Fadiga em pacientes com síndrome de COVID Longa: Investigação de mecanismos fisiológicos e perceptuais
Data
2024-06-25
Autores
Cilli, Eduardo Lourenço 
Orientadores
Silva, Bruno Moreira
Tipo
Trabalho de conclusão de curso
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A Síndrome da Fadiga Crônica (SFC) é uma doença complexa, também conhecida por encefalomielite mialgica, responsável por causar fadiga persistente mental e física e que resulta na incapacidade de realizar as tarefas do cotidiano, impactando negativamente a qualidade de vida. Essa doença ainda possui etiologia e pato-fisiologia indefinida, sendo o seu diagnóstico um grande desafio devido à variedade de sintomas inespecíficos e falta de um biomarcador objetivo e acurado. Esta dificuldade acarreta falsos diagnósticos de depressão ou Burnout, impossibilitando o tratamento correto e gerando falsos dados da prevalência da SFC. Durante e após a pandemia de COVID-19, a SFC voltou a ter destaque no âmbito clínico e da pesquisa, pois parte dos pacientes com COVID-19 longa relata fadiga muscular, mesmo sem apresentar doenças cardiorrespiratórias e com quadros leves da doença em sua fase aguda. Sendo assim, a hipótese atual, ainda não confirmada, é que o vírus transpassa a barreira hematoencefálica (BHE) e atinge regiões cerebrais responsáveis pela sensação de esforço e fadiga, ocasionando disfunção ou morte de neurônios, debilitando essas regiões e gerando uma sensação exacerbada de esforço e fadiga ao desempenhar atividades físicas e mentais. Apesar de existir um teste de força de preensão manual como um marcador objetivo da presença de SFC em pacientes com câncer e outras infecções virais, tal teste ainda não foi empregado para detectar objetivamente a presença da SFC em pacientes com COVID longa. Além disso, os mecanismos subjacentes à geração de fadiga na COVID longa ainda não são bem conhecidos. Com isso, o presente estudo visa utilizar um teste de exercício de preensão manual para detecção da SFC em pacientes com COVID longa. Além disso, foram realizadas medidas de percepção de esforço e de fadiga, força e atividade elétrica muscular durante o teste de exercício para obter pistas sobre mecanismos de geração de fadiga e parâmetros para interpretar respostas fisiológicas e perceptuais em pacientes com COVID Longa que possuem a SFC. Os achados desse estudo indicam uma alteração na força máxima basal e ao longo do tempo no grupo COVID longa nos exercícios de aquisição de força máxima, protocolo de preensão manual e na contração voluntária máxima sustentada com a mão não dominante. Além disso, não foi possível obter dados que indicam a presença de fadiga central, nem mudanças na atividade elétrica muscular ao longo do protocolo e, por conta da falta de alterações no índice de fadiga e de recuperação, o protocolo de pareamento de força, nesse contexto, não se mostrou eficaz de identificar pacientes com COVID longa que possuem SFC. Sendo assim, conclui-se que o grupo COVID longa possui uma força basal menos que o grupo Controle, entretanto possui uma fadiga, recuperação e percepção do esforço similares.
Chronic Fatigue Syndrome (CFS) is a complex disease, also known as myalgic encephalomyelitis, responsible for causing persistent mental and physical fatigue and resulting in the inability to perform everyday tasks, negatively impacting quality of life. This disease still has an undefined etiology and pathophysiology, and its diagnosis is a major challenge due to the variety of non-specific symptoms and the lack of an objective and accurate biomarker. This difficulty leads to false diagnoses of depression or burnout, making correct treatment impossible and generating false data on the prevalence of CFS. During and after the COVID-19 pandemic, CFS has once again come to the fore in clinical and research circles, as some patients with long-term COVID-19 report muscle fatigue, even without cardiorespiratory diseases and with mild cases of the disease in its acute phase. Therefore, the current hypothesis, which has not yet been confirmed, is that the virus crosses the blood-brain barrier (BBB) and reaches brain regions responsible for the sensation of effort and fatigue, causing dysfunction or death of neurons, weakening these regions and generating an exacerbated sensation of effort and fatigue when performing physical and mental activities. Although a handgrip strength test exists as an objective marker of the presence of CFS in patients with cancer and other viral infections, this test has not yet been used to objectively detect the presence of CFS in patients with long COVID. In addition, the mechanisms underlying the generation of fatigue in long COVID are still not well understood. Therefore, this study aims to use a handgrip exercise test to detect CFS in patients with long COVID. In addition, measures of perceived exertion and fatigue, strength, and muscle electrical activity were taken during the exercise test to obtain clues about fatigue-generating mechanisms and parameters for interpreting physiological and perceptual responses in patients with Long COVID who have CFS. The findings of this study indicate a change in maximum strength at baseline and over time in the Long COVID group in the maximum strength acquisition exercises, handgrip protocol and maximum sustained voluntary contraction with the non-dominant hand. In addition, it was not possible to obtain data indicating the presence of central fatigue, nor changes in muscle electrical activity throughout the protocol and, due to the lack of changes in the fatigue and recovery index, the strength pairing protocol, in this context, did not prove to be effective in identifying patients with long COVID who have CFS. Therefore, it can be concluded that the Long COVID group has lower baseline strength than the Control group, but has similar fatigue, recovery and perceived exertion.
Chronic Fatigue Syndrome (CFS) is a complex disease, also known as myalgic encephalomyelitis, responsible for causing persistent mental and physical fatigue and resulting in the inability to perform everyday tasks, negatively impacting quality of life. This disease still has an undefined etiology and pathophysiology, and its diagnosis is a major challenge due to the variety of non-specific symptoms and the lack of an objective and accurate biomarker. This difficulty leads to false diagnoses of depression or burnout, making correct treatment impossible and generating false data on the prevalence of CFS. During and after the COVID-19 pandemic, CFS has once again come to the fore in clinical and research circles, as some patients with long-term COVID-19 report muscle fatigue, even without cardiorespiratory diseases and with mild cases of the disease in its acute phase. Therefore, the current hypothesis, which has not yet been confirmed, is that the virus crosses the blood-brain barrier (BBB) and reaches brain regions responsible for the sensation of effort and fatigue, causing dysfunction or death of neurons, weakening these regions and generating an exacerbated sensation of effort and fatigue when performing physical and mental activities. Although a handgrip strength test exists as an objective marker of the presence of CFS in patients with cancer and other viral infections, this test has not yet been used to objectively detect the presence of CFS in patients with long COVID. In addition, the mechanisms underlying the generation of fatigue in long COVID are still not well understood. Therefore, this study aims to use a handgrip exercise test to detect CFS in patients with long COVID. In addition, measures of perceived exertion and fatigue, strength, and muscle electrical activity were taken during the exercise test to obtain clues about fatigue-generating mechanisms and parameters for interpreting physiological and perceptual responses in patients with Long COVID who have CFS. The findings of this study indicate a change in maximum strength at baseline and over time in the Long COVID group in the maximum strength acquisition exercises, handgrip protocol and maximum sustained voluntary contraction with the non-dominant hand. In addition, it was not possible to obtain data indicating the presence of central fatigue, nor changes in muscle electrical activity throughout the protocol and, due to the lack of changes in the fatigue and recovery index, the strength pairing protocol, in this context, did not prove to be effective in identifying patients with long COVID who have CFS. Therefore, it can be concluded that the Long COVID group has lower baseline strength than the Control group, but has similar fatigue, recovery and perceived exertion.
Descrição
Citação
CILLI, Eduardo Lourenço. Fadiga em pacientes com síndrome de COVID Longa: investigação de mecanismos fisiológicos e perceptuais. 2024. 41 f. Trabalho de Conclusão de Curso (Graduação em Biomedicina) - Escola Paulista de Medicina, Universidade Federal de São Paulo., São Paulo, 2024.