Three-month recovery from common negative physical, functional, and psychosocial effects among individuals infected with COVID-19: a single observational group repeated measure study

Purpose: We examined three-month recovery from common negative effects of COVID-19 infection on select physical, functional, and psychosocial parameters among infected individuals and their implications for rehabilitation programs. Methods: Twenty-one subjects participated in this study. Four standardized questionnaires were used to assess dyspnea, physical, and psychosocial variables in this study. The post-test survey was conducted 90 days following the pre-test survey. Wilcoxon-Signed Rank test and paired t-test were used to compare the variables data between pre- and post-testing time points. Results: Dyspnea scores decreased from (pre: 2 vs post:1, Z=-3.276, p=0.001, r=.50). Work performance scores increased from (pre: 42 ±25 vs post: 57 ±21, t(20) =-2.868, p=0.010, r=.62). Social functioning increased from (pre: 44 ±27 vs post: 60 ±24, t(20) =-3.525, p=0.002, r=.76) and pain scores from (pre: 42 ±30 vs post: 53 ±25, t(20) =-2.134, p=0.045, r=.46) also increased across the 90 days. Conclusions: Long-term symptoms after COVID-19 infection include ongoing physical, functional, and psychosocial deficits. While dyspnea decreased and work performance and social functioning increased, we observed a concomitant increase in pain scores over the 90-day measurement period. Long-term multidisciplinary rehabilitation programs should be designed to address the ongoing deficits among this population

Dynamics of Multiple Trafficking Behaviors of Individual Synaptic Vesicles Revealed by Quantum-Dot Based Presynaptic Probe

Although quantum dots (QDs) have provided invaluable information regarding the diffusive behaviors of postsynaptic receptors, their application in presynaptic terminals has been rather limited. In addition, the diffraction-limited nature of the presynaptic bouton has hampered detailed analyses of the behaviors of synaptic vesicles (SVs) at synapses. Here, we created a quantum-dot based presynaptic probe and characterized the dynamic behaviors of individual SVs. As previously reported, the SVs exhibited multiple exchanges between neighboring boutons. Actin disruption induced a dramatic decrease in the diffusive behaviors of SVs at synapses while microtubule disruption only reduced extrasynaptic mobility. Glycine-induced synaptic potentiation produced significant increases in synaptic and inter-boutonal trafficking of SVs, which were NMDA receptor- and actin-dependent while NMDA-induced synaptic depression decreased the mobility of the SVs at synapses. Together, our results show that sPH-AP-QD revealed previously unobserved trafficking properties of SVs around synapses, and the dynamic modulation of SV mobility could regulate presynaptic efficacy during synaptic activity

Structure of the Extracellular Portion of CD46 Provides Insights into Its Interactions with Complement Proteins and Pathogens

The human membrane cofactor protein (MCP, CD46) is a central component of the innate immune system. CD46 protects autologous cells from complement attack by binding to complement proteins C3b and C4b and serving as a cofactor for their cleavage. Recent data show that CD46 also plays a role in mediating acquired immune responses, and in triggering autophagy. In addition to these physiologic functions, a significant number of pathogens, including select adenoviruses, measles virus, human herpes virus 6 (HHV-6), Streptococci, and Neisseria, use CD46 as a cell attachment receptor. We have determined the crystal structure of the extracellular region of CD46 in complex with the human adenovirus type 11 fiber knob. Extracellular CD46 comprises four short consensus repeats (SCR1-SCR4) that form an elongated structure resembling a hockey stick, with a long shaft and a short blade. Domains SCR1, SCR2 and SCR3 are arranged in a nearly linear fashion. Unexpectedly, however, the structure reveals a profound bend between domains SCR3 and SCR4, which has implications for the interactions with ligands as well as the orientation of the protein at the cell surface. This bend can be attributed to an insertion of five hydrophobic residues in a SCR3 surface loop. Residues in this loop have been implicated in interactions with complement, indicating that the bend participates in binding to C3b and C4b. The structure provides an accurate framework for mapping all known ligand binding sites onto the surface of CD46, thereby advancing an understanding of how CD46 acts as a receptor for pathogens and physiologic ligands of the immune system

Complications related to deep venous thrombosis prophylaxis in trauma: a systematic review of the literature

Deep venous thrombosis prophylaxis is essential to the appropriate management of multisystem trauma patients. Without thromboprophylaxis, the rate of venous thrombosis and subsequent pulmonary embolism is substantial. Three prophylactic modalities are common: pharmacologic anticoagulation, mechanical compression devices, and inferior vena cava filtration. A systematic review was completed using PRISMA guidelines to evaluate the potential complications of DVT prophylactic options. Level one evidence currently supports the use of low molecular weight heparins for thromboprophylaxis in the trauma patient. Unfortunately, multiple techniques are not infrequently required for complex multisystem trauma patients. Each modality has potential complications. The risks of heparin include bleeding and heparin induced thrombocytopenia. Mechanical compression devices can result in local soft tissue injury, bleeding and patient non-compliance. Inferior vena cava filters migrate, cause inferior vena cava occlusion, and penetrate the vessel wall. While the use of these techniques can be life saving, they must be appropriately utilized

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ABSTRACT INTRODUCTION Chronic kidney disease of unknown etiology is occurring in various geographic areas worldwide. Cases lack typical risk factors associated with chronic kidney disease, such as diabetes and hypertension. It is epidemic in El Salvador, Central America, where it is diagnosed with increasing frequency in young, otherwise-healthy male farmworkers. Suspected causes include agrochemical use (especially in sugarcane ¿ elds), physical heat stress, and heavy metal exposure. OBJECTIVE To evaluate the geographic relationship between unspeci¿ ed chronic kidney disease (unCKD) and nondiabetic chronic renal failure (ndESRD) hospital admissions in El Salvador with the proximity to cultivated crops and ambient temperatures. METHODS Data on unCKD and ndESRD were compared with environmental variables, crop area cultivated (indicator of agrochemical use) and high ambient temperatures. Using geographically weighted regression analysis, two model sets were created using reported municipal hospital admission rates per ten thousand population for unCKD 2006-2010 and rates of ndESRD 2005-2010. These were assessed against local percent of land cultivated by crop (sugarcane, coffee, corn, cotton, sorghum, and beans) and mean maximum ambient temperature, with Moran's indices determining data clustering. Two-dimensional geographic models illustrated parameter spatial distribution. RESULTS Bivariate geographically weighted regressions showed statistically signi¿ cant correlations between percent area of sugarcane, corn, cotton, coffee, and bean cultivation, as well as mean maximum ambient temperature with both unCKD and ndESRD hospital admission rates. Percent area of sugarcane cultivation had greatest statistical weight (p 0.001; R p 2 = 0.77 for unCKD). The most statistically signi¿ cant multivariate geographically weighted regression model for unCKD included percent area of sugarcane, cotton and corn cultivation (p 0.001; R p 2 = 0.80), while, for ndESRD, it included the percent area of sugarcane, corn, cotton and coffee cultivation (R p 2 = 0.52). Univariate unCKD and ndESRD Moran's I (0.20 and 0.33, respectively) indicated some degree of clustering. Ambient temperature did not improve multivariate geographically-weighted regression models for unCKD or ndESRD. Local bivariate Moran's indices with relatively high positive values and statistical signi¿ cance (0.3-1.0, p 0.05) indicated positive clustering between unCKD hospital admission rates and percent area of sugarcane as well as cotton cultivation. The greatest positive response for clustering values did not consistently plot near the highest temperatures; there were some positive clusters in regions of lower temperatures. Clusters of ndESRD were also observed, some in areas of relatively low chronic kidney disease incidence in western El Salvador. CONCLUSIONS High temperatures do not appear to strongly inÀ uence occurrence of unCKDu proxies. CKDu in El Salvador may arise from proximity to agriculture to which agrochemicals are applied, especially in sugarcane cultivation. The ¿ ndings of this preliminary ecological study suggest that more research is needed to assess and quantify presence of speci¿ c agrochemicals in high-CKDu areas

Persistent dyspnea, declined moderate to vigorous physical activity, functional status, and quality of life during the post-acute phase of COVID-19 infection: A pilot case control study.

Abstract Purpose: The purpose of this study was to explore the multifaceted impacts of post-acute phase of COVID-19 infection on the sense of dyspnea, select intensities of physical activity, functional, and psychological variables among survivors compared to age matched healthy participants and their implications for rehabilitation programs in this population. Methods: Seventy-eight (male, female age 30-70 yrs.) participants (39 COVID-infected, CI and 39 age-matched healthy controls, HC). Four questionnaires were used to assess the variables in this study: dyspnea scale of the Modified Medical Research Council (mMRC), International Physical Activity Questionnaire (IPAQ), Functional Status Questionnaire (FSQ), and the RAND-36 measure of health-related quality of life. A Mann Whitney test was used to compare the variables data between HC and CI. Results: Dyspnea scores in CI group were significantly higher than in HC group (mean = 1.77 vs 0.13). Scores of IPAQ, FSQ and RAND-36 HRQoL questionnaires were also significantly lower in CI than in HC group. However, sitting and walking activity scores of IPAQ were not significantly different between both groups. Conclusions: The results of the CI group were significantly different than the HC group in all parameters (except sitting and walking components of the IPAQ) of the questionnaires used in this study. Our findings provide the multi-disciplinary rehabilitation professionals the opportunity to tailor their interventions to meet the specific needs of COVID-19 survivors

A Multifaceted Organizational Physician Assessment Program

Objective: To provide validity evidence for a multifaceted organizational program for assessing physician performance and evaluate the practical and psychometric consequences of 2 approaches to scoring (mean vs top box scores). Participants and Methods: Participants included physicians with a predominantly outpatient practice in general internal medicine (n=95), neurology (n=99), and psychiatry (n=39) at Mayo Clinic from January 1, 2013, through December 31, 2014. Study measures included hire year, patient complaint and compliment rates, note-signing timeliness, cost per episode of care, and Likert-scaled surveys from patients, learners, and colleagues (scored using mean ratings and top box percentages). Results: Physicians had a mean ± SD of 0.32±1.78 complaints and 0.12±0.76 compliments per 100 outpatient visits. Most notes were signed on time (mean ± SD, 96%±6.6%). Mean ± SD cost was 0.56±0.59 SDs above the institutional average. Mean ± SD scores were 3.77±0.25 on 4-point and 4.06±0.31 to 4.94±0.08 on 5-point Likert-scaled surveys. Mean ± SD top box scores ranged from 18.6%±16.8% to 90.7%±10.5%. Learner survey scores were positively associated with patient survey scores (r=0.26; P=.003) and negatively associated with years in practice (r=−0.20; P=.02). Conclusion: This study provides validity evidence for 7 assessments commonly used by medical centers to measure physician performance and reports that top box scores amplify differences among high-performing physicians. These findings inform the most appropriate uses of physician performance data and provide practical guidance to organizations seeking to implement similar assessment programs or use existing performance data in more meaningful ways