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Surg. Postural Tachycardia Syndrome and Inappropriate Sinus Tachycardia: Role Am. Thromb. Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): rationale and feasibility of a shared pragmatic protocol. If it happens, healthcare providers can effectively and immediately treat the reaction. Am. Survivors of previous coronavirus infections, including the SARS epidemic of 2003 and the Middle East respiratory syndrome (MERS) outbreak of 2012, have demonstrated a similar constellation of persistent symptoms, reinforcing concern for clinically significant sequelae of COVID-19 (refs. https://doi.org/10.1016/j.hrthm.2020.12.007 (2020). Neuropsychol. This 2:1:1 comparative design allowed us to establish study reference values for the assessment of HRV and to characterize presumable damage to the sympathetic versus parasympathetic input to the heart rate in the setting of PCS. Hypofibrinolytic state and high thrombin generation may play a major role in SARS-COV2 associated thrombosis. & Lakshminrusimha, S. Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Blood Adv. 20, e276e288 (2020). To assess cardiac autonomic function, a 2:1:1 comparative sub-analysis was conducted against both fully recovered patients with previous SARS-CoV-2 infection and individuals without prior SARS-CoV-2 infection. Neurol. Lancet Gastroenterol. Assoc. Hui, D. S. et al. J. Respir. J. Metab. Garrigues, E. et al. Bortolato, B., Carvalho, A. F., Soczynska, J. K., Perini, G. I. Belvis, R. Headaches during COVID-19: my clinical case and review of the literature. In the meantime, to ensure continued support, we are displaying the site without styles Google Scholar. Biol. Postural Orthostatic Tachycardia Syndrome: Possibly Covid Vaccine The risk of thrombotic complications in the post-acute COVID-19 phase is probably linked to the duration and severity of a hyperinflammatory state, although how long this persists is unknown. Now Katalin Kariko, 66, known to colleagues as Kati, has emerged as one of the heroes of Covid-19 vaccine development. JAMA Cardiol. Virol. A prospective study of 12-week respiratory outcomes in COVID-19-related hospitalisations. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Carf, A., Bernabei, R., Landi, F., Gemelli Against COVID-19 Post-Acute Care Study Group. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems networkUnited States, MarchJune 2020. 130). The Chief Scientist Office Cardiovascular and Pulmonary Imaging in SARS Coronavirus Disease-19 (CISCO-19) study. Brain Commun. Thrombi in the renal microcirculation may also potentially contribute to the development of renal injury179. Huang, Y. et al. JAMA Netw. J. Open 3, e2025197 (2020). D.A. Cognitive impairment has been noted with or without fluctuations, including brain fog, which may manifest as difficulties with concentration, memory, receptive language and/or executive function139,140,141. This may be associated with reduced cardiac reserve, corticosteroid use and dysregulation of the reninangiotensinaldosterone system (RAAS). Postolache, T. T., Benros, M. E. & Brenner, L. A. Targetable biological mechanisms implicated in emergent psychiatric conditions associated with SARS-CoV-2 infection. A comparable incidence of coronary artery aneurysm and dilation has been noted among MIS-C and Kawasaki disease (20 and 25%, respectively)206. Answered 1 year ago. At our institution, patients with persistent symptoms, such as tiredness, shortness of breath, dizziness, brain fog, chest pain, or headache, 3months after an acute SARS-CoV-2 infection are referred to a multi-disciplinary PCS unit supported by infectologists, cardiologists, neurologists, rheumatologists, nutritionists, rehabilitators, and psychologists. Spyropoulos, A. C. et al. J. Phys. Pre-existing diabetes may first become apparent during the acute phase of COVID-19 and can generally be treated long term with agents other than insulin, even if initially associated with DKA. Pavoni, V. et al. Dis. Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up. Despite initial theoretical concerns regarding increased levels of ACE2 and the risk of acute COVID-19 with the use of RAAS inhibitors, they have been shown to be safe and should be continued in those with stable cardiovascular disease126,127. Lancet Respir. For the purpose of this review, we defined post-acute COVID-19 as persistent symptoms and/or delayed or long-term complications of SARS-CoV-2 infection beyond 4weeks from the onset of symptoms (Fig. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Thank you for visiting nature.com. 41, 30383044 (2020). 116, 16661687 (2020). Article Kress, J. P. & Hall, J. Dis. Biol. 75, 29502973 (2020). Schondorf, R. & Low, P. A. Idiopathic postural orthostatic tachycardia syndrome: An attenuated form of acute pandysautonomia?. Elevated Heart Rate Most Likely Caused by Medical Condition J.A., V.B. Serial echocardiographic assessment is recommended at intervals of 12 and 46weeks after presentation212. To the best of our knowledge, this is the first prospective series of consecutive PCS patients in whom a comprehensive cardiovascular evaluation has been performed for the investigation of IST. Huang, C. et al. Eur. Similar VTE rates have been reported in retrospective studies from the United Kingdom83,84. Faecalibacterium prausnitzii and human intestinal health. Lancet Haematol. Lancet 397, 220232 (2021). Cardiac autonomic nervous system imbalance with decreased parasympathetic activity may explain this phenomenon. N. Engl. Platelet activation and plateletmonocyte aggregates formation trigger tissue factor expression in severe COVID-19 patients. COVID-19-mediated postural orthostatic tachycardia syndrome (POTS) is an evolving troublesome disorder that predominantly affects young females. Blood 136, 13301341 (2020). Leonard-Lorant, I. et al. Heart J. However, caution is warranted that ongoing and future studies integrate and analyze information along multiple axes (for example, clinical and socioeconomic axes, resource deficits and external stressors) to prevent inaccurate contextualization218. 2, 12001203 (2020). The severity of illness during acute COVID-19 (measured, for example, by admission to an intensive care unit (ICU) and/or requirement for non-invasive and/or invasive mechanical ventilation) has been significantly associated with the presence or persistence of symptoms (such as dyspnea, fatigue/muscular weakness and PTSD), reduction in health-related quality of life scores, pulmonary function abnormalities and radiographic abnormalities in the post-acute COVID-19 setting5,22,24. COVID-19 rapid guideline: managing the long-term effects of COVID-19. Am. Med. Ong, K.-C. et al. Overlapping features have been noted with Kawasaki disease, an acute pediatric medium-vessel vasculitis207. Int J. Stroke 15, 722732 (2020). Microbiol. . 20, 533534 (2020). 12(5), 498513. COVID-19 and multisystem inflammatory syndrome in children and adolescents. https://doi.org/10.23736/S1973-9087.21.06549-7 (2021). 20, 453454 (2020). However, this is not the first time that IST has been described after coronavirus infection. Olshanky, B. 100% healthy NP prior, never had Covid. Eur. General Physician 12 yrs exp Mumbai. J. Immunol. 36, 15791580 (2020). McElvaney, O. J. et al. 105, dgaa276 (2020). A majority of the patients (76%) reported at least one symptom. Post-acute COVID-19 syndrome. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Dermatology 237, 112 (2020). reports receiving royalties from UpToDate for chapters on stroke and COVID-19. In a cohort of 402 COVID-19 survivors in Italy 1month after hospitalization, approximately 56% screened positive in at least one of the domains evaluated for psychiatric sequelae (PTSD, depression, anxiety, insomnia and obsessive compulsive symptomatology)143. CAS Circulation 135, e927e999 (2017). 90). Post-acute COVID-19 syndrome | Nature Medicine Postural orthostatic tachycardia has already been described in the setting of PCS3,5. This phenomenon is regarded as ongoing symptomatic COVID-19 or post-COVID-19 syndrome (PCS) when remnant symptoms persist from 4 to 12weeks and for more than 12weeks, respectively2. Similarly, subacute thyroiditis with clinical thyrotoxicosis has been reported weeks after the resolution of respiratory symptoms184,185. You still have more than 100 heartbeats per minute, but there is nothing unusual on your ECG (electrocardiogram). Perrin, R. et al. 73(10), 11891206. https://doi.org/10.1007/s10286-017-0452-4 (2018). Clinically significant depression and anxiety were reported in approximately 3040% of patients following COVID-19, similar to patients with previous severe coronavirus infections11,12,15,143,144. Clinical and immunological features of severe and moderate coronavirus disease 2019. Kidney Int. Post-Vaccination Inflammatory Syndrome: a new syndrome - OAText Autonomic dysfunction in long COVID: Rationale, physiology and management strategies. Chow, D. et al. Aust. Cardiol. A comprehensive understanding of patient care needs beyond the acute phase will help in the development of infrastructure for COVID-19 clinics that will be equipped to provide integrated multispecialty care in the outpatient setting. A post-acute outpatient service established in Italy (hereby referred to as the post-acute COVID-19 Italian study)3 reported persistence of symptoms in 87.4% of 143 patients discharged from hospital who recovered from acute COVID-19 at a mean follow-up of 60d from the onset of the first symptom. There is no concrete evidence of lasting damage to pancreatic cells188. Dis. Ann, Neurol. PubMed Malnutrition has been noted in 2645% of patients with COVID-19, as evaluated by the Malnutrition Universal Screening Tool in an Italian study219. Carsana, L. et al. Med. Inappropriate sinus tachycardia in post-COVID-19 syndrome, https://doi.org/10.1038/s41598-021-03831-6. Curr. J. Coll. N. Engl. Lescure, F. X. et al. J. eNeurologicalSci 21, 100276 (2020). Among 1,800 patients requiring tracheostomies during acute COVID-19, only 52% were successfully weaned from mechanical ventilation 1month later in a national cohort study from Spain42. Su, H. et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Depending on resources, prioritization may be considered for those at high risk for post-acute COVID-19, defined as those with severe illness during acute COVID-19 and/or requirement for care in an ICU, advanced age and the presence of organ comorbidities (pre-existing respiratory disease, obesity, diabetes, hypertension, chronic cardiovascular disease, chronic kidney disease, post-organ transplant or active cancer). Posterior reversible encephalopathy syndrome in patients with COVID-19. Roberts, L. N. et al. Cellular damage, a robust innate immune response with inflammatory cytokine production, and a pro-coagulant state induced by SARS-CoV-2 infection may contribute to these sequelae6,7,8. Do, T. P. et al. South, K. et al. Song, E. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. SARS-CoV-2 and bat RaTG13 spike glycoprotein structures inform on virus evolution and furin-cleavage effects. Soc. Am. 16, e1002797 (2019). Greenhalgh, T., Knight, M., ACourt, C., Buxton, M. & Husain, L. Management of post-acute COVID-19 in primary care. Thus, laboratory parameters characterizing a presumable pro-inflammatory state and/or myocardial damage during the acute infection phase were not available. Beneficial effects of multi-disciplinary rehabilitation in post-acute COVID-19an observational cohort study. Only 3% of patients noted a skin rash at 6months follow-up in the post-acute COVID-19 Chinese study5. Inflammaging (a chronic low-level brain inflammation), along with the reduced ability to respond to new antigens and an accumulation of memory T cells (hallmarks of immunosenescence in aging and tissue injury158), may play a role in persistent effects of COVID-19. J. It is not yet known how long the increased severity of pre-existing diabetes or predisposition to DKA persists after infection, and this will be addressed by the international CoviDiab registry183. Preliminary data with cardiac magnetic resonance imaging (MRI) suggest that ongoing myocardial inflammation may be present at rates as high as 60% more than 2months after a diagnosis of COVID-19 at a COVID-testing center, although the reproducibility and consistency of these data have been debated113. Med. Immunol. COVID-19 and VTE/Anticoagulation: Frequently Asked Questions (American Society of Hematology, 2020); https://www.hematology.org/covid-19/covid-19-and-vte-anticoagulation. Haemost. Patients with IST had a higher mean heart rate, predominantly during the daytime, compared to recovered asymptomatic and uninfected subjects (986 vs. 848 vs. 816bpm, respectively; p<0.001). 31, 19591968 (2020). The role of antiplatelet agents such as aspirin as an alternative (or in conjunction with anticoagulation agents) for thromboprophylaxis in COVID-19 has not yet been defined and is currently being investigated as a prolonged primary thromboprophylaxis strategy in those managed as outpatients (ACTIV4 (NCT04498273)). Supraventricular tachycardia (SVT) is a condition where your heart suddenly beats much faster than normal. J. Rehabil. Complement activation in patients with COVID-19: a novel therapeutic target. At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. Respir. Protocols to provide nutritional support for patients (many of whom suffered from respiratory distress, nausea, diarrhea and anorexia, with resultant reduction in food intake) continue to be refined220. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. The study utilized survey questionnaires, physical examination, 6-min walk tests (6MWT) and blood tests and, in selected cases, pulmonary function tests (PFTs), high-resolution computed tomography of the chest and ultrasonography to evaluate post-acute COVID-19 end organ injury. Inappropriate sinus tachycardia (IST) is a syndrome of cardiac and extracardiac symptoms characterized by substantially fast sinus heart rate (HR) at rest (>100 bpm) or with minimal activity and . Postural orthostatic tachycardia syndrome - Wikipedia CAS Commun. Things that may lead to tachycardia include: Fever Heavy alcohol use or alcohol withdrawal High levels of caffeine High or low blood pressure Introduction. Circulation 141, 19031914 (2020). Morb. Patients in group 2 were also matched by disease chronology, and their acute infection had to have the same severity and be within the same 1-month period as the corresponding cases. Wang, Q. et al. Characteristics associated with racial/ethnic disparities in COVID-19 outcomes in an academic health care system. Serial clinical and imaging evaluation with electrocardiogram and echocardiogram at 412weeks may be considered in those with cardiovascular complications during acute infection, or persistent cardiac symptoms76,123. Post-acute COVID-19 syndrome. Luks, A. M. & Swenson, E. R. Pulse oximetry for monitoring patients with COVID-19 at home. PDF Suspected COVID-19 mRNA Vaccine-Induced Postural Orthostatic Eur. Internet Explorer). 188, 567576 (2013). The remaining parameters are less specific to a determined sympathetic versus parasympathetic influence on the heart rate and, thus, become less useful in characterizing a specific ANS disturbance. Inappropriate sinus tachycardia (IST) and postural tachycardia syndrome (POTS) are syndromes with overlapping clinical features of excessive sinus tachycardia. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Ongoing studies are evaluating long-term sequelae in these children (NCT04330261). 193, 37553768 (2014). Engelen, M. et al. Haemost. Simpson, R. & Robinson, L. Rehabilitation after critical illness in people with COVID-19 infection. Difficulty. Kanberg, N. et al. https://doi.org/10.1016/B978-0-12-386525-0.00106-2 (2012). 40, 3139 (2019). Inappropriate sinus tachycardia (IST) is a condition in which a person's heart rate, at rest and during exertion, is abnormally elevated for no apparent reason. The small size of the control group is also a limitation, and the real incidence of the disease should be ascertained in larger population studies. Am. J. Phys. https://doi.org/10.1016/j.jacc.2018.12.064 (2019). Am. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. The multi-organ sequelae of COVID-19 beyond the acute phase of infection are increasingly being appreciated as data and clinical experience in this timeframe accrue. Who Had Serious Side Effects from Covid 19 Vaccine? Patients with sinus rhythm rates 100bpm were prospectively enrolled in the study database and underwent further cardiovascular assessment. Model COVID-19 rehabilitation units such as those in Italy are already routinely assessing acute COVID-19 survivors for swallowing function, nutritional status and measures of functional independence219. Med. Most of the patients included in this study did not require hospital admission during the acute phase of SARS-CoV-2 infection. Jhaveri, K. D. et al. Inappropriate sinus tachycardia in post-COVID-19 syndrome Long COVID-19 and Postural Orthostatic Tachycardia Syndrome- Is 18, 18591865 (2020). However, reports of COVID-19 brain fog after mild COVID-19 suggest that dysautonomia may contribute as well163,164. 3(2), e000700. Article Autopsy studies in 39 cases of COVID-19 detected virus in the heart tissue of 62.5% of patients115. Ther. 100, 167169 (2005). B.B. Goldstein, D. S. The possible association between COVID-19 and postural tachycardia syndrome. 3, 117125 (2016). Disord. All these medications can change the potassium currents in the heart, which can cause prolongation of the QT interval. Lancet Psychiatry 7, 611627 (2020). Lancet Infect. Direct oral anticoagulants and low-molecular-weight heparin are preferred anticoagulation agents over vitamin K antagonists due to the lack of need to frequently monitor therapeutic levels, as well as the lower risk of drugdrug interactions108,109. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. All research activities were carried out in accordance with the Declaration of Helsinki. A. et al. The increased heart rate doesn't harm the heart and doesn't require medical treatment. 98, 219227 (2020). Lindner, D. et al. Outcome of 1890 tracheostomies for critical COVID-19 patients: a national cohort study in Spain. Mackey, K. et al. Am. Respir. Joint HFSA/ACC/AHA statement addresses concerns re: using RAAS antagonists in COVID-19. 18, 14211424 (2020). Pathol. You are using a browser version with limited support for CSS. Hair loss can possibly be attributed to telogen effluvium resulting from viral infection or a resultant stress response5. J. Atr. Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases. Bai, C. et al. Inappropriate sinus tachycardia occurs when there is a higher heart rate response or faster resting rate than necessary for the current physiological demand ( 23 ). D.B. J. Thromb. Altered lipid metabolism in recovered SARS patients twelve years after infection. Fibrotic changes on computed tomography scans of the chest, consisting primarily of reticulations or traction bronchiectasis, were observed 3months after hospital discharge in approximately 25 and 65% of survivors in cohort studies of mild-to-moderate cases45 and mostly severe cases49, respectively, as distinguished by a requirement for supplemental oxygen. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). Henderson, L. A. et al. 370, m3026 (2020). Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors. 8, 839842 (2020). Click here to view the video. https://doi.org/10.1111/ijd.15168 (2020). Hypotheses 144, 110055 (2020). While the definition of the post-acute COVID-19 timeline is evolving, it has been suggested to include persistence of symptoms or development of sequelae beyond 3 or 4weeks from the onset of acute symptoms of COVID-19 (refs. Hosey, M. M. & Needham, D. M. Survivorship after COVID-19 ICU stay. Opin. Assoc. & Jenkins, R. G. Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy. No report of Inappropriate sinus tachycardia is found in people who take L reuteri. This receptor is also present on the glial cells and neurons. Infectious diseases causing autonomic dysfunction. Chen, G. et al. Cardiol. Dyspnea while walking up the stairs (22.9%) was most commonly reported, while other symptoms included cough (15.4%) and persistent loss of taste and/or smell (13.1%). 21(1), e63e67. J. Halpin, S. J. et al. found that IST was the most common cardiovascular complication in a cohort of 121 patients with SARS. Therefore, 40 patients fulfilled the strict diagnostic criteria for IST, yielding an estimated prevalence of the disorder of 20%. 383, 789790 (2020). 27, 258263 (2021). Tachycardia Syndrome May Be a Distinct Marker for Long COVID - Medscape 184, 5861 (2019). In our initial experience with PCS patients, IST, which often overlaps with POTS, is also a common observation that has not been fully described to date. Am. Acute kidney injury due to collapsing glomerulopathy following COVID-19 Infection. It is a red, blotchy rash that can appear around the injection site, typically about 7 days after receiving the first dose of. & Rabinstein, A. Hormones (Athens) 20, 219221 (2021). Mechanisms of thromboinflammation include endothelial injury70,91,92,93, complement activation94,95,96, platelet activation and plateletleukocyte interactions97,98,99, neutrophil extracellular traps95,100,101, release of pro-inflammatory cytokines102, disruption of normal coagulant pathways103 and hypoxia104, similar to the pathophysiology of thrombotic microangiopathy syndromes105. A.G. received payment from the Arnold & Porter law firm for work related to the Sanofi clopidogrel litigation and from the Ben C. Martin law firm for work related to the Cook inferior vena cava filter litigation; received consulting fees from Edward Lifesciences; and holds equity in the healthcare telecardiology startup Heartbeat Health. Article Lancet Infect. All consecutive patients seen at this unit from June to December 2020 underwent a resting 12-lead ECG. Med. Google Scholar. Clin. Heart Assoc. 224). Sci. Possible Side Effects After Getting a COVID-19 Vaccine | CDC 63,64,65,66,67), which is higher than in other critically ill patient populations (110%)68,69. J. Critical illness myopathy as a consequence of COVID-19 infection. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. COVID-19 may also potentiate latent thyroid autoimmunity manifesting as new-onset Hashimotos thyroiditis186 or Graves disease187. J. Thromb. Coker, R. K. et al. Sadly, no research on us! Autonomic dysfunction after viral illness, resulting in postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia, has previously been reported as a result of adrenergic modulation121,122. Fibrillation. https://doi.org/10.1161/JAHA.113.000700 (2014). Google Scholar. Transplantation 102, 829837 (2018). Pract. Provided by the Springer Nature SharedIt content-sharing initiative. https://doi.org/10.1136/pgmj.2005.037515 (2006). Clin. Lung transplantation in pulmonary fibrosis secondary to influenza A pneumonia. Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia. was supported by National Institute of Neurological Disorders and Stroke grant T32 NS007153-36 and National Institute on Aging grant P30 AG066462-01. Invest. was supported by an institutional grant from the National Institutes of Health/National Heart, Lung, and Blood Institute to Columbia University Irving Medical Center (T32 HL007854). The timing of the emergence of MIS-C (which was lagging approximately 1month behind peak COVID-19 incidence in epicenters in Spring 2020211) and the finding that most patients are negative for acute infection but are antibody positive suggest that MIS-C may result from an aberrant acquired immune response rather than acute viral infection208. Res. Heneka, M. T., Golenbock, D., Latz, E., Morgan, D. & Brown, R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. The aim of this study was to investigate the prevalence and underlying pathophysiological mechanisms of IST in a consecutive and prospective population of PCS patients. & ENCOVID-BIO Network. 99, 470474 (2020). 'Inappropriate' Sinus Tachycardia - medscape.com Bharat, A. et al. Nephrol. She and her partner were COVID-19 vaccine injured. Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020). Incidence of venous thromboembolism in hospitalized patients with COVID-19. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Neurology 95, e1060e1070 (2020). J. Med. Physical and cognitive performance of patients with acute lung injury 1 year after initial trophic versus full enteral feeding. Crit. HR indicates heart rate; PNN50, percentage of adjacent NN intervals that differ from each other by more than 50 ms; SD, standard deviation of the interbeat interval; VLF, very low frequency; LF, low frequency; HF, high frequency. Inappropriate Sinus Tachycardia | Cardiac Arrhythmias | Forums - Patient 26, 370 (2020). Kudose, S. et al. Needham, D. M. et al.