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2 Minute Medicine Rewind October 14, 2024
1. In this prospective cohort of patients with post-COVID-19 syndrome (PCS), exercise-based medical rehabilitation led to improvements in physical and mental wellbeing, specifically improving cardiopulmonary fitness.
Evidence Rating Level: 1 (Excellent)
Post-COVID-19 syndrome (PCS) includes a variety of symptoms that emerge after an acute infection with SARS-CoV-2. These symptoms are distinguished by lasting longer than 12 weeks with the additional possibility of further development of new symptoms. Typically, the most prevalent symptoms include fatigue, muscular weakness, dyspnea, stress, and cognitive impairments. This prospective cohort study included patients with PCS treated in the inpatient unit. These patients were deemed eligible if they had at least one COVID-19 infection, and ongoing or newly developed deficits lasting at least 3 months before recruitment. A mix of therapies including active, cognitive, and passive therapies were provided to the patients as part of their rehabilitation process. The study assessed disease burden at three different points throughout the trial – enrollment, discharge, and after six months follow-up. Several questionnaires were used to measure fatigue, health-related quality of life which included weight domains, and work ability 6 months post discharge. In total, the rehabilitation center received referrals for 143 patients (36% female, 47.1±12.7 years; 64% male, 52.0±9.1 years; p=0.018) 262.0±128.8 days after infection with COVID-19. The results showed that the most commonly reported symptom was fatigue/exercise intolerance (81.4%), shortness of breath (74.5%) and cognitive dysfunction (52.4%). At baseline, women had a greater exercise capacity (82.0±14.3%) compared to men (68.8±13.3%, p<0.001), while also having better improvement in workload (p=0.026), and vital capacity (VC) at baseline (p=0.019). Additionally, women had higher heart rate and O2-pulse compared to men (p ≤ 0.018). Comparatively, men had higher values of FEV1, FEV1/VC, PEF, and maximum expiratory flow (MEF26-75) (p≤0.038). The mean time for patient rehabilitation took approximately 4 weeks (28.8 ± 6.1 days) with no significant difference between males and females (p = 0.401). Women with impaired pulmonary function had higher levels of fatigue and lower levels of wellbeing at baseline (p < 0.05). The patients noted improvements in their mental and physical health including fatigue, anxiety, and depression. In this prospective cohort study of patients with PCS, exercise rehabilitation helped to decrease restrictions in cardiopulmonary fitness and pulmonary function.
Sleep, well-being, and cognition in medical interns on a float or overnight call schedule
1. In a cohort of medical interns, working on a call schedule was associated with worse sleep, well-being, and cognition outcomes compared to working a float schedule.
2. In the call group, when naps were taken on night shifts, vigilance was improved compared to nights without naps.
Evidence Rating Level: 1 (Excellent)
Working extended hours has disruptive effects on the normal regulation of the circadian rhythm, but working long hours are required of health care workers. Specifically, long shifts are required of medical interns leading to many overnight shifts that negatively impact sleep and cognitive function. To assess the effectiveness of different working schedules, this study compared the cognitive performance of interns who worked on a call schedule compared to those who worked on a float schedule. The participants were recruited from hospital departments that followed either a fully on call schedule (the call group), or a float schedule (float group). The on-call group usually worked from 7 am to 5 pm but for 5-7 days a month, they performed an overnight call shift from 8 am to 1 pm the next day, while the float group mostly worked from 7 AM to 5 PM every day. To record the necessary data, the participants wore an Oura Ring 3 for sleep and physical activity and used an EMA smartphone application for daily cognitive assessments. The study included a total of 96 participants (mean [SD] age, 24.7 [1.1] years), with 41 being on a call schedule and 55 on a float schedule. Amongst the participants, there were 4808 nights of sleep (84.2%) recorded and 3390 days (59.3%) of well-being and cognitive assessments. Compared to the float group (mean [SD], 5.4 [2.3]), the call group participants reported poorer subjective sleep quality (PSQI mean [SD], 65 [2.3]; t = 2.16; 95% CI, 0.09 to 2.15; P = .03). As well, the float group reported higher SRI scores (mean [SD] score, 69.4 [6.16]) compared to the call group (SRI mean [SD] score, 56.1 [11.3]; t91 = 6.81; mean difference, 13.3; 95% CI, 9.40 to 17.22; P < .001). After participants completed overnight call shifts, they reported worse sleep quality (β = -0.98; 95% CI, -1.11 to -0.86; P < .001), and mood (β = -6.79; 95% CI, -9.32 to -4.27; P<.001), decreased motivation (β = -10.09; 95% CI, -12.55 to -7.63; P < .001), and increased sleepiness (β = 15.96; 95% CI, 13.01 to 18.90; P < .001) compared to their day shifts. The participants in the float group did not report significant changes. When night shifts included naps, vigilance performance was higher (16 ms faster; β = -15.72; 95% CI, -28.27 to -3.17; P = .01) compared to night shifts without naps. Overall, this cohort study showed that a float schedule was beneficial for physician sleep, mood, and cognitive performance, compared to a traditional call schedule.
Neurologic recovery at discharge and long-term survival after cardiac arrest
1. In a cohort of individuals who experienced cardiac arrest, complete neurologic recovery, defined as a Cerebral Performance Category (CPC) 1 was associated with improved long-term survival compared to moderate (CPC 2) or severe (CPC 3-4) neurologic disability.
Evidence Rating Level: 1 (Excellent)
After patients have experienced cardiac arrest, it is common to then experience brain injury as the cause of death. The pathophysiology behind this is likely due to global ischemia during cardiac arrest and reperfusion issues once circulation gets restored. It is of utmost importance to prevent brain injury after cardiac arrest, and thus improve neurologic recovery. Previous research has shown that a better Cerebral Performance Category (CPC) scale score has been associated with better long-term survival. To understand if this is true, this cohort study investigated whether complete neurologic recovery, defined as CPC 1 at discharge was associated with improved survival. This study included patients that experienced an in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) that were aged 18 years or older. CPC was used to define neurologic outcome at discharge among the patients. CPC 1 indicates minimal neurologic injury, CPC 2 indicates moderate neurological injury, CPC 3 indicates severe neurological disability, CPC 4 is a persistent vegetative state, and CPC 5 is equivalent to death. The primary outcome was survival during the follow-up period while the secondary outcome included survival in the subgroups of IHCA or OHCA. A total of 9390 patients (median [IQR] age, 69.0 [58.0-77.0] years) who survived a cardiac arrest were included in the study, and 5214 (65.3%) of them had a shockable rhythm. For neurologic outcome, 7374 patients (78.5%) had CPC 1, 1358 patients (14.5%) had CPC 2, and 658 patients (7.0%) had either CPC 3 or 4 at discharge. Of the patients included, 3102 died during the study period. The survival proportions were identified at 5 years to be 73.8% (95% CI, 72.5%-75.0%), 64.7% (95% CI, 62.4%-67.0%), and 54.2% (95% CI, 50.6%-57.8%) for CPC 1, CPC 2, and CPC 3 and 4 respectively. Death hazards increased with higher CPC score, compared to CPC 1 (CPC 2: aHR, 1.57 [95% CI, 1.40-1.75]; CPC 3-4: aHR, 2.46 [95% CI, 2.13-2.85]). The subgroups IHCA and OHCA saw similar associations. In summary, this cohort study found that complete neurologic recovery at discharge (CPC 1) was associated with increased long-term survival compared to moderate or severe neurologic function disabilities or coma (CPC 2 and CPC 3-4).
1. In a cohort of individuals with invasive ductal carcinoma (IDC) that underwent breast-conserving surgery (BCS) and adjuvant breast radiotherapy, the use of statins was associated with a decreased risk of major adverse cardiovascular events (MACE).
2. All statins were effective at reducing the risk of MACE; however, hydrophilic statins (specifically rosuvastatin and pravastatin) had the greatest positive effect.
Evidence Rating Level: 2 (Good)
Breast cancer is one of the most common types of cancers worldwide, including in Taiwan, where the incidence has increased in recent years. Radiation therapy is a new treatment that has therapeutic benefits for early-stage breast cancer after breast-conserving surgery (BCS). Although some positive effects are associated with this treatment, there is also evidence of cardiotoxicity effects varying based on radiation dose, systemic agents, and other risk factors for coronary heart disease in the patient. Previous preclinical studies have shown support for the cardioprotective benefits of statins; however, they have not been studied in this context or type of study before. Thus, the goal of this study was to understand the benefits of statin use and their ability to reduce major adverse cardiovascular event (MACE) risk in breast cancer patients undergoing BCS and radiotherapy. Patients were eligible to participate if they were 18 years or older, had a confirmed diagnosis of breast invasive ductal carcinoma (IDC), stage I disease with no metastasis, and an Eastern Cooperative Oncology Group performance status of 0 or 1. Adjusted hazard ratios (aHRs) were calculated to examine the relationship between statin use and MACE risk. The study included 1481 patients diagnosed with left-sided stage I breast IDC. Among these patients, 1039 and 442 patients were assigned to the nonstatin and statin groups respectively. After performing propensity score matching (PSM), the incidence of MACE was significantly higher in the nonstatin group compared to the statin group (33.61% vs 20.28%, P<0.0001). In the statin group, the aHR for MACE was 0.34 (95% CI, 0.25-0.44, P<0.0001) compared to the nonstatin group. Different classes of statins were examined, and all of them showed a similar protective effect compared with not using statins. Hydrophilic statins, specifically rosuvastatin and pravastatin had the greatest risk reduction in MACE incidence. There was a statistically significant difference in the 5-year cumulative incidence of MACE between the statin group (12.24%) versus the nonstatin group (31.70%) (P<0.0001). There was a dose-response relationship between the risk of MACE and the use of statins, where higher cumulative defined daily doses (cDDD) were associated with a lower MACE risk. Overall, in adults with stage I breast IDC who underwent BCS and whole breast radiation therapy, statin use was associated with a decreased risk of MACE.
1. In a randomized triple-blinded controlled trial, probiotic and vitamin D supplementation did not significantly change headache duration or serum levels of hs-CRP.
Evidence Rating Level: 1 (Excellent)
Migraines are primary headaches, often chronic, that affect more than 1 billion people globally. They are defined as recurrent headaches with two of four headache characteristics (unilateral, pulsating, moderate to severe, and aggravated by routine physical activity) with one additional correlated symptoms, such as nausea or vomiting, during the attacks. Probiotics may improve headaches through the gut-brain axis, however, research in this area is limited and there is no consensus. Vitamin D has also been implicated as a way to reduce the severity and frequency of migraine attacks through its effect on the brain-intestinal axis. With these possibilities in mind, this study aimed to evaluate the effect of probiotic and vitamin D co-supplementation on migraine frequency and severity, daily functioning, and serum levels of high sensitivity C-reactive protein (hs-CRP) in migraine patients. To achieve this, eligible participants were enrolled in a parallel randomized, placebo-controlled trial and randomly assigned to the probiotic plus vitamin D group or the placebo group. To be deemed eligible, participants had to be between the ages of 18 and 55 years, have a migraine history with or without aura, and had more than 2 attacks per month in the preceding 3 months. The Headache Impact Test-6 (HIT-6) was administered at baseline and at the end of the intervention to evaluate the ability of normal functioning. While the Depression, Anxiety, and Stress Scale (DASS) questionnaire was used to evaluate psychological characteristics of patients. A total of 72 patients with a mean age of 37.46 ± 8.32 (SD) years were enrolled. The mean values for systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were found to be lower in the probiotic group compared to the placebo group (109.08 vs 115.08 mmHg; P = 0.030 for SBP, 75.92 vs 79.08 mmHg; P = 0.047 for DBP, and 86.97 vs. 91.08 mmHg; P = 0.021 for MAP). Once again when comparing the groups, the probiotic and vitamin D group led to a significant increase in vitamin D serum levels compared to the placebo group (+ 12.86 ± 1.64 vs. + 1.12 ± 0.80 ng/mL, P < 0.001). Upon further comparison in the between-group analyses, the probiotic and vitamin D group had a significant reduction in migraine frequency (- 3.17 ± 0.84 vs. – 1.25 ± 0.34; P = 0.031) and severity (- 1.55 ± 0.35 vs. + 0.67 ± 0.29; P = 0.017) compared to the placebo group. There was no significant difference in headache duration, hs-CRP serum levels, or DASS and HIT–6 questionnaires (P>0.05). The results show that there may be a beneficial effect of probiotic and vitamin D supplementation, but more research is needed. Despite this, the study showed that these supplements did not change headache duration and serum levels of hs-CRP in adult patients with migraine headaches.
Image: PD
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