Post-COVID-19 acute sarcopenia: physiopathology and management

In this review, we discuss the pathophysiologic and management aspects of acute sarcopenia in relation to SARS-CoV-2 infection. COVID-19 is as a multi-organ infectious disease characterized by a severe inflammatory and highly catabolic status, influencing the deep changes in the body build, especially the amount, structure, and function of skeletal muscles which would amount to acutely developed sarcopenia. Acute sarcopenia may largely impact patients’ in-hospital prognosis as well as the vulnerability to the post-COVID-19 functional and physical deterioration. The individual outcome of the COVID-19 and the degree of muscle mass and functional loss may be influenced by multiple factors, including the patient’s general pre-infection medical and functional condition, especially in older adults. This paper gathers the information about how the SARS-CoV-2 hyper-inflammatory involvement exacerbates the immunosenescence process, enhances the endothelial damage, and due to mitochondrial dysfunction and autophagy, induces myofibrillar breakdown and muscle degradation. The aftermath of these acute and complex immunological SARS-CoV-2-related phenomena, augmented by anosmia, ageusia and altered microbiota may lead to decreased food intake and exacerbated catabolism. Moreover, the imposed physical inactivity, lock-down, quarantine or acute hospitalization with bedrest would intensify the acute sarcopenia process. All these deleterious mechanisms must be swiftly put to a check by a multidisciplinary approach including nutritional support, early physical as well cardio-pulmonary rehabilitation, and psychological support and cognitive training. The proposed holistic and early management of COVID-19 patients appears essential to minimize the disastrous functional outcomes of this disease and allow avoiding the long COVID-19 syndrome. © 2021, The Author(s)

Baseline new bone formation does not predict bone loss in ankylosing spondylitis as assessed by quantitative computed tomography (QCT) - 10-year follow-up

<p>Abstract</p> <p>Background</p> <p>To evaluate the relationship between bone loss and new bone formation in ankylosing spondylitis (AS) using 10-year X-ray, dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT) follow-up.</p> <p>Methods</p> <p>Fifteen AS patients free from medical conditions and drugs affecting bone metabolism underwent X-ray, DXA and QCT in 1999 and 2009.</p> <p>Results</p> <p>In spine QCT a statistically significant (p = 0,001) decrease of trabecular bone mineral content (BMC) was observed (change ± SD: 18.0 ± 7.3 mg/cm³). In contrast, spine DXA revealed a significant increase of bone mineral density (change ± SD: -0.15 ± 0.14 g/cm²). The mean BMC, both at baseline and follow-up was significantly lower (p = 0.02 and p = 0.005, respectively) in advanced radiological group as compared to early radiological group. However, in multiple regression model after adjustment for baseline BMC, the baseline radiological scoring did not influence the progression of bone loss as assessed with QCT (p = 0.22, p for BMC*X-ray syndesmophyte scoring interaction = 0.65, p for ANOVA-based X-ray syndesmophyte scoring*time interaction = 0.39). Baseline BMC was the only significant determinant of 10-year BMC change, to date the longest QCT follow-up data in AS.</p> <p>Conclusions</p> <p>In AS patients who were not using antiosteoporotic therapy spine trabecular bone density evaluated by QCT decreased over 10-year follow-up and was not related to baseline radiological severity of spine involvement.</p

Nadciśnienie tętnicze w wieku podeszłym — izolowane nadciśnienie skurczowe. Stanowisko Polskiego Towarzystwa Nadciśnienia Tętniczego

Wraz ze starzeniem się społeczeństw rośnie częstość występowania nadciśnienia tętniczego (NT). Szczególną postacią NTzwiązaną ze starzeniem się jest izolowane nadciśnienie skurczowe (ISH), w którym podwyższone są wartości ciśnienia skurczowego (SBP; ≥ 140 mm Hg), a wartości ciśnienia rozkurczowego (DBP) pozostają &lt; 90 mm Hg. Przyczyną rozwoju ISH jest przebudowa tętnic prowadząca do zwiększania ich sztywności. Częstość ISH według danych polskich wynosi 26,8% u osób &gt; 60. rż. Izolowane nadciśnienie skurczowe u osób w wieku podeszłym zwiększa ryzyko sercowo-naczyniowe, np. trzykrotnie ryzyku udaru niedokrwiennego mózgu i dwukrotnie ryzyko zawału serca. Zarówno rozpoznanie NT, jak i jego leczenie w grupie pacjentów w wieku podeszłym wiążą się z wieloma problemami, takimi jak towarzysząca wielochorobowość, odmienne patomechanizmy NT i odpowiedź na leki hipotensyjne, gorsza współpraca,zespół kruchości, czy tendencja do hipotonii ortostatycznej i upadków. Dostępne dane potwierdzają jednak, że leczenie hipotensyjne w tej grupie (w tym &gt; 80. rż.) istotnie zmniejsza ryzyko zdarzeń sercowo-naczyniowych i śmiertelność. W leczeniu ISH rekomenduje się wszystkie klasyczne grupy leków hipotensyjnych, ze wskazaniem na rozpoczynanie terapii u większości chorych od leku złożonego (SPC). Szczególną pozycję w leczeniu pacjentów po 80 rż. ma indapamid. U większości chorych z ISH w wieku podeszłym należy dążyć do osiągnięcia wartości SBP wynoszącej 130–139 mm Hg w pomiarze gabinetowym, bez obniżania wartości DBP &lt; 65 mm Hg. Dla pacjentów w wieku ≥ 80 lat, u których wcześniej osiągnięto wymienione cele terapeutyczne, przy dobrej tolerancji, należy je utrzymać. U chorych w wieku 80 lat i starszych, bardziej obciążonych, należy przyjąć wartość docelową SBP &lt; 150 mm Hg

Arterial stiffness, central hemodynamics, and cardiovascular risk in hypertension.

This review summarizes several scientific contributions at the recent Satellite Symposium of the European Society of Hypertension, held in Milan, Italy. Arterial stiffening and its hemodynamic consequences can be easily and reliably measured using a range of noninvasive techniques. However, like blood pressure (BP) measurements, arterial stiffness should be measured carefully under standardized patient conditions. Carotid-femoral pulse wave velocity has been proposed as the gold standard for arterial stiffness measurement and is a well recognized predictor of adverse cardiovascular outcome. Systolic BP and pulse pressure in the ascending aorta may be lower than pressures measured in the upper limb, especially in young individuals. A number of studies suggest closer correlation of end-organ damage with central BP than with peripheral BP, and central BP may provide additional prognostic information regarding cardiovascular risk. Moreover, BP-lowering drugs can have differential effects on central aortic pressures and hemodynamics compared with brachial BP. This may explain the greater beneficial effect provided by newer antihypertensive drugs beyond peripheral BP reduction. Although many methodological problems still hinder the wide clinical application of parameters of arterial stiffness, these will likely contribute to cardiovascular assessment and management in future clinical practice. Each of the abovementioned parameters reflects a different characteristic of the atherosclerotic process, involving functional and/or morphological changes in the vessel wall. Therefore, acquiring simultaneous measurements of different parameters of vascular function and structure could theoretically enhance the power to improve risk stratification. Continuous technological effort is necessary to refine our methods of investigation in order to detect early arterial abnormalities. Arterial stiffness and its consequences represent the great challenge of the twenty-first century for affluent countries, and "de-stiffening" will be the goal of the next decades

Relation of changes in obesity measures to changes in lipids in the LIPIDOGRAM PLUS Study.

<p>Mean changes in HDL-C (blue squares) and triglycerides (red circles) across quartiles of changes in BMI (top panel) and waist circumference (bottom panel) between 2004 and 2006. Data are means and standard errors, the bottom quartile represents subjects from the lowest 25% of distribution in BMI or waist circumference increase between 2004 and 2006. P-values for trend across quartiles; Padj - adjusted (for age, sex, region of recruitment, height, education and smoking) level of statistical significance from test for trend.</p