Sequelae and Comorbidities of COVID-19 Manifestations on the Cardiac and the Vascular Systems

COVID-19 patients with pre-existing cardiovascular conditions are at greater risk of severe illness due to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus. This review evaluates the highest risk factors for these patients, not limited to pre-existing hypertension, cardiac arrhythmias, hypercoagulation, ischemic heart disease, and a history of underlying heart conditions. SARS-CoV-2 may also precipitate de novo cardiac complications. The interplay between existing cardiac conditions and de novo cardiac complications is the focus of this review. In particular, SARS-CoV-2 patients present with hypercoagulation conditions, cardiac arrhythmias, as significant complications. Also, cardiac arrhythmias are another well-known cardiovascular-related complication seen in COVID-19 infections and merit discussion in this review. Amid the pandemic, myocardial infarction (MI) has been reported to a high degree in SARS-CoV-2 patients. Currently, the specific causative mechanism of the increased incidence of MI is unclear. However, studies suggest several links to high angiotensin-converting enzyme 2 (ACE2) expression in myocardial and endothelial cells, systemic hyper-inflammation, an imbalance between myocardial oxygen supply and demand, and loss of ACE2-mediated cardio-protection. Furthermore, hypertension and SARS-CoV-2 infection patients’ prognosis has shown mixed results across current studies. For this reason, an in-depth analysis of the interactions between SARS-CoV2 and the ACE2 cardio-protective mechanism is warranted. Similarly, ACE2 receptors are also expressed in the cerebral cortex tissue, both in neurons and glia. Therefore, it seems very possible for both cardiovascular and cerebrovascular systems to be damaged leading to further dysregulation and increased risk of mortality risk. This review aims to discuss the current literature related to potential complications of COVID-19 infection with hypertension and the vasculature, including the cervical one. Finally, age is a significant prognostic indicator among COVID-19 patients. For a mean age group of 70 years, the main presenting symptoms include fever, shortness of breath, and a persistent cough. Elderly patients with cardiovascular comorbidities, particularly hypertension and diabetes, represent a significant group of critical cases with increased case fatality rates. With the current understanding of COVID-19, it is essential to explore the mechanisms by which SARS-CoV-2 operates to improve clinical outcomes for patients suffering from underlying cardiovascular diseases and reduce the risk of such conditions de novo.

Development and Evaluation of Cultural Competence Course on Undergraduate Nursing Students in Vietnam

Cultural competence is a crucial requirement of nursing to promote caring for patients with diverse backgrounds. The purpose of this study was to develop a cultural competence course and to evaluate the effects of the course on undergraduate nursing students in Vietnam. A concurrent triangulation mixed-methods study was adopted using quantitative and qualitative data sources. Sixty-six nursing students were recruited for the following groups: cultural competence course with field experience (n = 22), stand-alone cultural competence course (n = 22), and a control group (n = 22). The findings indicated that significant group by time interactions in total cultural competence score (F = 66.73, p < 0.001) were found. Participants’ perceptions reflected on three categories: (a) journey to cultural competence, (b) satisfaction of cultural competence course, and (c) suggestions for improvements. No statistically significant differences between the two experimental groups were revealed, but “obtaining cultural experiences” and “expanding understanding of cultural competence through field experience” were immersed from participants having field experience. It is vital to expand cultural competency education into nursing curricula to enhance nursing students’ perspective of culturally competent care.

Parent-Child Autonomic Synchrony During Vicarious Extinction Learning in Pediatric PTSD

Children must learn basic functional processes directly from their caregivers and child psychopathology may disrupt this transmission. This transmission may be seen through biological measures like peripheral nervous system outputs like skin conductance (SCR). Fear learning deficits have been seen in affective disorders like PTSD and are useful for studying parent-child learning transmission. Our study uses a vicarious fear extinction paradigm to study if biological synchrony (SCR and heart rate variability (HRV)) are potential mechanisms in which children learn safety cues from their parents. There were 16 dyads (PTSD n=11, TD n=5) undergoing a vicarious fear extinction paradigm. We used cross-recurrence quantification analysis (CRQA) to assess SCR and HRV synchrony between parent-child dyads. We then used a linear model looking at group differences between PTSD dyads and typically developing (TD) dyads. For SCR, we saw a significant group difference (p=.037) indicating that TD dyads had higher SCR synchrony compared to PTSD dyads. For HRV, there were no group differences between PTSD and TD dyads (p=.325). These results suggest that SCR synchrony, but not HRV, may be a potential mechanism that allows for fear and safety learning in youth. While this is preliminary, it may give the first insights on how therapies such as Trauma-Focused Cognitive Behavioral Therapy critically rely on parental coaching to model appropriate fear responses to help their child to recover from trauma.

Patients’ Self-Report and Handwriting Performance Features as Indicators for Suspected Mild Cognitive Impairment in Parkinson’s Disease

Early identification of mild cognitive impairment (MCI) in Parkinson’s disease (PD) patients can lessen emotional and physical complications. In this study, a cognitive functional (CF) feature using cognitive and daily living items of the Unified Parkinson’s Disease Rating Scale served to define PD patients as suspected or not for MCI. The study aimed to compare objective handwriting performance measures with the perceived general functional abilities (PGF) of both groups, analyze correlations between handwriting performance measures and PGF for each group, and find out whether participants’ general functional abilities, depression levels, and digitized handwriting measures predicted this CF feature. Seventy-eight participants diagnosed with PD by a neurologist (25 suspected for MCI based on the CF feature) completed the PGF as part of the Daily Living Questionnaire and wrote on a digitizer-affixed paper in the Computerized Penmanship Handwriting Evaluation Test. Results indicated significant group differences in PGF scores and handwriting stroke width, and significant medium correlations between PGF score, pen-stroke width, and the CF feature. Regression analyses indicated that PGF scores and mean stroke width accounted for 28% of the CF feature variance above age. Nuances of perceived daily functional abilities validated by objective measures may contribute to the early identification of suspected PD-MCI.

Graph theory analysis of whole brain functional connectivity to assess disturbances associated with suicide attempts in bipolar disorder

Brain targets to lower the high risk of suicide in Bipolar Disorder (BD) are needed. Neuroimaging studies employing analyses dependent on regional assumptions could miss hubs of dysfunction critical to the pathophysiology of suicide behaviors and their prevention. This study applied intrinsic connectivity distribution (ICD), a whole brain graph‐theoretical approach, to identify hubs of functional connectivity (FC) disturbances associated with suicide attempts in BD. ICD, from functional magnetic resonance imaging data acquired while performing a task involving implicit emotion regulation processes important in BD and suicide behaviors, was compared across 40 adults with BD with prior suicide attempts (SAs), 49 with BD with no prior attempts (NSAs) and 51 healthy volunteers (HVs). Areas of significant group differences were used as seeds to identify regional FC differences and explore associations with suicide risk-related measures. ICD was significantly lower in SAs than in NSAs and HVs in bilateral ventromedial prefrontal cortex (vmPFC) and right anterior insula (RaIns). Seed connectivity revealed altered FC from vmPFC to bilateral anteromedial orbitofrontal cortex, left ventrolateral PFC (vlPFC) and cerebellum, and from RaIns to right vlPFC and temporopolar cortices. VmPFC and RaIns ICD were negatively associated with suicidal ideation severity, and vmPFC ICD with hopelessness and attempt lethality severity. The findings suggest that SAs with BD have vmPFC and RaIns hubs of dysfunction associated with altered FC to other ventral frontal, temporopolar and cerebellar cortices, and with suicidal ideation, hopelessness, and attempt lethality. These hubs may be targets for novel therapeutics to reduce suicide risk in BD.

Anterior cingulate metabolite levels, memory, and inhibitory control in abstinent men and women with Alcohol Use Disorder

Aims: Alcohol use disorder (AUD), has been shown to have harmful cognitive and physiological effects, including altered brain chemistry. Further, although men and women may differ in vulnerability to the neurobiological effects of AUD, results of existing studies have been conflicting. Brain metabolite levels and cognitive functions were examined in a cross section of men with AUD (AUDm) and women with AUD (AUDw) to determine degree of abnormalities after extended periods of abstinence (mean, six years), and to evaluate gender differences in cognitive and metabolite measures. Methods: Participants were 40 abstinent individuals with AUD (22 AUDw, 18 AUDm) and 50 age-equivalent non-AUD comparison participants (26 NCw, 24 NCm). Proton magnetic resonance spectroscopy (MRS) was employed at 3 Tesla to acquire metabolite spectra from the dorsal anterior cingulate cortex (dACC). Brain metabolites N-acetylaspartate (NAA), choline (Cho), myo-Inositol (mI), and glutamate & glutamine (Glx) were examined relative to measures of memory and inhibitory control. Results: Metabolite levels in the AUD group showed no significant differences from the NC group. Memory and inhibitory-control impairments were observed in the AUD group. There also were significant group-specific associations between metabolite ratios and measures of inhibitory control. There were no Group-by-Gender interactions for the four metabolite ratios. Conclusions: These findings demonstrate that brain metabolite levels in men and women with AUD, following long-term abstinence, do not differ from individuals without AUD. The data also provide evidence of associations between metabolite levels and measures of inhibitory control, a functional domain important for curtailing harmful drinking.

Associations of Motor Performance and Executive Functions: Comparing Children with Down Syndrome to Chronological and Mental Age-Matched Controls

Background. Children with Down syndrome (DS) exhibit lower motor and cognitive performance than typically developing children (TD). Although there is a relationship between these two developmental domains, only a few studies have addressed this association in children with DS compared to groups of the same chronological age (CA) or mental age (MA) within one study. This study aimed to fill this research gap. Method and Procedures. The Movement Assessment Battery for Children-2 and the Trail-Making Test was used to assess motor and cognitive performances in 12 children (M = 10.5 ± 10.08) with DS, 12 CA-matched, and 12 MA-matched controls. Results. There are significant group differences in the motor dimension (total test score; p < 0.001, η2p = 0.734), for processing speed (p < 0.001, η2p = 0.396), and cognitive flexibility (p < 0.001, η2p = 0.498). Between TD-CA and both other groups, the differences in the magnitude of correlations for the motor dimension balance are also significant (compared to DS: z = −2.489; p = 0.006, and to TD-MA: z = −3.12; p < 0.001). Conclusions. Our results suggest that the relationships depend on the studied cognitive and motor skills. It seems crucial to select a wide range of tasks for both domains that are as isolated as possible for future studies, to better understand the relationships between cognitive and motor skills in children with DS.

Static Postural Control Deficits in Adults with Myotonic Dystrophy Type 1, Steinert Disease

Background: Myotonic dystrophy type 1 (DM1) is characterized by progressive and predominantly distal muscle atrophy and myotonia. Gait and balance impairments, resulting in falls, are frequently reported in this population. However, the extent to which individuals with DM1 rely more on a specific sensory system for balance than asymptomatic individuals (AI) is unknown. Objective: Evaluate postural control performance in individuals with DM1 and its dependence on vision compared to AI. Methods: 20 participants with DM1, divided into two groups based on their diagnosis, i.e. adult and congenital phenotype, and 12 AI participants were recruited. Quiet standing postural control was assessed in two visual conditions: eyes-open and eyes-closed. The outcomes measures were center of pressure (CoP) mean velocity, CoP range of displacement in anteroposterior and mediolateral axis, and the 95% confidence ellipse’s surface. Friedman and Kruskal-Wallis analysis of variance were used to compare outcomes between conditions and groups, respectively. Results: Significant group effect and condition effect were observed on postural control performance. No significant difference was observed between the two DM1 groups. The significant differences observed between the AI group and the two DM1 groups in the eyes-open condition were also observed in the eyes-closed condition. Conclusions: The result revealed poorer postural control performance in people with DM1 compared to AI. The DM1 group also showed similar decrease in performance than AI in eyes-closed condition, suggesting no excessive visual dependency.

Event-Related Potentials in Women on the Pill: Neural Correlates of Positive and Erotic Stimulus Processing in Oral Contraceptive Users

Background/Aims: Exposure toward positive emotional cues with – and without – reproductive significance plays a crucial role in daily life and regarding well-being as well as mental health. While possible adverse effects of oral contraceptive (OC) use on female mental and sexual health are widely discussed, neural processing of positive emotional stimuli has not been systematically investigated in association with OC use. Considering reported effects on mood, well-being and sexual function, and proposed associations with depression, it was hypothesized that OC users showed reduced neural reactivity toward positive and erotic emotional stimuli during early as well as later stages of emotional processing and also rated these stimuli as less pleasant and less arousing compared to naturally cycling (NC) women.Method: Sixty-two female subjects (29 NC and 33 OC) were assessed at three time points across the natural menstrual cycle and corresponding time points of the OC regimen. Early (early posterior negativity, EPN) and late (late positive potential, LPP) event-related potentials in reaction to positive, erotic and neutral stimuli were collected during an Emotional Picture Stroop Paradigm (EPSP). At each appointment, subjects provided saliva samples for analysis of gonadal steroid concentration. Valence and arousal ratings were collected at the last appointment.Results: Oral contraceptive users had significantly lower endogenous estradiol and progesterone concentrations compared to NC women. No significant group differences in either subjective stimulus evaluations or neural reactivity toward positive and erotic emotional stimuli were observed. For the OC group, LPP amplitudes in reaction to erotic vs. neutral pictures differed significantly between measurement times across the OC regimen.Discussion: In this study, no evidence regarding alterations of neural reactivity toward positive and erotic stimuli in OC users compared to NC was found. Possible confounding factors and lines for future research are elaborated and discussed.

Objectively-measured step cadence and walking patterns in a rural African setting: a cross-sectional analysis

Objectives To investigate free-living, accelerometry-derived step cadence and walking strategy parameters in 263 adult women (19-56 years) within a rural African setting. Participants were categorised into weight groups: Under-Normal Weight (UW/NW: <25 kg.m−2), Overweight-Obese (OW/OB: ≥25 kg.m−2). From the minute-by-minute uni-axial accelerometry data, outcomes describing physical activity intensity, step volume, step cadence and step bouts were extracted. In addition, walking pattern parameters for step bout length and step cadence were determined. Results Average step volume was 13568 steps.day−1, and >85% of participants were classified as active-to-highly-active. Overall, ≈45% of daily steps was accumulated in the low-to-moderate intensity range. Peak cadence indices were higher in the UW/NW group (p≤0.0112). For both groups, 75% of steps were accumulated in bouts >15 minutes, and 95% of bouts were accumulated at 1-39 steps.minute−1. The UW/NW group employed a more varied step cadence, and higher cadences contributed more to step accumulation than the OW/OB group (p≤0.05). There were no significant group differences in bout length strategy parameters (p≥0.0861). Despite no difference between the weight groups in step volume, there were differences in some step cadence indices which reflect higher step intensities, and in cadence strategies chosen to accumulate steps.