Fatigue Symptoms Research Articles

Do acute mountain sickness and psychiatric disorders show overlapping symptoms?

The Lake Louise Score (LLS) is a common tool for diagnosing acute mountain sickness (AMS) after a recent gain in altitude. Required symptoms (headache, dizziness, fatigue or gastrointestinal symptoms) are unspecific, subjective and not detectable by physiological parameters. (Talks et al., 2022; Boos et al., 2018) This study aimed to enhance present knowledge concerning the impact of mental health on LLS. In a cross-sectional questionnaire study, we assessed 3 groups: 100 inpatients (Ward for psychosomatic medicine – Innsbruck, PSY), 73 mentally healthy individuals (Innsbruck, Austria at an altitude of 570 m, CO) and 223 mountaineers in Nepal (Pheriche 4,371 m and Dingboche 4,410 m, NEPAL). Beside social demographics and LLS 2018 (cutoff for LLS-positivity: LLS ≥ 3 including at least 1 point for headache), we examined symptoms of anxiety (Zung Self-Rating Anxiety Scale [SAS], General Anxiety Disorder Questionnaire 7 [GAD-7]), affective states (International Positive and Negative Affect Schedule Short form [I-PANAS-SF]) and sleep (Insomnia Severity Index [ISI]). In this preliminary analysis, the average age was 39 ± 16 years in PSY, 34 ± 16 years in CO and 40 ± 14 years in NEPAL. Gender distribution showed greater portion of women in PSY and CO (PSY: 72% female 24% male 3% non-binary, CO: 64% female 36% male) contrary to NEPAL (36% female 64% male). At sea level, 67% scored LLS-positive in PSY and 12% in CO (Fishers exact test, p < 0.001). In NEPAL 25% met AMS-criteria by LLS. CO and NEPAL score significantly lower in LLS than PSY (ANOVA: diff = -3.70, p < 0.0001; diff = -3.68, p < 0.0001, respectively). PSY and CO showed significant weak to moderate correlations (Spearman-Rho, p < 0.001) of anxiety (SAS, GAD), affective states (I-PANAS-SF) and sleep impairment (ISI) with LLS-sum. NEPAL showed significant very-weak to weak correlations of insomnia, anxiety and negative affect with LLS-sum. Using logistic regression analysis (Figure 1), higher odds of LLS-positivity are significantly associated with insomnia and anxiety (ISI, SAS) in PSY, with anxiety in CO (SAS) and insomnia and negative affect in NEPAL. While of course a recent gain in altitude is a prerequisite for the diagnosis of AMS this study shows that patients with pre-existing mental illness at low altitude score more frequently false-positive on the LLS than a mentally healthy cohort. Symptoms of anxiety, negative affect and sleep disturbance can affect the AMS-defining questionnaire of LLS both at sea level and at high altitude. There is still uncertainty on a possible common pathophysiological pathway of psychiatric diseases and AMS since there is no Gold Standard in diagnosing AMS. Concerning (well-)established risk-factors for AMS like speed of ascent (Berger et al., 2023) and female sex (Hou et al., 2019), we see no evident data. The data presented here suggest that strength of expression of negative affect can cause positive LLS scoring. Acute mountain sickness and psychiatric disorders show overlapping symptoms at sea level. At high altitudes, negative affect seems to be a possible cause for the development of AMS. Further research focus should be placed on mountaineers in high altitude with psychiatric disorders and their mental state.

The Omicron Variant Is Associated with a Reduced Risk of the Post COVID-19 Condition and Its Main Phenotypes Compared to the Wild-Type Virus: Results from the EuCARE-POSTCOVID-19 Study.

Post COVID-19 condition (PCC) is defined as ongoing symptoms at ≥1 month after acute COVID-19. We investigated the risk of PCC in an international cohort according to viral variants. We included 7699 hospitalized patients in six centers (January 2020-June 2023); a subset of participants with ≥1 visit over the year after clinical recovery were analyzed. Variants were observed or estimated using Global Data Science Initiative (GISAID) data. Because patients returning for a post COVID-19 visit may have a higher PCC risk, and because the variant could be associated with the probability of returning, we used weighted logistic regressions. We estimated the proportion of the effect of wild-type (WT) virus vs. Omicron on PCC, which was mediated by Intensive Care Unit (ICU) admission, through a mediation analysis. In total, 1317 patients returned for a post COVID visit at a median of 2.6 (IQR 1.84-3.97) months after clinical recovery. WT was present in 69.6% of participants, followed by the Alpha (14.4%), Delta (8.9%), Gamma (3.9%) and Omicron strains (3.3%). Among patients with PCC, the most common manifestations were fatigue (51.7%), brain fog (32.7%) and respiratory symptoms (37.2%). Omicron vs. WT was associated with a reduced risk of PCC and PCC clusters; conversely, we observed a higher risk with the Delta and Alpha variants vs. WT. In total, 42% of the WT effect vs. Omicron on PCC risk appeared to be mediated by ICU admission. A reduced PCC risk was observed after Omicron infection, suggesting a possible reduction in the PCC burden over time. A non-negligible proportion of the variant effect on PCC risk seems mediated by increased disease severity during the acute disease.

Physician reported toxicities and patient reported quality of life of transperineal ultrasound-guided radiotherapy of prostate cancer

PurposeThis study aims to address therapy-related toxicities and quality of life in prostate cancer patients undergoing transperineal ultrasound (TPUS) guided radiotherapy (RT). MethodsAcute and late gastrointestinal (GI) and genitourinary (GU) toxicities were assessed by physicians using CTCAE v5.0. Patient-reported quality of life outcomes were evaluated using EORTC QLQ-C30, -PR25 and IPSS. We utilized Volumetric Modulated Arc Therapy (VMAT) or intensity modulated radiation therapy (IMRT) as the RT technique for this study. The assessments were carried out before RT, at RT end, 3 months after RT and subsequently at 1-year intervals. Prostate-specific antigen (PSA) was also evaluated at each follow-up. ResultsIn this study, a total of 164 patients were enrolled, while among them, 112 patients delivered quality-of-life data in a prospective evaluation. The median pre-treatment PSA was 7.9 ng/mL (range: 1.8–169 ng/ml). At the median follow-up of 19 months (3–82 months), the median PSA decreased to 0.22 ng/ml. Acute grade II GI and GU toxicities occurred in 8.6 % and 21.5 % patients at RT end. Regarding late toxicities, 2.2 % patients experienced grade II GI toxicities at 27 months and only one patient at 51 months, whereas no grade II GU late toxicities were reported at these time points. Quality of life scores also indicated a well-tolerated treatment. Patients mainly experienced acute clinically relevant symptoms of fatigue, pain, as well as deterioration in bowel and urinary symptoms. However, most symptoms normalized at 3 months and remained stable thereafter. Overall functioning showed a similar decline at RT end but improved over time. ConclusionThe outcomes of TPUS-guided RT demonstrated promising results in terms of minimal physician-reported toxicities and satisfactory patient-reported QoL.

"The Decision to End Speech Therapy Brought More Peace and Tranquility Into Our Family": Exploring Speech-Related Treatment Fatigue and Dropout in Parents and Children With a Cleft Palate.

Treatment fatigue is a complex, multidimensional, multicausal, and subjective phenomenon that is not yet well explored and understood in the area of speech therapy. The purpose of this study was to investigate speech-related treatment fatigue and speech treatment dropout in parents and children with a cleft (lip and) palate receiving or having received speech treatment for cleft-related articulation disorders. Thirteen participants were included in this study (n = seven parents with a median age of 40 years and n = six children with a median age of 10 years). Qualitative semistructured interviews were conducted separately with parents and children to investigate their experiences with cleft speech treatment. An inductive thematic approach was used to analyze the data and construct different themes. Rigor of the data was verified by conducting an investigator triangulation and by performing member checks. The analyses of the interviews yielded three major themes of importance to the children and their parents: (a) physical symptoms of treatment fatigue, (b) psychological symptoms of treatment fatigue, and (c) from treatment fatigue to treatment dropout. Physical symptoms of treatment fatigue were mainly related to transportation burden. On a psychological level, speech treatment may potentially lead to a cognitive-emotional overload. These feelings are primarily related to the practical issue of scheduling required treatment sessions in the family agenda. The decision to discontinue speech treatment was reported to be multifactorial. In this decision-making process, data suggested that the child's perspective must be heard more.

Fatigue and sensorimotor instability : Neurologically controlled conversion of post-COVID-19 patients

For the treatment of the symptoms of post-COVID-19 syndrome, no causal therapy is currently widely recommended according to evidence-based criteria. The overarching goal of the intervention study over a3-year period (Q1-2021-Q4-2023) was to evaluate the changes in the key symptoms of fatigue and sensorimotor instability through individualized stress-controlled training therapy and through intensified cognitive behavioral therapy. In the 3‑year period 407 vaccinated nucleocapsid positive patients were treated at the Post-COVID-19 Center Lausitz (Senftenberg). In 78(around 19%) fatigue/immunometabolic depression and sensorimotor instability were identified as the leading syndromes. The evaluation of the individualized stress-controlled training therapy was based on the specific post-COVID-19 syndrome and motor fatigue parameters. The secondary psychosomatic syndrome was assessed using cognitive fatigue parameters and cognitive behavioral therapy instruments. The investigation of -parameters influencing behavior took place in Q2-2023-Q4-2023 with aguide-supported qualitative interview among the participants. The post-COVID-19 key symptoms "fatigue," "sensorimotor instability," "neuropsychiatric symptoms," "cardiac/autonomic dysfunction," and "pain" improved significantly in the overall cohort and in the gender-specific analysis. Adeterioration occurred in "secondary psychosomatic symptoms". Atherapeutic effect was demonstrated for all motor fatigue parameters for the entire cohort using the Cohen's dvalue. An intensification of cognitive behavioral therapy achieved positive effects through an increasing development of the patients' own activity and their self-control using persuasion and gamification.

SMART-goal domains and goal attainment in an individualized, goal-oriented intervention for children with acquired brain injury and their families

ABSTRACT Pediatric acquired brain injury (pABI) may lead to long-lasting challenges in need of rehabilitation-efforts years after the insult. The Child in Context Intervention (CICI) is an individualized, goal-oriented intervention targeting children with pABI, their families and schools in the chronic phase. This paper describes the goals that patients and families in the CICI intervention group identified to work on. The 29 participating families worked on 90 goals that were predominantly coded to the domains of Body functioning (46.6%) and Activities and participation (40.5%), according to the International Classification of functioning, Disability and Health (ICF). The most frequently used codes focused on fatigue and emotional symptoms, in addition to codes in the AP domain describing the need for increased independence in everyday life at school, at home, and socially. Goal attainment in the intervention group was high, with positive progress on 94.4% of the goals and positive goal achievement for all included families. The high level of goal attainment provides promising evidence of the CICI programme’s efficacy, and highlights the need to further develop evidence-based rehabilitation programs for children with pABI in the chronic stage of recovery. Trial registration ClinicalTrials.gov identifier: NCT04798859.

Dual-factor model of sleep and diet: a new approach to understanding central fatigue.

Numerous studies have recently examined the impact of dietary factors such as high-fat diets on fatigue. Our study aims to investigate whether high-fat diet (HFD) alone or combined with alternate-day fasting (ADF) can lead to the central fatigue symptoms and to investigate the potential integration of dietary and sleep variables in the development of central fatigue models. Seventy-five male Wistar rats were divided into five groups: control, HFD, HFD + ADF, modified multiple platform method (MMPM), and MMPM+HFD + ADF. Each group underwent a 21-day modeling period according to their respective protocol. Their behavioral characteristics, fatigue biochemical markers, hippocampal pathological changes, mitochondrial ultrastructure, and oxidative stress damage were analyzed. Our findings demonstrate that using only HFD did not cause central fatigue, but combining it with ADF did. This combination led to reduced exercise endurance, decreased locomotor activity, impaired learning and memory abilities, along with alterations in serum levels of alanine aminotransferase (ALT), creatine kinase (CK), and lactate (LAC), as well as hippocampal pathological damage and other central fatigue symptoms. Moreover, the MMPM+HFD + ADF method led to the most obvious central fatigue symptoms in rats, including a variety of behavioral changes, alterations in fatigue-related biochemical metabolic markers, prominent pathological changes in hippocampal tissue, severe damage to the ultrastructure of mitochondria in hippocampal regions, changes in neurotransmitters, and evident oxidative stress damage. Additionally, it was observed that rats subjected to HFD + ADF, MMPM, and MMPM+HFD + ADF modeling method exhibited significant brain oxidative stress damage. We have demonstrated the promotive role of dietary factors in the development of central fatigue and have successfully established a more stable and clinically relevant animal model of central fatigue by integrating dietary and sleep factors.

Research on the soothing Liver - Qi stagnation method in the treatment of postoperative papillary thyroid carcinoma patients' concomitant depression: A randomized controlled clinical trial.

Postoperative papillary thyroid carcinoma (P-PTC) patients often grapple with depression fueled by the looming threat of recurrence. While the Liver-Qi stagnation method is frequently employed for depression management, a notable scarcity of clinical trials exists regarding its application in patients with P-PTC and concurrent depression. This study presents a randomized controlled clinical trial, aiming to establish the efficacy of the Liver-Qi stagnation method in alleviating depression in patients with P-PTC. In this randomized controlled clinical trial, P-PTC patients diagnosed with concomitant depression were systematically enrolled. Subjects were randomly assigned to either the control or test group, both receiving standard treatment comprising Levothyroxine sodium tablets and decoction of benefiting Qi and nourishing Yin. Additionally, the test group received supplementation with bupleuri radix-paeoniae alba radix (CH-BS) alongside the baseline therapy. The intervention spanned 12 weeks. Pre- and post-treatment evaluations were conducted using the Hamilton Depression Scale (HAMD), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Traditional Chinese Medicine (TCM) syndrome score scale. Concurrently, blood inflammatory factors and serum 5-hydroxytryptamine (5-HT) levels were measured to comprehensively assess treatment outcomes. During the 12-week intervention, the test group demonstrated a significant reduction in HAMD scores compared to the control group (P < .05). Moreover, post-treatment serum 5-HT levels were significantly elevated in the test group compared to the control group (P < .05). Findings gleaned from the EORTC QLQ - C30 revealed a noteworthy improvement in social function and overall quality of life scores within both groups post-treatment in comparison to baseline (P < .05). Concurrently, post-treatment scores for fatigue and insomnia symptoms witnessed a significant decrease compared to baseline (P < .05). Notably, the test group exhibited superior scores in the emotional domain in contrast to the control group (P < .05). Both groups exhibited a substantial decrease in TCM syndrome scores from baseline (P < .05). Noteworthy increases were found in IFN-γ < 2.44 rate (62.86%) and IL-6 < 2.44 rate (74.29%) in the test group compared to pretreatment levels (P < .05). The soothing Liver-Qi stagnation method induces a rise in serum 5-HT levels, reducing depression-related inflammatory factors, culminating in the alleviation of depression for P-PTC.

Effects of yoga compared with health promotion on health-related quality of life in adults with post-COVID-19 condition: protocol for a randomised controlled trial

IntroductionPost-COVID-19 condition (post COVID, also known as long COVID) is a global public health issue estimated to affect over 100 million people. Common symptoms include fatigue, dyspnoea and cognitive dysfunction...

Digital cognitive behavioural therapy for insomnia versus digital sleep education control in an Australian community-based sample: a randomised controlled trial.

Insomnia is a prevalent condition in Australia that increases the risk of depression and anxiety symptoms. Cognitive behaviour therapy for insomnia (CBT-i) is the recommended 'first line' treatment but is accessed by a minority of people with insomnia. To improve CBT-i access in Australia, we aimed to develop and test a self-guided interactive digital CBT-i program. An online randomised controlled trial was conducted from August 2022 to August 2023 to investigate the effect of digital CBT-i, versus digital sleep education control, on symptoms of insomnia (ISI), depression (PHQ-9), anxiety (GAD-7), fatigue, sleepiness and maladaptive beliefs about sleep at 8-week follow-up. The control group accessed the intervention after the 8-week follow-up. Questionnaires were additionally administered at 16 and 24 weeks. Intent-to-treat mixed models and complete-case chi-squared analyses were used. Participants included 62 adults with insomnia symptoms (age M (SD) = 52.5 (16.3), 82% female, ISI = 18.6 (2.9)). There were no between-group differences in baseline characteristics or missing 8-week data (14.5%). After adjusting for baseline scores, CBT-i was associated with lower insomnia (Diffadj (95% CI) = 7.32 (5.0-9.6), P < 0.001, d = 1.64), depression (3.36 (1.3-5.4), p = 0.002, d = 0.84), fatigue (5.2 (2.5-7.9), P < 0.001, d = 1.00) and maladaptive beliefs about sleep (11.0 (4.1-18.0), P = 0.002, d = 0.82), but not anxiety symptoms at 8 weeks (1.84 (-0.1 to 3.8), p = 0.060, d = 0.50). Compared to control, CBT-i was associated with greater rates of insomnia remission (ISI <8; 0.0%, vs 40.0%, P < 0.001) and response at 8 weeks (ISI reduction ≥6; 7.1% vs 72.0%, P < 0.001). Improvements in insomnia and depression were maintained at 24 weeks in the CBT-i group. This interactive digital CBT-i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT-i access and uptake.

Types of depression in patients with coronary heart disease: Results from the THORESCI study

BackgroundBoth coronary heart diseases (CHD) and depression are highly prevalent and bidirectionally related. The precise nature of this relationship remains unclear. Defining depressive subtypes could help unravel this relationship. Therefore, the aim of this study was to explore depressive subtypes in patients with CHD. Methods1530 patients (21.3 % women, mean age: 64.7 years (SD = 10.1)) were included in latent class analysis with nine indicators derived from the PHQ-9 and BDI-II representing symptoms of depression as described in the DSM-5 criteria. The best-fitting latent class model was confirmed with double cross-validation. Classes were characterized using demographic, medical, psychiatric, and cardiovascular (risk) factors. ResultsA 3-class model demonstrated the best fit to the data, resulting in a depressed (5.4 %), fatigued (13.5 %), and non-depressed class (81.1 %). Having medical comorbidities, a history of psychiatric problems, negative affectivity, and anxiety symptoms increased the odds of belonging to the depressed group (OR 3.02, 95%CI 1.19–7.68, OR 3.61, 95%CI 1.44–9.02, OR 1.16, 95%CI 1.04–1.30, and OR 1.89, 95%CI 1.66–2.15, respectively). Belonging to the fatigued group was associated with increased odds of having an elective PCI (OR 2.12, 95%CI 1.27–3.55), insufficient physical activity (OR 2.19, 95%CI 1.20–3.99), comorbid medical conditions (OR 2.15, 95%CI 1.21–3.81), a history of psychiatric problems (OR 2.25, 95%CI 1.25–4.05), and anxiety symptoms (OR 1.48, 95%CI 1.34–1.63) compared with the non-depressed group. LimitationsFuture studies should include more people with depressive symptoms. ConclusionsPatients with CHD and medical or psychiatric risk factors should be offered support to decrease or prevent depressive or fatigue symptoms.

Quality-of-Life Outcomes from NRG/NSABP B-39/RTOG 0413: Whole-breast Irradiation vs Accelerated Partial-breast Irradiation after Breast Conserving Surgery.

NRG Oncology (NRG)/NSABP B-39/RTOG 0413 compared whole-breast irradiation (WBI) to accelerated partial-breast irradiation (APBI). APBI was not equivalent to WBI in local tumor control. Secondary outcome was Quality-of-life (QOL). The QOL sub-study used validated self-report questionnaires including the Breast Cancer Treatment Outcome Scale (BCTOS) and SF-36 vitality scale. Assessments occurred: before randomization, at treatment completion (chemotherapy or radiotherapy), 4-weeks later, at 6-, 12-, 24-, and 36-months. Primary aims: cosmesis change equivalency (baseline to 3 years; a priori margin of equivalence 0.4 standard deviations) and fatigue change superiority (baseline to end-of-treatment (EOT)) for APBI vs WBI, by patient groups treated with or without chemotherapy when appropriate. From 3/21/05-5/25/09, 975 patients enrolled in this sub-study; 950 had follow-up data. APBI had 3-year cosmesis equivalent to WBI (95%CI,-0.0001-0.16; equivalence margin -0.22-0.22) in all patients. The APBI group without chemotherapy had less EOT fatigue (p = .011; mean score APBI 63 vs WBI 59); APBI group receiving chemotherapy had worse EOT fatigue (p = .011; APBI 43 vs WBI 49). The APBI group reported less pain (BCTOS) at EOT (WBI 2.29 vs APBI 1.97), but worse pain at 3-years (WBI 1.62 vs APBI 1.71). APBI patients reported greater convenience of care than with WBI and reported less symptom severity at EOT and 4-weeks later. Cosmetic outcomes were similar for APBI and WBI groups, with small statistically significant differences in other outcomes that varied over time. Differences in fatigue and other symptoms appeared to resolve by ≥ 6 months. APBI may be preferred by some patients, for whom extended treatment is burdensome.

VALIDITY AND RELIABILITY OF THE SHSQ-25 FOR ASSESSING SUBOPTIMAL HEALTH STATUS AMONG HANOI MEDICAL UNIVERSITY STUDENTS

The Suboptimal Health Status Questionnaire (SHSQ-25) has been validated in different languages, such as Chinese and other Asian countries. This study, conducted in 2023, aims to examine the validity and reliability of the Vietnamese version of SHSQ-25 using data from 353 undergraduate students at Hanoi Medical University. Reliability was evaluated through test-retest reliability using the Intraclass Correlation Coefficient (ICC) and internal consistency using Cronbach’s alpha. The subscales for fatigue, mental status, cardiovascular, and digestive symptoms demonstrated good test-retest reliability, with ICC values ranging from 0.416 to 0.703, and high internal consistency, with Cronbach's \(\alpha\) ranging from 0.81 to 0.90. However, the immune system subscale exhibited lower reliability, with an ICC of 0.276 and a Cronbach’s \(\alpha\) of 0.53, indicating less consistency between measurements. Validity was assessed through Exploratory Factor Analysis (EFA), which was performed to determine the underlying structure of the Vietnamese version, and Confirmatory Factor Analysis (CFA), which was used to further assess its fit to the data. EFA results revealed a new 5-factor structure. CFA supported the 5-factor model, but findings indicated that further refinement of the SHSQ-25 may be warranted to optimize its factor structure and item composition.

Seasonal indoor air quality, self-reported health and comfort amongst tenants living at Danish multi-family social housing sites

Studies have identified seasonal differences between the indoor environment and residents’ comfort, as well as an association between indoor air quality (IAQ) and residents’ overall health. Furthermore, measured IAQ is not always aligned with perceived IAQ. The HOME-Health study is a cross-sectional study with seasonal measurements of IAQ amongst residents living in social housing. The aim is to describe and analyse measured and perceived IAQ, and residents’ health symptoms. We found a lower relative humidity, temperature (TP) and air change level (h−1) level, and a higher carbon dioxide (CO2) level during winter compared to summer. In general, higher IAQ levels were measured in apartments with increased crowdedness. The inability to be able to create cross ventilation increased TP, and a larger number of rooms decreased TP. Overall, there was no clear alignment between measured and perceived IAQ, but we found a trend that higher CO2-levels led to a perception of poor IAQ especially during summer. Overall, draught and thermal discomfort were the most common complaints. Self-reported humidity was increased during winter and was associated with nasal and respiratory symptoms, whereas self-reported humidity during summer was associated with fatigue and dermal symptoms. Findings show challenges with IAQ in Danish social housing that are associated with negative health issues.

Symptom Persistence Following COVID-19 Infection among an Indigenous Community Residing in the Isthmus of Tehuantepec, Oaxaca, Mexico.

Introduction/Objectives: Several studies have documented the development and persistence of symptoms related to COVID-19 and its secondary complications up to 12 months after the infection. We aimed to identify the medical complications following COVID-19 infection in the Indigenous Zapotec population of the Isthmus of Tehuantepec region in Oaxaca, Mexico. Methods: This is a cross-sectional analytical study that included 90 Indigenous Zapotec participants (30 males and 60 females) from the Tehuantepec region, Oaxaca, Mexico, who had an infectious process due to SARS-CoV-2. Sociodemographic and clinical data were identified through questionnaires. Results: Among the 201 participants, 90 individuals (66.7% women, 33.3% men) had contracted COVID-19. Out of these, 61 individuals reported persistent symptoms post-infection, with a mean symptom duration of 13.87 months. The results show significant variations in symptom duration based on age, marital status, educational attainment, vaccination status, and blood group. The most commonly reported symptoms included a dry cough, fever, myalgia, fatigue, headache, and depressive symptoms. Conclusions: This study highlights the post-COVID-19 symptoms and their prevalence within a specific sample of the Indigenous Zapotec population in Oaxaca, along with the sociodemographic and clinical factors influencing the duration of these symptoms. It underscores the necessity of personalized recovery strategies and highlights the critical role of vaccination in mitigating the long-term impacts of SARS-CoV-2.

Skeletal muscle symptoms and quantitative MRI in females with dystrophinopathy.

The dystrophinopathies primarily affect males; however, female carriers of pathogenic dystrophin variants can develop skeletal muscle symptoms. This study aimed to evaluate muscle involvement and symptoms in females with dystrophinopathy using quantitative magnetic resonance imaging (MRI), functional assessments, and patient-reported outcomes. Controls and females with dystrophinopathy with muscle symptoms of pain, weakness, fatigue, or excessive tightness were enrolled in this cross-sectional study. Participants underwent lower extremity MRI to quantify muscle inflammation, replacement by fat, and disease asymmetry. Cardiac MRI, functional ability, muscle symptoms, and serum creatine kinase levels were also evaluated. Six pediatric females with dystrophinopathy (mean age: 11.7 years), 11 adult females with dystrophinopathy (mean age: 41.3 years), and seven controls enrolled. The mean fat fraction was increased in females with dystrophinopathy compared to controls in the soleus (0.11 vs. 0.03, p = .0272) and vastus lateralis (0.16 vs. 0.03, p = .004). Magnetic resonance spectroscopy water T2, indicative of muscle inflammation, was elevated in the soleus and/or vastus lateralis in 11 of 17 individuals. North Star Ambulatory Assessment score was lower in the dystrophinopathy group compared to controls (29 vs. 34 points, p = .0428). From cardiac MRI, left ventricle T1 relaxation times were elevated in females with dystrophinopathy compared to controls (1311 ± 55 vs. 1263 ± 25 ms, p < .05), but ejection fraction and circumferential strain did not differ. Symptomatic females with dystrophinopathy quantitatively demonstrate muscle replacement by fat and inflammation, along with impairments in functional ability and cardiac function. Additional research is needed to evaluate how symptoms and muscle involvement change longitudinally.

Post-Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After Infection During Pregnancy.

To estimate the prevalence of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) after infection with SARS-CoV-2 during pregnancy and to characterize associated risk factors. In a multicenter cohort study (NIH RECOVER [Researching COVID to Enhance Recovery]-Pregnancy Cohort), individuals who were pregnant during their first SARS-CoV-2 infection were enrolled across the United States from December 2021 to September 2023, either within 30 days of their infection or at differential time points thereafter. The primary outcome was PASC , defined as score of 12 or higher based on symptoms and severity as previously published by the NIH RECOVER-Adult Cohort, at the first study visit at least 6 months after the participant's first SARS-CoV-2 infection. Risk factors for PASC were evaluated, including sociodemographic characteristics, clinical characteristics before SARS-CoV-2 infection (baseline comorbidities, trimester of infection, vaccination status), and acute infection severity (classified by need for oxygen therapy). Multivariable logistic regression models were fitted to estimate associations between these characteristics and presence of PASC. Of the 1,502 participants, 61.1% had their first SARS-CoV-2 infection on or after December 1, 2021 (ie, during Omicron variant dominance); 51.4% were fully vaccinated before infection; and 182 (12.1%) were enrolled within 30 days of their acute infection. The prevalence of PASC was 9.3% (95% CI, 7.9-10.9%) measured at a median of 10.3 months (interquartile range 6.1-21.5) after first infection. The most common symptoms among individuals with PASC were postexertional malaise (77.7%), fatigue (76.3%), and gastrointestinal symptoms (61.2%). In a multivariable model, the proportion PASC positive with vs without history of obesity (14.9% vs 7.5%, adjusted odds ratio [aOR] 1.65, 95% CI, 1.12-2.43), depression or anxiety disorder (14.4% vs 6.1%, aOR 2.64, 95% CI, 1.79-3.88) before first infection, economic hardship (self-reported difficulty covering expenses) (12.5% vs 6.9%, aOR 1.57, 95% CI, 1.05-2.34), and treatment with oxygen during acute SARS-CoV-2 infection (18.1% vs 8.7%, aOR 1.86, 95% CI, 1.00-3.44) were associated with increased prevalence of PASC. The prevalence of PASC at a median time of 10.3 months after SARS-CoV-2 infection during pregnancy was 9.3% in the NIH RECOVER-Pregnancy Cohort. The predominant symptoms were postexertional malaise, fatigue, and gastrointestinal symptoms. Several socioeconomic and clinical characteristics were associated with PASC after infection during pregnancy. ClinicalTrials.gov , NCT05172024.

Feasibility of a nurse-initiated brief cognitive behavioral strategy intervention program for symptom clusters experienced by patients with advanced non-small cell lung cancer

BackgroundA nurse-initiated brief cognitive behavioral Strategy (CBS) intervention program has shown alleviation effects of single symptoms. However, the feasibility of the brief CBS for symptoms included in the Pain and Fatigue symptom clusters in patients with advanced nonsmall cell lung cancer (NSCLC) has not been evaluated. ObjectiveTo evaluate the feasibility of application of the nurse-initiated brief CBS intervention program focusing on pain and fatigue symptoms among the Pain and Fatigue/anorexia symptom clusters experienced by patients with advanced NSCLC. MethodsIn this one-group pretest-posttest design, participants were 15 outpatients with NSCLC undergoing medical treatment (UMIN 000026996). After expressing consent to the study participation, the participants completed a baseline questionnaire and were given a booklet explaining brief cognitive behavioral therapies (relaxation, problem-solving strategies for symptom relief), exercise therapy, and tools. We provided follow-up calls five times and evaluated the retention and changes in symptom severities till the 10th week after the intervention. ResultsOf 15 participants, 10 (66.7%) completed the program. For pain relief strategies, 87% chose deep breathing for relaxation, and 80% fatigue relief with exercises. The median symptom severities (at the baseline and Wk10) showed downward tendencies: pain (2.00, 1.00), sadness (1.00, 0.00), and anxiety (1.00, 0.50). Implications for practiceWe need a randomized controlled trial to further test the effectiveness of the intervention in alleviating symptom and improving QOL of this population. ConclusionsThe nurse-initiated brief CBS intervention program is clinically practical in this population. Nurses may provide useful support for patient symptom management by brief CBS.

Osteopathic Considerations in the Medical Treatment of a Patient with COVID-Related Respiratory Distress

Abstract We present a case of a woman hospitalized for acute hypoxic respiratory failure secondary to suspected post coronavirus disease 19 (COVID-19) pneumonitis who clinically improved after addition of sequenced Osteopathic Manipulative Treatment (OMT) to her medical management. Objective signs (such as oxygen saturation, SPO2) improved, resulting in decreased oxygen volume requirements by 75% after 1 treatment of OMT, and by 97.5% over her remaining hospitalization. Subjective symptoms of dyspnea, chest tightness, fatigue and mental health also improved. Her most significant somatic dysfunctions (SD), which were primarily in her thoracic, ribcage and cervical regions, were correlated with her clinical presentation and disease process. This suggests that SD was likely a modifiable risk factor impairing her normal adaptive physiologic processes and therefore treating SD with sequenced OMT may have contributed to her realizing a higher health potential when combined with standard medical care.

Navigating Specific Targets of Breast Cancer Symptoms: An Innovative Computer-Simulated Intervention Analysis

PurposeTo pinpoint optimal interventions by dissecting the complex symptom interactions, encompassing both their static and temporal dimensions. MethodsThe study incorporated a cross-sectional survey utilizing the MD Anderson Symptom Inventory. Participants with breast cancer undergoing chemotherapy were recruited from the “Be Resilient to Breast Cancer” from April 2023 to June 2024. Static symptom interrelationships were elucidated using undirected and Bayesian network models, complemented by an exploration of their dynamic counterparts through computer-simulated interventions. ResultsThe study included 602 patients with breast cancer. Both undirected networks and computer-simulated interventions concurred on the symptoms of distress and fatigue as optimal alleviation targets. The Bayesian network and computer-simulated interventions both emphasized “shortness of breath” as preventive care. Notably, Distress appeared to be the most effective target for interventions, and compared to fatigue (decreasing score=1.84∼2.20, decreasing prevalence=14.2∼16.7%). Conversely, disturbed sleep, despite its high position in Bayesian network, had no propelling effects on increasing the network’s overall symptom activity levels (increasing score<1). ConclusionsComputer-simulated intervention integrating with traditional network analysis can improve intervention precision and efficacy by prioritizing individual symptom impacts, both statically and dynamically.