 ± 1%) than sham group (-6 ± 2%, -9 ± 6%, respectively). These results suggest that the FIR lamp therapy was effective for enhancing recovery from a soccer match.

Pregabalina preoperatoria previene las fasciculaciones y mialgias inducidas por succinilcolina: metaanálisis de ensayos aleatorizados / Preoperative pregabalin prevents succinylcholine-induced fasciculations and myalgias: A meta-analysis of randomized trials

La succinilcolina es el bloqueador neuromuscular de referencia para la inducción de secuencia rápida. Sin embargo, su uso se asocia a fasciculaciones y mialgias. Se realizó una revisión sistemática y un metaanálisis. Se incluyeron ensayos clínicos controlados aleatorizados comparando gabapentinoides frente a placebo, para la prevención de fasciculaciones y mialgias inducidas por succinilcolina. Se incluyeron seis estudios clínicos aleatorizados. El número total de pacientes fue de 481, de los cuales 241 se incluyeron en el grupo de intervención y 240 en el grupo de placebo. Los gabapentinoides redujeron la incidencia de mialgia inducida por succinilcolina (RR=0,69; IC95%: 0,56-0,84; p<0,001), que siguió siendo estadísticamente significativa para pregabalina (RR=0,71; IC95%: 0,54-0,93; p=0,013) y gabapentina (RR=0,61; IC95%: 0,45-0,82; p=0,001) por separado. No hubo diferencia entre los grupos en cuanto a fasciculaciones (RR=0,92; IC95%: 0,82-1,03; p=0,148). El uso preoperatorio de gabapentinoides se asocia a una menor incidencia de mialgias inducidas por succinilcolina dentro de las primeras 24horas posteriores al procedimiento. (AU)

Succinylcholine is the gold standard neuromuscular blocker for rapid sequence induction, however, its use is associated with fasciculations and myalgias. A systematic review and meta-analysis including randomized controlled clinical trials was performed comparing gabapentinoids versus placebo for the prevention of fasciculations and succinylcholine-induced myalgias. Six randomized clinical studies were included. The total number of patients was 481, of which 241 were in the intervention group and 240 in the placebo group. Gabapentinoids reduced the incidence of succinylcholine-induced myalgia (RR=.69; 95%CI: .56-.84; P<.001), which remained statistically significant for pregabalin (RR=.71; 95%CI: .54-.93; P=.013) and gabapentin (RR=.61; 95%CI: .45-.82; P=.001) separately. There was no difference between the groups in fasciculations (RR=.92; 95%CI: .82-1.03; P=.148). Preoperative use of gabapentinoids is associated with lower incidence of succinylcholine-induced myalgias within the first 24hours after the procedure. (AU)

Temporomandibular involvement in children and adolescents with juvenile idiopathic arthritis: a 2-year prospective cohort study.

This study aimed to clinically evaluate temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) and the ability to identify and/or predict development of TMJ-deformities over time using cone beam computed tomography (CBCT). The predictive value of self-reported TMJ pain was also assessed. A prospective longitudinal cohort study comprising 54 children with JIA, 39 girls and 15 boys, was performed. All children had active disease at baseline, 50% with the subtype oligoarthritis. Repeated clinical orofacial and CBCT examinations were performed over a two-year period. At baseline, 39% had radiographic TMJ deformities (24% unilateral, 15% bilateral), at 2-year follow-up, 42% (p > 0.05). Both progressing and improving TMJ deformities were observed. An association was found between TMJ-deformities and self-reported TMJ pain at baseline (p = 0.01). Maximum unassisted mouth opening (MUO) was smaller for children with TMJ-deformities (p < 0.05). The prevalence of palpatory muscle pain was high (48-59%) but not predictive of development of TMJ-deformities. TMJ noises increased over time and crepitations were associated with TMJ-deformities (p < 0.05). In conclusion, in children with JIA, self-reported TMJ pain and dysfunction were common and predictive of TMJ deformities. TMJ deformities were associated with smaller MUO and palpatory TMJ pain as well as crepitations. Trial registration. ClinicalTrials.gov Protocol id: 2010/2089-31/2.

Effects of Percussive Massage Treatments on Symptoms Associated with Eccentric Exercise-Induced Muscle Damage.

Percussive massage (PM) is an emerging recovery treatment despite the lack of research on its effects post-eccentric exercise (post-EE). This study investigated the effects of PM treatments (immediately, 24, 48, and 72 h post-EE) on the maximal isometric torque (MIT), range of motion (ROM), and an 11-point numerical rating scale (NRS) of soreness of the nondominant arm's biceps brachii from 24-72 h post-EE. Seventeen untrained, college-aged subjects performed 60 eccentric elbow flexion actions with their nondominant arms. Nine received 1 minute of PM, versus eight who rested quietly (control [CON]). In order, NRS, ROM, and MIT (relative to body mass) were collected pre-eccentric exercise (pre-EE) and after treatment (AT) at 24, 48, and 72 h post-EE. NRS was also collected before treatment (BT). Electromyographic (EMG) and mechanomyographic (MMG) amplitudes were collected during the MIT and normalized to pre-EE. There were no interactions for MIT, EMG, or MMG, but there were interactions for ROM and NRS. For ROM, the PM group had higher values than the CON 24-72 h by ~6-8°, a faster return to pre-EE (PM: 48 h, CON: 72 h), and exceeded their pre-EE at 72 h by ~4°. The groups' NRS values did not differ BT 24-72 h; however, the PM group lowered their NRS from BT to AT within every visit by ~1 point per visit, which resulted in them having lower values than the CON from 24-72 h by ~2-3 points. Additionally, the PM group returned their NRS to pre-EE faster than the CON (PM: BT 72 h, CON: never). In conclusion, PM treatments may improve ROM without affecting isometric strength or muscle activation 24-72 h post-EE. Although the PM treatments did not enhance the recovery from delayed onset muscle soreness until 72 h, they consistently provided immediate, temporary relief when used 24-72 h post-EE.

How Does Altering the Volume-Load of Plyometric Exercises Affect the Inflammatory Response, Oxidative Stress, and Muscle Damage in Male Soccer Players?

Incorporating plyometric exercises (PE) into soccer players' conditioning routines is vital for boosting their performance. Nevertheless, the effects of PE sessions with diverse volume loads on inflammation, oxidative stress, and muscle damage are not yet clearly understood. This study aimed to examine the effects of altering the volume-loads of PE on indicators of oxidative muscle damage and inflammation. The study involved forty young male soccer players who were randomly assigned to three different volume-loads of PE (Low volume-load [100 jumps]: LVL, n = 10; Moderate volume-load [150 jumps]: MVL, n = 10; and High volume-load [200 jumps]: HVL, n = 10) and a control group (CON = 10). The levels of various biomarkers including delayed onset muscle soreness (DOMS), serum lactate dehydrogenase (LDH), creatine kinase (CK), 8-hydroxy-2-deoxyguanosine (8-OHdG), malondialdehyde (MDA), protein carbonyl (PC), leukocytes, neutrophils, interleukin-6 (IL-6), and C-reactive protein (CRP) were measured at different time points. These measurements were taken at rest, immediately after completion of PE, and 24-, 48-, and 72-hours post-PE. The CK, LDH, DOMS, 8-OHdG, MDA, and PC levels were significantly increased (p < 0.05) after the PE protocol, reaching their peak values between 24 to 48 hours post-PE for all the volume-loaded groups. The levels of leukocytes, neutrophils, and IL-6 also increased after the PE session but returned to resting values within 24 hours post-PE. On the other hand, CRP levels increased at 24 hours post-PE for all the treatment groups (p < 0.05). The changes observed in the indicators of muscle damage and inflammation in response to different volume-loads of PE was not significant. However, the HVL and MVL indicated significant differences compared to LVL in the 8-OHdG (at 48-hour) and MDA (at 72-hour). Athletes engaging in higher volume-loads demonstrated more pronounced responses in terms of biochemical variables (specifically, LVL < MVL < HVL); however, these changes were not statistically significant (except 8-OHdG and MDA).

[Analysis of clinical characteristics of 129 acute and chronic occupational brucellosis in HulunBuir City].

Objective: To analyze the epidemiological characteristics and clinical data of acute and chronic occupational brucellosis patients in order to provide a scientific basis for the prevention and treatment of occupational brucellosis. Methods: In October 2022, a study was conducted on 129 patients diagnosed with occupational brucellosis by HulunBuir Center for Disease Control and Prevention from January 2016 to December 2021. The epidemiological characteristics, clinical features, and laboratory test results of patients in the acute and chronic phases were compared and analyzed using chi-square test and student's t test. Results: The acute phase patients included 38 men and 4 women with an average age of (36.6±8.4) years old; the chronic phase patients included 73 men and 14 women with an average age of (38.4±7.9) years old. There were no significant differences in gender and age between the two groups (P>0.05). The patients had a clear history of occupational exposure, and the proportion of veterinarians in acute stage (21 cases, 50.0%) was significantly higher than that in chronic stage (25 cases, 28.7%), the difference was statistically significant (P<0.05). The symptoms of fever and loss of appetite in acute phase of occupational brucellosis were significantly higher than those in chronic phase, and the symptoms of fatigue and joint muscle pain were significantly lower than those in chronic phase, with statistical significances (P<0.05). The increase of alanine aminotransferase, aspartate aminotransferase, C-reactive protein, erythrocyte sedimentation rate and positive rate of blood culture in acute stage were significantly higher than those in chronic stage, with statistical significances (P<0.05) . Conclusion: Occupational brucellosis patients are predominantly middle-aged men, the acute phase is characterized by fever, loss of appetite, and increased inflammatory indicators and liver enzymes, while the chronic phase is characterized by symptoms such as fatigue and joint muscle pain. Brucellosis related occupational exposure population should seek medical treatment as soon as possible when the above symptoms occur, timely detection and treatment of occupational diseases.

Genetic Variations in Susceptibility to Traumatic Muscle Injuries and Muscle Pain among Brazilian High-Performance Athletes.

Traumatic muscle injuries (TMIs) and muscle pain (MP) negatively impact athletes' performance and quality of life. Both conditions have a complex pathophysiology involving the interplay between genetic and environmental factors. Yet, the existing data are scarce and controversial. To provide more insights, this study aimed to investigate the association of single-nucleotide polymorphisms (SNPs) previously linked to athletic status with TMI and MP after exercise among Brazilian high-performance athletes from different sports modalities (N = 345). The impact of important environmental determinants was also assessed. From the six evaluated SNPs (ACTN3 rs1815739, FAAH rs324420, PPARGC1A rs8192678, ADRB2 rs1042713, NOS3 rs1799983, and VDR rs731236), none was significantly associated with TMI. Regarding MP after exercise, ACTN3 rs1815739 (CC/CT vs. TT; adjusted odds ratio (aOR) = 1.90; 95% confidence interval (95%Cl), 1.01-3.57) and FAAH rs324420 (AA vs. AC/CC; aOR = 2.30; 95%Cl, 1.08-4.91) were independent predictors according to multivariate binomial analyses adjusted for age (≥23 vs. <23 years), sex (male vs. female), and tobacco consumption (yes vs. no). External validation is warranted to assess the predictive value of ACTN3 rs1815739 and FAAH rs324420. This could have implications for prophylactic interventions to improve athletes' quality of life.

The Effect of Prior Creatine Intake for 28 Days on Accelerated Recovery from Exercise-Induced Muscle Damage: A Double-Blind, Randomized, Placebo-Controlled Trial.

Despite the known beneficial effects of creatine in treating exercise-induced muscle damage (EIMD), its effectiveness remains unclear. This study investigates the recovery effect of creatine monohydrate (CrM) on EIMD. Twenty healthy men (21-36 years) were subjected to stratified, randomized, double-blind assignments. The creatine (CRE) and placebo (PLA) groups ingested creatine and crystalline cellulose, respectively, for 28 days. They subsequently performed dumbbell exercises while emphasizing eccentric contraction of the elbow flexors. The EIMD was evaluated before and after exercise. The range of motion was significantly higher in the CRE group than in the PLA group 24 h (h) post exercise. A similar difference was detected in maximum voluntary contraction at 0, 48, 96, and 168 h post exercise (p = 0.017-0.047). The upper arm circumference was significantly lower in the CRE group than in the PLA group at 48, 72, 96, and 168 h post exercise (p = 0.002-0.030). Similar variation was observed in the shear modulus of the biceps brachii muscle at 96 and 168 h post exercise (p = 0.003-0.021) and in muscle fatigue at 0 and 168 h post exercise (p = 0.012-0.032). These findings demonstrate CrM-mediated accelerated recovery from EIMD, suggesting that CrM is an effective supplement for EIMD recovery.

Joint angle-specific neuromuscular time course of recovery after isometric resistance exercise at shorter and longer muscle lengths.

Resistance training at longer muscle lengths induces greater muscle hypertrophy and different neuromuscular functional adaptations than training at shorter muscle lengths. However, the acute time course of recovery of neuromuscular characteristics after resistance exercise at shorter and longer muscle lengths in the quadriceps has never been described. Eight healthy young participants (4 M, 4 F) were randomly assigned to perform four sets of eight maximal isometric contractions at shorter (SL; 50° knee flexion) or longer (LL; 90° knee flexion) muscle lengths in a crossover fashion. During exercise, peak torque (PT), muscle activity [electromyogram (EMG)], and internal muscle forces were assessed. PT and EMG at shorter (PT50, EMG50) and longer (PT90, EMG90) muscle lengths, creatine kinase (CK), and muscle soreness were measured at baseline, immediately after exercise (Post), after 24 h (24 h), and after 48 h (48 h). During exercise, EMG (P = 0.002) and internal muscle forces (P = 0.017) were greater in LL than in SL. During recovery, there was a main effect of exercise angle, with PT50 (P = 0.002), PT90 (P = 0.016), and EMG50 (P = 0.002) all significantly reduced to a greater degree in LL compared with SL. CK and muscle soreness increased after resistance exercise, but there were no differences between SL and LL. The present results suggest that if the preceding isometric resistance exercise is performed at longer muscle lengths, function and muscle activity at shorter and longer muscle lengths are inhibited to a larger degree in the subsequent recovery period. This information can be used by practitioners to manipulate exercise prescription.NEW & NOTEWORTHY Despite the established long-term benefits of training at longer muscle lengths for muscle size and strength, acutely performing resistance exercise at longer muscle lengths may require a longer time course of neuromuscular recovery compared with performing resistance exercises at shorter muscle lengths. Furthermore, there appear to be different joint angle-specific recovery profiles, depending on the muscle length of the preceding exercise.

A taxonomy of threat and soothing influences in rheumatic and musculoskeletal diseases and central sensitivity syndromes / Una taxonomía de amenazas e influencias calmantes en enfermedades reumáticas y musculoesqueléticas y síndromes de sensibilidad central

Background: An imbalance in affect regulation, reflected by a hyperactive threat system and hypoactive soothing system, may impact physical symptoms in people with rheumatic and musculoskeletal diseases (RMD) and central sensitivity syndromes (CSS), including chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome. This study aimed to identify and structure comprehensive overviews of threat and soothing influences that may worsen or alleviate physical symptoms in people with RMD or CSS. Method: A concept mapping procedure was used. An online open-question survey (N = 686, 641 [93.4%] women) yielded comprehensive sets of 40 threats and 40 soothers that were individually sorted by people with RMD or CSS (N = 115, 112 [97.4%] women). Results: Hierarchical cluster analyses generated eight threat clusters: environmental stimuli, physical symptoms, food and drugs, inactivity, demands, effort, invalidation, and emotional stress. Ten soother clusters were identified: social emotional support, rest and balance, pleasant surroundings, illness understanding, positive mindset and autonomy, spirituality, leisure activity, wellness, treatment and care, and nutrition and treats. Conclusions: Our study provided a comprehensive taxonomy of threats and soothers in people with RMD or CSS. The results can be used in experimental research to label threat and soothing stimuli and in clinical practice to screen and monitor relevant treatment targets.(AU)

Impact of lumbar delayed-onset muscle soreness on postural stability in standing postures.

BACKGROUND: Similar impact on proprioception has been observed in participants with lumbar delayed-onset muscle soreness (DOMS) and chronic low back pain (LBP), raising questions about the relevance of lumbar DOMS as a suitable pain model for LBP when assessing back pain-related postural stability changes. RESEARCH QUESTION: Does lumbar DOMS impact postural stability? METHODS: Twenty healthy adults participated in this experimental study and underwent a posturographic examination before and 24 to 36 h after a protocol designed to induce lumbar DOMS. Posturographic examination was assessed during quiet standing on both feet with eyes opened (EO), with eyes closed (EC), and on one-leg (OL) standing with eyes opened. Postural stability was assessed through center of pressure (COP) parameters (COP area, velocity, root mean square, mean power frequency) which were compared using repeated measure ANOVA. Moreover, pain, soreness and pressure pain threshold (PPT) on specific muscles were assessed. RESULTS: There was a significant main effect of the postural condition on all COP variables investigated. More specifically, each COP variable reached a significantly higher value in the OL stance condition than in both EO and EC bipedal conditions (all with p < 0.001). In addition, the COP velocity and the mean power frequency along the anteroposterior direction both reached a significantly higher value in EC than in EO (p < 0.001). In contrast, there was no significant main effect of the DOMS nor significant DOMS X postural condition interaction on any of the COP variables. There was a significant decrease in the PPT value for both the left and right erector spinae muscles, as well as the left biceps femoris. SIGNIFICANCE: Lumbar DOMS had no impact on postural stability, which contrasts findings in participants with clinical LBP. Although DOMS induces similar trunk sensorimotor adaptations to clinical LBP, it does not appear to trigger similar postural stability adaptations.

Immediate crossover fatigue after unilateral submaximal eccentric contractions of the knee flexors involves peripheral alterations and increased global perceived fatigue.

After a unilateral muscle exercise, the performance of the non-exercised contralateral limb muscle can be also impaired. This crossover fatigue phenomenon is still debated in the literature and very few studies have investigated the influence of eccentric contractions. This study was designed to assess neuromuscular adaptations involved in the crossover fatigue of the non-exercised contralateral knee flexor muscles. Seventeen healthy young men performed a unilateral submaximal eccentric exercise of the right knee flexors until a 20% reduction in maximal voluntary isometric contraction torque was attained in the exercised limb. Before (PRE), immediately after exercise cessation (POST) and 24 hours later (POST24), neuromuscular function and perceived muscle soreness were measured in both the exercised limb and non-exercised limb. In addition, global perceived fatigue was assessed at each measurement time. At POST, significant reductions in maximal voluntary isometric contraction were observed in the exercised limb (-28.1%, p < 0.001) and in the non-exercised limb (-8.5%, p < 0.05), evidencing crossover fatigue. At POST, voluntary activation decreased in the exercised limb only (-6.0%, p < 0.001), while electrically evoked potentiated doublet torque was impaired in both the exercised limb and the non-exercised limb (-11.6%, p = 0.001). In addition, global perceived fatigue significantly increased at POST (p < 0.001). At POST24, all measured variables returned to PRE values, except for perceived muscle soreness scores exhibiting greater values than PRE (p < 0.05). A possible cumulative interaction between peripheral alterations and global perceived fatigue may account for the immediate crossover fatigue observed in the non-exercised limb.

Short-term side effects of COVID-19 vaccines among healthcare workers: a multicenter study in Iran.

Since the initiation of the COVID-19 vaccination effort, there has been widespread concern regarding vaccine efficacy and potential side effects. This study aimed to explore the short-term side effects of four available COVID-19 vaccines (Sputnik V, Sinopharm, Oxford-AstraZeneca, and Covaxin) among healthcare workers (HCWs) in Iran. The multicenter study involved 1575 HCWs, with the majority received Sputnik V (74.1%), followed by Covaxin (15.6%), Sinopharm (6.4%), and Oxford-AstraZeneca (3.8%). The prevalence of at least one side effect after the first and second dose COVID-19 vaccine was 84.6% and 72.9%, respectively. The common side effects (presented in > 50% of the study participants) after the first dose of the vaccine were injection site pain (61.7%), myalgia (51.8%), and muscle pain (50.9%). The most reported side effects after the second dose of the vaccine were injection site pain (26.8%), myalgia (15.8%), fever (10.3%), headache (9.9%), and chills (9.2%). In conclusion, according to the COVID-19 vaccine type, different side effects might occur following the first and second doses of vaccination. These findings assist in addressing the ongoing problems of vaccination hesitancy which has been driven by widespread worries about the vaccine safety profile.

Influence of Second-Generation Oral Contraceptives on Muscle Recovery after Repeated Resistance Exercise in Trained Females.

PURPOSE: Oral contraceptives (OCs) are commonly used by female athletes, but their effects on skeletal muscle are still poorly understood. We investigated if physically trained females using second-generation OCs differed from nonusers of OCs in the recovery of muscle function and muscle damage markers after repeated resistance exercise sessions. METHODS: We recruited 20 trained second-generation OC users and 20 trained nonusers to perform three strenuous resistance exercise sessions. Before, and 3, 24, and 48 h after exercise, blood samples were collected, and participants were evaluated for muscle soreness, maximal isometric and isokinetic muscle strength, vertical jump height, Wingate power performance, leg press strength, and intermittent recovery capacity (yo-yo test). All participants were provided with an energy-macronutrient-balanced diet during the experimental period. RESULTS: After resistance exercise, maximal isometric and isokinetic muscle strength, rate of force development, vertical jump height, and Wingate peak and average power were reduced, whereas markers of muscle damage were increased in both groups (P < 0.05). OC users experienced a greater reduction in isokinetic strength 3, 24, and 48 h after exercise compared with nonusers of OCs (interaction: P < 0.05). No other interactions were observed. CONCLUSIONS: We demonstrate that measures of muscle strength recovery after three strenuous resistance exercise sessions are comparable between trained females using second-generation OCs and nonusers of OCs. However, group differences were observed for isolated dynamic (isokinetic) muscle strength, suggesting a marginal benefit of not using OCs when accelerated recovery is needed.

The Dose-Response in Elite Soccer: Preliminary Insights From Menstrual-Cycle Tracking During the FIFA Women's World Cup 2019.

PURPOSE: This preliminary study examined the influence of estimated menstrual-cycle (MC) phase on responses to soccer matches and training sessions in preparation for and during the FIFA (Fédération internationale de football association) Women's World Cup 2019. METHODS: Twenty outfield players representing a national team were tracked over a 45-day period. External (10-Hz global positioning system; total and distance covered at high-metabolic power [≥20 W·kg-1]) and internal load measures (minutes ≥80% heart-rate maximum, sessional ratings of perceived exertion) were collected during all training and matches, with single-item wellness measures (fatigue, soreness, sleep quality, and sleep duration) collected each morning prior to activity. MC phase was estimated individually via an algorithm, informed from pretournament survey responses and ongoing symptom reporting (FitrWoman). Model comparison statistics were used to determine the impact of estimated MC phase in nonhormonal contraceptive users (n = 16). RESULTS: Sessional rating of perceived exertion responses to total distances ≥5 km were higher during the luteal phase (+0.6-1.0 au; P ≤ .0178) versus menstruation (phase 1), but no other observable dose-response trends were observed. Sleep, fatigue, and soreness ratings were not typically associated with MC phase, with the exception of exacerbated fatigue ratings in luteal versus follicular phase 48 hours postmatch (-0.73 au, P = .0275). CONCLUSIONS: Preliminary findings suggest that estimated MC phase may contribute to the understanding of the dose-response to soccer training and matches.

Effectiveness of anterior repositioning splint versus other occlusal splints in the management of temporomandibular joint disc displacement with reduction: A meta-analysis.

BACKGROUND: Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy. Anterior repositioning splint (ARS) is the most commonly prescribed splint by dental practitioners, but not getting a normal disc-condyle relationship always and other side effects lead to need of comparing with other occlusal splints. This review will help in informed decision-making by clinicians in choosing an appropriate splint type for patients. AIM: The aim is to compare the effectiveness of ARS in the management of DDwR with other occlusal splints for TMJ and muscle pain, TMJ noise, any adverse effects, regaining normal disc-condyle relationship. MATERIALS AND METHODS: We followed published protocol in the International prospective register of systematic reviews. Databases were searched till May 2023 using different search strategies as per the database. Title and abstract screening, followed by full-text screening and data extraction with risk of bias, was done by two independent reviewers in Covidence. Outcomes were reported as risk ratio (RR) or mean difference (MD) for dichotomous or continuous outcomes, respectively, using RevMan 5.4 (Review Manager 5.4) software. We used a random effect model for statistical analysis. Certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation Guideline Development Tool (GRADEpro GDT) software. RESULTS: A total of 1145 reports were found from a database search. After screening, four studies were included for systematic reviews. Other occlusal splints reported were sagittal vertical extrusion device and mandibular ARS, full hard stabilization splint of canine or centric stabilization type. Data of only two studies could be used for meta-analysis having 30 participants received ARS and 40 received other occlusal splints. We did not find evidence of any difference between ARS and other occlusal splints for TMJ clicking in short term (RR 1.25, 95% confidence interval [CI] 0.91-1.72) but a small difference in favor of other occlusal splint in long term (RR 2.40, 95% CI 1.04-5.55). No evidence of any difference was found between both treatments for TMJ pain in short term (MD-5.68, 95% CI-17.31-5.95) and long term (MD 0.00, 95% CI-2.86-2.86) and muscle pain in short term. The certainty of evidence for comparison of two treatments for different outcomes was of low or very low level. CONCLUSION: Evidence is uncertain that other occlusal splints reduced TMJ clicking slightly in comparison to ARS. For the remaining outcomes, no evidence of any difference was found between the two splints and it may be biased due to selection bias, inadequate blinding of participants, and outcome assessor.

Neurochemical mechanism of muscular pain: Insight from the study on delayed onset muscle soreness.

We reviewed fundamental studies on muscular pain, encompassing the characteristics of primary afferent fibers and neurons, spinal and thalamic projections, several muscular pain models, and possible neurochemical mechanisms of muscle pain. Most parts of this review were based on data obtained from animal experiments, and some researches on humans were also introduced. We focused on delayed-onset muscle soreness (DOMS) induced by lengthening contractions (LC), suitable for studying myofascial pain syndromes. The muscular mechanical withdrawal threshold (MMWT) decreased 1-3 days after LC in rats. Changing the speed and range of stretching showed that muscle injury seldom occurred, except in extreme conditions, and that DOMS occurred in parameters without muscle damage. The B2 bradykinin receptor-nerve growth factor (NGF) route and COX-2-glial cell line-derived neurotrophic factor (GDNF) route were involved in the development of DOMS. The interactions between these routes occurred at two levels. A repeated-bout effect was observed in MMWT and NGF upregulation, and this study showed that adaptation possibly occurred before B2 bradykinin receptor activation. We have also briefly discussed the prevention and treatment of DOMS.