Publications by authors named "L Martine Bek"

4 Publications

  • Page 1 of 1

Persistent Health Problems beyond Pulmonary Recovery up to 6 Months after Hospitalization for SARS-CoV-2; A Longitudinal Study of Respiratory, Physical and Psychological Outcomes.

Ann Am Thorac Soc 2021 Sep 28. Epub 2021 Sep 28.

Erasmus Medical Center, 6993, Pulmonary Medicine, Rotterdam, Zuid-Holland, Netherlands.

Rationale: Data on longitudinal recovery after hospitalization for SARS-CoV-2 remain currently scarce, just as outcomes beyond 3 months follow-up.

Objective: The aim of the study was to evaluate the sequelae up to 6 months after hospitalization for SARS-CoV-2 infection, considering 1) the recovery of pulmonary function and radiological abnormalities, physical and mental health status, and health-related quality of life (HR-QoL); and 2) the predictors of the most clinically relevant sequelae.

Methods: Patients were evaluated at 6 weeks, 3 and 6 months after hospitalization with pulmonary function testing, radiological evaluation, and online questionnaires on physical and mental health status and HR-QoL. Outcomes were analyzed with repeated measurements analyses.

Results: Ninety-two patients were included; mean age 58.2±12.3 years, and 58 (63.0%) males. The estimated percentage of patients with impaired FVC improved from 25% at 6 weeks to 11% at 6 months; for impaired diffusion capacity this percentage improved from 63% to 46%.. Radiologically ground glass decreased, but fibrosis persisted. The majority of patients (89.1%) still reported >1 symptom 6 months after discharge. Fatigue decreased significantly over time (p=0.006). Nonetheless, fatigue remained present in 51% of the patients at 6 months. HR-QoL (nearly) normalized in most domains at 6 months, except for physical role functioning, with persistent fatigue and length of hospitalization as most important predictors.

Conclusions: During the first 6 months after hospitalization for SARS-CoV-2 most patients demonstrated continuing recovery across all health domains, but persistent sequelae were frequent. Fatigue was the most frequent residual and persisting symptom up to 6 months after hospitalization, importantly impacting HR-QoL.
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September 2021

CO-FLOW: COvid-19 Follow-up care paths and Long-term Outcomes Within the Dutch health care system: study protocol of a multicenter prospective cohort study following patients 2 years after hospital discharge.

BMC Health Serv Res 2021 Aug 21;21(1):847. Epub 2021 Aug 21.

Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Background: First studies indicate that up to 6 months after hospital discharge, coronavirus disease 2019 (COVID-19) causes severe physical, cognitive, and psychological impairments, which may affect participation and health-related quality of life (HRQoL). After hospitalization for COVID-19, a number of patients are referred to medical rehabilitation centers or skilled nursing facilities for further treatment, while others go home with or without aftercare. The aftercare paths include 1] community-based rehabilitation; 2] in- and outpatient medical rehabilitation; 3] inpatient rehabilitation in skilled nursing facilities; and 4] sheltered care (inpatient). These aftercare paths and the trajectories of recovery after COVID-19 urgently need long-term in-depth evaluation to optimize and personalize treatment. CO-FLOW aims, by following the outcomes and aftercare paths of all COVID-19 patients after hospital discharge, to systematically study over a 2-year period: 1] trajectories of physical, cognitive, and psychological recovery; 2] patient flows, healthcare utilization, patient satisfaction with aftercare, and barriers/facilitators regarding aftercare as experienced by healthcare professionals; 3] effects of physical, cognitive, and psychological outcomes on participation and HRQoL; and 4] predictors for long-term recovery, health care utilization, and patient satisfaction with aftercare.

Methods: CO-FLOW is a multicenter prospective cohort study in the mid-west of the Netherlands with a 2-year follow-up period. Measurements comprise non-invasive clinical tests and patient reported outcome measures from a combined rehabilitation, pulmonary, and intensive care perspective. Measurements are performed at 3, 6, 12, and 24 months after hospital discharge and, if applicable, at rehabilitation discharge. CO-FLOW aims to include at least 500 patients who survived hospitalization for COVID-19, aged ≥18 years.

Discussion: CO-FLOW will provide in-depth knowledge on the long-term sequelae of COVID-19 and the quality of current aftercare paths for patients who survived hospitalization. This knowledge is a prerequisite to facilitate the right care in the right place for COVID-19 and comparable future infectious diseases.

Trial Registration: The Netherlands Trial Register (NTR), . Registered: 12-06-2020, CO-FLOW trialregister no. NL8710.
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August 2021

genotype influences skeletal muscle mass regulation and response to dexamethasone.

Sci Adv 2021 Jul 2;7(27). Epub 2021 Jul 2.

Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, VIC, Australia.

Homozygosity for the common null polymorphism ( 577X) results in α-actinin-3 deficiency in ~20% of humans worldwide and is linked to reduced sprint and power performance in both elite athletes and the general population. α-Actinin-3 deficiency is also associated with reduced muscle mass, increased risk of sarcopenia, and altered muscle wasting response induced by denervation and immobilization. Here, we show that α-actinin-3 plays a key role in the regulation of protein synthesis and breakdown signaling in skeletal muscle and influences muscle mass from early postnatal development. We also show that α-actinin-3 deficiency reduces the atrophic and anti-inflammatory response to the glucocorticoid dexamethasone in muscle and protects against dexamethasone-induced muscle wasting in female but not male mice. The effects of α-actinin-3 deficiency on muscle mass regulation and response to muscle wasting provide an additional mechanistic explanation for the positive selection of the 577X allele in recent human history.
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July 2021

A higher proportion of men than of women fainted in the phase without nitroglycerin in tilt-induced vasovagal syncope.

Clin Auton Res 2020 10 18;30(5):441-447. Epub 2020 Jan 18.

Department of Neurology, Leiden University Medical Centre, K5-Q, PO Box 9600, 2300 RC, Leiden, The Netherlands.

Purpose: Vasovagal syncope (VVS) affects more women than men. We determined whether this sex ratio affects tilt table test (TTT) results.

Methods: We retrospectively studied TTT outcomes in suspected VVS. TTT consisted of supine rest, a maximum 20 min of head-up tilt without and, if nitroglycerin was needed, a further maximum 20 min after nitroglycerin administration. TTT was terminated if VVS occurred. We used binary logistic regression for the entire TTT and for each phase, with VVS as outcome and age and sex as predictors.

Results: TTT provoked vasovagal (pre)syncope in 494 out of 766 tests (64%). The proportion of men and women who fainted during the entire TTT did not differ significantly between the sexes (p = 0.13, corrected for age). A lower proportion of women than men had VVS in the phase without nitroglycerin (odds ratio 0.54; 95% confidence interval 0.37-0.79; p = 0.002, corrected for age), whereas a higher proportion of women than men fainted after nitroglycerin (odds ratio 1.58; 95% confidence interval 1.13-2.21; p = 0.008, corrected for age). These sex differences remained significant after correction for a history of orthostatic versus emotional triggers. The effect of sex on TTT outcome was closely associated with differences of blood pressure change upon tilt-up (lower in men in both TTT phases: without nitroglycerin p = 0.003; with nitroglycerin p = 0.05), but not with heart rate changes.

Conclusion: Men were more susceptible to induction of VVS without nitroglycerin and women after it. The unexpected findings may be due to sex-specific pathophysiological differences.
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October 2020