Neuromuscular recovery from severe- and extreme-intensity exercise in men and women

Maximal voluntary contraction force (MVC), potentiated twitch force (Qpot), and voluntary activation (%VA) recover to baseline within 90s following extreme-intensity exercise. However, methodological limitations masked important recovery kinetics. We hypothesized reductions in MVC, Qpot, and %VA at task failure following extreme-intensity exercise would be less than following severe-intensity exercise, and Qpot and MVC following extreme-intensity exercise would show significant recovery within 120s but remain depressed following severe-intensity exercise. Twelve subjects (6 men) completed two severe-intensity (40, 50%MVC) and two extreme-intensity (70, 80%MVC) isometric knee-extension exercise bouts to task failure (Tlim). Neuromuscular function was measured at baseline, Tlim, and through 150s of recovery. Each intensity significantly reduced MVC and Qpot compared to baseline. MVC was greater at T¬lim (p<0.01) and at 150s of recovery (p=0.004) following exercise at 80%MVC compared to severe-intensity exercise. Partial recovery of MVC and Qpot were detected within 150s following Tlim for each exercise intensity; Qpot recovered to baseline values within 150s of recovery following exercise at 80%MVC. No differences in %VA were detected pre- to post-exercise or across recovery for any intensity. Although further analysis showed sex-specific differences in MVC and Qpot, future studies should closely examine sex-dependent responses to extreme-intensity exercise. It is clear, however, that these data reinforce that mechanisms limiting exercise tolerance during extreme-intensity exercise recover quickly. NOVELTY: •Severe- and extreme-intensity exercise cause independent responses in fatigue accumulation and the subsequent recovery time courses. •Recovery of MVC and Qpot occurs much faster following extreme-intensity exercise in both men and women.

Mean Levels of B-type Natriuretic Peptide (BNP) in Patients with Mitral Stenosis Caused by Rheumatic Heart Disease

Objective: Mitral stenosis caused by rheumatic heart disease (RHD) is the most common cause of valvular lesion in adults and prevalent in developing countries like Pakistan. Higher natriuretic peptide (BNP) levels can be observed in patients with moderate to severe untreated mitral stenosis and are associated with higher rates of morbidity and mortality. That is why this study aims to determine the association between levels of pro-BNP with severity (mild. Moderate, and severe) of mitral stenosis. Patients and Methods: This was a clinical prospective study carried out in the department of adult cardiology, national institute of cardiovascular diseases, Karachi from 8th august 2019 to 7th February 2020. Total 68 patients of either gender with age between 25-70 years had mitral stenosis of moderate to severe intensity (mitral valve area ≤1.5 cm2), diagnosed on echocardiography were included for final analysis. A simple blood sample was taken for the assessment of pro-BNP levels. Questionnaire was used for demographic & clinical data collection and analysed using SPSS version 22.0. Results: The overall mean age of study subjects was 42.21±11.50 years, ranging from 25 – 70 years. Among them, females were prevalent (n = 43, 63.2%). The overall mean serum BNP level was 1071.12±807.26 pg/ml and the mean difference of serum BNP level was not significant among groups of gender, age, and diabetes mellitus with p>0.05. Significantly raised levels of BNP were observed in patients with severe mitral stenosis as compared to moderate mitral stenosis, p<0.05 Conclusion: In conclusion, the mean BNP levels were higher in patients with severe Mitral Stenosis. Therefore, BNP may be used to complement the clinical and echocardiographic assessments in patients with Mitral Stenosis.

Anxiety, Perceived Stress, and Resilience during the COVID-19 Pandemic: Population Estimates of Persons Presenting to a General Practitioner in Romania

Facing the COVID-19 pandemic, individuals are experiencing severe mental distress. Thus, during the last year, drastic changes occurred in everyday life of every human being. Following social distancing and economic insecurity, significant increases in mental health concerns (loneliness, anxiety, depression, or insomnia) have developed. The objective of this study was to explore the anxiety, perceived stress, and resilience in a population presenting at the general practitioner, during the COVID-19 pandemic. Data were collected between February and April 2021 and 440 individuals who presented to the general practitioner were evaluated. Concerning anxiety level, almost half of the respondents (49,3%, N = 217) scored above the threshold value on the anxiety scale (mild intensity 38.6%, moderate intensity 9.9%, severe intensity 0.8%). Having a low level of resilience, as well as experiencing a high level of stress, are both predictive of the occurrence of high anxiety (p < 0.001, r = −0.551 and p < 0.001, r = 0.622, respectively). Furthermore, resilience is negatively related to perceived stress (p < 0.001, r = −0.676). It is critical in the current crisis to recognize those at risk of developing mental illnesses, taking into consideration the various socioeconomic classes, as well as to maintain and improve the general public’s mental health using appropriate psychological interventions.

Shorter constant work rate cycling tests as proxies for longer tests in highly trained cyclists

Severe-intensity constant work rate (CWR) cycling tests are useful for monitoring training progression and adaptation as they impose significant physiological and psychological strain and thus simulate the high-intensity competition environment. However, fatiguing tests require substantial recovery and may disrupt athlete training or competition preparation. Therefore, the development of a brief, minimally fatiguing test providing comparable information is desirable. Purpose : To determine whether physiological variables measured during, and functional decline in maximal power output immediately after, a 2-min CWR test can act as a proxy for 4-min test outcomes. Methods : Physiological stress was monitored and pre-to-post-CWR changes in 10-s sprint power computed (to estimate performance fatigability) during 2- and 4-min CWR tests in high-level cyclists. Results : The 2-min CWR test evoked a smaller decline in sprint mechanical power (32% vs. 47%, p <0.001), however both the physiological variables and sprint mechanical power were independently and strongly correlated between 2- and 4-min tests. Differences in V?O 2peak and blood lactate concentration in both CWR tests were strongly associated with the decline in sprint mechanical power. Conclusion : Physiological variables measured during, and the loss in sprint mechanical power measured after, a severe-intensity 2-min CWR test were less than in the 4-min test. Yet strong correlations between 2- and 4-min test outcomes indicated that the 2-min test can be used as a proxy for the longer test. Because shorter tests are less strenuous, they should have less impact on training and competition preparation and may therefore be more practically applicable within the elite performance environment.

COVID-19 Pandemic: Psychological Impact on Postgraduate Gynae Residents in Pakistan

Objective: The aim of this study is to determine the psychological impact (anxiety, stress and depression) on postgraduate Gynae residents in Pakistan during COVID-19. Study Design: Cross-sectional study Place and Duration: The study was conducted through a questionnaire of Google Proforma which was distributed among the PGRs of Gynae and Obs department of different centres of Pakistan. The study was conducted for nine months during from April 2020 to December 2020. Methods: Total 180 participants (PGRs) were presented in this study. Complete characteristics of the participant were obtained. Postgraduate Gynae Residents from different centers were enrolled in this study. DASS-21 scale was used to measure the severity of anxiety, depression and stress among all participants. Complete data was analyzed by SPSS 24.0 version. Results: Mean age of the participants was 30.24±3.08 years. 109 (60.5%) participants were married and the rest 71 (39.5%) were unmarried residents. Frequency of depression was found among 130 (72.2%) participants followed by anxiety 118 (65.5%), stress found in 105 (58.3%) participants. Conclusion: We concluded in this study that the prevalence of psychological impacts on Gynae residents were significantly higher in terms of mild, moderate and severe intensity. Early detection and prevention of factors i.e. depression, anxiety and stress are necessary in hospitals. Keywords: Post graduate, Gynae residents, COVID-19, Psychological impacts

Steady-state $$\dot{V}{\text{O}}_{2}$$ above MLSS: evidence that critical speed better represents maximal metabolic steady state in well-trained runners

The metabolic boundary separating the heavy-intensity and severe-intensity exercise domains is of scientific and practical interest but there is controversy concerning whether the maximal lactate steady state (MLSS) or critical power (synonymous with critical speed, CS) better represents this boundary. We measured the running speeds at MLSS and CS and investigated their ability to discriminate speeds at which $$\dot{V}{\text{O}}_{2}$$ V ˙ O 2 was stable over time from speeds at which a steady-state $$\dot{V}{\text{O}}_{2}$$ V ˙ O 2 could not be established. Ten well-trained male distance runners completed 9–12 constant-speed treadmill tests, including 3–5 runs of up to 30-min duration for the assessment of MLSS and at least 4 runs performed to the limit of tolerance for assessment of CS. The running speeds at CS and MLSS were significantly different (16.4 ± 1.3 vs. 15.2 ± 0.9 km/h, respectively; P < 0.001). Blood lactate concentration was higher and increased with time at a speed 0.5 km/h higher than MLSS compared to MLSS (P < 0.01); however, pulmonary $$\dot{V}{\text{O}}_{2}$$ V ˙ O 2 did not change significantly between 10 and 30 min at either MLSS or MLSS + 0.5 km/h. In contrast, $$\dot{V}{\text{O}}_{2}$$ V ˙ O 2 increased significantly over time and reached $$\dot{V}{\text{O}}_{2\,\,\max }$$ V ˙ O 2 max at end-exercise at a speed ~ 0.4 km/h above CS (P < 0.05) but remained stable at a speed ~ 0.5 km/h below CS. The stability of $$\dot{V}{\text{O}}_{2}$$ V ˙ O 2 at a speed exceeding MLSS suggests that MLSS underestimates the maximal metabolic steady state. These results indicate that CS more closely represents the maximal metabolic steady state when the latter is appropriately defined according to the ability to stabilise pulmonary $$\dot{V}{\text{O}}_{2}$$ V ˙ O 2 .

Frequency and phenotype of headache in covid-19: a study of 2194 patients

To estimate the frequency of headache in patients with confirmed COVID-19 and characterize the phenotype of headache attributed to COVID-19, comparing patients depending on the need of hospitalization and sex, an observational study was done. We systematically screened all eligible patients from a reference population of 261,431 between March 8 (first case) and April 11, 2020. A physician administered a survey assessing demographic and clinical data and the phenotype of the headache. During the study period, 2194 patients out of the population at risk were diagnosed with COVID-19. Headache was described by 514/2194 patients (23.4%, 95% CI 21.7–25.3%), including 383/1614 (23.7%) outpatients and 131/580 (22.6%) inpatients. The headache phenotype was studied in detail in 458 patients (mean age, 51 years; 72% female; prior history of headache, 49%). Headache was the most frequent first symptom of COVID-19. Median headache onset was within 24 h, median duration was 7 days and persisted after 1 month in 13% of patients. Pain was bilateral (80%), predominantly frontal (71%), with pressing quality (75%), of severe intensity. Systemic symptoms were present in 98% of patients. Headache frequency and phenotype was similar in patients with and without need for hospitalization and when comparing male and female patients, being more intense in females.Trial registration: This study was supported by the Institute of Health Carlos III (ISCIII), code 07.04.467804.74011 and Regional Health Administration, Gerencia Regional de Salud, Castilla y Leon (GRS: 2289/A/2020).

Impact of retrofitting work on vulnerability reduction of local buildings in Kabul, Afghanistan

Rapid urbanisation of Afghan cities without proper construction regulation has exposed their population to a high risk of damage from disasters such as earthquakes. With the growing construction of local non-engineered buildings and an existing level of hazard of 0.8 g, a high risk of casualties and building damage threatens Kabul in the event of a disaster. This study reports and evaluates a recent retrofitting project in Kabul City by ‘Project for City Resilience’, carried out under the supervision of the United Nation Human Settlements Program (UN-Habitat) for 48 retrofitted sun-dried clay brick masonry buildings in Kabul. The project was executed by local masons and welders who were trained as a part of the project, and the main tasks included installation of an additional steel frame, additional reinforced concrete foundation ring, ceiling replacement and wall strengthening (via mesh and plaster). After a visual assessment of retrofitted buildings considering the original retrofitting design and actual work done, a vulnerability index for retrofitted buildings was developed based on a behaviour modifier factor, which was assigned to each retrofitting activity using a combination of values and a proportion of scores for each retrofitting activity. The results indicate that training of local masons and welders to undertake retrofitting activities could decrease the damage ratio by 15% – 20% for peak ground acceleration values of 0.3 g and higher. The methods mentioned in this study can be used to make existing sun-dried clay brick masonry buildings sufficiently resistant to earthquakes of moderate-to-severe intensity.

Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey

<b><i>Introduction:</i></b> Moral distress is a negative affective response to a situation in which one is compelled to act in a way that conflicts with one’s values. Little is known about the workplace scenarios that elicit moral distress in nephrology fellows. <b><i>Methods:</i></b> We sent a moral distress survey to 148 nephrology fellowship directors with a request to forward it to their fellows. Using a 5-point (0–4) scale, fellows rated both the frequency (never to very frequently) and severity (not at all disturbing to very disturbing) of commonly encountered workplace scenarios. Ratings of ≥3 were used to define “frequent” and “moderate-to-severe” moral distress. <b><i>Results:</i></b> The survey was forwarded by 64 fellowship directors to 386 fellows, 142 of whom (37%) responded. Their mean age was 33 ± 3.6 years and 43% were female. The scenarios that most commonly elicited moderate to severe moral distress were initiating dialysis in situations that the fellow considered futile (77%), continuing dialysis in a hopelessly ill patient (81%) and carrying a high patient census (75%), and observing other providers giving overly optimistic descriptions of the benefits of dialysis (64%). Approximately 27% had considered quitting fellowship during training, including 9% at the time of survey completion. <b><i>Conclusion:</i></b> A substantial majority of nephrology trainees experienced moral distress of moderate to severe intensity, mainly related to the futile treatment of hopelessly ill patients. Efforts to reduce moral distress in trainees are required.