Complaints Of Fatigue Research Articles

V-V ECMO for severe Chlamydia psittaci pneumonia presenting with sudden cardiac arrest: A case report and literature review.

Psittacosis, also known as parrot fever, is an infectious disease caused by Chlamydia psittaci, which can lead to C psittaci pneumonia. Clinical manifestations are highly nonspecific, which can vary from asymptomatic infection to severe pneumonia and even death. In this case presentation, we reported one 65-year-old male case of C psittaci pneumonia who was admitted to our hospital on December 2, 2022 due to the chief complaints of poor appetite and fatigue for 3 days as the clinical manifestations. He denied contact with birds but admitted riding horses 1 week ago. Chlamydia psittaci pneumonia of patient was confirmed through metagenomic sequencing of bronchoalveolar lavage fluid under bronchoscopy. Patient was treated with V-V ECMO, invasive mechanical ventilation and CRRT. On December 12, the patient was successfully weaned off V-V ECMO and discharged on December 20, 2022. During postoperative follow-up, CT scan in a local hospital revealed the infiltrative lesions of the lung were absent. This case prompts that metagenomic next-generation sequencing is a feasible diagnostic tool for psittacosis, which can rapidly worsen and even cause sudden cardiac arrest. V-V ECMO might be a viable emergency therapeutic option.

Evaluation of occupational therapy in persons with COVID-19: a pre-post observational cohort study.

Persons with COVID-19 may experience limitations in daily functioning and can be referred to occupational therapy. To evaluate changes in daily functioning, cognitive complaints, fatigue and self-management of persons with COVID-19 who received occupational therapy in primary care.To get insights in the volume and duration of occupational therapy. A pre-post observational cohort study from October 2020 until April 2021. Fifty-eight occupational therapy practices in primary care throughout the Netherlands participated with 68 occupational therapists. 228 adults (≥18 years) with COVID-19, referred to occupational therapy, gave informed consent and participated in the pre-post evaluation. The mean age was 49 years (SD 13) and 79% of the patients was female. The most frequently reported complaints included fatigue and cognitive complaints. Occupational therapy using Dutch guidelines for occupational therapy in clients with COVID-19. Performance and satisfaction with performance using the Canadian Occupational Performance Measure (COPM); the impact of Cognitive Complaints on Participation (CoCo-P); and daily activities, self-management and perceived contribution of occupational therapy using the Patient Reported Outcome Measure for Occupational Therapy (PROM-OT). COPM-performance score improved with a mean difference of 2.9 points (95% CI 2.7 to 3.2), and COPM-satisfaction score improved with 3.2 points (95% CI 2.9 to 3.5). CoCo-P score improved with a mean difference of 20.9 points (95% CI from 14.4 to 27.4), and PROM-OT improved with 42.8 points (95% CI from 40.2 to 45.4). Participants received a median of seven sessions of occupational therapy (IQR 5-10) with a median duration of 18 weeks (IQR 12-25). They valued the contribution of occupational therapy to their improved functioning with a mean score of 8 (SD 1.4) and recommended this to others with a mean score of 9 (SD 1.2). Persons with COVID-19 who received occupational therapy in primary care improved significantly in daily functioning and highly valued occupational therapy.

Ketogenic diet in adult patients with mitochondrial myopathy

BackgroundThis study aimed to explore the feasibility, safety and efficacy of a Modified Atkins Diet (MAD) in patients with mitochondrial myopathy (MM). MethodsPatients with genetically proven mitochondrial disorder and exercise intolerance or muscle weakness followed a twelve week MAD. Feasibility was measured by diet duration and ketone levels. Safety was assessed by monitoring adverse events (AE). Efficacy was assessed by a maximal incremental test and a muscle performance test. ResultsEight out of twenty patients completed the twelve week intervention. Reasons to discontinue were the occurrence of AE: rhabdomyolysis (n = 3), vomiting (n = 1), fatigue (n = 6), constipation (n = 1), in combination with a lack of improvement and adherence difficulties. On an individual level, various positive effects were reported including improvements in VO2peak (n = 6), anaerobic threshold (n = 9), muscle fatigue resistance (n = 5), muscle strength (n = 7), fatigue (n = 6), glucose tolerance (n = 7), migraine (n = 3), sleep (n = 3), and gastrointestinal complaints (n = 2). Lipid profile improved and thirteen patients lost weight. All patients with mitochondrial DNA (mtDNA) deletions, experienced muscle related AE. The five patients with the m.3243A>G mutation achieved the longest diet duration. Discussion/conclusionMAD feasibility, safety and efficacy is variable in MD patients. MAD appears to be unsuitable for MD patients with mtDNA deletions. All patients should be monitored closely for adverse events when initiating the diet. Further research should focus on predictive factors to consider the diet, effectiveness of less stringent carbohydrate restricted diets.

8126 PTH-Independent, Calcitriol-Mediated Hypercalcemia In Renal Cell Carcinoma

Abstract Disclosure: G.K. Rai: None. A. De Rosairo: None. K. Madani: None. D. Sacoto: None. A.A. Franco-Akel, MD: None. R. Belokovskaya: None. Hypercalcemia of malignancy is a known complication of advanced cancer. It occurs through various mechanisms, one of which is via 1,25-dihydroxyvitamin D (calcitriol). Calcitriol-mediated hypercalcemia accounts for approximately 1% of cases of hypercalcemia in the setting of malignancy and is usually seen in lymphomatous solid tumors. We present a gentleman with clear cell renal cell carcinoma associated with hypercalcemia with normal levels of intact parathyroid hormone (PTH), PTH-related protein (PTHrP), and 25-hydroxyvitamin D but elevated calcitriol levels. A 48 year-old-male with no significant past medical history with complaints of fatigue, hematuria, and weight loss of 38 pounds in 3 months was following urology for an elective right-sided nephrectomy. MRI of the abdomen and pelvis found a 16.1 cm renal mass with necrotic areas, causing mass effects on the liver, pancreas, and IVC. Preoperative laboratory showed hypercalcemia of 13.7 mg/dL (corrected 13.9 mg/dL) with microcytic anemia (hemoglobin 8.8 g/dL, MCV 72 fl). Workup showed low iPTH (3 pg/dL), 25-hydroxyvitamin D (16.9 ng/dL), and phosphorus level (1.7mg/dL) with elevated calcitriol (94.3 pg/dL) and a normal PTHrP. CT chest showed multiple pulmonary nodules on bilateral lobes, with the largest nodule ∼ 4.5 mm. Hypercalcemia was managed with IV fluids, calcitonin 300 units Q12 for two days, Denosumab IV infusion, prednisone 60 mg for three days, and oral ergocalciferol 50,000 units weekly. Calcium levels normalized, after which the patient underwent nephrectomy. Pathology revealed renal cell carcinoma grade G4 with mixed features of clear cell carcinoma with sarcomatoid and rhabdoid features. We report an incidental finding of hypercalcemia in a patient with renal mass. The elevated calcitriol levels can be attributed to ectopic calcitriol production through the renal mass. Post nephrectomy calcium levels remained within normal range for consecutive weeks. With this, we concur that hypercalcemia most likely originated from the renal mass that had ectopic production of calcitriol. Dysregulated calcitriol production is a well-known complication of lymphomas and granulomatous disease but is seldom reported with solid tumors. Usually, the etiology for hypercalcemia in patients with renal cell carcinoma is the overproduction of PTHrP, which was not the case with our patient. The ultimate resolution of hypercalcemia of malignancy was attained by treating the underlying malignancy. Presentation: 6/1/2024

8126 PTH-independent, Calcitriol-mediated Hypercalcemia in Renal Cell Carcinoma

Abstract Disclosure: G.K. Rai: None. A. De Rosairo: None. K. Madani: None. D. Sacoto: None. A.A. Franco-Akel, MD: None. R. Belokovskaya: None. Hypercalcemia of malignancy is a known complication of advanced cancer. It occurs through various mechanisms, one of which is via 1,25-dihydroxyvitamin D (calcitriol). Calcitriol-mediated hypercalcemia accounts for approximately 1% of cases of hypercalcemia in the setting of malignancy and is usually seen in lymphomatous solid tumors. We present a gentleman with clear cell renal cell carcinoma associated with hypercalcemia with normal levels of intact parathyroid hormone (PTH), PTH-related protein (PTHrP), and 25-hydroxyvitamin D but elevated calcitriol levels. A 48 year-old-male with no significant past medical history with complaints of fatigue, hematuria, and weight loss of 38 pounds in 3 months was following urology for an elective right-sided nephrectomy. MRI of the abdomen and pelvis found a 16.1 cm renal mass with necrotic areas, causing mass effects on the liver, pancreas, and IVC. Preoperative laboratory showed hypercalcemia of 13.7 mg/dL (corrected 13.9 mg/dL) with microcytic anemia (hemoglobin 8.8 g/dL, MCV 72 fl). Workup showed low iPTH (3 pg/dL), 25-hydroxyvitamin D (16.9 ng/dL), and phosphorus level (1.7mg/dL) with elevated calcitriol (94.3 pg/dL) and a normal PTHrP. CT chest showed multiple pulmonary nodules on bilateral lobes, with the largest nodule ∼ 4.5 mm. Hypercalcemia was managed with IV fluids, calcitonin 300 units Q12 for two days, Denosumab IV infusion, prednisone 60 mg for three days, and oral ergocalciferol 50,000 units weekly. Calcium levels normalized, after which the patient underwent nephrectomy. Pathology revealed renal cell carcinoma grade G4 with mixed features of clear cell carcinoma with sarcomatoid and rhabdoid features. We report an incidental finding of hypercalcemia in a patient with renal mass. The elevated calcitriol levels can be attributed to ectopic calcitriol production through the renal mass. Post nephrectomy calcium levels remained within normal range for consecutive weeks. With this, we concur that hypercalcemia most likely originated from the renal mass that had ectopic production of calcitriol. Dysregulated calcitriol production is a well-known complication of lymphomas and granulomatous disease but is seldom reported with solid tumors. Usually, the etiology for hypercalcemia in patients with renal cell carcinoma is the overproduction of PTHrP, which was not the case with our patient. The ultimate resolution of hypercalcemia of malignancy was attained by treating the underlying malignancy. Presentation: 6/1/2024

6770 Graves’ disease induced by COVID-19 infection in a 49 year old male

Abstract Disclosure: N. Al-hosainat: None. A. Al Najada: None. T. Salar: None. S. Iqbal: None. K. Abdel Gadir: None. Introduction: Graves’ disease is an autoimmune disease causing hyperthyroidism, characterized by elevated thyrotropin-receptor antibodies. COVID-19 infection has been increasingly reported as a trigger of thyroid illness including Graves’ disease. We present a unique case of 49-year-old patient who was diagnosed with Graves’ disease after COVID-19 infection. Case description: A 49-year-old male patient with history of prediabetes presented with complaints of tremor, fatigue, generalized itching, and unintentional weight loss (30 Ibs in 6 months). He had COVID-19 infection 3 months prior. The remainder of review of systems was negative. No family history of thyroid disease. On exam, the patient had sinus tachycardia with otherwise normal vital signs. Diffuse thyromegaly was noted along with an intermittent fine tremor of the extremities. Blood work was notable for low TSH <0.01 uIU/mL, elevated free T4 (3.4 ng/dL), free T3 (17.6ng/dL), and TSH receptor antibody (12 IU/L). Thyroid ultrasound showed mild goiter with 2 nodules, one of which was TIRADS 4 and 1.5cm. This nodule was biopsied and found to be benign. Radioactive iodine uptake scan revealed homogeneous diffuse increased thyroid uptake. The diagnosis of Graves’ disease was made, and the patient was started on propranolol and methimazole with significant improvement of his symptoms and his laboratory tests normalizing. Discussion: Graves' disease is an autoimmune disease, characterized by hyperthyroidism, goiter, occasional orbitopathy and dermopathy. Caused by antibodies against thyroid-stimulating hormone receptors which stimulate thyroid hormone secretion and thyroid growth. Treatment is aimed to decrease thyroid hormone synthesis by either a Thionamide, radioiodine ablation, or surgery. Remission rates with antithyroid drugs average under 40 percent after one to two years of treatment and could exceed 80 percent after 5 to 10 years of treatment. COVID-19 is a multi-system disease, caused by SARS-CoV-2 virus, transmitted by large droplets and small particle aerosols, was declared a pandemic in 2020 and affected millions of people worldwide. There is emerging data showing the association of COVID-19 with various thyroid diseases including thyroiditis and relapse of known Graves' disease after the infection. We present a case of newly diagnosed Graves’ disease after COVID-19 infection in a patient with no personal or family history of such disease which raises the concern of autoimmune pathway activation induced by the infection. The onset of Graves’ disease after COVID-19 infection does not depend on the presence of pre-existing thyroid pathology and in this case responded well to antithyroid medication. Conclusion: COVID-19 can lead to the development of a range of medical illnesses. In patients who develop symptoms of thyrotoxicosis, Graves’ disease should be suspected, investigated, and treated appropriately Presentation: 6/3/2024

7295 Giant Pituitary Adenoma with Rapid Symptomatic Progression and Postoperative Mortality

Abstract Disclosure: R.D. Kennedy: None. M. Nicholson: None. Introduction: Giant pituitary adenomas, defined as pituitary adenomas measuring greater than 4 cm, present a therapeutic challenge because of their size, clinical features, and increased potential for complications following surgical intervention. Early detection and intervention to prevent growth and progression is paramount. We present a case of a patient with a giant 6.3 cm pituitary adenoma who had significant neurologic compromise, requiring surgical intervention, with resultant postoperative complications and death. Case:Patient is a 41 year old male with known history of pituitary adenoma who presented on 11/1/2023, from outside hospital, to the Neuroendocrine clinic with complaints of excessive truncal obesity, impotence, fatigue, and apathy. Vital signs were within normal limits. Physical exam revealed clouding of consciousness, grossly intact cranial nerve function, truncal obesity, and diminished power, tone, and bulk of the extremities. Formal visual field testing revealed bitemporal hemianopsia. A head CT scan revealed a 6.3 cm sellar mass with expansion of the sella, invasion of soft tissue into the sphenoid sinus, and extension of soft tissue cranially to the level of the third ventricle eccentric to the left. There was no evidence of apoplexy. Lab results revealed Prolactin of 924 ng/mL. The patient had been taking Bromocriptine, 2.5 mg daily, for at least three weeks. Less than three weeks after his initial evaluation, he returned to the hospital with complaint of acute ataxia. Pituitary MRI revealed 6.3 cm sellar mass with evidence of acute and subacute blood products, stretching of the optic chiasm from mass effect, extension into the bilateral cavernous sinuses, superior left MCA displacement, posterior left PCA displacement, 5 mm midline shift, uncal herniation and descending transtentorial herniation. The patient underwent endoscopic transsphenoidal resection with subsequent craniotomy for debulking. Postoperatively, he developed new right sided hemiplegia with aphasia with subsequent MRI finding of watershed infarct at the left MCA/PCA lateral posterior border zone territories with increasing mass effect over a 30 day hospital stay. He developed progressive global edema with worsening uncal and tonsillar herniations. Brain death was pronounced on 11/30/23. Discussion:This case highlights the importance of early intervention in patients with giant pituitary adenomas. Our patient had been experiencing right sided weakness for at least one year prior to his admission to our facility. In this case, earlier treatment with a dopamine agonist may have decreased the size of the adenoma or prevented rapid growth. This may have precluded the need for surgical intervention on an adenoma of this size, which carries increased risk for postoperative complications. Presentation: 6/2/2024

7336 Decades In The Dark: The Long Road To Diagnosing And Treating Hypophosphatasia

Abstract Disclosure: V.A. Mendpara: None. G. Madrigal Loria: None. L.Z. Khan: None. Background: Hypophosphatasia (HPP) is a rare bone disorder that results from deficient activity of the tissue non-specific isoenzyme alkaline phosphatase (ALP).[1] This case highlights a patient whose diagnosis of this treatable genetic condition was significantly delayed for almost two decades, despite receiving care at a prominent academic institution. The patient's persistently low ALP levels in routine lab tests were overlooked by multiple clinicians, leading to a delay in her care and eventual treatment. Case presentation: A 61-year-old Caucasian woman presented at the endocrinology clinic with complaints of severe fatigue, generalized pain, multiple childhood fractures, and ongoing dental issues. The rheumatology clinic to which she was referred for polyarthralgia diagnosed her with Hypophosphatasia (HPP) after noting chronically low alkaline phosphatase (ALP) levels from her previous charts ranging from 15 to 24 U/L (normal range: 34 to 123 U/L) over two decades. Her serum calcium, parathyroid hormone (PTH), and 25-hydroxy vitamin D levels were within normal ranges. A DEXA scan revealed normal bone density, effectively ruling out osteoporosis. Further investigation showed elevated Vitamin B6 levels at 219.6 nmol/L (normal range: 20.0 to 125.0 nmol/L), raising suspicion for HPP. The patient's family history provided additional insight, with her mother having a history of short stature and fractures and her son experiencing premature tooth loss at the age of 2. A genetic evaluation identified a heterozygous pathogenic variant in the ALPL gene (c.881A>C, p.Asp294Ala), confirming the diagnosis of autosomal dominant HPP. Initiating treatment with Asfotase alfa, a medication targeting HPP, resulted in a marked improvement in the patient's symptoms. Discussion: This case shows the diagnostic complexities of HPP, stressing the significance of actively screening for this condition via ALP levels in routine laboratory testing or during osteoporosis evaluations. The diagnostic process is critical to distinguish HPP from primary osteoporosis, as treatment and potential risks differ significantly. Inadvertent use of bisphosphonates can worsen hypomineralization and lead to atypical femoral fractures in HPP patients. Asfotase alfa enzyme replacement therapy, available since 2015, offers a targeted approach by replacing the enzyme defect, thereby mitigating symptoms. Heightened awareness among healthcare providers of HPP in adults holds the potential to enhance diagnosis rates and facilitate improved treatment outcomes for this highly treatable condition.[1] Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition. ASBMR. Presentation: 6/2/2024

7627 Prevalence Of True Endocrinopathies In Patients Presenting To An Endocrine Clinic With Fatigue

Abstract Disclosure: C. Dimech: None. K. Barnett: None. F. Hasan: None. Introduction: Fatigue is a common chief complaint, resulting in approximately 7 million physician office visits per year in the US. Fatigue is a non-specific symptom which can be associated with many acute or chronic conditions. In our clinical experience fatigue is a frequent reason for referral to the endocrine clinic, and often assessment does not reveal an endocrine pathology. However, the prevalence of endocrinopathies discovered following endocrinology assessment has not been well studied. Methods: In this retrospective study, we completed chart review of electronic medical records of patients who were evaluated for a chief complaint of fatigue at outpatient endocrinology centers belonging to an integrated health network in the Pittsburgh Metro area. We included patients aged 18-40 years old from 01/01/2019- 12/31/2022. We hypothesized that there is not a significant incidence of endocrinopathies found on evaluation. Results: Extensive clinical and laboratory data were gathered for 226 patients during the study period. 39.9% of patients were self-referred. 60.1% of patients seen were through physician referrals, however 17.9% of these patients had no prior investigations completed. The majority of patients evaluated for fatigue were female (76.5% vs 23.5%). 55.3% of patients were 30-39 years of age. 27% of patients were overweight and 23% were obese with BMI 30 or greater. Nearly half of all patients had a diagnosis of anxiety or depression (51.7% and 48.2% respectively). Of those patients with anxiety, 57.3% were prescribed an SSRI or SNRI. Similarly, 58.7% of patients with depression were prescribed an SSRI/SNRI. Patients most commonly reported other non-specific symptoms such as weight gain, poor sleep and poor mood (51.3%, 38.9%, 25.2% respectively). 54.9% of female patients presenting with fatigue were concerned for thyroid dysfunction whereas 45.3% of male patients were concerned for hypogonadism. 12.3% of patients evaluated never completed the recommended testing. Vitamin D deficiency was notably prevalent in 42.4% of patients tested. One patient was found to have secondary adrenal insufficiency in the setting of chronic exogenous glucocorticoid use for back pain. Of 163 patients tested for thyroid dysfunction, no new diagnoses of thyroid abnormalities were revealed. Conclusion: In this study, laboratory testing from an endocrinology consultation was not useful in detecting newly discovered endocrinopathies as a cause of fatigue. Presentation: 6/2/2024

Modern Approaches to Diagnosing Cognitive Impairments in Patients with Multiple Sclerosis

Multiple sclerosis in patients can cause not only motor, sensory, cerebellar and autonomic dysfunctions, but also cognitive and psychoemotional disorders such as difficulty with learning and recalling information, problems focusing on tasks and maintaining attention, slowed ability to process information, depression, anxiety. Cognitive impairment can appear at any stage of the disease and can be observed in more than half of patients.  Patients with multiple sclerosis may not fully recognize or underestimate their complaints of psycho-emotional disturbances, fatigue or pain.  For this reason, doctors should rely on the results of neuropsychological tests. Like all symptoms of multiple sclerosis, cognitive impairment is highly variable and significantly affects patients' work habits, social interactions and quality of life. Therefore, the assessment of cognitive functions in patients with multiple sclerosis is of undoubted interest.

Effects of N95 Masks Versus Surgical/Loop Masks on Arterial Blood Gases and Adverse Symptoms in Operating Room Staff During Prolonged Usage: A Pilot Study.

The COVID-19pandemic continues to have a catastrophic impact on the global population. N95 masks are commonly used as filtering facepiece respirators for healthcare workers. At the end of long shifts, they have reported headaches, dizziness, fatigue, exhaustion, and physical and mental discomfort. There is a lack of data on the effects of N95 masks on blood gases in healthcare workers who wear masks for longer durations. We analyzed and compared the effects of continuously wearing N95 versus loop/surgical masks on various symptomology parameters and arterial blood gases for longer durations. This was a non-blinded, pilot, observational study at a single academic institution. Utilizing a survey, we collected information on operating room staff volunteers (demographics, mask use, and symptoms) and measured transcutaneous partial pressure carbon dioxide (tcPCO2) and oxygen saturation (SpO2) before and after the subject's shift to identify changes. Thirty-nine subjects enrolled in the study (N95 mask = 13, loop/surgical mask = 26). Overall, 69.2% of the subjects continuously wore a mask for five or more hours on their shift. There was a statistical difference with reported fatigue with exclusively wearing an N95 mask versus a loop/surgical mask (p=0.017). None of the other parameters showed a statistical difference between groups. The tcPCO2 was not statistically different between mask types at the beginning of the shift (p=0.922) or at the end of the shift (p=0.188), although tcPCO2 levels increased. The SpO2 was not statistically different between the mask types at the beginning of the shift (p=0.883) or at the end of the shift (p=0.505) with SpO2 decreasing. Individuals exclusively wearing an N95 mask reported a statistically greater number of complaints of fatigue after their shift. No statistical differences were observed in arterial blood gas parameters measured for SpO2 and tcPCO2 between mask groups. No definitive conclusions can be made due to the small sample size.

The Effect of Deep Breathing Exercise Therapy Combination of Aromatherapy Based on Orem's Self Care Theory on Fatigue and Sleep Quality in Chronic Kidney Disease Patients Hemodialysis

Patients hemodialysis with experience complaints of anemia, fatigue, sleep disturbances, and increased urea levels. Fatigue and sleep disorders are still a high problem in Indonesia. Increased urea levels can cause decreased appetite, poor nutritional intake and complaints of fatigue. The aim of the research was to analyze the effect of deep breathing exercise therapy combined with Orem self-care based aromatherapy on fatigue levels and sleep quality. The design in this research is quasi-experimental. Population of all hemodialysis patients at RSI Jemursari Surabaya. The sample size was 40 people, divided into 2 groups, namely the intervention group and the control group. The sampling technique was taken using a total sampling technique. Data were analyzed using the independent t-test a < 0.05 and looking at the difference in values using the delta test. The results of research conducted at RSI Jemursari Surabaya, showed that the average fatigue score in the intervention group before giving deep breathing exercise therapy, a combination of aromatherapy based on self-care Orem, was 36.90 and after being given the intervention, it was found to decrease by 15.90, while the control group did not. given any therapy, according to hospital standards of 34.65 and experienced a decrease of 19.65. Based on the independent t - test, it shows p = 0.003 and sleep quality shows p = 0.001, which means that deep breathing exercise therapy combined with aromatherapy based on Orem self-care has an effect on fatigue and sleep quality. Deep breathing exercise therapy a combination of aromatherapy based on Self-Care Orem according to standards, can reduce fatigue levels and improve sleep quality.

Design of Ergonomic Flour Dough Mixer with Participatory Approach to Increase Work Productivity MSME Employees

Culinary businesses that are members of MSMEs usually process foodstuffs, including stirring flour dough manually using their hands. It is ineffective, makes you tired quickly, and takes a long time. Usually there are complaints such as complaints of arm muscles, complaints of fatigue in the hands, pain in the palms, and it takes a long time, resulting in subpar worker productivity. Consequently, a participation flour dough mixer that is ergonomic is required. In order to conduct this research, an experimental design of a flour dough mixer was created and applied to sixteen samples of MSME employees in the Tabanan Regency. The Nordic Body Map questionnaire was used to measure musculoskeletal diseases, and the workload was divided by the survey results to determine job productivity. The employee's work pulse was measured using a pulse meter. The findings demonstrated that the ergonomic flour dough mixer was designed based on the worker's anthropometric measurements. The tool's height was matched to the worker's standing elbow height, and the container's dimensions matched the worker's hand's reach. The design of an ergonomic flour dough mixer can reduce the workload of MSME employees by 15.1%; reduce musculoskeletal disorders of MSME employees by 47.9%; reduce MSME employee fatigue by 52.3%; and increase the work productivity of MSME employees by 501.1%.

The effect of using method timer media on reducing eye fatigue industry workers

The outcomes of an initial research on eye fatigue in the Digital Industry in Yogyakarta, Indonesia revealed that 76% of the employees encountered complaints of eye fatigue as a result of prolonged computer usage. Eye fatigue is considered one of the parameters of office ergonomics in accordance with Indonesian Minister of Health Regulation No. 48 of 2016. One method recommended by this regulation to mitigate eye fatigue is to incorporate short breaks using the 20-20-20 technique. However, a considerable number of workers tend to disregard these recommendations, necessitating the use of media reminders, such as timers, to enforce discipline among workers. The objective of this research was to assess the impact of employing a timer-based media using the 20-20-20 method on the reduction of eye fatigue. The research employed a quasi-experimental design with a nonequivalent control group. In this research, a total of forty workers were selected as the sample population and subsequently divided into two groups: the intervention group and the control group. Sampling was conducted to select a total of 20 workers for each group through purposive sampling. Bivariate analysis was performed using the Sign test and Mann-Whitney test, with a significance threshold of 95% (α=0.05). The results of the statistical tests conducted in both the intervention and control groups revealed a significant difference in reducing eye fatigue, with a p-value of 0.041. This research concludes that the utilization of the 20-20-20 method timer media has a significant effect on reducing eye fatigue among workers.

Neurological long-COVID: Associations among fatigue, dysautonomia, depression, and subjective memory complaints

IntroductionLong-COVID is a multisystem disease characterized by a varied presentation of symptoms. According to most recent research, the most common symptom of long-COVID is fatigue, which up to this date lacks a universally accepted definition. This study aimed to investigate neurocognitive and physical manifestations of neurological long-COVID, particularly fatigue and its relation with autonomic disfunction, cognitive impairment (known as, brain fog), and depressive symptoms. Furthermore, the study provided insights into predictors of fatigue in long-COVID. MethodsThe included patients (n=141) were referred to the neuro-long-COVID ambulatory service of Trieste from 30 September 2021–02 March 2022. Patients were given self-reporting questionnaires to screen for fatigue, autonomic dysfunction, cognitive impairment and depressive symptoms. The questionnaires adopted for these conditions to be assessed were Fatigue Severity Scale (FSS), COMPASS-31, Prospective-Retrospective Memory Questionnaire (PRMQ), and Beck Depression Inventory (BDI). Participants were divided into two groups, fatigued and non-fatigued patients, based on FSS scoring (scores > 4.67 indicate fatigued patients). The questionnaire scores of the two groups were then compared. ResultsFatigued patients had significantly higher scores in COMPASS (p<0.001, Cohen’s d=1.077), BDI (p<0.001, Cohen's d=0.862), and PRMQ ( p<0.001, Cohen's d=1.159).Furthermore, the multivariate regression analysis showed that predictors of fatigue in long-COVID were symptomatological burden in acute infection (OR=1.38, 95 % CI 1.020–1.887, p=0.037) and in long-COVID (OR=1.78, 95 % CI 1.133–2.2824, p=0.013), COMPASS-31>16 (OR=3.44, 95 % CI 1240–9.560, p=0.018) and BDI>15 (OR=5.1, 95 % CI 1.715–15.164, p=0.003). ConclusionThis study showed associations between fatigue, dysautonomia and depression, as well as with symptom burden in acute and long-COVID.

Gulf War Illness Is Associated with Host Gut Microbiome Dysbiosis and Is Linked to Altered Species Abundance in Veterans from the BBRAIN Cohort.

Gulf War Illness (GWI) is a debilitating condition marked by chronic fatigue, cognitive problems, pain, and gastrointestinal (GI) complaints in veterans who were deployed to the 1990-1991 Gulf War. Fatigue, GI complaints, and other chronic symptoms continue to persist more than 30 years post-deployment. Several potential mechanisms for the persistent illness have been identified and our prior pilot study linked an altered gut microbiome with the disorder. This study further validates and builds on our prior preliminary findings of host gut microbiome dysbiosis in veterans with GWI. Using stool samples and Multidimensional Fatigue Inventory (MFI) data from 89 GW veteran participants (63 GWI cases and 26 controls) from the Boston biorepository, recruitment, and integrative network (BBRAIN) for Gulf War Illness, we found that the host gut bacterial signature of veterans with GWI showed significantly different Bray-Curtis beta diversity than control veterans. Specifically, a higher Firmicutes to Bacteroidetes ratio, decrease in Akkermansia sp., Bacteroides thetaiotamicron, Bacteroides fragilis, and Lachnospiraceae genera and increase in Blautia, Streptococcus, Klebsiella, and Clostridium genera, that are associated with gut, immune, and brain health, were shown. Further, using MaAsLin and Boruta algorithms, Coprococcus and Eisenbergiella were identified as important predictors of GWI with an area under the curve ROC predictive value of 74.8%. Higher self-reported MFI scores in veterans with GWI were also significantly associated with an altered gut bacterial diversity and species abundance of Lachnospiraceae and Blautia. These results suggest potential therapeutic targets for veterans with GWI that target the gut microbiome and specific symptoms of the illness.

Beneficial Effects of Ginger Extract on Eye Fatigue and Shoulder Stiffness: A Randomized, Double-Blind, and Placebo-Controlled Parallel Study.

This study aimed to assess ginger extract's impact on ocular and peripheral blood flow and its potential to alleviate eye fatigue and shoulder stiffness. This study included 100 healthy individuals aged 20-73 years with eye fatigue and shoulder stiffness. Participants were randomly assigned to receive either placebo capsules or ginger extract capsules daily for eight weeks. Ocular blood flow, peripheral blood flow, eye fatigue (visual analog scale [VAS]), shoulder stiffness (VAS), body warmth (VAS), and shoulder muscle stiffness were assessed at weeks 0, 4, and 8, respectively. No improvement in ocular blood flow was observed under the study conditions. Conversely, peripheral blood flow in deep areas was enhanced in females (p = 0.033). Subgroup analysis by age (≥51 or <51 years) revealed that ginger's effect on enhancing peripheral blood flow in deep vessels was restricted in females under 51 (p = 0.017). Similarly, subjective complaints of eye fatigue and shoulder stiffness were improved by ginger consumption in females under 51. Body warmth was favorably changed significantly in males ≥51 years due to ginger consumption. The muscle stiffness showed no statistically significant changes. In conclusion, ginger consumption reduces eye fatigue and shoulder stiffness by enhancing peripheral blood flow in relatively young females.

Diabetic Lung: An Entity Complicated by Coronavirus Disease 2019 Pneumonia

ABSTRACT Background: Diabetes is an important public health problem and considering the extent of the aftermath following coronavirus disease 2019 (COVID-19) pandemic, this study aimed to evaluate the effect of each disease on lung function individually and also to assess how both the disease entities together in combination affect the lungs. Methods: This observational study included adult patients below the age of 60 years with complaints of fatigue. Included patients were assessed for their basic demographics and history of COVID-19 pneumonia. For those diagnosed with diabetes mellitus (DM), the duration of DM and HbA1C were noted. For all included patients, spirometry was performed. Results were statistically analyzed. Results: Comparing the spirometry measures of DM patients with and without a history of COVID-19 pneumonia, the mean forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced expiratory flow (FEF) 25%–75% for DM patients with COVID-19 pneumonia history was significantly lower than DM patients without a history of COVID-19 pneumonia (P &lt; 0.0001). Comparing the spirometry measures of patients (DM vs. non-DM) with a history of COVID-19 pneumonia, the mean FEV1, FVC, FEV1/FVC, and FEF 25%–75% for DM patients with COVID-19 pneumonia history was significantly lower than non-DM patients (P &lt; 0.0001). Conclusion: Considering the high burden of the diabetic population and the extent of the pandemic’s aftermath, clinicians should be aware of this and aim to optimize control of blood glucose levels in uncontrolled diabetics with a history of COVID-19 to prevent the deterioration of lung function.

Altered brain perfusion and oxygen levels relate to sleepiness and attention in post-COVID syndrome.

Persisting neurological symptoms after COVID-19 affect up to 10% of patients and can manifest in fatigue and cognitive complaints. Based on recent evidence, we evaluated whether cerebral hemodynamic changes contribute to post-COVID syndrome (PCS). Using resting-state functional magnetic resonance imaging, we investigated brain perfusion and oxygen level estimates in 47 patients (44.4 ± 11.6 years; F:M = 38:9) and 47 individually matched healthy control participants. Group differences were calculated using two-sample t-tests. Multivariable linear regression was used for associations of each regional perfusion and oxygen level measure with cognition and sleepiness measures. Exploratory hazard ratios were calculated for each brain metric with clinical measures. Patients presented with high levels of fatigue (79%) and daytime sleepiness (45%). We found widespread decreased brain oxygen levels, most evident in the white matter (false discovery rate adjusted-p-value (p-FDR) = 0.038) and cortical grey matter (p-FDR = 0.015). Brain perfusion did not differ between patients and healthy participants. However, delayed patient caudate nucleus perfusion was associated with better executive function (p-FDR = 0.008). Delayed perfusion in the cortical grey matter and hippocampus were associated with a reduced risk of daytime sleepiness (hazard ratio (HR) = 0.07, p = 0.037 and HR = 0.06, p = 0.034). Decreased putamen oxygen levels were associated with a reduced risk of poor cognitive outcome (HR = 0.22, p = 0.019). Meanwhile, lower thalamic oxygen levels were associated with a higher risk of cognitive fatigue (HR = 6.29, p = 0.017). Our findings of lower regional brain blood oxygen levels suggest increased cerebral metabolism in PCS, which potentially holds a compensatory function. These hemodynamic changes were related to symptom severity, possibly representing metabolic adaptations.

Fatigue, Fogginess, and Sleep Complaints: Presence and Impact on Functioning After Childhood Traumatic Brain Injury.

The purpose of this study was to examine the occurrence and impact of fatigue, fogginess, and sleep complaints on functioning at 3, 6, 10, and 16 months after childhood traumatic brain injury (TBI). Eighty-eight caregivers completed online surveys regarding their children with TBI, with 17 participants included at the final time point. Measures included questions related to demographic and injury characteristics, executive functioning, social relations, health-related quality of life, and fatigue, fogginess, and sleep complaints. Fatigue, fogginess, and sleep complaints were persistent and ultimately increased at 16 months postinjury. Over half of the participants were experiencing each symptom at 16 months postinjury (i.e., 52.94% fatigue and fogginess, 58.82% sleep complaints). At 16 months postinjury, fatigue was significantly associated with female sex, and fatigue and sleep complaints were significantly associated with lower physical quality of life, but no other differences were found with symptoms and current functioning. The results of this study support that fatigue, fogginess, and sleep complaints can persist (from baseline, from postinjury, and in fluctuation) chronically for about half of the children with TBI but little association or impact on other domains of functioning. The present study supports the continued investigation of fatigue, fogginess, and sleep complaints after childhood brain injury, but further investigation with a larger sample size is necessary to inform clinical practices for assessment and management, particularly for speech-language pathologists in rehabilitation and educational settings.