Feasibility of an Outpatient Training Program after COVID-19

Long-term physical consequences of coronavirus disease 2019 (COVID-19) are currently being reported. As a result, the focus is turning towards interventions that support recovery after hospitalization. To date, the feasibility of an outpatient program for people recovering from COVID-19 has not been investigated. This study presents data for a physiotherapy-led, comprehensive outpatient pulmonary rehabilitation (PR) program. Patients were recruited after hospital discharge. Training consisted of twice weekly, interval-based aerobic cycle endurance (ACE) training, followed by resistance training (RT); 60–90 min per session at intensities of 50% peak work rate; education and physical activity coaching were also provided. Feasibility outcomes included: recruitment and dropout rates, number of training sessions undertaken, and tolerability for dose and training mode. Of the 65 patients discharged home during the study period, 12 were successfully enrolled onto the program. Three dropouts (25%) were reported after 11–19 sessions. Tolerability of interval-based training was 83% and 100% for exercise duration of ACE and RT, respectively; 92% for training intensity, 83% progressive increase of intensity, and 83% mode in ACE. We tentatively suggest from these preliminary findings that the PR protocol used may be both feasible, and confer benefits to a small subgroup of patients recovering from COVID-19

Perfect magnetohydrodynamics as a field theory

We propose the generally covariant action for the theory of a self-coupled complex scalar field and electromagnetism which by virtue of constraints is equivalent, in the regime of long wavelengths, to perfect magnetohydrodynamics (MHD). We recover from it the Euler equation with Lorentz force, and the thermodynamic relations for a prefect fluid. The equation of state of the latter is related to the scalar field's self potential. We introduce 1+3 notation to elucidate the relation between MHD and field variables. In our approach the requirement that the scalar field be single valued leads to the quantization of a certain circulation in steps of $\hbar$; this feature leads, in the classical limit, to the conservation of that circulation. The circulation is identical to that in Oron's generalization of Kelvin's circulation theorem to perfect MHD; we here characterize the new conserved helicity associated with it. We also demonstrate the existence for MHD of two Bernoulli-like theorems for each spacetime symmetry of the flow and geometry; one of these is pertinent to suitably defined potential flow. We exhibit the conserved quantities explicitly in the case that two symmetries are simultaneously present, and give examples. Also in this case we exhibit a new conserved MHD circulation distinct from Oron's, and provide an example.Comment: RevTeX, 16 pages, no figures; clarifications added and typos corrected; version to be published in Phys. Rev.

One year follow-up of physical performance and quality of life in patients surviving COVID-19: a prospective cohort study

INTRODUCTION: The coronavirus disease (COVID-19) continues to affect many countries globally, with the long-term impact of the disease now being recognized. According to the latest research, some of the affected individuals continue to experience functional limitations, reduced physical performance and impaired health-related quality of life (HRQoL) even after eight months. This prospective cohort study aimed to describe the longer-term recovery of physical performance and HRQoL in COVID-19 survivors over one year. METHOD: A cohort (n = 43; 32-84 years old) hospitalized with COVID-19 between March and June 2020 was followed over one year and assessed at three time points: hospital discharge, 3 months and 12 months post-admission. Participants experienced mild (10/43) to critical (6/43) pneumonia and stayed in the hospital for a median of 10 days (IQR 9). Participants were assessed for physical performance (six-minute walk test), HRQoL (EQ-5D-5L), COVID-19 related limitations in functionality (PCFS), hospital-related anxiety and depression (HADS-A/-D), lung function (FEV1, FVC) and dyspnea during activity (mMRC). All assessments were conducted by physiotherapists trained in cardio-respiratory rehabilitation. RESULTS: After discharge, 8/34 showed reduced physical performance, 9/42 had lower HRQoL and 14/32 had COVID-19 induced limitations in functionality on the PCFS scale. Physical performance did not change significantly between discharge and 12-month follow-up, but 15/34 participants showed clinically relevant improvements in walking distance (>30 m). However, 16/34 had a decreased walking distance >30 m when comparing 3-month to 12-month follow-up. At 12 months, 12/41 of participants still perceived COVID-19 related limitations in daily life on the PCFS scale. For HRQoL, 12/41 participants still perceived moderate-to-severe symptoms of pain and discomfort and 13/41 slight-to-severe symptoms of anxiety and depression. CONCLUSION: This cohort of adult patients hospitalized for mild to severe COVID-19 in Switzerland was generally mildly affected but still reported some limitations after one year. These results offer preliminary indications for ongoing support after hospitalization and point towards the need for specific, individualized follow-up to support their recovery. ClinicalTrials.gov (NCT04375709

The surgical management of recurrent stress urinary incontinence: a systematic review

BACKGROUND: Despite a wide spectrum of interventions, surgical treatments of recurrent stress urinary incontinence (SUI) are associated with high failure rates. OBJECTIVES: To systematically review current evidence on the effectiveness of surgical interventions for recurrent SUI. DATA SOURCES: An electronic database search was undertaken (1980-2014). Keywords were: "stress urinary incontinence," "failure," "recurrence," "treatment." References of identified studies and abstracts from conferences were considered. STUDY SELECTION: We restricted the search to female patients and currently used surgical procedures, including studies with five or more cases. After the initial yield, studies were selected following title screening, abstract and full text scrutiny. RESULTS: The pooled objective cure rates of colposuspension for recurrent SUI are 76% (95% CI ±5.04), whereas rates for midurethral sling procedures are 68.5% (95% CI ±3.11). Repeat midurethral sling procedures have pooled success rates of 66.2% (95% CI ±4) but those of the transobturator approach appear lower than retropubic procedures. Pubovaginal slings for recurrent SUI have pooled success of 79.3% (95% CI ±6.54). Success rates for adjustable continence therapy and adjustable slings for recurrent SUI are 53.8% (95% CI ±5.28), whereas for midurethral sling fixation procedures the pooled success is 61% (95% CI ±10.56). Urethral bulking injections have success rates of 38% (95% CI ±10.7). Laparoscopic two-team sling procedures, salvage spiral slings, and artificial urinary sphincter have shown promising results, but there are limited data on recurrent cases. CONCLUSION: There is a wide spectrum of surgical interventions reported for secondary or tertiary treatment of SUI. A common characteristic for all recurrent procedures is a lower success rate compared with those reported following primary procedures

Quantifying the evolution and impact of antimalarial drug resistance: drug use, spread of resistance, and drug failure over a 12-year period in Papua New Guinea

BACKGROUND. Antimalarial use is a key factor driving drug resistance and reduced treatment effectiveness in Plasmodium falciparum malaria, but there are few formal, quantitative analyses of this process. METHODS. We analyzed drug usage, drug failure rates, and the frequencies of mutations and haplotypes known to be associated with drug resistance over a 12-year period (1991-2002) in a site in Papua New Guinea. This period included 2 successive treatment policies: amodiaquine (AQ) or chloroquine (CQ) from 1991 through 2000 and their subsequent replacement by sulfadoxine-pyrimethamine (SP) plus AQ or SP plus CQ. RESULTS. Drug use approximated 1 treatment per person-year and was associated with increasing frequencies of pfcrt and pfmdr1 mutations and of treatment failure. The frequency of pfdhfr mutations also increased, especially after the change in treatment policy. Treatment failure rates multiplied by 3.5 between 1996 and 2000 but then decreased dramatically after treatment policy change. CONCLUSIONS. With high levels of resistance to CQ, AQ, and SP, the deployment of the combination of both drugs appears to increase clinical effectiveness but does not decelerate growth of resistance. Our estimates of mutation and haplotype frequencies provide estimates of selection coefficients acting in this environment, which are key parameters for understanding the dynamics of resistanc