A Study Protocol to Assess Musculoskeletal Problems in Post Covid-19 Subjects | Chapter 4 | Disease and Health Research: New Insights Vol. 2

 

Background: The severe acute respiratory syndrome coronavirus 2 is the cause of the global pandemic known as COVID-19 (SARS-COV-2), which has captivated the entire world.  It has been demonstrated that the coronavirus interacts with the angiotensin-converting enzyme-2 (ACE-2) present in skeletal muscles, increasing its susceptibility to direct viral invasion. The fibrotic activity of muscle fibroblasts increases, aggravating the inflammatory response. The participants exhibit musculoskeletal complaints, including fatigue, myalgia, arthralgia, muscle weakness, decreased bone mineral density, and anomalies in soft tissues. Further examination of COVID-19 individuals showed elevated levels of creatine phosphokinase, myalgia, and arthritic changes, including myositis. A long-term study found that the most common musculoskeletal complaints between two weeks and one month after hospitalization were myalgia, arthralgia, and fatigue. The current study's goal is to analyze various musculoskeletal concerns in COVID-19 participants.

 

Outcome Measures: A standard Nordic musculoskeletal questionnaire will be taken for all subjects. Depending on the problem and joint involved outcome measures like NPDI, SPADI, DASH, OLBDQ, HHS, WOMAC, FADI, CFS, LEFS, and FAS will be used.

 

Statistical Analysis: Descriptive statistical analysis like mean, and standard deviation will be done by using SPSS’s latest version software by taking the help of a Biostatistician after ensuring the normal distribution and analysis. To find out the association between two variables Fisher’s exact test and Pearson chi-square test will be used.

 

Results: The results of this study will also be important for subjects affected with COVID-19 symptoms to better understand their long-term musculoskeletal problems with a duration of more than 3 months from affection with the virus which may or may not affect their functional performance and physical activity levels.

 

Conclusion: This study will be helpful in finding the prevalence of musculoskeletal problems among post-COVID-19 subjects. If any particular symptoms are found to be more prominent strategies to cope and manage those symptoms in COVID-19 subjects can be developed in the future by doing further research.

 

Clinical Trial Registration: The study is registered with the Clinical Trials Registry- India (CTRI), with the registration number for the trial being CTRI/2022/08/ 044661.

 

Author(s) Details

Noel Samuel Macwan
College of Physiotherapy, Sumandeep Vidyapeeth (Deemed to be University), Piparia, Waghodia, Vadodara, Gujarat, 391760, India.

 

Kalpana Vasava
College of Physiotherapy, Sumandeep Vidyapeeth (Deemed to be University), Piparia, Waghodia, Vadodara, Gujarat, 391760, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/dhrni/v2/1256

Transient Primary Bone Marrow Edema Syndrome - Systematic Review and Proposal for a Management Protocol | Chapter 5 | New Visions in Medicine and Medical Science Vol. 8

Background: Transient primary bone marrow edema syndrome (TPBMES), a set of conditions affecting weight-bearing joints, mostly of the lower limbs, presents acutely with severe local pain, disproportionate to the physical findings. This disease is designated by an array of terms, not all of which are in the consensus. But they seem to refer to a single disease entity, whether the hips, the knees, or the foot and ankle are affected, singly, bilaterally, or in a migratory pattern. The diagnosis of bone marrow edema of a temporary nature is based on the MRI. Moreover, systemic osteoporosis has been detected in association with some cases of TPBMES, but the significance of this combined occurrence is not clear. Moreover, whether "migratory" TPBMES represents a more aggressive expression of the disease is not yet settled.

Objectives: This study was initiated to resolve the numerous ambiguities concerning this disease entity.

Data Sources: A search in PubMed looking for TPBMES or equivalent terms.

Study Eligibility Criteria: Single or isolated case reports were excluded. Two reviews were excluded as they did not agree with the basic classification of the entity. Inclusion criteria of patients: a history of sudden onset of pain in the affected joint, in the absence of more than minimal trauma, and confirmation of bone marrow edema by MRI and follow-up evidence of the resolution, as shown by MRI. Exclusion criteria of patients: insidious onset of pain and evidence of avascular necrosis, infection, significant trauma of bone, stress fractures, or inflammatory arthropathy, based on the MRI and the laboratory. Remote studies were not based on the MRI.

Study Appraisal and Synthesis Methods: Based on a review featuring 141 patients, several clinical, radiological and pathological data were extracted into an all-inclusive table (not shown). Four tables were built thereof. Tables 2-4 were conceived to summarize independently all the variables in every recognized form of TPBMES (see Table 1). The association between TPBMES and systemic osteoporosis is shown in an additional table.

Results: Table 2 features the demographic and clinical studies, as distributed among the different TPBMES subtypes. A total of 546 patients were assigned mainly to 342 TOH patients, most of them males. Next, were 105 patients with TOH of pregnancy. A lesser subset was composed of 49 F&A patients, mainly women. Table 3 shows the allocation of clinical features and risk factors to TPBMES subsets. Pain was by far the most frequent symptom. Subchondral fractures were detected in TOH and TOH of pregnancy. Overweight and vitamin D deficiency have been suggested as additional risk factors. Table 4 depicts the treatment and follow-up of TPBMES patients. Bisphosphonates have been recommended for TOH and "migratory" osteoporosis patients. Tables 5 and 6 demonstrate the interaction between TPBMES and systemic osteoporosis and with migratory osteoporosis, highlighting the common self-limited nature of TPBMES, as well as the frequently extended course of this combined occurrence.

Limitations: See Fig. 1.

Conclusions: The different subsets in the TPBMES classification have several features in common, notably an MRI-based diagnosis and a self-limited outcome, even in the absence of modern therapy. Thus, they should be considered as belonging to a single disease entity, with some variable traits. Of note, a tendency for TPBMES to be associated with systemic osteoporosis, sometimes in addition to a "migratory" pattern, has been reported in conjunction with an abnormally extended course of the disease. These are the patients who raised our concern and who evoked the necessity for a therapeutic intervention to limit their suffering (see suggested management protocol, Fig. 2).

Author(s) Details:

Nissim Ohana,
Department of Architecture, Jamia Millia Islamia, New Delhi, India.


Dimitri Sheinis
Department of Orthopedic Surgery, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.


Daniel Benharroch
Department of Pathology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.

Please see the link here: https://doi.org/10.9734/bpi/nvmms/v8/115