Author Interviews, Columbia, COVID -19 Coronavirus, Exercise - Fitness, Heart Disease, JAMA / 05.03.2021
COVID-19: Using Guidelines, Safe Return to Sports is Possible
MedicalResearch.com Interview with:
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Dr. Engel[/caption]
David J. Engel, MD, FACC
Division of Cardiology
Columbia University Irving Medical Center
New York, New York
MedicalResearch.com: What is the background for this study?
Response: Early reports and observations in the COVID-19 pandemic found that patients recovering from mild to severe forms of COVID-19 illness had a higher prevalence of cardiac injury in comparison with what historically has been seen and reported with other viruses. This cardiac injury, categorized as inflammatory heart disease, could have serious implications, including a risk for exercise-triggered sudden cardiac death, for athletes and highly active people who have had prior COVID-19 illness and who return to intensive exercise activity with unknowing subclinical cardiac injury.
To address these concerns in COVID positive athletes, the ACC generated return to play cardiac screening recommendations (troponin blood test, ECG, resting echocardiogram) for all competitive athletes after COVID-19 infection prior to resumption of competitive and intensive sport activity. The professional leagues were among the first organizations to return to full-scale sport activity in the setting of the pandemic, and they uniformly adopted and implemented the ACC return to play screening recommendations for all athletes that tested positive for COVID-19. The leagues recognized that there was value in collaborating and formally analyzing their pooled cardiac data, not only for league athlete health and safety purposes, but also to share broadly this information to add to the growing body of knowledge about the virus.
Dr. Engel[/caption]
David J. Engel, MD, FACC
Division of Cardiology
Columbia University Irving Medical Center
New York, New York
MedicalResearch.com: What is the background for this study?
Response: Early reports and observations in the COVID-19 pandemic found that patients recovering from mild to severe forms of COVID-19 illness had a higher prevalence of cardiac injury in comparison with what historically has been seen and reported with other viruses. This cardiac injury, categorized as inflammatory heart disease, could have serious implications, including a risk for exercise-triggered sudden cardiac death, for athletes and highly active people who have had prior COVID-19 illness and who return to intensive exercise activity with unknowing subclinical cardiac injury.
To address these concerns in COVID positive athletes, the ACC generated return to play cardiac screening recommendations (troponin blood test, ECG, resting echocardiogram) for all competitive athletes after COVID-19 infection prior to resumption of competitive and intensive sport activity. The professional leagues were among the first organizations to return to full-scale sport activity in the setting of the pandemic, and they uniformly adopted and implemented the ACC return to play screening recommendations for all athletes that tested positive for COVID-19. The leagues recognized that there was value in collaborating and formally analyzing their pooled cardiac data, not only for league athlete health and safety purposes, but also to share broadly this information to add to the growing body of knowledge about the virus.
Dr. Traverso[/caption]
Carlo Giovanni Traverso, MB, BChir, PhD
Associate Physician, Brigham and Women's Hospital
Assistant Professor,
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Dr. Chai[/caption]
Peter R. Chai, MD, MMS
Emergency Medicine Physician and Medical Toxicologist
Harvard Medical School
Brigham and Women's Hospital
Department of Medicine
MedicalResearch.com: What is the background for this study? What are some of the functions that Dr. Spot can facilitate?
Response: During the COVID-19 pandemic, we wanted to consider innovative methods to provide additional social distance for physicians evaluating low acuity individuals who may have COVID-19 disease in the emergency department. While other health systems had instituted processes like evaluating patients from outside of emergency department rooms or calling patients to obtain a history, we considered the use of a mobile robotic system in collaboration with Boston Dynamics to provide telemedicine triage on an agile platform that could be navigated around a busy emergency department. Dr. Spot was built with a camera system to help an operator navigate it through an emergency department into a patient room where an on-board tablet would permit face-to-face triage and assessment of individuals.
Dr. El Khoudary[/caption]
Samar El Khoudary, PhD, MPH, BPharm, FAHA
Associate Professor of Epidemiology
University of Pittsburgh Graduate School of Public Health
MedicalResearch.com: What is the background for this study?
Response: Research increasingly shows that it isn’t so important how much fat a woman is carrying, which doctors typically measure using weight and BMI, as it is where she is carrying that fat. To investigate this, we looked at 25 years of data on 362 women from Pittsburgh and Chicago who participated in the
Laura M. Bogart, PhD
Senior Behavioral Scientist
RAND Corporation
Santa Monica, CA 90407-2138
MedicalResearch.com: What is the background for this study?
Response: Recent media polls continue to show that Black Americans are less likely to intend to get the COVID-19 vaccine than White Americans, and initial state data show a similar racial/ethnic disparity in vaccination rates. Initial uptake of the vaccine has been significantly affected by inequities in vaccine access and supply. In addition to these challenges, other factors contribute to hesitancy around vaccination, including self-perceived risk of infection, trust in the vaccine itself, trust in healthcare systems, healthcare providers, and policymakers who support the vaccine, and trust in the pharmaceutical industry and clinical research. In this study, we conducted a survey of a nationally representative sample of 207 Black Americans in late 2020, after initial COVID-19 vaccine effectiveness and safety data were released to the public. We also did in-depth interviews with a subsample of those surveyed who said that they would not get vaccinated. In addition, we engaged with a stakeholder advisory committee comprised of individuals who represent different subgroups and organizations in Black communities in the U.S., in order to discuss the results and make recommendations for policies to increase COVID-19 vaccination among Black Americans.
Catharina Svanborg M.D., Ph.D.
Professor at Lund University Department of Laboratory Medicine,
Division of Microbiology, Immunology and Glycobiology
Founder/Chairman of the Board at HAMLET Pharma
MedicalResearch.com: What is the background for this study?
Like many unexpected scientific developments, this finding was serendipitous. In our search for the molecular basis of host susceptibility to infection, we discovered that infection directly affects MYC levels.
Gene expression analysis revealed that MYC itself was inhibited and that genes regulated by MYC were affected in children with acute kidney infection. Rapid reductions in MYC levels was further confirmed by infecting human kidney cells with the pathogenic E. coli bacteria isolated from patients with acute pyelonephritis, allowing us to formulate the hypothesis that bacteria regulate host MYC levels during acute infection and to investigate the mechanism leading to this inhibition. This work was conducted by the
Dr. Crosbie[/caption]
Eric Crosbie, PhD, MA
Assistant Professor
School of Community Health Sciences
Ozmen Institute for Global Studies
University of Nevada Reno
MedicalResearch.com: What is the background for this study?
Response: My colleague Dr. Laura Schmidt and I established a framework for studying preemption (when a higher level of government limits the authority of lower levels to enact laws) by studying the
Kathryn Foti, PhD, MPH
Postdoctoral fellow
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
MedicalResearch.com: What is the background for this study?
Response: The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Blood Pressure (BP) in Chronic Kidney Disease (CKD) provides recommendations for the management of BP in individuals with nondialysis CKD, incorporating new evidence since the publication of its previous guideline in 2012.
The 2021 KDIGO guideline recommends a target systolic BP <120 mmHg based on standardized office BP measurement. This BP goal is largely informed by the findings of the SPRINT trial which found targeting SBP <120 mmHg compared with <140 mmHg reduced the risk of cardiovascular disease by 25% and all-cause mortality by 27%. The benefits were similar for participants with and without CKD.
In our study, we sought to examine the potential implications of the 2021 KDIGO guideline for BP lowering among US adults with CKD compared to the 2012 KDIGO guideline (target BP ≤130/80 mmHg in adults with albuminuria or ≤140/90 mmHg or under without albuminuria) and the 2017 American College of Cardiology/American Heart Association (target BP <130/80 mmHg) guideline. Additionally, we determined implications of the 2021 KDIGO guideline for angiotensin converting enzyme inhibitor (ACEi) or angiotensin II-receptor blocker (ARB) use for those with albuminuria (recommended at systolic BP ≥120 mmHg) compared to the 2012 KDIGO guideline (recommended at BP >130/80 mmHg).
Dr. Zimmerman[/caption]
Frederick Zimmerman, PhD
Professor, Department of Health Policy and Management
Fielding School of Public Health
UCLA
MedicalResearch.com: What is the background for this study?
Response: The science on school transmissions of COVID is becoming clearer all the time in its conclusion that there is little to no transmission in school environments as long as reasonable precautions are taken. Yet one recent study got a lot of attention for claiming that states that allowed their schools to remain open in the early days of the pandemic saw more cases. That study did not control for several important factors that might explain this association, so our study aimed to correct that work.
Dr. Swerlick[/caption]
Robert A. Swerlick, MD
Professor and Alicia Leizman Stonecipher Chair of Dermatology
Emory University School of Medicine
Atlanta, GA 30322
MedicalResearch.com: What is the background for this study?
Response: Financial incentives have the potential to drive provider behavior, even unintentionally. The aim of this study was to evaluate differences in clinic “productivity” measures that occur in outpatient dermatology encounters. Specifically, we used data from 2016-2020 at one academic dermatology practice to evaluate differences in work relative value units (wRVUs, a measure of clinical productivity) and financial reimbursement by patient race, sex, and age. 66,463 encounters were included in this study, among which 70.1% of encounters were for white patients, 59.6% were for females, and the mean age was 55.9 years old.
Dr. Taub[/caption]
Pam R. Taub, MD, FACC, FASPC
Director of Step Family Foundation Cardiovascular Rehabilitation and Wellness Center
Associate Professor of Medicine
UC San Diego Health System
Division of Cardiovascular Medicine
MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by postural orthostatic tachycardia syndrome? Is it more common in patients who have incompletely recovered from a COVID-19 infection?
Response: Postural Orthostatic Tachycardia Syndrome (POTS) is a, complex multisystem clinical syndrome Patients experience a wide spectrum of symptoms of varying severity, which are often debilitating. Upon assuming an upright standing position from being supine, patients experience an increase in heart rate by 30 beats per minute (bpm) from supine position, This is often accompanied by lightheadedness, palpitations, dyspnea, mental clouding (“brain fog”), headaches.
POTS can occur after infections as it thought to be triggered by the immune system . The hypothesis is that when the body is fighting an infection some of the antibodies it produces can attack our regulatory systems that control heart rate and blood pressure.
We are seeing an increase in POTS cases occurring after COVID-19 infection. These patient are referred to as the “long haulers”
These long haulers have elevated heart rate, fatigue, brain fog and shortness of breath with activity consistent with POTS.
We are seeing that COVID-19 is another infection that can lead to POTS.
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