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A failure to fully recover following coronavirus disease 2019 (COVID-19) may have a profound impact on high-functioning populations ranging from frontline emergency services to professional or amateur/recreational athletes. The aim of the study is to describe the medium-term cardiopulmonary exercise profiles of individuals with "persistent symptoms" and individuals who feel "recovered" after hospitalization or mild-moderate community infection following COVID-19 to an age, sex, and job-role matched control group. A total of 113 participants underwent cardiopulmonary functional tests at a mean of 159 ± 7 days (∼5 mo) following acute illness; 27 hospitalized with persistent symptoms (hospitalized-symptomatic), 8 hospitalized and now recovered (hospitalized-recovered); 34 community managed with persistent symptoms (community-symptomatic); 18 community managed and now recovered (community-recovered); and 26 controls. Hospitalized groups had the least favorable body composition (body mass, body mass index, and waist circumference) compared with controls. Hospitalized-symptomatic and community-symptomatic individuals had a lower oxygen uptake (V̇o

Individuals who contract coronavirus disease 2019 (COVID-19) can suffer with persistent and debilitating symptoms long after the initial acute illness. Heart rate (HR) profiles determined during cardiopulmonary exercise testing (CPET) and delivered as part of a post-COVID recovery service may provide insight into the presence and impact of dysautonomia on functional ability.Using an active, working-age, post-COVID-19 population, the purpose of this study was to (1) determine and characterize any association between subjective symptoms and dysautonomia; and (2) identify objective exercise capacity differences between patients classified "with" and those "without" dysautonomia.Patients referred to a post-COVID-19 service underwent comprehensive clinical assessment, including self-reported symptoms, CPET, and secondary care investigations when indicated. Resting HR75 bpm, HR increase with exercise89 bpm, and HR recovery25 bpm 1 minute after exercise were used to define dysautonomia. Anonymized data were analyzed and associations with symptoms, and CPET outcomes were determined.Fifty-one of the 205 patients (25%) reviewed as part of this service evaluation had dysautonomia. There were no associations between symptoms or perceived functional limitation and dysautonomia (P.05). Patients with dysautonomia demonstrated objective functional limitations with significantly reduced work rate (219 ± 37 W vs 253 ± 52 W; P.001) and peak oxygen consumption (V̇oDysautonomia is associated with objective functional limitations but is not associated with subjective symptoms or limitation.

BackgroundPost-COVID-19 syndrome presents a challenge when determining the occupational grading of symptomatic military personnel, and their ability to deploy. In particular, the accurate assessment of patients with post COVID-19 syndrome is complicated by health anxiety and coincident symptomatic autonomic dysfunction. We therefore sought to determine whether either symptoms or objective cardiopulmonary exercise testing could predict clinically significant findings in the UK Armed Forces.Methods113 consecutive patients were assessed in a post COVID-19 military clinical assessment pathway. This included symptom reporting, history, examination, spirometry, echocardiography and cardiopulmonary exercise testing (CPET) in all, with chest CT, dual-energy CTPA and cardiac MRI where indicated. Symptoms, CPET findings and presence/absence of significant pathology were reviewed. Data were analysed to identify diagnostic strategies that may be used to exclude significant disease.Results7/113 (6%) patients had clinically significant disease adjudicated by cardiothoracic multi-disciplinary team. These patients had reduced fitness (&Vdot;O2 26.7(±5·1) vs. 34.6(±7·0) ml/kg/min; p = 0·002) and functional capacity (peak power 200 (±36) vs. 247 (±55) Watts; p = 0·026) compared to those without significant disease. Simple CPET criteria (&Vdot;O2 30.0 or VE/&Vdot;CO2 slope >35.0 in isolation) excluded significant disease with sensitivity and specificity of 86% and 83% respectively (AUC 0.89). The addition of capillary blood gases to estimate A-a gradient improved diagnostic performance to 100% sensitivity and 78% specificity (AUC 0.92). Symptoms and spirometry did not discriminate significant disease.ConclusionUK Armed Forces personnel with persistent symptoms post SARS-CoV-2 infection demonstrate reassuringly little organ pathology. CPET and functional capacity testing, but not reported symptoms, allow the exclusion of clinically significant disease.

Treated groups One group of mature biofilms was exposed to Penicillin G alone and the other with combination of Penicillin G with Rifampicin for 96 hrs respectively. Again, the discs were retrieved, sonicated and the number of viable bacteria were counted by chemilumiluminesence and culture Results All P.acnes biofilms responded to treatment with a significant reduction in bacterial numbers. Combination therapy was more effective and produced greater reductions (96.6%) of viable bacteria populating the biofilms than penicillin alone, 93.3% (p < 0.01). Complete eradication of the biofilm was not achieved in any cases.