Physical and psychological reconditioning in long COVID syndrome: Results of an out-of-hospital exercise and psychological - based rehabilitation program.

Background: Long Covid Syndrome (LCS) is used to describe signs and symptoms that continue or develop after acute COVID-19 infection. Natural history and treatment of this syndrome are still poorly understood, even if evidences suggest the potential role of physical rehabilitation in improving symptoms in these patients. Aim of the study: The aim of the present study was to evaluate effectiveness, safety and feasibility of an out-of-hospital multidisciplinary rehabilitation (MDR) program, based both on physical and psychological reconditioning, in reducing symptoms and improving physical fitness and psychological parameters in patients with LCS. Methods: Thirty consecutive patients with LCS (18 males, mean age 58 years) underwent an accurate medical screening process including anthropometric and muscular strength evaluation, cardiopulmonary exercise test, quality of life (QoL) and psychological appraisal before and after a MDR program. Results: At baseline, all LCS patients were strongly symptomatic and showed severe impairments in physical performance, QoL and psychological parameters. No adverse effects and dropouts were observed during the exercise training sessions. After the MDR program, COVID-19 residual symptoms significantly decreased, and significant improvements in upper and lower limb muscular strength, cardiopulmonary parameters, perceived physical and mental health, depression and anxiety were observed. Conclusions: The present study confirms the severe physical and psychological impairment of patients with LCS and suggests that a MDR program is effective, safe and feasible in these patients and could promote their physical and psychological recovery.

Safety of surgical masks during physical activity evaluated with graded cycle ergometry test.

BACKGROUND: At the time of the coronavirus disease 2019 (COVID-19) pandemic wearing surgical mask (SM) is recommended for the prevention of contracting or exposing others to airborne transmission of COVID-19. It is somewhat controversial whether wearing SM during exercise affects performance and health status and/or may influence the results. In order to give an answer we planned a prospective, randomized, crossover study to evaluate the effects of wearing a SM or no-SM in 33 (17 male) physically active healthy subjects during a graded exercise cycle ergometry test. METHODS: The two tests were performed in random order in the same subjects. The participants were all tested the same day, after a recovery time of at least of one hour, in order to avoid interferences on physical performances. Arterial oxygen saturation, heart rate and arterial blood pressure were assessed throughout the exercise tests every step of two minutes, at the end of exercise, performed at the same time with and without mask. RESULTS: Wearing SM had no effect on performance, since the duration of cycle ergometry test with SM and without SM median, respectively, was 14.2 (lower-upper quartile 13.9-14.8) versus 14.3 (13.9-15.5) minutes (P=0.094), and median peak power was 150 W (150-180) versus 150 W (120-180) (P=0.754). CONCLUSIONS: When expressed relative to peak exercise performance, no differences were found between wearing or not wearing SM regarding arterial oxygen saturation, or heart rate at any time during the exercise tests. Wearing SM during vigorous exercise had no detrimental effect on cardiovascular parameters, as well as on exercise metrics in all participants. No ventricular repolarization abnormalities and no arrhythmias were reported on the electrocardiograms.

Stress Cardiomyopathy in COVID-19 Disease.

Patients affected by COVID-19 pneumonia may develop stress cardiomyopathy, also known as Takotsubo syndrome (TTS), at different stages during the disease and with different degrees of left ventricular dysfunction. We describe three cases of TTS in COVID-19-positive patients with different clinical presentations and outcomes. One of them died, while in the other two coronary angiography confirmed the diagnosis but was postponed until after pneumonia resolution because of the risk of virus spread. LEARNING POINTS: An association between COVID-19 and cardiac involvement is highlighted.The incidence of Takotsubo syndrome has increased during this pandemic, possibly because it is caused by acute stress.

Pulmonary Hypertension in COVID-19 Pneumoniae: It Is Not Always as It Seems.

A patient affected by COVID-19 pneumonia may develop pulmonary hypertension (PH) and secondary right ventricular (RV) involvement, due to lung parenchymal and interstitial damage and altered pulmonary haemodynamics, even in non-advanced phases of the disease. This is a consequence of hypoxic vasoconstriction of the pulmonary circulation, the use of positive end-expiratory pressure (PEEP) in mechanical ventilation, pulmonary endothelial injury, and local inflammatory thrombotic and/or thromboembolic processes. We report the case of a young man admitted with a diagnosis of COVID-19 pneumoniae with PH unrelated to viral infection and in whom partial anomalous pulmonary venous drainage (PAPVD) was eventually diagnosed. LEARNING POINTS: COVID-19 patients, even if previously well, can have pulmonary hypertension due to other causes.The cause of pulmonary hypertension should always be sought and not assumed, even in COVID-19 patients.

[Healthcare delivery to patients with heart failure: from healthcare networks to management of end-stage disease]. / Assistenza allo scompenso cardiaco cronico: dalla rete assistenziale alla gestione della terminalità

In geriatrics, end-stage chronic heart failure, old age and death are often an almost obliged clinical and existential continuum. Accompanying these patients to death with dignity and relief is an issue deserving a high degree of cultural attention not only by our discipline, but also by all other specialties and scientific societies that are devoted to the management of terminal illness. Involved professionals are too often in troubles in identifying the conditions that mark the boundary between continuing or stopping the specific treatments. Management of terminal illness requires the ability to identify and treat the complexity of patient's frailty; to discern when continuing therapy is still appropriate; to prepare young physicians in the soft communicative modalities needed to cope with such delicate problems; to face with patient's family expectations in front of death. It is also necessary to distinguish technocratic medicine from humanistic medicine, including human, cultural and overall coordinating capabilities and sharing these capabilities with all actors involved, focusing attention mainly on patient's dignity. Advanced or end-stage chronic heart failure is a peculiar clinical arena that requires close interaction among hospitals, outpatient health district services, and families' needs, expectations and support. Multidimensional assessment teams, firstly introduced into daily clinical practice by geriatricians, address individualized choices and share part of knowledge with cardiology teams. Dichotomy and cultural and scientific debate between aggressive treatment and euthanasia should not prevent from discussing crucial issues such as therapy withdrawal.