Aerobic exercise speeds recovery in adolescents with concussion.

Here.

ABSTRACT

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Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial

Authors: Prof John J Leddy, MD, Prof Christina L Master, MD, Rebekah Mannix, MD, Douglas J Wiebe, PhD, Matthew F Grady, MD, William P Meehan, MD, et al.

Published:September 30, 2021

DOI:https://doi.org/10.1016/S2352-4642(21)00267-4

Summary

Background

Sport-related concussion is a public health problem, particularly in adolescents. Quality of life is reduced in adolescents with persistent post-concussive symptoms (symptoms >28 days). We replicated a previous randomised controlled trial to validate the safety, efficacy, and generalisability of, and objective adherence to, prescribed early targeted heart rate subsymptom threshold aerobic exercise compared with placebo-like stretching exercise for adolescent recovery from sport-related concussion and for reducing the risk of persistent post-concussive symptoms.

Methods

This randomised controlled trial was done at three community and hospital-affiliated sports medicine concussion centres in the USA. Male and female adolescent athletes (aged 13–18 years) presenting within 10 days of sport-related concussion were randomly assigned to individualised subsymptom threshold aerobic or stretching exercise at least 20 min daily, for up to 4 weeks after injury. Exercise adherence and intensity were measured by heart rate monitors. The primary outcome was clinical recovery (ie, return to baseline symptoms, normal exercise tolerance, and a normal physical examination) within the 4-week intervention period, and development of persistent post-concussive symptoms beyond 28 days after injury. This study is registered with ClinicalTrials.gov, NCT02959216.

Findings

Between Aug 1, 2018, and March 31, 2020, 118 adolescents were recruited (61 were randomly assigned to the aerobic exercise group and 57 to the stretching exercise group) and included in the intention-to-treat analysis. On survival analysis, controlling for sex, site, and mean daily exercise time, patients assigned to aerobic exercise were more likely to recover within 4 weeks after injury compared with those assigned to stretching exercise, with a 48% reduced risk of persistent post-concussive symptoms (hazard ratio for stretching vs aerobic exercise of 0·52 [95% CI 0·28–0·97], p=0·039). No adverse events were reported.

Interpretation

This multicentre study found that early treatment with subsymptom threshold aerobic exercise safely speeds recovery from sport-related concussion and reduces the risk for persistent post-concussive symptoms, an important result given the impact of delayed recovery on adolescent quality of life. Adherence was good and there were no adverse events from this non-pharmacological treatment. These results suggest that physicians should not only permit, but consider prescribing, early subsymptom threshold physical activity to adolescents as treatment for sport-related concussion and to reduce the risk of persistent post-concussive symptoms.

COVID-19 on the Big Island after vaccine availability

At Hilo Medical Center, there have been 0 Covid related hospitalizations for vaccinated individuals in recent weeks! This means that 100% of our hospitalized COVID-19 patients are unvaccinated, suggesting that here we see that vaccinations against COVID-19 are effective in preventing severe illness, hospitalizations and utilization of our limited resources and staff time.
There have been a few ED visits for flulike and related vaccine reactions, none serious.
As of 2 July 2021, we have 4 unvaccinated, COVID-positive patients in our hospital, 3 in our 11-bed ICU with 1 patient on a ventilator and 1 in our Obstetric Unit. 98% of hospitalized COVID-positive patients in our state are unvaccinated, and these still can get very very sick. Clearly the risk benefit favors vaccines at any adult age!
After all, currently we have about a 50 50 ratio of fully vaccinated to not people on island, and it's clear who the losers in that gamble are...

World distribution of mammalian coronaviruses: One reason the pandemic started in Wuhan

It's currently fashionable in many US circles to speculate that Covid-19 started in a Wuhan lab. But according to this 2017 paper, more coronaviruses are to be found in the regions around Wuhan than much of the rest of the world. The next SARS will also likely start in Asia, or perhaps Africa. That could have happened with or without help of a lab, and without a lab seems more likely at the moment.

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ABSTRACT

Global patterns in coronavirus diversity

Simon J. Anthony, Christine K. Johnson, Denise J. Greig, Sarah Kramer, Xiaoyu Che, Heather Wells, Allison L. Hicks, Damien O. Joly, Nathan D. Wolfe, Peter Daszak

Virus Evolution, Volume 3, Issue 1, January 2017, vex012, https://doi.org/10.1093/ve/vex012

Published: 12 June 2017

Since the emergence of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrom Coronavirus (MERS-CoV) it has become increasingly clear that bats are important reservoirs of CoVs. Despite this, only 6% of all CoV sequences in GenBank are from bats. The remaining 94% largely consist of known pathogens of public health or agricultural significance, indicating that current research effort is heavily biased towards describing known diseases rather than the ‘pre-emergent’ diversity in bats. Our study addresses this critical gap, and focuses on resource poor countries where the risk of zoonotic emergence is believed to be highest. We surveyed the diversity of CoVs in multiple host taxa from twenty countries to explore the factors driving viral diversity at a global scale. We identified sequences representing 100 discrete phylogenetic clusters, ninety-one of which were found in bats, and used ecological and epidemiologic analyses to show that patterns of CoV diversity correlate with those of bat diversity. This cements bats as the major evolutionary reservoirs and ecological drivers of CoV diversity. Co-phylogenetic reconciliation analysis was also used to show that host switching has contributed to CoV evolution, and a preliminary analysis suggests that regional variation exists in the dynamics of this process. Overall our study represents a model for exploring global viral diversity and advances our fundamental understanding of CoV biodiversity and the potential risk factors associated with zoonotic emergence.

Remaining risks

"The big risk unmasked, unvaccinated people are posing is to themselves."
Article here (Bloomberg).

The map is not the territory

If consciousness is the territory, current AI is at best a partial map of that territory.

Rare and Common Presentations and Conditions

Common presentations of rare conditions are more common than rare presentations of common conditions.

What does the above even mean?

There are a very large number — thousands — of individually rare conditions. So even though any single given rare condition is only rarely seen, having any rare condition whatsoever is relatively common. On the other hand, there are a limited number of truly common conditions: the common cold, reactive depression, and back pain, for example.

According to the geneticists, “A rare disease is generally considered to be a disease that affects fewer than 200,000 people in the United States at any given time. There are more than 6,800 rare diseases. Altogether, rare diseases affect an estimated 25 million to 30 million Americans.”

If we consider a rare presentation of a common disease to be defined similarly, this would mean that this would likewise be about a 1 in 1500 presentation of a common condition. If 1/3 of the US population has at least one common condition at any given time, this means that about 100,000,000 persons in the US have a common condition; if 1/1500 had a rare presentation, this would in turn mean that there are only about 70,000 persons with rare presentations of common conditions per year. This is much less than the over 25,000,000 with a rare condition.

So it turns out that, based on prevalence data, the number of people with a rare but otherwise typical condition significantly outnumbers the number of people with only a rare presentation of one of the common conditions.

The anxious patient doing an unfortunate Internet search for their diagnosis may err because they choose a rare presentation of a rare condition over the common presentation of a common condition from which they suffer, and not because they find a rare condition that truly fits them best.

The machine runs on: "The Machine Stops" by yearend in 2021, we hope?

If you've never read E. M. Forster's classic The Machine Stops, written when the telephone was cutting edge tech, 2021 is the year you should.

See this link:

The Machine Stops

Let us not forget that social distancing is not social. Quarantine and related distancing is a necessary evil, and necessary evils are still, well, evil.

The dysfunctions promoted by our isolation under fear of the coronavirus should not be permitted to outlast the need for isolation. There are far better solutions incoming, such as immunization.