News Scan for Nov 30, 2021

'Long COVID' and chronic fatigue
;
COVID-19 myocarditis in athletes
;
Fast food antibiotics

Study ties long-haul COVID-19 with chronic fatigue, breathing problems

Many COVID-19 survivors experience impaired circulation, abnormal breathing patterns, and chronic fatigue syndrome an average of 9 months after diagnosis, finds a small, single-center study yesterday in JACC: Heart Failure.

In the first study to link long-haul COVID-19 with chronic fatigue syndrome, researchers from the Icahn School of Medicine at Mount Sinai used cardiopulmonary exercise testing (CPET) and symptom reports to find the causes of shortness of breath in 23 women and 18 men with long-haul COVID.

Shortness of breath is a common symptom in the roughly 20% of COVID-19 survivors with long-haul COVID, the authors noted. All participants had normal lung function tests, chest x-rays, chest computed tomographic scans, and echocardiograms. Average patient age was 45 years.

Mean left ventricular ejection fraction was 59%. Peak VO2 (oxygen uptake) averaged 20.3 milliliters per kilogram per minute (77% of predicted VO2). VE/VCO2 slope (increase in ventilation in response to carbon dioxide [CO2] production) was, on average, 30.

PetCO2 (CO2 partial pressure in the arterial blood) at rest was 33.5 millimeters of mercury (mm Hg). Twenty-four patients (58.5%) had a peak VO2 less than 80% of predicted. All patients with peak VO2 less than 80% had limited exercise capacity because of poor circulation.

Fifteen of 17 patients with normal peak VO2 had ventilatory abnormalities, including a peak respiratory rate of greater than 55 breaths per minute (3 patients) or dysfunctional breathing (12). Of all patients, 88% (36 patients) had ventilatory abnormalities and dysfunctional breathing (26), increased VE/VCO2 (17), and/or hypocapnia (PetCO2 less than 35 mm Hg) (25). Nineteen patients (46%) met the criteria for chronic fatigue syndrome.

In an American College of Cardiology news release, lead study author Donna Mancini, MD, said that COVID-19 survivors may have residual organ damage from their infections  "The CPET results demonstrate several abnormalities including reduced exercise capacity, excessive ventilatory response and abnormal breathing patterns which would impact their normal daily life activities," she said.

Mancini said that rapid, abnormally deep, or dysfunctional breathing can be addressed with the use of breathing exercises or retraining.
Nov 29 JACC Heart Fail study
Nov 29 American College of Cardiology news release

 

COVID-19 infection linked to myocarditis in college athletes

A small but significant percentage of college athletes with COVID-19 develop myocarditis, a potentially dangerous inflammation of the heart muscle, according to a study presented yesterday at the annual meeting of the Radiological Society of North America (RSNA).

Myocarditis typically follows bacterial or viral infections. In college athletes, previous damage and scarring to the heart muscle caused by myocarditis has been linked to up to 20% of sudden athlete deaths.

To conduct the study, researchers looked at 1,597 cardiac magnetic resonance imaging (MRI) exams conducted at the 13 participating schools in the Big Ten Cardiac Registry. Thirty-seven of the college athletes with COVID-19 had myocarditis (2.3%), but 20 of the 37 (54%) had neither cardiac symptoms nor cardiac testing abnormalities.

"Testing patients for clinical symptoms of myocarditis only captured a small percentage of all patients who had myocardial inflammation," said Jean Jeudy, MD, professor and radiologist at the University of Maryland School of Medicine, in an RSNA press release. "Cardiac MRI for all athletes yielded a 7.4-fold increase in detection."

Jeudy said that, in the COVID-19 era, the role of MRI as a screening tool for college athletes needs to be explored.
Nov 29 RSNA
press release

 

Groups urge McDonald's to follow through on antibiotics commitments

A coalition of food, health, and consumer groups last week sent a letter to McDonald's urging the company to follow through on its pledges to reduce antibiotic use in beef.

The letter, signed by members of US PIRG (Public Interest Research Groups) Education Fund, the Natural Resources Defense Council, the Antibiotic Resistance Action Center, Center for Food Safety, and several others, called out McDonald's for missing its 2020 deadline for setting meaningful reduction targets for use of medically important antibiotics in its global beef and dairy supply chains. The widespread use of medically important antibiotics to prevent and treat disease in beef and dairy cattle has become a major target of antibiotic stewardship advocates.

The company set the deadline in December 2018, when it announced that it would measure medically important antibiotic use and establish reduction targets among beef suppliers in the 10 countries (including the United States) that make up 85% of its beef supply chain by the end of 2020. The company also said it would begin reporting progress on meeting those targets in 2022.

The 2018 announcement was widely praised by antibiotic stewardship advocates at the time, given that McDonald's is the world's largest fast food chain and one of the world's biggest buyers of beef. There was hope that the move could spur a shift toward antibiotic-free beef that would replicate what's been seen in the poultry industry.

The groups are now calling on McDonald's to fulfill its commitments by setting aggressive antibiotic reduction targets in its beef supply, particularly in the United States; publicly reporting on their progress in meeting those targets; and using third-party auditors to verify antibiotic use practices among its beef suppliers.

"As a leader in the fast food sector and the beef production industry, McDonald's is poised to lead the way in producing meat ethically and without the overuse of antibiotics," the groups wrote. "Fulfilling your commitment to reduce antibiotic use in beef will also set an important example for other fast food companies who have made similar commitments to do so, and help spark change."
Nov 24 letter to McDonald's

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